Monthly Archives: August 2015

Sensory Regulation, What Is It?

By Maureen Karwowski, OT

As I sit at my desk typing this blog on my laptop, I am regulated enough to focus on this task.  I am able to filter out the sounds of the lights buzzing, my coworkers typing, the feeling of my clothing, and the light coming in from the window beside me.  I will admit that some times I am able to do this, and not others.  For a child with sensory processing challenges, the interpretation and responses to the  sensory experiences I described can be ineffective.  These ineffective responses can impact a child’s overall regulation and can affect many areas of development.  It is estimated 01_Mason Esquivelthat 1 of 20 children are impacted by a sensory processing deficit (Ahn, Miller, Milberger, McIntosh, 2004).

I have worked with many children with sensory processing challenges as a pediatric occupational therapist.  I know from my work that every person presents with their own unique sensory profile.  Since every child is so unique, I am required to closely assess each client to be sure that I understand where their challenges are and what I can do to assist them.  A skilled occupational therapist will use a variety of assessments, some are standardized evaluations, and others are from observations of the child.  A thorough assessment will address three areas of sensory processing: sensory regulation, sensory modulation, and sensory discrimination.  Today’s topic is sensory regulation.

Sensory regulation refers to a person’s ability to keep their arousal at the right level for the situation.  Adequate self-regulation is essential to the development of attention, regulation of sleep/wake cycles, control of emotions, as well as the daily transitions that make up a child’s routine.  Sensory regulation is necessary for social interactions and learning.

One of my clients, who has significant challenges with this skill described a story about how at school, he loves to run around on the playground at recess.  He told me that the problem is that all of the other kids can slow down after recess, line up and then go back into school.

“I get so revved up that I can’t control myself anymore.”10_Logan

His teachers stated that he ran into the building, bumping into other kids at times, and did not respond to verbal directions.  This is a great example of how regulation issues can impact transitions and school.  This story ends well for this little boy.  His mother and I worked together and identified what were the factors that were impacting his regulation challenges.  For this boy, he was sensitive to movement and visual input.  He was correct in his statement that running around on the playground “revved” him up.  In occupational therapy sessions, and at home with his parents, we worked to address his challenges with movement and with visual input.  This in turn assisted him with his transition from running around to lining up to go back inside the school much easier.  We also worked on using some “tools” to help him with this transition, such as being given an earlier warning than the other kids from the teacher, he blew the whistle which gave him a chance to take a deep breath, and was in charge of carrying the bin of recess equipment into school which gave him some heavy work.

We all have strategies that assist us in keeping our arousal level where they need to be.  People chew gum, drink coffee, fiddle with objects, all in an effort to keep alert.  We also have strategies to calm ourselves down such as deep breaths, working out, knitting, herbal tea.  It is very important for children with sensory regulation challenges that we identify what are the regulating strategies that they can use to assist them.  Something as simple as chair pushups, sucking on a piece of candy, squeezing a stress ball, or rocking in a rocking chair can be useful.  It is important to customize these strategies to your child, as everyone responds differently.

I find that my occupational therapy sessions are the most effective when the parents and I are working together to identify the child’s sensory processing challenges and how those challenges are impacting daily life.

Stay tuned, as my next blog post will discuss sensory modulation.  Sensory modulation is the amount of sensitivity a person experiences towards a sensory experience.

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.

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7 Tips for Raising Happy, Healthy Eaters

By: Jessica Drake-Simmons, M.S. CCC-SLP

Eating can be a daily struggle and constant stressor for many families. The eating battles can be a point of looming contention at any given moment in a day.

It is important to keep the ultimate objective in the forefronts of our minds when it comes to feeding our little friends. Our goal is not to get kids to swallow vegetables through teary eyes during dinner tonight. Our goal is to develop children who like a variety of healthy food. We want to raise children who will grow up enjoying nutritious foods, not just viewing them as an obligation.

