Episode 321: Understanding Baby Milestones: Guide to Early Development with Dr. Allison Mell PT, DPT

Hi and welcome to episode 321 of the Untethered podcast. Today we have Dr. Allison Mel joining us. Dr. Mel is a seasoned pediatric physical therapist with over 15 years of experience helping children move, grow and thrive. She worked in sensory gyms, school settings and now specializes in early development with a focus on babies. Allison is the founder of Tots on Target and the creator of the Tot Spot, a growing online membership that offers parents easy to understand guidance, developmental tools and expert support to help kids reach their milestones. With confidence, the big presence on Instagram, and a passion for making pediatric development approachable, Allison blends clinical expertise with a real life perspective of being a mom of four. She's on a mission to empower families and providers with the knowledge they need to support little ones from day one. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, airway, tethered oral tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct coral rest posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Alison, welcome to the podcast.

Thank you so much for having me. I am so excited to be here.

I'm excited to have you. I know we're going to have an amazing conversation around milestones and all the things today, but before we jump in, will you just share a little bit? You know, everyone heard your bio, but share a little bit about, you know, your background and how you came to working with the population that you do now.

Sure. So I started out as a physical therapist, but I always knew I wanted to work with kids. Right. A lot of people think of physical therapy and like a shoulder injury or a back injury, but I always knew that I wanted to work with children and right after graduate school I basically jumped right into the pediatric world and I've worked in Sensory gyms in the school setting. And more recently, I've really been diving deep into the baby world and really where it all begins in baby development. And I have grown to just love what I do. I love educating parents so that they're on the lookout for what is normal and not normal, or should we say typical and atypical what they should be like, okay, this is not the way my older child did it, but it's still okay. Or, you know what? This doesn't look right. I want to get a jump start on that, and I want to help out and make sure that my baby is on track. And so I think that when parents have the information, they are so much more empowered to make the best decisions for their babies, help their babies, support their children along their journey, and just make it all work. And so that's really where I've kind of come to now is I'm really big in the space of educating parents.

I love that. I feel like when I started this podcast, my goal was really to get information out to professionals. And then just by nature of having this as a podcast, it attracted so many parents. And now I have a lot of parents who come to me and say, okay, I listened to this episode, and it really helped me understand, you know, x better. And now I reached out to this provider, and I was really able to advocate for my child. And I'm like, that is so cool. And like, you're saying when parents are given the right tools and information, it's just. It makes their life so much easier. They can help their child. You know, it's. It's very cool. So I love. I love this.

Yeah. So it also is like, there's so much information out there that it's hard for parents to discern what should I. Which resource do I rely on? Because a lot of times there's conflicting information out there, you know, and. And that's because there are so many opinions, and what works for one person doesn't work for another. And so it's also helpful to have those resources that you're like, okay, this makes sense to me. This is what I'm seeing. This is then, you know, the plan I'm going to follow or, you know, the information I'm going to use to make my next steps.

Absolutely, 100%. I think it's so interesting. I was working on this, like, parent toolkit, just, like, a little bonus thing for, like, therapists to, you know, share with families and stuff. And one of the things that kept coming up was just, like, parents Ask all the time, why are you the first person to tell me X and like why haven't I heard this here? Or why does this conflict with those two people told me. And you know, I think it's like you said, it's so, so it's challenging. There's so much information out there. How do you figure out like who to listen to, what information to use for your situation?

Yeah, exactly.

Yeah. So let's dive into some, some of these milestones then because we know you know your stuff. So parents, listen up. But what are some of like the big developmental milestones that parents, you recommend parents look out for maybe in the first year of life.

So everybody kind of usually knows about tummy time. Maybe, maybe they're told by their pediatrician and those like newborn visit, it's you know, put their, you know, put your baby on their tummy, not to sleep but during play. And people kind of seem to know about tummy time. But that's really just the beginning. It's the basis for our development. And then really babies go on to do so much more, as we know. And so the big milestones that we're looking out for are rolling, sitting, crawling and walking. And what we really want to pay attention to is to make sure that babies are doing those movements within the typical timeframes and that the quality, quality of movement is there, that we're seeing good quality of movement, which the time frames they are for rolling, it's like a four to six month milestone. Sitting is a six to eight month milestone, crawling is a seven to 10 month milestone and walking would be a 10 to 15 month milestone. A huge range there. And some will even say up to 18 months is considered typical. And those are, you know, pretty big ranges. And so a lot of parents will hear like, you know, oh, your baby will do things when they're ready, you know, don't worry, every baby is different. They'll meet their milestones when they want to. And that can be true because we don't expect every baby to meet their milestone at exactly the same time. Like in pregnancy when you're reading, you know what to expect when you're expecting. And you know, at 26 weeks your baby is like this and at 38 weeks your baby's like this. But in reality, once babies are here, they're not going to do everything at the exact same time as everyone else or your previous child or your niece or nephew. But we do want to make sure they're meeting those milestones within those time frames or at least Making significant progress and like, almost fully mastering those milestones by the end of that time frame. And then there's, of course, the quality of movement that matters so much. And we want to make sure that babies are using both sides of their body equally, that they're moving fluidly, that they're. That they're being able to navigate their environment in an easy way and movements aren't so difficult or really they're using one side of their body more than the other.

