Explore expert opinions on the impact of Baby First Year development practices like Swaddling, learn practical tips for supporting early development in this episode of the MamasteFit Podcast.
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Roxanne: Dr. Amelie is a Pediatric Physical Therapist who specializes in gross motor development and wellness. She has worked in all areas of pediatric health, from hospitals to outpatient clinics, as well as home health. Her own experience as a first time mom brought to light just how little education and support parents are given with regards to developmental milestones, gross motor skills, and essentially what the heck to do with a baby.
Her goal in starting Grasping Gross Motors was to create a space where education is easy to understand and recommendations are realistic for parents to implement. She provides in-person pediatric physical therapy services, as well as in-person and virtual wellness sessions to help bridge the gap between what you’re told in your pediatrician’s office or in your mom group and what actually is going on in your everyday life.
Gina: Dr. Amelie, thank you so much for being here with us today. We were really excited to chat all about pediatric milestones and development, a topic I’m sure a lot of us are concerned about with our babies. Are they meeting their milestones on time? Are we doing the right things as parents to support their development, or are we ruining them for life?
So thank you for being here with us.
Dr. Amelie: Thank you for having me. I’m so excited to kind of delve into some of this with you guys and answer a bunch of questions that have been brought up recently.
What are some common reflexes and milestones that we're looking for in like a newborn baby on like day one or so?
Dr. Amelie: So typically, and Roxanne, you probably know a lot of these too, a lot of what we’re looking for on the first day, especially right after a baby’s been born, are their APGAR scores, what are their reflexes looking like? Are they alert and aware? Typically, that’s more done on the nursing side.
Physical therapists are usually only called in if there’s a concern with bony anomalies or if they have tone, which is like abnormal muscle movements or tightness.
We typically don’t get brought in until they’re comfortable safely in the NICU and kind of regulated, and that’s more on the side world. We’ll get called in. But even on that, the biggest tool is usually they’re APGAR scores first and just how alert they were when they were born, how easily they are soothed, what’s their state regulation like, those types of things.
That’s what’s being worked on across the board in those first few days, even if they are brought into the NICU.
What are some common tests that nurses and medical providers may be doing in the hospital or near birth location to assess baby then?
Roxanne: So there are a few reflexes that we’re just assessing at the birth and we check them throughout their entire hospital stay to make sure that they’re still present. We’re looking for they’re rooting reflex, if you touch their cheek, do they turn towards that direction?
Their Palmar Grasp, if you put your finger inside of a baby’s hand, they’re going to grasp around it. And then can they hold it? So I usually will try to like lift them up a little bit and they usually will hold on because that’s just part of that reflex.
There’s the Babinski reflex where they’ll flail their toes for lack of a better word, I think flail their toes out or flare their toes out when you like touch the bottom of their feet.
The Moro reflex is the startle reflex that a lot of people will talk about, especially with swaddling now being like a hot topic of whether or not you should swaddle your baby because of the Moro reflex. And this is if a baby feels like they’re falling or there’s like a sudden sound, they will like startle themselves awake and you’ll like see their hands kind of like jut out and they look like they were, like, frightened or terrified.
And that is a reflex that’s completely normal. So people are like, oh, if you swaddle them, they won’t startle themselves awake with this reflex. And then the other side is, well, if you swaddle them, then this reflex will never go away. So I’m sure you’ve heard of that controversy of swaddling versus not swaddling.
Do you have opinions on swaddling, as a PT, is that controversial?
Dr. Amelie: I don’t feel like it’s as controversial in the PT world as it is in, like the mom world. It’s not even something I ask my patients.
Honestly, as a mom, I can tell you my kid hated to be swaddled. So I tried and tried and tried and she just didn’t want to do it. But no, there hasn’t been, I have never seen like definitive research one way or the other that shows whether it’s good or bad.
I think it’s one of those just hot topics that has gotten picked up on like TikTok and Instagram and is now a thing or I’m one that’s like, if your baby likes it and it helps them, great. If not, you don’t need to force it on them. But there’s no research one way or the other.
Baby Containers...to use or not to use?
Gina: It sounds like that kind of revolves with a lot of things with mom life and whether or not we should do things that may or may not be inhibiting our baby’s development.
And a big one for us is containers. So when I work out, this is how we actually got connected. I sometimes will put Sophia in like a bouncer or a walker or something because it entertains her for like 10 to 15 minutes and she doesn’t last long in them.
But for 10 minutes I can like get like a full portion of my workout done and I use like a bouncer when my babies were little and I was showering or I just to put them in something that like a dog wasn’t going to walk on them or an older sibling wasn’t going to like roll over them.
And I knew that they were just in this safe place for me while I did something like, What is your opinion on containers both from like a PT perspective? Like what would the concern with containers be? And then also from like a realistic mom perspective as a PT, I would love to hear your thoughts.
Dr. Amelie: So I feel like, yes, we could talk about this for a long time. The whole issue with containers right from a PT perspective comes from and, you both know this, right, that the more opportunities your baby has to move, the better at movement they’re going to get. So, yes, if your kid’s in a container for like 8 hours a day, it’s probably going to be a problem, right?
Like if they never are on the floor and they’re never allowed freedom to move, yes. There’s going to we’re going to see delays and we’re going to see issues. But they also need time not on the floor like I’ve never met a baby that’s happy on the floor 24/7. You can’t carry them all the time.
Gina: I’m sure there’s a mom on Instagram that has messaged us whose baby is on the floor 24/7.
Dr. Amelie: Well, that was not my kid. Okay? I’m like, sorry, that was not me.
So what I recommend to patients like in the clinic and this was pre having my own child and that kind of changed things was no more than 15 minutes at a time, ideally no more than 3 to 4 times a day. Right? Like that’s a safe window as again, you have to shower, you have to cook dinner like you have other kids to tend to.
And yes, I have two 85 pound dogs. Like I can’t leave my baby on the floor and be in the shower and not expect one of them to, like, be licking her when I get out. So you have to have that realistic standpoint. But then I also learned as a mom, there were days where she was definitely in containers more than that, she was colicky, she had reflux. Like if I fed her, I couldn’t put her immediately down and sometimes I had to go do something else. So she had to go in like the Bjorn chair, and that’s just what it was. And there were some days where the only thing that soothed her was the swing. So she was in the swing, right?
Because for me, it comes down to, and this is as a provider now that I’ve had my own babies as well. Also, what’s better for their nervous system if they’re so disregulated and crying and fussy, is it better to leave them on the floor screaming or put them in something that’s going to soothe them? At least get them in a better place of state regulation.
