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Welcome

Special Kids, Special Care

NICU Consortium Meeting

April 25, 2018

A special thank you to our grantors and sponsors

Newborn Hope for their support of our Safe Sleep Going Home Program that provides newborn wearable sleep sacs to the NICU for parents and our Family Support Grants Program.

University Hills Rotary for their support of the Safe Sleep Going Home Program

HCP – Colorado Department of Public Health and Environment, Program for Children with Special Health Care Needs for their continued support of the NICU Consortium Educational Meetings /Webinar

SAVE THE DATE – September 19, 2018 7:30 am to 4:30 pm

Supporting Positive Social and Emotional Development for Fragile Babies and their Families: An Infant Mental Health Approach for All Providers Denver First Church, 3800 E Hampden Ave, Cherry Hills Village, CO 80113

Thank you to New NICU Consortium Fellows - Benefits • Continuation of the NICU Consortium Education Meetings/Webinars

• Professional Education Certificate of Development for 2 Hours for each NICU Consortium

NICU Consortium Partnership Meeting – May 18, 2018 10 am to 12 noon

Jefferson County Health Department, 945 Parfet St., Lakewood, CO 80215

Special Kids, Special Care Inc. Offers

NICU Outreach: Safe Sleep Going Home Program Halo Wearable Sleep Sacs for families in need are provided to NICU staff, public health nurses, and early interventionist to assist them with their education about Safe Sleep

Family Support Grants for Families in Need Cribs for Kids infant crib, safe sleep video, sleep sac Respite care for up to 10 hours In-home lactation support and consultation Scholarships for families

Premature Infant Massage Classes Baby carriers working with Babywearing International

Contact Barbara: Specialcare@sk-sc.org

Agenda

9:15 am Dr. Jen’s Top 10 Fun and Easy Strategies for Primitive Reflex Integration, In Infants and Children Jennifer Spiric, PT, DPT, Kids In Motion, Of Spiric Therapies, LLC

10:30 am Benefits of Babywearing for Preterm Infants: With Special Consideration for Their Safety Brandis Rouch and Heidi Jakal, Volunteers, Babywearing Educators Babywearing International of Denver

Huffington Post

Dr. Jen’s Top 10 Fun and Easy Strategies for Primitive Reflex Integration,

In Infants and Children

Jennifer Spiric, PT, DPT Kids In Motion

Of Spiric Therapies, LLC

Pediatric Physical Therapist

Movement specialist

Child-led therapist

Developmental analyst

Mommy

Kids in Motion,

of Spiric Therapies, LLC

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Objectives 1. Review the concept of a primitive reflex

2. Understand the importance of primitive reflex integration for ease movement and learning

3. Learn activities that you can start using today to help the infants and children you know and work with start to integrate primitive reflexes into patterns that will help them reach motor milestones and learn age-appropriate skills in other areas of development.

4. Leave today with a written reference and basic instructions for home and clinic-based activities for reflex integration in infants and kids.

Kids in Motion,

of Spiric Therapies, LLC

So what is a reflex??

Stimulus

Movement

Kids in Motion,

of Spiric Therapies, LLC

A reflex is an unconscious, protective movement pattern

based on sensory stimuli from the environment.

And what are primitive reflexes?

Kids in Motion,

of Spiric Therapies, LLC

Primitive Reflexes are…

• Unconscious movements

• Based on genetic motor programs typical for all humans

• Variable in their presentation, integration, and form

• Foundational for coordinated conscious movements throughout

childhood and adulthood

• Related to all areas of development (motor, vision, sensory

system, speech/language, cognitive, emotional, behavioral)

• Permanent motor plans, but more or less visible/strong based

on life events

Kids in Motion,

of Spiric Therapies, LLC

A few primitive reflexes

Suck- swallow- breathe

Rooting

Asymmetrical Tonic Neck (ANTR)

Symmetrical Tonic Neck (STNR)

Tonic Labyrinthine (TLR)

