Educational – Auckland Childrens Physio

11/Jun/2021

Babies have been swaddled or wrapped for thousands of years and it is enmeshed in many cultures around the world. It is designed to provide containment and mimic being in the womb. More recently in New Zealand swaddling was promoted with the introduction of the back-to-sleep campaign. Back sleeping is not an instinctive position for babies, but this combined approach helped them go to sleep and made an incredible difference to sudden infant death syndrome rates. However recently in some regions in New Zealand, there has been a move away from teaching new mothers how to swaddle. This intrigued me, so I went on a search to find the scientific evidence for the change in practice.

What does the research say?

Key findings: Tight, full-body, heavy fabric swaddling can cause significant issues

Swaddling that is tight with arms bound to their side (elbows straight) has been found to increase chest (respiratory) infections compared to non-swaddled babies
Tight swaddling around the hips and legs has been linked to hip development problems (hip dysplasia)
Heavy synthetic fabrics have been found to raise an infant’s body temperatures beyond the normally accepted temperature.

However there is nothing about how it might be beneficial for infants or parents if done correctly (hands up near their faces, loose around their hips, or not include their hips with a breathable light cotton fabric).

If you recall your antenatal ultrasound scans, you may have seen your baby’s hands up by their face or busily sucking on their thumb or fingers. Developmental swaddling which encourages their hands up by their face can help maintain this familiar and comforting position.
In neonatal units, supportive positioning is common practice as they are born with low muscle tone. Containment swaddling or nesting helps prevent over-stretching of chest muscles from the effects of gravity, provides good alignment of shoulder blades, and improves the baby’s energy expenditure. As a developmental therapist, there are noticeable differences in arm and body posture in non-swaddled term babies too. They tend to have tighter shoulder blade muscles and longer chest muscles making bringing their hands together and reaching up harder. It is visible when they are learning to roll and in sitting
Containment can help babies learn self-regulation, their ability to self-settle in the first few months after birth. If you are a new parent, you would be familiar with this period called the fourth trimester. During this time, parents are encouraged to support their babies to learn this skill which helps them go to sleep and return to sleep if woken after a sleep cycle.
I have heard the rumor babies who have not been swaddled lose their startle reflexes faster. In my experience, this is not the result of swaddling but the baby’s ability to control their arms. This voluntary control of their arms and legs is learned at around the age of two to three months. If we are comparing babies who are swaddled all the time during their awake periods then yes but I am recommending developmental swaddling for sleep only.
Good sleep is important to both parents and babies. For infants, good quality REM sleep is when they lay down their new learning for the day (motor learning) and this will help them learn the voluntary control discussed earlier as well as promote weight gain, growth, and stabilization of hormones compared to overtired upset babies.

When should I stop swaddling?

When your child starts showing signs of rolling from their back to their tummy is a good time to stop. For most babies, they learn to roll consistently at 4 to 5 months of age. Some babies roll earlier than this. If they have accidentally rolled over they might have demonstrated this skill once or twice then stop for a few weeks this is normal at 2 to 3 months of age.

I would recommend weaning the swaddling off. Start with no swaddling for day sleeps then progress to no swaddling for night sleeps after a few days of practice. The Love to dream range has a progression suit that allows you to zip off the arm covers to help them slowly get used to the change in sleep support.

Steps to Developmentally Swaddle

Hands up by their shoulders
keep it loose around hips and legs
use lightweight fabrics and do not overdress your baby

lay wrap with a point at one end – like a diamond
fold the top corner down around 1/3 of the wrap
lay baby on the wrap with fold line at the level of their ear lobes
tuck one hand into the “pocket” created from folding down the corner, pull the end across to the opposite side of their body, and tuck under
repeat with their other hand as in step 5
fold up the bottom of the wrap loosely fitting around their waist.

Watch the video to learn how to developmentally swaddle your baby. Check out the link here https://youtu.be/_BAikYKQylk

I don’t want to developmentally swaddle my baby.

I would recommend providing opportunities to counter the muscle imbalance changes through play if you do decide to not use developmental swaddling. Encouraging more side-lying play, using body slings, and supporting their arms together during cuddles and feeds will help.

Thank you for taking the time to learn more about developmental swaddling.

Hopefully, this has answered a few of your questions and also allowed you to work out what is best for you and your baby when it comes to swaddling. If you stick to the developmental method of swaddling with breathable light fabrics it can be a great way to ensure a successful night’s sleep. But if you find it stressful or challenging then swaddling may not be for you.

