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.

Kindermusik Home | Toddler Preschooler Infant Children Music Classes

I'm a big fan of Kindermusik! I am lucky enough to live in a bigger city where there are multiple locations that classes are conducted. Their classes are so fun, and some include learning sign language!

Kindermusik Home | Toddler Preschooler Infant Children Music Classes

I have had many OT (occupational therapy) clients who weren't learning to talk with just speech therapy or developmental services, but did learn to speak after attending Kindermusik classes! Now, it is not designed just for the special needs child yet these children potentially can benefit greatly. One child I am thinking of who benefited is a child with ASD (Autism Spectrum Disorder), and at age 2 1/2 he was still mostly non-verbal except for saying "mama, dada, and hi". After attending a few Kindermusik classes he began humming, then with a few more classes he began to insert a few simple words into the song mixed in with the humming. At that time, he still was unable to express his needs and wants, but at least he was speaking! Then, during speech therapy sessions the therapist began to encorporate his favorite Kindermusik songs and instruments with more traditional therapy techniques. Within six months the child had a vocabulary of between 75-100 words, and was able to express some basic needs and wants...yeah! Once he turned three years old, he graduated the program (early intervention) that I work for so for a while I didn't know how he was progressing. Then, about a year later I saw him at a birthday party that my daughter was attending. I could not believe the difference in his language skills! He was not only expressing basic needs/wants and labeling items, but he was socializing with other children as long as it wasn't too loud in the room. Unfortunately, his sensory processing skills hindered his ability to stay in the room for some of the games and as the "Happy Birthday" song was being sang, but Wow had he made progress! I don't think Kindermusik cured all of this child's speech/communication problems, but it did jump start his ability to talk.

October is National Sensory Awareness Month

I have been happily surprised lately while talking to some of the staff at daycares and Mother's Day Out (MDO) programs where I work with some children for occupational therapy services. They ACTUALLY have heard about sensory processing disorder (SPD)...yeah, it is not a foreign concept to them! At one MDO program I was at last month, the teacher even asked me if I thought she should refer another child for an OT evaluation due to him possibly having sensory processing problems. Now before you get overly elated that the OTs in our community have done the most amazing job ever, I have to let you know that this woman has a nephew with Asperger's and SPD. But still, it was exciting to have her initiate the topic.

I live in a suburban area outside of a large city with a school district that is well known for its great support of children with special needs. In fact, there is a special program just for children with Autism Spectrum Disorders. You know what that means don't you? It means we have people moving into our district at increasing rates each year. It also means that many community members are more aware of learning disorders and other special needs than in some of the other places. Many of the preschools/MDO programs, daycares, and babysitter organizations go out of their way to be inserviced on learning problems and in particular SPD. Now, I am not going to go so far as to say us OTs and special education/ early intervention staff have done everything we can do to educate our community. Of course we haven't! Everyone can always do more.

If you would like some ideas on how to raise awareness of sensory issues in your community, go to this link that provides contact information for a free electronic packet full of ideas to help you:

S. I. Focus

Since October is National Sensory Awareness Month, I will be doing a little extra educating on the topic. I've already done a 90 minute presentation to the new staff at my job last week, and I plan to do something at least once a week this month to bring awareness to SPD.

I do public speaking quite a bit on various therapy related topics including SPD. One thing that I have learned is to keep it simple when explaining SPD to people who have never heard of it, but don't over-simplify it either. If you plan to go out in the community and speak to groups about SPD, then make sure you know your audience. A group of doctors may not need the same explanation as a group of elementary school teachers. Doctors tend to want to know about "proof" through research whereas teachers like to know the functional implications and simple strategies to help the children.

Good luck with spreading the word about Sensory Processing Disorder!

Occupational Therapy for Feeding Skills During Family Mealtime

I have a lot of therapy strategies up my sleeve when it comes to pediatric feeding disorders. Some of them include fancy positioning equipment, oral-motor devices, stretches, and textured teething toys. Some of my strategies even require that I become "certified" just to use them. Yet, the most effective strategy that I have found so far is to show up during family meal or snack time for children and during a scheduled bottle feeding for infants. It sounds SO simple, but it works!

For many of the children I work with they can perform a certain skill such as munching a soft diced vegetable if I was to give them just a couple of pieces in between some mouth exercises at a time in which they were not even hungry. They might even be able to hold a spoon if we practiced scooping up toys out of a sand box while we are playing in their room. But that doesn't mean they have the muscular endurance and sensory processing abilities to chew three different foods on the plate while using utensils to feed themselves. It is hard for many children with feeding disorders to handle more than one food due to the various flavors, temperatures, resistances, and textures. Additionally, they may be able to chew the food, swallow the drink, and manipulate the cup and utensils when sitting alone, but can't handle it when there are more people present. Why is that? Well, every child may have a different reason, and I am not going to know "why" unless I directly observe the meal within the natural setting: family meal time. If that isn't possible, then I observe snack time.

