ZERO TO THREE: Steps Toward Crawling

Here is a great article on what happens right before a child typically learns how to crawl and the various styles of crawlers:

ZERO TO THREE: Steps Toward Crawling

The only thing I would add to this article is some other types of atypical crawling:
-segmented: the child crawls but it appears slow, and not fluid as if every movement of the arms or legs have to be thought out. This can be a sign of a variety of problems including neurological
-bunny hop: the child crawls with the hands and then hops forward with both feet simultaneously coming up under him, just like a rabbit does. This can be a sign of neurological, muscular, or orthopedic problems
-bear crawls and can't bend knees- this is when the knees are extended vs. bent, it can be nothing to worry about unless that is all the child can do. It could be due to muscular tightness, orthopedic, or neurological problems

These atypical patterns in addition to the ones listed in the article (e.g. using one side only) may resolve after the child has been crawling for a couple of months. If they do not, this should be discussed with the child's pediatrician to consider a referral for therapy and/or a specialist (neuro or ortho)..

It is important that children crawl, but not mandatory. I have a 16 year old niece who skipped crawling and began walking at 8 months. She climbed furniture by 10 months, and went on to be a high level competitive gymnast. She takes advanced classes at high school. So, although she has no gross motor or learning problems, skipping crawling can be an indicator for that...not always, but can be sometimes. Crawling helps the brain learn to use the two sides of the brain together, develop arches within the hand muscles for fine motor control, and promote depth perception (eyes). Maybe this is why my niece's handwriting isn't exactly the best...not awful, but not great either!

Study of Early Child Care and Youth Development (SECCYD)

A common suggestion that I make for toddlers with a developmental delay, particularly with language skills, is to go to daycare, preschool, or Mother's Day Out (MDO) for at least 2 days a week. I make this suggestion especially for children who don't have siblings or who are the oldest child. Children need to be around other children their age which helps them learn how to play, talk, and share. Having said that, there is a difference between how kids thrive in good child care and low quality child care. Here is a link to an interesting study that evaluated how children progressed with development in different types of daycare:

Study of Early Child Care and Youth Development (SECCYD)

I realize that not everyone wants to send their child to a facility such as MDO or daycare, or maybe they want to but can't afford it. In that case, I help the parents brainstorm other ways to be around children, such as play groups, library story time/ craft time (FREE!!!), church activities, neighborhood groups, and other public places that may have free admission at least once per week such as an interactive children's museum. My subdivision has a monthly newsletter and within it, dates/times are identified for Mom's groups, play groups, and special events. It may not be the same teacher and peers each time like a daycare or preschool would be, but at least there is socialization among the children.

Autism Speaks, Community, Family Services,

I came across an amazing website "Autism Speaks" recently. I was so impressed with how they had very detailed videos displaying what a typically developing child would look like for a particular play or language skill, and how a child with autism may look like doing the same task. Also on this site was a huge data base of different types of treatment in the various cities in each state. What a great source for a parent of a newly diagnosed child or for a family that will be moving to a new town! Here is the link with the names and numbers to some facilities in Texas:

Autism Speaks, Community, Family Services, Texas: Categories

Even though this link is for Texas, the other states are represented also. Some of the links include: ABA, early intervnetion (birth to three years), preschools, OT/PT/Speech therapy, biomedical interventions, doctors, and community support. I will definately be sharing information from this site with the families that I work with!

iPod | iPhone | iPad Apps for Special Needs Children

I was just fiddling around with my iPhone and downloading some applications today. My search was on a variety of pediatric diagnoses seen in OT, PT, and speech, and not too many came up, which surprises me. But once I read how much has to go into creating an app I figured out why there aren't many! There are over 200,000 apps. available so maybe I just couldn't find the right ones. I have MANY ideas on some possible apps, and maybe one day I will actually get around to creating one...too bad I am not good friends or relatives with a computer programmer! One app that I came across that I did like was one specifically for children with autism:

iPod | iPhone | iPad Apps for Autism

Another one was for identifying a baby's various cries. So many of the parents have problems with deciphering the cries, which means the baby may get over-fed, put down for sleep too often, or over-stimulated. This app looked like it could be beneficial to new parents: http://www.crytranslator.com/

I would love to hear of some of the other good apps out there. Please, send info. on them!

Helping Children Play Within an Organized Space

My daughter and I went through all of her toys yesterday to make room for all of the toys she got for Christmas last month. I had her make various piles: one for toys to keep, one for missing pieces, another for toys to donate, and of course the trash can! Within the donate pile, I started to think of who I could give each item to such as a particular child on my caseload, her younger 2 year old brother, a daycare, or the Goodwill.

