Functional Fourth Trimester
Functional fourth trimester is a podcast series for new parents- covering common postpartum challenges, practical strategies, and featuring conversations with parents and healthcare professionals.
Functional Fourth Trimester
Tummy Time and Milestones: What to Expect in the Early Months
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On today's episode, we talk with guest speakers Christine Hernandez and Haydee Medrano all about infant development. We discuss what developmental milestones are, some key ones to be on the lookout for, red flags of development, and what you can do to help support your baby's development. The link below will take you to our blog post for this episode which has more information, resources, tools, and how to get in touch with our guest speakers. We will also be posting a handout on our social media platforms with more information about developmental milestones.
Blog: https://thepostpartumot.com/tummy-time-and-milestones-what-to-expect-in-the-early-months/
Welcome to Functional Fourth Trimester, a podcast created to support new parents as they return to daily life after having a baby.
SPEAKER_00Each episode will talk through common postpartum challenges, share practical education and strategies, and hear from real parents and healthcare professionals along the way.
SPEAKER_02Whether you're listening during a feeding, a walk, or a quiet moment, this space is for you. I'm Lauren.
SPEAKER_00And I'm Melissa, and we're excited to jump right into today's topic.
SPEAKER_02Rolling over, crawling, walking, these are just some of the developmental milestones for infants and toddlers. A lot of parents are constantly worried about if their baby is developing on track and if they should be doing different things to aid in their development. That is why today we will be talking all about developmental milestones to help educate parents on what to expect and provide ways to help support infant development. I am pleased to introduce our guest speakers today. First, we have Christine Hernandez, an occupational therapist, certified breastfeeding specialist, and functional pelvic health practitioner. She believes that motherhood deserves more than survival mode. She also has first-hand experience as a mom herself. Joining her, we have Aide Medrano. Aide is an occupational therapist, certified breastfeeding specialist, and pelvic health therapist. She is passionate about nurturing the mother and baby connection. They are both co-owners of Bloom Her Path, which is a maternal and infant therapy practice that aims to support women during pregnancy and postpartum. Thank you both for joining us today. We're so glad you're here.
SPEAKER_03Thank you for having us. Hi, yes, we're happy to be here.
SPEAKER_02I would love to briefly start off with talking about what developmental milestones even are, especially for somebody who's never really heard that terminology before, isn't super familiar with what infant development is.
SPEAKER_01Sure. So I'll start. So developmental milestones are skills that most babies achieve during a certain age. What milestones help us understand is a baby's motor, sensory, cognitive, and social skills. We group milestones in four different categories. Those are the big categories: gross motor. So we want to think about big body movements like tummy time, rolling, sitting, crawling, walking, fine motor movements, more small hand gestures like grasping, reaching, transferring a toy from one hand to the other, communication skills like responding to sound, babbling, or in social cognitive skills, so like eye contact, bonding, curiosity, problem solving, those kinds of things.
SPEAKER_03A lot of people get stuck on them and really start to worry, but they're more of a guideline just to kind of there's so much development that happens in that first year. And so just to kind of know what we're working towards, what we should be working on and seeing. Um, and then if there is a delay within a range, um, then for us to start working on it. And the sooner we start addressing it and working on it, then better for family and baby.
SPEAKER_00Sometimes parents will see other infants doing things and then wonder if their infant is okay. And occasionally they'll their motor milestones will move faster or their speech will move faster. It's just kind of depends on the child. They develop at different rates, but still being aware of like, is this something that now we should look into getting support for?
SPEAKER_01So we host developmental playgroups and we get that question a lot from parents in the group, and and they're seeing it because they're comparing their child to the other child. So we have to do a lot of education on the ranges of development, but also still being able to just educate parents on when, you know, when it would be a red flag.
SPEAKER_02Yeah, I think that's such a good point with really emphasizing that it is a range. There's not just like one specific set date that your kid needs to be achieving a particular milestone, but it can be a range. Um, speaking of kind of going off what you were just saying, I would love to talk about what some of those like kind of key major milestones within that first year are that we usually like talk to parents about and like when do those typically develop in those ranges?
