Sunday, August 30, 2009
Saturday, August 29, 2009
- Ear infections or vertigo. The balance receptors are in the inner ear, and any disturbance with the ear can hinder balancing abilities
- Orthopedic impairments: whether it be pigeon-toed, bow-legged, tippy toe walkers, flat or pronated feet, or other differences, it could be the bones out of alignment for whatever reason including muscle tone, joint laxity, or muscle weakness. Also, kids who tend to "w-sit" often have hips that turn in and pronated feet (collapse at the arch and turn in)
- Sensory processing: vestibular (sense of motion and balance), tactile (sense of touch), vision, and proprioceptive (body-in-space awareness) senses contribute to balance, and if there is a problem in one of these senses, the child may fall often or bump into things
- Needing glasses for visual acuity
- Cross-eyed (AKA strabismus)
- Shoes: lack of wearing them or poor fitting shoes can hinder balance skills
- Environment: maybe the room set-up is too "busy" and hard for the child to maneuver without falling.
- Strength and tone: some kids are "floppy" and/or have low endurance
- Hyper-activity or autistic spectrum disorder (ASD): these kids may be extra busy, therefore use momentum as they zoom around the room, so fall often. This is even the case for a child with advanced gross motor skills who can climb the staircase as a baby, but when not on an apparatus (swingset, stairs, slide, etc), he falls
I have a mommy radar and it has helped in so many situations. I believe that all moms have some built-in radar, and just need to listen to it. When my son was a couple of weeks old and was massively spitting up, I knew in my gut that he had a dairy allergy just like my daughter had. So, I quit consuming dairy so that my breast milk wouldn't have any. Guess what, my son got somewhat better. By the age of 5 months, he got tested by the allergist, and results indicated what my radar told me...my son is allergic to dairy products. Good thing I didn't wait until he was old enough to be tested...I listened to my gut! That would have been alot of unnecessary belly aches and hives had I not quit consuming cow's milk. I also pushed for my son to get on reflux medications, because he was losing weight, congested, gassy, lots of hiccups, and spit up quite often. I had to convince the doctor that my child needed the med.s...guess what, my son got better with two med.s, not completely perfect, but much better. For some reason, our regular doctor was out of town during this time, so I had to see one of his partners. She didn't know me, nor do I think she knew I was a pediatric OT until after our discussion on reflux. I would like for a doctor to listen to me as a mom, and not have them listen more because they know that I work with special needs infants. I would hope that as a mom my word is good enough, and that I should get some help for my kid. This is why so often at work, I have to talk personally to the doctor or type up a letter for the doctor to know what I am seeing during therapy sessions.
So many of the mothers of my clients or so many of my friends start to doubt their "mommy radar". Maybe it is because other friends or their mother-in-law convinced them that the child is okay. Or maybe they are more passive and don't want to argue with a physician. But there is another category of moms, and those are the fiesty little women who let their "mommy radar" be the driving force to figure out what is going on with their child and how to fix whatever is going on. I see this drive in many moms of children with degenerative diseases. I also see this drive in moms of kids who have been diagnosed with autism....especially since the etiology of autism is such a debated topic. And of course what mom isn't going to become an investigator to figure out why the child is the way he is and what can be done for the child to be as functional as possible....or depending upon the diagnosis, find a cure for the child's disease or disability.
There is another category of moms that I sometimes work with and that is the group who are in denial. This is a typical stage of grief but it can also be a hinderance to the child making some progress. Because I work with infants and toddlers, it is much easier for a parent to be in denial than when the child is older. Especially if a child has behavior problems, the parent will say "He's just acting two years old". Now, two year olds are known for being stubborn, independent, "busy", and at times inattentive. But, a child with a developmental disability is different. It might be that the tantrums are more frequent, longer or more intense than most kids that age. Or it might be that the child is "fleeting" around the room disorganized like a hummingbird, whereas two year olds are "busy", but not disorganized. Even my son who is 14 months old can sit and stack blocks or focus on a fine motor activity for 5 minutes if he so wishes. Now, he doesn't do that all day long, but he can briefly stick to one activity. This is where so many of the kids with a developmental delay differ. Because they can't focus for long, their speech, cognition, and fine-motor skills suffer! So, this makes me wonder is the denial a lack of knowledge on what typical development is or is it a purposeful coping mechanism in which in the back of that parents mind they know there really is something wrong. Well, it is obviously a different answer for different families. Culture, education, and family dynamics can all feed into the reason for denial or appearance of denial. I have witnessed moms being told by a physician that the child has cerebral palsy. Then, when hearing the mom talk to other people she will say the child is fine neurologically. This could be her not understanding, not wanting to reveal the information, or could be denial.
