Hip Helpers

It has been a while since I have suggested "hip helpers" for a client, but this past week I am SO glad that I did! My 15-month old client has low muscle tone and is able to propel around only by scooting with one leg up as the other is rotated down to the floor along with one fist propping/pushing off. He has too much sensory sensitivity in his hands to crawl. As a result of this scooting position, he is having difficulties sitting with his legs in front, side-sit, ring sit, criss-cross sit, or standing; he appears to be in pain and have over stretched ligaments. He even sleeps with both hips externally rotated. This is where the help of the product "hip helper" came in. It is similar to lycra biking shorts, except for the seam is sewn between the legs in order for the legs to stay together. See the product at:

Hip Helpers Home

Wearing them helps align the childs hips. As an OT working on fine-motor skills and core strengthening with this client, this has allowed me to keep him aligned and balanced in sitting so that his arms are free to both manipulate a toy instead of one hand propping on the floor. Since we just started using them, I am hoping that each week this toddler will figure out where midline is and improve bilateral integration... and after that the sky is the limit!


Check out the site therapists/parents, because you might think this is for your little one!

Infant massage

As an occupational therapist who works with infants and toddlers, I have seen first hand how great infant massage can be! This article highlights this:

Infant massage: Understand this soothing therapy - MayoClinic.com

Seven years ago, I went through training to become a certified infant touch & massage instructor (CITMI). I did this so that I could teach parents of my clients how to massage their babies. Sometimes when a child has multiple disabilities and medical problems, there is minimal things that a parent can do to truly bond with their baby. When you teach those parents how to massage their infant and how to read the signs of their baby (respiration, state of arousal, emotion, etc), all of a sudden the parent seems to feel more competent as a parent that they could provide a source of enjoyment for this baby who has so many medical needs. Also, for some children it shows that touch doesn't have to mean pain. Medically fragile infants have been poked with needles and tubes so much that they may become aversive to touch if not exposed to a pleasurable touch as well.

For babies with development delays massage can be beneficial too. The massage can loosen tight muscles as well as stimulate floppy muscles. The massage can aid in "body in space" awareness which can then lead to the child achieving motor milestones such as rolling over to the tummy and back.

Massage can be just as important for typically developing infants, especially if they tend to have constipation or reflux. When I was going through the training, my daughter was 2 years old; she really enjoyed me practicing the various massage strokes on her arms, legs, and tummy. She would even come ly on my lap and say "saj me mama"... a great measure of bonding and success!

The Feeding Relationship

Just wanted to share this informative article on how to start a good "mealtime" relationship with your child right from the start- infancy!

ZERO TO THREE: The Feeding Relationship

Since I have been working in an early intervention setting for the past 9 years, I truly agree that the beginning is the time to start promoting bonding and healthy mealtime habits. This article gives suggestions for the child who is not medically fragile. Unfortunately, so many of the medically fragile children that I work with for occupational therapy have LOTS of feeding & bonding issues from the start: living in the NICU vs. going home, tube feeding vs. oral feeding, oral aversions, surgeries, etc. When that is the case, there are many things that can be done by the family, nurses, therapists, etc. to help make sure bonding takes place and that feeding issues are resolved as much as possible in that particular situation. I always let the family know that the baby loves them, not me, and therefore I can show them how to feed, massage, or play with their baby, but it is the family members that need to do those things on a daily basis which just reinforces a stronger attachment on the part of the baby and the adult/family member!

Temper Tantrums

When our children have tantrums, it's usually not fun to endure as the parent! Often the "terrible twos" begin around 18 months of age as the child starts to gain his/her independence. However, some children don't start this resistive behavior until they are three years old. Not every child is the same! When a child with a developmental delay or disability begins to receive intervention (therapy, counseling, ABA), it is not unusual to see the child have tantrums once the cognitive and language skills improve... they are going through a stage that they didn't go through at an age-expected time. So, sometimes children seem worse when really they are improving with cognitive reasoning.

Often, a child with a disability is tantrumming because he/she is: not able to comprehend what is asked of him/her, perceives the activity too difficult, is frustrated when needing help to complete an activity, is tired (fatigues quickly with weak muscles, poor sleep patterns, etc.), or can't fully express what he/she is thinking.

Here is a link that describes tantrums for children who aren't delayed.  So a child who is delayed may not go through the behaviors described at that specific age, but the description of why they are acting that way still stands.