SPEAKER_01So within the first two months, one of the things we would like to see by by two months of age is tummy time, um, some tolerance to tummy time, baby being able to lift their head for a brief period to about 45 degrees. Uh, we want to see their body out of physiological flexion and their legs in some extension in that tummy time position and their ability to prop themselves on their forearm and support themselves a little bit. We start seeing more hands opening. Um, we definitely want to see baby when they're on their back being able to keep their body more in midline and not hold any type of preference. So keeping more of that body more in midline by two months of age. You know, those are some key milestones for that age group. By four months, we want to see some pre-rolling skills, maybe baby being able to roll onto their side. Or we might see already babies, you know, moving to rolling onto their belly. But we definitely want to see by that four months of age being able to roll onto their sides. And we'll start seeing more hands and toys to mouth. So by three months of age, we're already kind of seeing the skill, but by four months, we definitely want to see it master being able to bring those hands to midline, work on that coordination down that middle, and being able to bring their hands to mouth and toys to mouth.
SPEAKER_03About six months, we want baby to be rolling from their back to their belly and then starting to show signs of rolling from their belly to their back, also starting to sit, and it doesn't have to be unassisted, you know, mom's still close by or showing baby how to tripod sit with both arms out in front of them, holding themselves up. So still giving themselves some support, but starting to stay a little bit longer each time. Nine months, we find motorwise, we want them to be able to hold two objects, one in each hand, and start banging that they realize things make noise. So they're hearing the noise, they're using both hands, that bilateral coordination, and you know, meeting them together to make that noise, start crawling. And this is a big one. And we um we don't agree. I know there's been a lot of talk about whether crawling should still be a milestone if it's okay for babies to skip it, and we strongly encourage it because it's it shows so many benefits. Um, that bilateral reciprocation, um, weight bearing through arms and legs, strengthening the core. It's been linked to reading comprehension once they get to elementary school. So we really push for crawling and getting um, so at nine months they should be getting up into quadruped, and which is all fours and extension on their arms and weight bearing. The army crawl kind of cues us that there might be some muscle tightness going on somewhere in the body that's kind of making it a little harder for baby to move. So we address that a lot also. Um, and then when sitting, they should start to pivot. And so, you know, putting toys out of reach. So they're starting to want to reach for them and move their body kind of turning, not just staying in that sitting position or just flopping over because they don't reach it. Um, so they should be able to keep their body upright and still reach in all directions around them. And then starting to reach that 12 months, we want just stacking with simple cups, measuring cups, um, some large blocks. It doesn't have to be small blocks, but just at least stacking two items. They should be interested in wanting to pull to stand, whether against mom on the sofa, maybe a little like cube toy. And then while they're squatting, they should also have that strength to be able to still hold on to whatever they're they pulled up to stand on and pick up a toy and get back up. Um, they might be a little wobbly, but that's where we start learning those independent sit-to-stand transfers and going back down to sitting from standing. Then they start cruising along furniture. So along the sofa, you know, move their toys down. So they want to do those side steps. And we're not looking for them to walk on their own yet, but still taking those sidesteps and maybe a step or two away without holding on to something. Because I know this is a big one that parents worry about. If they're not walking by 15 months, then that's a red flag. And that's when we definitely, you know, you want to talk to your pediatrician and a therapist as well.
SPEAKER_02It's a good thing to point out too, which it's like I know a lot of parents think, oh, 12 months is is when they should be walking. And if it's past that, then they're delayed. But like you said, like 15 months is really where we start getting maybe a little bit more concerned if they're not doing it. So it doesn't have to be like right at the 12-month mark, which I think is a common misconception that a lot of parents have.
SPEAKER_01And I would say too, just with red flags a little bit, there's red flags within these other areas as well. Because we've had parents too that there's possibly been some red flags with meeting these milestones, and then they're not discussing it with their pediatrician until walking, but we missed, you know, some other critical milestones with independent sitting or crawling, and then everything kind of gets a little bit more delayed. Um, so there are still critical windows for a child to meet that milestone, and if it's not being met or there's some concern on the parents' end to to really be able to advocate and and get that early intervention.
SPEAKER_00So, do you have any like small little things that parents could watch for? I know that you mentioned the army crawling could potentially mean that there's tightness or other things, even like you know how some babies will do like the one leg crawl. Is that like little things like that that they could be like, huh, okay, this is something happening with my infant now. Maybe it's not a concern, maybe it's something that like tightness or something else that we could look into, just a few little things that they could be looking at that could kind of help their infant continue to progress in their milestones and not just get to that, like, oh, we're 15 months and we're not walking. We could have done something at six months and supported that progression and development.
