Baby with a pacifier

Pacifiers – Time to Give it Up?

Pacifier. Binky. Paci. Buppy. Ga ga. Dee dee. Whatever you call it, many moms know it as Mommy’s best friend. Those little rubber plugs are miracle workers, they help to calm a fussy baby, soothe a sleepy baby, and relax a restless one. But when is it time to give it up? And why? And most importantly, how?


12 months. This is when your baby should be transitioning away from bottle to sippy cup or open cup drinking as well.


12 months marks the beginning of a dramatic increase in speech development. With frequent pacifier use, your child:

  • May be less likely to produce the beginning stages of speech and language development, like babbling and first words.
  • Will have his mouth in an unnatural position, potentially affecting the way his tongue and lip muscles develop for proper Baby with a pacifierspeech production.
  • May develop an unnatural tongue position at rest as the tongue is pushed forward between the teeth. This can lead to the development of a lisped production of “s” and “z” sounds.
  • May have more frequent ear infections. One study showed that children who did not use pacifiers had 33 percent fewer middle ear infections.
  • May develop an abnormal unnatural arc to their front teeth causing their upper teeth to tip forward toward the lip. There’s no evidence that pacifiers can cause damage to baby teeth, but permanent teeth is a different story.


  • Sooner rather than later

o   Taking away the pacifier when your child is still young (think 3-5 months) can make the transition easier for you and for him as he hasn’t developed the habit as deeply yet and he doesn’t have the ability to express his displeasure or negotiate with words.

  • Going Cold Turkey

o   You are the parent. You have the power! The transition may be rocky at first, but stick with it for a few days and your child is likely to find another way to calm himself.

o   Some creative ideas on how to go cold turkey:

  • Lose it; whether intentional or not. Play dumb and say you have no idea where they possibly could have gone.
  • Pick a day and reason why the pacifier is going away. For example, “It’s your third birthday and you’re going to be a big boy. Big boys don’t use binkies!”
  • Cut off the tip and say the pacifier is broken.
  • Leave it for Santa/Easter Bunny/Binky Fairy.
  • Give it away. For example, tell your child that the “new babies” need the pacifiers. Package them up and drop them off at the doctors office or day care.

*These ideas are best for older children, 2-3 years old.

  • Gradual

o   A slow, gradual weaning process may work best for you and your child. Restrict the pacifier use to certain times (i.e. bedtime only) or places (i.e. in the crib or in his room).

  • Read about it

o   Kids love a good bedtime story, so why not make it one about getting rid of the binky? Here are some recommendations:

  • Bye-bye Binky” by Brigitte Weninger
  • “Bye-Bye, Pacifier” (A Muppet Babies book), by Louise Gikow
  • “No More Pacifier” by Ricki Booker
  • “Pacifiers Are Not Forever” by Elizabeth Verdick

Standardized test

Breaking Down Standardized Assessment Scores

So, your child had a speech-language evaluation and the therapist hands you the report. After a quick glance you see lots of numbers, percentile rankings, terms like “compared to same age peers”, “within the average range”, raw scores, standard scores, scaled scores, age-equivalents….whew. That is a lot of information to take in, process, and understand. And even when your speech therapist explains all the numbers you may not remember what’s what by the time she’s done (was she even speaking English??). Interpreting standardized assessment scores can be confusing, especially if you’ve never been exposed to it before. Believe me, these are things that speech therapists are directly taught in graduate school, we don’t just know it.Standardized test

The majority of speech-language assessments are norm-referenced tests. What this means is that your child’s performance is compared to a large sample of children their same age.  Norm-referenced tests often yield a variety of scores. Here is quick cheat sheet to help you understand and interpret those scores:

Raw Score

The raw score is the number of items your child answered correctly. For example, if the test or sub-test has 20 items and your child answers 17 of them correctly, their raw score is 17. However, the raw score doesn’t really tell us much until we convert it into the standard score and percentile rank. Bottom line, raw score = how many test items your child got right.

Standard Score

The standard score is a way of showing how close a score is to the average score that was obtained in the sample.  Now, there’s a lot of math involved in converting the scores, however, all of that glorious math is done by the test creators. They create a nice, organized little table that lays out all of the information for the test administration (your speech therapist). So the speech therapist takes the child’s raw score and looks it up in the table in the test manual. The table converts the raw score to the standard score like magic.

The most important thing for parents to understand with standard scores is what is considered “average”. Common practice on standardized tests used for speech and language assessments is that 100 is the mean score and the standard deviation is +15 or -15.  This means that scores between 85 and 115are considered to be within the average range. Anything above 115 is considered “above average” and anything below 85 is considered “below average”.

So, say your child gets a raw score of 17. The therapist looks up the standard score that is correlated to 17 in the test manual and reports that as the standard score. Let’s say the standard score came out to be 105; that’s great! That score is considered to be within the average range when compared to same age peers.

