Monday, November 16, 2009

Finding Christmas Gifts For Toddlers With Developmental Delays

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

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

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

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

Friday, November 13, 2009

Ambidextrous Versus No Hand Preference

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

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

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

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

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

Tuesday, November 10, 2009

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

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

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

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

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

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

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

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

Thursday, November 5, 2009

Heart Defects in Babies Contribute to Feeding Problems

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

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

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

Monday, November 2, 2009

Allergy Testing

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

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

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