Category Archives: occupational therapy

From one mom to another: Early Intervention tips

By: Laura Van Zandt, MS, OTR/L

Having a newborn baby can be just as equally thrilling as it can be equally exhausting. Adjusting back to home life can be overwhelming at times as you are healing and beginning to learn all about your new bundle of joy. Understanding that all newborn babies are very different from each other, here are five tips that I found helpful as both a new mom and pediatric occupational therapist:

  1. First and foremost remember to breathe and smile. This time of your life is both wonderful and stressful. Deep breathing has been proven to be very beneficial. The many benefits include a reduction in stress and blood pressure. Deep breathing releases natural “free-good” hormones in our body. Learning a few techniques and tuning into your body for just a few moments can help. If you can force a smile on your face. A smile can be enough sometimes to turn any situation into something to find humor within.

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    Try calming breaths while giving your infant a massage.
  2. Use your tribe and forget as much as possible about modesty. Your tribe, or your support team, doesn’t care what you look like or that you haven’t showered in several days. They love you for who you are and not anything else. Those first weeks can be challenging, especially if you have a children with medical needs. Let them help so you can a little rest to keep yourself going strong.
  3. Talk to yourself. It might feel funny at first but it can help. It doesn’t matter what you say. I often find myself talking about anything and everything- the plan for the day, what is happening right now, about my son’s family, etc. The added benefit of talking to yourself is your child also gets to hear your voice.
  4. Try to develop routines early. It’s really hard the first weeks adjusting and even thinking about routines. I’m not even sure most newborns have routines aside from eat, sleep, and diaper changes; however, if you can try to establish some routines it will help your sanity and also help your newborn develop. For my little one, we try to follow a little routine of eat, quiet alert/play if he stays awake, and sleep. I try to use similar songs and even sing the same song over and over when he is trying to sleep. You can even plan to take a stroller walk around the block the same time every day. Having routines help signal to our bodies a sense of calmness and can provide a little bit of organization when things are crazy.
  5. baby sleeping on white cotton
    Photo by Pixabay on Pexels.com

    Sensory strategies can be your best friend. Some ideas include the use of auditory input such as white noise, talking softly, or singing, movement and swings, and deep pressure or swaddling. It was crazy what a little bit of white noise did for my son. It was enough to calm and quiet him. Now I use it at bedtime to help him get back into a deeper sleep. I use one with a timer so it doesn’t run continuously. I also talk a lot to my son. It was amazing how fast he learned to recognize my voice and respond to a calm voice, if he wasn’t too upset. I was never someone who spoke aloud but now I found myself telling him all kinds of things. I think the soft melody of my voice must have some calming property for him. Also deep pressure and movement can help a newborn in those early months. When a newborn enters this world they are in a position called physiological flexion which they slowly work out of over the next month or two. Swaddling provides physical boundaries much like the womb which allows your child to feel secure. When they wiggle within the swaddle believe it or not they are learning very early about where their body is in relation to this great big world they entered. Along with swaddling you can also try massage. Infant massage has shown to be a wonderful bonding time for newborns are their parents. Movement is the next sensory strategy. I was very lucky my son loved his swing from the very beginning. I don’t know if this had anything to do with how much I moved around on my job, but back and forth movement is one of the best ways to help calm a child. Rocking chairs and swings can be your best friend.

If you find this newborn phase to be very difficult or think you child may not be reaching his/her milestones, talk with your pediatrician and schedule an evaluation. Many parents find physical, speech, occupational or nutritional therapy for short or long periods provide much needed support and growth for their infants. Learn more at eastersealsdfvr.org. 

 

 

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Improve Children’s Handwriting

By: Laura Van Zandt, MS, OTR/L

There are many reasons children are referred to occupational therapy, but one of the most common, especially for school-age children, is because of difficulties with handwriting. Expectations for handwriting increase quickly between grades.

In most preschools, handwriting is done through more hands-on activities (think playing with play dough or using a paint brush). Then in kindergarten, children are expected to be able to write. By first and second grade, they are expected to write for longer periods of time with accuracy.

Many of the children we see as Occupational Therapists are able to write, but might have concerns with proximal stability (think core and shoulder strength), endurance, or have an inefficient grip on their writing instruments that may lead to messy handwriting. Other reasons might also be related to vision or sensory processing.

NicholasBelow are a few tools for children to help their hands for strength, endurance, and grasp.

Some things to keep in mind when picking out writing tools for children:

  • The smaller the writing instrument is, the more likely it is to encourage a tripod-like grasp (you may need to build up the handle to encourage)
  • For kids with decreased grasp strength, drawing and coloring with markers or gel crayons may be easier and decrease frustration when presented with more challenging activities
  • Work on a vertical surface whenever possible. It’s not only great for working on increasing upper extremity and core strength, it encourages wrist extension which is important for proper grasp on writing instruments

Squiggle pen

squiggle

Who doesn’t remember this pen from their childhood!? The Squiggle Wiggle Writer is a vibrating pen that produces squiggly lines. It comes with 3 interchangeable pens which slide in and out of the tip of the pen (which is great for working on bilateral coordination). The vibration is great for providing children with sensory input while drawing or writing which helps with focus and attention.

Mechanical pencils

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Picture by: www.raymondgeddes.com

I am a huge fan of using mechanical pencils with children because it helps them work on grading the pressure they use when writing. If you press too hard, the tip will break which gets frustrating after a few tries.

