Monday, March 24, 2014


This is one problem that hits close to home. In May 2010, First Lady Michelle Obama of the United States was in full swing with her campaign against childhood obesity.
obesity_image_01According to the Centers for Disease Control and Prevention and reports from the National Health and Nutrition Examination Survey, the prevalence of overweight children between 6-19 years of age is between 17-18 percentile in the United States. This is a disturbing global trend; the number of obese children has tripled over the past four decades across the world.
Why is childhood obesity a problem?
There are several medical issues directly associated to obesity:
  1. Hypertension
  2. Diabetes
  3. Respiratory disease
  4. Increased risk of injury
After a child turns 6, the chances that obesity will persist into adulthood increase by 50%. The sooner obesity is treated, the greater the likelihood that the individual can achieve a normal adult weight.
Is Your Child At Risk?
Here are the known risk factors:
  • Season (winter), population density (large urban areas) are associated with higher childhood and adolescent obesity.
  • Both parents happen to be obese (body frame tends to be inherited).  
  • Levels of parental education and socioeconomic class.
  • Dietary fat intake.
  • Time spent watching television. The average American child watches approximately 25 hours of television per week.
So what contributes to childhood obesity?
  • Diet: High-fat diets, irregular meals and inactivity continue to be primary contributors to obesity. Limit/avoid the “empty calories” like sodas, candy and chips.
  • Inactivitygirl_watching_tv_6011989Inactivity is widely recognized as a contributor to obesity. Children aged 6 to 11 years watch 23.5 hours of TV per week and adolescents ages 12 to 17 years watch about 22 hours. A study published in the American Journal of Clinical Nutrition assessed the effects of reducing television watching and video game-playing in obese 3rd and 4th grade students. The results showed that the body fat level of the children who received the intervention for 6 months dropped significantly compared to the controls.
The Emotional Factor
Children, like adults, can eat in response to moods. Emotions that commonly lead to overeating include sadness, loneliness, anger and celebration. Children can learn to identify their feelings before eating and control the “misinterpreted” urges to eat.
Obese children report greater number of life changes (indicative of stress) compared with other adolescents. Depression, anxiety, social and behavior problems are commonly reported by obese children.
Exercise As The Solution
A physical therapist can determine realistic weight loss or maintenance goals and help the child accept his / her natural body frame. Otherwise, he/she will constantly strive for an unrealistic weight, often leading to restrictive dieting, overeating or binging. Weight loss of one-half to 1 pound per week is realistic. If a child you know needs help, seek the services of a physical therapist, who can set goals that are small and attainable so that the child doesn't feel discouraged.
football_dad_with_kidsEncourage daily activity in obese children. Sports participation contributes to improved fitness levels, specifically increased endurance, strength, self-esteem, energy and often, improved mood. Family involvement is crucial.
A physical therapist can identify what (if any) changes family members must make to improve the health and fitness level of everyone in the family—not just the obese member. The parents must become good role models with their eating, exercise and stress management. Strive for an attitude of "we're going to do this together."

Wednesday, February 5, 2014


You know the drill well.  It's been a long day.  You're tired.  They're tired.  You give them a bath, put them in the bed, read a bedtime story and turn out the lights.  You're done.  Finally.  You can take the next hour and relax.  Maybe catch up with the latest happenings on Facebook.  Read some of that book you've been dying to dive into.  Eat uninterrupted.  But then you hear a sound coming from their room.  Someone is jumping on the bed.  You go in, give a firm warning and head down the hallway again. Silence.  But it's short lived.  They're back up again.  This time they're playing with the faucet in the bathroom sink.  You give a pleading speech and they reluctantly head into their room. A few minutes later though, the loud crash of something breaking assaults the fragile silence.  You stomp back into the room to find that the lamp is in pieces on the floor as well as the new toy you bought just the other day.  Why won't this kid go to sleep, you ask?  Exhausted, you grab the broom and dust pan.  Just a typical night.  You know it's going to be at least two hours before they get to sleep.

Sound familiar?  Don't worry, you're not alone.  Many children with Autism and Asberger's deal with insomnia.  Sometimes it's caused by the absence of a consistent bedtime routine, fear of the dark, or long napping during the day time.  Or maybe your child is unable to remain asleep.  Maybe he or she is easily awakened by the slightest noise.  Or maybe he or she just gets hungry in the middle of the night.  Don't despair.  We've adapted ten suggestions from the book, "1001 Great Ideas for Teaching and Raising Children with Autism and Asperger's," by Ellen Notbohm and Veronica Zysk on how to get your little one to fall asleep better and stay that way.  

