The Ultimate Secrets of Healthy Development For Your Baby— Bir th to 3 years
A World Changing Guide By Occupational Therapists Paula Tarver, OTR/L & Jeanne Martin, OTR/L
Copyright Š 2011 Advance My Baby, Inc. All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including emailing, photocopying, screen capturing, recording, or by an information storage and retrieval system, without written permission from the publisher. The authors and publisher disclaim any liability arising directly or indirectly from the use of this book. It is the intention of the authors to educate and guide moms, dads, grandparents, and other caregivers by sharing with them the skills and knowledge necessary to promote optimal overall growth and development of their child. This book is not intended to replace skills or therapy services or medical advice from your healthcare provider. Published by Advance My Baby, Inc., Valrico, Florida Visit us @ www.AdvanceMyBaby.com Advance My Baby is a trademark of Advance My Baby, Inc. Printed in the United States of America. Photos by Jeanne Martin, Christine Reynolds Photography, Laurie Altmann, Michele Milligan. Stock photography from istockphoto.com. Design by Exclaimit!, Inc. Paula Tarver and Jeanne Martin AdvanceMyBaby: the ultimate secrets of healthy development for your baby — birth to 3 years / by Paula Tarver, OTR/L and Jeanne Martin, OTR/L ISBN: 978-0-615-42045-5 13 12 11 10 9 8 7 6 5 4 3 2 1 First Edition
Dedication This book is dedicated to Elks everywhere, the Florida Elks Children’s Therapy Services, Inc., and to Ben Brown Jr., administrator, for giving us this opportunity to serve the children of Florida. To my Mother, Bonnie Jean Coelho, who was my inspiration. She believed in me and provided the unconditional support and encouragement I needed throughout my journey in life. I love you, Mom! — Jeanne Finally, this book is dedicated to my father, Kenneth Hansen, who was the icon of the family and a living example of unconditional love and dedication to family that went above and beyond the call of duty. He was my rock that I could always lean on. I love you, Dad! — Paula
Acknowledgments With much thanks to Mikey, Billy, Ashley and Amanda, Jeanne’s beautiful nephews and nieces. Also, to her brothers-in-law, Mark and Bill, her sisters, Laurie and Michele, and her cousins, Jessica, Selena and spouses, for allowing use of their children’s photos and Sandy Chiellini for photo editing. We are grateful for those who edited the book led by Dan Martin and supported by Carol Shaefer, Michael Barton and Linda Carroll. Much thanks to our husbands, Steven and Hewett, for their patience and support. This book reflects the profound influences in our profession, starting with the Hawaii Early Learning Profile and Early Intervention Developmental Profile Vol. 2. We also draw upon the work of Jean Ayres and Lucy Miller for their ground-breaking work in the area of sensory processing disorder, along with Sheila Frick, OTR, and Mary Kawar, OTR. Developmental milestones established over the years by those in the medical and occupational therapy arenas have been synthesized with our own 35 years of observation and experience to bring you this life-changing book. Finally, this work is made possible by the participation of caregivers: i.e., moms, dads, grandparents, uncles and aunts, medical practitioners, foster parents, daycare personnel, and others. Your desire to provide the best for the baby in your life, motivates us to provide user-friendly instruction, education and information for the joy of hearing you say, “Advance My Baby.”
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Publisher’s Note As you read this manual, you will note the adoption of a gender-neutral writing style referenced as “casual,” in “The Chicago Manual of Style.” Instead of the historical “he,” we have opted for “they,” “them,” “theirs,” and “themselves,” when referencing the “infant,” “baby” or “toddler.” While old-school grammarians may have trouble with our crossover of mixing singular and plural, we have done so to minimize the offensiveness of parents reading “he” when they have a little girl or “she” when they have a little boy.
