“Critical Time:” Infant Development 0 to 3 Months

After the first few weeks of life, we enter an important time for your baby’s development. What you do and don’t do now can have an impact on the rest of their patterns. As Dr. Husband noted (and highlighted and underlined) next to “6 weeks,” this is a “Critical Time!”

Around six weeks, babies start noticing toys and wanting them. These (and probably mom) are now motivators for movement. During her tummy time, we’re looking for her to accomplish her first bodily support by weight bearing on her forearms and upper abdominal quadrants (Dynamic Neuromuscular Stabilization presentation).

Again I will note here the importance of placing your baby on a flat firm surface. According to Marianne Hermsen-Van Warnrooy, “A slightly tilted surface, like a bouncinette...changes the force or direction of gravity. This will inhibit the development of good muscle balance because he cannot learn to lift his legs up in this position” (p. 28). If your baby has an issue such as refluxing, flat on her back may be difficult, but it’s important to try for this as much as possible.

Encouraging Ideal Patterns = Tummy Time! 

My son's tummy time at almost three months.

Keep up the good work every day, but remember not to bring baby’s arms forward. Also, take your hands away and let her get comfy on her own. If she hates it, then get down on your tummy, too, mom, so you can be face-to-face. Coo and sing to her. I’m sure your wonderful voice and beautiful face will encourage her to learn to bring her own arms forward and lift her head. Once she can do this she will enjoy this position much more, but maybe not your singing.

Teachable Moment!
I didn’t remember this from last time at all, so I wanted to point it out here. Hermsen-Van Warnrooy says that if your baby tends to roll onto her back after she has been placed on her tummy, “this is an indication that the tummy position encourages muscle imbalance in your baby and he shouldn’t be there. If this happens, it is better to leave tummy time for a while” (p. 30). Noted!

Do’s and Don’ts

• DO dress your baby in non-restrictive clothing. If clothing is hindering movement, it doesn’t matter how cute it is, it has to go!
• DO touch and be touched. Let your baby feel her face, hands and hair and your face, hands and hair.
• DO squeeze those little limbs. Deep gentle squeezes on each limb are good. Rubbing isn’t.
• DON’T disturb a happy baby. Take a deep breath and enjoy the moments when your baby is just content lying on her back or doing her tummy time. Soak it up!
• DON’T encourage stages that are ahead of her. Ex: rolling over. These things take time for a reason—stay tuned!

Newborn Do's & Don'ts

OK, now on to the good stuff! I’m definitely getting to the point in this pregnancy of wishing she was here already! Even though the thought of a toddler and an infant together freaks me out a bit, I’m getting extremely excited to meet her and introduce her to her big brother.

Having recently held one of our friend’s newborns, I was reminded just how tiny these little humans are. But just because they are tiny, doesn’t mean there aren’t important aspects of their day-to-day we shouldn’t consider for ideal development.

My son at just a week or two old sleeping on his back.

As we dig into this information, please note that I’m going to pull from Marianne Hermsen-Van Wanrooy’s book “Baby Moves.” If I pique your interest, I suggest you purchase it. It’s a great reference guide and written for parents (vs. medical professionals). Throughout my posts I’ll also be referencing Dynamic Neuromuscular Stabilization and, of course, Dr. Husband. I’ll note all of these.

Two Positions
Your newborn only needs two positions—(1) on his back and (2) on his tummy. For both, you want to use a flat, firm surface—no pillows or blankets are necessary. By placing him on a harder surface verses a softer one, you are allowing important trigger zones to be activated by the ground.

Back: While on his back, encourage your baby with your voice and face to move his head to both sides. Also when laying him down to sleep alternate his head direction (Hermsen-Van Wanrooy, p. 23). 

My son at a week or two old being burped.
But it looks like he passed out from milk :)

Tummy: You’ll want to do “tummy time” once a day, but only for as long as your baby is happy. Make sure his arms are not stretched forward but rather tucked underneath. The same goes for his legs (p. 24)

Do’s & Don’ts

• DO place baby on his back to sleep. On tummy has been associated with SIDS. On side has caused hip dislocations in some children (p. 25).
• DO have him horizontal as much as possible. Upright to burp is fine, but this is pretty much the only time that he needs to be upright.
• DON’T sit him up, stand him up or jump him on his feet. This encourages a primitive reflex that we want to "disappear" for better fluidity of walking (p.26).
• DON’T leave him in a car seat for too long.
• DON’T over-stimulate him.
• DON’T pull him up by his hands.