Spinal Galant

Pull to sit

Moro

Landau

Babinski

Automatic gait

Protective extension

Trunk extension

Hands/toes grasp

Robinson Hands Grasp

Leg Cross Flexion-Extension

Foot tendon guard

Bauer crawling

Babkin Palomental

Spinal Perez

Kids in Motion,

of Spiric Therapies, LLC

Scrunch and Stretch (spinal galant)

Finger Walks (spinal perez)

Riding Horseback (spinal galant)

Gentle Pull to Sit - at Wrists (hands pulling)

Airplane Game (hands supporting)

Reach and Roll (ATNR)

Bicycle Legs and Penguin Waddles (leg cross flexion extension)

Cobra (spinal perez)

Partner Straight Arm Pushes (hands supporting)

Duck walks (Babinski)

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1. “Scrunch and Stretch”

(spinal galant)

For infants (any age):

Lay infant on his side, so that head is in line with body and top shoulder and top hip are pointing up at ceiling. Gently bring top shoulder and top hip together and apart in an accordion motion, 7x each side. Remember to hold for 2-3 sec in each end position. Look for shirt or skin to wrinkle and then stretch. Older infants should gentle lift and lower head in response to movement. Complete several cycles daily, per tolerance of the infant. The movement should be very enjoyable.

For older children:

Use the same motion as described for infants. Invite the child to “feel” the movement first cycle (7reps each side), then “join” the movement second cycle (7 reps each side).

2. “Finger Walks”

(spinal perez)

Tips:

Use the soft pads of your fingers, not finger tips.

Make sure you are walking along spinal muscles, NOT the spine itself.

If infant or child is ticklish or flinches, go more SLOWLY.

For infants (any age) and children:

In a tummy-lying (prone) or seated position, walk your fingers up the two muscles along the spine, from diaper line (sacrum) to base of skull (occiput). Keeping your fingers on the infant or child, switch directions to walk fingers out to elbows along backs of shoulders. Use flat hands to “wipe” from shoulder blades to diaper line (sacrum). Start over. Complete 3 cycles in a row if possible. Complete several times daily.

*Adapted from Brain Gym Spinal Walks

3. “Riding Horseback”

(spinal galant)

For infants (who can sit with support at waist) and children:

Sit the child on your leg and gently lean the child to one side and then the other. Pause on each side so the child uses his own muscles to return to upright. Look for one side to “scrunch” or wrinkle skin/shirt. Increase the amount of lean as the child gets stronger.

Challenge: straddle your leg or seated on top of a large ball with adult holding the child’s waist or thighs.

4. “Gentle Pull-to-Sit”

(hands pulling) For infants (2 months and older) and children:

Pull gently at the infant/child’s WRISTS (just below the thumb). Look for chin to tuck and elbows to bend actively pulling to start movement.

Tips:

If chin tuck is tricky, start on a pillow, incline, couch arm, etc. to give a gravity advantage.

Excellent activity for children who have difficulty with speech and communication delays, frequently hit their head when falling backward, have difficulty sharing, have difficulty pouring or scribbling/writing.

Try pulling to sit at a variety of different angles for babies and children with low abdominal muscle tone or babies with torticollis.

**Infants should tuck their chin and actively pull to

sit by age 4 months (adjusted age). Children of all

ages should instinctively tuck chin, pull by bending

both elbows, and sit up when they feel the input

at both wrists.

5. “Airplane Game”

(hands supporting)

For infants (who can hold their head up while on tummy and push up onto straight arms):

Hold the infant face-down and practice “landing” hands on a variety of surface types. Gently rock the infant’s body forward and backward or side-to-side and make sure she keeps arms straight with weight shifts.

For children:

Help the child lay facedown over a large ball and practice reaching arms to the ground as the ball rolls her body forward. Rock the ball forward and backward or side-to-side and make sure the child keeps arms straight. OR Encourage the child to walk hands forward off the edge of a couch or toddler bed. OR Hold the child at the ribcage and legs and encourage wheelbarrow walking (make sure the child does NOT arch through low back).

