Being Consistent and Predictable Helps Kids With Their Development

I may not be the most spontaneous, exciting person on earth with my predictable routines, "To Do" lists, and consistent ways of dealing with my children. But oh well! Children (and adults) benefit from predictability; it brings them comfort and the feeling of being safe. If my daughter didn't know when bed time was every night, and whether or not I would be present at the bus stop at 4:10 every weekday, she would probably be more of a worrier and not know what to expect. In that same way, if my rules for chores and behavior changed daily as well as how I handled misbehavior, then she would not find comfort in that either. There would also be a lot more acting up, because she would try to see if today will be the day she gets by with something. Lucky for her I am consistent.

Also, for my toddler son, my predictable routines of diaper changes then breakfast then play, etc. help with his language and cognitive development. I also tend to say the same phrases over and over. When I think he might be thirsty I ask "Do you want a drink?" then he says "drink" and nods his head. But what if sometimes I said milk and then other times said cup, drink, ba-ba, juice, or other words? Well, it most likely would take him longer to come up with a word to let me know he is thirsty.

So often when I go in as an OT to help out families, just helping them make predictable routines helps to blossom the child's development. And this is before I have ever started working directly on fine-motor, self-help, sensory integration, or other developmental skills. Now you may say that you are not a schedule kind of person like me and that you don't always want nap, supper, and bedtime to be the exact time everyday. Well, that's okay, as long as you make it a similar time, like plus or minus 30-45 minutes. But even if not that, just approaching activities and using similar words each day is predictable, and that is helpful too. For example, if the child fusses and fights against brushing his teeth because he is in the "terrible twos" or has tactile defensiveness in the mouth, then singing the same song or counting to 10 each time you brush the child's teeth helps the child predict that there will be an ending to this task. That helps the child to not feel that this will last forever so he must fight you. I have seen children with severe cognitive deficits do well with teethbrushing or other "hated" routines as long as it was predictable; now it may take them longer to catch on, but they do. Something as simple as counting to the same number each time can keep a mom from having to hold down her flailing child as she torturously brushes his teeth.

Predictable times of eating and drinking also help with potty training because it is easier to figure out what time of day the child will pee and poop. Kids who graze with a sippee cup or eat different times each day aren't as likely to pee and poop at the same time each day. This is one reason some kids potty train better once they start daycare or Mother's Day Out...because they have a schedule and don't let the little tots walk around the classroom with cups at all times of the day.

Also, for kids in foster care or from orphanages, keeping predictable routines can help them not only feel safe but also to bond with you. Many kids from foreign orphanages don't get held, fed, or played with as often as a child in a stable family environment. Many foster parents report that the foster child hords food and over eats...well, that tells me that the child previously didn't know when he would get his next meal so he better shovel alot in his mouth. Many of the kids taken from their homes were neglected prior to going into the foster care system. So, just playing and feeding the child at approximately the same time each day gives them amazing comfort. For that matter, not yelling when they "act up" as well as spending quality time with them goes a far way too. In terms of hugging and other physical affections, that is debatable because the child may have been physically or sexually abused. But for the child neglected and not abused, hugs, massage, and other touch play is beneficial. But once again, make the way you touch them be a predictable way.
Children from foreign orphanages may take a bit longer to bond depending upon how old they are. This is due to a variety of reasons including cultural differences, not having 1 on 1 attention, and the list goes on.

Well, I am now through blogging because my son's 15 minutes of T.V. time in the morning is over. We will go play in the floor, most likely with his train, cars, and blocks. I am guessing we will also sing his favorite songs and look at books. Then, before you know it snack time will creep up on us. We are such creatures of habit!

Yoga for Young Children

I feel great! I just returned from yoga class, and the majority of my lower back pain is gone! Yoga is great for stretching tight muscles as well as strengthening core/trunk muscles and learning to calm down. The breathing in-out and slow, controlled movements help one to slow down.

