Crawling in Babies









“My doctor mentioned crawling isn’t important”

“He is too lazy to crawl. He just loves to stand!  I think he is excited to walk!”

Crawling baby









“My so so so relative’s grandchild never crawled and she’s fine”


These are just a few things I hear in my day to day practice from parents regarding crawling in babies. I get it!

Crawling is hard for babies, it takes a lot out of them especially for those who disliked tummy time.


Crawling baby


I spent every day, multiple times of the day (thanks to maternity leave), for over a month; working on crawling on hands and knees for my little one (who was content with creeping), till she finally did it!


You Know Why????





Playing on Swings



Particularly for lifelong skills that are essential YEARS down the line..






Crawling Baby


Crawling baby






  1. CRAWLING develops stability around the wrist, elbow, shoulder complex muscles along with hip, knee and pelvic muscles which can barely be second by any other milestone in this way. This stability is extremely important for support, protection and precision during growing sport related activities and to protect from impeding injuries.


Crawling in Babies

2. rawling stretches hand, fingers and wrist muscles allowing advanced grasp of objects that vary in size and shape. For e.g. colour with a chalk, open a         doorknob,  cut with scissor.






Crawling Baby


3. Crawling for months before a baby starts walking functionally (freely in whole room) strengthens, builds co-     activation and develops proprioceptive feedback to such intensity that without it, links to poor handwriting skills,   clumsiness and lack of coordination necessary for advanced sports play.





Crawling Baby


4. Crawling enhances visual development which leads to better reading and focusing skills e.g. catching a ball, kicking and dodging a football in field,    copying down notes from classroom board.












  1. Crawling develops ability to use all 4 limbs with a synchronous pattern and adds to strong upright posture. I have seen kids who have never crawled showing clumsinessàpredisposing them to INJURY.


I am reaching out to all the parents to kindly encourage crawling in all your babies and let them reap its huge benefits. In case of concerns or any delay noticed, reach out to us to screen your baby.



Written by:   Shivangi Trivedi (Pediatric Physiotherapist)


Book an Appointment to have your Child evaluated with me at this Downtown Toronto Clinic





Rise of Torticollis

One of the reasons which drives me to write on a topic is when I there is sudden surge of a particular condition of patients. That’s exactly what’s happening these days; I am seeing a lot of patients with Rise of Torticollis.

What is Torticollis?

Torticollis is a condition involving the muscles which cause twisting of the neck. The term comes from two Latin words: tortus, which means twisted, and collum, which means neck.

Infant or toddler with torticollis or wry neck












Rise of Torticollis is caused by shortening of Sternocleidomastoid, a muscle which runs on the back of the ear to the collarbone.

  • Shortened Sternocleidomastoid will cause the neck to bend to the same side and turn to the opposite side.
  • Difficulty breastfeeding on one side and preference for other side mainly
  • Flattening of face on one side and fullness on other side
  • Facial asymmetry
  • Looking at one side more with head turned to that side
  • Flattening of back of the head on one side
  • Mild delay in rolling, sitting, gross motor activities

Infant with flattened head from sleeping positions







So you may ask, why would this muscle shorten?  It’s mainly due to the position of baby in the womb wherein it may be either cramped up or in abnormal position like breech. It can also occur due to injury during birth process by the shoulder getting stuck or forceps/vacuum delivery.


Pediatric Physiotherapy works wonders on improving the position of head and neck and avoiding/covering the delay in gross motor and sensory milestones. Early Intervention wherein the baby/child is screened and treated as early as possible has the best results.

What would your physiotherapy sessions look like?

  • On the first day, I typically assess the baby/child in detail wherein I go through the history, presentation and symptoms of the baby/child, different system assessments like Musculoskeletal, sensory, rule out other systems like cognitive to ensure nothing is missed out. After a thorough assessment, goals are set by discussing with parents and caregivers and a treatment plan is chalked out.
  • In follow up sessions, treatment strategies are devised based on neurodevelopmental and sensory integration principles with play therapy.
  • Goals are achieved and reset with ongoing modifications in treatment strategies.
  • Families are given an exercise program to carry out at home to see faster results.

