My child has flat feet, what will I do?

Oftentimes, I hear this from parents and, I understand their concern that their babies' or kids' foot looks different.

What are flat feet?

Flat feet are also called pes planus. Below is a picture of a flat foot wherein the medial arch or inner border disappears during weight bearing.

An 8 month old with flat foot but arch is starting to develop.

A kid 10 years old with very low arch or the inner border of foot touching the floor when standing or when the foot is loaded.

Having flat feet is normal in babies until they are about two years old. More often than not, as parents we confused a child's fat feet with flat feet.

What causes flat foot?


Flat foot can be caused by genetic predisposition or inherited, muscle weakness and ligamentous laxity.

However, in kids who are delayed in walking, they could also have flat feet as the arches are still weak and have not fully developed.


The pictures below correspond to the same feet as above but no weight is put on it and you can visibly observe the arch.

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This is called a flexible flatfoot. If the child doesn't complain of pain, it is ok but if pain develops or there is discomfort during any activities, it is  highly recommended that you see a doctor and would most likely recommend you to a physical therapist. Flat foot can also be congenital or rigid which is rare.

So,what can you do with your kid or baby with flat foot with no other conditions such as cerebral palsy,pain...

BAREFOOT....being barefoot allows our kids to develop the arches naturally. The foot is constantly challenged especially when walking  in the sand or uneven surfaces. It may not be practical most of the time but when there is an opportunity, go for it.

Tip-toeing while walking and skipping rope also helps form a natural arch for older kids, if they are already physically able to do so.

What about insoles for my kids? 


Insoles are commonly worn to help support the arches. My opinion is they are great if there is pain,discomfort that intervenes with activities but if no other concern, its not necessary. An insole supports the arch but doesn't develop it, so wearing one just weakens the arch more. And lastly, it is always good to consult a physical therapist for an evaluation.

Why do OT 's and PT's discourage "W" sitting?

 I had a client earlier today and saw him in this position.

"W" sitting is a position when children sit with both knees bent and legs turned out forming a letter W on the floor. It is very common among children that parents think its just normal to sit in that position.

In my experience, I usually see it happening before a baby starts crawling especially during transitions from any position to sitting. It gets more frequent when a baby starts to crawl.  Using it to transition or move from one position to the other is ok but the problem lies when staying in or prolonging that position.

W sitting front view

W sitting view from behind

So why a baby or child prefers it?

When  a baby is on W position, he is stable. It widens the base of support due to legs are out.W sitting is very common among babies who are generally has decreased tone, has loose joints and those with poor balance.

Long term effects?


 When babies and children are on this position, they would no longer engage or use their trunk muscles due to added stability of a wide support. Thus,leading to disuse and further weakness. Another observation I had is, babies tend not to use the arms to cross the midline as trunk rotation is limited and also they can't weight shift on the buttocks. Shortening of the following muscles is also very common especially on the hamstrings,gastrocs and heel cords. Later in life, this causes low back pain and knee and foot problems.

 What can we do as parents,caregivers?

The moment we see our kids do this, we need to correct them right away meaning instructing them to sit cross legged,side sit,sit with legs out straight or bent. Early correction is a must so that it doesn't become a habit. And if you think your kids are not growing typically in comparison to other kids their age,consult with your pediatrician and bring your concerns to them.

Baby Jaela Cooing!

Cooing is vowel like sounds.Check out my baby Jaela cooing.

Open mouth vowel sounds such as "aah" are usually the first to be produced because no rounding of the lips is needed.When producing open vowel sounds, the tongue is near  to the bottom teeth.Closed vowel sounds typically follow and these sounds are  "ee" and "oo" and in close vowel sounds, tongue position is near the roof of the mouth. It is encouraged when babies coo,we should repeat the sounds they make and give them time to respond thru facial expression or they repeat the sound you make.


On the other hand, I learned from our speech therapist this month,May, is Better Hearing and Speech Month.  As Early Intervention is becoming more transdiciplinary, it would always be our advantage to know what other disciplines are doing and incorporate in our own management so that a true transdisciplinary approach is accomplished...Till then..Have a great weekend.

Leg Length Discrepancy(LLD) and external heel lift

 Leg length discrepancy  or LLD is a condition where one leg is shorter than the other. It could be classified as true or functional. True LLD is when the femur or tibia is short and functional is when the pelvis is not properly aligned.

 Working in the Pacific Island of CNMI is a challenge due to its location. We are limited in almost all resources, nonetheless, we do the best we can with what we have.