I bought Yoga Kids (R) DVDs for my daughter back when she was almost 3 years old, and she loves the DVDs so much we still exercise to them here and there. My 2 favorite DVDs are Silly to Calm (R) and ABCs (R). She likes the ABCs DVD because each letter of the alphabet represents a fun animal or pose. For example, "I" is for iguana and you are supposed to hold a plank position (extended arms such as when doing push ups). I would have thought that my limberness back from gymnastics and dance classes would have been passed on down to my daughter, but it wasn't. So, I especially like that these poses help with stretching her legs and feet, especially her hamstrings. Many children like my daughter who do not have a developmental disability tend to have muscle weakness and/or tightness throughout their bodies. This over time can get worse especially when coupled with stress. So, that's where the benefits to the breathing in-out during the stretches is beneficial. Also, for kids who are more hyper-active, the breathing lessons of yoga help the child to self-regulate and calm down to focus better. I recommend these DVDs for higher level functioning children (e.g. mild CP, developmental delay, sensory integration disorder) soon before they graduate the ECI (birth to three years) program that I work for. They can be found online at www.yogakids.com or at Target(R).

For babies and toddlers, there's Itsy Bitsy Yoga. They have DVDs available at Target (R) and books at Barnes & Noble (R) as well as other locations. I love the book because it shows exactly how to position the little ones. It is a mix of yoga and infant massage. This I especially love, since I am also an infant massage instructor (CITMI). I lend my book and DVDs out to my clients quite often. So many of the children I work with have muscle tightness and/or poor body-in-space awareness, so massage and stretches are perfect to help! Some of the exercises are "mommy and me", so that is also good for the moms to exercise too! Their website is www.itsybitsyyoga.com

The benefits to yoga are numerous! And well documented through research as well. Benefits extend to post surgery, postnatally, and the list goes on.

For children who are tippy toe walkers, the infamous downward dog position can help lengthen the heel cords. For children who have upper body weakness, that same position is beneficial to stabilize the scapulae and rotator cuff muscles of the shoulder. For me, I enjoy going late in the evening (8-9 pm) like I did today, because it helps me relax before bed time, which translates into me falling asleep quicker. Well, I am off to bed. Good night!

T.V, is it so bad?

We don't watch too much television in my household. In fact, some days we don't even turn it on at all. But since it has been cold lately, I have let the kids watch it some. My six year old either watches videos, movies, or the Disney (R) channel...that's it. I don't trust what is on other channels, sometimes even the cartoon channels aren't so safe, at least by my values! My son either watches PBS or Elmo (R) videos. Even then, it is for limited amounts of time. Of course, as I am typing this I can just hear him saying "Elmo, Elmo!".

I don't believe that T.V. in and of itself is bad, just when it is in excess and the wrong show! Small children don't need to be watching violent or sexual adult programs in the evening! They also don't need to be watching too much educational television programs. Why? Well, there isn't much socialization, learning to wait, playing, gross motor activity going on during the average T.V. program.

But what about if you watch the show with your toddler, repeat simple words, and ask questions? Then, I think it is fine. With preschoolers and elementary age children, they can learn nice facts such as while watching shows about animals. Some of them also need time to relax after a long day of school. But of course, that doesn't mean sitting at the television for 3 hours in the evening!

Some videos geared toward infants and toddlers claim to "make your baby smarter", but I think that has never been proven, and in fact one big company was forced by the courts to reimburse people for their money if they so wish, because it wasn't able to prove it help children get any smarter! There are some baby videos I like more than others. For example, Brainy Baby (R) does a better job over some other popular companies. Why? Because their videos tend to say words more often, not just music. One video I have in Spanish from Brainy Baby (R) shows a picture of various dogs and says "perro" over 6 times, whereas some other brands may only say "dog" or "perro" once. So, the point is to stimulate the language center of the brain. You may want to sit next to the child, and also say "dog", then show a picture in a book of a dog or have a toy dog nearby. This way it is more interactive, which makes learning more likely to occur.

When going into homes as an occupational therapist, I get to see many families' routines, including television watching habits. If the mom is constantly watching her T.V. programs during the day, she is less likely to be speaking to her child. Some families have the T.V. on all day, and may even eat meals while watching it. This has actually been proven with research for people to over eat and make poorer food choices, because they aren't focused on when their bodies tell them they aref a full, instead they are distracted. This coupled with less activity is a recipe for childhood (and adult) obesity! Also, I shouldn't be having to encourage a family to reduce their T.V. watching down from 8 hours a day, especially when the child's language and social skills are severely delayed such as with autism.

So, I think T.V is fine as long as it is not the "babysitter" and is in small increments of time. And for toddlers, I approve of T.V. when it is more interactive.

