Monday, May 31, 2010

Melatonin and Sleep | National Sleep Foundation - Information on Sleep Health and Safety

I get asked very often for suggestions on children's sleep problems. We go down the basic suggestions such as keeping a consistent bedtime routine, not too much gross-motor activity 30-60 minutes before bedtime, keeping the noise down in the home, eliminating caffeine from the diet, putting away electronic devices 30 minutes before bedtime, and staying away from anxiety-inducing activities (e.g. if the child hates his hairwashed then do it earlier in the day not prior to bedtime). And then we start to analyze that particular child's possible problems related to sleep. For example, a child with cerebral palsy may need to be stretched and massaged so that his muscles can relax, whereas a child with an autism spectrum disorder may need lots of pillows confining the child in the bed along with a heavy quilt and "white noise" playing in the background for that additional calming sensory input. Sometimes those ideas work, and other times they don't. Although I have not ever personally used melatonin as a supplement for sleep, many of the families I work with have used it. Most of them have success and the child sleeps better. Some do not have success. Check out this article at the link below to to see if it might be of assistance to you or your child.

Melatonin and Sleep | National Sleep Foundation - Information on Sleep Health and Safety

As I type this half of my family is still asleep and it is 9 a.m. But I'm letting them sleep in since it is a holiday- Memorial Day! Thank you to all of the veterans who have fought for freedom for all of us in the USA!

Thursday, May 27, 2010

Assistive Technology for Children Who Have Cerebral Palsy: Augmentation Communication Devices

Lately I have helped quite a few families with purchasing different types of assistive technology (AT) devices. AT is technology that aids people with disabilities in performing functional activities that are difficult or impossible unless adapted. This might include adapted eating supplies, special computer keyboards, adapted toys, or equipment for blind or deaf persons. The following link discusses augementative communication (AAC) devices, which is a computerized output system that helps the person talk. I have seen children as young as 2 years old use an AAC device. Depending upon the child's level of cognition and motion in hands, the pre-AAC devices (e.g. Big Mac or Jelly Bean switch) that control battery-operated toys can be used beginning at around 12-18 months of age.

Assistive Technology for Children Who Have Cerebral Palsy: Augmentation Communication Devices

Wednesday, May 26, 2010

Responding to Toddlers Who Bite

About 9 months ago, my 23-month old son began biting his sister when he became frustrated. Then, once he became more verbal the unwelcomed behavior faded away. Also, when I was able to figure out why he was mad, I would label what he was thinking, and that reduced the biting. So, if his older sister was playing with a toy he wanted, and I saw "that look" on his face, then I said "my turn" as I helped him point to himself and then had her share with him. So, in my son's situation the biting was due to him lacking the language skills to express what he wanted to say. Many of the kids I work with for therapy bite for the same reason, but others bite for other reasons. Here is a link to Zero to Three's website providing information on toddler biting and how to redirect it:

Zero To Three: Chew on This: Responding to Toddlers Who Bite

Out of the blue the behavior popped back into our lives again. Just yesterday, my son tried to bite my arm. This time it wasn't due to lacking language skills, it was because he was mad at me. He was playing at his train table, and I said "Let's go bye-bye". He didn't want to go, so I picked him up whereas usually he walks over to the door, and then that was when he attempted to bite me. But I caught him in time, and turned his face away from my arm. I then labeled his feelings and said "You are sad that we are leaving. Bye-bye trains and cars." He waved goodbye to his toys and then was happy again. My son is usually a happy-go-lucky toddler, but those "terrible two's" take over from time to time. But the nice thing he is usually redirectable or distracted easily. Us Moms and Dads have to be one step ahead of our little toddlers to help diminish those unwanted behaviors!

The Zero to Three link I provided above is not geared at children with developmentally delays or special needs, but I think the information still applies. Yet I also think there are other reasons for biting and undesirable behaviors with special needs kids including side effects to medication, seizures, and pain (from gastrointestinal discomfort, headaches, or other medical problems). Additionally, many of these children have multiple developmental delays which means a simple task such as completing a formboard puzzle or playing at the park takes more effort than it does for a typically developing child. By the end of the day, these young children are exhausted and it doesn't take much for a tantrum or "meltdown" to occur.
If your child receives occupational, physical, or speech therapy, be sure to discuss the undesirable behaviors and see if they have any suggestions.

Friday, May 21, 2010

Kid's Recipes | 10 Edible Play Dough Crafts for Busy Little Kids

Having fun with food is so important for a young child's development! Many picky eaters could expand their food choices just by having a different mindset. How better than to make edible play dough! Lots of fun is to be had with edible play dough, and then to top it off, everyone gets to eat it when they are through playing!