After evaluating a baby with LLD and finding out it is true LLD, I can't wait for June or December for a team from Shriners Hospital to come and evaluate him.Furthermore, baby is already walking using a posterior walker.  LLD can cause scoliosis and back pain.Thorough evaluation reveals Left leg is shorter by 2.2 cm. I ask baby's parents  for his shoe so I can add an external heel lift.They gladly gave it to me and brought it to the office. I told them I will be bringing it on my next visit.
Since it is just temporary pending the Shriners team evaluation, I made use of  cardboard  to make external heel lift. I traced the heel of shoe onto the cardboard and made a lot until it was already 2.2cm when stacked together.

 I traced and made cut outs of cardboard and stacked them together using a paper tape.

Side view of the shoe with the lift. I used paper tape to hold together the cut out card board heels and scotch tape to hold it onto the shoe. Dad and mom were informed to reinforce tape if it loosens up.

Bottom view of both shoes

After the baby wore the modified shoe, he was walking with very minimal limp to none.

Parents are happy while waiting for Shriners this June 2012.

The Importance of Tummy Time

Tummy Time! You can do it Jaela, lift your head some more!

Supported  tummy time using log pillow.

Tummy time is very important in a baby's development. It is the position where you place baby on their tummy.It can begin as soon as after birth however, my personal opinion is to start when belly button is fully healed..However due to SIDS,babies nowadays rarely been given this opportunity to be on their tummy.

Tummy time must be supervised and should be encouraged. It must be done only when the baby is awake and during play.Babies tolerance to it should be increased. With my baby Jaela, we started tummy time when she was a month old, Right after birth,she had infection on her belly button requiring hospitalization thus delaying tummy time.

Tummy time encourages the baby to lift his head,push up on his arms as well as lift up upper back thus strengthening the muscles on these areas.These skills are needed later on for rolling,crawling,sitting,etc.

I would initially use supported tummy time with small log pillows or towel roll place under the chest and as the baby is able to develop more strength,I would then remove the pillow.

Easter Monday in Tinian Island!

It was Easter Monday,I woke up late and had to rush to the airport. A few minutes in the air and I was back on the island of Tinian for an evaluation.  It's been months since I've been on the island.  Our team includes Teacher Robin,Service Coordinator Doris and me.
The evaluation went well and we didn't qualify the baby for early intervention but was placed on monitoring every 3 months. Baby is back on track with development despite some setbacks weeks earlier and a traumatic incident.  Truly God has His ways!

Teacher Robin at the Check In Counter

Teacher Robin and me.Do I really want to fly in this plane!

Cockpit of Cherokee 6

After a 15 minute flight, we arrived in Tinian.

Tesa,our contact in Tinian.

Following a snail pace tractor.

We flew back to Saipan right after. My wife fetched me at the airport and a big hug from the kids when we  got home.That was my Easter Monday.

True Meaning of Easter!

Our little Bunny sitting on her own!

Come and get me! Jaela trying to reach a bunny cookie.

 My family did a lot of  spring cleaning last Saturday. Everyone took turns in carrying Jaela or playing/entertaining her during tummy time. On Sunday, a day of rest, we went to Church and the message was on the Resurrection, it was Easter Sunday. We need to remember that almost two thousand years ago, God sent his only begotten Son Jesus Christ to die for you and me that we would be saved from condemnation and have eternal life. Have a Blessed Easter!

Overview of Developmental Milestones

Jaela independently sitting at 6 months.

Developmental milestones are a series of events occurring at predictable age of a child. These events refers to the areas of  child development.These milestones are used by professionals in order to determine if our children have delays in one or more areas.. We must consider though that every child is unique and therefore, they vary.

What are the areas of a child's development?

A typical child goes through 5 areas of development. These are the following:

1) Gross Motor- this area of development deals with how a child gets to things/toys he desires by using the large muscles of of the body. This could be rolling,scooting,crawling,etc,
2) Fine Motor-is a skill of how a child uses his hands to explore,manipulate/play toys, way of holding a crayon or how they hold a spoon to eat, etc.This skill uses small muscles of the body particularly the hands..
3) Language-a baby doesn't talk right away the moment they are born. So how they communicate with their parents to get what they need is language skill. A baby's first form of "language" is crying.They cry when they are hungry, need diaper change,etc.

4) Cognitive-this is the ability of a child to process the situation surrounding him. Processing  requires learning and an appropriate response to it. An example of this skill is how a new born respond to sounds. He may have increased movement,remain still,eyes widen or shift,cry,or breathing pattern change or a typical baby of  around 6 months would already have an interest in people and objects. Babies this age would already look, listen and touch as they interact with people.
5) Social Emotional-is the ability of a child to interact with the people around him. Typically, a newborn loves to be held and cuddled frequently.Some people say, that in order not to spoil the infant child ,we shouldn't carry them when they cry. However, it is not true. When we carry and cuddle them when they cry,they are learning to trust,love and form a close relationship with parent.

On my next post, I will be discussing the Developmental Milestones as it relates to how our child develops and grows. Till then!

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