Sunday, December 20, 2009

The Most Common Infant Disablities and How to Recognize Them

The Most Common Infant Disablities and How to Recognize Them

Saturday, December 19, 2009

Books for Toddlers

My 18 month old son has a few of his favorite books. One of them in particular is a Baby Einstein (R) book that has an animal on each page, with a fabric or texture that goes with the animal- fur for the dog, faux leather for the turtle, and rough velcro for the hedgehog. Funny enough, he doesn't prefer any of the many toddler books his sister liked...too girly I guess! I saved them just in case, oh well! Her very favorite book was Goodnight Moon, and in fact I had to buy 2 extra books because she looked at them so many times, the first 2 fell apart. Until she pointed it out to me at the ripe old age of 2 years, I never noticed that on each page the tiny mouse is in a different place. Funny how girls are so good with details!

Toddlers are tough on thin paper books, so I'm glad for cardboard, thick pages. But there are some things to think about in particuar. First of all, you want a variety of books. Some are good for visual skills whereas others are better to promote language skills or touch processing. Below is a few different types of books for toddlers:

1. Song books: these books may either have a verse per page or a song per page. One of my favorites is the Wheels on the Bus book with a different verse on each page- the pictures are cute. Some books may even have a CD that comes with them.

2. Textured books- the different feels on each page tend to capture young children's attention. These books are often thick since the textures add bulk to it.

3. Foam puzzle books- these books may have it where each page has an animal or shape insert that can be taken out and placed back in.

4. Simple vs. detailed designs: very young toddlers can focus on pages better that only have one picture and not many details in the background. Very commonly in these types of books are animals or shapes. These types of books are also good for children with visual processing delays. More detailed pictures are better for older toddlers and preschoolers.

5. Books with noises or songs- may have a button to push to activate the song or noise. Although these are often a favorite of the kids, it can be annoying to the adults after awhile! I've been known to hide these books after awhile!

6. Pop-up books- when you turn the page, an insert pops up. We have an Elmo (R) book that does this, but it tore within the first week of owning it...that is the problem with these books- toddlers tend to tear up the pop-up insert.

7. Hidden windows or tabs to pull open- once again, these tear easily for the young toddlers, but the older toddlers and preschoolers may have the fine-motor control to use the books without accidentally tearing them. My daughter's favorite hidden window book was a Christmas Little People (R) book, that had animals, elves, and gifts behind the various lift up window. For example, when you lift up the paper ornament on the tree, a gift was underneath. Her favorite tab pull book was one that moved animals within water or on land as if they were swimming or running as the tab was being pulled.

8. Fabric books- these books are usually just a few pages long and are made of various materials such as jeans.

9. Manipulative books- each page may have something to manipulate such as a belt fastener, a button, etc.

Well, I'm off to go read to my two children!

Friday, December 18, 2009

Setting Up the Environment to Help Young Children Focus Longer

Babies and toddlers are well-known to be active and not wanting to sit still for too long. But they should be able to focus on activities progressively longer as they approach their 2nd birthday.

My 18-month old son can sit 10 minutes looking through a basket of "gadgets", 5 minutes looking at a simple book or rolling/bouncing a ball with someone else or himself, and about 15 minutes watching an Elmo (R) video before he starts wondering around. If he is interested in a manipulative toy, he may sit there for quite a while and figure it out, take it apart, then put it back together. But overall, he is "all boy" preferring to run, climb, and just tinker around. I definately have to be careful leaving the room for too long (e.g. like to go to the bathroom), or I'll come back to find him standing on the dining room table! This morning he spilled his Dad's cold cup of coffee all over the floor...thank goodness for the steam vacuum! We didn't know he could reach that high, but apparently he glad, it wasn't a freshly brewed, steaming hot cup of coffee! It's not that I wasn't watching him, but I had only briefly turned around. Man, are toddlers quick!

Toddlers with special needs or developmental delays often have even shorter of an attention span and ability to focus than their peers who are typically developing. Below are some strategies to improve their ability to focus during play time:

1. Declutter the room by putting toys in containers, baskets, and the toy box. Leave out the larger toys and a few of the favorite toys though. My experience is that if there is too much out on the floor or the room is "chaotic", then the child will walk past the toys or be too overwhelmed to know what to pick out. When children don't interact with the toy and aim around aimlessly they may get destructive; at the very least, they are not spending time gaining important developmental skills. Now keep in mind, there are some children who are the opposite, they are too passive, and in that case, leave more toys sitting around, but not messy! If toys aren't out, these children won't going exploring and prefer to just sit there.

2. If the child is visually overwhelmed easily, then have play time in a room with less furniture and "things", such as in a spare bed room.

3. Make sure the child is getting lots of opportunities for gross-motor play, so that he will then focus for toys that require him to sit or stand still such as books, puzzles, train table, block stacking, etc. Indoor gross-motor play ideas include: rocking horse, tunnel, mini-trampoline, pulling wagon full of toys, and bouncing on exercise ball. Outdoor gross-motor play ideas are endless including riding a tricycle, swing, slide, and kicking a ball.

4. Provide toys that aren't too simple but aren't too difficult. Toys that can be played with in more than one may increase the chance that the child will play with it longer. Store "baby" toys out of sight!

5. Get on the floor and play with the child! If the child has limited play skills, then teach him how to play! That way, when you need an extra moment in the kitchen or bathroom, the child will know how to play with himself for a longer amount of time.

Now, go ahead, go play!

Friday, December 11, 2009

Take Your Child's Therapist Holiday Shopping With You!

Since I work for an early intervention program, I have the luxury of going into the family's natural environment whether it be the home, daycare, relative's home, or the community. The community settings could be anywhere the family naturally goes and where "typically developing infants and toddlers" would go. This could be the library, park, restaurant, or store. I may go into these public places to help figure out some strategies to make the routine more functional for the child and family. So, if the child is scared of the playground at McDonald's, but the family goes there on a weekly basis, then I can justify doing a therapy session at that setting. An occupational therapy visit in the grocery store may be to figure out ways to help the child balance in the front section of the cart. The list goes on and on of ways that I can help the family in the community.

The biggest way I can help this time of year, is to go holiday (AKA Christmas) shopping with the family. Maybe I am going with the child and family because of typical therapy reasons such as helping reduce sensory stimulation, transitions, following directions, balance, etc, etc, etc. But I can also use my expertise and background in "activity analysis" to help the parents pick out appropriate toys for the child. When a child has a developmental delay or medical diagnosis, it is not always so simple to pick out toys. My experience is that families tend to purchase toys that are too easy for the child as opposed to challenging the child.

Toy ideas for a child with ASD (Autism Spectrum Disorder) might be geared toward improving social-emotional, sensory processing, cognition, or language skills. For example, a doll and stroller set or textured formboard puzzles. In comparison, toy ideas for a child who has suffered a stroke (AKA hemiparesis or hemiplegia) might be the ones that encourage both sides of the body to work together such as a ball, t-ball stand, golf set, wagon, tricycle, and Mr. Potato Head (R).

If your child is too old for the local early intervention program because of being over the age of 3 years or if he receives therapy services privately, then see what kind of deal you can make with the professional seeing him. Maybe since insurance wouldn't pay for a shopping trip, you could pay privately. If this is not an option, then maybe the last 20 minutes of the therapy session could be used for the parent and therapist to go to websites for the stores they will shop at (e.g. Target (R), Toys R US (R), Wal-mart, or Amazon (R)), and discuss toy ideas and why they would be good for that child. If that is not an option either, then maybe call the therapist a few days in advance of the therapy session and ask her for a list of toys that would be good for your child to have; not just a generic list of toys, but one that is indivualized to your child.

Don't be afraid to ask! This is my favorite time of year for more than one reason, but one of those reasons is shopping with my clients and their families!

Friday, December 4, 2009

Identifying Problematic Reflux Symptoms in Infants

I have written before about my now 17 month old son's case of infant reflux. It was not a fun experience. But it is behind us for now. He has officially been off of all medications for four months...yeah! We can no longer call him "Milk shake", but we have plenty of other nick names we call him!

What is reflux? Well, all babies spit up somewhat and when stomach contents come back up, it is called reflux. It is only a problem if it happens excessively which can erode the lining of the esophagus as well as hindering weight gain or creating quite a fussy baby.

I am writing about reflux again, because I want to discuss symptoms of infant reflux that often go unnoticed. So often the clients I work with have feeding problems that are made worse by their reflux. Many of the obvious signs are excessive spitting up, poor weight gain, and one of two feeding patterns, either being a "grazer" or a "guzzler". For some reason kids who don't excessively spit up, but just have wet burps, seem to not come under the radar. They may have other symptoms such as arching, pulling back from the nipple, chronic congestion and cough, gas, and constipation, but because they don't have massive spitting up episodes, the reflux goes unnoticed. Often, you can see a baby swallow the stomach contents that have been refluxed up, but they just didn't spit it out. This causes pain in the throat. Too bad some of these babies are not on an anti-acid such as Prevacid (R) or Zantac. They typically become happier babies once placed on such medications, and even sleep a lot better too.

Another common problem, which was a problem with my son, is motility. This is the rate at which the stomach empties and the contents move through the intestines. My son would spit up massively 2 hours after a feeding. It was such a problem before he was put on an additional medication for motility, that he had to sleep in a bouncer seat for a few months. Even when I inclined the mattress in his bassinett or crib, he would cough and choke on his spit up. He would get a hoarse voice, cry, arch his back, and become fussy. Yet when he was placed upright, he didn't have these symptoms and he went back to being happy and calm. I was told to keep him upright for 30 minutes after a feeding, but that was not long enough for him! Another symptom of the motility problem was massive gas. Somehow my son would pass gas and we would all look at each other in amazement that a baby had tooted so loud...the gas was as loud as a fraternity boy after eating pizza and drinking beer all weekend! Because of the gas and excess air, he wouldn't take but 4 oz. at a time even at 7 months of age, because his stomach was already feeling full. Finally, once he became more mobile by crawling, cruising, and walking, he took 6-8 oz. during one feeding. Needless to say, he was gaining weight but at a slower rate than expected. Now, this may be okay for my son because other than multiple food allergies, he has no other medical problems. But what about the kids I work with that have heart problems and other medical diagnoses. So often, these kids can't afford to not be gaining more weight.

