Easterseals DuPage & Fox Valley Vision Clinic

By: Kristin Roemer, MS, OTR/L

The Importance of Vision

As a first grader, I got my first pair of eyeglasses at age 7. My school had an acuity screening, which showed that I could not see clearly from a certain distance. Getting glasses made seeing the board and all the materials within my classroom so much sharper and brighter. While many of us are familiar with the big “E” chart and understand the need for glasses for an acuity problem, we may not think as much about the other aspects of a person’s functional vision and how that impacts their participation in daily routines.

The Vision Clinic screening at Easterseals involves consultation with a developmental optometrist and an occupational therapist to screen for visual concerns and to discuss how these may be impacting a child’s participation in the classroom or at home. First and foremost, the developmental optometrist assesses the overall health of the eye structures and the need for a prescription. Two more areas, visual efficiency skills and visual processing skills, round out what makes up our vision.

Visual Efficiency Skills

Visual efficiency skills consist of three categories:

1. Oculomotor skills (or “eye tracking”):

• Fixation – the ability to maintain one’s gaze on a single image
• Smooth pursuits – the ability to keep one’s gaze on a moving image
• Saccades – quick movements between different visual targets

2. Accommodation (or “eye focusing”):

• The ability to sustain focus for an extended length of time
• The ability to change focus from far to near and back again

3. Binocularity: (also called eye teaming or coordination)

• Convergence and divergence: the ability of the eyes to move closer or farther and to keep a single image, not see double

Visual Efficiency Examples

If you think about your child sitting at their desk at school, each of these areas are put into play for them to be successful. Your child must use smooth pursuits to follow their teacher around the room and to follow along while reading. They must fixate and complete saccadic movements to look from one part of the board to another, such as when comparing two math equations. When they shift their gaze from up at the board back down to their desk, they are converging and diverging their eyes.

Keeping the information that they are looking at crisp and clear without “spacing out” and letting words get blurry involves their focusing system. When something about any of these systems is off, it can cause great difficulty in completing schoolwork. Even if a child is able to successfully hold each of these things together to complete a quick acuity screen, it may not show the bigger picture of how these skills have an impact on a full day in school or at home.

Visual Processing Skills

Visual processing skills refer to the brain’s ability to interpret visual information in different ways. These skills include:

• Visual discrimination – the ability to recognize details/differences among similar objects
• Form constancy – the ability to recognize an object in different contexts or in different sizes/colors/orientation
• Visual closure – the ability to visualize the whole picture when given a partial picture
• Visual figure-ground – the ability to perceive and locate an object in a busy visual field
• Visual-spatial relationships – the ability to perceive the position of objects in relation to each other and to oneself
• Visual memory – the ability to remember for immediate recall certain characteristics of an object
• Visual sequential memory – the ability to remember forms/characters in the correct order

Visual Processing Examples

Let’s imagine your child, now at home, is helping out with their chores and getting ready to get out the door. A child with a visual discrimination concern will have trouble matching up socks when they’re helping to sort laundry. When you ask your child to grab their homework off the messy kitchen counter, they may have difficulty locating it if they have poor figure ground skills. A child with form constancy problems may have trouble recognizing letters or words in different fonts or in different contexts, such as reading off a cereal box or from their assignment notebook. Let’s say you’ve asked your child with a visual closure problem to find their shoe, but they are unable to find it because it is partially obscured by a coat strewn halfway over it.

Maybe you show your middle schooler a neighbor’s address and ask them to drop off a letter down the street, but your child has difficulty with visual sequential memory and can’t remember the order of the house number. Your child, who is consistently clumsy, knocking over cups of water when reaching for the ketchup at the dinner table, may be having problems with visual-spatial relationships and be unable to adequately judge the distance between items. A child with visual memory difficulties may have poor reading comprehension, which can make for a frustrating situation when following a recipe or gathering up items from a list.

Vision Clinic Details and What to Expect

Who knew so much went into the way you take in information visually?! The occupational therapists on our team understand that the different sensory systems in our body affect how we navigate the environment and participate in various parts of daily life. If your OT feels that a developmental optometrist should be consulted to screen your child’s visual skills, they will first complete some screening activities themselves to grossly assess your child’s visual efficiency skills. If appropriate, they will also conduct some standardized assessments to get a baseline number for different visual processing skills. This information, along with identifying functional activities that may be difficult, is shared with the developmental optometrist before the clinic so the doctor can get a broader picture of how things have been going.

Our Vision Clinic typically takes place on the last Wednesday of the month. If possible, your child’s treating therapist will be present and able to share from her perspective how vision has impacted participation in therapy sessions based on what she has observed and in conversation with you. If s/he is not able to attend, she will touch base ahead of time with the OT running the clinic, who will then be able to share information and ask questions during the clinic. Information gathered from the screening will be shared informally with the treating therapist as well as a full report scanned into your child’s chart and emailed out for your records. In any case, if further consultation is needed with the optometrist, our therapists are able to contact their office and discuss strategies or action plans in more detail.

Recommendations and Additional Steps

Recommendations from the clinic may vary – the developmental optometrist may identify a few areas that need particular attention over the next few months. You will receive a list of activities to try at home, as well as toys and games that help promote visual development, and your therapist will also incorporate different activities into their therapy session. Sometimes, addressing these areas at home and in OT is all that a child needs to improve their visual skills adequately.

Other times, it may be recommended to go into the optometrist’s office for a more thorough evaluation. Some problems can be fixed with a pair of glasses (either performance lenses during tabletop tasks, glasses to address near or farsightedness, or specialty glasses with prisms), while others may require more intensive work in vision therapy. If this is the case, you will receive a packet of recommended providers in the area along with information about the typical vision therapy focus and progression. It is recommended that all children see an optometrist yearly to monitor vision development, regardless of suspected problems.

How to Get Started

If you feel that much of this information resonates for your child, ask your treating therapist about attending the Vision Clinic at Easterseals DuPage & Fox Valley. You can also contact our Clinic Coordinator, Christy Stringini, at 630-261-6216 or cstringini@eastersealsdfvr.org to facilitate this process. We look forward to *seeing* you!

Executive Functioning Strategies for Kids: An OT Perspective

By: Kelly Nesbitt, MOT, OTR/L  

What is executive functioning?

Executive functioning refers to organizing, problem-solving, working memory, sequencing and efficient execution of ideas to complete a task. Executive functioning is a complex process involving good sustained attention, organization of ideas, inhibiting impulses, time management, and problem-solving (Calderon, 2011).

General functioning would be tough without these skills in everyday life. There are many strategies that Occupational Therapists can help a child improve their executive functioning skills to better participate in their daily routines, which will be discussed below.

When do kids need to use executive functioning skills?

As an OT, I look at executive functioning specific to how kids can execute their daily “occupations,” such as getting dressed, packing up their backpacks, completing their self-care routines, or completing a craft.  Almost all tasks kids do during the day involve some executive functioning skills. For instance, when they encounter a problem, they must come up with a new idea, organize how to execute a plan, gather supplies needed, and adjust their plan if something new arises. Take the example of getting dressed in the morning, for example. When you tell your 7-year-old child, “Go get dressed before school,” your child must… 

1. Be regulated enough in their body to understand and process the verbal directions given to them. Do they know what “go get dressed before school” means?
2. Have an idea of what they want to wear- Do they need shorts? Leggings? Jeans? Once they realize it’s cold outside, do they know the necessary steps to take?
3. Visualize what supplies they need on a cold day: socks, shoes, underwear, a shirt and pants. They need to know where to go in the house to find all these supplies.
4. Once they have this “list” of what they need, they need to gather these materials. Your child must be able to draw on their memory to know where do I find my clothes? My dresser? My closet?
5. Then find all these articles of clothing in their room, keeping in mind everything they need and staying focused on this task (sustained attention) and getting it done in a reasonable amount of time before mom calls them to get in the car for school.
6. If they find every article of clothing but realize that they cannot find their jeans, do they have a strategy to solve this issue? Can they ask Mom? Can they look in the laundry room if mom or dad has washed their jeans and it just hasn’t been put away yet?
7. Once your child finds out that their jeans were just in their brother’s room, can they then sequence the steps accurately of dressing in their school clothes? (take off PJs, pull on their underwear, then pants, then their shirt)
8. Be able to evaluate to see if the task was completed correctly. Did they forget a sock? Did they miss a step? Did they complete the task on time?