 

Twist and Write Pencil

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This pencil was designed for a child’s hand. The Y design not only encourages a child to utilize a tripod grasp, but it also forces them to use less pressure allowing them to write for longer periods of time without tiring.

 

Small Pencils, Broken Crayons

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I always have a collection of 1/2 pencils to use with the kids. The shorter a pencil, the more likely they are to use a proper grasp.

 

Beginning Writers

palm eggs

Crayola has launched a handful of new products meant just for little hands. These egg-shaped crayons are the perfect size and shape for your little artist. There are many benefits of children drawing at an early age including developing fine motor and grasping skills, encourages creativity and imagination, improves hand-eye coordination and bilateral coordination.

If you have an easel, I highly recommend having even the youngest of artists to use that because working on a vertical surface is great for kids of all ages. Working on a vertical surface helps increase core and upper extremity strength while encouraging proper wrist position, head and neck position, promotes bilateral coordination, and crossing midline skills.

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Stylus

 

pexels-photo-416396.jpegFor a variety of reasons, kids spend more time on tablets these days. As with all things, as long as you don’t overdo it, working on the iPad can provide a lot of benefits. One of the things I recommend to all parents is that if they are going to let their kids use an iPad or other kind of tablet, be sure to have them use a stylus as much as possible to help develop fine motor and grasping skills. I think this is especially important if your child is doing any kind of handwriting or drawing apps. There are a lot of different stylus’ to choose.

 

Sidewalk Chalk or Small Chalk Pieces

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One of my favorite outdoor activity is drawing with chalk.

 

Learning Without Tears Flip Crayons

flip crayons
Photo by: therapro.com

This is one great product. The crayons are already nice and small to encourage a tripod grasp and having a different color on each end encourages in-hand manipulation skills.

 

Triangle Shapes

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Triangle shapes are perfect to encourage the use of just your first three fingers.

Forbidden Tools

window crayons  bathtub crayons

Who doesn’t like the power of doing something forbidden like writing on windows or in the bathtub! These special items from crayola are designed to encourage writing and creativity is a fun way but also keep mom and dad’s sanity with easier clean up!

For more information on occupational therapy services at Easterseals DuPage & Fox Valley, visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

Techniques of Occupational Therapy: Integrated Manual Therapy

Editor’s Note: Janet Mroz serves on the Occupational Therapy team at Easterseals DuPage & Fox Valley. She has been an occupational therapist for over 30 years and below are excerpts from a couple interviews about her work.

Janet Mroz.jpgWithin the field of Occupational Therapy there are a variety of techniques offered. The sciences are constantly evolving, which makes the profession fascinating and fun, especially for those who enjoy learning about one of the most complicated objects, the brain.

Circumstances in a person’s life can lead them to different areas of the journey. Janet was introduced to alternative medicine because of a significant car accident she faced.  Due to the injuries sustained and because traditional medicine did not resolve her medical issues, she was lead down the path of alternative medicine. At the Upledger Institute she learned about Cranial Sacral Therapy (CST) and studied the program for multiple years.

Upledger Institute says “CST is a gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system – comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord.

Using a soft touch generally no greater than 5 grams, or about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system.

By complementing the body’s natural healing processes, CST is increasingly used as a preventive health measure for its ability to bolster resistance to disease, and is effective for a wide range of medical problems associated with pain and dysfunction, some of which include:

  • Migraine Headaches
  • Chronic Neck and Back Pain
  • Motor-Coordination Impairments
  • Colic
  • Autism
  • Central Nervous System Disorders
  • Infantile Disorders
  • Learning Disabilities

Janet also learned about Integrated Manual Therapy techniques that impact not only the cs craniosacral system but also impact the fascial system, organs, lymph system, and nervous system. She enjoys learning this field and continues to work with a mentor to continually improve her abilities. In addition, working with various colleagues that are trained in IMT has introduced her to additional alternative approaches which makes it very rewarding for her.

Janet’s Integrated Manual Therapy (IMT) program is based from this study and incorporated into a traditional occupational therapy approach (and sometimes aquatic therapy settings). The therapy helps a body achieve balance to help a body work as optimally as possible. A person’s anatomical, physiological and emotional systems can all take a toll on a body’s balance. Through this very light pressure at specific points of the body she investigates and eases the primary cause of the current pain or dysfunction. Her work may help a person have improved mobility and movement, circulation, sensory function and immune responsiveness.

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This treatment is very individualized and Janet feels that many people can benefit from the treatment, even those without a disability. Janet will often get “tune ups” so that her body is able to work with less compensations and work as optimally as possible with less effort. The treatments may benefit many people to live with less pain, greater mobility, greater energy and better sleep.

For more information about Occupational Therapy services such as IMT at Easterseals DuPage & Fox Valley, visit our website.

What are Fine Motor Skills?

By: Kelly Nesbitt, Occupational Therapist

If you’re a parent, you know how busy your child’s hands are 24/7. Kids are constantly using their hands to pinch, squish, pull, draw, and manipulate toys and objects in their environment; all thanks to fine motor skills that they have developed over months of play and exploration. But what are fine motor skills exactly, and why do they matter?

