Weighted Vest

Can we use weighted jacket for my child? Is a weighted blanket beneficial? Can a body sock help?

These are questions that parents ask me frequently. But a clear answer is difficult without considering many perspectives. 

Weighted vests and compression vests have been used by therapists to provide deep pressure input to the trunk which is known to improve attention, decrease fidgety movements, and promote self- regulation in a child. All of these lead to better performance in general.

The purchasing cost of these products in India have significantly come down during the last few years. Yet, in my perspective, the affordability of these equipment for a middle-income Indian household remains low. When several sensory equipment are available now in the country, how do you figure out which one is useful or not, which one is better than another, and what would work for a particular child during a certain time period?  

There are other equipment too - swings, rocker board, therapy ball, fine motor toys, sensory fidgets. What can parents buy, what can they avoid buying, how much investment can they make, and how do you decide one versus another.

Product Picture from Amazon

This post is about the weighted and pressure vest, the body sock, and the weighted blanket.  Each of these provides deep pressure input, and in that they are similar but not the same.

The body sock is made of lycra, one can think about it as a lycra sack with openings in the centre.  A child wears it, and moves their body segments or moves the body as a whole while being in the body sock. Lycra material provides some resistance and therefore proprioceptive input to the body. Most children enjoy wearing this body sock, but there are many others who are not willing to put it on, or cry when the mom attempts to make them wear it.

Product Picture from Amazon

The weighted blanket is useful during sleep time or nap time, or for draping it for a short time during wake hours.

The weighted vest and the compression vest offer deep pressure input. The proprioceptive input through each is similar, but not the same. The weighted vest provides a sense of grounding to the body. The compression vest provides a sense of ‘continuous hug’ to the body.

In a nutshell, each of the four equipment is beneficial to a child with autism, ADHD, and sensory processing differences. Points to consider prior to buying-

1. Is the child going to allow you to put it on in the first place? As described with a body sock, many children are not willing to put on the weighted vest. It may take many attempts to try putting it on before the child accepting it. This requires parents to be extremely patient for many days or weeks.

2. If the child does like it and wears it, will they leave it on for 20-30 minutes prior to removing it? India is a tropical country and we don’t live in air-conditioned rooms all the time. Except for winters, a child feels hot and perspires while using the weighted vest. The compression vest has to be carefully worn, because it may affect the child’s respiration and air exchange if there is increased compression.  

3. Some children don’t like to cover themselves with a regular sheet or a blanket, which rules out the use of a weighted blanket. But if the child has serious sleep issues, a weighted blanket is highly likely to help.

4. The last and most important information I would like to share is that there is no single equipment that would be magical. It would only be helpful, but not a concrete solution. For a child to make gains in therapy, we need a variety of equipment and variety of material, as well as repetition / persistence.

5. Research findings have not reported significant behavioral changes in children using weighted vests.

Using the Indian ingenuity or jugaad, I use weight cuffs on ankles or the abdomen during therapy sessions. But I admit that most children take them off immediately or cry or refrain from allowing us to put them on. So we keep trying for many sessions, sometimes for weeks and months.

The weighted vest is viewed as a passive equipment. In order to provide active proprioceptive input, do the following frequently and consistently. These are examples of active physical work by the child; the brain always learns better during active engagement.

·       Have your child push a heavy chair frequently and make a game out of it.

·       Have them pull a weighted trolley bag in the house, and in the apartment grounds.

·       Have them wear a backpack that weighs 10% of their body weight and take them for a walk.

·       Climb the ladders and use the wall climbers in the park.

In my clinical experience in India, I use the pressure vest for infants and toddlers to achieve a better trunk control during therapy sessions…..only during cooler weather in Bangalore.  Very few parents, about less than 5% have bought a weighted vest or a body sock. And after buying, either they have not been able to use it for more than 3-4 months or used sparingly due to personal reasons.

Some parents have bought therapy equipment as suggested by other therapists, and then have complained that it was not useful. For others, there was a complain of lack of space and a sense of frustration as to ‘how much can we buy’?

Due to all the reasons discussed, I refrain from asking any parent to buy therapy equipment, particularly when cost is a factor, the weighted vest being one of them. Parents can try it out - but cost, usage, storage, and the amount of benefit it will provide to your child is debateable. 

Note: Another option is to buy an inexpensive jeans jacket which most likely has 4 pockets in front. One can stitch patches of cloth behind too. Make small sand bags and insert them into the pockets. You have made a weighted jacket in the least expensive way. A few of my parents have done this many years ago. 

Before buying a weighted blanket, maybe you can do a trial of using 2-3 blankets at a time to see if your child keeps them on. 

 #weightedvest #weightedjacket #bodysock #weightedblanket #compressionvest #sensoryintegration  #deeppressuretouch #deeppressureinput #proprioceptiveinput #proprioception #attention #focus #movement #selfregulation

 

 

Walker for my Baby?