The last group of moms I see is the ones who initially had worries. Those worries were put to rest by medical staff that were giving off wrong information by saying the child will "grow out of it, he'll be just fine!"...not purposefully wrong, of course, but that is what they truly thought at that time. FYI, I see this happen frequently with sensory processing problems (see www.sense-ablebaby.com for "red flags" of poor sensory processing with infants). Then, as months go on the mom is wondering why the child hasn't improved. Then, right before the kid turns three years old and is about to graduate from the early intervention program, the child will receive a definitive diagnosis. The parents will want to make up for lost time and have us "fix" the child or do as much as possible before the kid turns three years old. So, all of the sudden, a family that didn't want my services more than twice a month, wants me at their home at least twice weekly. This category happens alot with genetic diagnoses (e.g. chromosomal abnormalities, mitochondrial diseases). The parents also tend to have a lot of guilt for not listening to their initial gut instincts and for "wasting" time. It is not uncommon for this category of moms to have even had us do an evaluation a year before receiving services. But after the evaluation, the doctor talked them out of receiving therapy services. Or maybe, the doctor didn't do this and the parent just wasn't ready yet. FYI: there are many excellent physicians who suggest parents go get therapy evaluations and yet the parent is not worried, & the evaluation never takes place. So it is not always the doctor to blame!
Listen to your "mommy radar", and for those men out there, listen to your "daddy radar"!
Friday, August 28, 2009
Tuesday, August 25, 2009
Sunday, August 23, 2009
This did let me get a small glimpse of what the kids with auditory sensitivity go through. No wonder so many of them are grouchy! So many of these children can't tune out the background noises (e.g. lights, other conversations, air conditioner) from the foreground noises (e.g. teacher's voice, TV), therefore all noises seem to be the same volume and intensity. Also, some of these noises are actually perceived as painful to them. Thank goodness I only perceived the snoring as annoying, but definately not painful. These children may cover their ears due to the pain or may shutdown by tuning everyone out. That is why they may not respond quickly when their name is called. They may also seem to be in their own little world. Now, some of these children have autism spectrum disorder (ASD) but many do not. And because of their "shutting down" and tuning people out, they may get wrongly diagnosed. This is one reason it is so important to address the sensory processing problems (SPD), so that the child gets the accurate kind of help. Some of these children may or may not have a central auditory processing disorder (CAPD), but this can only be tested for once the child is 7 years old by an audiologist. There are accomodations to help the child with noise sensitivity (e.g. flush the toilet after they leave the bathroom, change the ringer tone on the telephone, etc.), but that can't help in all environments. Intervention from an occupational therapist or speech language pathologist with training in sensory integration treatment may be necessary. Also, sound therapy may help such as Tomatis, Therapeutic Listening, AIT, and other programs. I am trained in the Therapeutic Listening program and have seen many children benefit from it. These sound therapies not only help with noise sensitivity, they often help with coordination, muscle tone, attention span, and language skills.
Saturday, August 22, 2009
This whole process gets me thinking of the young children I work with who have sensory processing problems and how they must really dread haircuts. Some of the kids I work with are sensitive to touch, noise, and smells....this would not exactly make for a fun outing when going to a hair salon. Some of the moms of these children have told me that a few of their tricks for making haircuts tolerable are:
- Go to the salon at a less busy time when there is less noise and commotion
- Go to the salon on a Tuesday earlier in the morning when the smell is less pungent or "loud". Most salons are closed on Sundays and Mondays, so by Tuesdays alot of the shampoo, hairspray, and hair dye smells have lessened
- For the very first visit to a hair salon or for a visit that has had a long lapse in time, have the child visit a day or two before the hair appointment. This helps the child to get familiar with the person and surroundings including the large mirrors, chair up off of the ground, etc.