Yeah, this. This describes my second child to a T. My first one was very tight, but my second one was very successfully compensating and dragging her leg behind her as she scooted across the room very quickly. And it was amazing because I ended up taking her. She went through. She went to PT throughout, like, her first eight months of life. And more so because I noticed, like, we're on, like, the tail end of where we're supposed to be hitting some of these gross motor milestones. And I just really want to make sure that we're not falling behind and if we can support. Support her, like, let's get her in and let's get this going. And anyways, it wasn't until she was closer to maybe like, 12 to 13 months that she. I had taken her to some other professionals, too, and she. She was tongue tied. She was released at five days old and all that fun stuff, but all of a sudden, like, she was pulling to stand at that point, and I was like, okay, we're. We're doing some great things here, but we still had not crawled on both knees. And one day I look over and she just crawls across the couch, and I'm, like, beside myself. And my husband's like, what does it matter if she can walk already? Like, she's already. She just started walking. I was like, oh, it matters. It matters. I was like, one, that's an unstable environment. Two, like, she's crossing midline. I'm seeing her cross midline right here. She's got her knee down. Like, everything is like, the quite. You're talking about the quality of the movement. Right. Like, yes, she was functioning, but was she most functional when she was dragging her? Like, no. Right. And so anyways, it was very interesting.

Yeah. What you're describing is really compensation. Right. And especially with that history of having an oral tie, whether it's released or not. I've seen it. You know, you can release the tie, but it doesn't mean that the effects on the full body aren't there. And so this is a very common presentation when we have that history of oral ties or maybe even reflux, where we're going to see baby using one side of the body more than the other, or there's some stiff and jerky movements. And a lot of times parents are hearing like, don't worry about it. As long as your baby can get from point A to point B, it doesn't matter how. And that's why I really try to advocate for the quality of movement. Because, yes, maybe your baby can very efficiently get across the room. They can get to their toy, they can get to their food, whatever it is that they're trying to get. They absolutely can, because they've learned to compensate for whatever in their body is not working as it should be. But it doesn't mean that it's not a sign of an underlying reason. There is an underlying reason why they're moving that way. Otherwise they would be moving with the quality of movement that we would expect.

Yeah. So. So can you explain? Because I'm definitely not the right person to do this, because I just knew when she started crawling after she was already walking, I was like, this is important. I know we hit this milestone late, but this is super important. So can you explain for parents who are like, well, why is that important? Like, why do milestones matter? Like, what is actually happening in development when babies hit milestones and they're not falling behind like my child was.

Yeah, yeah. So what. What are they getting? That. And that's really important because, again, so many parents here, as long as your baby can get around, it doesn't matter how. Maybe they're scooting on their bottoms, maybe they're rolling across the room when they're still, you know, 11 months old. And that's just how they're getting around. But there are several things that we want babies to be getting out of these milestones. It's not just a mode of transportation. It is about building a very, very strong foundation that is setting them up, them up for success for literally years to come. And so what is that? Number one, we're building a tremendous amount of strength during this. These foundational milestones. So when babies are starting out with tummy time, right, and they're lifting up their heads against gravity and they're working their shoulders a little bit because they're propping themselves up. That's great. And then beyond that, through rolling, they're developing a tremendous amount of core strength and shoulder strength. And through crawling especially, we are getting a tremendous amount of also shoulder strength, arm strength, hand strength, core hips. They're all engaged in this movement, right. We look at it like crawling isn't so hard, but for babies this is a real workout and that strength isn't again, just important. For now, it's actually going to support them for stair climbing, for jumping, for running around with their friends on the playground, for writing and a pencil grasp, coloring in the lines with good endurance so they don't get tired while they're coloring, cutting with scissors, buttoning and zippering for self dressing. These are actually all things that we don't realize takes a lot of strength until our kids don't have that strength to do it. And crawling is actually a very, very big part of the strength, the full body strength that our babies need to then build on for those higher level skills. So that's number one. We're also getting a lot of sensory input through all of these milestones. And if you have an older child, any listeners who have older children, you might have heard like sensory play, right? And we think of that as playing with sand or mud or dirt or slime, whatever it is, right. We're like, oh, this is great sensory play. But actually rolling and crawling are also the base, the basis of our sensory play and development because we are getting a tremendous amount of input through the joints that are giving our brains feedback about where our body is in space, where our body parts are in relation to each other. And so as babies roll around on the floor, crawl across the floor, they're getting all that deep pressure into their bodies that then supports them later on recognizing personal space so they're not in their friends faces that they're keeping a proper distance when they're walking in line down the hallway that they are grading for. So they place that block on the block tower gently enough that it's not going to knock everything else over. These are all things that are, that are built up through that. Our sensory systems that are developed through crawling and rolling also gives that proprioceptive input. That's the name of the sense. But it also helps develop our balance. By rolling around and moving our head against gravity in different ways, which also is done through crawling. We're actually supporting our balance. Which is ironic that rolling and spinning actually helps us with better balance, but it does.

Yeah.

Those are big parts of why these movements are so foundational for future development. Yeah.

As you're explaining this, I'm sitting here thinking like my balance has been one of my biggest things I've struggled with in like my Pilates reformer classes. And I went to a PT who basically said to me, five years ago, he was like, I want you to do Pilates Reformer. Like, you need to build core strength. And, you know, and I'm hypermobile. So he was like, I don't like yoga for you. And anyways, so in my classes, sometimes they'll have us do something where we, like, fully extend our neck, and we're, like, looking upside down, almost, like, over the back of the Reformer. And it will. It used to throw me through a complete loop. Like, I was like, no, I can't do that. Like, I. I can dip my head back with my eyes closed and still feel dizzy. And then at other points, like, I. So anyways, I've, like, so interesting. Yeah, I've slowly worked towards it. And it's like, as my core has gotten stronger, my balance has definitely improved because of the core strength. But also just I feel like now I. I have the ability, like, not full capability yet, but I have a greater ability to play with that and try and go full extension with my neck and come back up and not feel like the room is spinning and I'm going to fall over.

