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.

Postitional Plagiocephaly

Positional plagiocephaly. Flat head syndrome- due to positioning of the infant on the back for extended periods of time. With the back-to-sleep campaign that began in the early 1990s, many parents became afraid of placing a baby on his/her stomach- and left their infants on their back, in swings, and/or carseats. Has the increase in positional plagiocephaly also caused a rise in developmental delays? According to a 2010 study that was published in Science Daily, babies with flat heads may be at a higher risk for cognitive and motor delays. It makes sense- when an infant is always on his/her back, he/she does not receive the proprioceptive input (feeling of where body is in relation to space) or the neck extension (straightening). The child could potentially be delayed in meeting milestones. After all, it is more difficult to attend to a stimulus while on your back (then on your stomach). Additionally, many babies will take longer to learn how to roll, crawl, sit, and stand, as the core muscles will not be strong enough to move against gravity. As an occupational therapist, I work with many kids that have positional plagiocephaly. During the session, I teach families how to place their babies during waking hours - as well as how to engage them - to prevent worsening of and correct the flat spot. Although pediatricians recommend back-to-sleep, I encourage families to keep babies OFF of their backs (out of the supine position) as much as possible during waking hours. What can you do? Here are three "quick" suggestions to PREVENT positional plagiocephaly. TUMMY TIME! I can't say it enough. Although a Tummy Time article on parents.com mentioned to place an infant on his/her stomach beginning "around the 3-4 month mark," I believe it should happen MUCH earlier. You can put your baby on YOUR stomach- after feeding, while he/she is sleeping, and during waking hours during the newborn stage. It is a great way to bond with your baby and can also help with burping! (In all fairness, the article DID mention this.) ***Just be careful until the umbilical cord has fallen off. Be a switch-hitter! Switch sides in your arms (after every feed) and in the crib (each night)- get your baby comfortable resting his/her head on BOTH sides. Just because it is made- does not mean it is right for your child. Meaning- just because Bumbo seats, exersaucers, jumpers, walkers, and swings (etc...) are readily available in many, many stores, they are not necessarily appropriate for your child- in his/her current stage of development. Although those items can be great distractions- extended use may NOT be recommended. It is very scary to be a parent nowadays- I TOTALLY get it. Remember that you are not alone. If your parent instinct tells your that your child may have positional plagiocephaly, speak to your pediatrician. I am also available to lend my expert opinion about positioning and engaging "activities" to do with your baby.

Creating a Crawler. Almost.

Nature vs. Nurture. You can't always change nature, but you sure can nurture- offer tools to help your kiddo meet milestones and achieve success. My 6-month-old is crawling. Almost. Although he has been army crawling for over a week, yesterday he took four purposeful movements in quadruped position (on all fours!).

My EtiKid(s) began kicking in utero! I actually have videos of my stomach lurching side to side as the older one kicked as hard as he could -from the inside. That being said, I am an Occupational Therapist and Early Childhood Education Teacher. Having studied a lot of child development, I knew enough about the importance of positioning and environment- giving him with opportunities and motivation to meet success. I did not use hand-over-hand cuing to teach him, but he was provided with a stimulating-enough environment and appropriate positions to foster his development. Although every child develops at his/her own pace and nothing with children is guaranteed, offering developmentally appropriate tools can help your child thrive. Here are 3 QUICK tips to foster those gross motor skills. 1) Play- Someone was almost always on the floor playing with him. He was read to, shown cause and effect toys, and smiled at throughout the day. Also, there is an older sibling. I made sure that there was a lot of interaction between the two and clearly the baby now wants to be just like his big brother. (PS- big brother began crawling at 6.5 mos- and he was provided with the same "tools," minus the older sibling. *sigh 2) Tummy Time- can't be stressed enough. Some "experts" recommend 30 minutes per day to parents. I did FAR more. Pretty much every waking moment was spent on his stomach or upright in my arms (his middle name is "hold me!"). 3) Reaching- While laying on a mat, I put some bright toys that were sure to be his favorite just out of reach. This also helped to improve his grasping skills. Through our efforts to overcome shoulder dystocia, we created a crawling monster. Almost.