- For the child who has touch (tactile) sensitivity, make sure the stylist knows to apply firmer pressure to the head as she is cutting. Bring a favorite blanket or towel to wrap around the child's shoulders instead of the plastic cover up typically used.
- For the child with an auditory sensitivity, maybe a pair of scissors that make less noise could be chosen. Another idea is at home, let the child hear the sound of snipping scissors near his/her ears so that at the salon it is less scary.
- For the child with anxiety due to sensitivities, poor discrimination, or poor motor planning, then consider making a social story. A social story is an individualized story about a particular situation. In this case, staple 3-4 pieces of typing paper together after folding the paper in half. Then, on each page list out what will happen at the salon. Keep the story positive such as saying "NAME gets to sit in the special chair while she gets a haircut" but don't say "NAME doesn't stand in the chair and jump off". Read the story every night for a few days or longer, before going to the hair cut appointment. This way the predictability about what will occur should lessen some of the anxiety. When children are less anxious, then the sensory sensitivities may not be as extreme.
- For the child with poor balance or fear of heights, then consider getting a stool under the child's feet so he/she can feel more posturally secure. If necessary, have the haircut take place in a child's chair from the lobby as opposed to the taller adult chair. For these children, it is not recommended to tilt their heads back much when getting the hair washed.
- Consider washing the child's hair at home before the haircut (that day or day before) so that the child only has minimal things done to his/her head at the salon
- If you are lucky enough to live in a larger town, consider going to a hair salon that specializes in children. Some of these facilities even have "racing car" chairs to sit in to make the haircut more playful and fun
- At the end of the visit, make sure the child is rewarded whether it be with a sticker, hug, verbal compliment, or special toy
Friday, August 21, 2009
Some of my tips include:
- Have the child help clean up the mess. This grosses some kids out, however others think it is fun. So in the later case, helping to clean up would be a reward
- I don't recommend the duct tape idea that many try. I have seen children's skin react to the adhesive. Remember that body heat makes adhesive stick to the skin more so if the diaper scoots around and the adhesive is on the skin, this could be bad. One child I know of even had the skin tore off...ouch!
- My most common suggestion is to put the child in footed pajamas with a zipper, but put them on backwards. If you live in a hotter area like I do, then it is a good idea to cut off the feet to the pajamas. I do not have the shoulder range of motion to undo a zipper that goes from my neck to my buttocks, so I doubt that any toddler does either. Yet, if the pajamas are too large on the child, he could wiggle it around, so make sure the pajamas are a little tighter in the bodice and neck.
- Depending upon the child's cognition level, use rewards after each nap that he left his diaper on or didn't smear the poop
- If the child has touch sensitivity and the awareness of his bowel movements, it may be time to start potty training and he is just giving of readiness signals. I had one mom even put a potty in the child's bedroom so that he would use it when she wasn't around (like at nap or night) and choose not to play with the diaper or pull up
- Some children still find away to pull off the diaper and play with its contents, in this case behavioral strategies and techniques such as those suggested by a psychologist or applied behavior analyst (ABA) may be necessary
Thursday, August 20, 2009
Wednesday, August 19, 2009
Shopping is not always fun, but I have figured out what they can and can't eat. Something as simple as commercial chicken nuggets may have dairy and/or soy within the ingredients. I am constantly reading the ingredients list on boxes to new items, or in my case, potential new items that I may add to foods my kids can eat. I was glad to see that Betty Crocker (R) even has gluten free cake mix now. At the regular grocery store, I can find some items that are fine, but just not as large of a quantity as I do at Whole Foods (R). There is also a small "whole in the wall" store I go to near my house for vitamins, cookies, and a few other small items. Good thing that my children love fruits and vegetables, because for the most part those are safe for them to eat (except pineapples for my son). The grocery bill is usually quite large! I have tried coupons, but it isn't so easy finding coupons for the exact items that my kids eat, but sometimes you can get lucky. Earlier this year I was watching Dr. Phil (rare occasion that I would even watch TV at all!) and he had this lady as a guest that said she can spend only $800 annually on groceries. Of course, I'm saying "What?!?!?!?" because that is about what I spend in just 2 to 2.5 months. God bless her for the ability to find coupons for what she can eat, but I don't think it is possible for my family to do! If it is, I would love some advice on staying within such a budget!
