Tag Archives: children

Audiology Intervention for Children with Down Syndrome

By: Karyn Voels Malesevic, AuD, CCC-A, Manager of Audiology and Family Services

Children who have Down Syndrome can often have hearing loss, so a therapy center that also has an Audiology Department onsite can make coordinating care easier. Their hearing loss may range from permanent and needing hearing aids to having frequent middle ear infections and require consistent hearing tests.

According to the research article Understanding Hearing and Hearing Loss in Children with Down Syndrome, “Children with Down Syndrome are at a greater risk for permanent and transient hearing loss as compared with their typically developing peers. Long-term consequences of late or failed diagnosis, particularly in this population, can significantly affect quality of life, including school performance, speech and language, behavioral challenges, community engagement, and safety. Therefore, ongoing audiologic monitoring and otologic management is highly recommended for this group into adulthood.”
hearing2

Easterseals DuPage & Fox Valley has Audiologists in our Elgin and Villa Park centers who are experts at working with children that may have been considered “difficult to test” by other clinics.

We are able to fit hearing aids and make repairs and earmolds on children and adults through state programs such as Early lntervention, Medicaid, DSCC, ORS, and via private insurance or private pay options with very competitive pricing.

At Easterseals we work with the local educational Audiologists, who serve children with hearing loss that are in school. That work allows for cohesive coordination between school testing and any hearing aid or other specialized services that may be needed at an outside clinic.

We are also proud that we can continue to see the children in our care as they grow up into adulthood via our audiology clinics.

For more information on our hearing services, visit eastersealsdfvr.org/hearing.

 

Advertisements

Routines and Why They Can Help

By: Laura Van Zandt, MS, OTR/L

Routines are very important for all children, but they can be particularly important for children with developmental delays. Routines help provide a sense of certainty and security for children by offering them a predictable pattern that allows them to know what to expect, which will result in less frustration as well as fewer tantrums or meltdowns.

Certain routines are almost universal, such as morning and bedtime routines, but others may exist for specific circumstances or stages of life, such as your family’s weekend morning or school or summer routine.

A great place to start a routine is having a set bedtime. The American Academy of Pediatrics recommends that children ages 3-5 should get 10-13 hours of sleep a day (including naps) and children ages 6-12 should get 9-12 hours of sleep each night. The benefits of getting enough sleep are numerous and include mental/physical health, attention, memory, learning, behavior, and more. The AAP also recommends no screen time 30 minutes prior to bed, no electronics in children’s bedrooms, and having a set bedtime routine.

Setting up a bedtime routine:

Ryan - web
Photo from Take Three Photography

Bedtime routines can be anything you want them to be, as long as they are familiar and predictable. For my infant son, he takes a bath every other day. After his bath (or mom and dad quiet playtime on non-bath days), he gets a nice massage and we read a couple goodnight books. When he shows us signs of being tired, we turn off the bedside lamp, swaddle, and turn on the white noise machine.

This routine is something I hope to keep as he gets older. For an older child, you can do a similar routine but you will need to add in time for personal hygiene and perhaps next day activities such as pick out your clothes, pack your backpack, etc. You can use a similar routine for naps, except they would just be shorter.

Aside from bedtime, morning routines, can also be beneficial. Some families have different weekday and weekend morning routines, but other children may need to have one routine that stays the same regardless of the day.

Mealtime can also present an important routine. An easy place to start is to try to have meals around the same time each day. I know this isn’t always possible- but getting as close to a specific time each day can be beneficial and having everyone sit together to eat.

Additionally, having chores to do in family routines helps children develop a sense of responsibility and some basic skills, like the ability to manage time. These are skills children can use for later in life that you can begin at a young age. One great example is singing the “clean up” song when it’s time to finish an activity and move onto something different.

“Clean up clean up
everybody everywhere.
Clean up clean up
everybody do your share.

Clean up clean up
everybody everywhere.
Clean up clean up
everybody do your share.”

Routines can also be great for teaching personal hygiene. Ever heard a parent sing the ABC song while their child washes their hands? This is just one great example.

