Obviously, no baby is going to spend 100% of their time playing on the floor or a mat/blanket. At some point you need to cook or shower and you need a place for the baby where they’re safe from the toddler, the dog, or somewhere you know they won’t roll away. This is the time to use the exersaucer, sling seat, or bumbo seat; but try to limit the time spent in these devices to 20-30 minutes per day, collectively.
Here’s why you should consider moving away from positioning devices…
The biggest problem with these devices is children are placed in them well before they have the proper trunk and/or head control to really utilize them properly. With an exersaucer, most babies are also unable to place their feet flat on the bottom but are still pushing up into standing. This can increase extension tone, decrease ankle range of motion/muscle shortening, and can possibly be linked to future toe walking.
With a bumbo or sling seat, the baby is not placed in optimal sitting alignment causing poor sitting posture. While these appear to provide great support and make 4 month old babies look like they can sit independently, the truth is the device isn’t allowing your baby to utilize their core muscles to actively sit.
The bottom line is, if the positioning device is doing all the work, what is your child learning to do?
The best place for your child to play and spend the majority of their time is on the floor or on a blanket/mat. This allows them the opportunity to properly explore their environments and practice typical movement patterns like reaching for their feet, rolling to their side, rolling over, spending time in prone, pivoting, and creeping/crawling.
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://secureservercdn.net/188.8.131.52/fnf.6b5.myftpupload.com/wp-content/uploads/2017/01/Blog-Crossing-Midline-FeaturedImage.png?time=1599000451186183Mary Kate Mulryhttps://secureservercdn.net/184.108.40.206/fnf.6b5.myftpupload.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
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://secureservercdn.net/220.127.116.11/fnf.6b5.myftpupload.com/wp-content/uploads/2016/12/Blog-Social-Emotional-FeaturedImage.png?time=1599000451186183Rachel Ostrovhttps://secureservercdn.net/18.104.22.168/fnf.6b5.myftpupload.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
Here are some examples of how a holiday tradition can be turned into a speech and language activity:
Looking at Holiday Lights
For a younger child: Play a silly sentence game. Make a sentence about the light display but put in a nonsense word. See if your child can fix the silly mistake. For example, “The snowman is under the grass.” or “There is an elephant on the roof.” Then see if your child can make a silly sentence for you to correct.
For an older child: Create complex sentences. Challenge your child to use the conjunctions and or but to talk about the lights. For example, “The window has a wreath and the garage has a bow.” or “This house has only white lights, but that house has all different colored lights.”
For a child working on speech sounds: See if the child can find decorations containing their sounds. For example, if a child is working on /l/, they can practice saying blue lights, yellowlights, snowglobe, soldier, and igloo.
Singing Holiday Songs
For a younger child: Work on rhyming by starting a well-known carol then substituting a non-rhyming word in place of a rhyming word. For example, “Dashing through the snow, in a one horse open sleigh. O’er the fields we go, laughing all the go.”
For an older child: Make inferences about song lyrics by asking your child why For example, “Why do you think Santa asked Rudolph to guide his sleigh?”
For a child working on speech sounds: Listen to a familiar song and have your child write down every word with their sound. Then go back and practice saying the words they wrote. For example, a child working on final /l/ can listen to “Chanukah, Oh Chanukah” and practice saying the words we’ll, all, while, and table.
Decorating the Christmas Tree
For a younger child: Teach directional concepts. Ask your child, “Should I put this ornament above the tinsel or below the tinsel?” or “Should I put the star on the top or on the bottom?” while showing them what each directional word means.
For the older child: Practice describing ornaments by word features. Have the child say the shape, size, color, material it’s made of, and parts. You can play a guessing game where the child describes clues about the ornament and you guess which one they are describing.
For a child working on speech sounds: Pick a word that has a child’s sound in it and have your child repeat the word while decorating the tree. For example, a child working on “ng” can say “hang” every time someone hangs an ornament. A child working on /r/ can say “wrap” a number of times while wrapping lights around the tree.
Making Holiday Crafts
For the younger child: Practice requesting. Provide your child with all necessary materials but leave one item out. Encourage them to make sure they have all the items they need and have them ask questions if they do not have everything.
For the older child: Work on narrative skills. Have the child pretend they are leading a how-to TV show. Have them use the words first, next, then, and last to give at least four steps. Build the craft yourself and see if the directions are clear enough to be followed and encourage your child to clarify communication breakdowns if needed.