Tuesday, August 18, 2009
So often when I go to a client's home, the toys are scattered throughout the home or they are put nicely in dark containers out of the child's reach. Now, there are times both of these situations could help a child. But sometimes, the child needs the opposite of what they have. If a child tends to fleet around from one activity to another seemingly like a tornado, then less toys within reach may be better. Also, help the child to clean up one activity before going to another when possible. I don't think the house has to stay spic-n-span all day, but too much stuff out on tables and the floor can overwhelm some children. On the other hand, a more passive child may need more toys setting out, because if not, he would just not play with the toys or think to request to play with them. This child may also need a little more help learning how to play with a toy. Although a one and two year old's attention span may not last through the evening news (30 minutes), many of them can play with the same toy for at least 5 minutes. Remember that a toddler's attention span is not super long, but consider the quality. When he played with the toy, was he focused on it or did he give up easily when not figuring it out? Did he play with the toy or did he just dump it on the floor? Look at the quality of play, not just the quantity of toys and how long he can sit still. Some kids may sit and play with a toy for 15 minutes but just perseverate on playing with it one way, such as rolling a car back and forth. Did the child also say "beep, beep", crash the cars, or drive the car under the table as if it were a long bridge? When possible, expand how long and the variety of ways a child can play with a toy. One way to help with this is to have a semi-organized play space that is not too over-whelming and not too under-whelming!
Monday, August 17, 2009
Are you tempted to put the baby in a walker to give him a chance to stand up or to give yourself a break from chasing after him as he crawls away? I can understand. But there are better choices. If you need 5 minutes to get the dishes done, put the baby in his highchair near you as he takes a snack or plays with toys. If you need a moment to take a shower, then put the baby in his play yard within your sight (although I'm not the biggest fan of those either, because they tend to be over-used). If you need the baby to bear weight into his legs, then have him practice standing at the couch, an activity table, or other surface while you supervise him. Another option is the standing activity bouncers. But, if you put the baby in one of those, make sure it is for a limited time and his feet are at the proper height as suggested in the instructions. One thing I tend to see with the infants and toddlers I work with through early intervention, is that the baby leans to the side or is too far up on his tip toes, or worse is in the device for 30 minutes multiple times per day...yikes! Also, some parents put their babies in these devices too soon. A 3 month old should not be in a standing bouncer, jumparoo, johnny jump up, or any other similar device that can be bought at the nearby retail center. Developmentally, a 3 month old should be on his tummy, back, side, beginning to roll, sitting in your lap, being held, and briefly standing with total assistance by the adult holding him....not a standing device! However, a 3 month old could sit in a bouncy seat or infant swing...once again, on a limited basis as you wouldn't want to contribute to him getting a flat head or a delay in his motor skills! If you need tips on helping your baby tolerate tummy time, go to http://tiny.cc/TUtUo.
Friday, August 14, 2009
When I am in a client's home I just search through the play room, toy box, and other areas to find objects that are in the environment that could be included within an obstacle course. Below are some common things within homes that could be used:
- Place mats: place 2-3 in a row and have the child jump from one to the next
- Blankets and chairs: create a tunnel to crawl through by draping a blanket over 2 chairs
- Large pillows or couch cushions: pile a bunch of pillows together and have the child climb over them, slither under them, log roll or forward roll over them
- Coffee or end tables: slither under them like a snake or walk around them forward or backwards
- Exercise ball: roll, bounce (on bottom, standing, back, or belly), carry over head, "crash" into it
- Heavy quilts: take a "magic carpet" ride by being pulled on it or pulling sibling on it as they sit or lay down
- Laundry basket: the child can push it while it is inverted, or sit in it and be pushed or spun
- Balled up socks: toss balled up socks into a box or large plastic bowl
- Stairs: walk up or down them, "booty bounce" as the child bumps down as he sits on his bottom
- Common toys kids have: trampoline, rocking horse, tricycle or other ride-on toy, tunnel, tent
- Activities to incorporate: marching, jumping, hopping, running, walking or jumping backwards, rolling, bear crawl, crab walk, army crawl, galloping, spinning, donkey kicks
Wednesday, August 12, 2009
The following list is just a few signs of readiness for the child to begin potty training:
- understands what the toilet is for and may watch parents, friends, or siblings on the toilet
- can express that he needs to go potty whether it be with words, pictures, or sign language; has a word for pee and poop
- can sit on the potty for at least one minute without getting up, and is willing to sit longer if redirected or distracted. If the child is hyperactive, but willing to sit with redirection he may be ready
- wakes up from naps with a dry diaper or a diaper that is not completely soaked; has stretches of time where the diaper is dry for at least 90 minutes to 2 hours
- shows a desire for independence to do things on his own
- wants to wear "big kid" panties or underwear
- is emotionally ready by being in a receptive mood and not negative. Being controlling and too stubborn may be a problem unless it can be redirected
- shows a preference for a clean diaper or at least knows the difference between a clean and soiled diaper
- has regular bowel movements (BM). If meals and snacks happen at a predictable time, this helps with knowing when the BM and urination is likely to occur
- can follow simple directions and copy other people
- can cope with fears and be somewhat cooperative
- during play is pretending that the stuffed animals or dolls are going to the toilet or getting a diaper change.
