March is National Sleep Awareness month and the perfect time to give some thought to whether your child and family are getting adequate sleep. According to recent statistics , an average of 35% of kids ages 4 months - 14 years are not (!) and the effects of insufficient sleep can take a toll on your child's mood, behavior, learning and development as well as the family as a whole. Fortunately, there is help. Since 2011 o ur team has supported countless families since 2011 to improve the quality and quantity of their sleep and address nap & bedtime battles, frequent night waking, fears & separation anxiety, and moving away from feeding/rocking/holding to sleep and co-sleeping. Our 1:1 support options , available virtually or in our Haverford, PA office, include a 60-minute mini session for scenarios where just a few tweaks are needed, up to a package that includes one month of daily support and a medical screening with a physician who is triple-board certified in pediatrics, pulmonology and sleep medicine, Dr. Funke-Afolabi-Brown. Reach out to learn more about how we can support your family's sleep needs today.

Thank you to Kristin Quinn of Toddlers and Tomatoes for this guest post ! When the average person gets hungry, they eat. Sometimes, they even think about a delicious food, their mouth starts to water, they get excited about obtaining said food, and they look forward to their snack or meal. This is why it is SO difficult for the ‘average person’ to understand feeding issues. Sure, all kids are picky eaters … to an extent, and for a period of time, usually. But people, even educated, medical professionals on occasion, can’t seem to wrap their heads around ‘feeding issues’ that go beyond the ‘typical’ childhood phenomenon of complaining at dinnertime. Even when parents themselves have a child with feeding issues, it is still a mystery. Even though they are living it day to day, it is still hard to comprehend. I like to break it down like this: If your child is having a hard time with food, think about all of the steps that are involved in eating. Really, try it. You’ve probably never given a second thought to the numerous steps involved in consuming food. Here is just a list off the top of my head. I am sure that my speech therapist, occupational therapist, GI doc, and dietician friends can come up with a bunch more! Child becomes aware that mealtime is approaching. They start to think about whatever it is that makes eating difficult for them (smell, texture, hunger, sitting still, using a utensil, chewing, swallowing – or lack of hunger, etc.) They may start talking about not wanting to come to the table, or start crying, or acting out. Child is asked to come to the table, closer to the ‘eating experience’. They don’t want to. They may not want to sit in the chair, they may not want to see the food or smell it. They might physically resist coming to the table. Child sees the food on the table, or worse, on their plate in front of them. They have to accept the food visually. They have to SEE that food that is so difficult for them to manage (for whatever reason). Child is presented with the food in front of them, or prepped on a utensil for them to pick up or allow into their mouth. Child smells the food. So now, they are seated, which may be an issue for them, they are looking at the food, they are smelling the food … all before it is even in their mouth!! Child has to PICK UP THE UTENSIL or the food itself and PUT IT IN THEIR MOUTH. Imagine how much that takes out of them when they DON’T want to eat what is in front of them. They have to either put it in themselves, or allow it to be put in. This is where a lot of behaviors come out …pushing, throwing the food, crying, gagging, coughing (even at just the sight or smell). Once the food gets in, if it gets in … they have to manage the food. Maybe they don’t have the skills to chew and swallow properly, or maybe they are sensitive to different textures. Here is where we often see an increase in gagging and coughing. Sometimes the gags and coughs are a result of all of this time to think about how difficult eating is going to be in conjunction with actually having the food in their mouth. Then, once the kiddo has managed the food in their oral cavity, they have to SWALLOW it. Again, often gagging and coughing are at play, and sometimes vomit. But why? What is the issue …are they not managing the food effectively? Are they worked up with anxiety? Are there other, yet to be determined issues? Once it is swallowed, there is a whole new set of ‘steps’. How is their GI tract going to handle the food? Are there allergies? Diagnosed? Undiagnosed? Are they going to vomit some more? Are they going to be constipated? Are they going to have a reflux episode? When you start to think of all the steps involved in eating, it is a wonder it comes so easily to the rest of us. When trying to support a child with feeding issues, or a friend, or yourself, consider all that is truly involved in eating. What would you add to the list?

