Helping Young Kids Accept Touch To Their Mouth

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

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

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

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

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

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

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

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

Setting Up the Environment to Help Young Children Focus Longer

Babies and toddlers are well-known to be active and not wanting to sit still for too long. But they should be able to focus on activities progressively longer as they approach their 2nd birthday.

My 18-month old son can sit 10 minutes looking through a basket of "gadgets", 5 minutes looking at a simple book or rolling/bouncing a ball with someone else or himself, and about 15 minutes watching an Elmo (R) video before he starts wondering around. If he is interested in a manipulative toy, he may sit there for quite a while and figure it out, take it apart, then put it back together. But overall, he is "all boy" preferring to run, climb, and just tinker around. I definately have to be careful leaving the room for too long (e.g. like to go to the bathroom), or I'll come back to find him standing on the dining room table! This morning he spilled his Dad's cold cup of coffee all over the floor...thank goodness for the steam vacuum! We didn't know he could reach that high, but apparently he can...so glad, it wasn't a freshly brewed, steaming hot cup of coffee! It's not that I wasn't watching him, but I had only briefly turned around. Man, are toddlers quick!

Toddlers with special needs or developmental delays often have even shorter of an attention span and ability to focus than their peers who are typically developing. Below are some strategies to improve their ability to focus during play time:

1. Declutter the room by putting toys in containers, baskets, and the toy box. Leave out the larger toys and a few of the favorite toys though. My experience is that if there is too much out on the floor or the room is "chaotic", then the child will walk past the toys or be too overwhelmed to know what to pick out. When children don't interact with the toy and aim around aimlessly they may get destructive; at the very least, they are not spending time gaining important developmental skills. Now keep in mind, there are some children who are the opposite, they are too passive, and in that case, leave more toys sitting around, but not messy! If toys aren't out, these children won't going exploring and prefer to just sit there.

2. If the child is visually overwhelmed easily, then have play time in a room with less furniture and "things", such as in a spare bed room.

3. Make sure the child is getting lots of opportunities for gross-motor play, so that he will then focus for toys that require him to sit or stand still such as books, puzzles, train table, block stacking, etc. Indoor gross-motor play ideas include: rocking horse, tunnel, mini-trampoline, pulling wagon full of toys, and bouncing on exercise ball. Outdoor gross-motor play ideas are endless including riding a tricycle, swing, slide, and kicking a ball.

4. Provide toys that aren't too simple but aren't too difficult. Toys that can be played with in more than one may increase the chance that the child will play with it longer. Store "baby" toys out of sight!

5. Get on the floor and play with the child! If the child has limited play skills, then teach him how to play! That way, when you need an extra moment in the kitchen or bathroom, the child will know how to play with himself for a longer amount of time.

Now, go ahead, go play!

Teaching Toddlers How to Play with Toys

Shouldn't all kids just know how to play? Not necessarily. Some kids can fiddle around with a toy and figure out what to do with it. Others learn by watching another child and then imitating what that other child did. For some children, especially those with developmental disabilities, they don't learn by either one of those ways. They must be taught, and even then the lessons need to be broken down into simple steps. These steps may need to be repeated an hour later or the next day. For children with muscle tone or orthopedic abnormalities, the difficulties in learning may be due to fatigue and mechanics. But eventually, with repetition and patience, the child can learn how to play.



Quite often when I am asked to "come look at a toddler" at work and give my advice to why this child is behind in his development or he has destructive behaviors such as breaking toys, throwing things, or tearing apart other household items, I realize that the child doesn't know how to play. So much of a typically developing toddler's time is spent in play. But some of the toddlers with a delay in development are running around wild, just sitting there doing nothing, watching TV, or "getting into trouble". If they do play it may be limited such as only playing with certain toys and being perseverative in the way they play. An example of perseverative or controlling play is when a child insists on stacking blocks and doing nothing else with the blocks. If someone tries to help them make a house or train with the blocks, they get upset. This is because they have such a limited repertoire of how to play. When some of these toddlers get bored with the same old toys or not knowing how to play, they may become destructive. These behaviors the toddler has would be diminished if he just knew how to play.

