Monday, January 26, 2015

ADHD or just being an active kid?

credit: Envato Images
Dear Melissa,
My daughter’s kindergarten teacher is concerned that she has ADHD. How do I know if she has ADHD or not? If she does have ADHD, what are the best treatment options?

I frequently get this question from parents. The Centers for Disease Control and Prevention calculated that 11% of children in the U.S. had an ADHD diagnosis in 2011. That was up from 7.8% in 2003. Among all children in the U.S., 6.1% were taking an ADHD medication in 2011, such as Adderall and Ritalin, up from 4.8% in 2007. With rates this high, ADHD is a challenge that many families and every classroom teacher will have to face.

What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood brain disorders and can continue through adolescence and into adulthood. Kids with ADHD struggle with focus and attention, have difficulty controlling behavior, and exhibit hyperactivity. Attention Deficit Disorder (ADD) is similar to ADHD in terms of deficits in focus and attention, but hyperactivity is not a problem.

ADHD or not?
Many young children have difficulty attending to classroom instruction. But does that mean they have ADHD? Certainly not! According to Dr. George Depaul, a 
psychology specialist in the field of ADHD research, upwards of 40% of elementary students are reported by their teachers to be easily distracted or lacking in focus (Metcalf, 2012). Considering the rise of academic demands in younger grades, combined with the decline in recess and other extracurricular time, no wonder there are problems! Other explanations for inattentiveness could be classroom chaos, boredom, a family crisis at home, or anxiety and depression problems. By working with your child's pediatrician, psychiatrist and/or psychologist, hopefully the right diagnosis (or non-diagnosis) is reached.

How is ADHD diagnosed?
If your child's teacher raises a concern or you suspect ADHD, a good first step is to talk to your child’s pediatrician. Some pediatricians perform ADHD assessments themselves. However, many will refer the family to a mental health specialist (such as a psychiatrist or psychologist) with a specialty in childhood mental health disorders such as ADHD. The pediatrician and mental health professional will also rule out other possible causes for the inattentive behaviors such as deficits in vision or hearing, seizures, insomnia, anxiety, Autism, depression, and learning disabilities.

Generally, the processes of diagnosis for ADHD include interviews with the parents and the child, as well as various standardized tests and questionnaires. In order to qualify for a diagnosis for ADHD, symptoms need to occur in more than one setting (such as both home and school), and they should also demonstrate a negative impact on an individual’s daily life.

What are Treatment Options?
There are MANY treatments for ADHD available. Stay tuned...I will discuss treatment options on my next post. 

Has your child been diagnosed with ADHD? How did you discover your child's diagnosis?
Please share!
What is ADHDNational Institutes of Health
ADHD or Not? Why a Diagnosis Matters, Web MD, Eric Metcalf (2012)
ADHDCenter for Disease Control & Prevention
Diagnosing ADHD in Children: Guidelines & Information for Parents, American Academy of Pediatrics, (updated January 2015) 
ADHD, Stimulant Treatment, and Growth: A Longitudinal Study, E. Hardstand, Weaver, Katusic, Colligan, Kumar, Chan, Voigt, Barbaresi, American Academy of Pediatrics, Pediatrics, Volume 134, (October 2014) 
Stimulant Treatment of ADHD and Cigarette Smoking: A Meta-Analysis, E. Schoenfelder, Faraone, Kollins, American Academy of Pediatrics, Pediatrics Volume 133, Number 6 (June, 2014)
ADHD Resource Center, American Academy of Child & Adolescent Psychiatry (updated October, 2014)

Monday, January 19, 2015

"because I said so!"

credit: envato
Dear Melissa,
When adults tell children to follow directions, “because I said so!” that should be enough of an explanation for any child.