SPEAKER_01So I definitely think, you know, being able to see occupational therapy and supporting infants from even a wellness perspective is is very beneficial, where there doesn't have to be a developmental delay or a diagnosis for parents to seek out support. So even within that zero to two month age range from birth, we might be hearing parents say that their child had a lot of head control at a very, very early age. And that's a red flag for us. Even meeting early milestones or milestones very advanced could indicate, okay, is there some tension in the body that is showing these early milestones? So even that zero to two months, we really want baby to be able to lift their head briefly, turn it side to side, but not really sustain that head control from a very early position. So that might be indicating to us, okay, there could be, you know, something, something there. We'll we'll start seeing some maybe asymmetry come into play with being able to achieve their milestones or or that head preference, even from a very early age. Um, and those are some of the things that when we're working with some one month to two month olds, we're we're kind of seeing those red flags and it's impacting, you know, feeding, because that's a lot of what we do. So um, even from just that zero to two month period, some early red flags would be some stiffness and some head turning preference or holding their head very early on. Um, my daughter was one of those being able to hold her head right at birth um in a tummy-time position for a prolonged time. Um, so those are some things within just that very early age range that we would see.
SPEAKER_03And just to touch um a little on that too. So we say asymmetry, that's not something that the parents are really looking at or had heard before. And so that's if we see like, you know, babies always holding a shoulder up or, you know, on their tummy, this shoulder is higher or more out. And so that's when we say asymmetry. We want baby's shoulders to be at the same level. And so how I mentioned looking at occupational therapy for wellness, also, I think that's what we're we're really trying to make more common and why we do our community classes. We've recently this year moved to having them free once a month just to educate families on little signs that you can look for. And so if you're starting to see baby wants to look one way at a month, two months, then we can address it sooner and spend less time in therapy than come six months and baby now has a flat spot on their head, and both shoulders are really tight, and they are not able to roll because they're so tight and rigid, you know, in their body.
SPEAKER_00I 100% agree with that. And my goal is that every single family and infant is getting occupational therapy after birth. I think that when you think of therapy, it's something is wrong with my child, but that's not always the case. You're like you guys are saying, you're looking at the child and saying, Oh, like we have a little bit of tightness here, or this is something we could work on. It's kind of helping guide the parents with the development of their child and being able to catch things earlier on that will then prevent delays later. So I think that our support is much needed after birth, and it should come to the place where it's just common. Like, you're not seeing an occupational therapist after you had your baby. What on earth? Like, you need to go see somebody. So I love that you're doing that. Do you guys do virtual stuff as well or more uh just in person in your group classes?
SPEAKER_03We do both. Um, our group classes have primarily been um in person in our you know with our local community, but I have done some virtu like a virtual kind of one-on-one session going over milestones. Um, somebody reached out to me for Michelle Emanuel's website. She was a therapist herself, but didn't work with PEADs, and so she's like, I need to know what exactly is going on, what am I seeing? And so we did that virtually.
SPEAKER_02Yeah, I love the emphasis on prevention and early intervention because I think we somebody kind of touched on it earlier. Preventing and like getting to things earlier helps save you time and money later down the road. Because it's like if you will, if yeah, if you wait till 15 months, but there's all these other things going on, it's gonna take even more work to try to correct that versus if you catch something at two months old. It's gonna be a lot less work, a lot less time to really be able to optimize their development. So I think that's so important that there's things you can be doing from day one. You don't have to wait till you see a delay.
SPEAKER_03And just making small tweaks. Sometimes it's placing toys on the other side or placing them higher, just offering them in various planes. It's it's the same toy, it's the same simple activity, but just giving it a little tweak can really make a difference and we can make a bigger impact the earlier we get in there.
SPEAKER_00In my experience with working with families postpartum for over 10 years, you don't always know what's next. And every baby's different. So then being able to say, like, hey, what are things I could work on next with my baby to help them reach that next milestone? Or what what are the next milestones? What will my infant be working on next? And so you're kind of guiding them through that process of, hey, these are things you could look for, these are ways you could play with your baby, these are ways you could engage with your baby.
SPEAKER_01Our community participants have said about just the classes where they just didn't know how to actually play with baby or what are the appropriate toys for this age, um, or how long should they be playing with baby. Um, and a lot of just that very early exposure to sensory play and bonding with their child, really we see the development. I mean, we've seen progress in babies just coming to community group and seeing the change in their development just from that. And then if there are additional concerns that we're kind of screening within groups or parents are asking, then then they can, then they can come in for more one-on-one and we can support the family more individualized, but the groups have been able to really give them that ability to learn a lot more.
