Ergo for Families Who Have Infants/Toddlers
By Jamie McGaha, OTD, OTR/L, CHT, CEAS,  COMT-UE

We recently received a very intriguing question from one of our grads. A working clinician, she asked us a question about a subject we normally do not hear a lot about: Do we have any helpful ergonomic resources related to setting up a nursery to make it more ergonomically friendly? As a matter of fact, we do.

I see a number of parents (new and those with many children) who have thumb, hand and wrist pain from a variety of tasks including breastfeeding, carrying heavy car seats, diapering, getting up off the floor repeatedly, negotiating a variety of fasteners and snaps that seem better made for straight-jackets than tiny humans! My first line of defense is often ergonomics and body mechanics training. 

Besides the good basics of lower center of gravity to lift, appropriate base of support and making sure to the lift from the legs, there are some specific modifications for those dealing with hand/wrist/digit pain, check out “Baby handling tips.” In general keeping the wrist neutral and the thumbs abducted toward the palms help, repeated wrist radial deviation and thumb extension often lead to Dequervain’s or “New Mom Thumb”. I educate patients on the “football” carry and the “scoop and lift” to avoid those painful repetitive motions when getting babies out of cribs and car seats.

There is also a handout attached more specifically about DeQuervains as many parents that I see have Dequervain’s; some also have thumb arthritis or wrist tendonitis. See the “Mommy thumb and tips” on that specifically and the last page additional tips for carriers, travel etc. I find many parents are not using a carrier that is appropriate for them or at times their baby’s size, which can lead to postural compensations on the parents end.

Some other thoughts:

If you have breastfeeding moms, assess where they feed: is it in a supported back chair, do they use a breastfeeding pillow for additional support?  Are they constantly cradling the baby’s head with the wrist and thumb in poor position for a prolonged period of time?

What does their baby usually wear? For my parents with thumb arthritis I vote velcro or magnetic closures over snaps and zippers. https://www.easymagneticclose.com/

Where do they do the majority of diaper changes? Are they bent way over with shoulders protracted and elbows extended, causing the wrist and digits to do most of the work? Are the changing items within easy reach?

Are they on the floor a lot with the kiddos? Are they able to complete floor sitting to standing with good mechanics or do they have to force all of their body weight through the wrists? Making sure to be near a surface to help get up versus going on to all fours all the time.

Is their house craft zone central for the kids? Do they have spring loaded ergonomic scissors to use since mom or dad maybe do the most cutting?

What’s meal prep time like? Lots of chopping can put an already tired hand/wrist out of commission afterwards. Do they have a food processor? Are pre-chopped items available? Can they use a rocker knife? I’m a personal fan of Mezzalunas https://www.amazon.com/Mezzaluna-Vegetable-Chopper-Chopped-Industrial/dp/B00MM169AK

I also truly believe that posture and strengthening of the mid, low back and core muscles is critical to prevent distal upper extremity overuse. For postpartum moms, they may need to wait for clearance from medical professionals to resume those types of activities, especially core. You may suggest when they are ready, asking their physician for a referral to Physical Therapy to work on safely strengthening those posture muscles. Many moms also experience balance and pelvic floor dysfunction during pregnancy and after, which Physical Therapy can also help greatly. You can help a family locate the appropriate physical therapy specialist here: http://aptaapps.apta.org/DirectoryofCertifiedSpecialists/default.aspx

Lastly, If you have a parent that just continually complains of pain, has obvious swelling and limitations in ROM, or needs a custom splint, suggesting they see a hand specialist is a good idea. The American Society of Hand Therapists has a locator for a Certified hand therapist here: https://www.asht.org/find-a-therapist