What does family meal time look like? It is different for everyone. I tell the families to set everything up as if I wasn't there. The meal may occur in front of the TV on the couch with one of the three siblings next to the child I am working with or it may occur at the dining room table with every household member present. I just want to see what naturally occurs during the meal time routine...there is no right or wrong. For some children they may not be able to participate in family meal time because of the noise level. For others it might be that they are sitting too close to a sibling that keeps inadvertently touching them. Even after I observe family meal time, I may still not know why the child is having difficulty with eating. That is when I watch the child eat a variety of foods while he is alone. If I figure it out, then we may work on specific skills separate from meal time, but even then the intention is to include the child in family meal time. Some children may need some 1:1 work with oral motor exercises, fine motor play, a "sensory diet", and other strategies immediately prior to family meal.

For those kids who can't handle eating with their family, maybe they could at least sit and socialize or just "be" there, even if they have to eat before or after everyone else. Just "being" with everyone else at the table might be the only way a medically-involved or tube-fed child can participate, and that is okay.

It breaks my heart when I find out that the child with the feeding disorder is not included in any form or fashion just because he has a feeding disorder. If the child's sensory processing abilities don't allow him to be with the rest of the family, then maybe he could help with meal preparation or setting the table.

For babies with feeding disorders, I show up for occupational therapy at one of their scheduled feedings and watch the parent (or caregiver) feed the child. I offer suggestions if needed. I may follow up with stretches and ideas for pacing, positioning, burping, and nipple/bottle changes. If the child is having alot of problems, then I may feed the child. But the problem with that is that babies that are oral feeders get usually 6-8 bottles a day and I am not going to be present for all of those feedings! So, the natural routine of the meal is going to be the adult holding the baby (or placing them in a device) while feeding him. Sometimes I do the first half of the feeding process for training purposes, and then after the baby has burped I will have the parent try to do the same things I did. After all, feeding your baby is the most basic thing that every parent wants to do successfully!

I guess my biggest "take home point" from this blog entry today is try to work with the child within the natural routines. If the strategies given to the family aren't meaningful to them and feel like extra work, then they will not work on them between the therapy visits. On the other hand, if the strategies are purposeful and occur within routines they already have, then the family is more likely to use the therapist's ideas.

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.

How to Improve a Toddler's Balance & Vestibular Processing Skills During Play | eHow.com

Typically developing toddlers like to defy gravity whether it be spinning around in Daddy's arms, swinging in the backyard, or jumping on the bed. But when a toddler has consecutive ear infections, sensory processing disorder, low muscle tone, or any other thing that impairs balance, movement may not be so fun for them.

Below is a link that gives ideas to add movement into a toddler's play routine:

How to Improve a Toddler's Balance & Vestibular Processing Skills During Play | eHow.com

The vestibular system, located in the inner ear, is in charge of balancing the body every time the head moves. Muscle tone, bones (orthopedic alignment), nerves, and the eyes also have a big role in balancing too. If something is wrong with any of those body parts, then the person can have poor balance. So, if your toddler is absolutely terrified of movement in some directions no matter what you do, then he may need an occupational or physical therapy evaluation to determine the cause.

Expanding Food Choices of Toddlers

My 25 month old son used to eat "everything under the sun", but over the last three or four months he has been a bit pickier about his food choices. At times, he refuses foods he typically likes. Unfortunately, this is part of being a toddler and exerting his independence. Since I know that, I still offer the food but I don't create a power struggle. If he tries to throw the food, I just tell him to keep the food on his plate. Looking at it on his plate reminds him that the food still exists. Typically, he will eat that food a different time, so at least he still eats it sometimes. Now, if I weren't an occupational therapist who works with toddlers I might approach the situation differently, especially since I came from a home where we were told to eat everything on the plate or we couldn't get dessert and/or couldn't get up from the table until the plate was clean!

One thing that seems to work on introducing new foods to my son is having him sit at the table next to his older sister and watch her eat. Thank goodness she isn't a picky eater! Until this week, my son wouldn't eat green beans (BTW I don't like them either). But my daughter LOVES them, so I cook them at least a once every 7-10 days. Over the last couple of months, he went from saying "no beans" to allowing them to sit on his plate without saying anything; then he progressed to touching them and bringing them to his lips. Well, on Monday night I cooked green beans and he ate two of them willingly as he watched his sister eat them...yeah! Then, the next evening I heated up some left overs and not only did he eat the 5 beans I gave him, he asked for more of them without being prompted...yeah, again!

I think toddlers learn from older children whether it be a sibling, cousin, neighbor, or another child at a babysitter's home or a daycare. So consider pairing up the picky toddler with the not-so-picky eater who is older during snacks and meals. Even if it doesn't help right away, the child is looking at the food. Research shows that parents and caregivers give up to easily on getting a child to eat a particular food, and that on average it takes 10-15 presenations of that food before the child will like it. Now, if you force the child to eat it, I can almost guarantee it will take even longer! Toddlers like things to be their idea not yours, and repeated offerings of a particular food increases the chance that one day that toddler will choose to eat it. I do think there comes a point where you may have to conclude that the child just doesn't like that food for whatever reason: color, smell, shape, taste, texture, etc. After all, I don't like every food on the planet either!