SPEAKER_02That's awesome. And kind of I would love to expand on that a little bit. You've mentioned a couple, maybe like things that you could do to really help support and aid the infant development process. Do you guys have any other kind of like things to try or random strategies or ways to play or interact that parents could be trying to implement at home to really support and help progress the development?
SPEAKER_03Yeah, there's of course so many toys to pick from, um, but we try to keep it just really simple, not anything extravagant. A simple toy with some music, like soft music, um, a simple toy with some kind of soft lighting. It doesn't have to be definitely like no stroke lights or anything, but just a soft light. So those music and lights at different points will help you engage baby if baby's still kind of, you know, not sure what's going on, but you can really get that eye tracking. And so simple tracking from right to left, up and down helps baby move towards those next milestones. I haven't met a baby that doesn't like a crinkle toy, like the little cloths that have the crinkle, whether it's a book, a little square cloth with like a toy hanging, anything that has that foil crinkle noise, they will absolutely get their attention. Um, so any kind of toy like that.
SPEAKER_01I was gonna say you, mom, family, um, dog, friends, those I would say that's like my number one is getting the family involved and being able to have that face-to-face interaction or that skin-to-skin contact. You're the favorite toy. And then comes all these other cool toys that we have on the market and the ones that we kind of recommend are the our go-tos, because sometimes families still like to have a basket of toys and things, but you as the parent are like that number one because they can see you just a few inches and start working on tracking that way, and they can kind of hear the sound of your heart if they if they're if baby's on mom's skin to skin and regulate that way, um, and then listening to you. So you're kind of the first toy.
SPEAKER_03And just narrating your day, what you're doing, if you're making your coffee in the morning, you know, just talking about what you're doing, you're opening and closing, using simple words. So you start introducing vocabulary already, um, always like like sing songgy voice, because that kind of gets their attention when our intonations are going up and down, and then singing. Pick pick one or two favorite songs that are easy for you to remember and just sing to baby, you know, that will become a repetition to them and you know, more likely for them to pick up on.
SPEAKER_01And then I was just gonna say, once mom's comfortable kind of transferring on and off the floor, or if that's something that we're working on with mom, if they're seeing us for pelvic health and we're working on some, you know, different positionings for mom. But I like also to get, you know, parents down to the floor if we're already, if baby's appropriate now to be on the floor, you know, after about two, three weeks, you know, getting baby more freedom of play on the floor, kind of having parents down on the floor with them as well. So if baby's in sideline position, parent can be in sideline position too, and having some eye contact and then everything um Christine was saying too, with adding some of that communication in there too.
SPEAKER_00I love the communication piece. I didn't realize how much I talked to my son when he was little. His first words were that and this. And I realized that I was always walking around and saying, that that is a flag, or that look at this. Like, this is a cup, this is mama's cup, or like I was always saying that and this, which isn't perfectly necessary. But then once he got old enough, he would point and say that because he wanted me to tell him what that was. He's curious. So babies are very curious, and they love that engagement and even the routine of things like song, because then that's very familiar to them, and then they can start to like learn it, sing it, and have that engagement.
SPEAKER_02Yeah, definitely. I think sometimes they forget that babies are just like soaking up the world around them and like exploring and learning about things, and parents are who they're learning from and who they're watching, and so even just that like simple conversation and singing and interacting with them is gonna help them learn so much. And I would love to also kind of jump back to we had mentioned tummy time a little bit and had talked about how that's such an important milestone within those first like two months. And I know a lot of parents can feel like a little bit anxious about well, how do I start tummy time? When do I start tummy time? What does that look like? How do you even do it? Um, so I was wondering if you guys had anything that you could kind of tips to share about tummy time in general and how that can help with development.
SPEAKER_01So I recommend starting tummy time from day one, but day one looks a little bit different than a two, three-month-old. So day one, really until about two weeks, I really encourage a lot of skin to skin. So tummy time on parents' chest. That's really kind of where, you know, that's where the early tummy time starts. And then about two to three weeks is when I'll start encouraging parents that they can put their infant down on um a tummy time mat or a favorite blanket, kind of having that smell, be able to be um regulating and familiar.
