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Scott Webb: Sensory and motor development is the gradual process by which a child mentally grows and gains using coordination of the large muscles of the legs, trunk, and arms, and the smaller muscles of the hands, and the baby begins to experience new awareness with the use of their five senses. And joining me today to tell us about himself and the sensory and motor development work he does with babies and families is David Blaski. He's an occupational therapist with certifications in sensory integration and visual motor rehab.

This is the Franciscan Health Doc Pod. I'm Scott Webb. David, thanks so much for your time today. As I was just mentioning, this is a really cool topic. We're going to talk about sensorimotor development and potential concerns parents may have. But before we get to that, tell listeners about yourself and what you do at Franciscan.

Dave Blaski: Well, my name is David Blaski. I'm a pediatric and neonatal occupational therapist who has been working for the past 30 years in pediatric rehabilitation. I'm a specialist in the evaluation and treatment of sensory processing disorders as it applies to infants, children and adolescents. I am also a trained neonatal therapist who has worked for over 25 years in the newborn intensive care unit, working with high risk infants. In addition to that, I also happened to be an inventor. I developed the first aquatic orthotic that allows children with cerebral palsy to swim. And so my whole focus in occupational therapy has been towards not only just treating disability, but also to help prevent them, which is what led to the development of this particular course that we offer to people in the community, how to recognize concerns in infants, and that because of the first 12 months of their lives is a very critical period, during that time, if we can find issues, problems that are developing, we can actually do things to stave off them becoming a lifelong, sometimes crippling disability. This is the same reason why I work in the NICU with infants. If we can identify problems early, then we can give them a better neurodevelopmental outcome that may not be something that affects them the rest of their lives.

Scott Webb: That is so cool, David. I love hearing about you and I don't think I've ever actually spoken with an inventor. So this is kind of a thrill for me, and especially as it relates to families and babies. So let's talk about sensory motor development in babies. What do parents need to know? What are the milestones and so on.

Dave Blaski: Well, the thing is that the first 12 months of your and my life, the entire foundation for everything that was going to happen from that point was laid down. There's a simple little formula we use that sensory is the basis of motor, motor is the basis of learning. If a child has a problem learning a particular skill that other children learn, we can trace it back to a motor system that serves that. That motor system in turn is controlled by a sensory system that was laid down in both their early development.

For example, here's a little couple of things you can do in the privacy of your own home and amaze your friends at parties. Watch any adult male interact with an infant. They will do two things they are unaware they're doing. Number one, when you interact with an infant, you will raise your eyebrows and you will raise the tone of your voice. That's because the infant's hearing is tuned to higher tones. A woman's voice is 220 Hertz. A man's voice is 110 Hertz. So what happens is, is because when we were babies, we had a higher tone that we looked for sensory-wise, we still do it when we're adults. So watch any adult male interact with the baby, they will do, "Hi. How are you doing?" You raise the tone of your voice because their ears are more attuned to it. You also raise your eyebrows cause that's the early communication behavior in an infant. When an infant raises their eyebrows looking at you, they want you to talk and interact with them. And it's called an innate disposition. We're born with it and we continue throughout our lives.

The other thing you can do sensory motor-wise is ask a person to write their name down. And while they're writing, ask them where their tongue is. When you write, the tongue goes to the front roof of your mouth. And the reason why is that's one of the early stabilization points for motor development. Why do you think babies mouth objects? They can actually learn about shape and identifying shapes at six months of age by mouthing them without visualizing them.

Vision's another thing. In an infant, we know that they always said that babies are legally blind. They can't see at birth. Well, actually the truth of matter is, is that a 32-week premature infant can see an object six to nine inches from the tip of its nose. Their vision's monocular. They don't have depth and distance perception. But a baby of 32 weeks can see an object clearly six to nine inches from his nose. From 33 to 36 weeks, it can see an object not only within a 12-inch distance of its nose, but it can also track them moving vertically, horizontally in an arc. Past 36 weeks onto the 40 week term date, they can not only see objects, track them within that one-foot distance, but they can also show visual preference for things they like to look at and things they don't like to look at. So actually, infants are born with a sensory system that is constantly developing so that they can survive and interact within the world. Vision guides their movement, and so we always want parents to be aware of that there are certain not only milestones, but there are certain red flags that can indicate something might be going on, that they should seek a professional to help identify.