Yes. Yes. That is super interesting. And again, that vestibular sense that's responsible for our balance is housed in the inner ear, which is why those movements of the head against gravity in different ways stimulates that. And there's a sensitivity there for you, obviously. And it's something that in our babies, we need to develop it over time. We don't just come out right with great balance. Right. We know that our toddlers toddle because they fall over. They have to develop these senses. They have to develop that strength. And there's so many other important benefits that come from these milestones. I could literally go on for, like, a day, but we'll keep it short. But it's. But it really is something that takes time to develop, and we don't want to skip over. I really compare milestones like math. You can't skip over the basic addition and subtraction and jump to long division and algebra. It's not possible. And so we really want to focus on these early developmental milestones, make sure that our babies are mastering them so that later on when they're in preschool and kindergarten and doing Pilates, that they are able to do all those things.

Yeah, no, I mean, that's incredible, because I think about all these children that I've worked with, and it's. I mean, we always say everything is so interconnected, but this just kind of goes to show everything is so interconnected. You know, you get These children who struggle with any number of things that you have mentioned here. And you know, we always ask about milestones and when they were achieved on our, our intakes. Because even though we're not pts as speech therapists doing feeding therapy, speech, you know, we're language even. Still curious, I need to know, like, what's happened in this child's medical history? What does their developmental history look like? So I guess for a parent, right, if they're like, you know, because you kind of talked before about how everybody, you know, every everybody or baby develops at their own pace, quote unquote. If a parent's listening to this and they're kind of like, okay, but how do I tell? Like, do they just go back and look at those milestones? And if their baby's not developing in the recommended range, like, do you recommend they reach out for an evaluation? Like, what would the next step be?

Sure. So if you're noticing, I like to say that, right, we want to make sure that babies are meeting those milestones within those time frames and we want to make sure that babies are making continuous progress. Like, parents will a lot of times reach out to me and say, like, okay, my, my bab baby is, you know, nine months old and not crawling. Do I have to worry? Right? So that's like one that I say, okay, well what else is going on? Is your baby just sitting there? Right? Is baby just sitting and they're lumping around and they're hanging out and they are not reaching for toys, they're not grasping, they're not trying to get out of sitting, they're not really doing anything, then yes, right, we're not. We don't have to wait for that 10 month mark to say, okay, let's go start working on this skill. But if you tell me at nine months your baby is pivoting in circles and trying to rock on all fours and maybe can get in and out of sitting, maybe not, There are other things that are going on that are working towards that milestone that I'm like, okay, we can give baby a little bit more time. So it's really about noticing the progress. I actually have a free developmental checklist on my website that you can look at. What are those mini milestones or the mini stones as some of the therapists like to call that, because we're not going to just all of a sudden crawl. There are so many other things that we're going to see before baby starts crawling that they can push up through straight arms, that they can tuck their knees under them that they can rock on all fours. Maybe they're planking, downward, dogging, they're doing some interesting movements and then they'll be able to take off on all fours. Right. The other thing that I always want parents to look out for is that quality of movement. So if you are noticing that your baby is only rolling in one direction, that they are, that they do have their legs sticking out, you know, to one side and it's not really engaging as they're trying to move around. Those are things that we really want to also pay attention to because there's always a reason. And in the case with oral ties, there is always. We have to look at the full body to make sure. Is there tension throughout the entire body that's causing that? Right. That even though we might have treated the tie or working on the tie, but everything is connected in our bodies and so we want to make sure that we're treating that.

Yeah. I always love to say we're connected from the tip of our tongue to the tip of our toes. And so, you know, I know with my own kids, one was released at 24 months, one was released at 5 days old. Interestingly enough, my older one was like super. Both my babies could hold their necks up at birth, which I thought was fantastic with the first one, but then quickly learned that was not a good thing. But she was also the kid. My older one, she's almost 10, but she like, I think she was six months old and she was like climbing up the equipment at little gym. And you know, then she was holding herself for 90 seconds from like a bar and people were like, wow, she's so strong. And I was like, freak of nature. I don't know what's going on here. Like, no other kid is doing this. I feel like this is, I mean, it was interesting because like from a function standpoint, you look at her and you're like, she can independently do a lot of things that other six month olds are not doing yet. She would actually like climb up, flip her body around and slide down the other side at six months, like seven months or so. And then she was, she crawled up the stairs at six months and at seven months she was crawling back down all completely independently. And I was just like, I don't know what's going on here.

I don't even have baby gates to be set up for this.

I was like, I am not ready for this. I am not ready for this. She still walked, I think, like in a normal time frame. But yeah, it was fascinating because then I started to learn all about the connection. You know, this is like, almost 10 years ago. And I was like, oh, oh, okay. We're. We're a little tense, right? And. And I really dove into that whole tip of the tongue to tip of the toes thing. And so for my second, I was like, all right, we got to get on this a little sooner.

Yeah. And a lot of parents will say, one of the things I tell parents to look out for. Does your baby always want to be straight and vertical? Because parents was like, yes, my baby loves to stand. And they're four months old. And I'm like, right. Developmentally, babies should not. They could bear weight through. You know, if you're holding them up on your lap and they're standing and bouncing. Okay. But you're giving a lot of the support. If your baby always wants to be straight and vertical and doesn't like to be flexed, we have to look out for those things because that is a sign of that full body tension you're talking about where you're like, wow, my baby's a superstar. They're gonna walk at six months. And you're like, okay, let's slow that roll a little bit. Okay. And we need to look and say, okay, what is going on? Is it just that they really are that almighty powerful, or is it that the compensations are actually what's causing those movements?

Yeah, totally was compensation for her. It was. Yeah. She was that kid who needed to sleep on an incline. She needed to, like, she wanted. She was pushing up, like, almost at birth, pushing up off of me to, like, be, like, you said, upright. When you said vertical, I was like, yeah, that sounds about right.

Always like to be straight. And they're like, I don't know. My baby just loves to be standing and like that. That is nice and good. But let's also make sure that they can sit and flex and crawl. Right. And roll and all those things that they need to do, which they're not going to do if they're always stick straight.