Often these babies are labeled with colic and not given medicine. The parents just live with a fussy baby in hopes that the child will grow out of it around 12 weeks of age. Now, that may be the case, but maybe not. If it is reflux, not colic, once again they may grow out of it, but may not. A baby who doesn't calm when being held may have more than just colic. The pain could be gas, reflux, ear infections, etc. Try massaging the belly in a clockwise direction and also strokes that start at the bottom of the sternum and end at the naval; this way if it was gas, you are massaging it out.

Another thing to note is that changing formula usually does not make a difference. It may make a difference for a baby who also has a food intolerance to soy or dairy. Also, using these bottles that reduce gas only make a minimal difference. They help because then the baby takes in less air...unless he/she is a massive guzzler, then it really doesn't matter which bottle or nipple is used.

One other clue that a baby has a reflux problem is anti-histamines or other similar medications don't decrease the congestion, and in fact they may make it worse. That's because the wet burps are contributing to the congestion, not an allergic response to allergens or because the baby has a cold or other virus. The wet burps, leave acid behind on the throat which makes the body create more mucus leading to a nasal drip. This in turn leads to a hoarse voice, which can become even worse when the baby wakes up screaming in the middle of the night because of the pain.

Sometimes introducing baby food helps, but not always. My son spit up the baby food, which meant either me or the furniture was going to be wearing the food he ate within the next half hour of him eating it...yuck! But I do know that adding baby cereal or food helps with some babies reflux symptoms because it adds to the weight of the contents and may lessen the acidity.

These babies should spit up less when in side lying or in tummy time than when lying on the back, due to the position of the stomach. However, having said that, some babies with reflux spit up in any position other than upright. I do believe that not every baby needs medicine, but if every other trick in the book has worked, then why not try it!

I'll end by saying I was always jealous of those ladies who would laugh at a baby shower as the pregnant person opened a package of burp cloths as a gift. These ladies would say something like "You don't need that. In fact, my babies never spit up, I never used burp cloths at all."...of course, I'm thinking "If your baby is anything like mine, you'll need ten more packages of burp cloths!"

Tuesday, December 1, 2009

Strengthening Activities for Toe-Walkers

There is a variety of reasons that a young child may excessively toe-walk. Reasons could include muscle weakness, neurological damage, orthopedic abnormalities, abnormal muscle tone, poor sensory processing, being over-whelmed, habit, and the list goes on. The following are a few activities to help strengthen the opposite set of muscles (anterior tibialis, peroneals), because often a toe-walker has over developed calf muscles (gastrocnemius and soleus).
  • squatting- playing in squatting helps thigh muscles (quadriceps) and the front of the ankles. Try "playing" in that position for a while, and you'll soon feel "the burn".
  • Heel walking- walk with the toes off the ground and the heels "dug in"
  • Bear walk (AKA in yoga "downward dog"- crawl position with the legs straight and bottom in the air. Try to get the heels down as flat as possible. This can be done on a flat surface such as the carpet or on uneven terrain such as in the sandbox or on grass. It can also be done while crawling up a staircase
  • Frog jump: squat slightly then jump forward
  • Popcorn jump: squat low to the ground the quickly jump straight up
  • One-foot balance activities such as while dancing or climbing or pretending to be a flamingo
  • Play "Ring Around the Rosie" and switch it up to jumping, heel walking, running, slow walk
  • Foot wrestling: have two kids lay on the floor with knees bent and feet facing toward each other, and then they can push against each other with their feet.

Helping Young Siblings to Take Turns

I am not always the most patient person when waiting for it to be my turn...especially at the grocery store when I'm hungry. That's why I try not to go shopping on an empty stomach. Now, if it is difficult for me to wait, share, and take turns at 30-something years of age, then, wow, how much harder is it for a toddler or preschooler. Especially when they are siblings and wanting to play with the same toy at home. Many typically developing and/or developmentally delayed children have difficulties with grasping the word "wait" or "share". They need a visual or auditory cue in addition to just being told. Even worse, is when an adult says "be nice" to the kids when they are fighting over a toy; what does "be nice" really mean----nothing. The kids need specific criteria to follow until they can thoroughly understand how to take turns and share. Listed below are just a few ideas that may help young siblings to share:

  • Use a kitchen digital timer that beeps: set it at 5 minutes (or any other time increment). When it beeps at the end of that time, then the kids know that it is the other person's turn. Examples of using this could be for favorite puzzles, swings, train, bikes, video games, or other desirable toys.
  • When possible, get two (or the number equal to number of kids) toys that look the same. If the similar toys differ slightly and the kids are fighting over a particular one, then set the timer.
  • Consider putting the items in "time out" for the day or afternoon if the kids can't seem to share. Now if one sibling is 18 months and the other is 4 years old, then that is probably not fair to the older child, so in that case a cue may better be able to teach the younger child.
  • Use a sand hour glass timer such as the ones that come with board games. Often the timer lasts 1-3 minutes. Once the sand has poured into the bottom portion, then it is the other child's turn.
  • If the kids are arguing over playing with a toy during a car ride, then let one play with it on the way to the destination and the other on the way home.
  • If the kids are fighting over a television show, then discuss ahead of time whose turn is first. If they both have a favorite show on at the same time on different channels and there is only one TV, then maybe alternate days or use a DVR.
  • Spend a special time with each child so they don't feel the need to fight over you, the parent. This might be reading to one and then the other before bed time. It might be taking each one of them to the park individually. No matter what the special time is, make it about that child only.

Whether you own two of every toy or not, kids still need to learn to take turns and share. Learning it at home first really helps them with interacting with peers such as at preschool, the park, church, and other places within the community.

Monday, November 16, 2009

Finding Christmas Gifts For Toddlers With Developmental Delays

For some reason Christmas shopping starts sooner and sooner each year. I noticed that before Halloween had even come, Christmas stuff was already out. When I was younger, I would always go shopping with my mom, sister, and other female relatives the day after Thanksgiving. We would shop hard and hunt for the best bargains. We would have a car full, and had finished off at least half of the list in an 8-hour exhausting! So, instead of fighting off that shopping starts earlier, I'm going along with it. Last year, I had everything purchased by the first week of December. Boy, was it relaxing to enjoy the rest of the time to absorb what Christmas is all about. I attended church plays, parties, and other events from mid to late December without the worry of not having completed my shopping.

Even though I get an earlier start, I don't always find it so simple to know what I'm buying for whom. I don't like to charge too much money, and I like to pay off things, which means I get gifts that are thought-provoking but not huge money items (e.g. TV, vehicle, etc). I'm finding it a bit hard to find toys for my 17-month old son. Because alot of "boy" toys are more for two year olds and older. Unfortunately, he still mouthes toys. However, his imagination is emerging and he likes to roll cars as he makes car noises and places the Little People (R) animals in the farm; he seems to have fun doing these things. He stacks blocks and similar things, but he gets bored with simple toys. If he could learn to not stick toys in his mouth, we could advance to more complex toys.

Now, as hard as I find it to know what to buy whom, I know that it is even harder for parents, friends, and relatives of a developmentally delayed child. My suggestion for those families is to ask the parents what to get the child. Because a 2 1/2 year old (chronologically) child, may only be developmentally at a 1 1/2 year old level. For parents who aren't sure what to get, ask your child's clinicians: speech, occupational, or physical therapist, as well as preschool teachers. Also, go to websites such as Target (R) or Toys R Us (R) and look up toys that are at the child's developmental level, not chronological age. I think that some sites out there on the Web even have kid's gift registries. What a great idea for a child with special needs! Whether you are part of a registry or not, start to write down some ideas from these sites. I also frequently go to consignment (used) stores for kids and can find some amazing bargains. That way if the child doesn't like the toy, I didn't spend too much. You have to go to these places often to get the better items because toys such as train tables, doll houses, and other popular gifts don't last long. The local store that I go to only takes items that are in good shape and won't resale them unless they have all of the pieces. Another option for bargains is garage sales and toy exchange programs (rental).

Also analyze the toy for what it does or doesn't do. If you have a delayed child who isn't speaking yet, then musical or speaking toys may be good stimulation for them. If you have a child who doesn't know how to play with toys, then try open-ended items such as blocks, cars, Tinker Toys (R), Bristle Blocks (R), and balls, then as they progress doll houses, Barbies (R), action figures, etc. may be more beneficial. Also, buy toys that expect skills that are slightly ahead of where the child functions presently, in order to challenge the child. Now saying this, I do believe toy size and material should be taken into consideration- foam blocks may be chewed on, but plastic ones wouldn't. A simple "swallow" test for toddlers is to get the cardboard insert from a roll of toilet paper and try to fit the toy in it. If it fits, then it is too small for a child who still "eats" toys. The insert is supposedly similar in size to the throat. Finally, check out information on development at website, which has information mainly in English and some in Spanish; it even has printable handouts on how to play with children during everyday activities.

Friday, November 13, 2009

Ambidextrous Versus No Hand Preference

Most children begin to prefer using one hand over the other for skilled activities (e.g. eating meal with a spoon, throwing a ball at a target) by the time they are in preschool (age 3-5 years). Technically, they aren't considered "behind" if they haven't done this even up until the age of 7 years when their brain becomes fully myelinated. Yet, some developmental standardized tests show that it's a skill that should be present at 2 years of age. It helps if the child has chosen a hand dominance by preschool and kindergarten when they are learning to write letters and draw pictures. Since 96% of people are right-handed, chances are you can put the crayon in the child's right hand and be correct about your choice. But definately, don't fight with the child if they start using the left hand, just let them do it. Maybe they can perform an activity such as cutting out shapes by taking turns with each hand. And eventually, one hand will feel "just right" to them, and they will choose a preference.