The above statement actually comes from a discussion I had with a local child psychologist several months ago. If I thought saying, "because I said so!" provided children with opportunities to develop thoughtful self-discipline, then I would be all for it. However, it is difficult to make that argument. I strongly feel that every direction I give to a child is a little, two second teachable moment. It is my hope that if I provide enough of these tiny teachable moments, then I have given the child the tools he needs to make the best choices he can throughout his life. 
My trial and error approach 
I have gathered these ideas from lots of books and blogs then taken a trial and error approach over 7 years of being a mama and over a decade of being a pediatric occupational therapist. As a disclaimer, this blog is largely my opinion. This is simply me sharing my personal style of behavior modification and preferences in dealing with challenging behaviors. 

Teaching children...not programming robots
We want our children to learn how to make good choices rather than blindly following directions. If we don’t teach a child the reasoning behind our directions, then how will they know how to make good choices when we are not there? 
My formula for giving directions
Give a 5-7 word command followed by a 5-7 word explanation to describe the “cause and effect” nature of the situation. That’s it. My directions are not up for debate. Who has time for that? If the child starts to argue, I just repeat my directions.
Examples of cause and effect directions and natural consequences 
Direction: "Wash your hands. I don't want you to get sick."
If a child refuses to wash his hands, then I won’t let him touch any of the fun equipment in the clinic to keep him/others safe from germs.
Direction: "Hold my hand in the parking lot, so you don’t get squished by a car."
What if the child refuses to hold my hand in the parking lot? Then I will help him “practice” by pacing back in forth in the parking lot, holding my hand. My #1 job in life is to keep children safe.  

Direction: "Wear your coat. You will feel cold outside without one." 
No coat? Then no playing outside. We can sit at the table and work inside, because again, it is my #1 job to keep kids safe. 

Keep it simple
Children can’t process a 5 minute discussion over every command. Their language skills are simply not that advanced. After the first few words, your voice simply turns into “wah wah wah” like the teacher in the Peanuts cartoons.  
Give "the look"  
What about the child that keeps asking why?  Well, you have given your direction. You have already answered “why”.  This is when I throw in "the look” and simply say, “I have given you my explanation." 

Eons ago one our own TEAM OT's, Cara Duran, and I were roommates during OT school. It is from her that I picked up a phrase that I use daily: “Life’s all about choices.” Sometimes we have two good choices like cake or ice cream. Sometimes we have two bad choices like tooth pain or a root canal. By teaching children about causes and effects, we empower them to make good choices even when confronted with challenging options. 
I love, love, LOVE having fun and playing with kiddos and I hope they think of me as fun adult who loves them to pieces. However, it is not my job to be their best friend. It is my job to teach them how to make good choices. I will not always be there to look over their shoulder and prompt them. At some point, I need to be able to trust them to make their own choices.

Your thoughts? Please share!

20 Things You Should Never Say To Your Child, Carla Field, WYFF News (2014)
The Explosive Child, Ross Greene (2014)
25 Ways to talk so children will listen, William Sears, (2013)

Monday, January 12, 2015

Picky Eaters

image: Evato
Dear Melissa,
My goal for the new year was to get my 4 year old to try new foods, but it isn't working!  It seems as if every meal time has turned into a battle for control and I think I am losing! Any ideas?

That sounds really frustrating! The good news is there are many, many tricks to help create more success at meal times. However, let me start by sharing my three basic tenets when dealing with children. As soon as you learn to let these go, the easier your life will be.  
  1. You can’t make them eat.
  2. You can’t make them sleep.
  3. You can’t make them potty. 
Given these tenets, a parent may think there is no hope. However, by finding ways to decrease battles for control, parents can have success tackling these traditionally challenging arenas of parenting. With the parents I work with I often share "The 5 Rules" to help decrease tension and battles over control at meal times. These rules create a black and white “contract” between you and your child. There is no room for negotiation. Both parties know exactly what to expect, are allowed to make their own choices, and have an element of control.* 
*Note: Talk to your physician and therapist before proceeding if your child is significantly underweight or has severe sensory aversions toward food. Severe sensory aversion is defined as having less than 20 “preferred foods” or having eliminated entire food groups.

1) Parents Choose "WHEN"
Parents decide when meals and snacks are scheduled. Ideally, a child will have 3 meals and 1-3 snacks depending on age, with snack frequency decreasing as a child ages. This allows 4-6 opportunities for good nutrition per day. However, “grazing” is NOT allowed.

