Picky Eater vs. Problem Feeder

Eating. What’s not to love? Whether it’s a gooey, cheesy slice of pizza or a warm cookie fresh out of the oven (yum!), let’s face it -humans love to eat.  Little humans, ehh not so much. Little ones can be incredibly stubborn when it comes to eating, especially when they’re toddlers. What three year old didn’t go through a phase of just eating her go-to; whether it was mac-and-cheese, hot dogs, or PB&J. Many parents have said the words “picky eater” in reference to their child’s eating habits, but it’s important to know the differences between your run-of-the-mill picky eater versus your problem feeder.

Problem feeding is not a normal part of child development. Feeding problems are estimated to occur in up to 25% of normally developing children and in up to 35% of children with neurodevelopmental disabilities. A common definition for feeding problems is “the refusal or inability to eat certain foods.” Feeding problems can lead to serious medical issues such as malnutrition, dehydration, and impaired intellectual, emotional and academic development. Because of these potential impacts on the child’s development, early recognition and management are critical.

The table below can help you determine if your child’s eating skills are following a normal trajectory or further evaluation is needed:

Picky Eater

Problem Feeder

Eats a decreased variety of foods, usually around 30 foods Eats a restricted variety of food, usually 20 or fewer foods
Foods lost due to “burn out” (i.e. one too many hot dogs = refusal) are typically incorporated back into the child’s diet after about 2 weeks Will eat food over and over again like a picky eater but once they burn out, they will not incorporate that food back into their diet
Can tolerate new foods on their plate, will touch or taste a new food even if they aren’t really excited about it Crying/screaming/melt-down mode if a new food is on their plate and will not tolerate touching or tasting
Eats at least one food from most food group textures (e.g. crunchy, soft, puree, etc.) Refuses entire categories of food textures
Will eat a food after being exposed to it at least 10 times Will not try a new food after 10 or more exposures
Sometimes reported as a “picky eater” at pediatric wellness visits Persistently reported as a “picky eater” at pediatric wellness visits

What to do if you suspect your child is a picky eater:

  • Always eat with your child. Eating is a social experience! If your child is expected to eat alone he may feel left out or neglected. (“Why do I have to eat if no one else is?”)
  • Stick to a routine. Give your child three meals and two snacks at the same time each day (or about the same time each day, let’s be realistic here).  Offer juice or milk with his meals, not in between, to avoid filling up his tummy and decreasing his appetite. Offer water in between meals to quench his thirst.
  • At meal times, always offer him one to two preferred foods (i.e. hot dog, chicken nugget) and one new food. When he sees his preferred food, he will feel more comfortable with his plate. Try to make the new food something you’re eating as well.
  • Always talk positively about food! Even if you don’t like something, do your very best not to talk negatively about it. For example, “Mmm, these sweet potatoes are so yummy!” NOT “Ugh, these potatoes are mushy and gross!”
  • Make it fun! Get some different dips out for his chicken nuggets – ranch, BBQ sauce, ketchup, mustard! Cut sandwiches out with a cookie cutter. Use food coloring. Serve breakfast, for dinner!
  • Have your child help! Let him pick things out at the grocery store. Have him wash the vegetables or fruit. Let him mix up the batter.

What to do if you suspect your child is a problem feeder:

Works Cited:

  1. Sisson LA, Van Hasselt VB. Feeding disorders. In: Luiselli JK, editor. Behavioral Medicine and Developmental Disabilities. New York: Springer-Verlag; 1989. pp. 45–73.
  2. Palmer S, Horn S. Feeding problems in children. In: Palmer S, Ekvall S, editors. Pediatric Nutrition in Developmental Disorders. Vol. 13. Springfield: Charles C Thomas; 1978. p. 107–129.
  3. Feeding problems in infancy and early childhood: Identification and management
  4. Debby Arts-Rodas, Diane Benoit
  5. Paediatr Child Health. 1998 Jan-Feb; 3(1): 21–27.
  6. Toomey, Kay. Copyright 2000/2010. Picky Eaters versus Problem Feeders.

How Do I Know if My Child Has a Reading Disability?

Reading Disabilities are estimated to occur at a prevalence rate of 5-10%.  A disability, which is a more chronic struggle with reading without early identification and intervention, must be differentiated from the child who demonstrates a slower process in the normal developmental curve of reading development.  A disability will not resolve with repeated practice, extra attention, or the passage of time.  Below are a few clues to help figure out if there really is a disability.