6. “Reach and Roll”

(ATNR)

For infants (any age) and children:

Encourage rolling several times in a row with arms reaching forward.

Tips:

Try rolling the child up into a

blanket “burrito”

Encourage rolling down soft

inclines or hills.

Dangle a toy in front of an infant to

encourage forward reach.

Encourage child to hold a small ball

or stuffed animal overhead while

rolling to encourage arms

overhead.

Remember to roll sometimes

toward the Right side and

sometimes toward the Left side.

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7. “Bicycle Legs”

(leg cross flexion-extension)

For infants (of any age):

Bicycle legs so that one knee bends while other is straight. Pause for 1-2 sec at each endpoint.

For older infants and toddlers:

Lying on her back, help or instruct the child to bring one knee to chest and keep other leg straight. Switch back and forth so that one leg bends at the same time as the other leg straightens.

For older children:

Gently resist the bottom of the foot near the heel during bicycle legs so the child has to push against slight resistance to switch leg positions.

7. “Penguin Waddles”

(leg cross flexion-extension)

For infants (who can stand with hands held or walk independently):

Standing with hands on supportive surface or with hands held, encourage the child to “waddle like a penguin” from one foot to the other. Stance leg should stay straight while “penguin” leg lifts slightly to the side.

For children:

Encourage older child to lean from side to side without support. Look for symmetry and upright posture (no forward lean or losing balance to the side). Use footprints or colored spots to mark spots for feet. Challenge: occasionally call out “freeze” to see if the child can hold balance while standing on one leg with opposite leg out to the side.

8. “Cobra”

(spinal perez)

For infants (who can hold up their head on tummy):

Lay the baby tummy down on your chest or legs and encourage head lift. Gently stabilize by pressing downward on pelvis (diaper).

For children:

Start by lying on stomach and encourage child to push up to straight arms and look upward. Use a textbook, weighted lap pad, or other gentle resistance at pelvis to stabilize downward.

9. “Partner Straight

Arm Pushes”

(hands supporting) For older children:

Standing in front of you, encourage the child to put hands against yours (open palms) and push. The child should maintain straight arms (without hyperextending elbows). Challenge: once the child can maintain straight arms and push consistently, have the child stand in front of you with arms at sides, then lean forward, reach arms forward, and “catch” himself with open palms against your open palms and push with straight arms.

Option for children who cannot stand independently: hold the child at the ribcage or waist and encourage them to “reach for your shoulders”

Independent option: push against a vertical wall or door.

10. “Duck Walks”

(Babinski)

Encourage the toddler or older child to walk with toes facing in all different

directions:

Walk on tiptoes.

Walk on heels

Walk with toes pointing inward.

Walk with toes pointing outward.

Walk sideways by crossing one foot over the other (grapevine walking).

Tips: use painter’s tape, belt, or jumprope to mark a start line and finish line.

Use cutouts of footprints or chalk footprints to show foot placement for toes-in

and toes-out walking.

Remember to make it fun!!

Sensory and primitive reflex information is processed in a part

of the brain that is near the part related to emotions. So, reflex

integration is most effective if the process is enjoyable,

rhythmic, and fun.

Feel free to use rhythmic background music, gentle

metronomes, or nursery rhyme songs to pair with these

activities. And make movements predictable!!!

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Resources: • Masgutova Neurosensorimotor Reflex Integration (MNRI)

https://masgutovamethod.com/become-an-mnri-student

• Rhythmic Movement Training

http://rhythmicmovement.org/

• Brain Balance

https://www.brainbalancecenters.com/

• Pathways.org

• Brain Gym

http://www.braingym.org/about

Kids in Motion,

of Spiric Therapies, LLC

Thank you!!

