Skill of the Week: The Parents' Guide to the First Year of Life

Congratulations! You just brought your little bundle of joy home from the hospital, and you are so excited to start the rest of your life. You begin to envision your child as a happy baby, growing into a feisty toddler, and beam at the thought of the two of you, hugging, on the first day of preschool. Until... Another fleeting thought... You realize that there are so many stages for your baby to first go through, and you are immediately overwhelmed at the thought of raising your child in a developmentally appropriate manner. As a pediatric occupational therapist and mommy x 3, I know that it is absolutely frightening to think of every skill that you "should" work on every day- in order to help your child meet developmental milestones. After all, not everyone has the time or energy (hello, newborn sleep-deprivation!) to go through the daily developmental checklist. After working with some of my early intervention families, I realized that many parents would truly appreciate having one skill to focus on each week, incorporating attainable goals to help their children reach milestones. "Skill of the Week" will offer families an opportunity to engage their babies, using best practices for cognitive, fine motor, gross motor, and social and emotional skill development. The series will highlight one skill per week throughout the baby's first year of life, which a family can easily incorporate into their [child's] daily routine. Toy suggestions will also be provided- to complement the skill that is being featured. You might be saying, I will enjoy my child as soon as she can sit or talk or run or go to school. Perhaps you think, "babies are not my thing." But they can be when you realize all that your child can and will do. So I say, let's work on one skill at a time, marveling in each new achievement. I promise, it really is amazing.

What Should We Play With? For Infants, Ages 4-6 Months

What Should We Play With? Part II Although it has been a while, I have received requests for the next post to be about the best toys for infants, ages 4-6 months. This is one of the hardest stages because your baby is beginning to be mobile but is not quite ready to be seated upright for extended periods of time in exersaucers and such (refer to this post for more information as to why). Babies at this stage are rapidly developing and becoming more like little people (and much less like little zombies, who primarily want to eat, sleep, be held, and be changed!). Therefore, toys at this stage should be more stimulating, to increase their level of awareness. In addition, toys that work on cause/effect (touch this and lights go on) are important. The following toys can all be found on Amazon.com. Tummy Time Mat Tummy time is one of the most, if not THE MOST, important positions for this stage of development. See Part I for more information. The Tiny Love Activity Gym mat is also a favorite, as the lights, sounds, and items to grab while on the back and stomach are stimulating for the babies. In addition, they can practice rolling all over because their are fun things to see at every corner! Sit them up on the mat- have them grab and reach the items that are at shoulder-level... This mat can have many uses!

Activity Table This Fisher Price table is a great example of the type of toy to give your growing infant. The legs can be modified accordingly to allow the baby to access the various components of the table while in tummy time, on the side, seated, and standing. This activity table has room to grow with your baby - and you will notice that he/she will play differently with the table throughout various stages of development (rolling, sitting, crawling, walking).

Activity Bars Your child is working on grabbing, pulling, and pushing. Keep your child busy on walks or long car rides with this activity bar! This is also a great way to have your child practice sitting up...

Board Books Touch and feel board books are my favorite for babies this age! Aside from beginning to see words, large pictures and feel textures, they are easy to clean and begin to teach babies how to turn pages (left to right). The books also offer entertainment when seated in tummy time and ensure that you are focusing attention on your baby (after all, who doesn't like attention!?!?!). This book of baby animals was/is a favorite of my EtiKids! They love to hear and make the sounds of the animals!

How To: Know When Your Infant is Ready to Sit Up

A mother in one of my Mom-groups on Facebook recently posed a question- regarding the positioning of her daughter. While in daycare, her 3-month-old was seated upright in a Bumbo seat with toys placed on a tray in front of her. While many parents agreed that it was ok to do so in order to prepare the infant for sitting upright, the OT (Occupational Therapist) in me said otherwise. This now leads me to the age-old question: When is it ok to start sitting up a baby? My response was/is: An OT is primarily concerned with the positioning of the child to help him/her improve all domains of development and meet milestones. At the infant stage, appropriate positioning will foster increased socialization skills and awareness by simultaneously developing strength. This will also enable the baby to maintain positions for extended periods of time. Skipping the important steps/milestones may actually delay your child's development! At 3 months of age, most babies do not have consistent head/neck control, as bobbing is frequently seen. To foster this skill, caregivers should gradually reduce the amount of support provided while holding the baby. For example, instead of supporting the head/neck with the whole hand- try using only fingers. Additionally, until a baby has developed very strong spinal muscles, they should not be placed in Bumbo seats or upright on Boppy pillows for too long. If there is curvature of the spine (and you can seen the vertebrae sticking out)or leaning to the side, the baby is not ready to sit by him/herself.

In her blog, Janet Lansbury writes that sitting babies in restrictive seats (exersaucer, infant seats, and jumpers) for extended periods of time will potentially cause your child to skip important milestones such as rolling and crawling! The belief of MANY parents is that these items are helpful for parenting (providing opportunities to shower and such). As with much of the equipment for babies, they should be used in moderation. Tummy time with toys placed in front of the child would be more appropriate at this stage to increase head/neck development, strengthen the extensor (straightening) muscles of the spine, increase grip/fine motor skills and continue to increase awareness of the environment that surrounds him/her. Placing the toys in front and around the baby will foster rotation and mobility, which will help the child learn to roll over and eventually crawl. Additionally, your child will receive more proprioceptive sensory input, which teaches about his/her body in space. But that being said- it is not an age thing so much as developmental. If your child has great head/neck control, the spine is extended (straight) when sitting up (while you hold her), and the baby can maintain an upright posture- go for it!

