Monday, December 20, 2010

Kindermusik Home | Toddler Preschooler Infant Children Music Classes

I'm a big fan of Kindermusik! I am lucky enough to live in a bigger city where there are multiple locations that classes are conducted. Their classes are so fun, and some include learning sign language!

Kindermusik Home | Toddler Preschooler Infant Children Music Classes

I have had many OT (occupational therapy) clients who weren't learning to talk with just speech therapy or developmental services, but did learn to speak after attending Kindermusik classes! Now, it is not designed just for the special needs child yet these children potentially can benefit greatly. One child I am thinking of who benefited is a child with ASD (Autism Spectrum Disorder), and at age 2 1/2 he was still mostly non-verbal except for saying "mama, dada, and hi". After attending a few Kindermusik classes he began humming, then with a few more classes he began to insert a few simple words into the song mixed in with the humming. At that time, he still was unable to express his needs and wants, but at least he was speaking! Then, during speech therapy sessions the therapist began to encorporate his favorite Kindermusik songs and instruments with more traditional therapy techniques. Within six months the child had a vocabulary of between 75-100 words, and was able to express some basic needs and wants...yeah! Once he turned three years old, he graduated the program (early intervention) that I work for so for a while I didn't know how he was progressing. Then, about a year later I saw him at a birthday party that my daughter was attending. I could not believe the difference in his language skills! He was not only expressing basic needs/wants and labeling items, but he was socializing with other children as long as it wasn't too loud in the room. Unfortunately, his sensory processing skills hindered his ability to stay in the room for some of the games and as the "Happy Birthday" song was being sang, but Wow had he made progress! I don't think Kindermusik cured all of this child's speech/communication problems, but it did jump start his ability to talk.

Sunday, December 12, 2010

Tummy Time for Baby | Articles | Babies Today

Tummy Time for Baby | Articles | Babies Today

Gifts for Kids With Special Needs

It's that time of year already! Whether you celebrate Christmas, Hanukkah, or any other holiday filled with gift giving, it is time to think about what to give your loved ones. This can be difficult when thinking of what to get a friend or relative with special needs. Here is a link filled with considerations for gift giving to children with Autism:

Gifts for Kids With Autism |

Many of the parents of the kids I work with like to identify adapted toys in therapy catalogs as potential gifts. The families then provide their friends and relatives with links to the therapy companies' websites. This is especially a good idea when the child has physical disabilities that limit the way he can manipulate commercial toys found in local retail stores. Here are a few companies to consider purchasing special needs toys from:

For infants, toddlers, and preschool age children:

For children of all ages:

and and

Friday, December 3, 2010

Mother-Infant Interaction: Achieving Synchrony : Nursing Research

I went to a conference today. I always love to learn new things, and then share the info. and resources with others. Found out today about this study on mother-infant interaction, and thouht I'd share:

Mother-Infant Interaction: Achieving Synchrony : Nursing Research

The smallest of interactions can make a difference. It might be as simple as picking up a baby when he's crying or it might be talking in a soothing voice to them as you give eye contact. But what ever the interaction, it is SO important to keep it positive.

Wednesday, November 24, 2010

Rice Allergy - Is Rice Allergy Becoming A More Commonly Seen Allergy?

Both my son and daughter have food allergies and my son also has FPIES (food protein-induced entercolitis syndrome). One allergy of his that we became aware of this past week is rice. It is not usually a common food for people to be allergic to, but according to this link it is on the rise:

Rice Allergy - Is Rice Allergy Becoming A More Commonly Seen Allergy?

Although I am glad to have figured out which food was the culprit, it is not an easy allergy to deal with when he already can't consume dairy, eggs, peanuts, almonds, and soy. It is a good thing he mostly drinks hemp milk! So many of the products for people with dairy, gluten, and soy allergies have rice flour as the substitute.

If you have some favorite products for people who suffer from these same food allergies, I would love to hear about it!

Friday, November 19, 2010

ZERO TO THREE: Playing with Babies

Although it might be instinct to rock and comfort a crying baby, it is often not instinct to know how to play with a baby. The link below gives some great tips on playing with babies:

ZERO TO THREE: Playing with Babies

One of my favorite things to play with babies is "Peek-a-Boo" cute to see the look on the baby's face!

Tuesday, November 16, 2010

Resources on Sensory Processing Disorder - Free Downloads

I am the handout queen...not really, it is just a title I have given myself. I love to provide families with handouts, website links, and other resources. When parents take the time to read up on topics that are related to their child's developmental delays, it is SO much easier for me to have a meaningful conversation with them about how to better help their child. My time with families is very limited, 1-2 times per week usually, and unfortunately this is not enough time to teach families everything they need to know.

One website that I am fond of is "sensory street". Here is a link to this site's resource page that includes many free downloads on topics related to nutrition/feeding problems and sensory processing disorder/ sensory integration dysfunction:

free sensory downloads

I especially like the download of "Do You Know Me?". Not only does it come in English and Spanish, but it is concise and easy to understand especially for visual learners. This handout can be given to family members, caregivers, teachers, and any other professional working with children with learning problems or other special needs.

Wednesday, November 10, 2010

Do You Have Any Idea of the Chemicals Used in Fast Food Chicken

So many of us are uninformed of what actually is in the food we eat. This is the case when we eat "quick" meals at home out of a box, but it is especially the case when we eat fast food! Here is an article that hopefully will make you think twice about going through the drive-thru of a fast food restaurant:

Do You Have Any Idea of the Chemicals Used in Fast Food Chicken

The reason we go eat fast food is because so often we are too busy to cook after a long day of work and helping the kids with school work or toting them to sports lessons or other places. One thing I do is cook foods ahead of time and put them in the freezer. Then, I thaw the meal out in the refrigerator in the morning before leaving for work. This saves preparation time when I arrive home, and all I need to do is bake it! Other things I do is use the crock-pot or cook quick recipes with fresh ingredients. One of my favorite cook books has a big section on 15, 20, and 30 minute meals...this includes the time needed to prepare and cook it. And when I am working as well as a mom to two young children, I need all of the short cuts I can take without resorting to fast food! I would love to here what other people do to make nutritious meals in a hurry. Key words are "nutritious" and "hurry"!

Wednesday, November 3, 2010

Indoor Gross Motor Activities

Today it is cold and rainy outside. That means my kids didn't get to play outside like they typically do before and/or after supper. Now that it's November, there will be more and more days like this where we have to be entertained indoors.

Here are a few ideas that I use to keep my kids involved in gross motor activities while staying indoors, and maybe they will work for you too:

1. "Simon Says": I usually start out as Simon while playing with just my 7 year old daughter, then my 2 year old son usually joins us and tries his best to imitate everything his big sis does. I tend to call out these commands: standing on one foot, animal imitations (bird, cow, donkey, bear, crab, snake, etc), twirling, jumping jacks, clap while jumping, tip-toe walk, heel walk, jump from side-to-side, clap hands over their heads or behind their backs, touch one hand to the opposite foot, and walk backwards.

2. Obstacle course: We have a big space in our living room and entry way that makes a great location for an obstacle course. We use our fabric tunnel, mini-trampoline, fabric tent, blankets draped over the back of chairs, large pillows, couch cushions, and a hula-hoop to either jump in-an-out of or to climb through. I have the kids go through the obstacle course consecutively together or to do it individually while "racing the clock". Motions involved include climbing over, under, and through, jumping forward and backward, crawling forward or backward, and rolling (log or forward).

3. Kids yoga or other exercise videos: my children's favorite video is from Yoga Kids (R); the poses on the video are fun and in alphabetical order, A-Z. "A" is a pose that looks similar to an alligator and "R" is a pose that looks similar to a rocking horse. The suggested ages are 3-5 years, but I think many 2 year olds can at least try it. My son probably is motivated to try the poses because his sister and I are doing them as well.

4. Chores: I completely believe in child labor and teaching kids to be responsible for chores! They are good for building strength and coordination! My kids help carry bags from the car as well as clean their rooms or any other area where they have played and made a mess. Both of my kids like to help fold towels, not that they are excellent at it, but at least they are active and trying! My older child is also expected to make her bed and help "set the table" before dinner.

5. Cooking: stirring batter and rolling out dough is lots of upper body gross-motor fun! Pounding over the food chopper can be quite a blast also!

6. Dress-up: My kids like to play dress up and then act out the character. We have costumes for Peter Pan, Captain Hook, various princesses, cowboy, police man, baseball, soccer, as well as random hats, scarves, and shoes to play with.

7. Playing games in various positions: I like to play card games with my daughter while we are facing each other and propped on our forearms lying on our bellies. I like to draw and color with my son while we are standing at his easel. It is also fun to draw while on paper taped to the bottom of a table or chair while lying under it, but I am not sure I trust him with this yet, maybe as he gets closer to 3 years of age! Sometimes my daughter and I sing songs while we are hanging off of the couch with our heads on the floor...can only do this one for a short amount of time!

8. Sing songs with body actions: "Wheels on the Bus", "Ants Go Marching", "Row, Row, Row, Your Boat", "Getty Up Horsie", and "Ring-Around-the-Rosie". These are fun as long as you have energy to keep up with your kids!

Use your imagination to keep the kids active! Just remember not to over-use video games and television during the autumn and winter months. Keeping kids moving is important for motor and cognitive development as well as to reduce chances of obesity!

