Peezing: verb

Sneezing and peeing at the same time

“I had no idea there was physical therapy for this!” This is one of the most common phrases I hear in my practice. Although it is gaining more exposure, many women still have not heard of pelvic floor physical therapy. A great deal of women I treat have been dealing with pelvic floor musculature dysfunction for YEARS. As you probably already know, physical therapists are specialists in the musculoskeletal system. However, what you may not know, is that a pelvic floor physical therapist has had more specialized training in the muscles that are known as your pelvic floor.

What Is the Pelvic Floor and How Can Physical Therapy Help?

Pelvic floor muscles are a group of muscles (not just one) that attach along the brim of your pelvis. The pelvic floor muscles are oriented like a hammock. They connect to your tailbone in the back and to your pubic bone in the front. The pelvic floor’s main functions are helping control urination, sexual function, helping control bowel movements, core stability, and organ support. When these muscles are not functioning properly, incontinence (which includes peezing), constipation, a heaviness feeling, and/or pelvic pain may occur.

If you are experiencing any of these symptoms, please contact MOSAIC at (406) 388-4988. We can discuss if physical therapy will be beneficial for you. We can help with acute (new) or chronic (longstanding) problems that are unique to women.

So there, now you have a name for when you sneeze and pee at the same time. Aaannnndddd you know there is help for these symptoms. So don’t let peezing be your normal!

Click here to learn more about MOSAIC’s pelvic floor physical therapy programs! The American Physical Therapy Association’s Section on Women’s Health also offers information on many pelvic health conditions.

It’s an exciting time when your child starts using words to communicate…but when do speech sound errors like “tar” for “car” go from cute and age appropriate, to areas of concern? Specific sounds and speech patterns develop at different times, improving how well a child is understood by their parents, peers, and caretakers. By 18 months, a child should be at least 25% intelligible to their family, meaning that parents understand about a quarter of what is said. At 24 months, children are 50-75% intelligible and should be approaching 100% intelligibility at age three. Speech errors can be expected and age appropriate or unexpected. These errors come from two different concepts:

Speech Sounds – Phonology

All children make predictable errors as they are learning to talk like adults. These are called Phonological Processes and are common substitutions or distortions of sounds that fade as the child gets older. These errors are considered “expected,” so long as they do not persist past the age of elimination. For example:

• Backing: When velar/back sounds, /k, g/ are replaced with alveolar/front sounds, /t, d/. This typically resolves by 3.5 years old. (i.e. “tootie” for cookie or “boot” for book)
• Stopping: When an air flow sound like /s/ or /z/ is consistently replaced with a stop such as /t/. This resolves between age 3 and 5. (i.e. “tand” for sand)
• Final Consonant Deletion: leaving off ending sounds in words. This typically resolves by 3 years old. (i.e. “boo” for “book”)

 Articulation

Articulation errors come from producing a sound inaccurately, based on the placement of the articulators in the mouth, distorting the sound we hear. A common example of this would be “thoo” for “zoo.” The child is putting their tongue in the incorrect place (between their teeth), causing what we perceive as a “th” instead of a /z/. Specific speech sounds typically develop as follows:

• By age 3: p, m, h, n, w, b
• By age 4: k, g, d, t
• Between age 3-6: l, s, r
• Between age 3.5-7: ch, sh, z, v, th

During an evaluation, speech therapists consider all of these factors, along with oral motor planning and sequencing, to create a treatment plan for each individual child if help with speech sound development is required. To learn more, check out another MOSAIC Speech Sounds blog.

Additional Resources include:
www.asha.org
www.speech-language-therapy.com
www.ldonline.org

Body mechanics play a significant roll in preventing and treating pain of all kinds. Poor body mechanics can place additional stress on certain areas of the body which can cause irritation or inflammation.  Here are a few general recommendations:

• Lift heavy objects with even weight distribution. Lift with the legs when possible, keep your core engaged, and avoid bending forward. This is especially important when picking up kids or babies.
• Avoid lifting heavy weights from awkward positions. If you have a child with a crib, lower the side of crib before reaching in, or stand on a stable platform or step to improve body mechanics and alignment.
• Avoid crossing of the legs or side sitting when possible.
• Do not hold a child, baby, or other heavy objects on one hip. Keep heavy loads, including children, close to your body and positioned in front of you. For children, you may also want to use a pack or baby wearing wrap.
• Avoid standing with the majority of weight on one leg where the hip juts out to the side. Again, even weight distribution.
• Adjust your sleeping position. If you are a side sleeper, try putting one to two pillows between the knees. Placing 1-2 pillows under the knees can take stress off of the SI joint and low back, if you sleep on your back.