- will look at a book or video on potty training aimed at a toddler's level of understanding
Tuesday, August 11, 2009
The following are some common self-stimulating behaviors:
- flicking fingers or waving hands in front of their face
- spinning toys continuously
- watching ceiling fan
- staring at lights
- staring at lines on the wall, floor tile, or within the furniture (e.g. legs of table)
- shredding paper
- spinning or swinging
- head banging
- teeth grinding
- playing with spit or fingernails
- acting out a movie scene or telling the same story repeatedly
- repetition of odd noises including throat sounds
- pinching or scratching self
A few ideas on how to stop or reduce the self-stimming behavior are:
- If the child is self-stimming because he is bored or a sensory seeker, then provide activities that provide sensory input such as jumping on a trampoline, rocking horse, ride-on toy, tunnel, finger paint, play-dough, musical toys or instruments, etc. Also, make sure to leave toys setting out in baskets or containers that are visible, because some kids won't play with toys that are stored away in closets or drawers.
- If the child is self-stimming because he is over-whelmed or upset, then figure out what could reduce his overloaded feeling. When he is upset because he can't express his needs or wants, then get ideas from his/her speech therapist. Also see the previous post this month on this blog on helping a child to talk if he is delayed in communication skills. If the child is upset because he is hungry or has another basic need, then help the child with it. If he is upset because he "Can't get his way", then hopefully working on behavior managment along with offering other things to do and play will help.
- If the child is self-stimming because he is unsure of what to do or unable to motor plan well, then help him with doing something else or redirect it. For example, if a child with limited play skills perseverates on jumping, then jump next to him and say "You must want to be a frog, ribbit, ribbit" and encourage him to imitate a frog. Then, after a few minutes change animals and see if he can imitate you. Doing this helps with the motor planning problem by showing him what else can be done.
- Some kids with limited play skills will only play with toys in simple ways. For example, mabye the child will only build blocks into a tower and become upset if asked to build a different structure. This can be slowly redirected such as to build a train next to his tower, and push the block train with "choo-choo" sounds. He may not build a train that day, but maybe will the next time you try this. Do not feed into the child's limited patterns of play! This is not helping his development in terms of cognition, social-emotional, language, or fine-motor skills. Teach him how to plan in other ways.
- You can also redirect self-stimming by providing a distraction.
- Be aware that some children will begin the self-stimming behavior as soon as you walk away. Others may stop the behavior you redirected but then gain a different self-stimming behavior; if that is the case, consider that the child needs more sensory input (AKA sensory diet) and is doing the self-stimming because he is a sensory seeker.
Often redirecting self-stimming or helping the child to play with toys in a new way requires a lot of thinking outside of the box and getting down on the floor to play with the child, such as with the DIR / floortime approach.
Monday, August 10, 2009
One way I help to prepare the two and three year olds I work with for preschool is to introduce social stories. Social stories are stories individualized to that child's situation and explain the steps involved in a positive manner. A social story for the first day of school may involve 6-8 simple pages explaining the events of the day. Reading this home-made book over and over to the child helps them to better know what will be happening which reduces anxiety.
