Gastroesophageal reflux (GER) characterizes the reverse flow of gastric contents into the esophagus. To some extent, this is a physiological process that can occur throughout the day in both children and adults. If ger-related problems occur, we define it as gastroesophageal reflux disease (GERD).Risk factors in childhood include: chronic respiratory diseases (bronchial asthma, primary ciliary dyskinesia, cystic fibrosis, etc.), constipation, obesity and psychomotor delay. However, it often occurs without these factors. GER is formed by transient relaxation of the lower esophageal sphincter (DJS).

The esophagus runs from the oral cavity to the stomach through an opening (hiatus) in the diaphragm. The diaphragm is the main respiratory muscle and determines the optimal tension in the thoracic and abdominal cavity. DJS is located under the diaphragm, in the lower region of the esophagus (called cardia, or gastroesophageal junction). DJS can be thought of as a muscle ring that differs from other muscles of the esophagus and stomach by a higher tension and also by a different response to hormonal, pharmacological and nerve stimuli. The separation of the esophagus and stomach is achieved precisely by the higher tension of the DSJ. The main causes of GERD include a decrease in DJS tension, antral hypomotility (reduced mobility of the stomach in the area of DJS, possibly even duodenogastric reflux – reflux of bile from the small intestine to the stomach).

Difficulties caused by GER arise from exposure of esophageal tissue to gastric acidic contents. GERD can manifest itself: pylorosis, pain behind the sternum, a feeling of acidity in the mouth, repeated vomiting, increased tooth decay, morning sore throat. These specific problems may be associated with non-specific difficulties such as: restlessness, intermittent sleep, refusal to eat, more serious symptoms include aspiration pneumonia, chronic bronchitis, irritating cough, apnea, repeated inflammation of the larynx, middle ears and sinuses.

In addition to these somatic difficulties, we find specific associated blocks in muscles and ligamentous formations and their concatenation indicating this dysfunction. Sometimes the typical standing of a child with GERD is noticeable, with the center of gravity in front, up to a slight forward bend, with the right shoulder slightly oriented forward and the left shoulder turned backwards and slightly drooping .A slight rotation of the torso to the left is probably the result of turning the lower part of the esophagus downwards and obliquely to the left. During neural examination, we find the involvement of n. vagus and n. phrenicus on the left, which we palpate as higher tension in precisely defined areas.

In hiatal hernia (part of the stomach de facto passes through the hole in the diaphragm), which is also one of the causes of GERD, we find tension on the fascia of the neck and torso on the left. Due to the above disorders associated with GERD, the child may complain of pain in the left side of the neck and left-sided headache, left-sided pain in the upper limb. The fourth intercostal is often sensitive. In adults, up to left-sided frozen shoulder syndrome may occur. I have repeatedly encountered this comorbidity in a long-lasting GERD in an adult patient, and it is not so common in a child and an adolescent. However, what is a frequent phenomenon in children is the limited mobility of the jaw joint connecting and the pain of the head part behind the left ear, in the area of the cranial seam of the so-called occipitomastoideal suture.

There are many different investigative procedures. In children, a carefully conducted medical history is probably the most important, and the gold standard is the 24-hour measurement of pH in the esophagus (esophageal pHmetry). Which is represented by the introduction of a thin probe through the nose into the esophagus; connection of the probe recording the pH in the esophagus. The patient performs normal activities within 24 hours, eats normal food, and then the probe is taken out and the record is evaluated (note: there are also other special examination methods, but they are not the topic of this text).

If GERD is suspected, treatment should be initiated in the first place. In the hands of the doctor is the question of the use of medication, but its results in children may be questionable (the desired effect is not always achieved even in adults). In most professional articles, you will read that in children from toddler to adolescent age, it is not proven that success in treatment is brought by some of the regimen measures that are usually recommended for infants. Thus, similar recommendations can be applied in adolescents as in adults.Therefore, the advice remains very general: first of all, it is recommended to reduce weight in obese people, do not smoke and drink alcohol, do not eat shortly before falling asleep, or adjust the position in sleep (e.g. sleep on the left side).