Yeah. Well. And then the other thing, too, is tummy time in some of these kids who are so tense, especially if there is a tongue tie present, whether it's been released or not. I know we struggle because we'll recommend tummy time in sessions, like when we do feeding, and we'll recommend, you know, that they go see PT or OT or who. Whoever they're going to be seeing from, you know, to focus more on the rest of the body. And a lot of these babies cannot tolerate it, like, flat on the ground, they do better like either on a wedge or laying on the parent. And so is that also something you're shaking your head, something that you're like?

Well, the truth is there's also a lot of times also reflux, also other things, right? So sometimes it's in isolation that you know is high. And sometimes there's also other things going on, like reflux, which you're like, where's the tension coming from? Is it from the mouth or is it from the belly or both? And they're just like meeting in the middle. And so when we have babies who have that reflux, I'll just start there. It is going to be painful to be on their bellies. And so that's something that we would also want to deal with either medically we need to handle the reflux or change that angle against gravity. And so sometimes doing tummy time on an incline or on the parent's chest relieves some of the tension on the belly. If your baby is screaming in tummy time, stop. We don't want babies. It is not worth it to cause pain to your baby. So if your baby is screaming in tummy time, then stop. And we need to figure out what is the cause. And if there's really pain, then we need to work on that. There's also for babies who have oral ties, when there's tension in the mouth, it can lead to tension through the neck and the upper chest. And so when babies are on their bellies and they're trying to lift their heads and all those, those muscles and the fascia that's all really tight there, and it can feel very difficult for baby to lift their heads up, and that's really challenging for them. And so sometimes again, putting them on that incline gives them a little bit of an easier time looking around. Changing the angle can make such a difference. And we want to make sure that we're, you know, then building up slowly so that we're building more arm strength, that we are stretching the neck and making sure that we're getting more range of motion there so that it makes. Makes that prone positioning, that belly down positioning easier.

Amazing. Thank you. I feel like tummy time was challenging with my first, but a little bit easier with the second. So, yeah, it's one of those things I think parents really stress over these days because you see a ton of talk around it online. And again, I think it's one of those things where it's like, well, who do I listen to? What do I listen to? How do I Know if, like, my baby needs help and all that.

And parents always want to know, like, how much tummy time does my baby need to do? Right? And, like, there's really no exact answer to how much tummy. I mean, if you want to ask, like, the gold standard would be your baby, you know, every wake window, your baby's on their belly to play right back to sleep. Tummy to play would be like, let's do that. And it's just not always realistic because most babies are not as comfortable on their bellies because we don't put them to sleep that way. And so we need to be realistic as parents as, you know, what is going to work in our day. So there are a few things that parents can do. One is, after every diaper change, put your baby on their belly. That sometimes is an easy way to say, I'm going to get a few minutes five to six times a day, because your baby is going to need a diaper change throughout the day. Right. And so if you say, okay, I'm going to put my baby on this way, it's like just part of the routine. You don't even have to, like, find the time to make for tummy time. So that's one thing. Otherwise I say try like two to three times a day. Where, like, are your quote unquote session times for whatever skills you're working on, if you are. If you do need to support your baby in milestones and help them out, and then you can pick those times. You're like, okay, I'm focusing on this and we're gonna, you know, do what we need to do. Change the angle, lie in my chest. Sometimes I tell parents, like, roll up a small towel or blanket and put it under their chest with their, like, under the armpits. And that can also make a big difference to baby's comfort.

Interesting. I like that. Yeah. Yeah. Because I definitely had a kid who was just not a fan of that. We were not a fan of tummy time.

And not every parent has a wedge, you know, like a wedge cushion or something like that. And so everybody has a blanket or a towel. And so if you roll it up where it goes under, it actually just elevates that angle just a little bit. And it often makes a big difference.

Yeah. Okay. So one thing you mentioned is that a lot of these babies do sleep on their backs. What about the babies who are super tense that are constantly flipping over and, like, maybe they only can flip over one way by two or three months of age and they're Actually, they are sleeping on their bellies because that's the position they end up in. Still, tummy time would be like highly recommended for them as well, outside of sleep. That's important.

Similarly, I would say similar. We want to, certainly at these ages, I usually say we don't have to worry as much about tummy time when they're rolling consistently during play because they're getting all of that good input that tummy time is providing. But now they're getting it through rolling. So you don't have to be like, oh, I need to make sure that my baby's on their tummies for this amount of time. It's. We can just allow them to kind of roll around the floor if they're doing that. But it is part of typical development that babies will roll in one direction, meaning belly to back or back to belly and not the reverse, which can really disrupt sleep for both baby and parents. One of my kids was like this. And I think for a month she was waking up in the middle of the night, like crying because she couldn't get back over. And it was, it was a time. You know what I mean? I know. And I'm sure many parents are like, yes, this is hard. And so what you're going to do is we definitely. What we're going to want to do is make sure that we're practicing during wake times, because during the night, babies are going to automatically do whatever skill they've learned and their bodies kind of automated. What we want to do is make sure that we're practicing during our wake time so that it becomes more instinctive, but it will take a little bit of time. In many cases where baby does learn to roll over onto their belly and then to practice going over onto their back might take a few weeks. It is the case. But practicing passively doing it will make a difference. A lot of times the brain is learning those motions. So if you practice with your baby and you're passively rolling them over belly to back through the day, then their brain is learning that and it becomes part of their automatic motor planning.

Amazing. And I love too, you said something earlier a couple times just about how some of these are like foundational skills too, and how you kind of have to. It's almost like task analyze, break down even some of those foundational skills even further to get to those. And so I just, it just makes me think of like, would you build a house without a foundation? No, the house will crumble. So basically all of these skills that you're talking about are so critical to succeeding in life.

