The walking stage is a huge milestone for every child. It’s an exciting new time when your baby officially becomes a toddler. Most babies learn to walk between 12 and 15 months. A baby is considered delayed in walking once they turn 18 months old. When a child is delayed in a certain gross motor skill, parents are always curious why this delay is happening.
Here are some reasons that your baby may be delayed in walking:
Muscle weakness and/or low muscle tone. This is the most common reason. A child who has weakness or low tone in their core and hip muscles may have difficulty with walking. Sometimes this weakness affects the earlier milestones such as crawling, pulling up to stand, and cruising. If your baby had difficulty learning early milestones, they are more likely to have difficulty with walking. A physical therapist can do exercises with your child to strengthen their muscles and help them learn to walk.
Orthopedic concerns. This involves the bones and joints in a child’s legs and how they are aligned. An example is hip dysplasia. These concerns are diagnosed by an orthopedic surgeon and are treated in a variety of ways.
Neurological concerns. This involves the nerves, muscle fibers, and nervous system of the body. An example is diplegic cerebral palsy. These types of concerns are diagnosed by a neurologist.
Orthopedic and neurologic concerns can be very scary to parents. It is important to understand that a delay in walking does not automatically mean that your child has an orthopedic or neurological disability. If you think your child is delayed in walking, speak to your pediatrician. A pediatric physical therapist can evaluate red flags for causes of delayed walking, as well as help your child to learn this skill.
As babies grow and develop certain milestones are often celebrated, such as rolling, sitting, crawling, and walking. As a pediatric occupational therapist, one of the milestones I always celebrate might not be visible to the untrained eye. Crossing midline, defined as the ability to reach across the body’s invisible midline with your arms or legs to perform tasks on the opposite side of the body, is a required skill for many higher level coordination activities.
This skill typically develops around 18 months of age. Oftentimes when children are referred for occupational therapy due to poor fine motor skills, handwriting, or coordination, they are not crossing midline efficiently.
Some ways to observe whether or not your child is crossing midline efficiently include:
Watching to see if your child switches hands during drawing tasks. Do they switch from left hand to right hand to avoid their arm crossing over when drawing lines across paper?
Evaluating hand dominance: by age 6, children should have developed a hand dominance. Children with poor midline integration may not yet have developed a hand dominance.
Tracking an object across midline: this can be observed during reading, as decreased midline integration can lead to poor ocular motor skill development required for scanning.
Observing ball skills: children who are not yet crossing midline may have a difficult time crossing their dominant leg over their non-dominant leg to kick a ball forward.
Assessing self-care skills: putting on socks, shoes, and belts may be extremely difficult as these are activities that require one hand to cross over to assist the other in the process.
Children who have difficulty crossing midline may not be able to keep up with their peers, which may cause increased frustration during participation at school and in social situations. In addition, crossing midline is a required skill needed in order to complete more challenging bilateral coordination activities, such as cutting with scissors, using a fork and knife to cut food, tying shoe laces, writing out the alphabet, and engaging in sports.
https://www.nspt4kids.com/wp-content/uploads/2017/01/Blog-Crossing-Midline-FeaturedImage.png186183Mary Kate Mulryhttps://www.nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngMary Kate Mulry2017-01-27 12:02:512019-09-05 18:46:52Why Crossing Midline is Important for Development
As children get older and start spending more time with peers, it is natural that they begin comparing themselves to others. It’s healthy for children to want to excel and do their best, but it becomes problematic when it comes at the expense of their self-esteem. Self-esteem can take time to develop and strengthen, but there are some things you can do to help enhance it during the earlier years.
What to Look for in a Child with Low Self-Esteem
If you notice your child making a lot of negative self-statements, this is indicative that he or she may be struggling with self-esteem. Negative self-statements are self-deprecating and tend to represent black and white thinking patterns. An example of a negative self-statement would be “I am dumb” or “I will never be good at this.”
It is very healthy for children to develop interests or hobbies and to spend time around others who enjoy similar things. Explore a variety of activities with your child and try to provide him/her with options. Whether it’s a cooking class or swimming lessons, your child is bound to show interest in something. Listen to your child and give him/her the autonomy to choose something that really interests him/her. Check out your local park district or community center to see what programs they offer. The Chicago Park District has dozens of wonderful programs and activities that may interest your child.
