Monthly Archives: October 2017

How to Help A Clumsy Child

By: Cassidy McCoy PT, DPT

Developmental Coordination Disorder (DCD) is a delay in motor skill development or a difficulty with coordinating movement that makes a child unable to perform common daily tasks. This delay is not due to an identifiable medical or neurological condition that would explain their coordination problems.

Children with DCD are frequently described as “clumsy” or “awkward”, but typically have normal or above average intellectual abilities. However, their motor coordination difficulties may impact their academic progress, social integration and emotional development.

DCD is commonly associated with other developmental conditions such as learning disabilities, attention deficit disorders, speech-language delays, and emotional/behavioral problems.

Meeting Challenges
Photo by Ann Mehrman

Children with DCD generally have difficulty with activities including, but not limited to, climbing up and down stairs, tying their shoes, riding a bike, or doing buttons on their clothing.

How does a child with DCD present?

Typical Presentation:

  • Decreased balance
  • – Decreased bilateral coordination
    • Skipping
    • Jumping jacks
  • Decreased ball handling skills
  • Decreased high level balance skills
    • Hopping
    • Balance beam walking
  • Decreased postural control
  • Decreased proprioception

Other areas of concern may be handwriting, executive function, and initiating social interactions.

How to help

Because children with DCD typically have normal to above average cognitive skills, using a cognitive approach to improve their motor planning can help to ingrain motor skills to make movements more automatic. This cognitive approach helps by working on breaking down a motor skill into smaller pieces, as well as, having the child verbalizes the activity before performing, and reporting on the outcome of the attempt.

Example: GPDC

  • Goal: What am I going to do?
  • Plan: How am I going to do it?
  • Do it: Perform the skill
  • Check: How did the plan work?

Other Activities

Core strengthening is important for children with DCD. You must have a stable trunk/core to appropriately move your arms and legs. Improving core stability will improve balance, postural control, and proprioception, leading to improved coordination.

Some activities to improve core strengthening:

  • Heavy pushing: fill a laundry basket to weight it down and have you child push it across the floor. Carpet flooring will add extra resistance from friction.
  • Hannah_TClimbing: climbing up onto furniture or onto playground equipment while maintaining their abdomen off the surface and arms extended.
  • Wheelbarrow walking or planks: putting weight through extended arms will help to increase abdominal engagement and strength.
  • Standing on unstable surfaces: Standing on various surfaces such as: pillows, cushions, foam mat, or BOSU ball helps to improve postural control. They can perform a variety of activities on these surfaces including balancing with eyes closed, squatting to pick up a toy from the floor, catching/tossing a ball, or reaching up overhead for an object.

Click here to learn more about Physical Therapy programs to improve strength, balance and coordination at at Easter Seals DuPage & Fox Valley.

References:

  1. https://canchild.ca/en/diagnoses/developmental-coordination-disorder
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Got Calcium?

By Dana Sivak, Easter Seals DuPage & Fox Valley Dietetic Intern and Northern Illinois University Student

“Got milk?” is a saying originally part of a campaign generated by the dairy industry to remind consumers of the importance for consuming milk on one of the premises that it serves as a good source of calcium. But why, we might ask, do we need to focus our energy on consuming calcium? Calcium is the most abundant mineral in the body, with 99% of it found in bone and teeth. Throughout the course of the day, calcium is constantly being broken down, reabsorbed, and resourced back to form new bones.  In children, especially, the turnover rate of bone is ever-present to support growth and development. By age 24, on average, humans reach peak-bone mass, and thus it is important that we maximize our efforts to nutritionally meet our body’s calcium needs– so encourage your child to sport that milk mustache proudly!

The Recommended Dietary Allowance (RDA) for calcium changed last November after further research determined a greater need for calcium in our diets. The following are the US Food and Nutrition Board’s updated RDA values for calcium based on age:

  • 0-6 months = 200 mg
  • 7-12 months = 260 mg
  • 1-3 years = 700 mg
  • 4-8 years = 1000 mg
  • 9-18 years = 1300 mg
  • 19-50 years = 1000 mg
  • 51-70 years = 1000 mg (male) or 1200 (female)
  • 71+ years = 1200 mg

Now you might ask, how do I know if I’m meeting my child’s needs? (…and yours?! Your health matters, too!) The simplest answer for this is to check the nutrition label for the exact content of calcium provided for the food items typically consumed in your household.