Percentile Rank

The percentile rank tells you what percentage of the sample scored equal to or less than your child’s score. Remember that magical little table that converted the raw score to the standard score? It also tells you the percentile rank. So, if your child’s percentile rank was 50, they scored as well as or better than 50% of the sample population; though the other 50% of the population did better on the test.

To demonstrate a low percentile rank:

o   If the percentile rank was 12, they scored as well or better than 12% of the sample population, but 88% of the sample population achieved a higher score.

To demonstrate a high percentile rank:

o   If the percentile rank was 95%, they scored as well as or better than 95% of the population and only 5% achieved a higher score.

Bottom line, the higher the percentile rank, the better your child did compared to his same age peers.


Many parents remember this score most often because it’s easy to comprehend; but it’s often very misleading. “Oh no! My 5 year old child is understanding language at a 2 year, 5 month old level!” Well, that may not be the case and the age-equivalent scores are not very helpful in understanding your child’s actual skill level.

The age-equivalent represents the mean score of the sample for a particular age group. For example, an age-equivalent score of 4 years, 2 months corresponds to the average raw score obtained by 4 year, 2 month old children in the sample population. The reason the age-equivalent scores are not truly valid is that they do not take in to consideration the range of normal performance for children whose scores fall within the average range (Remember the 85-115 rule?) Also, these scores compare children to the “average X-year old”. Well sorry, the “average X-year old” does not exist. “Average” refers to a range of performance for an age group. Bottom line, ignore the age-equivalent scores. It tells you nothing about your child’s performance and is often very misleading. Rely on the standard scores and percentile ranks to compare your child to same aged peers.

Wow. That was a lot of information. Hopefully, this cheat sheet helped you understand the basics of norm-referenced testing scores. Of course, ask your speech therapist any and all of your questions regarding the scores. They will be more than happy to break them down for you and help you interpret the complicated mess of numbers!

Child scared of the dark

How To Deal With Nighttime Anxiety

Try these steps to reduce nighttime anxiety and improve compliance with evening time routine.

At the end of a long and exhausting day, how do you effectively transition your kids from the stimulation of the day to the peace and quiet of the night? Now, combine that tall order with nighttime anxiety. It would appear as though this would be more difficult, but there are simple strategies to integrate into the nighttime routine to reduce anxiety and increase overall compliance with this tricky transition.

1. During non-triggering times, talk with your child about what causes them to feel nervous or anxious with regards to bedtime. Are they afraid of the dark? A monster under their bed? A zombie in the closet? Identify with them what they are afraid of and then problem-solve with them ways to reduce their fear. If they are afraid of the dark, offer to keep their door open with a hall light on in addition to a nightlight. If they are spooked out about creatures living in their room, add an additional step before lights out to go through their room with them and search for these alleged monsters. When they see they are non-existent prior to bedtime and with support of their parent, they can feel more at ease going to sleep. Set up a plan with your child to eradicate irrational thoughts to facilitate more restful nights.

2. Begin the transition to bed earlier. If it takes a long time for your child to “unplug” and transition to bed, starting earlier can be helpful – even if it is just a conversation about starting the routine soon. If a child has anxiety about nighttime, the more advanced preparation and warning they have, the better. They can begin their thought-process and, in turn, anxiety-reduction process sooner to aid in a smoother transition. Create positive, self-coping talk that you can model for your child about bedtime such as “Sleep is important because it recharges us for the day,” or, “Bedtime is a chance for us to reflect on our high points from the day and set positive goals for the next day,” and, “Everybody sleeps.”

3. Integrate the use of a “worry doll” or “worry journal” that the child can externalize their fears and worries prior to bed to reduce rumination of irrational thoughts or fears. The worry doll can be a doll or figure that can hold the child’s worries while they are asleep. The child can tell the doll what it is worried about and clear their mind before bed. This can also present an opportunity for the parent to listen and hear what is concerning the child. If it is not appropriate for the child to have a doll (i.e. older child or male), encourage the use of a worry journal to either draw or write out concerns prior to bed. The journal will house the worries so the child can clear their mind and focus on positive, coping self-talk prior to bed.

Father Consoling Child

Helping Kids Cope With Siblings’ Health Issues

Illness and injury of a child can impact an entire family, especially healthy siblings. Whether the changes include extra doctor visits, therapy visits, or hospitalizations, the healthy sibling’s life will be effected in some way.

