Hey, did you hear? The PedsDocTalk Podcast is nominated for a Signal Award! We're sending out a little signal of our own and asking for your vote. It takes less than 3 minutes, and every vote helps more parents find the show. Thank you for listening, sharing, and being part of this community.

When the children were younger, they would sometimes sit in the W-sit and well-meaning people will DM me: "Dr. Mona, I've heard of W-sitting. Is that all right?"

My children do sometimes sit in the W-position. They also frequently sit in all sorts of other positions, are able to move in and out of these positions, and they also do planks with me when I work out. I am not concerned about their core muscles. However, I can see why the question keeps coming up. The W-sit has acquired a bad reputation on the internet, and once you've heard that, it's hard to stop noticing it.

I can also understand being a worried parent. My son suffered a stroke and had seizures, and for a long time I kept a close eye on his developmental milestones. When it came to speech, I was so determined to get him to talk that I never paused long enough to allow him to do so. All day I would say, "see red, see ball, see mama, see dada", and I'm certain that he just wanted me to relax. The worries we have ourselves appear in the way we play with our children, even when we know better.

Fear stimulates sales. A post with the message “if your baby doesn't crawl, then there's a problem” will attract far more comments and shares than one that says, “it depends.” As a result, parents end up skipping over very black-and-white guidelines regarding tummy time, crawling, W-sitting, and toe walking, guidelines which are often accompanied by a course for sale.

Official advice is no exception. When the CDC revised its milestone checklists in 2022, it removed crawling because the age range is so broad and some children who are developing normally never crawl at all. Many people online were unhappy about this. And although I see the mechanisms of crawling is crucial, I also know we are looking at the big picture. A baby who skips crawling and goes straight from sitting well, scooting well, and pulling to stand is very different from a baby who isn't moving or exploring at all or showing concerning signs in other motor skills.

One of the main reasons I wanted to speak to Jena Schultz, DPT, is that she is a pediatric physical therapist and forms part of the small group - only about 1% of physical therapists - who have board certification in pediatrics; she owns Driving Development, a pediatric physical therapy clinic based in North Texas, and is the mother of two children. In fact, Jena took a year off of social media because the fear-based messages were taking a toll on her, even though her patients were still exposed to that kind of content; when she returned, she set a new aim: to create her own path of reassurance rather than contributing to anxiety.

Most of the questions parents direct to Jena and me fall into a grey area. A developmental milestone that seems abnormal on its own can mean something completely different when you consider the child's overall situation. Since I am a general pediatrician, this is one of the main things I have to do; I have to examine how the child's motor, speech, thinking, and social skills relate to each other, and it is this broad perspective that enables me to decide whether we can just keep watching or whether it's necessary to involve someone like Jena.

I liked a phrase of Jena's: act early without overreacting.

She also has a view regarding tummy time that differs from what we often hear. And our conversation about crawling is filled with nuance and support of child development. 

Not all cases live in a gray area, and Jena and I are firm on head shape and preference for how the head turns in the early months. When I see babies, I am particular about this point and always look at the head from above, check where the ears are positioned, since in many instances a flat spot can be addressed by repositioning, and check the neck muscles. Jena has also explained how important timing is and that, with a young baby, those figures are worth listening to.

A baby having a flat spot doesn't mean you've done anything wrong, since some babies have softer heads and the position they occupy in the womb can contribute; in fact, Jena's second child had one as well, and it was dealt with by repositioning.

Milestone ranges exist, and in some cases these ranges are broad; towards the end of our talk, Jena gives a question you can ask yourself whenever something about your baby seems wrong, a question which will help you distinguish your instinct from online concern.

In this episode, we discuss the myths surrounding tummy time, examine the idea of skipping crawling in more detail, look at what to be aware of with W-sitting and toe walking, explain why it's important to detect abnormalities in head shape and torticollis early on, and consider how to decide whom to take advice from online.

You can listen to my complete interview with Jena Schultz on any podcast platform and see her on Instagram under the handle @drivingdevelopment.

I am so grateful that you continue to make space for these conversations. If the podcast has been helpful to you, leaving a review wherever you listen is one of the simplest ways to help more parents find the show.

And I always want to hear from you. Reply to this email and let me know what topics, questions, or conversations you would love to hear more about in future episodes.