leafy greensCalcium rich foods are commonly thought to be those that exist within the dairy food group, such as milk, cheese, yogurt, and ice cream. These types of food provided a natural, readily available, and rich source of calcium to our diets. But what if your household is “dairy” free or someone in your household either has a lactose intolerance or cow’s milk protein allergy? Not to worry! There are other rich food sources of calcium to consider, too! Non-dairy sources of calcium include dark green leafy vegetables such as spinach and kale, as well as broccoli, green beans, and green bell peppers.  Other sources included fortified food products such as cereals, fruits juices (orange juice) and cow’s milk alternatives.  Smaller amounts of calcium can be found in seafood (sardines, scallops, shrimp, whitefish/salmon), tofu, legumes and nuts, eggs, and yes – even chocolate! Table 1 demonstrates the calcium content comparison for these various food sources.

Table 1. Calcium content of various calcium-rich food sources. (from the National Institute of Health’s website.

Food Item Recommended Serving Size Calcium Content (mg)
Milk 1 C
·         Cow’s milk, nonfat, with added vitamins A and D 299 mg
·         Silk Soymilk, unsweetened, with added calcium, vitamins A, D, B12, and riboflavin 299 mg
·         Rice milk, unsweetened, with added calcium and vitamins A and D 283 mg
·         Hemp Milk, Living Harvest Tempt, Vanilla 300mg
·         Oat Milk, Pacific Foods, Organic Oat Original 350mg
·         Coconut milk, Silk Original 450mg
·         Almond Dream almond milk, with added vitamins A, D, and B12 300 mg
·         Ripple Milk 450mg
·         Silk Protein Nut milk 450 mg
Yogurt, plain, low fat 1 C (8 oz) 415 mg
Mozzarella Cheese, part skim 1.5 oz. 333 mg
Cheddar Cheese 1.;5 oz. 307 mg
Orange Juice, Calcium-fortified 6 oz 261mg
Tofu, firm, made with calcium sulfate ½ C 253 mg
Fortified Cereal ½ C 100-1000 mg
Spinach 1 C 216 mg
Green Vegetables ½ C 60 mg
White Fish or Salmon 3 oz. (1 filet) 70 mg
Nuts (Ie. Peanuts or Almonds) ¼ C 60 mg
Chocolate 5 squares 50 mg
Eggs 1 egg 25 mg

Inadequate intake of calcium over time can cause osteopenia, a less severe and reversible precursor to osteoporosis. Those who do not sufficiently meet their calcium intake, are at an increased risk for skeletal fracture injuries.  Similar to vitamin D deficiency, additional at-risk populations are those who spend most of their time indoors and those who live north of the equator. This is because Vitamin D functions with calcium to aid in its absorption. Without adequate Vitamin D, the calcium of foods eaten may not be fully functional once digested. Lastly, those who do not partake in weight-bearing activities on a routine basis are more likely to have an increased need for calcium. This is because bone is not able to be broken down and thereby calcium is not able to help contribute to the reformation of new bone. Annual bone-DEXA testing is recommended for those who are at risk.

Efforts should be made to maximize bone development during critical stages of an infant, toddlers, and child’s growth to minimize future risk of osteoporosis. If efforts cannot be made from a physical activity standpoint due to a disability, one’s calcium intake in the form of food or possible requirement for supplement should be highly prioritized. To help with such planning, it is recommended to advocate for your child’s welfare and seek out further information for the level of risk your child is at by discussing this with their physician. Furthermore, it is recommended to meet with a dietitian who can assess the diet specific to calcium and offer suggestions for ensuring adequate intake.

 

If you find your child has nutrition problems including failure to thrive, obesity, poor feeding skills, sensory disorders, and gastrointestinal disorders or others, schedule a nutritional evaluation with Easter Seals DuPage & Fox Valley today. Learn more at eastersealsdfvr.org/nutrition.

What is Sensory Processing Disorder?

By: Laura Van Zandt, OTR/L

As an occupational therapist, I have heard sensory referred to as many different things. Just a few examples include “sensory integration, sensory processing, sensory disorder, sensory dysfunction”. Not only is this confusing as an occupational therapist, but it has to be extremely confusing to parents too.