Photo by Nancy Kerner
Photo by Nancy Kerner

There are not quick fixes to turning a selective eater into an adventurous eater overnight. However, with consistent implementation of the following strategies, you will be on your way there!

  1. Encourage Food Exploration! Join your child in exploring new or non-preferred foods and make it fun! This may help decrease anxiety caused by new foods. We experience food through our eyes, nose, mouth, and skin prior to tasting a food. Having a hesitant eater experience the temperature and texture of foods smushed between their fingers can be a beneficial step before expecting the child to smush that food between their teeth. Expose your children to foods by letting them touch, smell, kiss, lick and bite the presented foods. Let your child PLAY with their food! Don’t worry about the mess! Food should be a joyful experience. Talk about the food and describe what it looks like how it feels, how it smells and how it tastes. Let your child help you prepare meals. The Kitchn provides ideas for the many simple steps in cooking that even young children can help with!  Learn about food!  Plant a garden.  Visit the farmers market and the grocery store.
  2. Make the meal time about being together as a family. Meal time should be a pleasurable experience for everyone and an opportunity to spend quality time with the family. If a child is a part of a joyful low-stress meal experience, he will be more likely to independently consume more of the presented foods.
  3. Be positive and supportive but… Beware of rewarding your child by paying a great deal of attention to what the child is NOT doing. When we constantly cheer for our children, we can be reinforcing the pursed lips that are rejecting the airplane spoon. Rather, make a single statement about the action you would like to see occur (e.g.. “Maybe you would like to try giving your apple slice a kiss?” “It would be awesome to see you knock the corn kernels on your teeth!”) and praise the desired behavior after it occurs. Pay little or no attention to the negative behaviors.
  4. Don’t force a child to eat! Policing a selective eater’s food consumption fosters negative feelings with the nutritious foods we want them to eat! We want positive and happy feelings associated with meals in order to support healthy eating habits! Letting children be in control of the foods you provide helps them feel calm and promotes a positive experience with the foods. It also allows them to learn to listen to their bodies and be in control of nutritious choices.
  5. Offer small portions. If someone put a plate of eel in front of me and told me that this was dinner and I had to eat it or else… AHHH!! No way! I would probably gag at the site. But, if I was encouraged to try just one tiny bite? Well, I could probably do that. Putting a small portion of a new food on your child’s plate will present an obtainable expectation. It may even provide the child with an opportunity to request more!
  6. Rotate and repeat! Regardless of whether your child liked the food, repeating the food will build familiarity. Repeated positive exposures to a food can be essential in learning to eat the food. Don’t think of uneaten food as wasted. A small portion of uneaten food on a plate is a valuable learning experience for a hesitant eater.
  7. Pair foods together. Present dips and spreads like hummus, peanut butter, ketchup or salad dressing to make non-preferred foods more pleasurable. Pair mealtime favorites like chicken nuggets with a small serving of a new vegetable.

Selective eating can stem from GI issues, food allergies or food intolerance and therefore will require medical attention. If your child is particularly resistant or consumes a limited diet, don’t hesitate to seek guidance from an occupational therapist or speech-language pathologist.

Easter Seals DuPage & Fox Valley offers a feeding clinic which provides an interdisciplinary team consisting of a gastroenterologist, speech-language pathologist, registered dietitian and parent liaison to assess and provide recommendations related to feeding challenges. Contact our Intake Coordinator at 630.261.6287 to ask questions or schedule an appointment.

Here are some great resources to make happy and healthy eating obtainable in your home:speech pinterest

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.

6 Tips for a Smooth Transition Back to School

By: Laura Van Zandt, OTR/L

School is right around the corner if it isn’t already here for many of you. With school starting again, gone are the lazy days of summer and once again the hustle and bustle of getting you kids out the door and getting them to do their homework is resuming. Whether your child is just starting school or is nearing the end of his/her K-12 educational career, here are some tips to help ease the transition back to school. You won’t be able to avoid the business at the beginning of your day, but you can try to ease the morning stress to make the day go smoother.

