In both settings, the pain management team is committed to improving patients’ quality of life by offering them the tools to manage and overcome their pain. They provide treatment options tailored to meet the patients’ goals, such as medication management, interventional pain procedures, physical therapy, cognitive behavior therapy, relaxation therapy, guided imagery, aromatherapy, medical acupuncture, massage therapy, yoga therapy and more. The team also provides education on how to manage pain through lifestyle modifications like paced physical activity, diet and improved sleep hygiene.

Watch the videos below to learn more about the aromatherapy, massage therapy and yoga therapy services at Cook Children’s.

The white smoke from the official's starter gun rises in the air as the runners sprint around the track.

Two, four, six, eight...

The competitive cheerleaders chant before they begin their routine.

There’s dead silence. Then the sound erupts of gymnasts’ landing and sticking.

These moments make up three of Bryce Gray's favorite passions. People who know and love 16-year-old Bryce, describe her as a premier multi-sport athlete, a great leader, and a trusted friend. Yet, her favorite interest came to a screeching halt during a routine physical.

"I was tumbling and everything was normal. I had some pain, but I just thought it was typical back pain. I was doing backflips every day," Bryce recalled.

During her appointment, Bryce and her mother Shemita learned she had scoliosis, which was the source of her back pain. 

"At the time, I time didn't know what scoliosis was," Bryce remembered. "After going to get fitted for a brace, I realized it was serious."

Bryce wore a back brace prescribed for 6-18 hours a day very compliantly, for 16 months. She was only allowed to remove her brace to shower and practice sports. She complained her clothes no longer fit and became self-conscious going to school, not sure how her peers would react.

"My friends made the best of it and started to call me Bryce-bot," Bryce said. "They would joke that I looked like a robot because of how hard the plastic was on my brace."

Bryce was released to actively compete just in time for summer. She and Shemita believed she'd made progress wearing the brace and were relieved when Bryce was able to stop bracing. By the end of summer, Shemita realized something wasn't right as Bryce complained of breathing problems.

"She told me she thought she had asthma," Shemita remembered. "She kept complaining about her breathing and I knew I needed to get her to the doctor.”

Bryce saw Lauren LaMont, M.D., an orthopedic surgeon at Cook Children’s Medical Center.

That doctor's appointment would be a turning point for Bryce. The family learned Bryce’s curve had grown over the summer, and her spinal curve had worsened. Her hips were also uneven.

"They told us her curve was progressive and had started to press against her lungs," Shemita explained.

"I have dreams of being a college athlete. When I got my diagnosis, I felt like everything was put on hold," Bryce expressed emphatically. 

Dr. LaMont explained that Bryce's condition would continue to worsen, and surgery would be her only option for correction.

"If you took an X-ray of a normal back curve, it would measure between zero and 10 degrees and no one would question it," Dr. LaMont said. "Bryce's curve was near 60 degrees, and we knew she would need surgery."

After receiving the news, Shemita allowed Bryce to decide when she’d have the procedure. Out of fear, Bryce continued putting the surgery off.

"I knew what was best, but I didn't want to go through the pain and the healing process," Bryce said. "After a breakdown at the hospital, Dr. LaMont helped calm me down and I had surgery three days later."

The week before surgery, Bryce received the news she'd been selected as captain of her cheer team. She'd worked hard to achieve this honor.

"I felt shattered," Bryce remembered. "I was cheer captain. It was the middle of the summer, and I couldn't hang out with any of my friends. It was hard."

Dr. Lamont performed a posterior spinal fusion. The surgery took four hours, and Bryce spent four days at Cook Children’s for post-op care.

"I went in through her back and put rods and screws inside to straighten her spine out as much as possible," Dr. LaMont said. "We then fused the area so the spine no longer moves."

Once Bryce was home, she learned there wasn't much she could do for herself. She needed help showering, turning over in the middle of the night, and getting up the stairs. Because her surgery took place while COVID-19 precautions were in place, she was unable to have visitors and could only see family and friends through video chats. She also began a rigorous physical therapy regimen.

Bryce finished her last session of physical therapy in early January and was released to continue with her activities. Her orders require her to take it slow. Bryce admits it hasn't been as easy as she'd hoped.

"Getting back to normal is not going well," Bryce admits. "I knew I had metal rods in my back, but I didn't think much of it because I'm an athlete. I tried getting back into track and cheer at the same time, and quickly realized it was a bad idea."

Bryce decided to sit out of track and field and focus on getting stronger in cheer and tumbling. She has known how to do a back handspring since she was a toddler and finds it frustrating that she now needs help.

Shemita says watching her daughter go through this process has been grueling, but she's learned a lot from Bryce's determination to get better. Shemita has faith her daughter will continue to excel, no matter how long it takes.

"She's very resilient," Shemita said. "She's strong-willed, and a hard worker. I have no doubts about her recovery. I want her to take it slow."

Dr. Lamont agrees Bryce should ease back into her activities, especially if she wants to heal and continue to live out her dreams.

"She will feel different as she gets back into tumbling and some of more of her flipping routines because the mobility of her spine is different,” Dr. Lamont explained. “I don't want her to stop being an athlete. Part of the reason we fixed her back is so she can continue living her life the way she desires. She has to be patient.” 

As Bryce continues to get stronger, she reflects on how she can help other young women with scoliosis.

"Whatever sport you're doing is not more important than your life or your future," Bryce said. "You have to stay strong and positive to get through the recovery process, and you'll be able to get back to doing what you love.”

Bryce has two more years of high school and still wants to go to college on an athletic scholarship. Instead of seeing her surgery as something that put her dreams on hold, she's shifted her mindset and now believes it was a temporary obstacle for her to come back as an even stronger champion. 

“Our Joey likes to move at his own pace,” said his mother Denise Belles.

Joey arrived at Cook Children’s in June of 2019. What his family thought were headaches from recent growth spurts and allergies turned out to be a rare form of cancer called pineoblastoma. A tumor was growing in his head and spinal fluid was building up in his brain.

“At the time, he was going to football camp and loved it. Then we did the CT scan and within days, we got the diagnosis that changed our lives forever,” said Denise.

On July 3, Cook Children’s neurosurgeon Daniel Hansen, M.D. removed Joey’s tumor. Luckily, Dr. Hansen was able to get the entire mass at once. From there, Joey began a strict regimen of proton radiation therapy. In November, he was admitted to Cook Children’s Bone Marrow Transplant Unit to begin stem cell chemotherapy.

“It was really hard on his body,” Denise said. “You deplete them (patients) of everything and start from scratch. But the doctor said to Joey ‘You don’t have a shot if you don’t have the right attitude.’ So we came up with a plan and no matter what, we were going to be positive about it.”

Part of the plan came together after a visit with a physical therapist. She asked Joey to start walking and told him that if he kept track of his progress, he could win a gift card once he hit 10 miles. The incentive is part of a new program at Cook Children’s called ‘Miles in Motion’ which encourages hematology/oncology patients to get moving.

“When I first got here, I was sick and I was moving pretty slow,” said Joey. “We started walking the first day, but I could only do two laps.”

Joey would log his walks on a piece of paper in his room. Soon, the papers began piling up as he started making multiple laps around the unit.

