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.

Take Your Child's Therapist Holiday Shopping With You!

Since I work for an early intervention program, I have the luxury of going into the family's natural environment whether it be the home, daycare, relative's home, or the community. The community settings could be anywhere the family naturally goes and where "typically developing infants and toddlers" would go. This could be the library, park, restaurant, or store. I may go into these public places to help figure out some strategies to make the routine more functional for the child and family. So, if the child is scared of the playground at McDonald's, but the family goes there on a weekly basis, then I can justify doing a therapy session at that setting. An occupational therapy visit in the grocery store may be to figure out ways to help the child balance in the front section of the cart. The list goes on and on of ways that I can help the family in the community.

The biggest way I can help this time of year, is to go holiday (AKA Christmas) shopping with the family. Maybe I am going with the child and family because of typical therapy reasons such as helping reduce sensory stimulation, transitions, following directions, balance, etc, etc, etc. But I can also use my expertise and background in "activity analysis" to help the parents pick out appropriate toys for the child. When a child has a developmental delay or medical diagnosis, it is not always so simple to pick out toys. My experience is that families tend to purchase toys that are too easy for the child as opposed to challenging the child.

Toy ideas for a child with ASD (Autism Spectrum Disorder) might be geared toward improving social-emotional, sensory processing, cognition, or language skills. For example, a doll and stroller set or textured formboard puzzles. In comparison, toy ideas for a child who has suffered a stroke (AKA hemiparesis or hemiplegia) might be the ones that encourage both sides of the body to work together such as a ball, t-ball stand, golf set, wagon, tricycle, and Mr. Potato Head (R).

If your child is too old for the local early intervention program because of being over the age of 3 years or if he receives therapy services privately, then see what kind of deal you can make with the professional seeing him. Maybe since insurance wouldn't pay for a shopping trip, you could pay privately. If this is not an option, then maybe the last 20 minutes of the therapy session could be used for the parent and therapist to go to websites for the stores they will shop at (e.g. Target (R), Toys R US (R), Wal-mart, or Amazon (R)), and discuss toy ideas and why they would be good for that child. If that is not an option either, then maybe call the therapist a few days in advance of the therapy session and ask her for a list of toys that would be good for your child to have; not just a generic list of toys, but one that is indivualized to your child.

Don't be afraid to ask! This is my favorite time of year for more than one reason, but one of those reasons is shopping with my clients and their families!

HIPP- supplemental to medicaid

It is sad but true that families may not receive therapy services if they don't have the money to pay for it. So, I am always looking for information to help families with this problem. As I've stated before I work for an early intervention program as an occupational therapist. I have worked in more than one US state. I recently became aware of a program called HIPP that helps families with paying co-pays. I am not sure of what states this program is in, but I do know it is in Texas. In Texas, early intervention services are paid for on a sliding scale based upon how much money the family makes unless the child has a third-party payer to pay for services. Third-party payer services include: private insurance, medicaid, or CHIP. Some families who have private insurance have to meet a deductible before payment of therapy and developmental services kick in. During this time of economic hardship, than can be difficult...especially if there is a high deductible to meet. HIPP helps the families pay for the co-pays and as long as one family member in the house is on medicaid, then the family could be eligible for the program. For a link and more info. on this topic: https://www.gethipptexas.com

Sensory Strategies for Adapting the Environment to Help Young Children with Sensory Processing Problems / SPD: Part One

Since I work for an early intervention program, I get the opportunity to work in the homes and daycares of many young children under the age of three years. Even though I am providing ways for the child to improve his skills directly, I also provide ideas for altering the environment to help these children. For children with sensory processing problems, we may go through numerous ideas before something works for that child and family...after all intervention should be individualized. But there are some basic ideas that pretty much work for everyone (minus someone here or there). In my blog today, I am going to share a few of those basic ideas.

