Formula Concerns & Availability

by: Easterseals DuPage & Fox Valley Nutrition Team

Given the shortage of formula in the country (a combination of supply chain issues and product recalls), we know many families are looking to us for help. We understand the ability to feed your child shouldn’t be a concern. For many, this is a scary and anxious time. It has been hard during our nutrition evaluations to recommend any specific type of formula, as the availability is hard to control. A can today may not be available the next time you need it. No one should be without the nutrition they need, and we are here for you.

To help, we have talked with all of our formula contacts to give you resources to find formula and recommendations. We did our best to get you access and an insider view on what steps you can take. Scroll to the manufacturer you need for QR codes, guides to switch formula and more.

We know that manufacturers and legislators are doing everything possible to make more options available. But it will still take 6-8 weeks to get availability at a more comfortable level. In the meantime, please only take what you need for a week or two. Leave formula, especially specialty formula for children with allergies, on the shelf for those that truly need it. And please don’t dilute formula to make it last longer. This results in a lack of nutrition and not enough calories for infants. This can have serious consequences, such as increase risk of seizure.

Finally, please be cautious with recipes that are floating around to make your own baby formula, without consulting with a medical professional first. Many homemade recipes contain ingredients that are not safe for young infants, are low in calories, and are not nutritionally complete. Feeding a baby homemade formula can cause problems with growth and nutritional deficiencies.

About Formula & Brands

Just like adults, babies need protein, fat, and carbohydrates in their diet. Infant formulas sometimes differ in which specific proteins, fats, and carbohydrates they feature. Breast milk has two protein sources: whey and casein. Some infant formulas have both of these proteins, while others only have whey. All meet the FDA’s requirements. Similarly, infant formulas can differ in the type of fat they use. All infant formulas sold in the U.S., whether they are name-brand or store-brand, must meet the FDA’s standards to ensure proper nutrition for your baby.

Generic or store brand infant formulas are very similar to national brands. They even use similar marketing terms, including:

• Advantage = Advance
• Gentle = Gentlease
• Sensitivity = Sensitive
• Tender = Gentle

Most store-brand baby formulas contain DHA and ARA, prebiotics, and nucleotides, just like brand-name infant formulas. Almost all—including store brands made for Walmart (Parent’s Choice), Target (up & up), Walgreens (Well Beginnings), and Kroger (Comforts for Baby), etc.—are made by the same manufacturer: Perrigo Nutritionals. Read more from verywellfamily.

Some children have no issues with transitioning to a new formula, while others may need a little time to adjust. For some children, new adjustments to their diet may cause gastrointestinal (GI) changes. If you need support for your baby’s allergies, constipation or other emerging GI issues, please contact a pediatric dietician for support.

Due to the shortage, now may be the time to move a toddler or older child off of formula and transition to another option. We know this change can be scary. But many families have found this has been a needed push with a beneficial outcome.

See below for a formula comparison chart that you can use to find comparable formulas if your usual brand is sold out. Again, generic brands are perfectly okay to feed your baby.

From Feed to Succeed LLC

Online Support

The support from communities to help those in need of formula is so heartwarming. Consider reaching out to friends and family to help find formula for your baby as they shop. Purchasing donor breast milk from your local milk bank, may be an option. While there is a high demand they are also experiencing more donations of extra milk. One such resource is the Mothers’ Milk Bank of the Western Great Lakes.

Use caution with milk sharing or buying milk over the internet from places other than an official milk bank as these may contain contaminants. If someone is offering extra formula they no longer need, please be sure the formula is not expired and has been stored in a temperature controlled location (i.e. not in a garage).

Instacart is a helpful resource that shows where formula is on shelves. You don’t have to shop on Instacart, but use as a locater in your area.

Community Facebook groups like local Mom Groups, parenting groups and more can help share tips or resources for formula. Chicagoland Formula Finders is a recent and helpful resource for many.

Formula Availability

Scroll down to find more information from Enfamil, Gerber, Kate Farms, Nutricia, Similac and WIC programs (alphabetized).

Enfamil

Enfamil.com has a store locater that is updated three times a day. They also share this qr code and product comparison chart below.

Nutramigen is an extensively hydrolysed formula for the dietary management of infants with mild to moderate cow’s milk allergy. It is hypoallergenic, which means it has been specially formulated to not cause allergic reactions in most infants with cow’s milk allergy. This formula has been more available at this time, but please only purchase if necessary.

At Reckitt/MJN, we see this as a very serious issue, because we understand the responsibility we have in making the single source of nutrition for so many infants, therefore can be no short cuts for this vulnerable population. Our manufacturing facilities are operating 24/7. This has allowed us to supply 30% more product to market YTD, which allows us to provide formula to an additional 200,000 babies per month since the Abbott recall occurred.

It is important to note our manufacturing is near pharmaceutical grade and quality and safety are paramount. Our goal is to get as many feedings to shelf as possible, but our highest priority are those mothers and infants in the WIC program as they are the most vulnerable in our society. Where Abbott can no longer meet their commitments, we are filling the gap as much as we can.

We’re continually looking for more ways to increase supply, while ensuring the highest levels of safety and quality. We’re also working closely with President Biden, the FDA, and the USDA to expedite approval for us to use a factory outside of the U.S., access key ingredients, and make it easier to ensure the most vulnerable babies have access to the formula they need. We know parents and caregivers are concerned about formula supply on the shelves, we are working with our retail partners to support limiting purchases to 1- week supply per household and always recommend buying formula from a reputable source.

