Low Muscle Tone Revealed

Muscle tone refers to the muscle’s ability to sustain a contraction. It is different than muscle strength, which refers the muscles’ power. A child with low muscle tone is often observed to sit with a slouched posture, may have difficulty holding their head upright when sitting at a desk and may be observed to prop their head up with their hand. Mother and child with balance ballOther observations include having difficulty sitting for extended periods of time, particularly without back support or w-sitting, where the legs are splayed out to the side in the shape of a ‘w’ when sitting on the ground.

Muscle tone cannot actually be changed, though through occupational or physical therapy, muscles will become stronger and compensate for the low muscle tone to help support your child through his/her daily tasks.

Here are five activities to help address strength, endurance and low muscle tone at home and in the community:

  1. At the park, have your child lie on his belly on the slide and pull himself up the slide using only his arms.
  2. Complete yoga poses that work on balance and core strength, like down dog or plank.
  3. Using a weighted ball or BOSU ball, have your child lift the ball overhead with both arms, lower it to the floor and balance his hands on the ball while he jumps his feet backwards into a plank position. Repeat these steps 10 times.
  4. Have your child lie on his back on the floor. With his legs raised off the floor and knees bent, have him weave a ball between his legs.
  5. Encourage your child to use the monkey bars or hang from the zip-line when at the park.

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Sensory Strategies and Other Ideas for Kids with Autism

Sensory strategies are associated with a variety of diagnoses and conditions through childhood, adolescence and adulthood.  These strategies are non-invasive accommodations that can be made in any context, to all daily activities in all environments. Sensory strategies are often referred to as “movement breaks,” or other similar titles, but provide the same suggestions and are truly sensory strategies at their core.

These strategies have been found to be very useful for children with Autism who also have sensory processing challenges:

  • Mother plays with childUtilize a visual schedule throughout the day (both at home and at school).  Visual schedules are often easier to understand for a child with autism, or any young child, as there is a pictorial representation of each activity or time of day.  Using a visual schedule more clearly outlines the expectations that you have for the child and gives him/her a sense of control over their day.  A visual schedule may also be used as a tool to develop a morning and bedtime routine and increase independence in self-care activities, such as brushing teeth and getting dressed.
  • Allowing the child to take a 2-3 minute movement break every 10-15 minutes.  This break should involve intense movement when possible, such as jumping jacks, pushups, jumping on a trampoline, etc.  When intense movement is not appropriate, breaks may involve the student walking to the drinking fountain, getting up to sharpen his/her pencil and/or walking to the bathroom.
  • If an assigned task involves intense academic work, such as testing, lengthy projects or problem-solving assignments the child should be given the opportunity to take a longer break (approximately 10 minutes) to allow time for more intense physical exercise.

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  • Utilize a timer during activities and make sure it is visible to the child.  Timers can be either visual, meaning that there is an area of the clock that becomes shaded and as time elapses the shaded area becomes smaller and smaller however there is no noise associated with it, or auditory, in which there is a digital display and an alarm that sounds when the time has fully elapsed.  Using a timer is especially helpful during preferred activities, such as free-play, as it sets a clear limit for the child regarding how long they will have to participate in this designated activity.  This makes the environment and the activity more predictable and eliminates any element of surprise which is present during verbal warnings such as “2 more minutes,” and should make transitions happen more easily.
  • Along with a timer, providing transition warnings and using transition items will help a child with autism move from one activity to the next.  A transition warning can be used in conjunction with a timer to create more clear expectations surrounding transitioning from one activity to the next.  A transition warning involves setting the timer for how long the child will have until moving on to the next activity, as well as verbally or visually communicating that the transition is approaching.  For example, if a child has 5 minutes of free play prior to a structured task, when I set the timer for 5 minutes I would tell him/her “You have 5 minutes to play and then when the timer beeps it is time to go sit at the table.”  Then when there are 2 minutes remaining on the timer I would follow-up with “Look at the timer, you only have 2 more minutes until table time.”  If a child does not yet understand the concept of time, the visual timer would be the better choice for a timer as you can clearly see the shaded or colored area disappearing.
      • A transition item is a physical thing that the child is allowed to bring from one activity to the next.  If a child was playing with blocks and it was time to go to the table for a writing activity, a transition item could be allowing the child to bring a block with to the table.  Or substitute an item, such as allowing him/her to bring an action figure, small doll or ball with him/her from the block area to the table.  Transition items help stop “tantrums” or the feeling that something is being taken away form the child and make the transition smoother.
  • Provide a toy or item for the child to manipulate during solitary work.  These items are often referred to as “fidgets,” and provide the child with an outlet to release their restlessness.  Rather than continuously moving his/her body, the child can move his/her hands quietly in their lap or on their desk while manipulating the fidget.
These sensory strategies can be implemented in the classroom, at home and in most other settings where a child is expected to be able to sit and attend to a task (church, Sunday school, music lessons, camp, etc.).  Incorporating these strategies into particularly difficult parts of the day can also have an immense positive impact on the child; for example, incorporating physical exercise into transitional periods may lessen the stress that these times put on both the child and the adult.  These sensory strategies are not strict rules to abide by, but are general guidelines to be expanded upon or adapted to fit each child’s individual needs.