Kid's Recipes | 10 Edible Play Dough Crafts for Busy Little Kids

Be careful with some of the ingredients such as peanut butter since some young children have food allergies. Some kids don't have to actually eat it for an allergic reaction to occur, some only have to smell or touch it!

Wednesday, May 19, 2010

Improving a Toddler's Balance & Vestibular Processing Skills During Play

My 23-month old son is like most toddlers, he's busy and likes to climb. If I leave the room and return a few minutes later, I am likely to find him standing on a chair or behind the couch. Yet, even though he loves to be in motion, he sometimes still falls. The good thing is, he doesn't fall as often as he did when he had just learned to walk. But, somehow he gets "bobos" on his forehead at least once a month.

Many parents ask me "How do you help a toddler's balance skills?". Well, first of all, know that most toddlers still fall from time to time, but if a child is falling excessively then discuss this with the pediatrician. If that doctor feels that the toddler is falling excessively, then maybe a physical therapy (PT) evaluation will be suggested. PT can look at to see if there are any possible problems orthopedically, neurologically, developmentally, or with the child's level of strength. If these problems have been ruled out, then the child's sensory processing skills should be evaluated, in particular the vestibular system. This can be done by either a PT or occupational therapist (OT), depending upon the therapist's training. The vestibular system has receptors in the inner ear that detect which direction the head (and body) is moving. The possibilities for directions of movement include: up-down, front-to-back, side-to-side, upside down, and in circles. If a child has difficulties processing vestibular input, it may be because he over-reacts, under-reacts, or overly craves the input. Examples of overly reacting would be the child not wanting to be tossed in the air or being scared of swinging. An example of under-reacting, would be a child who seems lethargic and needs extra time running or jum[ing to detect that he is moving. In comparison, a child who overly craves vestibular input can be described as the "Energizer Bunny", and doesn't seem to tire of the motion. Although toddlers should like to move around some, eventually they should move onto to a sit down activity such as rolling cars, feeding a doll, or stacking blocks. A toddler who overly craves vestibular input, may not be able to focus while staying seated more than 20 seconds. Vestibular problems may also be because the child has poor: postural control, the ability to discriminate the input, or an ability to motor plan his actions. An additional problem could be visual processing and/or a poor ability to see far or near; if this is the case, the chid should be evaluated by an eye doctor. For more on understanding sensory processing problems in toddlers or older children visit: and and for more on understanding sensory processing problems in babies visit:

Also, I wanted to share this article that I wrote almost 9 months ago on an informational site. I purposefully simplified the description of vestibular input so that the average person could understand it. It gives ideas on how to help with balance and vestibular processing for toddlers:

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

I purposefully kept the list of activities simple and short, and suggestions are things that can be done anywhere not just in a therapy clinic. Feel free to comment on any fun ideas you have found that help to develop balance and stimulate the vestibular system. The more ideas, the better!

Friday, May 14, 2010

Child product recalls | Child safety recalls | Latest recalls | BabyCenter

When it comes to recalls on toys and baby items, many of the things we have in our home have been on the list. My daughter's crib was recalled, so we got a replacement. We then used that crib for my son. I wouldn't have known that crib was recalled too had I not called the company looking for a replacement part for a broken piece on the drop rail. So, once again I was lucky enough to get reimbursed my few hundred dollars and went to purchase another crib. So far so good on this one, probably because there isn't a drop rail! I find it so hard to keep up with all of the recalled products these days, so I'm glad that this link lists them all:

Child product recalls | Child safety recalls | Latest recalls | BabyCenter

Hope you don't have too many of the recalled items!

Thursday, May 13, 2010

Why is My Baby Crying?

Most pregnant women dream about their baby and what that baby may sound like when crying. I watched TLC's "Baby Story" many times while on bedrest with my now 6 year old daughter. She was delivered a little earlier than expected, and was only 5 lbs. and 2 oz. And small babies' cries do not sound the same as full-term or bigger babies' cries. My daughter sounded more like a farm animal than a human! When the nurses opened the nursery door, I could identify my daughter's cries from the other babies' cries...that's because she was the only one that sounded like a little lamb! No kidding!

New parents often have a hard time knowing why the baby is crying. Many assume the baby is hungry, but feeding a baby every time he cries isn't a good idea, especially if the baby has a tummy ache. So, it is nice to learn what the different cries sound like and what they mean. This link discusses the various cries:

Alertness & Crying

When a baby's cries all sound the same, it can indicate a variety of problems including communication, neurological, structural (airway, abdominal, etc.) and cognitive delays. But sometimes once we learn to decipher the various cries and what they indicate, we notice the baby does have various cries. Maybe he has one for when he's hungry and another one for when he has pain (tummy ache, fever, etc.), and maybe even another cry for when he's bored. But when this isn't the case, it is definately something to discuss with the child's pediatrician.