Needless to say, a lot of brain power actually goes into what seemingly is a simple task to most adults.  

How do I know if my child has executive functioning difficulties?

A diagnosis like attention deficit hyperactivity disorder (ADHD) or autism can certainly be a factor, but there are many neurological, mental health and behavioral disorders that can affect a child’s executive functioning skills. An Occupational Therapist, Speech Pathologist or Social Worker, can help you determine if their difficulties are from executive functioning difficulties or if there are other sensory, postural, mental health, and/or motor planning issues underlying. Some signs that executive functioning may be hard for your child include (but are not limited to)…. 

• You have to constantly prompt kids to get dressed in the morning or walk them step-by-step through daily routines that you know they know how to do 
• Your child consistently forgets their homework assignments at home, or their binder is so disorganized that they cannot find what they need in it 
• Your child consistently forgets to do chores (not just avoiding them) or does them incompletely (when you know they understand what to do)  
• They get distracted easily. You ask your child to do something, and you consistently find them doing something completely different (watching tv, playing with a different toy) 
• Homework tasks are really hard (especially around 2^nd grade, where the workload increases) 
• Teachers have described them as “disorganized” or “getting distracted in class.” 

Strategies to help: 

Environmental setup: 

Picture from: HPIM4516.JPG (1600×1194) (googleusercontent.com) 

• Keep the environment at home decluttered (as much as possible). Have designated spaces where toys belong that are denoted with labels (for kids that read) or pictures (for children who are not yet reading). I recommend taking literal pictures on your phone of what goes in the bin and printing it out so that your child makes the connection of what actual items go in that bin.  

• For homework completion, you can have two bins at the table where the child does their homework, labeled “to do” and “done.” You can put all the papers the child must complete in the to-do bin, and as the child finishes each, they can move them to the “done” bin. Sometimes this concrete step helps a child’s brain visualize what is left to complete and what is already complete.

Visual schedules: 

• Have a visual schedule of activities you want your child to complete. This schedule has small pictures that go in see-through sleeves. Once an activity is completed, the child can take the picture out of the sleeve and put it in a pouch at the bottom. Again, I’d recommend you take pictures of the child’s literal tasks/them doing the tasks to help improve comprehension of what the picture represents.  

Timers: 

Count “ups”/ Clocks– For children who both do and do not know how to tell time, I recommend using a clock to help them manage time. If you have an analog clock with a glass or plastic face, use Expo markers to draw pie segments on the clock face of what task you want the child to do.  

For this example, if you need to be out the door by 3 o’clock, tell the child that they need to get dressed while the big hand is in the orange area. Children who can read can have more complex segments delineated on the clock for multi-steps.  

Countdowns/timers: 

Time Timer clocks count DOWN how much time is left, which can be helpful for children when it’s almost time to transition away from the TV or leave for school in the morning.  

Executive Functioning Support

If you feel like your child is struggling consistently with executive functioning tasks, an Occupational Therapist can specifically look at these skills in an OT evaluation.  Our skilled therapy team works across ages and diagnoses and can help create a personalized plan to help your child.

To learn more about services at Easterseals DuPage & Fox Valley, call us at 630.282.2022 or email info@eastersealsdfvr.org.

References: 

Executive function in children: Why it matters and how to help – Harvard Health by Johanna Calderon, PhD 2011  

DIR Floortime®: A Parent and Child Empowerment Model

By: Kelly Nesbitt MOT, OTR/L & Certified DIR Floortime Therapist

DIR Floortime is a multidisciplinary, developmental treatment approach that has profoundly shaped my clinical practice as an Occupational Therapist. I have personally seen a variety of children thrive with this approach. I have been lucky enough to learn all about DIR Floortime at Easterseals. While DIR is a very complex model, I wanted to have an overview of this model that parents can refer to and start off on their journey of learning and growing with their child.

Author’s Note: I use both identity-affirming language “autistic children” and person-first language “children with autism” throughout this post, as these are two schools of thought within the autism advocacy community regarding how to refer to someone with this diagnosis. Generally, I use the language that feels most respectful to each individual family and child. As I am not someone with autism, I don’t have the lived experience to make a judgment on which school of thought is “right.”

Dr. Stanley Greenspan and Dr. Serena Wieder explain their model, DIR Floortime ®

What is DIR Floortime?

DIR, which stands for Developmental Individual Differences Relationship Model, is the theoretical framework that works to promote the relationship between the child and parent, looking at the unique individual differences (sensory processing, motor, neurology, developmental, cognitive, and social-emotional skills) of the child and using playful, child-led strategies to support engagement and development.

All these Individual differences and the Relationship you have with your child all help catapult your child forward Developmentally. Floortime is the practice or application of DIR theory in which you literally “get down on the floor” with the child and “get into their world,” exploring their interests through affective, playful engagement in order to help them grow. The most important part of DIR Floortime is the “R,” which stands for “Relationship;” your relationship with your child drives all the development and meaning they derive from the world. DIR Floortime is, at its core, a parent coaching model.

Growing research is showing that this developmental, multidisciplinary approach is an effective treatment option for working with children with Autism Spectrum Disorders. Multiple randomized-controlled studies have been published since 2011 identifying statistically significant improvement in children with autism who used Floortime versus traditional behavioral approaches.

How Therapists Are Involved

Your therapist will help coach you on how to use your child’s strengths and interests to accomplish your child’s goals. It aims to empower parents, who are the “experts” in their child, to trust their instincts, follow their child’s lead, and fundamentally look at the child’s capacities in a strengths-based approach. Essentially, this model looks at and bases treatment decisions around all the wonderful things a child can do and what strengths they already possess.

What I love about DIR Floortime:

It Respects the Parent’s and Child’s Knowledge

As an OT, I hold the core assumption that every parent and child is trying their best based on their mental, emotional, and physical capacities at that moment. This model coincides with that belief on a profound level. Since DIR Floortime is a strengths-based model that presumes competence of both the parent and child, this approach really helps me go into a session with an empathetic heart and help you use “what is going well” with your child and expand from there.

Because this approach is centered upon relationships, it’s incredibly important that all families feel comfortable with their therapist as a cheerleader and coach and are able to be vulnerable in sessions. Parenting is incredibly complex, hard, and rewarding, and your therapist rides all those ups and downs with you, not as an “expert” in DIR, but as someone who is in your and your child’s corner. Even if a session is really hard, there is always something positive that can be found together, and growth can occur from there.

It is Neurodiversity-Affirming

I also love DIR Floortime, as it is neurodiversity-affirming. Neurodiversity-affirming practice refers to celebrating the unique diversity of neurological functioning that makes humans beautifully complex. It honors the interests and experiences of the neurodiverse child (children with Autism, ADHD, sensory processing differences, OCD, anxiety, and more). This approach assumes that children “don’t need to be fixed or cured,” just supported where they are developmentally and accepting their uniqueness; We see the child as inherently good the way they are. This model doesn’t see, as some may say, “unusual interests” in Autism but rather sees a child with a passion that can teach us more about something we may have never thought twice about.

