6. Early Childhood Development with guest expert Ruth Bayliss, The Children's Physio

Introducing Ruth Bayliss: The Children's Physio's Journey Welcome to the health and child pods. My name is Johnny. I'm joined by my Co host Emma and we're also thrilled today to be joined by Ruth the children's physio. Ruth is a pediatric physiotherapist who is also set up her own private dementia under the name the Children's Physio Links will be in the virus. Please check that out. She's a pediatric physician with the NHS experience as well working at places like Almond St. and the Portland Hospital. And she is the clinical director and manages a team of pediatric physios that work across the southeast, If I'm right, Ruth, London, Greater London, Berkshire and Surrey area. And the topic of today is going to be all around normal development. So this this will be a big one. I see, you know, your, your new parents wandering around when your baby should sit up, tummy time, when they should walk, Should you use child walkers? All these questions we think of as new parents. So hopefully we cover some of those today and it'll be a nice one for you guys to talk into. So first of all, I just want to say a big welcome to you Reef, and thank you for joining. Speaker 2 Thank you. Speaker 1 And you know, tell us a little bit about yourselves. How did you end up where you are? And you know, what's what's your story with with what inspired you to get into Pediatrics? Speaker 2 Oh, I was always Pediatrics from the outset. I think if you cut me in half, it would be there internally in my core. I just love working with children. That was the the thing that started it. And then the thing that really said that was working with parents and just having that opportunity to make an impact not just to an individual, but to a whole sort of family unit. And I think the more I've worked in Pediatrics, the more the more that's just given me a drive to help more parents and more children. And yeah, that's sort of taken me from each part of my career on to the next one really is I think I've just got this internal drive going. What's next? What more can I do? So, yeah, it's like you said, I started out in the NHS, found PEDs as quickly as I could, and then I've been really lucky to stay in Pediatrics ever since then. It was only, it was, yeah, it was a specialist physio at Great Ormond Street when I started to think where else do I want to go and where, where can I take this career and where can it take me, I guess. And that's when I started the children's physio. So yeah, it started as a evening and weekend hobby and it's grown into a business that covers a really wide area and we have just the best team of expert physios and so best to be able to call them colleagues and team members. So yeah. But I think, yeah, Pediatrics for me has just always been for me. I love it's the variety and the children and everything that just makes it so special. I think that's why I'm so excited to talk to you today about all things development because it's such a huge topic and it's such an important one. And I think you could be forgiven for thinking it's very, it's very, you know, it's kind of a rope learning thing. It's these movements at these ages and it's just memorizing those and then you move on. But it's not that at all. It's so incredibly varied and nuanced. And I don't think, you know, in the thousands of children I've probably seen, I don't think I've met one that's done the same thing or done something expected. They all do everything slightly differently. I think that's the joy of it. So yeah, I'm really looking forward to speaking about all things development with you today. Speaker 1 Fantastic and a lovely little summary about your journey, but the listeners, I think it's great for the context that the different environments you've worked in as well across your career. You know you've worked from neonates when they're really teeny tiny and kind of intensive care units all the way through the different environments from community into school aged children, kids. So again, probably giving you a really nice exposure and understanding to what normal looks like in each of these phases as well. Understanding Milestones: Guidelines, Not Deadlines for Development And that's a nice Segway probably into the first sort of area of as conversation around this. As a parent myself, I remember it's really hard to not get sucked into the kind of they should be doing this at this point and they should be, you know, walking by 1212 months or whatever it is. And you almost become a little bit fixated on these timelines. What is your take on the kind of milestones conversation? And if you could maybe, and I know it's a huge topic, but maybe briefly touch on what are the kinds of big milestones and in your experience, what are the kind of rough timelines? Because that's the thing you've already said, they're all different. What are the rough kind of timelines that we should be kind of working on? Speaker 2 Yeah, My sort of general take on, I mean, even the word milestones I think is a confusing one for parents. If you think about what a milestone is, it's a steps marker along a step path and it gives you this impression that it's going to be really linear and they're going to do this. So then the next milestone is this and and so on and so forth. But that's not the case. There are so many different areas of development from gross motor, fine motor, social language. And John not going to find a child would like to find maybe there's one out there that happened to go down the route of doing absolutely every single one in that really textbook order. But I haven't come across 1 yet. And I think so, yeah, my thoughts on what I'm saying straight off the bat is maybe we should try and think of something else to call it, because I think it's already putting this pressure and this idea that it's a very linear thing. There are of course, age brains and guidelines that we're working towards, but they are guidelines, not deadlines. That's something I love to say to parents. And within that there is so much variation. So I think if anyone would, if I could take one thing, if I could have a parent take one thing away from this conversation, it would be to try and enjoy as much as you can the stage that your baby is AT and not worry about what should be coming next or when is the next thing going to happen. Because milestones and these big skills that babies learn can either be moments of big emotion and angst and worry and concern. All they can and really should be moments of pure joy and excitement, like their first steps