References:

Patricia Franco, Nicole Seret, Jean-Noël Van Hees, Sonia Scaillet, José Groswasser, André Kahn. Influence of Swaddling on Sleep and Arousal Characteristics of Healthy Infants, Pediatrics May 2005, 115 (5) 1307-1311; DOI: 10.1542/peds.2004-1460
Bregje E. van Sleuwen, Adèle C. Engelberts, Magda M. Boere-Boonekamp, Wietse Kuis, Tom W.J. Schulpen and Monique P. L’Hoir. Swaddling: A Systematic Review, Pediatrics October 2007, 120 (4) e1097-e1106; DOI: https://doi.org/10.1542/peds.2006-2083
Nelson, Antonia M. RNC-MNN, PhD, CNE, IBCLC Risks and Benefits of Swaddling Healthy Infants, MCN, The American Journal of Maternal/Child Nursing: July/August 2017 – Volume 42 – Issue 4 – p 216-225 doi: 10.1097/NMC.0000000000000344

Louise Pearce

05/Mar/2021

As a parent, we are striving to provide and support our children so they can flourish. Although we are considering how we are influencing their day-to-day, we are also looking further into the future. How can we help and prepare them for adulthood? This is even more challenging if your child has a diagnosis of Cerebral Palsy. There are so many other elements to their care that you need to consider and make choices about. Treatments or Therapy is one of them and trying to navigate this area can be a minefield.

Iona Novak, Cathy Morgan, Michael Fahey, and their incredible team have produced a guide through their extensive systematic review. If you are not familiar with them, they are leading experts within the field of Cerebral palsy (across the world). They have done the hard work for us, scouring the literature to determine what evidence supports specific interventions and developed a novel traffic light system to make it clearer. Treatments or interventions are clearly grouped into “Do it” (green), “Probably do it” (Yellow) with a clear cut-off with a “worth it line”. This line highlights that areas below this line are lacking in evidence, or if in red are likely to cause harm. The total opposite of what you are trying to achieve as a parent and clinician.

Evidence for prevention and treatment of CP from Novak et al (2020) — Novak, I., Morgan, C., Fahey, M. et al. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep 20, 3 (2020). https://doi.org/10.1007/s11910-020-1022-z

It is great to see that therapy options offered at Auckland Children’s Therapy (Motor and Early Intervention) are in the “Do it” or “Probably do it” which supports its effectiveness in helping children with CP. If you would like to know more about any of the interventions mentioned above, we are happy to discuss these and see if these are interventions you can add to your child’s therapy program.

Reference: Novak, I., Morgan, C., Fahey, M. et al. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep 20, 3 (2020). https://doi.org/10.1007/s11910-020-1022-z

Louise Pearce

09/Feb/2021

Tummy-time doesn’t have to be a battle although it can feel like it when your babe is protesting. Starting tummy-time when they are newborns is a great place to start but it can be hard to find when to fit it in. In the first few weeks, it feels like they are sleeping, feeding, pooping, and crying on repeat. The ‘awake and ready to play’ window for tummy time just doesn’t seem to happen. Keep trying but often parents find it easier the older they get. Generally from eight weeks on they have longer ‘awake’ periods. It is also good to try and work out what might be making tummy-time less enjoyable for your baby. This might require an external pair of eyes but things like reflux, neck and shoulder strength or family history of very flexible joints can be factors.

How can we overcome the tummy-time battle?

Set the right expectations. They might only manage 20 or 30 seconds their first few times before they start getting grizzly.
Alignment helps. Help position their elbows inline or slightly in front of their shoulders and tucked into their side. When they are first learning to push up on their tummy, they often struggle to keep their arms against their side.
Get creative and try different positions. Tummy-time can be over your lap, supermans in the air when you bring them through from their bedroom, lying tummy to tummy on your chest, lying across a big ball (starting semi-upright (way easier for them), after a change on their change mat.
Use distractions and keep it fun. Get down to their eye level, try lying face to face on the mat. Use a mirror to see themselves or crinkly noisy fabric that they can explore.
Practice practice practice. They need to build up their muscle strength and endurance. Roll them off their tummy, keep it playful, after a short rest, try again. Practice a few times in a row. It is also important to practice tummy-time on the floor or a firm surface (carpet or mat) as this is where they will learn how it feels to have weight through their shoulders, forearms, and tummy it is very different from lying tummy to tummy with you. They will feel little weight shifts that are vital for reaching and crawling development.

