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: www.spdnetwork.org and www.sensorysmarts.com and for more on understanding sensory processing problems in babies visit: www.sense-ablebaby.com

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 | eHow.com

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!

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!

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.

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.

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.

Symptoms of Tongue-Tied (Short Frenulum, Ankyloglossia)

Recently I had a friend whose baby was diagnosed with being tongue-tied, also known as ankyloglossia and short frenulum. I wish that her baby boy had been diagnosed sooner, but it took over a month. Although that seems long to me since I work with small babies, I know that some people go even longer before having an answer to their child's feeding and language problems.

My friend's son had poor feeding problems from the beginning and didn't learn how to breastfeed. That should have been the first clue of a problem, because Mom had already successfully breastfed her older son for a year. She said when she attempted to breastfeed him, it hurt really bad, even after she tried to put his lips on the right part of her areola. I only wish she could have gotten together with a lactation consultant (LC) because I think it would have been diagnosed then, but she didn't go to a LC. So, Mom switched her son to a bottle, but not just one bottle, she went through 5 different types of bottles and nipples before she found the "right" one. Even then, he only drank an ounce or two of formula at a time and it took over 20 minutes just for that small amount. He had poor suction on the nipple of his bottle and pacifiers, which lets us know his tongue wasn't working very efficiently. Somehow he was slowly gaining weight and not losing, yet the quality of life was chaotic for Mom because she was practically feeding him most of his waking hours.

After talking to her sister-in-law over the phone who lived far away, but who happens to be a pediatric nurse, my friend realized what it was- ankyloglossia. She was asked to look to see if he could stick his tongue out over the gumline, and he couldn't. She was asked if the tip of his tongue looks like the bottom of a heart because of the skin under the tongue bounding the tongue down, and guess what, it did have a heart shape. My friend was advised to take this information back to her pediatrician, so she did. Once the doctor got a better look, she realized that other symptoms were present. They included: high palate, gags easily, and sometimes has trouble swallowing liquid (would just hold it in the oral cavity). Also noted was that he had tight neck muscles, maybe because he was using every head/neck muscle he had just to drink from a bottle. My friend's son was also diagnosed with GERD (reflux), so I think that the feeding problems were blamed on that, but once the medicine didn't fix everything, it was obvious there was more going on than reflux.
He then got his frenulum (skin under the tongue) clipped. Feeding problems got immediately better, and he has gained weight at a higher rate now. He doesn't even need to do any oral-motor exercises, he just figured it out after a couple of feedings, and he can even drink from more than one type of bottle. So, not only were mealtime problems resolved so were any possible future speech problems! And even better, parents can sleep more at night with less frequent wakings for a feeding!

Every once in a while, I am the one that notices ankyloglossia, but usually it has been identified by the hospital staff, pediatrician, or lactation consultant long before the child was sent to me for a feeding disorder. Sometimes when I catch it, there are other problems as well including delayed gross-motor skills, poor sleeping, and irritability...of course if I couldn't eat and sleep well, I would be grumpy too! So, don't assume that just because no one has ever diagnosed your baby with being tongue-tied that he doesn't have it. If you notice the above-mentioned symptoms, please call your child's physician and have them do a detailed oral exam!

Improving Balance Through Simple Play

I used to work in a therapy clinic and before that a hospital. One of the positives to those facilities, was LOTS of equipment including swings, rocker boards, balance beams, balls of various sizes, rock walls, air mattresses, trampolines, and more! It is so much easier to help children work on their balance with all of this equipment. The downside is that the child doesn't have this equipment at home, and at the most the child is getting 1-3 hours of weekly therapy in the clinic. So, what about all of those waking hours spent in play at home with no equipment? How can the family help the child improve on his balance skills? Well, going to the park, restaurant playgrounds, and mall play areas are great ideas, but those locations are limited also...you can't live there after all. You also can't live at the facilities that have gymnastics, dance, and karate lessons.

I like to teach parents simple ways to help a child improve his balance skills that doesn't require any equipment at all; just their bodies and items they already have around the home. Some simple ideas for babies and young toddlers include:

-Lap play: have the child sit on your lap while facing you, and as you sing and talk to him, bounce him gently up/down and side-to-side to help elicit equilibrium reactions in which the arms come out to the side and the head comes back to the middle. I sing songs such as "The Noble Duke of York", "Rock, Rock, Rock Your Boat", "Getty Up Horsie", and make up songs that don't even exist. Initially, place your hands on the child's trunk (belly/back), then as he improves, lower your hands toward his hips. Be sure to watch the facial reactions in order to know if you can make it harder or should slow down.

-Animal walks: toddlers love to play pretend such as getting on all fours on the floor and pretending to be a cow or puppy. They also like to slither on their bellies as if they were a snake. My two favorite animal imitations are donkey kicks (get on all fours and kick the legs behing you) and bear crawl (similar to a dog, but straighten the legs so that the bottom is pointed in the air, if you are into Yoga it is the "Downward. Dog" pose). Try these or make up some animal imitations.

-Dance: Hold the older baby or toddler in your arms while you sway side-to-side, spin both ways, or jump up and down. Even lean over to see if the child can handle his head being upside down.

-Jumping on the bed: hold the child if he can't jump yet and help him jump. Then after awhile, place him on the floor and see if he can stand longer on his own. Often, the proprioceptive input from jumping helps with "body in space" awareness". If the child can independently stand and jump, then make the game harder such as squatting to jump like a frog or bunny, or add singing or music, especially a song about jumping. For an older toddler, have them jump down from a stool or over the stool as if they are Jack Be Nimble jumping of the candlestick!

I have many more ideas...the sky is the limit! I just listed a few to let you know that you don't need lots of expensive equipment to work on balance skills in between therapy visits. Well, time to go join my husband and daughter playing "Five Little Monkeys Jumping On the Bed".