Pediatric physiotherapy is part of many families parenting journey with their children at different ages and stages. This blog will cover some frequently asked questions many families have regarding physical development, baby gear, sleep + gross motor milestones, toileting and more.

My daughter and I have accessed various services at Mulberry Wellness and are thankful for the compassionate, professional care we’ve received over the years. If you are looking for a multidisciplinary clinic in Hamilton, be sure to check them out!

Meet Carrie – Pediatric Physiotherapist

Hello! I’m Carrie, a pediatric physiotherapist, mom to a beautiful 18-month-old daughter, pet lover, outdoor addict, and the owner of Mulberry Wellness. I was born and raised in Nova Scotia, where my mom homeschooled my four brothers and I and I then did my undergrad in Kinesiology. I came to Ontario to complete a Masters of Physiotherapy at the University of Western Ontario. Upon graduation, I worked in research (co-author on the Canadian Physical Activity Guidelines for the Early Years, The Canadian Sedentary Behaviour Guidelines for the Early Years and a bunch of other publications), physiotherapy home care, rehabilitation and clinical environments and spent time at an orphanage in Mexico providing treatment and education to kids and staff. In 2019 I opened Mulberry Wellness with the dream of a place that would provide one-to-one, quality, caring treatment for the whole family in a friendly, welcoming space. I might be a little biased, but I’ve been blessed to have had such wonderful people – patients and practitioners – walk through the doors and I’m pretty thrilled with how it turned out!

Why did you decide to become a Physiotherapist?

I grew up in a very active, sports and activity-oriented home. Whatever my brothers did I had to try, so movement and activity has always been a big part of my life. I’ve also always loved working with kids so I decided I wanted to be a gym teacher, leading me to do my undergrad degree in kinesiology. I quickly found that teaching might not be for me, and as I progressed through my degree, I found I was really drawn to caring/helping professions. After a knee injury and lots of rehab, I realized that physio might be a good fit for me, largely because I didn’t quite know what else I wanted to do. When I started, I wanted to work with sports teams and athletes, or so I thought. Then I did a pediatrics elective and realized that was where my passion lay. After physio school, I started a PhD in childhood exercise medicine, which is what brought me to Hamilton. About six months into the program, I realized how much I missed patient interaction and decided I really did prefer clinical work and patient interaction over research. Thirteen years later, here I am…!

What are some goals you’ve helped families achieve in your professional practice?

• All family’s goals are so different, and the excitement and sense of accomplishment of reaching a goal are always so rewarding, no matter if it’s a first step in a little one who had a hard time getting there, rolling over, ‘catching up’ on motor milestones, or just reassurance that its ‘yup, that’s normal’. I love to set small goals in each session as fostering confidence in motor skills and self is a big part of what we do! 
• I think another huge part of my role as a pediatric physiotherapist is promoting optimal development by assisting parents to understand the role they play in this development. I really love it when families come in early – just a few tips and a little bit of education can really foster strong motor development and can even prevent some common issues we might see down the road. So, I love seeing ‘my’ babies come back at 1, 2, 3 years old for a check in and be doing so well!

How has your motherhood experience changed your professional practice?

Well, it’s been humbling, that’s for sure. I worked in pediatrics for about ten years before I became a mom and there is NOTHING that has impacted my practice more or opened my eyes more to the challenges, worries and anxiety, the mom (and dad) intuition, the pride and joy with every accomplishment, the lack of time for anything and all the grey areas I was so black and white on before. 

In addition, my daughter was diagnosed with hip dysplasia and was in a brace for nearly five months while we worked with an orthopaedic surgeon, physio and osteo (shoutout to Mansi, Kaitlyn and Megan!) and waited to see what the next steps would be. Experiencing that from the other side has definitely changed the way I think, practice, navigate our healthcare system and communicate with parents. You really don’t know until you know!

What is your professional opinion on “containers” (e.g., bumbo seats, exersaucers, jolly jumpers, etc.) and how can they impact physical development for a baby? Are there any guidelines you’d suggest when using these items (e.g., time limitations, etc.)?

Well, I’d have to say I’m not a fan of most, and I’ll expand on my feelings and guidelines below. But first let’s talk about why most of us physios don’t like containers. Containers hinder normal movement and motor development. They also tend to place little ones in a completely supported or unnatural position where they cannot or are discouraged to properly move or strengthen their trunk muscles.  Also, when we place little ones in containers that put them in positions they are not developmentally ready for, they often can’t independently create the motor plans independently for the transitions they need to reach those positions. Other consequences I see are poor core strength and tolerance for “tummy time,” leading to plagiocephaly (flat spots on baby’s heads) and delays in motor milestones (rolling, crawling, walking). 