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Contents Preface v About the Authors
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How to Use This Manual
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Introduction
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Chapter 1
Sensory Integration
1
Chapter 2
Premature Babies
11
Chapter 3
Birth to 2 months
25
Chapter 4
3 - 5 months
45
Chapter 5
6 - 9 months
65
Chapter 6
10 - 12 months
83
Chapter 7
13 - 15 months
105
Chapter 8
16 - 19 months
119
Chapter 9
20 -22 months
133
Chapter 10
23 - 25 months
147
Chapter 11
26 - 29 months
161
Chapter 12
30 - 32 months
175
Chapter 13
33 - 36 months
189
Glossary
203
Bibliography
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Advance My Baby Services
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Preface Babies are not born with a how-to manual, but this is what you have with Advance My Baby.
with parents asking why they had never before been shown these techniques, the two women believed it was their duty to take this message You now can put into place the building blocks to the world. This manual you hold is designed that lead to academic success, athletic prowess, to advance the baby of every caregiver. You are emotional balance and social acceptance. For on the cusp of a trend to transform the world — the first time, instruction is provided for the first one baby at a time. 36 months of life that create the ultimate foundation for your baby. The Advance My Baby manual can be used individually in the home. It can be used in small The greatest discoveries are often accidental groups. Those with the ability to lead can do and this manual is no different. Authors and so in a larger setting in their community. Local occupational therapists, Jeanne Martin and Paula support groups and online interaction provide Tarver, were forced to come up with better systems additional knowledge and methodology. to work with children after time constraints compromised the program in which they were www.AdvanceMyBaby.com, the companion operating. Their answer was to train the parents website, offers an assessment to measure progin something called “Sensory Integration.” ress of your baby and leads you to chapters in this book to enhance development of your Sensory integration relates to the brain’s ability baby. to interpret senses, organize them, and respond to the information for functional behavior. Our AMB Monthly Home Checklists helps you stay brain receives sensory messages and turns them on track daily with activities and exercises to into responses. This helps us orient ourselves to promote the development of your baby. the world around us. When you are finished with this manual, you Thousands of cases prove the merit of sensory will know you have created the ultimate enviintegration intervention. Ms. Martin and Ms. ronment for your baby to thrive and grow. Tarver watched their own success skyrocket as parents took an educated, active role in the Are you ready? sensory development of their children. After so many dramatic stories of transformation, and Let’s begin to advance our babies!
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About the Authors Jeanne Martin and Paula Tarver graduated in 1998 from Barry University in North Miami, FL, with their Bachelor’s of Science Degrees, majoring in Occupational Therapy. They have over 35 years of experience between them with specialized training in sensory integration and child growth and development. After graduation, they were selected as two of the 20 therapists hired to provide in-home therapy for the Florida Elks Children’s Therapy Services throughout the state of Florida. The Elk’s program provides free inhome occupational therapy and physical therapy services to children who have developmental delays and live in Florida. Most parents believe their child is developing normally, until their child is forced out of day care, not talking by age three, not toilet trained by age four, or starts having serious emotional and social problems between ages five to 12. Often, these were the children that were
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assigned to Paula and Jeanne and they determined the sensory system that needed to be targeted. When the two discussed their patient case loads with each other, they noted a common theme among the families — 80-90% of the children’s parents did not know basic growth and develop-
Paula Tarver OTR/L u
Jeanne Martin OTR/L u
mental milestones (i.e. when a baby should two therapists had provided. The parents bebe off a bottle; when the baby should be potty came part of the solution in the effectiveness of trained; the appropriate age to button a shirt, etc.). their baby’s development. They developed a specific plan for each child and trained the parents on a daily home program of exercises and activities selected to address the child’s individual needs. They believed that parent education had to be a major priority if the therapists were going to make a difference in the child’s life within six months or 24 treatments.
The two therapists continued to monitor national trends showing an increase in developmental discrepancies, and the idea to write a book was born.
The principles have since been perfected on Jeanne’s own daughter, who was born during the writing of this manual. Today, her daughter They spent 50% of their time working with par- is up to 10 months advanced compared to other ents to educate them on sensory integration and children of the same age. their child’s development. They came to see an informed parent was an empowered parent. Jeanne and Paula’s intention is to now share their As parents understood what was causing their knowledge and working expertise with as many child’s delays and what needed to be addressed families as possible. They want parents to have to catch the child up with health care norms, the a source to which they can turn for guidance and parents were proactive using the education the answers.
