Parents perceive the first steps of a child as a very joyful family event. But it can be overshadowed by the detection of such orthopedic pathology as hallux valgus. This violation usually becomes obvious just before the start of walking and after some time. The famous children's doctor and author of books on children's health, Evgeniy Komarovsky, talks about the causes of the problem and what to do in this situation.
In medicine, valgus is a deformation of the feet in which they are in a cruciform position in relation to each other, reminiscent of the Latin X. Most often, the pathology becomes noticeable when the child tries to step on the feet and take the first steps - the pathology is expressed in the fact that when When walking, the baby rests on the inside of the foot.
Steps are extremely difficult for such a baby - he gets tired quickly, sometimes experiences pain, and the steps themselves are shaky and uncertain. Orthopedists describe this condition in terms of the processes occurring in the feet - the toes and heels are turned outward, the middle part of the foot is slightly lowered. If the legs are straightened and pressed against each other in the knee area, the distance between the ankle bones will be more than 3-4 centimeters. If the height of the arch of the foot is significantly reduced, then orthopedists will say that the child has planovalgus feet. Valgus flatfoot is considered the most common diagnosis in pediatric orthopedics.
There are two types of such curvature of the feet: congenital and physiological (acquired) . In the first case, the legs are bent even during the period of intrauterine development of the fetus under the influence of certain factors about which medicine still does not know much. Congenital foot pathologies are usually quite severe, and they can be seen in the first 2-3 months of a child’s independent life.
Acquired deformity is often associated with errors in the development and functioning of the musculoskeletal system, ligaments, and tendons. It is precisely such violations that become obvious closer to the age of one year. Those at risk include babies with weakened muscles, premature babies suffering from rickets, and those who have suffered frequent and severe viral infections in the first year of life. The legs are at risk of becoming bent in obese children, since the load on the lower limbs with excess weight is very significant.
Sometimes parents themselves are to blame for the occurrence of pathology. Thus, putting the baby on his feet too early may well “trigger” the mechanism of foot deformation, and insufficient load on the foot, walking exclusively on a flat floor can cause acquired flat feet or planovalgus foot.
Flat feet scare parents no less . However, Komarovsky advises not to panic, because from birth absolutely all children have flat feet, this is a feature of babies. The arch of the foot will form gradually as the load on the legs increases, and here everything is in the hands of the parents, with the exception of congenital flat feet, which can only be corrected surgically.
There are four main degrees of hallux valgus according to the severity of the defect and the severity of its course:
Flat feet also have several degrees, which are similarly classified according to the degree of deviation of the arch of the foot from the norm. As in the case of hallux valgus, the first and second degrees of ordinary flat feet are treated quite simply and quickly. The third and fourth will be more difficult.
The child is diagnosed by an orthopedic surgeon . This is done on the basis of a visual examination and prescribed additional studies, which include radiography of the feet, computer plantography, and podometry. If such studies are not prescribed, and the doctor diagnoses you accordingly, you should consult another doctor. Quite often, young patients with confirmed hallux valgus pathology are recommended to visit a neurologist to rule out problems with the peripheral and central nervous systems.
As soon as the reasons that underlie the modification of the feet are identified, the doctor will determine the type of lesion by etiology:
When diagnosing flat feet, the same techniques and research methods are used.
The child’s foot is finally formed only by the age of 12, so many problems found by specialists and parents themselves at a more tender age can and should be corrected before this moment, says Dr. Komarovsky.
Typically, treatment for both flat feet and hallux valgus is aimed at strengthening the ligamentous apparatus, foot muscles, and forming the arch. For this purpose, foot baths, therapeutic massage, magnetic therapy, electrophoresis, swimming, and physical therapy are prescribed. In case of congenital pathology, the lower limbs are immobilized using plaster. If all these measures do not achieve the desired effect, the child may be recommended surgery.
There is a lot of controversy around children's shoes and everything connected with them. There is no single generally accepted opinion on this matter.
Let me share some thoughts on the topic.
Let's start from the very beginning.
What are foot arches and why are they needed?
What is flat feet? Why does it happen and what is bad about it? The human foot can be compared to a car spring, which usually has the shape of an arc, but when the instantaneous load increases (the car jumps over potholes and potholes), it flattens, thus “damping” a significant part of the shock. A worn spring loses its arc shape. Its participation in the “extinguishing” of concussion is reduced. Therefore, the shock is transmitted higher and the car mechanism wears out faster.