2) Parents Choose "WHERE"

Parents decide where the child/family will eat. At the dinner table, in the car on the way to/from school, etc. However, taking a bite or 2 and walking away from the dinner table, coming back, walking away, coming back, is NOT allowed.

3) Parents Choose "WHAT"

Parents decide what will be placed on the plate, or what snack/meal will be packed. (Kids are required to allow the food to at least exist on the plate, even if they literally don’t even touch it).

4) Kids Choose "WHETHER"

Kids choose whether or not they will eat a certain food. It is OK if they only eat one type of food at a particular offering. You can offer a preferred food from a different food group at the next food offering. The key is to get a bit of variety of the course of day/week, not necessarily at a particular meal.

5) Kids Choose "HOW MUCH"

Kids choose how much of a particular food they will eat. Kids have the choice to eat more than one serving of a particular food without touching the other food(s). However, you do have the right to limit the number of servings at some point so as to not give 10 servings of bananas, because of course, that would cause a tummy ache.

Stick to your guns.
A child should not be allowed to throw a tantrum or whine in order to pick out whatever he wants from the pantry. Yes, this should be obvious, but this rule is routinely broken. Stick to your guns! You are the parent, you can do this!

Offer choices...but don't be a short order cook.
1) Meals should have 3 different items offered.
2) Snacks should have 1-2 different items offered.
3) Offer at least 1 preferred food and 1 non-preferred food per meal (unless you get to the point where your child eats so well that there is no need to offer non-preferred foods!).  
4) Do not cook spaghetti for the family and chicken nuggets for the “picky eater”. If the family wants spaghetti, the entire family gets spaghetti. You can modify it by not adding sauce for example, but everyone gets spaghetti. Just make sure that there is at least 1 preferred item on the “picky eater’s” plate, such as a banana, roll, etc... 

Plants are a must (french fries don't count...sorry!).
1) Every meal and most snacks should contain a plant. I always tell my children “pick a plant” and then give them 2-3 fruit/veggie items to choose from. Numerous studies have shown if you simply give children a choice of “plants” then they will be much more likely to actually eat them. This has created some weird combos in my house (Taco Bell with steamed broccoli, anyone?), but it has created an expectation that ALL meals contain real plants (french fries don’t count, sorry!). 
2) Do not worry so much about a child eating vegetables, as long as he is getting a wide variety of fruit. Keep offering the veggies as non-preferred foods and keep putting a bite or two of veggies on the plate. 

Don't worry...
1) If it feels like your child has “skipped” a meal, don't worry. In reality, he probably had a few bites of food and a cup of milk. That is a meal for a young child! 
2) It is OK for a child to choose to pass on a meal/snack. Again, as long as your child’s doctor is not concerned that your child is extremely under weight. Your child will likely make up for the missed calories at the next meal, or even the next day. 

Begin a food adventure
If your child does decide to eat a small portion of a new food, you can add additional incentives such as sticker charts or nickels to work toward rewards. You can also create a “food adventure guide” to help a child record his new food discoveries. 

Seek out extra help if... 
If you have tried the above techniques without success, you may need a more tailored approach to your child’s food aversions. Talk to your child's pediatrician and/or therapist if your child exhibits any of the following behaviors/symptoms: 
a) routinely skips several meals in a row,
b) appears to have severely controlling behaviors surrounding food,
c) expresses significant anxiety with new foods,
d) is losing weight,
e) routinely gags when trying new foods.

Who can help?

A certified Speech and/or Occupational Therapist with additional specialized training should be able to help. Many of Children's Therapy TEAM's therapists have had extensive training in helping families overcome food defensiveness. Many of our therapists have received Food Chaining Certification, considered a gold standard training in broadening a child's picky palate. 

Is your child a picky eater?  
What techniques have you used to help your child try new foods?  

