You have probably heard of RICE after an injury (Rest, Ice, Compress, and Elevate). But recent scientific evidence reveals that icing injuries is actually outdated advice! And here’s why: ice helps to decrease inflammation, but for healing to occur, our bodies need inflammation. Let’s take a look at how tissue healing works for a little science lesson: Whether you just had surgery or sprained your ankle, your tissues will go through 3 phases of healing:

1. Inflammatory phase
2. Proliferation phase
3. Remodeling phase

There is a lack of evidence of the actual times these phases occur at. But, tissue healing processes should be viewed as a continuum with overlapping timeframes. All tissues will go through the same pattern of healing, but the timeframe may be different depending on the type of injury.

Inflammatory Phase (Day 0-6)

The first part of the healing process is the inflammatory phase. This is where bleeding occurs due to widening of blood vessels (dilation) and the release of a chemical called histamine. Histamine helps other cells come into the area of healing, like white blood cells. Any dead tissue will be cleaned up.

Proliferation Phase (Day 4-24)

Cells that help build new tissue start to place new, immature tissue in random fashion. This tissue does not have the same tissue properties as healthy tissue. It is weaker than healthy tissue.

Remodeling Phase (Day 21-2 Years)

The new tissue that is “weak” (or immature) is being converted to more mature tissue. Why is this important to know? When we load tissue too fast, we may cause a disruption in this healing process. Likewise, we can also not load the tissue enough. This is especially important to help immature tissue become mature tissue. Tissues will adapt to the load we put on it!

What Should I Do?

We need inflammation to help the healing process. RICE may delay healing instead of helping! What should I do when I have an injury? Give it PEACE & LOVE!

Seek out physical therapy at MOSAIC to help rule out fractures, dislocations, or anything that may require emergency medicine. If you have questions, reach out to our adult physical therapist!

References:

1. https://theprehabguys.com/the-truth-about-icing-injuries/

2. Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE.

3. British Journal of Sports Medicine. 2020;54:72-73.

Your baby is crying again, arching their back, and is inconsolable. You try to feed them, and they suck for a minute but then baby pulls away and starts to cry. Baby takes a pacifier for a few moments. You breathe and try to lay them down, just to have baby start fussing again and wanting to be picked back up. Or, has your little one ever spit up after a feeding, even an hour or two after eating? Maybe they just burped, and something came up that gave them a sour face? Or baby started to move their tongue in and out and then you notice them swallow hard and fuss a little bit? All these babies are likely experiencing infant reflux.

What is Reflux?

Reflux, or Gastroesophageal Reflux (GER), occurs when contents from the stomach go back up in to the esophagus, the muscular tube that connects the throat to the stomach. The contents are then either pushed back down to the stomach as the esophagus contracts, or move up the throat and may become spit up or sometimes vomit. A lot of people experience reflux, and it does not bother them. Others may find it briefly uncomfortable. Sometimes it may be necessary to use medications to help reduce the discomfort.

Why Does My Baby Have Reflux?

Most infants have reflux because the opening from the lower esophagus to the stomach (aka the lower esophageal sphincter) does not mature until a baby gets closer to one year of age. It has been reported that as many as 60-70% of babies 3-4 months old experience vomiting related to reflux at least one time in a 24-hour period. Gastroesophageal Reflux tends to peak in infants around 4 months and spitting up tends to decrease around 12 months.

For many infants reflux does not cause a lot of problems, and they do not experience fussiness when they spit up, continue to gain weight appropriately, and stay on track to meet developmental milestones. When complications arise from reflux it is referred to as Gastroesophageal Reflux Disease (GERD). If left unmanaged, GERD may lead to: failure to thrive, respiratory infections and/or possible asthma, scarring or strictures in the esophagus, ulcerations, inflammation of the esophagus, or abnormal and feeding aversions to bottle, breast, and solid foods. As children get older they may be called “picky eaters” or limit what they eat due to discomfort or pain.

Signs and Symptoms of Infant Reflux

Signs and symptoms of GERD in infants may go beyond spitting up and/or vomiting. The following may be some indications that your infant is experiencing GERD:

• Difficulty latching or staying latched on a bottle or breast
• Aggressively attacking the nipple for 1-2 ounces then pulling away, arching back, and crying
• Prevalent coughing, choking, wet burps, or aspiration (when contents enters the lungs)
• Sour smelling breath
• Wheezing, difficulty breathing, frequent upper respiratory infections
• Coughing when laying on their back during naps or at night
• Being irritable and fussy
• Preferring to be fed in a more upright position
• Arching their back or making a bobbing motion with their upper body
• Not rolling over when developmentally appropriate
• Failure to gain weight
• Difficulty transitioning to solid foods

Strategies to Help with Infant Reflux

Feed baby in a side lying position to decrease infant reflux

This position mimics the natural position of breastfeeding.