As the main therapeutic method, I would recommend manual treatment such as visceral and neural techniques, exercises focused on the proper functioning of the diaphragm and trunk muscles and specific regime measures. It is necessary to work with the diaphragm, tissues and organs around the cardia, or in the neck and head area. Neural treatment of nerves that are negatively affected by GERD and that innervate DJS can also help. We can never forget the treatment of the fascia of the chest and neck. All these methods are not demanding for an adult or a child, neither in terms of time nor otherwise. Only if it is necessary to work with the diaphragm and other muscles of the trunk, it is necessary to find time for daily exercises in the home environment. Working with the diaphragm means changing the tension of the muscle and ligamentous part, as well as the surrounding muscles, optimizing their mutual coordination and their activity. If a parent exercises with a child at home, a better effect is always achieved. It is up to each physiotherapist what method of harmonizing the tone of the diaphragm he chooses and how he is able to pass the exercise to parents and the child patient.

In addition to the general advice, I would also like to specify the regime’s measures. Children should not eat immediately before bedtime, they should not wear a tight belt or other tight clothing, I recommend sleeping with the upper torso and head on the pillow, not staying long in a forward bend or during sports or other activity, do not stay with raised arms or bowed head, prevent constipation with an appropriate diet and avoid eating oranges and other citrus, chocolate, tea, fatty foods, fried foods, mustard, if you already consume these foods so never in the evening, but as a first course and in small quantities. For girls who are already menstruating, it is advisable to avoid food just before menstruation, because hormonal changes in the body also affect the tone of DJS. For adolescents or anyone else who suffers from GERD and not only because of GERD, I do not recommend coffee, tobacco or alcohol.

Mgr. Michaela Zahrádka Kohlerová

Reference
1. BARRAL, Jean-Pierre, MERCIER, Pierre. Viscerální terapie, Poznání, ISBN 80-239-6721-5.
2. http://eportal.chirurgie.upol.cz/portal_final/?page_id=241
3. http://www.nemcb.cz/cz/page/76/Vysetreni-hodinovou-phmetrii.html?detail=409
4. KLUSÁČEK, Dalibor. GASTROEZOFAGEÁLNÍ REFLUX V DĚTSKÉM VĚKU. Pediatrie pro praxi [online]. 2001, roč. 2, vol. 1, s. 36-38, dostupné také z <http://www.solen.cz/pdfs/ped/2001/01/11.pdf>. ISSN 1803-5264.
5. MUNTAU, Ania Carolina. Pediatrie. 4. vydání. Praha: Grada, 2009. s. 359. ISBN 978-80-247-2525-3.
6. THOMSON, Mike Andrew. Endoscopic approaches to the treatment of GERD. J Pediatr Gastroenterol Nutr [online]. 2011, vol. 53 Suppl 2, s. S11-3, dostupné také z <https://www.ncbi.nlm.nih.gov/pubmed/22235451>. ISSN 0277-2116 (print), 1536-4801.
7. VAN DER POL, Rachel, Marije SMITE a Marc A BENNINGA, et al. Non-pharmacological therapies for GERD in infants and children. J Pediatr Gastroenterol Nutr [online]. 2011, vol. 53 Suppl 2, s. S6-8, dostupné také z <https://www.ncbi.nlm.nih.gov/pubmed/22235448>. ISSN 0277-2116 (print), 1536-4801.
8. VANDENPLAS, Yvan, Colin D RUDOLPH a Carlo DI LORENZO, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr [online]. 2009, vol. 49, no. 4, s. 498-547, dostupné také z <https://www.ncbi.nlm.nih.gov/pubmed/19745761>. ISSN 0277-2116 (print), 1536-4801.
9. WENZL, Tobias G, Marc A BENNINGA a Clara M LOOTS, et al. Indications, methodology, and interpretation of combined esophageal impedance-pH monitoring in children: ESPGHAN EURO-PIG standard protocol. J Pediatr Gastroenterol Nutr [online]. 2012, vol. 55, no. 2, s. 230-4, dostupné také z <https://www.ncbi.nlm.nih.gov/pubmed/22711055>. ISSN 0277-2116 (print), 1536-4801.

Článek Gastroesophageal reflux in children from toddler period to adulthood se nejdříve objevil na BeBalanced.

The first months of life are key, from the aspect of motor development. It may seem very early, but knowing the typical motor milestones and when approximately they should occur is extremely important in the diagnosis and treatment of developmental disturbances.

Ideally, it’s best to capture a delay in development, or a non-physiological development as early as possible, before any substitute patterns are created by the newborn and then fixed into their movement repertoire. From the 6th week of life, a baby is already able to develop compensatory mechanisms therefore the earlier the treatment the better, as we can still highly influence the maturing brain and reinforce the ideal patterns.