Other ideas to expand the food choices of toddlers include:

- Don't get in the rut of fixing the same meals over and over. Not that it isn't okay to repeat some of the same meals, but introduce new foods as often as possible. This may take planning ahead so that you have new foods in the pantry and refrigerator. Even mixing meals up helps somewhat, for example: sometimes corn is served with chicken and carrots, and other times it is served with turkey and rice. This helps reduce the rigidity that some toddlers tend to exhibit.

- When offering new foods, try a food that is similar to a food the child already likes. For example, if the child loves Gala apples, then try different types of apples such as Macintosh, Fuji, and Golden Delicious. Also, pears have a similar taste to apples too. Another example might include that if the child likes plain apple sauce, then try cinnamon apple sauce or peach apple sauce; the taste may differ slightly but the texture will be the same.

- Be creative and fun with snacks and meals. Using cookie cutters to cut sandwiches into child-friendly shapes worked like a charm for getting my daughter to eat a turkey sandwich for the first time back when she was a toddler. After doing this for 4-5 times I just presented her with a plain sandwich, no special shapes, and she ate it just as quickly as if it had been in the shape of a heart. Other ideas might include drawing smiley faces out of ketchup onto a piece of meat and putting food onto a plate with the child's favorite character on it.

-Make sure every meal has at least one food that the child likes and don't force him to eat the others, just encourage it. At the very least, the child needs to look at it and smell it. Now, if the the child has an autism spectrum disorder or sensory processing disorder, then just being in the same room as that smell may be all they can handle at first, but the ultimate goal is getting that food on the child's plate so that one day he may actually eat it and like it.

- Have the child help cook the meal. When I make home-made pizza both of my kids help. My son obviously can't help as much, but he rolls out the dough with the rolling pin whereas my daughter can spread the sauce. I leave the oven light on as it is cooking for them to peek at here and there, and both kids are super excited about eating the meal by the time it comes out of the oven.

-Encourage the child to eat healthy foods such as fruit and vegetables as opposed to fried fast food. This means be a living example, because "monkey see, monkey do"; so if the rest of the family eats junk food and is picky with vegetables, then the toddler won't be any different unless the other familly members change their habits. This lifestyle also sets the child up to be at risk for obesity and diabetes. Type 2 diabetes in children is on the rise, and it could be prevented by healthier lifestyle and food choices; on the other hand, type 1 diabetes is acquired in childhood (usually) and isn't due to being over-weight.

- If your child has feeding difficulties due to sensory or motor problems, then consult with an occupational therapist or speech pathologist who specializes in feeding. Not all therapists are experts in feeding, so shop around until you find a good fit!

- Read the book "Food Chaining" which is written by feeding specialists and gives great ideas on how to introduce new foods slowly. If the child is just a picky eater with no oral aversions or oral-motor problems, then suggestions from this book alone may help. If there is something more going on, then direct therapy intervention should be considered.

Wow, all of this talk about eating has made me hungry for a snack...got to go!

Amazon.com: IQ Preschool Lace up Pup: Toys & Games

Stringing beads isn't as easy as it looks. It takes two hands, and each one has to do something different than the other one. Then, if it is a fat string and a small hole, it requires shifting repetitively with the thumb and index finger. So many of the little children I work with can't string beads whether it be due to stiff fingers, weak muscle strength, low vision, or a poor attention span. That is why I am always looking for toys that are adapted or easier for a special needs child to succeed. A few years ago while I was at an OT home visit, I fell in love with the lace up pup toy that the little boy had in his toy box. It has large holes which makes it easy to stick the lace through. It also has a wooden "needle" at the end to help the string go in the hole better, as well as tucking it back through the end when you are finished with the activity...no more lost beads! Here is a link that has a picture and purchase info:


Amazon.com: IQ Preschool Lace up Pup: Toys & Games

I own the pup, but it also comes in a snake. My two year old son loves to play with it. When he lets me sneak it away from home, I take it on home visits to use with some of my clients. "Testing" toys out allows the parents to decide if they want to go buy it or not...I always hate to suggest buying a toy unless the child has tried it out first. Lately, I have seen children with diagnoses of cerebral palsy, down syndrome, and autism be successful with this toy whereas they weren't with other stringing bead sets. I'm not making any money off of suggesting this link, it just happens to be one of my favorite toys in my "OT bag".

What Is Dyspraxia? How Is Dyspraxia Treated?

