A series of early intervention tutorials from Firefly and Flying Start’s Nick Mant, PT

Part 1. Starting strong - 3 essential early positions
    1.1: Back Lying (Supine)
    1.2: Tummy Lying (Prone)
    1.3: Side Lying

Part 2. Sitting pretty - transitioning from the early positions
    2.1: Sitting and Side Sitting
    2.2: Lying to Sitting   

Part 3. Moving on - kneeling and crawling positions
    3.1: Kneeling and 4-point kneeling
    3.2: Transition sitting to 4-point kneeling   

Part 1. Starting strong - 3 essential early positions

I am a physiotherapist who works with children with developmental delay, sometimes caused by a diagnosed condition, sometimes of unknown cause and always with varying degrees of severity.

In ALL cases without fail I try to teach parents the importance of early building blocks within child development, which are often overlooked in the pursuit of walking – the skill that, understandably, most of us strive for our children to accomplish.

We know how these early skills link together to make your child reach their potential – and the best bit is, it isn't much to remember!

In this blog, I will be starting on the earliest of skills from the baby we take home from the hospital playing on their back to the skills leading to tummy time and rolling.  Come back to the next blogs where I will be moving on to sitting & kneeling skills as well as how to encourage the transitions between.

I will be using the Playpak with the children I am seeing. I find Playpak to be one of the most versatile bits of kit available to encourage child development from floor positions up to standing, and it comes in a very portable package.

When I am recommending activities for children to encourage development I advise they should be done throughout the day and not in set physio sessions. So the portability of the Playpak makes it ideal to take to the various places your child will visit throughout their week.

Children learn through new and interesting things in positions that allow their body to achieve.

If they are playing in new positions and experiencing the movements their body can do, then they will be getting the best results.

However if they are adopting destructive positions, learning to accomplish tasks with poor movement patterns, then we are not achieving what we set out to. A destructive position/posture is one which will likely cause harm or increase movement difficulty in the near or distant future.

A poor movement pattern re-enforces destructive postures. Movements need to be repeated many times before they are learned – and often need re-learning when we then move onto another skill.

So if a child learns poor movement patterns they will repeat the movement over and over again until it is established. We need to intervene early to prevent this, to give a child every opportunity to learn the best possible movements and to encourage the best postures, allowing them to better succeed when they progress to positions against gravity.

Let's look at back lying (supine), tummy lying (prone), and side lying.

1.1 Back Lying (Supine)

Laying on our back is the first position you can really have interactive play with your infant. It is the easiest way for you to talk to them and establish early turn taking for communication. Your face, after all, will be the most interesting thing for them at this time!

A typical child will initially be quite flexed with bent arms and legs when first taken home from the hospital. This “physiological flexion” helps the baby to keep their head in the middle and to orientate themselves with the new world they are in - all the additional light, sound and touch they are experiencing having left the womb.

It is common for children with physical difficulties to not have experienced this physiological flexion. Therefore we support them in a back lying position in a way that they can find their middle, their hands and legs, and are able to look around without having to worry about keeping their head still and moving their eyes separately.

Babies move away from the flexed position by stretching their arms and legs independently of each other - if a child has physical difficulties this may be difficult. This is an early building block of moving limbs one at a time independent of the other side, leading to activities such as crawling.

In back lying we can bring feet to opposite hand, working tummy muscles but also separating it from the other foot in the mind’s eye. Supporting a child in a position that allows active movement also helps them develop awareness of their own body by themselves.

Common difficultes

Children will often have too much straightening (extension) because of increased muscle tone (hypertonic muscles) or their trunk may be very floppy (hypotonic) making it hard to lift away from the surface. Their head often stretches back (extends) and turns to one side making it hard for children to learn what and where the rest of their body is, and how their eyes/head relate to it. 

They will often struggle to bring their shoulder joints and shoulder blades (shoulder girdle) away from the supporting surface, finding it hard to learn how to use their hands and develop a mid-line awareness. Alternatively, heavy legs, due to possible low tone or spinal problems, will weigh down the pelvis and bottom of the trunk. Supporting a more flexed position will make it easier for a child to use their tummy muscles (abdominals) and progress to moving away from back lying (supine).

Solutions

By making a “nest” for baby we are helping them come to a flexed position. This will help them to use their tummy muscles and keep head in the middle. 

The shoulder girdle is forward making it easier to use the arms and bring them in front of the head, and the hips are supported making it easier to lift the legs. We can easily work on looking at objects being moved from left to right and reaching games with the arms. Looking at our feet is an excellent way to introduce them to baby.

 

Aims

Simple support to the shoulder girdle can help baby maintain mid-line of their head – allowing them to focus on the toy, as well as giving them the opportunity to reach up with their hands. Babies, in truth, haven't got a clue what their hands are to start with – this gives them an opportunity to play with them and learn about them.

I often think “did the child I am seeing ever get a chance to take their hands to their mouth?” this early skill/opportunity can really help a child then progress to rolling and propping in prone & sitting - then onwards to crawling.

Think, how can we roll if our arms are pinned to the floor by the weight of the shoulders?

How can we learn to sit if we are unable to place our hands forward?

And how can we crawl if we have never taken weight through our arms? This position can also help develop awareness of mid-line, tracking and head control.

Read on to learn about the next of the 3 essential early positions - tummy lying

Part 1 Webinar!

Nick talked us through his early intervention tutorials live over a series of webinars in March and April 2016.

Part 1: Starting strong in 3 essential early positions is available below.

 

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