For a child working on speech sounds: Create a phrase that the child must use for each part of the craft. For example, a child working on ch can say,” I chose the ____.” A child working on /g/ can say, “I got a ____.”
Executive Functions are a set of higher order mental processes that allow an individual, or in this case, children; the ability to control their thoughts, actions, and attention in their ever-changing environment. Often, children can present with executive functioning issues as a result of many different factors such as Autism and ADHD.
Below are some executive functioning skills and how they present in both individuals with normal and poor executive functioning, and some tools/strategies for parents:
Your child has trouble being organized or often loses, or misplaces items.
Create a “home space” for your child’s items. This can include simply labeling areas of the home where items should be stored, so your child knows where to place items and lowers the risk of loss. Make checklists or use planners to help your child create a schedule.
Your child easily forgets what they just heard, or what they were asked to do.
Make connections in every lesson. Have you ever heard of ROY G. BIV? – this is how most people remember the colors of the rainbow. When teaching new content such as tying a shoe use cute, age appropriate analogies such as the bunny rabbit in the hole. Also, helping your child visualize information by writing it down, drawing pictures, and even becoming the teacher are great tools as well.
Your child may not seem aware of themselves such as when they are doing well.
Behavior charts are a great tool to help your child self-manage their own behavior. Choose an important behavior for your child to manage and how often you would like for your child to “check in” on this behavior.
Task Initiation/Planning and Prioritizing
Your child takes forever to get started on a particular task or has trouble planning activities.
Break whole tasks down into smaller achievable steps. If the desired result is for your child to complete an entire homework sheet, maybe setting a goal to do the first 2 problems together can be a happy medium. Also allowing your child to take breaks or receive rewards between tasks are a good strategy as well.
Your child often has trouble with new ideas, transitions and spontaneity.
Visual schedules and first/then language are your biggest friend. For a child who has trouble being flexible, try to alert your child to changes in routine as far in advance as you can. To help combat rigidity such as not wanting to try a new food, try to approach slow and steady first. This can include tasting a small amount of a new food instead of a large portion.
Your child often has trouble controlling their emotions and impulses when they are sad, happy, or angry.
Speak and repeat. When providing directions to a child, if applicable, state the directions remembering to adhere to your child’s learner and listener styles, and then have your child repeat back to you. Use social stories and modeling: For example, if your child often gets upset when they lose a game, a social story can help teach tools on how to act in this situation.
https://secureservercdn.net/22.214.171.124/fnf.6b5.myftpupload.com/wp-content/uploads/2016/12/Blog-Executive-Functioning-FeaturedImage.png?time=1599000451186183Faith Champhttps://secureservercdn.net/126.96.36.199/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngFaith Champ2016-12-02 05:30:092016-12-01 11:16:17Executive Functioning Skills: How Can I Help My Child?
Children aren’t born with executive functioning or self-regulation skills, rather their brain has the capacity to develop them. As a result, these skills that support a child’s capacity to learn, grow and develop can be inhibited by a number of factors including stress, environment, relationships, or delays. They can blossom and develop more fully with support from adults and the environment around them. Some children require more focused support to better develop executive functioning and self-regulation skills. Support can be through Early Education Opportunities and/or more formal intervention and support like Occupational Therapy, Behavior Therapy or Mental Health Services.
How to Identify on Track Development for Executive Functioning and Self-Regulation Skills
Positive Engagement in School
Your child has a positive experience at school, cooperates with expectations and meets expectations most days.
Your child completes their work in a timely manner and typically understands the material.
Your child’s school work is typically organized and can be located easily.
For younger children, they attend school most days without difficulty. They can share what happens at school each day and can tolerate when things change.
Your child can get along with others, can initiate interaction and negotiate play appropriately.
Your child typically understands and follows routine expectations and rules.
Your child typically responds to redirection without difficulty.
Your child can communicate his needs, wants, or wishes appropriately and effectively.
Your child can take responsibility for their actions and can understand the consequences.
For younger children, they engage in turn-taking, sharing, and show emerging empathy for others if they get hurt or sick.
Healthy and Safe Choices
Your child makes safe choices when interacting with others across settings (home, school, and in the community).
Your child can recognize and understand the importance of rules and safety.