Sensory processing is the brains ability to detect and respond to sensory input it receives from the body, other people, and the environment. Young children (toddlers and preschoolers) often respond well to adapting the environment in order to help them process sensations better. Below are some categories of sensory processing problems and some possible ways to adapt their surroundings:

1. Over-responsiveness: these children over-respond to sensations by getting upset, avoidance, shut-down, and/or anxiety.
Adaptations include:

• Reduce clutter on the walls and floor: this can over-stimulate these children. Organize the room and remove the excess wall decorations. Put toys in containers and baskets versus scattered all over.
• Go shopping at times that are less crowded versus a chaotic time like Saturday
• Give them plenty of space when they are playing next to another child, this reduces the chances of accidentally getting bumped or hearing noises perceived as annoying
• Don't let them be a loner, this is a sign of being over-whelmed. Pair them up with a calmer child on the playground or a calmer sibling at home

2. Sensory Seeking: these children can't seem to get enough of movement, touch, noise, etc. It is like they are driven by a motor. Adaptations include:

• Make sure they have lots of toys and opportunities for movement: swing set, trampoline, tunnels, bicycles, scooterboards
• Give a variety of opportunities for play during daily routines: bath tub toys while bathing, textured fabric on high chair seat or chair cushions, bag of toys to fidget with during car rides, bag of toys to fidget with while in a cart/stroller for shopping trips, etc.
• Look through catalogs that sell sensory integration products. There are many toys made especially for these children. Look for the words "vestibular" and "proprioception" equipment
• Let them sing songs with motions: "wheels on the bus" or "ring around the rosie" are good choices
• As you play with them, have them pretend to be an animal and set the room up for such. If they are crawling around pretending to be a bear, then add large pillows to the floor or crawl through tunnels. Make believe play is good, especially at home when you don't have the expensive sensory integration equipment that is at therapy clinics

Stay tuned for Part 2 to cover the other categories of SPD/ sensory processing problems. Also check out some ideas for working with babies with sensory processing problems at

http://www.sense-ablebaby.com/

Would finish now, but I am off to go play with my two children on the floor as we pretend to be snakes slithering on our bellies to provide imaginative play and tactile input to our bellies!

Back to the Basics: Breastfeeding

I just finished attending a 2-day conference on breastfeeding. Why did I attend this? Well, not only am I very pro-breastfeeding, but I am an occupational therapist who works alot with infants and toddlers with feeding problems. At all of the feeding conferences I have attended in the past along with other occupational therapists and speech language pathologists, much of the information is geared towards bottle feeding. So, I decided that I am going to learn more about breastfeeding. Now, I nursed both of my children for one year, so I knew some about the subject already. But after attending this conference, I realized alot about atypical situations and breastfeeding the medically involved child. I thoroughly loved the conference, and left knowing that I had done the best thing ever by nursing my two kids. Of course, we know that breastfeeding helps boost the immune system of the baby, reduces chances of breast cancer in the mom, and aids in parent-infant bonding and attachment, but there are also so many other benefits to it.

I just think it is so bizarre that in third world countries pretty much everyone breastfeeds, and the few babies who aren't nursed often don't survive. This is because the formula doesn't offer anti-bodies to the numerous diseases they are exposed to. Yet, in a developed country like the US, so many women don't breastfeed. Now, I can't judge women who don't. They have their reasons. And as I learned at the course, some women just can't produce breast milk for various reasons. But many of the women who can successfully lactate, choose not to breastfeed. Maybe that is because our society doesn't really promote breastfeeding like it should here in the US. Over in some European countries, breastfeeding rates are much higher, maybe because they can take a maternity leave up to a year.

The reason I named this blog "Back to the Basics" is because there is not one single baby formula out on the market that is superior to breastmilk. They can simulate the DHA and some of the other nutrients, but not all of them! The best thing for our baby is free, and no matter the country or the amount of salary you earn, you usually can lactate. It is so basic, yet here in the US we make it so complicated!

The only person or thing that cow's milk is perfect for is a baby cow (calf)! There are so many formulas out on the market because so many children can't digest a standard formula. There is formula for sensitivities, allergies, and lactose intolerance. But for those women who can't lactate or who choose not to breastfeed, I am thankful for the numerous choices so that babies can be as healthy as possible.

Next week when I return to work, I hope that I can help all of the babies with their feeding problems whether they receive breastmilk from a bottle or directly from their mom, or if they receive formula from a bottle or g-tube. My mission as an OT is to help the babies and their families to be as functional as possible.

So much of feeding is related to understanding the signals given by the baby. Some of these are discussed on my website: http://www.sense-ablebaby.com/