That is when I come in to the picture. This means I need to be an investigator and figure out why this toddler is acting up. Is he bad because he is evil? Most likely not. I find that very rarely is there not a reason for a behavior problem. Reasons include: seizures, developmental delays (especially language- receptive and expressive), food allergies, and plain ole' not knowing how to play with toys.



Before parents are able to say "Go play with your toys" to their toddler, there are some things to consider:

• What is the child's physcial and cognitive abilities? Figure out is it really reasonable or not to expect this child to do such a thing. Does the child have the manipulation skills, muscular endurance, and problem solving abilities to play with the toys that are there.
• Can the child make choices? If he can't make choices when you verbally ask a question such as "Do you want to play with the puzzles or the trains?", then he isn't going to say this to himself and go choose an activity unaided when you go ask him to play.
• Is he motivated to play with the toys he has? If he is 2 years old and still has baby toys as opposed to "big boy" toys, then he isn't likely to go play with the toys.
• How long of an attention span does this toddler have? Do the toys require a longer attention span than he has (e.g. game boards, intricate puzzles)?
• Is there some structure to how his toys are kept and organized? If the toys are just dumped and scattered around, some toddlers are too overwhelmed by this to figure out what to go play. However, if they had toys kept in containers, shelves, baskets, or a toy box they may be more likely to know which toy to play with, especially if the adult guides them to a certain container.
• Has the parents, caregivers, or other adults in the chld's life spent enough time getting down on the floor and playing with the child? If not, then why? If it is because the adults don't have time, then make it. If it is because the adults don't remember how to play, then go get one of the many books out there on toddler games and toddler activities and read it. Just think back to things you would have liked when you were young. For example, I always wanted a sit-n-spin (R) but never had one. I played on one at a friend's house when I had the chance. So, I bought one for my daughter when she was 2 1/2, and sure enough she loved it! She didn't play with it daily, but she did enjoyed it. Browse the toy catalogs or toy aisles at the store if you are unsure of what to play. Just have fun playing!

Remember that many kids need to be shown how to play. If you show them that a toy car doesn't just get rolled back and forth but can be crashing into blocks, racing off of a table or couch, and driving under furniture as you make car noises "beep, beep" then they may then have more ideas on how to play. For toddlers and other children who tend to be rigid and controlling in their play skills, you may only be able to show them one more way to use a doll, blocks, or cars. But if you show them one new way to play per week, then within a month, they learned 4 new ways to play with toys. Before you know it, the child will have many choices of what to play when Mom hollers out "Go play in your room!".

Imaginative Play

It is so cute to watch kids, especially toddlers and preschoolers use their imagination during play. As a therapist, I can often get little kids to do some amazing things with imaginative play, and the little ones don't even realize they are improving with their body strength, communication, sensory processing, or other areas of development. They just think they are playing. With imagination: ankle weights become "space boots", arms out to the side become "butterfly wings", and slithering on the belly turns one into a "sneaky snake". Even though as an occupational therapist, my main training is not in speech and language skills, I can really work on expressive and receptive language skills during imaginative play.



I have to hand it to my husband, he is actually better at imaginative play than I am. And that is saying something, because I love to play and act silly. Last year my daughter was really into the Peter Pan Disney movie. So, my husband went to a local party supply store and bought her a Peter Pan costume and some pirate accessories. My husband and then 4-year old daughter would play for up to 30 minutes as she acted out scenes from the movie. He even "threw her" onto the bed as if she was being shot out of the canon. She also jumped from the bed to his arms as she was "walking the plank". It was so cute. Now, I am sad that she isn't as into acting out stories. She is in kindergarten and is much more into playing with games, dolls, tea party, and her friends.



So, today I was watching my 15 month old son play with an unactivated cell phone as he said "hi". I was thinking, "yeah", I get to watch his imagination develop. He is at the age where it is just emerging. Let the fun begin!