For ideas of indoor activities for children with sensory processing disorder (SPD) or autism (ASD) known as a sensory diet, check out the following website Also, ask your child's occupational, physical, and/or speech therapist for a handout on activities to do at home to keep your child busy. This will also greatly impact behavior because they won't be bored!

Sunday, October 24, 2010

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

Choosing the "just right" costume can make or break the Halloween holiday for children, especially children with sensory processing disorder (SPD) or an autism spectrum disorder (ASD). Here are some suggestions on choosing a costume:

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

A Halloween costume could be new with some of the considerations listed in the link above, or it could be something the child wears often such as a sports team uniform or "dress-up" play clothes. I would love to hear what worked for your child as a Halloween costume and what made it so successful!

Tuesday, October 19, 2010

Free Downloads on Sensory Processing Disorder

Since October is Sensory Awareness Month, I thought that I would share an awesome resource which is a link to free downloads on sensory processing disorder (SPD):

SPD free downloads

Let's do all we can this month to make more people aware of the symptoms of SPD! One easy way to do that is to share handouts that are written in simple and precise language. More people are likely to read a one to two page handout than a long book. Go ahead, print some of these handouts off and pass them around to teachers, friends, parents, caregivers, and anyone else that could benefit from the information.

Friday, October 15, 2010

Nutritional Guidelines for Toddlers - iVillage

Today I went to a 6 hour workshop on the topic of nutrition. The speaker presented on how important good nutrition is for exercise and muscle building. So, nutrition is on my mind! Since tomorrow is my assigned day to take snacks for my daughter's soccer team after the game, I couldn't help but analyze what snack would be the best post-exercise snack as I was listening to the speaker. I decided to bring G2 (Gatorade) and granola snacks. Getting carbohydrates, proteins, and hydration within 30 minutes of a work-out or sport activity is very important, as well as drinking fluid every 10-15 minutes during the activity. It's a good thing this soccer club blows the whistle in 10-15 minute increments for mandatory water breaks!

Good nutrition is not only important for active children participating in sports, but it is important just for normal growth and development. Many of the clients I work with need more calories than what is expected of their peers with no medical problems. This might be because of cardiac problems, prematurity, spasticity of the muscles, mitochondrial disorders, or various diagnoses that tend to burn calories at a higher rate than is normal. So even though this link I'm including is nutritional guidelines for typically deveoping toddlers, the information gives a baseline of what is necessary:

Nutritional Guidelines for Toddlers - iVillage

Many of the kids I work with are blessed enough to be seen by our dietician, but unfortunately not every facility has a dietician. So, I hope the information in the above-mentioned link is helpful to those who don't have access to a dietician or nutritionist who specializes in pediatrics. If the child you are concerned about (may be your child or a client) does not have a dietician or nutritionist because there are none in your area, it might be worth the drive and money to a facility in a nearby town (or even a far away town!), even if it is just once every month or two.

Wednesday, October 13, 2010

Children's Hemiplegia and Stroke Association

Many children have hemiplegia due to cerebral palsy, a stroke, or any other injury to the brain. Hemiplegia is when one side of the body has abnormal muscle tone and tightness due to a brain injury or stroke on the opposite side of the brain. In comparison, hemiparesis is when the person has muscle weakness and "floppy" tone (AKA flaccidity) due to the same reason. This means if the person has a stroke on the left side of the brain, then the right side of the body will be effected. The person loses not only muscle strength, mobility of the joints, and coordination but also sensation. When a person doesn't have full sensation in a limb, then they tend to not use it. For adults with this problem if they have normal cognitive skills, they can force themselves to use the arm and leg on the involved side of the body. Also, an older child might be able to do this. But for infants, toddlers, and young children this is not typically the case especially if they had the brain injury in utero and never had typical movement of the involved side of the body. Physical and occupational therapists have strategies they can teach the child and parent to aid in the child using the arm and leg, but sometimes this just doesn't work, because the child wants to use the other side because it is easier to use and it has full sensation.

Some children who have hemiplegia may benefit from constraint Induced Movement Therapy (CIMT) which is the technical word used for "forced use". The following link has links to various articles and research that has been conducted on the effectiveness of this approach with children.

Children's Hemiplegia and Stroke Association

I had a co-worker about 6 years ago who was conducting her thesis on CIMT. She set up a summer CIMT camp at the clinic we worked at in which several school-age children with hemiplegia participated. They had their non-involved arm casted so that they weren't tempted to use it. This "forced" them to use their involved arm which was hypothesized to build strength, coordination, and sensation. Certain criteria had to be met just to participate, because if the child had too much spasticity or other problems then CIMT wasn't going to be able to help. CIMT is not for children who can't use the arm at all (complete paralysis); there has to be at least some movement.

The end results of the project were good. Although every child made progress, I am not sure that any of them achieved completely "normal" use of the involved arm, but I do know they all continued to receive weekly OT and PT to build upon the progress that was made over the summer.

I have not ever used CIMT with the toddlers that I work with at early intervention (ECI), because I think they would just be frustrated and confused. Maybe a child in preschool or early elementary age would better understand the purpose of CIMT and not get so frustrated. However, I do "hold" the involved arm down for an activity as well as place toys to that side of them so they are more likely to use the involved hand instead of ignore it. Other techniques I use with young children with hemiplegia or hemiparesis include: NDT handling, bimanual activities, electrical stimulation, dynamic and static splinting/orthotics, kinesiotaping, adaptive equipment, infant massage, and sensory integration therapy. My favorite dynamic splint for infants is the Joe Cool (TM) splint, but they tend to not be as effective with the toddlers because they have figured out how to unstrap the velcro! The most important thing in helping infants and toddlers with hemiplegia/hemiparesis is teaching simple therapy techniques to the caregivers and parents because they are the ones who are primarily with the child all day long. For some of my kids who attend daycare in large classrooms and have parents who work long hours, the techniques asked of the caregiver might be simple such as making sure the child wears his hand splint during table-top and "centers" activities. I also suggest that at snack and lunch time that food and drinks be placed to the center and each side of the child to increase the chance that he may use his more involved hand; if the food and drinks are placed only on the non-involved side, then the child is not likely to use the hand that needs to get stronger. These are simple and do-able suggestions! If I give complicated strategies, the caregivers are not likely to have the time to perform them.

Sunday, October 10, 2010

Turning Everyday Items Into Therapy Tools

This week has been one of those weeks that just flew right by: doctor visits, allergy shots, soccer practice and game, birthday party for my daughter (7th), work, and all of the normal things that happen in a week! So, I was just realizing that I haven't blogged since last week. I couldn't even think of anything interesting to blog about not that nothing interesting happened, but because it was such a busy week that everything that happened work-wise seems so long ago. It was about that time that I started the last load of laundry and realized what I should write about: laundry baskets and other everyday items. "Laundry baskets" are not ordinally the most interesting topic, but I'm going to discuss how they can be used as a therapy tool to help children with meeting their developmental milestones.

Laundry baskets:
1. When inverted they are an excellent item for children to push around the room. If the child can stand but not yet walk, this is especially a great activity because of their wide base of support the child gets lots of stability. For those children who can already walk and need upper body strengthening, pushing the basket across carpet can give some extra resistance.

2. Have the child sit in the laundry basket and take him/her for a ride. For children with a language delay, you can encourage them to say/sign "more" or "stop" as you push them across the floor. For children who need to work on social engagement, have another child push the basket and then they can switch rider-pusher in order to work on turn-taking and talking to a peer.

3. Have the child sit in the laundry basket as the basket is on an adult's lap. The adult can tilt, bounce, or rock the basket for vestibular input to work on balance/equilibrium skills.

1. Magic Carpet Ride: Have the child lay on a blanket as you grab one end of it and run across the floor. This is a perfect opportunity for the child to say he wants to go slower, faster, more, or "all done" with words or sign language. It can also be a turn-taking activity if there is another child; the child pulling is getting lots of proprioceptive input whereas the child who is lying down gets vestibular input.

2.Hot dog: Have the child roll up in the blanket as if he is the weiner and pretend that the blanket is a bun. Then, give the child deep pressure as you pretend to put different condiments on the "hot dog". Give joint compressions to the feet as you "shake on salt and pepper".

3. For infants and toddlers (or light-weight preschoolers), a blanket can be used as a swing. Two adults can each grab an end as the child lays in the center. They can bounce the blanket up and down or rock it side-to-side. The child can have his body perpendicular to the adults and then switch to being parallel to the adults in order to give input to different receptors of the vestibular system.

Large Bowls:
1. When inverted, they make wonderful drums! If you have plastic or wooden spoons, those make great drumsticks. But if you only have a bowl, the child can bang it with his hands as if it is a bongo drum.

2.Put a ping pong ball in a large bowl, then move the bowl in a circular direction (clock-wise). Stop, then move the bowl in the opposite direction (counter clock-wise). This is a great activity for eye tracking in a circular direction. For children with low vision or poor attention span, use contrasting colors such as a black bowl with a white ball. For eye-hand coordination, the child can try to stop it with his hands and grab it.

3. Have the child jump over the bowl pretending it is a "candlestick" while you repeat: Jack be nimble, Jack be quick, Jack jumped over the candlestick!

1. Wad a pair of socks up to the size of a bean bag and use them for bean bag toss at a target such as a bowl, box, or any other item around the home. If you bounce them off of an exercise ball or mini-trampoline, they will go flying across the room...usually guaranteed to make the child laugh!