1.  Document, document, document.  Keep a journal and write down when and how often sleeping issues occur.
2. Look for physical issues that may be hindering sleep
3. Look for behavioral issues that may be hindering sleep
4. Set up a regular bedtime and STICK TO IT!  No if, ands or buts.  This one will be difficult at first but will get easier as you become more firm with your expectations.
5. Don't over-stimulate your little one right before bed.  This means no sugar or chocolate.  And please don't introduce any electronics (TV, computer, or games) within one hour of  bedtime.
6. Allow your child to ONLY fall asleep in his bed.  Make it the only location meant for sleep.
7. Create an environment that encourages sleep.  The room should be dark, quiet and at a comfortable temperature
8. Try your best not to let your child wander.  Install a Dutch door with the top open and the bottom locked.
9. Look around the room and try to eliminate any sensory-disturbing items such as ticking clocks, tree branches that scratch the window(s), or humming appliances such as heating or cooling units.
10. Try to make sure that the environment your child goes to sleep in remains that way for the duration of his sleep.

We welcome your comments on this subject and can't wait to hear your thoughts!

Wednesday, January 22, 2014


Torticollis literally means, “twisted neck” in Latin.  Also known as “wry neck” or “loxia,” Torticollis is a fixed or dynamic tilt, rotation, or flexion of the head and/or neck. This is usually manifested by a baby’s head being tilted to one side with their chin towards the opposite side.
The First Thing You Didn’t Know About Torticollis
There are actually three types of Torticollis.  The first type is called, Congenital Muscular Torticollis.  Although not completely clear, it’s most thought to be caused by trauma to the neck during birth or abnormal positioning of the baby while in the uterus (for example, a breech position).
This kind of Torticollis is usually discovered between six to eight weeks after birth when a baby begins to have more control over his head.  The sternocleidomastoid muscle (SCM), a muscle in the neck, becomes excessively shortened and causes the baby to be unable to turn and/or tilt his head.  If the shortened muscle is caused by trauma, the SCM will develop scar tissue as it heals, restricting the baby from turning his head.  The second type of Torticollis is Acquired Torticollis.  This type usually develops after the baby has reached its first birthday.  A child might develop it if he or she sleeps in the wrong position or injures his head.  The SCM and other muscles of the neck may spasm, causing the head to tilt to one side.  This type of Torticollis may also be caused by an upper respiratory infection when the lymph nodes in the neck swell. The third type of Torticollis is Spasmodic Torticollis (ak.a. Cervical Dystonia).  It is caused by a dysfunction of the brain which causes the muscles around the neck to contract intermittently or all the time.   This type of torticollis may be extremely painful and cause the shoulders to be uneven.  This type of Torticollis is mainly seen in adults.
The Second Thing You Didn’t Know About Torticollis
Did you know that Tortocollis is described depending on the position of the neck?  There are four positions:
  1. laterocollis : This is when the head is tipped to the side towards the shoulder. (think this: the ear is trying to touch the shoulder)
  2. rotational torticollis : This is when the head is actually rotated to one side.
  3. anterocollis : This is when the head and neck is tilted forward (think this: chin to chest).
  4. retrocollis : When the head is tilted backwards
The Third Thing You Didn’t Know About Torticollis

Physical Therapy provides treatment of Torticollis!  It is always a good idea to get an evaluation by a pediatric physical therapist if you suspect that your child has Torticollis. This type of therapist is specially trained to handle pediatric diagnoses.  He or she will assess and measure the range of motion of your child’s neck and evaluate any muscle tightness.  S/he will also evaluate your child’s muscle strength and gross motor skills.  Lastly, he or she will check for other conditions that can occur with torticollis such as plagiocephaly (abnormal head shape), hip dysplasia (misalignment of the hip joint), and spine problems. The therapist will then discuss these results with the family and make appropriate recommendations for physical therapy treatment. If it is indicated, the physical therapist will then perform a stretching program to the neck and instruct the family in a stretching and positioning program designed specifically to the child's needs. He or she will also educate the parent in how to perform a daily home exercise program.   

Why is Early Treatment Important?
Receiving early treatment for Torticollis is important.  It can prevent a permanent shortening of the involved muscle, avoid the need for surgery and prevent plagiocephaly (flattening of the head on one side), delayed developmental motor skills and facial asymmetries.
At Rapha Physical Therapy, our pediatric therapists use a hands-on method to treat Torticollis coupled with health education and internet resources.  We typically see significant results between 6 to 8 weeks and complete recovery within 12 visits.  When Torticollis treatment is implemented early, the majority of children recover completely in a short period of time.  Don’t go it alone.  If you see that your child’s head is tilted towards one side, talk to your doctor about treatment and ask for a referral to a pediatric physical therapist.