or their first words or their, you know, the first time they roll over and catch you a guard and all these things that your baby's first. And I think sometimes as parents and as professionals, we can get so bogged down in this, the way things should be and the way things ought to be, that you can lose the magic of the moment. So that would be something I'd really like people to get from this conversation is just the confidence to know what to look for and when and be able to exist in the stage that a child's AT and just enjoy it. Because before you know it, the next stage is going to be upon you and you'll be Googling a completely different thing and worrying about a completely different milestone. I don't know when that ever stops. If any parents know when that stops, let me know. Tracking Head Control, Rolling, and Sitting Development But in in general terms, if we go really broadly over the different areas of development and then as a pediatric physio, the ones we focus on most are the gross motor ones. So they're sort of the ones that are outlined the most. But yes, your gross motel, which are your big skills, your sort of big ticket movements from the big muscles. So they're things like rolling, sitting, crawling, walking, and then you've got more of your fine motor development. So things like grasping, things like pointering, waving, gestures, they also come into more like social skills. So you're talking and you're babbling and and that also links to that all your language things as well. So they're like your 4 main areas of development within your gross motor, which I think the one for me definitely is Pedro physio. We get most bogged down with the sort of time frames you're thinking of from newborn to three months, which is a huge time frame in itself. The main one we're looking for that, that first sign that we've got some, some gross motor development going on is head control. And that's what we're really looking for in the first three months of life is may be able to start controlling that head a little bit more. And when they're on their tummy, are they lifting it up and doing that in a really nice controlled way, not just arching, holding it up with an, but are they able to actually lift it up and start to potentially look around or, or fix and follow on something? So just looking at that really nice head control in those past few months, which then leads really nicely into rolling, which is the one we'd probably start to look for next. Rolling can happen any time from sort of three to seven months, which if you think again about about your baby and that time frame is just vast. It's huge, isn't? Speaker 1 It, yeah, it's huge, yeah. Speaker 2 And rolling isn't just, you know, tummy to back and back to tummy. You want to be looking for you want to be looking for both those things. But it's also can they roll and do that to both sides? You usually start to see tummy to back first. That tends to happen first because it's just easier for a baby to go from their tummy. So when they're on their front, they've got more motivating factors. A lot of babies don't particularly like being on their tummy and they want to get back to lying on their back and also they haven't quite strengthened their trunk and core muscles just yet, which they need in order to go from their back onto their tummy. So you tend to see it in that order. So tummy to back comes first and then back to tummy usually wallows and you want to be looking that baby can do that to both sides. Everyone different. I'm going to say that 1000 times in this conversation, I think some babies will do it loads and they'll absolutely love rolling and you'll be able to keep them still. Some babies will need a little bit of coaxing, a little bit of support with that. Some would do it once and you'll think, great tick box and then you'll wait and watch and they never do it again. And you think, wow, what's happened to you? And it's just, yeah, it's just one of those lovely things that they like to do to keep us on our toes. So yeah, that's right. And you have between four and seven months for rolling. Sitting tends to be that first big one that parents really like to focus on. I think perhaps it's because it links so much to feeding and when baby can start solids, which is again, a whole milestone in itself. But you're looking for a baby to be able to sit round about six months, sit independently without support by seven months would be the ideal. But again, it depends on so many different factors. All of these. Do you know the genetic makeup of your, the jacket makeup, the physical aspects of your baby? Some babies are really tall and long in the body, which then makes it a lot more difficult to stick and maintain sitting balance as a baby that's perhaps a bit more short in stature. Bigger babies, smaller babies, all these things that are already variants become even more important when you're looking at things like the gross motor skills. But sitting, usually we'd see around about that six to seven month mark. And then you want to also be thinking about the transition from these positions. So are they able to get into sitting by themselves? So you might have a baby who's able to sit up beautifully at six months, but has absolutely no idea how to motor plan their way in and out of that position. And you might, on the other hand, have a baby that isn't quite sitting by themselves yet, but they are able to come in and out of sitting quite nicely. And both of those things have have pros and cons. And there's pediatric physios, you know, we're going to be looking at both of those and thinking that's a baby that's progressing towards sitting really well. Whereas a parent, you might be thinking, my baby's not sitting yet. So I think it's how they move between positions is also a really important one, not just the tick box in can they do that milestone itself. Exploring Diverse Crawling Styles and Child Motivation And after sitting, usually you're going to see crawling or sometimes crawling can come sooner anytime I'd say between 7:00 and 11:00 months. And when I say crawling, I also mean just general floor mobility. Speaker 1 You're touch, you're touching on something we're definitely going to talk about a little bit later as well. And but again, 7 to 11 months, it's what it's massive. It's four months like every child's life. So I think that so many people are going to hear that and go, I feel relieved probably because I think a parent sometimes, whether you like it or not, you compare and, you know, if we're honest about it, it's a human great, you know, and and people will do it whether