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    • Marissa Fourie
    • Carli Schmidt
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The importance of crawling

31/10/2014

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Crawling is the one milestone you do not want your baby to skip.  Although to us crawling may seem pretty simple, we often underestimate the effect that this action has on brain and movement development. Crawling is important for the development of muscle strength, balance, coordination, fine motor development, vision, spatial understanding and problem solving, all aspects important for walking later on.  Research has also shown that school-going children who have skipped crawling generally struggle more with sports involving the upper limb, ball sports, mathematical concepts and copying work from the blackboard.

Crawling can develop any time from 6 to 10 months of age (for premmies, remember to correct their actual age).  Your child will not attempt to crawl unless he has mastered stable sitting yet.   He may not necessarily crawl in the traditional fashion, but may instead prefer bum shuffling, crawling backwards, leopard crawl, bear walk (on hands and feet) or crab crawl (“upside down”).  Do not worry if he is a bit slow to move, or if he prefers to motor himself around in a more non-conventional way.  Do seek medical advice, however, if your child uses only the one side of her body to attempt propelling himself forward, or if he makes no effort at all to move his body around purposefully by age 10 months.

How can I help my baby master the art of crawling?  

  • Tummy time is important. This helps your baby to develop anti-gravity strength of the trunk, neck and limbs;
  • Reaching out to objects when on her stomach or sitting will improve balance, righting reactions and weightbearing though her arms;
  • Let her play with her feet when lying on her back, to assist with midline crossing;
  • Let her stand on all fours over your thigh – this makes for a great playing position for the two of you;
  • When she is confident on all fours, place objects just out of her reach to encourage movement towards them; Enourage the kneeling position – place toys on a step or foot stool in front of her;
  • LIMIT the use of a walking ring, jolly jumper and sitting support – these all inhibit normal development patterns.

What if your little one has skipped crawling altogether, and just started walking almost right away?  Well, functionally, your child will be mobile to play, investigate and do the things that toddlers like to do.  However, by not crawling, he will very likely miss out on at least some development of balance, coordination and strength training, especially in the arms and shoulders. Encourage crawling games to still have the benefits, even at a later age.  Here are some ideas:

  • Use push-along toys, such as cars, in crawling;
  • Hold races between friends or siblings in different ways of crawling, including conventional crawling, leopard crawling, crab walking and bunny-hopping;
  • Engage in fantasy games in which he gets to be any quadrupedal animal, thus moving along on all fours;
  • Build an obstacle course in which he will need to crawl at least a couple of times to fit through narrow spaces;
  • Play “wheelbarrow” – start on the stomach, pushing down through his hands with straight arms. A friend gets to lift his feet off the ground and “push” him forward as if he is a wheelbarrow.  He will need to “walk” foward on her hands, keeping the arms straight.​
  • Let him lie flat on his tummy with his weight supported on his elbows, when paging through a book, building blocks or colouring in.
Never “force” your child into crawling – it is important that he develops at his own rate.  And don’t forget, once his crawling days have started, your sitting days are officially over... :-)


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HELP, HEADACHE!!

22/10/2014

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Headache is one of the most common and debilitating conditions around.  Any veteran of headaches will know that once it has properly kicked in, your entire system struggles to operate effectively.  While it is a much researched topic, many of the causes of headaches are still being debated upon.  Possibilities for the source of headaches are endless, ranging from tension to tumors, sport and sex.  Where do we start eliminating?

Below is a list of often-missed factors that may be responsible for the hammer pounding in your head. These can all be addressed by simple lifestyle alterations, which may just help for those headaches never to return again.

  • EYESIGHT  

Degenerating eyesight is a common culprit, especially with frequent computer work.  These headaches often appear as cluster- or migraine type headaches, which worstens towards the end of the day. The patient may occasionaly have a blurry vision and find it hard to focus. Experts recommend eye tests two-yearly for those who do not wear spectacles or contact lenses, and yearly check-ups for people with visual aids.


  • GRINDING YOUR TEETH

Night-time teeth grinders often wake up with a slight headache, which progresses as the day goes along.  Pain may be on either or both sides of the head, and are often located in the temples, behind the eyes, around the jaw or at the base of the skull.  A night of grinding may leave your jaw slightly numb in the morning.  Your dentist will be able to confirm whether you are a grinder by looking at the wearing pattern of the molar teeth.  A custom-made bite plate may provide a solution to eliminate the source of your headache.


  • MUSCLE SPASM AND/OR VERTEBRAL PAIN

Tight, painful muscles in the neck and shoulders are one of the big causes of tension headaches.  Often, previous spinal trauma leads to vertebral pain and stiffness, which will certainly increase the occurance of muscle spasm and headaches.  Other causes for muscle spasms may be stress, muscle overuse, faulty posture and ergonomics and a prolonged sedentary position (see below).  These headaches are often more intense to one side that the other, and may be located in well-localised patterns (for example, behind your eye, or a band-like pain around your head).  Your physiotherapist will be able to assist in relieving these symptoms and aid you to prevent reinjury by means of slight adaptations to posture and lifestyle.  Regular heat, stretches and stress management techniques can also help to keep you spasm-fee.