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Fine motor skills typically refer to the ability of the hands (through development of the small muscles of the hand and experiential learning) to manipulate objects in order to accomplish specific tasks. Without fine motor skills, your child would have trouble zipping up their coat, buttoning their jeans, tying their shoes, pinching finger foods during dinner, writing with a pencil, scribbling with crayons, opening containers to get a snack, pushing LEGO® together, or turning pages in their favorite bedtime story.

How do fine motor skills typically develop? While every child develops fine motor skills at different rates, children typically develop fine motor skills in this general developmental sequence:

Babies: Learning to reach, grab, and pinch!

  • 1-2 months old:
    • Bat arms inaccurately toward a toy placed by them and will occasionally struggle to grasp onto toys in an intentional manner.
    • Babies at this stage (from birth to approximately 4-6 months old) have a reflexive grasp, meaning that if an object is placed in their palm, they will automatically grasp around the object.
  • 3-4 months:
    • Grasp onto objects in the palm of their hands without their thumb helping them hold onto the object.
  • 5 months:
    • Reach and grasp onto objects placed by them with greater accuracy.
    • Begin to use the thumb more in grasping with their palm of their hand around 4-5 months. This is called a “palmar grasp
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    Photo by Lauren Vitiello

    6-8 months:

    • Reach accurately to items they want.
    • Start using their first 3 fingers (thumb, index, and middle fingers) to hold items in the palm of their hands. OT’s refer to this type of grasp as a “radial palmar grasp
  • 9 months:
    • Start to primarily use their fingers to hold onto objects. For example, they may hold a block between their thumb, index and middle fingers around their knuckles and not with the very tips of their fingers. OT’s refer to this kind of grasp as a “radial digital grasp
  • 10-11 months:
    • Develop an “inferior pincer grasp” in which they can use the pads of their thumb and index fingers to “pinch” onto objects
    • Become interested in dropping objects into containers for play
    • Starts scribbling on paper while coloring

Toddlers: Learning to manipulate, grasp, and cut with scissors

  • 12 months:
    • Develop a “superior” or “fine pincer grasp” in which they can use the very tips of their thumb and index finger to pinch onto smaller objects. Think about how you would pick up a tiny bead with your thumb and index finger; that’s the superior pincer grasp!
    • Move small items in one hand from their fingertips to the palms of their hand. This is referred to as “finger-to-palm translation.” A good example of finger to palm translation is the action of picking up multiple coins, one-at-a-time, with the fingers and moving them into the palm of your hands.
    • Color using their whole hand to grip onto markers and crayons with their palms facing up, known as a “palmar-supinate grasp.
  • 15-18 months:
    • Kids are able to stack 2 cubes on top of each other
    • Kids are able to put large puzzle pieces into a puzzle
  • 2 years:
    • Develop the ability to move small objects from their palm to their fingers, also known as “palm-to-finger translation.”
    • Start motion of twisting caps on bottles with their fingers tips, called “simple rotation.”
    • When drawing, copies an adult in making horizontal, vertical, and circular marks
    • Unbutton buttons
  • 2-3 years
    • Color using a “digital-pronate grasp” where the palm faces down and whole fist is wrapped around the marker or crayon, with one or two fingers “pointing” on the utensil.
    • Start to use scissors to make small little cuts into paper.
  • Marita Blanken_3_MG_9081A3-4 years
    • At 3, kids can copy a pre-drawn vertical and horizontal line and circle
    • Thread medium sized beads onto string
    • Color/write using a “static tripod grasp”, which means that kids use their thumb, index, and middle finger to hold onto a pencil with the tips of their fingers and use their wrist to move the utensil.
    • Uses scissors to cut straight lines and simple shapes like squares and triangles. At this point, cutting out circles is pretty tricky.
    • Around 4 ½ years, kids may begin using a “dynamic tripod grasp” which involves the thumb, index, and middle finger to hold a utensil with the tips of their fingers and use the motion of their fingers to draw
    • Around 4-5 years old, a child is able to write some letters and numbers and may be able to write their own name
    • Can copy a cross when drawing

Kindergarten

  • 5-6 years
    • Further development of the dynamic tripod grasp occurs from 4 ½ -6 years old
    • Cuts out complex shapes with scissors and is able to more neatly cut out circles
    • Able to copy a triangle
    • Copy most uppercase and lower case letters
    • Print their name
    • Tie shoes

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Of course, this is not an exhaustive list of the fine motor skills that kids display at different ages. But, this list will definitely give you an idea of what skills you should see in your little one in time.

 

If you have any questions about your child’s fine motor development or any concerns get connected with an occupational therapist. The Occupational Therapy team at Easter Seals DuPage & Fox Valley offer a depth of knowledge and range of certifications to assist children with autism or physical challenges at any level of involvement. Because each child’s needs are different, we create an individualized treatment plan based on parent concerns and the most current treatment approaches. Click here to learn more. 

References

[1] Case-Smith and O’Brien (2015). Occupational Therapy for Children and Adolescents (7th ed.). Saint Louis, MO: Elsevier

[2] Rita P. Fleming-Castaldy (2014). National Occupational Therapy Certification Exam Review & Study Guide. Scranton, PA: TherapyEd.

[3] Lurie Children’s Hospital (2018) Fine Motor Development Milestones. Retrieved from: https://www.luriechildrens.org/en-us/care-services/specialties-services/occupational-therapy/developmental-milestones/Pages/fine-motor-skills.aspx

 

 

 

 

[1] Case-Smith and O’Brien (2015). Occupational Therapy for Children and Adolescents (7th ed.). Saint Louis, MO: Elsevier

2 Rita P. Fleming-Castaldy (2014). National Occupational Therapy Certification Exam Review & Study Guide. Scranton, PA: TherapyEd.