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How to Use This Manual When Jeanne and Paula work with children, The AMB On-Line Assessment reveals the they first evaluate the child to see where they performance levels of your child in all six are functioning developmentally, and create developmental categories: their treatment plan around the child’s specific strengths and weaknesses. Language Gross Motor They focus on building the foundational framework from which other skills emerge. They take a sensory approach to improve the efficiency of the child’s processing skills, build muscle, promote balance and coordination, and develop eye-hand integration. After catching the child up with gross motor skills, they focus their attention on developing the visual/fine motor skills.
Fine Motor
Self-Care
Cognitive
Emotional & Social
The Assessment provides a printout that serves as a guide to assist in the use of this book. It can be used to improve communication between doctor/patient, therapist/client, as well as, teacher/student. Parents will be able to track their Both, the AMB On-Line Assessment and the children’s progress and address any delays that Advance My Baby manual allow you to take come along before they become larger issues. the same work approach with your child. The first chapter on Sensory Integration explains You will have a hard time teaching a child to the importance of a healthy central nervous walk if they do not have the following: system which is the foundation for all growth 1. Trunk strength to hold up their body and development. A healthy vestibular system 2. Balance through their hips to maintain (the inner part of the ear that connects with the upright standing balance brain) is the key component to highly efficient 3. Bilateral coordination (the use of both processing of the seven senses: sides of the brain to communicate back • Smell and forth to work together to move the • Touch legs in a fluid manner) • Taste 4. Properly functioning vestibular system • Vision / Visual Perception to know where they are in space and • Hearing / Auditory Processing whether they are moving forward/ • Movement / Balance backward/upward/downward or around • Kinesthesia / Muscle Tone in a circle, and 5. Adequate visual perception to know If you have a newborn, proceed to Chapter 3 where they are going — “ 0 to 2 months,” after reading Chapter 1 — Sensory Integration. You will learn as you go. It is recommended that you start by Read one chapter at a time or jump ahead to the completing the AMB On-Line Assessment next chapter to see what you can expect to work at www.AdvanceMyBaby.com. on in the next three months of development.
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All stages of development are important and should not be skipped if you want your child to progress in a normal sequence. If your child is struggling in a certain area, you can give that area a little more focus and attention until you see the emergence of the required skills. When that skill is acquired, the stage of development is reached. Various play activities and exercises should be provided to the child on a daily basis for optimal skill development.
difficulty with coloring, drawing, cutting, and completing simple shape puzzles. Another example is a baby that is 10 months of age who does not have the head/neck/trunk strength, and shoulder/hip stability (3 to 5 month development) required to hold their body up into the crawling position; they will not be ready to work on crawling and may even have difficulty maintaining upright sitting balance.
If you have a child that you are concerned may You will need to work on the 3-5 month level of skills have a developmental delay, start with Chapter until they have mastered these milestones and are 3, “0 to 2 Months,” and make sure that your ready for the next level, which is 6 - 9 month skills. child has met all the milestones in that chapter. A secret to achieving higher proficiency levels For example, you may find that your 3-year-old is to focus on building a strong foundation of sensory integration skills. This is done through child is functioning at the following: stimulation of the vestibular system, which is • 22-months gross-motor skills enhanced by the following activities: • 8-months fine-motor skills • Spinning • Rocking • 18-months self-care skills • Walking • Swinging • 9-months social/emotional skills • Running • Jumping • 10-months speech and language skills • Balancing • Bouncing Start at those levels of development, work on the set of skills that comes next, and work your Each chapter in the manual has activities and way up until they have caught up developmen- exercises for each stage of development. tally in all areas. If you are uncomfortable playing and interacting with your child for any reason, then it is If your toddler is 24 months (2 years of age) and recommended that you seek out a professional you immediately start working on 24 month old therapist to guide and direct you until you feel skills when they need to be working on 15-month- comfortable on your own. old skills, you are setting your toddler up for failure. The activities and exercises will be too hard, which This manual is not intended to replace seeking out could cause them to feel badly about their skills and professional intervention from a local occupational therapist, physical therapist, or speech therapist, they may not want to participate in the activities. but is a complement to these therapies. An educated For example, if your child’s hand movements parent or caregiver is the best advocate for their are not developed or they are not processing child and will have a better understanding of their through their eyes efficiently, they will have overall growth and development.