2. Empty a clean load of laundry out onto the bed or other clean surface and have the child sort the socks by color and/or design. This is great for oculomotor skills and the visual perceptual skills of figure ground, visual memory, visual discrimination, and form constancy, especially if there are other items in the pile besides just socks.

3. Put potatoes or other items similar in weight within larger socks and use them as weights for the lap or over the shoulder; good for proprioception and/or muscle strengthening.

There are SO many more everyday items that can be used therapeutically. What are your favorite activities to do with household items? I would love to hear your ideas!

Sunday, October 3, 2010

October is National Sensory Awareness Month

I have been happily surprised lately while talking to some of the staff at daycares and Mother's Day Out (MDO) programs where I work with some children for occupational therapy services. They ACTUALLY have heard about sensory processing disorder (SPD)...yeah, it is not a foreign concept to them! At one MDO program I was at last month, the teacher even asked me if I thought she should refer another child for an OT evaluation due to him possibly having sensory processing problems. Now before you get overly elated that the OTs in our community have done the most amazing job ever, I have to let you know that this woman has a nephew with Asperger's and SPD. But still, it was exciting to have her initiate the topic.

I live in a suburban area outside of a large city with a school district that is well known for its great support of children with special needs. In fact, there is a special program just for children with Autism Spectrum Disorders. You know what that means don't you? It means we have people moving into our district at increasing rates each year. It also means that many community members are more aware of learning disorders and other special needs than in some of the other places. Many of the preschools/MDO programs, daycares, and babysitter organizations go out of their way to be inserviced on learning problems and in particular SPD. Now, I am not going to go so far as to say us OTs and special education/ early intervention staff have done everything we can do to educate our community. Of course we haven't! Everyone can always do more.

If you would like some ideas on how to raise awareness of sensory issues in your community, go to this link that provides contact information for a free electronic packet full of ideas to help you:

S. I. Focus

Since October is National Sensory Awareness Month, I will be doing a little extra educating on the topic. I've already done a 90 minute presentation to the new staff at my job last week, and I plan to do something at least once a week this month to bring awareness to SPD.

I do public speaking quite a bit on various therapy related topics including SPD. One thing that I have learned is to keep it simple when explaining SPD to people who have never heard of it, but don't over-simplify it either. If you plan to go out in the community and speak to groups about SPD, then make sure you know your audience. A group of doctors may not need the same explanation as a group of elementary school teachers. Doctors tend to want to know about "proof" through research whereas teachers like to know the functional implications and simple strategies to help the children.

Good luck with spreading the word about Sensory Processing Disorder!

Friday, October 1, 2010

Occupational Therapy for Feeding Skills During Family Mealtime

I have a lot of therapy strategies up my sleeve when it comes to pediatric feeding disorders. Some of them include fancy positioning equipment, oral-motor devices, stretches, and textured teething toys. Some of my strategies even require that I become "certified" just to use them. Yet, the most effective strategy that I have found so far is to show up during family meal or snack time for children and during a scheduled bottle feeding for infants. It sounds SO simple, but it works!

For many of the children I work with they can perform a certain skill such as munching a soft diced vegetable if I was to give them just a couple of pieces in between some mouth exercises at a time in which they were not even hungry. They might even be able to hold a spoon if we practiced scooping up toys out of a sand box while we are playing in their room. But that doesn't mean they have the muscular endurance and sensory processing abilities to chew three different foods on the plate while using utensils to feed themselves. It is hard for many children with feeding disorders to handle more than one food due to the various flavors, temperatures, resistances, and textures. Additionally, they may be able to chew the food, swallow the drink, and manipulate the cup and utensils when sitting alone, but can't handle it when there are more people present. Why is that? Well, every child may have a different reason, and I am not going to know "why" unless I directly observe the meal within the natural setting: family meal time. If that isn't possible, then I observe snack time.

What does family meal time look like? It is different for everyone. I tell the families to set everything up as if I wasn't there. The meal may occur in front of the TV on the couch with one of the three siblings next to the child I am working with or it may occur at the dining room table with every household member present. I just want to see what naturally occurs during the meal time routine...there is no right or wrong. For some children they may not be able to participate in family meal time because of the noise level. For others it might be that they are sitting too close to a sibling that keeps inadvertently touching them. Even after I observe family meal time, I may still not know why the child is having difficulty with eating. That is when I watch the child eat a variety of foods while he is alone. If I figure it out, then we may work on specific skills separate from meal time, but even then the intention is to include the child in family meal time. Some children may need some 1:1 work with oral motor exercises, fine motor play, a "sensory diet", and other strategies immediately prior to family meal.

For those kids who can't handle eating with their family, maybe they could at least sit and socialize or just "be" there, even if they have to eat before or after everyone else. Just "being" with everyone else at the table might be the only way a medically-involved or tube-fed child can participate, and that is okay.

It breaks my heart when I find out that the child with the feeding disorder is not included in any form or fashion just because he has a feeding disorder. If the child's sensory processing abilities don't allow him to be with the rest of the family, then maybe he could help with meal preparation or setting the table.

For babies with feeding disorders, I show up for occupational therapy at one of their scheduled feedings and watch the parent (or caregiver) feed the child. I offer suggestions if needed. I may follow up with stretches and ideas for pacing, positioning, burping, and nipple/bottle changes. If the child is having alot of problems, then I may feed the child. But the problem with that is that babies that are oral feeders get usually 6-8 bottles a day and I am not going to be present for all of those feedings! So, the natural routine of the meal is going to be the adult holding the baby (or placing them in a device) while feeding him. Sometimes I do the first half of the feeding process for training purposes, and then after the baby has burped I will have the parent try to do the same things I did. After all, feeding your baby is the most basic thing that every parent wants to do successfully!

I guess my biggest "take home point" from this blog entry today is try to work with the child within the natural routines. If the strategies given to the family aren't meaningful to them and feel like extra work, then they will not work on them between the therapy visits. On the other hand, if the strategies are purposeful and occur within routines they already have, then the family is more likely to use the therapist's ideas.

Wednesday, September 29, 2010


Nystagmus is when the eyes oscillate. This movement can be either side-to-side, up-down, or in a rotary motion. Nystagmus is a normal thing after a person has been spun in circles, but not when the person has just turned their head to the side or is sitting still. There are different reasons behind an atypical nystagmus (meaning not after being spun), but the most common reason I see it in children is when they have neurological damage. Here is a link that explains it well:


Because the eyes are oscillating, often the children complain of things looking blurry when they look straight ahead. Since there is not a cure for it, children should be allowed to adapt in order to perform activities to the front of them such as reading and writing. The most common adaptation is the child tilting their head and looking out of the corner of their eyes. Now, this may be something we wouldn't want a child to do if they have other diagnoses such as hemiplegia/hemiparesis with hemianopsia or other one-sided problems. In those cases we would want to encourage the child to look to the middle of their body with the paper or book placed to the center of them. Just be aware that forcing a child with nystagmus to look straight ahead to perform table-top activities could give them headaches and cause them to be distractible....if everything I tried to focus on was blurry, I would lose focus quickly too! Fidgeting and grouchiness will soon follow the distractibility if forced to keep looking to the center. This is especially hard when dealing with toddlers and preschoolers because sometimes they lack the words to express that things look blurry, whereas older children can often tell us their symptoms.

Another accommodation could be to angle the papers that they are reading or writing on. Anywhere from a 30-90 degree angle could be appropriate. An example of writing on a 90 degree angle would be to draw on paper taped to the refrigerator. An example of a 30 degree angle would be taping or clamping paper on to a 3-ring binder that is declined, with the rings perpendicular to the child. Angles in between those could be achieved on a desk or standing easel.

When dealing with puzzles, artwork, or other fine motor activities it may also be appropriate for the child to be allowed to stand up to do the task and not be forced to stay seated. So often in daycares or Mother's Day Out programs I see that the little children are being taught to stay in their chair, but this may not be appropriate for a child with a nystagmus problem.

If the child with nystagmus is young and the pediatrician is not aware of it, be sure and share this information with them. Maybe a referral to a developmental optometrist, opthalmologist, or neurologist will be needed. If the child is older and hasn't been to an eye doctor lately, a referral to either the developmental optometrist or opthalmologist may be needed. Many developmental optometrists will write up reports full of functional information that can be shared with the daycares/schools and placed within an IEP.

Friday, September 24, 2010

Food Protein Induced Enterocolitis Syndrome - FAAN

My kids have food allergies to dairy, eggs, nuts, and some food additives (dyes, nitrates) in addition to having reactions to soy products due to food protein induced enterocolitis syndrome. This may result in diarrhea or vomiting. The "allergy" test which looks at IgE levels will show up negative for an entercolitis problem. This type of entercolitis is seen when the person can't handle soy and dairy products. Entercolitis also differs from lactose intolerance because it is not due to lacking the enzyme lactase that breaks down milk sugar; it goes beyond having bloating and gas.

I am often surprised at how many pediatric GI doctors do not even look at this diagnosis as a possibility. Sometimes the parents of the kids I work with are told to give the child soy or dairy after the IgE test shows no positive sign of allergy. I think if the parent is seeing the child in GI discomfort, then the food shouldn't be added back into the diet. The allergist doctor that my children go to is the one that educated me on food protein induced entercolitis syndrome, yet my experience is that even some allergists don't look into this possibility. I realize though that every doctor has different trainings and experiences...wish more of them new about this possibility!

