Premature Introduction of Solids to a Baby

Premature Introduction of Solids to a Baby
By Colleen Riordan, CCC-SLP
Speech and Feeding Therapist, Kids Place

First milestones for babies can be very exciting for a new parent.  First smiles, first words, and first steps are moments to be cherished.  But is there such a thing as pushing for these milestones to happen too early?  In the case of introducing solids to an infant, the answer is yes.  Although common advice is to begin introducing solids at 6 months of age, some health professionals are now giving the green light for solids at 4 months of age.  Recent polls have also revealed that some infants are receiving their first tastes of infant cereals and purees as young as 2 months.  Although it may be tempting to give your baby solids before 6 months of age, it is important to take into account your baby’s nutritional needs, gastrointestinal maturity, oral-motor development and a number of readiness cues.

Nutrition

Through the age of 6 months, breast milk or formula provides all of your baby’s nutritional needs.  In fact, many infants can thrive on breast milk or formula alone through 9 months of age.  Infant cereals and purees cannot provide the necessary calories, fat and nutrients for an infant’s developing body and mind.  Between the ages of 6 and 9 months, introduction of solids is for practice only; breast milk or formula is essential.  Some erroneously believe that infant cereal is necessary for iron supplementation. This is untrue.  Typically developing infants are born with iron stores to last them at least through the seventh month of life.  Another myth is that adding cereal to a bottle before 6 months of age will help a baby sleep through the night.  There are no studies to support this idea.  Adding cereal will change the nutrient content of the formula, and is linked to higher risk of obesity later in life.

Gastrointestinal Maturity

Before 6 months of age, infants have what is referred to as an “open gut”.  They are unable to filer out harmful substances and allergens.  Similarly, the intestinal tract is also unable to facilitate adequate absorption of nutrients in anything other than breast milk or formula, which contains enzymes to digest fats, proteins and starch.   By feeding a baby solids before his GI tract is mature, there is a higher risk of diabetes and food allergies.

Oral-motor Skills

Babies will exhibit a tongue thrust reflex which disappears between the ages of 4 and 6 months.  This reflex exists to protect an infant’s airway.  Before 6 months, infants will exhibit a sucking motion, a movement that is effective for anterior/posterior transit of liquids.  In order to deal with solids effectively, infants need to develop some tongue lateralization and rudimentary munching skills.  These skills are typically developed by 6 months.  Add to this the fact that most infants do not get their first teeth until after 6 months; this may be an evolutionary cue to us that infants are just not fully equipped to begin eating solids until after 6 months.

Reading the Cues

Many books will tell you that once a baby has doubled her birth weight, he is ready to begin solids.  Remember, that it is the combination of maturity of intestinal tract, nutritional needs, and oral motor skills that should be taken into account, instead of age or weight.   Conversely, if your baby is underweight at 4 or 6 months, the best nutrition is provided by breast milk or formula, and not solids.  Another cue parents should look for is the infant’s interest in the food that others are eating around her.  While this may be one readiness cue, it is also important to remember that infants are becoming great imitators at this age, mimicking your movements while eating.  This may be more of a social interaction than a cue that she really wants what’s on your plate!

Introduction of solids is one milestone that does not need to be forced. You will be eating with your baby in no time.  For now, enjoy the special moments breast or bottle feeding your infant, as they will go by quickly!                                                          

When a Home Exercise Program is Not Enough

When a Home Exercise Program is Not Enough
By Ryann Roberts, DPT
Owner and Physical Therapist, AZOPT

Ever had an injury or nagging pain that just won’t go away?  During the course of exercise, sports, and sometimes normal daily activities, these injuries occur frequently.  Some people will turn to word of mouth, YouTube, or a medical professional for assistance.  They will receive an abundance of information, exercise, and movements that may help alleviate or reduce the pain.  Many of these stretches and activities loosen tight muscles, strengthen weak muscles, alleviate the pain, and help you achieve full return to activity.  But what do you do when the home exercise program (HEP) does not resolve your injuries fully?