Healthy siblings can display a wide range of feelings and emotions which may include:

Here are some ways to support these well siblings and help them through their feelings:

  • Be honest with them about what is happening.  Share your feelings so they know it is okay to share their feelings.
  • Give your time, not gifts.  Set up specific times to spend one-on-one with the healthy sibling. Try marking them down on a calendar so that younger children have a “visual” to remind them.
  • Continue daily routines.  Keeping (as much as possible) a normal schedule for mealtimes, school, homework, chores and bed time can help the child/teen stay focused and on task.  Work with the healthy sibling to design a calendar or schedule to keep posted so they know “what is when”.
  • Try to prepare for changes in the house.  If a parent will be absent from the home, a babysitter or family member may come in to help.  Let the sibling know this in advance and set up rules/guidelines so everyone is on the same page.
  • Keep teachers informed of changes.  This will help school understand if there are behavioral issues and will allow them to be sensitive and understanding to the situation.
  • Validate the feelings of the healthy sibling. Reassure them that they are not to blame and it is okay to feel the way they feel.

If you would like to seek out extra help, North Shore Pediatric Therapy has an experienced Social Work team that can help work through the various emotions and behaviors.

Insurance form

Sorting Out Insurance: PPO’s vs. HMO’s

Insurance is a wonderful thing to have as it helps us get the medical attention we need, but trying to understand the ins and outs of Insurance can be a bit frustrating. Below are some basic facts and terminology as well as questions to ask your insurance provider when trying to figure out if a medical procedure or therapy is covered.

What is the difference between a PPO and an HMO?

–A PPO allows the individual or family covered under the plan to go anywhere they want for treatment/services.

–An HMO has a list of providers they are contracted with for services, so you must choose from the list if you want services to be paid for by the insurance.

I have an HMO, what is the next step once a specialist or facility is found?

Once you select a specialist or a facility, you will need a “Referral” from your Primary Care Physician (PCP).  This is created by your PCP office and sent to the HMO for approval and authorization.

–When you contact your PCP, ask for a “referral coordinator”…this person will be the most helpful.

–If there is not a “referral coordinator” on staff, make sure to tell the nurse or receptionist you need a “Referral for the HMO”.

My PCP gave me a Referral, how do I know if it is correct?

–This is where things can get tricky!  Sometimes a PCP will write a Referral for services, but it is not approved by the HMO.  To tell if it is correct, look for an “authorization #” and an “approval to and from date”.  There may also be a specific number of visits that are approved.

  • Here are some basic terms and what they mean:

1) Deductible (DED):  This is what you must pay or “meet” before the insurance will start to pay their portion.  Sometimes there is an Individual DED and sometimes a Family DED.  Ask the insurance if you need to meet one or both of them before they will pay for services.

2) 80/20, 90/10, etc:  This refers to the percentages that the insurance will pay and the responsible party will pay.  The first number is the insurance’s part!

3) Copays:  This is what the responsible party pays for each visit.

4) Pre-authorization:  This may be required prior to starting services.  A reference or case number is usually given to track the review process by the insurance company.  You may also need authorization after a specific number of visits to continue therapy.

5) Visit limit (max # of visits):  These are usually seen when therapy is involved.  There are some policies that have no limit, so you can be seen as many times as needed, as long as there is a medical necessity.  Also, just because you may be given a visit number, it does not mean you are guaranteed all of them. The insurance may review your case and determine the therapy is not medically necessary anymore.

a) Hard Max:  This is the number of visits allowed by the insurance company during the policy year.  Unfortunately, there is no way to get more visits if you run out.

b) Soft Max:  If you should need more than the allotted amount, you are able to have the insurance review the case to see if more visits can be given.

Top 10 Gifts Moms Want For Mothers Day

What does mom want for mothers day?  Listen up Dads, because we have compiled the top 10 gifts moms have opened up to us about mothers daywanting for Mother’s Day!

  1. For my kids to behave
  2. To sleep in
  3. Breakfast in Bed
  4. A new diamond
  5. A new puppy
  6. A free day to do what I want while my husband or sitter watches the kids
  7. To BBQ with my parents and inlaws
  8. To BBQ without my inlaws
  9. To be gifted with nice clothing
  10. Date night with the hubby

Mothers Day is full of rushing, eating, laughing and hugging.   Make sure your family knows your expectations for this day.  Expectations are very important and can make or break your day.  Enjoy this wonderful day for you Chicago Moms and Moms all over!

Parents’ Roles in Creating Healthy Eaters

At some point during your young child’s life, you may face challenges that involve getting them to eat well. Often, the first challenge family eating dinnerpresents itself during the toddler years, in which children can become quite picky and more defiant. As kids are exposed to so many unhealthy foods that are specifically marketed towards kids and teens, these foods can cause excess weight gain.

When parents come to me seeking nutritional counseling for their child, we spend a lot of time discussing their role in their child’s nutrition. The reason behind this is because children learn so much about food and eating from the family. Consider the paradigm of nature vs nurture. Yes, there are certain inborn physiological predispositions children may have toward food and eating. This is the “nature” side of the paradigm; however there is also the “nurture” side, in which you influence how your children eat. Your kids have 3-5 learning experiences with you that are related to food each day (meals + snacks), beginning from infancy. Children are only able to eat and learn what foods you choose to present to them and in what manner you present food.