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7 Reasons to Attend NSPT’s New Bucktown Clinic Open house!

The Chicago Clinic has recently expanded to a new and improved space! We would like to celebrate and introduce ourselves by opening the doors to the community. We are so excited to share our new space with both our existing families and also hope to meet some new faces!

New Clinic Open House

  1. It is hard to find fun for the whole family, without paying a high price in the city. The open house is a FREE event that you can bring your family and friends to!
  2. There will be endless entertaining fun for your children of all ages, including a magician, face painter, balloon maker, and games.
  3. Kids will have an opportunity to explore their creative side by making various crafts!
  4. A sensory table will provide an outlet for the children to explore their senses while engaging with other kids and having a blast. There will also be Occupational Therapists to answer any questions regarding various sensory strategies and tools.
  5. Parents will have an opportunity to speak with experts in fields such as speech therapy, physical therapy and occupational therapy, as well as counselors, academic specialists, and more.
  6. Learn more about North Shore Pediatric Therapy’s multidisciplinary approach to treatment.
  7. Check out the new state- of- the- art facility, with over 4,000 square feet of therapy rooms and equipment.

Event Details:

Date: Saturday, September 15th
Time: 11:00-2:00
Location: 1657 W. Cortland St. (corner of Cortland and Paulina; 1 block south of Armitage)
Chicago, Il 60622

For more information regarding this event please contact Lauren at 877-486-4140 or LaurenW@NSPT4Kids.com

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Swimming- A Fun and Beneficial Sport

Swimming is a great sport and pastime, particularly for children with sensory processing difficulties, as the waterBoy in swimming pool provides a multi-sensory experience for the body. Swimming also addresses a variety of skills, ultimately improving your child’s sensory processing, strength, endurance and coordination.

Proprioceptive/tactile processing: The feel of water on the body gives proprioceptive input, the input to the muscle and the joints, and gives a sense of where the body is in relation to other body parts. The constant sense of the water against the skin provides deep proprioceptive input and helps with developing body awareness.

Vestibular processing: Somersaults under water or headstands at the bottom of the pool provide vestibular input, as the body is responding to the changes in head position and assisting with balance to complete these tasks.

Auditory processing: The pool environment typically provides a loud and vibrant auditory experience, as children’s laughter and happy shrieks are heard while they play in the pool.

Strength: Moving the body against water when swimming is a workout for the muscles! The water provides natural resistance for muscles, which in the long run, builds up overall body strength.

Endurance: Not only does the resistance of the water against the body make the body stronger, it also assists with endurance. As the muscles become stronger, they will be able to endure swimming and other activities for longer periods of time.

Coordination: Swimming strokes are very complex. The brain must take in all of the sensory information from the environment and act quickly to move the arms, legs, torso and head in a coordinated fashion to produce the movement.

So many children find swimming exciting and fun, and love spending summer days at the pool. Parents can also appreciate spending time at the pool knowing that this activity is not only fun, but also good for their child!

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Healthy Barbecue for Parents and Kids

Grilling season is going to be wrapping up in the next few months, but not before one of the biggest grill-out holidays of the season:  Labor Day! Summer barbecues are a time to celebrate with good food. You can still have good food and be healthy at your barbecue.

Parents with both of their children sharing food at the Barbecue

Here are some healthy barbecue pointers that I follow for myself and my family:

Choose organic meats. My picks:

  • Organic chicken breast or drumsticks (the drumsticks are only $3.00-$4.00 for 5 large pieces at Trader Joe’s)
  • Organic, local, grass fed ground beef from Fruitful Yield (at about $5.00 per pound, it doesn’t cost much more than non-organic)
  • Trader Joe’s 100% beef, nitrate- & nitrite-free hot dogs
  • Applegate brand organic hot dogs, which can be found in many grocery stores

Choose whole grain or 100% whole wheat hot dog and hamburger buns

You can find these at any grocery store, and really, they don’t taste different. Especially with all the yummy grill flavor coming through, and of course condiments.