I was thinking about dyspraxia today. Mostly because I was watching my 2 year old imitate nearly everything his older (6 yrs) sister did. This morning, he didn't want to eat his apple until he saw her eat an apple. He didn't want to brush his teeth until he saw her do it. Then, as they played upstairs it seemed like he had no problem joining her play and doing what she did. As they were stacking blocks, she decided to get creative and build a "telephone" out of the blocks. Once finished, she "talked" on the phone. I expected him to build a car or house as he usually does, or even attempt to imitate her telephone structure...but he didn't. He built a camera. That's right, a camera! It caught me off guard when he came up to me with his connected blocks, put them to his eye, and said "cheese". I laughed of course, and told him I liked his camera; he then repeatedly said "camera'.

This whole scenario would be too difficult for some of the young kids I work with, for various reasons but mostly due to poor motor planning (aka dyspraxia). Good motor planning includes the ability to imitate another person's actions as well as sequencing out the steps to a new task and making coordinated movements with the body. All too often young kids with developmental disabilities have to be taught how to play, so the above scenario would be hard. It took visual memory, expressive language, motor planning/sequencing, imitation, sensory processing, fine-motor, cognition, and social-emotional skills. For a checklist of detailed signs and symptoms of dyspraxia for various age groups go to:


What Is Dyspraxia? How Is Dyspraxia Treated?

I've seen many kids with dyspraxia make huge gains, especially when their family and school understood what it was. Often, extra repetitions of teaching a task, patience, and lots of sensory input help the child learn. Occupational therapy is usually beneficial, and since some of the children have language delays also, they can benefit from speech therapy. It is important to find something the child is good at to boost their self-esteem. This doesn't typically include a sport such as soccer that requires the person to motor plan their actions against a moving ball and other moving people. Sometimes non-competitive activities such as karate, piano playing, and art classes are beneficial.

Responding to Toddlers Who Bite

About 9 months ago, my 23-month old son began biting his sister when he became frustrated. Then, once he became more verbal the unwelcomed behavior faded away. Also, when I was able to figure out why he was mad, I would label what he was thinking, and that reduced the biting. So, if his older sister was playing with a toy he wanted, and I saw "that look" on his face, then I said "my turn" as I helped him point to himself and then had her share with him. So, in my son's situation the biting was due to him lacking the language skills to express what he wanted to say. Many of the kids I work with for therapy bite for the same reason, but others bite for other reasons. Here is a link to Zero to Three's website providing information on toddler biting and how to redirect it:



Zero To Three: Chew on This: Responding to Toddlers Who Bite

Out of the blue the behavior popped back into our lives again. Just yesterday, my son tried to bite my arm. This time it wasn't due to lacking language skills, it was because he was mad at me. He was playing at his train table, and I said "Let's go bye-bye". He didn't want to go, so I picked him up whereas usually he walks over to the door, and then that was when he attempted to bite me. But I caught him in time, and turned his face away from my arm. I then labeled his feelings and said "You are sad that we are leaving. Bye-bye trains and cars." He waved goodbye to his toys and then was happy again. My son is usually a happy-go-lucky toddler, but those "terrible two's" take over from time to time. But the nice thing he is usually redirectable or distracted easily. Us Moms and Dads have to be one step ahead of our little toddlers to help diminish those unwanted behaviors!

The Zero to Three link I provided above is not geared at children with developmentally delays or special needs, but I think the information still applies. Yet I also think there are other reasons for biting and undesirable behaviors with special needs kids including side effects to medication, seizures, and pain (from gastrointestinal discomfort, headaches, or other medical problems). Additionally, many of these children have multiple developmental delays which means a simple task such as completing a formboard puzzle or playing at the park takes more effort than it does for a typically developing child. By the end of the day, these young children are exhausted and it doesn't take much for a tantrum or "meltdown" to occur.
If your child receives occupational, physical, or speech therapy, be sure to discuss the undesirable behaviors and see if they have any suggestions.

Improving a Toddler's Balance & Vestibular Processing Skills During Play

My 23-month old son is like most toddlers, he's busy and likes to climb. If I leave the room and return a few minutes later, I am likely to find him standing on a chair or behind the couch. Yet, even though he loves to be in motion, he sometimes still falls. The good thing is, he doesn't fall as often as he did when he had just learned to walk. But, somehow he gets "bobos" on his forehead at least once a month.