Sensory processing is a broad term that is used to refer to the way sensations are received and organized by the brain and how our bodies respond to this sensation and appropriately use it to interact within our environment. Our brains not only process information through the senses of touch, taste, smell, sight and sound but our brains also process information from our inner ear, muscles, joints, and ligaments to help us with movement and body position. All the sensory systems need to work together for effective sensory processing.

Overview of these sensory systems

  • Visual sense: is the ability to interpret what is seen regarding contrasts of light and dark, color, and movement.
  • Olfactory sense: is the ability to interpret smells
  • Auditory sense: is the ability to interpret what is heard regarding volume, pitch, and rhythm.
  • Gustatory sense: is the ability to interpret to receive taste sensations
  • Tactile sense: is the ability to interpret touch sensations like pressure, vibration, movement, temperature and pain.
  • Proprioceptive Sense: is the ability to interpret where your body parts are in relation to each other.
  • Vestibular sense: is the ability to interpret information relating to movement and balance related

If there is inefficiency in processing sensory information, a child’s ability to function is compromised and there be difficulties in the child’s arousal, alertness, attention as well as play, self-care, fine motor and gross motor skills. This difficulty has increasingly become known as sensory processing disorder and was first recognized by Dr. A. Jean Ayres, occupational therapist, educational psychologist, and neuroscientists.

Sensory processing disorder can be a confusing term. No two children are alike. Symptoms of sensory processing disorder, like most disorders, occur within a broad spectrum of abilities. While most of us have occasional difficulties processing sensory information, for individuals with sensory processing disorder, these difficulties are persistent and can significantly disrupt everyday life.

22_Everett_MazzieSome children may experience difficulties processing sensory information in all or only a few areas of sensory processing. Likewise, it is also common for some children to not experience difficulties in any one sensory system but have difficulties combining the sensory systems to develop a meaningful response. A child’s response to a certain type of sensory input or activity may vary from one instance to the next and is impacted by the events preceding the activity, how the child feels (tired, fidgety, ill, healthy), and the context in which the activity occurs (quiet, noisy, busy, structured). When describing a child’s sensory processing, it is important to remember that anyone’s sensory processing patterns are merely a reflection of that person’s ways of responding to sensory experiences in the course of everyday life (at home and school). Knowing a person’s patterns creates a tool for gaining insights about what settings and activities are likely to be easier or more challenging and reveals possibilities for navigating successfully in everyday life.

Sensory processing disorders can be divided into three main areas: sensory modulation, sensory-based motor, and sensory discrimination.

Sensory modulation disorder refers to the ability to filter sensations and to attend to those that are relevant in a graded and adaptive manner whereas sensory discrimination disorder refers to difficulty interpreting subtle qualities of objects, places, people or other environments.

Sensory modulation disorder can further be broken down into children who are over-responsive, under-responsive, or sensory cravers/seekers. Children who are sensory over-responsive are often predisposed to respond too much, too soon, or for too long to sensory stimuli most people find quite tolerable. These children are often in ‘fight or flight’ to common daily sensations and may try to avoid or minimize sensations or act out to counterbalance feeling constantly bombarded.

20150320_ES-LegoRoom-19.jpgFor example, a child who is over-responsive to touch sensation may find physical contact, clothing, and other touch sensory input difficult. Children who are sensory under-responsive are often unaware of sensory stimuli, have a delay before responding, or responses are muted/less intense as compared to the average person. They may appear withdrawn, difficult to engage, or self-absorbed because they do not detect the sensory input to the environment. For example, a child who is under-responsive to touch sensation may not be aware of clothing twisted on their body or messes on their face. The child who is sensory craving is driven to obtain sensory stimulation but getting the stimulation results in disorganization. They tend to be constantly moving, crashing, bumping, and/or jumping. They may “need” to touch everything and not understand what is their space versus other space. Sensory cravers can be difficult to decipher between children with ADHD.

In children whose sensory processing of messages from their muscles and joints is impaired, posture and motor skills can be affected. Children with a sensory postural disorder may have a poor perception of position of body, poorly developed movement patterns that depend on core stability, and appear weak with poor endurance. When posture is impaired these children might seek additional support by leaning on walls or resting their head on their hands when working at the table. When motor skills are involved these children often have difficulty with the ability to make a plan to execute an action as well as execute the necessary actions supporting the performance.

Click here to link to our sensory processing intake form to see if your child might benefit from an occupational therapy evaluation to determine if there is a sensory basis for your child’s difficulties.