At work, so often the toddlers I work with can't yet participate in imaginative play until we work on some underlying skills: joint attention, memory, following simple instructions, sensory processing, & imitating other peoples actions, sounds, or words. So often the attention and imitation are the two biggies we work on. I get so excited when I get to work on the high level skill of imagination! All of the sudden we can be clowns in the circus, cowboys on a horse, and any zoo animal we so desire to be! Sometimes it is even fun to make up an animal or thing that doesn't yet exist!

Well, I am off to go watch the ultimate imagination movie with my daughter and husband on the couch...Toy Story. From the opening scene of the boy playing with his toys to the way the creators of the movie have the toys come to life, this movie is full of imagination! It's been around for awhile, but we love it. We are ready for Toy Story 3 that is due out in 2010!

Fun Activities To Play With Toddlers

Today at work I had a blast! I knew I had won the heart over of a new toddler client when he gave me a zerbert...you know, a slobbery kiss with tooting noises. The goal of the OT session today was to help with his poor balance and upper body strength. But he didn't know that, he just thought that some lady came to play with him. You know that a toddler had fun with your activities during the therapy session when they don't want you to leave. Even though this family had lots of toys and a big house, and parents willing to buy any toy that would help this child improve with his developmental delays in motor and speech skills, I opted for fun activities for a toddler that are free. I did this by searching the game room and his bedroom for any toy, game, or activity that could be used to help his balance. Then, we played things that require absolutely no equipment, just our bodies. Some fun activities for toddlers that we played were:

• Animal walks with animal noises: donkey kicks as we said "eh-oh", bear crawl as we growled (the downward dog yoga pose), slithering on the belly like a snake as we hissed, and jumping like a frog as we said "ribbit"
• Obstacle course: we had a step stool to jump off of, a tunnel to crawl through, a large tall table to slither under, and a large pillow to crash onto after a 5 foot bout of "wheelbarrow walking". Although he had fun and was giggling, we had to help with sequencing. Don't add too many items to the obstacle course of a toddler.
• Lap play: as he sat on my lap and I bounced him, I encouraged him to act like a cowboy riding a bull. As he had his arms in the air and I bounced him, I also "threw" off his balance to the sides to encourage him to use his arms to protect himself. Without protective extension, the toddler will have lots of bo-bos!
• He wanted to play chase, but I discouraged this for him, although it may be good with other kids. This little toddler has a habit of running off when things become too difficult either at home, community, or at his preschool. So, I didn't want to feed into this. But I did however encourage other reciprocal activities such as turn-taking, rolling or kicking ball back and forth
• "rough housing": him and his Dad rough house, so I showed the family how to do this where this toddler boy could be building up trunk strength (core stability) and improving in his upper body strength
• I encouraged him to sing songs and perform novel motions. Examples, "If You Are Happy & You Know It, Clap Your Feet"- this really takes trunk balance to sit on the floor as your feet clap together. Another song was "Jump Around the Rosies" instead of "Ring Around the Rosies".
• Be creative when playing toddler games...the sillier the better. At home with my own toddler, I turn on the TV to a toddler music station, and he loves to move and dance to the music as he plays in the living room
• I encouraged the mom to take the little boy to the park and swimming pool, 2 really good activities to build strength and coordination
• I suggested that after he has got out the "wiggles" to encourage him to sit in a chair without a back and play with puzzles, stringing beads, Mr.Potato Head or other 2-handed activities. This lil' toddler has difficulty crossing the middle of his body or using 2 hands at once due to mild low muscle tone in his trunk and extremity muscles
• I suggested the parents use their exercise ball to have the lil' tot balance and bounce on in different positions: sitting, lying on back, lying on belly, sidely, or stand
• Water art out on the sidewalk as he squats: get sponges or paint brushes and play away! the water dries quickly (or at least where I live because it is hot here!) and they can start all over again!
• The final tip, was to have him help with yard work such as using the water hose or watering can to water the flowers. This is fun and buids upper body strength. You might even get lucky enough to see a butterfly or lady bug!

The possibility of toddler games is endless and so often the activities can be played for free. This is such a fun age because they are usually redirectable and easily distracted, even if they can be stubborn from time to time.