Can we suggest a walker in babies with milestone delays as they have less lower back strength? 

This question is frequently asked to me by parents and fresh therapists alike. Walkers become an attractive toy for young parents because they offer mobility to a young child. 

  Walkers can vary in their design and therefore serve different purposes. This is one type of walker, an upright push-toy that my own kids used in the 90s. 

  Product Picture from Amazon

In contrast, the walker shown above has 4 wheels and a sling seat. Many parents use this walker because they feel that the baby will start to walk earlier. However, research looking into the walker conveys the opposite. Using a walker does not or may not help the baby to walk, but rather interferes with the development of important milestones. When this walker is used early on, starting around 7-8 months of age, muscles of the body do not get utilized the way they should be, as a part of development. And hence can sometimes have negative implications in the child’s future.

In my long experience as a pediatric physical therapist, I witnessed the time when these walkers (wheels and hammock seat) were banned in the USA in the late 80s. Much later in 2004, Canada placed a ban on all sales of these walkers including the used ones at yard sales. In the late 80s, I was working in New York city. At the time, in the world of pediatric physical & occupational therapy, there were discussions about the negative consequences of this walker.  Experienced therapists who worked with babies were quick to observe the drawbacks of using this walker. I do not remember how those walkers came back to the market, because I did not see them in the 90s when my own children were growing up in the USA.

There are many articles online that discuss the pros & cons of this walker. Some favorable arguments state that besides mobility, putting the child in the walker provides some respite to the mom. Others speak about the safety hazards when young children use the walker.

Being a pediatric physical therapist, I would like to speak about developmental concerns when an infant is placed in a walker for prolonged time periods.

When parents use the walker for a 9-10 months old child with  typical development, you are taking away the opportunities for tummy time, crawling,  tall-kneeling, and pull-to stand, all of which hold multiple benefits.  Frequently missed opportunities of these crucial movements result into compromised trunk muscle stability and core activation. Weight-bearing on the feet may not be adequate and can possibly lead to toe-walking. Furthermore, the muscle work that occurs numerous times during transitions between various body positions – lying to rolling over, sit-to-all fours, crawling to sitting, sit-to-kneel, pull-to-stand……that is so important for sensory & motor development…..is missed out. (Hence the importance of a moving infant spending time on the floor; today it is called as floor time. Traditionally, floor time was amply provided to babies so that they could roll over, come to sit, and progress to crawling that would lead to exploration of the environment).

Amongst children with developmental delays, prolonged use of this walker is likely to cause abnormal tightness in hip abductors, hip external rotators, and the tendo-achilles muscles. Other likely consequences would be decreased proprioception through the lower trunk and the lower extremities. Hence trunk strength, weight-bearing through the hands & upper body, cross crawling, trunk rotation, all do not develop adequately and lead to deficits in vision perception, vestibular processing, and reflex integration. All of this is sensorymotor development that occurs during the first 2 years of life. When the child has developmental delays, you are causing further deprivation of sensory-motor components by using a walker with wheels and hammock seat.

I am not trying to project that only after crawling, a child can walk. Rather, in early intervention session, I include many positions in parallel -- prone, all 4s positions, weight-bearing in supported standing if possible.  And gradually progress to walking with pushing a heavy chair (any chair with weights on it), while I facilitate the lower extremities as needed.

The consequences of using a walker may look different for different children, and are likely to be realized only after a few years. I have many children starting grade 1 in regular schools who have been referred to me for handwriting and attention. They have a history of not crawled or used the walker in early childhood. And now at 6 or 7 years of age while in grade school, they have poor core strength, weak hands and finger strength, thus leading to issues with handwriting and attention. I believe that young parents need to be educated about the role of tummy time and crawling and the value of transitioning between positions frequently as an infant. 

I absolutely agree that we need early mobility for our children with developmental delays, but not at the compromise of trunk stability and weight-bearing through various joints. The early mobility can be provided to the child in other ways.

Watch the following video; this walker was used more as a play item, months after the child has achieved independent walking. This child is using the push-toy walker just as if it was a cart. He steers it, pauses to bite on an apple while holding on to the walker, and uses the walker to run fast. This is a 22 months old child. He is learning how to steer the walker, turn it around, pull it and push it with the right force required. In the process he is learning so much  – body-spatial awareness, force gradation, and sense of direction.

There are Indian versions in wood material that children of my generation had used decades ago.

 

 

Product Picture from Amazon

However, we did enough crawling, prone, rolling, and pull-to-stand prior to using these. And that made all the difference in development as well as learning!

#childwalker #babywalker #walking #balance #trunk #hip #crawling #sensory motor #childdevelopment #movement #mobility #injuries