Friday, February 26, 2010

Simple Strategies to Help with Plagiocephaly

Plagiocephaly is a fancy word for mis-shapen head. It can happen for many different reasons in a small infant, especially since their heads are malleable and change shape easily.

My now 20 month old son had a slighly flat spot on the back of his head because he was positioned upright and reclined which put pressure on his head. We had to position him like that due to his severe reflux. I think the flat spot would have been worse had I not put him in "tummy time" so much of his waking hours. Of course, I couldn't lay him in this position until at least 45-60 minutes after a feeding or he would vomit. Once he got around 5-6 months of age, he would roll over and sleep on his tummy. By 7 months he was crawling. These things in addition to all of the reflux medications he was on contributed to a better head shape by 8-9 months of age. His head shape was never severe enough for a helmet. But I explained his situation to indicate how easy it is for a child's head to get mis-shapen and back to being okay.

Often, a baby with torticollis or neurological damage is prone to plagiocephaly. Also, babies with medical problems who aren't able to move age-appropriately, such as preemies, those with heart defects, and babies who have had multiple surgeries. Another reason can be being a multiple (twins, triplets, or more) or a large baby born to a petite mom; this is because there isn't as much wiggle room and they may get stuck with the neck and head in an awkward position.

If your child has been diagnosed with plagiocephaly then hopefully he/she is getting occupational and/or physical therapy services. Therapy can help with neck/trunk strength, stretches, and massage as well as helping with any necessary adaptive equipment to help reposition the baby.

Some simple strategies to help when the head is mis-shapen on the left or right side:

-switch the way the baby is carried, sometimes over the left shoulder and sometimes over the right

-switch the way the baby is held when being fed, sometimes on your right side, other times to your left side

-when using a changing table for diapering, alternate which end the baby's head is at, this helps the baby to look in different directions

-move positioning equipment within the room: bouncy seat, bouncers, swings, etc. so that the view is not always the same for the baby

-when approaching the baby as he/she is in a device or on the floor on a blanket, come from different directions to help the baby look to each side as well as overhead and to the front

-don't sit the child in a Bumbo (R) seat or standing bouncer before he/she has the trunk control to be in it. This is also the case with Jumparoos (R) and Johnny Jump Ups (R). If the baby doesn't have enough trunk or head control, then he will lean to the side which only perpetuates the asymmetry of the head

-offer the baby toys to each side of him wherever he is: swing, floor overhead gym, carseat, on tummy on blanket on floor, etc.

-get down on the floor and play with the baby, sometimes be on his right side, other times on the left or to the front

-infant massage indirectly initially such as to the belly or legs, and then if tolerated to the chest, neck, and arms

-follow through with all exercises/stretches given by the PT and/or OT. Be careful about getting aggressive stretches off of the internet, because depending upon the etiology of the plagiocephaly these stretches could be hurting the baby

Final thought: if your child's doctor prescribes a helmet to help with head shape, then by all means get a helmet and use it the suggested wearing schedule (usually 23 hrs a day). I have seen some amazing changes in head shapes of babies with helmets.

To see pictures of plagiocephaly and helmets, visit

Friday, February 19, 2010

Helping Young Kids Speak Through Singing

My family has a joke that none of us can stay on tune while singing, but oh well, we still like to sing. But I have to admit, I don't sing as loud at church as I do in my car, because I don't really want people looking around and thinking "Who is that really off key singer?". Not that others would judge, I just play it safe.

My two kids and many of the infant/toddler clients I work with (in occupational therapy) enjoy singing. I actually don't mind singing loud around small children, especially since they don't expect me to be as good as if I were auditioning for American Idol! In fact, many kids I work with start to say simple words from a song before they speak to express their needs and desires. Singing is what "gets the ball rolling".

My son is now 20 months old and is speaking quite a bit. He has at least 50 spontaneous words and others that he will repeat when asked. But I think back to before his first birthday, and he loved for me to sing "Itsy Bitsy Spider". As he got older, he tried to imitate the hand motions and sing a word or two. But before he was saying some of the words, he would stop and really listen. Other times he would dance or sway and even try to hum. This let me know he was really into the singing. One technique I used with my son (and some clients) is sticking to just two or three of the same songs/verses and repeating them often. Then, I would intermittently pause to see if he would gesture me to sing more or even better yet to see if he would try to say the next word as if he was "filling in the blank". This is one of those techniques that takes a bit of patience, because it can be mundane to an adult to sing the same song day in and out. But small children need that, that is how they learn. When choosing a song, choose one with a simple repetitive rhythm such as "Twinkle Little Star" or "Wheels on the Bus". These two are also nice songs to teach because they have hand motions to go along, and some children may start by imitating the body action before saying a word. And that's okay, at least it is some sort of participation that lets you know they are absorbing the cognitive component of a song.