Seven New Strategies for Feeding a Picky Eater, Evonne Lack,
Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child's Diet, Cheri Fraker, Mark Fishbein, Sibyl Cox, Larua Walbert (2007)
Busy Moms' Resolutions, Children's Therapy TEAM Blog (2014) 

Monday, January 5, 2015

W Sitting, a cause for concern?

Dear Melissa,
I just started noticing my 18-month-old daughter "W" sitting today. When is there cause for concern?

To address your question I have invited Shannon McIvor (PT, DPT), a member of our fantastic TEAM physical therapy department, to be a guest writer this week. She shared the following response to your question:

Don't worry...
If your daughter occasionally transitions through w-sitting when playing, then don't worry. It is not uncommon for kids to transition through w-sitting to achieve a new position. This posture may sometimes be used for stability and balance while playing. There are many positions of sitting that a child may use throughout the day. In addition to w-sitting, these may include ring sitting, sitting on heels in a low kneel, taylor sitting (criss-cross applesauce), long sitting with legs in front, side sitting, etc. 

It is a concern...
If you notice that w-sitting seems to be your child’s only means of sitting and she has great difficulty with other sitting positions, this should be brought to the attention of your pediatrician. If your child uses w-sitting more frequently than other positions, then she may simply need frequent cuing to change position.

If a child frequently w-sits, then...
She may be predisposed to hip dislocation and knee conditions later in life. Therefore, w-sitting should be discouraged in all children, but especially in children with diagnosed developmental delay, lower extremity orthopedic concerns, changes in muscle tone, or a diagnosed neurological condition.

Be proactive.
The easiest way to prevent this sitting posture, and any long-term problems that it may cause, is to not allow it to become a habit in the first place. This is particularly important when your child is first learning how to sit. Promoting other sitting positions and having your child practice various positions will enhance their trunk control and abdominal strength. 

Provide cues, again, again, and again.
For older children who have already turned to w-sitting as their “go-to” sitting position, persistent verbal cues of “fix your legs” will be a frequent phrase heard in the household, preschool, school, daycare, after-school care, etc. This may mean that the child starts with side-sitting, allowing one leg to still be behind the body, or pulling her legs closer together and turning her feet in to sit on her heels. Eventually she transitions to ring sitting or pretzel sitting (criss-cross applesauce) as a more proper means of floor sitting. Consistency and persistence from family members and caregivers throughout the day will eventually assist children into a sitting position that is better for their knees and hips. 

How a pediatric PT can help.
A pediatric PT can work with families to support the transition to healthier seating postures. They can work with a child directly to strengthen their hips and abdominals. This will assist in obtaining and maintaining other seated positions. PTs can also provide individualized guidance for families given the child's specific needs.

Helpful Resources
Zero to Three Development, National Center for Infants, Toddlers and Families (2014)
Does your child W-Sit?, Donna Greco, Physical Therapy and Rehab (1999)
What's Wrong with "W Sitting" in ChildrenJaime Ruffing, Early Intervention Support, (2014) 

Thank you Shannon for guest writing this week! 
Your expertise is greatly appreciated.

Please feel free to share your questions or comments at:

I love hearing from you!

Monday, December 29, 2014

Busy Moms' Resolutions

image: envato
Dear Melissa,
I admit that when my family gets busy, I tend to not feed my kids as well. I'm ready to start the New Year right. Do you have any tips?
You are not alone! I applaud you for taking the first step...being willing to change! This is a perfect time for the WHOLE family to work on goals to help promote health. When it comes to weight loss/gain, these topics should be discussed with your child’s pediatrician. However, the following are a few general strategies I use with my own kids to help prevent
 crankiness and promote health.

1) Eat 5 servings of fruits/vegetables every day. 
It seems as if everyone has an opinion as to what constitutes a “healthy diet”. Gluten free. Vegetarian. Mediterranean. Paleo. Low fat. Low carb. However, almost all dietitians agree that, in general, a mostly plant-based diet is best. We all know this; we need to just plan ahead and do it!
TIP: Keep a bowl of fruit and/or vegetables on the kitchen table for easy access and promote these items as snacks rather than “junk food.” 