Many parents ask me "How do you help a toddler's balance skills?". Well, first of all, know that most toddlers still fall from time to time, but if a child is falling excessively then discuss this with the pediatrician. If that doctor feels that the toddler is falling excessively, then maybe a physical therapy (PT) evaluation will be suggested. PT can look at to see if there are any possible problems orthopedically, neurologically, developmentally, or with the child's level of strength. If these problems have been ruled out, then the child's sensory processing skills should be evaluated, in particular the vestibular system. This can be done by either a PT or occupational therapist (OT), depending upon the therapist's training. The vestibular system has receptors in the inner ear that detect which direction the head (and body) is moving. The possibilities for directions of movement include: up-down, front-to-back, side-to-side, upside down, and in circles. If a child has difficulties processing vestibular input, it may be because he over-reacts, under-reacts, or overly craves the input. Examples of overly reacting would be the child not wanting to be tossed in the air or being scared of swinging. An example of under-reacting, would be a child who seems lethargic and needs extra time running or jum[ing to detect that he is moving. In comparison, a child who overly craves vestibular input can be described as the "Energizer Bunny", and doesn't seem to tire of the motion. Although toddlers should like to move around some, eventually they should move onto to a sit down activity such as rolling cars, feeding a doll, or stacking blocks. A toddler who overly craves vestibular input, may not be able to focus while staying seated more than 20 seconds. Vestibular problems may also be because the child has poor: postural control, the ability to discriminate the input, or an ability to motor plan his actions. An additional problem could be visual processing and/or a poor ability to see far or near; if this is the case, the chid should be evaluated by an eye doctor. For more on understanding sensory processing problems in toddlers or older children visit: www.spdnetwork.org and www.sensorysmarts.com and for more on understanding sensory processing problems in babies visit: www.sense-ablebaby.com

Also, I wanted to share this article that I wrote almost 9 months ago on an informational site. I purposefully simplified the description of vestibular input so that the average person could understand it. It gives ideas on how to help with balance and vestibular processing for toddlers:

How to Improve a Toddler's Balance & Vestibular Processing Skills During Play | eHow.com

I purposefully kept the list of activities simple and short, and suggestions are things that can be done anywhere not just in a therapy clinic. Feel free to comment on any fun ideas you have found that help to develop balance and stimulate the vestibular system. The more ideas, the better!

When It's More Than Just A Cleft Lip and Palate

One of my childhood friends had a baby a few years ago that was born with a complete cleft lip and palate (unilateral). Luckily, after several surgeries and speech therapy, the young boy caught up with his development. But some families are not as lucky. Sometimes there are more things going on with the child. Often, these things are obvious such as heart or kidney defects, genetic syndromes, or neurological impairments. Other times, the problems are mild so it takes longer to get noticed; even the ones that are genetically linked. I'm not sure if the pediatrician doesn't refer the children for genetic testing or if the family doesn't find it necessary to meet with a geneticist.

Since cleft lips and palates may occur due to a neural tube defect that takes place during the first trimester of pregnancy, other parts of the body- especially in the mid-line may have not been formed properly either. Somethings I often see in children with cleft lips and palates include dysgenesis of the corpus callosum, global hypotonia, poor crossing of midline, swallowing problems (esophageal), and strabismus (eyes turning in). These children luckily get referred for occupational therapy (OT) and/or physical therapy (PT) in addition to speech therapy. The ones who do not get referred right away are often the ones with mild hypotonia and incoordination on both sides of their body; maybe they are just a little behind with their fine-motor and gross-motor skills as a toddler or preschooler. If this is not addressed, these children approach school with a disadvantage and all of the sudden a mild delay that is not addressed becomes a significant delay. This is when it is helpful to have a speech therapist (SLP) who knows alot about motor skills so that they can properly refer to PT and OT. If you are a parent or SLP who is wondering when it is appropriate to refer to PT/OT, then consider the following:

- Can your child keep up with his/her peers at birthday parties, playgrounds, or other group situations? Does the child fatigue easily?

- Can he/she jump by age 2 1/2? Ride a tricycle by 3 y/o? Do jumping jacks by kindergarten?

-Can the child play in a variety of postures: on the belly in the floor, in side-sit, ring-sit or criss-cross, long-sit, or kneeling?

- Does the child have a hand dominance by preschool age? even when there is a dominance the child should be able to use both arms and legs as well as cross the middle of the body. Does the child ignore one of his hands or efficiently use 2 hands such as to throw a ball and manipulate interlocking blocks? Does the child rotate his body in the chair to avoid crossing the midline of the body?

-Can the child feed himself with utensils age-appropriately? hold a cup?

-Is the child's pre-writing or handwriting skills delayed or sloppy?

If the answers warrant concern, then it is suggested that your child receive a PT and/or OT evaluation. After the evaluations, the therapists can discuss if therapy intervention or home exercise program are needed.

Ideas For Developing Coordination On Both Sides Of The Body

I often work with little kids who have cerebral palsy (hemiplegia, diplegia), peripheral nerve injuries, a stroke, or for whatever reason are stronger on one side of their body than the other. Below are some ideas for encouraging them to use both hands and/or feet:

1. Ribbon Dancers: long wands with ribbons on them. You can have the child carry one in each hand while you do the same, and then move the wands around imitating each other.

2. Zoom Ball: a ball that slides along two parallel strings with handle bars at each end. This activity takes two people, but is SO fun, because as one person closes their arms to catch the ball, the other has to open their arms to send the ball to the other side.