And a lot of times that’s what those swings and like bouncy chairs can be used to help with, is to give them some extra input that will actually kind of help regulate their nervous system. And then you may be able to get some more floor time done.
But this whole idea that your baby has to live on the floor, 24/7 is just. I think it came from like the whole push for more tummy time.
But there has to be a balance. I don’t know. I could never do it. I wouldn’t have survived six months in without my swing and my bouncy chair like that. Just it is what it is.
Gina: Yeah. The same for my workouts. I definitely need something to put my baby in just for, like, short periods of time so she can just be entertained and I can finish my workout. Like my car seat is a container that is restricting her movement too I need to drive places. So if we do this, like, never use a container.
Okay, will, do you just never leave your house, right? A car seat is a container.
Dr. Amelie: Like if you don’t have the bassinet of the Uppa Baby, like any time you’re in the stroller, that’s a container, right? Like, I think I told you I had someone message me and tell me while, like, every hour you’re in the car seat, you should be an extra hour on the floor. And I’m like, I live in Houston.
Roxanne: Where do these extra hours come from?
Dr. Amelie: Right. I was like, it can take us.
Roxanne: Do you have a 48 hour day.
Dr. Amelie: It can take me an hour to get to a doctor’s appointment with my baby and then an hour back home. I’m like, there’s no extra time. And I’m like, Especially if they’re coming to see me in clinic.
So you want me to tell my parents they have to drive 30 minutes to come see me? So that’s an hour in a car, probably.
They’re going to do an hour of PT, go home and add an extra hour on to your day. I’m like, This is it. That’s not the world I live in. Like, I don’t know what these other people do, but that’s not my world and that’s not my kid. And so I learned once I became a mom, it’s all about balance and our mental health as a mom, right?
For you to be able to finish a workout, for me to be able to shower before I go to work, if that means they’re in a chair for 20 minutes, like everyone’s going to be okay.
What are some early things that parents and caregivers can do with their babies to support that early physical development?
Gina: Yeah, I think what you said about, you know, babies nervous system and kind of their mental state is also an important part of their development. It’s not all are they crawling and walking and running? There is more to our development than just the physical aspect of it. So what are some early things that parents and caregivers can do with their babies to support that early physical development?
And then, I mean, we already kind of talked about the mental aspect of it, but like what are those early things that we can do with our babies?
Dr. Amelie: So you kind of hit the nail on the head like the first three months. And this is something I tell all of my patients and parents. The first three months is really all about nervous system regulation. Yes, we’re going to introduce tummy time and rolling and some of these other movements, but your baby’s trying to figure out what happened, right?
They left a very warm, soothing environment and are now kind of bombarded with sounds and smells and lights and all of this stuff that it just takes them time to integrate into our world. So that first and foremost, those first three months is truly just about regulation. Establishing, feeding, what sleep you can get. Those are going to be the priority.
Yes, tummy time and physical movement is important, but if you don’t have those other pieces, then the physical aspect is not going to be there, right? If you’re struggling with nourishment and feeding your baby.
Calories in, calories out. Right. If they’re struggling to get calories in, how are we going to expect them to do activities that cause calories to come out?
Same thing with sleep, if they haven’t slept or you’re waking constantly for different reasons, if they’re super tired than during the day, how do you expect them to be alert enough to do tummy time or to do some of these other activities?
So I think one of my biggest things that I talk about with new parents or young families is kind of to lower that bar and that expectation of what’s actually going to happen in those first three months.
Yes, you may have a very regulated baby and you can get some more things done, but it’s also okay if you like, my child was, we struggled, like I said, with colic and reflux and sleep and all of these other things that definitely affected what she could physically do those first three months. And that’s okay.
But that’s where we see a lot of patients come in and these these new moms have just so much anxiety because they can’t do X, Y, or Z that they saw on Instagram.
And it’s like, that’s not realistic for every baby. And that’s that’s okay. That’s not affecting their long term development.
What will effect their long term development if they’re so disregulated six, eight, ten months down the road, like you’re going to have way more problems than if you worked on that first and then focused on that physical aspect of it.
How do you regulate their nervous system?
Roxanne: So my son also had like pretty bad colic for the first few months. And so like I totally get like it’s a struggle. Like take in one minute at a time. But what are ways you can help disregulate…or regulate…how do you regulate their nervous system? Like what are things to help them do that?
Dr. Amelie: So the biggest thing and I will say I work in an office, if you can see the pictures behind me with a chiropractor, a nervous system chiropractor. So we do a lot of work together. So that’s one of the biggest things is chiropractic care can help a lot with nervous system regulation. There’s a whole subset of chiropractors that are nervous system chiropractors. So they practice on kind of function of the nervous system regulating the nervous system. So if you have a really disregulated baby, even if you come to see me, that’s typically what I recommend is to get them on board. It’s not like you think of like adult chiropractors, like they’re not like cracking anything, but they can help just kind of regulate and calm down kind of the extra things that are going on and just really start to kind of hone in on the nervous system.
So that’s a big piece.
Another one along with that kind of that realm of lowering your expectation is like most babies are not happy on the floor before three or four months and like that’s okay. They can do tummy time on top of you like on your chest. Using a ball is a really big one for most parents.
Bouncing on a ball will typically help regulate babies. If you think about the movement in the womb, I do a lot of tummy time and even like side-lying play, back play on a ball again because if we can give them some of that bouncing movement while they’re doing some exercises like great, it usually regulates them a little bit more.
Another one I just tell parents is if they’re upset, hold them. Don’t force them to stay on the ground when they’re screaming and crying, like all you’re going to do is build up aversions to being in those positions. I know there are some like tough love PTs out there that will just be like, We’re crying through it and there are times where that’s appropriate.
But with like a four month old baby, like, that’s not that’s not going to work.
Roxanne: They’ll be fine.
Tummy Time
Dr. Amelie: So again, it’s like lowering your expectations of like tummy time with a three or four month old is not going to be ten, 15 minutes, like good job if you get 5 minutes done at a time. And so I think parents hear from other parents or the pediatrician’s office or whoever is doing your primary care. Oh, how’s tummy time going?
And you just assume they need to be there for like 30 minutes or an hour at a time. I’ve seen maybe one baby where that’s the case and they just slept on their belly.