Separation Anxiety

Although I know that separation anxiety is a normal part of development, it doesn't make my 19-month old son look any less pitiful to me when he cries bloody murder when I leave him. Thank goodness he usually quits fairly quickly after I leave. I also have to remind myself that him displaying this behavior means that he has age-appropriate social-emotional, communication, and cognitive skill development.

This past week was a bit unusual for us. My husband was gone most of the week on a business trip. And although I worked two days this week as usual, I also attended a two day professional conference. That means my son had four LONG days away from me. It also meant the two work days were spent with the babysitter, who he absolutely adores; and that Grandma came to stay two days with us so I could attend the conference. Although my son loves my mother-in-law, she is not his Mommy. When I came home on Friday evening, he clung to me not even wanting to let me go to the bathroom on my own! Once again I reminded myself this is normal, and that one day 10 years from now, I'll wish he wanted me around all of the time.

Children who never display separation anxiety may have a good reason, but then again it is a "red flag" for a problem with social-emotional development such as with autism spectrum disorders, bonding and attachment disorders, and some developmental disorders. A child who lives with many adult family members or who has been in numerous foster homes may not show separation anxiety from the parent (or foster parent). However, the child in the foster home may display it later on once he is in a consistent home.

Separation anxiety starts around the time the child becomes mobile ( crawling and walking) and realizes he can be separate from his parent/ caregiver. It also emerges around the time of "object permanence", so the child is truly fearful that since he can't see you now, that you won't return. It typically diminishes once the child understands that Mommy (or Daddy) will come back later. By the preschool years when the child wants to play with other kids, he may be ecstatic when you drop him off to leave and cry when you come to pick him up. My daughter cried when I took her to her little preschool up to age 3 1/2 years; now that she is in kindergarten, she is excited to leave to the bus stop and be away from her parents!

Suggestions on helping separation anxiety to not be so devestating are:

1. Start out by leaving for only small amounts of time, then build up to longer times. For children who are carried in a sling much of the time and who co-sleep, a small separation may be as simple as him sitting in the high chair or standing in a bouncer while you are only 10 feet away. For another child, it may mean that you leave for 5 minutes to go get the mail outside or leave to run a 20 minute errand.

2. Be honest about your departure and your arrival. Don't sneak away or lie by saying you'll be right back unless that is truly the case.

3. For a child with special needs, maybe take him to a daycare, babysitter, church class, etc. that has a small adult-to-child ratio so he can get more individualized attention.

4. Let the child carry around a small photo book with pictures of you and other family members so he can look at them when he wants to.

5. Create conssistent "bye-bye" and "reuniting" routines. Predictability is calming for kids of all ages, especially babies and toddlers.

As I finish typing this with one hand, my son is up from his nap and clinging to me, which reminds me that separation for longer bouts of time than usual can increase clinging behavior for the next couple of days!

Adaptive Eating Utensils for Kids

I am enjoying that my 19 month old son likes to feed himself applesauce with a spoon. If I try to feed it to him, he clamps his mouth shut and turns his head. I love that! He may be messy, but oh well! How else can he learn if he doesn't practice? Toddlers should want to use a spoon on their own! But some toddlers aren't physically able, even if they are emotionally and cognitively ready to not be fed by an adult anymore. This is where adaptive utensils come into play!

The particular adapted spoon, fork, or spork that is needed depends upon the child's strength of upper body muscles, coordination, muscle tone, and range of motion. Some of the adapted utensils may have a: built-up (larger round) handle- foam or plastic, angled metal portion, curved handle, swivel metal, or weighted handle. So why are some of these utensils needed?

A built up handle is for someone with limited range of motion, abnormal muscle tone, or strength.

A weighted handle is for someone with ataxia or tremors as well as for someone with decreased sensation- the added weight lets them feel the utensil better.

Curved handles and angled or swivel metal utensils may be for someone with limited forearm, wrist, or finger active range of motion or limited control of muscles such as with tremors or spasticity.

Common diagnoses that use adaptive utensils include: Cerebral Palsy, Stroke, Muscular Dystrophy, Arthrogyposis, Brachial Plexus Injury, and many others.