A flat foot is similar to a flat spring. This means that with flat feet, when walking (and even more so during running and jumping), the knee, hip, sacroiliac, and lumbar joints are exposed to excessive stress.
What we colloquially call flat feet can be a manifestation of different conditions.
1) Anatomical flatfoot. (Pes planus)
In this condition, the bones of the foot are positioned in such a way that the foot remains flat at all times. In some cases, this condition requires surgical intervention, in some cases it can be corrected conservatively. This type of flatfoot is much less common than functional flatfoot (see below).
2) Functional flatfoot. (Pes valgus)
In this condition, the foot has no anatomical defects and without load has a normal shape. But under load, overpronation is observed (excessive inward rotation of the foot, in which the medial (inner) ankle drops down, and the internal angle formed by the Achilles tendon is more than 186 degrees.) It looks as if the person is not standing on the entire foot, but only on its inner part. This happens because the muscles that should hold the foot straight do not work well. (More specifically: support for the arches of the foot is provided by small plantar muscles, tendons of the Tibialis posterior muscles (the main muscular stabilizer of the longitudinal arch of the foot), Tibialis anterior, Peronus longus. The plantar fascia and ligaments also participate in the support of the arches of the foot, the normal development of which depends on the active mobility of the joints and sufficient local blood supply provided by muscle work.)
With overpronation, overload occurs on the lateral (outer) articular surfaces of the bones of the foot, as well as overstrain of the ligaments and tendons located on the inside of the foot. In addition, overpronation of the foot is a significant factor in the occurrence of injuries to the internal parallel ligament of the knee, internal meniscus, anterior cruciate ligament and damage to the patellar cartilage. (Excessive load on these objects during overpronation is perfectly demonstrated in the model and does not require RCT).
3) The two types of flat feet described above can be combined (pes planovalgus).
From a clinical point of view, the debate about what kind of shoes should be for children who do not have congenital pathologies, and whether they are needed at all, is a debate about the prevention of overpronation.
Most children are born without pronounced arches.
They develop, as a rule, up to 10-12 years. If during this period there is not sufficient development of the muscles that support the foot in the optimal position, then the child’s weight becomes excessive for them and overpronation develops, i.e. functional flatfoot.
Why can muscles be delayed in development?
1) Insufficient and monotonous activity. For example, if the child’s movements are limited to moving from the TV to the computer and back.
2) Walking on a monotonously flat, hard surface.
For example, if the child’s feet are not familiar with a surface other than the floor of a city apartment.
(Bought “for growth”, inherited from relatives, etc.)
In other words, if a child leads a computer-film lifestyle from early childhood and walks around barefoot at home, and when outside wears sneakers two sizes too large, he is guaranteed to have functional flat feet.
What prevents overpronation from occurring?
1) Varied physical activity. From early childhood, a child spends a lot of time on the stairs of the gymnastics corner, donated by smart, caring parents for his own birth, runs a lot, jumps, swims, rides a bike a lot, skis in winter, that is, leads a NORMAL lifestyle for a child.
2) Walking barefoot on a variety of surfaces, requiring instantaneous tension-relaxation reactions of different muscle groups. (To avoid falling, injecting yourself, etc.) There is also a positive effect from massaging the plantar surfaces with pebbles, cones, etc.
3) Properly selected shoes that will help maintain the foot in an optimal position while walking on a uniformly flat, hard surface.
Thus, if a child spends most of his time in a city apartment and does not have access to outdoor games, properly selected shoes remain the only obstacle to the development of functional flat feet.
What is the right shoe? If we are not talking about existing disorders, it does not have to be “orthopedic” or have any features other than those listed below.
1) Heel. If the heel is raised, the muscles that support the arches of the feet are more actively involved when walking and, accordingly, develop better.
2) The rigid heel does not allow the heel to “fall” inward, which ensures even distribution of the load on the muscles.
3) Slight support for the longitudinal (inner) arch of the foot (soft insole-instep support), as a rule, indicates that the shoes are of high quality, but in no case should cause discomfort to the child. (For more information about instep supports, see below)
4) The foot should not “ride” inside the shoe.
What to do if a child develops flat feet?
1) Try to follow the recommendations to prevent the occurrence of overpronation (see above).
2) Special exercises that few people do, so I don’t dwell on them.
3) Corrective insoles and arch supports. There are two requirements for them.
First: When loaded, they should keep the feet in a neutral position, forming the arches of the feet and not allowing the feet to “fall in” inward.