Here are some tips if you are looking to introduce routines into your daily life:

  1. Only change one part of the day at a time.

2. Come up with your basic non-negotiables and then give your children some                    choices (bedtime stories together or separate?).

3. Make a poster with the routine, including photos in the right order, to allow for              self-monitoring. In a good routine, everyone understands their roles, knows what              they need to do and sees their roles as reasonable and fair.blog_visual

4. Follow the same routine every single day for at least one month, after which it will         become habit and your older kids should be able to keep themselves on schedule for         the easy routines.

Establishing routines has lots of great benefits that can help both you and your child develop scheduling abilities, and increase the likelihood that your family will have a smooth day.

For more information on Easterseals DuPage & Fox Valley, visit eastersealsdfvr.org. 

Pretend Play Activities

By: Laura Bueche MOT OTR/L

26_Jack and Kathleen

Pretend play is an important piece of development. It promotes social skills, cognitive flexibility, imagination, language, and helps kids process the world around them. When your child participates in pretend play, they are learning the social and emotional roles of life in a fun, hands-on manner. It can stimulate creativity and help them grow to be more comfortable with themselves and the role they play in their everyday lives.

Included below is a list of potential pretend play scenarios to get your creative parent ideas flowing:

Doctor: This is a great pretend game to teach your kids about responsibility, while encouraging them to be proud of “taking care” of someone else!

Kitchen/restaurant/coffee shop/ ice cream shop: This is a great way to help your children learn about food and nutrition, and get them interested in what goes in their bodies and how it fuels their energy.

Grocery store: Another fun way to help them learn about nutrition, while also helping them improve math skills by counting and setting prices for different items being “sold”.

Animal shop/vet: A fun hands-on approach to learn about animals and the important role they play in many peoples lives

Airport: This is a great way to help children understand the different means of transportation and travel people utilize, especially if they have never gone anywhere far from home

Beach vacation: Similar to playing airport, this can help kids understand about travel and the vast and different climates many people live in, especially if your family does not live near a beach.

Brownie Miliana2.jpg

Baby bath time/ feeding baby/ baby diaper/ baby bed time:

Similar to playing Doctor, this is a great way for kids to foster an interest in responsibility and taking care of others, while also boosting their confidence in discovering their helpful abilities!

Camping adventure: This is a way to improve kids outdoor skills, while teaching them about nature and the environment they live in.

Pirate treasure map adventure: This is a fun way to get kids creativity flowing and help them learn about adventures they can take and create in their mind

Haunted house: This can be as scary or safe as your child is comfortable with, and can allow them to explore and set boundaries in their mind for what makes him/her comfortable

Dress up/fashion show:

dress up

This is a fun way to let kids try on a new role for size, and to help give them the experience of “walking in other peoples shoes”

Police man/woman: Similar to playing dress up, this gives kids the impression of what kind of jobs people in their community hold

Gardening/ making mud soup/ building sand castles: A very hands-on way to explore nature and learn about the plants and trees they see everyday

Making toy/Lego cities: This allows kids to be totally free-spirited in constructing what they think a fun space to live/play in would be.LEGO Run Pre-Party 029.JPG

Making puppets/puppet theater: This is a healthy and fun way for kids to express their emotions and feelings, while also allowing them to explore new emotions they may not be familiarized with yet.

Firefighter: Identical to playing police officer, this allows children to try out the role of what a firefighter does for their community.

Pretty mixed race girl and Caucasian boy pretending to be superh

Super hero/ defeat bad guys and save good guys:

This helps kids understand right from wrong and the values you as a family have, while also helping them feel good about the choices they make.

Tea party: This is a fun way for kids to make up their own rules and find out what it means to be “in charge” of a dining situation

Post office: Kids can learn about roles in their community and better understand a job they see people enact daily.

Car washplaying carwash.jpgPerfect for a summer day, playing car wash can show your kids real life chores in a positive way, while also making for a fun water activity.

Fishing boat: This is a great way to get your kids to explore nature in their minds, as well as understand a fun hobby many people enjoy.