I am not a good artist, but I think I have made some good social stories for my own child and other children. They don't care if you are a good artist. Usually, the kids like that there is a picture of them on the paper. I typically take 3-4 pieces of white typing paper and fold it in half. Then, I staple it down the middle to bind it like a book. On the first outside piece of paper, I draw a picture of the child and add a catchy title for the scenario. For the first day of school, the title could be something similar to "?Name Goes to School". Examples of how to make the page after that might be to draw a picture of the teacher next to your child. The caption could be "Mrs. ? is my teacher. She is very nice." The next page may be a picture of children at circle time with a caption such as "We sit in a circle on the floor next to our friends as we sing and listen to stories." Each page can list out other events, but remember to keep the captions positive. Don't say "We don't kick and hit our friends," but instead say "We use our hands and feet to play nicely with our friends."
Some of the social stories I have written for my daughter when she was younger (2-4 years old) have torn apart because she looked at them so many times. Her favorite ones were about potty training, birthday parties, and becoming a big sister.
Friday, August 7, 2009
Thursday, August 6, 2009
Some other quick ideas for making the bedtime routine more successful is to quit "rough housing" or other alerting play activities at least 45 minutes prior to "lights out". Many young children can't "shift gears" quickly and then have trouble calming down enough to sleep. If your child is sensitive to touch, then do teethbrushing and bathing at least 45 minutes prior to "lights out". This is because the activities that are aversive to them over-alert them and then it is hard for them to calm down. Trying more calming activities prior to bed are better choices for promoting the child to fall asleep quicker. Ideas include reading or being read to, soft music, playing with quiet toys, and cuddling with family members. Don't use loud or brightly blinking toys close to bedtime. Some kids can't play games that require a lot of problem-solving close to bedtime because they then can't slow down their mind enough to fall asleep. My daughter fits into this category....she is a deep thinker and wants to solve the world's problems. So, I really have to choose pre-bedtime activities wisely with her. I definately don't let her watch the news, that would worry her too much. For now "Good night, sleep tight!"
Tips to help your toddler talk more:
- Give choices throughout the day beginning with two items and build-up to more items as he improves. An example includes holding 2 different cups up & asking which cup he wants to drink from. It doesn't really matter which one he chooses, but he had to think of an answer & choose by either looking, gesturing, or speaking. Other choices could include clothing, toys, and foods. Only give choices that you are willing to live with. Do not begin by asking "What do you want to eat?" but instead ask "Would you like to eat carrots or apples for lunch?". Then, if the child doesn't seem to understand, then hold up the 2 choices for him to see.
- Remember that toddlers who have a severe delay may need to just initially work on gesturing or pointing to what they want. Do not pressure them to talk, but set up the environment and situations to where he is more likely to talk.
- Sing songs. Initially stick to one or two simple songs and repeat them over and over. Then, once you know the child knows the words to the song, or at least some of the words, you can sing and intermittently pause. When you pause, wait for him to possibly say the word that comes next. Some good starter songs are the ones that also include simple motions such as "Twinkle, Twinkle Little Star", "Wheels on the Bus" and "Pat-a-Cake"
- Pretend that you don't know what he wants when he grunts. Get the wrong item or gesture with your hands that you don't know. Let him lead you to what he wants if necessary. Then, when he gets the item, you verbally label it....pause before giving it to him and see if he will repeat the word. If not, give it to him. Continue this process until he eventually says the word. Good examples for this are his favorite toy or food.
- Put some of his favorite toys slightly out of reach on a shelf or in a clear closed container. This way he has to express that he wants it.
- Try not to anticipate all of his needs, because if you do, the child has no reason to talk. Slow yourself down and let the child ask for his wants and needs.
- Read books with simple pictures to the child. Read the same 2 or 3 books to him over-and-over so he can anticipate the words that are to come next. Ask questions and encourage pointing and labeling the picture. There is no need to read every single word, especially for a child with a short attention span.
- Consider using pictures of items to help the child express his wants and needs. You could have a laminated picture of a cup and another picture for a snack placed on the refrigerator, and when he is thirsty or hungry he can let you know by bringing the picture to you. When he does, verbally say the word such as "cracker". "You want a cracker". Hopefully, he will start to say this word. Start with only a couple of pictures and build up to more.
- Pair the words you say with sign-language. Studies show that this helps vocabulary and doesn't slow it down. Some children are more visual and kinetic so may learn this way better initially.