3 Lurie Children’s Hospital (2018) Fine Motor Development Milestones. Retrieved from: https://www.luriechildrens.org/en-us/care-services/specialties-services/occupational-therapy/developmental-milestones/Pages/fine-motor-skills.aspx

 

 

 

 

Sleep Tips for All Ages

By: Laura Van Zandt, OTR/L

As a soon to be new mom, sleep is something that is very important to me and something I will soon be getting very little of in my life! I often get questions by parents about sleep and how to better help their little ones develop good sleep habits and routines. There are many great sleep books available  to read and review for sleep suggestions. Many are targeted towards babies; however, they still contain useful information about typical sleep patterns as well as some guidelines for establishing sleep routines and how to sleep coach. In order to better prepare myself and my husband, I’ve been reviewing some of my handouts on sleep and wanted to share what I found useful.

My first step with families is to help them understand that sleep is a learned behavior. There are many reasons children have difficulties with sleeping. A child may have difficulty sleeping because:

  •  She hasn’t yet learned to put herself down to sleep
  • He might have difficulty self-calming and quieting his body and mind for sleep.
  • She might have separation anxiety
  • He is testing limits
  • She might have an overactive imagination
  • He wants to play longer and will resist going to bed
  • She is sensitive to noise, textures, or odors which makes it difficult to relax to sleep.

04_Bodhi2.jpgOlder children have increasing demands on their time from school, sports, extracurricular activities, and other social activities which can impact sleep.  A child might also snore or have noisy breathing during sleep which should be evaluated by their pediatrician with possibly a referral to an ENT to rule out sleep apnea or enlarged adenoids.

Going to sleep and getting enough sleep are skills we need to teach our children. Optimal sleep helps to ensure children are able to play and ready to participate in daily activities. It also promotes brain development and growth.

How many hours does a child need to sleep?

Newborns sleep about 8 to 9 hours in the daytime and about 8 hours at night. Most babies do not begin sleeping through the night (6 to 8 hours) without waking until at least 3 months of age; however, this varies considerably and some babies do not sleep through the night until closer to 1 year.

Infants typically sleep 9-12 hours during the night and take half hour to two hour naps, one to four times a day, fewer as they reach age one. Research shows that when infants are put to bed drowsy but not asleep, they are more likely to become self-soothers which allows them to fall asleep independently and put themselves back to sleep when they wake up. Babies need our help to establish their own sleeping and waking patterns. You can help your baby sleep by recognizing signs of sleep readiness, teaching him/her to fall asleep on their own, and providing the right environment for comfortable and safe sleep. Your baby may show signs of being ready for sleep by rubbing their eyes, yawning, becoming fussier, or looking away.

Toddlers need about 12-14 hours of sleep in a 24 hour period. When they reach about 18 months of age their nap times will typically decrease to one a day lasting one to three hours. Caregivers should try to avoid naps occurring too close to bedtime as this could delay sleep at night.

Preschoolers typically sleep 11-13 hours each night and most do not nap after 5 years of age. It is not uncommon for preschoolers to experience nighttime fears and nightmares in addition to sleepwalking and sleep terrors.

Children ages 5-12 years need 10-11 hours of sleep. Older children may show signs of insufficient sleep by falling sleeping when it is not nap time, frequently waking-up tired and crabbing, seeming irritable or difficulty to please, appearing clingy, or may have a short attention span.

Here are some general tips for all ages.

19_JOERGENRUDAbel.jpgRoutines and consistency is a critical. Parents and caregivers can significantly influence a child’s sleep through scheduling and routines. Some kids do well taking a bath and reading books/telling a story while lying in bed and preparing to sleep. Reading together can be a great way to spend some quality time together and allow the body to relax. Some kids might also need some calming heavy work input prior to bath time or getting into bed for stories. One of the first things new parents learn at the hospital is how to swaddle their newborn because snugly wrapping your baby in a blanket provides calming deep pressure tactile and proprioceptive sensory input allowing the newborn to feel secure and safe. Rocking chairs and baby swings are also some of the most valued and used pieces of baby equipment because of the repetitive movement qualities that provides calming vestibular sensory input.

Some examples of calming heavy work input and movement that might help your child include massage, yoga, pillow squishes, gentle, rhythmical, and linear swinging for at least 15 minutes before bedtime. I would recommend trying simple games that don’t have a competitive nature to them since they are more likely to increase arousal level. We want our children to learn to calm down and be quiet before bedtime.

Darkness is key. Make sure that the bedroom where your child sleeps is as dark as possible and pay special attention to blocking out the early morning sun. Sunlight is a natural wake-up signal; using room-darkening shades and curtains to block out light will help your child sleep. If you are going to use a night light in your child’s room, try to make a compromise and place one right outside your child’s bedroom or opt to turn off the night light after an hour. You can also try a touch operated, battery powered night light with a timer that goes off if your child wakes up in the middle of the night and needs to use the bathroom or hears a noise and needs to be reassured briefly.