Santa’s work shop: If you and your family celebrate Christmas, this is a wonderful way to introduce the holiday to your children and help them understand the tradition of Santa Clause and what that means to your family.

Farmer: Similar to playing police officer or firefighter, this can help children understand a job people either in or out of their community hold, while also helping them develop a healthy relationship with food and animals.

 

Doll house: This is a great way to get your children interested in how a household runs and the work it takes to sustain a healthy lifestyle, as well as be a fun outlet for them to get creative and cultivate different personalities and traits for each doll.

23a_Brady_and_Cooper_CoulterRace track/ train tracks:

Similar to playing airport, this helps demonstrate to children the different means of transportation available to them, as well as foster a desire to explore and travel

Many of these pretend activities/games include props, but always feel free to encourage your children to use their imagination and create props in their mind or with another item in your house, especially if the props are not readily available to you.

5 Tips for Keeping Hearing Aids on Babies/Toddlers

By: Beth Rosales, Au.D, CCC-A.

hearing1

As both an audiologist and a mother of 2 young children who wear hearing aids, I definitely understand that keeping hearing aids on your child can be a very difficult task. Young children and babies seem to love to get their hands on those hearing aids and pull them right out of their ears! I often hear from parents of babies and toddlers that they have tried to keep the hearing aids on their child, but it seems impossible. As a result the child doesn’t wear the hearing aids regularly, which means he or she is not hearing very well most of the time, and this will likely delay oral speech and language development.

When 2 of my boys ended up needing hearing aids, I knew I had to do everything I could to keep their hearing aids on their ears when they were awake. Well, I can say from personal experience that the struggle is very real when it comes to keeping hearing aids on young babies and children, but utilizing some helpful tools and tips can make it a lot easier.

Tip #1 – Pilot hats

Baby nico on swingThis is best for babies up to 18 months old or so. I fell in love with pilot hats and here’s why you should too. Not only are they cute, but they will make your life so much easier!! For my boys, pilot hats worked better than anything else when they were very young. The pilot hats should be lightweight and ideally have mesh sides or very thin material that will not block the sound from entering the microphones of the hearing aids. It’s important to get a pilot hat that fits well. If it is too loose, then it will be too easy for your little one to get his hands under the hat.

Here are some great places to get pilot hats that work well with hearing aids:

  • LilNells: https://www.etsy.com/shop/LilNells  My personal favorite shop! The hats fit my sons very well, and she makes them with snap closures, as well as ties. I love the snap closure because they are harder for toddlers to undo (tie up closures can work too, but tie closures are easier for kids to play with and untie). The shop owner also has options with mesh sides available and unlined (thin) hats, both of which are good for hearing aids. She is great at making custom orders, so if you see a hat you like that doesn’t have mesh sides, send her a message to see if she can make it with mesh sides, or if you have an idea or color you’d like, just send her a message to see if it is possible. Hats cost about $15 – $18.
  • Anchor Your Hearing shop: etsy.com/shop/AnchorYourHearing. These hats come with mesh sides which are very breathable so there won’t be too much material covering the microphones of the hearing aids. You can email the owner of the shop through etsy with any questions about orders, sizes, etc. Hats cost about $15-$18.
  • Emmifaye shop: etsy.com/shop/emmifaye. Another etsy shop that sells pilot hats for hearing aids with mesh sides. Cost per hat is about $12.
  • Hanna Anderson hannaandersson.com. These hats are also an option ($14 for the Pilot Cap – not the “winter” pilot caps which are lined, but rather the regular pilot caps which are thinner, not lined, and less expensive than the winter hats).
  • Silkawear silkawear.com. Cost is about $28 per hat.

Tip #2 – Crochet type of Headbands

baby headbandIf pilot hats don’t work, but your child tolerates wearing headbands well, then consider trying crochet type of headbands (worn over the ear, somewhat like the mesh pilot hats). Some patients have found that tight fitting, crochet type of headbands are useful to hold the hearing aids on and these can sometimes be found at stores like Target or Walmart. They can also be found online at stores or on etsy.com.

