Saturday, May 14, 2011

Alexander's Low Tone

Babies are typically supposed to crawl by nine month, and Alexander wasn't.  So basically at his 9 month check-up, I asked for a referral for First Steps.  He wasn't even scooting fast at that point either.  He was evaluated by Indiana's program for developmental delays in the under 3 set.  Each state has a similar program, which is federally funded; they are just called different names elsewhere.  Here in Indiana, our program is called First Steps.  You can read more about the program on that site.  The evaluation is free.  If your child doesn't qualify, that's it.  However, you can have your child retested every 3 or 6 months (I can't remember which) to see if they then qualify.

There were 2 women that came and evaluated him: an OT (occupational therapist) and a PT.  They brought several toys and played with him for about an hour in our home to check for various things.  To qualify, the child needs to have a 25% delay in one area, or two 20% delays in different areas.  Alexander had a delay in Gross and in Fine Motor skills.  At his age he was still "palming" toys instead of using his finger tips to hold them, which would be a fine motor indicator.  They also checked his belly without clothes on (dipe still on), and could see he had low tone. 

Most people don't know very much about "low tone" so here is a link to read more about what it is, and some problems that can accompany it.  Basically, it means that he is a little floppy and loose.  :)  At 6 months he still couldn't sit like propped in a Boppy.  He can sit now, but I've seen a baby CRAWLING at 6 months before!  And ALL PTs will tell you that babies need to crawl before they walk.

Anyways, after he qualified, we started on weekly PT sessions before his first birthday.  To strengthen his core, we bounce him on a giant exercise ball.  We put him in the 4 point crawling position and try to help him crawl.  However, he gets physically tired very quickly.  Another thing we do is try to practice up the stairs, as it's great to help learn the coordination of crawling. 

Our PT does not want him to WALK before he crawls and so we aren't practicing walking, although there is no real "harm" in it.  He seems to now have all the strength he physically needs to crawl, but it's a coordination thing.  Miss Nikki, the PT lady, also said it's very hard to get scooters, like Alex, to start crawling because he's so used to what he's fast at.

Anyways, I do his exercises with him in the morning when he first wakes up, and then after he wakes up from his naps in the late afternoon as then he is the most rested.

Claire also had low muscle tone and did First Steps, which is why I knew of the program.  Sometimes I wish I would have had Alexander evaluated even earlier, but it is what it is.  Claire's low tone was oral aversion...she had a tough time with mixed textures and eating in general until she was around 18 months old.  She was evaluated at 15 months after the doctor had labeled her failure to thrive (FTT).  She had weighed 24 lbs. at 9 months and at 15 months she was 23.  She was only nursing and not interested in solids foods offered to her.  She was also very gaggy and had problems moving her lips right to pull the foods off a spoon offered at evaluation time.

So because Alexander was eating WAY better than Claire did at that age, I though things might be ok, but low tone is very genetic.  Some people think that PT doesn't help, and that kids will develop when ready.  However, a type of therapy that is very readily acceptable is speech therapy.  If Alex had a speech delay, I wouldn't hesitate to put him in speech therapy.  I would say it is very common when we are out and about for people to comment on his scooting.  They either think it's really cute and novel, or they have none a scooter themselves and advise PT!

There is a strong link in the coordination with hand writing and the crawling motion.  Luckily we did catch this early though!  Miss Nikki is confident that he will crawl, although sometimes scooters may actually walk before they crawl.  Usually she likes to see them crawl a good 2 months before walking.  There is also issues with the HIPS.  A lot of people think that his knees might be hurt from scooting, but actually the tightness occurs in the hips and lower back muscles.

Alex also does a lot of W sitting...a big BIG no-no in the PT world.  W sitting is just what it sounds like...the baby/toddler sits with his legs in a W position vs. the more preferred straight legged pose.  The W pose is very bad on the knees...good thing Alex's are soft because he sits like that. all. the. time.  Claire did to, and I think it's pretty typical of when babies are first getting mobile anyways.  I try to tell him to put his legs straight, but I usually have to move his legs and tell him.

Also of interest, is that recurrent ear infections are an indicator listed on the First Steps paper work for Developmental Delays.  I'm sure having fluid in his ears from September through January wasn't very helpful as far as helping him learn to balance and such.

So if you want to be helpful rather than hurtful, read up on the topic and ask about "what new movements is he doing lately?" rather than "Is he walking yet?"  Nope...he's not crawling yet, either.  He has now pulled to standing on his own a total of 4 times in the past week!!!  All on different days. 

Alex also seems very vocal when moving his bowels, with lots of grunting and straining.  I do think this is related to his poor core muscles.  He has a much easier time going #2 when I put him on the Baby Bjorn potty.  That potty is supposedly the most "ergonomic" baby potty.  Claire thinks it's so funny he essentially poops in a bowl and has no recollection of pooping or peeing on it!

I even have had someone tell me that it's my "fault" for not working with him more on crawling.  Really?  That's like telling someone with vision or hearing loss that it's their fault. 

I was really cautious with starting solids with Alexander.  I was afraid he'd have the same oral aversions as Claire did.  But he is a magnificent eater!  He also popped out 4 teeth between month 6 and 7 which helped immensely with the biting of little bits of food.  He LOVES all food and is a great eater!  I have to cut him off most of the time.   When he was a little younger, sometimes I would over-do the feedings and he'd spit up later...his way of delayed self-regulation ;)

Well thanks for listening!  I hope you have a great weekend!


Randy said...

Hi Maria! Lots of great information there! Thanks so much for sharing it. Perhaps others will realize a need for First Steps for a child of theirs as well. I wish they knew about First Steps when Katie was a baby. She did not crawl and as a result, when she was 5 or 6, we had to do lots of crawling therapy with her. And amazingly enough, her printing greatly improved right away, among other things! Well, thanks again! Carla

Scribbles and Splatters said...

Maria- I think you are a terrific mom for getting him early intervention and not just shrugging it off. Every baby is different and what you are doing for Alexander (First Step program) is so helpful to him and he will be crawling (and walking!) in no time. More mothers need to be aware of baby/child development and not be afraid to use these free and helpful resources! (Our program in Ohio is called Help Me Grow and I used it for Lily from when she was 2.5 to 3 years old because she was so shy and it was effecting her social development. It helped a ton for her!)
I hope nobody else says anything hurtful to you about Alexander not crawling or walking yet. That's horrible that people would say something! Best of luck with First Steps!

Sarah A.T.J. said...

Thanks for the great info, you really have researched this! I'm so glad Alex is getting the therapy he needs:)

And yes, I've noticed that people do seem to think if your baby doesn't do this, this, or this at such and such a time in his/her life, then it must be the parent's fault. Grrr:( NOT TRUE!