- Use simple words for instructions such as "Come here" or "Give me the ball". Remember to wait before repeating the instructions. If the child wanders off, help him to physically follow the simple commands.
- Limit the amount of time the child watches television. Watching too much TV doesn't help a child's attention span, motor skills, or speaking. Also, there is no reciprocal conversational skills taught to a child when watching television. Yet, some language skills may be stimulated when watching TV briefly if there is interaction. An example is when watching a cartoon, you can point to and label the characters as well as sing along with the theme song.
- When playing with toys such as cars, planes, and animals, make sounds for that toy such as "honk, honk", "vmmmm", or growling. It may seem silly to model some sounds, but kids like it.
- If your child is older than one year old and still uses a pacifier, limit the use of it or completely discontinue! The AAP (Amercian Academy of Pediatrics) recommends the use of a pacifier for up to a year of age if the child needs it. Children may need it to self-calm when upset or before bedtime. Any other time than that becomes just a habit...and not a good one!. It is very difficult to talk if a pacifier is in the mouth the majority of the time. It is also not beneficial for the development of tongue, lip, and cheek muscles. There is another entry on this blog site on how to wean a toddler off of a pacifier, and can be found in the blog archives.
These are just a few of the basics that I tend to suggest on a frequent basis. I hope these ideas help you or at least remind you of another idea that can help! If you don't already work with a speech-language pathologist or developmental specialist, I recommend you consider it! Helping our little one as early as possible is the best thing!
Wednesday, August 5, 2009
My son had a flat spot in the back of his head for the first few months of his life. And even though I laid him down on the floor to play on his tummy, he still had a flat head. It eventually worked itself out, but it is not as round as mine. My husband has a mildly flat head in the back so maybe it is hereditary that both of my children have this same head shape as their dad. But I somewhat blame his case of infant reflux. His reflux was so severe that he went from the 75th percentile for weight at one month of age down to the 25th percentile by 3 months of age. He was on 2 reflux medicines by 4 months of age. But prior to this, he had to be left upright beyond the suggested 15-20 minutes after being fed. Sometimes he would vomit up massive amounts of liquid even 1 hour later...later found out he also has a motility problem. He would choke in his sleep even when placed on a mattress that was inclined at bedtime and naptime. So, I put him in this soothing glider that is at the same angle as a bouncy seat but snuggles the baby in it with more curviness for the head. I hate that he had so much pressure on his head, but I could never have fallen asleep wondering if my son was going to aspirate on his spit up, and possibly lose conciousness, turn blue, or worse, die. Unfortunately, I have seen too many bad situations at work when a baby has severe infant reflux. So, the flat head is the price we had to pay.
Some tips on helping with the head shape for a baby with plagiocephaly, flat head, or just mis-shapen:
- Let the baby play on the floor on his tummy multiple times a day for at least 5 minute increments. If he dislikes this position, then get down to talk or play with him as well as leave toys nearby.
- If his head is flatter on one side of the head than the other, then all throughout the day, do things with him that require him to look to each side. Examples include switching the end that his head is on in the crib or diaper changing table, alternate which hip or shoulder he is being carried over, move the bouncie seat or infant swing to different places in the room so he has to look different directions.
- Introduce infant massage to relax the muscles. Often when the child is favoring one side of his body over the other side, then he gets tightness in the neck or shoulder muscles. Infant massage also helps with improving the sensation to the side of the body that is less favored.
- Have your doctor assess the baby's muscle tone. If the baby has low muscle tone (AKA hypotonia), he may need a physical or occupational therapy evaluation. The low muscle tone may impact his gross motor skills such as rolling and crawling, his feeding skills, and his fine motor skills to reach and grasp for toys. Some babies may also have muscle weakness, torticollis (tight sternocleidomastoid muscle- (SCM)), neurological impairments, or otherwise tight muscles. If this is the case, then therapy may help with preventing bad movement patterns and hopefully lessen developmental delays, but seeing a specialist such as a neurologist may be a good thing in order to know the reason why this is happening.