3. Rolling pin to roll out play-dough or cookie dough, then use cookie cutters

4. Mr. Potato Head: one hand is used to hold Mr. Potato while the other is used to insert the pieces

5. Imitating animals: bear crawl, dog, donkey kicks, slither like a snake

6. Scooter board: child lies on his tummy and propels self with both arms

7. Step in paint and walk across butcher paper to do feet art; could also do this with water out on the sidewalk, but of course this artwork will dry up from the sun

8. Obstacle course: climb up, crawl over or through things, jump forward or backward

9. Pushing objects such as large boxes or containers, laundry baskets, strollers

10. Bicycle

11. Yoga: kids yoga books and DVDs are usually easy to follow along

12. Songs with motions of the arms and legs: If You Are Happy & You Know It, Wheels on the Bus, Twinkle Little Star, Little Bunny FuFu

13. Roll cars with one in each hand. The cars that are to be shaken first are fun

There are so many more things that can be done to encourage using both arms and legs. Use your imagnination and you will be able to come up with so many more! Also, ask your child's physical and occupational therapist to give you some exercises and games to work on in between therapy sessions.

Improving Balance Through Simple Play

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

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

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

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

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

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

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

Defying Gravity...Carnivals Should Be Fun!

Today my family of four along with my sister-in-law went to the carnival. Within the "kiddy" section, there were simple rides like the carousel but there were some more gravity-defying rides as well. My husband enjoyed riding the rides with my 6 year old daughter while my 21-month old son stayed in the stroller and I took pictures of everyone. But I did manage to get on one ride with my daughter, and boy was it fun! It was a ride that went in a circlular pattern while the kids/adults layed two people to an "airplane". While on our airplane, we were lying on our bellies and strapped in from behind. Not only did the ride go in a forward circular pattern, but it also went up/down making you feel as if you were "losing your stomach". Now, I grabbed my little one's hand, because I was thinking she may freak out. But I was wrong, she squealed with laughter. She had so much fun! And she should have. Once kids are of a certain age, they should think it is so much fun to move in various ways against gravity. It is not uncommon to see a toddler trying to be upside down off a couch or jumping off of furniture!

There are five directions to move within space: up/down, forward/backward, circles (rotary and axial), upside down, and sideways. Swinging on a swingset back and forth is a simple way to move, whereas riding the carnival ride today as described above was more complicated because it combined movements. When we move in these various directions, vestibular receptors in the inner ear are stimulated. The vestibular system can be a tricky sense. When a person has an ear infection or vertigo, this system can go haywire and throw the person's balance off. It is quite scary to feel off balance. That is why some kids with vestibular disorders don't like carnival rides. In fact, some would probably whether do anything but get on that ride!

If you have a child who doesn't like to play at the park on the swings, slides, or climbing devices, it is possible that he has difficulties with vestibular processing. If the child also has a gross motor delay or falls often, this should be discussed with the child's physician. Physical or occupational therapy services may be necessary to help the child. It may seem trivial when the child is only 2 years old, but if the problem is not corrected, the child ends up being a grade schooler who can't ride a bike or roller skate with his peers. He may also be the type who is clumsy, making him be the last one chosen to play games during school recess such as for soccer or dodge ball. If you suspect that your child has problems with vestibular processing, it is definately worth checking out.

Some other signs of the problem could include: low muscle tone, delayed development with two handed activities, clingy to parent when should be playing with peers (especially at birthday parties), fatigues easily, scared to sit in chair or on potty due to dangling feet, short attention span, and delayed eye-hand coordination. Those were all symptoms of kids who are over-responsive to vestibular input or who have sensory based motor disorders. Kids who are under-responsive are more lethargic and passive. Kids who are sensory seekers are described as the energizer bunnies and can never seem to get enough movement unless they are asleep. Some of these kids are even known to tire out the family's energetic dog! They tend to jump from high surfaces, fidget, and spin around. All of this over activity needs to be directed, especially if the child has a language or fine-motor delay. These children may or may not have a sensory processing disorder (SPD, AKA sensory integration dysfuncton), but should be checked out by a therapist. I don't think that every child with the above-mentioned symptoms necessarily has a vestibular disorder, there could be other things going on including neurological deficits, other disabilities, or environmental factors. An example of an environmental factor is lack of or decreased stimulation such as being at home all day with a mom who is on bedrest and can't help the child get the necessary exercise he needs, so he overly seeks out movement such as jumping off of high surfaces. This is the case where it is well worth it to pay extra for a young babysitter to come over to play or to invest in a mini-trampoline for the living room. So, not every referral to a therapist will mean the child needs intervention, but maybe at least some ideas can be generated for helping the child.

Simple Strategies to Help with Plagiocephaly

Plagiocephaly is a fancy word for mis-shapen head. It can happen for many different reasons in a small infant, especially since their heads are malleable and change shape easily.

My now 20 month old son had a slighly flat spot on the back of his head because he was positioned upright and reclined which put pressure on his head. We had to position him like that due to his severe reflux. I think the flat spot would have been worse had I not put him in "tummy time" so much of his waking hours. Of course, I couldn't lay him in this position until at least 45-60 minutes after a feeding or he would vomit. Once he got around 5-6 months of age, he would roll over and sleep on his tummy. By 7 months he was crawling. These things in addition to all of the reflux medications he was on contributed to a better head shape by 8-9 months of age. His head shape was never severe enough for a helmet. But I explained his situation to indicate how easy it is for a child's head to get mis-shapen and back to being okay.