Your child can make healthy choices for themselves (balanced eating, exercising or participating in activities that make them feel good).
Your child can access and utilize help when needed.
For younger children, they can talk about the rules at home and school. They can cooperate with important routines like sleeping, eating and toileting.
Communication and Coping Skills
Your child can express their needs, wants, and feelings verbally and effectively.
Your child can typically communicate or express their frustration or anger in a safe, appropriate manner.
Your child can accept support or help from others.
Your child can advocate for themselves appropriately.
For younger children they can ask for help, ask for their needs with words or gestures, and can calm down with adult support.
How to Promote Executive Functioning and Self-Regulation skills
Provide a visual guide for routine and rules at home.
Make expectations clear and concise; talk about what happened if expectations are not being met.
Provide 1 or 2 step directions when giving instructions.
Spend time together for multi-step activities like art, a puzzle or baking activity; talk about the steps needed.
Encourage and praise hard work and persistence especially when trying something new or challenging.
Use first/then statements i.e. “First we put the toys away, then we can have snack.”
Take time for calm and quiet activities together i.e. reading, taking a walk and coloring.
Model how to calm down or take deep breaths when upset.
Model healthy living and safe choices.
Develop Family Rituals that provide time to reflect and share about thoughts, feelings, and experiences (i.e. Highs and lows from the day over dinner, 3 best parts of the day on the drive home, marking off days on a calendar to look forward to a family outing).
Talk and share about feelings. Be willing to share your own.
https://secureservercdn.net/188.8.131.52/fnf.6b5.myftpupload.com/wp-content/uploads/2016/11/Blog-Executive-Functioning-FeaturedImage.png?time=1599000451186183Meghan Greeleyhttps://secureservercdn.net/184.108.40.206/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngMeghan Greeley2016-11-30 05:30:162019-12-20 20:04:40Executive Functioning and Self-Regulation Skills for My Child
A child who is still developing his or her articulation skills may need some feedback in order to fix speech errors and improve intelligibility.
The following tips will help you respond to a child who produces articulation errors:
Repeat the misarticulated word in your response with a slight emphasis on the target word. For example, if the student says, “I want the wed pencil,” you can respond, “Okay—here is the red”
Describe features about the misarticulated sound. For example, “The /s/ is a hissy sound. The air goes sssss like a snake hissing” or “The /v/ is made when our teeth bite down on our lip.”
Give the child a consistent visual cue for the target sound, such as dragging a finger across the lips for /m/ or putting a thumb under the chin for /k/ or /g/.
For a child who can read, contrast sounds that contain the correct sound and the incorrect sound by writing them out. For example, you can write out thin fin and show the child that one is made with a th and the other with an f.
If you know that the child is able to produce the target sound, give him or her feedback on what you heard. You can say, “I heard you say doe, did you mean doe or go?” or feign difficulty understanding, such as, “You want to doe home? What do you mean, doe home?”
As a parent or a teacher, it is important to acknowledge attempts at communication while providing feedback on speech sound production. If your child continues to demonstrate speech sound errors or is frustrated with his or her speech, seek out the advice of a speech-language pathologist.
https://secureservercdn.net/220.127.116.11/fnf.6b5.myftpupload.com/wp-content/uploads/2016/11/Blog-Articulation-Errors-FeaturedImage.png?time=1599000451186183North Shore Pediatric Therapyhttps://secureservercdn.net/18.104.22.168/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngNorth Shore Pediatric Therapy2016-11-18 05:30:412020-06-09 15:12:335 Tips on How to Respond to Articulation Errors
Primitive reflexes are foundational motor responses to sensory input that appear in utero or shortly after birth for the purpose of defense and survival. They are the foundation for higher level motor, cognitive or intellectual processes that develop as a child matures and takes on increasing demands.
Most primitive reflexes integrate within the first year of life meaning that complex, adaptive and purpose-driven actions can over-ride automatic responses. Postural reflexes, which typically begin to develop in the second year or life, are automatic reactions with a higher level response. They develop a child’s equilibrium reactions for balance and coordination as the child begins to sit, stand, walk and run. Their development is heavily influenced by the integration of primitive reflexes.