Most infants/babies when diagnosed and treated early especially within first 3 months, respond well and gain appropriate positioning within few months of therapy. However, in rare situations especially when intervened at an older age, may require surgery to lengthen the sternocleidomastoid muscle.


Pediatric Physiotherapist in Downtown TorontoWritten by:   Shivangi Trivedi (Pediatric Physiotherapist)


Book an Appointment to have your Child evaluated with me at this Downtown Toronto Clinic




In Toe Walking

Now that it’s summer, I see a lot more kids and adolescents playing outdoors. I was amazed at the number of children I have seen walking with toes pointed in! Let’s understand more in details of what it is and how it affects children as they grow.

Firstly, what is a normal hip joint?

The Hip joint is one of the most important and strongest joint of the body which bears body weight and plays a major role in our daily activities. It is a ball and socket joint wherein the ball of femur (bone between hip and knee) moves within the pelvic socket called Acetabulum. It is a stable joint with supporting structures providing inert support and minimizing friction, making it pain free and without problems in majority of people through their lifetime.

Now let’s figure out what is Femoral Anteversion?

Femoral Anteversion is inward twisting of femur (thigh bone). In toddlers and children (younger than 7yrs), walking with feet slightly turned in, is normal part of their hip alignment. Their legs start to straighten once the baby learns to weight bear on their feet and walk (by around 9-12 months) and reach normal adult range by 7 years of age. Excessive inward twisting beyond this age causes your child’s knees and feet to turn in giving a pigeon toed appearance or in toeing gait (walking pattern).

What causes Femoral Anteversion?

Although the exact cause is unknown, it is believed to be a consequence of a child’s developmental habits. When the child is first learning to sit, it’s easier for a child to do so in “W” sitting as it is favoured by natural hip position, broad base and lesser use of core muscles.

What   signs and symptoms should you look out for?

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Child walks with knees and foot turned in (In toeing)








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Awkward running pattern where foot swings out during running



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Preferred W sitting as a child or uses it through adolescence





In addition, a child may complain of pain around his/her hip, knee or ankle; frequently lose balance or find it difficult to engage in outdoor sports like skating, hockey, soccer which put a demand on child’s dynamic balance.


How can Physiotherapy help?

 Although, it is commonly the parents and caregivers who notice these signs and symptoms in their child, I have also come across adolescents who would approach parents with these concerns. Parents, caregivers or adolescents are always encouraged to see a physician or physiotherapist regarding their symptoms and get a thorough assessment.

During examination, the child may commonly demonstrate decreased range in outward turning of hip (external rotation) and backwards (extension) with weakness of hip, knee and ankle muscles. Many may commonly exhibit lower strength in core abdominal and back extensors.


Even if Physiotherapy may not completely change the structure of hip joint specially if the child is post skeletal maturity age (varies from child to child, but on an average around mid-teens),  it definitely helps to control the progress of hip turning-in and brings about significant changes in child`s function.


Physiotherapy is generally aimed at:

  • Improving range at hip
  • Strengthening hip, knee, ankle muscles
  • Building up core strength of abdominals and back extensors
  • Improving or maintaining trunk and lower limb alignment through use of Specialized Orthotic Garment Systems


It`s always best to be alert and act promptly, than be late and sorry


Written by Shivangi Trivedi (Registered Physiotherapist, Specialized Pediatric Training)

Book an Appointment to have your Child evaluated with me at this Downtown Toronto Clinic








Swaddling your Infant

Every new mother would have received advice from elders in the family, “Wrap the child tight, it will sleep well, grow stronger”. A lot has changed since the ancient times where new mothers would be taught how to wrap her child only by her mother! In the modern age, you have prenatal classes, Nurses teaching swaddling to new mothers in hospitals and to add on, lot of information on the internet for new parents which may sometimes be confusing or contradicting. Even so, I have come across numerous babies clothed too tight or in faulty positions which can be unsafe to the new baby. This got me thinking and encouraged me to write about this ancient art of ‘Swaddling’ and how it’s now modified after curious research on it.
Let’s look at the science behind Swaddling. The foetus in mother’s womb is in position of flexion with arms held close and hips curled up into flexion.