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Introduction Advance My Baby is the first parent-friendly, professional, comprehensive manual to address all areas of development. Each chapter covers developmental areas of gross motor, fine motor, cognitive, language, emotional, social, and selfcare skills along with activities and exercises that the parent can do with the child to promote the various developmental skills for optimal overall growth and development. The reader will encounter blue boxes and red-framed boxes along the way that share information of key points that will help the reader grasp core concepts of development. Advance My Baby, the book, is a self-help manual for parents that will empower them with knowledge and expertise to develop beautiful healthy babies no matter their socioeconomic situation. The book is structured in three- and four-month developmental stages so that the reader learns as they go. This information is powerful. It gives parents the knowledge and skills to make the most of their time with their child. You will learn to assess normal development so that you will be able to recognize developmental delays if it should occur. This allows early detection and intervention. You will be taken through an exploratory journey through the “Secrets of Healthy Development� which are the very foundation of life itself.
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Chapter 1 13 12 11 10 9 8 7 6 5 4 3
Sensory Integration Sensory Integration (SI) SI Activities
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Sensory Integration 13 12 11 10 9 8 7 6 5 4 3 1
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Our sensory system is made up of seven basic senses: smell, touch, taste, vision/visual perception, hearing/auditory processing, movement/ balance, and kinesthesia/muscle tone. Sensory Integration (also called Sensory Processing) is the brain’s ability to interpret, organize, and respond to the information that we receive through these senses for functional behavior. It receives sensory messages and turns them into responses. This helps us orient to the world around us. It helps us relax, concentrate, and move safely throughout our day. The more effective our nervous system processes the information it receives, the better our response to the stimulus, and the more coordinated, or “in sync,” we become with our environment. Sensory processing disorders are more common than people are aware of and affect about 10% of the population. Sensory processing issues range from mild to severe. These sensory distortions lead to behavior problems, affect the way we move through our environment, influence the way we learn, relate to others, and how we feel about ourselves. The brain is designed to constantly take in sensory information for optimal brain function. When it is deprived of daily stimulation, it malfunctions, resulting in the inability to process information received through the senses. When two or more senses
are malfunctioning it is called sensory processing disorder. A classic example of insufficient sensory stimulation at critical times of development is the case of the premature baby. They are placed in an incubator for a few days to several months. They do not receive the deep pressure through their joints and muscles like they did in their mother’s womb. The volume is 10 times greater in the incubator with constant buzzing low frequency sounds. They are stuck with a needle every 30-minutes or so to draw blood, which in turn teaches them that touch is very painful and annoying. They often have nasogastric tubes down their nose and throat, which often leads to aversion to textures and flavors in the mouth. The environment is very sterile without the daily normal smells i.e. home cooking, flowers blooming, fresh cut grass, or sounds such as music, television, dogs barking, birds chirping, etc…that one would encounter on a regular basis around the home. It is important for caregivers to understand that the child with sensory processing disorder will not “grow out of it” on their own. These children need understanding and help, for no child can overcome the obstacles alone. They need to be treated by a pediatric occupational therapist specializing
Foundational Levels of Sensory Processing
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This level requires a solid foundation of the lower levels in order to develop self-control/regulation (behavior), to learn and grow academically, and to learn to feed, dress and bathe themselves.
Perceptual Motor: Level 3
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As babies’ central nervous systems efficiently process the sensory input in their environment, they will develop visual and auditory attention, language skills, and eye-hand coordination.
Sensory Motor: Level 2 As your sensory processing becomes integrated, the baby then develops the ability to imitate, gain security during movement, learn to filter irrelevant input, and become aware of each side of their body.
Sensory Processing: Level 1 Our basic seven senses are the foundation of our sensory processing, which develop our perceptions of the world around us. These are: smell, touch, taste, vision/visual perception, hearing/ auditory processing, movement/balance, and kinesthesia/muscle tone.