Breathing & Labor Preparation

With this pregnancy, I’ve really come to like 10-minute workouts that I just find on YouTube. Considering my gym is now my basement at 5:30am, I have to do something to mix things up. These are doable and keep me entertained. Note: Dr. Husband doesn’t love all of the exercises in these videos, so he has suggested modifications to them to keep me safe.

But my main point in telling you this is that during a recent 10-minute yoga video from Katy Appleton yoga, I remembered the importance of breathing in terms of labor preparation.

Here’s the video:

I guess she just struck a chord with me in terms of embracing the pain and breathing into and through it. 

Proper Breathing
When I talked with Dr. Husband about how I think I need to work on this again, he used it as a teachable moment. According to him, proper respiration occurs when all sections of the diaphragm contract together as one unit. This flattens the diaphragm and increases intra-abdominal pressure. As you breathe and push, if you have a diaphragm that is strengthened and functions properly, you’ll have more intra-abdominal pressure pushing down.

With improper function of the diaphragm the muscle contracts mostly toward your back, and pushes your intra-abdominal pressure more forward verses down toward your pelvis. This is not ideal for pushing out a baby.

Practice
To practice proper breathing:

1. Put your fingers on your belly, and your thumb in the space between your pelvis and ribs on your back, so you’re digging your hands into the soft spot on your back and your belly. 
2. As you breathe in, your waist should expand out into your fingers and your thumb. The ribs can expand out in all directions, but they shouldn’t move up. When most people take a deep breath in, they suck their belly in and lift their ribs up; however, we want to do the opposite. We want to expand the ribs and belly and not move the ribs up. 
3. After you’ve gotten the hang of this, be mindful of the feeling when you work out and practice it. You’ll be thankful you did if it means a few less pushes! 

(PS: Dr. Husband said to note in this post that this function of your core/diaphragm is also the only way you’ll ever use your glutes and pelvic floor correctly...it's important!)

Squat—Great Exercise for Pregnant Women

There’s no doubt that staying in shape during pregnancy is tough. The last thing you might feel like doing is working out, especially as you get bigger and movement becomes more awkward. But exercise during pregnancy is extremely important for so many reasons—your baby’s health, your health, labor preparation, your post-baby bod, etc.

 In those moments you do feel inspired there is one exercise you should definitely work in—squats. 

When done correctly, squats engage your:

• Pelvic floor muscles
• Glute muscles
• Abdominal muscles

These not only help stabilize your pelvis as hormones relax the ligaments, but having these muscles in shape will also help with you delivery.

All this being said, Dr. Husband is adamant that your squat be done correctly. To quote him:

"If you don’t perform squats correctly, it’s not a matter of if you’ll get hurt, it’s a matter of when.”

Squat Technique

Every person’s structure is unique, but you probably want your feet a little wider than shoulder width and your toes pointed out a bit (not straight ahead).

Knees should stay over the foot, not inside and not too far in front of the toes.

As you squat down, you want to keep your back in a neutral position, meaning you don’t want it flexed or extended too much. For example, if you put a yard stick from your pelvis to between your shoulder blades, you’d want it to stay in contact with you back throughout the entire movement.

Finally, the key to a squat is that it is a butt muscle exercise, so if you’re not feeling contraction or activity in your butt muscles—if only in your quads—you’re not doing it correctly.

The number of reps and sets you do should depend on how many you can do correctly. If your form starts to break down, you need to stop.

Pregnancy Aches & Pains

As I've told you, my third trimester has started with a bang of heart burn, exhaustion and low back pain. Don't get me wrong, it's all worth it, but I'm thankful to have Dr. Husband who willingly listens to my complaints. He has also come to the rescue with some simple, easy-to-implement advice that has reduced or cured some of my "typical' pregnancy aches and pains.

Note: Make sure to discuss any of your issues and potential solutions with your doctor.