Treating torticollis is one of my greatest passions as a pediatric PT. Research has shown that the earlier a baby begins PT, the better their outcomes will be and the shorter their treatment duration will be. The best thing to do is to reach out to a pediatric PT as soon as you notice any signs of torticollis . These signs include: * A head tilt to one side only * A head turn preference to one side only (may also see head flattening on the back of the head on this side) * Use of one arm more than the other * Preference to feed from one side only (breast or bottle) Below are some of my favorite tips and tricks for treating torticollis that a parent or caregiver can start right away, even before you see your pediatric PT. You will notice that neck stretches are not included in these tips. I strongly believe that a baby should be evaluated by a practitioner who is skilled in this area before starting stretches on your own! Tip #1: Baby turns head side to side Encouraging baby to actively turn their head to both sides is a great way to help them improve their neck symmetry and flexibility. This activity can be done in any developmental position: on the belly, on the back, on the side, or sitting in your lap facing you. When baby makes eye contact with you, slowly move your face to the right and left and have baby follow your face with their eyes. Be sure to move far enough to each side so baby has to turn their head to keep following you! If your baby prefers to turn their head to one side only, it is a great idea to practice this more to their non-preferred side. The goal is to promote equal and symmetrical movement in the neck to decrease the head turn preference. Tip #2: Change the set up of baby’s environment Environmental set up can be a big factor in treating torticollis. If your baby always has to look in one direction to see a caregiver approaching, or is always facing the same way in the crib or on the changing table, it can contribute to a head turn preference. To switch things up, place baby in their crib or bassinet in the opposite orientation as their norm so they have to turn their head to the other side to see someone approaching. This can be done on the changing table too, and offers quite an experience for the parent to change your baby’s diaper with your non-dominant hand! Tip #3: Limit time in containers Containers are anything that “contains” your baby, and there are no shortage of them! Just a few examples of containers: Bouncers Swings Strollers Carseats Sit-me-up and Bumbo seats Jumpers Walkers Exersaucers Containers became very popular after the Back to Sleep campaign started in the 90’s, when parents were encouraged to place babies on their backs to prevent SIDS. So, many companies decided to make containers to promote babies being on their backs. All that time on the back = more pressure on the very moldable bones of the skull = flat spots. The problem with containers is that, in addition to contributing to flat head syndrome and torticollis, they limit free body movement. Limiting free movement of the head, arms, trunk, and legs can hinder typical development. My gold standard recommendation is to limit time in containers to 30 minutes per day. If families find that to be too challenging at first, I recommend limiting to 15 minutes at a time and not to move from one container right to another. Also, aim to give your baby twice the amount of floor time for play as they spend in containers. I never guilt parents for using containers, but instead, try to empower you to use containers as a tool when you need a break! Tip #4: Play on side opposite of a flat spot Torticollis most commonly presents with a head tilt to one side and a head rotation preference to the opposite side. Often, a baby will have flattening on the back of the head on the side of the rotation preference. To help correct the flattening and prevent it from getting worse, place baby in sidelying to play on the side opposite of the flattening. Use a baby mirror, colorful or textured blankets, or musical toys to make it fun. Sidelying is one of my favorite play positions for infants and it is a crucial part of treatment for torticollis and plagiocephaly. Tip #5: Elevated tummy time Tummy time is a staple in the treatment of torticollis. It helps to strengthen the muscles of the neck and shoulders, making it easier for baby to lift and turn their head side to side. Young infants tolerate tummy time best in an upright position when they are still building up their tolerance. In an upright position, is it easier for baby to lift the head and chest as compared to being horizontal on the floor because it is a “gravity minimized” position as compared to being horizontal on the floor. Examples of upright tummy time include: Over a caregiver’s lap On a caregiver’s chest or tummy On a Boppy pillow Tummy time can start to move toward the floor once your baby is tolerating elevated tummy time and has developed improved neck strength and head control. Letting them practice tummy time in a position that is not as challenging sets them up for success! I hope these tips will help a parent or caregiver get started on torticollis treatment early, as soon as they have a concern. As always, it is important to also seek out a pediatric PT who is experienced in treating torticollis and plagiocephaly to create with a personalized treatment plan for your baby and use skilled handling techniques to lead to the best possible outcomes.