With effective treatment provided by an occupational therapist, your child can develop the ability to process sensory information in an adaptive manner and learn strategies to help him or her cope with everyday experiences. Our occupational therapists are trained to use a variety of different standardized tests and clinical observations as well as caregiver input to help put all the pieces together of the puzzle and make appropriate referrals. Then our therapists expertly look at the match between the child, the activities and expectations, and the context to determine when there is a mismatch that needs intervention attention.

For more information visit our sensory processing webpage and visit the links below.

 

How to Talk to Your Baby: Tips for Parents Expanding Speech/Language Skills

By: Valerie Heneghan, CCC-SLP/L

Each baby’s development is unique and magnificent! However, parents will often ask us these questions:

  • How do I know if I am doing enough to foster speech and language development to keep my baby on track?
  • What communication milestones should I be looking for?

In general, these are a few communication milestones that you should be looking for in the first year of life from the American Speech-Language Hearing Association (ASHA). 

Birth-3 Months

  • Seems to recognize your voice and quiets if crying
  • Makes pleasure sounds (cooing, gooing)
  • Cries differently for different needs
  • Smiles when sees you

baby34-6 Months

  • Moves eyes in direction of sounds
  • Babbling sounds more speech-like with many different sounds, including p, b and m
  • Vocalizes excitement and displeasure

7 Months – 1 Year

  • Begins to respond to requests (e.g. “Come here” or “Want more?”)
  • Babbling has both long and short groups of sounds such as “tata upup bibibibi”
  • Uses gestures to communicate (waving, holding arms to be picked up)
  • Has one or two words (hi, dog, dada, mama) around first birthday, although sounds may not be clear

Here are 8 tips to help meet these milestones, engage, and expand your child’s ability to communicate.

  • Child-directed communication. The amount and quality of language has a huge impact on your child’s communication development. Research has shown that babies benefit greater from child-directed communication rather than language that is overheard (e.g., asking your child a question vs. listening to the TV in the background) Take the time to smile and enjoy your child through communication exchanges.

 

  • Imitate your child’s sounds and actions. Imitation is a very important skill for your child to learn.  Imitating your baby encourages him/her to notice you and even imitate your actions and/or words. This skill is vital for expanding babbling to initiating first words (e.g., “Mamama”, “babo”, etc.).

 

  • Put the child’s message into words.  When your child sends you a message by reaching, pointing, looking, or making a sound; put into words what you think he is trying to tell you.  Be repetitive, children learn through repeated exposure to target words. (e.g., Do you see the ball? Ball, Here is the ball.).

 

  • Talk with your child during every day routines and activities. When your child hears familiar words and sentences in the same contexts every day, it helps to build his understanding of language.  This is one of the best ways to learn more difficult concepts as well such as verbs, prepositions, etc. (e.g., Look the dog is running. He is running so fast!)

Baby nico on swing

  • Be face to face. When playing with your child, get down to his/her eye level.  Sit facing him/her when he is in his high chair or while playing on the floor.  This way, your child can see and hear you better fostering communication and imitation attempts. During this time, use gestures such as pointing, and imitating daily routines (e.g., washing hands, stirring spoon, kissing babies, etc.)

 

  • Offer your child choices. Hold up two objects and show each object as you name it.  You can ask, “Do you want crackers or bananas?”  Observe how your child communicates his/her choice-looking at the one he/she wants, reaching toward it, pointing to it, making a sound or saying the word.  As soon as your child lets you know what he/she wants, give it to him/her which will allow him/her to experience the power of communication!

 

  • Pause during a familiar routine to tell your child it’s his turn. When you and your child are doing something repeatedly (e.g., swinging, tickling).  Pause during the activity from time to time.  For example, after you have tickled your child, stop the game and WAIT for him/her to let you know that he/she wants more.  Don’t say anything-just look expectantly.  See if your child will tell you to continue in anticipation for that desired activity.

 

  • Sign Language. Sign language is the use of a gestural system to communicate. Signs can be used to reduce frustration and give the child a way to communicate his wants and needs while he/she is still coordinating their speech production system. (My personal favorites are “more”, “all done”, “milk”, and “up”).

    all_done
    From babysignlanguage.com

 

In summary, the best way to foster speech-language development with your child in their first year of life is to: TALK, PLAY, READ, and SING!  If you have any questions or need additional support, please contact a speech-language pathologist for more information.

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.org.