they think they are or not. And that that gives that passive stress. I think sometimes I was like, Oh my gosh, why aren't they doing it? What's going on? So so here you say that I think the people listening will be like such a big relief. Speaker 2 Well, I mean, crawling is one of those one, I think. I mean, in the UK we recognise crawling as a milestone. But in America and the CDC, they actually took crawling out of the developmental milestones, which is, and when you're speaking to like colleagues overseas, I think they, you know, they're really trying to advocate to go put back in because it's a huge milestone. Floor mobility and how a child chooses to get from A to B is monumental and it tells you for me, it's why the first cues that tells you a lot about that child's physical abilities. It can be a real window into where where they're strong, where they're weak, if there's any imbalances, their preferences, what motivates them. Crawling is is when you start and the age and start to crawl. That's the time that sort of comes out is when you start to see a child's personality come through a lot more as well. And I think the fact that that sort of lines up with crawling and how they choose to crawl says a lot about us as human being. I find it fascinating. And it's just, yeah, I think so, yeah, 77 months. It's a huge, huge time frame. And there are so many different ways. So I I could talk about crawling all day long and all the different types. So just to really briefly talk, it's the the commando crawl or the Army crawl or Tammy crawl, as people call it. And you've got your four point crawling, 3 point crawling, asymmetrical crawls, bottom shuffling, rolling. Some children just get from A to B by rolling their way along the floor. So yeah, we can talk about crawling all day long. I think it's fascinating. Speaker 3 It's so funny you say that actually. And I think you've highlighted things so well. And I absolutely love your tagline of guidelines, deadlines, because I think we can end the talk right there because that is literally the best summary of development ever. And you've just listed off a number of crawling ways, which summarizes the difference. And I'm sure all of us agree that this is one of the really common things that we get asked by parents. And one of the referrals we often get is abnormal crawling or worried about sort of asymmetrical crawling or they only bottom shuffle, they don't wait there on their arms. And you mentioned about the link with personalities. I'm curious to hear more on that. What sort of things have you noticed with regards to the sort of different crawling styles and personality? Isn't it? Speaker 2 So I think whenever I see a child with a parent that's got a concern about certain things to development and if we keep it to crawling, I really like to start to try and tend to get curious. Try it. Rather than worrying about what they're not doing, let's look at what they are doing and be really curious about what that is. Because if you can find out that child's motivation, you can often find out the reason behind what they're doing. So some children are really motivated by toys and play and high level stimulus and things like that and some aren't at all. Some don't want to look at toys. They don't. They're not interested in books. Some. Speaker 3 Just they will move for themes, but they will take out. Speaker 1 I don't blame them, that would be my motivation. Speaker 2 Say, I think I think what you can really when you get curious and you look at what is this child's motivation, then you start to see why they're crawling the way they're crawling. I often find that children who are army crawling, yes, there's physical reasons like perhaps they haven't got the shoulder stability to go onto extended arms. Perhaps their core isn't as strong as we'd like it. But the real reason is that the is a really motivated, highly motivated movers and they've actually learned how to move before their bodies managed to catch up with. Perhaps we ought to do it in a four point ideal crawling way. So these are usually your children that just have so much energy and want to move around loads, whereas your bottom shufflers are much more likely to be children who really enjoy sitting and perhaps, oh, that bust about going over there to explore that dangerous plug socket that you thought was out of reach. They're very content being sat with the book or wait and just yeah, like maybe moving a little bit when they really need to. And it, I think it starts you sort of you spark their curiosity and you spark their ability to me when you sort of see that, that train of thought with them and you sort of you've got that child that's sitting and not moving, but actually they're managing just fine and they're really content and they're really like solid in their step. Whereas perhaps children who aren't as solid in their sitting and fall back onto their tummy and have that motivation to move and they go into army crawling. So I think there's certainly different nuances to it. I'm sure it's not just personality, but I think when you find out what's motivating the child to move or not me, that's when you start to see why perhaps that movement pattern has taken preference over the others. Speaker 1 You've just really made me reflect through that summary. And when you think about it, they are just all different. And it's kind of embracing their own personalities rather than assuming they all need to be doing exactly the same thing at the same time. And yeah, it's just a really refreshing way to look at it. And I must admit, from my own experience as a parent, probably quite enlightening to me in my own approach because like you say, they may have different motivations or they may have, you know, different eccentricities as to why they do what they're doing. And it's trying to figure that out and tap into that and embrace it almost rather than try and change it. You know what I mean? Speaker 2 Yeah, absolutely. I think. I think. We're as paediatric physios, we're very much, or I think we're very much of the opinion that all fours and four point crawling is the ideal. There's the optimum crawling pattern. But what I really like to say to parents is that that's not necessarily what we're aiming for. When we're looking at a baby crawling and we're looking at the different styles and the reasons why they're crawling, The end goal isn't to get them on all fours and four point crawling because that's not necessarily what they're going to do. Particularly if they've been army crawling for a long time and they're really good at it and they're really fast