Here, we will describe a child’s physical development, in terms of quality, during the first year of life, so that you may deduce how your child moves and recognize any ‘weak’  links in their development, especially for example after a difficult birth, or for babies with higher risk for developmental delays. Moreover, if you have any doubts or questions, please do not hesitate to contact us, we would be glad to help.

1st month of life
When babies are born and leave the mother’s womb, they struggle with a lot of changes and stresses from the new environment. They have to deal with the influence of gravity, begin to breathe by themselves, manage their temperature, eat food via the mouth and cope with digestion and excretion. Although they are able to see, just a short distance, they’re unable to observe who and what is around them. They’re also bombarded with other sensory inputs; auditory, olfactory, taste and tactile sensations. All this places high demands on the body of the small newborn, which is why they tend to sleep for the majority of the day.

The position of a healthy newborn is asymmetric. They often prefer to look to one side. This is called a physiological predilection. However, they should be able to rotate the head to the opposite side when an adequate stimuli is introduced, for example, if they smell the mother’s breast milk then they’re able to turn their head towards it but normally returns the head to the side of predilection afterwards.
When the newborn lies on their backs, they usually move constantly in a jerky manner and here we may observe the legs and arms kicking and moving alternately. The movements are generalized and non-purposeful. When we lay them on their stomach, their head is turned to one side to breathe and they support themselves on their bent knees and arms placing their head at a position lower than their pelvis.

At the age of 6 weeks

From 4 to 6 weeks, the predilection and jerky movements slowly begin to disappear and even if you lay a child on their stomach, their pelvis should appear to be lower. Eye contact fixation appears in most children, as they begin to observe objects and express a desire to grasp it by turning and lifting their heads up. Their main impulse and motivation to move are mainly their emotional needs. Their attempts to reach for objects may elicit the position of the „fencer“ as they turn their head to the side of the stimulus/object of interest, and stretch out their hand in an effort to grasp it (free fists), while the other hand flexes to a bent position.

In the photograph above, the child is in a ‘’fencer’’ type position, however it’s not ideal. Why not? It’s important to distinguish a physiological fencer position from an abnormal one. The hand on the stretched out side in the picture isn’t in a free fist but instead a closed fist, with an inward rotation of the arm, therefore it isn’t prepared for grasping. This means that the child has weakened deep abdominal muscles that are not providing enough stability in the trunk area to allow for good distal movement, and when this is the case we can observe that the belly of the baby is protruding to the sides and their lower ribs point out, as in the photo. These difficulties can be treated successfully by the Vojta method. If left untreated, the baby would continue to develop with weakened deep belly muscles and reach all the motor milestones, however they would just do so by creating inadequate motor patterns and compensations.

On the stomach position, a 6-week-old baby should rest on the forearms and belly, and already be able to raise the head a little bit from the activation of the deep neck muscles, but can’t hold it for long. You would also notice that the pelvis isn’t lifted up high anymore, and the feet are stretched out loosely on the ground. We should change positions of the child at this age frequently.  It’s practically important to give the baby sufficient tummy-time, preferably without diapers.

At the age of 8 weeks

During this period, a so-called physiological dystonia is typical. This is when the baby ‘’shakes’’ their hands and feet upon seeing their mother or a toy. Parents are sometimes concerned about such movements and ask whether this is normal, and it is. The desire to reach for an object is also expressed by movement of their whole body and the use of different facial expressions.

On the tummy, a baby at 8 weeks is able to lift the head in a neutral position and keep optical contact while supporting on the forearms and the lowest part of their abdomen. Rotation of the head still isn’t completely isolated and causes a side-bending of the spine. They still have their hands enclosed in fists.  On the back, the child should also be able to raise the legs off the bed and hands symmetrically and show contact of the fingers, but more often the legs rest with the heels on the table.

3 months

The age of 3 months is considered one of the most important milestones. A strong foundation is created around this age. The quality of this foundation is responsible for how the baby will hold their posture up until adulthood as well.

At this age, the baby can already take a completely symmetrical position. While lying on the stomach, the body weight is shifted to the pelvic region and elbows, allowing an even extension of the spine and raising of the chest to a higher position with their palms open. They are able to hold a longer eye contact and rotate the head to both sides (30 degrees) and communicate with their surroundings. The baby should be stable on the belly and shouldn’t show tendencies to fall or turn around. If a child turns to his back or belly at this stage, it’s not an expression of their rapid development but on the contrary, a sign of instability. While on the back, there is contact of both hands, palm to palm, and the legs are lifted off the ground with 90 degree flexion at the hips, knees and ankles. A lot of hand-to-mouth play is seen at this age.