Gina: So Sophie only loved tummy time because I was on the floor with her. Her siblings are on the floor with her. Like we were changing her positions, like we had a mirror in front of her. But, like, if she was just there by herself and she wasn’t sleeping, she was like, absolutely not. Yeah, absolutely.
Roxanne: I don’t even like to lay on the Ground by myself.
Dr. Amelie: Right. So and so if you think about that, right. No one wants to lay flat, lift their head up and just like that’s not exciting for anyone. But to your point, the other thing is to vary their position. There’s so much more to development than just being on your tummy, right? They need to be on their sides. They need to be on their back.
They need to be like introduced to the mechanisms of rolling. All of that should be include it in quote unquote like tummy time.
Tummy time is not just like pancake your kid’s flat on the ground and like, good luck. But that’s kind of what most parents are told, like when they go to the pediatrician, like, oh, just put them on their belly, but you actually can have too much tummy time.
Like we see a lot of kids. If you think about if they’re flat on their belly all the time, all they’ve done has worked on their back extensors and their postural extensors and they’ve never fired their flexors. These are the kids that are like, what we call like swimming and flopping and they actually, like they have trouble sitting, they have trouble crawling because the only position they’ve been introduced to and the only muscles that have been strengthened are their extensor muscles.
That’s in itself a problem. But so many parents are told tummy time, that all they focus on is tummy time without learning or doing anything else. And then we have more problems.
Roxanne: It’s almost like it’s not tummy time, it’s just like floor time.
Dr. Amelie: Yes, that’s what I tell parents. It’s floor time. Like, yes, it needs to be on their bellies, but like it also needs to be on their sides and on their back. And I’ve done some different posts, too, because that can be done like propped on your legs, that can be done on your chest. Like with Chloe’s reflux. Like we did not spend a lot of time flat, so we did a lot of like incline side lying and inclined back play.
There’s all these other positions that you can be in that technically count, but nobody’s given that education. Right? And they’re just told. Yeah, put them flat on their bellies like good luck. Yeah. And I don’t know that always ended up in a lot of spit up in my house.
Gina: I was told that baby wearing is also a tummy time option. Is that true in your opinion?
Dr. Amelie: Yes, in the first few weeks and months, yes. I think once they get to like four and six months and they’re a little bit stronger and have more head control, it’s not as beneficial for them. If you think about how we’re supporting them when we’re baby wearing them, they’re able to move their head. Yes, but they’re not.
Roxanne: Don’t baby wear! It’s a container!
Dr. Amelie: They’re not. Well, I know somebody will tell us that. Right. Somebody is going to message me and be like the solly wrap is a container. But like if I think it’s good in those first few months, especially just getting them used to that position, but then like four months on they really should be doing more like pushing through their arms and actually actively weight bearing.
And so then at least in my house, the baby carrier is just a nap place at that point.
Gina: That’s how it was for my first. The baby carrier was her place that she napped
Roxanne: It was so cute. She would come up and like holding the baby carrier. Yeah, I’d just be like, “Uuhba Uuhba”
Gina: So, in Korean which is when you carry the baby on your back, you call it an “Uhbabaa”. And so my mom would say, “Oh, do you want to be in the Uhbabaa?” And so then my oldest, who was like a year at the time, would be crying, holding it, going, “UHHBA UUHBA”. And then we would put her on our back and
Roxanne: she’d fall asleep within minutes.
Dr. Amelie: But yes, thats still Chloe like she knows now she has, like, the visual acuity to know what it is, and she gets so excited because she knows that’s where she’s going and it’s now.
Gina: That’s awesome.
Dr. Amelie: But I can’t then realistically say like, that’s tummy time, right? Like she’s just napping on me.
Gina: I mean, it makes sense for the beginning to that. It’s also a place that they’re going to get more regulated as well, like being right up against like your chest.
Dr: Amelie: Yes
Gina: I think mostly it’s going to be front carrying for babies that age. But like just being against like mom’s chest
Dr. Amelie: please only front carry if your baby’s that little please only front carry your baby.
Gina: I’ve seen some crazy techniques that I’m like, oh, my goodness.
Roxanne: Yeah, I can barely use the rings slings
Sophie's Wonky Crawl...to intervene or not?
Gina: So Sophie has this like crazy little crawl. So she’s six months now. And so we’ve kind of moved past the baby wear them all the time instead of tummy time or floor time. And now she is like army crawling, but she’s only army crawling with her right arm and she’s kicking with her left leg. And then the other side is just like kind of grabbing things,
Dr. Amelie: flailing
Gina: and it’s like always the right arm that’s just like wiggling down the street or the floor, but it’s always that same side. Is there anything that I should be doing? Like, should I be concerned about this? Like, she’s really young, but.
Dr. Amelie: Yeah, so she’s still is like six months is still pretty young. So again, everyone who’s anti-container Sophie is doing things ahead of schedule. She’s fine in her container.
So what she’s showing is kind of the first instances of preferences, but she’s kind of in that tricky stage where it’s not one side. What she’s showing us is if you think about like the abdominal sling and that x that it makes, she is showing a side preference for part of that kind of X position.
Right. So she wants to use one arm and the opposite leg in theory. Right. Then her left arm is weaker. She just likes to flail that side out. Right. She’s pulling with her, right? Yeah. And then just kind of letting her right leg kind of lag behind. So she and we can I can send you some things. What we would want to do with her is start to get her into a kneeling position and kind of forcibly work on her right Glutes firing more and then her left scapula firing more. Right.
So she’s kind of showing us she has some weakness there. It’s not necessarily a side preference as much as it is just some weakness and a motor pattern she’s developing to kind of compensate for that weakness. They’re pretty easy to fix most of the time. It’s just like throwing in some different exercises and kind of practicing some different things with her.
The issues, though, that typically come, or when we see them become issues, right, is if you go to the pediatrician, they didn’t ask to see a video or they didn’t like talk through it the way I just did with you. They said, oh, is she army crawling? Yes. Check. Okay, we’re moving on.
And so then what happens is six months later, they’re still not fully crawling or they’re doing what we call like the hitch crawl where one legs up and they look almost like a half frog. It’s really uncomfortable look.
Roxanne: My son did that.
Dr. Amelie: Yes, but it gets missed because nobody’s kind of catching those first signs of some motor pattern weaknesses that need to be addressed. So that’s where a lot of our patients come from or I try to get them in earlier, is if we can address the pattern before it truly becomes ingrained and they start doing like a hitch crawl.
