With the holidays approaching - tomorrow - the amount of added stress on everyone can make the easiest baby crazy. Here are some tried and true methods of calming almost any baby for at least a while. One tidbit to keep in mind is that some babies accomodate to calming tactics meaning something that worked for a while no longer works. Usually trying a new method will work but it may take some trial and error to figure out which one works best.

The Happiest Baby on the Block, by Dr. Harvey Karp recommends:

Swaddling - There are many versions of the technique but the key is to keep the arms and legs swaddled as well.

Shushing - "SHhhh" - Loudly and constantly

Swinging - while cradled in your arms not necessarily gently but not violently

Sidelying - sometimes on their stomachs or in the football carry or facing out rather than nestled in to your body

Sucking - pacifier, bottle, breast, finger (usually a clean pinky with nail resting on the tongue)

These require you to exercise - not bad if you are trying to shed some pregnancy weight...

Deep knee beds

Walking

Bjorn

Sling

stroller outside

bouncing on a therapy ball

bouncing genlty on a trampoline

Some ideas that require more effort from you

Driving in the car

Swinging on a swing

warm bath

Music/noise:

Anything with a base thump

White noise machine

The dryer or washer

The vacuum

Baby Einstein

News radio

Recording of woumb sounds

Baby heart beat recording

Watching tv (golf - because they whisper)

Ceiling fan/bathroom fan

Watching:

Traffic

Fireplace

TV

Mirror

Rain

Shower

Each child is different so if you have a tried and true way you have used please share it with all of us!!

Happy Thanksgiving!!

Torticollis and Plagiocephaly

These posts should not be substituted for medical advice or considered medical advice. I am a pediatric physical therapist but would never consider advising someone without having seen them. Anyone with concerns based on what they read here should definitely schedule an appointment with their pediatrician.

In my last post I did not discuss the pseudotumor that is often associated with the congenital muscular torticollis. This is a knot in the muscle that is usually felt below the ear in the neck. It is called a pseudotumor because it feels like a tumor but is not a tumor. It resolves with treatment of torticollis. Sometimes fibrous tissue will remain after the tumor disappears.

Congenital Muscular Torticollis (where the muscles are involved vs the eyes or spine) can be treated by a pediatric physical therapist. Typically the treatment lasts about a year which sounds like a long time but the treatment sessions typically reduce to once a month after full range of motion is achieved. The reason the treatment continues is that while children are learning to sit, crawl, and walk they resort to positions that are easy for them to handle while they work on the new skill. Have you ever seen an adult learning to ski? They resort to the same position a toddler does as they are learning to walk. For a baby with torticollis the means the old rotated and laterally flexed position. Parents often report seeing it right before they notice their child attempting the new skill which makes them think their child is regressing though that is not the case.

Treatment involves stretching the tight muscles and strengthening the weak muscles. The therapist will teach the parents how to stretch the muscle but will also teach them how to help the baby stretch and strengthen the muscle through activities a baby normally does. The therapist will encourage the parents to hold the child in certain positions and perform the exercises diligently 5-6 times a day until full range of motion can be attained by the baby.

Gross motor development can be delayed slightly in children with torticollis. Because they are working so hard on holding their head up they have a hard time working on the normal motor milestones. Typically the children with torticollis catch up to their counter parts and some never have the delay to start with.

Sometimes children require an orthoses for the neck to assist with head positioning. The most common orthoses for cervical alignment is the TOT collar (Tubular Orthoses for Torticollis). I personally have found them rather effective if the stretching and strengthening are not working as well as desired. http://www.symmetric-designs.com/the-tot-collar-for-torticollis-treatment.html

At times the torticollis is severe enough to warrant surgery. Sometimes there is scar tissure that develops in and around the muscle which needs to be released. If you have been working with your child for an extended period of time (greater than a year) without resolve you may want to consider consulting a physician who has treated torticollis surgically. At some hospitals it is the craniofacial/plastic surgeon at others it is an orthopedic or neurosurgeon.

Assymmetry in the face: Sometimes parents notice some assymmetry in the facial structure of their child with torticollis. Usually the lower jaw (mandible), the bone around the eye (occiput) and cheekbone(zygomatic arch) are involved. Often these resolve without treatment because as any muscle develops and strengthens it pulls on the bone causing bone growth. Parents will sometimes report that they don't see the assymmetry anymore "except when I look at my child in the mirror."

What is plagiocephaly? Plagiocephaly is a malformation in the molding of the skull causing an oblique flattening in the skull. It is often associated with torticollis. Infants with torticollis have a shortened neck muscle (sternocleidomastoid) causing them to rotate and laterally flex their head. As a result they tend to lie in the same position causing the back of the head to flatten on one side. Plagiocephaly can be mild to severe. In recent years there has been an increased trend to treat the plagiocephaly with a cranial remolding orthoses. These devices look simply like partial helmets. Most of the parents I have spoken to really like the device as they feel they can really see a change in the head shape in a fairly short period of time ~3mos. One site which demonstrates the orthoses is http://www.orthomerica.com/products/cranial/cranialindex.htm

As a parent the best way to help your child with torticollis is to get him or her diagnosed and treated. Sometimes the torticollis will resolve but if you have noticed the torticollis there is a good chance it has not resolved yet and should be evaluated by a professional. Please read the post prior to this one for some basics on torticollis which were not discussed here.