So often when a child has a speech and language delay, the family and caregivers can hardly wait for the child to start expressing his needs. I don't blame them, it can be frustrating when a tot throws a tantrum because you have no idea what he wants. For some kids, using some basic strategies to get them to talk works, and before you know it, they are letting you know they are hungry or want to go outside. But for other kids, strategies have to be a bit more sneaky and fun. Well, what can be more fun than singing and playing while doing it! I love to use "Ring Around the Rosie" with older toddlers because they love to run and "crash" onto the floor. One thing I do is to just sing it normal for 1-2 rounds, and then after that I don't crash or have them crash to the floor until they say "down" during the last part of the song that goes "we all fall down!" For a child with a severe speech delay, they may only grunt for the word down and for a child with Autism Spectrum Disorder they may simply give me a glance, but it is a start. A glance is a form of communication that can be shaped eventually into words or higher forms of communication...and to think, something as simple as a song can be that powerful!

Some days at work I feel like I have sang the same song WAY too many times. Other days I am so glad to be singing those wonderful toddler tunes. Maybe that is why I am guilty of listening to toddler CDs in my car even when the children have been dropped off at school and the babysitter's home! The slightly funny thing is that I have more of my children's music CDs in my car than I do of my own! At least my iPod has absolutely no toddler tunes...that might be kind of taking it too far if I did!

The Most Common Infant Disablities and How to Recognize Them

The Most Common Infant Disablities and How to Recognize Them

Saturday, February 13, 2010

The Drive-Thru Carwash, What's Not To Like?

My two children love to go through the car wash after I fill up my car tank with gas. What's not to like about the drive-thru car wash anyways? The car gets sprayed with water, soaped up, and "blow dried" before you leave the tunnel. Well, it is quite the sensory rich experience, because the car is moving while all of these noisy machines are coming at you!

Although my typically developing kids think it is fun, I can see why a child with sensory over-responsiveness, poor motor planning (AKA dyspraxia), and/or anxiety would not think it is fun. If lots of noise, sights, movement, and smells tend to be over-whelming to a child, then the car wash is not the place to go for entertainment!

This gets me thinking, how many common daily or week events would be over-whelming to these children. Well, just to name a few: going to the grocery store, taking a bath including washing hair, mealtime (preparation and eating), singing at church, going to the local park, and playing with other children. Then, there's always the events that tend to happen on a monthly or quarterly basis: birthday or holiday parties, haircuts, zoo, and going to the movie theater. How fun would life be, if these things created more anxiety?

Children who over-respond to sensory input to the point where it interferes with functioning in life events, could benefit from occupational therapy services. Children who have difficulties with motor planning and learning new activities or with transitions could often benefit from occupational therapy as well; these kids tend to be clumsy and may need physical therapy, and may also have a speech delay requiring speech therapy.

One thing that is beneficial to do at home for these children is to make routines predictable. This helps them to feel in control because they know the order of events. But we all know that the unexpected can happen, so the best thing to do is be calm and provide calming sensory input (see ). Realize that the child gets upset and reacts the way he does because of the "fight, flight, or fright" response. If attending occupational therapy treatment, ask the therapist for a home program and ideas on how to handle tough situations. This is especially the case if the child has been diagnosed with sensory processing disorder (AKA sensory integration dysfunction).

Well, I'm off to go cook a new recipe- not a predictable experience. And I'm doing this after I attended a sporting event, took my child to a roller rink with her friend, and cleaned up my son's vomit...none of which are predictable experiences! Wow, and it's not even 5 pm yet!

Monday, February 8, 2010

Helping Babies With Reflux

I spend a lot of time at work helping premature or developmentally disabled infants with feeding problems. I have also become a resource for many of my friends with babies who either are known to have reflux or are having feeding or weight gaining issues. One website I have found helpful is:

I also like the book Colic Solved by B. Vartabedian, M.D., a pediatric GI doctor who talks about reflux and "colic"

My son had reflux problems even after he was one years of age. Many kids improve with spitting up once they have started solid foods, but some do not. I have previously blogged on how my son had problems gaining weight and was somewhat fussy due to the spitting up episodes; we called him "Milkshake"! Thank goodness for the medicines, positioning, burp cloths, and time!