Exactly. And if the baby is struggling with rolling, some of the things I talked about crawling, but like some of the things you'd want to look out for, you know, is your baby able to prop themselves up on forearms or extended like straight arms? Right. Some babies, like they don't have even have any shoulder strength to push off of their belly and their, their arms are kind of out by their side. They're not really doing much, they're not participating. So you want to make sure, you know, at 4 months, 5 months, babies are propping up on their forearms and by six months they are pushing up is baby when they're on their back, are they, are they playing with their feet? Are they able to raise up their feet and try to reach for them? That's a good sign of core strength and flexibility. Are they able to reach with their arms to midline and across midline? When I say midline, I mean the imaginary line that runs down the center of the body. And we want babies to be able to reach across their bodies in order to roll over back to belly. And so these are things that we want to look out for as baby's approaching that rolling mile milestone.

Amazing. Okay, so now I have a controversial question. So maybe not so controversial, but the CDC back in like what, 20, 22 or something removed crawling altogether from their list of milestones, which I know a lot of OT and PT friends and US SLPs as well, we were all kind of in it. We were like, what are you doing? I don't know if they've removed anything else or if they just shifted milestones back. Recently I saw some more discussion around it and I didn't dive too far in, but thoughts on all this.

I believe that Ro, one of the rolling milestones was also removed. Like either back to belly or belly to back and right. Crawling was eliminated. And I have a lot to say on this topic, which is, which is that I don't really understand the reason for that unless they were just trying to condense the milestone checklist. I'm not really sure why crawling would be eliminated altogether when for thousands of years babies are crawling. Like it doesn't really make sense. And unfortunately the trickle down effect has led to parents being told that crawling is not a milestone. Don't worry about it. Again, going back to. As long as your baby can get from point A to point B or your baby will walk eventually, just don't worry about it. And that's the result. That's the effect that has Happened. And I hear this from parents all the time, which is they go to their pediatrician, right? Their baby is at the nine month well checkup. Baby's not calling crawling, baby's not making attempts to move. And they're like, don't worry about it. There's no milestone that they're checking off, right? There's nothing there for them to say, you know, And I question that because the cdc, it's kind of a reference. I don't know why it became this. Like, that is the standard of which all babies are supposed to go by. And so their parents are left being wondering when, how long they're supposed to wait and see, right? Is it till 12 months now? Is it till 15? Like, how long are they waiting and seeing? And they're not really given any tips. They're not given instructions of, okay, if you're not seeing this, this and this, call a pt, call an ot, call a speech therapist, right? They're not being given that guidance. And a big part of me says for pediatricians, I wish that they knew more about this topic, but they're not motor development specialists. They're not the ones that know they have to know about feeding and weight gain and eczema, skin rashes, diaper rashes, the flu, right? They're doing a lot of other stuff. And so to expect that they also know about developmental milestones, well, that's a big ask. And babies are not in performance mode while they're at those, well, checkups, right? Babies are cold, they have stranger danger, they don't want to be there, they're crying, they probably needed to be fed, and they need their diaper changed. All in that, you know, 20 minutes that you're seeing your pediatrician, if you have that long. And so your baby is not showing off any skills or lack thereof. The pediatrician might look at your baby and say, oh, well, they didn't move around for me, but they're crying. Of course, I wouldn't expect them to be moving around. They're not actually getting a good understanding of what your baby is capable of doing. They're getting a tiny snapshot. And so we're expecting our pediatrician to be able to like, kind of look and see and take a little bit of what we're saying and then give us that guidance. And unfortunately, that's not happening. And certainly not happening now that the CDC did change those, those that milestone checklist, the guidelines. And that's why I think it's unfortunate but helpful for parents to then go out and you Know, it's important to hear this information that we want our kids to have this strong foundation. There is a window here where we can give our babies the support they need if they are falling behind. We don't want to miss out on that opportunity. Yeah.

And I guess another question kind of on a same topic, but different, different topic related to this. Do you feel, because I know this was a big concern that we all had, especially for kids who might be, you know, able to access access services through their local county or insurance coverage. Do you feel like this removal of this skill has impacted kids accessing maybe skill or services that they need?

It's a really good question. From my understanding because I haven't been in the early intervention system in a while now. From my understanding, they were still using the old, the old evaluation tools. From what I had heard of, like that crawling is a miles. I believe that they were still. Yeah, I though I have heard of parents going sometimes even to pts and they're like working on walking instead of crawling, which I'm like, no, come on, I need to educate you too.

You're supposed to know this.

Come on, be part of the team. But I, but I, I do believe though, and the real effect that I've seen is that parents are waiting a long time. There's then wait lists to get your evaluation and now where you could have maybe started something at 8, 9 months. Parents are waiting till like 11 months and then by the time they get the evaluation, they get started with services. We're so behind that maybe the PT does feel like, well, we're already at 12 months. What are we working on crawling for? Let's get them walking, you know, and like, because we've, I don't want to say we've missed the window. I've gotten 12 and 13 month olds crawling. But it's that kind of time period where like, well, what should I be working on now? Because we're really past that milestone and so do we work on that foundational component that we really want to make sure we have, which is where I go by, I tend to follow, or are we working towards that next functional skill where we're really 12 months is now in the middle of the walking milestone. And so I think it can be a confusing thing of like, where do I go from here? And I think that wait time is problematic. I understand the dilemma, but I wish that pediatricians when again you're looking at those things of the quality of movement delays, you know, we're not seeing those mini milestones coming about that there was more proactive approach to referring out for services.

Yeah, yeah, no, it's, it's interesting. I think kids are making it into the system, if you will, a little bit later unfortunately, because they didn't just change motor milestones, they changed all kinds of milestones. You know, CDC guideline wise and, and I do know and so I'm glad to hear that some of the systems are still or not systems, but counties, you know, county based programs are still still hopefully using some of these assessment tools.