Tip #3 – Toupee Tape

toupee tape.jpgHooray for toupee tape! Some children benefit from using toupee tape on the behind-the-ear part of the hearing aid. I use this on my 4-year-old son’s hearing aids when he has gymnastics class! It helps stop his hearing aids from flopping off his ears. This is basically like 2-sided tape that you can use on skin. You can cut the tape into a small square or rectangle to fit onto the hearing aid. Place the tape on the behind-the-ear hearing aid, and then tape it to the child’s head since it is meant for skin contact. Some people have found this helpful to use along with the hats or headbands. My 4-year-old no longer needs a pilot hat, so this is a nice solution for when he is doing sports activities. You likely need to replace the toupee tape daily or whenever you take the hearing aids off your child and then put them back on him. Toupee tape can be purchased at places like Sally’s Beauty Supply (local stores carry this). www.sallybeauty.com.

Tip #4 – Otoclips

octoclips.jpg

I love otoclips! Otoclips are helpful in preventing the loss of hearing aids when a child pulls them off. An otoclip is attached to the hearing aid and it has a cord and clip that is attached the child’s clothing so that if the child pulls the hearing aid off, it will be hanging from the cord attached to the clothing.

Here are some websites that sell otoclips:

  • Westone: www.westone.com. Search for “otoclip” and if your child wears one hearing aid, he will need “monaural” and if your child has 2 hearing aids, he will need “binaural”.
  • ADCO Hearing: http://www.adcohearing.com/. Website offers a very large variety of tools for hearing aids and hearing loss, including otoclips (under “hearing aid supplies”, “clips and loss protection”).
  • The Bebop Shop (etsy.com): https://www.etsy.com/shop/thebebopshop. Very cute otoclip options, as well as some matching hair clips.

For additional tips and resources, visit Hearinglikeme.com. 

Tip #5 – Positive attitude

Have a positive attitude about your child’s hearing aids! Young children pick up on how their parents feel about things. Remember, hearing aids are a very good thing. Hearing aids will help your child hear speech and other sounds that they otherwise would not detect. This will help your child develop oral speech and language skills. So if oral communication is what you want for your child, then hearing aids will help them move toward reaching this goal. Hearing aids are wonderful things!

For more information on hearing services for children or adults, visit eastersealsdfvr.org/hearing.

Communication Breakdown

By: Courtney Leonard, MS, CCC-SLP/L

Editor’s Note: Please welcome, Speech-Language Pathologist, Courtney, to the blog. She is a big fan of music and has sprinkled references to a number of songs below. See if you can spot them all!

The road to verbal communication is a long and winding road. This road is often met with many roadblocks (i.e., mismatches in communication) or “communication breakdowns” as well as many repairs which can then “lead you to the door” of effective and efficient verbal communication. Each breakdown affords us another opportunity to broaden and engage in a wider variety of communication opportunities.

Communication is happening all around you every minute of the day. From a baby cooing in response to a loved one’s verbalizations, a toddler pointing and grunting to his favorite snack, a teenager expressing frustration with the boys her age, to adults imparting wisdom on the next generation- communication is something we do day in and day out. We communicate for a wide variety of purposes including expressing wants, needs, thoughts and emotions. We communicate to build relationships, repair relationships, and grow relationships. We communicate to advocate for ourselves, to forgive, and to make promises. Communication often, becomes such a natural part of our day that we often forget just how complex communication is.

Communication comes in a variety of forms both verbal and non-verbal. The term “communication” often brings pictures of spoken words and conversation to mind; however, communication is so much more.

baby with block .jpgBefore we reach our destination of verbal communication, we have to learn how to be effective non-verbal communicators. We begin growing our non-verbal skills as infants and young babies by learning to regulate our bodies with loved ones, learning to attend to faces, maintain attention to faces, and responding to faces to which we are attending (e.g., smiling when smiled at, frowning when frowned at, cooing when talked to, etc.). As we continue our road to verbal communication, we learn to initiate engagement with our caregivers using our voices and smiles and learn to continue engagement with our caregivers by continually responding or initiating to maintain attention. As these circles become more frequent, natural, and smooth, purposeful non-verbal communication begins starting with gaze shifting (i.e., moving eyes toward preferred activity/toy), and joint attention (i.e., making eye contact with caregiver, shifting gaze to preferred toy/thing to comment on, and shifting gaze back to caregiver). I like to refer to “joint attention” as the skill we acquire so we can say “Did you see that cute guy!?” to a friend without having to use words. As gaze shifting and joint attention strengthen reaching, pointing, and gesturing begin to emerge. Once these skills are strongly in place, then we begin to see first words.