It Encourages Interests and Doesn’t Label

I remember hearing an adult with Autism explain how when he was little, he always saw profound beauty in light reflecting off droplets of rain or in suncatchers on windows. He described how he would flap his hands in excitement as the droplets slid down the window or light danced through the glass and onto the floor, his body unable to contain the excitement at witnessing something so wondrous.

I wonder if, as a child, this boy may have been described as having an “unusual interest” in windows and “stereotyped behaviors” rather than someone with a unique sensory system and neurology who is having a joy-filled sensory experience. I have also heard of some Autistic advocates reporting that it must be sad that “neurotypical” people don’t get to experience the profound joy of stimming and seeing the beauty that surrounds us in everyday experiences.

I think this is a wonderful way to look at neurodiversity- what can these children show us about experiencing the world with a newfound sense of wonder and excitement. How can we reframe pathologizing neurodiverse children and instead amplify their voices and experiences to learn something exciting and new?

DIR Floortime looks at a child as a human being, not a diagnosis or label, who has great ideas that should be honored.

DIR Therapy at Easterseals

Lucky for us all, Easterseals has many certified DIR Floortime Therapists in the Occupational Therapy, Social Work, and Speech Therapy departments! You can request a therapist who has this specialization. However, if one is not currently available at the time your child needs therapy, don’t worry! Easterseals has an environment of constant collaboration and clinical supervision, so a non-certified Floortime therapist can still provide a strengths-based, child-led approach with mentorship and consultation from a certified DIR Floortime therapist.

Easterseals provides an environment that celebrates neurodiverse children’s experiences and, through the DIR Floortime model, allows parents to help their children gain skills and grow!

If you are interested in getting started with DIR therapy for your child at Easterseals, we have many qualified therapists to guide you through the process!

Learn more here to get started.

Where can I learn more? DIR Resources

Websites:

Profectum Parent Toolbox (this is a wealth of videos, webinars, worksheets, and educational materials to help walk parents through all aspects of this model. Available in English and Spanish)

Profectum.org and ICDL.org are the two large organizations of DIR Floortime. Both websites have a wealth of information and training opportunities for professionals and parents.

ABA vs. DIR Floortime? This is a look at these two different approaches to help you decide which is a better fit for your family

 DIR Floortime Quick Fact Sheet   (This link is a list of clinical research and evidence supporting this model)

Affect Autism Podcast What is it? – Affect Autism: We chose play, joy every day (this is one of my favorite podcasts about DIR Floortime, exploring a range of topics within this model)

Books about DIR Floortime and Related approaches:

• Brain-Body Parenting by Mona Delahooke PhD (2022)
• Beyond Behaviors by Mona Delahooke PhD (2019)
• Visual/Spatial Portals to Thinking Feeling and Movement by Serena Wieder PhD and Harry Wachs O.D. (2012)
• Engaging Autism by Stanley Greenspan, M.D. and Serena Wieder, PhD (2007)
• The First Idea: How Symbols, Language and Intelligence Evolved from Our Primate Ancestors to Modern Humans by Stanley L. Greenspan, M.D. and Stuart G. Shanker, D. Phil (2004)
• The Secure Child by Stanley Greenspan, M.D. (2001)
• The Irreducible Needs of Children by T. Berry Brazelton, M.D. and Stanley L. Greenspan, M.D. (2000)
• Building Health Minds by Stanley Greenspan, M.D. (1999)

Healthy Sleep Hygiene for Kids

By: Kelly Nesbitt, MOT, OTR/L

One of the trickiest parts of a child’s daily routine for families is sleep, going to sleep, staying asleep, and finding consistency in the bedtime routine. Below are some helpful tips to make your child’s bedtime restful and not stressful.

Author’s Notes: I use both identity-affirming language, “autistic children,” and person-first language, “children with autism,” throughout this post, as these are two schools of thought within the autism advocacy community of how to refer to someone with this diagnosis. Generally, I use the language that feels most respectful to each individual family and child. As I am not someone with autism, I don’t have the lived experience to make a judgment on which school of thought is “right.”

Also falling asleep and staying asleep is a complicated process. Both environmental modifications as well as your child’s physiological processes impact sleep. Don’t be afraid to bring up sleep to your child’s pediatrician if you are worried that even with good sleep hygiene, your child is still not sleeping well.

Steps for a Child’s Bedtime Success

First, ensure your child’s room is set up in an optimal sleeping environment. Physical set-up includes:

1. A Quiet Room: If it can be helped, having children not share a room so that if one child wakes up in the household, it does not wake up your other children. If you have two children sleeping in the same room, you can try having music or a white noise machine playing in the background so that the children can get used to having noise present in the room.
2. A Dark Room: Also, ensure that the room is dark (with the exception of a nightlight if a child needs it), which helps a child’s brain know it is time to sleep. Trial blackout curtains if a lot of light creeps in the windows, if your child is going to bed when the sun is setting, or if there is ambient street light coming into the room.
3. A Cool room:  A cool room is optimal for sleep. A room between 60 and 68 degrees is cool enough for children to sleep well. (Best Temperature to Sleep: Research and Sleep Tips (healthline.com)

Consistency is Key

One of the biggest keys to having good sleep hygiene is having consistency every night. This means a consistent bedtime, routine, and expectations for sleep. Give yourself and your child about 30-45 minutes to start the whole bedtime routine and keep it consistent every night.

As a family, you can decide what activities are calming for your child that you can work into your routine for bedtime (taking a warm bubble bath, changing into PJs, and listening to quiet music for a few minutes before you tuck them in).  It will take some trial and error to find what makes your child feel calm and sleepy.

 I recommend keeping a journal or note on your phone on what time you started the bedtime routine, what activities you chose, and what time your child got to sleep. This will help you find patterns of what worked in the routine and what did not work.  

Limit screen time to 1 hour (at least) before bed

This is a big one. Screen time is often very overstimulating for kids and sends signals to a child’s brain to stay awake! In fact, a review of many studies from the American Academy of Pediatrics shows that “In >90% of these studies, more screen time was associated with delayed bedtimes and shorter total sleep time among children and adolescents.” So how do we reduce screen time around bedtime?

About an hour before bed, turn off the electronics! That means tablets, iPhones, laptops, and televisions. There are parent control apps (check them out here: How to Check Screen Time on Different Devices (guidingtech.com). These apps can turn off children’s apps or even password lock the device at a certain time. It’s also recommended that children do not have access to devices in their rooms (no televisions or tablets in their rooms). You want your child to associate their bedroom as a calm space for sleep, not for sitting and watching shows.  Replace screen time with reading time, unstructured playtime with their toys, or quiet music and drawing time. This hour before bed can be explained to older kids as “a time to quiet our bodies and minds.”  The activities you do before bed with your child (discussed more below) should be quieter, organizing, and not high-energy activities.

This change to limiting screen time will likely be a tough adjustment for kids, as it’s difficult to beat the immediate gratification and fun of visually stimulatory ipads, iphones and TV. But consistency is key, and kids are resilient, so they will accommodate over time. Make it a challenge for yourself, too- take a break from electronics with the kids at night and don’t get them back out until they are asleep!

Find Out What Activities are Calming

Play around with what activities you try an hour before bedtime. Here are some quieter activities that can promote settling kids’ bodies for bed:

Heavy Work/Proprioceptive activities: Heavy work/proprioceptive input is compression to joints that sends calming signals to the central nervous system. Any activity that has “pushing, pulling or carrying” contains proprioceptive input. The trick with heavy work input around bedtime is selecting activities that are not going to be too active. Do these activities for about 10-30 minutes or until you notice that your child is looking tired or their body is regulated.  These activities could include:

• Doing wall push-ups
• Pushing a toy container around to pick up toys
• Pull a weighted blanket with their stuffed animals on it
• Lay on bellies on hardwood or linoleum floor and pull with their arms (you can put a towel on the floor for the child to lay on to get less resistance when they pull).
• Have the child fill a fabric bag with what bedtime stories they want to read that night and carry it to their room

Calming Bath time: Draw a warm bath for your little one with calming bubbles if your child enjoys that. There are also some cute light-up bath toys to play with along with having the overhead lights turned down (if it’s safe to do so). Always make sure that your child is supervised when in the bathtub.