Clues that Indicate Your Child May Have a Reading Disability:

  • Your child has difficulty with basic rhyming.
  • Your child has always been slow to learn the alphabet and maybe even numbers.
  • Your child struggles with sound-letter associations.
  •  Your child’s writing is illegible.
  • Your child likes to be read to but never wants to read.
  • Sight words, despite repeated practice, are easily forgotten by your child.

At times, differentiating between a disability and other factors (e.g., attention, motivation and interest, or behavior) can make accurate identification difficult.  An evaluation can help tease apart any related factors that may be impacting your child’s success.  If you are concerned with your child’s reading development, you can request an evaluation through our Neuropsychology Diagnostic Clinic.  We have clinicians trained in the diagnosis and assessment of reading disabilities and are able to provide efficacious recommendations to best help your child.
Click here to read about signs of a reading disability across grades.


Turn a Bully Into an Ally

What is one seemingly positive characteristic of a bully?

Great leadership skills. They can gather a group of followers and move in a pack to accomplish a lot.  Most bullies use this skill for negative outcomes, but think of what good could be accomplished if we taught bullies to use this strength for good?

We need to teach bullies that great leaders have certain qualities.  Bullies can be taught that they are great leaders, and great leaders use their leadership skills for good.   The bully can be taught this by the assignment of positive leadership tasks.  For example, assign the bully to a time of day to make sure each and every kid is taken care of.  At lunch, the bully ensures each child has food and is not eating alone. If she is, charge the bully with finding a solution.  At PE, have the bully ensure each girl is picked first on a team at least once and gets to be team captain at least once.

Once the bully feels the power of leading for good, she may just become one of the best leaders and members of the class.  Make strong powered kids into true positive leaders and see more leaders and team players blossom!

For more on handling bullies, read Mean Girls and bullying Boys: How Parents Can Help, and How to Include Bullying In Your Child’s IEP.

The Rewards of Adaptive Bicycles for Children

Bicycle or tricycle riding is an important component of childhood. For certain children with medical complexities, there are special equipment that enable them to explore the world just like any other child.

When I was working as a physical therapist on the pediatric floor of a rehabilitation hospital, I encountered many children and families impacted by debilitating conditions and circumstances. From cerebral palsy and brain injury, to spinal injury, or cancer, many of the children I met proved that being physically and cognitively limited did not keep them from participating in stimulating play activities.

Adaptive tricycles are designed to provide less able-bodied children a way to exercise their limbs, practice their skills and encourage their participation. 

They often come with various features and accessories such as extra wide frames, trunk reinforcement, head support, leg straps, hand straps, steering assist, etc. They make it possible for children who have low muscle tone, motor control, coordination, or cognitive function to engage in locomotion.

How Can an Adaptive Bicycle Help?

For children with diagnoses that reduce their trunk control, adaptive bikes provide a safe environment where they can work on coordinating their limbs while having their back fully supported or strapped in.  For children who fatigue easily due to their medical conditions, adaptive bikes offer the option of having an adult help steer from behind.  For children who lack the motor control to alternately pedal their legs, foot straps and connected pedals make the reciprocal motion easier by putting muscles and joints through those much needed ranges. Depending on the type of bike, adaptive handles can also accommodate all kinds of grip. So when a child with upper body weakness has a hard time grasping or holding the handlebars to steer a regular bike, an adaptive bike allows them more control of their locomotion.

Durable wheels and a parking brake make adaptive bikes safe for children with a wide range of physical abilities and conditions.  Children with medical complexities who are restricted to a wheelchair can still benefit from rides in an adaptive bike.  Aerobic training and upright posture, as well as limb movements (facilitated or self-initiated), are an essential part of the growth and rehabilitation process for children of all different capabilities. All of this is made easy by special equipment such as the adaptive bike. Being outside and being able to participate in activities with other children promote emotional health and create positive environments for mental and physical growth.

The Rewards of Using Adaptive Bicycles

I have watched many children blossom behind the wheel of an adaptive bicycle. Taking part in that transition is such a rewarding process.  Children who were unable to move certain parts of their bodies after an injury were eventually able to transfer what they learned during cycling to standing and walking tasks. Toddlers who were never able to stand on their own were able to experience, for the first time, limb movements and self-propulsion locomotion. Seeing the smiles on their faces, and hearing the laughter of their parents and siblings… Those moments definitely made my job worthwhile.