Second: they must be made of elastic material so that the “spring” function of the foot is preserved (see the beginning). Restoring the arch of the foot without preserving this function makes no sense. (“The spring” function of the foot is ensured by mobility in the Chopart joints (formed by the calcaneocuboid and talonavicular joints) and Lisfranc (formed by the tarsometatarsal joints)).
As practice shows, such devices, even in adults, can help eliminate flat feet, due to the optimal inclusion of the tibiali anterior & posterior and peronus longus muscles in the movement of the foot during walking/running/jumping. The use of such instep supports is indicated not only for functional flat feet, but also for anatomical flat feet that do not require surgical correction.
In fairness, it should be noted that there is such a disorder as “hollow foot” (pes cavus) - the opposite of flat feet. If we use an analogy with a car spring, we can say that something similar will happen if we install springs from KAMAZ on a Zhiguli, that is, the springs will last a very long time, but the mechanism of the Zhiguli will not last long, since it will shake too much from - due to unjustified stiffness of the springs. In this condition, the use of special orthopedic insoles is indicated, designed to increase the area of contact of the feet with the surface when walking and reduce the rigidity of the contact. Also, there are physiotherapeutic techniques and exercise therapy aimed at reducing the tone of the muscles that support the arches of the feet.
Most readers are very familiar with the famous phrase “mother and child” from books and articles.
To begin with, I note that when speaking about grandmothers, the author, of course, also means grandfathers.
Considerable abilities are required in order to characterize the role without vulgarity and the use of profanity.
It just so happens that a varied diet is traditionally viewed as an indispensable attribute not only.
Let's start with a definition, because the term “newborn” itself is an elastic concept.
The process of searching and absorbing food is the basis of the existence of all living things.
Let's start with platitudes: without water, the human body can survive for several days.
The diaper has been a staple item of infant clothing for several thousand years.
It is absolutely obvious that normal, loving parents are very sensitive to the nutrition of their children.
How to avoid all this? What to do if you couldn’t avoid it? And the night is like day.
In distant Soviet times, television, with very rare exceptions, did not spoil us with heartbreaking horror films.
Observing the child, comparing him with other children, communicating with friends, normal loving parents constantly.
Let's start with a well-known fact: a person sleeps a third of his life.
As a person who worked for quite a long time in an infectious diseases hospital, I can say with confidence: for everyone.
But with a very large number of different diseases affecting infants (children of the first year of life) they occur almost exclusively.
These problems are not at all simple, and finding the right solutions is very difficult - the number of specialists is too large.
The article “Recreation is not only for children” was devoted to global, strategic issues and examined the main principles.
In the body there are groups of cells that perform certain common and similar functions; these cells are called “tissues”.
The phrase “viral hepatitis” is translated from medical language into human language quite simply - inflammation of the liver.
Recently, the words chlamydia and chlamydia are found more and more often, and the phrases “treating chlamydia” and “diagnosis.
Parents often turn to pediatricians asking why dark circles that resemble bruises appear under their child’s eyes. If there was no injury or blow, the child did not hit his head, then impressionable mothers immediately regard the appearance of such bruises as an unambiguous sign of some very serious disease. In fact, bruises under the eyes do not always indicate any pathology. However, they can actually “signal” about violations, says the famous pediatrician Evgeniy Komarovsky.
The parents of every second child complain from time to time about the appearance of strange circles under the eyes. Bruise is different from bruise, and it is very important to understand which bruises should cause concern and be the basis for examination, and which are just an individual feature of the baby’s appearance.
If a child has deep-set eyes, then circles under the eyes are just a common appearance feature. As a rule, one of the parents has exactly the same ones. Bruises often accompany fair-skinned children, who from birth have very thin skin, blond hair, and blue eyes. Their small vessels come so close to the thin translucent skin under the eyes that it really creates the illusion of bruises.
Both of these cases should not cause any concern to parents. Such “cosmetic” bruises may, by the way, disappear altogether over time, since the facial bones of the skull are actively growing and changing facial features.
The most harmless reasons for the appearance of circles under the eyes, according to Komarovsky, are banal overwork and lack of sleep. If parents raise a child without a specific routine, do not insist on mandatory daytime sleep, and also do not regulate the time that the child spends in front of the TV or computer monitor, then the appearance of dark circles is an understandable consequence of severe fatigue.