Additional Sensory Supports

Here are some additional sensory supports that could be added to bedtime to help your child prepare their body for sleep:

OLFACTORY/SMELL:

• Use gently scented lotions with soothing scents (chamomile, lavender, vanilla, for example) for an olfactory signal for your child to get ready for bed.
• Trial essential oil diffusers (that are out of reach of children in their room) with calming scents

TACTILE/TOUCH:

•  Trial using a weighted blanket at bedtime or during quiet time. See this blog post for more information: The Benefits of Weighted Blankets – Easterseals DuPage & Fox Valley Blog (wordpress.com). To sleep with, a child’s weighted blanket be no more than 10% of their body weight!
• Rub your child’s back while they lay in bed with deep pressure, which is calming.
• Cuddle with deep squeezes to their body (think of swaddling a baby to sleep)
• Allow children to have access to their security blanket or toy (often children use these items to remind them of their parents’ love and literally take that with them as they look at that toy)

VISUAL/LOOK:

• If you can, dim the lights in your house or turn off a few lights so the house is a little darker before bed.
• Again, limit screen time
• Have a soft, warm night light in the child’s room
• Have the child’s toys “out of sight and out of mind” during bedtime. They can have their preferred stuffed animal if they are old enough, but other tempting toys should be put away.

GUSTATORY/TASTE:

• Have warm milk prior to bed
• Avoid a big meal or snack right before bedtime, as it’s hard to sleep when you are digesting a lot of foods.

AUDITORY/HEAR:

• Use a quieter, softer tone of voice to help signal to your child that it’s time to settle down.
• Play a white noise machine in the bedroom
• For children 3 and up, there are Children’s bedtime podcasts to listen to during getting ready for bed. Select stories that are slow-paced, and the narrators have a calming voice.
• Play soft music in the background during the bedtime routine

VESTIBULAR/MOVEMENT:

• If your child is soothed by being rocked, you can make a blanket swing with 2 adults holding the ends of the blanket and your child climbing in. Give your child slow, rhythmic movements which are calming.
• Read bedtime stories in a rocking chair

You can also talk with your child’s Occupational Therapist about what other activities and sensory supports can work for your child.

Cuddle and Connect

Once your little one is all settled into bed, use this opportunity to connect with your child with a special routine or routine that is important to you as a family. This can be reading a bedtime story, saying prayers together, reviewing the best parts of the day, saying what you are grateful for, or singing a bedtime song.

Feeling safe and connected with their parents is a good way to bond and send them to sleep. That being said, sometimes separating from mom and dad in order to go to bed is really scary and a normal childhood fear. Having this consistent shared time can help a child feel safe and secure prior to going to bed. You can also read some separation-themed stories to help them to ease this anxiety.  (Children’s Books about Separation Anxiety – Sleeping Should Be Easy)

A Note on Autism

I would be remiss not to mention that even with immaculate sleep hygiene, some autistic children still have difficulty falling asleep and maintaining sleep. There is a higher prevalence of insomnia in autistic children than in their neurotypical peers. There are some theories that gastrointestinal issues, possible sleep apnea, anxiety, restless leg syndrome, epilepsy, medication side effects and/or hormone imbalances can contribute to more sleep issues in children with autism (Wide Awake: Why children with autism struggle with sleep). It is recommended that parents who have concerns with their child with Autism’s sleep discuss this with their therapy team as well as the pediatrician. Their pediatrician may refer them for a sleep study to evaluate the quality of their sleep and what barriers contribute to them not sleeping well.

Wishing all a good and restful night!

References:

• “Digital Media and Sleep in Childhood and Adolescence” by Monique K. Le Bourgeois, PhD, Lauren Hale, PhD, Anne-Marie Chang, PhD, Lameese D. Akacem, PhD, Hawley E. Montomery-Downs PhD, Orfeu M. Boxton, PhD.  November 1, 2017. Link: Digital Media and Sleep in Childhood and Adolescence | Pediatrics | American Academy of Pediatrics (aap.org)
• Wide awake: Why children with autism struggle with sleep | Spectrum | Autism Research News (spectrumnews.org) by Ingfei Chen (Oct 7, 2015)
• Best Temperature to Sleep: Research and Sleep Tips (healthline.com) by Bethany Fulton (Dec 13, 2019)
• Children’s Books about Separation Anxiety – Sleeping Should Be Easy
• How to Check Screen Time on Different Devices (guidingtech.com)

Strategies to Help Children Eat New Fruits and Vegetables

By: Valerie Heneghan, M.A. CCC-SLP/L, C/NDT

As a mother of two young children, having your child eat more fruits and vegetables is always the goal. If you are like me, when my children were starting to eat solids, I could easily offer them various fruits and vegetables.  They would typically take the food offered on their highchairs, explore it and even take bites of it.  But as they got older, they became more selective.

There are many reasons why a child may be unwilling to try new food on any particular day. Maybe the presence of a new food made them panic, and they were never introduced again. Some children may recall a negative experience with a particular food that made them gag or throw up. Now they don’t trust any similar association with that food, such as color, shape, or specific packaging.

The good news is that it’s never too late to try new foods!

Helpful strategies to start exploring new foods

1. Building Trust Around Food

This idea may not be top of mind when you think about getting your kids to eat more fruits and vegetables, but it is critical. We need our children to be calm and ready to learn when introduced to new foods. This process starts with a trusting and nurturing relationship between the child and the caregiver.

A great place to start is being true to your word regarding food. As a parent, there is a strong temptation to sneak in vegetables in a meal. Or tell your kids it’s a fruit snack instead of these are your vitamins.

However, Trying to “sneak in” healthy foods doesn’t always lead to long-term good habits, especially with selective or “picky” eaters. Children know their foods, and if you alter it without them knowing, they will likely believe that you will do it again in the future and may reject that particular food or develop more habits that make them more selective such as watching you open the package, only eating foods when they are a specific temperature, etc. Instead, have them change foods or cook with you if they choose to and call foods by their actual name.

2. Supportive Seating and Environment

When possible, offer your child a secure place to eat where their pelvis is upright, and their feet are grounded into a surface. Think about an environment that is inviting to focus on a new task. 

For example, limit distracting sounds, have a clear table, a predictable setting, etc.

3. Offers Not Demands

When trying something for the first time, or food they once ate and no longer have been eating, encourage exploration and positive experiences with that new food rather than the amount of consumption. The first interaction with a new food may be smelling it, touching it with a utensil, passing it to someone else, etc. You can talk about how it looks, make funny faces with it, do actions with the food like dancing or telling jokes, etc. 

As a mother, I do understand at the end of the day, all you want is for your child to eat the dinner you prepared for them, and when they refuse it, that can be frustrating. As a child, however, I remember being served foods I had never eaten before and told I couldn’t leave the table until I ate everything on my plate. So I sat at the table trying to hide foods under other foods, sneaking little bits to the dogs under the table, any trick I could try to make it look like I complied with the rules. Trying new foods cannot be an all-or-nothing process for children. This is simply ineffective for both the child and the parent.