If you are having pain and these suggestions do not resolve your symptoms, it may be time to see a Physical Therapist for a more thorough assessment and treatment plan. For more information or to schedule an appointment, contact MOSAIC Rehabilitation at 406-388-4988 or visit mosaicrehabmt.com. Also, check out our guidelines on how to set up a computer workstation.

Screen time is an inescapable reality today. There is however, strong research that too much screen time can have serious health consequences. In November of 2016, the American Academy of Pediatrics released a policy statement with research backed positions regarding screen time and young children. Continue reading for a summary of that statement.

Who Should Have Screen Time?

Under Age 2

Children in this age group learn best from face to face interactions and adult conversations and play. Screen time in the form of face timing or skype is acceptable for children under two. This is according to the American Academy of Pediatrics. However, any sort of screen entertainment before the age of 2 can be harmful to learning and attention development. This even includes learning based screen use.

Preschoolers Aged 3-5

Children in this age group can learn from interactions with media. But, their brain best absorbs the information when it is shared with an adult. Additionally, learning based apps and shows are most helpful when an adult or older peer is interacting with the media along side them. Choose apps and shows that have variety in content and encourage two player interactions. For instance, Sesame Workshops and PBS Kids apps and shows have research backing their ability to help kids learn early reading and math skills. In addition, it’s important to keep screen time to about one hour per day, tallied up between all screens.

Skills that help learning and school readiness the most include: the ability to control emotions and impulses, flexible thinking, and sticking with a difficult task. These are learned best through interactions with parents, other caring adults, or playing outside with friends. These skills are not well learned through digital media.

Older Children and Teenagers

Children in this age group benefit the most from learning the skills of balance. Spend time modeling healthy screen use. Talk with them about how a balanced life includes some screen time but also play, school, and sleep. Sit and watch with kids or engage in the same social media sites your teens are on to stay up to date. Keep internet accessing devices in public rooms of the house.

Where Is Screen Use Appropriate?

Create “screen free zones” and “screen free times of day.” Use screens in small doses in group areas of the home, such as the dining room or living room. Save bedrooms for sleeping. Use driving in the car, shopping trips, and waiting in waiting rooms as opportunities to talk with your child. Discussing the world around them supports language skill development in young children and gives older kids a chance to connect through story telling or sharing their latest interest with you.

When To Use Screens

Avoid screens first thing in the morning or within a 1 to 2-hour window of bedtime. Our sleep hormones and sleep rhythms are regulated by exposure to natural light. Looking at blue light, the light emitted from screens, tricks our brain into being more awake and can upset healthy sleep-wake times.

How Do I Navigate the Ever Changing Apps and Media Options For Kids Of All Ages?

Access online support systems like commonsensemedia.org. “Common Sense Media helps families make smart media choices. We offer the largest, most trusted library of independent age-based and educational ratings and reviews for movies, games, apps, TV shows, websites, books, and music. Our Parent Concerns and Parent Blog help families understand and navigate the problems and possibilities of raising children in the digital age.”

Build a Family Media Plan with healthychildren.org or use their Media Time Calculator https://www.healthychildren.org/English/family-life/Media/Pages/default.aspx.

Has your little one ever spit up after a feeding? This may occur even an hour or two after eating. Maybe he burped and something consequently gave him a sour face? Or he started to move his tongue in and out for example, and then you noticed him swallow? If so, he was likely experiencing reflux.

What is Reflux?

Gastroesophageal Reflux (GER), simply referred to as reflux, occurs when contents from the stomach go back up in to the esophagus (the muscular tube that connects the throat to the stomach). Then, the contents are either pushed back down to the stomach or move up the throat, subsequently becoming spit up or sometimes vomit. Dr. Kay Toomey, pediatric psychologist, reports that children and adults may reflux up to five times following a meal, however, it typically does not bother them.

Is Reflux Normal?

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

For many infants this does not cause problems. They do not experience fussiness when they spit up, continue to gain weight appropriately, and stay on track to meet developmental milestones.  However, when complications arise from reflux it is referred to as Gastroesophageal Reflux Disease (GERD). Above all, if left unmanaged, GERD may lead to: failure to thrive, respiratory infections and/or possible asthma. Furthermore, it could also lead to scarring or strictures in the esophagus, ulcerations and inflammation of the esophagus. Sandifer syndrome (a combination of GERD and abnormal movements of the back and neck that may look like your little one is having a seizure), or feeding aversions to bottle, breast, and solid foods are also complications which may occur. In addition, as children get older they may be called “picky eaters” or limit what they eat due to discomfort or pain.

Do Infants With GERD Always Spit Up or Vomit?

In short, infants with GERD may not spit up or vomit every time they experience reflux.