SPEAKER_03And just to touch on parents and baby doing tummy time together, it can be sitting upright, it can be laying down. And when you're laying down, you change the gravity force on baby and mom. Um, you can also put them on your lap, you know, across your lap. They're still close to you, but they're right here, you know. So there's different variations. It doesn't have to be the same way. And I always tell parents to change it up each time. So baby's having a different experience, but it's still, you know, you're still working on the same stuff and you're still holding baby and right, helping them co-regulate, but they don't get bored or kind of tired of it. You're kind of switching it up.
SPEAKER_01If we start seeing some difficulties with tolerating, we might talk to the families about different positions even on the floor, um, maybe rolling up a receiving blanket and giving them some support under the arms, or if there's a wedge that we have in clinic. That they might be interested in getting, just, you know, modifying the position for tummy time. We do encourage families to kind of pay attention to their infants' cues. So if they start seeing them get a little bit dysregulated, then we want to encourage them, okay, it's probably time to get them out of tummy time, regulate with them a little bit more, and then we can try, we can try again. A lot of our families will ask us, well, how much time? And we kind of pull away from it being a time-based um activity to more uh a regulated um activity. So we want baby and moms to for it to be pleasurable and enjoyable and fun. Um so short windows, short periods of tummy time throughout the day is kind of what we encourage our families.
SPEAKER_02I love that. Yeah, just like looking at the infant for their signals and cues for when it might be too much. And I know like in the OT world, we talk so much about like the just right challenge. And I feel like that's so important with development. We want it to be just a little bit hard so that they are learning this new skill. And we don't want it to be way too easy that they're just like, I've got this master, this is easy now. Try things out and experiment and say what's gonna be just a little bit hard to get them to really develop those new skills versus this is way too hard and they're just so dysregulated.
SPEAKER_01If our um moms are also having just a difficult time with a routine, um, we'll kind of talk a little bit about habit stacking as well. So one way that we might habit stack to start incorporating tummy time a little bit more might be after a diaper change. Um, so maybe rolling baby onto um onto tummy time right after and you know, whatever baby can tolerate. If there's a tolerance um difficulty, or mom's still just trying to build a routine that might be a way that we start um incorporating um purposeful play a little bit more.
SPEAKER_03We're fine with different surface surfaces, um, but the best surface is always the floor. It doesn't mean you always have to go to the floor, but we just want to be sure that's in there somewhere because the floor is, you know, a little harder, stiffer baby has to work their muscles a little more versus the bed that the mattress, you know, is soft and it kind of gives into them and they kind of sink in. Um so yes, and that again, like just kind of change your position throughout the day or where you're doing it. Um but the floor is the the gold standard. Not a lot of families, but if you think families are kind of don't want to put baby on the floor, you know, they're like, oh, the floor, you know, is it dirty or not? I'm like, so let's pick a blanket or a mat that you're comfortable with. Um, but we want that hard surface. We want them, you know, putting weight through their hands, through their arms, their legs. So that's why we that's our gold standard.
SPEAKER_02Yeah. And I love to just see how like the milestones build off of each other. Kind of like you were talking about with if you skip something like crawling, it's gonna make some of those milestones later a little bit more difficult because you missed some of the skills and the input and the things that were needed to really progress in that order. Like I feel like a lot of times when I, you know, am reading things about like prematurity or developmental delays, a big emphasis is the progression rather than the exact time. Where it's like it's important to make sure you're hitting the order correctly so that you're building them off of each other versus like And not skipping. And not skipping, exactly, versus like, are you hitting it at the exact time you should be? Right. I wanted to thank our guest speakers today. We so enjoyed having you guys on this episode and really value hearing all of the specifics and education and tips about developmental milestones and how best we can support our baby's developments those first few months. In the description of this episode, there will be a link to our blog post for this episode, and on that post, I will attach more resources and handouts about developmental milestones and websites you can go to if you are needing more information about specific milestones or other tips and tricks for how to best support your baby's development. Thank you all so much for joining us on this episode. We look forward to talking with you next time.
SPEAKER_00I hope today's conversation gave you something practical to take into your day or simply remind you that what you're experiencing is normal. Returning to daily life after birth is a process, and support matters.
SPEAKER_02However, your day continues from here, be gentle with yourself. You're doing important work. Thanks for listening. We'll meet you back here next time.