Baby-Led Weaning A Developmental Perspective

Baby-led weaning.  Every parent has experienced the scenario. Seated comfortably at dinner with their six-month old baby in his high chair, a mother and father look over to see the face of an infant who wants nothing to do with his puréed carrots. He wants only one thing: their grilled chicken and steamed green beans. So, what’s a parent to do? The infant is at an age when pediatricians say that parents can start to offer smooth, blended (puréed) foods as a way to introduce different flavors. Yet some parents feel that, if their infant shows interest in solid foods, he or she must be ready for those foods.

baby-led weaning

Does your baby show interest in a new food?

Baby-led weaning (BLW) is an infant-driven feeding approach in which the parent offers the infant any food in which he or she shows interest. This could include, but is certainly not limited to, raw apples, french fries, potato chips, fish sticks, pieces of grilled chicken, and carrot sticks. Many parents report success with BLW, though studies have demonstrated an increased risk of choking using this approach. But why?

 

Each parent has to decide what works best for their child. (Parenting seems to be an endless series of decisions, does it not?) As with all decisions in parenting – bottle vs. breast, pacifier vs. no pacifier, co-sleeping vs. separate crib, Baby- Led Weaning vs. progressive textures – it’s important to have the facts. Once we have the facts, we as parents can make educated decisions about what’s best for our family and our little ones.

When deciding if BLW is right for your infant, there are many points about normal development that are important to consider. A large number of developmental factors play a role in an infant’s feeding progression. These include: vision (the infant’s ability to see the food), sensory input (the infant’s ability to distinguish different colors, tastes, smells, and textures of various foods), trunk control (the infant’s ability to sit up and support himself, promoting a safe, upright position for eating solid foods), and fine motor skills (the infant’s ability to hold a piece of food in his hand and bring it to his mouth).

While  all of these are important, some of the most critical developmental milestones to be aware of when considering BLW are those associated with the progression of oral motor functions. In order to safely chew and swallow foods, a person’s oral motor skills must be refined about to be able to 1) keep the food in his mouth, 2) move the food forward and backward, as well as side to side using his tongue, 3) chew the foods in a rotary pattern (this is a circular chewing pattern, like a cow chewing cud, not just munching or smashing the foods against the roof of the mouth), and 4) be able to purposely move the food backward in the mouth using the tongue.

Below are the milestones related to oral motor development that are important for readiness for solid foods (not just liquids or purées):

  • 0-4 months: During this time, infants continue to develop reflexes that protect their airway and prevent choking. They are able to coordinate two to three sucks from a nipple or bottle prior to swallowing, and respond with consistency to stimulation provided around the mouth (for example, a pacifier or toys).
  • 4-6 months: Infants continue to develop the ability to move liquid and watery purees backward in the mouth with their tongues, though these textures continue to move backward primarily through pressure within the mouth when the lips are closed. The tongue begins to move items back and forth (but not yet from side to side, which is important for being able to effectively chew.) Around six months, a primitive “munching” pattern may begin to emerge. This marks the first step toward a rotary chewing pattern.
  • 6-9 months: This is when developmentally mature movement of a bite of food from side to side in the mouth occurs. Infants are able to transition slightly more textured foods forward and backward, side to side in the mouth, and demonstrate emerging ability to chew these foods. Infants continue to move food to the back of the throat to swallow primarily via pressure within the mouth, rather than coordinated tongue movement. The primitive munch continues to be refined.
  • 10-12 months: Infants develop the ability to lick food off their lips effectively. Biting becomes more isolated, which is important in development of rotary chewing. Rotary chewing begins to emerge toward the end of this timeframe, but continues to be refined from 12-24 months. By this age, infants demonstrate the ability to move foods from side to side in their mouths without difficulty.
  • 14-16 months: Infants are able to chew and move firmer and more textured bites of the food throughout the mouth. By this age, they are able to reliably keep a bite of food in the mouth (hooray for no more bibs!)

All of these abilities (containment of a bite in the mouth, moving a bite forward and backward, moving a bite side to side, rotary chewing, active rather than passive movement of a bite backward to swallow) should be present for chewing and swallowing of solid foods to be considered safe.

You know your baby best. You are also in the best position to make the safest choice based on his or her abilities and whether BLW is right for your infant. If you have any questions, consult with your trusted medical provider.