As an adult with that experience, I try to problem-solve how to make new food more approachable. Is it by playing a familiar game, such as playing basketball with blackberries, do we turn the celery stalk into a paintbrush? Do we offer that the food can stay on the table but doesn’t have to go on their plate until they are ready to learn more about it? Be creative and have fun with it!

4. Exposure to Variety

Keep offering those new foods!  It will likely take repeated exposure before kids are willing to try something new. Food is not wasted if not eaten because initial exposure to new foods is just as important, so children can learn more about it and increase their willingness to try it later.

5. Family Mealtime Routines

Whenever possible, try to have family meals together where kids and adults eat the same food and can take how much they would like on their plates. This simple practice can keep exposure to new foods more consistent. Keep the conversation light and positive during mealtime (Ex: If you could be any animal at the zoo, what would you be? etc.) With a routine, kids will know what to expect. And seeing someone else eat the same food, will give them a chance to observe that it is safe to try it too. And don’t “yuck someone’s yum.” Normalize if a child decides they like a certain dip with the food or want to mix foods together.

Feeding Support at Easterseals

Nearly 90% of children with special health care needs are at risk for some type of nutrition-related problem.

If you need additional support for your child’s feeding needs, our multi-disciplinary therapy team offers comprehensive support through our nutrition services, feeding clinic, speech-language feeding specialists and our fun with foods group.

To learn more about services at Easterseals DuPage & Fox Valley, call us at 630.282.2022 or email info@eastersealsdfvr.org.

Speech-Language Pathology Scope of Service

By: Anne O’Dowd, Pediatric Speech-Language Pathologist, CF-SLP

What does Speech Therapy Include?

Perhaps your child or another child you know is referred to see a speech-language pathologist from their doctor. When you think about the areas a speech-language pathologist treats, it is easy to assume we work only in the areas of speech and language, as our title implies. This is a common misconception.

In fact, our field is much larger than our title offers it to be. To provide a better view of the areas we treat, below is an extensive list of our scope or service delivery areas. A speech pathologist can help a child in nine key development needs. Please note that this list is not exhaustive, not all service delivery areas are offered at Easterseals DuPage & Fox Valley, and individual speech-language pathologists can specialize in one or several areas. Areas in which we practice vary in development, some continuing to evolve (e.g., literacy) and others emerging.

Learn more about our speech services here.

Speech

Speech refers to the production of speech sounds, individually and in words. Children produce several typical speech errors that decrease over the first few years of life, resulting in adult-like speech. Intelligibility, how well an outside listener without context can understand an individual’s speech, is one quick tool we can use to measure speech development. Below are some examples of the service delivery areas we treat regarding speech:

• Articulation: errors in individual speech sounds
• Phonological: errors that follow rule-based, predictable patterns (e.g., phonological processes of stopping, final consonant deletion, or weak syllable deletion)
• Motor planning and execution: developmental or acquired disorders at a motor/neurological level characterized by difficulty producing consistent, predictable speech patterns

Language

Photo by Keira Burton on Pexels.com

Language refers to expressing and comprehending words through multiple modalities, including speech, writing, reading, speech-generating devices, picture symbols, and gestures. We use language for various intents, including sharing ideas and ensuring our needs are met. Below are some examples of the service delivery areas we treat regarding language:

• Phonology: system of speech sounds and how we combine them to make meaningful words
• Morphology: use of word forms to create new words
• Syntax: combining words to create grammatically correct sentence structures
• Semantics: appropriate use and identification of word meanings
• Pragmatics: social aspects of communication and language use
• Literacy: spelling, reading, writing
• Prelinguistic communication: (e.g., intentionality, communicative signaling, joint attention)
• Paralinguistic communication: (e.g., body language, signs, gestures)

Fluency

Fluency refers to the rhythm of our speech. Typical speech is characterized by occasional disfluent moments (e.g., pauses and repetitions), although a higher frequency of these may be a cause for concern. Below are some examples of the service delivery areas we treat regarding fluency:

• Stuttering: disfluencies in speech, including repetitions, blocks, and prolongations
• Cluttering: abnormally fast and/or irregular rate of speech

Voice

Photo by Stan Kedziorski-Carr

Voice refers to the quality, pitch, and volume of an individual’s voice. A voice disorder is present when one or more of these voice qualities are perceived as different or inappropriate for an individual’s gender, age, culture, and geographic location. Causes for variation in voice can be organic (e.g., structural changes due to aging, vocal fold paralysis) or functional (e.g., vocal fatigue). Below are some examples of the service delivery areas we treat regarding voice:

• Pitch: how “high” or “low” one’s voice is
• Loudness: the volume of one’s voice
• Alaryngeal speech: speech production utilizing a substitute for the vocal folds in the larynx

Resonance

Resonance in speech refers to the production of a filtered sound, beginning at the vocal folds. The sound travels through the pharynx and oral and nasal cavity. As it passes through, it is filtered and enhanced based on the shape and/or size of an individual’s vocal tract. Below are some examples of the service delivery areas we treat regarding resonance:

• Hypo- and hypernasality: not enough or too much sound energy in the nasal cavity
• Cul-de-sac resonance: when sound energy is “trapped” in the oral, nasal, or pharyngeal cavity due to an obstruction

Auditory Habilitation

Photo by Christine Carroll

Typically, when discussing the pediatric population, Auditory Habilitation instead of rehabilitation is used as rehabilitation refers to restoring a skill that was lost. Often, a young child who presents with hearing loss or is Deaf has not yet developed age-appropriate auditory skills and therefore is not restoring the skill. Below are some examples of the service delivery areas we treat regarding aural habilitation/rehabilitation:

• Auditory processing: comprehension and interpretation of auditory information
• Speech, language, communication, and listening skills: as affected by deafness, hearing loss

Learn more about our audiology services here.

Cognitive-Communication Disorders

Speech-language pathologists also provide services for individuals with Cognitive-Communication Disorders.  In the pediatric population, the most common etiologies for cognitive-communication disorders are autism spectrum disorder, cerebral palsy, developmental delay, and traumatic brain injury. Below are some examples of the service delivery areas we treat regarding cognitive communication:

• Executive functioning: includes working memory, inhibitory control, and cognitive flexibility
• Attention: ability to attend to someone or something
• Memory: includes episodic, semantic, procedural, short-term and working, sensory, and prospective memory
• Problem–solving: obtaining, processing, and collaborating the information needed to find a solution to a simple or complex issue

Feeding and Swallowing

Photo by AMSW Photography -Alisha Smith Watkins on Pexels.com

Feeding and swallowing refer to how individuals transport food and drink from their environment into their bodies. Speech-language pathologists are involved in the parts of this process that involve the mouth, pharynx, and esophagus. We collaborate with other specialists, such as nutritionists, occupational therapists, and gastroenterologists, to meet each child’s individual feeding and swallowing needs. Below are some examples of the service delivery areas we treat regarding feeding and swallowing:

• Oral, pharyngeal, and esophageal phase of swallow: components of the swallow that occur in the mouth, pharynx, and esophagus; abnormal swallow can occur in one or multiple phases
• Atypical eating: (e.g., food refusal, food sensitivity, negative physiological response)

Learn more about our feeding clinic here.

Augmentative and Assistive Technology

Photo by Michael Vanko

Augmentative and Assistive Communication (AAC) includes all forms of communication that are used to supplement or replace oral speech to express thoughts, needs, wants and ideas. AAC allows children to communicate more easily and, in doing so, reduces frustrations for the individual and his or her family. There are several forms of AAC ranging from light tech to high tech. Below are some examples of the service delivery areas we provide in AT services:

• Diagnostic Therapy – working with a child to explore access methods that are consistent and least restrictive to a robust communication system
• Assistive Tech/ Speech Therapy – building language skills and learning how to operate the communication system to be able to express wants and needs
• Customization of systems – setting up, maintaining, or generalizing communication systems to all environments
• Consultations – may work with other providers/school team members to ensure consistency of aided language partners
• Parent training – provide parents the tools to implement operations of communication systems and to be a language model

Learn more about our Assistive Technology (AT) and Augmentative and Alternative Communication (AAC) services here.