Not having chosen a hand preference yet should not be confused with being ambidextrous, which is being highly skilled in each hand such as writing just as neatly with either hand, manipulating chop sticks with either hand, or hitting the baseball with the bat in either hand. Often, it may not be known if a child is ambidextrous until middle elementary school years, since preschoolers are just learning to perform fine-motor activities.

So what is dominance confusion? Well, this is when the child isn't that skilled in either hand, and may only use the side of the body that is convenient for that moment. For example, if you placed a spoon to the left side of the child's plate, then he would eat with his left hand...and would probably be messy with it. If you had placed the spoon on the right side of the plate, he would have used the right hand to feed himself. He may not cross over the middle of his body as noted by not transferring items from one hand to the other and only reaching with the hand closest to the item he is about to grasp. This might also accompany other problems since crossing the midline of the body requires that the two sides of the motor hemispheres of the brain "talk" to one another. Often, I see global muscle weakness in these kids and a poor ability to perform 2-handed activities such as holding the paper with one hand while the other writes on/cuts paper or one hand holding Mr. Potato Head's (R) body while the other hand inserts body parts . This is known as poor bilateral (two sides of the body) coordination which is often seen with certain syndromes (e.g. Down), cerebral palsy, sensory processing disorder (AKA sensory integration dysfunction), prematurity, and developmental delay. Anytime you see poor bilateral body coordination, there is a tendency for the child to have a speech and language delay, since the mouth is on both sides of the body. These children might also be clumsy such as with climbing, falling when running, not jumping well, and delayed with learning to ride a bicycle.

If you are wondering if your child is ambidextrous, get a checklist of fine-motor skills a child his/her age should be able to do. Then, have the child perform all of the skills with the right hand, then later do the same with the left hand. If he could do good with both sides, then he may truly be ambidextrous.

Also, remember that a person with a right hand preference could be good at using the left hand for certain things, especially when taught a certain skill with the left hand. For example, I was taught to tie my shoelaces by my left-handed sister, so I do that skill like a left-handed person would do. I have tried to change how I tie shoes, shoot pool, and perform the other numerous skills she helped to teach me, but my brain has already learned those things using the left hand. Now, if I were ambidextrous (which I'm not), I would have been able to generalize those skills to the right hand and make the switch easily. So are you a lefty, righty, or amby?

Tuesday, November 10, 2009

Why Would a Toddler Talk If He Doesn't Have a Reason?

If my husband waited on me hand-and-foot, did all my chores, and took care of every need of our children, we might actually talk less. Why? Because there wouldn't be discussions about who is going to take my daughter to soccer practice, what to add to the grocery list, and who is giving my son his bath. Because the answer is that he would do it all. Now doesn't that seem silly. Of course, because we should share the load. Now, we would still have conversations about the weather, our travel plans, politics, religion, etc., but not discussions on day-to-day issues. This parallels to children with language delays. If the parents are chasing the child around with food, picking out all of their toys and clothing, and not setting boundaries for discipline, then the child has no reason to talk. Give the child a reason to communicate!

If you want to help a child with a language delay, give him a reason to talk. I'm talking about a delay, not some disorder such as cranio-facial malformations or paralyzed vocal cords. Some tips for giving a child a reason to talk are:

  • Serve small amounts of food so that the child has to request more. This may be with words, grunts, gestures, or sign language, but at least that is a start.

  • Provide choices even if they don't seem important. Ask "Do you want to wear the red shirt or the yellow shirt?" Now the child may not know his colors, but when you hold up two shirts, he gets to make a choice. This gives the child a sense of being in control, which means he may be less defiant later when you want control!

  • Put favorite toys slightly out of reach, so that the child has to ask for help, point, or otherwise let his wishes be known.

  • Label what you are doing, playing with, or what he is doing. For example, when you provide the child with a cup, say "Drink, here is a drink". Keep it simple as opposed to saying some long drawn out sentence.

Some children truly need the help of a speech language pathologist (AKA speech therapist), whereas others just need the environment and caregivers to give them a reason to talk!

Thursday, November 5, 2009

Heart Defects in Babies Contribute to Feeding Problems

So often, I work with babies that have various heart defects and more often than not, the babies have feeding problems too. Even after the heart problems have been resolved through surgery or the child "growing out of it", the feeding problems linger into toddlerhood. Why? The number one reason: if you can't breathe well, it is really hard to chew and swallow! This may initially be a poor latch on to the breast or bottle and failure to thrive, because not getting enough ounces during a feeding and burning lots of calories during the feed don't exactly help the infant gain weight. Then, medical staff decide to switch to a high calorie formula that unfortunately has an "yuck" taste, or at least I think that is what the babies are revealing to me. Then, there is feeding tube discussion. Because if the baby can't consume enough calories orally, then an NG (nasal gastric) or (G) gastric tube may be necessary. What a mess! It is a vicious cycle of trying to get the baby to gain weight, especially if surgery is in the future. Then, parents get anxious and the baby "feels" it, which impairs the feeding session even more...uggh! So, then I or another occupational therapist steps in and works with nursing, GI doctors, the pediatrician, and any other person that can help. Often, within a few months things do improve and the baby gets on the right track of gaining weight...yeah! I often recommend strategies to calm the baby so that the suck-swallow-breathe during a feeding is more organized, check out for strategies on calming a baby and the environment.

Once the baby is learning to chew and eat table food, it is often easier for the child to just swallow the food whole than it is to take the time to chew. Many of these children become picky eaters because they know that it is way easier to consume yogurt than it is to chew string cheese! I start out helping the baby learn to use the proper mouth muscles and eat small pieces of food. If you don't work on feeding, you risk a child with an extremely limited diet that may need a feeding tube! Double uggh! However, if a tube is necessary, then so it is. But, feeding skills go backwards unless it is worked on hard! Also, often a swallow study is necessary to make sure the baby doesn't have reflux or doesn't have mechanical problems that would cause the infant to aspirate.

I think that anyone who has a baby that fits the description above, really needs a well-trained occupational therapist (OT), or maybe a speech-language pathologist, to work with the child. OTs can address the other motor delays as well such as not rolling or sitting up on time. So often, babies who have had heart surgery aren't able to lay on their tummy for awhile which impairs rolling and crawling skills. The therapist really needs to communicate with the physician on the plan of care! During therapy sessions, it is a must for the parents to be trained and replicate to the best of their ability what the therapist shows them to do during a feeding. If the baby is medically fragile, a home health nurse may be assigned; in this case, it is a great idea for the OT (or SLP) to work closely with the nurse. Depending upon the nurse's experience with feeding babies, they may need ideas on nipples, positioning, etc.

Monday, November 2, 2009

Allergy Testing

I'm so glad November is here...October was super crazy in terms of having sick children, busy at work, favorite tree infested with beetles and getting cut down, computer crashing, busy weekend plans, etc... I'm also glad November is here because that is when my children get re-tested for their food allergies. They will both be tested with the skin test, you know, the one where they scratch the surface of the skin with about 50 or so potential allergens. My daughter goes in today, and my son will go in later this month. Since she is down to just 2 food allergies at the age of 6 years, I'm so hoping she will completely outgrow the food allergies! My son goes back later this month, but since his list of food allergies has grown to 7 things, I am not so hopeful that he is yet to the stage of improvement. According to the allergist, highly allergic kids tend to get better during the preschool years, and he is only 16 months old.

My daughter had received the RAST blood test a couple of times, but the allergist said that there tends to be false positives and negatives with the RAST more than with the skin test. Poor thing, this morning at the breakfast table she was sneezing and sniffling, because unfortunately she was unable to take anti-histamines for the past few days. This allows for more accurate results.
She will also be tested for environmental allergens including pets, dust, mold, pollens, etc. Last time she came out allergic to dogs, dust, ragweed, and oak tree pollen. We will be considering allergy shots, because so many times when she is playing outside, the allergens trigger an asthma attack. I want her to get better, not to live isolated in a bubble!

We really need to keep in mind that these little kids with allergies are impacted in all areas of life. When you have allergies, you may feel sluggish and not all that interested in playing or school work!

Friday, October 23, 2009

Abnormal Muscle Tone: Functional versus "Pretty"

When children have abnormal muscle tone such as tight muscles (spasticity) or tremor-like motions (ataxia), then the motions that they make may not exactly look pretty. This is because there is damage somewhere within the neuromuscular system whether it be in the brain such as with cerebral palsy or at the cellular level of the muscles such as with muscular dystrophy.

Back when I had just graduated from therapy school, I went to numerous classes on learning how to improve a patient's muscle strength, tone, and movement patterns. It was my mission to help everyone look typical. That was soon found to not be so realistic. And although a difference can be made with mildly involved persons in a fairly short time, it may take a while for very involved patients such as those who have suffered a TBI- tramautic brain injury. This is because of numerous reasons (medical, neurological, orthopedic, cognitive, behavioral, etc.). So, until their movements look stronger what are we to do? Well, I believe the therapist's duty is to work on functional skills.

For example, I would love for a child with cerebral palsy to hold the spoon perfectly and not spill any food, but that may not be realistic in the short term...for some kids, it may never be realistic. The immediate goal should not be to not let the child feed himself unless he has used the "proper" movement patterns, but instead to make sure the child is functional, even if that means that the movements do not look "pretty". It may mean using a wide handled, curved, or swivel spoon. Although the ultimate goal as a therapist is for the most efficient movement patterns by each muscle group during a functional task, this can take time to develop, and requires daily strengthening. Maybe it can be practiced during snack or at the end of a meal, but it would only frustrate a child to be helping them move "properly" during every single bite. Yet, as a therapist why is it so hard for me to just sit back and watch a sloppy eater? I have had to chill out and realize that I am being a much better therapist by encouraging independence even if the movements aren't the prettiest.

