Feeling crushed by physio - she just wn't crawl

[Sleepstarved]

Our problems are pretty minor compared to most on here but I know some of you will understand.
DD is 15mo and has gross motor delay but no-one knows why.
Physio has said its a significant delay and her development is fragmented.
On paper she sounds ok, can roll, get up to sitting, sit unaided, get from sitting onto knees by pulling on furniture, commando crawl, cruise and walk holding two fingers.
Her problem is she can't crawl on all fours so can't really pull to standing. She also cannot stand unsupported although is getting there. She is incredibly cautious.
She is progressing but v slowly and physio says no point seeing her more than monthly.
Portage assessed her as borderline and is already talking about dropping her from weekly to fortnightly even though only seen her 3 times.
DD had some words, daddy, ca for cat, woof sometimes, spoon sometimes but that has all gone recently.
We have done everything we can think of to get her to crawl, she will go over cushions, legs ect but keeps sliding legs back so she is on belly. She has only recently restarted pushing up on straight arms (did I at 7mo but stopped).
At wits end. If only she'd get on to all fours the rest would soon follow.
Any ideas?

Oh, mama, how did I ever miss 'this way, that way, forwards and backwards, over the deep blue sea', for the gym ball - it's ideal!! Perfect! I used to sing it as a brownie - how did I ever not make the link?! far too late for us, now, but I will deffo remember that one for everyone else! Will try to remember to attribute correctly!

I would use the long reaching stuff to pick stuff up and return to the centre, as well as to initiate moving from sitting to all fours... That way working on core stability as well... You can do similar with a physio roll, or bench, or anything she can sit on like a horse lol. She will probably need some pelvic girdle support from you, but any reaching from different sitting positions and returning to the centre is fab. It's much easier if you have a helper that can wiggle sparkly or interesting stuff just in or out of reach, all around her, whilst you are concentrating on keeping her pelvis secure. You do need three hands sometimes!

To be absolutely fair, it was some time before core stuff was isolated as a main cause of dd2's issues - early physio was v much centred on ticking boxes, so I don't think it's unusual. We had joint physio and ot appointments from just before second birthday, and it was really that team working in partnership that noticed the link between her core and wider issues, iykwim. So it all fell into place at that point, and made a lot of sense in hindsight. So although I had been doing some core stuff from v early, it wasn't picked up as a major signifier. Once we realised, we could trace movements and issues right back to newborn, though. V interesting stuff.

Hadn't heard that about scapulae and winging either, V interesting.

madwoman She arches her back sometimes to get back upright, physio says its compensatory for the weak core, not reflexy (CP has been pretty much ruled out).
She would hold her hands up in high guard when first sitting and will do it now when trying to get into sitting from lying over inflatable barrel ect if she can't 'walk' her hands backwards.
It is also a major tantrum thing, along with smacking her forehead into the floor

sneeze, no winging from what I can tell. She does seem more comfortable with straight arms than she did maybe two months ago, so maybe it is coming. Its glacial pace though .
I know crawling is important but I really wouldn't mind at this point if she doesn't do it.
For me the real problem is that she can't really pull to standing from her commando crawling position so needs to be on all fours for that.
She is a bit stuck and cannot connect the commando crawling and sitting to the standing holding on and cruising that she can already do.
That's what the physio means by fragmented development, it has always been the transition movements she has found hard.
DD is so confusing.

Hmm sound like hypermobility to me. Are her feet flat?

Make sure you see someone who know lot about hypermobility eg paed rheumatologist or privately (nhs for under 5s only if complicated I think) at Gt Ormond St Hypermobility Clinic (see HMSA website).

We used a ladder stool made by Smirthwaite to help to learn to sit to stand - on loan from physio. Plus boots really helped.

See smirthwaite ladder back chair. Also heath field chair ie a heavy non tipping chair at right height so feet are on floor and arms at right height, and stable table. Physio should loan these or OT.

Ps! My child knelt at ladder and then pulled himself up to standing. Also did this at box side.

Sleepstarved, I have 3 DSs and none of them crawled (but they all bottom shuffled) and all were late walkers. DS2 was probably officially delayed with his gross motor skills, but I never had him checked out (sat at 9 months, didn't walk till 21 months). Also none of them learned to crawl until after they could walk. DS3 was very delayed, however and didn't sit without falling over till 12 months and couldn't sit from lying down till he was nearly 2 I think. He walked at 2.6.

We were referred to the physio for him and were only seen a few times (maybe 2/3 times a year), but like others have said, his delays were in part due to hypermobile joints. He also had low muscle tone in his lower body. One thing that was quite helpful (apologies if it's been mentioned already - haven't read whole thread ) was one of those inflatable rolly things that you can buy for crawling babies to push across the floor (I think ELC or mothercare do them). We found that putting this under his tummy gave him support and also encouraged him to take weight on his arms and legs.

DS3 is 3 and a half now and only started crawling recently (also hated being on his tummy) although he can run!

Physio should be more than up on hyper mobility though, ESP if they have already identified low trunk tone.

Yy to ladder etc, physio arranged all of ours. Didn't get a heathfield until over 2, though, had a jenx giraffe up to that point. Ditto with piedros etc, usually reserved for slightly older children as most indie shoe shops sell supportive boots with good ankle support for tinies (although op has said no issues with rolling ankles etc).

Tbh, whatever the cause of the hyper mobility and/ or low tone, the therapy is identical, and the physio should be more than capable of dealing. We've only had one pants physio, but it is irritating!