Food Protein Induced Enterocolitis Syndrome - FAAN

If you've not went to a doctor for your child's digestive or allergy problems, then please do. You may want to visit an allergist if your child hasn't got better and has already seen a GI doctor. Some of my clients have even needed to go to the neurologist to rule out other problems such as metabolic or mitochondrial disorders which can have an impact on the GI system. One thing that is important to do before the doctor's visit is to keep a food diary. List out what the child ate, what time, and if there were any behaviors or digestive problems (e.g. burping, vomiting, refluxing, diarrhea, constipation, gas). If you've done this for over a week, you might be able to see a pattern and figure out the culprit. Sometimes not, but then you are able to rule out which food is not the offender!

Monday, September 20, 2010

ZERO TO THREE: Aggressive Behavior

I think that all toddlers can become easily frustrated from time to time. I know that my 27 month old son does! Overall, he is a laid back child. But since he began preschool three weeks ago, some new behaviors have arised. He has become more possessive of his toys while chanting "mine, mine!" and seems a bit more impatient, and even pinched another child after she "stole" a toy from him. How I and the staff choose to deal with these behaviors can make all of the difference in the world! I think these behaviors are normal for his age, but they should definately be redirected. Some suggestions on how to handle aggressive behavior are on the following link:

ZERO TO THREE: Aggressive Behavior

Children with developmental delays tend to get frustrated when they can't express what they want to say or when they become over-whelmed. That is when aggression may peek out in them...not because they are a bad child, but because they want what they want and when no one understands that, it can become frustrating! Many of the kids I work with become aggressive such as pushing, biting, or kicking when another child takes a toy from them. This is often because they don't yet have the ability to say "mine, mine". So, it may be frustrating that a toddler seems selfish, but it is better that they let you know they wanted that toy by saying "mine" than by pushing another child. If a teacher or other adult doesn't understand that, then the child may be wrongly punished. Although the child may need to go to time-out for hurting another child, he should also be encouraged to "use his words". I think that the suggestions in the link above mixed with suggestions by a speech language pathologist, occupational therapist, and/or developmental specialist (with ECI/EI)should help minimize the aggression in a child with developmental delay.

Thursday, September 16, 2010

Brachial Plexus Injury in Infants, Health Facts For You, UW Health, University of Wisconsin Hospital, Madison

Brachial Plexus Injuries can occur at any time in life, but the risk to babies is more likely to occur in the womb or during delivery. So often they are not obvious until the baby is a couple of months old and not moving the arm equal to the other arm, and sometimes not even moving the arm at all. Another symptom I see is that the baby's clavical (collar bone) starts growing more forward due to the nerve not stimulating proper bone growth.
Here is a link describing brachial plexus injuries:

Brachial Plexus Injury in Infants, Health Facts For You, UW Health, University of Wisconsin Hospital, Madison

If you are concerned that your infant does not move one arm as well as the other, please discuss this with your pediatrician. An evaluation with a neurologist may be necessary to rule out a brachial plexus injury. Other problems that it could be include hemiplegic cerebral palsy, torticollis (neck muscle), orthopedic impairments, nerve impingement, and other things that should be looked at by a physician. The baby may need physical and/or occupational therapy to help learn to use the arm better as well as to provide stretches/exercises.

Sunday, September 12, 2010

Will My Baby Catchup? Growth and Prematurity

When evaluating premature babies, I often get asked the question "Will my baby catch up?", and I found a good link that can answer that question in detail:

Will My Baby Catchup? Growth and Prematurity

After reading this link you know that it depends upon the situation of how quickly (and if) the baby will catch up!

Friday, September 10, 2010

Changing the Environment & Interaction Style to Help Kids with Developmental & Sensory Processing Delays

I have worked in a variety of settings: school system, hospital, outpatient clinics (more than one), early intervention, and home health. I have been working in early intervention and home health over the past 6 years, because I have found it to be my "niche". Why is that you ask? Well, I believe that helping children in their natural environments such as the home, daycare, and other community settings is where the biggest changes will be made. Now I am not saying therapy clinics are a bad place; I have worked in those settings and thoroughly enjoyed it and know that most of the kids had fun there. But the main focus of working with a child in a clinic, is the child and his deficits. Yet, in their natural environments the focus is not only the child but all of the people that come into contact with him on a regular basis and how every one and thing can help. Isolating the child in a clinic to work on fine-motor, feeding, language, behavior or whatever other skills doesn't necessarily carryover to how the child will function in another environment in which all of those "therapy toys" are not present; it may carryover for somethings and it may not. In home health settings, a therapist helps the family utilize what they already have in the places the child will be at on a regular basis.

A recent example of what a difference I was able to make in a child's life was through teaching the daycare staff how to work with a particular young boy. He is almost 2 years old and has significant developmental delays as well as mild spasticity due to some complications with being born at 27 weeks gestation- "a preemie". He has limited range of motion in his upper body in which it is hard for him to raise his arms over his head. He also has difficulty with tight hamstrings- the muscles in the back of the legs. So, when I observed "music and movement" time at the daycare, I was able to help the teacher incorporate some stretches and movements that would benefit this child as well as his peers, including touching toes while sitting in the floor. Now, he will get to do these stretches 5 times a week since he goes to daycare 5 days a week and they follow the same schedule each day. In addition, we altered the chair that he sits in at lunch time to a shorter chair so that he can now independently climb in and out of the chair. Other areas that were helped were naptime, outdoor play on the playground, and "centers" for fine-motor play. By teaching the teachers how to adapt the activities, alter their interactions such as by saying particular phrases, and by altering things within the environment, this child became more independent. If I had seen this child in a clinic, my focus would have been to teach some of these skills but without meeting the daycare staff and watching the sequence of the routines, I would not have been able to help this child as much.

Another example includes a child I see at his home who has significant behavior problems, sensory processing problems, and a short attention span. By teaching his mom to set up activities that he can be independent with at a small table within her line of vision, she can now cook dinner without him "getting in trouble". In the past, this child only acted well when given immediate 1:1 attention by an adult. So, I taught Mom to help him with an activity, and initially be on the other side of the room from him. Then, she progressed to leaving for 1-2 minutes, which then led to her being away from his side for 5-10 minutes. Within no time, she was able to do this in the kitchen and successfully cook supper without any (or at least only at times) "meltdowns". If I had not been in the home to teach his mom this activity, and only told her how to do it, he would probably not have been successful with this. The first time we tried to leave his side as he played alone even briefly, she wasn't thinking "it was going to work". So often, the parents and other caregivers just need us (therapists and other professionals) to show them how to do something and then they can do it on their own.

In the past, I thought that when I worked in a clinic and typed up a home program full of suggestions that that would help; that may be the case for some families, but most need to be shown! Also, I was giving general suggestions even if I thought I was individualizing it, because I had never walked into that child's daycare or home, so how could I have been completely individualizing it! Really, I was giving exercises and strategies aimed at decreasing the child's deficits such as poor balance, hand weakness, etc. I now realize I was only helping such a small portion of that child's daily routines.

If your child receives private OT, PT, SLP or other services at a clinic or other place than the home or daycare, ask the therapist to come do one or more home visits. If that is not possible, make video recordings of the different routines that don't work well.

Monday, September 6, 2010

ADHD diagnosis and poor diet now conclusively linked in Australian study - San Francisco adhd |

Something we all know, or at least think, has now become the focus of research. Eating diets of highly processed foods may contribute to ADHD:

ADHD diagnosis and poor diet now conclusively linked in Australian study - San Francisco adhd |

My husband has an aunt who told us about her quest to feed her children, especially her son, only "healthy" foods and no junk foods back in the late 1970's and early 1980's. She didn't have the luxury of the internet and reading some of the recent research about how to eat organic and "whole" foods. But she said all of her trips to the library and meeting with a dietician was well worth it. She said her son had got diagnosed with ADHD. He was constantly wiggling, impulsive, and had a short atttention was not his favorite place. Then, when she omitted white breads and pastas, food dyes, fried foods, corn syrup, candy, and other highly processed foods, she said his behavior and school performance made a 180 degree turn for the better! I have such respect for her and all of her hard work to feed her family well. I am going down the same route as her, but I have it much easier in terms of gathering information yet I still find it hard. If it weren't for my children's food allergies, I may have never learned some of these things. So that is why I am actually thankful that my children have multiple food allergies and can't eat a lot of junk! They think fruit ice pops and sorbet are the best many kids in the USA think that...not enough! So amazing that fixing our diets can impact behavior, school performance, and lessen the chances of childhood obesity. Wow, is that powerful!

Thursday, September 2, 2010

Developmental disability, early intervention, developmental delays, autism screening and early intervention autism : First Signs

If you are concerned that your young child may have autism, check out this great website that gives lots of information on early diagnosis and intervention:

Developmental disability, early intervention, developmental delays, autism screening and early intervention autism : First Signs

I would love to hear of any other great websites that you recommend for early detection of autism.