Also, responsibility goes to the parents for carrying out daily activities and exercises to help the child improve. I wouldn't just go to the gym once a week and expect to gain a better figure, so how could we expect that a child with neurological damage is going to improve with tone and strength by only going to therapy once or twice a week? The therapist MUST train the parents to do easy activities and exercises to incorportate into daily routines. Examples include having the child push the siblings stroller to build arm and leg strength, buy toys that encourage manipualtion, carrying grocery bags, "rough house" with parents, taking the child to the park to work on climbing, sliding, and swinging, and the list goes on.

Finally, we as therapists need to know when it is time to discharge a patient from services and guide them to community facilities such as karate or gymnastic lessons. There are some children who have endured years of therapy at a high frequency and although overall they have made gains, there comes a time when those gains aren't so drastic. It could be due to hormones, growth, attitude, needing a change, or that there is just an extreme amount of neurological damage. No matter the reason, I completely believe that it is okay to discharge a child from therapy even if all of his movement patterns are not "pretty". Now, if the child is willing to do all of the work it takes to get stronger and change movement patterns, then I might keep them in therapy longer. But I would still emphasize function. If the child wants to be an artist, then we would work on movements that are made at an easel. If the child wants to be a secretary, then we would work on typing skills whether it be with two hands on a typical keyboard or with a device on an adapted keyboard. I would also work on movement patterns needed to play, cook, clean, dance, or participate in sports.

Sunday, October 18, 2009

Repetition of Simple Words When Learning Language

Yesterday at the grocery store my 16-month old son told every employee and other customers"Hi" no less than 100 times! It would have been slightly annoying after the 75th time if I didn't work with young kids with developmental delays. So, instead of rolling my eyes, I chose to smile and be glad he is wanting to talk to others. He has about 10 words that he uses, some on a daily basis and others at least every few days. But each word was used repetitiously in the beginning. Like the word "banana"; when at the store about 2 months ago, he said "nana" over and over throughout the whole grocery store visit as he pointed to the bananas I had placed in the cart. Now, he only says "nana" when he sees the fruit bowl in our kitchen or when he actually wants to eat one. Typically, kids do this. Kids with disabilities or delays, may only use a word intermittently or say it a couple of times, and not say it again for a few weeks.

During therapy with young children with delays as well as with my interactions with my own son, I purposefully keep my sentences simple and repetitious. When rolling the ball back and forth to a child, I may say the word "ball" 20 times or more. I also pause to let the child have a chance to say it or go after it if it rolled away. This is important because the brain may take multiple times to make that connection that the sound of "ball" matches the actual object. So, then next time the child wants to play ball, they just have to say it. Some kids with disabilities may use sign language or pictures instead of words, but even then, they need repetition of those approaches too. Also, if I start the activity out the next time by saying "Get the ball",...pause..."ball", I hope that the child goes to retrieve it. If not, then I help them go get it, and hope that the next time the child will remember what a ball is.

In addition to repeating the words multiple times, the other big thing to remember is keep the sentences simple. I don't have to describe every detail of an activity especially since the child doesn't understand all of those words. That also increases the chance that the child will tune me out. But if I keep is short, I am more likely to gain the child's attention.

Sunday, October 11, 2009

Knowing When Your Toddler Is Ready To Get Potty Trained

It sure is frustrating to try to potty train a toddler before he or she is ready. Knowing When Your Toddler Is Ready To Get Potty Trained gives you tips to know if your little one is ready. Often, special needs children are late with potty training due to weak muscles, delayed language, or medical complications; this is not always the case, as I once had an 18 month old client with mild cerebral palsy be successfully potty trained. As suggested, kids need some form of communication, but not necessarily words. I have worked with many kids with autism who indicate the need to go potty with pictures or sign language. So, don't assume that your special needs toddler may not be ahead of his peers with this skill!

Keeping Your Baby Happy While Shopping

I wrote this article for hub pages and give quite a few survival tips for Keeping Your Baby Happy While Shopping

Saturday, October 10, 2009

Helping Special Needs Kids Minimize the Risk of Contracting the Seasonal Flu & Swine Flu

Even though the swine flu is two words, these days it is as if it were a dirty four-letter word. If you have it or have had it, you know that people treat you as if you have the plague. Now, for you and I or people who are otherwise healthy, we are probably fine to catch it. But not so for many special needs kids especially those who are medically fragile or who have not-so-great immune systems. Knock on wood, I have had patients and relatives come down with it and even cough on my face as they were ill, and I still haven't caught it. Sure am glad I take my multi-vitamin and probiotics daily! Now, as sure as I type this I will start coughing and get body aches with a high fever, but I do think there are ways to minimize the chance that you catch it. Notice I said minimize, not a guarantee of not getting either kind of flu. I am not going to tell you anything awe inspiring that anyone else hasn't said: wash your hands many times throughout the day and after contact with a suspected or confirmed infected person, cover your mouth when you sneeze or cough, take your vitamins, eat healthy foods rich in vitamin C and anti-oxidants, etc, etc, etc.

But how can we minimize the risk of a kid with special needs getting either the swine flu or seasonal flu? Well, if you are a parent of a special needs child who is homebound, change clothes after coming home from work or the community, wash hands thoroughly with soap and water for at least 15 seconds, keep the house clean, and STAY away from hugging, kissing, or touching saliva if you have a fever, headache, body aches or any other symptoms. Doesn't this sound like common sense. You would think! But so many of us are so focused on caring for the children that we ignore a fever or body aches.

For children who aren't homebound, teach them to not lick/mouth on non-food items such as toys, because if they touch a toy after a sick child at preschool, church, or elsewhere has touched it, then "WHAMMO", the virus has a chance to attack the mouth! Teach the child to wash hands regularly or for the caregiver to remind and help the child wash hands. If you can avoid places with a bunch of children such as fast-food playgrounds, that might be smart to avoid during flu season. If you must go to those places, go at a slower time such as during the week as opposed to the weekend.

Getting the flu shot may be beneficial for some kids, but not an option for others. This may be due to allergic reactions to eggs or other vaccine ingredients. My children are allergic to eggs, so I can't really do much about that except to make sure they get lots of rest, water, fruits, and vegetables as well as supplements. This may help the immune system fight a potential invading virus. But if doing those things doesn't help your child, take him or her to the doctor at the first sign of the flu so Tamiflu (R) or other medications can be given if the doctor deems it necessary.

Wednesday, October 7, 2009

Take Time for Your Young Kids- Don't Be In Such A Hurry

My friends and relatives say that I am a high energy person. I have to agree, because I like to do things fast. I can clean the dishes, laundry, and other parts of the house in light speed. My paperwork is always (unless I am ill) turned in on time at work. I can blog, cook supper, and talk on the phone simulataneously. So, it does not come natural for me to "stop and smell the roses" with my two children; somehow, usually I do slow down for them. If I weren't an OT with lots of training in child development, I probably wouldn't slow down for them. Especially in this day and age of cell phones, internet, video games, etc.

It is during the everyday routines and activities that young kids are learning from their parents, caregivers, and the environment. This might mean a slow-paced walk in your backyard as your toddler points to the flowers and birds, or throws trash away. What a great opportunity for language development! It might also mean that the trip up the staircase takes 5 minutes as your little one stops to talk, sing, or go up-down-up-down. What a great opportunity for gross-motor development. Even though it might seem cumbersome to let them go at such a pace, it is at this time that they are learning. I am glad my kids don't move around as quick as I do, because I think that kids subjected to this think they always have to be doing something. That would leave little time for reading, "free play", naps, imaginative play in the child's bedroom, etc. It makes me sad when I see families out and about running errands, sports activities, or other things late at night when they have been going at that pace all day long for most of the week; one or two days a night is fine, but not every night like this! Not good for the kids, and not good for the adults. Our bodies need time to rest and relax. Many kids who live fast-paced lives think they have to be constantly entertained. Once again, not good. I think this contributes to impulsivity, inattentiveness, and hyper-activity.

Many times a child with a developmental delay can improve during everyday activities, that is if the families just take that opportunity. For example, not being in a rush in the morning, means that the child can help put his shirt and shoes on. If the family is in a rush, usually the child has clothing put on him and he doesn't have to help at all.

Think about how this information could impact your family routines. Could you let the kids help you prepare supper at home instead of preparing everything yourself or eating out at a fast-food place? Could you let the kids help you with the trash, laundry, or other chores? These activities help with problem-solving, motor, and language skills. I plan this weekend to make a huge fruit salad for the extended family. I could hurry up and do it myself, but I am choosing to let my daughter help me. It's a great time for me to have her use a measuring cup, stir, and count food pieces. And I have no doubt that when we serve it to our family members, she will have a huge smile on her face and be more than willing to tell them she made it!

Tuesday, October 6, 2009

The Most Common Infant Disablities and How to Recognize Them

I wrote this article on hubpages and I hope parents who are searching for some answers and resources find it useful: The Most Common Infant Disablities and How to Recognize Them

Egg Allergy in Young Kids

I could write a book on food allergies, but I won't. I will just stick to small articles and blogs. Both of my kids, several relatives, and many clients suffer from food allergies. This is a topic I wasn't too familiar with 6 years ago, but "wow" has 6 years changed what I know. I have given the long details in a previous blog how both of my children began having food allergies as small infants. I breastfed and refrained from eating what they were allergic to. There was limited choices of formula, only elemental (Elecare (R) and Neocate (R)); they were expensive, and I knew that breastfeeding was the best choice. So, if I had to eliminate these foods from my diet, you can imagine how much investigating I had to do initially. Now, I have so many recipes and know what can and can't be cooked.