Thank you to Joe Metzger of Safer Babies for this guest post ! Is Childproofing Actually Necessary? Whether you childproof your home yourself or hire a professional, babyproofing is the wise choice for modern families. Skeptical? Consider the following: (1) "When you know better you do better." (Maya Angelou) Our parents and grandparents didn't have modern baby-proofing products when we were kids. But just because they didn't use them then, doesn't mean we shouldn't use them now. Knowledge is power. The information we have today on home hazard statistics, combined with the availability of child safety products, compels us to act responsibly to ensure our kids' safety. (Older generations also didn't use child safety seats!) (2) Injury statistics are made up of real children, whose parents never expected them to get hurt. It's easy to distance ourselves from statistics. But when the statistics become real names and faces, their message is more poignant and urgent. As for safety professionals, we are diligent because we're familiar with real-life stories: toddlers who have died from TVs or furniture falling on top of them; young kids who drown when they wander off unexpectedly; children falling out of bedroom windows. We have the inside story on head injuries and broken bones occurring from falls downstairs, and the desperate calls made to poison control. We are here to help protect your family from those kinds of painful circumstances. Why gamble with being a statistic, when there are simple ways to keep your baby safer? (3) Modern technology is distracting. With the use of smartphones, tablets, and laptops child injuries are actually on the rise. We all have minutes now when our eyes are averted checking a message, sending a quick text, or browsing the internet. Sometimes we are distracted more than we ever intend to be! Little hands can find big trouble when they are unsupervised in an un-babyproofed space. (4) Pick your battles and make them count! Discipline is hard work and a lifelong process. Children need to learn obedience. But human nature dictates that we don't easily listen to anyone who constantly yells "No" at us. Don't begin your baby's life with a series of " No opening the cabinets! No going upstairs! No pulling the wires. No, don't touch that! Stop! No. NO!" Childproof your home and you'll feel less stress, your baby will feel less stress, and you'll have more patience (and more attention from your child) when an important "No!" is necessary. ( 5) Babyproofing helps when someone else in charge. Even if you are a 100% perfectly attentive, vigilant parent who can without a doubt, and without stress, prevent your young child from encountering all dangerous hazards in your home - you are not with your child 100% of the time. Babyproofing will decrease your stress and worry when you are away, and make things easier for those you entrust with your child. Safer Babies has over 25 years experience and offers FREE In-Home Babyproofing Consultations for families in the Philadelphia, Main Line Philadelphia & DE area. Their goal is to improve the everyday life of young families by increasing safety & decreasing stress.

February is Child Sleep Awareness month and the perfect time to give some thought to whether your child and family are getting adequate sleep. According to recent statistics , an average of 35% of kids ages 4 months - 14 years are not (!) and the effects of insufficient sleep can take a toll on your child's mood, behavior, learning and development as well as the family as a whole. Fortunately, there is help. Since 2011 o ur team has supported countless families since 2011 to improve the quality and quantity of their sleep and address nap & bedtime battles, frequent night waking, fears & separation anxiety, and moving away from feeding/rocking/holding to sleep and co-sleeping. Our 1:1 support options , available virtually or in our Haverford, PA office, include a 60-minute mini session for scenarios where just a few tweaks are needed, up to a package that includes one month of daily support and a medical screening with a physician who is triple-board certified in pediatrics, pulmonology and sleep medicine, Dr. Funke-Afolabi-Brown. Reach out to learn more about how we can support your family's sleep needs today.

