Wednesday, October 10, 2018

Toys That Promote Development...and Toys That Don't!

The holidays are approaching! Halloween is coming up, then soon after it will be Thanksgiving, and then before we know it Hanukkah and Christmas will be here! If you're someone who plans ahead like myself, you are probably already making lists on your Amazon account of what toys and gifts to buy your loved ones. With this in mind, I decided to make a list of toys that I love to promote motor development, alongside with the toys that I don't love.

Recently in my practice I have been getting many referrals for children with no diagnosis other than "Gross Motor Delay." When I gather my subjective data for these kiddos, the parents talk about how their child is not yet crawling or walking. When I dig a little deeper, I find that the children are not having as much "explorational" play - that is, they are not using their body to move during play. With the craziness of life, many parents and caregivers opt to what I call "crate toys" to place their baby in for extended periods of time so that they can go about their business while the child is happy and entertained.

Remember that floor playtime is CRUCIAL for development. Play allows children to learn about their bodies, help the brain organize itself, improve cognitive growth, and much more. I understand that life can get busy, and if you are home alone with the baby and the only safe place to put your child is a "crate toy" while you run to pour yourself another cup of coffee or go to the bathroom, that is totally fine. However, the more time these children are spent in the "crates," that is time taken away from them to learn how their body moves during free play on the floor.

Here is a list of my most favorite and least favorite toys for development!

YES: Playpen/Pack 'n Play

Playpens provide a safe little area for your child to play and learn! If you are going to another person's house and you know that their home may not be baby proof, bringing along a playpen will not only allow your child to experience more unstructured play, but it will make you feel comfortable knowing that your child is safe.

NO: Bumbo Seat
Image result for bumbo seat
The Bumbo seat is severely restricting and limits crucial spontaneous movements of the trunk, arms and legs. Take a look at this kiddo in the picture - he can't move his legs or his arms! If he spends too much time in this seat, he will not learn how to move his arms and legs and he will not learn how to engage his core to allow him to sit upright and independently.
Research shows that when infants are in positioning devices, their leg movements are significantly reduced as compared to having no device at all (Jiang 2016). This is important because babies and children learn from experiences, so we want to give them as many opportunities as possible to experience movement!

YES: Boppy Pillow
Image result for boppy pillow
The Boppy pillow has so many wonderful uses throughout the first few months of your child's life! It allows both you and the baby to be more comfortable during nursing and bottle feeding. In between feedings, it's a great way to keep the baby propped up while they digest. As they get older, some babies prefer to do tummy time on the Boppy as it makes it easier for them to lift their head up against gravity. It also allows them to learn how to sit and use their trunk and core musculature to maintain upright - and if they tip over, they get to land in the soft cushion of the Boppy!

NO: ExerSaucer

Similar to the Bumbo seat, this type of toy restricts movement, especially of the trunk and ankles. Although the baby can move his arms, he will have difficulty rotating his trunk to fully appreciate exploring his surroundings.
Research shows that too much time spent in the Exersaucer causes restrictions of ankle range of motion, poor trunk control, decreased trunk rotation, and inappropriate movement patterns, all that effect their ability to achieve their gross motor milestones (Lenke 2003).

YES: Play Table

Play tables are a great motivation to get our kids up into standing and bearing weight through their legs! Once they are sitting independently and crawling, using a play table to encourage them to pull to stand and play in standing is highly recommended. The play table offers adequate support for them to lean and hold on to maintain their balance while offering fun motivation to maintain this position.

NO: Baby Walker
Just like the Exersaucer, the baby walker restricts movement of the trunk and blocks the baby from being able to see his feet, which is crucial for development of higher motor skills to be able to see where his legs are and how they are moving. I tell parents imagine never playing golf before, then being handed a club while being blindfolded and then telling you to play golf - think of how hard that is! While some parents get excited that their child is "walking" in the baby walker, because they can't see their feet they are not receiving the proper visual and proprioceptive input for their body to learn the proper movement patterns, which leads to abnormal movement patterns and delays in walking.
An old study that is often cited found that children who spent more time in baby walkers showed delays in the onset of crawling compared to children who spent less time in the baby walkers, concluding that too much time in this device can also delay other motor skills as well (Crouchman 1986).

YES: Push Toy
Push toys are a great way to get kids to practice walking! It allows them to practice their upright mobility with an unstable surface, allowing them to rely on anticipatory balance reactions to maintain their standing position. Plus, it's less pressure on your back if you are constantly trying to walk with them holding onto their hands!
However: make sure your child is ready to walk! If your child is not yet sitting or crawling independently, they are not ready to walk! In fact, using this toy too early can cause abnormal movement patterns which will in turn cause them to have a delay in their walking ability.

NO: Hanging Jumper Toy

Image result for hanging baby jumper
Very similar to the baby walker and the Exersaucer, this device restricts movement of the trunk and pelvis and does not allow them to see their feet, which as we know is crucial for development of higher motor skills and leads to abnormal movement patterns. While some parents think the baby is learning to "jump" in these toys, the abnormal movements patterns that they learn in these devices are incorrect in how to actually jump. I also like to tell parens that the average age for children to jump is 2 years old, so a baby should not be jumping at this point in their development.
Abbott et al (2001) found statistically significant correlations between total equipment use of multiple types of "crates" and infant motor development. The infants in this study, all around 8 months of age, that had increased equipment use scored lower on the Alberta Infant Motor Scale, or AIMS, which is a commonly used standardized tests to look at infant motor development from 0-18 months old.