It’s a lot easier to fix with someone who is six months old like Sophie, and you can kind of pretty easily get her in different positions where at like ten, 12 months, even some of my patients like 18 months, they know the word no and they’re not going to do it. And then you’re like fighting with them to get them to do some of these things.
But where Sophie’s at is really just going to be positioning and putting her into different spots and kind of forcing the other side of her body to start moving the other thing I would probably recommend is if you do know a nervous system chiropractor, just to see if there’s anything kind of in her thoracic spine or her hip that could be stopping her from firing that other side of her body.
But I always say, right, like especially Sophie’s a classic example of the movement. And the movement patterns matter more than the month they meet a milestone like we could all be going like, Yay, Sophie, like you’re doing something early, like, but if you’re doing it with a pattern that’s not optimal, what are you actually gaining from that? Right.
And I think so many parents focus on, oh, I found X, Y, Z kind of milestone checklist on Instagram and oh, I have to do all of these things and check all of these boxes. But there’s no education as far as like, yes, you need to do these things or that’s when we expect you to do them. But if the movement pattern isn’t right or the motor planning is off, it’s not necessarily like a good thing that you’re meeting milestones.
Does that make sense?
Gina: Yeah. So even though she is like early because I don’t think most babies start like becoming like super mobile until like closer to eight or nine months.
Dr. Amelie: Yes.
Gina: And so she’s already like on the early side, but she is really showing a preference towards this specific swing or this certain diagonal of this swing. And it’s something that I have noticed that I’m like, I feel like we need to start working on the other side.
Dr. Amelie: Right
Gina: And so if I brought it up to my pediatrician, I’m like, they might be like, Oh, well, she’s really early. Like, she’s ahead in her milestones. And I’m like, Yeah, but is it doing this on both sides? She’s just doing it only on that one. And, like, I feel like I need to be doing something things with her so that she can start working on the other side as well.
Dr. Amelie: Right.
Gina: So I think it is important for those that are listening to know that, yes, you’re your baby and your kid can be ahead like with the check mark milestone. But how they are doing, it can still indicate like a potential issue. And like Dr. Amelie is saying, like if we can address it earlier, it’s going to be so much easier to help them as opposed to like waiting until they’ve like passed the milestone, if that makes sense.
Dr. Amelie: Yes
Roxanne: I feel like like knowing that you can go see a pediatric PT if you have like any sort of concerns. And they could also tell you like, hey, things are fine, they’re doing great.
Dr. Amelie: So we do that a lot. I will consult and do evals and very frequently be like, they’re fine. Like here’s some exercises, practices this at home. Like, yeah, that’s why I also offer like wellness check ins, essentially like well-child checks at a doctor’s office. But you come to see me, and it’s for that reason, like, let’s just check in and let’s make sure you’re meeting milestones, but you’re doing them appropriately and correctly so that if there are issues, we stop them beforehand.
But to your point, most pediatricians are probably going to tell you, oh, just wait and see. Like, you’re fine. And that’s where a lot of times, like, you’ll see PT and pediatricians, not all pediatricians. I work with a lot of very good pediatricians, but that’s where sometimes there’s a disconnect between what we know and what we understand with movement and what they’re looking for as far as like milestones and when they consider a patient delayed.
When to ask for help?
Gina: Yeah, I think some of it is understanding like what is actually an issue as the parent and knowing to bring it up because if you don’t recognize that hey like they’re always favoring this side and actually that might be an issue like I would have never brought that up to my pediatrician and we actually just had an appointment for her like two weeks ago and I didn’t bring it up because I hadn’t noticed it until the other day and I was like, Oh, wait, she’s always doing the same side. And I wouldn’t have thought to how brought it up to my pediatrician like I would have been like, Oh, I should contact a PT about this because they’re going to give me exercises to do. But then I was also like, Well, she’s really early, like with her milestones, so like maybe I shouldn’t because they’re just going to tell me to just wait because she’s early.
So this is good to know. Like, you know, paying attention to how your baby is moving and then bringing that up to your pediatrician specifically or like doing that like wellness consult with the PT to make sure baby is developing well within that first year, like physically can be really helpful.
So what are some common like milestones like very generalized that a baby should meet within like the first year of life.
Dr. Amelie: So the big ones, right?
I call them like the big four. Rolling, sitting, crawling, walking.
Like that’s really what people are looking for and like the broadest ones.
So typically rolling we see between like four and six months
Crawling somewhere 8 to 10.
Sorry, I skipped sitting sittings typically around 6 to 7 months.
Walking is where it gets really sticky and it’s a very long kind of span. We typically see walking anywhere from 12 to 18 months. I say if you’re not walking by about sixteen months, I’d say come in for a consult. But in average we sometimes see late walkers as far as 18 months.
What I typically use as my rule of thumb is I give a grace period of a month to two months.
So rolling, for example, if you’re getting towards that seven month mark, seven and a half months in your baby’s still not rolling time to come in. Right?
Like I said, babies aren’t robots. They don’t know, like, oh, it’s six months. I should have rolled and now I should be sitting. They don’t know that. And that’s what we expect. Like parents are like, Oh, well, they’re six months old.
I’m like, Yeah, like if they don’t have the motor patterns or their movement, they’re not going to do it.
So I say to give them a month to two month buffer, but if you’re starting to get to the end of that buffer and you still aren’t seeing those skills coming through, I would definitely reach out to you and consult and see kind of what the issue is.
Like I said, walking tends to be that really gray area. I hate to break it to everyone, but like your kids, probably not walking at 12 months. Some do, and some walk early. There are early walkers, but more often than not, 14-16 months is more of like an average of true walking skills and so I get a lot of like messages, oh my God, my kid’s 12 months and they’re not walking.
And I’m like, they have half a year left. Like, they don’t like that’s it’s one of those skills that’s such a gray area. And I feel like it’s the biggest one for parents. Like we’re waiting and waiting and waiting and sometimes they take a really long time.
Gina: Yeah, I definitely found that when my kids were walking, it was like a game changer with like the activities that we can do because, like, I’m not going to take my crawling baby to like a museum and be like, okay, you just crawl all over the floor. And so once they could walk, it was like so much more fun.
And so I totally can understand the desire for your baby to start walking early, because it’s like this whole new world, like, opens up. And so, like, for Roxanne Colin was the latest walker like when did he start walking.
Roxanne: Colin was weird so he definitely, I probably should have brought him to a pediatric PT earlier. But life is hard by yourself with two kids without any family. So…He definitely had like that janky crawl. He crawled at like similar time as my daughter and she started walking around nine months. So when nine months came around, he’s still doing his little janky crawl as I like, what? I would help him, so he would use like both legs.