Jennifer Spiric, PT, DPT

Kids in Motion,

of Spiric Therapies, LLC

kidsinmotionCO@gmail.com

Upcoming Educational Events Beginning Rhythms & Keys to Caregiving

Supporting Infants and Families At-risk - May 10 and 11, 2018 Thursday and Friday - 8:30 am to 4:30 pm

• Supporting the Breastfeeding Dyad – June 7 & 8, 2018 Thursday 10 am to 4:30 and Friday 8:30 am to 4:30 pm

Links to register on the Special Kids, Special Care Website

www.specialcare@sk-sc.org

Break Reminders Benefits of Babywearing

for Preterm Infants With Special Consideration for Their Safety

Benefits of Kangaroo Care

and/or Babywearing for Preemies

• Increased weight and size- study showed that six hours of skin

to skin contact per day resulted in significant increases in

weight, length, and head circumference. G Gathwala, B Singh, J Singh,

Effect of Kangaroo Mother Care on physical growth, breastfeeding and its acceptability. Tropical

Doctor, 40(4) 2010

• Better sleep and emotional regulation- another showed that

kangaroo care with premature babies resulted in more

organized sleep cycles, regulation of negative emotion, and

better handling of stimuli. Feldman, R., Weller, A., Sirota, L., & Eidelman, A. I.

(2002). Skin-to-skin contact (kangaroo care) promotes self-regulation in premature infants: Sleep-

wake cyclicity, arousal modulation, and sustained exploration. Developmental Psychology, 38(2),

194-207.

• Reduced stress- it is well documented that children who aren’t

touched fail to thrive. Lack of touch results in increased

cortisol levels, which can contribute to poor outcomes in

premature infants and delayed growth.

• Less crying (which leads to less stress…)- Infants who are

held/carried at least three hours during the day cry around

50% less during the evening hours. UA Hunziker, RG Barr, Increased carrying

reduces infant crying: A randomized controlled trial, Pediatrics, 77 1986

• Better ability to regulate temperature- Actually a compilation of

studies that covers many benefits, including to the mother. Ann

L. Jefferies, Kangaroo care for the preterm infant and family, Paediatr Child Health, 2012 Mar: 17(3):

141-43

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Benefits to the Caregiver

• Facilitates bonding.

• Increases breastfeeding success.

• More touch doesn’t only reduce baby’s stress- it

also increases mother’s mood and reduces

likelihood of postpartum mood disorders.

• Simple act of touching and/or carrying makes

parent feel productive/useful/in control.

Babywearing

Safety:

ABC’s

-Airway

-Body Positioning

-Comfort

Babywearing

Safety: TICKS

-Tight

-In View

-Close Enough To Kiss

-Keep Chin off Chest

-Supported Back

The Most Important

Thing:

THE AIRWAY

Recommendations for Preemie

Babywearing

• While in NICU focus on kangaroo

care.

• Make first attempts in hospital while

monitored.

• Ring slings and thinner woven wraps

are ideal until 8lbs (assuming typical

muscle tone).

• Avoid stretchy wraps until 8lbs.

• If unsure, get help from BWI, a

friend, a babywearing consultant.

Ring Sling

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Woven Wrap Stretchy Wrap

Meh Dai/

Bei Dai

Soft Structured

Carrier

Resources for Parents

• Preemie Babywearing group on Facebook.

• Babywearing International

(www.babywearinginternational.org)

• Local Babywearing Group (check Facebook,

Meetup)

• Babywearing Consultant

Don’t miss a NICU Consortium Education Meeting or a NICU Consortium Partnership Meeting

Please sign up on the Website: www.specialkids-specialcare.org

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NICU Consortium Partnership Leadership Council

Leadership

Chair Petora Manetto-Spratt

Co-chair Lisa Hymes

Secretary Carolyn Kwerneland

Treasurer Beth Cole

Workgroup Chairs

Mental Health - Emily McNeil

Capacity Building - Kristin Frank

Program Development – Evelin Gomez

Family Engagement – Mekida Wilson

Community Representatives

Parents - Amber Minogue

JFK Partners - Renee Charlifue-Smith

Physicians - Sharon Langendoerfer

NICU Consortium Education – Paulina Erices