Each reflex is associated with development of a particular area of the brain and lays the groundwork for control of motor coordination, social and emotional development, intellectual processing, and sensory integration. When primitive reflexes do not adequately integrate, persistence of these patterns may interfere with related milestones. When a reflex is present, it can be viewed as a signal that function in that region of the brain is not optimized. When difficulties in a particular area of functioning exist, research has demonstrated a strong correlation with the persistence of reflexes originating from the area of the brain regulating those functions.
Why might some reflexes not be integrated?
There are many explanations for why a reflex (or several reflexes) may not be integrated. Factors such as genetics, unusual gestational or birth history, limited sensory-motor experiences, or early disease, illness, or trauma may contribute to persistence of reflexes. It is important to note that many children, and even fully functioning adults, do not have all of their reflexes fully integrated. It is when an individual displays a cluster of symptoms impacting sensory, motor, emotional, social or academic functioning that reflex integration becomes an important component to examine.
What happens if reflexes do not integrate?
Since primitive reflexes are major factors in motor development, a child with persistence of one or more primitive reflexes may experience a variety of challenges. Primitive reflexes are what help infants initially learn about their inner and outer environments, and are heavily linked to the sensory system.
If reflexes persist, they interfere with the development of higher level sensory systems (visual, auditory, tactile, taste, vestibular, smell, and proprioceptive). Interference with sensory systems can lead to learning, behavioral, and/or social challenges for children, especially in academic settings. Additionally, postural reflexes, which depend on the integration of primitive reflexes, are unable to fully develop. Underdevelopment of these reflexes causes delays in righting reactions related to balance, movement and gravity. An individual who has not developed efficient postural control will have to compensate for these automatic adjustments by expending extra energy to consciously control basic movements.
Below are just a few red flags of persistent primitive reflexes:
Over/under-responsivity to light, sound, touch, and/or movement
Difficulty with reading, spelling, math, or writing
Difficulty remaining still, completing work while seated, or frequent fidgeting
Poor grasping abilities. May grasp pencil too tight or too loosely
Difficulties with eating (pickiness, excessive drooling, messy eater)
Poor balance and/or coordination
Poor spatial awareness and/or depth perception
Difficulty knowing left from right
Poor bladder control and/or gastrointestinal issues
What do we do if reflexes are not integrated?
Activities and exercises that target specific reflex pathways can be introduced in order to strengthen particular neurological pathways. By developing these pathways, we aim to integrate the reflex and mature related functions.
https://secureservercdn.net/22.214.171.124/fnf.6b5.myftpupload.com/wp-content/uploads/2016/10/Blog-Primitive-Reflexes-FeaturedImage.png?time=1599000451186183Shannon Phelanhttps://secureservercdn.net/126.96.36.199/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngShannon Phelan2016-11-01 05:30:402016-10-28 13:39:53Primitive Reflexes: What Are They and Why Do They Matter?
Mealtime and achieving food milestones can be a stressful time for many families, especially for those whose kids demonstrate difficulty consuming a variety of flavors and textures. Instead of stressing over consuming those calories and pumping on the weight, take time to relax and enjoy a meal. Take away the stressors from your day and use mealtimes as an opportunity to bond with your little one. There is great variety in the development of infants and toddlers due to differences in the rate of physical and mental development as well as how often these skills are promoted by caregivers. As children develop their preferences for different foods (tastes & textures), they learn to accept or reject specific foods, which is OKAY!
The old mother’s tale “you can’t get up until you finish your peas” has proven to be an ineffective way to have children smoothly go through the realm of trying different foods. Instead of “forcing” your child to eat different foods, give them options…”you can eat 5 or 6 peas…you pick!” Give great verbal praise despite how big of a gain the child has made that meal.
Please see the developmental chart below that guides you through a variety of food milestones while providing ideas on how to keep mealtime positive!
