Health – Auckland Childrens Physio

30/Sep/2021

Crutches can be an important part of your child’s recovery following a leg or foot injury. They work by reducing the amount of weight placed on an injured leg while the child is mobile. By teaching your child to use their crutches correctly, they can be active while their injury heals quicker.

How to teach your child to walk with crutches

Standing Up

While sitting have your child hold both crutches firmly in one hand forming an ‘H’ shape with the crutch handles. Keep their non-affected (good) foot flat on the floor. Then have them lean forward and use their other hand to push up from the seat or armrest.

Sitting Down

Have your child back up close, feeling the back of the chair behind their good leg, followed by taking their hands out of the crutchers and hold with one hand. Using their other hand, have them reach back for the chair and lower themselves down.

Walking

Throughout the walking sequence your child wants to keep their crutches in a position that is neither too wide, nor too narrow.

Non-weight bearing

Lead with their crutches first, 2-3 feet in front of them. Have them lean forward to bring their weight over the crutches and then, pushing through their arms, hop-forward with their uninjured foot/leg. Try to only bring their good leg forward to an imaginary line between the two crutches.

Touch-weight bearing

Keeping their injured leg and crutches together, move the crutches forward 2-3 feet. Place the toes only on the ground (small amount of weight through their toes). Encourage them to imagine there is a strawberry or tomato under their foot that they do not want to squash. Follow by stepping through with their good leg.

Weight-bearing as tolerated

Keeping their injured leg and crutches together step forward and put as much weight through their injured leg as they feel comfortable. Push through the crutches to bring the good leg through to meet the crutches.

Turning Around

It’s important for your child not to just pivot on their good foot, rather they need to hop around to change direction. Start by having your child hold their crutches out at their sides and then get them to take small steps or hops around in the direction they want to turn – they want to keep a similar turning motion to that of the hands of a ticking clock.

Going Up Stairs

If it’s unsafe, it can just be easiest for your child to sit on the lowest step and shuffle up step by step on their bottom. If they are intending to walk up with their crutches, start by having them place their good foot and crutches close to the first step. Next, have them lean forward, bringing their weight over their crutches and have them step up (avoid hopping) to the first step with their good foot. From here have them continue the sequence while trying to keep their body leaning slightly forward. If you have one handrail, use this with one crutch. Use the crutch in the same sequence as if you had two. Hang the other crutch around your forearm or have a family member take the crutch up to the top of the stairs.

Going Down Stairs

Again if it’s unsafe have your child sit on the top step and down on their bottom. To walk downstairs with crutches start by having your child place their crutches carefully down to step below them. Place the crutches on the outer half of the step near the edge. Have them move their injured foot out in front of crutches and then lean slightly forward to bring weight through the crutches. Next, have them while pushing firmly through arms, step down on their good foot to the step below. Stop on each step to check their balance before continuing slowly down the stairs, repeating the sequence.

Additional safety tips for walking with crutches

Prevent slips or tripping by avoiding loose mats or rugs.
Avoid areas where there is surface water, uneven ground, grass or cracked sidewalk.
Make sure your child is wearing non-slip closed-back shoes and never let them walk with crutches while wearing socks – as they are too slippery.
To avoid tripping over them, try to keep your family pets contained as much as possible during their recovery.
Continue to review the ferrules (the rubber bits at the end of the crutches) for wear.
Use a backpack or your pockets to carry things so that their hands are kept free to use their crutches.

Louise Pearce

20/Jun/2021

When we look at how babies develop we know that they learn at slightly different speeds but there are key time points where we expect to see them achieving certain movements e.g. rolling by 5 months. Learning to move is a complex process, it relies on many systems working together. Some children may learn slower as they have been exposed to risk factors during pregnancy or in the first few months of life. Infants who are born premature (>36 weeks), having a low birth weight, their mother had an infection whilst pregnant (listeria or toxoplasmosis), there was reduced placenta health, can increase the risk of them having a neurological concern or cerebral palsy. However, we are lucky with current research and international collaboration of specialists within the area of child development as we now know what we should be looking out for. What are the red flags or movements that we see in the baby that means we should be taking a closer look?

So what are these “early warning” signs?

Is your baby showing a hand preference before 1 year?
Are they older than 6 months and they cannot get their feet to their mouth or their legs feel stiff and are hard to bend?
Are they older than 4 months and keep their hands closed tightly (fisted/ clenched) most of the time?
Are they not able to hold their head in line with their body when pulled up to sitting (older than 4 months of age)?
Are they Can they sit by themselves

Louise Pearce

20/Jun/2021

Advice for new school parents

Your baby is all grown up and off to school. You most likely have a looong list of things that they need. A school bag would definitely be on the list. Your child might already have a back pack that they used for kindy or childcare but is it right for school? How they will use their school bag is likely to be different. We need to ask ourselves; 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. walking to school, waiting to catch the bus? And is it comfy? It is important to consider these points and what the ‘tradeoffs’ are for each on the ‘health’ of your growing child’s back.