Living with egg allergies means no flu shots or yellow fever vaccine (if severe allergy, no MMR shot), certain desserts are eliminated, and no country breaskfasts being served. My daughter's egg allergy used to be so bad that we couldn't even cook them in our home because her eyes would swell up just from the aroma. Now, she is still allergic but not as bad. Living with egg allergies also means that my kids aren't going to eat cake at another child's birthday party. I plan ahead and make a "special" cake. I use cake mixes that are egg, dairy, & nut free and sometimes also use the ones that are gluten free. Actually, the vanilla flavor ones are not too bad, whereas the chocolate ones require acquiring a taste for it; I spit out the chocolate cake the first time I bit into it 5 years ago at her 1st birthday party. Now, I can swallow it but am not gung-ho about it. So, I just usually buy the vanilla flavor that tastes similar to muffin mix. If your child only suffers from egg allergies and not others, you can most likely buy a regular cake mix and just use a substitute. Eggs are the binder, liquid, and leavening agent of the recipe, so the substitute needs to have those qualities. One suitable substitute is flax seed oil. Another is using 1 tbs of vinegar with 1 1/2 tsp of baking soda (or 2 tsp baking powder, but make sure it is egg-free) in place of one egg. Some of the nutrients found in eggs can also be found in meat, fish, poultry, legumes, grains, vegetables, and hemp products. I give both of my children various vitamins, probiotics, and cod liver oil everyday so they can get the nutrients they are missing out on because of food allergies. They also drink a hemp beverage which also contains calcium.

Living with egg allergies is manageable once you know what you can and can't eat. I teach both of my children to never take food from someone else and ask "Did my mommy say I can have that?". I drilled the staff at my daughter's preschool about only letting her eat from her lunch. It meant at holiday parties she didn't eat what everyone else ate, but "oh well", I just brought her "special" snacks. My son is too young to understand, but I am working on teaching him too. Any babysitter or relative that takes care of my kids knows not to vere from what I asked them to feed my children. Sometimes the person didn't listen which meant a dose of benadryl or a shot of epinephrine. But we have survived. Once you get a grip on what the child can have, you realize there are actually a lot of good foods and recipes out there. But it also means less trips to fast-food joints or restaurants; you never know if foods with eggs were cooked on the grill or oil vat, which means cross-contamination. One good source on food allergies is

My daughter is supposed to go to the allergist this week and get retested. She gets re-tested once a year, and has already grown out of nut and soy allergies. Cross your fingers for us that she grows out of the remainder of the food allergies including eggs!

Wednesday, September 30, 2009

Surviving Birthday Parties with Kids with Special Needs

This weekend, my daughter is having a birthday party. It will be at a tea room and she is so excited about the tea party they will have there as well as the dress up, make up, nails painted, and other fun! I just bought the party favors this morning and I am ready for the party, except for making her the "special" cupcakes because of her food allergies- I will make those the morning of the party.

This gets me thinking of alot of the birthday parties I have attended of some of my clients, or where I have went to a party and a kid with special needs has been there. Parties are hard for many of these kids, especially if they aren't verbal or mobile, or get easily overwhelmed by the noise and movement of all of the other kids.

A couple of tips I see that have helped kids with special needs survive the party is:

  • Prepare them for what will be happening at the party and talk about it or show pictures ahead of time. Consider making a story about it so the events aren't so unpredictable. If the party is at a facility or home he has never been to, show up a few days ahead of time to familiarize the child with the surroundings.

  • Find out what is on the menu. If the child is a picky eater or has food allergies, make sure you pack snacks.

  • Allow the child to not keep up with the others or sit next to the others if he is not ready. If he has difficulties transitioning from one activity to another, don't expect him to participate in all activities. His idea of fun may be different than the other kids' ideas of fun. If the child has poor balance or afraid he'll fall, then maybe being near the child or partnering him up with another "helpful" kid might make him more willing to participate.

  • If he is slow to warm up, show up 15-30 minutes early to the party.

  • If the child is overly sensitive to noises, go in another room or go outside while the "Happy Birthday" song is being sung or horns are being blown

  • If the child is obsessed or "stuck" on a balloon or other birthday decoration, don't hesitate to let him play with it if the hostess is okay with that. If you know that this may happen ahead of time, maybe buy a special balloon for your child.

Friday, September 25, 2009

Sense-Able Beginnings: Toddler Activity: Sandwich & Burrito Game

Here is a good activity that can be included in the sensory diet of a child with sensory processing disorder. It can also be put in the home exercise program for young kids with muscle weakness, language delays, and motor planning problems. Sense-Able Beginnings: Toddler Activity: Sandwich & Burrito Game

Head Banging

When a young child bangs his head repeatedly, it can be scary to us parents. My 15 month old son recently went through a stage in which he wanted to bang his head on the stroller and high-chair. I don't think he was doing it for any particular reason; he did it once and seemed to like it, so he kept doing it. I nipped this behavior in the bud by completely reclining the back of the stroller and the high-chair. This meant if he was to throw himself back, nothing was immediately there to bang his head on. He tried it once, and realized it made him lay down. So, he quit trying it.

It is not considered abnormal to head bang, however, many children with special needs bang their head and do so excessively. Some kids do it to the point that you are left wondering how they aren't in excruciating pain. More than one book on raising infants and toddlers reports that up to 10% of typically developing young children head bang in order to fall asleep. This statistic sounds a bit high to me, but maybe it included children in the statistics who were similar to my son where they just tried it for a month or so. Yet, many of the kids I work with are chronic head bangers. I try to put my thinking cap on and help the parents come up with solutions to diminish the head banging. Often, we are successful, but sometimes not. Many of those kids eventually outgrow the behavior when they were ready. Listed below are some tips that have worked for some kids that I have worked with over the years. Consider why the child is head banging:

  • Is the child frustrated with a toy or person? If so, help him come up with other ways to appropriately release anger. One idea includes a place to retreat to when he is upset such as a tent. Within this tent provide toys or music that are typically calming and/or fun for him. For some kids, don't place anything in the tent other than a pillow or bean bag because they may need only minimal input.
  • Is he upset that you don't understand his wants and needs? If he is completely non-verbal, then PECS, sign-language, augmentative communication devices, or other strategies taught by a speech-language pathologist, ABA therapist, or other special educ. staff may need to be implemented. If he is verbal, but just can't express himself when upset, then give a couple of choices. This makes him feel validated as well as helping him express his wants and needs. The choices can be with words, sign language, gestures, or pictures.
  • Is the child just bored? Many kids, especially those with sensory processing disorder (SPD) or an autism spectrum disorder (ASD), need lots of movement opportunities or they get bored. Indoor activities may include: trampoline, tunnel, rocking horse, help clean and do chores, and obstacle course. Outdoor activities include: playground equipment with swings, slides, and climbing structures; swimming, walking/running, bikeriding, wagon rides, and yard work. Even a toddler can "help" dig weeds or water the flowers. Maybe the child is bored because he doesn't know how to play with toys or by himself. Get suggestions from your special education staff (OT, PT, SLP, ABA, developmental teacher, EIS, etc.) on toys and activities that may be easier for the child to learn to play.
  • Is the child a sensory seeker and needs that deep input head banging provides? Try lots of "rough housing" (supervised), jumping, and the other activities listed in the previous question-answer. Head massage or vibration may be helpful too.
  • Does he have seizures or migraines on a regular basis? Even if he is on medications that doesn't mean these problems are under control. I have had numerous kids over the years head bang, eye poke, & nose poke during, before, or after a seizure. Some kids have mixed types and although they may usually stare off, that may not always be the case.
  • Does the child have a visual impairment or functional visual deficit? For children with some vision (low vision) or who see double (diplopia), they may get eye aches and think it feels good to bang their head. In this case, darken the room and minimize the work the eyes must do. If the child is head banging as you are having them work on puzzles or other fine-motor activities, then give frequent breaks or cut the session short. If the child should be wearing glasses, then insist they do. Build up to all day starting with 30 minute increments; but don't skip a whole day or play with toys up close without the child wearing the prescription glasses.
  • Is he dependent upon head banging to rock himself to sleep because he has no other strategies? If so, help teach self-reglation and self-calming activities. Some kids suck their thumbs until they fall asleep whereas others hum, sing, or hold a soft toy. For this child, provide lots of motion activities throughout the day which may shorten the length of time the child head bangs in the evening. Some kids do well with compression such as tightly tucked in sheets, large heavy pillows placed around their bed, and tight pajamas.
  • If the head banging is so severe that the walls or furniture are getting damaged, then this is excessive force. Consider having the child wear a soft helmet to protect his own head as well as the surfaces he hits. Try using lots of pillows too.
  • Is the child head banging for attention or avoidance? If so, behavioral strategies may be needed to stop this behavior. If it is for attention, then quit being the audience and try your best to ignore it. Now, everyone in the family and at school (preschool) must be on board, or the child thinks he just has to head bang harder or longer in order to gain your attention. Try to give attention to him when he is not head the computer, TV, and phone talking that you do for another time, and give the child lots of positive attention during his waking hours.
  • Does the child have a reason to have an itchy head? Lice, eczema, dandruff, scabbs, etc. should be considered. If you do not know what lice or their eggs look like, then search the Web and I'm sure you can find loads of information. Discuss treatment for lice with your child's physician. If eczema is a possibility, then discuss this with your child's physician; the child may need prescription shampoo and lotion for his head.

Wednesday, September 23, 2009

Sense-Able Beginnings: Tummy Time

Tummy Time isn't always fun for all babies. This blog entry discusses ideas on helping an infant tolerate lying on his tummy Sense-Able Beginnings: Tummy Time. Babies who have been hospitalized for extensive periods such as with heart problems or being born prematurely may dislike tummy time...but they still need to do tummy time if allowed by the doctor. This helps them to achieve the developmental milestones of rolling and crawling on time!