5 Ways to Improve Fine Motor Skills with Valentines

It’s that special time of the year again. Bags of candy and cards adorned with hearts and kind messages line the aisles of our local grocery and convenient stores. Our kids wait with great anticipation for their classroom Valentine’s Day parties when they are allowed to pass out and receive cards; play games, and eat delicious sugar-filled treats. While this time of the year can be difficulty to enjoy as we’re trudging through the snow covered streets, try to take time to enjoy the season and help your child to spruce up her fine motor skills!

5 ways to turn Valentine’s Day into a platform for improving fine motor skills:

  1. Cutting: This year, instead of buying pre-made cards from the grocery store, help your children cut their own cards from their favorite colored construction paper. For the younger kids, cutting straight lines for a square or cutting across a piece of paper to create smaller squares is the first place to start. For kiddos who are older (4 ½- 6), try to encourage them to cut simple shapes including circles or hearts. If your child is up for the challenge, encourage her to cut out the shape using a hole-puncher. The resistance that the hole puncher provides and repetitive motion to cut the entire shape will surely improve your child’s hand strength. Cutting is an excellent way to improve hand strength, bilateral coordination, visual motor skills, and fine motor planning.
  2. Writing Name: Making Valentines cards is an excellent way for your child to practice writing her name. Practice and repetition is key in building new foundational skills. What a better way to provide repetition than asking your child to sign a card for all of her classmates? If a child needs more help, try to show her how you would write her name, letter by letter, on a separate piece of paper. In your child’s handwriting skills are advanced, encourage her to write a short message to her best friends. The more she practices, the better her handwriting will become!
  3. Gluing: Gluing is another way to promote fine motor skills and hand strength. If your child chooses to use a glue stick, encourage her to use her dominant hand with the same grasp pattern that she uses for writing and coloring activities with her pencils and markers.
  4. Stickers and Stamps: Placing stickers on cards can also help your child to improve her fine motor control. Bending and manipulating a sheet in order to peel the desired sticker from the page and manipulating the sticker to place it on her Valentine takes a lot of patience, bilateral coordination, and fine motor planning.
  5. Folding: Folding is a very challenging activity for a lot of kiddos. Practicing manipulating paper so that the sides match up while folding and stabilizing the two ends together to create a crease in the middle of the paper requires a lot of visual and fine motor planning.

Valentine’s Day, as with many other holidays, affords children an opportunity to practice their fine motor skills. There should not be any limits to their creativity in making cards for their friends. Encourage them to practice new and emerging fine motor skills this season as they’re creating their cards!

Relaxation Strategies for Children

How do we teach our children to relax and self-soothe in a society that is inundated with constant stimuli? How do we re-frame the evil term “boredom” into an opportunity to make peace with our inner thoughts and feelings and calm our body? Often times, even adults, need prompting to relax and take a load off.

Here are some examples of activities that both you and your children can engage in to “recharge your batteries” and face the world with a more balanced mindset:

1. Mindfulness—Easier said than done. Mindfulness is the practice of connecting the mind and body to enhance attention and focus to the task at hand.  It means living in the moment and quieting out other “noise” to focus your attention moment to moment. This is a nonjudgmental practice that incorporates all the senses to be fully present. Two of my favorite ways to practice mindfulness are when you are eating or bathing.

  • Eating. We commonly eat in transit, in front of the TV, talking with others, or while multitasking. When we don’t focus on just the act of eating we miss a lot of cues such as satiety, flavor, texture, etc. Practice mindfulness when eating. Prepare your food and sit in a quiet space. Before indulging your food notice your body cues about the food. Are you starving, craving salt, is your stomach growling. Still, before consummation, notice the color of your food, the texture of your sandwich, the way the sandwich smells. We are wanting to eat with all our senses. Take a bite. What does it taste like and smell like? How does the meat and cheese and bread feel in your mouth? How many bites does it take to swallow? What does the sandwich feel like in your stomach? You get the picture. When we focus on the experience of eating in the moment we are more attune to how we feel and our mind and body and in connection.
  • Bathing. The same can be said for bathing. Notice how the water feels on your body, the temperature, the texture. Notice the smells of the product and how it feels to massage your scalp full of shampoo. Remember, use your senses to be present in the experience and try and steer clear of other intrusive thoughts that may enter about your upcoming day.