• To get in the correct position, place your legs together and feet on a box or something where your feet are approximately 1 foot off the ground.
• Hold your baby so that they are lying on their side, with their toes and nose in the same direction, ear towards the floor.
• Support their head and neck so it does not lean back with one hand, and use the other hand to hold the bottle.
• In this position the baby can take a break when they need to, and it eliminates any pooling of the milk in the back of their throat, like if the baby was positioned with nose towards the ceiling. It is a safer feeding position as gravity assists the baby so that they can pace their feedings better and minimize coughing and choking.  This also promotes a nice suck, swallow, breathe pattern.
• A YouTube video, the Beckman Bottle Feeding in Sidelying, is nice resource.

Keep baby upright

Hold your baby in a more upright position for 30 minutes following feedings, if possible. Gravity can help contents stay in the stomach in this position. Be careful not to jostle or bounce your baby too much while the food is settling. Walking around and moving about are fine as this may also be comforting.

Try smaller, more frequent feedings

Feed your baby slightly less than usual if you’re bottle-feeding. Or, cut back a little on the amount of nursing time if you’re breast-feeding. Increase frequency of feedings to ensure appropriate weight gain.

Take time to burp your baby

Frequent burps during and after feeding can keep air from building up in your baby’s stomach.

• To burp, face your baby out, at an angle, with their feet resting on your thighs.
• Brace their upper chest with one hand and gently pat their back, 1 tap per second.
• Your baby may push against your legs, helping them to release any gas they may have. A YouTube video, the Beckman Happy Baby Burping Position, is another great resource.

There are a variety of strategies to help with reflux, but if signs/symptoms persist or worsen, please contact your pediatrician. For additional general information on reflux, MOSAIC has competent feeding therapists that can address your questions. They may be able to assist your family if your infant or child is having difficulty with eating at any age.

What are the effects of stroke on speech and the ability to swallow? We often don’t think about the act of speaking or swallowing. After all, we have been doing so since before we can remember. A stroke changes all of this. A stroke is an injury to the brain that occurs when blood flow is blocked or reduced. Severity of symptoms following a stroke vary from mild and transitory to severe and permanent. After a stroke, you may not be able to speak clearly or at all. You may be unable to follow directions or conversation or have difficulty coming up with words or putting words into a sentence. A stroke may also cause you to have difficulty swallowing. During the rehabilitation process you will likely work with a speech–language pathologist and hear the following medical terms.

Effects of Stroke – Aphasia

Aphasia is a language disorder that occurs after a stroke. It may make it difficult to talk, understand, read, and write.  When talking, a person who has had a stroke may not remember the word they wish to say. They may say a different word such as “cup” when they mean “plate,” mix up sounds in words such as “pick diller” for “dill pickle,” or use made up words. They may even have trouble saying longer sentences. A person who has had a stroke may not understand what is said when they are listening to family or friends. This is especially true if the person is speaking quickly or in a noisy room. They may no longer understand jokes. It is not uncommon to also have trouble reading books or forms, spelling words, writing notes or cards, and doing math calculations.

Dysarthria/Apraxia

Dysarthria and apraxia make it difficult for stoke survivors to say sounds, resulting in speech that is hard to understand. Dysarthria is a weakness in the muscles of the mouth, lips, tongue, and in muscles that control breathing. It makes it difficult to say sounds clearly or loudly enough. Apraxia also makes it difficult to say sounds correctly, but for a different reason. Apraxia is not muscle weakness; it is difficulty getting the muscles of your mouth, tongue, and lips to move the correct way to say sounds.

Dysphagia

Dysphagia is difficulty chewing and swallowing. It involves the muscles of the mouth, throat, and esophagus (tube to stomach). People with dysphagia may drool, lose food from their mouth when chewing, have food left in their mouth after swallowing, complain of food getting stuck in their throat or of pain when eating, and cough or choke during meals. Often people will lose weight, become dehydrated, or be unable to swallow pills.

A speech–language pathologist treats all of these impairments. The specific technique used will depend on the impairment and the severity of the impairment. Family members may also participate in therapy sessions to better understand the effects of a stroke and how to help a person recover function. If a person has a severe stroke, a full recovery might not be possible. Family members will be taught to help that person compensate while remaining as independent as possible. Recovery time from a stroke varies, but beginning treatment early will help a person who has had a stroke regain lost skills more quickly.

Check out Speech Therapy Treatment for Adults for more details on how speech therapy can help. For more resources or to learn more about strokes, visit stroke.org.