I see many people in the gym or who come into my office at AZOPT and tell me despite finding a good HEP and performing the exercises correctly and frequently, the pain still will not go away.  My response is always the same – you need the skilled hands of a physical therapist to manually release the restricted tissue.  A skilled physical therapist uses techniques and stretches you will not receive any other way.  A physical therapist will push your limits safely and effectively in a way you cannot on your own.

You can only foam roll or lacrosse ball out a tissue so much and so deep compared to what manual therapy from a physical therapist can perform with their hands.  Physical therapists can ‘feel’ the restriction and use several deep tissue methods to release the restriction deeper than a foam roll or a lacrosse ball.  A physical therapist’s hands can get pin point to the exact restriction and effect positive change. 

I talk with athletes daily about aches and pains they are having and how they should best attack the pain or restriction.  I am happy to give general stretches and advice to best resolve their problem, but nothing compares to the time spent on the table manually working through the pain.  On the table, I am able to feel the restriction and range of motion loss, and trace it to a certain area that is causing the limitation, thus the pain.  Through repeated sessions, I am able to address every factor contributing to the problem. 

HEPs are very good; I give them to my patients all the time, but as a part of a larger program.  I give instruction and advice all the time.  Without actually spending time with the person on the table, my advice is limited.  If your routine is working for you and you are able to function or compete on a daily basis with this program, then keep going!  If you find you are constantly searching for that next great stretch on the Internet to fix your problem, have a physical therapist perform an evaluation.

I treat the CrossFit Fury Games athletes consistently.  I know what their tissues feel like.  I know each individual’s range of motion.  Therefore, I also know their medical ailments and when their bodies are tight.  I can prepare them for competition in a couple sessions because they see me regularly.  I know their bodies.  They know that self-stretching and foam rolling will only take them so far.  At AZOPT, we understand all athletes because we are athletes.  We understand the physical demand of exercise from the everyday person trying to get fit to the competitive athlete we all admire. 

I decided to write this blog because I see too many people looking for the easy answer to their pain.  I do not mind giving advice to anyone who asks, but if you truly want the answer, you need to come see us.  Treating pain without the use of medication takes time and effort.  The easy answer is “take 2 of these and call me in the morning”.  The hard answer is “make an appointment and let’s get to work”.  You spend so much time, money, and energy to get healthy; do not fail yourself at the point of pain.  Put in that extra rep and call to make an appointment; we can only help you if you allow us to.  It was not easy getting to the point where you need help, and it will be work getting beyond the pain.  Physical therapy is the natural cure for the ailing athlete. 

If you are having nagging pain or an injury that just will not go away, give us a call at (623) 242-6908 and make an appointment.  We are here to help you get Stronger, Faster, Safer.  

Bouncers, Walkers and ExerSaucers, Oh My!

Bouncers, Walkers and ExerSaucers, Oh My!

By Bobbi Michels, PT

Kids Place Pediatric Physical Therapist

For a first time parent, standing in a Babies R Us equipment aisle is an overwhelming experience.  With all of the advertisements and Consumer Reports, it’s hard to tell which piece of equipment to use with your child.  There are bouncers, swings, Bumbo seats, ExerSaucers, and more.  So, what do you really need? 

The answer – nothing!  Truthfully, most infants are happy simply being held and listening to familiar voices.  When awake and not being held, infants are best on their stomachs on the floor, where they can explore their bodies and develop motor skills.  But this is an unrealistic proposition.  Parents still must have time for daily household activities like laundry, cooking, and dishes.  You also deserve a shower, maybe even a relaxing bath.

So what do you do with your baby when holding them or placing them on the floor is not an option?  This may be a very appropriate time to place your baby in their crib or playpen.  You may think this would also be a good time to place your baby in special equipment, like walkers or Exersaucers?  We say NO!