Physical therapist Lydia Robey was part of the team that came up with the idea for ‘Miles in Motion’ as part of a quality and safety initiative to get patients out of their beds and exercising.

“We were brainstorming how to increase activity for this particular group of patients and one of our dieticians pointed out that these kids were losing muscle mass at a far greater rate than they should,” said Robey. “Some of that was due to inactivity, as well as steroids and medications that cause muscle atrophy. We started reviewing the literature and the evidence just became overwhelming of how important exercise is.”

Robey said due to varying blood counts, patients are not always able to do resistance exercise. However, she says walking is always good.

“Everyone agrees that walking is safe, so we wanted to find a way to motivate and empower families and patients to start walking as part of their daily routine,” explained Robey.

Joey and his parents did just that. They committed to walking each day during his four separate hospital stays, which spanned between two and four weeks each.

“For about a week, I did two to four laps a day and then I started getting to 10 and I thought ‘Wow, this is good!’ and then I started doing 20,” Joey exclaimed.

Before he knew it, Joey was walking more than 30 laps at a time, a feat that seemed impossible when he first started.

“There really is a noticeable difference between the first time I saw him and how he is now,” said Haleigh Schreck, one of Joey’s physical therapists. “He walks every single day on his own, no matter what he’s going through treatment-wise. His drive and motivation are very impressive.”

Last week, Joey hit a milestone that not even his physical therapists thought was possible. Joey marked off his 26^th mile in the ‘Miles in Motion’ program, which is equivalent to walking an entire marathon. Walking a marathon was never even a goal for Joey or for the ‘Miles in Motion’ program, but as he got closer to mile 26, he knew he had to go for it.

“We were just like, we’re this close to getting a marathon and I decided ‘I’m gonna do this,’” said Joey.

On Thursday, Feb. 20, Joey made his final laps around the unit were he’d been walking for the past four months. This time, nurses, child life specialists and physical therapists lined the walls. They held up handmade signs and cheered him on. With just five laps to go, Joey took one step at a time, thanking his mom and dad for their support as they finished the journey together.

At the final lap, excitement built as the medical staff cheered his name. “Joey, Joey, Joey!” they chanted until breaking into a loud roar as Joey ran through the finish line, a paper streamer strung across the hallway.

He did it. Joey walked a marathon.

“It was awesome,” he said basking in the wonder of his achievement. “I could have never done it without my family, the whole team we have. Everyone has been so supportive of me. It’s just truly amazing what we have done, me and my parents.”

This wasn’t the first marathon completed by a member of the Belles family. Denise ran the New York marathon in 2010, but she said this one was much better.

“This one is more rewarding,” Denise said. “His training was harder. I definitely feel more fulfilled with his than mine. It means so much more.”

If that wasn’t enough, finishing a marathon wasn’t Joey’s only major accomplishment of the day. It was also his final day of chemo.

“In the beginning, I really thought this was going to be devastating,” said Joey. “But everyone has been helping me and pushing me. With them, I knew I could get through this and do it with power.”

While he did have a supportive family and medical team, Joey also did what his doctor advised and had the right mindset throughout his cancer journey.

“Joey has been an amazing patient to work with,” said Haleigh. “I can’t remember a time when he wasn’t just smiling and having the most positive attitude. He blew all of our expectations out of the water.”

“I’m so proud of him. It shows how if you have the right mindset then you can overcome anything,” his mom said.

With his treatment coming to an end, Joey and his family are making plans for the future. They’re downsizing to a smaller home so they can take more trips together. This summer, they hope to go to Italy.

“We’re a close-knit family. We just love being together, but this has brought us so much closer,” said Denise. “We don’t want to wait to do stuff, like travel, anymore. We enjoy each other and we don’t take anything for granted.”

Children initially begin to walk between the ages of 12 and 15 months. In the early stages of walking, you may notice your child “waddling” with their feet wide and their arms out like an airplane. Once a child has become more comfortable with walking, you may notice them becoming “brave” and attempting to walk fast or even run. As a child goes through these stages of development, you may find your him or her falling several times during the day.

It’s normal for children to fall frequently as they are learning to walk. In the early stages of walking/running, a child is learning to plan movements, find their balance and explore new-found independence.

As children gain more control of their body, you will find they begin to walk with a narrower base and their arms are at their side. A child will walk/run with decreased hesitance and you should notice less falls. This will occur within the first 2-3 years of learning to walk.

When should you be concerned about your child’s falling? There are many different reasons why children lose their balance throughout the day.

• Pay attention to when your child is falling and ask yourself a few simple questions:

• Did the type of shoe he or she is wearing change? Often times children have difficulty finding their foot placement with new shoes, especially ones that are heavy (such as a boot) or non-supportive (such as a sandal or slip-on shoe.

• Are they only falling when reaching a curb or changing surfaces? Sometimes vision can play a big role in a child’s ability to maintain balance with walking and running. If you suspect a visual deficit, you should contact an eye care specialist.

• Does your child only fall when playing with peers their age? Children have to think constantly about their next move when walking/running during play. You may find that they will trip or fall when attempting to keep up with peers their age. This could be the cause of decreased coordination, meaning they are having a difficult time organizing movements during play, causing them to fall.

• Try to pay attention to how your child is falling, sometimes a child may have a difficult time clearing their toes when walking/running and will fall. This would be good to mention to your pediatrician for possible referral to a physical therapist.

If your child is falling more than 10 times per day and doesn’t fit into the above categories, it may be beneficial to talk to your pediatrician about a physical therapy evaluation to assess your child’s needs.

About the author

Morgan Hubbard, PT, DPT, is a physical therapist at Cook Children's. Physical therapy at Cook Children's focuses on large motor and functional skils to enhance development, restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's has Rehabilition Services in locations in Fort Worth, Hurst and most recently in Mansfield. If you would like to schedule an appointment or speak to our staff, please call 682-885-4063.

I’ll be honest. I haven’t paid much attention to the NBA Finals this year. I’m much more impressed that the Rangers are over .500 at this point and in thick of playoff contention for a Wild Card spot…

Anyways, the NBA Finals are heading into Game 6, with the Toronto Raptors up 3-2 over the Golden State Warriors. When I heard on Monday afternoon that Kevin Durant was planning to play in Game 5, my stomach dropped. If you aren’t aware, Kevin Durant suffered what was called a “mild calf strain” on May 8, during a game against the Houston Rockets in the Western Conference semifinals. What was initially labeled as a “mild” injury, was later in the month described as worse than first thought by head coach Steve Kerr.

Even Durant said he originally thought the injury was worse than a strain. This past Sunday, the day before Game 5 of the finals, Durant practiced with his team for the first time since the injury. It was the perfect making of a sports fairytale – a team down 3-1 in the series desperately seeking a win to avoid losing the championship, the injured hero boldly rushing his return to save the team and hopefully deliver a championship… except the opposite happened.

In the second quarter, Durant pulled up suddenly on a crossover move and then dropped to the floor clearly in pain. Replay appeared to show his calf cramp and shrivel up. He had to be helped off the floor and ultimately left the arena on crutches and in a boot. On Wednesday, Durant confirmed what I feared: an Achilles tendon rupture.

Now that he's had surgery, you can likely rule him out for the entire 2019-2020 season. Recovery from an Achilles tendon rupture and returning to high level sport is roughly 12 months after surgery. So naturally, the questions begin. Who is to blame? Did he rush his recovery? Was he truly ready?