This is the highest priority for us as a company and the entire industry. We are confident that by working together and remaining focused on this problem, we will solve it, ensuring that parents and infants have access to the nutrition that they need.

Helping Hand for Special Kids Program

This program can help with a one time gift of formula in cases of financial assistance or multiple births. With help from a medical professional or one of our dieticians, choose from one of the three applicable programs. Offer is limited to one formula gift per household, per birth. Programs and offers subject to change without notice. Only parents and/or legal guardians who meet offer qualifications are eligible. View the program application.

Gerber

While we are a small player in the U.S. infant formula market, we are absolutely committed to doing everything we can to help get parents and caregivers the formula they need so their babies can thrive. We have significantly increased the amount of our infant formula available to consumers by ramping up production and accelerating general product availability to retailers and online, as well as in hospitals for those most vulnerable. We are also working through our Parent Resource Center, website, social media and industry groups to help make sure essential information is available for those parents and caregivers seeking it.

Demand for Gerber formula has increased due to a national infant formula shortage. This increased demand may result in some temporary out of stock issues at certain stores. Each retailer has the best estimate of when specific products will be on their shelves. For information about which retailers in your area carry Gerber formula, you can visit https://www.gerber.com/shop-by-product/formula.

While individual stores may be temporarily out of stock, it should return soon, or you can order from our website.

Our Parent Resource Center is available 24/7 to help parents with any feeding queries, including help in finding our formulas and suggesting recommended alternatives, as it is generally okay to switch routine infant formula brands (800-4-GERBER). If an infant is on a specialty formula for a medical condition or for treatment of allergy, switching infant formula should be discussed with your health care provider before doing so.

Kate Farms

We understand that patients, caregivers, and healthcare professionals are pressed to find alternatives. Kate Farms formulas may be a solution for patients affected by the Abbott recall. Our formulas are only for children one and up, but could be appropriate for kiddos aging out of an infant formula including those who are appropriate for a peptide challenge and were formerly on an amino acid product. Below are a a few crosswalk tools which show which Kate Farms products would be considered “equivalent”, and we have a dedicated out of stock webpage here:  https://www.katefarms.com/customer-service/out-of-stock-support/.

The Nutritional Applications Pediatric Formulas is also a helpful resource to show what may be appropriate by disease state.  The pediatric transition guide is also helpful for tube fed patients. Learn more about transitioning to a new formula with this guide in partnership with a Registered Dietician.

Kate Farms formulas:          

• Indicated for ages 1 and up
• No common allergens. Do not contain milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, or soybeans —but are not tested to be hypoallergenic
• Unlike powdered formulas, Kate Farms formulas use aseptic processing and are commercially sterile
• Offer pediatric peptide formulas made with organic hydrolyzed pea protein (HCPCS B4161) and pediatric standard formulas made with organic intact pea protein (HCPCS B4160)— not amino acid or elemental
• Nutritionally complete, taste great, and designed for oral or tube feeding (flow smoothly through tubes down to 6.5 Fr)
• Eligible for insurance coverage: Medicare, Medicaid, private plans, and select WIC* programs
• Samples arrive within two days to healthcare offices or patient homes at the request of a healthcare professional. Visit katefarms.com/samples.

Kate Farms formulas are broadly eligible for insurance. Your home medical supplier will check your coverage and ship Kate Farms to you. Or you can purchase any one of our formulas online with free 2-day shipping at katefarms.com.

Nutricia

We offer nutritional solutions that positively impact the health from early life and onwards into old age.

1. Nutricia Navigator contains information on the service which can investigate coverage options and locate DMEs or pharmacies in their area that may have product available. 
2. Neocate.com.  Always provides updated information on ordering directly from Nutricia. Parents can enter in their email addresses to receive a notification when it is back in stock at Nutricia.
3. Walgreens.com.  They will indicate if they have availability in any store.  If they see it is available, you can call the store first before going. 

Similac

For families whose babies require specialty, metabolic formulas, the FDA recently informed Abbott Nutrition that the agency has no objection to releasing urgent, life-sustaining supplies of certain specialty and metabolic formulas on a case-by-case basis. Abbott has established a request line for patients and caregivers seeking access to their specialty formulas: 1-800-881-0876.

We know that our recent recall caused additional stress and anxiety in an already challenging situation of a global supply shortage. We are working hard to help moms, dads and caregivers get the high-quality nutrition they need for their babies.

Abbott is working closely with the FDA to restart operations at the Sturgis, Mich., facility. We continue to make progress on corrective actions and will be implementing additional actions as we work toward addressing items related to the recent recall. In the meantime, we are working to increase the supply of infant formula by prioritizing infant formula production at our facilities that provide product to the U.S. market.

Below is a QR code that is updated regularly to show availability of infant formulas at different large box stores. More will be available in the next few weeks.

WIC

We have a special obligation to WIC families. About one-half of babies born in Illinois participate in WIC in the first year of their lives. We will continue to do everything possible to safeguard their development and access to safe, nutritious formula.”

said IDHS Secretary Grace B. Hou

The state of Illinois is taking a series of steps in response to the current, nationwide infant formula shortage. Senate unanimously passed the House’s bill to add flexibility to WIC benefits. The federal nutrition program for women, infants, and children is the largest infant formula buyer in the country — making up about half of all formula purchases. The approved legislation would waive the contract requirements for emergencies (like during a formula shortage), and allow mothers to purchase other formulas available without having to pay out of pocket.