If a child has poor development or weakened activation of the deep abdominal muscles, they would spend the majority of the time lying on the back with their feet down, or constantly kicking and doing „bridges“, as compensation. Sometimes, that can also be normal behavior, however it wouldn’t last more than a few weeks. To distinguish a true weak belly, flaring out of the ribs or the abdominal muscles to the sides occurs every time a child would raise their legs.

4-6 months

As we’ve already mentioned previously, during the first 3 months of development, an important foundation is built which is the main support base for all movements of the limbs. This is due to the balanced activation of both the extensors and flexors of the axial organ and the intra-abdominal pressure created within the abdomen. The abdominal pressure is created by the abdominal muscles, the pelvic floor muscles and the diaphragm. The quality of this balanced activation can be seen from the position of the child lying on his back, symmetrically and very stable. If this support base is insufficient or weak, there would be overloading or worsened movements of the limbs and they would eventually wear and tear. Lack of any of these key areas will be reflected in further developments but not necessarily like a delay in development milestones, but rather in the quality of movements being carried out. This can result for example in scoliosis, or other faulty postures such as: flat legs, crooked knees, rounded or flat back, bulging belly, protruded shoulder blades, forward-head posture and so on, which are seemingly small things but may still cause a lot of problems in adulthood like the majority of pain syndromes we see today.

4^th-5th month

After a child of this age, we want nothing but a pretty stable position on their back and tummy. A child in four months already searches the sources of sounds with their stronger eyesight. The child is able to change their voice, laugh and usually require more contact and attention and could recognize the faces of their loved ones and build strong relationships with them, specifically the mother. By 4.5 months old, the child should perform all their skills symmetrically on both left and right sides. If you have registered that the child prefers to support or use one side more than the other and that this lasts for over two weeks, it’s recommended to seek medical attention. We may also recognize that the child when anxious to grasp something, creates an airplane position with their limbs and this unstable position is often a sign of weak abdominal muscles and inadequate support of the upper extremities. This may later be connected to problems in crawling.

The most important position when the child is on their stomach is the crossed-pattern support position. This is when the child supports on one elbow and the opposite knee (both limbs in flexion), and grasps at toys with the free arm. Here, the deep core muscles are activated creating a neutral position in the hips. This also allows for rotation and extension of the spine up to the lower back. In the back lying position, the baby begins to reach for toys in mid-line, examine them by manipulation and move them from hand to hand. They also begin to grasp across mid-line, which is the very beginning of turning to the side. The legs are lifted above the floor/bed almost all the time with a higher range of hip flexion that they are able to touch their knees, and their feet have full contact with each other.

By age of 5 months, the child straightens up even higher on the tummy by extending the arms fully and weight bearing on the upper thighs. When handling toys in the midline, they may show a type of ‘swimming’ position but just for a brief moment (not to be confused with airplane position which isn’t ideal), where they extend their legs and arms out before changing their position. The child should also be able to reach for toys that are higher than the shoulder, from the ability to flex the shoulders above 90 degrees (higher development of the shoulder joint). While lying on the back, the turning process begins and it’s important to notice how the rotation is being done. It should not be by the use of the head or excessive movement of the arms and legs but by the body as a whole. If a bad way of turning is seen, it may be a sign that the previous development wasn’t ideal. Also, you may find that your child doesn’t roll often at all, which is then recommended to motivate turning more by the use of toys and helping your baby perform the movement correctly.

6 months

A child at this age can see at an angle of more than 180 degrees, and has better focus and able to see a greater distance. The presence of any asymmetry in the eye movement or sight is a definite reason to visit an ophthalmologist. They begin to also mimic sounds and pronounce their first syllables. With the ability to move the tongue and the jaw to the sides, the baby is able to chew and therefore can start to eat solid foods. If a child is unable to chew by this age, it’s likely that a speech disorder may occur in the future.

In terms of motor development, a child of age 6 months is very similar to 5 months with the important exception in grasping. At 6 months, a child can already reach and grasp for toys using radial grasping. This is when the thumb and index fingers are the main and first contact with the object. They also often chew on what’s grabbed and explore it with the hands and mouth and often also play with their feet (at 7 months, they begin to put their toes into their mouth). Turning to the belly process becomes typical and regular, meaning completed oblique muscle chains activation.