So back to my opinion. This is a great example of the question above. Prior to my daughter, I would have said something along the lines of ‘no, never, ever’. Now, while I still don’t like containers, my view is a little more tempered – now I say ‘use some containers sparingly. Obviously, some are important and necessary, like a car seat, and a safe chair for meals. The containers I have or had in my home are a carseat, a highchair and a rock-n-play in the bathroom. We all need to be able to cook dinner, clear our heads and maybe even use the bathroom now and then. In those instances, a container such as an infant swing where you can set your babe down safely can be a lifesaver and I don’t think there is anything detrimental to using some containers for those short periods.  For longer periods I think there are better alternatives – for instance a playpen, babywearing, etc. Regardless of what you use, I think it’s very important to be educated about them prior to deciding if you’ll use them.

A few important notes if you are using a container with your baby: 

• Newborns don’t have head and neck control, so any container should offer good support for their head and neck
• In any container, it’s important to be aware of hip, pelvis, and spine positioning
• A child should be developmentally ready for a container. E.g., A child needs head and neck control and core strength before using a stander
• One big no for me is a Jolly Jumper – It’s not good for little’s hip development and many other reasons such as jumping is a skill that usually occurs around 20 months of age. A six-month-old doesn’t need to jump. Ditto on Bumbo – check out a Bobby-style pillow or the Upseat instead!

What is your professional opinion on restricted sleep items (e.g., SNOO) and on weighted sleep sacks (e.g., nested bean, merlin suit, etc.) with regards to baby’s physical development and positioning?

• I know the feeling of just wanting something, anything to make your baby sleep just a little longer – I tried a bassinet, a different bassinet, and then a side sleeper before conceding it was not just the sleep space that was going to change sleep. But a Snoo is not something that I would recommend, for several reasons. Just like the question above, I don’t like things that restrict or alter babies’ natural movement and sensory/vestibular development. In my opinion and experience, the Snoo can inhibit trunk strength and control, vestibular system development and may increase the risk of plagiocephaly (flat areas on the head) and retained reflexes.  
• Regarding weighted sleep sacks, I’m going to be really unpopular as I’m going to say no again, that’s not something I would recommend, and for some of the same reasons as above. Weighted sleepsuits also restrict normal movement patterns and sensory processing and can also affect reflex integration, head shape, and motor development. I think there are some better options!

If a baby requires boots/bars/spica cast, how may these devices impact their baby’s sleep? Are there any limitations to sleep support that must be considered if a baby was using one of these devices?

So this is one that hits home for me and I’ll tell you straight up, this will be a mix of my personal and professional experience as my daughter was in a brace, and it did make sleep challenging. 

As a pediatric physio, we tell parents a few things.

1. That they should be using positioning (wedges, etc.) to make sure Baby is as comfortable as possible

2. Some families may be told by their supervising physician to wake Baby every X hours to check the cast is dry – use this time to check and also to change their position

3. We need to remember that a restrictive device will reduce free movement – even in a newborn – and this can impact sleeping and

4. Kiddos often adapt surprisingly well and return to their previous sleep habits. 

As a mom of a kiddo with a brace, knowing the above and having spoken to many moms working through the same, what I see most often is a return to close to the previous sleep pattern. This is great if you had a good sleeper before the brace and tough if you did not. In my case, I did not. I thought about doing ‘sleep training’ and reaching out for support but always felt so guilty, that she may be crying because she was uncomfortable, or scared of not being able to roll, etc. So I figured I would wait and when we were finished with the brace things would be better. Then the brace came off and there was no magical sleep change. In fact, NOTHING changed. If I could do it over again, and what I recommend now to other parents in the same situation, is to reach out for support the second I knew the brace was needed or before if at all possible. Making sure that the sleep coach I was working with had a gentle approach that would take into account the extra layer (for both parent and babe) that the brace, cast, etc. brings. Someone like Chelsea.

If a baby wasn’t rolling over by 6 months, should a family seek consultation?

While every little one is on their own timeline and there is a range of ‘normal’ within all motor milestones, if your little one is not rolling or has stopped rolling over at six months then a check in is a good idea. We need to remember that, even though we talk about the dos and don’ts above with containers and sleep items, just because your little one is not sitting or rolling or crawling when so and so did, does not mean there is something wrong with your child or that you did anything wrong.