  • ERGONOMICS AND POSTURE

Sitting for prolonged periods may increase your risk for headaches, especially when maintaining a forward-head posture, rounded shoulders and drawn-up shoulder blades. Visit your physiotherapist and have a workstation evaluation done in order to optimise your office ergonomics. It may take as much as adjsuting your chair height or repositioning your keyboard to resolve the problem.


  • SINUSITIS

Sinusitis can occur due to acute infection or prolonged exposure to allergens. Often seasonal, certain allergies can lead to the irritation and inflammation of mucus membranes in the sinuses.  This can result in headache on either or both sides of the face, around the cheekbones and/or above the eyes. Headache often increases with head movement or when bending over.  Speak to your doctor or pharmacist about your symptoms and recommended medication.  Also make regular use of a saline nasal spray during the course of the day. Your physiotherapist can help to improve sinus drainage by means of electrotherapy and manual therapy treatment.


  • DIET

A change in diet may resolve your problem all together.  The best way to identify a food substance which may elicit your headache is by means of elimination.  Avoid the specific substance completely for two weeks WITHOUT changing the rest of your diet, and note whether or not your headaches recur at a different intensity and duration.  Food substances that may trigger headahces include:  

  1. Dairy products such as yoghurt, sour cream, ice cream and strong, matured cheeses;
  2. Certain meat products such as pork, seafood or chicken livers and processed meat (such as polony and sausage)
  3. Fatty or fried foods
  4. Chocolate and nuts
  5. Caffeine-containing drinks
  6. Alcoholic drinks, specifically red wine.

  • WITHDRAWAL SYMPTOMS

Are you busy to quit smoking, decrease your coffee intake or discontinue chronic medication? Withdrawal may well be the cause of your headache.  Try to decrease your intake more gradually, and drink a lot of water to assist your body with detoxifying.  Most importantly, just hang in there! It will wear off sooner or later – and your body is going to thank you! (Remember never to discontinue chronic medication without your doctor’s input.)


  • HORMONES

Ladies, your headache is most probably hormone-related if you experience it in a regular pattern on a monthly basis, especially if it occurs close to your menstrual period.  If you have recently started on new contraceptive or hormone replacement medication, this too can be the cause of headache.  Speak to your gynaecologist if symptoms persist.


  • DEHYDRATION

Headache can occur simply due to you not taking in enough fluids.  When a headache hits, have a glass of water and monitor your symptoms for the following 20 minutes.  If the headache is due to dehydration, it should subside.  Be sure to take in at least 2 litres of fluid (preferably water) per day, and up to 3 litres on warmer days, especially if you spend a lot of time outdoors.

SO WHEN SHOULD I WORRY ABOUT MY HEADACHE?

The following are pointers that may indicate a more serious reason behind your headache.  Seek medical help if any of these occur:

  • Intense headache with neck stiffness, light sensitivity, nausea, fever and/or flu-like symptoms;
  • Any weakness or loss of sensation to any of your limbs or other body parts;
  • Sudden visual disturbances;
  • Loss of consciousness, disorientation or personality change;
  • “Thunderclap” headache – rapid time between onset and peak of headace (about 5 seconds);
  • Longstanding headache not reacting to any medical treatment

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Get movin’, pregnant fairy!

8/10/2014

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Yes, we know you are big and uncomfortable, your back hurts and you are tired at the end of the day. But guess what, instead of adding even more strain and effort, mild exercise may actually turn all of these around for you!

A couple of good reasons for moms-to-be to get moving:


Control weight gain: Weight gain in pregnancy is inevitable – and important! However, excessive weight gain will leave you with some unneccesary flab after labour. Regular moderate exercise now, will save you a massive lot of effort in weight loss later.

Improve fitness and heart health: During pregnancy, your heart needs to work on an extra 1.25 litres of blood than before. Controlled aerobic exercise will assist to strengthen your heart muscle, improve oxygenation to your body and improve your fitness. This will also improve your general endurance, and you may feel less short of breath in the later stages of pregnancy.

Increase energy levels: In adjunct to fitness and heart health, exercise improves circulation to all parts of the body, and improves the transfer of oxygen to the cells, leaving you feeling more energised. Your endurance increases, your sleep improves and you will just feel much more energetic in general.

Prevent back pain and stability: Strenghtening of your core muscles will take strain off your vertebrae, and improve your balance when your centre-of-gravity starts to become, well, a bit off-centre.

Decreases your chances of contracting pregnancy-related medical conditions, such as diabetes, constipation, high blood pressure, varicose veins and blood clots. Swollen feet and ankles will also be significantly alleviated.