Lauren Most, CCC-SLP, is a speech-language pathologist for Tx:Team partnered with Frederick Regional Health System. She received her Bachelor’s degree in speech-language pathology from Loyola University in Maryland, and her Master’s degree from the University of Maryland, College Park. Her work includes providing services to infants and toddlers in the neonatal intensive care unit and the community who have difficulty with feeding and/or swallowing.

Tx:Team partners with Canvas: our next hire is only a text away

recruiting

Changing the Landscape of Recruiting

Indianapolis, IN: The recruiting process has now been tailored to today’s candidate with the introduction by text.  Tx:Team, has partnered with Canvas, the world’s first text-based interviewing platform,  to be the first rehabilitation company to use this unique texting service in the hiring process.

 

What does the partnership bring to Tx:Team Recruiting?

The Tx:Team recruiting process has always been personal. But now, with the addition of the Canvas platform, candidates will be able to have conversations with Tx:Team recruiters at their convenience. With estimates of 50 million millennials to be hired between now and 2025, the hiring process must evolve to attract this texting generation. Starting the conversation through text not only adds a personal touch for the candidate, but it also allows the recruiter to engage and screen candidates much earlier in the recruitment cycle than ever before.

 

As therapists, our passion, is delivering healthcare, and we provide rewarding, stable careers for skilled therapists. At the very the heart of our success are the committed, caring clinicians changing the lives of patients every day at our Tx:Team clinics. As our name suggests, we build teams that work together to deliver the highest standard of healthcare. The concept of working as a team, and helping and caring for each other, is the essence of Tx:Team.

 

We believe that to create the strongest teams, it’s critical that we attract the right talent and find the perfect place for them to grow their skills. With the partnership of Tx:Team and Canvas, we believe those rehab teams are just a text away.

 

About Tx:Team

Tx:Team is a national physical, occupational, and speech therapy company that partners with healthcare facilities or at an employer’s health clinic, providing a complete, integrated therapy solution. We supply talented clinicians and support staff, and we manage the delivery of their services. We do this efficiently, economically, and effectively. Our model offers exceptional benefits to our clients, our patients, and the dedicated therapists and staff who are at the very heart of Tx:Team.  Follow Tx:Team on Facebook, Twitter, and LinkedIn. #txteamrehab

To see all positions available with Tx:Team, visit Careers.

Avoiding Sports Specialization to Preserve our Young Athletes’ Health

Nicholas, Harbaugh, PTA

Sports Specialization has led to a trend over the past couple of years involving our young athletes: the increase in cases of injuries ranging from simple overuse to breaks and/or sprains. This increase in rate and number of injuries seen in young athletes, according to multiple studies, can be linked to the increase of sport specialization in children.  Sport specialization is defined as “year-round intensive training in a single sport at the exclusion of other sports.”

Sport specialization has been associated with high volume training that can result is psychological and physiological stress in an athlete. This stress has been linked to an increased rate of burnout in athletes, as well as recurring and overuse injuries in multiple studies. Overuse injuries otherwise known as cumulative trauma disorders, are described as tissue damage that is a result from repetitive demand over the course of time. The term refers to a vast array of diagnoses: occupational, recreational, and habitual activities. Along with these studies the American Academy of Pediatrics (AAP) have released statements on their position against sport specialization to prevent these problems from arising.

sports specialization

Children were not always encouraged to specialize in a sport. A factor that may have contributed to this cultural change may be in part due to the increased pressure that coaches and parents place on their children to perform at a higher level to attain a collegiate scholarship or professional contract. In 1993, Ericsson and colleagues proposed a statement that in order for a musician to achieve mastery/expertise in that area you must practice for 10,000 hours. Parents and coaches have adopted this rule and applied it to sports to justify year-round intensive training. Many have adopted and applied this rule to athletes without realizing this was made primarily for musicians. These are high, sometimes costly, expectations for an athlete who performs repetitive, rigorous, sometimes high velocity movements and techniques year round without adequate rest time.

Some people ask “But doesn’t focusing on a sport make our youth excel at that particular sport?” Studies have shown that is not necessarily the case. Some studies have even shown that most multisport athletes (participating in 2-3 sports) show more promise to excel in a sport than a specialized athlete due to an increased overall athleticism and better gross motor function. Many professional and collegiate athletes were multisport athletes.