Such bruises also do not require examination by doctors . It is enough to establish a daily routine, make sure that the child sleeps at a quiet hour, goes to bed on time in the evening and gets full rest at night. Cartoons and computer games are limited.
Quite often, bruises under the eyes appear in children whose intestines have parasites. This happens because helminths secrete waste products that are toxic to the baby. At the same time, the child’s hemoglobin level in the blood decreases.
You need to carefully watch your child. If dark circles are accompanied by other symptoms (decreased or increased appetite, weight loss, headaches, itching in the perineal area), the child must be shown to an infectious disease doctor and undergo blood and stool tests. After treatment aimed at getting rid of parasites, the circles under the eyes will disappear without a trace.
With an unbalanced diet, irregular meals, and also if the child’s diet contains products of low and questionable quality, the body reacts to this gastronomic chaos with general systemic metabolic disorders. At the same time, circles under the eyes also appear. They may be evidence of a lack of certain vitamins, most often group B, vitamin E, A and D, as well as calcium. Blood tests and consultation with a pediatrician will help identify these disorders.
If a child has recently suffered from an illness, especially a viral one, the appearance of circles under the eyes should not surprise parents at all, says Komarovsky. Children's imperfect immunity is “tired”, hemoglobin has decreased. It is enough to give the child a rest after illness, not to take him to kindergarten or school right away, to walk in the fresh air more often and eat more fruits and vegetables so that such circles under the eyes disappear within a maximum of one week.
This is where the relatively “easy” reasons end. More serious things are starting to happen.
Sometimes circles under the eyes indicate pathological processes associated with poor circulation and disruptions in the lymphatic system. The first thing Komarovsky advises to examine is the kidneys. Usually, an ultrasound of the kidneys is quite enough to, together with blood and urine tests, show the true state of the excretory system. Typically, in children with kidney diseases, circles under the eyes are combined with the formation of bags and general swelling of the face (especially in the morning, after a night's sleep)
Deep blue bruises may indicate heart problems. Their appearance is associated with oxygen starvation of the entire body, which develops against the background of cardiovascular diseases.
Red bruises and circles of a reddish hue can be external manifestations of an allergy. An inadequate reaction can be caused by absolutely any type of allergy - food, seasonal, drug, allergy to animal hair, house dust.
Dark circles under the eyes often accompany inflammation and proliferation of the palatine tonsil in children, which is popularly called simply “adenoids.” In this case, nasal breathing is impaired, sometimes it is completely absent. If a child has been in this state for quite a long time, not only dark circles under the eyes appear on his face, but also special facial changes, which in medicine are called “adenoid mask” (mouth half open, chin down).
Brown circles - bruises can be a sign of hepatitis, liver disease, and thyroid disease. Saturated yellows are sometimes a sign of problems with hematopoietic processes.
And very rarely (but this also happens) circles under the eyes appear due to diseases in the oral cavity - for example, with caries. In this case, you need to trust the pediatric dentist. After successful treatment, the circles will disappear the next day.
In toddlers in the first year of life, dark circles under the eyes may appear due to fatigue, disruption of sleep and wakefulness, as well as due to a deficiency of iron and essential vitamins (if for some reason there are not enough of them in breast milk). Children under 12 months with this problem should definitely be shown to a pediatrician to get comprehensive answers to all questions.
“Ambulance” for dark circles under the eyes should be called without unnecessary hesitation in two cases: if the child’s facial features sharply sharpen (sunken eyes) and pronounced bruises appear, at the same time breathing problems and severe weakness arise. This may indicate acute heart problems that require prompt hospitalization and qualified medical care.
The second case is the appearance of deep bruises under the eyes due to vomiting or prolonged diarrhea. In this case, the circles indicate the onset of acute dehydration. Dehydration is deadly for children, especially young ones.
Evgeny Komarovsky advises not to panic. If a child’s bruises are not a feature of their appearance, then you should consult a pediatrician. The doctor will prescribe laboratory tests of blood, urine, and feces. If necessary, an ultrasound of the kidneys and urinary tract will be performed. If the cause is in the kidneys, the child will be treated by a nephrologist and urologist.
If your kidneys are normal, your pediatrician will refer you to a cardiologist to check your heart function. The doctor will find out if the child has vegetative-vascular dystonia, measure blood pressure, and, if necessary, do an electrocardiogram and ultrasound of the heart and blood vessels.