And I wonder if that will change.

Well, and the thing that concerns me honestly because I also worked in like infant and toddler program in Maryland back, back in the day. They based like if a child qualified they had to have a 25% or more delay. And that was often based on the CDC guidelines. So even though we were using certain assessment tools, they were kind of like our system tells us if this is a 25% or more delay. And I used to override it sometimes and be like this kid needs therapy. I don't percentage you think they're at. These are foundational skills. If they don't have them, like why are we going to create an even bigger gap by not serving this child? And so I was kind of a rebel. But yeah, yeah.

And like that's what you hope for, right? And it's a very hard call to make because you're like well if I add these up and, and, and some of the testing is kind of, you're like how did they even come up with these specific tasks that a baby's supposed to do, a toddler's supposed to do? You're like, why these versus that? Like I remember when I was evaluating a lot in the school system, it went from like, can a child like kneel on a like be in a kneeling position to like jumping. Like I forgot what like the next step was, but like it was like a big like jump. And I'm like, well there's a lot that happens in between there of like kneeling and like going up four steps. Like it was just a very big difference. And you're like, this is not a great tool, but those are the tools that are out there. And so that's where sometimes you hope for, you know, somebody to advocate on your behalf and as a parent, you know, push a little bit and make sure you are advocating saying no, I really need this, you know, this service for my child. And sometimes that push can also get your child what they need.

Yeah. And I, and I think it really holds across the Board because it just makes me think about, about what we do in feeding. Right? Like, just like you're saying you have these foundational skills. It's so fascinating because we'll screen a kid, not even do a full assessment, and we'll see these splinter skills. We'll see like, oh, they have some later skills, but some, somehow we, we skipped some of the earlier ones. We can't do those yet. And you know, maybe they had it when they were in an infant and it was more reflexive, but the reflex never like integrated. They don't really have, you know, control over it now. And so just with like their tongue movements or whatever the case may be and like, we'll go back just like you kind of said, and work on those foundational movements because you really, truly can't build like when you speak about the quality of movement and functioning properly, it, you really aren't going to get there unless you have those foundational skills in place. So I think it, it's a really big conversation that I think more parents need to have access to and understand so that they, you know, they, they know why we get a little bit crazy about certain skills being taught and our passion behind it. But really it's also like we're trying to set the kid up for success going forward.

And I've gotten some, some pushback from some pediatricians out there, like don't tell. I have gotten messages actually of like, don't tell parents not to trust their doctor. Doctor. Right. And I, and I'm like, that's not exactly my message. Right. But I actually have, I've gotten those messages and I'm like, it's not that I'm telling parents to not trust their pediatrician. I'm telling you to trust your pediatrician in the areas that they are the experts. Right. And to expect that a pediatrician is going to be an expert in every area doesn't make sense. It doesn't make sense. And so, so we, and maybe there is also education to be done in the medical community as well of like, you know, I often say that if a child, if a parent takes their six year old to the pediatrician, they're going for a well checkup. And they mentioned, you know, my child is struggling with coloring and cutting and copying from the blackboard and other things that are going on. They can't get dressed and buttoned, whatever it is. Right. They're struggling. The doctor might say at that point, oh, you know, can you get OT services for them? They're not going to go Back and look when that child was nine months old and say, did this child crawl? They're not going to do that. It's not what the doctor's doing. But you and I do that when we evaluate the six year old for services. Right. We're the ones asking the parents, tell me about your child's early development, what did they do when they were babies? And so we're making those connections where again, this isn't a shame on the pediatrician, but that's not what the pediatrician is going to do.

It's not really their job necessarily even. Right. So why be offended?

You don't have to be offended, but it's okay to say, listen, this is our area of expertise. This is not. And so we need to refer out or we need to learn enough so that we know when to refer out. That's really an important part. And I think that there's a gap there.

Yeah, yeah. I mean, I 100% agree that we are in that same scenario when it comes to like pediatric feeding and even speech and language development. Because is. I can't tell you how many times like I think, and I think a lot of people get their panties in a bundle when anybody's like, I'm a specialist, that person is not necessarily a specialist. And it's like, let's put our ego aside with our patients. You know, best interest in mind. Nobody's assuming anything negative about you. We're just saying, hey, this is what I do, this is what they do. Yeah, like, let us help your kid. You know? And so yeah, it's, it's, it's a wild world out there.

I think after you and I have probably listened to so many parents feeling a little helpless, feeling frustrated, like they don't, they know that something's going on. They know that something's not right and they don't know what it is and they don't know where to turn. That's when we're like, right. This is why it's so important for parents to know who to go to for these questions because they're left feeling helpless. And that's not the way any parent should feel.

Yeah, I do feel like in the age of social media, we are getting a lot of parents who are like, like seeking information. And again, not to say that it's always the right information or the best, but they're at least seeking, they're trusting their gut more. And I think it's just, you know, I've been a big, big advocate of parents. Like, if you feel like something is off and you can't pinpoint it. That doesn't make you crazy. Like, you find a provider that's going to go down that path with you and help you figure out what that thing is. And I think that in so many parents, brains, step one is the pediatrician.

Yeah.

It always is, Right. They're always like, well, I'm gonna go make an appointment with a pediatrician. And I. I like to say, look, you. You can do that. But they are not PTs, they are not OTs, they are not SLPs. So after you make that appointment with them, let's make an evaluation appointment with this provider, too. So that step one, but here's step two, right? It's because I feel like sometimes you go and listen again, not to throw them under the bus, but sometimes some pediatricians are like, everything's fine. They look great, like they're doing great. What are you worried about, Mom? And it's like this.

They're gaining weight. Everything's fine.