Studies indicate the two leading causes of head injuries in babies are from the use of walkers and falling from baby furniture.  Other studies indicate 40 percent of babies are injured during the use of a walker - falling down stairs, climbing out of the device, or tipping over in the device.  In most instances parents were present and supervising their baby prior to the injury, but were unable to react fast enough to prevent the injury. 

What about using an ExerSaucer or jumpy to work on leg strength, balance, and gait skills improvement?  Several studies have examined and concluded that motor development is decreased in infants and toddlers who spend the most time in play-assisted equipment.  On the same lines, in a study by A.L. Abbott and D.J. Bartlett, infants with lower equipment use scored higher on motor development tasks when tested using the standardized test - Alberta Infant Motor Scale. 

When placed in a walker or equipment that allows a baby to stand, the baby uses mostly the muscles in the back of the leg.  This is especially true in the beginning as they will often push forward leaning their chest on the support surface and rise up on tip-toes to move the device using both feet together.  This position does not allow the same use of the muscles at the front of the legs or the use of tummy muscles.  Walking requires equal use and strength of both the front and back leg muscles.  In these types of equipment, the baby’s balance point or center of gravity is lower and behind the normal balance point when leaning forward in equipment.  Further, normal balance reactions and arms are not used in the same manner as normal walking.

You are now asking, what are the possible long-term health risks of what we just described?  Without the proper development of leg muscles and balance there is an increased risk of muscle weakness and tightness which can lead to future surgeries and expensive medical bills.  We treat children who develop into “toe-walkers” which causes the foot and calf to shorten and tighten, eventually requiring surgery to release the muscles and realign the foot.  We also treat children with muscle weakness at the front of their leg, or at their hips and knees, causing many challenges with basic movements like dressing or walking up stairs.  Not all children will develop these issues with the use of these types of equipment, but the possibility exists.

If you find you have acquired a myriad of equipment, our recommendation is to limit the time your baby spends in equipment.  We understand you cannot hold your baby all day.  The floor may not always be the best option with older kids or pets around.  In Arizona, parents often are afraid their tile floors will cause injuries.  Our suggestion: use a pack and go or a playpen.  Using these will allow your baby to explore their environment and bodies to gain strength and awareness the way we did as children.  If you want to use walkers or ExerSaucers, the maximum amount of time per day in any piece of equipment should be 15 minutes.  Please note:  you should always supervise your baby closely in equipment to decrease the incidence of an injury.  As always, encourage your baby to spend most of their "play" time on the floor sitting, crawling, cruising and perfecting other motor skill milestones.

Read more: http://www.livestrong.com/article/495767-is-a-bouncer-harmful-for-a-babys-development/#ixzz2TEbM4D8x

References/Sources:

• Kauffman IB, Ridenour M (1977) Influence of an infant walker on onset and quality of walking pattern of locomotion: an electromyographic investigation. Percept Mot Skills 45:1323–1329. MedlineWeb of Science
• Kavanagh CA, Banco L (1982) The infant walker: a previously unrecognized health hazard. Am J Dis Child 136:205–206. CrossRefMedline
• Fazen LE III., Felizberto PI (1982) Baby walker injuries. Pediatrics 70:106–109. Abstract/FREE Full Text
• Stoffman JM, Bass MJ, Fox AM (1984) Head injuries related to the use of baby walkers. Can Med Assoc J 131:573–575. Abstract
• Infant walkers: developmental tool or weapon? Jacquelyn Chamberlin, OTR/L The Children’s Medical Center.
• Chelsea and Westminster Hospital; Promoting Your Baby's Physical Development; January 2011
• Consumer Reports; Bouncer-Seat Safety; April 2007
• "Child: Care, Health and Development"; Infant Motor Development; A.L. Abbott, D.J. Bartlett; May 2001
• National Institute of Child Health and Human Development; Safe Sleep; August 2009
• Healthy Children; Movement: 8 to 12 Months; May 12, 2011