When your baby or child isn’t sleeping, you may be willing to try anything to get those little eyes to close. And while well-meaning friends and family always have their best (often unsolicited!) advice handy, many parents end up compounding sleep challenges by following inaccurate advice. Here are 5 common sleep myths you’ll want to avoid falling for. The Myth: "If I Put My Baby to Bed Later, They Will Sleep Later the Next Morning.” The Reality: Adults can compensate for a late bedtime by sleeping in the next morning. Babies and children, whose sleep is heavily dictated by their internal clock, often cannot. A pattern of too-late bedtimes will create a sleep deficit, which may in turn trigger even earlier waking, compounding the deficit. Overtired bodies respond by releasing hormones, such as the stress hormone cortisol, at times when they aren't needed or helpful which creates more difficulties in falling asleep and staying asleep. Surprisingly, the fix is often an earlier bedtime . Try it! Your child may sleep better and longer. The Myth: "If My Child Naps Less During the Day, They Will Sleep Better at Night." The Reality: Following this guidance can create a vicious cycle of over-tiredness. Nap deprivation can cause difficulty settling for naps and at bedtime, shortened nap lengths, frequent night waking, and early rising. A good night of sleep starts in the morning by getting adequate naps with ideal wake windows between sleep periods. Newborns need sleep about every 1-2 hours. For a fussy baby, try to start the soothing routine well ahead of the goal sleep time and possibly even before you see any obvious sleepy cues. Babies 6 months or older need to sleep about every 2-3 hours. Toddlers can stretch about 4-5 hours between sleep periods. Figuring out your baby’s “sleep window” can mean smoother and longer nap times. The Myth: “My Child Just Needs Less Sleep Than Most Children Their Age.” The Reality: Yes, total sleep requirements do vary from child to child and there is a wide range of "normal". Some children reach developmental milestones earlier and seem to need less sleep than their same age peers. You know your child best, and no generic chart or ‘rule’ can substitute for your own good sense. Be aware, however, that some very alert, busy children actually need the same or even more sleep than their peers. They are just better at hiding signs of tiredness and more tenacious in fighting sleep and routine. If sleep is a struggle, your child looks visibly tired, or if you are experiencing behavioral challenges, they are likely getting insufficient sleep. Far more parents suspect their child needs less than their peers than the number of children who actually do. The Myth: “I Can't Improve Sleep My Baby's Sleep Because I'm Not Ready to Stop Nursing or Co-sleeping." The Reality: A solid foundation for healthy sleep as well as practicing and mastering how to fall asleep can happen within any sleeping or feeding arrangement. While co-sleeping does create additional challenges or variables, that doesn't need to stop you from helping your baby get the sleep they need. If you enjoy nursing and want to continue, that’s great! However, allow baby to practice falling asleep without the breast and out of arms some of the time too. Or work on trading down their sleep associations , for example moving from feeding to sleep to snuggling to sleep. The Myth: “I Can't Improve Sleep Because I Don't Want My Child to Cry it Out.” The Reality: The ‘cry it out’ debate has raged on for years but no single approach will fit or work for everyone and gentler, more gradual methods exist that very often work just as well. Certainly, be prepared for a few tears, but you can limit those tears of communication and support your little one with, you guessed it, consistency! Choose a method that suits your lifestyle so you can follow through regularly. It would be lovely to believe that, once your baby is sleep trained, you’ll never have to do it again. However, developmental milestones, especially in the early years, can temporarily disrupt even the best sleeper’s good habits. Shake those up with travel, illness, moving, or a new sibling, and you may find you have to begin again. Don’t worry – these changes are almost always temporary. Just think — one day, your baby will be a teen, and you’ll be looking for guidance on how to get them out of bed! If you need support to address sleep challenges with your baby, toddler or school age child, our team is ready to help. You May Also Be Interested In: The #1 Reason Your Baby is Fighting Sleep Why is My Baby Waking So Much?! Do I Need to Sleep-Train My Baby? Which Method is Best? 3 Ways to Decide Does Changing Sleep Habits Mean My Baby Has to Cry?