We will likely never know, but I do think this offers a great opportunity to talk about the importance of allowing adequate time for full recovery. In my role as a sports physical therapist at Cook Children’s, I have the pleasure of working with kids and young adults of all ages usually trying to return to some level of sport. My day is typically filled with cases such as the volleyball player with an ankle sprain, the baseball pitcher with elbow pain, the soccer player recovering from an ACL reconstruction, the basketball player with a hamstring strain or the football player who fractured his leg.

I love my job. I love helping these patients get back to doing what they love. But I also recognize that I have a great responsibility to make sure that each patient is genuinely ready to resume their chosen sport.

The physicians I work with depend on my feedback to determine readiness. I’ve been “the bad guy” on more than one occasion and told a patient that I didn’t think he or she was quite ready to play in the tournament that weekend. It’s a tough position to be in, and I recognize that sometimes it’s not received well by both the parents and child, but I always come back to the responsibility and trust instilled in me to make sure that their child is truly ready to play.

We have tests and measures in physical therapy that we use to assess readiness, and we also can simulate game time situations in a controlled environment. I can never 100% guarantee that reinjury will not occur, but I want to be as close as possible. I don’t want that basketball player with the history of a hamstring strain to fully tear his hamstring. I don’t want that volleyball player with an ankle sprain to not have full strength back, change the way she jumps, and then land awkwardly and tear her ACL. On the day of their last appointment with me, I always tell each patient that I genuinely hope they never see me again in the clinic.

My motivation and ultimate goal is that each and every patient has full strength, control, awareness and confidence upon finishing physical therapy. If your child has suffered an injury, we are here to help. Our physical therapy staff collaborate with your physician to create and customize our plan to get your child back in the game. We have their best interests at heart and want to do everything possible to avoid reinjury. The process may feel long, but patience and persistence will certainly pay off.

If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 866-205-7270.

I hear this almost daily as a pediatric physical therapist. However, tummy time is more important than ever these days.

Our babies today tend to have more time on their backs than on their tummies. The Back to Sleep Campaign instructs parents to place children on their backs in their cribs to prevent SIDS (Sudden Infant Death Syndrome). We also have car seats that transport easily into shopping carts and strollers, bouncy seats, swings and rockers. Even when babies are nursing or taking a bottle, they are held in a parent’s arms, essentially on their back. All of this leads to decreased tummy time. But if we have all of these safety precautions and modern conveniences, then why make a baby cry on her tummy?

• Tummy time promotes neck and trunk strengthening for head control. It can be a baby’s first workout.
• Tummy time prevents babies from getting a flat spot on the back of their heads. These flat spots can lead to changes in head shape, facial appearance, and jaw alignment. In more significant cases, children may require the use of a special helmet to reshape their head. In tummy time, babies are taking pressure off the back of their heads and learning to move.
• Tummy time allows a baby to visually explore their surroundings.
• Babies learn to move, roll and reach side to side while on their tummies. These are all the first steps to bigger things like walking, running and climbing.
• In tummy time, babies push up on their hands and arms. They are building strength in their shoulders and hands. This time in weight bearing plays into handwriting, gripping and sensory development.

Tips for Tummy Time

Tummy time is not always easy, but there are definitely ways to help make it a success.

1. Start early. Even newborn babies can play on their tummies. It’s never too soon to let babies learn to explore on their tummies, getting that sensation of weight bearing on their stomachs, pushing with their hands and toes.

2. Build them up! If your baby is having a hard time lifting their head up, you can lay them on your chest while you are reclined on the couch. You can also place a rolled up blanket or towel under their chest to lift them a little and help make it easier for them. As they build their neck strength and head control, you can try laying them flat on their tummies again.

3. Get on the floor with them! Infants of all ages love faces. Especially the faces of those who care for them. A child will follow and respond to a caring face at a younger age than they will a toy. Getting on the floor with them and talking with them will often help them stay on their bellies longer without fussing.

4. Perform tummy time frequently. To start, a few minutes of tummy time after every diaper change is great. Each day, try to add 5 more minutes to their tummy time practice. With these short but frequent times, they will begin to build their strength and tolerance for tummy time.

5. Don’t give up! As tummy time becomes part of a baby’s routine, they will gain strength and learn to move and explore. Once it’s part of a baby’s routine, his strength will build quickly. He will be getting all of the wonderful benefits of moving, exploring, feeling and seeing the world from his tummy. And watch out! You might soon find that your baby actually loves being on his tummy!

About the author

Carrie Carney is a physical therapist at Cook Children's. Physical therapy focuses on large motor and functional skills to enhance development restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's offers Rehabilitation Services in Fort Worth, Hurst and Mansfield.

So who is considered a “running” athlete? Cross-country and track first come to mind, but don’t forget sports such as soccer, football, or lacrosse. A typical soccer game played at the varsity level can consist of 7-9 miles, if an athlete plays the entire game. And in the peak of the season, a cross country athlete might run 20-30 miles per week or more.

Each sport comes with its own recommendations of training intensity for kids. The number one rule to remember when it comes to fitness in kids is to emphasize fun and safety. When running stops being fun or aches and pains become commonplace, that’s when we need to worry we’re pushing our kids too far. Keep these tips in mind to help prevent injuries.

• Invest in a good pair of running shoes, socks, and appropriate clothing. Most local running stores have employees trained in gait (walking) and running analysis. They make educated recommendations on proper footwear for each individual. Running shoes should be changed every 300-500 miles or if breakdown is occurring. Moisture wicking (not cotton!) socks and clothing are also important to prevent blisters and help with body heat regulation.
• Maintain a well-balanced diet, and drink plenty of water every day – not just race/game day. Proper nutrition is important in all kids but especially in athletes.
• Avoid running in extreme heat or cold. High humidity should also be avoided. If you are running in warm weather, remember to wear bright, reflective clothing made of wicking material, and be sure to hydrate often. If running in cooler weather, dress in thin, wicking layers, and don’t forget gloves and a hat. Hydration is still crucial in colder temperatures, too.
• Stretch both before and after running. It’s important to stretch the major muscle groups in your legs – quads (thighs), hamstrings (back of your thighs), calves, and hips. Dynamic stretching  prior to running is an excellent warm-up, while static stretching can be used as part of a cool down. Foam rolling is also beneficial for these muscle groups.
• Follow intense running/workout days with an easy or rest day. Youth should have 1-2 rest days per week.
• Running should not be your only form of exercise. Cross training is very important. Biking, swimming, and elliptical are excellent alternatives.
• Build your mileage gradually - no more than a 10 percent increase per week. The most common injures that affect runners are typically the result of overuse. Too sharp of an increase in mileage can predispose runners to injuries like shin splints, tendinitis, or even stress fractures.
• Taking a walking break is not a sign of failure. Walk/jog intervals can help with increasing overall endurance.
• If possible, avoid running on uneven or slanted surfaces (like the sides of roads).
• Be alert and aware of your surroundings. Run with a partner or let someone know which route you’ll take. If you listen to music while running, keep one ear free. Avoid running at night.
• Work with coaches/trainers on proper running technique. Many local running stores also offer free classes on running form.
• Don’t ignore pain! “No Pain, No Gain” does not apply. Unfortunately, aches and pains from running can happen. Don’t ignore it or think it will go away.