1. Decide when you have to get up. It will be much easier to decide what time your child needs to go to bed if you know what time they have to get up in the morning. Most experts agree children need between 9 and 10 hours of sleep each night to be at their best. If you know your child must be up at 6 a.m. in order to be ready for school by 7:30 a.m., you would want your child to begin getting ready for bed around 7:30 p.m.

You may want to explain to your child the importance of a good night’s sleep. Getting enough sleep is important for the body to heal itself and allow ourselves to have enough energy to stay awake during the day. It also helps us focus and be less cranky when we have to do tasks we are not particularly interested.

2. Call a family meeting and decide who will be responsible for which tasks each morning. For example, dad will make sure the kids are dressed and their teeth are brushed while mom will take care of breakfast and lunches. Don’t forget to assign these tasks or similar tasks to your children too! This will not only help ease the stress of the morning but it will also help develop their executive function skills which will help serve your child well throughout all grade levels in school. For developmentally appropriate ideas for your children click here.

3. Draw up a schedule or start a family calendar. Designate a spot if possible within your home that is consistent for the family calendar. The family spot can also be used to help make returning back from school easier. If you have young children include photos or illustrations representing the task they need to do. Clipboards are an excellent resource for individual family members to have to list his/her own chores.

Family calendars help to keep things organized
Family calendars help to keep things organized.

4. Do what you can the night before. The more you do before you go to bed, the less frantic you are likely to feel in the morning cramming in as much as possible.

  • Run the dishes overnight (bonuses this sometimes can save money!) or run the dryer to have clean clothes. Lay out tomorrow’s clothing.
  • Maintain a steady supply of quick breakfast foods for this days when it just happens and you are running late. Kid’s growing bodies and developing brains need regular refueling. When kids skip breakfast, they don’t get what they need to perform their best.
  • Hang complete outfits together in your closet or put outfits in bins to quickly grab. Keep your children’s matching shirts and pants in the same drawer or on the same hanger so they can find them easily without help.
  • Gather everything that you will take with you the next day and assemble them in one place near the door your exit from in the morning.
  • Teach your children to get everything ready for the next day before they got to bed. Make lunches, distribute lunch money, and pack backpacks. Take a picture of a completed backpack and attach to a luggage tag so all your child has to do is “match the picture” to make sure everything is included.
  • “Match the Picture” is a concept taught by Sarah Ward where the adult can take a picture of the desired end product and assists the child in breaking down the steps to create both a written and visual to match when completing a goal. This concept can be very helpful in eliminating the need to “nag” your child though every step as well as support independence.

5. Ease the transition back from a full day of school to home by allowing your children a break to move and be active. Go for quality, not quantity with after school programs. Your child will benefit most from one or two activities that are fun, reinforce social development, and teach new skills. Remember children need movement. After sitting for an extended period of time during a school day, giving your kids an opportunity to need can be extremely beneficial.

Regular movement has been shown to increase focus in children of all ages. Movement also helps all children regulate (i.e. adjust their energy) and lower rates of behavioral problems. Research shows that physical exercise influences the central dopaminergic, noradrenergic, and serotonergic systems. Together those systems help manage our mood, appetite, sleep, learning, as well as alertness, focus, and motivation.

Ideas for active play might include tossing a ball/back and forth with a peer, playing tag outside, going for a bike ride on the sidewalk, exploring how your body moves by climbing/cartwheeling/summersaulting/etc., or just taking a short walk. Other active play ideas include exploring different textures or drawing with sidewalk chalk. Here is a link to some fantastic indoor play ideas.

6. Set up a time and place for homework. Having a set place to study and complete homework helps send the signal to your children that learning is important. As much as possible, try to make yourself available during homework time….even if that means you still might be cooking dinner or doing the laundry.

One example of a homework station.
One example of a homework station.