Choose produce from the farmers market

Add some veggies to your grilling repertoire. Right now in season there is plentiful corn on the cob, eggplant, yellow and green zucchini, onions, potatoes, fennel, all colored peppers, mushrooms, and more. If your kids are old enough, ask them to help wash and even chop some of the veggies for you into large pieces. Toss the veggies in olive oil and sprinkle with salt and pepper. Grill them, turning them once. After removing from the grill, drizzle a little balsamic vinegar over them and sprinkle with chopped parsley. Serve in a large dish- beautiful with all the colors!

Make fruit skewers with yogurt dip

Again, get your kids involved by having them help wash, portion, and skewer a variety of fruits. Be creative and make a rainbow of colors with different fruits. You can make a simple fruit dip with vanilla yogurt (or any fruit flavored yogurt really).

Try pasta salad instead of traditional potato salad

You can make a delicious, healthier version of pasta salad by using whole wheat pasta or quinoa, an olive oil and vinegar dressing, and plenty of veggies, olives, fresh herbs and spices to flavor it.

Manage portions

Of course, there will likely be a variety of not-so-healthy food choices at any barbecue. Make just one plate of food, and make it reflect the Healthy Plate Model:  half of the plate filled with fruit and veggies, the other half split between whole grains and protein. Have a small dessert and drink water instead of soda.

Very important

Avoid over-cooking or charring foods on the grill, as this results in formation of cancer-causing compounds called heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs). You can avoid these by cooking on lower flame for longer, pre-cook the meat a bit to decrease time needed on the grill, and trim off any charred pieces you do get.

Happy grilling!

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Developing Hand-Eye Coordination

Hand-eye coordination is the synchronization of eye and hand movements. It involves proprioception (knowing where your body is in space) combined with processing visual input. Any task that requires the coordination of vision and hand movements involves hand-eye coordination. Examples of hand-eye coordination include grasping objects, catching and throwing a ball, playing an instrument while reading music, reading and writing, or playing a video game.

Hand-Eye Coordination in Infants

There are many ways to encourage development of hand-eye coordination in a child. Just like any other skill, the more time spent doing activities that involve hand-eye coordination, the easier the skill will become. In infants, reaching and playing with objects and toys are great ways to foster development of hand-eye coordination. As they get older and are able to sit independently, you can play with balls, encouraging the baby to roll and corral them. Playing with blocks and other toys that involve putting something in or taking something out are also great ways for an infant to develop this skill.

Hand-Eye Coordination in Toddlers

With toddlers, continue to play with various sized and textured balls to develop hand-eye coordination. By the age of three, a toddler should be able to “fling” a ball forwards and catch a ball against their chest. To help develop his aim, you can practice tossing balls into hula-hoops or targets on a wall (start with big targets and get smaller as the child progresses and gets older). To practice catching with only the hands, start with bigger and softer balls (like koosh balls or bean bags). Progress to smaller and harder balls (like a tennis ball) as the child gets older.

Hand-Eye Coordination in 4 Year Olds and Older

Coloring and creating crafts is another fun and great way to develop hand-eye coordination. Some fun crafts to do include stringing beads or macaroni, finger painting, or playing with play-dough. When a child is four years or older, games that involve slight hand movements can also further facilitate growth in this area. Examples of these games are Jenga, Honey-Bee Tree, or Topple (all available at any toy store). Complex puzzles, Legos, or building blocks are other great hand-eye coordination activities.

Children who have poor hand-eye coordination often refuse or choose not to participate in activities that involve this skill. The activities mentioned above can be very beneficial in assisting these children in improving their hand-eye coordination. Some children struggle immensely with every-day activities due to poor coordination skills. These children may require extra assistance from an occupational therapist or a physical therapist.

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How to Determine if a Child Has Executive Functioning Difficulties | Pediatric Therapy Tv

In today’s Webisode, a pediatric neuropsychologist explains ways to tell if a child struggles with executive functioning.  Click here to download a FREE checklist on Executive Functioning Signs by age!

In this video you will learn:

  • What factors the child struggles with daily
  • How executive functioning issues start at home
  • What a child needs help with when they suffer from executive functioning

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide
audience, this is Pediatric Therapy TV, where we provide experience and
innovation to maximize your child’s potential. Now, your host, here’s
Robyn.

Robyn: Hello, and welcome to Pediatric Therapy TV. I’m your host, Robyn
Ackerman, and today I’m sitting here with Dr. Greg Stasi, a Pediatric
Neuropsychologist. Doctor, can you give us some tips on how to identify if
a child needs help with executive functioning?