Every Fall we are swimming in calls and emails from exhausted parents whose baby or child is waking way too early every morning. So let’s talk about it! First, let’s make sure we’re talking about the same thing. Babies and children are programmed to be early to bed and early to rise so, typically, waking at 6 or later is considered normal. We define early rising as regularly waking before 6 am, before an adequate total of sleep, or at a time that is unusually early compared to your child’s normal wake time. So what causes a child to gradually or suddenly begin waking too early? Bedtime is Too Late or Too Far Out From the End of Nap The most common cause is too late of a bedtime or, similarly, too long of a wakeful period from the end of nap to bedtime. Our little ones have an internal clock that tells them when to feel sleepy and when to wake up as well as how long they can comfortably manage being awake. Going to bed after their ideal time actually causes them to pop awake earlier the next morning. As counterintuitive as it may seem, going to bed even a tad too late or too tired often results in less sleep rather than more. Many parents fall into this trap in the spring and summer months as it stays light out later and we are extra busy with traveling and socializing. Your child’s clock and sleep needs, however, do not shift later with the daylight so this can cause a delayed reaction that surfaces in the Fall. So, if bedtime has recently shifted in your home or naps have been hit or miss that is the likely culprit for the early wake up call. Take a close look at your recent family schedule and aim as often as possible to shift back or at least closer to the schedule that was in place when all was well with sleep. The Room is Too Bright The level of light in your child’s room can interfere with sleep year round but especially during those seasonally extra-long days. Daylight has a big impact on sleep as the reduction of daylight in the evening causes our bodies to release the sleep helping hormone, Melatonin and the rising of the sun signals our brain to wake up. So if the summer sunlight is streaming into your child’s room at bedtime and the crack of dawn the next morning sleep struggles may ensue. Blackout curtains can be a lifesaver or, in a pinch, thick black trash bags and tape around the window frames. For some very sensitive children even the light that streams in the sides of the curtains is enough to trigger a wake up. For these little ones wrap around curtain rods may be necessary or a product like the ones available at BlackoutEZ.com or SleepoutCurtains.com . If you are traveling or have windows that are too large to cover, consider the SlumberPod . Developmental Leaps If your little one is approaching or mastering a new cognitive or motor skill this leap can cause temporary early rising. For example if they are learning to roll, crawl, about to take their first steps or acquiring new vocabulary very quickly their brain and body may be so revved up that they pop awake bright and early wanting to practice. Naps often suffer during leaps too which can compound the problem. Your best bet during a leap is to try to keep your child as rested as possible until normal sleep patterns resume. If they have a back-up sleep method such as the car or stroller use that to your advantage to tank them up on sleep. If not, a temporary earlier bedtime can help offset the early rising, not by solving it but by keeping sleep totals high until the leap passes and a normal wake time and bedtime can resume. Early Wake Time is Being Reinforced Whatever the cause of your child’s early rising you’ll want to be cautious to avoid reinforcing it as the new time to start the day. While it is much easier to just let them get up whenever they wake, that will reinforce this as the new wake time making it much harder to correct. Instead, aim to have a set time when it is okay to start the day (you can use 6 am or after 11 hours of sleep or whatever was normal for your child) and treat anything before that time as you would a middle of the night waking. That may mean responding with a quick check in, helping back to sleep or ignoring depending on what you are comfortable with. The goal would be to persist with that response either until your child returns to sleep or until the clock strikes the set time at which point you can get them up to start the day. While it will feel frustrating to leave your child in their room and not have them return to sleep, it will accomplish the goal of not reinforcing the early waking time which can pave the way for correcting the habit. For children 18 months and older you can consider introducing a toddler clock such as the Gro, OK to Wake, or Hatch clocks. These can help a child to understand when it is and isn’t time to get up (without relying on sunlight) and make your responses seem much less arbitrary. Falling Back on the Clock The end of daylight saving can easily rock your child's sleep timing and totals. Overnight we decide that baby's usual wake time is now "too early". It stinks for everyone and it isn't your child's fault. You can read our tips on shifting before or after the clocks change below. The goal is to prevent a domino effect of overtiredness and/or getting stuck on schedule that starts and ends too early, so you'll want to make sure you are helping them shift back to more reasonable times/your goal times a little bit each day. How to Survive Falling Back on the Clock These are just a few of the reasons mornings may creep or have crept earlier for your family. Whatever the cause, you can take steps to reclaim your mornings! And if you can’t sort out the cause or solution on your own, our sleep team is ready to help.