I go through the kids' rooms at least twice a year and it helps our whole home to not be taken over by toys! I plan to do my son's room tomorrow...but without his help! He is like the average two year old who doesn't want to part with toys even when they are broken. This is why he has a couple of injured Barbie dolls that were previously his sister's, you know, the one's that have a missing foot or received a "haircut" that wasn't so attractive!

This event got me to thinking that as an occupational therapist working in the homes of families with special needs children I am able to help families go through their toys and organize them. I can help find the toys that are appropriate for the child (and siblings) to play with as well as box up toys that are too young for them developmentally. So often the children I work with that have developmental delays get over-whelmed by too many toys in a space; so I find that removing toys not used anymore really helps them focus better on the toys that are still left. Something so simple can help a child to have a longer attention span or even less sensory defensiveness. For kids with poor motor planning, it helps them to make better choices of what to play with as opposed to choosing a "baby" toy. For example, if all of the rattles are put away, then maybe the child will reach for blocks, books, or dolls.

For children with delayed language, make sure you leave some musical toys and other items that promote language such as a tape player they can carry around, "microphone", megaphone, whistles, and books.

For children who are sensory seeking/ hyper-active, you may need to make sure you have some action toys in the room such as a mini-trampoline, tunnel, or balls.

For children with poor motor planning, low muscle tone, and/or sensory under-responsiveness (low registration), make sure you have toys setting out visibly and not all of them stored away in closed containers high up on a shelf. These children will most likely not seek those toys out when asked to "go play in your room". I recommend a few toys put in a couple of baskets within their reach. Too many toys in one basket can be over-whelming, so don't over do it! Also, have toys that they would be successful with and some that are for the next developmental milestone. Cars, balls, and dolls are simple toys, whereas a kitchen with plastic food, a race track, and Mr. Potato Head are more challenging. If all of the toys are too difficult for them then the child will just get frustrated and depending upon the diagnosis may choose to sel-stim.

A child with abnormal muscle tone who tends to slump or w-sit could benefit from a kiddy table and chair to offer support and an alternative to just playing on the floor; make sure the table and chairs are at the proper height. If the chair is too low then the child will lean and hunch over the table. If the chair is too high, then the child's feet will dangle which offers less stability for the posture muscles. If the chair is a good height but the table is too high, then the child will have his elbows too high for good fine-motor skills including legible handwriting for homework (older kids) or scribbling (younger kids). Some children will give up when a task is too hard and may even walk away whereas others will start to "act up".

Of course, one of the most important things is teaching the child to clean up. If he/she is not physically or mentally capable of cleaning the entire space, then think of at least one thing they could do. For some kids it may even be that you have to offer hand-over-hand assist through each step. For children with a poor ability to transition, then this is a nice transition helper, especially if it is done in a predictable way. Predictability could include singing the "Clean Up" song each time, or it could include watching a video for 10 minutes after the room is cleaned. There isn't a magic routine, yet structure and predictability help so many children (with or without special needs!).

The list goes on and on about all of the ways you could organize toys and alter a play space. Hopefully, the ones I've listed get you to thinking of how you could help your own child or a client!

CTV Toronto - Sibling spacing may be tied to autism risk: study - CTV News

An interesting study about siblings age and the incidence of autism:

CTV Toronto - Sibling spacing may be tied to autism risk: study - CTV News

I hope they keep finding more clues to the causes ( or possibilities) so they can work on prevention and cures for autism!

TheraSuit- Suit Therapy for Kids with Cerebral Palsy

I worked recently with a child (diagnosed with cerebral palsy) who made many gains with the Suit Therapy using the TheraSuit. Here is a link:

Therapists Use New Methods For Children with Cerebral Palsy | OT Pediatrics News

I've had many kids over the years try alternative therapies, and some of them with good results. The kids have traveled to other facilities for weeks to months receiving various therapies in hopes of getting better motion, balance, and functional skills. All of the ones that have made significant improvements have been the ones who recieved intensive therapy of multiple hours a day: Suit Therapy, Constraint Induced Therapy, hyperbarric oxygen, and many other therapies that aimed at integrating reflexes and providing lots of proprioceptive input. This makes me wonder if NDT and some of the other popular therapies used by most therapists would get similar results if we provided multiple hours of therapy a day....food for thought!