and they've learned this is the way to do it, why would I do it anyway else? But what we can do is look at where those muscle weaknesses are, where the imbalance is, and do different guided exercises in different positions to play to help strengthen those areas. And it might be the outcome that because we've strengthened them, baby then does start to crawl on all fours. But it's not always the outcome. But I think if you're a parent listing, at least have that reassurance that your baby is moving around as they ought to be getting from A to B. And if you have had concerns and you've had someone come to check it out and there's been a little bit of, Yep, their arms are a bit weak, But do this exercise or do more floor time or your tummy time, and it will sort itself out. And it hasn't sorted itself out. Don't worry because you're doing the things to get the arms strong and the arms will now be strong. They're still not crawling on all fours, perhaps because why bother when they've learned that they can army crawl and get there twice as fast? Speaker 3 Exactly. Speaker 2 And I, I think that's an important thing to note. Like we're, we're not trying to get perfect here. There is no perfect. It's about working just as you would with an adult. They're an individual. They've got their own set of preferences and motivations. They've got their own reasonings for doing things. And we've got to try and work with that rather than and still up what we think is the best way to do something. So I would always, I was trying to reassure parents when they're like, we've been doing it, we've been following the exercises, They're still not on all fours. They must still be weak. It's just like if you're doing it, they're definitely getting stronger. Babies learn to move by moving. So if you're moving and playing in the right way, then they're going to be getting strong in all the right ways. However they choose to crawl, that's on them. And you can bring it up on their 18th birthday and we can all have a good. Understanding Corrected Age and Avoiding Parental Comparisons I think it's, it's a feeling like we, we all have our own fingerprints, we all have our own handwriting. It's the same way like we're all individuals for a reason. And that's not kind of restricted to nobility in the, we're not robots. We shouldn't follow this linear passion as you mentioned earlier. And one thing that Johnny mentioned that really resonated is that sort of comparison. And I think as new parents, I definitely see it a lot when it comes to clinic, but parents can't help but compared to their friends, children and their NCT groups. And I wonder if the health professionals, we need to sort of change our questioning because it is something we always ask. It's like, are they rolling? Are they doing this? When do they do this? And we are quite prescriptive on when did they do this. So I just wonder what's your experience with that sort of comparison and parental expectations? Speaker 2 Oh gosh, I mean, I can speak to you about this as a physio, which is what you've got me here for, or I can speak to you as a parent, and it's probably. Speaker 1 Very much. Really. Yeah. Speaker 2 Because it's so true what you said, Johnny. We are so conditioned to compare and even trying not to, it's impossible not to. And if there's a niggle of worry there, it's even harder not to. It's like ignore the pink elephant in the rain trap situation. Like the more you try not to do it, the more you're naturally going to do it. And I think what I would just say to parents is that you have, when you're in that NCT group or you're in that baby class or you're even comparing it to a sibling, you have such a small snapshot of what that baby is doing in that moment. And there are so many different reasons why one baby might be doing something differently to another. And when I mentioned all the different areas of development earlier, just because you have a baby who is doing a certain gross milestone by a certain age, even if it's early, it doesn't mean that it's an advanced baby. It just means it's early. And just because they are really good at crawling doesn't mean they're really advanced and really progressive in all the other things. So you, I think there's that phrase, you either get a Walker or a talker, which is really like taking it right down to basic. But there's a lot to be said in that and there are, This is why it's, it's not a linear path at all. There are so many different areas of development and you might have a six month old or you know, you might have a 7 month old who is sitting really well eating their thunderous taste of something new because they absolutely love their food and they're really smashing it with solids. But they're not showing any sign whatsoever of crawling yet. But they might Babble and give you a high 5 when they've eaten their tenth piece of food of the day that's completely new and different. And then you go to the baby class and there's a baby there that's crawling. And you think, oh, my baby's not crawling. And suddenly all those wonderful things that your baby is doing go right out the window. And all you focus on is the one thing they're not doing or the one thing that that child did. But you just, you don't have a picture. That child might be from a they might have siblings. They might then, you know, I think you don't know each individual child's birth history and how they came into the world and at what stage they came into the world. I think a huge thing I haven't mentioned is for parents who have children who were born prematurely is to take the guideline ages from their corrected age, which I know having spoken to loads of parents that when they are discharged from that neonatal unit, they're just not getting told that and they're treating them. Speaker 1 What does that what does that mean? Sorry to cut you off. What does that mean for the parents that are listening? Like if you were to explain like you have a corrected age, what does that exactly mean? Speaker 2 Absolutely. So if your baby was born say 5 weeks early, so 5 weeks prematurely, so at 35 weeks and not 40 weeks, then when your baby is 12 weeks old, their corrected age would be 12 -, 5. So their corrected age, their developmental age would be 7 weeks. So if you've got 2 babies at 12 weeks old, but you're comparing side by side in a baby class and one of them is mining and holding their head up in tummy time and the other one is not, but the other one was born prematurely, you need to actually see that as it's a seven week old with a 12 week old that you're comparing. And in a baby's, you know, a baby's