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A correct Swaddling technique is aimed to recreate this womb space especially in new born infants and neonates up to 2 months of age. Parents would commonly ask me this question, “ How should one swaddle a child?” I would always answer, “Swaddle – firstly, according to child’s comfort and secondly, catering to natural posture of the child”.

To make things simple, let me show you how we can swaddle a child at different months…

Newborn- 2 months

Swaddle a child maintaining Fetal position at this age.

1.Step One

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Place blanket on a flat surface in a diamond position in front of you Fold the top corner down about 6 inches, and place baby in the center of the blanket with top fold of blanket placed at angle of neck and shoulder


2.Step Two

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Starting on your left, bring the 1st corner over and tuck snugly behind baby. Ensure baby’s hips and knees are in a flexed froglike position inside the swaddle.
*Do not straighten or over extend your baby’s arms and legs.


3.Step Three

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The bottom corner goes up and over baby’s left shoulder and behind baby’s back. The weight of the baby will help to keep the swaddle secure.



4.Step Four

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Take the 3rd corner across and all the way around behind baby, tucking the tail of the blanket into the fold in the front.
*Avoid having the blanket touch baby’s cheek. This can stimulate baby’s rooting response and wake baby. Ensure face and neck areas are free of swaddle cloth.



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Swaddle according to comfort such that there is a 2 finger space between baby’s arms and the swaddle cloth
This allows for tiny arm movements during sleep while still giving a cozy environment to the child. The space also allows the child to breathe well in the swaddle without restriction




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Hips start getting more extended from flexed foetal position due to kicking movements and tummy time as baby nears 4months. So swaddle with muslin cloth as shown in previous stage but at this stage allowing hips to stay naturally extended (straightened) without pulling them straight (as seen in above baby)
*Till 6 months of age, hips not completely straightened, so DO NOT pull the legs straight when swaddling

4months Onwards

Babies now roll from side to supine and are more active from 4th month of age. It’s best to keep a weighted blanket during sleep hours and wean swaddling from this stage to avoid risk of respiratory distress, which can be precipitated by increasing baby movements causing swaddle cloth to trap around neck or face.

Best cloth material for Swaddle?

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I would suggest using a thin muslin cloth for swaddling which gives room for baby`s skin to breathe.

Although there is an ongoing debate whether should Swaddling be done, I would like to say,
‘Swaddling when done correctly has various benefits’

  • Infants arouse less and sleep longer
  • Comforting flexed posture gained through swaddling helps to manage pain and distress in infants e.g. Colicky pain, GERD, flatulence, constipation
  • Provides baby’s growing nervous system with valuable information and feedback about this little body that they are just getting used to. The comforting tightness of swaddle is a type of deep pressure input (called Proprioceptive input or body awareness) to the body and limbs that help the brain learn about this new body of theirs, in a very calming, organizing way.
  • Improved Neuromuscular development, less physiologic distress, better motor organization and more self-regulatory ability through facilitation of midline orientation, gentle flexed posture and increased body awareness
  • Secondarily may also prevent other serious problems triggered by infant crying and parental exhaustion like postpartum depression, breastfeeding failure and child abuse.

Now that we went through steps to swaddle a baby and its benefits, it’s natural to ask oneself how long should a baby be swaddled? To answer that, I would tell, swaddle when you see the baby starting to get sleepy through the time the baby is asleep. Gently loosen the swaddle and open the baby if the baby has slept too long and it’s time for baby to feed.

* DO NOT swaddle when the baby is awake and active*

Remember, not everything is rosy about swaddling! There are a few precautions new parents have to take when baby is swaddled

SmallRedXNever put child in prone when swaddled
SmallRedXNever pull legs straight
SmallRedXLet the arms be softly in mid-line rather than pulling it straight down or across
SmallRedXNever wrap child too tight
Toronto Physiotherapy 11Observe for signs of increased body heat especially if one lives in warmer areas like redness of facial skin, sweating over scalp hair or forehead. Loosen your swaddle cloth or open it

Ola! Take care of them and you will see your cute ‘Baby Burrito’ stay calm, sleep peacefully and with all that, enjoy your time with your bundle of joy!