Each child has their own strengths, talents, and qualities that make them unique. That being said, it is great to point them out when you notice them! It is human nature to enjoy hearing that others are noticing the things we are doing well. At the same time, it is important to help your child understand that they are not defined by their achievements. Think about some adjectives that describe your child (i.e. compassionate, kind, caring). These intrinsic qualities are really what makes someone special – not the amount of trophies or ribbons on their shelf. Plant Love Grow is a wonderful website that has lots of self-esteem boosting activities that you and your child can do together.
https://www.nspt4kids.com/wp-content/uploads/2017/01/Blog-Self-Esteem-FeaturedImage.png186183Rachel Warsawhttps://www.nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngRachel Warsaw2017-01-24 05:30:322017-01-18 16:11:46How to Help a Child Who is Struggling with Self-Esteem
A baby typically starts babbling, using speech-like sounds, between four to six months of age. Usually, the sounds p, b, and m are the first to develop. Additionally, in this age range, a baby is more interactive with the parent or caregiver, laughing and vocalizing displeasure or excitement. Between seven months to a year of age, communication will expand and most babies are producing repetitive consonant-vowel combinations such as baba or dada, using gestures for communication, using vocalization to gain and maintain attention, and by one year of age a baby typically has one or two words or word approximations.
A parent or caregiver can support their baby’s language development or “talking” by encouraging all communication, interacting on their baby’s level, and making communication opportunities.
Match your child’s communications and interaction attempts, including repeating his/her vocalizations and gestures. By matching your baby’s vocalizations, you are communicating on a level that allows them to maintain communication turn-taking. Additionally target speech games and songs such as itsy-bitsy spider, peek-a-boo, and gestures such as clapping, blowing kisses, and waving hi/bye.
Talk through daily routines such as bath time, bedtime, get dressed, and feedings. You are providing your baby with the associated language during these daily routines. Talk through the plan for the day, what will you be doing, where you are going, who are they seeing, etc.
Teach your child gestures and signs to support language development.
Teach your child animal sounds (e.g., moo, baa) and environmental sounds (e.g., vroom, beep).
Spend time reading to your child and labeling pictures in books.
Reinforce your baby’s communication attempts by giving them eye contact and interacting with him or her.
Simplify your language during communication interactions with your baby.
Make communication opportunities within routines and daily activities.
Limit your baby’s exposure to television and/or videos. A 1:1 interaction between a parent and child is preferable to support turn-taking communication.
Remember there is a range of typical development. Not all babies will have their first words around one year of age!
https://www.nspt4kids.com/wp-content/uploads/2017/01/Blog-Talking-Baby-FeaturedImage.png186183Julie Paskarhttps://www.nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngJulie Paskar2017-01-12 09:22:342019-09-20 10:10:37How to Get Your Baby Talking
Idiopathic toe walking is a type of walking pattern that occurs when children walk on their tip-toes instead of using the more “typical” heel first pattern. Idiopathic is a term that refers to the fact that this toe walking occurs spontaneously, usually out of habit, and is not due to another medical cause.
A non-idiopathic cause may be cerebral palsy, autism, sensory processing disorder, muscular dystrophy or brain injury. As children learn to walk, some toe walking is to be expected. When this becomes a strong habit that they do not grow out of, or the predominant pattern as they are new walkers, then several issues can arise.
The following are negative consequences of toe walking:
Tight ankles or contractures can develop
Poor balance reactions, frequent falling
Muscle imbalances “up the chain” meaning decreased hip or core strength due to the different postural alignment
Difficulty with body mechanics including squatting or performing stairs, secondary to tight calve muscles
Inability to stand with heels flat on the ground
Pain in ankles, knees or hips due to faulty mechanics
Surgery, casting, night splinting or daily bracing may be necessary
While some toe walking should not be alarming, the earlier you intervene, the better. Discuss this with your pediatrician or see a physical therapist who can provide early strategies to stop the cascade of effects that can be seen later.
https://www.nspt4kids.com/wp-content/uploads/2017/01/Blog-Toe-Walking-FeaturedImage.png186183Lauren Beekerhttps://www.nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngLauren Beeker2017-01-06 09:56:432017-07-20 11:22:19Why is Toe Walking Bad?
Occupational therapists are skilled in assessing how a child’s sensory processing abilities, fine motor skills, visual motor skills and gross motor skills impact performance and function in daily life including self-care, play and academics. Proficient skills in these areas are imperative for children to be successful in the classroom environment.
Sensory processing skills support a child’s ability to learn. A child who is unable to process environmental stimuli effectively and efficiently will be unavailable to learn. Children with sensory processing dysfunction may have difficulty sitting still for an extended period of time in their desks or during circle time, they may be unable to pay attention when others around them are talking or they may have difficulty standing in line without touching, or hanging on a friend in front of them. These behaviors are a result of poor processing of the vestibular, auditory and proprioceptive systems, respectively.
Efficient fine motor skills are necessary to complete academic work. From writing to cutting with scissors and keyboarding to making crafts, fluid fine motor skills help children complete classroom activities and homework.
Efficient visual motor skills provide a foundation for writing and copying from the board as well as completing math work.
