Babies and early years

What is early years physio?

Within the Early Years speciality we work with babies and pre-school children across Telford and Shropshire. We see a variety of children with and without a formal medical diagnosis, from those with a delay in their motor development to children with more complex needs such as cerebral palsy and Down’s syndrome.

Our aim is to ensure that every child achieves their full potential in everyday life. We look at a child’s physical development and their gross motor (movement of legs and body) skills and devise a tailored therapy plan of advice for parents and carers that is designed to meet the particular needs and goals of each child and their family.

Common concerns

Below you can find out more about these common concerns that are actually a typical part of your child's development.

If you are still concerned after reading these, please see our Getting more help page

Flat feet

Flat feet is when the arch on the inside of the foot looks low or 'fallen in'

Before the age of 3 years all children have flat feet, as well as the majority of children under 6 years. This is because the arch on the inside of the foot does not begin to develop until after 3 years.

Over 95% of children grow out of their flat feet and develop a normal arch. The other 5% continue to have flat feet, but only a small number will ever have a problem.

If your child is having pain or finding it difficult to run, then they would benefit from an assessment from Physio - see our Getting more help page. They may also find an insole helps with pain or running - see Podiatry where you can self refer to their children's gait clinic.

For more information, please see this leaflet on flat feet from the APCP

Having correct footwear is also important for all toddlers and children - please see this guide to choosing footwear for children rom the APCP

Intoeing

Some children’s feet turn in when they walk. This is called intoeing or ‘pigeon toe’ and is very common in young children. It is one of the most common normal variants in children and is most frequently seen in both feet.

Children who intoe may appear to trip more often at first but this soon resolves. They can be just as good at sport and are no more likely to suffer back or hip problems or arthritis than anyone else. It will not get worse and should improve over time. Falling is not caused by intoeing but is part of the process of learning to walk. Intoeing will not affect your child’s ability to walk, run or jump in the long term.

Intoeing may be more obvious if your child has flexible joints or when they are tired.

Ways to help:

• Discourage 'w' sitting and encourage cross legged sitting
• Encourage any out-toed activities such as ballet, swimming breaststroke or horse riding
• For older children you can encourage hip strengthening exercises to encourage out-toeing such as penguin walking or 'crocodiles' where the child lies on their side with knees bent and lifts there knee up and down, keeping their feet together [add picture]

Please see this leaflet on intoeing from the APCP for more information

Having correct footwear is also important for all toddlers and children - please see this guide to choosing footwear for children from the APCP

Toe walking

Toe walking is when the heel doesnt touch the ground when walking or standing.

It is a typical part of development when children first begins to walk as they are finding their balance, they should grow out of toe walking after they have been walking for about 3 months or the first 2 years of their life

Walking on toes can also be common in children with Autism or other sensory difficulties. As they enjoy the sensation, it is harder to discourage.

Advice for persistent toe walkers

If it persists, then a referral to Physio would be beneficial. See our Getting more help page. Physio would likely advise on:

• Calf stretches to prevent this muscle becoming tight.
• Wearing supportive hard-backed shoes, ideally boots that come up over the ankle, as this can discourage them coming up onto their toes.
• Parents encouraging the child to stand with their heels touching the floor, and walk with their heels striking the ground first. For younger children parents may need to facilitate this gently with their hands.

Sudden onset of toe walking after a child has already walked typically
This is less common and we would recommend a referral to physiotherapy to help find the cause of this. See our Getting more help page

Knock knees and bow legs

Both bow-legs and knock-knees are a typical part of a child's growth.

Bow-legs

As the legs grow and develop from birth, they normally go through a period of being bow-legged. This is when if the baby stands or lies with their feet together, there is a space between the knees; it is present in both legs.

This bowing is due to the forming of the legs while the baby is still in the womb when the bones are soft and flexible. The bend in the legs often causes the child to also walk with feet pointing inwards.

Bow-legs is usually present from birth to 18 months but can sometimes be present until 4 years of age. The bow-legs usually straighten out with no treatment.

If you are concerned about whether or not the bowing is getting better, then you can take photographs of your child's legs every six months to keep a record of the change.

When to seek further help: There is no evidence Physiotherapy can help bow legs however, you should see your GP for a referral to Orthopaedics for assessment if the bow-legs are severe, getting worse, develop after age 5 years, involve only one leg, or if the child is very short.

Knock-knees

At the age of 3 to 5 years, many children go through a period of mild knock-knees. This is when if the child stands with knees together, there is an open space between the ankles. As with bow-legs, this is a normal process noted during a child’s development.

By 8 years of age the knee usually straightens itself, although some knees may not completely correct until 12-14 years. A lot of adults still have some mild degree of knock-knee. Knock-knees are more common if the child is overweight.

When to seek further help: There is no evidence Physiotherapy can help knock knees however, you should see your GP for a referral to Orthopaedics for assessment if the knock knees are severe, getting worse, involve only one leg, or your child is limping.

Delayed milestones

A common misconception is that babies should all hit there milestones at the same age, for example that all babies should be walking on their own by 12 months. In fact, there is an age range that is all considered typical. Here are some examples of typical ranges:

• Lying on tummy lifting head and upper chest up, using forearms to support themselves 1-4 months
• Holding head steady in supported sitting 3-4 months
• Rolling 5-7 months
• Sitting without support 5-9 months
• Crawling / wriggling forwards on tummy 5-11 months
• Pulling to standing at furniture 7-12 months
• Cruising (stepping along furniture) 9-16 months
• Walking independently 9.5 - 17.5 months (for children that bottom shuffle, walking is typically later between 17 - 28 months )
• Walking upstairs holding hands 13-22 months
• Jumps after being shown 17-30 months

Please see the section below on ideas to help promote your baby's motor skills, or if you are still worried please see our Getting more help page

How can I help promote by baby's motor development?