But he started taking steps when he was like 11 months, like just one or two steps at a time, but wouldn’t do more than that and then would just do his crawl. So he didn’t actually start walking, walking till 15 months.
So that took like three months for him to like start to actually independently walk.
He would walk with the walker. I’m like we had like a stroller that he would like push, like Lily would be in the stroller and he would push her, 30lbs pushing his sister, but he just wouldn’t walk by himself.
So I don’t know if it was a bit of a confidence thing, but I think like around 15 months, like two days before I was like maybe this is concerning and I almost like set up an appointment for him and then like two days later he started just walking around the house.
he’s like, I don’t want to go to a doctor. I’m good.
Dr. Amelie: That happens all the time. I get people, I’ll get them on the schedule and they show up and they’re like, Well, we were worried about this and now we’re not. And that what he showed is actually pretty common to maybe not. It seems like he took a little bit longer than like we typically expect. But a lot of kids will like cruise along like a couch or take one or two steps, but it can take another month to two months before they’re truly walking.
And so, again, that’s why it’s this really gray area and it’s very almost like baby to baby. I’m very hesitant when I like blanketly say things about walking because it is so personal to each kid and then on top of that, for all the milestones before, like anybody panics, you have to when we’re talking about those milestones, we’re also mentally adjusting for their gestational age.
So I did a post on Instagram that so many people, I didn’t realize, like it’s ingrained in my head. It’s like normal. But I got so many questions about actual age and then like gestational age and chronological age and all of those things. And essentially any week that they were born early, right?
So Chloe was born 37 ish, I say she’s more like a 36 weaker. She gets four extra weeks to do any milestone. So she’s technically six months, but in my head I clinically look at her like a five month old.
Right? So if you have a baby that was born at 34 weeks, they get almost two extra months to a milestone before we really start to get concerned about delays. And so I think a lot of times parents don’t realize that that doesn’t just apply to those really preemie like 29, 30 weekers.
It’s those 36 weekers, 37 weekers. Like they still get that extra time.
If you think about if your baby was born at 37 weeks, that’s 21 plus days that they missed in utero. They still had a lot to do. And so we have to give them that time. But as a mom, right, that’s a long time.
Like my kids, six months, like, oh, my God. Like, we’re not doing X, Y, Z. But then I have to remind myself, okay, she was born almost four weeks early. And so you have to adjust in your head. When we talk about milestones at any point, I always like caution parents because it’s still so specific to every baby.
Gestational Age and milestone adjustment
Roxanne: So would you say that like you would also say like on the flip side, do you see babies that go past their due date usually will meet their milestones sooner.
Dr. Amelie: They don’t get any extra credit.
Roxanne: Oh, I was going to say Adeline and Sophie were born nearly 42 weeks and they’re phenomenal, advanced babies. Both my kids were born right at 40 weeks.
Dr. Amelie: No extra credit for them. I know. I’m like look.
Roxanne: they are just normal.
Gina: That is funny because Eoghan, he was about like a week or two behind Adeline. He was born like one day after his due date. And so Adeline, everything was like two weeks And then like two weeks later, like, Eoghan would do it kind of thing. So it was kind of funny.
And Sophie was born at the same gestation as Adeline. Yeah, but there’s another thing that also goes by gestational age, which is, I don’t know if you’ve heard of Wonder Weeks. Yeah, which is the like mental leaps. And so what Wonder Weeks has documented is kind of the mental changes that happen with our babies, like perception of the world.
And so the way that we perceive the world as adults is not the same way that our babies, when they’re first born, perceive the world. And so at first they think of us all as like one being. So they don’t recognize that we are different entities. And so their first milestone or like mental leap is recognizing like I am a separate person in this giant world and it’s overwhelming.
And then there’s one at like five months where they can perceive distance, like they recognize like you moved away from me. I am now going to crawl towards you. And that’s kind of the initiator to mental milestone is kind of the thing that triggers the physical milestone as well is like I perceive distance and now I have to move my body to get to that thing that I want.
And so it’s interesting that and it makes sense that their physical milestones will match their mental milestones. Yes. And that is all going to be based off their gestational age, not necessarily their birth date. And so I think that is really helpful for parents to recognize, because when you do The Wonder Weeks app, you do it by their due date, not their birth date, which is like really interesting.
Dr. Amelie: Yes. And I confirm, we use it and I can confirm again, I know my own kid very well. She is very much gestational age, like on point, like I don’t even have to look at the app and I know we’re in a leap because it’s a disaster in my house.
Roxanne: Oh yeah. Every time.
Dr. Amelie: It makes sense, right? Like and I tell parents if they have babies that are struggling with moving, sometimes they’ll be like, oh, baby’s lazy. And I’m like, No. Like, kids inherently want to move, kids inherently want to explore. And it’s because of those cognitive changes that are happening in their brain and they’re learning our world and they want to explore and they want to move around and they want to do all these things.
And so if you have a baby that’s struggling for some reason with movement, like there’s no such thing as a lazy baby, but that’s a lot of times like what people say and they’re like, Oh, they’re just comfortable. And I’m like, No, they’re stuck there. If you use Wonder weeks or some people just follow like growth spurts and different things.
Like there’s so many different things that people can follow and they all pretty much in their own way, kind of connect and follow the same trajectory of their cognition, improves their vision, improves their understanding of the environment, improves. And that’s going to drive changes in their movement.
Importance of Four Major Milestones
Roxanne: So I know this is like changing topics here, but you listed the four milestones like the four major milestones. I have been told there is importance of them doing them in order, like not skipping. So like rolling first and then sitting on their own. And then sitting on their own. Transferring to crawling on their own. Not like you putting them in the crawl.
And then walking like because some babies will just like skip crawling altogether or they’ll never sit up on their own. They just go from rolling to crawling. What is the importance of that, I guess sequence, and why is it so important if you skip a sequence to seek help?
Dr. Amelie: So it’s all comes back to again, like motor planning, muscle pattern, it’s like movement and kind of connecting the brain to the body and learning different patterns. There’s I can’t remember the exact number. There’s probably 20 different papers that state the amount of neural connections that are formed in the first year of life is larger than at any other point.
So if you think about all of that and all of the things your brain and your body are learning how to do, and all the different synapses and connections that are forming, if you skip one of those milestones, you’re losing some of those motor planning and some of that patterning by skipping whatever it was, right? So if they didn’t learn to roll and they just learned to sit up, they lost the connection of their abdominals and their neck muscles.