life, even if you're born any two weeks premature or a week premature, a week is a huge amount of time in baby development. I see this a lot with them Smiling is one of the first ones I think we look for and get excited about as parents. And that usually happens between 6:00 and 8:00 weeks. So even if your baby was born only a week early, you've got to try and go from the corrected age for that. Don't be panicking when they're 8 weeks old because you've still got another another week to go before we need to even start being in any way worried about anything like that. So yeah, corrected age is really important and I thought it was maybe as professionals we think it's too obvious because I thought it would be something that parents are told about and it's explained to them when they're discharged from the neonatal unit. But there are so many parents they see more. So the ones where the child, the child wasn't really premature. So I think the children who were who were born very prematurely and have been in the neonatal unit for a long, long time and have a lot of intervention, they get given this message. But those parents and those babies where perhaps they were a week or two before full term and they're only in the neonatal unit for a 2448 hour period and then everything's fine and they're discharged or put back on the the general intention ward. They're not being given this information and three weeks. It's the huge amount of time in a small baby's life. And I think that would be something I just go back to the beginning when we spoke about the different guidelines. That'd be something I'd really make sure parents are aware of is try and go from their due date age rather than the age they were born, if they were born early. So that's the correct age. Really important definitely is for the. Speaker 3 Developmental stuff, isn't it? Because I think we often refer to term babies from about 37 weeks. So that is a three-week window of what we're classing babies as term. But as you say with those developmental milestones, especially early on, three weeks is a huge time frame. And you beautifully described earlier the massive variation in what is considered these typical ranges for a lot of, well, we're really touching on gross Mosa tonight, but it does really, really have a big impact for sure. Speaker 2 Yeah. And I think it's bring it back to the whole comparison thing. It's a huge thing to take into account and to just help hopefully help parents take a big a big exhale and just relax a little bit. If they were more, I mean, surely you have got that extra window time to play with. And I think that goes right up until sort of around 24 months. It's not, I think even babies, if you, if you got born prematurely, if they're not walking by 18 months and stuff, it's you're still needing to go from that corrected age. It's not just the really early stuff. And I think once they're over those initial hurdles from being born prematurely and they're, you know, they're a healthy driving baby, it can be forgotten about sometimes. There's there's that, there's that pocket of children that are just still caught in the middle. They weren't quite premature enough to be followed up with all the intervention from the neonatal unit. And they're not quite term to be doing everything that you'd expect a baby to be doing by that age. And they just lost in the middle. And I'd say right up until they're sort of walking, jumping, climbing, running, riding a bike, the fact they were born prematurely still does have an impact and still should be taken into account when you're looking at ages and comparing. Speaker 3 Hugely. And you touched really nicely on the fact that there is so much going on during these early few weeks and prematurity can obviously play a massive role in development. But there are obviously a lot of other things going on. We know so many parents that can have those sort of initial struggles with feeding for example. And if you think if you haven't got the energy that's being delivered by the food, that's going to have a huge knock on effect with development as well. So it's not as simple as hitting these milestones. There is so much more to consider. And I guess just to take about, I know we've kind of had missed the big elephant room, which is obviously walking. Navigating Walking Milestones and Equipment Choices So just go back when we talk about walking. And I think that's another big milestone, isn't it for parents. And as you said, a lot of people say 12 months is a typical age, but what's your view? What are the age ranges do you describe and what am I see you give? Speaker 2 I think the more you go through the milestones, the bigger the variance gets and it's perfectly within normal ranges to see a baby walk as young as seven months right up until 24 months round about 18 months is if you're, I would say if your child isn't walking at 18 months. And by walking, I mean they're not showing any signs of walking by 18 months. They're not putting up to stand, they're not cruising, they're not starting to take some steps to support. Then that's when I would always seek the advice of a healthcare professional. And I always say first port call would be like your GP or your health visitor or a local pediatric physio. And then if they're not walking by two years, then that's when I would look to seek for an onward referral. But it's again, like we've, like we've said, it's so varied and so nuanced and there are so many different mini milestones that come before those independent steps. And what you probably need at that stage as a parent is a health professional to look and evaluate the child and reassure you that all these mini milestones are there and they're happening. They haven't quite taken those independent steps yet. And they can give you the reasons why and help you get to the bottom of that. But yeah, I think The Walking and and that being a big one, but it's like it's 7 to 18 months. That's just. Speaker 1 What The Walking thing as well. Emma is the sort of baby and infant expert out of the two of us. I'm definitely leaning more of my dad experience than he's experienced. I'm much more kind of school age and adolescence is my real area. But one of the big things that you hear all the time in the conversation around walking is, you know, bounces and these little toys that kind of facilitate walking. And we've been so far in this conversation really positive about encouraging different timelines and recognizing that you kind of got to match the pace of your child and lean into what they're doing. I think an important part of this conversation