In coordination with the USDA Food & Nutrition Service, Illinois retailers are being encouraged to set aside formula for low-income families enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children program.

The Illinois Department of Human Services has also trained caseworkers to assist families with formula questions. The IDHS Help Line at 1-800-843-6154.T he Help Line is designed for Supplemental Nutrition Assistance Program and WIC customers primarily but is open to all residents of Illinois. Read more here.

For more information on our Feeding Clinic, nutrition and feeding services, visit: https://www.easterseals.com/dfv/our-programs/medical-rehabilitation/nutrition-therapy.html.

Staying Sane while Staying Home

By: Kelly Nesbitt, MOT, OTR/L, Occupational Therapist

Response to Coronavirus (COVID-19) 

Kids are finishing up the school year, you are still going to work/working remotely, running your home, and keeping your kids entertained during their summer! All this change can be very disorienting and stressful for everyone.  I wanted to put together a list of some suggestions that are “occupational therapist-approved” to help you navigate staying sane, keeping a good routine, carving out “family time”, and receiving therapy services remotely while being stuck inside the house! 

Routines

Probably the largest disruption to all of us at this time is that all of our daily routines are completely changed! Daily routines help provide structure to our lives, whether you are a child or an adult. Research by Ruth Segal, OTD and Assistant Professor in the Department of Occupational Therapy at New York University, reports that daily routines give families as sense of identity, organization, and provide socialization opportunities (Segal, 2004). Our kids are used to having a predictable day involving school, extra curriculars, play dates, and therapy appointments which help them organize their days and have meaningful interactions with family and friends. With this change to e-learning and staying home, it’s completely understandable that kids may feel stressed, anxious, and aimless without their routines. This stress may be more exacerbated for children with Autism Spectrum Disorder (ASD). Children with ASD can be heavily reliant upon predictability and routine, which have been thrown off because of the Coronavirus. For both neurotypical and children with ASD alike, using visual schedules, timers, and social stories may be good techniques to help your child cope with a new routine. 

Visual Schedules

Visual schedules can be as complex or simple as you need; they can be simple drawings on a piece of paper, an excel spreadsheet, or printed words/pictures from an online generator. For some of my clients, they are comforted and reassured when I draw 3 pictures of activities we are going to do in OT.

Honestly, whatever works for your kid and helps them feel organized is correct.  Whatever way you decide to create a visual schedule, it’s important to build in both structured and unstructured time for your children. They should have time built in for their academic work for school as well as a few hours for play time that is completely unstructured. Some kids may want to put a sticker next to an activity they completed, erase it on the whiteboard, cross it out, or just put a checkmark next to it. The sky’s the limit! Below are some examples of visual schedules and who it may be appropriate for:  

(Written schedule with times, appropriate for older elementary children who can tell time) 

(visual picture or words, as they are able to read. You can draw your own pictures or just print some off for younger children who cannot read.)  

More resources at: Free Templates for Daily Visual Schedules 

Timers

In conjunction with visual schedules, it can be helpful to utilize timers (sandtimers, timer on the microwave, on your iPhone, etc.) to help your children keep organized. The timer you use will have to be dependent upon your own child’s level of development as well as what they personally need to feel supported. Apps you can use: 

1. Children’s Countdown App: Great, free time app on smart phones that shows a picture countdown on the screen. The coundtown clock can be set for any amount of time and children do not need to understand how to tell time or have understanding of numbers to comprehend it.
2. Timed It! App: App for older children in which you can put in personalized tasks in minute increments and the app will help the child count down until they need to move on to the next task.
3. Timer on smart phone: just about all smart phones have a “clock” application in which there are capabilities for setting a timer. This would be good for older children who have a better sense of what an hour, minute, second is. Although, some younger children will understand the concept that they are only “all done” when the timer makes a sound.

Social Stories

For some children with ASD, social stories are a good way to help explain why their routine has changed or what the “story” of their day. Social stories are third person stories in which the child is the main character and different themes can be explored. Ask an Occupational or Speech therapists for help creating a social story, if needed. 

Here’s a link to example social stories and one of the final links on this page has a social story template: https://www.andnextcomesl.com/2018/07/free-social-stories-about-transitions.html.  

Reducing Stress Activities

 In this uncertain time, it’s important to have some outlets for both you and your children to decompress and still have fun together. Building in sensory activities into your daily routine will help your child remain calm and regulated throughout the day.  

Physical Activities and Heavy Work

Taking movement breaks throughout your day will help both you and your child stay sane while you are cooped up at the house.  Occupational therapists often discuss the benefits of heavy work and how this push, pull, or carry input (or proprioceptive input) to the muscles and joints has a regulating and calming affect. There are a multitude of heavy work activities you can do indoors. Such as:

1. Build a pillow fort with blankets, pillows & stuffed animals
2. Pull siblings on the hardwood floor while they are sitting or laying on a blanket
3. Do animal walk races across the room (bear walk, frog hop, crab walk, etc. Make up your own silly walk!)
4. Jumping Jacks or jump on a trampoline
5. Pull siblings in the wagon around the block
6. Have a wall push-up competition and find out who is the strongest in your house
7. Play towel tug-of-war
8. Plant flowers in the backyard or help with yard work (using little shovel, pull weeds, dig in the dirt)

My helpful tip to parents is, if the activity includes pushing, pulling, or carrying something; that’s heavy work! Get creative and come up with your own ideas!