Raising My Advanced EtiKid

My son started crawling at 6 1/2 months and walking at 10 1/2 months. Although that is no small feat, I am even more excited (and proud!) that he is extremely social and loves to interact with other people. I am WELL aware that most of his abilities are due to nature (he was very active in the womb, frequently causing the need for repeat ultrasounds!). I will say that I did recognize signs that he was ready and provided him with opportunities that encouraged him to develop his skills. As I have friends asking me what I have done to promote his development, I thought I would share some tips (not just as a parent but from an Occupational Therapist's perspective). 1) TUMMY TIME! From the time he was born, I would hold him across my arms or on my lap on his belly. Once he got a little older (2-3 months), I placed him onto a mat on the floor- on his tummy. He definitely did not like it at first, but I always started floor time in this position. Toys that made noise were placed in front of him - encouraging him to extend his tolerance of tummy time. This helped him to get a sense of his body in space, as he received a lot of sensory input from his stomach and arms being on the floor. It also helped him learn to lift his head and upper torso off of the ground, promoting neck extension (straightening). He became more aware of himself and his surroundings once he was able to look at objects and happenings around him. Sheryl Berk from Parents Magazine has additional tips for Tummy Time. 2) Lots of playtime... Many people mistakingly believe that a child who doesn't move can be left alone on the mat. I feel that it is even more important to engage, talk to, read to, and just generally sit on the floor with the infant. As a parent, OT, and child development specialist, this time is especially formative in a baby's life. Demonstrate how to use toys and give the infant the freedom to explore the objects as well. Make sure that the toy is "developmentally appropriate" (more about that to come in future posts). Additionally - just because a toy is in the store does not always mean that it is right for your child. Use your gut instinct. If that is not working at the moment- perhaps due to extreme sleep deprivation, call/email me. 3) Model social behavior - your baby is NEVER too young to learn social interactions. Smile, respond to their sounds, and use LOTS of language to foster their own speech communication skills. Providing and modeling interactions as soon as possible can only help the child learn how to engage with others. The more engaging a baby is, the more likely others will respond to him/her. 4) Be consistent. It is definitely too early for punitive measures. However, after 6+ months, a child can begin to learn safe vs. unsafe. Redirection is the BEST method for preventing unwanted behaviors. Yes it is exhausting, but it will make it easier to raise a polite little person in the not-so-distant future. For example, when my child wants to play with electric outlets (he looks at me and smiles as he touches them because HE KNOWS HE SHOULD NOT BE NEAR THEM!), I immediately say (in a stern voice), "Not safe." I then redirect his attention to his toys (on the other side of the room), and sit with him as we build the simple blocks or read a book. This list can go on and on (I will share more tips in coming weeks). I firmly believe in the adage that it "takes a village to raise a child." Therefore, I am sharing my wisdom as an Occupational Therapist (and parent!) and welcome any other tips you may have. Of course, if you have any questions, you can call me or email me. I look forward to hearing more stories about your own EtiKids!

Hot Plates, Cold Plates, Some Plates, No Plates

According to an article written by Jess in When Harry Met Sally, "restaurants are to people in the 80's what theatres were to people in the 60's." Dining out has become a social situation, a way for people to (re)connect with friends. The meals are filled with laughter and conversation; reminiscing about the past and fantasizing about the present. The only lull in the evening occurs at 1 awkward moment: how many plates must be served before one can and should start eating? Knowing that the food in restaurants is rarely brought out at the same time, does everyone need to have a dish in front of them before beginning the meal?

Different behaviors are revealed in the moments when the server brings out the first plates. Some of the people begin eating the moment their food arrives, carefully avoiding eye contact with the hungry stares around the table. On the flip side, others are adamant about waiting until all people at the table have been served, whether there are 4 people or 20. Which is correct?

To answer that burning question: neither is correct. Like many situations in life, the topic of "how many people need to be served before eating" falls into a gray category, with several aspects that need to be considered. First of all, how many people are sitting at the table? Second, is the meal a dinner salad or an entree? If the table has six people or less, all occupants should receive their food (hot or cold) before someone takes a bite. The only time it would be acceptable to begin eating earlier would be if those without food insist that the lucky folk start their meal instead of waiting for the rest of the entrees.

If the table has more than 6 people, statistics and math skills come into play... 3 "hot" plates (entrees, pastas, secondi) should be served before taking the first bite (dinner salads are not included in this). Of course, it is polite to provide permission for those with hot plates to begin immediately, as no one enjoys eating cold steak. If the table has more than 10 diners, it would be preferable for 4-5 hot plates to be served before delving in. Typically, one-third of the table should have their food... However, the most appropriate table etiquette would be to wait until permission to eat has been granted by those without plates (the conversation being, "no, please go ahead and eat. I insist!").

And of course, this manner can be taught to children that are of the preschool age and older. To utilize developmentally appropriate math skills, the child must count how many "hot" plates are served before they can begin. Sorting out the types of food that are "hot" versus "cold" enables the child to practice placing items into separate categories. Using one to one correspondence (assigning every meal a number) will keep the child entertained for a few moments. When the preschooler becomes a working adult, this skill will ensure that he/she will not become the "rudie" at the business dinner, who started eating before all of the bosses. Knowing how many plates should be served before eating is a practice that will help children in work and social situations in the future.

Bon Appetit!