2. Music—Music can be such a relaxing outlet but make sure that the music matches the mood that you are seeking. Kids commonly want to relax to Top 40 hits, Hip Hop, or other high energy music but this in fact does not aid in relaxation as the body will mirror the energy it is hearing. If you truly want to relax, I recommend jazz or classical in addition to natural noises provided by a sound machine (waves crashing, rain falling, rainforest, etc.). Listening to music can help kids relax in times of transition (after school before homework, after homework and before bed) or when they are emotionally triggered.

3. Deep Breathing and Muscle Relaxation—Relaxing the body and calming our breath can enhance relaxation either when someone is emotionally triggered to be upset or anxious, during transitions, or prior to upcoming stressful events. Deep breathing requires breathing in through your nose for 5 seconds, holding the breath for 5 seconds, and exhaling the breath through the mouth for 5 seconds. Repeat this 5 times. Muscle relaxation includes tightening and then releasing various muscle groups. Sit in a chair or lay down in a quiet space. Start from the bottom of the body and work your way up. Squeeze your feet and toes tightly for 10 seconds and then release. Squeeze your calves for 10 seconds and then release. Squeeze your thigh muscles for 10 seconds and then release. Continue up the body. By isolating each individual large muscle group you are calling your attention to that part of the body and scanning it to release any tension or stress. You can use these strategies when you want to relax or you can make these into habits and incorporate them into a daily routine.

Click here for 10 ways to help your child unwind before bed.



What is Co-Treating?

You may have heard your therapist say, “I think a co-treat would be a great option for your child!” But what does that really entail? Will your child still be getting a full treatment session? Will his current and most important goals be worked on? Will he benefit as much as a one-on-one session? When a co-treatment session is appropriate, the answer to all of those questions is…YES!

What is a co-treatment session?

Co-treatment sessions are when two therapists from different disciplines (Speech Therapy (SLP), Occupational Therapy (OT), Physical Therapy (PT), etc.) work together with your child to maximize therapeutic goals and progress.

When is a co-treatment session appropriate?

When the two disciplines share complimentary or similar goals.

EXAMPLE: Maintaining attention to task, executive functioning, pragmatics, etc. Playing a game where the child needs to interact with and attend to multiple people while sitting on a stability ball for balance. [all disciplines]
*When children have difficulty sustaining attention and arousal needed to participate in back-to-back therapy sessions.
EXAMPLE: Working on endurance/strength/coordination while simultaneously addressing language skills. Obstacle courses through the gym while working on verbal sequencing and following directions. [SLP + PT or OT]
*When activities within the co-treatment session can address goals of both disciplines.
EXAMPLE: Art projects can address fine motor functioning as well as language tasks like sequencing, verbal reasoning, and categorizing.
*When a child needs motivations or distractions. [OT + SLP]
EXAMPLE: Research has shown that physical activity increases expressive output. Playing catch while naming items in category or earning “tickets” for the swing by practicing speech sounds.  [PT or OT + SLP]
EXAMPLE: PT’s need distraction for some of their little clients who are working on standing or walking and working on language through play during these activities works well. [PT + SLP]

Why co-treat?

  • Allows therapists to create cohesive treatment plans that work towards both discipline’s goal in a shorter amount of time.
  • Allows for therapists to use similar strategies to encourage participation and good behavior in their one-on-one sessions with the child.
  • Allows for therapists to collaborate and discuss the child’s goals, treatment, and progress throughout the therapy process. Together, they can consistently update and generate plans and goals as the child succeeds.
  • Aids in generalization of skills to different environments, contexts, and communication partners.
  • Allows for problem-solving to take place in the moment. For example, an extra set of hands to teach or demonstrate a skill or utilizing a strategy to address a negative behavior.

Co-treatments sessions can be extremely beneficial for a child. There are endless ways therapists can work together to promote progress and success towards a child’s therapeutic goals.. However, co-treatments may not always be appropriate and are only done when the decision to do so is made collaboratively with the therapists and the parents.

Contact us for more information on the benefits of co-treating in therapy sessions.

Tipper vs. Dipper: How to Produce /S/ and /Z/ Speech Sounds

“Speech” can be thought of as verbal communication. It is the set of sounds that we make (using our voice and our articulators) that comprise syllables, words, and sentences. Speech alone carries no meaning, it is merely sound. Most speech sounds are mastered by 8-9 years old, with different sounds emerging at different ages.

/s/ and /z/ speech sounds can be challenging for many children. This sound is typically mastered close to 5 years old, however some children may continue to struggle past that point. When producing /s/ and /z/, there are 3 main factors to consider: place, manner, and voicing.