If your child is having pain from running or you are concerned about risk of injury, a visit to a physical therapist can be extremely beneficial. At Cook Children’s, our SPORTS physical therapists have experience with the common injuries that affect runners. We also have staff members who are active runners and understand the demands of the sport.

About the author

Melissa Bro, PT, DPT, is a physical therapist for the Cook Children's SPORTS Rehab program. Our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete's bones, muscles, body and mind. As a part of Cook Children's integrated pediatric health care system, our patients have access to a multitude of pediatric specialty areas with board certified doctors, as well as laboratory services, nutritional consultations and sports medicine counseling.

Patients benefit from this integrated system because it allows our staff to use all of the system's resources during treatment. It also improves communication between the various departments whose physicians are focused on caring for children and adolescents.

If you have a young runner, sign them up for the Cook Children's 5K at 9:30 a.m. on Saturday, Feb. 27, 2015, as part of the traditional Cowtown running weekend.

The more frightening thing is the amount of patients that we don’t read about who are undergoing the same surgery. More and more, young baseball players ages 15-19 years old are sustaining this same injury and having to undergo this surgical procedure.

Ulnar collateral ligament reconstruction used to be an injury that we saw in ball players later in their careers. John Smoltz played for the Atlanta Braves and was recently inducted into the Baseball Hall of Fame. His career benefitted from Tommy John surgery. Currently, he's the only player inducted into the Hall of Fame who received Tommy John surgery. But he warns against the number of young people receiving the surgery today, calling it an "epidemic."

"I want to encourage the families and parents that are out there that this is not normal to have a surgery at 14 and 15 years old," Smoltz said. "That you have time, that baseball is not a year-round sport. That you have an opportunity to be athletic and play other sports. Don’t let the institutions that are out there running before you guaranteeing scholarship dollars and signing bonuses that this is the way….

I want to encourage you, if nothing else, know that your children’s passion and desire to play baseball is something that they can do without a competitive pitch. Every throw a kid makes today is a competitive pitch. They don’t go outside, they don’t have fun, they don’t throw enough — but they’re competing and maxing out too hard, too early, and that’s why we’re having these problems. Please, take care of those great future arms.”

So are his concerns warranted? In short, yes.

A recent study showed that 15-19 year-olds accounted for 56.7 percent of the ulnar collateral ligament reconstructions performed in the U.S. between 2007-2011.

This is a scary statistic considering this means that over half the UCL reconstructions done in the U.S. are performed on patients who haven’t finished their freshman year of college. So why has this become so much more prevalent in younger athletes?

I think the simple answer is the volume of pitches being thrown. If we look at the trends with today’s young baseball players, more often than not they are playing year round, playing on multiple teams, and at times playing on multiple teams at the same time. At some point kids have to put down the baseball and give their arm a break.

Little leaguers who pitch have a major disadvantage compared to their major league counterparts: they are still growing. This means that each time they take the mound they are pitching with a new body. As kids grow taller, it means they have longer limbs that they have to control, and this takes more strength and more coordination, strength and coordination that often doesn’t keep pace with how fast the athlete is growing.

So how do we reverse the trend of these young baseball players dealing with this terrible injury? Here are four recommendations.

1.Decrease the volume of throws

2.Don’t pitch with fatigue

3.Don’t throw breaking pitches (until skeletally mature enough and skilled enough to do it correctly)

4.Delay specialization (play multiple sports)

Decrease the volume of throws

Decreasing pitch volume I feel is the most important of these three recommendations. It’s not just following pitch counts it’s avoiding playing multiple positions with a high volume of throws. I have had many patients come in and say “we follow all the recommended pitch counts,” but as I dig deeper I find out that, yes, they are following pitch counts, but the child is playing catcher when he isn’t pitching. The bottom line is that it isn’t just pitch count alone, it is the total volume of throws we need to think about.

Don’t pitch with fatigue

Making sure our players aren’t pitching fatigued is also a big part of keeping our young throwers safe. If a player is fatigued and continues to pitch, even if they haven’t reached their pitch count, they are putting themselves at risk. The National Athletic Trainers’ Association (NATA) Position Statement on Prevention of Pediatric Overuse Injuries cited a study showing that a greater percentage of pitchers with shoulder or elbow injuries started at another position and pitched with arm fatigue. So if a player has been out in the hot sun playing short stop in the first game of a double header it probably isn’t a wise decision for him to pitch in the second game

Don’t throw breaking pitches (until physically mature enough and skilled enough to do it correctly)

I think most parents of young baseball players have at least heard the recommendations to avoid curveballs and sliders until the player is older, but for some reason we still have young pitchers throwing these breaking pitches. Another study cited in the NATA Position Statement on Prevention of Pediatric Overuse Injuries showed the risk of elbow pain increased 86 percent in youth pitchers throwing sliders, and the risk of shoulder pain increased 56 percent for pitchers throwing curveballs. We as parents need to remember our kids are going to watch their favorite big league pitcher and want to throw all the same pitches it is up to us as parents to step in and say you aren’t ready for that.

Delaying Specialization

There is an interesting study finding that more of the successful, Hall of Fame–type pitchers come from up north, where Hall of Fame hitters come from all over — a lot of them from the South. The gist of the study was that because there are several months of the year in these northern states that it is too cold to be outside playing baseball these pitchers couldn’t participate in baseball year round. During the winter months they had to put the baseball down and do something else. Once again referring back to the NATA’s position statement they state, “Young athletes who participate in a variety of sports tend to have fewer injuries and play longer, thereby maintaining a higher level of physical activity than those who specialize before puberty.” Delaying specialization is also a big part of decreasing volume, because if kids are playing another sport they will get that nice break that they need from throwing.

This blog by no means touches on all the factors that lead to these injuries, and the four recommendations are by no means the complete list of ways to prevent these injuries, but following these recommendations is a good place to start to keep, our young ball players’ arms nice and healthy.

Resources

• Baseball Injury Prevention
• Top 10 questions parents have about sports injuries
• Young athlete's injury prevention guide
• Strength training in children/adolescents

“Stop Slouching!”

Why is my kid’s posture so poor?

THE PROBLEM

Do you get sick and tired of telling your child to sit up straight? Do you ever wonder why so many kids these days have slouched posture and often complain of back pain?

Let’s take a moment to think about a child’s typical day during the week.

1. They spend six hours a day at a desk in school. Most of this time is spent writing notes or typing with their hands in front of them and their head looking down.
2. When they are not in school, much time is spent playing video games, playing on their smartphones, surfing the Internet on the computer or texting. Again, arms are in front of them and head is down
3. They carry around a backpack that often weighs almost as much as they do and often times wear it low, resting on their low back or bottom. Backpacks should weigh no more than 10 percent of their body weight, be worn on both shoulders and fit snuggly to their back.

In April of 2012 – Archives of Pediatric and Adolescent Medicine published an article stating that only 51 percent of children went outside to walk or play per day with either parent.

Another national study found that the average American age 8-18 plays video games for greater than 13 hours per week. Studies also show that children today spend half as much time outdoors as their parents did when they were young. These kids prefer to stay inside to watch TV, surf the Internet, listen to music and even do their homework, rather than go play outside.