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Cognition: Level 4
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Baby is Born
At Level 4, the child will have the ability to concentrate, develop organizational skills, selfesteem, self-control, and self-confidence, with the capacity for abstract thought and reasoning, along with specialization of each side of the brain and body.
Signs of Sensory Processing Disorder 13 12 11 10 9 8 7 6 5 4 3
If your child has 10 or more of these signs or if they only have a couple signs which significantly interfere with their daily living activities, you should consult with a Pediatric Occupational Therapist specializing in sensory processing disorders. • • • • • • • • • • • • • • • • • • • • • • • • •
Uncoordinated – falls frequently Avoids movement activities Hyper-active or lethargic Puts hands over ears to block out loud noises/ unable to block out irrelevant sounds Walks on toes or has a bounce to their step Little awareness of pain or temperature Fascination with lights, fans, water Hand flapping/repetitive movements Spinning items i.e. wheels on cars Lines up toys Difficulty transitioning from one thing to another, resists new situations Poor tolerance to changes in environment Has self injurious behaviors (bites, hits, or bangs head) Aggressive towards others (bites, hits, pulls hair, pinches, pushes) Avoids swings, seesaw, heights, avoids playground equipment Poor fine motor skills, trouble with handwriting, may avoid schoolwork Reacts irritatedly or lashes out to people near or touching them Avoidance of certain “textures,” such as sand, grass, paste, and finger paints Does not like to get hands messy or dirty Spits out, rejects certain food textures, picky eater, failure to thrive Resists grooming – washing/brushing face, teeth, hair, cutting of nails Avoids certain textures of clothing Prefers to be naked Frequently adjusts clothing Wants tags removed from clothing
• • • • • • • • • • • • • • • • • • • • • • • • •
Takes shoes and socks off whenever possible Wants to be under a table or in a corner Poor eye contact Speech/language delay, poor articulation, communication deficits Seems to have weak muscles, tires easily, poor endurance Becomes anxious or distressed when feet leave the ground Has low self-esteem, or it is difficult to get them to try new things Climbs in inappropriate places Seeks out all kinds of movement Risk taker/poor safety awareness Constantly touches people and objects, tends to be irritating Is overly affectionate with others Seems anxious or nervous Has difficulty with dressing skills Difficult to comfort when upset Wants to touch/handle everything Puts inappropriate objects in mouth Presses too hard or soft using a pencil Poor coordination between their hands and their feet Hesitant at uneven surfaces Loves to swim, but hates baths, showers, hair washing Exhibits very controlling behavior Insists on wearing long sleeves/pants so that skin is not exposed Sits in “W” position (legs form a W shape) Problems with muscle tone, coordination, motor planning (brain’s ability to carry out a sequence of unfamiliar actions)
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Sensory Integration Activities (Bir th-6 mo.) These are activities that you should do on a daily basis with your baby/child. Many activities can or naturally will be performed several times a day. Listed below are a variety of activities that you can choose. The activities listed below incorporate all of our senses in combination of vestibular, proprioceptive, auditory, smell, touch, vision and taste, and are organizing and calming for most.
13 12 Tactile, gross motor, oral motor, and 11 auditory play activities 10 9 8 7 6 5 4 3 1
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• Massage • Rub body with lotion • Rocking: standing and swaying baby side to side in your arms or sit in a rocking chair and rock • Infant swing • Gentle bouncing: while swaddling baby in your arms, gently bounce your knees up and down • Tummy time: interact with baby when placed on stomach to play • Yoga ball: lay baby on stomach and on back to gently rock in all directions • Lighted toys • Musical toys • Noisy toys-rattles • Sing to baby • Place baby in front of mirror/mirrored toy • Talk to baby • Play soft music • Massage gums with your little/pinky finger or finger brush • Hold baby on lap facing away from you in a busy room • Hold baby at waist in ‘standing’ positon for bearing weight through legs and bounce softly • Swaddle in blanket • Gentle patting on the baby’s back or bottom • Food play-let baby get messy-eat without a shirt on
Perform activities for up to, but no longer than 15 minutes each time.