The time change is swiftly approaching and parents are beginning to panic! I don’t blame you. If you have a sensitive little one like I do, the time change can wreak havoc on the family’s sleep for a long time. Bedtime will feel a full hour later to your child and a 6am wake-up call abruptly becomes a 5 am one! Here are some tips to help your family prepare for the change and transition more smoothly... Before the Change: O ption #1 – Do Nothing! If you have a child who is rather adaptable and well rested and who is waking at a reasonable time each morning you may be able to go with option #1 and do nothing in preparation for the change. When your family wakes that morning simply shift the day’s schedule and activities to the new clock times and roll with it. Your child may be a little overtired and feel free to offer naps and bedtime slightly earlier if needed but your child should adjust within a few days. They may continue to wake "too early" on future mornings though and you'll need a plan for that so be sure to keep reading, just in case. Before the Change: Option #2 – Shift the Schedule in Advance If you have a more sensitive child, one who is already overtired or waking too early in the morning (before 6 a.m.), you may want to consider shifting their schedule in advance of the change. Remember that sleep times on Sunday will feel a full hour later to your child and, for a sensitive child, can wreak havoc on sleep and their mood. For these kiddos consider approaching the transition gradually by spreading the time shift out over four nights rather than one. You can do this by shifting wake time, meals, naps and bedtime 15 minutes later each day. For example, if bedtime is 7:00 p.m., you could begin on Thursday night by shifting that to 7:15 p.m., then 7:30 on Friday night and 7:45 on Saturday night. By Sunday night bedtime would be 8:00 p.m. which will again be 7:00 on the new clock. For highly sensitive children you can slow that process down even more, shifting the schedule by just 5-10 minutes at a time and/or every 2-3 nights and starting farther in advance. After the Change: Option #3 – Split the Difference/Shift After the Fact If you are/were unable to shift the schedule in advance or, if you plan to do nothing but your child struggles with that, you can split the difference. To split the difference shift your child’s schedule earlier by 30 minutes the day the clocks change and another 30 minutes earlier the following day. For example, if nap usually falls at 9 am and you put baby down at 9 am on the new clock that will feel like 10 am to them, a full 60 minutes later than usual. To avoid too much overtiredness you can split the difference, putting baby down at 8:30am on the new clock so they feel only 30 minutes overtired. Then, the following day, shift another 30 minutes back to napping at their usual time of 9 am on the new clock. Of course you can do this same shift in smaller increments after the fact as well, taking more than 2 days to match up to the new clock times. When in doubt, ask yourself, "What time does it feel like to my child?" Then decide how you can adjust to nudge them past that and closer to the time we now want it to feel like. Many children will adjust in a few days but the most sensitive and least adaptable ones can take a couple of weeks to fully adjust... * Don' t Get Stuck! Y our goal is to shift sleep back to your child's typical sleep times but on the new clock rather than allow their schedule to shift a full hour earlier and get stuck there. * Keep it Dark & Boring Regardless of how early your child wakes, b e sure to keep them in their crib/bed/room until their normal wake time. During the process your child will likely wake earlier than usual (according to the clock but not according to your child!) for a time. Do not get them up or allow them to get up before the new desired time. Avoid exposing them to lights, screens, and activity before the desired goal time. Over time that will help to reset their internal clock and get their wake time back on track. * Reprogram Their Toddler Clock If you are using a toddler wake-up clock be sure to reprogram it to wake at the new goal wake time. Have them remain in their crib/bed/room until the clock wakes up. * Get Outside! Since our internal clocks are set by daylight, aim to go outside in bright sunlight for 20-30 minutes each morning after the change. This too will help to reset your child’s internal clock and get things back on track more quickly. As with all things parenting, remember, this too shall pass! If you need support to navigate the time change, early rising or another sleep challenge, learn more about how we can help.