Family Game Night/Nightly Mealtime Tradition

Keeping special family routines will be important to make sure kids feel safe and supported when everyone is kind of stressed. Set aside time in your routine where you can all sit down and have a meal together with the television off. A family tradition at my house growing up was to play “Pot Boils Over” where one member of the family starts a silly story and after a few sentences says “pot boils over” and “passes” the story-telling to another family member to add on as they please. It’s a simple game that gets all family members involved, laughing, and thinking creatively.

Another mealtime routine I have heard of, is going around and saying one thing each family member is thankful for, what the best part of their day was, share a good joke, etc. This is also a great time for families to all sit down together and have game nights. You are going to be all home together, why not build some special memories and encourage social learning. Here are a few favorite games that can be played with multiple people, for different ages:

1. Games for younger children: Shoots and Ladders, Simon Says, Twister (help them with right and left), Follow the Leader, Go fish, Memory (match pictures by turning over cards), Jenga, Kerplunk
2. Games for Older children: Twister, Uno (each color you play can correspond to a fun activity such as “Make up your Own Dance Move” or “Do 2 Pushups”), Clue, Scrabble and Scrabble Junior, Telestrations (like telephone, but with drawing pictures), Apples to Apples, do a 200+ piece puzzle as a family, Guess Who?

Here’s another resource with more games: Our Favorite Board Games for Kids

Unplug

I am personally feeling inundated by COVID-19 news and I can get overwhelmed quickly, so I can imagine you and your children are feeling the same. I think it’s healthy to be aware of the evolving situation and current precautions, however it’s beneficial to “unplug” every once and a while when you are at home with your kids. Your children are very perceptive and can pick up on your stress and anxiety as they read your non-verbal cues and affect. Young children especially need their parents to “co regulate,” meaning they read your affect, mood, facial expressions and adjust their own regulation accordingly. If you exude a calm, cool, collected attitude when they are anxious, this will help them calm down and feel secure.

Therefore it’s important to turn off the news at some point and focus on having quality and uninterrupted play time with your kids. Do finger painting, make a fort out of blankets, play board games, read stories by flashlight, sit together and do a puzzle or color! Even just being available to your children, not distracted by technology or work, can be extremely beneficial to your kids.

As May is Mental Health Awareness Month, the CDC also recommends to take time to pause and breath during stress. Notice How you Feel. Take Breaks. Make time to sleep and exercise. Reach out and stay connected. Seek help if you are feeling overwhelmed or feeling unsafe. If you or your child needs help, our social work team can help.

Tele-Therapy Services

COVID-19 does not have to stop your child’s progress toward their goals! Your child can still receive therapy services remotely via tele-therapy.  Tele-therapy is a unique service delivery method in which your friendly Easterseals therapist will arrange a time and will send you a link via the Microsoft Teams app. From there, you just click on the link at your pre-arranged appointment time and you can have a video call with your therapist. Your therapist can then work on therapy goals with your child with you, the parent, being the therapist’s “hands” in the session. An occupational therapist will help coach you through appropriate handling techniques, sensory strategies, exercises, fine motor activities, feeding session and more remotely!  

All our therapists adopted this technology so your child will continually receive services with minimal interruption. It is our hope to keep providing exceptional therapy services to all of our clients during this difficult time. If you have any questions or concerns regarding tele-therapy, please reach out to one of your therapists or contact us at 630.620.4433.

Also stay tuned to our blog for more resources and tips from our therapists on helping families cope with increased time at home during COVID especially during the summer.

Sources:

• Segal, R. (2004). Family routines and rituals: A context for occupational therapy interventions. American Journal of Occupational Therapy, 58, 499–508.
• And Next Comes L Website link: https://www.andnextcomesl.com/2018/07/free-social-stories-about-transitions.html
• The Many Little Joys Website link: https://www.themanylittlejoys.com/gift-guide-our-favorite-board-games-for-kids/
• A Day in Our Shoes website link: https://adayinourshoes.com/free-printable-visual-schedules-for-home-and-daily-routines/

Clarifying the New Drink Guidelines for Children

By: Cindy Baranoski MS, RDN, LDN
Manager of Nutritional Therapy

Maybe you heard about this in the news last week, or maybe not. Either way, trying to make sense of what we should be offering our children to drink is always a dilemma. From the moment a baby is born, the question becomes, breast milk or formula. Breast milk being the optimal choice, but that’s not always possible, so formula is available.

Children less than 12 months of age should never be offered a bottle of straight up milk, but after 1 year, it is the go to drink recommended by everyone. Juice is often offered, but it is not the same as eating the fruit or vegetable. And sometimes in infancy, prune juice is given to help with stools, but that’s not a rule. Many children do not like milk, once done with breast milk or formula, and parents begin to offer anything to help ensure their child is hydrated.

Bring in the new options available for children to drink and it can be confusing to know what is best to offer. For example, plant based milks are all the rage now for many reasons, including allergies, family preferences, cultural reasons, and last resorts for a picky eater. They are flavored, unflavored, sweetened, and unsweetened. And the selection continues to grow, including rice, almond, coconut, soy, oat, hemp, split pea, cashew, and blends to name only a few. Though these may seem like a great alternative to cows milk, each one of them can be found fortified, unfortified, with added protein, or original version. Most plant milks are going to be lacking in protein, fat, and potentially key vitamins and minerals found in cow’s milk.  Diet modifications can be made to help ensure what is lacking in a plant milk can be found in other sources in the diet. But if cow’s milk cannot is not the choice for whatever reason, plant milks with diet modification can work.