Chapter 2 and playtime Activities Premature Babies
Premature Babies
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Preterm < 36 Weeks Gestation Neonatal Intensive Care Sensory Integration for Preemies Sensory Integration Activities Self Care Skills Therapeutic Positioning
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Premature Babies
Preterm < 36 Weeks Gestation
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There are 8-10% premature births for every birth in the United States. A premature infant is born before the 37th week of pregnancy, weighing much less than full-term babies. There are mild, moderate and severe cases of prematurity, which may result in medical problems and long-term health problems. Neonatologists (pediatricians who specialize in the care of newborns) measure the babiesâ&#x20AC;&#x2122; weight in grams, not pounds and ounces. Fullterm babies usually weigh more than 2,500 grams (about 5 lbs, 8oz).
Mild prematurity refers to babies with a birth weight range between 1500 and 2500g (between 3lbs 5oz and 5lbs 8oz) who are born between 33 and 36 weeks gestational age. Moderate prematurity refers to babies with a birth weight range between 1,000 and 1,500g (between about 2lbs 3oz to 3lbs 5oz) who are born between 28 and 32 weeks gestational age. Severe prematurity refers to babies with a birth weight of less than 1,000g (less than about 2lbs 3oz) who are born before 28 weeks gestational age.
With severe prematurity, comes an immature Central Nervous System (CNS) which will compromise the infantâ&#x20AC;&#x2122;s ability to cope with the environment of the neonatal intensive care unit. This can be complicated with prolonged critical illness that necessitates intensive nursing care and aggressive respiratory care if the lungs are not fully developed. The more premature the infant, the higher the risk of long-term effects. The most common long-term effect is some form of learning disability, usually in math, reading and vocabulary. Vision problems may also occur, but may be treated with surgery if caught early. Hearing, respiratory, digestive and feeding problems also are common long-term effects, because the infantâ&#x20AC;&#x2122;s internal organs did not have enough time to develop before its birth. The sound of the machines in the NICU cause auditory sensitivities and the feeling of tubing down their nose and throat, while in the NICU, can cause lack of coordination with their mouth, lips and tongue resulting in the inability to coordinate a suck-swallow-breathe pattern for taking a bottle. Later, it can also cause sensitivities and defensiveness to having food in their mouths, or cause a lack of sensation, not being able to feel where the food is located in their mouths. Premature babies usually have low muscle tone and move less than full-term infants, causing difficulty with developing adequate head control, reflexes and movement patterns, which result in a delay in motor development.
Activities and playtime Sensory Integration for Preemies
Premature Babies
The CNS is developed from bottom to top with critical aspects of sensory integration located in the lower levels, particularly the brainstem and thalamus. This is where the vestibular system is located.
The first known responses to vestibular input is the Moro reflex that appears at about 9-weeks gestation. The fetus continues to develop a repertoire of reflexes that are generally well established by the time of birth.
Refinement of lower-level basic functions such as postural control, balance, and tactile perception provides a foundation for higher-level functions such as academic ability, behavioral selfcontrol, self-regulation, ability to concentrate and the development of organizational skills, self-esteem, and self-confidence.
Touch/tactile, smell/olfactory, taste/gustatory and movement/proprioception sensations are particularly important to the newborn infant, who uses these to maintain contact with a caregiver. The tactile sensations play a key role in fostering feeling of security in the infant and are critically important in establishing a parentinfant bond.
It also impacts the capacity for abstract thought and reasoning, along with specialization of each side of the brain and body for complex motor skills such as those required in sports. So, by enhancing lower-level functions, one will have a positive influence on higher-level functions. The fetus starts to respond to tactile stimuli at approximately 5.5 weeks gestation (Humphrey, 1969; Short-de Graff, 1988).
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The tactile sense plays a key role in an infantâ&#x20AC;&#x2122;s emotional life because it is directly involved in making and accepting physical contact with others. This perception of physical touch will influence the emotional development and social relationships throughout the infantâ&#x20AC;&#x2122;s life span.
This is a primitive protective reaction that is seen when an embryo bends its head and upper body away from a light touch stimulus around the mouth.
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Premature Babies
Sensory Integration Activities Once the premature infant is medically stable, it is time to provide sensory input throughout the day to make up for what was missed or under stimulated and desensitize or normalize for what was over-stimulated while the infant was in the NICU.