Place of Production:

When producing /s/ and /z/ sounds, most people can be categorized as “tippers” or “dippers.” Tippers will bring their tongue tip up to touch their alveolar ridge (the ridge behind our top teeth), whereas dippers will bring their tongue tip down towards their bottom teeth, or anywhere in between. Both placements are correct so long as the tongue stays at midline behind the teeth. Each individual will find which placement works best, however if children struggle with placement an interdental (between the teeth) lisp may result.

Manner of Production:

The /s/ and /z/ sounds are classified as “fricatives,” or pushing air out continuously through a small opening. Many children will have difficulty with the manner of /s/ and /z/ production, and will “lateralize” their airflow, resulting in a lateralized lisp.

Voicing:

/s/ and /z/ place and manner of production are identical, however these two sounds differ when it comes to voicing. /s/ is the voiceless pair to /z/’s voiced sound. For example, when producing an /s/ sound, our vocal chords are off (not vibrating), however when producing a /z/ sound, our vocal chords are on and vibrating. Try it – put your hand on your throat and feel the vibration when producing a /z/, and feel the difference when producing an /s/! Many children will understand the difference between the two sounds but may substitute one for the other.

If your child has difficult producing our “snake” sound (/s/) or our “bee” sound (/z/) a licensed speech-language pathologist can help!

Click here for more blogs on sound production: /m/, /k/ and, /b/ and /p/.

Click here for a list of books to help with specific sound productions.

Signs of a Sensory Issue and Who Can Help

Everyone (children and adults both) have sensory issues and concerns.  As adults, we often learn to avoid noxious sensory inputs that we find to be bothersome.  Oftentimes, children are unable to avoid the sensory concerns that they find to be bothersome.  These sensory concerns can at times have a significant impact on a child’s social, emotional, and academic functioning.  Parents and educators are often unsure of when to actually seek help or what help to seek.

Questions to think about your child’s ability to deal with sensory input include the following:

  1. Does he have trouble with bright lights?  (has to have sun glasses at all times outside)
  2. Does he hate being touched?  (avoids hugs and contact from others)
  3. Does she seek out constant contact from others? (always wants to be hugged)
  4. Does he talk too loudly or too softly?

If you answer yes to any of these questions, it may prove beneficial to have your child evaluated.  Pediatric Occupational Therapists are often well trained in the assessment and intervention of sensory concerns.  They can  often work with the child to develop tolerance to the avoidant stimuli while also providing accommodations within his or her environment that help the child.

It is important to always keep in mind that there may be other medical or psychological concerns evident.  If you suspect that there may be something in addition to sensory concerns, have a consultation with the occupational therapist in order to determine if additional assessments or interventions are needed.

Additionally, don’t rule out ADHD and many other very associated issues.  You can learn more by visiting a pediatric neuropsychologist who can pinpoint the best treatment strategy.

Click here to download your Sensory Processing Disorder Red Flag Checklist.

Learning Disabilities Demystified

Learning concerns are one of the most common neurological issues with which children and adolescents present.  It has been estimated that approximately six percent of the general population meet the clinical criteria for a diagnosis of a learning disability.  The Diagnostic and Statistical Manual, Fifth Edition (American Psychiatric Association, 2013), which is the guide book for psychologists and psychiatrists that provides information regarding diagnostic information, indicates that there are several essential features of specific learning disabilities in children.

5 Features of Learning Disabilities in Children:

  1. Persistent difficulties learning basic foundational academic skills with onset during the early elementary years.  The manual indicates that these foundation academic skills include: reading of single words accurately and fluently, reading comprehension, written expression and spelling, arithmetic computation, and mathematical reasoning.
  2. A child’s performance is well below average for his or her age.
  3. Learning difficulties are readily apparent in the early school years in most individuals.  That being said, there are some instances in which the concerns are not fully evident until later in the individual’s academic life.
  4. The learning disorder is specific in that it is not attributed to other factors such as intellectual disability, socio-economic status, medical conditions, or environmental factors.
  5. The deficit may be restricted only one academic skill or domain.

Prior studies have indicated that learning disorders are more common in males than females.  There are several long-term consequences associated with learning disorders in which the individual never receives any intervention, including:  lower academic achievement, higher rates of high school dropout, higher levels of psychological distress, higher rates of unemployment, and lower incomes.
Data has indicated that children with learning disabilities are often at risk for a variety of co-existing conditions including ADHD and social-emotional concerns.  Click here for more information on learning disabilities.