With great motivation, the child is able to get to a 4-point crawling position on the hands and knees. In this position, the baby just swings forward and backwards without actually crawling and bears most of the weight on the knees. Any attempts to move the hands forward would normally cause them to fall back onto their stomach.

7 months and up

The next important milestones develop around 7 months and above, which is getting into the sitting position without any assistance. After that, the “verticalization” development begins, to get the child up to independent standing. Getting to crawling from lying and sitting positions becomes more repetitive and also just before crawling they may ‘creep’ for a while, using the same movements as in crawling but with the belly lowered to the ground. Eventually, the child will learn how to pull themselves up to standing using furniture or support and make a few unstable steps with a support. After 13 months, they are finally able to walk, sit and stand alone and enjoy carrying objects whilst doing so as well. Even once they reach this final milestone, do not expect that the child will not develop any problems, for at 2 or 3 years of age, movement difficulties can appear and be worse than in the first year of life.

An important note to end with is to remember that the child doesn’t have to develop according to a strict developmental chart. The maturation of the brain however always takes place under the same principles and same patterns, so it’s necessary for a child to pass through certain phases in a certain order, because the steps before are always necessary for the next higher level, like building blocks. We may not be concerned about some delays, however if they are delayed for a long period of time, over 3 weeks, or there is asymmetry or compensatory patterns present in their movement behavior then those are always indicative of therapy.

What we offer

We offer, in both English and in Czech, classes for mothers and their children on the physiological development of children from ages 0 up to 14 months.

Read more about our classes or register for them at following links:

Baby 3-7 months Development Class

Baby 8-14 months Development Class

by Farah Droubi

Článek Physiological development of babies – First Year se nejdříve objevil na BeBalanced.

Flat feet, or pes planus, are defined by the collapse of the arches of the feet and fall of the heel inwards making the feet look flat on the ground. Are flat feet in children normal, or abnormal? Very normal, more specifically up until the age of 4 years.

WHY? Babies are born with flat feet. The ligaments and tiny muscles of the feet only start to develop once the feet are loaded in standing, therefore, when a child begins to get up and walk! The speed of this development varies from child to child and because of this there’s an important fat pad at the surface of these little feet protecting them by distributing the weight more evenly across to avoid overloading of the joints but also makes the arches less visible.

This fat pad disappears by 3-4 years, with the increase of neuro-muscular control and strengthening of the skeletal system. However there may still remain some rotational deformities at the knees and hips which may cause incorrect diagnosis of flat feet or just unnecessary concerns to parents.

There are too many of these unnecessary doctor visits and orthotic prescriptions to children with ‘flat feet’ today. If there is no underlying pathology, disease or injury and you are a concerned parent, simply ask your child to perform a toe stance — does an arch appear in this position? Or does it still appear very flat? If an arch appears upon a toe stance, then it’s most likely a flexible flat foot that either needs more time to develop or at times (below age 4 and a bit older) or it is a lazy foot needing more attention. Flexible flat foot usually affects both feet symmetrically, and doesn’t cause any disability or pain.

If the foot remains flat during the toe stance then it may be a rigid flat foot, which is usually caused by a complication, for example of the tarsal bones, or have another reason for its delay in developing correctly. This is the least common type of flat foot, but is definitely an indication for visiting your family doctor especially if other symptoms such as pain, or changed walking pattern is present.

Treatment

The most important aspect for treating flat feet is to first distinguish between if they are rigid, or flexible and then if they present with symptoms (symptomatic) or asymptomatic.

The majority of flexible flat feet cases are asymptomatic. They require only monitoring for a period of time, alongside few specific flat feet exercises to speed up the development. Changes in mobility and growth last until 8 years of age approximately, therefore if there is persistence of flat feet past this age, another treatment approach may be necessary, such as orthotics. Keep in mind though, that flat feet may also be genetically determined.

Symptomatic flat feet on the other hand cause pain or some kind of disability. Frequently, a child may not complain of pain but show other signs such as a change in the way they walk to avoid the pain. In all cases, a rigid type flat foot requires medical attention to seek out the best intervention and most importantly, the cause of the foot disorder. In some cases it may be treated by the use of special orthopedic shoes, physiotherapy and activity modification and in more severe cases, orthotics and surgical intervention may be indicated.

WE CAN HELP YOU

The first step in conservatively managing flat feet is education of the patient and parents. If you have any questions or concerns, please do not hesitate to contact or visit us for advice or a consultation.