If you drive past a school take a minute to look at the kids walking to or going home 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. Their chest muscles are shortening whilst their back and shoulder muscles are being lengthened, their spine is being stressed and they are changing the messages from their brain to their muscles which will reinforce the bad posture.

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- neck curve is flatter and the mid-back curve has increased
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 they are wearing only one strap- 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 permeant desks and carrying more in their bag’s. 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’s 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 olds with an average weight of 20 Kgs this is 2 Kgs only.

How much is 2 Kgs?

2 Kgs = Lunch box (cheese sandwich (2 slices of bread), apple, yoghurt, 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
Full their drink bottle at school and empty it before leaving (if they are old enough to do this)

Reducing the risk of your child developing back pain will help ensure your child goes into adulthood with a ‘healthy back’. ??

Louise Pearce

17/Jun/2021

With winter sports well underway, it is important to remember children do get injuries that we can help prevent. ACC has been instrumental in leading the change with their ACC SportSmart program development. In collaboration with Netball NZ, Rugby NZ, Touch NZ, Football NZ and League NZ they each developed specific frameworks with focuses on warm-up, training and conditioning, and wellbeing resources that can be found through the following organizations.

Hopefully, as parent coaches, you are implementing these in your training and warm-up sessions. If you are watching from the sideline and are not sure if your child coach is aware of these you can help spread the word or start some of these exercises with your child at home. Although most of these frameworks are developed for the 10 + age group but the knowledge and exercises can be easily adapted for the younger children. For example; lunge exercises. They may not be able to lunge low but they can start to learn the exercise, build strength and challenges their balance.

Check out links for these specific programs;

RugbySmart https://www.rugbysmart.co.nz/

NetballSmart https://netballsmart.co.nz/

Fit4Football http://Fit4Football.co.nz

TouchFit360 http://touchnz.co.nz

LeagueSmart http://NZRL.co.nz/get-involved/leaguesmart

Advice on sport for school-age children

For younger children, they have collaborated with researchers to define key recommendations to protect their growing bodies from injury (growing number of serious injuries such as ACL tears), prevent burnout from sport and continue to develop a passion for healthy cultures with exercise and sport.

Key recommendations

Participate in a number of different sports (codes)
Avoid specialisation in one sport till the child is at least 10 to 12 years
Hours of training and games per week should be less than the child’s age
Kids should have twice as long free play time (e.g. kicking a footy with friends in the backyard) as they have in structured play (training and game of footy).
4 months off training each year for each single sport
Fun and friendship is the primary goal for kids and teens in sport

Remember the key for children in sport is FUN, FUN, FUN. We want to encourage a lifelong love of sports and fitness.

Louise Pearce

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

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

It is likely that you have tried turning their head to the other side when they are asleep. You have tried more tummy time. You have placed the toys on their non- favorite side but back their head goes. Although these are fantastic starting points to help with torticollis or head-turning preference, they are often not enough. If you are getting head shape changes then this just makes it even harder for your baby to turn their heads as often they have a lump or ridge that they have to get over. At Auckland Children’s Physio this is something that parents are reaching out for us to help with. Starting early to address this means fewer appointments and faster results. The best results we have seen this past year had have been from the babies who are 6 weeks old at the time of their assessment. They have only needed 2- 3 sessions and they are able to turn their heads equally and easily from side to side and can be discharged. We want this for all babies as we don’t want it to drag on and affect how they use their hands, their rolling but also the associate visual and face changes we see in the more severe cases.

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/May/2018

Hands to feet play is an important developmental milestone that we should encourage. Babies learn to move by layering each new skill on top of each other. They also use skills learnt in one position to help develop their abilities in another position. Hands to feet play will develop skills that will be useful when they learn to crawl, sit and in early walking. Most babies will learn to reach their knees by four months and by six months be busy exploring of their toes and feet. This might even include putting their toes in their mouth!

Older Posts

CLASSIC LIST

How to use crutches correctly

Are you worried about your baby’s movements?

Is your five year-old off to school? Is their school bag right for them?

Parent coaches- are you helping to keep your player’s injury free?

Should I swaddle my baby?

What therapy actually works in Cerebral Palsy?

Tummy time does make a difference

Head still favors one side?

Exercises to help your child after their leg fracture.

Hands to feet play – an important developmental milestone

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