Speech-Language Therapy at Easterseals DuPage & Fox Valley

If you are concerned about your child’s language or other development, take our free online developmental screening tool for children birth to age five. The Ages and Stages Questionnaire (ASQ) will showcase your child’s developmental milestones while uncovering any potential delays. Learn more at askeasterseals.com. 

To learn more about Speech Language services at Easterseals DuPage & Fox Valley, click here or call us at 630.282.2022.

Easterseals DuPage & Fox Valley Completes Another Successful CARF Accreditation

by: Theresa Forthofer, President & CEO

This past summer, Easterseals DuPage & Fox Valley successfully completed the Commission on Accreditation of Rehabilitation Facilities (CARF) re-accreditation process. As a highly respected and recognized third-party organization, CARF performs rigorous evaluations of service-based providers seeking accreditation. We are honored to be one of very few freestanding pediatric outpatient facilities in the area with CARF accreditation. 

Their audits ensure that top service providers are easily recognized by the public when looking for providers who follow internationally accepted standards. We are proud to say that for more than 40 years, Easterseals DuPage & Fox Valley has achieved the highest possible recognition from CARF, acknowledging our commitment to quality services and continual improvement.

“This achievement is an indication of our organization’s consistent dedication and commitment to improving health equity in our communities” said Theresa Forthofer, President & CEO of Easterseals DuPage & Fox Valley. “Our CARF accreditation signifies that each child is receiving state-of-the-art services from our collaborative team of experts.”

CARF Observations

Among the observations made by CARF in its survey of Easterseals DuPage & Fox Valley at our three center locations (pictured below, left to right, Villa Park, Naperville, and Elgin):

• The organization’s leadership values the staff members and has provided opportunities for them to develop through certifications and other educational experiences.
• The chief executive officer has many years of experience and is enthusiastic and dedicated to making a difference by presenting a series of lectures on diversity.
• During the last year, the organization recruited a bilingual clinical psychologist. This has expanded the organization’s capacity to serve a greater number of patients.
• The implementation of the early intervention program for persons with autism has made a big difference in children’s quality of life and the development of real-world skills.
• The development of the patient portal allows patients to book appointments and make payments in advance, so there are no delays in the clinic.

About CARF and Our Survey Process:

As a pediatric specialty program, we are required to demonstrate compliance with over 1800 standards.  Prior to the two-day survey, the survey team reviews clinical documentation samples, outcome and compliance reports, and thousands of policies.  During the survey, the team interviewed Center Leadership, Key Process Owners, Medical Advisory Board members, funders, and most important, clients and families.

CARF uses the ASPIRE to Excellence Quality Framework to guide their survey. Their framework operates on a continuous improvement model which “provides a logical, action-oriented approach to ensure that organizational purpose, planning, and activity result in the desired outcomes.

The entire CARF survey lasts two days, but accredited centers such as ours must demonstrate we have upheld standards over the last three years, as surveys are conducted every three years.

About Easterseals DuPage & Fox Valley

Easterseals DuPage & Fox Valley is a CARF accredited outpatient rehabilitation center with comprehensive services including occupational, physical and speech-language therapies, mental health, assistive technology, medical nutrition, audiology, autism services and inclusive childcare. With 80 therapists and professional staff specialized in early intervention, and further certified in Neuro-Developmental Treatment (NDT), Developmental, Individual-differences, & Relationship-based (DIR/Floortime) methods, Sequential Oral Sensory Approach, Sensory Integration and Praxis Test, feeding, motor, speech and sensory areas of specialties. Additionally Easterseals has a medical advisory board and affiliations with local hospitals and medical partners through our vision, orthotics, mobility, seating and diagnostic clinics. Learn more at https://www.easterseals.com/dfv/programs-and-services/.

Books to Improve Mental Health

By: Dr. Citlaly Gonzalez, Clinical Psychologist

Winter weather and a week off of school, what better time to cozy up with a nice pile of books? There is something magical about the world that is waiting inside a book and the places and times you can travel to, the feelings they evoke, and the things we can learn.  

As a psychologist, the opportunity to blend my appreciation for each person’s story and my love of reading has been an incredible thing.  In my work in our Autism Diagnostic Clinic, my job is to include a recommendation to support each child’s development. I find that including a list of book recommendations with each report has been a fun way for parents to support their child’s needs.  

When presented with the opportunity to write a blog about books I would recommend from a mental health lens, I jumped at the chance, but where to start? Books about feelings? Books on tough topics? My favorite children’s books? One blog post can’t cover them all (but maybe a part II or part III can try), so we’ll focus on the magic of reading with your child and what it can do to support connection, increase understanding of feelings and tough situations, and support the child’s sense of self.  

Books on Feelings 

There are so many books about feelings out there! It’s a beautiful thing. It’s best to start with feelings books at your child’s level. This could include introducing basic feelings concepts or stories with more complex social situations. Here are some of my go-to books!  

• For the youngest readers and those whose attention is best supported by simple books try the Feelings Book and Glad Monster, Sad Monster, both of which introduce feelings paired with bright illustrations. Lots of Feelings on the other hand uses photographs for children who might benefit from more realistic representations.  
• In the Boy with Big, Big Feelings, a little boy wonders why he has a “big, giant heart in a world that’s so heavy and kind, where all of the feelings under the sun feel as if they were made to be mine.” He learns that it’s okay to have big feelings and that it can even help us understand and connect with others!   
• A Whole Bunch of Feelings has been a favorite in our house. Each page has a brief introduction to a different feeling paired with an activity or question for discussion. We read a page at breakfast and made it part of our normal routine showing that any time is a good time to talk about our feelings.
• We usually followed up with one page from Breathe like a Bear for a quiet moment of meditation before we get our day started. See the theme, little moments, scheduled regularly, make for some big impact!  
• Think of who and what your child responds to, like their favorite characters. If you have a dinosaur lover, the “How do Dinosaurs” series might be a great place to start. Superhero lovers might be most interested in a book with their favorite characters, Super Heroes Have Feelings Too (DC Super Heroes).

Books on Tough Topics 

Our therapy team is often asked for book recommendations to talk about tough topics. We welcome opportunities to connect families with books that can help them navigate hard discussions. If you are going through a challenging moment, feel free to reach out to your therapist or our mental health team for book recommendations. Your local library may also provide a wealth of resources!  

Photo: Topics to Talk About display at the Berwyn Public Library 

• Books on Making mistakes: For the kids who can’t stand to make a mistake try The Girl Who Never Made Mistakes. Pair it with a conversation about the times you’ve made a mistake and how you recovered. Social-emotional learning happens when children are provided opportunities and models. 
• A Garbage Can Day–  talks about the feelings and choices that come with a rough day. Written by a local therapist and a teacher, this book is paired with a board game for reading and play.  
• When Sadness is at your Door personifies the feeling of sadness, making it easier for younger children to talk about what it feels like for them. It doesn’t look to resolve the problem or make the feeling go away, but to provide language to discuss it, ideas to cope, and reassurance that it is okay to feel deeply.  

• We are often asked for books on grief, change, and loss:  A Memory Box looks at grief from a child’s perspective and suggests an activity to do to keep the person present. The Invisible String uses a more subtle approach and looks at separation, both temporary and permanent, providing language to use when children really miss someone and wished they could be closer. The Fall of Freddie the Leaf is a more abstract book that discusses change through the framework of fear moving toward acceptance. It’s a classic book and good for all ages.  
• It’s not just “therapy books” that can be useful! Sometimes just regular books can open the door to conversation. Alexander and the Terrible, Horrible, No Good, Very Bad Day was a favorite in my home growing up. When one of us was having a bad day, my mom would ask if we were feeling a bit like Alexander. It allowed us to externalize the feeling and provided a touch of humor.   