Catalogs for therapy equipment such as www.sammonspreston.com sell numerous adaptive eating utensils. But I have found that sometimes you can use your own utensils and adapt them for a lower cost, depending upon the child's need. For example, if you just need a fatter handle, then try using rubber/plastic bicycle handle bars that can be found 2 for $1.00 at dollar stores; slip the spoon in the slot that would go around the bicycle handles. I've also used foam craft supplies along with electrical tape to creat a built-up handle; just wrap and tape. One that is real easy to use is Crayola (R) Model Magic (R) and shape exactly where you need the fingers to get support, and within a day the products dries. Only problem with this idea is it shouldn't get that wet or it can alter its shape. So you may not want a child who excessively sweats, drools alot, or is super messy to use this product.

I've learned as an occupational therapist to be creative with adapting feeding supplies and "Think outside of the box". Sometimes there just isn't a product already out on the market that can help a particular child. And sometimes, it's the parents who "Think outside of the box" and rig something up that works perfectly!

Encouraging Kids to Play on Their Belly

Lately, there has been lots of hype about putting babies on their belly during playtime. I am so glad for that, because it helps them to develop head, neck, trunk, and leg muscle strength. It is also a good position for visual development, digestion, and production of sounds. Babies who do not tolerate lying on their tummies are most likely going to be delayed with the gross motor skills of rolling and crawling. Whether the baby is placed on a "tummy time" mat or just over the parents lap, this is a good position!

But guess what...it is not just a position for babies! Children of all ages can benefit from lying on their belly while on the floor or a firm bed. A good time to encourage this could be as they are looking at a book, rolling trains on a track, playing video games or board games, or while watching TV. Many children will fatigue quickly because they don't have strong upper bodies, which can correlate to delayed coordination or poor stamina for handwriting and fine motor activities. What you want to see is that the child can prop up on their forearms with their elbows flexed and their head not sinking, and shoulders relaxed not hunched. Some children will roll to one side or just choose to sit up when this position becomes too difficult.

Some ideas to strengthen these muscles include:
1. Yoga
2. Animal imitations: snake, worm, alligator (lay down on belly and clap arms as if they are the teeth chomping down)
3. Wheelbarrow walk- for kids less strong, hold their hips instead of their feet
4. Push-ups
5. Army crawl (AKA commando crawl) through an obstacle course of pillows and under furniture

I have a fabric tunnel that my son and daughter love to crawl and army crawl through. Sometimes I put it next to the couch cushions and other pillows to set up a long obstacle course to climb through. Sometimes we go through it forward and other times backwards. Crawling backwards can really help with the trunk and arm strength too.

For kids who dislike this position, either have the sibling or yourself to get down on the floor to play with them. Often, a distraction may help them forget how much work it really is to play while lying on the belly!

Helping Young Kids Accept Touch To Their Mouth

So many of the little kids that I have worked with over the years are sensitive to touch in their mouth as well as being picky eaters. This is accompanied by a dislike for teethbrushing and not mouthing toys age-appropriately. Well, it is no wonder some of these kiddos dislike touch to their face and mouth after hearing their medical history. So many of these children have had tubes down their mouths and had syringes of medicine forced in their mouth many times! That is a recipe for an oral aversion!

One way to help these children to tolerate and accept touch to their mouth is through play. This can be playing with the toothbrush, their food, and mouth toys. Definately not forcing the objects in the child's mouth, but allowing the child to go at his own pace. This may mean that initially the child only touches the toothbrush and food with their fingers. Then, eventually the child sticks it in his mouth. This may progress to eating more foods and enjoying teethbrushing, then again it may not. But whatever the outcome, children like to initiate what goes in their mouth, not have objects or foods forced upon them. This leads to a power struggle and usually the child wins...not so good if the child needs to gain weight in order to receive a surgery or prevent him from getting a G-tube.

I am thinking back on a time that I showed a mom how to make toothbrushes and teethbrushing fun. I had her get two new toothbrushes. After taking them out of the packages, I pretended that they were drumsticks while singing this little toddler boy's favorite song. Just by singing this song I had his attention. A few minutes went by and he grabbed the toothbrushes from my hand and started playing with them in a drumming manner. I ignored him as I was talking to his mother, and what do you think happened? You guessed it, the toothbrushes went to his mouth for a few seconds. We ignored it, and he did it again. Now, keep in mind I wanted to squeal and clap, but I refrained because that might have distracted or over-whelmed him. Within five minutes time, he had put the toothbrushes in his mouth 7 or 8 times...yeah! This scenario sure beats his mom holding him down and forcing it in his mouth.