Wherever your homework station is in your house and whatever your homework station looks like in your house, make sure you have all the essentials readily available. This will help avoid time robbers (e.g. getting up to find stuff) and help eliminate any headaches over missing supplies. Pinterest has many great ideas for creating a homework station. Right now the bargain bin section in Target also has great supplies for organization. Purchasing a tri-fold poster at Staples is another fantastic idea to eliminate visual clutter and help your child focus.

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.

Taping: That Extra Set of Hands You Need

taping 3

By, Laura Znajda, PT,  Manager of Community Based Therapy and Continuing Education

Pediatric therapists have been known to use every one of their own limbs to assist children to align their bodies and move successfully. When the therapists run out of hands and feet, they turn to additional supports for help—adjuncts like therapeutic tape, elastic wraps, and compression garments.

Elastic tape over the Abdominal Oblique muscles helps this 8-year-old with Cerebral Palsy to activate the muscles that keep his ribcage and pelvis stable. This helps him sit with better balance and move his legs more easily while stepping.
Elastic tape over the Abdominal Oblique muscles helps this 8-year-old with Cerebral Palsy to activate the muscles that keep his ribcage and pelvis stable. This helps him sit with better balance and move his legs more easily while stepping.

Therapeutic Taping

Elastic tape (Kinesiotape and KT Tape are 2 well-known brands) has long been used in the sports and fitness industry to relieve pain and support muscles and joints. Now therapeutic taping is used with children as well, often to assist a weak muscle to work better or to re-align a body part so that the muscles can work more effectively.

Tape that is stretched over the Tibialis Anterior muscle helps this 2 year old with Down Syndrome lift her toes in order to step up stairs.
Tape that is stretched over the Tibialis Anterior muscle helps this 2 year old with Down Syndrome lift her toes in order to step up stairs.

Active exercise using the tape-assisted muscles is important to “re-train” the muscles to function in their new alignment. This helps the child practice using the muscles properly in functional tasks. Parents can maximize progress by building in practice throughout their daily routine, as one application of tape can be left in place for up to 5 days at a time.

Stepping on targets such as soft stepping stones is a fun activity to practice lifting the foot while the tape assists.
Stepping on targets such as soft stepping stones is a fun activity to practice lifting the foot while the tape assists.

Elastic Wraps

Fabric straps that stretch in two directions can be used to help align upper or lower limbs. They are particularly useful to bring the arm or leg toward a neutral position when it is rotated too far inward or outward. A physician and therapist must carefully assess that there is not a structural (bony) reason for the position of the limb prior to using wraps in attempt to change alignment.

Compression Garments
Compression garments, such as those made by Spio and Benik, are flexible articles of clothing that provide deep pressure sensory input as well as assist the wearer to returning the body to a mid-line position.

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Prone without supportive garments—this one-year-old with low muscle tone has difficulty accessing abdominal/gluteal musculature to anchor her pelvis on the floor, resulting in weight pitched forward on her chest and arms and inability to use arms for play.

taping 6

Prone with compression garments—improved ability to use abdominal/gluteal musculature to stabilize pelvis to floor allows weight to shift back off of chest and arms. This allows the child to begin to practice shifting her weight to lift one arm to a toy and eventually crawl forward.

Therapeutic tape, wraps and compression garments are helpful adjuncts in therapy and to assist children with alignment that allows them to activate weak musculature throughout their daily routines. Easter Seals DuPage & Fox Valley therapists are expanding their knowledge of using these beneficial tools through a continuing education course taught by Patricia Martin, PT and Audrey Yasukawa, MOT, OTR/L on September 18 & 19, 2015 at our Villa Park center. For a full list of continuing education courses visit: http://eastersealsdfvr.org/ce.

How to Prevent Your Baby From Getting a Flat Head

baby helmet

By: Bridget Hobbs, PT, DPT

You probably have seen them on babies in the mall, grocery store and at the park.  Baby helmets are everywhere!  Helmets have been used for a long time for safety with children that have seizures, but more recently they are also used to help mold babies’ heads that are flat back into a round shape.