There are so many variables, and we are all unique. An appointment may go something like ‘we’re seeing progress, all is good, here are some tips to help progress to rolling’ or it may help us pick out some things we need to work on to achieve rolling and subsequent motor milestones as they all build on each other!

What are some common developmental milestones a family could expect for their 12 month old?

Again, we remember that all kiddos are on different timelines and we’re looking for progression through skills in a fairly specific order. However, by twelve months we should be seeing or starting to see most of the following: 

• Crawling 
• Pulling to stand and standing without support (flat feet)
• Transitioning in and out of sitting well
• Getting to hands-and-knees position independently
• Performing squat to stand 
• Cruising both directions  
• Crawling up and (beginning) downstairs
• Beginning to take steps with no or minimal assistance

How can a physical developmental milestone (e.g., rolling, standing, etc.) impact a child’s sleep? What would be your recommendation to support this phase (e.g., daytime practice, etc.)?

I often hear from parents who are really excited about a new skill progression and then the next time I see them they are a little less excited and a lot more tired. A new skill is exciting! For us as parents but also for our kiddos and it’s hard to turn that and the desire to master that new skill off at sleep time. We see this most often with rolling, pulling up, crawling, and walking.  Sleep regression/skill progression blog here for common fussier phases! 

You’re right on – the best thing to do to work through sleep disturbance, from a PT perspective, is to provide plenty of time during the day to move freely and practice motor skills – the more time they can be on the ground in a safe space, moving and playing, the better! The second is to practice the specific skill with them in a fun manner – we call this purposeful play. There are lots of ways to encourage an emerging skill and practice with your kiddo – a pediatric PT can give you some ideas. Practicing and working on the skill serves a few purposes – the first is that it tires them out! Second, the sooner the skill is mastered the sooner it becomes less exciting and, third, it helps with the ‘practice quota’ some little ones seem to want to finish up at night.

For a family working on toileting skills, do you have any recommendations from a physio perspective that could support their journey? Potty vs regular toilet? Foot support?

Absolutely. As we all know, posture and comfort play a big role in a successful and comfortable toilet experience for all of us! A few guidelines to help with both and help the pelvic floor relax (the pelvic floor is a group of muscles that control bowel and bladder function):

• Sit with feet well supported and flat (no tippy toes!)
• Knees higher than hips, and
• Knees out to the side (open)

A regular toilet is made for an adult, so it does not support this posture for a little one. An insert (with a foot stool) or a potty on the floor can. From a posture and comfort standpoint, I prefer the floor potty. Also encourage your child to sit on the toilet or potty with their back straight and slightly leaning forward to further support optimal posture and relaxation. Have them sing a song or blow bubbles to help with the coordination of breathing, pressures, and their pelvic floor.

What’s one thing you would like to tell parents regarding setting their kids up for success with gross motor milestones?

Set them free!!! We learn and develop through movement, through trial and error, success and failure. We now live in a world of containers and screens that can limit or alter movement and free play for our little ones. There is often less outdoor time and floor play, and with a strong desire to protect our kiddos (and rightfully so) we can unintentionally limit their chance to develop strength, movement patterns and movement confidence. So, set them down and let them play and move and figure things out! Get them outside. Don’t be afraid to let them figure it out, and sometimes fail or fall (safely) and learn from that. Give them safe spaces for free play and movement challenges to work through and conquer!

You get a day off from work and mom life. How do you spend it?

Ohh, so many options. First, I’d finish a full cup of piping hot coffee in one sitting. Ok, two cups. After sleeping in – to noon. Then I’d go for a trail run or hike with my dogs as long as I want, maybe do some wineries with friends and then a sports game or dinner with hubby, followed by collapsing on the couch and staying up way too late.

If a family wants to connect with you and your clinic, how can they do that?

We’d love to hear from you! You can: 

• Call us – 905-529-8800
• Email – me: carrie@mulberrywellness.ca or Mulberry: info@mulberrywellness.ca or
• Visit our website – www.mulberrywellness.ca 

 

Wishing you a supported parenting journey,

Chelsea and Carrie

 

Chelsea is Mom of 2 and a Certified Baby, Toddler and Child Sleep Consultant with advanced certification in Infant and Early Mental Health and Pediatric Sleep Health. She supports families within Hamilton and beyond with hands-on, no cry-it-out, responsive methods. She has a Master’s of Professional Education (specialization in Applied Behaviour Analysis) and over 10 years of professional experience supporting families in the community. Chelsea works collaboratively with families to empower them with the confidence and tools they need to reach their unique sleep goals. Hear from rested families here and book a free call with Chelsea here to discuss how she can support your family’s journey to more sleep.