Decrease stress and anxiety and improve mental health: There may be a million reasons for you to feel a bit under the weather. Maybe you feel slightly like a whale, or you are stressing about the financial implications of raising a child, or the prospect on parenthood may be a bit too daunting. Often, with bigger baggier off-balance bodies, our self-confidence may fade away. Whatever your reason, exercise will help you feel more in control of yourself and your body. The release of feel-good hormones will also help lift your spirit quite a bit.

Aids with easier labour: Whether we want to know it or not, labour is a marathon event. The fitter and stronger your body, the easier the labour process will be – plain and simple.

Increases your recovery rate: Whether your baby are delivered normally or via C-section, the body goes through a lot to get the little one out into this world. Fitter and stronger mommies are able to get up and move about much quicker, and can handle and nurture their babies comfortably much sooner than their couch-potato counterparts.


Ideas for moderate exercise:

Not all of us are gym fanatics or marathon runners. Here are some alternative ideas:
  • Walking – not strolling along, but walking at a fast pace to get your heartrate up a bit.  
  • Swimming – wonderful exercise to strengthen your muscles and improve fitness while minimising strain on the joints 
  • Spinning – opt for a stationery gym bicycle rather than your usual mountainbike, to reduce the risk of falling
  • Yoga or pilates
  • Catch up on quality time with loved-ones – take your husband, dog or bestie along
  • Join a local prenatal exercise class

Important things to remember:
  • DO NOT overexert yourself. Start off slowly and gradually increase intensity and time of exercise.​
  • Take in a lot of fluid during and after exercise.​
  • Be sure to wear comfortable shoes and supportive socks.​
  • Whenever you experience any pain, lightheadedness, nausea, heart palpitations, tightness of the chest or any other unusual symptoms, stop with what you are doing. If it does not subside after a minute, seek medical attention.​
  • Refrain from exercise when you are ill.

So go on and get moving ladies! You owe it to your body and baby!

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Shoes or no shoes? The bare facts.

6/10/2014

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Not many things beat the absolute cuteness of a size 0 baby shoe.  Be it on the shelf of your favourite baby store, in a gift bag at your stork tea or on a photo announcing the coming your bambino, you just can’t wait to try that pair of adorable mini-me ballet pumps or sneakers on those little newborn feet.  When getting down to health issues, however, where do we set the boundaries for our little ones’ footwear?

When babies are born, their feet are certainly not little replicas of a grown-up’s feet.  All the little bones are still very soft and cartilaginous; no or minimal arching exists; and a newborn cannot selectively move his feet and toes seperately from each other.  Muscle tone is low, and very little muscle strength has developed.  Since your baby will not walk for the better part of his first year, shoes are there pretty much only to keep their feet warm. Footwear should thus be as comfortable as possible, and watch out for straps that may cut into the skin or laces tied up too tightly. Also, be sure that your baby’s shoes do not hinder him when he attempts to crawl – opt for softer, lighter shoes here.

When your infant starts to walk, there is often a question of whether to shoe up to support the stability of the feet, or to not let him wear any shoes at all.  A considerable amount of research has gone into this topic, and scientists have concluded that barefoot is the best way to go. Toddlers and young children walking barefoot for most of the time have shown improved balance, posture, muscle strength, range of motion of the foot joints, proprioception (continuous position orientation), coordination and general stability.  Due to the sensory input that the child gets when walking bearfoot, muscle strength and tone start to develop and improve, leading to general improvement in instability and balance.  Shoes may essentially “splint” the foot, inhibiting all joints to move through their full available range.  Shoes also have an effect on stance length, walking speed and cadence, all which will affect a normal gait pattern.

Obviously, we would not like our children to walk barefoot in public places, since they may be exposed to a number of harmful objects and/or substances (glass, dirt, etc.).  The good news is that shoes are not an absolute taboo – just be clever when you buy. Some tips to take in mind when buying shoes for your child:

  • Check the flexibility of the sole.  You should be able to almost bend the shoe in half, forming a U-shape with relative ease.  Thinner soles are better.

  • Avoid shoes with heals or arch support

  • Opt for shoes with a closure at the back and an adaptable closure on top (such as Valcro or laces).

  • Choose a shoe with a wider toe box to allow enough space for some toe movement.

  • Shoes should not fit too tight.  You should be able to put your little finger behind your child’s heel inside the shoe.

  • Let your child run around in the shop with the shoes on, and check for any signs of discomfort, either in her general expression or in her walking pattern.

  • Try to fit shoes towards the end of the day, when the feet are a little more swollen.

If you have any concerns about your child’s feet, stability or gait pattern, be sure to pay a visit to your paediatrician, physiotherapist or podiotrist.



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    Author

    Marissa Fourie is a physiotherapist in Stellenbosch with a special interest in musculoskeletal conditions, pediatrics, and post/prenatal health.

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