They lost the connection. That visual change, doing that roll, controlling their head to move in those different directions. They’ve lost the understanding of, Oh, I can reach with my arm, and then that’s going to move the rest of my body to turn. it’s not necessarily just about the physical movement, but it’s about what’s going on with their vision. It’s about what’s going on with the way they see the world and the environment. And every one of those milestones allows for a different interaction with the world
On the floor, they’re upright looking right, like just kind of turning their head. Sitting up, the first they’re kind of independently able to manipulate and kind of move around. And if you think about crawling and moving forward or backwards with your visual system, that’s a huge component of just visual integration and maturation of your eye muscles.
The biggest one we see is that probably that skip of crawling and going straight to walking, kind of like what we just talked about with Sophie, right? If you’re struggling to do any of that, that child likely has no abdominal control. But parents don’t realize a lot of times is standing is actually an easier position to be in than being in quadruped, than being in the crawling position.
If you think about doing like a bird dog or you think about doing like a dead bug, you think about how much core activation and trunk control that takes. It’s a lot easier for a baby to just stand up, lock out their hips and their knees and just kind of hang out on their ligaments and be like, Look at me.
They’re not actually doing any work. And so I like have to be the bad guy most of the time because parents come in and they’re like, Oh, we can’t crawl, but we can stand up. And I’m like, That’s because that’s an easier thing to do than crawling.
Gina: Have you ever tried to put a baby into a car seat that did not want to be in a car seat, and they plank? like that is the hardest position to get them out of.
Roxanne: Why are the planks so strong?
Dr. Amelie: Yeah. It happens. And it’s those extensors, right? Our babies, extensor muscles are so strong that that’s what they learn to use first. And so if all they’ve done is learn to do their extensors and they’ve never sat and they’ve never crawled, they’ve never gotten the flexion, those abdominal muscles, you can hang out in extension and stand all day long and not actually activate any true like muscles or postural control.
And so that’s why we want babies to do things in order for a reason. It’s not because I’m type A and a stickler about like a graph that’s in front of me. You can ask Dr. Julia at my the chiropractor I work with like I’m the most type B person on the planet. Like I don’t care about the graph in most of the checklists, but it’s all about the motor pattern and the planning.
And I can guarantee you, like if I go to a like a t-ball game, I can pick out the kids that didn’t crawl because they are kids that cannot figure out how to run. They cannot figure out hand-eye coordination. There’s so much more that goes into some of those developmental milestones far beyond the actual movement itself. So like somebody is going to message me and tell me the CDC said Crawl, it’s not a milestone anymore, but sorry, it needs to be like what?
Changes to Milestone Guidelines Opinion
Roxanne: They changed all the milestones
Dr. Amelie: they did, yes.
Roxanne: How do you feel about that as a PT?
Dr. Amelie: I use the old ones to be quite honest with you. So when they changed that they didn’t consult there is like the APTA is tPT group, There’s the AOTA which is the OT group, the occupational therapy group. And then there’s ASHA, which is the speech therapy like national boards and groups. They didn’t contact anyone from the three groups that are actual development specialists, right?
Like they didn’t talk to anybody and they changed all of this. So now I will say that most of us don’t use them. I use the old ones.
Roxanne: Is it hard, though? Like so like what if their pediatrician now uses these new milestones so then they don’t get into the next question we would ask, like these pediatricians, not like say that they’re bad or anything, but they’re like, oh, these are the new standards. These are what we’re going to use. And now, like, you go to them and be like, Hey, my kid is not sitting up yet.
And they’re like, Well, that’s totally normal because they just change the standard. So like, you don’t need to see physical therapy, but you’re like, No, but I would like a referral. And they’re like, No, we can’t put it in because they’re not delayed.
Dr. Amelie: So…
Roxanne: Then what do they do?
Dr. Amelie: The biggest thing and this is something I probably need to do a better job of too, is most people don’t know that you can there’s something called direct access. So one, you can Google your state and Google PT direct access. Most states have changed the laws to where we have doctorates in physical therapy. So we’re clinical doctors.
We can see patients without a referral. So I don’t need a referral from a pediatrician to do an evaluation or start a treatment plan. I’m legally required within 30 days to get a signature from them on my plan of care. But you don’t necessarily have to have a referral to be seen by a physical therapist.
The other thing would be not every state is doing that yet.
It would be, being a pain and kind of bugging them until they give you one. But most states now are moving towards direct access. So you can typically you may not always be able to get into like a hospital clinic, but like my clinic, since we’re not insurance based, I don’t have to submit for approval from insurance before I see a patient so they can just walk in. We schedule an appointment and they’re seen in clinic, but that’s actually where more of that referral issue comes into place because it’s an insurance thing, because insurances won’t cover it unless there’s a referral.
And so yeah, that’s why a lot of us are moving to private practice and don’t take insurance because it’s it’s just a middleman that’s slowing down a process that doesn’t like, kids develop quickly like we don’t need to wait five months to see a patient because we’re trying to get a referral and then insurance is deciding whether or not we should see them.
But that’s what I would tell most people is Google Direct Access and put in your state and see if that’s an option and then you would kind of have to work backwards from there.
Roxanne: Because I feel like doctors can always put in like a retroactive referral of like, hey, we’ve been seeing this PT and we have seen great benefits and like this is what they recommend, who you are also a doctor. Could you put in that referral so that our insurance can like pay us back for all of these visits? Because I know like PTs not cheap, but it’s like if insurance can give you something.
Dr. Amelie: And this is why most of us are changing our practices as well. When we move into private practices, what people don’t understand with insurance and PT is your insurance will tell you, right? Like I worked in the hospital system for like six years, so I saw kind of all of the the sides of it.
What they’ll tell you is whether or not your plan covers PT and is in network with whatever clinic you want to go to. What they don’t really delve into with you is how much per charge they’re going to cover. So every type of treatment I do is a different code. Yeah, they’re not telling you how much of that code they’re going to pay for.
I could find it. Or like our office department could find it somewhere, but I’m never told that as a clinician. So typically what happens is you pay whatever your co-pay is. I’ve seen $15 copays, I’ve seen like $200 and $300 copays and that’s like per session. Yeah. Yeah. So you pay that upfront and then likely in a month or two, you get another bill in the mail for every code that they didn’t cover.