The Terrible Twos - Toddler Temper Tantrums - Parenting.com

I was fairly lucky with my daughter (now 8) having minimal tantrums... at the time I didn't think that though! My son has far surpassed her in the tantrum department! Many of his "fits" wouldn't occur if he was an only child and didn't have to share toys and my time. Hopefully, in the long run he will be better at sharing, waiting, and negotiating.

No Child Left Behind

US Congress has yet to make updates to the NCLB put in place early in Bush's presidency. Here is a recap of the negatives and positives of it:

Foundations and Current Issues of Early Childhood Education/Chapter 6/6.1 - Wikibooks, open books for an open world

I hope that the replacement will improve services for infants/toddlers in early intervention (EI/ECI) programs as well as enhance the education of school-aged children. Until then some of the states are using a "quick fix" with waivers allowed by the present Obama administration.

I think it is important to write your congressman with any input that you may have on this very important topic...children are the future!

EWG's Shopper's Guide to Pesticides

I love fruit & now that it's summer, I am eating lots more than usual. I've been trying to buy organic fruits especially the ones that tend to have many pesticides. I stumbled upon this website which lists the "worst" fruits & veggies in terms of pesticides and lists out the top "clean" fruits & veggies:

Executive Summary | EWG's Shopper's Guide to Pesticides | Environmental Working Group | EWG.org

I have a favorite from the "worst" list, and that's strawberries...guess I definitely need to buy the organic berries. I have a second favorite which is on the "clean" list, and that's onion, but I feel okay about buying regular onions since they are not loaded with pesticides.

So many of the children with special needs are even more sensitive to pesticides and other chemicals than the rest of us, so I think it is especially important for their diet to be "clean"!

Resources on Cerebral Palsy

Whether you are a therapist or parent of a child with cerebral palsy (CP), you know that you can never have too many resources! I stumbled upon a site recently, that I thought had good information and resources: About MyChild™ • MyChild™

Another good site on CP for therapists and parents  is: http://www.ndta.org/

Easter Seals & United Cerebral Palsy (UCP) are also good places to look for information. The UCP in my area even allows families to borrow adapted toys & equipment, which is great because adapted toys are not exactly cheap!

If you know of any great resources out there, let me know!

Individualizing Approaches to Daily Routines for Children with Sensory Processing Disorder

I love that there are so many books and websites that provide information on how to help children with sensory processing disorder (SPD, also known as sensory integration disorder-SID). It is a starting place for the parents, teachers, and therapists on how to better help each child. But the problem with generic advice, is that it only gets you so far. Some issues need to be resolved by individualizing the strategies for that particular child. I'm blessed to work with children in their homes for my two jobs (Early Intervention, Private Practice). This allows me to show up during the day at the time of the difficult routine. For example, if the child is having problems with dressing or feeding then I show up early in the morning. If the child is having problems at daycare at lunch or playtime then I show up mid-day. My schedule doesn't always work out perfect, but at least I am better able to help the parents and caregivers problem-solve the routine more thoroughly than when I worked at an out-patient therapy clinic. Recently, I helped a mother to adapt her toddler's dressing routine. Paying attention to the fabric of the clothing, background noise/distractions, and giving him some choice of shirts, socks, and pants helped reduce his tantrums.The suggestions were simple, but made a big difference! Mealtime is a particular routine that needs to be observed by the therapist. The height of the chair, fabric of the cushions, type of utensils and cups, and the sensory input of the environment can make a big difference in the quality of eating and the quantity of food eaten. If the child is disorganized due to things going on nearby (TV too loud, smells over-whelming, etc.), then he may throw a tantrum before the meal has even begun! I do work on oral-motor skills with my clients, yet it is amazing how working on the sensory qualities of the meal routine can impact the child too. If you have a child who goes to a clinic for therapy, I encourage you to look into having the therapist come for at least one home therapy visit or for you to video record the difficult routine. I enjoy analyzing video especially since I can go back to watch it repeatedly. I would love to hear of some of your ideas that have helped you to figure out solutions to difficult daily routines with your child with SPD.