Photo by tung256.

Juices have changed as well, with many companies offering non sugar sweetened fruit and/or vegetable juices. Some companies offering cold pressed and fruit/vegetable smoothies with additives, such as greens, protein and vitamins. Use of sweeteners such as grape juice or artificial sweeteners replace sugar and high fructose corn syrup. Juice is not the best option for anyone to be consuming regularly, or in quantity, when the food brings so much more nutrition to the diet that has yet to be identified or quantified.

And then there is water, but not just tap water, but bottled water, flavored water, sweetened waters, artificially sweetened waters, vitamin boost waters, and sparkling waters. As a general guideline, plain old regular water with nothing added or changed, is the best choice.

To help, the Academy of Nutrition and Dietetics, The American Academy of Pediatric Dentistry, the American Academy of Pediatrics and the American Heart association have made some updated recommendations.

Not Recommended

• Artificially sweetened beverages
• “Low-calorie” or “Zero- calorie” drinks
• Toddler and flavored milks
• Sugar sweetened beverages
• Caffeinated beverages
• Soda

Juice Recommendations

• Less than 1 year of age: Do not offer juice
• 1-3 years of age:                4 ounces a day or less a day
• 4-5 years of age:                4-6 ounces a day or less a day

Milk recommendations

• 1-2 years of age:                16-24 ounces of whole milk a day
• 2-3 years of age:                16 ounces of skim or low fat milk a day
• 4-5 years of age:                20 ounces of skim or low fat milk a day

Water Recommendations

• 6-12 months of age:         4-8 ounces a day
• 1-3 years of age:                8-32 ounces a day
• 4-5 years of age:                12-40 ounces a day

Finally, whenever something is happening out of the ordinary with any child, and there is a struggle or question of fluids, seek the advice of a Registered Dietitian Nutritionist to help guide what would be best. Looking at the child as a whole, their full diet, development, family choices, help with recommendations being made for fluids. This will ensure children receive optimal fluids, contributing to best growth and development.

For more information visit: eastersealsdfvr.org/nutrition or contact our Intake Coordinator at 630.261.6216.

Getting Ready For Fall by Teaching Your Child to Dress a Coat

By: Maureen Karwowski, OT

As the leaves begin to turn, it will soon be time to break out those sweaters and coats. This is a great time for your child to practice dressing their coat independently.

As an occupational therapist, I am always looking for ways to help my clients reach their maximum independence. As children become more independent, they develop more confidence and are more likely to try other challenges as well. For my clients that have fine motor difficulties, practicing dressing skills is a natural and routine way to help them develop their fine motor abilities.  Independence with dressing occurs one step at a time, so we can start with dressing a coat as the first step.

Once a child is able to stand securely, or sit securely if they have postural difficulties, it is a good time to start. Here is the “over the head” method that I would start with:

1. Place the coat on the floor or a low table
2. Lay the coat flat with the inside facing up
3. Stand facing the top or collar of the coat
4. Bend over and place the arms in the sleeves
5. Lift the entire coat up and overhead
6. When the arms come down you are all set!

Zipping up a coat requires more precise fine motor skills and strength. I would start by having the child zip up the coat once you have engaged the zipper. When assisting your child with any fasteners, always stand behind them to give them perspective on how their hands should work. You can use a zipper pull to make it easier for your child to grasp the zipper. A quick online search yields many cute options, but you can also use a key ring that you have at home. A magnetic zipper is also a nice alternative while your child is working on manipulating a zipper. Several clothing companies offer this.

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It is important to assist your child, while not jumping in too soon. Be sure to leave extra time, and focus on one step at a time. Once they are independent with this, then you can focus on promoting another dressing task. Good luck and stay warm!

To learn more about Easter Seals DuPage & Fox Valley occupational therapy services, visit eastersealsdfvr.org.

Beyond the Sippy Cup

By: Jennifer Tripoli, M.S., CCC-SLP

I often get asked the question “Should my child use a sippy cup?” It’s a difficult question to answer. Sippy cups were initially invented in the 1980s by a mechanical engineer who was sick and tired of cleaning up his son’s juice mess around the house. He uniquely devised a prototype for the no spill mechanism and just like that problem solved! He eventually sold his patent to Playtex ® and the rest is history as this became the go to type of cup for babies learning to transfer from bottle to cup.

I am sure you probably see tons and tons of children walking around the mall, playing at the park, and in the car with their sippy cups. This is the era of “to go” cups. Everyone, including adults bring their drinks (coffee, tea, water) to their next destination. I understand the convenience of sippy cups for parents and quite frankly I get it, but hopefully I can convince you to try out some other convenient cups that will support your child’s oral motor and speech development.

So why are they really SO bad?