Books to celebrate your child  

There are tough moments and there are beautiful moments and all of them deserve space and attention. At Easterseals we are dedicated to celebrating each child and their many skills, talents, and unique way of being. The following are some of my favorite books to celebrate children from a strengths-based frame.  (Bonus: These are some of my favorite gifts for my children’s classrooms as a gentle reminder that there are so many ways kids share their gifts!) 

• All the Ways to Be Smart: this beautiful book celebrates the many ways children share their gifts. It’s an important reminder that every child has strengths, and it is our job and joy to find and honor them.  
• All Kids are Good Kids: this simple board book was inspired by a child I saw in our clinic. Her frequent and unexpected behavior led to her belief that she was “bad.” Children (and adults!) don’t always make the best choice, but no child is ever bad, this book reminds us that all kids are good kids. Try these books from the same series too: All Kinds of Kindness, Love Makes a Family 
• I Know a Lot: Another great book to remind kids (and the grown-ups around them) that there are so many important things our kids know, things that matter, things they learn by playing and exploring the world around them. (These books are from the same series too: I am So Brave).  

Books to Support Connection 

• The Rabbit Listened: This is one of my very favorite books for parents to read to their children. Read more about why in this powerful blog written by Natalie Donald, an Easterseals social worker. At its core, the Rabbit Listened gently reminds us that in order to help, we need to first listen. I like to invite parents to identify which animal they think they’re being (Unsurprisingly, I am a chicken. I want to talk talk talk about it all).  Read it with your child and try to see which one you are, and lean in to listen to which one your child best responds to, knowing it can change across situations, moods, and needs.  
• Mama do you love me: This simple board book tells the story of a little girl with a big imagination who wonders what would happen if she did all the things she knew she wasn’t supposed to do. Each time, her mama assures her that some things might make her angry, surprised, or scared, but that no matter what she would still love her, because of who she is.  

The Book You Write Together 

The most important book you read might be the one you write together. How you write it, is up to you and your child.  

• Not all of us can keep up with baby books but we can all keep up with a quick note. I’d like to introduce you to the “My Child Can” journal. Whether it’s in a beautiful notebook, the margins of your planner, or the not-quite-a-book notes app on your phone, the “My Child Can” is a running list of all the milestones and little moments that make you smile. It might be “my child told me they have a best friend” or “My child learned to spell his name.” In this work, we spend a lot of time asking about the things children can’t do (yet), but this journal can be an important reminder of all the things your child can do. You may also choose to work with your child to teach them to do the same and focus on all the beautiful things they can do using an affirmation book. 
• Shared art journal (Draw with Mom): For kids who have started writing and drawing, I love a shared art journal (Draw with Dad). Keep the pressure low and the journal accessible and watch the communication blossom. Some days may be just a scribble or a funny picture while other days might include a more meaningful note, all of it helps support an open line of communication  

Reading is Wellness

Simply reading with your child is the best, no matter what book your reading, the connection between parent/guardian and child, language exposure, and of course the introduction to new themes all have the potential for so many benefits for wellness.

Our Mental Health team often receives requests for books on various themes which we happily oblige. We have recommendations for books on learning about feelings, grief, potty training, divorce, sharing a diagnosis, and more. We have another blog post with recommendations on best children books on disability. We have those recommendations and lots more! But here is my biggest tip, read these books before you think you need them. Have them accessible. Read about all abilities, cultures, and a wide range of challenges and situations. Normalize talking to your child about life challenges, feelings, and tough topics. This way, when a situation of their own comes up, they know it’s okay to talk about it. They will be less resistant to reading about it. They will be more prepared to handle it.  

An added reminder for the parents of children who haven’t yet discovered the magic of books –kids don’t always start out loving books. There was a long stretch of time with my own children when it looked like I was reading to myself or the dog, but I knew that even while running around the room, they were listening. Hearing the stories, exposing them to language, and even the rhythmic reading of toddler books are way to support both connection and reading.

As a bonus recommendation for the kids who are still learning to appreciate books, I love to recommend the Indestructible series and any book with interactive components or buttons. Kids are always taking in pieces from the world around them, whether it’s the words you are reading or the fact that you are sitting, present with them.  

So, if you are looking for a final gift to complete “the something you want, something you need, something you wear and something you read” I hope this list helps you find a new book to add under the tree, a book to quietly add to your library for “just in case” or even a simple surprise for an any day moment to have with your child. 

About Easterseals DuPage & Fox Valley

For additional information on services for children with disabilities, visit: https://www.easterseals.com/dfv/programs-and-services/. The Easterseals’ Mental Health & Family Support team strives to provide children and families with the mental health support they need to help thrive and empower one another. Our work helps caregivers and children experience more joyful interactions through attunement and connection. For more information on our services, contact us at socialservices@eastersealsdfvr.org.

It’s Summer! Let’s Go Ride A Bike!

By: Josephine Hipolito, Physical Therapist

Summertime is approaching, and around this time, caregivers often ask me to work on bike riding with their kids as one of their goals. As an avid cyclist, it’s one of my favorite things to teach because of the joy and freedom children feel when they learn to ride. Let’s start with a few tips on teaching children bike riding.

Things to Consider When Starting

1. Determine whether the child knows how to pedal.  If they do, skip the next section and go to the balance section to work on the balance aspect of bike riding .
2.  Remember you don’t have to follow this step by step. It’s more of a guide to see where your child is in the bike riding process and then proceed.

 Teaching Children Pedaling:  

1. Start with teaching “Air Cycling.” Most kids don’t understand the concept of extending one leg while the opposite leg is relaxed if they have never pedaled before. Their usual instinct if you tell them to push with their legs is to have both legs push simultaneously, so they usually get stuck when on a tricycle.
   
2. To practice the motion of pedaling, place your hands at the bottom of their feet and tell them to push against it on their bent leg. Use a little resistance when you do this. On a tricycle, kids often stop pedaling and move backward when they encounter resistance, so you want them to get used to resistance.

3. Once they master air cycling, start them on a tricycle with a pedal block (a device that holds their feet on the pedals) or strap their feet on the pedals using an ace wrap or velcro straps. Children usually tend to over-push with their feet at first, so their feet slip off the pedals. Wrapping their feet will keep them on the pedals. You can also get commercially available pedal straps like this one.

4. Once they master the pedal block, take off the straps so they can learn to control their leg movement and keep their feet on the pedals.

5. Make sure they master pedaling with a tricycle so that it becomes second nature to them when they graduate to a bicycle.

Balance Bike Versus a Bike with Training Wheels 

I often tell families ready to progress their children from a tricycle to a bike, to start with a balance bike. A balance bike is simply a bike without pedals where children use their legs instead of pedals to move.

Skip the step of learning with training wheels because children can get dependent on leaning on them for balance. The Balance Bike enables the child to learn to find their center of balance on their own  

NOTE: Not everyone will be able to get a balance bike and a bike with training wheels, so I recommend taking the training wheels AND the pedals off of a bike to convert it to a balance bike. 

 Biking with Training Wheels

The problem with a bike with training wheels is the braking system.  They use coaster brakes which means pedaling backward to activate the brakes. 

Kids tend to start pedaling backward when they encounter resistance which activates the brakes. It’s always difficult for kids with motor planning issues to figure this out. That’s why you ensure they master the pedaling part of bike riding before moving on.

