Transcript: How a Paediatric Occupational Therapist Can Help Families Thrive

This is a text transcript from The First Time Mum’s Chat podcast. The episode is called How a Paediatric Occupational Therapist Can Help Families Thrive and you can click on the link to view the full episode page, listen to the episode and view the show notes.

Helen Thompson: A lot of the parents that I talk to via my baby massage classes ask me whether everything is going as it should with their little one’s development. I’ve been on the lookout for an expert to talk to, who knows their stuff when it comes to baby development and in this week’s episode of First Time Mum’s Chat, I’m chatting with Paediatric Occupational Therapist, Munira Adenwalla.

Munira talks about how she helps babies to be able to get in and out of positions, so that they are comfortable with their bodies and explains how she contributes to their development by helping with all the little movements required to get up to sitting, standing and eventually crawling and walking.

During our chat, you’ll hear us talk about why it is important not to rush your baby to be doing their developmental milestones and let them take their own time. How a pediatric occupational therapist can help when babies are not meeting their developmental milestones, or, when your gut feeling is telling you that something isn’t right.

How a paediatric occupational therapist helps babies that are struggling with coming into sitting and crawling positions and to be more comfortable, relieving tension in their bodies, and so, so much more.

Hi Munira, and welcome to First Time Mum’s Chat. I’m delighted to be chatting with you today and finding out more about what you do and how you help families. Can you start by telling us about yourself and your background?

Munira Adenwalla: I’m Munira. I’m a pediatric occupational therapist of 25 years, and I have a practice that is online. I’m based in the UK. It’s called ot4kids and I work with babies up to children up to 13 with sensory processing coordination and other kind of diagnoses and a lot of my baby experience was from working in New York, where I worked in the early intervention program for children from 0 to 3.

So I’d see a lot of the babies as soon as they’d come home from the hospital, they would get with development. So that’s where my baby experience comes from. I’m also a mom to an 11 year old, so I’ve also had a baby and I’ve gone through some work with him as well. So I’ve got to practice what I preach in real life as well.

Helen Thompson: Oh, that sounds amazing. So you’ve had a lot of experience in that line with babies.

Munira Adenwalla: Yeah.

Helen Thompson: So as an occupational therapist, how do you work with babies? When we had the chat, you mentioned about baby owned movements. What does baby owned movements actually mean and how do you support that?

Munira Adenwalla: Yeah, so to me it means helping babies to be able to get in and out of positions so that they are comfortable with their bodies and they can get in and out of different positions. So for babies to be able to go from the back to their tummy or from their tummy to their back or babies being able to go from moving into sitting versus just being put into sitting or being able to have all the little movements that it takes to get up to sitting or standing and eventually to crawling and walking.

Helen Thompson: I’ve done a bit of tummy time and I also teach baby massage, so I’m aware of the basics of movement, especially when it comes to tummy time. So, would you be supporting them to roll in and out of tummy time as well as what you said?

Munira Adenwalla: Yeah, I think it depends on the age of the baby. So for instance with a newborn, you kind of naturally do a lot of tummy time because they’re often held against you. Or if you’re sitting on the sofa, you’ll have them against your body as the parent. So they’re naturally getting a lot off that tummy time in those positions or just the way that you may hold the baby. It depends on the baby and how comfortable they are in each position. Parents are quite good at reading their babies and figuring out, oh, they like being in this position or, or that position.

Then as the baby gets older, you then see them being more comfortable, like being on their side, or they roll from their back to their side. Then eventually they start rolling from their side to their tummy. First it’s an accident, and then it becomes a bit more purposeful that they do that rolling movement. So a lot of it will depend on their age and stage as well.

Helen Thompson: Yeah, you want to encourage them to do it themselves. I mean, the purpose of baby owned movements is to observe them and let them do it themselves. If at a certain age, they haven’t done it, is that when you would intervene and gently support them?

Munira Adenwalla: Yeah so I’ve had babies who might be 12 months, for instance, and they’re struggling with coming into sitting and crawling positions, or the baby doesn’t like to move and they get really tense with their body. So that’s when we come in to try and help work with the baby to be more comfortable with their bodies and to feel where their bodies are and to feel themselves going in and out of different positions without feeling lost in their body, if it makes sense and to work on those transitional movements to be going from tummy to side, side to sitting, sitting to hands and knees, hands and knees up to standing and walking eventually.