2) Mix protein with complex carbohydrates at all snacks/meals.
This prevents blood sugar swings and either crankiness or hunger later.

TIP: Easy, quick options include peanut butter toast, apple with a cheese stick, milk with graham crackers, celery with peanut butter or cheese, trail mix with dried fruit/nuts, low fat yogurt with granola and/or fruit, whole grain cereal with milk, turkey sandwich on whole wheat bread, etc.

3) Choose drinks carefully. 
Be leery of sweet drinks. About 1 in 5 children consume excessive calories from soda, other sugar sweetened beverages, and fruit juice, with juice being the major contributor (Clinical Pediatrics). There is some debate about milk. The Choose My Plate national nutrition site from the Department of Agriculture recommends water or low-fat milk. However, recent literature suggests a possible reverse relationship between fat content and milk - children who drink 2% or whole milk actually have lower BMI than children who drink skim or 1%. 
TIP: Only drink water or milk. Avoid or significantly limit all forms of sugar-sweetened drinks/sodas/juices. 

4) Eat Breakfast. 
We have heard it a million times and it is true. Breakfast is the most important meal of the day! Make sure it is a healthy meal consisting of a complex carbohydrate and protein. NO SIMPLE SWEETS!
TIP: Steer clear of toaster pastries, muffins, sugary cereal, and donuts. Better ideas for quick breakfasts would include whole-grain cereal and milk, yogurt with granola/fruit, a cheese stick with a piece of fresh fruit, peanut butter toast, etc... 

5) Move your Body!
Yes, the weather is cold outside, but it is still important for the family to move together. Reduce the TV/video game time and MOVE! Numerous studies have shown that exercise can help mood, attention, cognitive function, and cardiovascular health. WALK places whenever you can.
TIP: Consider "imagining you are animals" (e.g., bear walking, crab walking, crawling like puppies), pillow fights, indoor obstacle courses, or moving-your-body video games. You can simply turn on some music and just dance! 

6) Picky Eater Woes? 
Prioritize reaching out to your child’s speech therapist, occupational therapist, or pediatrician for help.
TIP: For some children who are picker eaters it can help to offer several healthy options, but then give the child the autonomy to choose what he or she eats. Your goal is to achieve variety throughout the entire day, but not necessarily at every meal. 

What tips do you have for making your child healthier for 2015? Please share!
Nutrient Intake and Consumption of Fruits and Vegetables in Young ChildrenRamsay, EskelsenBranenShultz and PlumbInfant, Child, & Adolescent Nutrition, Volume 6, (December 2014).

Opportunities to Reduce Children’s Excessive Consumption of Calories From Beverages, Clinical Pediatrics, Rader, Mullen, Sterkel, Strunk, Garbutt, Volume 53, (October 2014).
Food and Nutrition Information Center, Beltsville, Maryland,
United States Department of Agriculture,

Monday, December 22, 2014

Skip Crawling? A TEAM PT offers a follow-up

credit: envato
Dear Melissa,
My 8-month-old baby girl is starting to pull up on furniture! I really think she is just going to skip crawling and move right on to walking!  

So, your baby is pulling up on furniture, but never really went through the crawling phase? My response to this question last week prompted some wonderful discussions with members of Children's Therapy TEAM's Physical Therapy Department. One of our veteran Physical Therapists, Christina Ruby, has shared a treasure trove of knowledge with me. Her advice is, "Do not panic!"

First, Christina set me straight on the definition of crawling: 
  • Crawling is when a baby is in locomotion with her tummy and legs on the ground while using her elbows and forearms to help push her body along. This is also commonly called “Army Crawling". 
  • Creeping is the formal term for when children are in locomotion with their hands and knees on the ground and their belly lifted off of the ground. 
Creeping is actually the movement pattern I am discussing here. From this point forward in this post, I will properly refer to the type of locomotion in question as “creeping”. Christina suggests that even if children appear to be skipping the creeping phase, they can still practice the skills gained from creeping. Parents can provide frequent opportunities for their child to pull up, get back down, move to another piece of furniture, then pull up there. All of this up and down from hands and knees (creeping position) to standing will provide practice with trunk strength and control. It also helps with coordinating the right and left sides of the body. And for my two cents, even if a child is pulling up, it is still not too late to practice creeping! 