Článek The dilemma of your child’s feet. Flat or Lazy ? se nejdříve objevil na BeBalanced.

Jak jsme si popsali již v předchozích dílech našeho seriálu o ideálním psychomotorickém vývoji dítěte, mělo by mít dítě ve čtvrt roce z předchozího vývoje k dispozici pevný základ pro zapojení centra těla. Děje se tak díky rovnovážnému zapojení extenzorů (natahovačů) a flexorů (ohybačů) osového orgánu a nitrobřišnímu tlaku. Nitrobřišní tlak je zajišťován břišními svaly, pánevním dnem a bránicí. Dítě má tedy již plně napřímenou páteř, to znamená, že vleže na zádech je hezky symetrické, neuklání se, neprohýbá. Tento základ bude totiž i základem pro pohyb končetin. Pokud se základ vystaví nedostatečně, nebude ani dobré postavení v kloubech končetin. Ty se pak budou předčasně opotřebovávat. Takže už tady se rozhoduje, jestli dítě nebude mít třeba v brzké dospělosti problémy se zády či klouby. A že takové mladistvé vídáme. Někteří mají dokonce už v 15 letech diagnostikovaný výhřez ploténky či artrózu kolene. Proto je tak důležité vývoj sledovat.

5. měsíc

V pěti měsících se dítě v poloze na břiše zvedá na natažených rukách a přenáší zatížení z pupku až na stehna. Tento model předvádí nejčastěji, pokud chce dosáhnout na něco, co je daleko a nedosáhne na to. Opora o dlaně ještě není zcela dokonalá, ruce jsou opřeny o zápěstí, prsty lehce v pokrčení, ramena ještě mohou být lehce vtočená dovnitř. Při kontaktu s hračkou střídá dítě vzor opory o zápěstí se vzorem „plavání“, kdy dítě klesne na břicho, rozhodí ruce do stran, zvedá natažené nohy nad podložku, případně s nimi kope. Pokud dělá stále jen letadlo, nebo-li plave a nestřídá to s oporou o ruce, tak je to neideální a dítě už si zde vytváří přetížení krční a hlavně bederní páteře. Pokud chce hračku uchopit, musí se vrátit ke starému známému modelu ze 4,5 měsíců, tzv. opory o jeden loket a protilehlé koleno. Nově si umí sáhnout i pro hračku výše, až nad pravý úhel v rameni. Jedná se o jeden z důležitých prognostických údajů u dětí s větší tíží postižení (dítě ohrožené dětskou mozkovou obrnou), pokud dítě tuto dovednost zvládne, mělo by v budoucnu zvládnout stoj a chůzi.

Z polohy na zádech se dítě začíná otáčet na bok. Způsob otáčení je ale klíčový! Otočku vede hlava a svrchní ruka mířící za hračkou přes střed. Pohyb následují i nohy, které byly již připravené zvednuté nad podložku. Na boku umí setrvat a hrát si, umí se také vrátit zpět na záda. Na zádech objevuje svoje tělo až v úrovni kyčlí.

Velmi často ale vidíme neoptimální způsoby otáčení svědčící o tom, že předchozí vývoj neprobíhal zcela ideálně. Dítě se otáčí třeba tak, že se prohne a odtlačí se vzadu nohama nebo že hodí přes střed nohy a pak se dotočí celé anebo se naopak hodně vyhrbí, přitáhne kolínka k břichu a opět se takto přetočí.

A pak jsou děti, kterým se moc otáčet nechce. Ty pak vymyslí jiný způsob, jak vidět více do prostoru, a to ten, že vleže na zádech zvedají hlavičku nad zem. Toto je poměrně dost nežádoucí, protože dítě si dost přetěžuje krční svaly a opět si fixuje špatné stereotypy. Přitom nastimulovat dítě k otáčení je poměrně jednoduché. Cíleným cvičením Vojtovou metodou můžete dosáhnout rychlých výsledků.

Fyzioterapie pro novorozence, kojence a batolata

Článek Druhé tři měsíce na světě, aneb pokud není vytvořen dobrý základ, už se to začne projevovat, ale stále ještě není pozdě! – 2.díl se nejdříve objevil na BeBalanced.

The first weeks and months of life are crucial from the point of view of motor development and a good start of motor skills. It seems very early. The movement of the child is often solved after half a year of life, sometimes around the 9th month or year. And it’s very late. Since the child sees, his engine of development is the desire to get to the seen object. If it does not work physiologically, it creates spare mechanisms.Thus, from the 6th week of life, the baby can develop on replacement mechanisms. He fixes them and strengthens them with all the activity. Therefore, it is ideal and easiest to capture the development at the moment when replacement patterns are not created and fixed. If you missed the beginning, there’s nothing you can do, and the best thing you can do is not wait any longer.