Yeah. And it's almost like medical gaslighting without the doctors even intending to gaslight sometimes. And, you know, I think it's just parents and feel defeated, deflated. They're kind of like, I feel like I went out on a limb here. I advocated. It wasn't even comfortable to have this conversation with the pediatrician. I was basically told, nope, your kid's fine. And sometimes that's where. That's where the journey ends.

Yeah.

You know, and so it's very hard.

And I think that parents also then wonder, like, right, what if something's really wrong? Like, you know, they're nervous to go down that route and then also being kind of dismissed. It's like neither one feels right, you know? And I think also what's unfortunate is that parents aren't even told by the pediatrician that if you're in the United States, every state has an early intervention program where you can get a free evaluation. So there's like, literally no harm in telling a parent, hey, if you're worried, make the phone call. Right. Like, I don't understand why that's not even part of the conversation where you could say, listen, if you're concerned, you know, either look out for these things, or if you're not seeing progress in a month because. Because the. Well, checkups are spaced out. You can go months at a time without seeing your pediatrician. Hopefully your child isn't sick. Right. You're not going. And so if you're not going for those well checkups, you're not asking Those questions, months can go by before you're even readdressing that, that concern. And parents aren't even aware that they can actually get an evaluation.

Yeah, yeah, no, we've had that happen. We've also had, like, on the flip side, some parents go, well, I don't want my kid attached to, to the school system because I don't want them to carry forward this diagnosis if we get one. And, you know, it's very interesting having, having worked in that infant and toddler program, you go in on, what is it? An ifsp. So an Infant Family Service Plan. Ifsp, Infant Family Service Plan. And so whatever the child has, if you don't move to an iep, it doesn't carry forward into the kindergarten and beyond years. And so I've always encouraged families, like, get the services if you can. At least where we live in Maryland, they're free to even get the services. I know that's not true of every state. I know some states you do have to pay for the services or sometimes it's run through insurance or whatever. But, you know, I'm like, it can't hurt. It's not going to follow your child. It's at least going to give you some information to go off of and then you can decide what you do with it next.

Exactly. And sometimes giving them that extra support for a few months, a year to whatever it is that the challenge is, is going to make all the difference.

Right.

It doesn't mean that there is a lifelong challenge. It can sometimes mean your child just needs a little bit of support. And at this stage, that's okay.

Yeah. Yeah. And we've worked with a number of families who were seeing us through my private practice, and they're also getting county services. And we're like, hey, the more the merrier. Like, if this is. This is helping your kid, by all means, use this resource. Your taxes pay for it. You might as well.

Exactly, exactly. You're like, paying for it just through a different avenue. Go for it.

Yeah. So what are some other, like, I know you gave a couple tips already, but are there any other, like, simple things that parents could possibly do at home to kind of just support their baby's development? And I know we talked a lot about, like, tummy time and some of those things, but anything else.

So to build off of the tummy time and in a different way is we wanna limit container time as much as possible. And what is containers? What are containers? Containers are anything that a baby is put in that limits movement. And that could be Anything from the high chair, the bouncy seat, an exor saucer, and even a car seat. And so what that does is, is it constricts baby. It restricts that movement and that babies can't move against gravity, Try to wiggle around, practice their movements. And a lot of times we can go through an entire day and realize that our baby never hit the floor. And not by hitting, I mean just being on the floor. Like, you know, like they, we, you went to drop off your toddler at school and then you went to the supermarket and they're in the car seat and that became a stroller and then you're back in the car seat and then they fell asleep, so they're staying there. And then you, you get at home and you're putting them in the high chair and then they're down for a nap or whatever it is, right? And you go through so many hours where baby has never had an opportunity to play on the floor and move around. And then we're wondering why at 6 months, baby can't roll because they have such limited time to practice. This all takes practice. They're not going to just roll over. They have to practice and develop their strength and movement patterns. So that's a really, really, really big one that I think is important for parents to remember. And it really depends on the stage that we're working on. But I never tell parents that they have to go out and buy any toys. But keeping toys that are playful, open ended toys that don't have a lot of lights and sounds, that baby's gonna just watch and you know it's going to play for them. But things that are more interactive, like play tunnels, like those, you know, fun foam couches or blocks that babies can crawl over and reach and climb over. Those are all really good things to have around your house, your playroom that are going to support development, encourage babies to move rather than things that are going to just play for them and they're not going to be trying to develop their strength and their movement patterns.

Amazing. I learned about containers, I think after Lily and I will tell you, because she was that kid who wanted to be, like you said, you know, vertical. The only way she would really nap during the day was in the stroller on the go. And so we would go spend time in Nordstrom and walking around in the night because they had the nice nursing lounge. And like, I just, I look back at her and I'm like, oh, yep, she was pretty much a container baby and just really maintained that tension that she'd carried from birth for quite a while.

Yeah. And like, we also have to remember that, you know, we're human. Right. And every baby is different to some extent. I'm telling you. My baby's also all napped in the stroller on the go. I had, my first two are twins and I couldn't get them both to sleep at the same time unless I was walking. So that just became the way I put my babies down for naps was like on a walk, do what you gotta do. Totally relate. And we have to be understanding of the fact that life has to happen. We have to go on errands and we have to go do those things. And that's fine. And that's why I either say at every diaper change, change, or, you know, set aside 10 to 20 minutes twice a day that you're like, okay, this is like our floor time. This is again, others will say, you know, whatever amount of container time you have, double the amount of floor time. Some days that's gonna. I know that's like, it's a lofty goal. And if you can, great. Like, there are babies who are in my program when we do a lot of stretches for that tension and, and parents will come back to me, you know, a few weeks later and say, like, all of the old movement patterns, like the tightness seems to have come back. And I'll say, did you spend a lot of time in the car recently? Right. It's either like sickness or the car. Like, yeah, actually we did. And a lot of times that car seat is so it's. It's meant to restrict movement because, you know, there's no car seat for safety reasons. Babies should not be moving around. And when babies are in the car seat for long periods of time, it. It really. They end up in those movement in those positions that exacerbate that type of tightness. And so I say, even if you're gonna, you know, walk around Nordstrom and I power to you, I did it myself. Take your baby out of that car seat and put them in a regular stroller. They're going to be able to move around a little bit more, a little bit easier, and even just to wiggle around a little bit makes a big difference rather than being so restricted in a car seat.