Helen Thompson: I know a little bit about this through my child care career with development. Am I not right in saying that at 12 months they should be sitting, I’m not going to say walking, but they should be at the standing stage and holding on to something and taking their first steps?

Munira Adenwalla: Yeah and when babies are not meeting these milestones, that’s when you know, when they need a little extra help, because let’s say they may not be coming into sitting or they may not be able to sit or it’s hard for them to hold their head up for instance, or to get into crawl. So that’s when parents will know that they may need a little help.

Helen Thompson: Yeah, because I know that there are certain developmental stages that a baby should be doing certain things and if they’re not, you don’t want to rush them, but yet there’s a little red flag that you might think, Oh, they’re not learning to sit at around about 6 months or maybe older, 8 months, I guess, possibly even 9. When they’re around 3 – 4 months, they start rolling and if they’re not doing those things at that time, it’s something that a parent may think, oh, okay, well we’ll give them a little bit more time, and if they’re not doing it by a certain age, well, then we’ll intervene and get help. Are my guidelines roughly right?

Munira Adenwalla: Yeah, I think that’s right and I think also parents have a very good gut instinct about their child and if they ever feel that they’re not sure about something, it’s probably just good to go and see somebody. One, it could put your mind at ease and two, it could help you to get some ideas of how to move forward with your baby or ways to support the baby from now. So I always feel that as parents you just kind of have a little inkling, I know what’s going on with your baby. It’s good to have it checked out.

Helen Thompson: I agree, because every baby and every parent is different, and there’s no right way or wrong way of bringing up a baby, because we all do it differently and exploring those things so that you don’t get over anxious about it. At an early age, it’s probably better, rather than leaving it later, even if it’s just taking them to somebody like you and just saying, look, I’m sure my baby’s fine, they’re doing these things, can you just check out whether they’re on target with what they’re supposed to be doing at their age and development.

Munira Adenwalla: Yeah and I think it’s also about not rushing babies to be doing their milestones. So often we rush babies into sitting on their own, or we rush them into standing or being up on their feet. However, they haven’t done all the other skills that come before that yet. Often I find that children or babies, they’re much more stronger and coordinated and safer with their movements when they can get into that position themselves. So if it’s into sitting they’ll be much more stronger with their body and able to hold that sitting position once they get into that position themselves, if that makes sense.

Helen Thompson: Yeah and with crawling, a lot of parents have said to me, Oh, my child didn’t crawl. I’m not saying there’s anything wrong if your child didn’t crawl because some children don’t need to, but it does bring up that strength and that coordination in order to build those core muscles in order to stand. You’ve got to exercise those muscles in order to stand and in order to hold on to something. That is what the process of crawling is because you’re crossing the midline, you’re working with both sides of the brain and it also helps down the track. Would you agree, there’s nothing particularly wrong if they don’t crawl, but it’s important in the respects of building that strength and coordination.

Munira Adenwalla: Yeah, I’m actually a big fan of crawling, just because I see a lot of older children with handwriting difficulties and many of them have struggled with these skills as infants, according to their parents. I’m a big fan of crawling, I think it gives a lot of that sensory information to the body to feel your arms and your hands and your knees and your leg.

It just helps you to feel where your whole body is in space. It’s also that spatial exploration while on your hands, while you’re in that crawling position to explore what’s around you. Then there’s also the core strength and the shoulder strength that you get and all the strength up to your hands and your fingers and then when babies start moving their hands like this a little bit and picking up little pieces of lint on the carpet while crawling, they’re starting to develop those fine motor skills as well.

Like you said, it’s being able to use both sides of the body and stimulate both sides of the brain together, and we get that being able to reach and cross over the midline of your body. Then from there, once you’re on your hands and knees, that’s when babies start kind of lifting their body up when they feel ready and getting into that kneeling position, so that you can then eventually get up to standing. So, I’m a big fan of crawling. Even for the older children that I see, we actually go back to some of the crawling work, but in a fun age appropriate way, to develop some of those underlying skills with their body and to develop that strength and coordination and using their hands to develop the muscles in their hands will find motor skills.