And so a lot of times people wonder like, why would we pay cash pay instead of like using our insurance? And I’m like, Because you’re still running a gamble. I’ve had so many patients call me, like after I’ve discharged them and been like, Hey, I got a $2,000 bill in the mail and it’s all of the charges and codes that insurance said they didn’t cover or only covered a portion of.
So then the patient is responsible for paying the hospital the rest of it. And so the way we’ve changed and the way it’s kind of changing now is I charge a flat fee regardless of what we do in the treatment session. It’s a flat fee. I do what’s called super billing. So I when I do an invoice, it gives the patient’s family all of my NPI number, my licensing number, and then it gives them a breakdown of the codes that I’m billing for.
And I can guarantee you, because I know what hospitals charge per code, what I charge for a full 45 minute session is probably a third of what they charge for like a 15 minute chunk of a session. Yeah. Because right, they’re buffering what they know insurance is going to cover and not cover. And so in the long run, for 90% of people, it’s cheaper to do cash pay.
But I get it, you have to financially be able to like do that upfront.
Is there a perfect toy for baby's development?
Dr. Amelie: Parents always ask like, what are good toys? Or What are things that are like helpful for tummy time or playtime? And I’m like, it’s not the esthetically pleasing like beige pastel colored, like cute things that Instagram influencer told you to buy. Like, it’s the old school toys that your mother in law keeps sending you that you don’t want in the house.
That was so loud, but that’s what they want.
Gina: It’s what gets their attention.
Roxanne: They want the overstimulating, loud, obnoxious noises they do. And this is really nice, black and white, soothing rattle that just makes nice jingles.
Dr. Amelie: 0 to 3 months. You can give them the black and white toys. Yes, it just gets their attention. But 0 to 3 months, you can do the black and white. So that’s what I tell parents, because they always ask, like, what do we need?
I’m like, 0 to 3 months. You really need some black and white flashcards and maybe a rattle and like, you’re fine.
Gina: And your body.
Dr. Amelie: Yeah. And you, like, that’s really all they want. Like they don’t really want anything, but then like four months and up you better like up your toy game or they’re just not going to do.
Gina: They’re like get this out of my face. This black and white circle.
Dr. Amelie: Yeah. They’re just like, I’m done with this.
Gina: So you can either put your baby in a container and ruin their physical development, or you can put them and tell me time with this bright light up toy and ruin their mental development. You got to pick one or the other though.
Dr. Amelie: And just overstimulate them. No Montessori moms are going to come see Me, it’s fine
Roxanne: One of our employees is a montessori teacher. She’s going to listen to this
Dr. Amelia: and be like she’s going to be so mad
Roxanne: Guys…
Dr. Amelia: I’m Sorry.
Gina: number one tummy time to VTech light up cube.
Dr. Amelie: VTech light up cube. There is one that like spins, I’ll send you all the video, but it’s the most obnoxious thing ever. But all my kids that like don’t roll and don’t want to engage, guess when they roll. When there’s this like disco ball spinning and in their periphery and they go and get it.
I mean, that is the time to though, like sorting like sorting toys and things like that.
Once they’re sitting up, that’s a really good time to introduce some of those more like cause and effect toys. And that’s when I think you can really start to bring in some of those more like calm yoys.
Like quiet, not-so-noisy things because they want to learn that cause and effect, that sorting. Yes, I still use the ones that sing, but like there are a lot more options then because their attention is going to be on the task and not so much just whatever toy they’re staring at.
Gina: I do find that the Lovevery play kits are like the perfect toys for my kids. Like and they don’t light up and they don’t sing, but they’re very much like puzzles that are appropriate for each like age and so those have been my favorite toys for my kids and the ones that they play with the most besides Paw Patrol, because you can’t get away from Paw Patrol Patrol, Rubble on the double rubble.
Roxanne: Paw Patrol and Barbies
Gina: Rubble on the double
Dr. Amelie: Rubble on the double
Gina: He’s on the double guys.
Roxanne: Chase is on the case.
Gina: He is. Marshall’s fired up. I know them all.
Roxanne: To the sky.
Gina: I know all the new characters. I know all the variations of Paw Patrol. But yeah, so I have let the play kits have been really great.
Dr. Amelie: I think it’s a balance too. Like we have the mat, we have like the play mat. I got it. The lovevery Playmat from our like baby registry. I don’t have like the subscription, so I don’t know what all the boxes are. I’ve seen them at a lot of patients houses that I go to. I do like that they give you like direction, right?
So if it’s a mom who’s just like, I don’t know what’s going on or wants like specific things, they’re really good about giving you those options. I do think a lot of times if you need more cost effective options, Amazon will have a lot of the same stuff. They just right then you don’t get like kind of directive that comes with the lovevery play kits.
And that’s why I think the kids are great because it doesn’t overload your house with toys. Like I tell parents, you really only need two or three, maybe four things at a time for your kid to play with. You don’t need a full playroom of toys. I think most of us end up with that. My husband cringes because we have a six month old daughter.
Like I said, the whole corner of our living room is already full of toys for her. But like, that’s my job. So that’s my excuse. But like, most of the time, you can really get away with two or three toys. And I tell most parents, like your kids probably can be happy with like a red solo cup and some Mardi Gras beads. So it doesn’t need to be like super overwhelming. I have some moms come in and they just want like this all comprehensive list of everything they need.
And I’m like, pick a few things and it’s like.
Roxanne: Every baby’s so different. It’s like you just observe to see what things are gravitating towards and then use those things to help.
Dr. Amelie: Yeah. A month later, they’re going to want something different.
Collaborative Care
Gina: Are there any other professionals that can support your child’s physical development?
Dr. Amelie: So I think we’ve talked about, like I said, I work very closely with a chiropractor and I do believe there’s a lot of good things and overlap that we can kind of treat together. I see a lot of outcomes faster and kind of even better outcomes when it’s a child that sees both of us just because they can do a lot of things mobility wise and kind of movement wise that I can do too but it would take me a lot longer because I’m not physically adjusting them, whereas if they’re adjusted and aligned before we start and then I can work on the muscle and the movement patterns, we usually get a better outcome. Not to say I can’t do it on my own, but we usually get faster results if they’re seeing both of us.
So I’m obviously team chiropractor.
We do work a lot with speech language pathology. So SLPs especially for our kids that have oral tension tongue ties, tortocollis. Typically those things are all very interconnected. So if they haven’t been assessed for oral tension or tongue ties, I can do a pretty quick screen and then I’m quickly sending them out to see a speech pathologist because I can’t fix their tortocollis if we don’t also resolve their oral tension.