Tuesday, September 22, 2009

Washing a Kid's Hair Who Has Tactile Sensitivity

My two young kids absolutely love bath time. When they hear Daddy start the water, they dash upstairs to crawl in. They have fun during bath time for many reasons: playing with one another, splashing, playing with bath toys, singing & laughing. My 15 month old son could care less if the water is poured over his head in order to rinse out the shampoo. My daughter on the other hand, acts as if she is dying if any water touches her face. I have her wear a cloth over her eyes and tilt her head back to minimize the damage. If I am washing her hair, all goes well because I am careful to not get any water on her face. When Dad rinses the shampoo, she puts up more of a fight because he typically gets water in her eyes. My child doesn't have sensory processing disorder (SPD) or an extreme tactile sensitivity that I know of, but she is still sensitive to getting water on her face. Once she is upset about the water in her face while bathing, she is over it within 10 seconds after it has stopped. But unfortunately for a lot of the families I work with, once their toddler or young child with SPD or tactile sensitivity becomes upset, it is meltdown city, and then the child is so upset that he can't fall asleep for well over an hour.

While applying shampoo to the child's (with SPD or tactile sensitivity) head, it is a good idea for the adult to put the shampoo in their own palm before applying it to the child's head. The trickle of shampoo over the child's head may be aversive whereas the deeper touch of a palm full of shampoo isn't as aversive, usually. When rubbing in the shampoo, use firm massage strokes. If using organic shampoo without lauryl sulfate, the shampoo may not create suds, therefore suds can't fall into the child's eyes. To minimize water in the face while rinsing shampoo from the sensitive child's hair, try the following tips:

  • Have them tilt their head backwards as you rinse the shampoo out

  • Have them put a dry washcloth over their eyes as if it is a blindfold. It can catch any stray sprinkles of water

  • Use a sun visor to catch any water that would fall down the child's face

  • Use a Lil' Rinser (R). They have a website; I purchased one at Target (R). I have only used it a few times, and if put on properly, it helped minimize water in the eyes even if the head isn't tilted back

  • Only wash a young kid's hair up to 2 times per week unless they are extra dirty. Since they do not produce as much oil (pre-puberty) as an adult does, they don't need their hair washed as often.

  • Get tear-free shampoo and/or shampoo with natural/organic ingredients; this way the shampoo won't be as harmful

  • Wash the kid's hair earlier in the day or before supper, not at bedtime. This way if he is upset about it, it won't delay his ability to fall asleep. Many kids with SPD have a hard time winding down to fall asleep on any evening much less on an evening when they became upset

  • Consider showers. The deep pressure of water coming from a shower head may be less aversive than water trickling from the faucet or a cup used to rinse out shampoo

  • If you are concerned that the your young child may have sensory processing disorder but you are not sure, go to for information on kids and for information on babies.

Monday, September 21, 2009

Snacks for Toddlers with Oral-Motor Problems

My 15 month old son is a big snacker! He loves fruit, veggies, crackers, cookies, & pasta for snacks! He gets a mid-morning snack and a mid-afternoon snack. I make sure that I get the snacks down to a size, texture, and resistance that he can easily chew and swallow without me worrying about him choking. I have evaluated his oral-motor skills and have recently felt fine with giving him larger pieces of food than I had in the past. I still cut fruit into diced pieces or chunks, but just not as small as I previously did. Although I have introduced using the spoon to him, he mostly uses his fingers to feed himself.

Snacktime takes a little more thought when your toddler has oral-motor problems such as can't keep mouth closed while chewing, "pockets" food in the cheeks or roof of mouth, sucks food til its mushy to avoid chewing, overstuffs mouth or hordes, swallows food whole because of poor tongue mobility and jaw movements, and chokes easily. Or maybe your toddler has oral-sensory problems such as can't feel food on face or within mouth (might overstuff or pocket), chews and swallows better with high-taste (spicy, tart, etc) than low-taste foods, hyper-active gag reflex, or is a picky eater due to tactile sensitivities. When preparing simple snacks for your toddler consider some of the following things:

  • If he is a picky-eater and you want to introduce new foods, try foods that are similar in texture, taste (sweet, sour/tart, bland, salty, spicy) to other foods he already likes. For example, if he always eats Fuji apples, then try Gala or Braeburn apples as opposed to a very different taste such as a tart Grannysmith apple. If he likes regular saltine crackers, then offer him whole wheat saltine crackers. If you veer too far from what he likes, then he may not try other new foods you offer him. Slowly add new choices.
  • If he is a picky-eater, introduce new foods that are similar in texture to the ones he already prefers. Textures: crunchy, puree (e.g. pudding, yogurt), mushy, liquidy (soup), slimy, mixed ( e.g. casseroles), etc
  • Offer him foods of temperatures that he prefers. For example, if he prefers cold foods, then give hime fruit that has been refrigerated instead of at room temperature
  • Don't continue to offer him baby food once he is a toddler. Applesauce, pudding, and yogurt are fine to offer. Get the message across that he is "a big boy" or that she is "a big girl"
  • Cut up any circular foods into a different shape to lessen the chance of choking. I cut grapes into 6 rectangular-type shapes.
  • Consider the amount of calories. Maybe a bowl of mixed fruit could have a few avocado diced pieces snuck in. Avocado is very high in fat...the good kind. Many children with oral-motor problems don't get the amount of calories they really need. Also, sprinkling carnation instant breakfast (R) packets over ice cream is a good snack that also packs in the vitamins.
  • Offer some foods that will make him work harder so that he can gain endurance, but make some foods easy to consume to help with caloric intake. You don't want the child to think every snack is a therapy session or he will start to act up in order to avoid it. One approach is to have the child eat the foods that are harder for him for 1/3 of the snack and then consume the easier foods for 2/3. For example, offer him 3 Ritz (R) crackers with one of them topped with crumpled ground meat.
  • If the speech or occupational therapist that is working with your child showed you some "mouth exercises' to do before mealtime, then do them. One common one I suggest for toddlers with low muscle tone is to use vibration to "wake-up" the muscles. You can use a vibrating toothbrush to rub on the inside of the cheeks, gums, and tongue. Then let him eat. Then, use the vibrating toothbrush to actually brush hi teeth once the meal is over.
  • Look at a great website for many suggestions on food, the environment at mealtime, exercises and much more on feeding at The site is hosted by a well-known speech and language pathologist. The section titled "information papers" and "feed your mind" is where I have found loads of handouts to give parents that are written in easy to understand language.
  • Some young children with feeding problems have sensory processing problems. To see "red flags" for sensory processing problems, visit
  • Remember to perform all of the exercises the physical and/or occupational therapist gave you to help your child's head and trunk balance. This is so important for sitting balance in order for the child to have good throat alignment to not choke.

Friday, September 18, 2009

The Impact of Denying That A Child Has a Disability

Denial is one of the five stages of grief. It is how many people cope through the day; if they had to think of a "problem" or be realistic, then maybe they would "fall apart"; maybe not even be able to function through the day. Whether it be denying that there is a plumbing, marital, or workplace problem, eventually the truth will surface. Unfortunately, when denying (for a lengthy amount of time) that a child has a disability, developmental delay, or other special need, it is not helping the child any. I do believe that all parents will go through at least a short-term denial, and that is normal. But when it lingers to the point that the child is not getting the help that he or she needs, then I perceive that to be unhealthy.

Common things I see a parent denying is that:
  • The child needs genetic testing or other specialized testing such as an EEG or MRI
  • The child needs to see a specialist such as a neurologist, orthopedic doctor, psychologist, etc.
  • The child has more delays in development than perceived by the parents. This may be as simple as the parent cancelling therapy (speech, physical, occupational, ABA) sessions often because they are not deemed that important or as complicated as the parent refusing to follow through with a school district's or health care professional's suggestions such as receiving special education services
  • The child's need for a wheelchair. Even if the child learns to walk someday, they need an immediate means of mobility and to be upright for socializing with peers; mobility helps the child's self-esteem, endurance, and attention span

So why does this bother me so much? Well, so often I know the child could be functioning better. But also I know that one day when that child's legs are so stuck in a certain position that he needs surgery just to stay out of pain or when that child still can't read and write well in the 3rd grade, that the parents are going to regret the choices they had made 5 years prior. So many of the parents that either deny or just don't realize that the child's disability is as severe as it is, feel extremely guilty once reality hits. I especially find this to be the case with parents of children with autism or severe learning disabilities. They beat themselves up for not detecting the early signs or just blowing them off. I will sign off by saying if you have fallen to a bad case of denial, then first of all forgive yourself and ask your child for forgiveness. Then, move forward and be your child's strongest advocate. You can't ponder on the past, but you can change the future!

Study by Flinders University detects signs of autism in first weeks | The Australian

This is quite an interesting study. So much so that I had to post it. Since I work with infants, I am always looking for information on early diagnosis of various developmental disabilities.
Study by Flinders University detects signs of autism in first weeks The Australian

Thursday, September 17, 2009

Not Coloring On Walls- Toddler Activities

Toddlers love to be artists. Unfortunately, their artwork is not always created where it should may be on the wall! uggh! So often, some of the parents of the kids I work with are so excited that the child wants to use a marker or crayon that they are not initially bothered by the child coloring on the walls or floor. Then, by the time the newness of the skill wore off, they wished they had never let the child color on the walls.

Some tips for preventing this are:

  • Use Crayola (R) color wonder or other markers that can only be used on certain paper, that way the marks are not showing up on the walls.

  • Water sticks such as Aquadoodle (R)- these water markers won't hurt the wall other than soaking it! You can find activity mats in various sizes made for the water sticks.