Helen Thompson: It’s interesting you say that about older children, because I know when I was doing my Brain Gym course, that I found it really hard to crawl. I don’t know whether I crawled as a child. When you mentioned about crossing the midline, I actually find that movement actually quite hard to do. I have to really think about it, putting my left hand down, and then my right, and just doing that motion of crawling. As an adult, activities like jumping, I actually find that sort of motion quite hard. I really have to tell my brain what to do, even if I’m doing exercises. If I’m doing a stretch on my leg, I’ve got to say to myself, right, my left leg is bent and my right leg is straight in order for me to do it. I don’t know whether that’s because at the stage that you were talking about, that I didn’t have that strength when I was a child, I don’t know, but it’s just an interesting point that you said that.

Munira Adenwalla: Yeah, and I always say for the kids that we work with that these are skills that just happen automatically, and that have that natural inner body awareness for these skills to develop. It’s not something we wouldn’t necessarily not be teaching.

Helen Thompson: Yes, of course.

Munira Adenwalla: Yeah, it’s just stuff that happens automatically. Sometimes, parents will say, is it my fault that they haven’t done this developmental milestone or the other? I always say it’s never a parent’s fault. It’s just the way that the child’s brain is wired and that these skills develop automatically and naturally on their own, not because it’s being taught to them.

Helen Thompson: Yeah, I agree with you, and I think the process is all natural, but you do see some kids who don’t crawl, they don’t do that stage, they just get up and walk, and there’s nothing wrong with that but I think it’s important to maybe just teach them movements when they get older of how to cross the midline and how to work with both sides of the brain, whether that’s to do with crawling or whether that’s not.

Munira Adenwalla: Yeah, I guess as the kids get older, you’ll see if they have difficulties in other areas or not. Some kids don’t, they are fine in their other future learning skills and coordination skills. Or if they need support in different areas, then you may go back to doing activities that help them to feel where their body is and develop their body awareness and spatial awareness and strength and coordination for doing those future milestones.

Helen Thompson: So if somebody was to come to you as an occupational therapist, what would it look like for a parent who came to see you? What would you be doing with them?

Munira Adenwalla: Yeah, so if it’s a baby, I usually will first speak with the parent and get some background information on their birth history, medical history on their milestones and how the baby moves and plays and to tolerate being moved as well. So I’ll try and get that information from the parent.

I’ll also often have parents just send me little snippets of videos of the baby in different positions. So I’ll have a video of the baby on their back and seeing how they move while they’re on their back and on their tummy and seeing if they’re doing things like rolling or sitting and coming into sitting. We will talk through their milestones and see which ones are comfortable for the baby and then which ones are difficult. Then I will look at the baby and see how they are moving and just trying figure out which skills are missing and which ones they need support to develop and how we can go about doing that. A big part for me is helping babies to be able to move in and out of each of the positions that they should be doing for the age that they are at.

Helen Thompson: Yeah, I know with some physiotherapists, and I don’t know if you link together, but they work a lot with your neck. Some babies prefer one side and not the other and some babies find it hard to lift their neck up and down. So are those movements that you would look for to see if they need support?

Munira Adenwalla: Yeah, so we might see for instance if the baby is doing something more on one side than the other. Babies shouldn’t be having a strong preference to one side. They should be being symmetrically and equally with their body. They’re not yet like right handed or left handed. That’s actually a red flag if a baby is being right handed or left handed. It’s showing that there’s a weakness in their body. So we’d look at how they are, if they’re doing things one sided or not, or if one side is weaker than the other. Also if there’s any kind of a tension in their muscles or any kind of stiffness in how they are moving and seeing how they are with all the smaller movements to get somewhere. So, coming into sitting, can they first turn to their side and then put their hand down and then push up to sitting. So we’re looking at breaking up the skills into little baby steps.

Helen Thompson: Once you’ve done all that and you’ve gone through that procedure and you know what the little things are, do you give the parent very gentle movement exercises to help support whatever condition it is that they’re having trouble with?

Munira Adenwalla: Yeah, so we’ll try and find ways to incorporate some of the movements that the baby might need help developing into their daily routines, whether it’s doing it after a diaper change, or it’s whether it’s in the way that you hold the baby when you carry them around, or in the way that you might do some playing with the baby and helping finding ways to help them to be comfortable in their body to get in and out of those positions. Sometimes it might be finding different ways to massage their body to stimulate different muscles or relax different muscles that they need to be using that they may not be using to reach those milestones.

