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:
Nystagmus
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.
Wednesday, September 29, 2010
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!
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.
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.
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!
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.
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.
Wednesday, September 8, 2010
Monday, September 6, 2010
ADHD diagnosis and poor diet now conclusively linked in Australian study - San Francisco adhd | Examiner.com
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 | Examiner.com
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 span...school 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 desserts...how 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!
ADHD diagnosis and poor diet now conclusively linked in Australian study - San Francisco adhd | Examiner.com
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 span...school 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 desserts...how 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.
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.
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