Babies can have flat heads from crowding in-utero, which is very common with multiples.  However, there is an increasing number of cases of babies with flat head from positioning (or lack there-of) after they are born.   In fact, according to an article in the August 2013 issue of Pediatrics , 46.6 % of 440 infants studied from 7 to 12 weeks of age had positional plagiocephaly, or a flat head. Granted 78.3 % of children in the cohort study had a mild form of the condition; it does reveal that positional plagiocephaly is a very common occurrence these days.baby helmet

When your baby is born, her skull is very soft which has allowed her to travel through the birth canal.  They flexibility of the skull also allows for brain growth in the first years of life.  Because of this softness, the skull is very moldable.  Spending long periods of time in one position can lead to flatness of the side of the head (plagiocephaly) or back of the head (brachycephaly).

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The good news is that positional plagiocephaly is preventable.  Here are some tips that can help you manage your little ones’ head shape from day one.

  • Alternate the arm in which you carry your child. If you are right handed, it’s really tempting to just hold your baby in your left arm so it frees up the right hand to grab your cup of coffee or something out of the fridge.  However, when you just hold your baby in one arm, they are likely just using their neck muscles to look outward to one side.  Alternating which arm you use for carrying your baby encourages them to look both ways often, making their neck muscles strong and less likely to be tight on one side. Tightness on one side of the neck, otherwise known as torticollis, makes it difficult for your child to change their head position, which can lead to flat head.    In fact, many babies that have torticollis (tightness on one side of the neck) also have plagiocephaly (flat head).
  • When placing your baby down to sleep, alternate what side of the crib your baby’s head is on. This way, if baby is looking toward the door of the nursery or at a night light, they are alternating which side they are looking each night (or nap).  You can also switch which side of the changing pad you place your babies’ head when changing their diaper so they are looking both ways equally.  As a reminder, always place your child on their back to sleep.
  • Limit the time that your baby is in a container, for example car seats, strollers, bouncy seats and swings. Your baby does not have the ability to move her neck very much when placed in these containers, which can lead to tight neck muscles and flatness of the head.  As a mom of an infant myself, I know it is tempting to leave your child in the car seat when they fall asleep after being in the car.  Once in a while it is fine, and I am certainly guilty of it myself.  However, repeated naps in car seats can quickly become a problem.
  • Tummy time! I can’t say this enough…start tummy time early and do it often with your baby.  Some babies really don’t like it, but stick with it and they will gradually get used to it.  If they are really fussy, wait 1 hour after feeding to give their tummies time to settle after a meal.   For more tips on how to make tummy time easier for your child (and you!), refer to my previous blog “Yes! We Want Your Baby to Crawl!
Tummy time is important Photo by Lorae Mundt
Tummy time is a good way to prevent positional plagiocephaly. Photo by Lorae Mundt

Because of the “back to sleep” program, which started in 1992, babies are not on their tummies as much.  The back to sleep program has done an excellent job at reducing SIDS, but the tradeoff is that many children get plagiocephaly (flat heads) and torticollis (tight necks) from not spending enough play time on their tummy.   This often leads to physical therapy and a possible appointment at your nearest orthotist or baby helmet clinic.

Luckily, there are many clinics in the area that treat children with torticollis and plagiocephaly.  There are even specialized clinics that just fit babies for helmets and monitor their progress with head shape.  Most children have to wear baby head shaping helmets for a few months before they see good results with their head shape.

Pediatric physical therapy helps with stretching out tight muscles and strengthening weak neck muscles.   It also helps your child with their gross motor skills, such as rolling, crawling and standing, which can often be impacted by tight neck muscles and/or a flat head.   If your child has a flat head and/or tight neck muscles, schedule a physical therapy evaluation with a pediatric physical therapist at Easter Seals Dupage & Fox Valley by calling 630.261.6287.