Helen Thompson: I know that’s got something to do with the neck muscles. I’ve spoken to a craniosacral therapist, who said sometimes that there’s just a little thing in the neck where they just need a little bit of a massage or a little bit of a release of tension in order for them to move their neck more freely because sometimes they’ve just got a blockage in the muscle and they just need to release that tension in there.

Munira Adenwalla: It depends. Sometimes what you might see if a baby is tight in their hands, it might be because they’ve got tightness further in their neck or in their shoulders or in their ribs. Often what you might see is really a representation of something that’s happening closer to their body, if you know what I’m saying. Or sometimes if their toes are curling and their toes are tight, it’s often something up in the hips or even in the trunk. So that’s where we look at the massage and trying to figure out where something is coming from or where is the limitation coming from.

Helen Thompson: Yeah, because sometimes it’s referred pain, isn’t it? You may think it’s in the hands, but in fact, it’s probably in a completely different other part of the body because our bodies and our muscles all interlink. So I learned that from kinesiology, that if you’ve got a pain in your finger, it might not actually be the pain in your finger. It might be in a different part of your body relating to that area and that’s why your fingers sore.

Munira Adenwalla: Yeah, so this might be something a little different. What I’m trying to say is that sometimes there’s a tension, for instance, if you have a tightness in your shoulder, that’s going to really limit you from being able to use your hands and your fingers. Or if you have tightness in your hip, that’s going to limit how you are able to be flexible with your foot, for instance. So you might notice the fingers curling or the toes curling but it’s really indicating something that’s happening closer to the body.

Helen Thompson: Yeah, I totally get what you’re saying. When I teach baby massage, I think this is the right one, please correct me if I’m wrong. When your hands are sort of curled up, if you actually put your hand on top of your baby’s hand or their feet, and if they don’t straighten up, is that the Banksy reflex? I do that a lot with my baby massage clients. I always say to them, at the end, once you’ve done your feet, once you’ve massaged the feet and done it, just do that. Put your hand just above where the fingers are, or where the toes are, particularly where the toes, and your baby’s toes or fingers will automatically open up and they’ll automatically stretch. That’s called the Banksy reflex, isn’t it?

Munira Adenwalla: Babinski Reflex.

Helen Thompson: Yeah, and if they don’t do that, well then you’d know that there might be a little bit of an issue, and you might say I suggest you go and see an occupational therapist or something just to see whether everything’s okay because when you do that, they should straighten up their toes or their fingers.

Munira Adenwalla: Yeah. So all of these things are like a brain marker, it tells you what’s happening in different parts of the brain and it helps you to know what to plan and do next.

Helen Thompson: Yeah, I like what you do because I think it’s all done naturally through the body and working with the body to support the body. As we’ve mentioned, it’s not rushing. If they’re not going through it, it doesn’t mean there’s anything wrong and I want to stress that to mums too, as you stressed, that just because they’re not going through the particular milestone at the particular time they’ve got to do it, there’s nothing wrong. I think that’s really important to mention because that of course would be overwhelming and it can cause anxiety for parents if they look at the milestones and they think, my baby’s not doing it, there’s something wrong and they get overanxious about it.

What you do is just supporting them gently through it and saying, okay, well, they may not be doing this, but they’re doing that, we’ll support them in helping them to develop those milestones.

Munira Adenwalla: Yeah, helping them get the skills they need to reach each of those milestones. For me, it’s about work with getting in and out of those positions to reach those milestones. Using play and connecting with your parents as the motivator as well.

Helen Thompson: Yeah, play is a different topic altogether. I’ve done a few podcasts on play. Play is so, so valuable, not only for what we’re talking about, but for their intellectual development, their imaginary development, all of that. Play is the key to a lot of things with child’s development, and we talked earlier about rushing, but rushing with play and telling your child they can’t play and do things, I just think is inhibiting their development, because play is so valuable. You learn so much through play.

Munira Adenwalla: Yeah, it’s so much further and about giving kids the space to explore with their body and to come up with their own ways of playing on their own. Even as kids are older, there’s so much that they learn from their play with problem solving and dealing with managing complex social situations. All of those skills they learn through play. Even for adults, we need to be playing as well to keep our spirits up and our mental wellbeing. So I think that play goes throughout the lifespan.