Louise Pearce

20/Sep/2020

Tummy time can be a challenge for some infants but it’s worth the investment to make it a fun play position. Research shows babies that spend more time on their tummy when awake have better gross motor skills. They learn to sit by themselves, crawl, and pull up to stand earlier. This learning is directly related to the amount of time the infants spend on their tummy. Tummy time doesn’t need to be a battle, if they don’t like it we need to adapt and change the way they do it. Build their ability slowly as it is about having the strength and muscle endurance of their back and neck muscles to make it enjoyable. There are a number of ways that we can help your baby tackle tummy time so if they are 2.5 to 3 months old and still do not like it, get in touch.

Reference: Dudek-Shriber & Zelazny (2007)

Louise Pearce

07/Sep/2020

Have you ever noticed your baby explores and plays with a toy in one hand whilst their other which is empty is doing the same movements? or you may have noticed it when your toddler is trying to use scissors for the first time (or few times). This is called mirroring. It is due to the pathways in our brain that send the movement messages to our muscles sending lots. This overflow of extra messages gets sent down the track (nerve pathway) that crosses over from the one side of the brain (right hemisphere for example) that controls the opposite side (left hand) but has 10% of the track going down the same side (to the right hand). You also get it from one half of the brain talking to the other half (right side sending a message to the left side of the brain via the corpus callosum). This mirroring tends to be more noticeable when we are challenged, doing something that is really new or tricky. When infants and children become more skilled at the task the mirroring stops. The brain doesn’t get as excited and it sends a stopping signal “hey you don’t need to waste your energy doing that, your other hand is great”. We most frequently see it in infants and toddlers with it generally disappearing by 11 years of age.

References: Soska, Gaelon & Adoph (2012). Development of Psychobiology.

Louise Pearce

13/Apr/2020

Is your child anxious about standing? or walking with their leg turned after their fractured leg has healed? These exercises will help.

Some young children need a little helping hand to start walking after they get the “all clear” from the doctors. It doesn’t need to take a few weeks of them struggling to walk or need you to continue to carry them around. Unfortunately, not all children are able to be seen by a hospital children’s Physio when their cast has been removed but not to worry. I have put together a FREE booklet of exercises that you can start with your child to help speed up their progress. Try these exercises if you find they are walking with their foot turned out, finding it hard to bend their knee, or walking like they have a ‘peg leg’. Download a copy here or email us at info@aucklandchildrensphysio.co.nz to get your free copy.

Download FREE booklet here: Lets get playing again!

Louise Pearce

14/Jul/2016

When your baby is able to sit by themselves and are happily rolling side to side then they are probably ready to learn to sit up. This technique will teach them how to transition in and out of sitting. We start off by practicing the movement with them, this will show them how to shift their weight, what muscles to use and put the steps into sequence. As they get stronger they will need less hands-on and you might only start the movement for them. It is important that you practice this from each side (side-lying start position) even if your child has a favorite side to roll to. I often recommend to parents whose goal is for their baby’s to be able to sit up and lie down by themselves, to do this after each nappy change.

Steps:

Encourage baby to roll to their side e.g. right
Place your right hand under their right shoulder
Place your left hand just above their hip
Gently pull down on their left hip whilst giving support to their trunk with your right hand
Give them time to try and place their right hand on the floor and push up (straighten their arm)

Success- Sitting!

Louise Pearce

14/Jul/2016

Just like the other muscles in your body, your hands can get tired when over worked and can get cramp. Holding a pen and writing for three hours will definitely put your small hand muscles to the test. Use either exercise putty, Plasticine or firm Play dough to help give your hands the pre exam work out that they need. Do make sure that you give your hands a rest a few days before your exam, just as you would before an important running race or sporting competition. Also consider the weight and thickness of the pen you are planning to use for the exam.

Place the putty in the hand you write with. When doing the below exercises try to not use your other hand or another surface such as a table to shape it.

To start

roll it out between your fingers to make a Snake
make a ball
lay the snake on a table– pinch the snake using your thumb and a different finger all the way from one end to the other end e.g. thumb and first finger, thumb and second finger.
put the snake back in your hand and roll it up to make a snail
use your thumb and fingers to flatten it out to make a pancake
place the pancake over tented fingers (fingers all touching each other) and open up your fingers to make spider webs

Repeat as many times as your like- aim for your hand to feel tired.

Louise Pearce

18/Mar/2016

Your five-year old might be starting school or your teenager is complaining their back is sore after carrying their bag.
If this is the case we need to ask?

Is it the right size for their height?
Is it big enough to carry what they need?
Will they be wearing it for a long time e.g. waiting to catch the bus?
Is it comfy are the shoulder straps padded?

It is important to consider these points and what the ‘trade offs’ are for the health of your growing child’s back.