The crazy thing is all of this development happens within the first year of life! These skills often develop without much thought or ado and as parents, therapists, and caregivers, we are hardwired to receive and foster these very sophisticated communication opportunities just as children are hardwired to develop them.

There are times, however, that these skills don’t appear to have developed in children. This may happen for a variety of reasons including: physical limitations, sensory difficulties, early trauma, neuro difficulties, etc. Whatever the reason for the delay in developing these early communication skills, there are a few things you can do in order to begin working on developing these skills.

  1. Find times when your child is calm and regulated before interacting. This may be while you are swinging them in your arms, during diaper changes, bath times, laying on the floor or on the couch, or any other time your child is calm. Having calm and regulated bodies provides the foundation for meaningful interactions.
  2. baby2Be silly! Use big facial expressions and lots of intonation in your voice to catch your child’s eye. You can sing songs, blow raspberries, play peek-a-boo, or just talk with your child. When you notice they are attending to you, stick with the thing you are doing. Your child may need a break from the interaction at some point (i.e., they may look away or walk away) but you can use the same intonation and facial expressions to try and woo them back into the interaction. This takes a lot of practice and attempts to find what will work. Don’t give up, keep trying new things until you find what works best for you and your child.
  3. Move slower. Many times I find that kids need a slower pace in order to engage and maintain interactions. You can still use fun, giant intonation and facial expressions but use them more slowly and more exaggerated. This will give the child a chance to keep up with you and an opportunity to maintain engagement for longer periods.

Mmttfc comany things can impact a child’s development of his non-verbal and verbal skills. At times, it may be appropriate for a child to receive an occupational therapy or physical therapy evaluation and start a treatment plan to work on their sensory systems and/or strengthening of their bodies in conjunction with working on increasing their language skills.

Take our free screening tool, the Ages & Stages Questionnaire , to help measure and keep track of your child’s growth and development.

By detecting developmental delays early, you have the power to change lives and educational outcomes for children! If delays are identified, Easter Seals DuPage & Fox Valley can offer the support needed to be school-ready and build a foundation for a lifetime of learning. Learn more at eastersealsdfvr.org. 

Easy Indoor Activities for Energetic Kids

By: Laura Donatello, PT, DPT

When heavy rain and snow hit, it leaves kids indoors for the day with a lot of energy to burn. While playing in the snow and rain can be fun, freezing temperatures and wet, icy conditions have us stuck inside. Instead of reaching for the remote or the Ipad, here are some fun activities you can do with your child to satisfy their energetic needs.

Push-Pull Activities

This total body strengthening activity targets shoulder stability as a child pushes an object at or below shoulder height with straight arms, core to change direction, and lower extremities to power forward.

Push/Pull Activity Ideas:

  1. child and laundry
    Image from 3.bp.blogspot.com

    Hide some of your child’s favorite toys in a large open room. Have your child push a laundry basket around the room, and fill up the cart with toys. You can place toys at various heights, encouraging your child to stand on their toes, climb a couch cushion, or squat down to retrieve a toy. Pay attention to the type of flooring in the room. When using a plastic laundry basket, carpet will generally be more challenging to push against, and hardwood/tile will be easier.

  2. Have a race to see how fast he/she can push the basket to the end of the hall to retrieve a toy, and back. Races can be against siblings or parents, or be in the form of a relay race.
  3. Tie a string to the basket to make this a pulling activity.