• Promote immature tongue movement pattern or suckle
  • Sippy cups promote an anterior-posterior tongue movement pattern, similar to the way an infant extracts liquid from a bottle or breast (suckle pattern). We want to begin to promote a more upward and backward swallow pattern for infants and toddlers by way of an open cup or straw cup. Sippy cups promote a suckle pattern especially with continued use.
• Promote inappropriate tongue position for swallowing
  • The spout on the sippy cup can anchor the tongue tip down during swallowing. The only way for the tongue to move is forward. During a mature swallow pattern the tongue tip elevates to the area behind the upper teeth (alveolar ridge) as the tongue moves upward and backward.
• Promote speech sound errors
  • Continued and overuse of sippy cups (and pacifiers!) promote the tongue to rest forward in the mouth. This inappropriate resting tongue position can directly impact your child’s ability to produce certain sounds. For example, a child may produce the ‘th’ sound (a frontal produced sound) in for an ‘s’ sound (‘tho’ for ‘so’). It is important to note that not all children who use sippy cups will have speech sound errors. My thought is though let’s set our children up for success by using developmentally appropriate cups!
• Poor dental development and Dental Caries
  • Sippy cups can cause cavities and tooth decay. If your child is sipping on fruit drinks, milk, or any other sugary drinks, sugar can be left on their teeth which will cause the enamel to erode away. Sippy cups (and pacifiers!) can also cause misshaped oral cavities and affect resting tongue position.
• Risk of Injury
  • In my research on sippy cups, I came across a study proving sippy cups can be dangerous?! Who would have thought?! A study conducted in 2012 by Dr. Sarah Keim at Nationwide’s Children Hospital in Columbus, Ohio stated every 4 hours a child in the U.S. is rushed to the hospital due to an injury from a sippy cup, bottle, or pacifier. Dr. Keim stated this likely occurs due to the child learning to walk. As they are learning to walk, they trip and fall often. If they have a bottle, pacifier, or sippy cup in their mouth they can injure themselves.

So what’s the alternative?

• Open cups
  • Many parents think I am crazy when I suggest an open cup for a young child. Yes, it may seem a bit ambitious, but an important step in the development of good oral motor and feeding skills! When children drink from an open cup they are developing a more mature swallow pattern. A smaller open cup (with a smaller rim) will allow your child to have better motor control of the liquid. You can first try giving your child an open cup to practice without liquid (place a preferred pureed on the rim of the cup) or you can use thickened liquid in the cup for a slower flow.
• Straw Cups
  • It may take your child some time to learn how to extract liquid from a straw, but be patient and the skill should develop! When choosing a straw cup choose a straw that is thin versus thick. Also make sure the straw is not too long. It is possible for young children to drink from a straw cup with a suckle pattern. Some children are able to extract liquid from the straw by placing the straw under their tongue. To avoid this, you can slowly cut the straw ¼ inch at a time until the straw is short enough that the child cannot place his/her tongue underneath it.

Here are a few of my favorite open cups and straw cups!

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To learn more about development milestones and speech-language therapy services, visit eastersealsdfvr.org.

 

 

 

 

 

 

Just Breathe

 

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

The popularity of using breathing exercises with children is on the rise.  And, with good reason, because they work! When we focus on breathing fully and deeply, we move out of our sympathetic nervous system (fight or flight) and into our parasympathetic nervous system (relaxation and receptivity).  Breathing exercises are effective for the frustrated 4-year-old, the anxious teenager, the overwhelmed parent and the stressed out teacher.  There are an abundance of fascinating studies that have found that our body posture, facial expression and breathing, send messages to our brains about how we are feeling.  Therefore, we can take control of our feelings by doing something different with our bodies.

Research has found that something as simple as mindful breathing can have the following benefits:

1. Increase our focus
2. Promote instant feelings of calmness
3. Regulate our mood
4. Increase our confidence
5. Increase our joy

Some families find it helpful to have mindful breathing integrated into their regular routines.  For example, every time they are sitting in the car or at every trip to the bathroom they will participate in a simple breathing exercise.  Taking a few minutes at the beginning of an activity can also be an effective way to get a child in a calm, ready to learn state or to reduce stress in anxiety provoking situations.  Breathing exercises can also be an effective way of curbing a looming behavioral meltdown.

When teaching a child a breathing exercise, choose a time when the child is ready to learn.  If a child is in an anxious or frustrated state, he will have difficulty processing the directions.   Make the learning fun and multi-modal.

Image from theyogakids.com

Use a real object, picture or imaginative visualization to teach a breathing exercise.  I may show my little friend a stuffed bunny and ask:  “Do you know how bunnies breathe!?  A bunny takes 3 quick sniffs through its nose and then blows one deep breath through its nose.  I wonder if you could breathe like a bunny?” or “Imagine you had a balloon!  What color would your balloon be?  Let’s take a biiiiiiiig breath through our nose and blow the air out of our mouth into our balloon.  Wow, you made your balloon sooo big with those 3 big breaths!”

Here are my favorite, kid friendly, breathing exercises.

• http://www.momjunction.com/articles/fun-breathing-exercises-for-kids_00355492/
•  http://childhood101.com/2015/04/take-5-breathing-exercise/

For more information on Easter Seals DuPage & Fox Valley visit our website.

Teaching Your Child How to Tie Their Shoes

By: Laura Bueche MOT OTR/L

Teaching your child how to tie shoes can be frustrating for parent and child. This tricky dressing task relies on a variety of different components to work together such as: fine motor skills, bilateral hand skills, visual perceptual skills, sequencing, and attention.

Here are some easy tips and tricks I’ve picked up over the years to help your child be more successful with this tricky self-help task.

 SET UP FOR SUCCESS

Practice Off the Foot

It is much easier to learn how to tie a shoe when the shoe isn’t on your foot.  You can lace up an old shoe for your child to practice on, or you can make a “learning shoe” with cardboard or an egg carton.