Efficient gross motor skills are important within the school environment for moving safely throughout the school and classroom, engaging with peers on the playground or during gym, and sustaining appropriate posture while sitting at a desk to complete work.
When a child struggles in any of these areas, it may not always be obvious. Oftentimes, sensory processing difficulties go unnoticed for many years and the child is left with academic or behavioral challenges. Therefore, occupational therapy screens are essential for schools. An occupational therapist’s knowledge of child development, and its impact on daily functioning, can help identify children who would benefit from therapy services.
The screens can also be used as a preventative measure to ensure that a child’s development is on track and the child will have the foundational skills necessary to be available to learn. Occupational therapy screens also allow the opportunity for OTs to educate and collaborate with teachers and educators to provide suggestions that they can share with families and use in the classroom.
A tongue thrust is the most commonly known type of Orofacial Myofunctional Disorder. According to the American Speech-Language Hearing Association, this is when “the tongue moves forward in an exaggerated way during speech and/or swallowing. The tongue may lie too far forward during rest or may protrude between the upper and lower teeth during speech and swallowing and at rest.”
A tongue thrust or an Orofacial Myofunctional Disorder may impact speech, chewing and swallowing as well as create changes in the dental pattern. An improper tongue resting pattern may develop as a result of enlarged tonsils or adenoids, allergies, extended thumb, finger, or pacifier sucking. It may also be related to restrictions in tongue movement, lip movement or the shape and size of the mouth.
Who Can Help With A Tongue Thrust?
This issue may be identified by a pediatric dentist or orthodontist due to the bite pattern seen in the child. An open bite (where the front teeth do not meet creating an open space) may indicate that there is a tongue thrust or an abnormal tongue resting position. A Speech-Language Pathologist trained in the area of orofacial myology or a Certified Orofacial Myologist (who may be a speech-language pathologist or a dental professional) are among the professionals who can diagnose an OMD.
To screen for the possibility of an OMD, it is beneficial to look at all the underlying factors including:
Habits – Thumb sucking, finger sucking, tongue sucking, extended bottle use and overuse of a “sippy cup.”
Airway – Open mouth breathing, enlarged adenoids and/or tonsils, allergies.
Lips – Do the lips rest apart or together habitually? Are there structural restrictions that don’t allow comfortable lip closure?
Tongue – Any difficulty moving the tongue to the roof of the mouth? Does the tongue appear to move forward during speech? Any structural restrictions impacting the movement? Sometimes the “lingual frenum” which is the attachment under the tongue is too short or tight and creates issues with tongue movement.
Teeth – What does the bite pattern look like? Is there an “anterior open bite” (the upper and lower incisors don’t meet when the teeth are together)? The “anterior open bite” is a very common pattern seen with tongue thrusts and other OMDs.
Speech – Speech may sound distorted especially the sounds “s,” “z,” “sh” and “j.”
Chewing and Swallowing – May show up as eating too quickly, too slowly, messy eater, as the swallow pattern is altered. This is sometimes referred to as a “reverse swallow.”
How is tongue thrust treated?
The approach to treatment involves first the proper diagnosis and designing a tailored approach to the particular OMD and how it is presenting in the individual patient. The therapist works closely with the rest of the OMD team, which may include the physician, ENT, gastroenterologist, oral surgeon, dentist and orthodontist. Any habits, structural issues, allergies or airway restrictions are addressed by the appropriate professionals.
Using tailored exercises, the treating therapist addresses forming correct placement of the lips, tongue and jaw at rest and the habituation of this over time. Addressing correct swallow patterns and the carryover into the ability to do this on an everyday basis with all foods is also addressed. Also addressed by the speech-language pathologist are any speech articulation issues with increased emphasis of the correct placement of the tongue and the appropriate tongue pattern.
Successful treatment involves ongoing treatment in weekly therapy, daily exercises done in the home and a collaborative approach with the family and the other professionals on the team.
https://www.nspt4kids.com/wp-content/uploads/2016/12/Blog-Tongue-Thrust-FeaturedImage.png186183Stephanie McCabehttps://www.nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngStephanie McCabe2016-12-28 05:30:152019-09-04 21:48:34What is a Tongue Thrust?
It may be difficult to know whether or not your child is showing signs of a speech or language delay. Below are some key red flags to watch for:
By Age 1, your child cannot:
• Respond to his/her name
• Begin verbalizing first words
• Initiate or maintain eye contact
By Age 2, your child cannot:
• Begin combining two-word phrases (24 months)
• Child does not consistently add new words to expressive vocabulary
• Child does not follow simple instructions
• Child presents with limited play skills
By Age 3-5, your child cannot:
• Verbalize utterances without repeating parts of words or prolonging sounds (e.g. “m-m-m-my mother,” “ssssssister”)
• Seem to find the right words, describe an item or event without difficulty
• Begin combining four to five-word sentences
• Be understood by both familiar and unfamiliar listeners
• Repeat themselves to clarify without frustration
• Correctly produce vowels & majority of speech sounds (closer to 5 years old). Speech should be 90% intelligible to unfamiliar listeners by 5 years of age.
