• Deana Rosaia

The Do's & Don'ts: Development in the First Year

As Mommas we have so many questions. Lord knows I have them too. As a pediatric physical therapist? I have a short list of things I wish every momma knew before they left the hospital. We all do. It is a hazard of the job, and each therapist is going to be a bit different.


These are the things I get asked EVERY. SINGLE. DAY.


They are the same things, that so many mommas look at me and say "I wish I knew this sooner."


These are they things that can help mommas avoid developmental complications {sometimes} and they are pretty simple - we just need to know!


So without further distraction, toddler tantrum or peanut butter sticky finger on my computer keys.... here is my list.


The Do's


1. Start Tummy time on day one


As my fav freebie hand out says, they are not born hating their tummies, most of the time. What does this actually mean. Babies develop in the water world of the womb. They do not know up from down. The very important Back To Sleep program helps to prevent SIDS (thank goodness) but it significantly reduces the time our babies spend on their tummies compared to pre 1990's when babies slept prone. Our babies learn to prefer their backs as this is the default position.


Please hear me when I say this. Tummy time is THE MOST IMPORTANT developmental position you can place your baby, when awake, to develop their strength, proprioception, self soothing, and progress their motor milestones.


Those early months? Chest to chest on mom & dad is best. By 3 months, be looking to move your Little down to the floor on a play time mat or other firm surface.


2. Watch your babies head shape


This one will get ya, ladies. Pediatric physical therapist here - and my first baby had a flat spot on the back of his head. It can happen THAT FAST! I am talking days, not weeks. Make sure your baby turns their head both ways, equally. Should you notice a preference or flat spot - send me a message or chat with your pediatrician to get some 1:1 love and attention.


Why does this happen? Gravity. Those itty bitties are not born with sufficient strength in their necks to keep their head in the middle. So they naturally will go to one side. sometimes, they learn to like that side. Gravity takes over and those soft baby bones (flexible with intention for growing brains and birth) just smoosh into the surface, creating a flat spot. This can then lead to a tight neck muscle and the chicken & egg game can commence.


Sometimes, babies pick a side of preference because they had some form of birth trauma. Long after the birth injury has resolved, the baby is still left with a preference


Other babies are BORN with a preference that was developed in utero, a flat spot on their head, and or tight neck muscle. Most babies, it's acquired. I cannot say it enough - so I will say it again. If you are noticing your baby has a preference to turn their head one way more than the other, has a flat spot, or cannot turn their head equally each direction PLEASE send me a message or contact your pediatrician. The earlier these are assessed and addressed, the quicker they will resolve and secondary complications can be avoided.


3. Practice motor skills ON THE FLOOR, every day, from day one


The floor provides a firm surface for your baby to learn & grow. When a surface is firm and a baby produces effort to move, the surface pushes back, supporting the movement. See the Don'ts for the opposite situation. When? Find those moments when your baby is alert and calm. These windows will become more frequent and longer in that first 1-2 months - take advantage!


Physics aside - Just take it from me, you baby will be MUCH more successful with their movements & skills when supported on a firm surface. I have seen babies make dramatic strides in the quality of their skills by simply moving them to a supportive, firm surface. Think foam mat, towel on the floor, area rug or yoga mat. Get them on the floor!


4. Give them light weight toys to hold


The type of toy actually matters. Another blog post for another day {my fav toys} but this one is the most important. Beginning at about 2 months, babies need to practice grasping toys, just to practice holding on. This will lead to bringing toys to their mouths and quickly following will be early reaching & grasping. So many toys are crazy heavy, or hard to hold. My faves? (shameful shout out) the O-ball and Link toys.


The Don'ts


1. Do NOT use baby containers - GASP!


Ok, I said it. Now, let me explain


If it has a sling for their booty to rest while they stand, it shouldn't be a thing! This includes, but is not limited to exersaucers, bouncers, jumpy door hanging things - it seams the baby world is on an endless hunt to create more versions of these contraptions every time I turn around.


In the world of pediatric physical therapy, we are super anti baby container, most of the time. As a momma? I TOTALLY understand that sometimes we need to put our baby down, for 15 minutes to fold the laundry or make the mac n cheese for dinner (anyone else?) So, let me tell you why they are a problem, things to look out for, and when to be concerned.


These contraptions provide a sling for your baby to "sit" while also "stand" at the same time. The sling puts your babies pelvis in a "posterior pelvic tilt" which is the complete opposite position they need to achieve when they actually stand & walk. They then are also able to stand (usually poorly) and bounce (with only a small percentage of weight through their legs) and the end result can be some nasty bad habits.


Now, most babies can spend up to 20 minutes per day in a bouncer without resulting in any long lasting bad habits. But seriously, that is it, if you must. We all need a "place" to put our babies for a hot second. While these things are massive, noisy, and not my fav, the babies love them. So, use purposefully and sparingly.


There are several babies, however who I work with who absolutely should NOT use these contraptions under any circumstance. These are littles who may have already formed some bad habits or have other developmental concerns.


Things to watch & the habits that can form {Please please message me or consult your pediatrician if you see or are concerned regarding any of the following}

  • Standing up on their tip toes - bouncers often are too tall for babies and can teach them to stand on their toes

  • Motor delay - too much time in the bouncer and not enough on the floor can lead to delay in motor skills

  • Bouncing up and down anytime you hold your baby in standing - this will delay their independent standing skills.

Bouncers, baby walkers, jumpers - all the things - hear me, they WILL NOT make your babies legs stronger, and they will not make your babies walk faster.


Ok, let me step off my soap box and continue.


2. Do NOT work on motor skills on a soft surface (bed/couch)


Again, equal & opposite of the above, however this one I say on repeat, ALL. DAY. LONG. You are making it HARDER on your baby to do tummy time on the bed. When the surface is soft, your baby produces energy and movement, pushing into the surface, and instead of pushing back with support, they SINK into the bed resulting in their little necks having to do all the work versus their arms, shoulders, back and booty kicking in for the ride. This is going to make them mad, be really hard, and lead to tummy time haters. Just don't.


3. Do NOT let your baby get good at sitting before they are good at rolling


Ok, this one is odd, but hear me out.


The tummy time haters are gonna protest. They will cry every time you put them down on their bellies. They are going to grow and suddenly, they are 5/6 months and you realize, they are SO HAPPY when you help them sit! So, you sit them! Happy baby, happy momma. Babies LOVE being upright. They are human! They can see and engage in their world so well.


So, what is the problem? If you baby gets proficient at sitting BEFORE they learn how to roll, they will have a very challenging time learning floor mobility such as army crawling or 4 point crawling. You think the fuss was bad at 4 months on their tummies? Just wait. They are gonna give you hell at 7 months when they have perfected sitting independently but cannot roll, crawl or move themselves in their own environment. Independent floor mobility by 6-8 months is SO important for cognitive development.


My recommendation? Until your baby can roll proficiently back <> tummy - limited time in sitting to 25% of their play time. 75% of their play should be flat on the floor, perfecting their rolling & early crawling. 25% should be working on sitting.


Here is the magic - if you baby gets good at tummy time, they are building all the muscles they need to be good at sitting! Remember that tummy time is the most important position? well, this is one of the reasons why!


4. Do NOT wait to start playing on the floor


I know, it's basically the opposite of a DO listed above, but seriously, it WILL NOT be a welcome surprise for your baby come 4 months when you throw them on the floor wondering why they will not roll! They are gonna be SO MAD. It should start early & often.


Ok, if you hung in through all of that you are amazing. Never hesitate to send questions my way or comment below to ask me all the things!


xo, Deana

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