Different Color Laces

Buy two pairs of laces of two different colors. This will help your child with the visual perception piece. She or he will be better able to see the laces and differentiate, and avoid a tangled mess.

Visual Check List

Print out the sequence pictures from this blog to make a flip-book and follow along as you teach. This can help your child sequence through the steps.

One or Two Steps at a Time

Learning all the steps at once can be overwhelming. Read your child’s motivation and/or frustration levels to know when to push forward and when to call it a day.

Don’t Rush

Set aside time to practice. Rushing out the door is NOT the time for learning. Set aside a time to work on shoe tying when you can go at a slow and stress free pace.

Ok great! Now you are set up and ready to learn the magic formula to teach your child how to tie their shoes…

MISS LAURA’S MAGIC FORMULA

1. Hold the laces

2.  Make an “X”

3.  What lace is on top? (blue)

4.  Top Lace (blue) goes through the tunnel

5.  Pull Tight

6.  Make a loop

Not too big… Not too small…Not too far away

    7.  Blue lace goes aroouuund town

     8.  Drop it!

    9.  Thumb pushes bunny through the hole

   10.  Grab both bunny ears

           11.  Pull tight

DONE!!

Other Tips

Elastic shoelaces

Elastic shoelaces are great because they look just like regular laces and allow your child to slip on their sneakers without untying. This can be used as a great compensatory strategy or a temporary substitute while your child is in the process of leaning to tie shoes.

Hemiplegia

Here’s a resource for kids who need a one handed alternative.

Still having trouble?

Despite your best efforts, if your child is still having difficulty, perhaps it’s worth an occupational therapy screening or evaluation to determine if there is an underlying fine motor, visual motor, bilateral coordination, or visual perceptual problem. An occupational therapist will be able to adapt this shoe tying task to better fit your individual child’s needs.

Learn more about occupational therapy and other programs at eastersealsdfvr.org.

 

 

 

 

 

Can your child benefit from Constraint-Induced Movement Therapy?

By: Emily Muzzy, Occupational Therapist

What is Constraint Induced Movement Therapy (CIMT)? 
Constraint-Induced Movement is a therapeutic approach for children with one sided weakness such as hemiplegia, brachial plexus or other unilateral impairment. CIMT was originally utilized in the adult rehabilitation setting to treat post-stroke patients.  However, it was found that children with one-sided involvement could also benefit from this type of treatment. Numerous research studies have shown that by restraining the unaffected limb and intensifying  use of the affected limb, pediatric constraint induced movement therapy produces major and sustained improvement in motor function in children.

Children with one-sided involvement often experience “learned non-use” of the affected side.  Forced use of the affected side helps to regenerate neural pathways back to the brain, increasing awareness of that side.  This leads to increased spontaneity of use of the arm and improved function.  The forced use is attained by the child wearing a constraint cast on his/her uninvolved arm for a period of time each day (preferably a minimum of two hours).  The cast is made by an Occupational Therapist and is removable.  When the cast is worn, this allows for mass practice of therapeutic activities with the involved arm.

What should a child hope to gain in an intensive program utilizing CIMT?

• Typical goals of a CIMT program include improved quality of gross and fine motor skills and improved bilateral hand use for daily living tasks.
• Family education will be provided on use of the cast at home, and home program activities will be provided to promote successful use of the involved arm and hand.
• A skilled occupational therapist will help to develop specific functional goals for your child based on his/her specific needs.

Who is appropriate for constraint therapy?

• Typically, children with a diagnosis of hemiplegia, cerebral palsy or brachial plexus injury (though any child with one-sided involvement could be considered).
• This is generally used with children from 18 months to 10 years of age.  Younger children have a more plastic neurological system and greater gains may be seen with them than with older children.

After finishing a session of CIMT, one parent couldn’t believe her child’s progress after four weeks of therapy.

My child’s time in constraint camp improved his fine motor skills and he had fun while doing it!  He will always use his right side, but by putting on the cast, it strengthened his weak side and now he uses it more to support activities.

What does a session of constraint therapy look like?

• At this center, a child is seen for 4 weeks of intensive therapy, 3 times per week.  Each session lasts 2 hours per day.  The fourth week focuses on bilateral training without use of the constraint cast in order to practice functional activities with both hands.
• The therapy sessions of the CIMT program offered at this center should look like FUN!  We work hard to provide a variety of play-based activities that promote repeated use of the affected limb.
• Messy tactile play is used to promote increased awareness.  Activities like giving farm animals a bath in shaving cream, building sand castles, and finding play bugs in dirt are just some examples of the way kids can get messy with their involved hands.
• Activities to promote shoulder strengthening are incorporated through climbing over obstacle courses with ladders, slides, and tunnels.
• A variety of grasp and release activities are used.  Use of the “just right” size of objects is needed so the child can be successful.
• Activities on a vertical surface such as finger painting on the wall are beneficial for getting shoulder movement along with wrist and finger extension.
• The child will be constantly engaged in activities that will require use of his/her affected arm.

Two sessions of CIMT are offered this summer as part of our Community Based Therapy Programs.  For more information on registering, contact our Intake Coordinator at 630.261.6287. Check out the additional Community Based Therapy programs like Aquatic Therapy, Fun with Food and social skills programs  here.

Toe Walking in Toddlers…is it Normal?

By: Bridget Hobbs, PT, DPT

Walking on the balls of the feet or “toe-walking”, is quite common in children just learning to walk. The good news is that many children out-grow it within a few months of walking.  However, if your child is toe-walking beyond the age of 2, it is worth talking to your pediatrician about it, as there may be an underlying cause associated with this.