Torticollis: Does your child prefer look to one side?

Check the pictures you have been taking of your new baby. Does your child always tend to look to one side in the pictures? Have you noticed a preference for a certain side when they sleep? Do they not like breast feeding or prefer to do it only on one side? Do they get uspet when they are held a certain way?

Some children are born with a condition called torticollis. It is usually caused by the position of the baby in uetero. There are other reasons that the muscle can be involved such as a difficult delivery. The muscle (the sternocleidomastoid muscle (SCM)) in the neck which extends from the bone behind the ear (the mastoid) to the same side collar bone (clavicle) where it joins the breast bone(the sternum) becomes tight because the baby is unable to move out of this position in the last months of pregnancy. The muscle on both sides of the neck, therefore, do not develop equal length-tension ratio. The one on the opposite side is often a bit weak. Sometimes facial and cranial asymmetry, where the face and the skull are abnormally shaped, will accompany torticollis.

In this picture it is very subtle but if your child has torticollis you will know this posture. Her tight neck muscle would be on her left side.

This is important: it is unlikely that your child has torticollis if you see the tilt/rotation to one side as much as you see it on the other side or if the ratio is close.

Everyone has a sternocleidomastoid muscle on each side. This muscle, when it contracts on just one side, produces two movements. It turns the head opposite that side and tilts the head toward that side. (The tight muscle is on the right side for this little guy.)

A doctor should be seen if you are concerned that your child has torticollis. The earlier it is diagnosed and treated the better the outcome. A pediatric physical therapist should treat the condition. The treatment for this condition is stretching of the tight SCM and strengthening of the weak SCM. There are ways to incorporate the treatment into your day and to do it without a lot of discomfort to your baby.

Other reasons for this same posture to present in your child exist so be sure to have a pediatrician evaluate your child. Less common reasons for torticollis can be a tumor, infection or visual problem. These conditions will require other treatments.

For information on treatment techniques, plagiocephaly and more on torticollis watch for next week's blog.

Diapers, Calming, Strollers, Bjorn, Slings

Here are five of the best tips I was told as a new mom:

• When the diapers start to leak through - get the next size. They may seem big but the absorbency also increases with the size so go up the size and overlap the tabs.

• The Miracle Blanket. If you don't buy it learn how to swaddle well. http://www.miracleblanket.com/

• If your child is uncontrollably crying, try doing deep knee bends while holding them and either shushing or singing softly. It is a work out but when they fall asleep it is worth it!

• If you can test drive a few strollers before purchasing one, do it. I didn't follow this advice and ended up with 6 strollers!! No kidding - granted a few were double strollers after our second child!

• Figure out if you are a Bjorn person or a sling person. My husband was a Bjorn person but I was not so we had both. Fortunately, you can make a sling out of 4-5 feet of material. http://www.nandu.hu/english/practical/babycarrier.htm There are also a few on YouTube.

Mommy Relief

When you come home with your first child you know, because everyone has told you a THOUSAND times, that your life is gong to change. You accept that that is true because everyone has told you, but really how much can it change. You will have a baby, you babysat for the Smith kids a bunch and there were 3 of them, and Joey was like a month old when you started. Ok. You know the parents always came home to get them but you are competent. You are good with babies and you get at least 6 weeks off work. You know that you are up a few times a night to feed the baby and they sleep more than are awake in the beginning so you can nap when they nap. You can catch up with a few projects while the baby sleeps. Right?

Now before I help with the reality check, I do want to confirm that the babies are wonderful and snuggly and smell good and are so wonderfully cute. They can grab you hand and lift their head which they have no control of which is cute in and of itself. There is nothing better than having a baby sleep in your arms (if you have nothing else you need to get done) and you get lots of attention because people love babies.

Here are a few things that you may not have heard enough about which you might want to plan for. One, breast feeding, if it works for you, hurts! Some people tell you that the baby isn't latched on well or something. They tell you to feed the baby every three hours. To you, that means you might get 3 hours of sleep between feedings - that's all you need, right? But they forgot to tell you that the three hours is from the time the baby starts feeding not from the end of feeding. You may have a child that feeds in 15 minutes (like my second child) or you might have one that likes to take his time - 45 minutes - like my first child. THAT cuts into the sleep.
They don't tell you that while you love to sleep you are terrified of SIDS and so you watch them breath every breath for a few nights. They don't tell you that you can't sleep during naps because the laundry, the housekeeping and the shopping won't get done. So now you are sleep deprived.

And we were too! My sister and I are moms and after our second children were born we were lucky to find a nanny that we shared to help us out because we couldn't afford a full-time baby nurse. We recognized that it wasn't fair that it is really hard to enjoy newborns, so we started our mommy-relief program. The Mommy-Relief Program www.mommy-relief.com allows you to do the same thing. We provide a mommy reliever to give you some time. We like to say that you are not asking for a week in Paris, you're just asking for a shower. You can schedule any amount of time from 4 hours to 24 hours. We provide overnight care, mornings, evenings, three days a week, and any other combination you can come up with. Look for more information at our website and check back here for information regarding colic, jaundice, developmental milestones and more.

Our company is a medical staffing company so our background is medical. The information you will read here will come from that point of view as well as the point of view of a mom. I hope you find our blog interesting and enriching.