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!

To Chew or Not To Chew...

That is the question…

Kids put many objects into their mouths such as fingers, pen tops, pencil erasers, but one of the most socially acceptable items found in the oral cavity is chewing gum. A popular habit from the age of the caveman, it is often used to relieve stress, freshen breath, and may even prevent plaque buildup and gum disease. Studies by The Wrigley Science Institute (dedicated to studying gum), have suggested it may have an effect on appetite and memory. Not to mention that it is most helpful providing oral-motor stimulation to a child with sensory needs (talk to your Occupational Therapist about this). According to chewinggumfacts.com, over 100,000 tons of chewing gum are being consumed every year. It clearly provides enjoyment and sensory stimulation to many people. But... While gum can be useful, gum chewing can be one of the most annoying habits to watch.

Sticky and gooey, a piece of gum can be chewed for hours, used to blow bubbles or “put it on the bedpost overnight”** to resume chewing in the morning. It can end up on the bottom of an unsuspecting shoe, stuck in someone’s hair, strategically placed under a desk or plastered all over an unsuspecting face once the bubble bursts. It is pliable enough to stretch into long strands, twist into pretzels and can be used to make hideously loud clacking noises. Mostly, it is irritating to everyone else subjected to watching the monotonous chewing motion and listening to the sound effects of repetitive mastication. Since gum is not on the verge of extinction, should gum be banned or is there etiquette to chewing the rubber?

Two problems noted by Sheryl Eberly, author of 365 Manners Kids Should Know are the visual image and what to do after it’s been chewed (known as ABC gum). The most obvious solution is not to partake in the habit which is not really a viable alternative.

Following a few simple EtiKids' guidelines can help eliminate references to “chewing like a cow” or other ruminant animals from family, friends and teachers. Basically, chewing gum should be avoided in public places such as school, houses of worship, social events (weddings, birthday parties, theater), job interviews, private classes or studios, and any other place one may talk, eat or disturb others.

· Use small pieces one at a time, not giant wads that pad the cheeks. EtiKids stresses social skills and encourages behaviors that keep food inside the mouth. This is much easier to do if the mouth is not full. Bubbles are a no-no!

· Cracking gum and blowing bubbles is not an enjoyable experience for those not chewing. To be polite, refrain from such actions. The person on the left will be quite thankful.

· While chewing, lips should remain closed. This helps to eliminate sound effects. Chomping noises are never considered good manners.

· Share with friends. If one is tempted to slip a piece of gum into the mouth, make sure a piece is offered to accompanying friends.

· To remove gum from the mouth, place in a tissue and put in the trash. Please do not throw it in the toilet or spit it out. That’s a blog for another time!

Parents can set be helpful and set guidelines. Exaggerate for children what open mouth chewing looks like and discuss how it is perceived. Explain that it is difficult to remove if it gets on one’s clothes or in hair, and it should not to be swallowed.

Most important for safety, parents should remember choking is one of the leading causes of death to children that are age three and under. In addition to the usual dangers of hot dogs, peanuts and whole grapes, chewing gum is listed as a safety hazard by the American Academy of Pediatrics and should be a concern for parents. Be prepared, learn the Heimlich maneuver!

**DOES YOUR CHEWING GUM LOSE ITS FLAVOUR ON THE BEDPOST OVERNIGHT?

Oh-me, oh-my, oh-you
Whatever shall I do
Hallelujah, the question is peculiar
I'd give a lot of dough
If only I could know
The answer to my question
Is it yes or is it no

Does your chewing gum lose its flavour
On the bedpost overnight
If your mother says don't chew it
Do you swallow it in spite
Can you catch it on your tonsils
Can you heave it left and right
Does your chewing gum lose its flavour
On the bedpost overnight

Based on the 1924 original by Ernest Hare & Billy Jones, "Does The Spearmint Lose Its Flavor On The Bedpost Overnight? (Marty Bloom / Ernest Breuer / Billy Rose)

Lonnie Donegan - 1958 (Also recorded by: Ding Dongs)