Below are some tips about parents’ roles in developing healthy eaters:

  1. Be the eater you want your child to be. If you want your children to eat fruits and vegetables, then you need to eat fruits Read more

Risk of OCD after Childbirth

A recent article found in the Journal of Reproductive Health (March/April 2013) that was published by researchers at Northwestern pregnancyUniversity has indicated that new mothers are four-times more likely to present obsessive compulsive disorder symptoms than that of the general population.

Obsessive Compulsive Disorder (OCD) is a condition in which the individual engages in several repetitive or ritualistic behaviors in order to help deal with intrusive, anxiety-provoking thoughts. Having a newborn is a time of increased stress and anxiety. The entire family’s daily life and expectations change. It would be abnormal for a new parent to not exhibit any anxiety or stress during this time.

If family members or friends begin to notice a new mother engaging in excessive ritualistic behaviors that change daily activities, it may be time to seek help.

Symptoms to look out for:

  • Repetitive behaviors.
  • Checking things.
  • Washing hands, putting on hand sanitizer at an excessive degree.

Do not be afraid to approach a new mother about possible concerns and to suggest possible help and intervention if need be.

Are you Happy? How can you increase your happiness?

I’d like to think that I am generally a happy individual.  I greet people with a smile, share a laugh and look to the positives when happy familyconfronted with a challenge.  I too have fallen into the pitfall of thinking “I’ll be happy when…”.  This is dangerous thinking because once I have achieved filling in that blank, I am already thinking about the next thing or maybe that blank does not live up to my expectation of what I wanted to achieve. With that being said, how can I break this type of thinking and learn how to be happy in the present moment?  How can I increase my happiness now?

Research on Happiness:

More and more research is being done into the positive gains from happiness, optimism and positive emotions.  Research has shown that a happy brain proves to be a better functioning brain.  When we are focused on positive emotions, we tend to achieve more, are engaged in building deeper relationships and experience greater satisfaction with life.  Harvard researcher, educator and author, Shawn Achor, states that “people that work with a positive mindset, performance improves on nearly every level – productivity, creativity, and engagement”. (1)

The keys to happiness:

  • Getting more pleasure out of life (savoring sensory experiences)
  • Becoming more engaged in what you do
  • Finding ways of making your life feel more meaningful

The goal then is to spend part of every day engaging in positive exercises to increase happiness. Achor recommends spending 21 straight days engaging in any of the below exercises:

Tips to be more engaged and happy:

  • Gratitude journal- write three things that you are grateful for.
  • Write a positive message to someone in your social or professional network.
  • Exercise for 10 minutes each day.
  • Take two minutes of your time to describe in a journal the most meaningful experience in the past 24 hrs.

Others include:

  • Acts of altruism or kindness – can be random (let someone in line in front of you at a busy store or paying for the next person at a highway toll) or systematic (bring Sunday dinner to elderly neighbor).
  • Gratitude visit- write a letter expressing your gratitude towards a grandparent, mentor, friend, etc. Go visit that individual to read the letter to them.
  • Take 10-20 minutes a day to do something you truly enjoy. For me, this means making a fresh healthy juice to start my day.

As an experiment, I am currently engaged in increasing my happiness by writing a daily gratitude list, exercising 10 minutes a day and taking  10-20 minutes to make a healthy juice. At this point, I have already noticed a daily shift in my overall happiness.  Keep in mind that it is the simple and small steps that lead to big results.

1) Achor, S. (2012). Positive Intelligence. Harvard Business Review. January-February 2012.

Toe Walkers Part 2: When You Should Seek Help | Pediatric Therapy Tv

In today’s Webisode, a pediatric physical therapist discusses the intervention needed for a toe walking child.  For more on Toe walking, read this blog.

To Watch Part 1 of the Toe Walking Webisode, click here.

In this video you will learn:

  • How soon a toddler needs therapy intervention for toe walking
  • What is the maximum age  a child should stop toe walking

 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. I’m stranding here today with pediatric physical therapist, Colleen Kearns. Colleen, when it comes to toe walking, when is intervention needed?

Colleen: Well, when it comes to toe walking, the earlier the intervention, the better, because toe walking can become such a strong habit in children. The longer that they do toe walk, the harder it is to break that habit. And then, also I mentioned before, when the muscles do become shorter, the more the child’s toe walking, the shorter the muscles will become. And then the longer that it goes, the harder it’s going to be to reverse that. So, if the child is over 2 years old and walking on the toes over 50% of the time, so the majority of the time that they’re walking, then it’s time to seek intervention.

Robyn: All right. Thank you so much, Colleen. 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 That’s