Often, a baby with torticollis or neurological damage is prone to plagiocephaly. Also, babies with medical problems who aren't able to move age-appropriately, such as preemies, those with heart defects, and babies who have had multiple surgeries. Another reason can be being a multiple (twins, triplets, or more) or a large baby born to a petite mom; this is because there isn't as much wiggle room and they may get stuck with the neck and head in an awkward position.

If your child has been diagnosed with plagiocephaly then hopefully he/she is getting occupational and/or physical therapy services. Therapy can help with neck/trunk strength, stretches, and massage as well as helping with any necessary adaptive equipment to help reposition the baby.

Some simple strategies to help when the head is mis-shapen on the left or right side:

-switch the way the baby is carried, sometimes over the left shoulder and sometimes over the right

-switch the way the baby is held when being fed, sometimes on your right side, other times to your left side

-when using a changing table for diapering, alternate which end the baby's head is at, this helps the baby to look in different directions

-move positioning equipment within the room: bouncy seat, bouncers, swings, etc. so that the view is not always the same for the baby

-when approaching the baby as he/she is in a device or on the floor on a blanket, come from different directions to help the baby look to each side as well as overhead and to the front

-don't sit the child in a Bumbo (R) seat or standing bouncer before he/she has the trunk control to be in it. This is also the case with Jumparoos (R) and Johnny Jump Ups (R). If the baby doesn't have enough trunk or head control, then he will lean to the side which only perpetuates the asymmetry of the head

-offer the baby toys to each side of him wherever he is: swing, floor overhead gym, carseat, on tummy on blanket on floor, etc.

-get down on the floor and play with the baby, sometimes be on his right side, other times on the left or to the front

-infant massage indirectly initially such as to the belly or legs, and then if tolerated to the chest, neck, and arms

-follow through with all exercises/stretches given by the PT and/or OT. Be careful about getting aggressive stretches off of the internet, because depending upon the etiology of the plagiocephaly these stretches could be hurting the baby

Final thought: if your child's doctor prescribes a helmet to help with head shape, then by all means get a helmet and use it the suggested wearing schedule (usually 23 hrs a day). I have seen some amazing changes in head shapes of babies with helmets.

To see pictures of plagiocephaly and helmets, visit www.cranialtech.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.

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!

Abnormal Muscle Tone: Functional versus "Pretty"

When children have abnormal muscle tone such as tight muscles (spasticity) or tremor-like motions (ataxia), then the motions that they make may not exactly look pretty. This is because there is damage somewhere within the neuromuscular system whether it be in the brain such as with cerebral palsy or at the cellular level of the muscles such as with muscular dystrophy.

Back when I had just graduated from therapy school, I went to numerous classes on learning how to improve a patient's muscle strength, tone, and movement patterns. It was my mission to help everyone look typical. That was soon found to not be so realistic. And although a difference can be made with mildly involved persons in a fairly short time, it may take a while for very involved patients such as those who have suffered a TBI- tramautic brain injury. This is because of numerous reasons (medical, neurological, orthopedic, cognitive, behavioral, etc.). So, until their movements look stronger what are we to do? Well, I believe the therapist's duty is to work on functional skills.

For example, I would love for a child with cerebral palsy to hold the spoon perfectly and not spill any food, but that may not be realistic in the short term...for some kids, it may never be realistic. The immediate goal should not be to not let the child feed himself unless he has used the "proper" movement patterns, but instead to make sure the child is functional, even if that means that the movements do not look "pretty". It may mean using a wide handled, curved, or swivel spoon. Although the ultimate goal as a therapist is for the most efficient movement patterns by each muscle group during a functional task, this can take time to develop, and requires daily strengthening. Maybe it can be practiced during snack or at the end of a meal, but it would only frustrate a child to be helping them move "properly" during every single bite. Yet, as a therapist why is it so hard for me to just sit back and watch a sloppy eater? I have had to chill out and realize that I am being a much better therapist by encouraging independence even if the movements aren't the prettiest.

Also, responsibility goes to the parents for carrying out daily activities and exercises to help the child improve. I wouldn't just go to the gym once a week and expect to gain a better figure, so how could we expect that a child with neurological damage is going to improve with tone and strength by only going to therapy once or twice a week? The therapist MUST train the parents to do easy activities and exercises to incorportate into daily routines. Examples include having the child push the siblings stroller to build arm and leg strength, buy toys that encourage manipualtion, carrying grocery bags, "rough house" with parents, taking the child to the park to work on climbing, sliding, and swinging, and the list goes on.