YES: Baby Carriers

These baby carriers are especially great for children with Torticollis and Plagiocephaly. These allow for the baby to have less weight placed onto the backs of their soft skulls, therefore preventing any further skull malformation. If your child tends to look one way, especially in the car seat, this baby carrier allows for you to physically move their head and maintain it to their non-preferred side so that they can develop symmetrical range of motion. Plus, you get to be closer to your baby which is an excellent form of bonding between you two!

NO: Baby Swing

Graco Simple Sway Baby Swing, Abbington, One Size
Speaking of Torticollis and Plagiocephaly, I do not recommend the baby swing as it can further increase the severity of your baby's head shape. With the increase of families using carries such as the baby swing, extended use of car seats, etc., we are finding that more and more babies are being diagnoses with Plagiocephaly and require cranial orthoses to manage.
A research study from Littlefield et al (2003) found that out of their sample size of 636 babies over a three year span, over 25% of them spent 1.5 to 4 hrs, roughly 15% spent more than 4 hrs/day in these devices, and 5.7% slept in one of these device. They found that these babies often developed increased abnormal head shape as compared to their counterparts who spent less than 1.5 hours a day in these devices.

Please note that "normal use of car seats, carriers, swings and bouncy seats is not a concern; however, caution is warranted for infants who spend extended periods of time in these devices." (Littlefield 2003). So please don't feel like you have to say no to gifts that you receive from loved one if they are on my "No" list! Just make sure that your baby is not spending excessive time in these devices and that you continue to promote independent play :)

If you have any concerns about toys and your child's development, reach out to a Pediatric Physical Therapist!

- Crouchman, M. (1986). The effects of babywalkers on early locomotor development. Developmental Medicine & Child Neurology, 28(6), 757-761.
- Jiang, C., de Armendi, J. T., & Smith, B. A. (2016). The Immediate Effect of Positioning Devices on Infant Leg Movement Characteristics. Pediatric physical therapy: the official publication of the Section on Pediatrics of the American Physical Therapy Association, 28(3), 304.
- Lenke, M. C. (2003). Motor Outcomes in Premature Infants. Newborn and Infant Nursing Reviews, 3(3).
- Littlefield, T. R., Kelly, K. M., Reiff, J. L., & Pomatto, J. K. (2003). Car seats, infant carriers, and swings: their role in deformational plagiocephaly. JPO: Journal of Prosthetics and Orthotics, 15(3), 102-106.

DISCLAIMER: "The San Diego Pediatric PT" claims no credit for any images posted on this site unless otherwise noted. Images on this blog are copyright to its respectful owners. If there is an image appearing on this blog that belongs to you and do not wish for it appear on this site, please contact me via e-mail at with a link to said image and it will be promptly removed.

Saturday, January 20, 2018

Massage - How it Benefits the Child and Caregiver

As the new year kicks off, one of my new year's goals is to decrease my stress level, and what better way to stay relaxed with a nice massage? If you have never received a massage before, I highly recommend it. It has so many benefits, including improving circulation, decreasing muscle tension, and reducing stress hormones. But have you ever thought about how it could benefit infants as well?! Infants also experience stress; whether it is a preterm baby who stays in the hospital for weeks after their birth, to older babies who have difficulty self-regulating, research has shown that massage can be beneficial not just for the infant, but for the caregiver as well! I took an online course about infant massage by Catherine McDowell, OTR/L, LMBT, E-RYT200/RYT500, who has been an occupational therapist for over 20 years and is also a licensed massage and bodywork therapist, and this blog post summarizes some of the key takeaway points from her lecture.

Some of the many benefits of massage for infants include relieving gas and colic, relieving constipation and improving elimination, and improving discomfort from teething and growing pains. It has also been found that the relaxation response from infant massage helps to improve sleep patterns, improve their ability to self-soothe and regulate their behavioral states, and reduces stress hormones. Research has shown that babies who are held, massaged, carried, and rocked grow up to have less aggression and violent behaviors as adults.

Infant massage has been found to benefit the caregiver as well. The eye contact, soothing touch, and calm voice are all essential for intimate parent-infant bonding and attachment. Incorporating this into the daily routine helps parents and caregivers feel more confident in caring for their child, provides quality one-on-one time with the baby, and teaches them how to read their infants' cues and recognize their awareness states. Mothers with postpartum depression have shown improvement in their mood and teenaged mothers demonstrate improved bonding behaviors with their infants after starting infant massage. 

While anyone can give a massage, the first choice to massage the baby are the parents, grandparents, or guardians. Other people who care for the child outside the home, such as nurses and therapists who work in neonatal intensive care units and work with people with disabilities, are important as well.

The setting of the space prior to giving the massage is crucial to providing a relaxing environment for both the baby and caregiver. The best time to massage your baby is shortly before bed, when they are in this "quiet alert stage." Make sure the room is warm and comfortable and that the lighting is not overwhelming. While singing and talking are extremely encouraged, keep your voice soft and calm, avoiding any loud, sudden noises. If you are giving the massage, make sure you have all your supplies and equipment in the vicinity prior to beginning the massage so that you do not need to interrupt the session. Make sure you and the baby are both in comfortable positions.

While daily infant massage provides benefits, some reasons to not perform this technique include: acute infections, recent surgery, fever, diarrhea, and less than 72 hours after immunizations. Consult with your pediatric physical therapist and your pediatrician before you begin to implement this routine.

McDowell, C. (2017). Benefits of Infant Massage for Both Child and Caregiver [Text/Transcript]. Retrieved from

DISCLAIMER: "The San Diego Pediatric PT" claims no credit for any images posted on this site unless otherwise noted. Images on this blog are copyright to its respectful owners. If there is an image appearing on this blog that belongs to you and do not wish for it appear on this site, please contact me via e-mail at with a link to said image and it will be promptly removed.