13 12 11 10 9 8 7 6 5 4 Visual Integration 3 2
Premature babies have many special needs that make their care different from that of full-term babies. This is true while in the NICU and when they are at home. Listed are activities to do with your infant at home. Begin the activities immediately and do them consistently. You can be proactive with preventing or decreasing some of the long term problems that are common among preemies. You can learn to position, handle, and interact with your baby in order to promote appropriate development. You can learn to read your baby’s cues and responses to the environment so that you can help to reduce stress, and help them learn to organize themselves and manage “sensory inputs” such as touch, sounds, and lights. Learning and providing the following exercises can help limit delays in your infant’s fine and gross motor skills, personalsocial skills, and cognitive skills, such as attention, memory and problem-solving.
• Cuddle with your baby in your arms or lay the infant on your lap and talk or sing lullabies to them. The parent’s face is the most appropriate visual stimulus in
early infancy. The human face is threedimensional; has contrasting features; provides slow casual movements of eyes and mouth; is presented at various distances away from the infant; adapts to the arousal state of the infant; and is not always consistently present or static like a picture on a wall. • When providing visual integration to a preterm infant, you want to select softer,
Preterm infant behavioral cues can help to determine the appropriate amount of stimulation that the individual infant can tolerate. If you see that the baby looks stressed or is pulling away, these are behaviors that mean the stimulation is too much and should be terminated. When you see that the infant is calmed and relaxed by the stimulation, this is an indication that the stimulation is appropriate.
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Chapter 3 13 12 11 10 9 8 7 6 5 4 3
Birth to 2 months Gross Motor:
While Lying on Stomach
While Lying on Back
Supported Sitting (holding infant at waist)
Supported Standing (holding infant at waist)
Fine Motor Cognitive Language Self-Care Emotional & Social
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Birth to 2 months
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Gross Motor - While lying on stomach • • • • • •
Lifts head up off the floor for 1-2 seconds Rotates/turns and lifts head up While lying on side, rolls to back Turns head to breathe Holds head up 2-3 inches off the floor for 4-5 seconds Straightens both legs
Holds head up 2-3 inches off the floor for 4-5 seconds
Turns head to breathe
Rotates and lifts head up
These milestones listed above are the beginning of head, neck and trunk strengthening which is needed for upright sitting.
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Activities and playtime
Birth to 2 months
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Promoting gross motor skills while lying on stomach Lifts head up off the floor for 1-2 seconds: Holds head up 2-3 inches â&#x20AC;&#x192; off the floor for 4-5 seconds: Place infant on your stomach, face to face. Encourage your infant to lift up their head and look at you while you rattle toys, speak and make faces. Place your infantâ&#x20AC;&#x2122;s stomach over a yoga ball. Gently and slowly bounce, rock and circumduct the ball (roll the ball around in small circle to the left and right), to encourage an upward lift of the head. Place infant on stomach on the floor with musical and lighted toys in front. Use rattles to encourage the infant to lift up and look for the noise. This strengthens the shoulder, neck and back muscles.
While lying on side, rolls to back: Place infant on the their side and present a toy to them. Rattle and shake the toy moving it up above. You want the infant to watch the toy or reach for the toy as it moves from one side to the back. The reach and/or head movement as the toy changes position will naturally elicit the change in the infantâ&#x20AC;&#x2122;s position.
Rotates/turns and lifts head up: Place your infant over a rolled towel or Boppie. Use toys or rattles for infant to focus upon Move the rattle to the sides to encourage head turn.
If your baby is prone to having seizures that are stimulated by visual input, do NOT provide them with flashing/lighted toys. Be aware of lighting in the environment, and spinning ceiling fans, as these can also elicit seizures.
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It is important that parents provide an hour of tummy time once a day. Lie with your infant on your chest, or place them face-down in your lap, for about 15-20 minutes at a time. This is great for massaging the stomach and internal organs, it lowers the rib cage for proper breathing, and strengthens the neck and shoulder muscles. This can be done routinely throughout the day.