You have probably heard the terms gross motor skills or gross motor milestones. But what do those phrases actually mean? A simple way to think about gross motor skills are to think of them as BIG movements or movement of large parts of the body. More specifically, gross motor skills are skills that involve the large muscles in the arms, legs, and torso (core). Gross motor milestones are gross motor skills that typically develop at a certain age.

Most of the time we think about the gross motor milestones, such as:

• Rolling
• Sitting
• Crawling
• Walking
• Jumping

But there is SO much more to gross motor development. Gross motor skills encompass movement, balance, and coordination. Babies and kids need to master all of these areas in order to participate in activities. Activities are more complex movements that requires multiple gross motor skills put together. Things like riding a bike and playing sports. Gross motor skills build on top of one another. If one is missing, or the quality of it is poor, it can change the quality of the next skill or even delay it from happening.

Jumping

Think about jumping. What does a child need to be able to do? Stand. Squat and return to standing. Generate enough power in their knees and ankles to get off the ground. Arm swing. Have enough balance to land without falling. Vision. The child must see where they are jumping to so they don’t run into or land on an obstacle. If a child is missing any of these skills, they will not be able jump.

Basketball

Now think about playing basketball. There are tons of skills a child needs to be successful. The ability to run and jump. To catch and throw a ball. To shoot a ball. Each of these requires mastery of multiple skills to be able to do them. And then the child needs to be able to put all of these skills together and do them simultaneously. However, that doesn’t take the social emotional or cognitive requirements into consideration. Movement is so incredibly complicated (an amazing) when you really think about it. Which is why, as physical therapists, we focus so much not just on can you do it? But can you do it well?

And why we constantly talk about tummy time! Above all, doing supervised tummy time with your baby from day one prepares them for successful development. If you have questions about when your child should be doing what, check out the CDC’s Milestone Moments. To learn more about how to help gross motor skill develop, check out our articles here.

The first part of Breastfeeding Myths focused more on mothers and their bodies. This second section looks at myths of breastfeeding related to the needs of a baby.

Newborns need to be on a feeding schedule

Newborns tend to eat every 2-3 hours, but that can vary depending on how they feel, comfort, growth spurts, etc. Sometimes your little one may cluster feed – wanting to be at the breast frequently during the day. Reading a baby’s feeding cues is important, such as getting restless, turning head side to side, smacking and licking lips, or moving hands to mouth.

Babies only need to breastfeed off of one side

In most breastfeeding relationships, babies will nurse from both sides. Babies may take similar amounts of milk from both sides or take less from the second one. Initially, try to give your baby the opportunity to take both breasts during a feeding. As your milk adjusts and baby continues to grow, watch for signs baby is not interested or seems satisfied after eating on only one side.

Babies won’t breastfeed if they have had a bottle

A lot of babies are successful switching between breast and bottle. Even giving one bottle per day helps babies adjust to going between both. This can be especially important if a mother is going back to work.

Babies won’t breastfeed if they use a pacifier

Babies use sucking to help soothe themselves for the first 7-9 months of life. Some women allow babies to be at the breast to soothe and others prefer to use a pacifier. Just because a baby is allowed a pacifier does not mean they will not breast feed. If choosing a pacifier, educate yourself on the types and shapes appropriate for good oral development.

Do not use formula if you want to breastfeed

A lot of mothers use a combination of breastmilk and formula to feed their babies for a variety of reasons. When picking a formula, it is important to educate yourself on the types and preparation of formula to choose the best one for your baby. If you choose to use formula and still want to breastfeed, continue offering the breast to your baby as often as possible. Do not go longer than 3 hours during the day either offering the breast or pumping, as going longer can start to reduce milk supply.

It can be difficult to wean a baby if they breastfeed for longer than a year

There is not solid evidence to support that it is more difficult to wean a baby after a year. There is a lot of evidence to show that breastfeeding babies longer than a year, and even two years, is beneficial. This definitely does not mean that you have to or even want to. All babies and mothers are different, and you have to do what you feel is right for your feeding relationship with your child.

Breastfed babies tend to be more clingy than non breastfed babies

Each baby has a different personality. Some babies may appear clingy and others not, though this does not necessarily depend on being breastfed. Every baby is different no matter whether they are fed via breast, bottle, or a combination. The important thing is to hold, nurture, and love your child so that they feel safe and secure as they grow.

Babies can also experience difficulties with their latch when feeding at the breast or bottle, contributing to feeding problems. If you feel your baby is having difficulties, contact a professional such as Alyssa Lundquist, a speech-language pathologist AND certified lactation counselor. Or if you are wondering about more myths related to breastfeeding, click here.