is maybe a parent's understanding, you know, when there's a reason kids kind of have to build up to being able to stand because part of it is almost around them developing the muscles and the stability to be able to do it. I don't know about you guys, but sometimes I almost think some parents see it almost as like a training to get them walking when they may not be ready. Am I right in thinking around those things? What are what are you guys? Have you approached this topic so? Speaker 2 When I hear that a baby's walking really early, that sometimes concerns me more than when they're walking later because it makes me wonder why and what have they missed in order to get to that. And that's not always the case. Sometimes you do just have early walkers. But like you said, there is, there's this normal guidelines of development for a reason. As human beings, our skeleton and our muscles and bones need the time to develop and they need the different weights and forces going through those structures before they can move on to the next thing. And I think the baby industry and the way parents are marketed to to to to is just absurd. Speaker 1 Taking feeds into it. Speaker 2 How it massively, I mean right from day dot from tummy time. The amount of things on the market for tummy time is just ridiculous. All you need for tummy time is a safe floor space or your own chest to lay baby on. Yet now there's tummy time rolls and how is 1 roll going to be the right size for every single baby? It's just ridiculous. And all these all, yeah, all these toys and every baby's favorite toy is, is their family, is their parent that, that you don't need all these fancy toys and things you can buy. And then when you go, you know, further up that chain to, to walking, I think it's really hard. And I really feel for parents who don't have that, have the knowledge that that we're privileged to, because with really good intention, you could be buying quite expensive bits of equipment at times, You know, jamperoos, door bouncers, baby walkers in, you know, with the intention of supporting your child when actually, if they're not ready to do it yet, there's a reason. And there's no need to force that. There's there's no need to try and encourage that in any way other than putting them on the floor and letting them explore their environment in the way they want to do. And walking will come. It will. It's not going to, you know, with a typically developing child without pathology here, it's going to happen at some point. And the when it happens doesn't really matter anywhere near as much as the how it happens. And I think, I think that's, yeah, that's really important. So I am, I don't advocate any equipment to help with walking, only if I sort of assess the child and there was a real, if it was something like structurally, physically, they're there, They've got the motor planning, they've got the muscle strength, they've got the balance and the stability. Maybe it's just confidence then we might bring in something. But rarely. There are so many more things you can do to get a child walking without putting them on a piece of equipment that they're not really in control of. Speaker 3 Those there and I think summarised it beautifully because it is all about the ability, I would say like once a child is able to achieve those things. Speaker 2 I think we. Speaker 3 All understand that at some point parents need to put a child in a piece of equipment where they know they're safe while they run next door or they run to the bathroom, although you haven't done something for like hours that they've been putting off. So I think there's a case of the equipment can be used in a safe manner once the child has developed the skills to use it. They don't necessarily need to be used in order to achieve those skills. Speaker 1 Yeah, that's a nice way to put it. Tell you what, Fisher Price is going to love us, aren't they? Social Media, Trusted Resources, and When to Ask for Help And you know something? I was. I've been thinking about this through the whole conversation and it's a bit ironic because this is going on social media, but how much a part does social media play in forming these narratives, do you think? I can just think of my own personal experience as a parent. When you, you know you've got a baby or a newborn because your whole algorithm changes and suddenly you get flooded with all this information and like these tips and accounts. And it's, it could be pretty, pretty hard to navigate even with a healthcare professional rational brain. So how much do you think social media shapes these conversations? Speaker 2 I think it shapes the comparison and the urgency to hit milestones massively. And I think there's speaking really generally here, but there's a a generational thing where a lot of grandparents are saying, well, you know, in my day, we're never worried about this kind of thing. A baby will do it in their own pace, whereas now there's so much more information just being bombarded at parents and so many top tips. So top tips to get your baby into. Speaker 1 Yeah, 3 tips to get them doing something, yeah. Speaker 2 And I think it's on social media, everyone's an expert, right? And I think that's the difficulty for parents, It's trying to find your sources so that the information you're getting really is from experts. We're, I think in this day and age, we're all consumers of social media, whether we want to be or not sometimes. And it's trying to work out and filter what you're consuming really, and just trying to be a little bit more assertive and what you're taking on and where you're taking it from. I've seen so, so many accounts and you know, it's fantastic. Anyone who puts themself out there, it's a great thing to do. So I appreciate it. But it'll be a mum showing them the exercises that the physio taught them. But it's kind of like Chinese whispers at that point. Like it's not directly coming from a physio. It's what they've interpreted the physio to show them that Now they're showing mums on a video. And I think it can just really get diluted, the message and the techniques and the different ways to do it. So I think I would always urge parents to use social media for the good that it is and find professionals on there that you can really trust where the sort of the information is coming from so that what you're doing, you know, is safe to do. And if it ever gets too loud and too naughty making you compare, then just switch off because like I said, it's it's a snapshot and it's such a small snapshot of such a huge picture. So yeah, it's a minefield when you were. Speaker 3 