How it affects the kids

The positions discussed above, which kids are in for a large majority of their day, place the muscles on the front of their chest into a shortened position. After a while, it is difficult to stretch those muscles back out to attain proper posture independently. Tight muscles on the front of their chest cause them to continue to sit with their shoulders rounded forward and thus the cycle continues. The muscles in the front of their neck also become tightened, pulling their head forward. A forward head can also cause the muscles at the base of the skull in the back of the head to become tense.

Unfortunately, the inactivity caused by the increased time spent indoors also contributes to a poor core. The core consists of the muscles around the center of your body that help your back stay up straight. Without an active core, it is very difficult to maintain good posture and fatigue will set in quickly. A weak core in combination with prolonged periods of inactivity will likely lead to a cycle that is difficult to break, causing poor posture.

What to do

Have a homework station set up for kids. Doing homework on the bed or floor often makes posture worse and increases the curvature of their back while they are sitting. Kids should sit in a chair where their feet can touch the floor and their hips and knees are at 90 degrees. The table height should be so that their forearms are able to rest comfortably while they are working so that their shoulders can relax.

They should be in the same sitting posture for the computer and the screen should be at eye-level to keep their head in a good position as well. There are shelves made to lift computer screens up to eye-level, however, a large dictionary will often do the trick, as well.

The American Heart Association’s recommendation for physical activity for children is at least 60 minutes of moderate-vigorous intensity aerobic activity at least every day. As a parent, try to encourage your child to be active for at least one hour a day, either at school or at home. If you cannot find the time for your child to perform 60 minutes of straight activity, try to perform at least 30 minutes of activity twice per day.

It is never normal for a child to experience back pain or consistent headaches. If your child is experiencing either of these symptoms and is not actively being treated by a healthcare provider, please discuss these concerns with their doctor. Physical therapy can assist with improving posture and core strength to eliminate back pain.

Related information

• Cook Children's Sports Performance Orthopedic Rehab Team Specialists (SPORTS)
• Dynamic stretching
• The basics of sports injury prevention for kids
• The essential backpack 

Ball sports and games have many benefits for kids besides being a lot of fun. Playing ball helps kids develop skills:

Increased coordination with both hands

How?

o Stand in one place and dribble a basketball.

o Run while dribbling a ball.

o Playing/bumping a volleyball.

Increased hand eye coordination

How?

o Playing catch.

o Batting practice.

o Playing mini golf.

o Playing a racquet sport like tennis or ping pong.

Improved balance

How?

o Kicking a ball while standing in place.

o Kicking a ball while running.

o Jumping and reaching to catch a throw.

There are great ball options for kids of all ages and abilities. 

For kids 3 and under

Once babies can sit on their own, they can begin to roll a medium sized ball. As they grow, they will begin to use two hands to attempt to catch by pulling a ball closet to their body. Kicking is something that we should start to see with toddlers. At first your little one will walk into a ball to move it forward. As your child matures they will begin to lift one leg to kick. This requires balance and is a good challenge for toddlers and preschoolers. As their balance improves they will be able to the kick the ball harder and farther and in a straight line.

For grade school kids

At this age, kids are ready to be challenged with balls of different shapes and sizes like soccer balls, footballs, baseballs and tennis balls. These balls can be thrown and caught, but also can be used in more complex ways as part of a game. A great way to get this age group active is to create a game that they can play with friends.

For the preteen and teenagers

If your child is not yet involved in a team sport, it is important to continue to encourage them to be active with their friends, including games that include ball skills.

Sports are beneficial whether played on formal teams or as part of pick-up game with friends. Sports not only challenge your child physically, but encourage them to work on things like taking turns and being a good sport. Activities like soccer, baseball, and basketball require children to coordinate their own movements with the movements of other children in order to be successful. Teamwork and compromise are great skills for all kids to work on and will benefit them in many areas of their life.

So whether it is on their own, with siblings and friends, or as part of a team, encourage your kids to be active this summer and get involved with ball games. Remember that all kids should be getting at least one hour of physical activity a day and they will need lots of water when playing outside in the Texas summers. 

About the author

Kate Mcgee, PT, DPT, is a physical therapist at Cook Children's. Physical therapy at Cook Children's focuses on large motor and functional skils to enhance development, restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's has Rehabilition Services in locations in Fort Worth, Hurst and most recently in Mansfield.

Water sports are great because it allows one to exercise at a high intensity, there is not that much stress on the back and legs. It is great for a whole body work out and allows someone, in one hour, to be able to burn as many calories as in a one-hour run.

Typically, one doesn’t think of swimming as a sport that leads to many injuries. Swimming is an overhead sport and the human body is not made to handle a lot of overhead activities. Swimming too much can lead to overuse injuries. The main ones are shoulders pain and occasionally knee pain.

The training for competitive swimmers has changed in recent years. Training now requires swimming a lot of laps. All this swimming leads to more overuse injuries, like the ones we see in baseball pitchers and runners. Shoulder pain is the major problem swimmers will “swim” into because using the same muscles over and over can lead to the muscles in the chest and back being unequally strong. These muscles not being equal can lead to bad swimming form which will then lead to shoulder pain. Swimming strokes that can lead to shoulder pain are freestyle, back stroke and butterfly. Swimmers that participate in breast stroke are as at risk as other strokes for shoulder pain, but can also develop knee pain. This comes from the knee cap shifting and rubbing on other parts of the knee joint leading to knee pain.

It is important for coaches and parents to know how to keep their young swimmers safe, what to look for, and what questions to ask their kids to ensure that they are staying safe and not injuring themselves.

KNOW WHAT’S BEST FOR YOUR YOUNG SWIMMER:

Parents and coaches can help their swimmers by being an extra pairs of eyes, because the young athletes don’t know any better.

Rest: Athletes participating in overhead activities should not participate in these activities for at least three months out of the year. This means that it is good for parents to encourage their child to try different sports, specifically ones that don’t involve overhead activities.

Warmup: Ensure that your swimmer is warmed up properly. It is never good to get into a pool cold. The type of warm up is important too. Make sure that the warm ups are active and not passive stretches. There are a lot of traditional stretches that swimmers do to warm up their arms. These warm ups target parts of the shoulders that keep the joint stable. It is important to warm up and actively stretch the muscles themselves and not the shoulder joint.

Hydration: Lastly, make sure to drink a lot of water. Being in a pool dehydrates the body on top of the sweating that occurs while working out.

THINGS TO AVOID:

• Incorrect swimming form
• Excessive training without rest days
• Swimming the same stroke every time

WHAT TO WATCH FOR:

• GREEN LIGHT- Good: Muscle soreness is OK if it last 2-3 days
• RED LIGHT- Bad: If soreness last more than 2-3 days, or gets worse, and/or is sharp

(If it is a red light item one should seek help from a medical professional)

NOW WHAT:

Young Kids AGE: 5-9

• Training should not exceed 60 minutes and no more than three times a week.
• Learn how to properly perform the basics of the strokes.

Older Kids AGE: 10-16

• Training should not exceed 120 minutes and no more than 6 times a week.
• Learning how to decrease wasted energy with strokes.