- Do not leave the baby in positional devices that do not properly fit him and do not leave him in there for long. Many babies I work with that have leg tightness or weakness on one side are left in stand-up bouncers, swings, car seats, & bouncie seats WAY too long. They should only be in the briefly unless there is a reason such as a car ride, sleep, etc. I can definately tell you that 30 minutes for a 6 month old baby to stand up in a "Jumparoo" or "Johnny Jump Up" doorway bouncer is WAY too long, especially when he is not even angled in it correctly.
- Offer toys to each side of the baby such as in the high-chair, car seat, on your lap as he is sitting upright, or lying on the floor.
- Encourage the baby to ly on his side on both sides and to roll to each side (at an appropriate age)
- Give the reflux medicines as prescribed to you by the doctor. Remember that just because your baby needs to stay upright doesn't mean he stays in a device, you can hold him upright for the 15-20 minutes post-feeding.
- If improvements are not seen, please discuss this with your pediatrician as your baby may need a helmet to help with the head shape.
Hopefully, once your baby is sleeping less, playing more, and even crawling, the head shape will improve.
Tuesday, August 4, 2009
Children can't properly learn to take turns with peers and share toys if they haven't learned to be patient. Some ideas on helping toddlers and young children to wait is to not jump for every request they have. If you are busy, take your ole' sweet time and then respond to their wants.....unless the situation is a dangerous one which calls for a speedy response! Also, give them choices to slow down things. For example if your little one is grunting for a drink, you can show him (or her) 2 cups and let him make a choice. This just added at least 15 seconds to the time that he would have initially got the drink. Modeling patience is important as well. When you are at a store with your child, they are watching your responses to the cashier and other staff. Even if you want to complain, hold it in, because it is hard to teach patience if you yourself don't display it.
My 14 month old son seems to like to squeal while in his highchair to express his impatience; not a fun behavior. I do not respond to his request for food until he has quieted down. I give him a small amount of food as well so he has to communicate when he wants more by using sign language or making sounds. He says "nana" for all foods even though it was initially for bananas.
Other ideas to teach patience include playing games in which the child has to wait and then respond. An example includes rolling a ball back and forth to each other, or build a building with blocks while taking turns in who adds the next block. Most importantly, remember to be patient while teaching patience!
Sunday, August 2, 2009
I like to think that my children will learn from example. I try to treat all people with respect. When I see another person in the elevator or stand next to someone in the grocery store line, I look them in the eye and talk to them...no matter the race or if they have a disability. So, teaching my children to treat others with respect hasn't been hard so far, because they see their parents doing it already. This can be the root of the problem in explaining disabilities to other children...they haven't seen their parents interact with persons with a disability or haven't seen them show respect. This includes making fun of people or insulting someone by calling them "retarded"....how rude can you get! When I hear another person do such a thing, I am sure to set them straight!
When I am explaining a child's (or adult's) disability to another young child, I keep my explanations simple. I am thinking back to how I explained things to my now 5 year old daughter when she was 2 1/2 or 3 years old...I definately kept is short and simple. Although I am an occupational therapist and have taken my daughter to birthday parties of some of my young clients, she has also been exposed to persons with a disability elsewhere including church, stores, and our home.
When I explained to her about a child or adult who is visually impaired, I simply said "Her eyes do not work the same as ours do. Her hands and the special "machine" she has helps her to see." I did not explain the diagnosis or why the child was visually impaired nor did I talk about all of the intricacies of the adaptive equipment the child might have had. For young children, the simpler the better.
When I explained to her about a child or adult who uses a wheelchair, I simply said "His legs do not work the same as ours do, the wheelchair helps him to get to places." The only problem I had with adults in wheelchairs who were strangers was my daughter asking if she could take a ride. This is because one of our good friends who is paralyzed lets her sit on his lap and "go for a spin".
When I explained to her about developmental disabilities such as an Autism Spectrum Disorder (ASD) or Down Syndrome, I never told her the "diagnosis". I simply said, "He can't talk or play the same you and I do." This was enough for her, and she would play with them on the level that they could play. She even learned more sign language than I had initially taught her.
I think that my daughter now understands all of this better than some adults do. This last school year in her preschool class she enjoyed playing with a young boy with a severe speech impairment. She liked "translating" what he had to say or meant by his gestures. She had fun giggling and playing with him, and wasn't even the slightest bit bothered by his disability. She even seemed understanding when he had meltdowns and tantrums!