Monday, August 30, 2010

Caring For Boys Versus Girls

I've always known that girls and boys develop differently especially in the area of language and play. Now that my son is 26 months old this statement has become an even bigger fact in my life. It is funny to watch how long my son can play with his race track, look at his airplane and trains book, and interact with balls and other rolling toys. He will complete a puzzle, scribble, interlock toys, and build but after completing it, he moves back to his train table. At that same age, my daughter would have stuck with the developmental toys for 20-30 minutes. Here is a discussion link on this topic:

A Place of Our Own: Caring For Boys Versus Girls

"Boys will be boys":
Just remember that a boy with a significant language or fine-motor delay is not typical, just as a girl with a significant gross motor delay isn't typical just because of their sex. They will have slight differences, but should still fall within the "typical" range. So, if that is not the case for your child, please discuss your concerns with the child's doctor, and if necessary ask for an evaluation with your local early intervention program (ECI, EI) or outpatient pediatric therapy clinic (speech language pathology, occupational therapy, and/or physical therapy).

Thursday, August 26, 2010

Brain Gym - a program of physical movements that enhance learning and performance in ALL areas

My daughter who is in first grade came home from school yesterday and wanted to show me what she learned in PE class and said it was going to make her smarter. She put her arms out in front of her then crossed them at the wrists, then folded them in toward her, balanced on one foot, and pushed her tongue up against the roof of her mouth. I quickly said to her, "Ahh, that's a Brain Gym movement". She was amazed I knew that movement and wanted to look at my Brain Gym books I have in our study. I love the exercises from Brain Gym, and they can be used on kids of all ages as well as adults, here is a link:

Brain Gym - a program of physical movements that enhance learning and performance in ALL areas

I have used many of the movements within my occupational therapy sessions. Some involve crossing of the midline to help integrate the two sides of the brain, deep pressure for attention span, and eye movements which aid in tracking skills needed for reading. The benefits of Brain Gym are numerous!

Monday, August 16, 2010

Sensory Friendly Films

Tomorrow I am taking my daughter to go see Toy Story 3. She has seen it already with her grandparents, but she keeps saying that it is soooo good that I must go watch it with her; so I will. For her and I the loud volume, dark room, and any other extreme sensory experience is just part of the fun of going to the cinema. But for many children out there who have have special needs including sensory processing disorder (SPD) or autism spectrum disorder (ASD) the whole "sensory experience" is not so fun. That is why I think it is great that AMC entertainment has at selected theaters at least once a month "sensory friendly films":

AMC Entertainment

Some people aren't lucky enough to live in one of the locations of these theaters. So if this is the case, what are some things that can be done to make the movie experience not only tolerable, but fun? I think for the older kids, you could visit the theater at a time when no shows are playing so they can get used to the room- that is if they've never been before. For any child three years of age or older, you could write a social story about the whole movie experience to let them know what to expect; predictability helps to lessen anxiety which in turn lessens sensory defensiveness. If you aren't familiar with social stories, look it up, the idea was created by Carol Gray. Just remember to make the story positive and personal.

For the children with auditory defensiveness, try to sit in an area of the theater where no one else is sitting so that the noise made by other people is not bothersome; this may require going at an unpopular time such as in the morning. Also, ear muffs or ear plugs may dampen the sound. If the child becomes over-whelmed there is no shame in leaving, maybe come back another time and try again. For some kids it may take multiple attempts before they can sit through the entire movie.

For kids on special diets, check with the staff ahead of time and bring snacks they can have on their special diet which they tend to find comforting. Of course, I am reading some people's minds and thinking that you will just sneak those snacks in your purse!

Have any other ideas that have worked for you? I would love to hear about them.

Tuesday, August 10, 2010

Nurturing Parenting Programs - Stephen J. Bavolek, Ph.D.

It seems like every time I sit down to read the newspaper, I see some HORRIBLE case of child abuse or even worse a parent killing their child or step-child. So sad because it is 100% preventable! Even though I don't work often with children who have been physically or sexually abused, I do from time to time. Unfortunately, many of the children I work with have special needs (physical and mental) and can't express this event to anyone else.

As a professional who works in the homes with families, I am put in a place of educating the parents not just on rehab. techniques, but also how to discipline and love their child. One program that is worth professionals being trained in to learn how to do this is the Nurturing Parenting Program. I love the philosophy of the Nurturing Parenting Program which emphasizes positive, nurturing interactions between parent/caregiver and children. This fits right in with my other philosophies as an early intervention occupational therapist and infant massage instructor. To find out more about the program, go to this link:

Nurturing Parenting Programs - Stephen J. Bavolek, Ph.D.

If we can help educate these parents on other ways to discipline their child other than physical harm, then maybe, just maybe, we have made the most important change in that family member's life!

In addition, those of us who are parents and/or professionals can always learn more strategies to use in our own lives!

Wednesday, August 4, 2010

AAPM&R - What is a Physiatrist?

Physiatrists are doctors that help patients with their rehabiliation process. They are sometimes called "PM &R" doctors which stands for "physical medicine and rehabilitation". I often refer my clients to these doctors, especially when the child has multiple impairments including neurological, orthopedic, visual, and mental delays such as with cerebral palsy or certain syndromes. I also refer clients to them when I know something is going on with the child but I'm not sure whether to send them to an orthopedist or neurologist. I think physiatrists are well versed in different areas of disabilities therefore they may be the best professional to steer the family a particular direction. Here is a link to their professional organization:

AAPM&R - What is a Physiatrist?

I also think it is nice to have a physiatrist for the medically fragile child, because the need for adaptive equipment, assistive technology, and other functional items tends to get pushed to the bottom of the list for a sicker child, especially when the parents of the child have a variety of specialty doctors they are seeing on a regular basis. The physiatrist is the "one in charge" and facilitates the communication of all doctors and other professionals once the child is stabilized from the medical problems.

Saturday, July 31, 2010

Additives in Food Aren't Good For Us

My children not only have food allergies, but they are also sensitive to so many foods including additives and dyes. Their symptoms include irritability, over-emotional reactions, fatigue, and diarrhea. The foods they are sensitive to do not show up as an allergy on an IgE test. Many of the kids that I work with also have the same problem, but because they have developmental delays it is harder for them to tell us they have a tummy ache or we just blow off their tantrums as part of the developmental delay. The truth is that many of the processed foods, additives, and chemicals that are a part of our diet aren't good for any of us. I try my best to buy organic foods as well as natural products without trans-fats, dyes, yeast, and other additives; but to say that it is easy to do this would be a lie. It does mean that I spend a lot of time reading labels and investigating products on the internet before I go shopping. One website that has provided me with some great information is Feingold:


Since 75% of our immune system is in our gastro-intestinal tract it makes since to treat it right and eat natural products without all of those additives!

Tuesday, July 27, 2010

Normal Growth And Development Of Premature Infants - Care Guide

Recently, a friend of mine had her baby girl four weeks early. She had so many questions for me about what to expect for her "premature" daughter. Some included: Will she "catch up" soon? Will she be shorter than her peers? Will she always be at risk for respiratory infections? Will she ever sleep through the night? and the list went on. Here is a link to provide basic information on prematurity:

Normal Growth And Development Of Premature Infants - Care Guide

At work, some of the babies I work with were born only slightly early such as at 34-35 weeks gestation whereas other babies were born as soon as 24-25 weeks gestation. Obviously, the preemies who were born under 1000 grams at 28 weeks or sooner have many more health problems than those born just a month early. But either way, it is smart for the child to have a thorough developmental assessment with a local early childhood intervention (ECI) program once the baby gets to go home. ECI can help with developmental needs including feeding, motor, communication, and other delays that may arise.

Saturday, July 24, 2010

How to Improve a Toddler's Balance & Vestibular Processing Skills During Play |

Typically developing toddlers like to defy gravity whether it be spinning around in Daddy's arms, swinging in the backyard, or jumping on the bed. But when a toddler has consecutive ear infections, sensory processing disorder, low muscle tone, or any other thing that impairs balance, movement may not be so fun for them.

Below is a link that gives ideas to add movement into a toddler's play routine:

How to Improve a Toddler's Balance & Vestibular Processing Skills During Play |

The vestibular system, located in the inner ear, is in charge of balancing the body every time the head moves. Muscle tone, bones (orthopedic alignment), nerves, and the eyes also have a big role in balancing too. If something is wrong with any of those body parts, then the person can have poor balance. So, if your toddler is absolutely terrified of movement in some directions no matter what you do, then he may need an occupational or physical therapy evaluation to determine the cause.

Wednesday, July 21, 2010

Milk Allergy Facts, Symptoms - Facts

Whether it be within my circle of friends, while at work, church, and even the grocery store, I seem to be a magnet for people asking me all about milk allergies. Since I've dealt with my daughter being allergic to milk since she was an infant (she is now 6 1/2 yrs old), I am usually able to answer the questions aimed at me. One resource I tend to give is the food allergy and anaphylaxis network:

Milk Allergy Facts, Symptoms - Facts

One thing that I have learned over time is that dairy is not just in food, but also skin care products such as lotion, shampoo, and soap. So, read ingredients on foods as well as anything that contacts the skin.

Sunday, July 18, 2010

Pants on the Ground

I chose to name this entry "Pants on the Ground" not because I am a fan of this silly song that made its debute on Amercian Idol earlier this year, but because of potty training. My son has recently shown interest in potty training. He rarely produces anything, but at least he sits on the toilet for a while multiple times a day, and tells me after every bowel movement that he needs to go to the potty. So, there is a lot of work to be done in my home, but his interest has been sparked!