ZERO TO THREE Podcast Series on Early Childhood Development

These days it seems like there isn't enough time to do all of the reading on a variety of topics that I want to do. So, I often listen to podcasts while en route to-from work or while on an airplane. If you are wanting to know more about early childhood development, try this link from "Zero to Three" that has podcasts and resources:

ZERO TO THREE: Little Kids, Big Questions: A ZERO TO THREE Podcast Series on Early Childhood Development

I thought the "Turning On or Tuning Out: The Influence of Media on Young Children’s Development" Featuring Ellen Wartella, Ph.D. had good information in it.

disAbility Sports Training and Athletic Competition

It's always nice to stay active in sports, but for parents of children with disabilities it's not as easy as signing up just anywhere! The following link provides a long list of various links for adapted sports:

disAbility Sports Training and Athletic Competition

Play ball!

Therapists Consulting with School & Daycare Staff

It seems this year has been extra crazy and busy, which means I haven't blogged near as much as I did the previous two years...oh well, if life even slows down a bit, then I'll get back to blogging more. Ironically, I don't watch television very often or do other things that you would think should take me away from my blogging, yet somehow the days and evenings fly by!

In addition to me working part-time for an early intervention program in which I work in homes, daycares, and in the community with children ages birth to three years with special needs, I also work part-time for myself. I see a few children on a weekly basis as well as conducting consultations and evaluations for a local school district (not the one I work for ECI or the one my daughter attends). So, this year I have learned a lot about billing insurance companies, facilities, and Medicaid...lots of lessons have been learned! But the biggest thing that I've enjoyed doing this year (besides being a Mom of two children and a wife) is providing consultative services.

Consultations are really important and that is why most school occupational therapists spend most of their time doing that versus direct services. Because the therapist is only around a child a small part of the week (or for some kids even less), and the parents, teachers, or daycare staff are around them for the majority of the time, then doesn't it make sense to teach them a few simple strategies that can make a difference in that child's life. Some of the suggestions can be as simple as putting the child at a table that faces a less "busy" area and therefore is less distracting so the child can remain seated and do his "work". Ideas may also be as simple as rewording requests, keeping instructions short and simple, using a picture schedule system, or making sure the table/chair is at the appropriate height which provides better support for handwriting and focusing.

Consultative services doesn't mean that the child doesn't also need direct therapy, it just means that there may be adaptations to the environment that could make a functional difference. It might also mean that teaching the adults to interact differently with the child could make a difference. For example, for a child who transitions poorly between activities at a daycare one suggestion may be to give him a one minute verbal update of what will be coming next. Predictability often lessens anxiety in children with developmental disabilities, especially the children with sensory processing disorder (SPD) and autism spectrum disorder (ASD).

I've learned through the years to not get all of my "therapy kicks" out of directly interacting or touching the child. When I was first out of college, I wouldn't have dreamed that I could help out a five month old with Down Syndrom so much unless I was literally touching the child helping him to roll over or helping with some other motor or feeding skill. Yet, now I know that if I show the parents a few strategies for "tummy time", positioning while holding/feeding the baby, and diapering that I'm making a big, maybe even bigger difference than I am by directly working with the child. It has been a change for me not to be the one to feed the client, but to be the one guiding the parent either verbally or physically. After all, it's not "all about me"!

So, if your child gets direct services only at a clinic, then ask the therapist if she/he is willing to do a home visit at least once. Insurance may or may not pay for it, so funding could be an issue. If you can't afford to pay for the home therapy visit privately, then videotape the surroundings of your home during the daily routines that are difficult such as toothbrushing or meal times; have the therapist view it and give any suggestions on how to help that routine go smoother. Maybe the therapist will also be fine with you participating in the therapy session at the clinic so you can learn some activities to do with your child in between sessions. At the very least, get a handout individualized to your child on activities or adaptations that would be beneficial.

Making Halloween Fun For All

It's Halloween time! Many of us think it is fun, whereas others are not feeling the same amount of joy as the rest of us! In hopes of making the holiday more pleasant for all, I have provided a link on ideas for adapting this holiday for a child with Autism Spectrum Disorder. I also think these ideas could work well with any disability or young child:

http://www.autismsupport.org/halloween.html

My small family of four likes to dress as a theme. Last year we all dressed up as characters of Toy Story. This year we will be characters from Peter Pan...even the dog is dressing up as a pirate. Since my three year old son gets scared of "spooky" things easily, we probably will be wearing "happy" costumes for a while. Last year, he became very upset with the decorations we had on our front porch, and would only go out the back door until the decorations were taken down the day after Halloween. So, if you have a case like this, some of the ideas in the link may work well for you even with a child who doesn't have a developmental delay or diagnosis of autism.

Enjoy trick-or-treating and HAPPY HALLOWEEN!