Strategies and foods that should be introduced
Tips and Tricks
Nipple feeding by breast or bottle
Semi-reclined position during feeding
Breast milk or formula (approx. 18-28 ounces)
Sing songs or tell stories while you feed your infant, build a rapport
Start forming a consistent schedule
Breast milk or formula (approx. 25-32 ounces)
Make silly faces with your infant, make meal time a reciprocal relationship
Infant starts to put hands on bottle during feedings
Breast milk or formula (approx. 28-39 ounces)
˷4 mo, rice cereal trials
Always avoid television or electronics during meal time, practice songs or rhymes
Have your infant sitting at the table during adult meal times
Start to introduce pureed spoon feeds
Tongue will continue to “mash” the food to consume
Breast milk or formula (approx. 27-45 ounces)
Overly ripe fruits/vegetables
Rice or wheat cereal
Puree a food that you are having for dinner to make it easier with food preparation
Moves to a more upright position during feeds
Helps caregiver with moving spoon to mouth
Breast milk or formula (approx. 24-32 ounces)
Sweet potato mash
Puff cereal bites
Encourage infant to hold bottle independently
Think of a variety of different flavors to introduce, even mix flavors based off babies preference
Take small trials of foods from your plate to give baby to try
Progresses from pureed to more textured food
Increases finger feeding
Introduction of straw based cup or open cup
Moves to a more “munching” formation with jaw and tongue
Breast milk or formula (approx. 24 ounces)
Variety of fruit/vegetables
Mild cheese slices
Offer new foods without the expectation of eating the food (he/she can poke, smell, lick, etc)
Always offer small portions on a child sized bowl or plate (don’t overwhelm)
Grasps utensils and self-feeds
Complete transfer from bottle to straw based cup or open cup
White potato mash
Offer foods of different textures: pudding, soup, crackers, mashed sweet potatoes, etc
Have child come with you to the store to pick out their “special cup” to encourage discontinued use of nipple based bottle
Able to chew different textures and flavors
Never ask a child “Do you want ____” because you will have to respect if they say “no”
Holds open cup independently
Eats a wide variety of solid foods
Cleared to try any food
Have your toddler “get messy” with their food, spread the different textures on their hands, face, or even nose
Continuum into childhood
Continue to use choices to give your child the “control” during mealtimes
Have your child participate in mealtime prep as much as possible
Remember, mealtime goals shouldn’t be about consumption, but about a positive experience for the child. Always consult your pediatrician about diet concerns or questions.
1998, The American Dietetic Association. “Pediatric Manual of Clinical Dietetics”. 1998.
https://secureservercdn.net/188.8.131.52/fnf.6b5.myftpupload.com/wp-content/uploads/2016/06/Blog-Food-Milestones-FeaturedImage.png?time=1599000451186183Lora Collisonhttps://secureservercdn.net/184.108.40.206/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngLora Collison2016-06-23 05:30:052016-07-01 09:51:33Food Milestones: From Mashin’ to Munchin’
With what little time there is, it is important to maximize the efficiency of speech-language therapy, thereby increasing the chance of success. Life is busy, and children are involved in numerous after-school activities. Whether karate, dance, violin, or speech-language therapy, time after school is precious.
5 Tips to Make Speech-Language Therapy Successful
Frequency: After completing an initial evaluation, speech-language pathologists will make recommendations for ongoing therapy services. In many instances, a child attending therapy more than once per week may progress faster toward goals than children who do not attend sessions as frequently. Increased exposure to direct (or even indirect) intervention can result in greater therapy success.
Carryover: Carryover, or the idea that skills learned in the clinic will be transferred or generalized out of the clinic, is an important aspect in a variety of therapies. In order to make therapy a success, children who receive increased practice, and more time spent focusing on a given skill, will improve in abilities and rate of mastery.
Prioritizing Therapy: While after school activities are important, parents also need to make time for speech-language therapy. In order to make therapy a success it needs to become a priority. Consistently attending sessions, whether weekly or more often, is crucial to ongoing progress. Breaks in therapy can result in a regression of newly acquired skills and may prolong the therapy progress.
Positive experience: When therapists create a positive environment for therapy, children are more likely to participate, leading to greater gains and progress. When children are enjoying their time, they are more motivated to work hard. Conversely, when children are struggling to participate, both parents and clinicians can help children see the “what’s in it for me” factor. This may be a compromise of children and clinicians taking turns picking activities, children being “rewarded” with free time at the end of a session, or even a special treat upon conclusion of the session.
Parent Education: Providing information to parents about why speech-language therapy is important can help to justify the reason for ongoing therapy services. When parents are incorporated into the therapy progress, they are more likely to work on therapy goals outside of the clinic environment. Educating and including parents into the therapeutic progress can help to make therapy a success.
The therapeutic process may be difficult for children and families, however following these tips for success can help children to reach their potential, keep families engaged, as well improve speech-language skills!