One thing that I have done is begun to change his diaper in the bathroom while he is standing....unless it is a messy bowel movement, and then it is back to the wooden changing table to lay down! If he is standing as I change the diaper, then he gets the opportunity to pull up and down his pants before and after. Whereas if he is being changed lying down, he doesn't get that opportunity as easily. Since he likes to watch the other family members go to the bathroom, he is now getting the message that if he is standing instead of lying down that he is just like us. The more signals we can give to toddlers that they are "big boys" and "big girls" the more we are letting them know not to act like babies. And since babies wear diapers and big kids don't, merely changing the tot's diaper standing up and having them help participate in the process is one step toward successful potty training. Here is a link with some signs of readiness and suggestions for potty training:

Toilet Training-Home Treatment

Many of the kids that I work with for occupational therapy would have difficulty pulling their pants up and down whether it be because of orthopedic, visual, or neurological problems. So if this is also the case with your toddler, maybe you can have them participate in a different way. It might be helping pick out "big boy" underpants at the store or it might be choosing which of the bathrooms in the home to go to (as long as the home has 2 or more toilets!). Another thought is to adapt their ability to pull up and down their pants. More than once I have sewn loops inside the front left and right sides of young children's pants for them to have something to grasp. This is especially good for kids with limited wrist motion or strength. The sky is the limit when it comes to adapting a routine. Just keep the mindset of keeping the child actively involved in the process!

Friday, July 16, 2010

Expanding Food Choices of Toddlers

My 25 month old son used to eat "everything under the sun", but over the last three or four months he has been a bit pickier about his food choices. At times, he refuses foods he typically likes. Unfortunately, this is part of being a toddler and exerting his independence. Since I know that, I still offer the food but I don't create a power struggle. If he tries to throw the food, I just tell him to keep the food on his plate. Looking at it on his plate reminds him that the food still exists. Typically, he will eat that food a different time, so at least he still eats it sometimes. Now, if I weren't an occupational therapist who works with toddlers I might approach the situation differently, especially since I came from a home where we were told to eat everything on the plate or we couldn't get dessert and/or couldn't get up from the table until the plate was clean!

One thing that seems to work on introducing new foods to my son is having him sit at the table next to his older sister and watch her eat. Thank goodness she isn't a picky eater! Until this week, my son wouldn't eat green beans (BTW I don't like them either). But my daughter LOVES them, so I cook them at least a once every 7-10 days. Over the last couple of months, he went from saying "no beans" to allowing them to sit on his plate without saying anything; then he progressed to touching them and bringing them to his lips. Well, on Monday night I cooked green beans and he ate two of them willingly as he watched his sister eat them...yeah! Then, the next evening I heated up some left overs and not only did he eat the 5 beans I gave him, he asked for more of them without being prompted...yeah, again!

I think toddlers learn from older children whether it be a sibling, cousin, neighbor, or another child at a babysitter's home or a daycare. So consider pairing up the picky toddler with the not-so-picky eater who is older during snacks and meals. Even if it doesn't help right away, the child is looking at the food. Research shows that parents and caregivers give up to easily on getting a child to eat a particular food, and that on average it takes 10-15 presenations of that food before the child will like it. Now, if you force the child to eat it, I can almost guarantee it will take even longer! Toddlers like things to be their idea not yours, and repeated offerings of a particular food increases the chance that one day that toddler will choose to eat it. I do think there comes a point where you may have to conclude that the child just doesn't like that food for whatever reason: color, smell, shape, taste, texture, etc. After all, I don't like every food on the planet either!

Other ideas to expand the food choices of toddlers include:

- Don't get in the rut of fixing the same meals over and over. Not that it isn't okay to repeat some of the same meals, but introduce new foods as often as possible. This may take planning ahead so that you have new foods in the pantry and refrigerator. Even mixing meals up helps somewhat, for example: sometimes corn is served with chicken and carrots, and other times it is served with turkey and rice. This helps reduce the rigidity that some toddlers tend to exhibit.

- When offering new foods, try a food that is similar to a food the child already likes. For example, if the child loves Gala apples, then try different types of apples such as Macintosh, Fuji, and Golden Delicious. Also, pears have a similar taste to apples too. Another example might include that if the child likes plain apple sauce, then try cinnamon apple sauce or peach apple sauce; the taste may differ slightly but the texture will be the same.

- Be creative and fun with snacks and meals. Using cookie cutters to cut sandwiches into child-friendly shapes worked like a charm for getting my daughter to eat a turkey sandwich for the first time back when she was a toddler. After doing this for 4-5 times I just presented her with a plain sandwich, no special shapes, and she ate it just as quickly as if it had been in the shape of a heart. Other ideas might include drawing smiley faces out of ketchup onto a piece of meat and putting food onto a plate with the child's favorite character on it.

-Make sure every meal has at least one food that the child likes and don't force him to eat the others, just encourage it. At the very least, the child needs to look at it and smell it. Now, if the the child has an autism spectrum disorder or sensory processing disorder, then just being in the same room as that smell may be all they can handle at first, but the ultimate goal is getting that food on the child's plate so that one day he may actually eat it and like it.

- Have the child help cook the meal. When I make home-made pizza both of my kids help. My son obviously can't help as much, but he rolls out the dough with the rolling pin whereas my daughter can spread the sauce. I leave the oven light on as it is cooking for them to peek at here and there, and both kids are super excited about eating the meal by the time it comes out of the oven.

-Encourage the child to eat healthy foods such as fruit and vegetables as opposed to fried fast food. This means be a living example, because "monkey see, monkey do"; so if the rest of the family eats junk food and is picky with vegetables, then the toddler won't be any different unless the other familly members change their habits. This lifestyle also sets the child up to be at risk for obesity and diabetes. Type 2 diabetes in children is on the rise, and it could be prevented by healthier lifestyle and food choices; on the other hand, type 1 diabetes is acquired in childhood (usually) and isn't due to being over-weight.

- If your child has feeding difficulties due to sensory or motor problems, then consult with an occupational therapist or speech pathologist who specializes in feeding. Not all therapists are experts in feeding, so shop around until you find a good fit!

- Read the book "Food Chaining" which is written by feeding specialists and gives great ideas on how to introduce new foods slowly. If the child is just a picky eater with no oral aversions or oral-motor problems, then suggestions from this book alone may help. If there is something more going on, then direct therapy intervention should be considered.

Wow, all of this talk about eating has made me hungry for a to go!

Sunday, July 11, 2010

Fidget Toys

My family and I just returned from a week long vacation (3 hours ago to be specific). The one thing that helped my husband and I survive the 9 hour drive each way with two young kids was bags of toys, including fidget toys. I had a large bag of toys for each child to sort through and play with. So when my son got tired of playing with his cars, magna-doodle, and puzzle, the fidget toys were his next choice. He especially liked the stretchy, light up caterpillar fidget. On one of the "pit stops" I purchased a visual fidget; it is a 5 inch ball with a small fish and glitter inside it.

The term fidget basically just describes what a person would do with that toy...fidget. Fidgets are fun to turn around, pull, squeeze, shake, etc. Some children can benefit from them in the classroom to help them "wiggle" with their hands instead of getting out of their chair. For some kids, they have to be moving in order to listen or they zone out, so a fidget allows them to still be moving, just it is with their hands instead of their entire body. Fidgets are also beneficial for long car rides or waiting in doctor's office lobbies. When the child is playing with it, it keeps their mind off having to keep their body still. Some fidgets are textured which stimulates the tactile sense, whereas others are aiming at the visual, auditory, oral, or proprioceptive sensory systems. But you have to be careful with the auditory fidgets depending upon where you will use it, because you wouldn't want it to be too loud! Although fidgets are beneficial for many children, they are especially helpful for kids with sensory processing disorder (SPD), autism spectrum disorder (ASD), and ADD/ADHD.

Some things I had for my 2 year old son in his fidget bag for our long car ride included: small cars, fuzzy ball, stretchy caterpillar, zip up bag full of various action figures, wind-up fish, mini See-n-Say, aquarium tubing (for chewing), and other odds-and-ends that were too large for him to swallow had he decided to put them in his mouth. I'm not going to falsely say that for the entire 9 hours my son forgot he was strapped into his car seat against his will and was as happy as a lark, but I will say when he fussed, having toys as a distraction helped immensely! Now for my six year old daughter, she enjoyed her bag of toys also, but she has always been a champion traveler and wouldn't fuss even if she had nothing to do at all. But the fidgets made it more fun for her!

Still not sure what to use with your little one? Here is a link I found for some fidget toys that might stimulate some thought:

Toys for Learners: Trainers Warehouse Product Departments

I have also seen some great fidget toys at Walgreen's, Wal-Mart, and other retail stores. The dollar stores sometimes have good fidgets- just have to dig! Try to get a variety of fidget toys, because what works at one moment may not at the next, so it is nice to have quite a few in your bag of toys. I even save party favors from birthday parties my children have attended and toss them into the bag of toys. You might even want to go through your children's toy boxes to find fidget treasures. Another thing that makes good fidgets is the toys that come with a child's meal from a fast food restaurant as well as the prizes from cereal boxes. One of my favorite fidgets came from McDonald's over 4 years ago; in fact, I would go through the drive through to buy more kid's meals just for more of this toy; it was one of those intriguing toys that helps visual and fine-motor skills. By the way, I rarely eat fast food!