That is why we want to guide you through the movement development of the child, in terms of quality, so that you can read your child’s movement accordingly. It is not possible to capture everything, so if you have any doubts, do not be afraid to contact us, we will be happy to help you.

Fyzioterapie pro novorozence, kojence a batolata

1st month of life
When a baby is born and leaves the mother’s womb, it struggles with a lot of changes in the new environment. It has to cope with the influence of gravity, begins to breathe on its own, control its temperature, receive food through the mouth and thus struggle with digestion and excretion. It can see, but only sharply at a short distance and is not yet able to follow the object that has caught its eye. Despite this, he perceives all around him at once a lot of new not only visual, but also auditory, olfactory, taste and tactile sensations. All this places high demands on the body of a small newborn, which is why he eats or sleeps most of the day.
The position of a healthy newborn is asymmetrical, often preferring one side where he looks – this is called physiological predilection. However, it should be able to turn the head smoothly with an adequate stimulus, e.g. when we cover its view, or it feels the smell of the mother’s breast from the other side.
When the watchful person lies on his back, he usually moves his whole body in an uncoordinated way, we can observe kicking with his feet, untargeted throwing of his hands, opening and clenching his fingers into a fist. When we put him on his tummy, he lies on his knees and his hands are bent, his head is turned to one side so that he can breathe, but helical motion he can turn his head to the other side and back.

První tři měsíce na světě, aneb ideální psychomotorický vývoj miminka – 2.díl

Článek The first three months in the world or the ideal psychomotor development of the baby – part 1. se nejdříve objevil na BeBalanced.

A head predilection to one side in babies is a common reason for parents’ visits to a physiotherapist with concerns. There are various reasons, amongst them a physiological one, why a child would ‘prefer’ to hold their head to one side and it’s important to differentiate, a) whether or not it’s physiological, and b) if not, what’s causing it.

Plagiocephaly, also known as the flat head syndrome, is when the child’s head becomes flatter on one side and changes shape and this happens when the child is, for the majority of time, facing or laying their head towards one side. Positional torticollis is a related condition where the muscles in the baby’s neck on one side tighten causing the head to tilt to that side, making it difficult to turn the head. Both of these conditions could be a cause for the other or present themselves as a primary problem alone.

Firstly, it’s important to point out that newborns up to about six weeks of age all have an asymmetrical position of the body. In that age, there’s always a head predilection to one side and as it is part of the development process, it isn’t a concern. However, what to be aware of is that even with this asymmetry, the predilection isn’t constant and the babies are able to change their head positions and show us by rotating it to the other side occasionally. After six weeks of age, with the development of optical fixation, babies begin to turn the head to both sides symmetrically and usually don’t show favor to one side.

It’s important to notice when to act and in the correct time. If a baby younger than six weeks of age doesn’t show occasional turning of the head to both sides, especially even with motivation, and seems to be fixed to one side then it may be a good idea to have a doctor or physiotherapist consult. If a baby continues to prefer holding his head to one side after six weeks of age, and also seems to have a bow-like position of the body (with rotation to the opposite side), then it may be the start of the development of torticollis. Another symptom of positional torticollis may be that the turning of the head to the other side brings the back of the head down towards the shoulder and the baby would find it difficult to hold it there for long. The head may start to flatten (plagiocephaly) and less hair would also appear in the affected area. Eventually, this asymmetry can also appear on the face and in the worst cases, also affect hearing abilities of the ear on the affected side. Consequently, what looks like a small neck problem may affect the body as a whole in its development process and cause a delay in reaching motor milestones, poor quality of movements and asymmetry in growth of the spine and hip joints that leads to scoliosis.

The key to treatment of torticollis and plagiocephaly is how early the therapy begins. Treatment using reflex locomotion brings successful and effective results that are sustained throughout the infancy, with just a little monitoring and control check-ups for prevention. However, in some severe cases, if the conservative treatment doesn’t begin early enough or isn’t effective then a surgery may be necessary.

What causes head predilections?

The cause of the predilection can be, for example, a distress trauma during delivery that leads to injuries to soft tissues or the spine around the neck and head area. Other various causes may be from certain infections, developmental abnormalities, neurological disorders that cause muscle spasms and some types of genetic syndromes.

