Our goal is always to provide you with more knowledge to make informed decisions for your children’s health and wellbeing. Today, we are speaking with Emily who is a local business owner and physical therapist for some answers for commonly asked questions regarding physical therapy (PT).

Emily is a pediatric physical therapist and the owner of EMpower PT. EMpower provides in-home physical and occupational therapy throughout NYC, they utilize research-based techniques to treat children 0-5+ years old, while ensuring that care is personalized and easy to access.

👉 If you are interested in receiving services from EMpower PT email info@empowerpt.org or call/text (201) 591-5253.

1) How can parents work on tummy time when it seems like their baby HATES it?

Short and sweet is the best way to approach tummy time for a baby who gets easily frustrated in this position. 1-3 minutes before or after every diaper change is my go-to recommendation - this way, wake windows don’t get away from you and you aren’t laying in bed at the end of the day thinking, well I guess we will start tummy time tomorrow.

You should also prepare your little one for tummy time. That means providing gentle stretches first. Think about it, your little one has been in what I call the ‘shrimp position’ for 9 months…then all the sudden we lay them on the floor. That huge stretch to their core and neck muscles probably feels overwhelming.

My most prescribed stretches for newborns and infants are the Guppy Stretch, Smile Stretch, Football Hold, and Sacral Circles. Each of these stretches is demonstrated on my Instagram HERE.

Another tip is to vary the environment - try tummy time on your chest, on an exercise ball or on a couch (with close supervision/help). You can even break up tummy time with sidelying, this is another vital developmental position that caregivers and parents often forget about.

2) How can parents improve torticollis and head shape concerns at home?

First, it is important to mention that torticollis and head shape concerns are very common and incredibly treatable when intervention is provided early.

The best thing you can do is increase tummy time…tummy time, tummy time, tummy time! Even short sessions throughout the day help strengthen your baby's neck, shoulders, and back, while relieving pressure from their flat spot. This simple yet essential activity encourages your baby to lift and turn their head, which promotes muscle balance and improves head control.

I also recommend that while feeding, you offer bottles or breastfeed from both sides. Similarly, during play, position toys on your baby's less preferred side and try side lying as an alternate position to tummy time and back play. Encouraging your baby to move their head in both directions through gentle exercises and tummy time throughout the day can help improve neck muscle flexibility and strength. You can even switch the direction they sleep in each night - wherever they usually put their feet, place their head on that end of the crib tonight! Most babies turn their heads to look towards the door or towards their parent’s bed, by alternating where their head is in the crib, they may alternate where their head is turned as well.

If your baby continues to favor one side and their flatness persists, it may make rolling difficult for your little one as well as delay other milestones down the line. Babies who receive physical therapy early, make improvements much faster than those who don't receive physical therapy until later on. With gentle stretches, strengthening activities, and positioning strategies, we can support your baby's head shape, motor skills, and overall development.

3) How important is floor time for development? Are ‘containers’ bad?

There are so many options for seating systems and strollers these days that I often hear parents say, ‘We rotate stations’. This may include things like the Bjorn bouncer, an activity center, their highchair, and the stroller. I recommend avoiding multiple ‘stations’ throughout the day. Ideally, your little one is not in a ‘container’ for more than 60 minutes daily.

Of course, sometimes they need to be in a container so you can use the bathroom in peace or start the laundry. In that case I would make sure the container is developmentally appropriate.

For infants, the Bjorn bouncer is my favorite because there is enough space for their hips and head to move around relatively easily.
For 6+ months, the Upseat is my go-to. It was developed by a pediatric physical therapist and is spine and hip safe! It also has a tray to facilitate functional and age-appropriate play!
At 9+ months, I recommend use of a ‘playpen’. Your baby is probably becoming mobile at this point and placing them in an activity center is just going to slow down their progress!

In general, floor time is preferred over containers, but don’t drive yourself insane! Containers are okay in moderation!

4) What happens if a baby skips a milestone or is late to achieve a milestone? How do you know if they need physical therapy?

Although every baby develops on their own timeline, there are some general rules of thumb that I recommend following.

Rolling back to belly and belly to back, towards the right and left, by 6 months old.
Sitting independently by 7 months old.
Crawling and transitioning in and out of sitting independently by 9 months old.
Walking by 15 months old.

I often ask parents how long their child has been working on the same skill, rather than if they are ‘behind on milestones’. The reason for this is that once a child is slightly behind on one milestone, this will likely slightly delay the next milestone. Typically, if a child has been working on the same skill for more than 2 months, they may benefit from physical therapy to get them back on track.

If your child skips one of the major milestones above, I recommend a physical therapy assessment to see if there is a reason for this. For example, if a child skips rolling often their trunk rotation strength or range of motion is impaired - this may result in difficulty learning to get in and out of sitting a few months down the line. Each milestone prepares the child for the next, so unfortunately, skipping milestones often sets kiddos behind eventually.

Physical therapy does not need to come with a stigma, it does not mean your child is not excelling or that you did anything wrong as a parent/caregiver! Physical therapy for children is play based, which means their “workout” will just look like a structured play date! If you are worrying about a milestone and comparing your little one’s skills to other children on the playground, I assure you, a pediatric physical therapy evaluation will do wonders to ease your concerns and give you a structured play program to help your child reach their next milestone.

5) What do you recommend when a pediatrician does not place an Early Intervention referral because they do not think the child will qualify for physical therapy services?

This is a very common concern, because unfortunately there are just not enough early intervention providers available. I do not believe in the ‘wait and see’ approach. This is actually one of the many reasons I opened my own practice. As a parent, you truly know your child best, if you think ‘something’s going on’ or ‘they need PT!’ then I encourage you to look into ALL the options and choose what is best for your little one and your family.

Most commercial insurance companies will cover pediatric physical therapy, in some capacity, after your deductible has been met. It is typically easier to get insurance coverage if you attend physical therapy in a hospital network, but of course, said locations often have long waitlists. Of course, the only way to know for sure what your benefits are is to call your insurance carrier or have the physical therapy practice verify your benefits. In New York State, you can now see a physical therapist for 10 visits or 30 days, whichever comes first, without a prescription from a medical doctor.

Key Takeaways:

The floor is the best place for your child to play; you don’t need a fancy bouncer or stroller to keep them occupied.
Torticollis and head shape concerns are very common and can often be improved with targeted stretching and increased tummy time.
Children develop at their own pace, however there are general guidelines that we recommend following to identify if your child would benefit from physical therapy.

Special thanks to Emily for being our first guest for this expert Q&A!!