Provide some white noise. Parents and caregivers of babies can often be heard making the familiar “shushing” noise or quietly humming to quiet and calm their little ones. These repetitive, quiet sounds mimic the calming, reassuring noises the baby heard when he was in the womb. A sound machine or small fan in your baby’s room will provide a soothing hum of background noise. This has the added benefit of drowning out other noise that might otherwise wake your child

Adjust pajamas. Don’t let your child go to sleep in daytime clothes. Observe your child’s sensory preference for touch. Typically speaking, soft textures are not just comforting but it is also a tactile sign for your body to be calm and quiet down. If you are the parent of a baby, you might want to consider swaddling or using a sleep sack as they grow. Swaddling providers a snug comfort via deep pressure and tactile input that is similar to the womb space.

Look at different blankets and mattresses. Some children, especially children who might have difficulties with sensory processing, are sensitive to the feel of different textures. Blankets of different weights and materials might also be preferred at different times of the year. Weighted blankets or lycra sheets over the mattress may also be helpful options as the provide gentle but sustained deep pressure input which can be calming to the body. Some children like to create a cocoon of several blankets, prefer a sleeping bag, or some have favorite blankets that they use. I was surprised to find many different mattress textures. Try as many mattresses as possible in the store to see which is more comfortable.

plush.pngTry for natural warmth: Try tossing a blanket in the dryer or cuddling up to a warm scented stuffed animal. Warmth typically sends calming signals to the body to help quiet the mind.

Look at scents: Certain scents can have a calming effect on the nervous system and help to encourage sleep. There are a variety of different scents that can be calming.

Look at nutrition: Proper nutrition throughout the day can also significantly impact the ability to sleep at night. This can be difficult with our picky eaters but being more aware and trying to find a balance can be helpful. The biggest factors to keep in mind include:

  1. Plenty of protein
  2. Limiting carbohydrates and sugars
  3. Limiting preservatives, additives, and dyes,
  4. Having plenty of fruits and vegetables.

Incorporate heavy work during the day: Exercise helps tire our bodies out and make us ready for night. Provide plenty of opportunities throughout the day to engage in heavy work activities (i.e. push, pull, climb, squeeze, gentle rough housing). These activities can include pushing/pulling a laundry basket to the bathroom to complete nighttime routines. Inside the laundry basket include several heavy items as well as pajamas, toothbrush, toothpaste, favorite books to read, etc. The activities can also include wall push-ups to be completed by standing 2-3 ft. from a wall, placing hands on the wall, and slowly lowering body to wall. There are a ton of ideas for heavy work input. Heavy work input involves any type of activity where the person is actively moving their body against resistance.

Limit screen time: No screen time at least one hour prior to bedtime. It has been suggested that longer screen times may be affecting sleep by reducing the time spent doing other activities – such as exercise – that may be beneficial for sleep and sleep regulation. The content on the iPad can also impact sleep. For example, exciting video games, dramatic or scary television shows, or even stimulating phone conversations can engage the brain and lead to the release of hormones such as adrenaline. This can in turn make it more difficult to fall asleep or maintain sleep. Less obvious is the impact that light has on sleep and on our sleep-wake patterns in general.

Try an earlier bedtime: Contrary to popular belief, kids tend to sleep more and longer with an earlier bedtime. Ever heard of the “witching hour”? This is typically when kids are overtired and doing everything in their power to fight off sleep. If a child gets to the point of exhaustion or over tired, it can backfire on the nervous system. Just think of the nights when you pushed past your feeling of exhaustion because you just had to get that one last thing down. How did you feel later that night when trying to fall asleep? It was probably more difficult for you.

This is because when you work past your point of exhaustion it is usually because you are stressed. Stress releases the hormones adrenaline and cortisol. Cortisol normally rises and falls throughout the day and it typically highest at around 8AM and lowest between midnight and 4AM. Stress normally causes a surge in adrenal hormones like adrenaline and cortisol that increases alertness making it more difficult to relax into sound sleep. Frequent stress can chronically elevate these hormone levels, resulting in a hyper-vigilant state impacting continually restful sleep.

We ALL need sleep, and when there are concerns, it becomes even more important. When we are not getting enough sleep it impacts our mood, behavior, and overall self-regulation.

Visit eastersealsdfvr.org for more information about our occupational therapy services.

Additional Resources:

  • Stanford Children’s Health
  • St. Luke’s Hospital Sleep Medicine and Research Center
  • American Occupational Therapy Association
  • GetYourBabytoSleep.com

What is a “Sensory Diet”?

By: Laura Van Zandt, OTR/L

A “sensory diet” is a treatment strategy occupational therapists use to help children learn to process and understand sensory information from their environment and their own body to more effectively interact within the environment and with others. The term sensory diet was first coined and originated by occupational therapist, Patricia Wilbarger. A sensory diet is meant to be individualized to the child so that the activities provided are a ‘just-right’ challenge for the child. The “just right” challenge is defined as “a challenge that is on the edge of competency and engages the drive for mastery.”

A sensory diet is not too hard, yet not too easy. An effective sensory diet should include a wide variety of activities within the child’s day that provide a variety of sensory input for play and learning. An effective sensory diet should also be a collaboration with the client, family, and caretakers.

Occupational therapists often use the analogy of comparing a sensory diet to a balanced food diet to help parents and caretakers understand we need a variety of activities that feed all our sensory systems to allow them to work well together. Just like a well-balanced diet is often tailored to our individual bodies for different nutritional needs at different points in our lives, a sensory diet is an ongoing list of activities that is established over time and modified as needed to help address the imbalance in the child’s sensory processing abilities or as the environment changes and the demands shift.