Examine the Ohio State varsity recruitment habits of coach Urban Myers as they depict a preference for the

young athlete

There have been statements from multiple coaches, along with Urban Meyer’s graph, pertaining to their preference of multisport athletes for example

multisport athlete.  According to Pete Carroll former USC and current Seattle Seahawks coach: “The first questions I’ll ask kids are; “What other sports does he play? Does he play ball? All of those things are important to me. I hate that kids don’t play 3 sports in high school…. I really don’t favor kids having to specialize in one sport.” Dan Starsia University of Virginia men’s lacrosse coach and Tim Corbin of Vanderbilt Baseball both concur with Carroll.

 

If this is the thought process of elite coaches, why, as parents, is ours so different? If the athletes goal is to play in college or to try and make it to a professional level, they need to have an all-around athleticism as most elite athletes do.

Examples of multisport athletes are:

  • Michael Jordan- Basketball and Baseball
  • Abby Wambach- Soccer and Basketball
  • Terry Bradshaw- Football and Baseball
  • Amy Rodriguez- Soccer, Swim, Softball, and Track
  • Tom Brady- Football and Baseball
  • Lauren Holiday- Soccer, Track, and Basketball
  • Babe Zaharias- Track and Field, Golf, Basketball, Tennis, Swimming and Volleyball
  • Wilt Chamberlain- basketball, volleyball and track

With many elite athletes being multisport, we need to get away from the thought process that sport specialization will make our children elite. In fact, sport specialization may be the reason a child does not get to that elite level. With burnout and overuse, reoccurring, and surgery required injuries, specializing in one specific sport may actually do more harm.

Year round training through a child’s growth spurt period places an increased work load on lengthening muscles and developing joints. During a growth spurt, performing consistent intensive training throughout the year will increase the stress that is placed on muscle attachments and the coinciding joints. This increased work load causes an increased risk of joint and ligamentous damage and injury. The more repetitive the motion…the more risk for overuse injuries.

Common overuse injuries associated with sport specialization are as follows with patellofemoral (knee) pain being the most prominent:

  • Osgood-schlatter disease
  • Sever’s disease
  • Medial epicondyle apophysitis
  • Distal radial physeal stress syndrome
  • Proximal humeral physiolysis
  • Stress fracture (e.g. spondylolysis)

A common overuse injury seen in pitchers, for example, is ulnar collateral ligament damage which can lead to having Tommy John surgery. This is the reason why we have pitch counts to limit the amount of stress placed on the elbow joint and the associated ligaments.

To allow proper rest time for the young athlete in organized sports, the AAP recommends

  • that children play multiple sports (2-3)
  • play no more than 8 months a year
  • play no more hours per week than the child’s age (13 year old =13 hours) with a maximum of 16 hours per week total.

You may ask: “What do I if my child is specializing in a sport or gets injured in that sport?” The first thing to do if a child is injured is to get them examined by an orthopedist or physician. Depending on the findings, the next step would be starting a physical therapy plan to address the injury and to examine the mechanics of the athlete and their sport. The physical therapist will help evaluate each athlete’s situation on an individual basis and help to prevent any further injury or re-injury.

If an athlete does not suffer from an injury requiring immediate attention, it is recommended that he or she see a physical therapist to examine their movement patterns and form as well to prevent an injury from occurring and needing any further treatment. Before an athlete gets to that point though, the change must start at home with parents and coaches encouraging children to participate in multiple sports as well as decreasing the amount of pressure to play. After all, the main purpose of participating in sports is for overall physical activity and health and most importantly, fun, and enjoyment!

Talk to your children about their goals and encourage them to participate in more than one sport. Once you know their goals, you will know what they want to achieve! Encouraging diversity in sports can help to decrease the occurrence of overuse injuries.

Nicholas Harbaugh is a Physical Therapist Assistant at FMH Rehabilitation Aspen Ridge Outpatient Clinic.  Nick is experienced in treating orthopedic and sports-related injuries with  traditional land therapy techniques as well as aquatic therapy.

Exercise During Pregnancy

Amelia Iams, DPT

aquatic exercise during pregnancy

Exercise is important to include in everyone’s daily life, but it becomes even more important when you are pregnant. Pregnancy causes many changes in a woman’s body.  Hormone changes in the body cause softening of the ligaments, joint laxity, and instability in the ankles.  Hormones and anxiety can be the reason for increased mood swings.  Changes in the center of gravity due to a growing belly can cause increased occurrence of back pain.  Increased retention of fluid in the body causes swelling in both the hands and feet and can amplify complaints of constipation.