Scott Webb: Yeah, that's interesting, the way you put that about the red flags. And I'm just sort of picturing, my kids are older, they're 14 and 19 now, but I was trying to remember what they were like, you know, when they were little. And you're so right about the raising of the eyebrows and raising my voice with them when they were little. So it's just really cool to talk through some of this stuff with you. But when we think about the red flags or the perceived difficulties, sort of how and when do parents know. And then what should they do about it? Again, if there are are, you know, real difficulties or even perceived difficulties, what would be their next steps?

Dave Blaski: Well, some of the flags that parents should be aware of is things like if the infant has problems eating or sleeping or being able to calm themselves. Infants usually are kind of wired to be able to do certain behaviors that'll allow them to calm myself, whether it's sucking on a hand, whether it's bracing themselves. But if the infant is having trouble basically soothing themselves when they're upset; if they refuse to go to anyone other than the parents, say a grandparent, a family friend, and they refuse to go by them for some reason; if they rarely play with toys, if they have real upset behaviors when they're being changed or bathed or things like that, if they have very floppy kind of muscle tone. A big red flag we look for in infants, for example, is an infant that does not like being on their tummy. We always hear about tummy time with infants and that, especially since now, because of the Back To Sleep thing, because of SIDS and those kinds of risk factors, they want babies to sleep on their back. But as therapists, we always like babies when they're awake to be on their tummies. And a baby that does not like being on their tummy should be a red flag that there's something going on there that needs to be looked at by an occupational or physical therapist to determine what it might be with their muscle tone.

In general with developmental milestones, sometimes parents will treat them as a checklist. "Okay. You're six months old. Here's the list of what you should be doing." The truth of matter is that if you look at those development books and read them without looking at the age, but look at the progression of how an infant's development goes in those months, you'll see that one phase builds on another. An infant's movement is guided by vision, they look up to look at things that they hear, or they think they see in the environment that strengthens their neck. Their neck and shoulders then get strengthened from all that head lifting in prone position on their tummy. That strengthens their shoulders and their arms so that they can bear weight on them first on their forearms. And then as they get stronger, they push up on those arms and that weight shift to the bottom of the body kicks in the lower part of the body and they learn to push up on hands and knees. They rock on hands and knees until they do a few nosedives into the carpet, then they've realized that, "Wait a minute, if I put my arms out, I wouldn't do that." And so that leaves them to crawling, to sitting to walking. And it's very important that an infant follows those kinds of transitions and progressions.

One of the things we don't like infants to do is go from getting up at hands and knees to wanting to walk and skipping, crawling. Crawling is one of the biggest developmental milestones, because a lot of not only your upper body strength, but your fine motor development curves with crawling. Crawling is an important developmental milestone in an infant. We always think being precocious they walk first. No, no, we don't want them to, because those are the children that later on in around first, second grade in school are going to have some coordination problems that will trip them up in their academic, but also in their activities of daily living. And so we want infants to follow the neurodevelopmental pattern of development in order to have everything they need to succeed later on in life.

Scott Webb: Yeah. I see what you mean. Where as you say, some parents may use a checklist and may get concerned that something didn't happen at some milestone in that checklist. But the important part is that they are progressing, that they are going through these stages. And even if maybe a child takes just a little bit longer, as long as they get there and they move on to the next thing successfully, that's okay, right?

Dave Blaski: Yeah. And it's especially good because if you seek out somebody, get a different opinion on it, and one of the things that we always try to avoid now with everything that we know in pediatrics and neurodevelopmental treatment and even sensory processing disorders is that the earlier you can get a child help, the better the prognosis, because there's always things that we can do in premature infants when we work with them in the NICU. But then when we do the neurodevelopmental follow-up clinics afterwards, where we follow them up until they're about a year and a half, two years old if necessary, is because we can tweak along the way when we see these little problems. And we've been very successful over many years now of being able to see some of the things that could be early warning signs of cerebral palsy or anything like that, along those lines, are neuro-motor or neuromuscular problems. If we can get to that child early, provide the parents with the means of what they need to do and how to handle them, we can avoid the longer term disability, or sometimes in a cases that we've documented, we've been able to prevent the child from going down that path. And so sometimes, it's just as easy as training the parents and being there to support them.

Scott Webb: Yeah, I hear what you're saying. That's what I wanted to ask next, was really about the prognosis. So if a child is experiencing real difficulties and those difficulties, red flags are diagnosed early enough and the child is helped early enough, what's the prognosis for the most part?