Social Stories to Improve Behaviors

I am a big fan of social stories to teach young children and/or children with special needs (any age) when there is a problem with a behavior or the child is anxious about a situation. The concept originated by Carol Gray. Although social stories are often used with children with an autism spectrum disorder, I have found that you can use them with many children with developmental delays or young children with no delays. Here is a link on how to make one:

http://www.ehow.com/how_5135970_use-social-stories.html

This link probably gives ideas for grade school children, and adapting it for the toddlers would mean doing more of the work. I have had my own children help me by coloring some of the pictures in the book.

I have made quite a few for my own children, and they like to read them even after the issue has been solved. Back when my daughter (now 7 years old) was three years old, she was very scared to go to swim lessons. So, through reading the story to her daily she became less anxious. That is because the predictability of the lessons lessened her anxiety. So often, children act up when they do not know what to expect, and through writing an individualized story about what may happen and what is expected of them, their anxiety may lessen.

Some of the stories that I have taught families to write for their child have included: going to the dentist, airplane rides, gymnastics class, swimming lessons, birthday parties, Christmas day, potty training, the choir singing at church, and the list goes on. Remember, when writing a social story to stay as positive as possible and emphasize the behavior you want from the child and don't say a bunch of "no" and "don't". For example, if the child has a problem with running in the hallways at school you may say in the book "we walk in the hallway quietly and slowly while listening to the teacher" as opposed to "we don't run in the hallway and disobey the teacher".

I would love to hear stories about some of your favorite social stories that you have helped write!

Is your child ready for preschool?

Since most children are going back to school over the next couple of weeks, I thought I'd post a link on preschool readiness. Preschool is important for many children, especially those with learning disorders or developmental disabilities. If they go to preschool, then they may perform better in kindergarten. ..they may even have fun in kindergarten!

First 5 | California

I have a friend who used to be a kindergarten teacher. She once told me that the best thing a parent can do for any child to prepare them for kindergarten is to send them to preschool or another part-time program such as Mother's Day Out or daycare the year or two before starting kindergarten. It is hard to learn in kindergarten if the first part of the school year is full of separation anxiety... get that out of the way in preschool!

Halliwick Method to Teach Swimming

It's that time of year when most everyone wants to cool off in a pool, especially if you live in the southern USA like I do...too many days where it is 100 degrees F or above! For many of us, we want our kids to feel comfortable around the water, have safety awareness, and also learn how to swim. Some kids are harder to teach swimming to than others, and especially if the child has a medical or mental disability. Here is a link about the Halliwick method that can be used to teach swimming, it was created by a physical therapist who is an aquatic specialist. He has techniques for a variety of special needs including pediatric and orthopedic disabilities.

Halliwick

So go ahead, gather up your intertube, rubber duckies, and towel and head off to the swimming pool!

ZERO TO THREE: Self-Control 24 - 36 Months

Although my son turned 3 years old earlier this month, I do not expect him to never have tantrums or meltdowns. Yet, I already noticed over the past couple of months that they occur WAY less. Here is a link on the behavior and self-control of a two year old and some strategies to use:.

ZERO TO THREE: Self-Control 24 - 36 Months

Toddlers are SO much fun, but they are also unpredictable! So, it's always nice to have a better understanding of why they behave the way they do.

Simply Thick Lawsuit: Free Consultation with Attorney necrotizing enterocolitis NEC

Please spread the word about this important information regarding a recall on Simply Thick and a possible link to NEC:

Simply Thick Lawsuit: Free Consultation with Attorney necrotizing enterocolitis NEC

Animal Assisted Therapy for Special Needs Children

In honor of my family getting a puppy 2 weeks ago, I thought I'd post this link on how animals can help children with special needs:

Animal Assisted Therapy for Special Needs Children

When I worked at a rehab hospital for adults with neurological injuries I really enjoyed seeing the trained dogs come in and mingle with the patients. So many of the adults were so happy to see the dogs, and it was amazing how some of them tried to move an injured arm or speak more around the pet! I've also seen this same effect with children with special needs. Even children with only developmental delays do well with dogs. A few years ago I was working with a 16 month old boy who wasn't walking; he had mild sensory modulation problems, but other than that just a delay with walking and talking. His mother adopted a 2 year old dog, and guess what, the boy began walking and talking within 3 weeks of the family getting the dog. These two were best buddies, and it was so amazing to see how this gentle dog helped this boy. The little boy was motivated to walk so he could keep up with his best friend! I have many stories about how dogs, cats, and horses have helped the children I work with. I would love to hear your stories too!