Exercise during pregnancy provides similar benefits to your body as it does during other times in your life, but it also can prevent and minimize changes in the body and pain or discomfort that occurs when you are pregnant. Some of the proven benefits that exercise during pregnancy includes are:

  • Avoidance of excessive weight gain
  • Maintenance or improvement in endurance, muscle strength, and flexibility
  • Reduction of the likelihood of gestational diabetes
  • Decrease or reduction in symptoms of low back pain or pelvic girdle pain
  • Reduction in occurrence of preeclampsia
  • Decrease in the risk of cesarean delivery
  • Reduction in psychological stress

The American College of Obstetricians and Gynecologists (ACOG) states “for healthy pregnant and postpartum women, the guidelines recommend at least 150 minutes per week of moderate-intensity aerobic activity (ie, equivalent to brisk walking). This activity should be spread throughout the week and adjusted as medically indicated.”  That is equal to about 30 minutes 5 times a week of moderate exercise.  Research also indicates that including both strengthening and aerobic exercise to your routine is important to help support the changes that occur in your body with pregnancy.

Despite all the benefits to exercising while pregnant, most women do not begin an exercise program and those who were exercising prior to pregnancy actually decrease their activity during pregnancy.   Through several studies and surveys, women have stated various reasons for decreasing their activity during pregnancy.  The two most common reasons are: not enough time and pain with movement associated with the pregnancy.

Choosing an exercise program that is safe, can be maintained during the entire 40 weeks of pregnancy, and can fit into a busy work and family schedule is a difficult task.   It is recommended that pregnant women avoid high contact sports and activities that have an increased risk for falls or impact, such as soccer, basketball, hockey, snow skiing, water skiing, and off road cycling.  Exercises that require jumping and quick changes in directions, such as Zumba, Cross fit, and trail running, are not recommended due to joint instability brought on by hormones.  Also high impact aerobics can be difficult to and uncomfortable to perform later in pregnancy.

An underutilized exercise avenue is aquatic exercise programs. Several research studies have advocated the use of pool exercises for women who are pregnant.  The natural properties of water help alleviate many of the adverse changes associated with pregnancy.  The buoyancy of the water will help to eliminate the stresses on the joints and to support the abdomen.  Women have reported feeling more comfortable moving in the water and able to assume better postures as a result of the additional support.  Hydrostatic pressure is an additional benefit when exercising in the water.  The pressure that the water exerts on the body helps to decrease the swelling in the limbs brought on by pregnancy.

Aquatic exercise is non-weight bearing and low impact, so stress on the joints is minimized. Water provides natural resistance to movement which helps to strengthen muscles and thereby incorporating both strengthening and aerobic exercise into one session.  This can help you meet both suggestions for a healthy body during pregnancy without increasing the time you spend at the gym.  Many women stop exercising as their pregnancy progresses because of decreased balance, increased swelling in their feet, or pain and discomfort in their back.  The water helps to support the body, and it is not likely that you will be injured falling in the water. Several studies have proven that exercising in the water during pregnancy helps to decrease low back pain and reduce time off from work due to pain and discomfort.  There are many benefits to exercising in the pool that cannot be achieved with land based exercise, therefore making it an excellent option for women during pregnancy.

There are many fitness centers as well as physical therapy centers that offer aerobic exercise classes in a pool and individualized pool exercise sessions. Choosing the right one for you should be based on several factors, such as cost, location, available time, and expertise of the instructor.  In some cases aquatic therapy can be covered through your health insurance when provided by a physical therapist.  A physical therapist can help design an exercise program that is individualized to you.  Other options to consider when choosing a pool are temperature of the water, depth of the water, and air temperature of the pool area.  Exercising in the water decreases your ability to sweat but there is increased loss of heat through skin contact with both the water in the pool and the air temperature difference in the pool room.  It is recommended that pools utilized for aerobic exercise for pregnant individuals be at about 80-86 degrees Fahrenheit.  Most pools at a gym are cooler to allow for longer time and more intense exercise while therapeutic pools at rehabilitation clinics will be warmer and offer increased comfort for those suffering from back pain.