Equipment for babies - are they necessary?

Not all equipment for babies is helpful in the development of their motor skills, and may even delay them.

Below are some pieces of equipment that are not recommended by Physiotherapists.

Baby walkers and bouncers
Physiotherapists and other Health Professionals do not recommend the use of baby walkers or bouncers. These are walkers that babies sit in and scoot along or bounce in. There are two main reasons for this:

• Safety – even under supervision there are high numbers of accidents reported every year including: falling down stairs, head injuries, burns, scalds, and trapped arms / legs.
• Delayed development – some studies have shown that baby walkers and boucers do not encourage development and may actually delay the achievement of standing and walking. Contrary to popular belief, they do not teach a child to walk. They can cause a child to walk on their toes which may continue when they walk independently.

You can also find more information on this leaflet on baby walkers by the APCP, and the NHS UK website on walkers and bouncers

Do baby walkers strengthen babies legs?

Baby walkers interfere with the natural stance of the child and can teach the hips and knees to take weight in an abnormal position – this in turn can lead to long term changes to child’s walking pattern and can sometimes cause long term hip problems.

Baby walkers teach children to scoot along the floor using their toes and this strengthens the wrong muscles in the legs. This can have a big impact on balance and on general muscle and joint development, including long term foot and ankle problems [NHS Shetland]

What can I do instead to promote their motor development?

Floor play is a much more beneficial way for your baby to develop their muscle strength, weight shifting, and balance ready for walking.

See the above section on motor development for some ideas.

What about a push-a-long walker?

A push along walker is a great way of encouraging independent walking once your baby can stand on their own.

Sit-me-up chairs
Floor seats that prop your baby in a sitting position can delay your baby's ability to sit up on their own. You can also find more information on the NHS UK website on sit-me-up seats.

If you do choose to use a baby walker, bouncer or seat, it's best to use them for no more than 20 minutes a day.

Buggies
If your child requires a more supportive buggy discuss with your physio about a referral to Shropshire Wheelchair and Posture Services for a supportive buggy assessment

Car Seats
If your child requires a more supportive car seat please see the Regional Driving Assessment Centre Child Car Seat Assessment website for more information

Common conditions we treat

Head turning preference and Plagiocephaly
Plagiocephaly is the medical term for head flattening which is caused by pressure on the baby’s head when lying in the same position for prolonged periods of time, or a lack of tummy time. New born babies have very soft skulls which are susceptible to being moulded or flattened.

Often we find a child with Plagiocephaly has an associated head turning preference where they prefer to look to one side more than the other. This can lead to tight neck muscles and limit the baby turning their head fully, and may even cause them to tilt their head (known as Torticollis).

We therefore recommend any baby with plagiocephaly or head turning preference to be referred to physio.

Typical advice we give for head turning preferences and plagiocephaly

• Reposition your baby's head to look the other way after they fall asleep to take the pressure off the flattened side
• Swap which end of the cot your babies head is or rearrange your nursery furniture - this is because babies tend to look towards you or the light
• Increase tummy time. This can be on you or on the floor with a rolled towel under their chest. Try little and often and gradually build up the duration. See the tummy time poster above.
• Also try some side-lying and supported sitting.
• Reduce time spent in car seats
• If bottle feeding alternate the arm in which you hold your baby and encourage them to look away from their preferred side
• Encourage active head turning to their less preferred side using bright or noisy toys or peoples faces.
• Hold baby on your chest for cuddles with heir head facing to their less preferred side

For more information please see this leaflet on head turning preference and plagiocephaly from APCP

Motor development delay
For children that are delayed past the typical ranges of hitting their motor milestones (see common concerns section above), we recommend referral to physiotherapy, please see our getting mroe help page [link]. We then offer advice to parents and carers on ways to promote their child's motor skills.

Please our promoting baby's motor development section above which contains some ideas of how you can help your child develop their motor skills.

Any condition that effects a baby or child's day-to-day life
We assess any child that's movement is affecting their activities, with or without a diagnosis.

If your child has been diagnosed with a long term condition, please see our Long term conditions page [link] for more information.

What can't we help with?

Talipes (fixed) also known as 'Club Foot'
Fixed talipes is where a baby is born with a foot or feet that turn in and under. Early treatment should correct it. Treatment is managed by Orthopaedics not Physiotherapy - your health visitor or GP can refer you. Please see the NHS UK website on club foot for more information.

Developmental co-ordination disorder (DCD; dyspraxia)
DCD is a condition affecting physical co-ordination. It causes a child to perform less well than expected in daily activities for their age, and appear to move clumsily. In Shropshire and Telford this is managed through Children's Occupational Therapy not Physiotherapy. Please see their website on how you can self refer.

Motor = Global Development
If your child's motor development is delayed but it is inline with their global development then Physiotherapy is unlikely to be able to progress their motor skills more quickly.
If your child has severe global developmental delay please check out our other pages on long term conditions, special schools and respiratory physio.

Safe sleep advice

Your baby must always sleep on their back to reduce risk of cot death. Please see The Lullaby Trust for more information on safe sleep guidance.

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