PROPER WARM UP:

• 5 minutes of light swimming
• 15 minutes of active stretching
• 10 minutes of stroke and breathing exercises in the pool

At Cook Children’s, our SPORTS physical therapists are trained in proper rehabilitation of overuse injuries and work to restore full function and safely guide return to athletic activities. If your child has a history of injuries from swimming or you are concerned about risk of future injury, talk to your pediatrician about a referral to physical therapy.

Learn more here:

• USA Swimming
• Ovoiding overuse injuries
• Swimming Injury Prevention

The answer is complicated.

Yes, it's very important for toddlers ages 1-3 to interact with other kids their age and challenge their balance, strength and coordination. Sports are a great way to promote these skills and literature shows that athletes who play sports at a younger age are more likely to be active adults than their peers who don't participate in sports.

However, organized sports  may not be the best solution for children 3 and under, and aren't the only way to teach our children these skills. The list below describes activities for toddlers and some benefits of these activities for their development.

Swimming: Helps strengthen the arms and legs, as well as improve coordination since the child has to use both arms and both legs at the same time. Learning swimming at an early age helps promote good water safety habits later in life. You can practice swimming in a "parent and me" swimming class. 

Dance: Improves balance, coordination, strength and flexibility. You can practice in a class setting or by having a "dance party" or playing a game of "freeze dance" at home.

Biking: Between ages 2 and 3, kids should be able to begin riding a tricycle. For young kids, there are tricycles that offer a parent guide bar to help kids move and steer. You can practice biking in your neighborhood or on trails.

Soccer: Most teams start between ages 3-5; however, kicking a ball in the backyard with your toddler is a great way to help them learn to run, develop core strength and balance on one foot for a short period of time.

Basketball: Helps kids develop hand-eye coordination when dribbling and shooting and improve running and jumping skills, as well. You can play with an adjustable hoop in the driveway, or sing up for a community team (which will generally begin between ages 3-5).

T-Ball: Teaches running, balll skills and coordination skills. Using larger balls for young children will help them be successful with catching and throwing.

Yoga: Helps improve flexibility, which is very important since toddlers are growing quickly and develop tight musles quickly. Yoga can also improve strength (especially in the core muscles) and balance. Several toddler yoga videos can be found online, and classes are available throught out the DFW area.

Gymnastics: Another way to gain strength, balance and flexibility, gymnastics is a sport that children can begin learning as early as 18 months old. Many gyms have special toddler and preschool classes, as well as "parent and me" classes.

Yard games: The old staples of "tag" and "hide and seek" are great for teaching turn taking and problem solving, as well as practicing and running and climbing. Taking your child to a local playground also offers a wide variety of ways to practice climbing stairs, running, swinging, balance, etc. 

With all of these, safety is a primary concern. Toddlers are at high risk of injury when practicing new things. Contact your pediatrician if you feel like your child is having difficulty learning new skills and they may refer you for evaluation by a physical therapist to evaluate your child and help them learn these new skills.

About the author

Jodi Burgett PT, DPT, CPST, is the clinical coordinator of Neurodevelopmental Physical Therapy at Cook Children's. Physical therapy at Cook Children's focuses on large motor and functional skils to enhance development, restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's has Rehabilition Services in locations in Fort Worth, Hurst and most recently in Mansfield.

What is the core?

“Core” is the word we use to describe the muscles in the middle part of your body. It includes muscles in your stomach, back, hips, and around your shoulder blades. They are not your “six-pack” that you might be able to see from the outside. They are deeper in your body. Even though you can’t see them from the outside the same way you might see big biceps, they are just as important, if not more so.

What does the core do?

All of these muscle groups work together to help keep your body stable. They create a good base for your arms and legs to work on. They help you have good posture, which distributes forces evenly throughout your body. They also work to transfer forces to and from your legs and your arms, like when you kick or throw a ball.

Why is it important?

Having a weak core is a lot like having a chain where the middle link is broken. Your body just can’t work very well without it? Or something like that. When your core doesn’t do its job, other muscles, bones, or ligaments have to do the work. The problem is that they were not designed for that job, so they aren’t very good at it. Without your core muscles working to keep your spine stable, you may be more likely to have injuries like back pain. Having a weak core has also been linked to other injuries, such as anterior cruciate ligament (ACL) tears, shoulder injuries and ankle injuries to name just a few.

What if my child doesn’t play any sports? Is the core still important?

It is still very important to have strong core muscles. We use these muscles even when we are resting. They work hard to keep us strong while sitting in school, riding in the car, and playing outside with friends. The core muscles are so important that they should activate before any movement of your arms or your legs in order to keep your spine stable, even if it is just reaching into a cabinet to get a cup.

So what can I do?

• Make sure to talk to your child’s doctor before starting any exercise programs.
• Encourage your children to sit with good posture using their core to align their body. This means their shoulder blades should be pulled down and toward each other. Their heads should be in a line over their shoulders. They should be drawing their belly button in toward their spine, and they should not have a big curve in their lower back.
• Sitting on Swiss/Therapy balls while sitting at a table or while playing video games so it can activate the core muscles while doing homework or having play time.
• Have plank competitions as a family to engage everyone’s core. 
• Get moving … taking family walks, riding bikes, swimming, getting involved in physical activities such as Karate, dance, gymnastics to name just a few.
• Pilates and yoga classes are both good ways to work on core strength once your child has learned the basics.

Hopefully this article helped to explain a little bit more about the core. If you child is having pain, or is having a difficult time with the ideas above, consider talking with your doctor about a referral for physical therapy.

About the author

Jacky Arrow, PT, DPT, SCS, is a physical therapist for the SPORTS program at Cook Children's. Our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete's bones, muscles, body and mind.

The role of warming up and its impact on performance is debated regularly. Sometimes the coaches of our kids’ sports teams do not find the time to have the athletes perform an appropriate warm up prior to practice. They may not see enough benefit to use precious practice time for warming up. However, participating in sporting activities, practice or competition, without an appropriate warm up can not only decrease performance, but also place the athletes at risk for injury.

Much of the recently published evidence shows that static stretching (i.e. holding positions for set amounts of time) can decrease the muscles ability to respond to the stresses it experiences during activity. Static stretching may be of more benefit post workout or when only focused on increasing muscular length for improved flexibility.

A dynamic warm up or dynamic stretching is a method of warming up in which the athlete moves throughout available range of motion with stretches in a controlled manner. It has many benefits that are not seen with static stretching such as increasing blood flow to the muscles, increasing internal temperature, and preparing muscles for the sport specific movements they will need for the activity. This sort of warm up increases blood flow to the muscles and stretches them through specific motions that will be used while participating in their sport. In addition, most dynamic stretches target large muscle groups or multiple muscle groups together.

To successfully complete a dynamic warm up, athletes should follow some important steps. An appropriate warm up usually takes approximately 15 minutes.

1. Perform light aerobic activity to increase cardiac output and blood flow.

2. Follow with dynamic stretches to stretch muscles that will be needed for participation.

3. Optionally follow up with agility drills as desired. Examples include: butt kicks, high knees, skips, etc.

When performing dynamic stretches, it is important to monitor form and control. If dynamic stretches are performed without appropriate control, muscles can be stretched too far too quickly and pose a threat to injury. If you have an injury or need further guidance, please see a medical professional, such as your primary care physician or pediatrician.