Friday, July 2, 2010

Toothbrushing Tips

Just the word "toothbrush" can raise levels of anxiety in some parents. Especially the ones who feel as if they either have to force toothbrushing on their kids or just go without doing it. Kids with oral aversions, sensory processing disorder (SPD), and autism especially have a difficult time with teethbrushing. Add the toddler stage to those diagnoses and the resistance to the routine is even stronger!

I know that when my own two kids have had a long, over-whelming day the toothbrushing routine (as well as bathing and sleeping) doesn't run smoothly for us either! Here are some tips from Marsha Dunn Klein on the Meal Time Notions website to make it run more smoothly:

I think that when this routine finally starts to go smoother, it opens up the door to try other strategies with other routines such as dressing, bathing, and meal time. If these tips don't help, ask your occupational therapist for some home strategies. If your child doesn't have occupational therapy, maybe it is time for an evaluation!

Wednesday, June 30, 2010

How to begin a GFCF diet on a budget |

I've semi-perfected the art of cooking for my two kids "special" diets because of their food allergies. One trick I think that works is to cook recipes from vegetarian cookbooks because there isn't any eggs, dairy, or other artificial additives in the recipes. I just eliminate the nuts from the recipes that call for them. Another thing I did in the beginning was to spend HOURS reading ingredients on store bought food boxes as well as ingredients in regular recipe books or online cooking websites. I investigated the meaning of words such as "albumin" is a word for eggs, "durum" is a word for wheat, and "casein, whey, and lactose" represent dairy.

It can be over-whelming to start any new diet, especially if the child is a picky eater. Whether a parent is starting their child on a gluten-free casein-free diet or any other special diet because of food allergies or due to health reasons (celiac, autism, diabetes, etc.), it can be expensive and over-whelming to know where to start. This link gives a few ideas on how to do it and save some money:

How to begin a GFCF diet on a budget |

I wrote this article over a year ago. I would love to have your comments on what worked for you. But I do think any parent of a child on a "special" diet will tell you that it takes alot of time and energy to figure out what the child can safely eat, then after awhile it becomes second nature and isn't too difficult.

Saturday, June 26, 2010

Social- Emotional Milestones for a 24-36 Month Old Child

Many of the children I work with have global development delays, including social-emotional development. Here is an excellent hand-out for parents and caregivers to understand what a 2-3 year old child should be doing in the area of social-emotional skills:

Although parents of children who receive an early diagnosis of autism seem to be aware of their child's delays of social-emotional skills, my experience is that parents of kids with no diagnosis or a diagnosis other than autism don't seem to be as clued into this area of development. Many times the parents assume the child isn't playing with his peers appropriately because of his language and/or motor delays. But kids with delays in those areas often still play with their peers okay if that is the only area of delays. I think many kids have to literally work on these skills listed in this link. That might mean that a child with no siblings who stays at home with his mom all week, be exposed to other children on a regular basis such as going to the same park on a regular basis as well as to story time at the library, playground in the shopping centers, and MDO (mother's day out) program for 1-3 days a week for 5 hours each of those days. Play dates and play groups are also good especially if the child doesn't have other neighborhood kids to play with or young relatives that he sees on a regular basis. If all of these strategies still do not help, then an evaluation with a psychologist, occupational therapist, or speech therapist may be necessary. Another good suggestion is to receive a comprehensive evaluation with the local early childhood intervention (AKA EI or ECI) program which will evaluate and work with children up until their third birthday. If the child is almost 3 years old or older, then an evaluation by the public school could be beneficial. Also, look to see if your area has an early headstart program with any openings.

Reflux (GERD) in Babies & Young Children

I've blogged more than once on my personal experience of having a baby with severe reflux. But when I saw this article I just knew I had to post it and review my story once again:

My now 24-month old son took two reflux medications up until the age of 14 months. But lets rewind all the way back to the beginning. Starting at about one week of age he started spitting up a lot and when I laid him down in his bassinett he would cough on the spit up...quite scary, because I was afraid he would aspirate and die! So, I elevated the bassinett, added a wedge, and that still didn't work. The only way he could sleep without "choking on his spit up" was to lay on my chest as I was in the reclining chair or in a reclined bouncy seat. So starting around 3 weeks of life he started Zantac, an antacid. That medicine made him less grouchy, but he still refluxed up massive amounts of breast milk (he never had formula). In fact, we nick-named him Milkshake! Then, the pediatrician switched him to Prevacid, a proton-pump inhibitor, and my son did better with that medicine but still spit up alot, but at least he was a happy spitter. If it weren't for his sudden decrease in weight gain at that point we wouldn't have been worried. I pumped breast milk and was making plenty, so that wasn't the problem. Since his sister had food allergies and his bottom was red alot, I took him to see the allergy doctor hoping to get some answers. The doctor said he had to wait until my son was 6 months old to do formal food allergy testing, but until then I was to not eat the common culprits of eggs, dairy, and nuts. Guess what, my son spit up WAY less after I quit eating those foods! By the way, his food allergies were way more than those three and still are, but those were the biggies. Yet one other problem still remained, he would spit up even two hours after a feeding; so that suggestion of elevating/positioning the baby for 30 minutes after a feeding didn't work for us. The pediatrician then put my son on erythromycin, an antibiotic, as a prokinetic to speed up the motility of the stomach emptying into the intestines. He gave me the choice of Reglan or Erythromycin and I chose the later because of so many of my patients having lots of side effects on Reglan. Well, this medicine made all of the difference in the world. He started gaining weight and spitting up less, but still did spit up some. At this point, we were only using 2 burp cloths a day, whereas in the beginning we would go through no less than 5 or 6 a day! But soon after we introduced baby cereal and pureed food. I was hoping this would help him spit up less, but it didn't, and in fact, he spit up more. It wasn't until after my son was walking that we could go days without the medicine and him be okay. I think between gut maturity, age, and muscle strength of the abdomen he finally got better. Having said all of that, I do believe that for many babies, one medicine or positioning helps. For others they get better when cereal or purees are introduced. I'm sure much of my son's problems were the food allergies. Not too many of my patients have as bad of a case of GERD as my son, and thank goodness! Poor child couldn't sleep flat until 5 months of age! Every time I tried, he coughed, gagged, spit up, cried, and couldn't fall asleep. So glad that his head shape didn't suffer too much from sleeping for so many months in positioning devices! I contribute that to all of the sidely, tummy time, and upright sitting he did during his waking hours! Although I like this article I linked to at the top, I also like the book "Colic Solved" by Bryan Vartabedian, MD, because it explains things in simple language yet it is thorough and an easy read.

Thursday, June 24, 2010

Fussy Baby

I have a friend with a young "fussy" infant. She asks me for suggestions quite often. When she calls to complain I think that she secretly wants me to come rescue her...of course, if I was sleep deprived I probably would hope for the same thing! Not that I mind babysitting from time-to-time, it is better that she learn to calm her own baby. So this post is dedicated to my friend "R". Instead of me listing out everything I tell her, I thought I'd just post this link since it puts it so well:

Fussy Baby

Hope these ideas help! But if they don't, discuss the baby's symptoms with the pediatrician because there could be something more going on than just colic!

Sense-Able Beginnings: The Importance of Touch for Newborn Development

Sense-Able Beginnings: The Importance of Touch for Newborn Development

Tuesday, June 22, 2010

Hidden Treasures in My Neighbor's Trash

I pride my self in not being a pack rat. In fact, I donate unwanted items to charities on a regular basis. Anyone who knows me well knows I organize everything: my desk at work, my closets in our home, the garage, the kitchen, the kids' toybox, and the list goes on. I've been this way since I was young; I credit my mom who is also a natural organizer. So, it is not a natural instinct for me to tell someone I want to keep what they are throwing away. For me to say that means I must really think it is special! Typically, in my eyes another person's trash is just that, trash!

Today at work (early childhood intervention) the developmental specialist (EIS) who has a desk next to mine was clearing out all of her belongings from her desk shelves and drawers. She is only going to be my co-worker until the end of June, and then she is going into another field of work...sob, sob, sob because I enjoy her company! She won't be working with kids any more, so she has no interest in numerous inservice handouts and journal articles on children with disabilities. Of course I was touched that she saved handouts from my inservices as far back as 2004, until I realized she saves EVERYTHING...not sure she knows we have an industrial sized shredder in the next room over! Yet, I feel like the manuals and journal articles that I rescued from the trashcan were worthy of my reading one day. I took home two inservices manuals that looked particularly interesting; the subject of one is working with infants with auditory impairments and the other is on infants with visual impairments. I started reading the handouts (from 2002) and was impressed with the information except for the "resources" on the back page because many of the listed websites aren't even up on the internet anymore...what a shame! But at least the activities, checklists, and technical explanations are still accurate. But one website was up and running and it linked to all of the state's (USA) schools for the blind. Then, those sites linked to many other sites. If you are like me, you may begin reading one website and then ten minutes later you realized you've clicked on so many links that you aren't even sure where you began. The following link on babies with visual impairments was one of the links that seemed interesting:

Well, I'm off to go get my 3-hole hole puncher and 3" three-ring binder from upstairs so I can file all of these handouts that I consider as "hidden treasures from my neighbor's trash."