Dr. Greg: Of course. When we talk about executive functioning, we’re
talking about a child who struggles with organization, initiation on tasks,
problem solving, cognitive flexibility. This is a child where the morning
routine is going to be extremely difficult. They can’t follow through on
tasks. The parent has to follow through constantly to get them out the door
in the morning. It’s a child who starts projects at the last minute,
Sunday evening, when a project is due Monday morning. If we’re seeing the
child not be able to develop strategies on how to complete homework
assignments and if the child gets frustrated easily, those are all symptoms
and characteristics of what we’d expect in a child with an executive
functioning issue.

Robyn: All right. Well, thank you so much, and thank you to our viewers.
And remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of mind
to your family with the best in educational programming. To subscribe to
our broadcast, read our blogs, or learn more, visit our website at
learnmore.me. That’s learnmore.me.

Exercise Hydration: What is the Right Beverage for my Child?

With so many sports beverage and enhanced water products on the market, it’s good to know when they are actually useful. Many of these products have an ingredient list quite similar to soda, which is not something you typically would give your child or athlete after a workout. However, there are circumstances where nutrient and electrolyte replacement is very important for children and teens.

Child drinking a glass of water

Carbohydrates are an important nutrient to replenish because glycogen is the fuel which gets used up from muscle and liver stores during physical activity. Electrolytes, specifically sodium, potassium, and bicarbonate are important for nerve conduction and respiration. Some amounts are expired through sweat and given off with heavy breathing that comes with intense physical activity. For these reasons, carbohydrates and electrolytes need to be “replaced” after intense, continuous workouts lasting longer than 60 minutes, and can be achieved with electrolyte replacement beverages. This would apply to long distance runners, college or elite athletes in training, and swimmers, soccer, or basketball players who are doing continuous intense cardio training for more than an hour during workouts.

However, for most people hitting the gym for an hour or so, or kids playing in team sports or outside at the playground, nutrient and electrolyte replacement can be achieved from eating a normal, well-rounded diet. Eating a balanced meal or snack within an hour after physical activity is sufficient in this case. Drinking additional sports drinks will only provide extra calories and sugar (or diet sweeteners), and often artificial food coloring.

Use this table as a guide:

Commercial (or homemade*) electrolyte replacement beverage

  • Intense continuous physical activity lasting an hour or more such as running; drink 16-32 ounces of electrolyte replacement beverage. 30 grams of carb should be consumed for every 60 minutes of intense continuous cardio, within 30 minutes of activity. Electrolyte replacement is important if intense physical activity is in extreme heat, when sweating is excessive.

Chocolate milk (carb + pro + electrolytes)

  • College or elite athletes in training for several hours per day who need a quick, small meal + electrolyte replacement during or after long workouts lasting several hours. These athletes should consult with a dietitian who specializes in sports nutrition.

Coconut water

  • Natural electrolyte replacement beverage; high in potassium and lower in sodium and sugar than commercial electrolyte replacement beverages. Appropriate for moderate-high physical activity with sweating, such as spinning class, kickboxing, “boot camps”, outdoor sports in heat with continuous cardio 30-60 minutes, etc.

Water + well-rounded diet

  • As needed during and after any level of physical activity. This is all that is necessary for low or moderate physical activity such as playing outside, playing team sports, hitting the gym for 30-60 minutes, etc. A rule of thumb is 1 oz water for every 2 lbs body wt (50 oz/day for 100 lb person) daily. Increase as needed in heat or more strenuous activity.

*Recipe for homemade electrolyte replacement beverage, from Nancy Clark’s Sports Nutrition Guidebook

1/4 cup sugar
1/4 teaspoon salt
1/4 cup hot water
1/4 cup orange juice (not concentrate) plus 2 tablespoons lemon juice
3 1/2 cups cold water

  1. In the bottom of a pitcher, dissolve the sugar and salt in the hot water.
  2. Add the juice and the remaining water; chill.

Recipe makes 1 quart.
Per 8 ounce serving, recipe provides: 50 calories, 12 grams carbohydrate, 110 mg sodium, 43 mg potassium.
Compared to original Gatorade per 8 ounce serving: 50 calories, 14 g carbohydrate, 110 mg sodium, 30 mg potassium.

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Problem Feeders: When Picky Eating is a More Serious Problem

Following my last post about picky eaters, parents should know that there is a more severe level of picky eating, which has been termed problem feeding. In the medical community, it is often diagnosed as “feeding difficulties”.

Problem feeders have the following behaviors:

  • Young infants who refuse bottle or breast, or drink a small Mother feeds a babyamount then refuse. This results in a decreased overall volume consumed, and eventually weight loss and dehydration.
  • Toddlers and children who eat less than 20 foods.
  • Kids who “lose” foods that they once ate, and do not resume eating them even after a few weeks break. Eventually they may be down to 5-10 foods.
  • Kids who refuse certain textures altogether.
  • Kids who scream, cry, and panic over touching, smelling, or tasting a new food.
  • Kids who are unwilling to try almost any new food even after 10+ exposures.