  • Hide the crayons or put them in a container high up on a shelf. If you want some within the child's reach, only leave out 2 or 3. I find it better to not leave kids access to crayons until they understand that coloring doesn't happen on walls, floors, or furniture. If you give them access, hope you are watching them closely! If they disobey, put the crayons in "time out" such as up on a mantle or shelf.

  • Use washable crayons and markers, that way it will be easier to clean up. A good idea is to have the child help clean up if he has the cognition to understand consequences.

  • Have the child sit in a particular place when coloring as opposed to roaming around. This way you can keep an eye on him easier. Maybe place a stool or table/chairs in the middle of the room or away from a wall so the toddler isn't tempted to color on the wall

  • Use an easel. For the kids with low muscle tone or delayed vision, visual perception, or visual processing skills, this is especially beneficial. These children typically are better with control of their finger and wrist muscles for coloring when doing it in a vertical plane. An easel board or an over-the-door easel hanger are both good ideas. No easel or access to one? Tape pieces of paper to the refrigerator and have that be the easel. For children with visual problems, use contrasting colors of paper. If the refrigerator is white, use pink or pastel blue paper. If the refrigerator is black, use yellow or white paper. This helps give a boundary and for them to not draw off of the paper.

I am lucky that my 5 year old daughter never drew on the walls. She drew on her kiddy table a couple of times, and I had her help clean it up which eliminated a repeat offense. I am sure that I will not be as lucky with my son, but who knows? My sister was not as lucky as me. When her older daughter "L" was in preschool, she was pregnant with my other neice. Well "L" decided to draw a picture of the family on the wall. She made sure to draw a cute little baby head with a smile on top of her Mommy's large belly. It was soooooo cute, but she still got disciplined. Although, my sister waited until I got to see it before she painted over it! It was so cute it was hard to get mad, but she did have to learn there are consequences for disobeying.

Saturday, September 12, 2009

Importance of Good Shoes for Kids with Hypotonia

One thing I don't skimp on is tennis shoes. Well, let me correct myself, I usually don't skimp on tennis shoes. However, I recently bought a cheaper brand of shoes that only fit my daughter so-so, and within 2 weeks I was giving them away to someone else who needed a pair of shoes. Not sure why I bought them, but I think I was just trying to get the back-to-school shopping over and done with! Had they been horrible I would have tossed them in the trash, but I think they will work for someone else's foot just fine.

I think that having a good fitting shoe on a kid's feet is important, but it is especially important for kids with hypotonia; the fancy word for low muscle tone. Low muscle tone means that the muscles are floppy and not as quick to respond as they should be; that is why these children may fatigue easily, seem clumsy or fall, seem lazy, or are behind in gross motor development. Low muscle tone and muscle weakness aren't synonymous, as kids can have weakness without having hypotonia. But kids with hypotonia are generally weaker than their peers with typical muscle tone (notice I didn't say normal, I said typical).

I don't think to get a good pair of shoes, you necessarily have to spend a lot of money. I can go to Wal-Mart (R) or Target (R) and potentially find a good pair of tennis shoes for a toddler or young child. You want to make sure the shoe is supportive at the sides where the arches are, doesn't come up too high on the ankle as that could limit active range of motion (now there are some kids that need a higher shoe such as a boot, but only if it is not too rigid), is flexible enough to bend the shoe in half, and has a "toe off"- look at the front of the shoe and it should round up slightly on the bottom surface of the shoe, just like a running shoe does (not like a flat surfaced Keds (R) shoe). I find that Smart Fit (R) shoes at Payless Shoe Source (R) and Stride Rite (R) shoes are typically good for the younger kids. I just bought my daughter a pair of Nikes (R) the other day, but even with such a well-known brand, you need to be careful. That is because everyone's foot is made different. Some people tend to wear the shoe down more on the outside, so that is where they need more support (problem is called supination). Some people are the opposite and wear a shoe down more on the inside and need arch support (problem either flat feet AKA fallen arches, or pronation of the foot). The later of these is more common in kids with hypotonia. For older kids to wear on an everyday basis, often finding a cross training shoe is good, because it gives support in many ways and is not as specialized as a court shoe or a running shoe.

My 15 month old son has worn a good pair of shoes consistently since he learned to walk around the time of his 1st birthday. I live in a hot region, and flip-flops or going barefooted are common, so I didn't push him to wear the shoes before he really needed to. FYI: Kids with hypotonia may be walking hazards when wearing flip-flops or crocs. That is because these shoes don't give enough support. Many kids with hypotonia need a snugger fit with good support, or they will fall often! Let me save you a visit to the ER, toss the flip-flops or shoes without a back!

Friday, September 11, 2009

Teaching Toddlers How to Play with Toys

Shouldn't all kids just know how to play? Not necessarily. Some kids can fiddle around with a toy and figure out what to do with it. Others learn by watching another child and then imitating what that other child did. For some children, especially those with developmental disabilities, they don't learn by either one of those ways. They must be taught, and even then the lessons need to be broken down into simple steps. These steps may need to be repeated an hour later or the next day. For children with muscle tone or orthopedic abnormalities, the difficulties in learning may be due to fatigue and mechanics. But eventually, with repetition and patience, the child can learn how to play.

Quite often when I am asked to "come look at a toddler" at work and give my advice to why this child is behind in his development or he has destructive behaviors such as breaking toys, throwing things, or tearing apart other household items, I realize that the child doesn't know how to play. So much of a typically developing toddler's time is spent in play. But some of the toddlers with a delay in development are running around wild, just sitting there doing nothing, watching TV, or "getting into trouble". If they do play it may be limited such as only playing with certain toys and being perseverative in the way they play. An example of perseverative or controlling play is when a child insists on stacking blocks and doing nothing else with the blocks. If someone tries to help them make a house or train with the blocks, they get upset. This is because they have such a limited repertoire of how to play. When some of these toddlers get bored with the same old toys or not knowing how to play, they may become destructive. These behaviors the toddler has would be diminished if he just knew how to play.

That is when I come in to the picture. This means I need to be an investigator and figure out why this toddler is acting up. Is he bad because he is evil? Most likely not. I find that very rarely is there not a reason for a behavior problem. Reasons include: seizures, developmental delays (especially language- receptive and expressive), food allergies, and plain ole' not knowing how to play with toys.

Before parents are able to say "Go play with your toys" to their toddler, there are some things to consider:

  • What is the child's physcial and cognitive abilities? Figure out is it really reasonable or not to expect this child to do such a thing. Does the child have the manipulation skills, muscular endurance, and problem solving abilities to play with the toys that are there.
  • Can the child make choices? If he can't make choices when you verbally ask a question such as "Do you want to play with the puzzles or the trains?", then he isn't going to say this to himself and go choose an activity unaided when you go ask him to play.
  • Is he motivated to play with the toys he has? If he is 2 years old and still has baby toys as opposed to "big boy" toys, then he isn't likely to go play with the toys.
  • How long of an attention span does this toddler have? Do the toys require a longer attention span than he has (e.g. game boards, intricate puzzles)?
  • Is there some structure to how his toys are kept and organized? If the toys are just dumped and scattered around, some toddlers are too overwhelmed by this to figure out what to go play. However, if they had toys kept in containers, shelves, baskets, or a toy box they may be more likely to know which toy to play with, especially if the adult guides them to a certain container.
  • Has the parents, caregivers, or other adults in the chld's life spent enough time getting down on the floor and playing with the child? If not, then why? If it is because the adults don't have time, then make it. If it is because the adults don't remember how to play, then go get one of the many books out there on toddler games and toddler activities and read it. Just think back to things you would have liked when you were young. For example, I always wanted a sit-n-spin (R) but never had one. I played on one at a friend's house when I had the chance. So, I bought one for my daughter when she was 2 1/2, and sure enough she loved it! She didn't play with it daily, but she did enjoyed it. Browse the toy catalogs or toy aisles at the store if you are unsure of what to play. Just have fun playing!

Remember that many kids need to be shown how to play. If you show them that a toy car doesn't just get rolled back and forth but can be crashing into blocks, racing off of a table or couch, and driving under furniture as you make car noises "beep, beep" then they may then have more ideas on how to play. For toddlers and other children who tend to be rigid and controlling in their play skills, you may only be able to show them one more way to use a doll, blocks, or cars. But if you show them one new way to play per week, then within a month, they learned 4 new ways to play with toys. Before you know it, the child will have many choices of what to play when Mom hollers out "Go play in your room!".

Wednesday, September 9, 2009

HIPP- supplemental to medicaid

It is sad but true that families may not receive therapy services if they don't have the money to pay for it. So, I am always looking for information to help families with this problem. As I've stated before I work for an early intervention program as an occupational therapist. I have worked in more than one US state. I recently became aware of a program called HIPP that helps families with paying co-pays. I am not sure of what states this program is in, but I do know it is in Texas. In Texas, early intervention services are paid for on a sliding scale based upon how much money the family makes unless the child has a third-party payer to pay for services. Third-party payer services include: private insurance, medicaid, or CHIP. Some families who have private insurance have to meet a deductible before payment of therapy and developmental services kick in. During this time of economic hardship, than can be difficult...especially if there is a high deductible to meet. HIPP helps the families pay for the co-pays and as long as one family member in the house is on medicaid, then the family could be eligible for the program. For a link and more info. on this topic:

Tuesday, September 8, 2009

Weaning from Breastfeeding

I realized today that it has been 6 weeks since I weaned my son. I miss breastfeeding in a way, then again I do not miss it at all. I think that my family does not miss hearing the swooshing sound of my breast pump! I weaned my son off gradually beginning at 12 months. I am so glad that I didn't go cold turkey! Even though he has been completely weaned for 6 weeks, he still likes to take his morning drink while sitting in the recliner that I used to breast feed him in...I love it, I still get to cuddle with him. My goal was to breast feed for a year, and I made that and then some. Both of my babies were completely weaned by 13 1/2 months. If my children didn't have food allergies which forces me to refrain from foods they can't ingest, I might have been tempted to go longer. I enjoy the attachment and bonding that came along with breastfeeding, but not to the point that I could be one of those people who has a 5 year old kid on my breast....although I am not judging people who do that.