Helen Thompson: Yeah and it’s good that you mention it with the body as well, because play is not just about playing in the home corner or playing in a sand pit or exploring nature. It’s also about encouraging them to move in their own way because if they don’t play around with it they’re not going to learn how to do it. They’ve got to play with it and think, Oh, well, okay, if I go this way or if I go that way, Oh, I can do that. Or if I move my hands this way, I can do that. They’re learning all of those things and I think that’s why play is so valuable.

Munira Adenwalla: I think also for babies, their first toy is almost like their hand because they’re playing with it and exploring it in their mouth. Then they go through that cute phase where they’re kind of like looking and staring at their hand and they’re looking at everyone else’s hand. Their hand is their first toy, an extension of themselves. I think it’s really sweet. Yeah, it sounds like you’ve done quite a lot on play and it’s another interesting topic, isn’t it?

Helen Thompson: Yeah, it is and especially with the feet, when the baby learns to bring their foot up to their mouth, that’s quite a cute one as well. That’s all to do with what we’re talking about with development and baby owned movements.

Munira Adenwalla: Yeah, it’s all that body awareness that they’re getting by exploring their hands and their fingers and eventually getting their foot up to their mouth and exploring. It’s like finally they feel the ends of their bodies as well.

Helen Thompson: Yeah, that’s where the baby massage is also good because I do a lot of songs and I always encourage parents to look at their baby when they’re talking to them and massaging them and to use their fingers. It all comes back to originally what we talked about with the baby owned movement.

Munira Adenwalla: Yeah, and I love it. I think it just goes along with the massage work that you do as well is I love the idea of parents telling the baby what you’re going to do and how you’re going to be moving them, even when they are little and they may not be moving themselves as much. For us as parents to be telling the baby what you’re going to do with them so that they can start planning and knowing what to expect and then it’s just not as unknown to them as well.

Helen Thompson: It’s baby autonomy as well and that’s what you do. If you’re an occupational therapist, a physiotherapist or a baby massage therapist, if you communicate with your baby and say, okay, I’m just going to hold your leg and I’m going to just move it slightly. You tell them all the time what you’re going to do. I think that’s important to give them respect as well and telling them.

Munira Adenwalla: It starts with nice back and forth communication as well, isn’t it? In their own ways and for them to be able to read you and you them and it’s a nice lovely interaction.

Helen Thompson: It’s building up that trust, because as an occupational therapist, as well as a baby massage therapist, you need to, you need to build that trust and if you don’t give them that respect, you’re not going to build that trust.

Munira Adenwalla: Yeah, I didn’t mention this before, but that’s why a lot of the sessions, they start by really just playing and connecting with the baby before you start moving and doing something with them, because you first want to develop a connection and to build that trust with them. So I often will speak with the parents first so that the baby can see that I’m a comfortable, safe person and then I’ll engage with the baby.

Helen Thompson: I think that’s a good thing to do. So we’ve covered a lot of ground here. So if a parent wanted to get in touch with you, how would they go about doing that?

Munira Adenwalla: Yeah, so I have a website, it’s called ot4kids.co.uk and that’s the best way to reach me for baby consultations or baby work.

Helen Thompson: Well, thank you so much for being on this podcast. I’ve really enjoyed talking to you. I could sit here talking to you forever about this topic. So thank you so much for being here. I really enjoyed having you.

Munira Adenwalla: Yeah. And thank you so much for having me.

Helen Thompson: Munira shared some great insights on how a paediatric occupational therapist can help your little one. I highly encourage you to check out the OT4Kids website to find out more about Munira’s services and offerings. We also talked about the importance of play during our chat and I’ll also include links to some of the earlier First Time Mum’s Chat podcast episodes relating to play, which I am certain you’ll find of help in the episode show notes, which can be found at MyBabyMassage.net/podcast/139.

Next week, I’ll be talking with Jo Wilson about water based activities for babies and toddlers that not only help with safety, but also support their sensory whilst helping to soothe and calm both mum and infant. Be sure to listen to this episode when it comes out next week and please subscribe to First Time Mum’s Chat via your favourite platform so that you get quick and easy access to all of our episodes when they are live.