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.

Saturday, September 5, 2009

Imaginative Play

It is so cute to watch kids, especially toddlers and preschoolers use their imagination during play. As a therapist, I can often get little kids to do some amazing things with imaginative play, and the little ones don't even realize they are improving with their body strength, communication, sensory processing, or other areas of development. They just think they are playing. With imagination: ankle weights become "space boots", arms out to the side become "butterfly wings", and slithering on the belly turns one into a "sneaky snake". Even though as an occupational therapist, my main training is not in speech and language skills, I can really work on expressive and receptive language skills during imaginative play.

I have to hand it to my husband, he is actually better at imaginative play than I am. And that is saying something, because I love to play and act silly. Last year my daughter was really into the Peter Pan Disney movie. So, my husband went to a local party supply store and bought her a Peter Pan costume and some pirate accessories. My husband and then 4-year old daughter would play for up to 30 minutes as she acted out scenes from the movie. He even "threw her" onto the bed as if she was being shot out of the canon. She also jumped from the bed to his arms as she was "walking the plank". It was so cute. Now, I am sad that she isn't as into acting out stories. She is in kindergarten and is much more into playing with games, dolls, tea party, and her friends.

So, today I was watching my 15 month old son play with an unactivated cell phone as he said "hi". I was thinking, "yeah", I get to watch his imagination develop. He is at the age where it is just emerging. Let the fun begin!

At work, so often the toddlers I work with can't yet participate in imaginative play until we work on some underlying skills: joint attention, memory, following simple instructions, sensory processing, & imitating other peoples actions, sounds, or words. So often the attention and imitation are the two biggies we work on. I get so excited when I get to work on the high level skill of imagination! All of the sudden we can be clowns in the circus, cowboys on a horse, and any zoo animal we so desire to be! Sometimes it is even fun to make up an animal or thing that doesn't yet exist!

Well, I am off to go watch the ultimate imagination movie with my daughter and husband on the couch...Toy Story. From the opening scene of the boy playing with his toys to the way the creators of the movie have the toys come to life, this movie is full of imagination! It's been around for awhile, but we love it. We are ready for Toy Story 3 that is due out in 2010!

How to Choose a Halloween Costume for a Child with Autism |

How to Choose a Halloween Costume for a Child with Autism

Tuesday, September 1, 2009

Fun Activities To Play With Toddlers

Today at work I had a blast! I knew I had won the heart over of a new toddler client when he gave me a know, a slobbery kiss with tooting noises. The goal of the OT session today was to help with his poor balance and upper body strength. But he didn't know that, he just thought that some lady came to play with him. You know that a toddler had fun with your activities during the therapy session when they don't want you to leave. Even though this family had lots of toys and a big house, and parents willing to buy any toy that would help this child improve with his developmental delays in motor and speech skills, I opted for fun activities for a toddler that are free. I did this by searching the game room and his bedroom for any toy, game, or activity that could be used to help his balance. Then, we played things that require absolutely no equipment, just our bodies. Some fun activities for toddlers that we played were:

  • Animal walks with animal noises: donkey kicks as we said "eh-oh", bear crawl as we growled (the downward dog yoga pose), slithering on the belly like a snake as we hissed, and jumping like a frog as we said "ribbit"
  • Obstacle course: we had a step stool to jump off of, a tunnel to crawl through, a large tall table to slither under, and a large pillow to crash onto after a 5 foot bout of "wheelbarrow walking". Although he had fun and was giggling, we had to help with sequencing. Don't add too many items to the obstacle course of a toddler.
  • Lap play: as he sat on my lap and I bounced him, I encouraged him to act like a cowboy riding a bull. As he had his arms in the air and I bounced him, I also "threw" off his balance to the sides to encourage him to use his arms to protect himself. Without protective extension, the toddler will have lots of bo-bos!
  • He wanted to play chase, but I discouraged this for him, although it may be good with other kids. This little toddler has a habit of running off when things become too difficult either at home, community, or at his preschool. So, I didn't want to feed into this. But I did however encourage other reciprocal activities such as turn-taking, rolling or kicking ball back and forth
  • "rough housing": him and his Dad rough house, so I showed the family how to do this where this toddler boy could be building up trunk strength (core stability) and improving in his upper body strength
  • I encouraged him to sing songs and perform novel motions. Examples, "If You Are Happy & You Know It, Clap Your Feet"- this really takes trunk balance to sit on the floor as your feet clap together. Another song was "Jump Around the Rosies" instead of "Ring Around the Rosies".
  • Be creative when playing toddler games...the sillier the better. At home with my own toddler, I turn on the TV to a toddler music station, and he loves to move and dance to the music as he plays in the living room
  • I encouraged the mom to take the little boy to the park and swimming pool, 2 really good activities to build strength and coordination
  • I suggested that after he has got out the "wiggles" to encourage him to sit in a chair without a back and play with puzzles, stringing beads, Mr.Potato Head or other 2-handed activities. This lil' toddler has difficulty crossing the middle of his body or using 2 hands at once due to mild low muscle tone in his trunk and extremity muscles
  • I suggested the parents use their exercise ball to have the lil' tot balance and bounce on in different positions: sitting, lying on back, lying on belly, sidely, or stand
  • Water art out on the sidewalk as he squats: get sponges or paint brushes and play away! the water dries quickly (or at least where I live because it is hot here!) and they can start all over again!
  • The final tip, was to have him help with yard work such as using the water hose or watering can to water the flowers. This is fun and buids upper body strength. You might even get lucky enough to see a butterfly or lady bug!

The possibility of toddler games is endless and so often the activities can be played for free. This is such a fun age because they are usually redirectable and easily distracted, even if they can be stubborn from time to time.