Monday, May 10, 2010

When It's More Than Just A Cleft Lip and Palate

One of my childhood friends had a baby a few years ago that was born with a complete cleft lip and palate (unilateral). Luckily, after several surgeries and speech therapy, the young boy caught up with his development. But some families are not as lucky. Sometimes there are more things going on with the child. Often, these things are obvious such as heart or kidney defects, genetic syndromes, or neurological impairments. Other times, the problems are mild so it takes longer to get noticed; even the ones that are genetically linked. I'm not sure if the pediatrician doesn't refer the children for genetic testing or if the family doesn't find it necessary to meet with a geneticist.

Since cleft lips and palates may occur due to a neural tube defect that takes place during the first trimester of pregnancy, other parts of the body- especially in the mid-line may have not been formed properly either. Somethings I often see in children with cleft lips and palates include dysgenesis of the corpus callosum, global hypotonia, poor crossing of midline, swallowing problems (esophageal), and strabismus (eyes turning in). These children luckily get referred for occupational therapy (OT) and/or physical therapy (PT) in addition to speech therapy. The ones who do not get referred right away are often the ones with mild hypotonia and incoordination on both sides of their body; maybe they are just a little behind with their fine-motor and gross-motor skills as a toddler or preschooler. If this is not addressed, these children approach school with a disadvantage and all of the sudden a mild delay that is not addressed becomes a significant delay. This is when it is helpful to have a speech therapist (SLP) who knows alot about motor skills so that they can properly refer to PT and OT. If you are a parent or SLP who is wondering when it is appropriate to refer to PT/OT, then consider the following:

- Can your child keep up with his/her peers at birthday parties, playgrounds, or other group situations? Does the child fatigue easily?

- Can he/she jump by age 2 1/2? Ride a tricycle by 3 y/o? Do jumping jacks by kindergarten?

-Can the child play in a variety of postures: on the belly in the floor, in side-sit, ring-sit or criss-cross, long-sit, or kneeling?

- Does the child have a hand dominance by preschool age? even when there is a dominance the child should be able to use both arms and legs as well as cross the middle of the body. Does the child ignore one of his hands or efficiently use 2 hands such as to throw a ball and manipulate interlocking blocks? Does the child rotate his body in the chair to avoid crossing the midline of the body?

-Can the child feed himself with utensils age-appropriately? hold a cup?

-Is the child's pre-writing or handwriting skills delayed or sloppy?

If the answers warrant concern, then it is suggested that your child receive a PT and/or OT evaluation. After the evaluations, the therapists can discuss if therapy intervention or home exercise program are needed.

Saturday, May 1, 2010

Ideas For Developing Coordination On Both Sides Of The Body

I often work with little kids who have cerebral palsy (hemiplegia, diplegia), peripheral nerve injuries, a stroke, or for whatever reason are stronger on one side of their body than the other. Below are some ideas for encouraging them to use both hands and/or feet:

1. Ribbon Dancers: long wands with ribbons on them. You can have the child carry one in each hand while you do the same, and then move the wands around imitating each other.

2. Zoom Ball: a ball that slides along two parallel strings with handle bars at each end. This activity takes two people, but is SO fun, because as one person closes their arms to catch the ball, the other has to open their arms to send the ball to the other side.

3. Rolling pin to roll out play-dough or cookie dough, then use cookie cutters

4. Mr. Potato Head: one hand is used to hold Mr. Potato while the other is used to insert the pieces

5. Imitating animals: bear crawl, dog, donkey kicks, slither like a snake

6. Scooter board: child lies on his tummy and propels self with both arms

7. Step in paint and walk across butcher paper to do feet art; could also do this with water out on the sidewalk, but of course this artwork will dry up from the sun

8. Obstacle course: climb up, crawl over or through things, jump forward or backward

9. Pushing objects such as large boxes or containers, laundry baskets, strollers

10. Bicycle

11. Yoga: kids yoga books and DVDs are usually easy to follow along

12. Songs with motions of the arms and legs: If You Are Happy & You Know It, Wheels on the Bus, Twinkle Little Star, Little Bunny FuFu

13. Roll cars with one in each hand. The cars that are to be shaken first are fun

There are so many more things that can be done to encourage using both arms and legs. Use your imagnination and you will be able to come up with so many more! Also, ask your child's physical and occupational therapist to give you some exercises and games to work on in between therapy sessions.