Talking about resources like, do you have any resources that you recommend to parents? Speaker 2 I love the the exercise and developmental hand downloads or leaflets from EI Smart. Yeah, that early intervention it was, it's an amazing, amazing setup by paediatric OT called Betty Hutchinson. And she's developed this, these programmes and exercises along with loads of different professionals, physios, speech, occupational therapists, all looking at the different milestones and they're really nicely laid out on the website. Zero to three months or sitting, rolling, side sitting, they're all laid out really nicely. So you can just just get that snippet of information that you need and you know, it's been vetted and trusted and heavily researched because I know the team behind putting those together have worked really hard on doing so. So I see that's a really nice trusted source that you can get those from. Yeah, that tends to be my go to or to tell parents to go and have a look there and tell us. Don't. Speaker 1 We've talked a lot about kind of through the different age groups, some gross milestones or gross movements and rough timeframes which kids might achieve those and we've really leaned into that positive message of there is a real variance and it embraced that. I guess my question would be when would you start to think along some of those things? Actually, when should I go to the pediatrician or when should I go see a pediatric physio with some of those things? What would you guys often say to your your parents? Speaker 2 I learned about you Emma, but I don't want any parent living in worry and angst at this time. There is so many things to be worrying about from allergies, weaning, eczema, clothing, what they're and where they're going to go to nursery, what bugs oldest siblings are going to bring home. They just it's endless. And any parent that has any worry at all about milestones I would encourage to ask a professional about. I would much rather see 10 parents a day with worries that I can easily reassure and want anything to actually worry about, than see, you know, a mum that's been sleep, you know, having more sleepless nights than expected with a baby because she's worrying about what a baby should and shouldn't be doing. So my my sort of advice to any parent listing would be if you're worried, reach out to a professional and ask. No one's ever going to think it's a silly question and if it can be reassured nice and quickly, brilliant. And if not being proactive is so much better than being reactive and intervening early is never going to be a bad thing when it comes to development and physio and all the different skills and things and that you can teach a parent and guide a parent to do to help that baby. So it's difficult one, because we say, you know, every child's different and don't worry if they're not doing it by. But then there's also the, you know, the flip side of that where there are lots of things you can do to support a child's development. And it's just about knowing what those are. And I think parents feel that that knowledge should be in them somewhere and they should be able to tap into it and just do it. But it's, it's not. And just, you know, I don't have any expert knowledge on weaning and allergies to my baby, and I might worry about that. The same goes for a parent that doesn't have any expert knowledge on what is the best position to play with my baby or if their arms are weak, how do I help them strengthen their arms. So I think if there's anything like that, if you're seeing if they're not hitting a milestone by that guideline or if you're worried in any way, then that why I would say would be the time to reach out and just ask a professional. You know, this is what I'm thinking. These are my concerns, babies not doing X at this point. What do you think? And I think having that conversation would just help open up an avenue of different ways you can support your baby with what they're trying to achieve. Totally. Speaker 3 Agree. And I think we're obviously not focusing on it too much tonight, but they're are going to be a very small amount of cases where there might actually be something that is causing a sort of unusual pattern. And I know that's not really the purpose of the talk and we've mentioned it in other talks. But that's why I think I agree with Ruth. If there's ever any concern, you're better off just asking a healthcare professional and even just having your mind put at rest. At least then you know you can carry on playing with your child and not having to worry about are you doing something that's going to harm them? Am I going to do something that's making anything worse? Like it's just better to ask. And I think you beautifully also summarized earlier about The Walking, But generally speaking, around 18 months, if there's no signs of walking, that's like a classic time. We would say definitely seek help. And then I think one thing that's really important with development as well is that you are seeing those small progressions. And that's one of the things we look for as professionals is our children making like small gains. And if the progress isn't linear, it's like anything in life, we tend to have these really steep improvements and children might plateau a little bit and then all of a sudden in a week, they're hitting like loads of different milestones per SE. And I think that's what we're looking for is that trend of upward skills. And as we've said earlier, that those skills aren't always going to be gross, they might also be fine mojo and they might be working on social language skills a bit more as well. Essential Tips for Engaging Floor and Tummy Time I was just going to say, I mean, I it has so many questions, just tangents just based off kind of the things we've talked about tonight. But, you know, this probably is there a really big question, so probably just to touch on. But, you know, it's important that we don't obsess over these timelines. But presumably it's also really important that as parents, we are giving this very stimulation in order for these kids to learn to develop these skills and to want to do it as well. What do you recommend you know, little tips and little things that parents can do with kids. Help support them develop these skills. Speaker 2 So it is the most basic thing you could do, but it's floor time. And I think because it's so basic, it's so overlooked, but floor play is magic for babies development at every stage, whether it's rolling, sitting, crawling, putting up, stand, walking, get them on the floor and play with them down on their level on the