• Ask or answer simple questions
• Use rote phrases and sentences
• Play with peers and prefers to play alone
How Can a Speech or Language Delay Affect My Child?
Speech and language disorders can have a significant impact on a child’s ability to independently function in his/her environment. Without intervention, poor speech and language skills can lead to inability to communicate wants and needs across environments, social isolation and an inability to sustain an independent lifestyle.
How Can I Help Treat My Child’s Speech or Language Delay?
General treatment includes speech and language therapy from a speech-language pathologist, in order to evaluate and treat the specific aspects of the speech or language delay. Individual and/or group therapy may be recommended in order to treat all areas of the delay.
Our Speech and Language Approach at North Shore Pediatric Therapy
Our speech-language pathologists are trained in all areas of speech and language development. With extensive knowledge in typical speech and language, our pathologists can effectively identify and remediate speech and language disorders, using multi-sensory modalities.
https://www.nspt4kids.com/wp-content/uploads/2016/12/Blog-Speech-Red-Flags-FeaturedImage.png186183Breanne Carrohttps://www.nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngBreanne Carro2016-12-27 05:30:132019-09-04 21:44:31Red Flags for a Speech or Language Delay
In the fast-paced, high tech world of childhood, girls and boys are much more likely to reach for the iPad and Xbox than a set of dice. Although, technology can provide immense growth in your child’s life, it can also delay important social-emotional learning that the old-fashioned board game has to offer.
Below are some important reasons to bring back the board game to work on social-emotional growth:
Practice Social Skills
Board games are a fantastic outlet to practice turn-taking, rule following and positive sportsmanship. Depending on your child’s age, choose an appropriate game to begin the process of reading the rules, modeling the steps of a turn, and providing examples of positive praise and compliments. Commend your child as they begin to integrate this set of skills into their regular play!
Enhance Flexible Thinking
Board games also allow for children to work on improving their frustration tolerance. Many parents can often relate to observing their children shutting down, becoming angry, or walking away from the game after a missed turn, wrong move, or misunderstanding. Flexible thinking skills to practice include compromising, negotiating, and problem-solving. Taking a break and calm breathing can also be helpful strategies. Practicing how to handle frustration in the context of a board game will help children to better handle frustration in other areas of their lives.
Incorporate your child’s favorite stuffed animal or Lego character as an additional player in the board game when other family members are unavailable.
Cooperative games are a helpful way to practice teamwork and can prevent competition from getting in the way of practicing rule-following and turn-taking skills.
Involve your child in picking out the board game in order to increase their interest in this new activity.
https://www.nspt4kids.com/wp-content/uploads/2016/12/Blog-Social-Emotional-FeaturedImage.png186183Rachel Ostrovhttps://www.nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngRachel Ostrov2016-12-20 05:30:462016-12-16 11:08:53Improving Your Child's Social-Emotional Growth Through Board Games
In a national survey of 400 pediatric physical and occupational therapists, two-thirds of those surveyed say they’ve seen an increase in early motor delays in infants who spend too much time on their back while awake. Tummy time is an important and essential activity for infants to develop the strength and musculature they need to achieve their milestones in gross motor development.
What is tummy time?
Supervised time during the day that your baby spends on their tummy while they are awake
Why does my baby need tummy time?
Being on his or her tummy will help develop the muscles of the shoulder, neck, trunk, and back. This, in turn, will allow your child to achieve developmental milestones such as independent sitting, crawling, and standing
Tummy time will help prevent conditions such as torticollis and plagiocephaly (head flattening on portions of their head)
What if my baby doesn’t like tummy time?
The sooner you start tummy time, the sooner your child will get used to it!
If your child cannot keep their head up, use a towel roll, Boppy pillow, or small pillows to help prop them up until they can lift their head on their own
Place a mirror or their favorite toys in front of them to keep them entertained
Put them on your lap on their tummy
How much time do they need on their tummy?
You can start putting them on their tummy from day one for up to 5 minutes, 3-5 times a day. As they get stronger, they will be able to tolerate increased tummy time during the day.
But, always remember – back to sleep and tummy to play!
https://www.nspt4kids.com/wp-content/uploads/2016/12/Blog-Tummy-Time-FeaturedImage.png186183Arielle Ordonezhttps://www.nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngArielle Ordonez2016-12-14 05:30:052016-12-12 14:06:41Importance of Tummy Time