The Adventure: Infant Development 4 to 6 Months

The other day a friend of mine mentioned how right when babies start to get into a routine and really interact…we have to go back to work! Ugh! The three month mark is tough in terms of that if you’re a working mom, but no matter what the fourth, fifth and sixth month are an exciting time for you and your baby. She really starts to experience the world instead of just observing it. For her that’s such an adventure, and for you it is quite entertaining!

In terms of lying on her back (supine), she will gradually lift her legs up. This is the most basic, foundational element of all movement. We’re hoping she doesn’t have a diastasis and that her spine is flat (so her head isn’t tilted back).

The cover of Marianne Hermsen-Van Wanrooy's book, "Baby Moves," provides
an excellent example of the supine position for babies four to six months in age.

She’ll learn to grasp objects at midline and then across her body. She will also start to grasp her feet—you know that cute position where they can start to stick their toes in their mouths. But this is more than cute, it’s also an indication that she can lift her pelvis off the surface and stabilize on the upper part of her back (Marianne Hermsen-Van Wanrooy, p. 35).

With motivation and this ability to stabilize, she will learn to roll to each side. As her mommy, you should make sure she is rolling to each side. Our son preferred rolling to the left, so we ended up blocking his left side with an ottoman and put more motivation on the right—toys and ourselves. Pretty soon he was able to go both directions just fine.

Eventually, this rolling to each side will become a complete roll over, with baby supporting herself on her elbow. As a mommy, you should...write this date down in her baby book!

Thanks to all of her hard work (and yours), she is also mastering tummy time. She is able to see the world from a new perspective, which really provides motivation for additional movements. She will begin to use one of her hands to grasp for toys, so she’ll learn to support her weight on one elbow. 

During these months, we’re also looking for her to rotate her head, eyes and tongue without her body as this indicates that there has been integration of locomotion function. By the fifth month we’re looking for baby to support herself on the proximal parts of her palms and her thighs. (Dynamic Neuromuscular Stabilization, seminar notes.)

Do’s and Don’ts

• Do offer your baby small, light objects that she can easy lift and that are safe for her to put in her mouth (because everything will be going in her mouth!). Hermsen-Van Wanrooy suggests simple things like a sock (p. 37).
• Do off the objects to one hand at a time (p. 37).
• Do place toys on the floor to the side of your baby (p. 37).
• Don’t use toys that hang above her as these can cause muscle imbalance (p. 37).
• Don’t sit or stand your baby up (p. 48). I know it’s tempting, but she isn’t quite ready for that yet. We’re getting closer though!

“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!