Yeah, no, it's. It's interesting. I actually won one of those doona car seat stroller combinations.

Most popular.

I never took it out of the box. It was like they were brand new because this was like 10 years ago and I had like an uppababy stroller. And at certain points, like when she was really, really little, I would keep her in the car seat and just, you know, move the car seat over to the stroller because she was sleeping. I was like, I am not waking that child. She's asleep. But then as she got a little older, I was like. It just. I felt like she was so crunched in that little infant seat that I started moving her, even if she was sleeping, into the larger seat and just, you know, laying it down. But it's so fast. I'm like, I guess somebody, something about me knew that that car seat stroller combination was just not going to be good for her. So I never opened it. I ended up selling it, like, inbox, new to somebody.

Wow.

But I know it's become so popular.

The most popular stroller out there. Convenience, like, and I didn't. I mean, I don't think my twins now are 14. And so they didn't have that. They did have some of those, you know, contraptions where you take the car seat and you put it in. Yeah. But I had one for a double car seat, but it was impossible to move around, so I rarely used it. And so, again, I also make. Maybe just because I didn't even have the option, I ended up moving my babies always to a regular stroller. And I also wasn't so well versed on. I knew about containers, but, like, I wasn't even so, you know, really, I didn't go down that so far. And now I look back and I'm like, no, it was really important to take them out of that car seat. And it just happened to have been for me, you know?

Yeah. Yeah. I mean, I feel like by the time my second one rolled around about seven years ago, I was like, okay, we have a whole new level of knowledge. We gotta do more tummy time early on. We gotta get her into pt. We gotta do X, Y and Z. Yeah. I mean, it was a totally different feeding ball game. Her feeding was so much better because we were so focused on her whole body. You know, it was so. Even though we still had a leg that was dragging and we had other work to do, you know, it was definitely approached very differently. And, you know, but I had the knowledge, right. I had the knowledge that time around.

So the difference in that.

Oh, yeah.

That full body is so key. And that's why paying attention to the whole body, when maybe with an oral tie, you're focused on. On feeding and suck, swallow and all those things that I'M not well versed on because I'm not a specialist on oral ties specifically. But when you look at the whole body and you're like, right, only one arm is reaching and not the other one. Right. Or my baby has like zigzag toes. The toes, you know, curl over each other. And that's also a sign of full body tension. That vertical, straight posture, all these things. Right. Using one side. We're only rolling in one direction and not the other. Those are all signs to really pay attention.

Yeah. And it's, it's interesting because I have like their one year old photos up on a wall in my kitchen. And you've got like Lily sitting on the ground, who's my almost 10 year old. And they've got Mia, who's kind of up on this little like, stool, which probably was not the best for her because there was no foot support. So put the kid who has all this like gross motor stuff. We've been working on a little stool with no foot support. And her little toes do exactly what you just said. She kind of like turns into like, like tense her body and hold herself in that position. And it's like they're kind of like, I have to go look at it. But they're kind of just like flared out in a funny way. And I'm like, it's because she just, you know, her center of gravity was off and she did not have the right support. And so it's just again, it's all these things. And I look at that every single.

Day as I walk past that constant reminder.

Oh, my goodness. But I'm like, how far they've come, how far they've come. But yeah, I totally saw the difference. And, and it's like to your point too, you know, with feeding, one of the early signs that like we see also are babies who will feed better on one breast than the other because of their neck. Right. They have more tension on one side of the neck because of the tension in the mouth and in the neck and, you know, throughout the upper chest area as well. And so we'll tell parents, like, that's a pretty early sign. If baby is emptying one breast, not the other. They're fussing on one side. They seem to have a preference. There is probably some full body tension. And you definitely are going to want to, you know. Yes, talk to a feeding therapist if that's impacted. But you also need some form of work on the body, whether that's a pediatric physical therapist or, you know, whoever the person is in your area that works with breastfeeding infants, so. Or bottle feeding for that matter. But anyways, it. It's been so, so eye opening.

Yeah, absolutely.

Well, this has been amazing. So I know we could talk all day, but tell everyone where they can find you online on Instagram and we'll make sure to put that also in our. In our notes.

Thank you. So you can learn more about me. TutsonTarget.com and I run an online membership to help parents support their babies in their milestones. And so included in the membership is our courses on demand courses. Rolling, Crawling and Walking, plus infant Massage. So that it gives you a lot of great content that you can watch anytime. Plus you get direct access to me. I support my members every step of the way, so any questions you have, I will answer them. We run live group zoom calls so that parents can come and show me their baby, ask me their questions and make sure that their babies are on track. We have so many members who have that. Their babies have that history of oral ties and you know, they didn't get that guidance. And so that is. Is the program that I run. I'm also on Instagram, TikTok, YouTube, Pinterest, tots on Target is my handle and I'd love for everyone to come follow and learn more about milestones and everything else they need to know about development.

This is amazing. Where were you 10 years ago? Well, thank you, Allison. This has been fantastic. I know that some parents are definitely going to find this, you know, super helpful and I love that you have that membership for parents because I think that is so very needed. So thank you for sharing your knowledge with us.

Thank you so much for having me. I loved our discussion.

Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, air weight and feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources at all I offer@hbalkin.com or pop over to allybulcan on Instagram to get all the latest updates.