Related articles

• Does your child play one sport?
• Cook Children's Sports Performance Orthopedic Rehab Team Specialists (SPORTS)
• Dynamic stretching
• The basics of sports injury prevention for kids
• Rise of overuse injuries in school-age athletes 
• Top 10 questions parents have about sport injuries
• Young athlete’s injury prevention guide

About the author

Amanda Stukey, PT, DPT, is a physical therapist for the SPORTS program at Cook Children's. Our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete's bones, muscles, body and mind.

“Do you have any information on a little older child who has dysgraphia? He is 11 ½ years old, he is also a left-handed writer and eater, but does most sports right handed. To add confusion, his right foot, left foot dominance is somewhat equal. I would appreciate any information you can share.”

Kim Greenberg, M.O.T., O.T.R., an occupational therapist for Cook Children’s and works in the specialty clinics in Arlington and Mansfield, gave us some insight into dysgraphia.

Development of grasp

The growing curiosity of toddlers’ hands happens before we know it. They begin by watching their hands open and close, then playing with their hands in front of their eyes, eventually reaching for different rattles and toys, and soon pulling on mommy’s hair.

Crawling is also an essential developmental skill that builds upper body strength; especially building the hand muscles of the thumb, pointer, and middle fingers, as these are the fingers that will ultimately hold writing tool.

As children’s eye-hand coordination continue to progress, they will become increasingly curious and independent with holding their own bottle, cup, spoon and fork. Eventually, children will show interest in holding crayons and scribbling on paper. At first, a child may show a full fisted grasp pattern, and not show a preference to use either hand. I often recommend that parents do not force hand dominance. Therapists often recommend that a utensil or writing tool be placed in a neutral midline position in front of their child.

Hand dominance

Whichever hand children initiate using will typically become their dominant hand. Once children show their hand preference, parents may encourage their child to then develop their feeding and pre-writing skills. When children turn 6 years of age or begin kindergarten, they will have established their hand dominance of being either right-handed or left-handed.

Dysgraphia

Then there is the subject of dysgraphia, or “difficulty with handwriting.” Handwriting is a complex process. It involves a combination of many systems to include visual-motor, eye-hand coordination, motor planning, learning and memorizing the shapes and forms of letters and numbers. To complicate matters, there are also many types of handwriting curriculums. When a child has a diagnosis of dysgraphia, I often ask their parents to attempt to write using their non-dominant hand, as this is how it feels to our children as they begin to write. Now more then ever, there are more pressures on our children to be enrolled in pre-school and pre-kindergarten programs that force them to write when they’re simply not developmentally ready.

Sports

I have also worked with children who demonstrate a hand dominance for feeding and writing, and a different hand dominance for playing sports or a musical instrument. The fact remains that we live in a right-sided dominant world. I often educate my parents to support their child no matter what their natural hand dominance.

As a child begins playing sports or a musical instrument, a qualified coach or teacher will understand how hand and foot dominance affect the skills of the child. A “switch hitter” is often the most valuable position in baseball. A parent should feel empowered to tell their child’s coach and teachers of their child’s natural dominance, and that a child should be taught in a positive manner that develops his skill and confidence.

Conclusion

Most importantly, I would like to stress that even with the most proficient grasp pattern, a child may still demonstrate dysgraphia, or poor handwriting legibility.

In this instance, a child should be evaluated by an occupational therapist, either from a reputable outpatient clinic, such as the Rehab facilities at Cook Children’s or from an occupational therapist through his or her school district.

Kim Greenberg, M.O.T., O.T.R.

About the author

Kim Greenberg, M.O.T., O.T.R., an occupational therapist for Cook Children’s and works in the specialty clinics in Arlington and Mansfield. Cook Children's Healthcare System provides a full spectrum of occupational therapy including inpatient,outpatient, and home health.

Photo credit: Kelly Gavin, Texas Rangers.

There are so many different toys available these days, and it’s difficult to choose toys that your children will enjoy, but are also beneficial to their learning and development. Below are a few ideas of toys that will encourage the appropriate developmental skills by age group:

• Birth to 6 months: Young babies will benefit from rattles and other toys that are easy to grasp with tiny hands. Unbreakable mirrors will help your baby to visually focus and promote social and emotional development. Remember that all toys will go into their mouth at this age, so make sure all toys are safe. Tummy time is essential for developing gross motor skills and neck strength, and there are many different tummy time floor mats available.
• 7-12 months: Older babies are very interested in exploring their environment and love interactive toys. Cause and effect toys, or toys that make a response when touched, are great for learning at this age. Toys that move, such as push toys, pull toys and large balls will help your child learn to crawl and walk. Small drool-proof books with pictures will encourage bonding time with your children and develop language as you read to them.
• Toddlers (1-3 years): Toddlers are quickly learning language, fine and gross motor skills. Dolls, puppets and dress up clothes are great for pretend play and language development. Blocks, cars and puzzles will work on fine motor skills and develop hand strength. Ride on toys will develop coordination, leg strength and trunk strength. Balls for kicking, throwing and catching can advance hand-eye coordination.
• Preschoolers (4-5 years): Bicycles, tricycles and balls of all sizes are great for kids in the preschool age. It’s important to keep kids active so that they are learning coordination and balance skills. Make sure you include a helmet for safety! Video games, movies and computer/tablet games may be on your child’s wish list, but remember to limit screen time to 30-60 minutes per day. Board games are a good way to encourage play with family members as well as friends. They are also great for taking turns, learning rules and developing fine motor skills as you manipulate small pieces or dice.

About the author

Amanda Whitmire PT, DPT, is a physical therapist at Cook Children's. Physical therapy at Cook Children's focuses on large motor and functional skils to enhance development, restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's has Rehabilition Services in locations in Fort Worth, Hurst and most recently in Mansfield.

Think for a minute how your muscles would feel if you played as hard as your 3 year old does all day and you didn’t stretch your muscles. Most of us would get tight and sore very quickly. Our toddlers and young children get tight and sore too. Not to mention that kids are still growing, which adds tension to their muscles and joints.

Taking a few minutes each day to stretch with your toddler is important for their overall health and it may help with some of those ‘growing pains’ as they get older. Growing pains typically occur because the muscles and bones grow at different rates. As the bones grow, they stretch their muscles even tighter; therefore, kids often feel pain in their legs and arms. A regular stretching routine can help ease the tension in muscles that will help with flexibility, muscle pain and even pain control related to growth and tightness.

Here are a few stretching exercises that you can do with your toddler and young children. When performing these and other stretches, remember to hold them for 30-45 seconds to give your child’s muscles time to stretch. Try to avoid bouncing during the stretches too. Bouncing doesn’t allow the muscles to get a good stretch.

Toe Touches

Either standing or sitting on the floor, have your child bend at their waist and touch their toes. It is important to keep their knees straight during this exercise for them to feel this stretch.This stretches the hamstrings located in the back of their legs, and will help as kids grow taller.

Butterfly Stretch

Have your children sit down on the floor and put the soles of their feet together. Show them how to pull their feet toward their body and push their knees toward the floor. If your kids are really flexible, see if they can touch their nose to their toes!

Childs Pose

This is a great stretch for your kids’ back muscles. Have your children kneel on the floor with their toes touching and their knees slightly spread apart. Have them lean forward and rest their head on the floor to feel a good stretch in their hips and back muscles.