Indications 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 consequently, aspiration (when fluid enters the lungs)
• Wheezing, difficulty breathing, as well as 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

Signs and Symptoms Older Children are Experiencing GERD

• Have difficulty gaining weight
• Are described as a “picky eater”
• Limit the volume of liquids and/or solid food
• Prefer to “graze” throughout the day
• Vomit or report yucky tastes in their mouth
• Complain of discomfort in their chest or stomach
• Exhibit swallowing difficulties
• Have breathing issues such as asthma, wheezing, hoarseness, chronic coughing, or frequent upper respiratory infections

There are a variety of strategies to help with reflux, however, if signs/symptoms persist or worsen, such as the ones listed above, then your pediatrician may consider medical management or referral to a pediatric gastroenterologist. For additional information on reflux, MOSAIC has competent feeding therapists that can address your questions and assist your family if your infant or child is having difficulty with eating at any age.

References used for this article:

1. Citroner, G. Medically reviewed by Gill, K. ((2017, November 20). Sandifer Syndrome. healthline. Retrieved from https://www.healthline.com/health/sandifer-syndrome.
2. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Foundation for Children’s Digestive Health and Nutrition in collaboration with the American Academy of Pediatrics (2018). Parent’s Take Home Guide to GERD (Gastroesophageal Reflux Disease). Retrieved from https://patiented.solutions.aap.org/handout/aspx?gbosid=201474
3. Schwarz, S.M., & Hebra, A. (November 17, 2017). Pediatric Gastroesophageal Reflux: Practice Essentials, Background, Etiology, and Pathophysiology. Medscape. Retrieved from https://emedicine.medscape/com/article/930023-overview
4. Toomey, K. A. (2002/2010). Consequences of Gastroesophageal Reflux and Breastfeeding. Colorado Breastfeeding Update.
5. Toomey, K. A. (2002/2010). Developmental Timeline with Reflux.

 

Congratulations! You’ve had a baby! Now you get to experience all the challenges and joys that motherhood can bring. A mother’s world revolves around that little bundle of joy. Sure, now you may pee a little when you laugh and/or sneeze. You can’t sit up in bed as easily as you used to. Your usual exercise routine is so much harder. BUT, that’s totally normal and expected after giving birth to your little miracle…..right?

Oh my goodness, NO girl!

Mother’s bodies go through so many musculoskeletal changes during pregnancy to accommodate your growing babe and to get ready to give birth. It is really quite amazing. The not-so-fun changes include, but are not limited to, increased lumbar lordosis (curve in your low back), stretched out abdominal and pelvic floor muscles and tissues, feet “flattening”, and pelvic girdle laxity. Then, after that is all said and done, we’re expected to GIVE BIRTH?!! Whether we give birth via C-section or vaginally, why-oh-why would we neglect the fact that our bodies may need a little extra help healing and recovering?

What Can Help?

A good place to begin the healing process is with a visit to a women’s health physical therapist (PT). Your PT can address issues including bowel/bladder incontinence andsexual dysfunction. They can also address, diastasis rectus abdominus (your stretched out abdominal tissues) and postural impairments that may be giving you pain. Additionally, they can help you to implement proper body mechanics when caring for your baby. It’s always a good idea to check in with a women’s health PT after you’ve had a baby. They can help to make sure all of your pelvic floor and core muscles are working properly. They can also check to see if your tissues are healing, and will ensure proper progression of resuming your exercise routine.

How Can I Manage One More Thing!?

A notable barrier to seeing a women’s health PT is finding the time to make, and go to, an appointment when you have this new little one who depends on you for nearly everything. The good news is many women’s health PTs actually encourage their patients to bring their new baby as a teaching point. They can educate you on the proper way of carrying your baby and car seat so that you don’t hurt yourself further down the line. They can also help with positioning while breastfeeding to decrease the stress on your shoulders, neck, and back. So, go ahead, bring your little one along!

It’s Not Too Late

Another barrier women’s health PTs hear is, “I had a baby years ago, there’s no way my incontinence, my pelvic pain, my diastasis rectus, and/or my low back pain are fixable.” Not true my friend, not true. All of these issues can be treated at any age, regardless of how long ago you had your baby. Many women don’t actually have any symptoms of a weak pelvic floor until years after they have given birth.  So please don’t worry about your age if you are having pelvic floor dysfunction, any time in life is a good time to see a women’s health physical therapist!

Why would you wait to improve your quality of life when it can be done now? Taking care of yourself is the best selfish thing you can do.  The healthier you are as a mom, the better you can take care of your little one, and the less accidental peeing you will do when you laugh at all the silly stuff your kiddo will do while they are growing up.