Sunday, December 20, 2009

The Most Common Infant Disablities and How to Recognize Them

The Most Common Infant Disablities and How to Recognize Them

Saturday, December 19, 2009

Books for Toddlers

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

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

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

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

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

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

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

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

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

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

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

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

Friday, December 18, 2009

Setting Up the Environment to Help Young Children Focus Longer

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

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

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

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

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

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

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

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

Now, go ahead, go play!

Friday, December 11, 2009

Take Your Child's Therapist Holiday Shopping With You!

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

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

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

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

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

Friday, December 4, 2009

Identifying Problematic Reflux Symptoms in Infants

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

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

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

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

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

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

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

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

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

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

Tuesday, December 1, 2009

Strengthening Activities for Toe-Walkers

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

Helping Young Siblings to Take Turns

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

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

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