There are 3 main ways to wean from breastfeeding:
  1. Stop abruptly...cold turkey. But be aware that the mom may get sore or infected when doing this.
  2. Wean gradually. Typically, the middle of the day nursing sessions are dropped first, then the morning one is cut off, and finally the night time nursing session is stopped. Often, the session before bed is a comfort thing so it is harder to eliminate.
  3. Let the child wean when he is ready. This could be at 10 months or 4 years....this approach lets the child decide. Many people who are a part of Le Leche League may feel that this is a good approach to use. Once a child is eating a lot of table food, the breast milk supply will greatly reduce. Once the mom resumes her menstrual cycle and once the baby is one year old, the mom's hormones are altered and the taste of the milk may change subtly.

Babies and toddlers with special needs may need to take a longer amount of time in the weaning process. This could be due to a child with a medical problem takes comfort in nursing; he may also greatly benefit from the antibodies from the breastmilk. It could also be that sometimes a child with a developmental delay dislikes change or tends to be inflexible. There are many other reasons, but be aware that if you weaned a typically developing child easily in the past, you may not have a similar experience when trying to wean your toddler or child with special needs.

I am not a lactation consultant, but have attended conferences on the subject, and maybe one day if I clock in enough hours, I could sit for the exam. Til then, I will promote breastfeeding because it is wonderful, and I will use my knowledge to help my clients with feeding problems to improve in their feeding abilities!

Visual-Perceptual Skills...Do You See What I See?

Why is it that my husband can't seem to match up socks when doing laundry or why does he not have good sense of direction? How is it my 15-month old son can seem to maneuver around toys on the floor without bumping into things or falling? How is it I can perform high-level math problems in my head? The answer to all of these: visual perceptual (v-p) skills. Good V-P skills require that a person's eye is healthy, that the person have good movement of the eyes (oculomotor), and combine these two abilities with cognition. The result is V-P skills.

What does it take for an eye to be healthy? Well, the pupil/lens/retina must respond to light, the person must see clearly and not have fuzzy vision due to cataracts or an astygmatism. The person should be free of any eye disease/ disorder such as glaucoma or macular degeneration. And the person must have visual acuity, meaning they can see far and near clearly. When they can't, they may need corrective lenses (glasses or contact lenses). If the visual acuity problem is severe enough, the person may be considered legally blind, AKA visually impaired. Also, to have healthy eyes means no styes or conjunctivitis (AKA pink eye)...of course, these problems are only temporary.

Eye movements include the person tracking their eyes side-to-side, up-down, diagonal, and circular to following a moving object. As long as a person is over 6 months of age, they should be able to track their eyes while keeping their head still. People, especially children, with muscle weakness of the head or trunk muscles will often move their head to watch a moving object, versus keeping a stable head as the eyes move. This is important that the child get this skill so that he can efficiently learn to read and participate in sports. Another eye movement skill is convergence-divergence, which is the ability for the eyes to look at something up close (cross eyed) and then look at something far away. This is especially necessary for playing sports or sitting in the classroom to copy words from the blackboard onto paper. Other eye movements include saccades which is what eyes do to look at a sequence of pictures in a book or words on a page; the eyes look at multiple things on paper from left-to-right (in English; some languages are the opposite direction). When a child has problems with this skill, reading problems can occur. As a toddler, the child may refuse to look at books or seem inattentive due to his visual problems. If a child's eyes are not aligned such as with "lazy eye", AKA strabismus and amblyopia, then it is hard for him to have good eye tracking or saccades. If you notice a problem with your child's eye alignment after the age of 6 months, please take them to an eye doctor, either an opthalmologist (M.D.) or an optometrist (O.D.).

So, if a child has all of the above-mentioned things, then he has a chance of having decent or better visual-perceptual (V-P) skills. V-P skills are often defined as the brain's ability to interpret what the eyes see. I will not get into every area of V-P, but a couple of common areas are figure-ground and discrimination. Figure-ground skills help a toddler go find his favorite toy within a basket of other toys or helps a grade school child find a particular word within a page full of words. If a child has poor V-P skills, he might get scared in crowds, especially when he thinks he can't find his parents! He might also tend to not venture out on the playground. The slides and swings may seem scary if his V-P skills are delayed. The other area I mentioned, discrimination, lets a toddler learn the difference between a horse and cow when looking in a book or a preschooler to learn the difference between the letter "p" and "d". Also, necessary for V-P skills is cognition and memory. Without those two areas, the child is not likely to get his colors, numbers, animals, and letters correct...he may be late with learning these things. Often, a toddler boy who is a "busy body" may not be detected as having a V-P problem, because people will blow off his behavior as "just being a boy"....but there probably is a reason he doesn't want to sit down and do puzzles or color. It's because it is hard for him! Problems with V-P skills are often addressed with an occupational therapist or developmental optometrist. sure does take a lot of different areas just to learn an alphabet letter! And even more for a person to do a math problem within their head. But, once the child has basic V-P skills, he can also start to grow with his imagination, yet don't be surprised if this equals the beginnings of nightmares... a visual memory is not always a good thing for a toddler! The good news is if you are an adult with only "okay" V-P skills, there is hope. You can come up with strategies to accommodate. My husband adapts to his poor sense of direction by using a GPS! One of my friends doesn't send out an e-mail without having used spell-check first! An adaptation for a toddler or young child would be to limit the clutter in his play area and to read books to him that have simpler pages and less detail.

Sunday, September 6, 2009


Every picture my parents took of me sitting on the floor below the age of 4 years shows me "w-sitting". What is w-sitting? It is when the child sits on the floor with his knees bent and his ankles are right next to his if he had been kneeling and then just relaxed the feet out to each side. It is termed w-sitting, because looking at the child from a "bird's eye" view, the legs look like the letter "W". It is not good on the knees, hips, or feet. In fact I have awful knees probably because I was a big time w-sitter! They squeak when I bend over or walk up the stairs. If I go to aerobics class or walk a far distance, my knees ache for the next 3 days to the point that I can't sleep without pain medicine. So, I am not a fan of letting a child remain in a w-sitting posture for long lengths of time. I am now in my 30s but was told back in my 20s to quit jogging and aerobics classes or my need for a knee replacement would be sped up. So, I stick to biking, pilates, and, do I miss the adrenaline rush of a nice jog!

W-sitting is a posture that babies and toddlers use briefly as they move in and out of various postures. Little ones move so quickly, you will often see them transition from crawling, to sitting, to kneeling, to standing, back down to the floor, etc. So, w-sitting is not bad in and of itself. It is only not a good position if the child remains in that posture for long lengths of time, such as while playing with puzzles or watching television for 10 minutes. It puts unnecessary pressure on the knee joints and contributes to pronated feet (caving in at the ankles and collapsing at the arch). It can alter a child's balance and even make their gait look funny, especially while they run. My daughter tended to want to w-sit as a baby and toddler, and I had to redirect her quite often. I took her to a co-worker (at the time) who was a physical therapist and she gave us stretches and used kinesiotape to help with leg alignment.

Why do children w-sit? Most of the children use this posture because it is is less work for the trunk muscles because it widens their base of support. Some kids just prefer it just because. But many kids prefer it because they have low muscle tone (AKA hypotonia) or muscle weakness. It is common to see children with developmental disabilities such as cerebral palsy and down syndrome w-sit. I think that my daughter and I have mildly low muscle tone so that is why we have both been w-sitters. It is not uncommon for me to walk into a daycare (I do early intervention OT in natural environments) and see typically developing children using this posture. It does make me cringe, and oh how I want to correct the child. But I can't if the child is not my client. I can however educate the daycare staff about how w-sitting is not a posture that benefits children's gross motor development.

The following are some suggestions that I have found beneficial in reducing w-sitting in a baby, toddler, or older kid.

  • For a baby, just correct their posture by placing them in kneeling, criss-cross (AKA Indian style for those of us raised in the 1970s & 80s), or a side-sitting posture
  • For toddlers and children, encourage them to sit at a kiddy table and chair while performing fine motor activities such as coloring and puzzles. It is almost impossible to w-sit in a chair
  • While the child (not baby) is playing on the floor, have a stool, bench, or tray (like a "breakfast in bed" tray) available. Have the child slide his legs under the device. Because these devices have "legs" or sides, then it increases the chances that the child will sit with his legs out straight to the front of him.
  • If the child is in the "terrible twos" stage or is the type who likes control, then give him choices. When you see him w-sit, say "Would you like to fix your legs by sitting criss-cross or legs to the front?"
  • Make up a silly song as a reminder. I made up a song titled "Legs in Front" to the tune of Frere Jacque. Then, as I only hummed the tune, my daughter was reminded of correcting her legs out of w-sitting
  • Place toys to the side of the child so he will need to reach out of his base of support. This typically encourages a child to side in a side-sit posture (both knees are pointed towards one side or criss-cross style.
  • Try not to nag the child by constantly saying "fix your legs" or picking them up and placing them in another posture. I find it best to set up the environment for success by using some of the above-mentioned ideas. Don't redirect the child if he will only be in the w-sit position briefly...if you do, he will tune you out everytime you redirect him...not good!
  • There are probably many other ways to help with w-sitting but these are some common ones that I use
  • If it is severe enough of a problem, then the child probably needs a physical therapy evaluation. The PT may suggest certain stretches, therapy techniques, furniture, or shoes to help the child
  • If the child has sensory processing delays in addition to the low muscle tone, then the child may benefit from an occupational therapy evaluation. At there is loads of information on sensory processing problems seen in babies and some ideas to help.