A sensory diet is designed to help keep the child calm and organized via activities that based on a child’s preferences which then helps them to be able to learn, attend, and fulfill social expectations. As a child learns to remain calm and organized, they learn to better self-regulate and hopefully move from depending more on others to being more independent in managing their sensory needs. The goal of any sensory diet is to help overtime retrain your child’s brain to process sensory information in a more typical way so that can perform at their own unique best.

Each child has a unique set of sensory needs. Generally, if a child is more sensory seeking, they may benefit from adding more movement and stimulation that includes heavy work as well as other sensory stimulation (e.g. tastes, colors, smells) to help achieve a calm, organized more focused state so they are not constantly on the go looking for input. If a child is more sensory avoiding, they may also benefit from heavy work but may need it more graded and introduced slowly over time. The child may benefit more from activities that focus on reducing sensory input and breaking tools that allow them to limit information from their environment. One of the trickiest aspects of developing and implementing any sensory diet, is beginning to recognize your child’s signs and signals as well as starting to recognize when your child is over-reacting, shutting down, or under-reacting and adjusting the sensory input so your child remains just right and able to function.

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When occupational therapists provide ideas for a sensory diet, they keep in mind several different guiding principles:

  • Frequency of input: The frequency of need varies for each child and should be guided by observations of the child before and after each activity.
  • Intensity and duration of input: How much time you spend on each activity and how much sensory input (e.g. how much weight to use to push/carry/drag/lift, how loud to play the music, what type of tactile media to present, how much tactile media to present, etc.) is directly related to the child and how the child is doing not only on a specific day but also at a specific moment in time.
  • Timing of activities: Sensory diet activities are meant to be proactive and are best used before as well as during activities that are known to be tricky to the child.

    For example, if you know sitting for a mealtime is difficult for your child, you might want to help prep your child’s body and sensory system prior to sitting down. These activities should be tailored to your child; however, heavy work activities that actively require the child to use their muscles to push, pull, carry, drag, climb, bury, dig, suck, etc. are usually beneficial to many children. Sitting for a mealtime is a very complex sensory activity that involves all your sensory systems working together. You can try prepping your child’s sensory system prior to sitting down by re-arranging the chairs around the table and cleaning the table with spray bottles and towels to dry. You can try exploring different options for their chair- maybe your child might do well with a move-n-sit cushion or having a band around the legs of their chair to kick against. Your child might be bothered by the sounds of other people chewing their food and might benefit from noise cancellation headphones. Your child might be bothered by the sights of all the different foods or by all the foods touching each other. There are many different ideas and strategies to help both of those difficulties.

Your occupational therapist may ask you to become the detective and create a daily log of behavioral changes. You are your child’s best advocate and are the best expert in your child’s abilities and areas of growth. By creating a log of activities and your child’s responses to activities over the course of different days and different times, you can help better curtail some of the trial and error process that is inherent within any sensory diet due to our own individuality.

The sensory diet activity that might have worked well for another child with a similar difficulty, may not necessarily work for your child. The various times of the day and different environments may be work better for certain activities. Not all strategies work all the time. It is important to keep track of all the different activities your child responds positively to, so that you can create variety and have more than one strategy to help your child.

With help from 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. Learn more about our program. 

Resources:

  • Shiela Frick and Julia Wilbarger – “Creating Effective Performance, Precision, and Power in Treatment and Sensory Diets”
  • The Out of Sync ChildThe Out of Sync Child Has Fun, Growing an In-Sync Child by Carol Stock Kranowitz
  • childdevelopment.com

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.

 

My Kid is a Picky Eater and I Need Help!

By: Laura Van Zandt, OTR/L

peblog2Around 2 years of age, children enter the age of autonomy where they become aware of their individuality and become increasingly independent. This is also the age where they become increasing comfortable testing limits. Around this age, kids are most likely to start becoming “picky eaters.” By the time children enter preschool, many have begun to move past this phase and start to expand their food preferences; however, some children don’t move out of the picky eating stage and continue to refuse foods. Foods once liked may become dropped and not added back into their diet. The big difference between typical picky eating and avoidant /restrictive food intake disorder (AFRID) is that typical picky eating fades away in conjunction with repeated food exposure and a positive mealtime environment.

Children with ARFID may also have other health issues or conditions such as attention deficit hyperactivity disorder, autism, sensory processing, food allergies, constipation, and/or anxiety. Some children who were born prematurely may have required breathing and feeding tubes during hospitalization which can increase oral sensitivity. A child who had a choking episode in the past, was forced to eat, or who had multiple respiratory infections at a time when she was learning to eat may have developed negative associations with eating. Some children may have a sensory system which is offended by the texture, smell, odor, or appearance of food. These sensitivities may alter how kids experience food and result in their refusing to eat many foods. Anxiety can stem from the food itself, especially if it’s unfamiliar or disliked, or it can result from other factors such as pressure to eat at mealtime or a negative memory of eating. Older kids may experience social anxiety around their peers.

Parents often have good intuition and know when something is not right with their child’s eating patterns. Some signs of AFRID include refusing food due to its smell, texture or flavor, or a generalized lack of interest in eating. Children may have poor eating or feeding abilities, such as preferring pureed foods or a refusal to self-feed. They may be underweight or demonstrate slowed growth due to inadequate or poor nutrition. They may also show signs of anxiety or fear of eating. If you feel like your child’s eating patterns is moving beyond typical picky eating, please schedule an appointment with a pediatric occupational or speech therapist that specializes in feeding.