If the reason remains a secret, then the pediatrician is obliged to send the child to an allergist, who will conduct allergy tests and find out if the child is allergic to something. Treatment can be prescribed in a variety of ways (depending on the true cause). If there are worms, then antihelminthics and vitamins; if there are allergies, then antihistamines; if there is kidney damage, then diuretics and antibiotics. Since circles themselves are not a disease, there is no need to treat them directly. The pathology that caused such a “cosmetic effect” should be treated.
Usually there are no problems with diagnosing the causes, says Evgeny Komarovsky. In 70% of cases (and even more), parents’ worries turn out to be false—no pathologies are detected. If for their own peace of mind the mother and grandmother urgently need to take the child to specialists’ offices and undergo a bunch of tests, then let them do it. According to Evgeniy Komarovsky, unnecessary examinations have made no one feel worse.
It will be much better for the child himself if mom and dad reconsider his daily routine, provide him with a good night's rest (in a room that is well ventilated, where it is not hot or stuffy) and finally “tear” the child away from the computer and send him for a walk. Fresh air.
As a rule, all circles and bruises under the eyes disappear within a few days if the child begins to lead an active lifestyle and eat properly. Household members should definitely add foods high in iron to their baby’s diet - chicken yolk, buckwheat porridge, seaweed, liver.
When parents and grandmothers cannot give him something to drink, the child goes to the hospital on a drip. And then it turns out that it’s an IV.
If a dad sits on the sofa in front of the TV after work with beer and chips, then the chances that the child will not have much.
. people, unfortunately, underestimate their own capabilities and expect that a doctor will come and give a pill for everyone.
. “Cuckoo” really allows you to clear the nasopharynx of accumulated mucus and pus, but it is not able to reduce it.
Very fast and very decisive steps are needed, and these are impossible within the current system. Not the medical system.
. I must know that every day there is a need to speak publicly and rapidly change in a practical manner.
. I must admit that every day the desire and need to speak publicly is rapidly decreasing, which is due.
. When examining a child, the doctor is looking for an answer to the main question: is it serious or nonsense? (option: treat or go away on its own?).
The food system is not determined by the child. In general, family policy - what to eat, where to sleep, where to go, what to do - is determined.
The algorithm of male behavior is put into the boy’s head when he observes the behavior of his father, his own.
This image of the mother-heroine, which many of you seem completely natural, has a serious side effect.
Appetite is determined by lifestyle, level of energy expenditure, as well as the intensity of growth, which is directly related to quantity.
No decision regarding a child should be made by a parent alone. Dad must understand how to feed.
A child who has not seen anything other than mother's milk until 10–12 months, as a rule, refuses to drink solutions.
". Moms and dads don’t understand the difference between primary and secondary immunodeficiency at all. They don't understand all the time.
For 70 years, diphtheria serum was supplied to Ukraine from a single source - Russia. Even before the Maidan.
Dr. Komarovsky: “No rules - no Internet” - this should be the law.
I want to introduce health discrimination. I want me, as an employer, to be able to say: if you smoke.
The best roads should be laid not to the city hall, but to the school and kindergarten. The best buses are for schools. The roads need to be closed.
Any action to the detriment of health should be costly: not wearing a seat belt, riding a bicycle without a helmet, lighting a cigarette, unreasonably.
For children, preventing flat feet is very important. All babies have completely flat feet at birth. Physiological flat feet in children is considered to be up to 2-3 years of age, since the soles of their feet have a fat pad underneath. After the child begins to walk, flat feet gradually disappear and at the same time depressions form in the arches of the feet. When the foot muscles are underdeveloped, weak or excessively tired, flat feet occur due to the baby being on his feet for a long time.
Children complain of pain in the legs when walking, the inner edge of the shoe wears down, the heels protrude strongly backward, the arches of the feet are smoothed out or are not defined at all, and the gait changes.
In summer, children need to walk and run more often on the sand, on water along the banks of a river or sea in order to train the muscles of the arch of the foot. In the vessels of the legs, the speed of blood flow increases, this favors muscle growth in length, width and thickness.
From the first days of a baby's life, to prevent flat feet, it is useful to tickle the soles of his feet. At the same time, the baby bends his fingers, turning on the work of the corresponding muscles, as a result of which the arches of his feet deepen.
The crucial moment is the choice of the first shoes, they must be suitable in size, not be hard, have a leather sole and a rubber heel up to 1 cm high, then it is recommended to select orthopedic shoes for the child. It is not good for children to wear indoor shoes (slippers), flip-flops, or always wear sneakers.