If you drive past a school take a minute to look at the kids walking with their heavy school bag. If they are wearing both straps these are often loose with the bag hanging below their back. Initially when they set off they may look OK, but with each step their posture is changing and their body is adapting to the load.

Changes to their posture

shoulders are rounded and pulled forward affecting the arm position in the shoulder joint
head is pulled forward in front of their body
spine alignment affected causing the curve in the neck to flatten out and the mid-back curve increases (hunched)
smaller steps taken as body positioned forward affecting the muscle in their hips, knees and ankles
natural arm and opposite leg swing is reduced which is important for cross patterning
decreased walking efficiency
if wearing only one shoulder strap they will get shortening of back and neck muscles on the same side and lengthening of the other.

Over the years there has been an increase in children having neck and back pain. This is down to a number of factors such as our kids being less active, poor posture sitting watching TV or looking at other handheld devices but also due to schools having fewer lockers or desks and carrying more in their bag. Therefore adding a poorly fitted, poorly packed, thin strapped and too big a school bag to the mix isn’t going to help. As a result your child may experience back or neck pain or complain of ‘tingling’ or their arms feeling ‘funny’ from the pressure of the straps pressing on blood vessels and nerves that supply their arms.

There are numerous medical studies that have investigated back pain in children. The research shows that most children start to experience pain at around 11 years of age around the time they start to hit puberty. Other risk factors identified are being female, carrying a heavier weight, a bag that is too big (in proportion to the child) and increasing age. Interestingly they found that wearing one shoulder strap was the same as wearing two.

Unfortunately we can’t stop them growing up or change if they are a girl so we can only influence the bag size and weight. The curves in our spine are developed to enable us to carry greater weight than if it was straight. When we wear a heavy backpack it pulls our shoulders forward and we lose these natural curves and this is true for children, teenagers and adults although as adults we are less flexible in our joints and hopefully our muscles are stronger. This flattening of our spine puts uneven pressure on our vertebrae (bones) but also on our discs (cushions between our vertebrae) which long-term uneven pressure can cause them to bulge and press on our spinal cord (called a herniated disc).

It is recommended that children carry no more than 10 % of their body weight. For most 5 year-old’s with an average weight of 20 Kgs this is only 2 Kgs.

How much is 2 Kgs?
2 Kgs = Lunch box (cheese sandwich (2 slices of bread), apple, yogurt, banana, 2 biscuits), empty drink bottle (500 ml), pencil-case, 2 x 1B4 exercise books, P.E shoes, jumper.

Tips when selecting a school bag

Choose a bag that is proportional in size – when the straps are fitted the bottom of the bag should sit at the level of the hips
Shoulder straps should be well padded and wide to help spread the weight and fitted to reduce excess movement
Teach your child how to adjust their shoulder straps and place heavy items close to their back
Encourage them to use their locker or their desk to leave things they won’t need for the rest of the day
Fill their drink bottle at school and empty it before leaving (if they are old enough to do this)

If you are concerned your child has ongoing back pain or postural changes related to wearing their school bag, contact us today on 0221551677

Louise Pearce

18/Mar/2016

Did you use to climb trees when you were a child? Space nets or spider webs are our new alternative for our kids. They teach our children so much about their bodies and help challenge and develop their thinking. Although I am not far away from my toddler when she’s exploring, I am all for encouraging her to use them. They provide the same benefits that we learnt from climbing trees in our back yard and are also free!

They help your child develop:
Motor planning which is the process of deciding the sequence of what they need to do and how they will do it
Coordination which is the ability to turn on the right muscles at the right time to ensure smooth easy movement
Problem solving of how they will get from A to B and plan to over come obstacles
Total body strength, especially strengthening the muscles in their hands and feet from gripping and balancing
Balance to be able to stay on the net whilst testing the their limits
Muscle endurance to teach their muscles to work for longer
Concentration and focus on the same task till they have achieved what they set out to do
Flexibility of muscles and joints by providing a good stretch when reaching, ducking and climbing …especially good after a day sitting at school or playing on their phones or Ipad.
Confidence & Fun

Check out Auckland for kids for a list of some great children parks and green spaces in Auckland.

Older Posts

CLASSIC LIST

Should I swaddle my baby?

What therapy actually works in Cerebral Palsy?

Tummy-time a battle?

Tummy time does make a difference

Mirror movements in your baby hands?

Exercises to help your child after their leg fracture.

Teach your baby to sit up

Exams and hand cramp- easy exercises that can help.

For school parents – Is your child’s school bag right for them?

Changes to their posture

Tips when selecting a school bag

If you are concerned your child has ongoing back pain or postural changes related to wearing their school bag, contact us today on 0221551677

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