Why do some kids become problem feeders?

There is an underlying reason why they have a strong negative association with eating, to the point where they will starve themselves before consuming foods outside of their repertoire. There is often a medical diagnosis that contributes to the development of a problem feeder, such as:

In these cases, the child forms “oral aversion” associated with the pain and discomfort they feel/felt as a result of eating or swallowing. This association is made very strongly in the young developing brain, and in the case of problem feeders, overrides hunger. Oral aversion becomes a protective mechanism, which is why they panic over eating new foods. Problem feeders can be underweight or overweight as a result of their rigid food choices, depending on what type and how much food they eat.

The big difference between picky eaters and problem feeders:

Eventually, a picky eater will come around to eat some type of food they are presented with outside of their usual repertoire, if they are hungry enough. A problem feeder will not respond to hunger cues to meet their needs with the food options presented to them if it is outside of their “accepted” foods. Problem feeders will go on a food “strike”, even if it results in dehydration and malnutrition.

Problem feeders need assessment and feeding therapy, which can be effectively achieved with a multidisciplinary team, such as at North Shore Pediatric Therapy. NSPT has occupational therapists, speech therapists, and dietitians to work through sensory, oral-motor, and nutritional deficits as well as mealtime behaviors. We also have social workers for additional support and behavior guidance.  If you are concerned that your child is a problem feeder or a picky eater, contact our facility for an evaluation.

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Help! My child is a picky eater!

The picky eater phenomenon is not uncommon, and can be quite challenging and stressful for parents.

Picky eaters have the following characteristics/behaviors

  • Eat a limited number of foods (20-30).
  • Avoid classes of foods such as red meat or green vegetables.
  • May reject foods they previously accepted, but will re-accept these foods after a two-week break.
  • Will try some new foods after being exposed to the food several different times.
  • Will touch and play with new foods, although they may not eat it at first.
  • Picky eaters usually eat enough to support growth within normal ranges.  (1, 2)

How To Encourage Your Picky Eater, To Eat More:

To alleviate some stress, first examine if your expectations for your child’s eating is realistic. Kids are naturally wary of new things (think “stranger danger”), including new foods. Picky EaterTheir first reaction to something they have never seen, smelled, touched or tasted before is to not trust it. Do not be discouraged if your child doesn’t love hummus, spinach, and salmon right away. It takes an average of 8-15 exposures to a new food before the child will actually eat it (2). Also, toddlers and teens particularly want to exert their sense of control and opinion, including what they will (and won’t) eat. In other words, sometimes a strong-willed child will refuse to eat what you want them to just because it gives them control over that aspect of their environment.

Typically developing young children will eat according to their innate hunger and satiety cues. That is, they will eat what they need when they are hungry and not when they are satisfied. Imagine how you might feel if you were full from dinner, and someone comes at you with a spoonful of food telling you to take another bite. Imagine you are really full, and the thought of taking another bite makes you sick. Now this person starts yelling at you and threatening to punish you. How would you feel? It can be difficult to let go and trust your child’s appetite. Your job as the parent is to provide healthy meal choices, regular mealtimes and snacks, and a positive eating environment without toys or TV.

Finally, using bribes like “one more bite and you can have dessert”, and punishments such as “you can’t play outside if you don’t finish your plate” are not effective in the long run. Doing these things negates children’s natural ability to eat what they need. It also creates a negative, untrustworthy dynamic between the child and the caregiver at the table. Picky eaters will continue to thrive and meet their nutrition needs when provided an optimal mealtime environment. A dietitian at North Shore Pediatric Therapy can counsel families to help picky eaters.

However, there is a difference between a picky eater and a problem feeder. Problem feeders have more rigid food preferences, a dwindling number of accepted foods, and will refuse food (and drinks) that are not part of their repertoire to the point of malnutrition. These children require more intensive evaluation and therapy, and benefit from multidisciplinary treatment available at North Shore Pediatric Therapy. I will further discuss problem feeders in my blog next week.




  • Carruth BR, Skinner J, Houck K, Moran III J, Coletta F, Ott D. The phenomenon of “picky eater”: a behavioral marker in eating patterns of toddlers. J Am Coll Nutr 17:180-186, 1998.
  • Carruth BR, Ziegler PJ, Gordon A, Barr SI. Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food. J Am Diet Assoc. 2004 Jan;104(1Suppl1):s57-64.