There are a few main reasons why children toe-walk:

• Shortened Achilles tendon

A shortened Achilles tendon (bottom part of the calf) can cause less flexibility at the ankle, making it more difficult for a child to get his heel down when walking.  When this is the case, physical therapy can help stretch the calf muscle group and strengthen muscles in the core and front part of the lower leg. This therapy can help the child learn to walk with a more typical “heel to toe” walking pattern.  Sometimes your therapist will recommend a brace to wear during the day and/or at night in order to help get a child’s heel down when walking and stretch the Achilles tendon at night.  In some cases, a series of casts may be used to help gain range of motion at the ankle.  Surgery may be recommended for correction in rare cases or when “toe-walking” persists into later childhood.

• Sensory Processing

“Toe- walking” can also be a sensory-seeking behavior. Children who need more proprioceptive input will lock their knees and ankles. Children may also lock these joints to feel more stable and better prepare them for physical activities, such as running. Some children walk on their toes as they are hypersensitive to different textures or temperatures on the floor. “Toe-walking” can become a habit and if done frequently, can lead to tight Achilles tendons. This is why, if you or your pediatrician feel like your child has sensory concerns, that they are evaluated by an occupational therapist to help with strategies.

• Underlying Medical Diagnosis

If “toe- walking” persists beyond the age of 2 or if it is accompanied by muscle stiffness, difficulty with communication or language delays, coordination problems, or if your child toe-walks just on one side, it is a good idea to speak with your pediatrician about it so you can find out if there is an under-lying cause.  Diagnoses including Cerebral Palsy, Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie Tooth and Tethered Cord have all been linked with early “toe-walking”. Some (but not all) children with Autism and other Pervasive Development Disorders (PDD) have also been noted to toe-walk.

• Idiopathic “Toe-Walking”

Idiopathic “toe-walking” is used to describe a child who toe-walks without any known reason.  Children who walk on their toes may have frequent falls, lean more forward when they walk, and show more difficulty with balance. “Toe-walking” may also be hereditary, where more than one child in the family toe-walks.   Early recognition and intervention is fundamental to prevent a shortened calf muscle and help develop a normal walking pattern and balance reactions.

Many children “toe-walk” as they learn to walk, and with a proper heel-to-toe walking pattern, they learn fairly quickly. However, if you are concerned that your child is toe-walking beyond the age of 2, or is showing other difficulties with development, it is important to speak with your pediatrician.  They may refer you to a physical or occupational therapist who can further assist you and your child.

Learn more about Physical Therapy services at Easter Seals DuPage & Fox Valley: http://eastersealsdfvr.org/physical.therapy.

Using visual schedules: A Guide for Parents

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

Using visual schedules allows your child to see what is going to be happening in their day and the order of events.  Visual schedules can be customized to meet the needs of each child.  Getting started with a visual schedule can seem overwhelming, so this blog will help you recognize if your child would benefit from a visual schedule with ideas on how to get started.

7 Benefits of visual schedules:

1. Provides structure and predictability:  Visual schedules prepare a child for what is coming up, which can reduce anxiety. 
2. Eases transitions: Visual schedules are helpful in easing transitions from one activity to the next.
3. Reinforce verbal instructions: Most children process visual information better than auditory information.  Words disappear after we say them and the visuals give language a lasting component. 
4. Supports literacy development- Consistent exposure to written words can enforce reading of sight-words and provide an opportunity to practice reading through decoding.   
5. Supports development of executive functioning: Visual schedules enforce planning, sequencing, completing tasks independently and the natural consequences of time management.
6. Supports conversation skills: Many childrenn have difficulty recalling and retelling previous events.  Providing the visual framework of the schedule can help kids answer open-ended questions like: “What did you do today?” or “What was your favorite activity?”
7. Helps caregivers:  Having a plan in place can be calming for adults.  Creating a schedule helps the caregiver prepare for the day and use time effectively.

Decide on the format

Visual schedules come in all shapes and forms.  When selecting a visual schedule format, consider which would be most functional for you to use, along with what would be most beneficial for your child.  Some schedule forms take more preparation while schedules like line drawn images or written words can be done quickly and on the fly. 

  Here are some different types of visual schedules:

Apps on phone/tablet   Tangible pictures with Velcro Line drawing images  Written words

Decide on the length The length of the schedule will be based on your son or daughter’s needs and abilities. Some children may be able to use a whole day schedule while others will be overwhelmed by this amount of information and will need to see just one or two items at a time.

First/Then-This can be an effective format to introduce visual schedules without overwhelming the child with too much information.  It can assist a child in getting through the non-preferred first activity by seeing that next, she will get a preferred choice.

Part of the day with more specific activities                                              Monthly Calendar

 

 

Whole day with more general activities

It is beneficial to include your child as part of the process of creating the schedule.  The slowed down, one step at a time, verbal explanations paired with visuals helps the child understand and prepare for upcoming activities.  It can also be a nice opportunity for the child to have some autonomy and make choices about what their day will look like. Don’t feel that making a schedule means that you have to rigidly follow it.  Life is unpredictable and having a change in plans is something that we all have to adapt to.  The visual schedule can be a great tool to teach your kids about flexibility.

Learn more about Easter Seals DuPage & Fox Valley resources here: https://eastersealsdfvr.org/.