What can be done:

  1. Schedule a comprehensive evaluation with an occupational or speech therapist can assist you in helping rule in/out other medical conditions which may also be influencing your child’s eating behaviors and patterns. A therapist may also be able to make recommendations to further evaluate nutrition or evaluation for gastrointestinal issues causing discomfort or pain influencing feeding. They will help develop a comprehensive treatment plan that addresses all different angles of feeding.
  2. Read occupational therapists Maureen Karwowski’s blog regarding playing with your food. Research suggests that when too much negative pressure is placed on the child for eating, the child’s appetite may also decrease and could spur an emotional response leaving the child to dread mealtimes. Vice versa, additional research also suggests that when children are allowed to mess with their food and are given permission to touch, handle, and even squash foods they are actually more likely eat them. Allowing your child to handle food without the expectation to eat the food allows them to gradually desensitize their body to the sights, smells, and feeling of a variety of food. Allowing your child to play with food helps to build new brain pathways that help to reshape prior negative experiences with food.
  3. peblog1Recruit your child’s help. If you do not already meal plan, start meal planning and involving your child as much as possible in the process. When at the grocery store, ask your child to pick out food on the grocery list (even if it is not food your child regularly eats). At home, encourage your child to help rinse fruits and vegetables, stir batter, use scissors to cut herbs, or set the table. During mealtimes, serve dishes family style where everyone passes the different food bowls.
  4. Be patient and start very small. Your child might need repeated exposure to try a new food. You may also need to start by presenting a single bite of a vegetable or a fruit versus presenting a lot of the food immediately off the bat. Sometimes, even reading books about different foods, might be the place to start with your child.
  5. feast for 10.pngThink of fun and creative ways to present the same food. For example, if you child is learning how to like pizza, you can try serving pizza on a tortilla shell or on an English muffin. The following are a few books on food that are good to read with children:
  • Eating the Alphabet: Fruits and Vegetables from A to Z by Lois Ehlert
  • Cloudy with a Chance of Meatballs by Judi Barrett
  • I Will Not Ever Eat a Tomato by Lauren Child
  • The Seven Silly Eaters by Mary Ann Hoberman
  • Growing Vegetable Soup by Lois Ehlert
  • Feast for 10 by Cathryn Falwell
  1. Enroll your child in a food group. Easter Seals has routinely been offering an occupational therapy and speech therapy group called “Fun with Food” that helps children learn how to explore foods using all their senses, including touch, smell, sight, and taste. Each session will utilize sensory “warm up” games prior to heading to the kitchen for our snacks. Parents are encouraged to continue with food exploration at home based on weekly recommendations following each session.

Learn more about our occupational therapy services at http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

My Child Needs Deep Pressure! What Do I Do?

By: Laura Bueche, MOT OTR/L

Sensory Processing

Our bodies are constantly receiving and processing sensory information around us. Our senses give us the information we need to function in the world. We receive information from stimuli both outside and inside our bodies. Our sensory systems include auditory (hearing), vision, olfactory (smell), vestibular (movement), tactile (touch), gustatory (taste), and proprioceptive (body awareness). Sensory processing is the neurological process that organizes and interprets all the sensations we receive so we can function effectively within the environment.

What is Deep Pressure?

CatherineDeep touch pressure is a combination of a tactile and proprioceptive input which is often provided by firm holding, firm stroking, cuddling, hugging, and squeezing.

The proprioceptive sense refers to the sensory input and feedback that tells us about movement and body position. Proprioceptive receptors are located within our muscles, joints, ligaments, tendons, and connective tissues. It is one of the “deep senses” and could be considered the “position sense” (as Carol Stock Kranowitz refers to it in her book entitled  The Out-of-Sync Child.

If a child is having difficulty processing proprioceptive input, they’re brain isn’t receiving proper messages regarding whether muscles are being stretched, whether joints are bending or straightening, and how much of each of these is happening, children may seek out more intense forms of proprioceptive or deep pressure input. Kids with tactile and/or proprioceptive sensory processing dysfunction may seek out deep pressure input to send a stronger message to their nervous system. Deep pressure may help them “dampen” averse tactile sensations or may give them a greater sense of where their body is in a space.

 

Indicators of Deep Pressure Seeking

  • Tensing/squeezing muscles of the body
  • Crashing into furniture
  • Enjoys climbing into small spaces
  • Head banging
  • Grinding teeth
  • Pushing on chin
  • Stomping feet
  • Mouthing non-food items
  • Toe walking
  • Leaning into people

brushingDeep Pressure Input Activities

Deep Pressure Input Benefits

Deep pressure touch has been found to have beneficial effects in a variety of clinical settings (Barnard and Brazelton 1990, Gunzenhauser 1990). In anecdotal reports, deep touch pressure has been described to produce a calming effect in children with psychiatric disorders. Deep pressure stimulation, such as rolling up in a gym mat, has been used to calm children with autistic disorder and ADHD (Ayres 1979, King 1989). Lorna King (personal communication, 1990) reports that children with sleeping problems appear to sleep better inside of a mummy sleeping bag, which adapts to fit the body snuggly. It also has been used to reduce tactile defensiveness in children who cannot tolerate being touched. McClure and Holtz-Yotz (1991) found that deep pressure applied by foam-padded splints on the arms reduced self-injurious behavior and self-stimulation in an autistic child. (Ayers, 1992)