Reach for the Stars Stretch

We can’t forget about the arms! In sitting or standing, have your child reach their arms over their head to stretch their shoulders, arms and chest toward the stars.

Stretching can be beneficial for all children, but remember to consult your physical therapist or pediatrician if you have questions before starting a stretching routine for your child.

Jodi Burgett PT, DPT, CPST, is the clinical coordinator of Neurodevelopmental Physical Therapy at Cook Children's. Physical therapy at Cook Children's focuses on large motor and functional skils to enhance development, restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's has Rehabilition Services in locations in Fort Worth, Hurst and most recently in Mansfield.

Her day begins bright and early around 7 a.m. with cuddles from Mommy and then it’s time for her bottle feeding at 8. Other activities for the morning include a visit from the respiratory therapist (RT) for her breathing treatment and morning “massage.” Her “massage” is part of her chest physiotherapy where they use an oxygen mask to firmly pat her on her chest and back to help expand her lungs and break up any mucus she may have. This is one of Avery’s favorite parts of the day. We love to watch her as she lies in her bed on her stomach and dozes off to sleep as the RTs work their magic.

She may also get a visit from occupational or physical therapy for a morning workout where they work on fun things like learning to put her feet in her mouth and building her core strength to help her learn to roll over and sit up. They also have taught us about infant massage and given us stretches we can do with Avery to help her with her flexibility.

After her morning workout, she has likely worked up an appetite so it’s time to eat again. This time, a speech pathologist may come to give Avery her bottle. Learning to eat after 6 months is tough, so a speech pathologist is working with us on what bottles and nipples to use, positions to try when feeding her and different combinations of breast milk and formula to use. All of these things play an important factor in helping Avery to swallow efficiently and effectively and not having her food go down the “wrong way” which can cause aspiration and an infection in her lungs. We are about to introduce her to solid foods which will be another fun adventure!

Once she’s done eating, it’s usually time for a visit from Daddy, where she likes to squeeze in her afternoon nap on his lap. All the activity from the morning often wears her out for a few hours. She is, after all, a baby who needs her rest so she can grow healthy, new lung tissue.

In the afternoon, she may get a visit from the Child Life specialist for some “smile therapy” where we work on coaxing a smile out of her or arts and crafts activities with her footprints. The music therapist may come by to sing and play music while Avery works on her babbling.

Interspersed throughout this busy day of therapy visits, eating, naps and playtime, she also receives countless visits from the NICU staff and our family, all stopping by to see her outfit of the day and get an update on how she’s doing.

The late afternoon and early evening is reserved for family time where she plays on her play mat, works on tummy time or hangs out in her Bumbo® or exersaucer. By the time Shawn and I are ready to go home and sleep, Avery is usually asleep, worn out from all of the day’s activities. After all, she has to get a good night sleep so she can wake up and do it all over again the next day.

Related links:

• Avery's story - part 1
• Avery's story - part 2
• Avery's story - part 3
• Avery's story - part 4
• Avery's story - part 5
• Avery's journey - part 6

When first learning to walk, it’s normal for children to walk on their toes or the balls of their feet. By 18 to 24 months, children should be able to walk flat on their feet. If toe walking persists, it can cause excessive muscle tightness, pain and weakness. As a result, children may have difficulty running, increased falls and decreased coordination. It may also be a cause for concern for a parent or teacher.

Toe walking can have several causes:

1.Hypersensitivity – children with hypersensitivity dislike the feeling of certain sensations such as walking barefoot. To avoid textures they dislike, they may walk on their toes.

2.Hyposensitivity – children with hyposensitivity have a difficult time receiving sensory input. They may walk on their toes to compress the bones at the ankle joint and help the brain figure out where their body is in space (proprioception).

3.Positional – if your baby spent a lot of time on their toes in a walker or bouncer, they may have developed muscle tightness. This may cause your child to continue to walk on their toes as he or she gets older.

4.Underlying neurological problem – this may cause increased muscle tone or weakness that leads to toe walking compensation. Children diagnosed with cerebral palsy, muscular dystrophy or autism are more likely to walk on their toes.

5.Idiopathic – this means there is an unknown cause. Your child may have developed a habit that led to muscle tightness or shortening or it may be hereditary.

When should you be worried about your children’s toe walking?

1. If they are unable to put their foot in a flat position when standing or walking. This indicates muscle tightness or a shortened muscle in your child’s calves.

2.If they only walk on their toes on certain surfaces or when their shoes are off. Your child may have trouble tolerating certain sensations and rise up on his or her toes to minimize contact with that surface.

3.If they suddenly start to walk on their toes or if they have changes in their bowel and bladder function, they may have an underlying condition causing the toe walking.

4.If they frequently fall or have trouble running and always walk on their toes.

5.If they are older than 3 and/or you notice any of the above problems.

Talk to your child’s physician if you notice any of the above issues or are concerned about his or her toe walking. The doctor may monitor your children’s walking; refer you to a specialist or physical therapist for further examination.

Profession

Physical therapists are highly educated professionals trained to identify problems with movement and function of the human body. The physical therapists at Cook Children’s have either doctorate or master level education. Our physical therapists and physical therapist assistants are constantly advancing their training through continuing education and advanced certifications. We collaborate regularly with your doctors to ensure the highest level and quality of care.

Together, physical therapists and physical therapist assistants work to restore and improve normal body motion. We educate and empower our patients and families to be active participants in their recovery process. We also instruct on future injury prevention. The American Physical Therapy Association’s vision is “transforming society by optimizing movement to improve the human experience.” At Cook Children’s, our physical therapists and physical therapist assistants really do transform lives.

Patients

Our physical therapists see children for many different reasons. Some examples might include:

• Complaints of knee pain while running or back pain from sitting too long.
• Shoulder pain from playing a musical instrument.
• A difficult time recovering from surgery.
• Recovering from a broken bone.
• Growing pains after a quick growth spurt.
• Lack of endurance after a long hospital stay.

Physical therapy can help with all of these things and more. Physical therapists look to find what is causing the pain or difficulty. We then guide the recovery process and help restore normal function through the use of manual (hands-on) therapy, stretching, strengthening and neuromuscular re-education.

Cook Children’s

At Cook Children’s, our SPORTS (Sport Performance Orthopedic Rehab Team Specialists) physical therapists and physical therapist assistants have experience with pediatric specific problems. We recognize that children are unique and not just “small adults.” Kids require specialized care. We take time to perform focused evaluations and customize each child’s treatment. We seek patient and family input in the entire recovery process. We understand the importance of one-on-one time with your child to give them the attention they deserve.

Pain is never normal, and pain from activity should not be ignored. If you think your child may benefit from physical therapy, talk to your doctor or contact our department.

About the author

Melissa Bro, PT, DPT, is a physical therapist for the Cook Children's SPORTS Rehab program. Our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete's bones, muscles, body and mind. As a part of Cook Children's integrated pediatric health care system, our patients have access to a multitude of pediatric specialty areas with board certified doctors, as well as laboratory services, nutritional consultations and sports medicine counseling.

Patients benefit from this integrated system because it allows our staff to use all of the system's resources during treatment. It also improves communication between the various departments whose physicians are focused on caring for children and adolescents.