Physio doesn't think hypermobility is much of an issue if at all.
No mention of any of this equipment from her.
Is she sh*te? How do I handle that with her tactfully? She has had the most contact with DD and knows her best out of any of the professionals involved.
I could raise it with portage or get DD assessed by a private physio.
We see local paed soon, can raise it then.

From my experience, not all physios are hypermobility aware. Thank goodness for Gt Ormond St HMS Clinic. This clinic - nhs and private - sees a lot of hypermobile children unlike the usual physio - see HMSA website re nhs referral criteria.

practically thanks. I think I may raise this when we see the local paed next week and see what she thinks about hypermobility and if the physio is adequate.
I can also ask about the GOSH clinic next time we see our paed there.
I wonder if its possible she is hypermobile in her hips but not her ankles or feet. That is where DD is wobbliest.
DD would not need the heathfield chair as she can sit on any chair/stool at right height and play at a table with good posture.
The ladder back chair may help with getting to standing but the physio has said she doesn't want her pulling up with her arms, she wants her pushing up with her legs iuswim.

If she's hypermobile in her hips with low tone in trunk this will be good reason for delay as the whole core area will be unstable. I found the physio didn't mention DD's hypermobility at all until I raised it - it was the low tone causing the major issue as hypermobility is pretty common and doesn't usually cause an issue unless severe or coupled with other issues.

PS (have namechanged from Survivingspring - my DD also has the weak core/low muscle tone and slight CP!)

Sleepy. The book 'teaching motor skills to children with cerebral palsy and similar movement disorders' from amazon (can't copy and paste on iPad ) talks about how these children develop skills out of sync or not at all, affecting their development. It teaches transition in pictures!

Second everything said about the weak core....everything stems from that and we are concentrating on that and building strength generally.

Madwoman... I get a bit bored with all the repetitive rhymes and exercises and change the words...eg 5 little monkeys jumping on the bed.....social services get called in the end to that slack mother with 5 head injured monkeys!!

Hip sockets aren't formed properly until they start weight bearing, so the cups are shallower at the this point anyway (dd2 had annual hip x rays to check for hip subluxation etc as her hip sockets were initially quite flat - once she was using a standing frame and walker they deepened though. (untechnical description lol). From what you say, this sort of intervention isn't likely as she's trying to pull to stand and cruise, it's just the crawling that's the issue.

(ya gotta love monkeys! )

Still waiting on a new upright stander, DGS doesn't do enough standing, never seems enough hours in the day, but will get cracked on with a proper schedule
...been slacking a bit lately. Having a week off though as we all need a break and DD and family on holiday, even though weather is yuk.

We all have slacker months days. you have to be a mum/ gran as well as a therapist, and sometimes kids need to be three year olds instead of patients...

sneeze I bought that book but physio got a bit sniffy and said DD did not have a movement disorder or CP, so thought lack of bunny position ect was not important.
But anyway, I got her to do it a little bit the other day and she tolerated all fours for a little while, reached out for toy ect like that too.
She will walk holding a wooden spoon now feels safer with something in her hands and me just holding her shoulders - she would only hold two fingers before.
But today portage said DD needs SALT referral so am a bit but not surprised.
Will get ears checked too.
Am still by lack of strength exercises from physio but DH (who does all the stuff as is a SAHD) says this is because DD has point blank refused to cooperate if pushed in that way.

Thank you madwoman for my get out of jail free card

Sleepy. So physio sniffy cos DD does not have a movement problem.........but sees a physio

I also have ANOTHER book (got lots!) about normal motor development in huge detail and it also goes on about bunny, crawling, shoulder girdle strength etc !

You can never get a toddler to cooperate in exercises, but need imagination to make it a game. Easier said than done!

As for SALT takes forever and by the time they arrive DD will be chatting away.

Not diagnosed with movement disorder only delayed I guess is what she means.
I am losing my temper with her TBH because one session she was impressed with her cruising and wants us to challenge her then next she is unimpressed because it's irrelevant if DD cannot get up to cruise on her own.
Make your mind up!
Have resolved to ask paed if someone else should look at her.
Am down about SALT, portage had no idea how long it would take. We could get her assessed privately, have seen there are a few in our area.
Anyone got any experience of that?
Does this mean a global delay is more likely? Speech and motor seem connected but not in a simple way....
Thanks for sticking with me sneeze and madwoman - I am going on rather.

Is the only physical issue the not crawling or are there other things that the paediatrician is concerned about? Medically, crawling is NOT a developmental milestone and some children never do it- it sounds like she has her own way of getting around and is on her way to walking, anywhere within 8 months and 2 years is normal, so she has plenty of time to gain strength in her own time before it would be a worry.

Well, it can all be linked with low tone - dd2's does impact her speech, because her oromotor is / was a bit pants too. Less likely to be muscle tone if she hasn't had any history of feeding issues though. We were told dd2 wouldn't talk because her oromotor was so crapola.

And I'm guessing that isn't the case with your dd - but it's worth thinking about feeding / drooling etc and seeing if there is anything that could be linked with tone.... Tis all v tricky. What is the SLT referral for? General delay? Dd2 had her SLT from birth so we didn't ever have the whole waiting list blah. Such a pita.

Am finding the physio sniffiness v odd. Lots of kids aren't dx with cp or specifics until past two, just called 'developmental delay' until they can't ignore it any longer, so her insistence is a bit odd. Why exactly does she need a physio, then?

Spoon holding excellent btw. was posting about that somewhere else, I think, about the holding onto 'something' being a good tip to try. Our therapists used short lengths of wooden dowel with scary freaking bunny pictures on. A wooden spoon would have been far less traumatic!