Heart Burn

• Give your belly more room. I’m a desk jockey, so I either shift to my knees while I’m at my desk or take a quick walk. Just making sure you’re sitting up with proper posture is also helpful.
• Watch your portion sizes. Don’t fill up your stomach too much at one time. Instead eat several small meals per day.
• Sip, don’t chug. I’m constantly thirsty when pregnant, but I’m careful not to chug vast amounts of water at one time because even that refluxes. 
• Breathe into your belly. This is proper function of the diaphragm, which serves three purposes:

1. Postural stability (spinal stabilization) 
2. Respiratory
3. Sphincter for the lower esophagus 

Studies have shown that the function of the diaphragm does relate GERD:

• “The importance of the diaphragm in the etiology and the possibility of its use in the treatment of GERD”
• “Diaphragm function in GERD patients: PFT assessment with extended esophageal manometry"

Low Back Pain
Obviously, pregnancy can cause low back pain, but referencing “low back pain” is like referencing “heart disease”—it can be caused by so many different things and cause a variety of issues.

However, in general, during pregnancy low back pain is caused by the weight of your growing belly and the production of hormones that cause instability of the joints around your pelvis. All of this may tip your pelvis forward, causing strain on your back.

You can try doing glute bridge exercises and wearing an SI joint belt. However, if the pain persists, you should contact a medical professional for an official diagnosis and treatment.

These are the main issues I’ve faced. What are some of the aches and pains you’re experiencing and what has worked for you?

My Daily Reminder

As I mentioned in my previous post, our son was born five days early from his due date, which according to our math was probably also too early. Although we can’t say for certain, one of the possible effects of this early entry—besides his crabbiness and inability to sleep for long periods of time—could be his diastasis recti, shown in the video below. This visual reminder is a huge reason I'm writing this blog.

Tanget: "The Happiest Baby on the Block," by Harvey Karp, M.D., not only saved Dr. Husband and I when our son was so sad during those first eight months, he also struck a cord with us in terms of the importance of length of pregnancy with his "Missing Fourth Trimester" theory.

"In many ways your new baby is more a fetus than an infant, spending most of her time sleeping and being fed....Unlike baby horses whose survival depends on their big strong bodies, a human baby's survival depends on big smart brains. In fact, our babies' brains are so huge we have to 'evict' fetuses from the womb well before they're fully ready for the world to keep their heads from getting stuck in the birth canal."

So, yes, the baby has to come out before a fourth trimester (please don't think I'm arguing for that!), but wow is all that time in there such a gift for those brains!

Onward...

According to Dr. Husband, with his diastatis, our son can potentially suffer from:

• Structural issues such as decreased spinal curves or retroverted hips
• Low back pain
• Muscle imbalances, which can increase chance of injury

To combat these outcomes, there are some general things all parents should consider for their infants.

• Allow your baby to develop movement naturally. For example, when he starts to roll, let him do it on his terms. When she wants to walk, fight the urge to hold her hands. Though babies love to sit up, don't prop them up with pillows or baby chairs. 
• Go shoeless. When it comes to shoes, the best thing to do is not wear them! Allow your baby to be bare foot as much as possible. If he needs shoes, something with a very thin sole is best, so his feet can feel the ground.
• Limit practice of primitive reflexes. The most common issue is sucking, so wean your baby from the bottle and pacifier within the reasonable time frames. Our pediatrician suggested a full weaning from both by 18 months at the latest.

In the future:
Our son is almost two years old, so treating him is very difficult because he doesn't want to be still (ever), and forcing him is just traumatic for all of us. The above guidelines are great for infants, but if you're having questions regarding a toddler, you may consider looking into professional advice. When your child can understand the concept of being still, he or she would probably respond well to physical therapy. Dr. Husband will definitely be working with our son as soon as he can understand what the heck daddy is doing!

A Bit of Context

Originally Posted: March 5, 2014

For some context, my husband is a private practice chiropractor with more than 500 hours of post-graduate study and certification in manual therapy techniques beyond chiropractic. He has worked hard to diversify his study to encompass the best from many conservative care fields such as chiropractic, physical therapy, osteopathy and neurology to name a few.

