muscle tone

• By katek
• Posted October 29, 2008 at 10:37 pm
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Regarding a head turning preference, my son had torticollis, a stiffening of the neck muscles. I've been told that therapists are seeing it more and more in babies in general (in part b/c kids aren't spending as much time on their tummies since the Back to Sleep campaign). Basically, my son only turned his read to his right side for the most part. This tightening ended up affecting his arms b/c he wasn't reaching with the left side much as a result.

The good news is that it was identified right away. We did some simply stretches. I don't know that I'd be able to verbally describe them well. But if you ask your baby's pediatrician, s/he may have a sheet that would show you. Or a PT or OT could show you too. Our son's OT identified the torticollis at 2.5 months adjusted and gave us the stretches that we did during the diaper changes (easy to remember when you fit it into the routine).

There are some basic things that we changed in our handling of him that encouraged turning the head to the other side.
(1) Mix up the side from which you feed your baby. Because I'm right handed, I tended to put Henry in my left arm, his head turned right to drink from the bottle that I was holding with my right hand. Easy to see why he had a right side preference. So change things up and use both sides when feeding.
(2) Diaper changes. Same thing. We were always putting Henry's head to our left side b/c we are right handed. He'd look right into the room. So, we began to mix up the side to which he placed his head for diaper changes.
(3) Crib. Change up the side to which you put your baby to sleep so that baby will have the opportunity to look into the room using both sides of head.

By doing this and the stretches, we saw changes in his head turning within a month. He slowly gain arm strengthen in his left side too. Fortunate that we caught it early.

Henry had a little tightness in his legs and feet. Toes were clenched a lot until about 9 months adjusted. We did a lot of infant massage starting at 5 months adjusted. Wish we had done it regularly a lot sooner. The benefits are many (empirically verfiable through numerous studies). The EIP had an infant massage therapist train us in some basic techniques. I'm not a hippy, new age type (not that there's anything wrong with that), but I can't emphasize enough how beneficial I think that positive touch is for all babies but preemies especially.

Best wishes.

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• By katek
• Posted October 30, 2008 at 11:33 am
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mommyinneed,

I just found a link to a Word document posted online that contains some of the stretches that we did:
http://www.thefilyaws.com/torticollisstretching.doc

On the stretches, do everything gently. Don't force the head/neck, but gently stretch. And again, it might be worth it to consult a PT/OT just to get the basic moves down. We did the "carrying" stretch most often b/c it is very gentle. And we were carrying our son around anyway!

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• By VickieDakinPT
• Posted October 30, 2008 at 5:21 pm
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Muscle tone can be confusing. With preemies, muscle tone can appear low, especially in the arms. Until they build up enough strength, decreased strength can feel like low tone. Make sure he is getting enough tummy time or even better at this age time on his hands and knees. Help him rock if he doesn't start on his own.
Sounds like over all he is doing well. Congrats.

Vickie

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• By mommyinneed
• Posted October 30, 2008 at 8:33 pm
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thanks so much for the advice. I really really appreciate it

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• By brneyedgrl827
• Posted November 1, 2008 at 8:18 am
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katek:

what types of exercises/massages did you do for the tightness in henry's legs and feet? lynsey has tightness in her legs and feet as well (and also still has the tendency to clench her toes...she is now 14 1/2 months corrected). we were seeing a private physical therapist, but she wasn't a good fit...then we changed insurance companies when my husband got a new job and are currently bound by some pre-existing BS for a year. our developmental specialist has put in numerous requests to have lynsey evaluated by a PT from EI; we even went to see one of our state's developmental pediatrician so that she could write a letter of need in hopes of expediting the process, but so far, no luck. :/ the good news is that the tightness doesn't seem to affect her ability to walk and it doesn't seem to bother her (she a relatively new walker and toddles around just fine), but it's hard to tell if the tightness will affect the quality of movement in the long term.

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• By katek
• Posted November 3, 2008 at 1:22 pm
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I emailed brneyedgrl827 but I wanted to comment in case others are facing something similar.

We saw an infant massage therapist twice to get the basics of the massage down. We gave daily massages beginning at 5 months adjusted to about 9 months adjusted. I wish that we had started them earlier. By the time my son was crawling, it became really hard to keep him still enough to do a full body massage. Initially, the goal of the massage was to do the following body parts:
1. Leg/feet
2. Stomach/intestinal track (I Love You massage)
3. Chest/shoulders
4. Arms/hands
5. Face/head
6. Back

Once we got the movements down, the whole massage could be done in about 10 minutes. We often found, however, that our son usually had patience to make it through the stomach and sometimes chest/shoulder. He'd get really wiggly around the arms/hands. But we figured that the legs/feet and intestinal track were the most important goals for our purposes, so that was OK.

Around 8 months adjusted, the PT had us do some extra work with his feet b/c of the toe curling and a little tightness (this was independent of massage therapist). We used flat of thumb to trace from pad under the heal on the bottom of the foot along the pad toward the outside of the foot and then along the pad that's near the toes. When a person walks, they normally place heal down first and then weight moves on foot along the center of foot (mainly on the area toward the outside where pad is thickest), and then person pushes foot off ground from pads near the toes. Therefore, that's the area that the PT wanted us to activate the senses in our son's foot. We'd work heal to front of foot. If we were driving somewhere, I'd play with son's feet in the car doing the press along the pads. I'd also try to get him to relax his toes.

The trick with massage is to not make it so light that you end up tickling the child. It should be firm but not so firm that it is uncomfortable in anyway. The visual image that we were given was to think of it as pressing into a stick of butter that's been out for a 1/2 hour. You want your touch to be firm enough to draw a line in the butter but not press so hard that you create a deep ridge.

In addition, I've played and kissed his feet a lot ever since he came home. I was concerned that he'd have foot issues from the NICU (all of those stabs to the heal with needles). I've read that a lot of preemies have sensitive feet.

Our son's PT had us put him in shoes (open toed sandals) for several minutes a day to help unclench his toes. Her concern was that the toes help provide balance, and when they are clenched, the balance isn't as good. When our son was standing with shoes on, we'd try to remind his foot to use the whole of it (and help stretch toes out). If one has a baby who isn't clenching toes and doesn't have tone issues, my understanding is that they really don't need shoes, especially ones with height around the ankles (something about them restricting the ligaments). At one point, we did get high tops for our son at the PTs request (had to do with ankle strength). My point on the shoes is if one's child isn't having problems, then they aren't needed.

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