Obstacle Course

The possibilities are endless with obstacle courses. You can encourage your child to help create, set up, and clean up the course. Maybe incorporate your child’s favorite play scheme; he/she has to navigate the course to place a puzzle piece in the puzzle, feed their favorite doll, or animal. You can add multiple activities together, or just focus on a few. There are many gross motor skills that can be incorporated such as walking, jumping, balancing on one foot, and hopping.

Obstacle Course Ideas

  1. olympics.jpgLay out couch cushions on the floor for your child to step on, jump over, or climb through. Maybe even jump from cushion to cushion.
  2. Navigate a hopscotch course made out of tape on the floor. This can be modified into many different patterns such as a few boxes in a row, column, diagonal, or in a traditional hopscotch pattern. Your child can walk, jump, or hop from square to square.
  3. Crawl or squat under a string tied across two chairs.
  4. Walk on a bubble wrap road, walk across a taped line, or both!
  5. Crumple up old newspapers and grab a laundry basket to play newspaper basketball. For a balance challenge, have your child stand on a cushion or one leg to make a basket.

Exercise Dice

04_Bodhi2.jpg
Photo by Patti Mendoza

Create a six-sided dice out of cardboard and tape. On each side draw or print out a picture of a different activity such as clapping, jumping jacks, running in place, jumping, heel raises, and dancing. You can also create another dice with numbers on each side to determine how many times or seconds to complete an activity for.

Whatever activity you choose, be sure to have fun with it!

Easter Seals DuPage & Fox Valley enables infants, children, and adults with disabilities to achieve their maximum independence, and to provide support for the families who love and care for them. If you have questions on your child’s development and need an evaluation, contact us at 630.282.2022.

 

Is My Child Delayed?

By: Cassidy McCoy PT, DPT

It can often be challenging to determine whether or not your child is delayed. Some children may not exhibit difficulties in all areas, or the signs may be subtle. Common signs of a gross motor delay include but are not limited to: difficulty using both sides symmetrically, inability to sit independently between 6 and 9 months, and inability to independently walk between 12 and 18 months. However, not all signs of delay are as apparent as others.

15_Brady PembrokeOther signs that your child may have a physical delay, particularly with school aged children, is their ability to keep up with their peers. These children may appear clumsy on the playground, or stay away from obstacles that are difficult, such as climbing walls and monkey bars, or parents may receive reports their child is having difficulty with activities in P.E. class. Also, the child may be less motivated, or outright refuse, to be an active participant in extracurricular sports.

What should a parent or caregiver do if they think a child is delayed?

  1. Schedule an evaluation.

eval.png

Pediatric physical therapists utilize standardized assessments to accurately determine if a child is developmentally delayed. These assessments include all aspects of gross motor development including strength, balance, and gross motor skills. The resultant score of the assessments is able to provide the parent with information including the percent of delay and the age equivalent. This allows for the parents, child, and therapist to determine an appropriate, individualized plan of care and direction for treatment. The standardized assessments are also a way to show improvement following an episode of care.

  1. If you have any questions or are unsure if your child is delayed, use available resources to help.

mttfc comMake the First Five Count is Easter Seals FREE online child development screening tool to help measure and keep track of your child’s growth and development.

Take the ASQ-3 to look at key developmental areas: communication, gross motor, fine motor, problem solving and personal social skills. You will be asked to answer questions about things your child can and cannot do.

Take the ASQ SE-2 for a more in depth look at a child’s social and emotional skills. This survey includes questions about your child’s ability to calm down, take direction, follow rules, follow daily routine, demonstrate feelings and interact with others.

Also the CDC offers a developmental checklist that takes you through 2-months-old to 5-years-old. This checklists offers an easy to read guide if parents are concern that their child is delayed. They also offer a Milestone Tracker Mobile App for Apple and Android phones.

By detecting developmental delays early, you have the power to change lives and educational outcomes for children! If delays are identified, Easter Seals DuPage & Fox Valley can offer the support needed to be school-ready and build a foundation for a lifetime of learning. Learn more at eastersealsdfvr.org. 

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?

20150320_ES-LegoRoom-25.jpg

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
  • Vitiello_Cody_7
    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

20_MiraReynaSonia2

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.

Ada
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