floor. They will learn so much from being there. And it's not something from speaking to you as a as a parent now, not as a physio. And having banged on about floor trying for so many years, I didn't clock just how difficult it is to achieve sometimes until I had my second. And we've sort of go out for the day with my toddler and my baby would be in the car seat to the park and then in the buggy at the park and then back in the car seat. And it gets in the day. And I think they've not been on the floor months. We've been out all day and they've had all this wonderful stimulus, but they haven't been on the floor once. And I had to really take a step back from going here, there and everywhere and just take it back to the absolute basic of a day at home on the floor and really protecting that time for my my second baby. Just because life was just so busy even just to pick up and drop off with nursery and things, just getting that time. I suddenly realized I had to protect it and make sure that they got that 5-10 minutes of floor play because it's so important. So, yeah, get down on your baby's level on the floor. If it's for, you know, zero to three months and you're working on head control, lie opposite them. Look into their their face, nice and close when no one's when you're trying to lift their head up. That's going to be so much more engaging than looking at a toy. You know, you're marketed these lovely black and white flash cards and all these books and crinkly toys and and mirrors and they're all brilliant, but I promise you your face I've. Speaker 1 Got all these things it looks so ashamed they. Speaker 2 Are fantastic and I have them too and there's a place for them. But if you've only got a short window of time, like just you lying in front of your baby is going to be so much better. And then when they're going to that stage where you want them to crawl, it's bringing that level of floor play up, propping a step or a cushion in that safe floor area that they're used to and familiar to. Suddenly the toys are just on a level slightly higher so that when they're new looking at it, they've got to look, they've got to push up, they've got to work on all those muscles and get moving to get to that toy or get to that activity that they're interested in. And then you can start moving it further away, which then creates that motivation and desire to start moving. And the same when they are then at the age where you want them to start pulling up to stand and cruising, bring the level up again. So then the cushions are perhaps going to be a bit higher or you're going to be putting things on top of a chair or the sofa, but always bringing it back to playing on the floor in a safe place. That's where they're going to get strongest and that's where they're going to develop the best. So that'll be my top tip for anyone and myself. Apparently more time on the floor with the baby. Speaker 3 That is fantastic advice I have to say, and a real, real life situation. I'm curious because one of the things I come across quite a lot is parents saying they're struggling with the floor time, the tummy time. It's a really common thing. I think we know most children hate tummy time, yet we tell everyone to do it all the time. What are your top tips for tummy time? Speaker 2 Take the pressure off, make it enjoyable and a cuddle on your chest counts as tummy time. It doesn't have to be on the floor on a on a hard surface that's cold and unfamiliar for these really new tiny babies. Babies don't particularly like tummy time for so many reasons. They might have a full tummy of milk, they might struggle with reflux. The fear of going from this warm cosy space to suddenly this vast expanse of the hard floor. There's so many different reasons why babies don't like it. And just trying to force or push on through that because tummy time is what you do isn't the solution. The solution is take the pressure off and do it on you. Having baby up high on your shoulder when you're burping them, that counts as tummy time. And having baby in a sling and wearing baby and throughout the day is tummy time as well. Yeah, just. Speaker 1 A good one? I don't think many parents would know that. I think that's a really good one. Speaker 2 Yeah, absolutely. Can't. I think the World Health location suggests 30 minutes of tummy time. And I think that seems huge to parents when they put their baby on the floor and after 30 seconds they're screaming. But actually, by the time you've backed your baby on however many feeds they've done that day, and perhaps you've made them across your nap to get them dressed or to give them a little nice stretch, all these things count as tummy time too. It's not just the sort of the way I think it's, it's, I don't even know where it comes from this light among the floor and get them propping up. I would be doing that when they're a little bit older around like the sort of three month mark, getting them on a, on a more, a more hard surface and enjoying the floor and playing in those early days when everything is just crazy and scary for you and baby. Just more cuddles on their tummy and laying them across your lap. Those kinds of things are a really nice way to introduce baby to being in that position. Speaker 3 Yeah, totally. Concluding Advice and Gratitude to Our Guests And amazing little tips there. I think you've summarized some little tips for parents so beautifully. Speaker 1 But yeah, we could talk for another hour comfortably, but we've also got to recognize that that's a lot of content for for listeners to to get through. And you know, it's probably best that we leave things there. But I think we've covered a really nice kind of overview of some important topics. And I really just want to say thank you to you, Ruth, and to you, Emma, because definitely one of your areas of expertise as well. And what's felt really nice is just developing conversations around these topics through the chat and sharing your wisdom and the tips. And you guys both said it. And I say in clinic all the time, you know, if you're a parent and you're concerned, that's what we're there for reassurance. And if you're less worried, probably more likely to get to be doing things and being active and and enjoying it. That's what it's about at the end of the day, right? Enjoying that experience. So a really big thank you to you, Ruth, and to you Emma, for guiding me along this journey at the loads today. And we'd love to get you back at some point in the future on the show. But but thank you for you, Ruth. Thank you to the listeners and we'll catch you guys next time. Thanks for listening.