Dave Blaski: The prognosis is actually very positive. Let me give you an example. About 10 years ago, I had a 13-month-old infant that was referred to me. The diagnosis was cerebral palsy. The infant was 13 months old and weighed 13 pounds. She was a failure to thrive. In other words, she would only eat breast milk. She did not want any solid or even baby foods. And she was getting to the point where she was about to be put on a G-tube, a tube where they would feed her through her stomach because she wasn't getting enough calories from the breast milk. This infant could not sit at 13 months. She could not crawl. She was basically a lot of arching, stiff as a board. And so when the mother brought her in, now as a therapist, I don't treat a diagnosis. I treat the things I see. And that's an important thing to remember, is that diagnosis are important in and of itself, but sometimes what you really need to focus on is treating everything you see. When I took this infant in my hands, I was holding her feeling her muscle tone, and it didn't feel to me like it was true neurologic tone. This was almost like an avoidance behavior this child is doing for the arching. I took the child, got her to a sitting position on my lap as I'm talking to the mother and I'm asking the mother questions. I asked her, "Does she take a pacifier when she's upset like this?" Mother says, "Oh, no, she has never allowed anything by her mouth." So she doesn't mouth objects. As I'm sitting with her on my lap, I slightly stroke her forearm because I was starting to suspect something at this time. And I stroked her forearm and the child started scratching at it, like I stuck her with a pin. It turned out this child had a condition called sensory defensiveness, which is an overresponsivity to sensory input that most people wouldn't consider to be obnoxious in any way. So I put her-- told the mother, I said, "Listen, before we do anything, because she's supposed to get all three therapies..." I said, "We need to put her on the protocol to treat this defensiveness and get rid of it, because it would literally be a red flag, but it's also going to be a barrier to everything we try to do. All of us as therapists, physical therapy, speech are going to be spinning our wheels until we get rid of this condition." so I put this child on what's called the Wilbarger therabrush or deep pressure protocol, which is the accepted treatment for sensory defensiveness. This was on a Friday. The mother agreed to do the protocol as prescribed. The next day, the child ate two full jars of level two baby food at every feeding. On Sunday, ate three full jars of level three baby food at every feeding. She came in Monday for her physical therapy assessment and the child was putting everything into her mouth. She had a teething biscuit that had morphed out our arm because she was mouthing everything now. That week, she sat for the first time by herself. The next week, she got out of sitting to hands and knees. The next week, she was rocking on her hands and knees. The next week, she was crawling. The next week after, that she was pulling the stand and cruising on furniture. And the week after that, she started taking her first steps. We documented this between all three disciplines, but you can see the sensory part of it.

Now, if I had left the sensory defensiveness and treated her like a neuromuscular child, how do you think far we've all would've gotten if we were doing hands-on treatment to a child that didn't want to be touched? And so that's the importance of why you have to treat what you see, which is what we do as therapists, and then also treat the conditions that are in order. The brain works in a hierarchy, and it prioritizes certain things. Sensory defensiveness is the limbic system fight or flight. And so when you see that, no matter what the diagnosis the child has, whatever we see, we treat in that order. And that's what gives these kids the best developmental outcome..

Scott Webb: It's really amazing, David. I have learned so much from you today. I just love your approach, you know, treating the patient, treating what you see, what's there in the room with you, not a diagnosis on a screen or on a piece of paper. And I'm sure that's just wonderful for parents ultimately for the babies. Really awesome. I want to give you a chance before we wrap up here, tell listeners about the webinars that you do. What happens during those webinars, what can they expect, how can they register and so on?

Dave Blaski: What it is is basically some of the information that I've provided you today. Basically, I talk with parents, I give them stories of what certain things could look like in an infant's development, how their development is supposed to go along. And I give them a lot of hints and especially resources that they can tap into if they do have questions and concerns. We always encourage parents that they are those basic fundamental security their child has. They are also the people that basically the child should be able to trust among all other people. And so that's the reason why we give them resources and also that we're willing to listen to them. Because statistically, when a parent tells you something's wrong with your child's statistics are high in the favor of that the parent is right or correct over the professional. And so we want parents to be empowered that when they think something's wrong with their child, or they want something checked out just for their own peace of mind or whatever, that we're a resource for that. And we will listen to them and we will give them the information that they need to help their child to succeed. One of the nicest compliments I ever received was from a parent that told me, "I brought you a child with problems and you gave me back a daughter."

Scott Webb: That's amazing. And just today, the education, the information, and most importantly, David, really the compassion that I hear in your voice, I know that parents and babies are in such good hands with you and the other multidisciplinary team, you know, that would work to address these red flags and difficulties. So, really awesome. Thank you so much for your time. You stay well.

Dave Blaski: Well, thank you very much for having me.

Scott Webb: And to register for one of David's webinars, go to franciscanhealth.org/events and select the category children and childcare. And if you found this podcast to be helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.