And so, again, it’s kind of knowing enough about the body and what I do to know when we need to bring other people on board. We work a lot with occupational therapists, too. They do a lot of like functional movements with the hands. So once your kids getting older, right, and if they’re struggling to put hands to mouth or do like fine grasp for toys or food, that is more of an OT thing than a PT thing. Like, I can do some of it, but that’s not my wheelhouse.
We work a lot, kind of all encompassing together. I do try to work a lot with our pediatricians, too, and keep open lines of communication, especially with the ones that I know I see multiple of their patients because I feel like that’s how we kind of change this narrative of let’s stop, wait and see and let’s send them early, and then maybe they only need six sessions and then like monthly checkups instead of needing to see me, you know, twice a week for six or eight weeks, right?
So the earlier we are all getting involved, typically the better the outcomes are for the baby.
Gina: Yeah, we have taken our newborns to see chiropractors like shortly after birth to do like an adjustment on them because birth is a pretty tough event physically to go through for both mom and baby. And so we found a lot of like relieving tension and helping with like breastfeeding by seeing a chiropractor. We worked with like cranial sacral therapists and like myofunctional therapists to support like that airway health and like the tongue movement and stuff.
We have some functional dentists in our area that assess and look at like oral tension and tethers as well.
And so there’s definitely like a huge team of people that can help support our baby’s development. Like we don’t necessarily need everyone to be there, but it’s great to know that our professionals know who to refer to and can kind of recognize, Hey, this is a little bit out of my wheelhouse and so this is the other professional that you should seek like support for your baby’s development.
So it’s good to know, like there is a lot out there to kind of enhance our children’s development.
Hey, my baby might be ahead in their milestones, but they’re displaying some motor issues. Let me do early intervention as opposed to waiting until they’re, like, delayed or my baby is a few months delayed in like the milestones that they should be reaching. So let me like advocate for a referral for my pediatrician or to do that direct like access to a physical therapist or even seeing a cash based physical therapist.
So kind of knowing the options that are available I think is like really helpful. Is there any like last advice to put on the podcast that you have for our followers in regards to entry into parenthood with this overwhelm of like, I don’t want to ruin my child and I want to set them up for success so they can go to Harvard and become doctors and scientists.
What sage advice do you have for that parent?
Dr. Amelie: So it’s probably two things.
The first one is and I had to do this as a new mom myself, right? Like I’ve done this for six years and had my own child and was still like, wow, what is going on? Like, it’s a whole new world even for someone like me who does it all the time.
So the first thing is like delete all of the accounts on social media that are giving you that new mom anxiety and that stress and that guilt just stop. We’re all scrolling while we’re feeding or while we’re not sleeping like just delete all of those accounts that are starting to make you anxious because it likely has nothing to do. It’s not specific to your child. They have no idea what’s going on with your kids. So like, just take them off. That’s my first thing. It’s like, shut off anything that’s adding to an already very stressful and anxious state.
And then the second thing is like lower your expectations for your baby. Like you said, just had a very traumatic event that some kids recover from pretty quickly. Some babies it takes months to recover from, depending on what happened during their birth. And we need to give them that time and kind of honor the notion that like they don’t know what’s going on, like they’re taking it day by day and just trying to figure out what is happening.
So a big thing for me is just is lowering your expectation of like having this picture perfect child and this picture perfect like first 18 months, two years and just accepting like that. Some things may come easy, some things may come hard. Your baby could have delays even if you do everything perfectly right, right.
Like this is my job.I do it all day long and like I still fight at home with my daughter to make our use her left hand because she’s like doesn’t. She just Doesn’t want to use it.
Every baby is going to struggle in some degree.
And I think the biggest thing that I try to do with my parents is make them realize, like, if your child has delays or your child is struggling with something, like look at Sophie, like she’s loved, she’s healthy, she’s cared for. Like it’s nobody’s fault that she’s showing a wonky movement pattern, right?
That’s just how her body was.
Gina: Except completely my fault.
Roxanne: Completely Gina’s fault. She’s just failing, just failing.
Gina: It’s the walker. I put her in the walker.
Dr. Amelie: But that’s what people think, right? You automatically think as a parent like, Oh, I did something wrong. And that’s that’s not it. If you think about everything your baby has to do in those first two years and everything they’re learning, like I still mess up on things that I learned years ago to do correctly, right?
So like everything they’re doing as a brand new movement is a brand new like motor pattern.
It’s a brand new part of their life. Like we should expect them to mess up honestly more than we should expect them to get it right. And I think as parents, we expect them to get it right all of the time. And then when they don’t, we panic.
Roxanne: Yeah.
Dr. Amelie: On that note to like put your baby in the baby Bjorn chair and go take a shower, like they’re going to be fine. It’s okay. So that I feel like I need like on my signage outside. Like, get the swing, get the chair. Like, they’re fine.
Gina: It’s okay. Your baby’s like, regulation is also really important. Like, there’s more than just physical development.
Dr. Amelie: I think that’s a big piece of it. Like, it’s not just milestones. We’re not just worried about them meeting milestones. There’s so much more that goes into those first few years of life. But it’s okay to also be concerned and to ask for help. Like I get so many moms that tell me like, Oh, I’m just being overanxious and I’m, you know, it’s just me.
And I’m like, no, like you did the right thing. Like, come in and see me. Like, that’s why I offer virtual consults too, for that reason that like, it’s just a sounding board where essentially you call in and we just talk about what are you seeing, what are you concerned about? Let’s talk through some of this stuff so you don’t have this like anxious thought, like weighing down on you for weeks before you go back to see the pediatrician.
Sorry, that was way more than one thing, but those are my parting, my parting thoughts.
Learn more from Dr. Amelie
Gina: No, that was great. That was great. How can our listeners learn more from you and we’ll link all of your Instagram page and your website and stuff in the show notes as well.
Dr. Amelie: Instagram @GraspingGrossMotor. And then my website is the same graspinggrossmotor.com that links directly to like my booking site for either in-person stuff if you’re in Houston or I do do virtual stuff as well, and it’s essentially for that reason, I set it up to be able to reach more than just who I see here, because I know this is something that moms everywhere need to hear and kind of need a sounding board for.
That’s more tailored personally to them than like whatever. Even my own Instagram account, that’s like a general place. Like that’s where I would go for general education. But if you have specific questions directly about your child, like reach out so we can schedule something either in-person or virtually, because that’s where you’re actually going to get answers tailored to you And your child.