Finally, we as therapists need to know when it is time to discharge a patient from services and guide them to community facilities such as karate or gymnastic lessons. There are some children who have endured years of therapy at a high frequency and although overall they have made gains, there comes a time when those gains aren't so drastic. It could be due to hormones, growth, attitude, needing a change, or that there is just an extreme amount of neurological damage. No matter the reason, I completely believe that it is okay to discharge a child from therapy even if all of his movement patterns are not "pretty". Now, if the child is willing to do all of the work it takes to get stronger and change movement patterns, then I might keep them in therapy longer. But I would still emphasize function. If the child wants to be an artist, then we would work on movements that are made at an easel. If the child wants to be a secretary, then we would work on typing skills whether it be with two hands on a typical keyboard or with a device on an adapted keyboard. I would also work on movement patterns needed to play, cook, clean, dance, or participate in sports.

W-Sitting

Every picture my parents took of me sitting on the floor below the age of 4 years shows me "w-sitting". What is w-sitting? It is when the child sits on the floor with his knees bent and his ankles are right next to his bottom...as if he had been kneeling and then just relaxed the feet out to each side. It is termed w-sitting, because looking at the child from a "bird's eye" view, the legs look like the letter "W". It is not good on the knees, hips, or feet. In fact I have awful knees probably because I was a big time w-sitter! They squeak when I bend over or walk up the stairs. If I go to aerobics class or walk a far distance, my knees ache for the next 3 days to the point that I can't sleep without pain medicine. So, I am not a fan of letting a child remain in a w-sitting posture for long lengths of time. I am now in my 30s but was told back in my 20s to quit jogging and aerobics classes or my need for a knee replacement would be sped up. So, I stick to biking, pilates, and yoga....wow, do I miss the adrenaline rush of a nice jog!



W-sitting is a posture that babies and toddlers use briefly as they move in and out of various postures. Little ones move so quickly, you will often see them transition from crawling, to sitting, to kneeling, to standing, back down to the floor, etc. So, w-sitting is not bad in and of itself. It is only not a good position if the child remains in that posture for long lengths of time, such as while playing with puzzles or watching television for 10 minutes. It puts unnecessary pressure on the knee joints and contributes to pronated feet (caving in at the ankles and collapsing at the arch). It can alter a child's balance and even make their gait look funny, especially while they run. My daughter tended to want to w-sit as a baby and toddler, and I had to redirect her quite often. I took her to a co-worker (at the time) who was a physical therapist and she gave us stretches and used kinesiotape to help with leg alignment.



Why do children w-sit? Most of the children use this posture because it is easy...it is less work for the trunk muscles because it widens their base of support. Some kids just prefer it just because. But many kids prefer it because they have low muscle tone (AKA hypotonia) or muscle weakness. It is common to see children with developmental disabilities such as cerebral palsy and down syndrome w-sit. I think that my daughter and I have mildly low muscle tone so that is why we have both been w-sitters. It is not uncommon for me to walk into a daycare (I do early intervention OT in natural environments) and see typically developing children using this posture. It does make me cringe, and oh how I want to correct the child. But I can't if the child is not my client. I can however educate the daycare staff about how w-sitting is not a posture that benefits children's gross motor development.



The following are some suggestions that I have found beneficial in reducing w-sitting in a baby, toddler, or older kid.

• For a baby, just correct their posture by placing them in kneeling, criss-cross (AKA Indian style for those of us raised in the 1970s & 80s), or a side-sitting posture
• For toddlers and children, encourage them to sit at a kiddy table and chair while performing fine motor activities such as coloring and puzzles. It is almost impossible to w-sit in a chair
• While the child (not baby) is playing on the floor, have a stool, bench, or tray (like a "breakfast in bed" tray) available. Have the child slide his legs under the device. Because these devices have "legs" or sides, then it increases the chances that the child will sit with his legs out straight to the front of him.
• If the child is in the "terrible twos" stage or is the type who likes control, then give him choices. When you see him w-sit, say "Would you like to fix your legs by sitting criss-cross or legs to the front?"
• Make up a silly song as a reminder. I made up a song titled "Legs in Front" to the tune of Frere Jacque. Then, as I only hummed the tune, my daughter was reminded of correcting her legs out of w-sitting
• Place toys to the side of the child so he will need to reach out of his base of support. This typically encourages a child to side in a side-sit posture (both knees are pointed towards one side or criss-cross style.
• Try not to nag the child by constantly saying "fix your legs" or picking them up and placing them in another posture. I find it best to set up the environment for success by using some of the above-mentioned ideas. Don't redirect the child if he will only be in the w-sit position briefly...if you do, he will tune you out everytime you redirect him...not good!
• There are probably many other ways to help with w-sitting but these are some common ones that I use
• If it is severe enough of a problem, then the child probably needs a physical therapy evaluation. The PT may suggest certain stretches, therapy techniques, furniture, or shoes to help the child
• If the child has sensory processing delays in addition to the low muscle tone, then the child may benefit from an occupational therapy evaluation. At http://www.sense-ablebaby.com/ there is loads of information on sensory processing problems seen in babies and some ideas to help.