A child suffering from torticollis is often referred to as neurotic because of frequent crying. The neck problem can also have a negative impact on sleeping patterns of the baby and this causes further pain and discomfort. Other signs may even show upon breastfeeding time, when the baby prefers one breast and rejects the other because of the difficulty of turning its head. Keep in mind that passive rotation, or a forceful rotation of the head to the opposite side is not a correct or recommended way of treating the problem. In most cases, doing that aggravates the condition. It’s necessary for the treatment to consist of ways for the child to actively move the head and use the muscles in their correct function to cure the predilection effectively and permanently.

Do not hesitate to contact us and receive the correct advice and treatment. Our therapists are equipped with the right tools of treatment to successfully manage children who suffer from head predilections.

Článek Why does my baby prefer to look to one side? se nejdříve objevil na BeBalanced.

Vojta therapy was developed by a Czech neurologist, Prof. Vaclav Vojta, between 1950 and 1970’s. What started out as a principle, in the Czech Republic and Germany (where Prof. Vojta immigrated), is now known and used all over the world today as reflex locomotion.

From years of research and investigating various ways of treating children with neurological disorders, Prof. Vojta developed this specific method for both diagnosis and treatment of movement disturbances. Even though the method originated from an incentive to treat children, it’s widely used in adulthood as well for various conditions.

Reflex locomotion, is unrelated to our “reflexes” but describes instead the relationship between the specific target points (let’s call these “reflex” points) that are stimulated during the therapy and the movement patterns that are initiated as a response to that stimulation. The reflex points contain a large number of receptors and when stimulated in the correct way (mentioned in the next paragraph), they trigger pre-defined, involuntary motor reactions. These may or may not present as very obvious reactions such as a whole body movement, but may be just small specific activation of certain muscle synergies. This depends on the neuro-sensitivity and condition of the patient but also their age – the younger, the more reactive and exaggerated the responses are. Sometimes, the reactions could only be visible to the eyes of a Vojta specialist or physiotherapist with background knowledge in the technique.

The movement patterns and why they occur?

The responses that arise during reflex locomotion are precise movement patterns. These patterns are the same as those that appear as we develop from birth: grasping, rolling, crawling, standing up and lastly walking. They are innate patterns, genetically encoded within our nervous system and are present in everyone, no matter what the age, gender or condition. Such as we all develop in the same way, or ‘order’, these patterns when stimulated are identical in everyone, as well as‘automatic’- the patient has no conscious control over the movement that occurs.

For ease of imagination, think of our brain and nervous system having these specific neuro-motor pathways and links that are responsible for our functional movements as we develop, like crawling. In the case of a neurological impairment, or other movement disturbance, a ‘block’ could appear in one of these pathways, consequently influencing our motor behavior by changing the pattern (non-physiologically) or completely diminishing it.

Vojta therapy is focused on these neuro-motor pathways by stimulating them directly and repeatedly, via the ‘reflex points’and by placing the person in specific positions (on the back, side-lying or on the stomach) to‘switch on’and re-activate the functional connection between the nerves and the muscles that are necessary to initiate the movements.

Who’s Vojta therapy for?

Vojta therapy may be used in various conditions ranging from neurological impairments such as cerebral palsy, central coordination disorder, stroke, multiple sclerosis and peripheral palsies to orthopedic conditions after fractures, trauma and surgery. In adulthood, it’s often used as a preventive therapy to activate healthy movement stereotypes and thus prevent pain and future postural problems. In childhood, it’s crucial to begin as soon as possible when needed, before the newborn develops substitute patterns and is still ‘plastic’ enough to perceive the therapy quickly and successfully. Repetition of the therapy in children is indeed important and an integral part of treatment using Vojta therapy is to educate the parents on how to provide the exercises at home on a regular basis.

Vojta therapy elicits many other effects within the body and isn’t limited to just the neuro-motor system. During therapy, it has positive deep effects on the vegetative system, cardiopulmonary system (in terms of correct breathing pattern activation and blood circulation) and other, so it may also be used as a therapy for treatment of swallowing, breathing and chewing problems.

If you are interested in understanding and learning about Vojta therapy further, please look to their official website, www.vojta.com/en.

Regarding any questions or interest in Vojta therapy with one of our qualified physiotherapists, please do not hesitate to contact us.

Článek What is Vojta therapy and why we use it se nejdříve objevil na BeBalanced.