Keep an eye out for the following:  

1. Some kids tend to push with their legs while pulling on the handlebars, which causes the bikes to turn – as a PT, this signals to me that they need core strengthening 
2. Some kids will over push with their legs causing them to slip backward on the bike seat – I put a dycem (non-slip pad) or tie a theraband on the seat to prevent this .

 Tips to Use a Balance Bike 

1. Start with having the child walk with their legs while sitting on the saddle. See if they have the control to keep the bike from tipping or even recognize that the bike is tipped while they are riding it. They need to integrate this part. Children with body awareness issues will not even recognize that they are tilted when propelling a balance bike.
2. Watch out for kids who walk the bikes, but they are standing and not sitting on the seat. I sometimes use an ace wrap to secure their pelvis on the seat to prevent this 
3. Once they master keeping the bike upright, work on gliding .
4. Gliding – have them take three steps: 1, 2, 3, then bring their feet up to glide. Challenge them and ask them to see how far they can glide before they put their feet down.
5. I sometimes use floor markings like chalk on the surface to mark a certain point. Children can work on balancing better if they have a visual cue on how far to glide.
6. Once a child can glide for 10-20 feet consistently, I move them to a bike with two wheels (or put the pedals back on the bike).

Steps to Help Children Ride a Standard Bike 

1. Work in a parking lot of a school or a park early in the morning so that it will be empty and there are no distractions – avoid the sidewalks or hallways because the child needs to worry about staying within the confines of the space (it can become too stressful for them).
2. Try to find a parking lot with a little downward incline to help them get a little momentum to balance.
3. Let your child walk the bike out to the parking lot while holding the handlebar. This way, they learn to handle the bike and how to motor plan to keep it balanced.
4. Work on pedaling forward first.  Worry about turns later.
5. Have a gait belt (or Dad’s belt) around their trunk, so you have something to grab onto when they are riding (if they are not using a bike with a parent’s handle).
6. Give them a little push to start them up – they will usually start slow because they are apprehensive but what children don’t realize yet is they need momentum to be able to balance.  
7. Give them frequent breaks, and maybe bring a snack, as bike riding can be stressful while learning. Let them know that they have to do 2-3 laps then they can take a break. Break for 1-2 mins, get a drink or snacks, then return to bike riding. Use a timer so they know break time is over when it rings. This way, they may be more cooperative when they know they have a break.
8. Once they master going straight, you can work on turning – put cones on each end of the parking lot and ask them to turn around the cones. This way, they can practice tight turns.
9. Once they master turning,  work on tighter areas (e.g. a hallway, sidewalk) to narrow their space.  
10. Once they master tight areas, work on going up inclines.

Biking From a Complete Stop  

1. Determine the child’s balance leg – it’s usually the first leg they put down when they stop.  
2. Once that’s determined, the balance leg is the leg that will stay on the ground and will be pushing to get the bike going.  The other leg goes on the pedal (pedal leg).  
3. Teach the child to position the pedal (pedal leg side) in front of their shin so they can easily put their foot on it.  
4. Ask them to have the balance leg push on the ground while the pedal leg is pushing down on the pedal to start the bike .

Cycling Benefits

I hope this blog has been helpful wherever your child is on their cycling journey! Teaching children to cycle has numerous benefits to their development, including improving motor skills, strength and balance. It’s also a fun exercise that can be enjoyed with a sibling or friend!

if you ever have concerns about your child’s mobility, strength, or motor skills, Easterseals DuPage & Fox Valley is here to help! Learn more about our physical therapy services by visiting:
https://www.easterseals.com/dfv/our-programs/medical-rehabilitation/physical-therapy.

We also invite your family to join our annual Bike for the Kids in Elgin!

Cyclists of all ages and abilities are welcome to ride distances ranging from 12 miles – 50 miles or join us in reaching a 100-mile goal throughout the summer on the Strava app. Adapted bikes and trailers are welcome. All ages and abilities are encouraged to participate.

We are excited to take this ride to the Fox River Trail and celebrate together at Festival Park in Elgin with food, refreshment, entertainment and more!

Learn more and register here: https://www.givegab.com/campaigns/bikeforthekids2022

Positioning and Mobility Clinic Overview

By: Allie Katsiris, PT, DPT

What Does the Mobility Clinic Do?

The Positioning and Mobility Clinic at Easterseals provides a comprehensive evaluation of a child’s adaptive equipment needs. It is a collaborative clinic consisting of a physical therapist (PT) and an assistive technology professional (ATP) from a durable medical equipment vendor. Of course, the child and their family members are also valued members of the team. The two vendors that attend clinics at Easterseals are Numotion and National Seating and Mobility. There are a lot of options for seating and mobility devices available on the market, so the PT and ATP will utilize their knowledge, experience, and expertise to recommend the most appropriate equipment for your child.

The Process

At the initial evaluation, the PT and ATP will complete a comprehensive evaluation of the child including assessment of posture, range of motion, functional mobility skills, home assessment, and child/caregiver goals. Recommended mobility equipment may include: adaptive strollers, manual wheelchairs, power wheelchairs, or power assist wheelchairs. The clinician will also assess the need for specialized car seats or adaptive bathing equipment.

Following the initial evaluation, the PT will write a letter of medical necessity for the device. This letter will be sent to the child’s physician to be reviewed and signed. The vendor will submit the order and the letter to this insurance company for approval. Once approved, the device is ordered then delivered to the child. The PT and ATP work closely upon delivery to ensure the child is positioned appropriately and that the family understands all features for safe and effective use of the device. We recommended yearly rechecks to ensure that the device continues to properly support the child.

Home and Environmental Factors we Consider

There are many factors that are considered when deciding on a mobility device. In addition to evaluating postural alignment and medical history, the team will ask about your child’s current mobility skills and goals. We will consult with primary therapists as needed to best understand your child’s abilities, functional goals, and endurance level in order to best recommend a mobility device. The team will also ask about your child’s home and school environments. Some considerations include: whether your home has stairs, location of the child’s bedroom/bathroom, and width of doorways.

It is important that the child be able to utilize recommended equipment in all environments to promote his/her best alignment and independence. Another important factor in recommending a mobility device is how the child is transported. Do you drive a compact car or SUV? Do you have an adapted vehicle? Does your child ride the school bus? The answer to these questions will help guide to whether a folding or non-folding option and transit accessories are required. Due to insurance limitations and expectations that mobility equipment will last 5-10 years, it is important that all of these factors, growth, and future needs are considered in order for the equipment to support the child for years to come.

Quick facts about the various types of equipment:

Adaptive Strollers:

• Provide support for children who have decreased postural control, endurance, or safety in the community.
• They are typically lighter weight than wheelchairs and fold more easily.
• There are some limits to the customization of these devices.

Manual wheelchairs:

• Provide postural support for children who walk with limited endurance or who are unable to walk.
• A child can push/ move this device independently.
• There are folding and non-folding options.
• Can be customized to fit a child’s needs.

Tilt in Space wheelchairs:

• Provide postural support and can tilt backward for rest breaks or medical needs.
• Children are dependent on caregivers to propel the device.
• There are folding and non-folding options; although they tend to be bulkier than manual wheelchairs.
• Can be customized to fit a child’s needs.

Power wheelchairs:

• Provide postural support and power control
• Can be operated by the child.
• These are unable to fold so the family should consider home and car accessibility.
• Can be customized to fit a child’s needs.

How to Get Started

At Easterseals DuPage and Fox Valley, we appreciate the importance of providing children with a safe means of mobility. This allows children better access to their communities and increases overall participation with their family and peers. We also recognize that the equipment ordering process can be overwhelming, so we are here to support you and help your child obtain the equipment he/she needs to thrive! Please contact us to schedule an appointment: 630-282-2023 or click here to learn more.