ZERO TO THREE: Sleep Challenges in Infants and Toddlers: Why It Happens, What to Do

Whether it be from my friends or parents of children I work with, I get asked a lot of questions about how to help babies and young children sleep better. Here are some good ideas on the challenges of sleep:

ZERO TO THREE: Sleep Challenges in Infants and Toddlers: Why It Happens, What to Do

I've been lucky that my son slept through the night (7 hours or more) by 6 weeks of age and my daughter slept through the night by 8 weeks of age. Unless they were sick or teething, they have been excellent sleepers. Of course, there has been the occasional night mare or delay tactics in going up to bed, but overall I've been lucky in the area of "sleep". My husband and I put the children down at the predictable time of 7:30 for my son (he'll be 3 years old in June) and 8:00 on school nights for my 7 year old daughter. They have the potential to get 11 hours of sleep at night on a weekday, and then my son may or may not also take a nap at preschool or home (depends on if it is a day I work). For that age group children need 10-14 hours of sleep in a 24 hour period, and my children get that. So often, a child's behavior problems or school difficulties can be lessened by making sure they have a proper amount of sleep...notice I didn't say the problems vanish, just maybe lessen depending upon the child.

Feel free to post sleep problems and solutions that you have had with your child or a child you work with!

Increasing the Intensity of Sensory Input

A sensory diet is when additional sensory input is added into the child's daily activities. This might include making sure the child runs around or swings at recess as opposed to them just sitting there on a bench. It might also include a child wearing a weighted vest or backpack while on an outing. The list is never ending of how sensory input can be weaved into a child's daily routines: marching between locations, vibrating pen, "heavy work" activities such as cleaning the chalkboard or carrying groceries for parents, or even extra trips to the neighborhood park.

So what is a parent to do when they have tried a sensory diet and the child still needs more? Well, that is when the occupational therapist (or other clinician trained in sensory integration techniques) analyzes the input the child is receiving. They should be asking about intensity, duration, frequency, and mode of sensation.

Intensity levels can be altered with jumping by adding a mini-trampoline versus just jumping on the ground. This can be made even more intense by the child jumping on a large outdoor trampoline. Another way intensity could be increased is to buy special suspended equipment such as swings with bungee cords that allow extra resistance as the child swings. These can be found at:

www.southpawenterprises.com

Some of the families I work with already have the outdoor play gyms that have a swing, slide, ladder, and "rock" wall. Often, suspended equipment could be used with these play gym systems. So a regular sling seat swing could be replaced with the "frog" swing which is also a sling seat, but has bungee rope at the top so the child is bouncing up-down in addition to being able to swing front-to-back.

Intensity could be added to marching by adding 1-2 pound leg weights around the child's ankles as he marches. Other ideas include: Joint compressions, a game of tug-of-war, deep massage vs. light touch, songs with words versus just instrments...and the list is never-ending!

Duration: length of time of sensory input. So, if the family tends to let the child play at the park for 20 minutes, maybe the time should be lengthened to 30 minutes or more. This is especially the case for a child who has sensory modulation disorder with the symptoms of sensory seeking or sensory under-responsiveness.

Frequency: means the amount of times during the day. If the child only gets one "wiggle" break at school/home then maybe the child needs more "wiggle" breaks. The average adult attention span is only 45 minutes of listening, and for children it is even less. So, we know that many special needs children can't focus as long as a typically developing child...so, more "wiggle" breaks are needed! If breaks are not possible, then fidgets for the hands or a cushion for the bottom such as the Movin' Sit (R) could be helpful.

Mode of sensation: is the input tactile? auditory? visual? movement (vestibular and/or proprioceptive)? smell/taste? oral-motor? Changing up a sensory diet with various types of input may be necessary. This can be frustrating to teachers and parents because after a few months of the ideas given by the therapist they aren't getting as good of results. Altering the sensory diet can be a guessing game especially when the child fluctuates from day-to-day or even hour-to-hour!
Maybe if the child tends to like motion that is up-down such as bouncing on a ball or jumping on a trampoline, then a different kind of movement could be added to the sensory diet. Examples of more intense motion include rotary/spinning or upside down movement. Examples of less intense motion include front-to-back or side-to-side motion at a predictable pace.

I hope this article got you thinking! Once a sensory diet is in place, it probably will have to be tweaked here and there...especially if there are lots of changes in that child's life.