Safety and monitoring your exercise regimen in the pool is important. The properties of water will naturally decrease the heart rate by increasing the volume the heart pumps out.  If you use your heart rate to gauge your exercise, it is suggested that you decrease your heart rate guidelines by 15 beats per minute.  When exercising in a pool is better to gauge your exercise intensity by using a scale called Borg Rating of Perceived Exertion.  A physical therapist can provide you with the scale and educate you on how to use it.  Dehydration with exercise can occur in the pool as easily as it can on land.  Having access to water during exercise can be important to avoiding any complications with exercise.

All exercise programs are most effective when you can choose an activity they enjoy and a program that is individualized to your needs and goals. We highly recommend water aerobics or any aquatic exercise for women during pregnancy. Aquatic exercise is an exercise program that women would be able to follow throughout the entire 40 weeks of pregnancy.

 

Amelia Iams, DPT is a Physical Therapist at FMH Rehabilitation Aspen Ridge in the treatment and management of sports related and orthopedic injuries.

Join us for the Tx:Team Virtual Meet & Greet Mobile, AL

Are you a Physical Therapist in Alabama?

Join Tx:Team on Monday, February 27th from 12-1pm CST (1-2pm EST) physical therapistto “virtually” meet us!  Find out who we are and the opportunities we have available for Physical Therapists in Alabama!

For more information and to register for the event,             email [email protected]

Find out why “working with us is good therapy“!

 

Aquatic Therapy Can Help Get You Back to…

There is no worse feeling than the aching pain that won’t go away, prevents you from accomplishing everyday tasks, and keeps you from doing the activities you love. If you have recently been injured or identified with having a debilitating diagnosis, aquatic therapy may be your answer to a pain-free lifestyle and get back to the activities you enjoy.

Diagnoses for Patients who benefit from Aquatic Rehabilitationaquatic therapy

Spinal Issues: Thoracic, Cervical, and Lumbar Spine Issues, Posture Issues, Spine Compression Fractures, Herniated Discs, and Spinal Stenosis

Imagine you are floating vertically in the pool using a floatation device. Since you are not touching the bottom, the water decreases the effect of gravity on the spine and creates traction. This process removes the pain you are feeling so you can now focus on learning the therapist’s exercises and doing them appropriately. Core stabilization will be the focal point of your exercises as it permits increased trunk/back movement with less pain due to the warmth, buoyancy, and pressure of the water.

Lymphedema Issues

If you have lymphedema issues, you may be experiencing swelling in your extremities. When you find yourself in the SwimEx Pool, you will notice a decrease in the swelling due to the hydrostatic pressure, making it easier and less painful to do strength exercises. This decrease in swelling will also make walking much easier.

Foot and Ankle Issues: Achilles Tendon Repairs or Tears and Toe, Foot, or Ankle Fractures

Typically, your doctor will give you weight bearing restrictions and you will most likely need a device to assist you while you walk and/or a boot. However, due to the anti-gravity properties of the water, you would not have to adhere to the restrictions. Other positive effects would be a decrease in swelling and less painful side effects. The pool helps you recover much faster because it allows you to work on balance in the early stages of recovery. Normally, patients have a hard time working on this if they are not in the pool due to the stress and pain of their foot or ankle.

Knee or Hip Replacements: ACL Repairs, Arthroscopic Repairs of Hip/Knee, and Patellar Tendon Repairs

The water provides a good environment to work on range of motion, stretching, and strengthen of these tender areas. An important distinction between aquatic and land therapy is the level of soreness associated with each, with aquatic causing much less soreness. Also, aquatic therapy allows you to perform most exercises sooner than on land with much less pain, getting you back to normal in much less time.

Fibromyalgia and Chronic Pain patients

Normally physical therapy is the last straw for this type of diagnosis. However, physical therapy in the pool should be one of the first choices since it will help you build stamina, endurance, and strength and manage your pain.

There are many more diagnoses that can be treated utilizing aquatic therapy. If you are not able to tolerate the pain associated with land therapy, aquatic therapy is an excellent alternative due to the anti-gravity environment. You will feel less pain and pressure in the pool and be able to make progress sooner than typical land therapy.

Get the therapy you need so that you can get back to your day-to-day routine and the actives you love. The goal of any rehabilitation team is to get you back to doing the activities you enjoy. Swinging a tennis racket. Walking through the woods. Peddling a bike around town. Pushing a cart down the grocery aisle. Even folding laundry! No matter the activity, enjoy life!

The ultimate goal of any therapy program is to get you back to _______ .   What is your blank?

Contributors: Morgan Thompson, Amelia Iams, DPT, Cynthia Brendle, PTA