I don’t have a good photo to illustrate this point, but if you or your child are hypermobile, you know exactly what I am talking about. It can be any part of the body; shoulders that allow an arm to fold under the body and the child lies on top of the arm, crawling on the backs of the hands instead of the palms, standing on the sides of the feet, not the soles.
The mom of a child I currently treat told me that this topic is frequently appearing on her online parent’s group. Mostly innocent questions of “Does your child do this too?” and responses like “At least she is finally moving on her own” When I met her child, she was rolling her head backward to such a degree that it was clearly a risk to her cervical (neck) spine. We gradually decreased, and have almost eliminated, this behavior. This child is now using it to get attention when she is frustrated, not to explore movement or propel herself around the room.
Because of their extreme flexibility and the additional gradual stretching effects of these positions, most children will not register or report pain in these positions. Those of us with typical levels of flexibility can’t quite imagine that they aren’t in pain. Unfortunately, because of their decreased proprioception Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children and decreased sense of stability, many hypermobile kids will intentionally get into these awkward postures as they seek more sensory input. It can actually feel good to them to feel something!
The fact that your child isn’t in pain at the moment doesn’t mean that there isn’t damage occurring as you watch them contort their bodies, but the underlying inflammation and injury may only be perceived later, and sometimes not for years. Possibly not until tissue is seriously damaged, or a joint structure is injured. Nobody wants that to happen. If you think that there is a chance that your child is more than just loose-limbed, ask your therapist to read Could Your Pediatric Therapy Patient Have a Heritable Disorder of Connective Tissue? and get their opinion on whether to pursue more evaluations. Some causes of hypermobility have effects on other parts of the body. An informed parent is the best defense.
Here is what you can do about all those awkward postures:
- Discuss this behavior with your OT or PT, or with both of them. If they haven’t seen a particular behavior, take a photo or video on your phone.
- Your professional team should be able to explain the risks, and help you come up with a plan. For the child I mentioned above, we placed her on a cushion in a position where she could not initiate this extreme cervical hyperextension. Then we used Dr. Harvey Karp’s “kind ignoring” strategy. We turned away from her for a few seconds, and as soon as she stopped fussing, we offered a smile and a fun activity. After a few tries, she got the message and the fussing was only seconds. And it happens very infrequently now, not multiple times per day.
- Inform everyone that cares for your child about your plan to respond to these behaviors, to ensure consistency. Even nonverbal children learn routines and read body language. Just one adult who ignores the behavior will make getting rid of a behavior much, much harder.
- Find out as much as you can about safe positioning and movement. Your therapists are experts in this area. Their ideas may not be complicated, and they will have practical suggestions for you. I will admit that not all therapists will approach you on this subject. You may have to initiate this discussion and request their help. There are posts on this blog that could help you start a conversation. Read Three Ways To Reduce W-Sitting (And Why It Matters) and Kids With Low Muscle Tone: The Hidden Problems With Strollers . Educate yourself so that you know how to respond when your child develops a new movement pattern that creates a new risk. Kids are creative, but proactive parents can respond effectively!!