Episode 63: Nicole Pates


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Q&A with a baby physiotherapist: The milestones that matter by 18 months. Ep 63 with Nicole Pates

Do you find yourself comparing your little one to their peers, wondering why yours isn’t sitting, crawling, walking, or climbing yet? Then this episode is for you!

In healthHackers® episode 63, you’ll hear:

🔹The most important tip for every parent of an under 18-month old to help with physical development

🔹Ways to hold your baby for optimal muscle development 

🔹The milestones to be concerned about in the first year of your baby’s life

🔹How important is crawling? What about babies who go straight from sitting to walking?

🔹Baby walkers - which ones are a help or a hindrance? 

🔹At what age should you get help if your baby still isn’t walking?

🔹Shoes - what to look for when buying footwear for your baby

🔹Ways to make playtime a success (even if you think you’re not a ‘fun’ parent)

🔹How screen time affects physical and visual development (plus the key age range when this matters most)


When should my baby…?

I’ll admit it. This episode wasn’t just an opportunity to share my expert guest’s pediatric physical development insights with the healthHackers® audience. It was also a way to help me get some comfort as a new parent.

For months now, I’ve noticed a sense of urgency and comparison around making it to baby milestones. I’m mostly referring to motor skills - the physical strengthening of your child’s body as they master new abilities to move and touch their surroundings. Sitting, crawling, pulling themselves to standing… you know the ones I mean. 

Even award-winning pediatric physiotherapist, Nicole Pates, wasn't exempt from milestone anxiety with her own kids. It was one of the reasons she founded her Baby Play Academy.  

“When little ones are born, motor development is the most obvious thing that is occurring and the most obvious thing that people will tend to use as markers for your success as a parent,” she told me in healthHackers® episode 63.

Award-winning pediatric physiotherapist, Nicole Pates, wasn't exempt from milestone anxiety with her own kids

But that measurement of success is incorrect, she explained. 

“Motor development is unique to your little one and there are so many interacting factors around that. It's impossible for you to control.” 

Nicole is the director and founder of Western Kids Health in Perth, Australia. When she started her Baby Play Academy it was to help parents take evidence-based early intervention strategies with their little ones to support development through talking, moving and playing within their first 18 months. 

“I always laugh when I see the programs that get advertised all over the internet. It's like, ‘Let's make your child a genius in three months,’[or] ‘Let's have them walk to crawling by five months’. There's obviously things that we can do to optimize their natural development curve, but every baby cannot be crawling by eight and a half months because there's so much variety in development,” she told me.

‘The foundation of motor development is your connection to your child’

Nicole - who’s also a mother of two (with a great Instagram feed where you can see how she encourages healthy development with her own children) - said growth sequences are cultural too. 

“For example, in Papua New Guinea they carry their babies a lot because of the hazards and the dangers associated with putting your little ones on the floor. So their babies don't tend to crawl. They tend to sit and then walk. 

“Their little ones are not any worse off for it," she told me.

According to Nicole, the feeling of safety and connection with caregivers is vital for babies. 

“The foundation of motor development is your connection to your child. So your attachment. And people forget it is really the key component for your little one to have. To feel safe enough and to feel that security to want to explore their environment and to want to explore their body movements - and almost be little scientists figuring things out with the world.”

Babies develop at different rates and paces

“They need that secure connection with you and that trust within you to be able to safely do that, and to have the confidence to do that,” she said.

“We see it in clinic all the time. Little ones come in and they may be delayed, and it's not just their motor development. There’s trauma that's happened within the family or there's other things happening that are affecting that connection and that feeling of safety. It's not until that is settled that they will then start to progress in their motor development,“ Nicole told me.

No one wants to hear their baby is ‘delayed’ 

“That word ‘delayed’ comes with such heaviness to it,” Nicole said. But given that all babies develop at different paces, when should we be worried about our children?

“If they're losing skills - that's a flag to check in. If you feel that they're just not gaining skills, so it's been six weeks, two months, and nothing has really changed - you feel like they've plateaued - that might be a time to check in as well. Or there's that general delay where they're not smiling, giggling and interacting with you at six months and they're not physically where you think they should be," she explained.

Get a full rundown of Nicole’s check-in markers and what skills you want to be seeing by 15 months of age in healthHackers® episode 63

Barefoot is best for babies most of the time, Nicole explained

'Barefoot is best'

While walking still feels a little way off for my 11-month old, I was curious about practical items that could help with the process.

Baby walkers for example, would they be a help or hindrance? See episode 63 for Nicole’s visual examples of the types of walker to avoid(!).

How about shoes? For those early days, Nicole said barefoot is best. “You have to remember that the feet are like your baby’s sensory input,” she told me.

“When they're learning to walk, their feet are in contact with the ground. And that's really the key to their balance system.”

“Once your little one is up and taking their first wobbly steps, it takes anywhere between two to four months for them to consolidate that and start to look like they're actually walking around without their arms up and waddling side to side. So at that stage, we really still want them to be having the most sensory feedback they can in their feet.”

However, she warned that the first time your baby wears shoes shouldn't be the very first time they need to be wearing them. “Try shoes on earlier, but still spend the majority of the time barefoot before they're walking.“

Watch episode 63 to hear about Nicole’s ‘scrunch test’ for baby shoes.

Make green time greater than screen time

Given the societal messaging around unhelpful effects of screen time on cognitive development, I asked Nicole whether using phones, TVs, tablets and iPads could also affect a child’s physical development.

“It can be unhelpful if it's reducing the opportunities for physical development or movement and it can also be unhelpful for their visual development.”

“There's a lot of research, even pre-pandemic times, about short-sightedness in kids and the amount of screen time impacting visual development because your little one’s vision will continue to develop until they're eight, nine, 10 [years old].”

“Being outside offers an opportunity to focus into the distance to close [up], to track things from far away that are moving - lots of different opportunities that aren't offered on a screen”

“If you're going to spend time watching TV, try and spend as much - if not a little bit more - outside,” Nicole said

If anyone's reading this feeling guilty about resorting to screens when desperately needing to distract their kids… it’s OK! Nicole said:

“If you're at home all day by yourself and you need 20 minutes of TV, in my mind, your mental well-being - that security foundation for attachment - is the most important thing.“

You could also adopt Nicole’s “green time greater than screen time” approach.

“If you're going to spend time watching TV, try and spend as much - if not a little bit more - outside. The outside offers so many motor development opportunities. Not from just visual development, but physical development, and in terms of exploring and testing their physical boundaries.”

‘Variety is the spice of life’

“Often we get caught in the trap of doing the same thing, staying at home in that routine. Try and mix it up. What are you doing? When are you doing things? How you're holding your baby, the positions that you play in, the rooms that you play in. Because our role as parents is to support their development to create that independent, resilient, confident little munchkin.” 

When coming up with ideas for playing with your baby feels daunting or alien to you. Fret not. According to Nicole:
“Not every parent has to be fun. But if you can provide that opportunity, security and attachment - I think that's probably the biggest thing that you can do.”

Now for some final words of wisdom for any parent wondering whether or not they’ve always made the best decisions around encouraging their baby’s development…

“I say to parents, ‘Babies are beautiful because they adapt, their brains are so beautiful -  so don't ever blame or say "Oh, no…I've done this or that," because babies just adapt to different things and grow beautifully.”

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See Nicole’s academy here.

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