For our purposes, it is his certification in Dynamic Neuromuscular Stabilization (DNS) according to Dr. Pavel Kolar that is most intriguing since much of DNS is based off of developmental patterns of infants.

To quote my husband:

“The normal development process of infants is predictable and can be seen in every healthy infant with the exact same patterns. These patterns then become our map of what physiological movement is. This genetically predetermined process, guides our rehabilitation from infants to adults and these principles have been extremely successful in treating cerebral palsy patients as well as increasing the performance of professional and Olympic athletes.” 

And to quote the DNS website:

“The nervous system establishes programs that control human locomotion, which is compromised of posture and movement. This ‘motor control’ is largely established during the first critical years of life. Therefore, the Prague School emphasizes neurodevelopment aspects of motor control in order to assess and restore dysfunction of the locomotor system and associated syndromes.” 

The proper motor control that is established during these first few years of life has an effect on the structure of the body as well, which forms our joints, curves of the spine, angles of the hips, position of our feet, etc. This is indeed a critical time—and I hope you’re excited to explore more with me!

You Can Do It: "Term" Pregnancy

Originally Posted: March 3, 2014

Today I enter the third trimester of my pregnancy. The entrance into these final 12 weeks has started with a bang—a bang of intense heart burn and lower abdominal pressure.

For many women, myself included, these last weeks can be trying. When I was pregnant with my now 21-month-old son, the aches and pains, continued weight gain and lack of sleep wore me out. I always count my blessings (x 100!) that I have not yet had any serious medical issues during my pregnancies, but even these “normal” things can make the day-to-day difficult.

However, I hope I can enlighten you (and energize myself) as to just how much important work you are doing for your baby during this time, and especially at the bitter-sweet end.

I think many moms already understand the significance of the first 10-12 weeks of pregnancy. It’s truly a miracle that a group of cells turns into a functioning fetus at the end of such a short time—with organs and the general shape of a human being. But from mothers to physicians, I think there is a lack of emphasis on the importance of keeping that baby inside the womb until the 40th or even 41st or 42nd weeks. It seems that once “full term” is reached at 37 weeks, we consider ourselves done.

To this I say, “If we can help it, we’re not done!”

For my current pregnancy, my goal, though I may not have complete control, is to keep this baby in until June 1, which is one week past my doctor-prescribed due date. Why you ask?

Thanks to Dr. Husband’s post-doctorate education and training in infant development and movement (more on this soon), we see the effects of baby boy’s early arrival in his movement patterns already (more on this soon, too). Though he was only five days early according to his due date, we are convinced my due date was too early as well. So this time, there will be no three-mile walk, followed by a prenatal massage, followed by an Insanity work out. Do I know for certain I stimulated labor with my son? Yes—I call it the science of “mother’s instinct.”

Last fall, The American College of Obstetricians and Gynecologists “redefined ‘term pregnancy’ to improve newborn outcomes and expand efforts to prevent non-medically indicated deliveries before 39 weeks of gestation.”

Here are the new definitions of ‘term’ deliveries:

• Early term: 37 weeks 0 days to 38 weeks 6 days 
• Full term: 39 weeks 0 days to 40 weeks 6 days 
• Late term: 41 weeks 0 days to 41 weeks 6 days 
• Postterm: 42 weeks 0 days and beyond 

This was due to research showing that every week of gestation matters for the health of newborns. The last few weeks of pregnancy allow a baby’s brain and lungs to fully mature. The neuro-connections still being made during this time can impact a baby’s future movement patterns, among other things.

Sally Goddard summarizes the importance of brain development and movement in the introduction to her book, “Reflexes, Learning and Behavior: A Window Into the Child’s Mind:”

“All learning takes place in the brian; it is the body that acts as receptor for information and then becomes the vehicle through which knowledge is expressed. In this respect, movement lies at the heart of learning. Learning, language and behavior are all linked in some way to the function of the motor system and control of movement.” (p. xvi)

Although you cannot control the onset of labor, I hope those of you who are lucky enough to make it to the final weeks or beyond your due dates embrace this important time. There are so many connections being made for your baby that will have long standing effects on their movement patterns and development. You can do it!