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Birth to 2 months
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Language • • • • • •
Makes random sounds Makes sounds when content Looks at adult’s mouth and/or eyes when spoken to Moves head, arms and legs in response to noises or voices Cries when hungry or uncomfortable May gaze at a person up to one minute when spoken to
Looks at adult’s mouth and/or eyes when spoken to
Moves head, arms and legs in response to noises or voices (the infant responds to rattles and voice from adult playing with her)
May gaze at a person up to 1 minute when spoken to (the infant is gazing at a person talking to her who is seated in front of her)
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Basic response to voices and noise shows that the infant is aware of their immediate surroundings. This is the first step to understanding language.
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Activities and playtime
Birth to 2 months
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Promoting language skills Makes random sounds: Makes sounds when content: Respond to the infant positively to encourage them to express themselves orally. Looks at adult’s mouth and/or eyes when spoken to: May gaze at a person up to one minute when spoken to: Cuddle with infant in your arms and bring your face close to theirs so that they can examine your face. Babies are very nearsighted at this age. Talk or sing a lullaby to them to encourage attachment and familiarity of family members.
Cries when hungry or uncomfortable: Caregivers need to respond to the infant crying by trying to find out what the infant is trying to communicate. This is the first form of communication and helps to develop a pattern of interaction with caregivers. When the caregiver becomes intuitive and starts to tune into the variations of crying, they will know instinctively what the babies needs are. Is it I’m hungry cry?, I’m wet and want to be changed, cry?, I’m in distress and need help or am in pain, cry?
Moves head, arms and legs in response to noises or voices: You want to place the infant in areas of the home where the family hangs out together so that they are hearing various sounds and voices. This will help to develop the auditory processing for receptive language skills. This is a cue that the infant is hearing.
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It is important to know that you cannot spoil an infant at this age. It is very important that parents respond to the infant’s crying and provide comfort when needed. This is the infant’s only means to communicate to get the caregiver’s attention. The infant learns the various sounds it makes are useful and have meaning to others.
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Activities Wake Up Activities: Week # Rock and cuddle while receiving bottle or breast Bath, followed by lotion rub. Give lotion massage, including massage to hands and feet. Swaddle infant Brush gums/tongue with rubber infant brush 10-minute therapy ball: slow rocking and gentle bouncing while lying on belly and on back Tummy time 20-minutes. Place mirror and toys in front of infant and play and talk to infant Rock, sing and talk to infant Swing in infant swing Afternoon Activities: Week # Tummy time 20-minutes. Place mirror and toys in front of infant and play and talk to infant Swing in infant swing Carry infant in front loading pouch and walk around house doing housework or go for a walk 10-minute therapy ball. Slow rocking and gentle bouncing while lying on belly and on back Work on infant visually tracking toy/objects Hold infant on lap, talking and singing to him/her Massage hands and encourage infant to bring hands to mouth Rock, gently bounce, talk, read and sing to infant Evening Activities: Week # Work on infant visually tracking toy/objects Rock, gently bounce, talk, read and sing to infant Place infant on your chest while lying down for extra â&#x20AC;&#x153;tummy timeâ&#x20AC;? Encourage infant to lift head up Bath. Follow with a lotion rub, including massage to hands and feet Brush gums/teeth/tongue with rubber infant brush Do bedtime routine: i.e., swaddle, song, bottle, prayers, and say goodnight
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Use the checklist below to record activities with your infant. Place a check mark in the appropriate box as it is completed.
AMB monthly home checklist
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AMB On-Line Assessments AMB On-Line Assessments — The perfect companion to the Advance My Baby Manual Designed to track your baby’s development from birth to 36 months, AMB On-Line Assessments measure your baby’s grasp of developmental milestones in six categories: Research shows most mothers do not know when their babies should reach significant developmental milestones and wait longer than they should to seek a doctor’s evaluation. AMB On-line Assessments provide an objective program to help you gauge your baby’s developmental progress. The Assessments are designed to help identify developmental delays early if they should occur. They also show you where in the Advance My Baby manual you can find ways to overcome those delays. Print your baby’s personalized developmental report and present it to your pediatrician for more informed decisions about your child’s care.
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Gross Motor Fine Motor Cognitive Language Self-Care Emotional & Social
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