As I noted last week, creeping helps with visual development, sensory input, strength and coordination of the entire arm, and later, handwriting skills (Skip crawling and walk...Is it a good idea?). These are all things that OT tends to focus on. But, creeping helps out with so much more! Christina has offered insight based on her expertise as a Pediatric PT.

Core Strength Development
When a baby creeps with her belly off of the ground, it forces her back and abdominal muscles to work together to provide a stable foundation for the arms and legs to move. This sets up the foundation for proper posture, trunk strength, and balance later in life.

Coordinate all four extremities in a reciprocal manner 
When creeping, each arm and each leg moves at it’s own pace in a coordinated manner.  This coordination of right and left sides of the body as well as the upper and lower halves of the body takes a lot of work! This ability to coordinate all four quadrants sets the child up for successful movement patterns as they age. 

Weight shift from right to left
As we walk, we shift our weight from the right foot to the left foot and back to the right.  Same with creeping: right, left, right, left. Creeping is an important developmental milestone needed for walking.

Coordinated hip/knee/ankle/foot movements 
It is almost impossible to walk with our hips, knees, and ankles in a fixed position. We need to move! Creeping provides that rhythmical coordination of the hip/knee/ankle/foot. Practice makes perfect! As a child practices typical creeping patterns, this sets her up for success for when she takes those coveted first steps.  

Trunk rotation 
As a baby creeps, she naturally creeps for a bit, then sits to rest and look around before taking off creeping again. Every time she transitions from the creeping position on her hands and knees, to sitting, and back to hands and knees, it involves trunk rotation. As she matures, this will allow the child to not only have better balance as she is walking, but also give her the ability to reach and move in all planes, not just in a straight forward and back motion. 

Who knew creeping could do all that? Wow! Thank you Christina for sharing.

As always, I would love to hear about your experiences. 
You can both share and submit questions to

Six Reasons Why Crawling Is Important, Joanna Bounds, Kids Spot
Effects of Sleep Position on Infant Motor Development, Davis, Moon, Sachs, Ottolini, American Academy of Pediatrics (1998)
Crawling, an OT's Perspective, Melissa Foster, Children's Therapy TEAM Blog (2014)
Tummy Time for Babies, Melissa Foster, Children's Therapy TEAM Blog (2014)
Downs Syndrome, The Importance of Crawling on the Stomach, Robert Doman, Ellen Doman, National Association for Child Development Volume 22, Number 12 (2009) 

Monday, December 15, 2014

Skip Crawling and Walk...Is it a good idea?

credit: envato images
Dear Melissa,
My 8-month-old baby girl is starting to pull up on furniture! I really think she is just going to skip crawling and move right on to walking!  

WAIT!!!  But crawling is so important!  Yes, I am thrilled with every developmental milestone of any kid at any age. Every child has their own developmental path. The time it will take for children to reach certain milestones will vary. And any time a parent is proud of their child is a reason to celebrate. 

But…crawling is SO important!  I remember when both of my children were in the 10-15 month range; I was constantly asked about walking: “Is he walking yet, is he walking yet?”  As a mama with a background in child development, I don’t know how many times I felt my blood pressure rise and the need to bite my tongue, rather than get on my soap box on the importance of crawling.  “No, my 10-month-old child is NOT walking yet!  And that’s fantastic, because do you have ANY idea how important crawling is? (insert my rolling my eyes here!)”

So, here is my soapbox rant on the importance of crawling. In 1994, the American Academy of Pediatrics began their “back to sleep” campaign. SIDS fell by 50%, but numerous studies show that since that time, kids are slower to meet gross motor developmental milestones.Then they added “Back to sleep, prone to play”, but many parents were already so terrified of putting babies on their tummies, that the message did not really hit home. And, it seems like society is so focused on that monumental milestone of when a baby takes her first steps, that we have forgotten the importance of crawling, rolling, dynamic sitting, etc. 