To identify the initial forms of flat feet, children are examined by an orthopedic doctor at 3 months, 1 year, 3 years, 6 years, 7 years, 10 years, 15 years, 16 years. If you suspect your child has flat feet, you need to show him to an orthopedist. An orthopedist may suspect flat feet during a visual (external) examination of the child.
During examinations by an orthopedist, plantography is performed to identify flat feet. Special paint is applied to the child's feet, and then an imprint of the foot or both feet is made on a piece of paper. Based on the results of plantography, 4 degrees of flat feet can be identified: the first is mild, the fourth is the most severe. In addition, flat feet in children can be longitudinal or transverse.
The diagnosis of flat feet in children and its degree is confirmed by x-ray. An x-ray of the feet is done in two projections. Based on its results, a final diagnosis is made.
The diagnosis of flat feet is usually made for the first time at 5-6 years of age. If flat feet are detected in a child, physical therapy, massage of the legs and feet are indicated.
Young men with flat feet of the 3rd and 4th degree are exempt from military service.
This is all about flat feet in children. Stay healthy!
Begins to use complex subordinate clauses. The identification method is a natural situation. The adult talks casually with the child on any topic close to him. The child’s behavior is to use a subordinate clause at least once in his speech. Questions arise: “why?”, “when?”. The identification method is a natural situation. An adult records speech during the processes of feeding, dressing, and independent activity for 20-30 minutes. Child behavior - at least once uses the questions “why?” or “when?”
In his activities, he correctly uses geometric shapes for their intended purpose. The material is a geometric mosaic, accompanied by cards with images of simple objects (a house, a steamship, a house with a fence), which are based on basic geometric shapes. The identification method is a specially prepared situation. An adult gives the child a geometric mosaic, a sample card and offers to make the corresponding drawings by overlaying them on the sample. The child’s behavior is to correctly select the mosaic for the drawing.
Names 4 primary colors. Material - 8 monochromatic objects, 2 each of the same color, but of different shapes (for example, a red cone, a red cube, etc.). The identification technique is a provoking situation. The adult shows the child one object after another and asks: “What color is the ball?” (color alternates). Child behavior: correctly names 4 primary colors at least once.
Role-playing game elements appear. Material: various role-playing toys.
The identification technique is a provoking situation. The game room has selected attributes for a variety of story games. An adult records the child's play for 20-30 minutes. The child’s behavior reflects some plot, fulfills a role that is defined in a word.
The identification technique is a provoking situation. An adult watches a child play and asks him: “Who are you?” Child behavior - when asked by an adult, he names his role in accordance with the action being performed.
Complex plot buildings appear. Material - various geometric shapes (10-14 pcs.) 2 pcs. each form. The amount of material depends on where the child’s activities are organized - at the table or on the floor; if at the table, small or medium material is given, if on the floor - large construction material (you can give additional material: a car, small toys). The identification technique is a provoking situation. The child’s behavior - makes a plot building, for example, a garage, a road to it. Plays with this building.
Using plasticine and a pencil, he depicts simple objects and names them. Material - a piece of cylindrical plasticine, 4-6 cm long, 1.5-2 cm in diameter. Detection technique - a provoking situation. The child is given a piece of plasticine in the form of a cylinder and asked to mold something. The child’s behavior is to mold an object from plasticine and be sure to name it. The object must be similar to the object named by the child. Using a pencil or paints, he depicts simple objects and names them. Material - paper the size of a notebook sheet, pencil or paint (gouache diluted to the thickness of sour cream). The identification method is a specially prepared situation. An adult invites the child to draw something. The child’s behavior is to depict an object and be sure to name it. The image must be similar to the object named by the child.
Dresses independently, can fasten buttons and tie shoelaces with a little help from an adult. The detection method is a natural situation (while getting dressed). If necessary, an adult helps to fasten buttons or tie shoelaces. The child's behavior is dressing independently. Sometimes there may be a little help from an adult when buttoning a button or tying shoelaces.
Uses the napkin as needed without being reminded. The detection method is a natural situation (during feeding). Child behavior: if his face or hands are dirty, he uses a napkin.
Steps over a stick or rope, horizontally raised from the floor by 30-35 cm. Material - stick, rope raised to the specified height. The identification technique is a provoking situation. An adult invites the child to step over a stick or rope. The child's behavior is to step freely over a stick or rope without touching it.
Reference Guide/Ed. M. F. Rzyankina, V. P. Molochny