Do newborn infants have a sense of rhythm? | Psychology Today

I'm posting an interesting article on newborns and rhythm. I'm thinking that the babies have learned to listen to the beat of their mom's heart in the womb. It would be interesting to test premature newborn babies and see if they have a sense of rhythm as well...of course, it would be hard to find subjects since medical staff have other concerns much greater with these babies!

Do newborn infants have a sense of rhythm? | Psychology Today

I'm also thinking it would be interesting to find out if a baby didn't test well for a sense of rhythm would it correlate to a future auditory processing or motor planning problem in later childhood...hmmm, food for thought!

Monday, June 21, 2010 IQ Preschool Lace up Pup: Toys & Games

Stringing beads isn't as easy as it looks. It takes two hands, and each one has to do something different than the other one. Then, if it is a fat string and a small hole, it requires shifting repetitively with the thumb and index finger. So many of the little children I work with can't string beads whether it be due to stiff fingers, weak muscle strength, low vision, or a poor attention span. That is why I am always looking for toys that are adapted or easier for a special needs child to succeed. A few years ago while I was at an OT home visit, I fell in love with the lace up pup toy that the little boy had in his toy box. It has large holes which makes it easy to stick the lace through. It also has a wooden "needle" at the end to help the string go in the hole better, as well as tucking it back through the end when you are finished with the more lost beads! Here is a link that has a picture and purchase info: IQ Preschool Lace up Pup: Toys & Games

I own the pup, but it also comes in a snake. My two year old son loves to play with it. When he lets me sneak it away from home, I take it on home visits to use with some of my clients. "Testing" toys out allows the parents to decide if they want to go buy it or not...I always hate to suggest buying a toy unless the child has tried it out first. Lately, I have seen children with diagnoses of cerebral palsy, down syndrome, and autism be successful with this toy whereas they weren't with other stringing bead sets. I'm not making any money off of suggesting this link, it just happens to be one of my favorite toys in my "OT bag".

Thursday, June 17, 2010

What You Can Do to Support Your Baby's Language Development from Birth to 12 Months

My daughter just finished kindergarten two weeks ago. She would have been fine with going to school all summer long without a break because she loves school and everything about it: bus ride, recess, lessons in her main classroom, lunch, art, PE, and music class. Lets see if she still feels that way eight years from now...I hope so! When I think back about how I instilled in her a desire to learn, I think back to books. I read to her, labeled pictures, and let her "read" to me starting before her first birthday. I am doing the same things with my two year old son, and I hope that one day he loves preschool and elementary school as much as she has. The following link gives some ideas on how to develop language and literacy early on:

ZERO TO THREE: What You Can to Support Your Baby's Language Development from Birth to 12 Months

I think that many of the families of the infants and toddlers I work with do a great job of some of the suggestions listed in this link. The ones who do not often do not have books or educational toys maybe because of not having enough money or not understanding their importance. For the ones who can't afford books, I suggest going to the library (free) or dollar store (low cost). And for the families who think the child is too young to start looking at books, I provide handouts such as a copy of the link above or I show them the simple books I have. When I bring my books, I show the parents the response and interest the child has...that usually changes their minds and they realize the child is never too young! Sometimes the musical books in which you touch a button and a song or noise occurs gain the infant's attention. Other good choices of books include the ones with tactile pages such as fur or fuzz over the picture of an animal. Experiment with what gains your baby's or toddler's attention. Eventually, you will want to progress to small simple picture books with no noise or item to feel. You don't even have to read the book word for word, you can begin by pointing to pictures and encouraging the child to turn the page in order to be an active participant.

Sometimes books aren't offered to the children that I work with because of their special needs. But I have learned to make many accommodations for different disabilities. For example, for a child who has limited finger movement, foam pads can be placed between each thick cardboard page to make it easier to turn the pages. For children with limited head/neck/trunk movements, find a location to place the book that is easiest for the child to view it such as propping it on an easel in front of the child. For some children, maybe they will not be able to point to a picture, talk about the book, or turn the page, but they can at least listen to the adult read. If you think they can't understand you, still try. Maybe if the child is cuddling with the parent while being read to then at least attachment/bonding are occurring!

Tuesday, June 15, 2010

Too Many Infants Short on Vitamin D: MedlinePlus

Hope people are taking their babies out in the sun and giving vitamin supplements daily, because lack of vitamin D can occur in both breast-fed and formula-fed babies.

Too Many Infants Short on Vitamin D: MedlinePlus

Ask your pediatrician for a recommended brand of supplements!

Saturday, June 12, 2010

What Is Dyspraxia? How Is Dyspraxia Treated?

I was thinking about dyspraxia today. Mostly because I was watching my 2 year old imitate nearly everything his older (6 yrs) sister did. This morning, he didn't want to eat his apple until he saw her eat an apple. He didn't want to brush his teeth until he saw her do it. Then, as they played upstairs it seemed like he had no problem joining her play and doing what she did. As they were stacking blocks, she decided to get creative and build a "telephone" out of the blocks. Once finished, she "talked" on the phone. I expected him to build a car or house as he usually does, or even attempt to imitate her telephone structure...but he didn't. He built a camera. That's right, a camera! It caught me off guard when he came up to me with his connected blocks, put them to his eye, and said "cheese". I laughed of course, and told him I liked his camera; he then repeatedly said "camera'.

This whole scenario would be too difficult for some of the young kids I work with, for various reasons but mostly due to poor motor planning (aka dyspraxia). Good motor planning includes the ability to imitate another person's actions as well as sequencing out the steps to a new task and making coordinated movements with the body. All too often young kids with developmental disabilities have to be taught how to play, so the above scenario would be hard. It took visual memory, expressive language, motor planning/sequencing, imitation, sensory processing, fine-motor, cognition, and social-emotional skills. For a checklist of detailed signs and symptoms of dyspraxia for various age groups go to:

What Is Dyspraxia? How Is Dyspraxia Treated?

I've seen many kids with dyspraxia make huge gains, especially when their family and school understood what it was. Often, extra repetitions of teaching a task, patience, and lots of sensory input help the child learn. Occupational therapy is usually beneficial, and since some of the children have language delays also, they can benefit from speech therapy. It is important to find something the child is good at to boost their self-esteem. This doesn't typically include a sport such as soccer that requires the person to motor plan their actions against a moving ball and other moving people. Sometimes non-competitive activities such as karate, piano playing, and art classes are beneficial.

Thursday, June 10, 2010

Help Kids Hear - Facts & Figures About Hearing Loss in Children

Help Kids Hear - Facts & Figures About Hearing Loss in Children

Over-Stimulation Can Hinder Feeding Skills

My son had a runny nose today and was grumpy for the most part. Guess what...he wasn't that hungry! This boy LOVES to eat, so that is how I know when he is sick, because his appetite is less than usual. My two year old son is no exception from other kids...the appetite is the first to go and last to return.

Kids and babies with special needs especially tend to be less hungry when they are sick or when they aren't feeling well. "Not feeling well" could be a temporary state such as being upset, having indegestion, breathing fast, being tired, and the list goes on. I think for babies with sensory processing problems, especially those with medical needs or prematurity, it doesn't take much to make them feel "not well". It could be something as simple as gas, reflux, or over-stimulation. The following link includes signs of over-stimulation that a baby may display. This is important to know, because until a baby is calmer, he probably will not have a good sucking pattern, especially if respiratory problems exist.

Alertness & Crying

Also included in this link are the arousal levels of a baby. Studies show that babies are more coordinated with their sucking patterns when in a quiet alert state or even a bit drowsy, but not as well in the other arousal states (deep sleep, light sleep, active alert).

Tuesday, June 8, 2010

Vision Development - Children - Milestones in Vision Development

Everything about vision intrigues me. The color of eyes, how they work, how kids develop vision, and the list goes on. Vision is so important; it impacts not only fine-motor skills, but balance, communication, social-emotional, sensory processing, and cognitive skills. I'm posting this link, because I think it is important to consider these main visual milestones:

Vision Development - Children - Milestones in Vision Development

If you are concerned of your children's visual skills, discuss it with their pediatrician and ask for a referral to an eye doctor; depending upon your insurance, you may not need a referral. Be aware that an optometrist and an opthalmologist are not the same thing. An optometrist goes to optometry school (OD) and mostly deals with testing of near/far vision to identify the need for glasses/contacts; some do other things such as looking at the general health of they eye such as for glaucoma, macular degeneration, etc. An opthalmologist is a physcian (MD) who specializes in "eyes". Even though they can fit a person for glasses, they are looking for diseases/health of the eye and perform surgery if needed (e.g. for strabismus). Other eye professionals: 1. Optician is the professional who makes and fits the eyeglasses. 2. Developmental Optometrist: helps kids with learning problems or other disabilities to learn to use their eyes functionally, such as to not ignore an eye or to have fluid eye motions while reading. 3. Visually impaired (VI) teacher: works for school systems and early intervention programs with kids with a diagnosed visual impairment. 4. Orientation & Mobility (O&M) specialist: similar to VI teacher but emphasis is moving in environment around obstacles. 5. Dyslexia or reading specialists: private centers or school system professionals who have special training in these problems. Dyslexia is considered a learning problem (the brain) not a problem with the structure of the eye.

Friday, June 4, 2010

The Most Common Infant Disablities and How to Recognize Them

Here is an article I wrote a while back. It provides a list, statistics, and description of the most common disabilities seen in babies/ children.

The Most Common Infant Disablities and How to Recognize Them

It also provides links to books on some of those particular disabilities.