Babies who go through the crawling phase will later develop better eye-hand coordination when it comes to handwriting, sports, playing a musical instrument, etc. There is even a link between a lack of crawling and ADHD (but the verdict is still out on which may cause the other, you know…kind of like the chicken and the egg). I see this in my own practice. When a parent brings a child to me for handwriting help, one of the first questions I ask is “Did he crawl as a baby?”  More often than not, the answer is “No, but he was walking by 11 months!”

Why is crawling so important?
It strengthens the whole upper extremity.  
In laymen’s terms this means the whole shoulder, arm, and hand, down to the finger tips.  Even better, when a baby crawls while holding an object (think a toy car, rattle, etc) this strengthens all of the tiny intrinsic muscles of the hand, which are so vital for handwriting skills later on. 

It improves eye-hand coordination.  
When crawling, a baby often looks toward the object as she is crawling to it, or looks to the object, then to her hands, then to the object. This switching back and forth between near/far vision helps develop a child’s eye hand coordination and visual perception skills. When do we see this in big kids? Looking at the classroom board, then looking at the paper on the desk, and back again. Same thing. Babies who crawled have an advantage when it comes to having the eye hand coordination needed in school settings later on. 

Improves coordination of the right and left sides of the body.  
Walking primarily involves the weight shift of the right and left sides of the lower body. This is especially true when a baby is walking using push toys. In crawling, FOUR different sections of the body must all work together in unison. Right arm, left arm, right leg, left leg…it's very complicated to get all 4 areas working together in a rhythmic pattern. As a therapist, it definitely sets off red flags when a child consistently uses atypical movement patterns as a primary means for locomotion. An example of an atypical pattern is when a child sits and scoots on her bottom using one hand on the ground for support. Another example is when a child “crawls” but the legs don’t take turns moving in a back and forth pattern. Rather, they move forward together in a singular motion similar to a “bunny hop”. 

Improves sensory development.  
As a child crawls with her hands open she naturally will encounter many different textures on her hands. Smooth, cold tile. Fuzzy carpet. Big brother’s prickly bristle block that was left on the floor. You get the idea. Again, it is hard to know which one came first, but it is common for children who skip crawling to later have tactile sensory defensiveness, especially on their hands, such as resisting nail grooming, hand washing, finger paint, sand play, lotion, etc.  

Worried your baby may skip crawling 
and move straight to walking? 
Here are my top four tips:
1) Get on the floor with your baby!  
She may not want to be on the floor by herself. Get down on the floor and play with your baby. At times, model crawling yourself. 

2) Try to gently put your child on her hands and knees.  
Again, model this together. Siblings present? Make it a family affair! You can even put her on her tummy over a Boppy pillow for support if her arms/legs are not quite strong enough to support her yet. 

3) Make it a fun environment.  
Make sure that there is an open space for crawling. When next to furniture the child will tend to pull herself up and walk while holding on. Provide toys on the floor and spread them out to promote crawling from one toy to the next.
4) Practice, practice, practice.  
If your baby has started to crawl in the past few days, but she looks like she may want to take off walking already, get as much crawling in as you can. This was the situation with my daughter, and we would pretend to be puppies (barking and all!) as we crawled the full length of the house, from one room to the other. Has your baby already started to prefer walking? No worries! You can still encourage additional crawling practice through crawling under chairs, under the coffee table, through tunnels,’s always fun to pretend to be puppies/kitties!

Did your child crawl or not?  
Do you think it affected later gross or fine motor development? 
I would love to hear your thoughts!

You can send your ideas and questions to

Whats So Important About CrawlingMedCentral Health System  

Crawling and Creeping: A Milestone that should never be Missed, Center for Development Pediatric Therapies
Parenting: Do Babies need to Crawl?, Dina Roth Port, Parenting 

Tummy Time for Babies, Melissa Foster, Children's Therapy TEAM Blog 

Early infant crawling experience is reflected in later motor skill development, McEwan, Dihoff and Brozvic, (1991), Perceptual and Motor Skills