Deep touch stimulation is beneficial to typically developing babies (Barnard and Brazelton 1990, Gunzenhauser 1990). Institutionalized babies who received supplemental tactile stimulation, mainly deep touch pressure, developed more typically (Provence and Lipton 1962). Premature babies who receive stroking and tightly bound swaddling also are reported to show definite benefits (Anderson 1986, Field et al. 1986, Lieb et al. 1980). (Ayers, 1992)

If you think you child is seeking deep pressure input or has a sensory processing disorder, schedule an occupational therapy evaluation before trying to implement a sensory program at home. For more information on our occupational therapy program visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

 

Benefits of Outdoor Play

By: Laura Van Zandt, OTR/L

While visiting my family recently, I was reminded of the importance of outdoor play. I was lucky to grow up with a two-acre yard and large untamed wood behind my house. It granted me endless hours of exploring and freedom. Now, children have highly-scheduled lives and don’t have the opportunity to play outside as often. Safety is another legitimate concern for families reluctant to allow their children unsupervised play time outside.

But the whole family can benefit from play time outside. The benefits for children include:

9_DyeAsherLGross Motor Skills: The outdoors is one of the very best places for children to practice and master emerging physical skills. Children can freely experience gross motor skills like running, skipping, and jumping. It is also an appropriate area for the practice of ball-handling skills such as throwing and catching. There are also tons of opportunities for strengthening and coordination through sensoriomotor and heavy work activities such as sitting on a swing, pushing a swing, pulling a wagon, and lifting/carrying objects.

Fine Motor Skills: When children are playing outside they are constantly using their hands to pick up and hold an endless number of items. Each time they pick up something new, they must form their hand around a variety of different shapes. In turn, they learn to separate the two sides of their hands as well as learn how to develop grasp patterns.

27_Sims_McKenna_3.jpg

Sensory Processing Skills: The outdoors are full of boundless sensory processing opportunities. Each of our seven different senses (vision, auditory, tactile (touch), olfactory (smell), gustatory (taste), vestibular (balance), and proprioception (body’s ability to sense itself) are constantly given a vast array of opportunities.

Just close your eyes and listen to all the different sounds. Can you identify the different birds? Open your eyes and now look. Can you find the bird that made that sound? Sit down and feel the grass on your skin. Talk a walk down to a neighborhood garden and smell the different flowers. Which one is your favorite? Can you find the fresh vegetables and fruits? How do they taste? Bend down and simulate your vestibular sense as you pick the different vegetables and fruits. Put them in your wagon and give your proprioceptive system a workout as you pull it up the hill.

Cognitive and Social Skills: Without all the bells and whistles of electronics, children are more likely to invent games as they learn how they can interact within the outside world. Who can jump the furthest over the stick? Who can run the fastest to the biggest tree? Where can I find the best hiding spot for hide-and-seek? Inventing games offers children the possibility to test boundaries and invent rules. In the process, children learn why rules are therefore necessary. They also learn the fine art of flexibility, and give and take with others. Children learn how to work together for a common goal and how to problem solve and use materials in new ways. They can also learn how to take turns and wait while playing on the playground.

Health: Playing outside is also a natural way to relieve stress. Sunlight provides vitamin D, which helps prevent bone problems, heart disease, and diabetes. Our vision is also known to be helped by playing outside (Optometry and Vision Science, 2009 January). Believe it or not, playing in the dirt also helps boost the immune system and handling bugs can help with auto-immune diseases.

Studies show that as many as half of American children are not getting enough exercise, and that risk factors like hypertension and arteriosclerosis are showing up at age 5. So simply going for a walk can greatly help children. Studies have also suggested that playing outside may help to reduce the signs and symptoms of ADHD in children by reducing attention deficit symptoms (American Journal of Public Health, 2004 September).

Activities by Age for the Great Outdoors

Infants:

08_Finn
Photo by Petra Ford
  • Lay a blanket down and have tummy time outside
  • Introduce grass, leaves, and sand in their hands as they exercise fine motor skills of touching and holding
  • Face the infant toward children at play to stimulate their eyes
  • Place the infant in a safely secured swing
  • Push an infant in a stroller around the neighborhood or park

Toddlers:

  • Blowing bubbles and trying to catch
  • Peek-a-boo around trees, bushes, and playground equipment
  • Explore in a sandbox
  • Encourage exploration on small playground equipment
  • Water play with cups and plastic containers
  • Push and pull equipment

Preschool:Gardening Blog1

  • Create a garden or plant some flowers
  • Go on a nature hike with a scavenger list of items to find
  • Use sidewalk chalk to create pictures
  • Collect twigs, branches, and sticks
  • Collect pinecones for making nut butter bird feeders
  • Fly a kite
  • Allow free time/ independent play

 

School Age:jorge-on-bike

  • Running outside
  • Kick a ball
  • Jump rope
  • Hop-scotch
  • Go on hike
  • Plant and maintain a garden
  • Ride a bike
  • Build forts outdoors

Easter Seals DuPage & Fox Valley’s therapy is modeled on play. If you have concerns about your child’s development or want an evaluation, visit www.eastersealsdfvr.org for more information.