This same little boy was also a very picky eater and underweight in addition to other developmental problems. He had a limited low fat diet. So, the dietician and I had given his mom numerous dietary suggestions and I worked on oral-motor skills as well. I also suggested food chaining strategies in which the family barely alters his food in terms of texture or taste. For example, he likes a soup dish from his native country in which it contains soft vegetables, noodles, and chicken. I suggested adding vegetables that were slightly firmer. I suggested that his mom let him play with food and to relax if it doesn't make it to his mouth or lips. He is a little boy who feels the anxiety, therefore everyone around him needs to relax. So what if the kitchen tile or his hands have food all over them! Do we want him to eat or be clean?

One other strategy I often teach is infant massage. Often, massaging the whole body and then moving toward the neck/face/mouth is helpful. Once the child is relaxed, then he may accept facial touch.

Another strategy is song motions or play involving touch to the face/head such as having the child cover his face with his (or your) hands during peek-a-boo. Singing and performing motions to "Head, Shoulders, Knees, and Toes" is a good one, because the emphasis isn't just on the face, but is also on other body parts. This is a bit sly and tricky, but it is amazing how many kids accept touch to the face while being sang to or singing along.

Kids also like mouth toys such as whistles, bubble blowers, and teething rings. I especially like the teether toys that can also be a manipulative such as a cell phone or key ring; kids are smart enough to know what is solely for the mouth, and for that reason some kids may be turned off by a gel teether toy and not by a teether key ring.

There are numerous ideas on how to play with a child and use touch during games and reciprocal interaction between adult and child. Yet, the common thread is having fun and not forcing anything upon them! Quit when the child is over-whelmed and watch for symptoms of over-stimulation such as grimacing, hiccups, turning red or pale, and faster heart rate. For more information on sensory processing problems in babies and strategies for calming the young child, visit www.sense-ablebaby.com

What Ever Becomes of the Children I Work With?

Recently, I have bumped into families that I had previously worked with. Each time, I recognized the mom first, not the child. And it was just a fluke that I was even in those places, because they weren't stores or times that I would have been typically shopping. It was meant to be that I ran into them! I have been an occupational therapist in this city for 12 1/2 years, so I should expect to be "wow-ed" to see what my young clients have grown into. It is a good thing that I don't forget faces and names very often. However, when I do forget a name, it usually comes back to me after talking to them for awhile.

The most amazing encounter was this young man who is now a teenager; I provided occupational therapy from pre-K through first grade with him. Wow, what a handsome young man he has become. He is now over 6 feet tall! Just think, he was once small enough for me to toss around over a therapy ball! This young man has a diagnosis of cerebral palsy and he continues to walk with a reverse walker. I had hoped that one day he would ambulate without any devices. But I think by watching him walk, his leg muscles are just too tight, especially since he is so tall. Often kids who walk briefly on their own when they are small, can't walk independently once they have grown because of tight tendons. On the happier side, it was nice to see how bright, articulate, and handsome he is!

Three times this past year, I have ran into families that have a child diagnosed with autism. These children that graduated the ECI program I work with at the age of 3 years are now in pre-K or kindergarten. All of them have made amazing progress in either the private or public school programs they have attended. All of them have made massive progress with their language skills, behavior, and attention span. All but one are in a regular education classroom. The one common thing with these families was that they work with their child at home, enroll them in a program while the child is 3-5 years old, and are on "special" diets. This really makes me smile, because when I quit working with children at the age of three years there are so many roads that family and child could go down.

Up intil 2004, I worked primarily in outpatient settings with children birth to 18 years of age. So, I know what children with autism, down syndrome, cerebral palsy, and other developmental disorders look like as babies, children, teenagers, and adults. There is such a wide range of how these children look and function. But once again the common thread of the children who make the most improvement is families who are willing to work with their child...not just take them to a clinic or school and let someone else do all the work. After all, their are seven days in a week which can also be thought of "there are 168 hrs in a week". Even if therapies total 10 hours a week, school totals 40 hours a week, and the child sleeps 70 hours a week, there is still a remainder of 48 hours in the week. What is the child doing during this time? Well, hopefully a little bit of rest and relaxation mixed in with family time in the home and community.