Written by: Shivangi Trivedi (Registered Physiotherapist, Specialized Pediatric Training)

Book an appointment to have you Child evaluated with me at this Downtown Toronto Clinic


Tummy Time

For long time I’ve been driving down the importance of Tummy Time to countless parents who have come to the clinic seeking help for conditions like gross motor delay(missed/late crawling, sitting, standing), torticollis (neck tilt) and light and shabby handwriting. This past March, I saw a child 8 months of age brought to clinic with parents citing concerns of sleeping for long hours, getting tired easily and not rolling yet. When I went through a detailed history, it was understood that the child A was born preterm at 34weeks with birth weight of 1.5kgs. Being low birth weight, parents didn’t put the child on tummy or play activities in his initial months with worry of causing harm. This concern can be faced by many parents and early intervention is the need of hour in these scenarios.
Let’s look back a little and discuss why Early intervention and Tummy time is so important for your child’s development. All through gestation (pregnancy time) foetus as it grows in mother’s womb curls up in flexion for want of space. As a result, babies are born in relative flexion and stay that way for 4 weeks, till gravity acts on them and all the random movements in first month of age, gets them to straighten gradually from 2nd month onwards. Tummy Time facilitates extension which helps the babies to come out of the flexed fetal position. Every newborn, when placed on her mother’s abdomen, soon after birth, has the ability to find her mother’s breast all on her own and to decide when to take the first breastfeed. This is called the ‘Breast Crawl’. It was first described in 1987 at the Karolinska Institute in Sweden (Widström et al, 1987).

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This is the best time to start introducing Tummy Time!


From my experience, a baby right from newborn does not tend to mind being face down while against mom or dad’s chest. Start with few seconds e.g. 15 seconds such that baby doesn’t cry and slowly increase to 30minutes as baby gets older. So lay back, and enjoy these cuddles with your baby, it’s the starting place for building your baby’s endurance in Tummy Time.

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As advancement, try placing your child on a soft blanket on the mat or over your knees.

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Cultivating the habit of Tummy Time is best when done as part of routine like after a shower, diaper change, active play time with baby. These frequent, short intervals of Tummy Time build endurance and strength without too much resistance from your baby and you’ll soon notice your baby is beginning to lift their head a little by 2 months of age to look around.
By 3 months of age, your baby will be a lot of active with more wakeful hours. This is a great time to get your baby a ‘Baby Gym’ as is popularly called. It has colourful patterns, textured soft surface and sensory toys hanging over and around them. Playing with your baby is best at baby’s eye level. So make it funny and get down on the floor to engage with your child. You will realise the baby is starting to sing to you in her own language. The Tummy Time will also do wonders for your sore back from work! Get eye to eye, sing a song, plant a few kisses, rattle a gentle toy, push /pull a toy. Essentially as per age of baby, anything that diverts them for few minutes off the hard work performed! And please, let them hassle a little before you pounce on your urge to move them. Ensure you ROLL them over, don’t pick them up. Let them learn that rolling will get them out of Tummy Time. Once settled, gradually as your baby gets comfortable you can roll them back to their tummy and do another few minutes.
Important tip is: Don’t carry your baby all the time when you are home. Let the baby play on mat and explore the environment around.
So back to why is Tummy Time so necessary?
It helps to:
• strengthen neck and back muscles thus preventing positional torticollis, plagiocephaly and delays in development
• strengthen shoulder and hand muscles aiding better grip and handwriting
• promote visual development
• promotes crawling which builds a very strong foundation for upper body strength, abdominal-gluteal strength and eye hand and eye foot coordination thus overall improving muscle tone
• promote digestion (helps babies to push out gas, making them less crankier)
Zoom forward to baby A, at discharge at 13 months of age, he was way more active, sleeping lesser hours than before, picked up on crucial milestones of crawling, pull to stand, standing independently and parents were ecstatic when he took those much awaited first steps.


Written by:  Shivangi Trivedi, (Registered Physiotherapist, Pediatric Specialty)

Book an Appointment to have your child evaluated with me at this Downtown Toronto Clinic