Remember that a baby doesn't have to necessarily spit up massive amounts to be diagnosed with reflux (GERD). Wet burps, hiccups, congestion, tummy aches/gas, and fussiness can be symptoms too. Overall my son was a "Happy Spitter", but sometimes the acids of the spit-up really hurt his throat and he became fussy. Thank goodness for Prevacid (R)! The Zantac (R) was helpful earlier on, but then not so much later on. But every baby is different. He also took a medicine for motility to speed up the digestion process; this may be needed if the baby is spitting up even 2 hours after a bottle/ breastfeeding.

A big pet peave of mine is when parents don't continue to give their baby the prescribed reflux meds! Maybe they do this because the baby is gaining weight or they didn't think it was helping, or maybe the baby spits up less. But "Hey" maybe the child got better because he had been taking the medicine! But any wet burp is going to irritate the throat, that is why so many of these kids guzzle down a bottle or pull away and don't want to drink. It is also the reason they don't sit up well because they are arching back in pain. Remember to discuss discontinuation of meds with the doctor! Maybe something else could work better or a different dose or giving it at a different time of day. The doctor probably has plenty of swell ideas, but he/she needs to know!

Now I am stepping off of my soapbox and thankful that we haven't needed any burp cloths in my house for the autumn and winter months...yeah! I am passing them along to a dear friend of mine who has a young infant who spits up often! Remember: Spit Happens

Sense-Able Baby Website

Home Page

Great resource on sensory processing problems in infants. Also provides ideas on calming babies, understanding why they are crying, and body signals they give off to let you know when they are hungry, sleepy, or ready to play. Great links page on a variety of resources for babies who are typically developing and special needs.

Sunday, February 7, 2010

Alternative Dairy Beverages

I have blogged before on my two children's food allergies. I could probably write a handbook and cook book on the subject. I remember when my daughter was a small baby and would have allergic reactions such as hives and rashes. Her reactions were from various foods she was allergic to that I had eaten, that were then passed on through my breast milk. Initially, I found it very difficult to alter my diet since I could only eat foods she was not allergic to. Stressed out doesn't even begin to describe how I felt at the time!

Since then, I have learned to cook and buy products that do not have the foods my kids can't have (dairy, eggs, red food dye, nuts; was also soy, oats, citrus). Here are some alternative dairy beverages and reasons they may be used over the other choices:

-soy beverage: good alternative especially for cooking, but many kids are also allergic to soy.

-rice beverage: tastes like skin milk, but low in fat; not the best alternative for a toddler needing to gain weight.

-almond beverage: great taste, but many kids are also allergic to nuts, and those who aren't are likely to grow into the allergy with continual exposure to almond milk. Unfortunately, this was the case with my son- after 10 days, he became allergic to it.

-oat beverage: good taste, not the best to cook with. More protein and fat than rice milk. Not good for kids on a gluten-free diet, because although oats don't have gluten there is cross-contamination with other grains during storage.

-hemp beverage: good taste, similar to pine nuts. High in omega 3 and 6, good levels of fat and protein. Not as easy to find in the stores as some other beverages. It is processed in Canada since it is illegal to grow cabannis (AKA marijuana) in the USA; hemp comes from the plant's seed and doesn't contain THC!

-hazelnut beverage: tastes distinctly sweet and nutty. Not good for kids with nut allergies or those at risk for it.

-Dairy-Free (R) beverage: made with potato flour, no fat, cholestorol or protein. Good if you are trying to lose weight, not good for toddlers who need higher fat levels.

Remember to buy these products that have been enriched with calcium and vitamin D. If you can't get your kids to drink these beverages, then try a dairy-free calcium liquid supplement or chewable vitamin. Also, there are many other foods out there that have calcium either added or naturally in them. Even carrots and broccoli have a small amount of calcium. However, it is a lot harder to get the necessary amount.
Don't forget that when purchasing vitamins or probiotics to buy products for vegans or those that distinctly state they don't contain any dairy or it's derivatives, and for the highly allergenic kids, they shouldn't even consume products that are processed on the same machinery as other products that may contain dairy.

In my house, I tend to stock up on hemp and rice beverages. Well, I'm off to go drink a large glass of rice milk....yummy!