Tag Archives: development

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.

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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. 

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What are Fine Motor Skills?

By: Kelly Nesbitt, Occupational Therapist

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

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

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

Babies: Learning to reach, grab, and pinch!

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

    6-8 months:

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

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

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

Kindergarten

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

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

 

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

References

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

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

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

 

 

 

 

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

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

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

 

 

 

 

Sleep Tips for All Ages

By: Laura Van Zandt, OTR/L

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

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

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

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

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

How many hours does a child need to sleep?

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

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

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

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

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

Here are some general tips for all ages.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Additional Resources:

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

Tips for Infants with Torticollis

By: Cassidy McCoy PT, DPT

Torticollis is the third most common congenital anomaly that affects infants. It is defined as a head preference, usually a head tilt with one ear close to the shoulder with head rotation to the opposite direction. This is typically due to a muscular imbalance/tightness through one of the sternocleidomastoids, a muscle that crosses the head and neck, or from positioning in utero.

Torticollis can affect the entire child. It is not just an issue of the head and neck.

Without intervention, an infant with torticollis can lead to multiple sequelae in an infant/child. The head preference can lead to the following, however not limited to:

  • Plagiocephaly – flattening of one side of the head
  • Lack of visual tracking to the involved side
  • Decreased use of the involved sides hand/arm
  • Shortening through the entire involved side including head, trunk and hips
  • Decreased midline skills
  • Decreased sitting balance
  • Imbalance of muscular strength between right and left sides

The biggest treatment intervention that can assist in “correcting” the affects of torticollis is positioning.

The following examples will be for an infant/child with a tilt to the right (right ear to right shoulder).

  1. Rolling: With a right tilt, your child will more easily roll over their left side to access toys
    1. Place toys or shake a rattle on their right side to encourage them to roll over their right side
  2. baby3Sitting: With a right tilt, your child will sit with more of their weight over the left side of their body.
    1. Place toys over to the left side to encourage the shift their weight over the right hip
  3. Face-Face Play and Crib positioning: Typically with a right tilt, the infant/child will prefer to look to the left.
    1. Position your body to the right side your child’s face to encourage them to look to the right
    2. Position them in their crib so they need to turn their head of the right in order to see the door/your face
  4. Carrying positions:
    1. Tilted carry: Hold your child facing away from you body, with their back against your chest, tilt them to the right. This will encourage your child to lift their head to the left, increasing strength of the left side and actively stretching the tight right side.
  1. Tummy Time:
    1. This is an important part of any child’s development, however, for children affected by torticollis, tummy time important for constantly stretching the muscle by lifting and turning their head.
    2. Toy placement in prone with a tilt to the right is the same as in sitting. Place the toys to the left to encourage weight shift over the right side of the body to reach and play with the toys using the left arm.

See my previous blog for more tips and trick on tummy time. If you have concerns about your infant’s development, contact our Intake Coordinator at 630.282.2022 to ask questions or schedule an appointment.

Through my Parenting Eyes

By: Theresa Forthofer, CEO & President of Easter Seals DuPage & Fox Valley

While I am the President and CEO of Easter Seals DuPage & Fox Valley, I also happen to be the mother of three children.  Two of my children have Myotonic Muscular Dystrophy and Autism. My oldest, Ryan, was diagnosed when he was 7 years old.  He is now 24 years old. My youngest was diagnosed with the Congenital form of Muscular Dystrophy within days of his birth and he is now 18.

forthofer family

Having two boys with Muscular Dystrophy, meant lots of doctor visits and hours of therapy every week.  Throughout the years we had several different therapists and we liked them all.  They were all very nice and the boys were making progress.  Therefore, we assumed everything was great and the boys were doing the best they could.  Looking back, I sincerely wish I knew then, what I know now.  While they were progressing, they were not reaching their full potential.

I may be biased, but what I have learned since becoming President and CEO isn’t as significant as what I have learned about raising two boys with disabilities.  I share my story to help at least one other family find their child’s true potential.

For nearly 7 years, my son had (unsuccessfully) worked on putting his shoes and socks on independently.  His Early Intervention therapist worked on it, his private therapists from a nearby clinic worked on it, and his school therapists worked on it.  Over and over again we were told, he doesn’t have the strength.

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Photo by Alexi Procopos

However, when I came to Easter Seals, I asked about Occupational Therapy for Justin.  I wanted him to put his shoes and socks on independently.  In just two sessions, his therapist asked me what our next goal was because he was putting his shoes and socks on independently.  I didn’t believe her and made her show me.  He did it and is still doing it!  His therapist explained it was a motor planning issue not a strength issue for Justin.  For years, I dreaded leaving the house because putting his shoes and socks on became something to battle over. Now those days are long behind us.  No more excuses for being late!

Occupational therapy worked so well, I signed Justin up for the feeding clinic.  At 12 years old, he weighed 40 pounds and we had tried everything.  We saw an endocrinologist, feeding therapists, nutritionists, etc.  The best solution was growth hormones, but Myotonic Dystrophy has cardiac complications, so this was not advised.

After attending the feeding clinic and starting a few relatively small changes, he gained 10 pounds in three months – 25% of his body weight!  He will likely always be small for his age, but we wish it hadn’t taken us so long to figure out these needs and find the experts at Easter Seals.  They imagined a future beyond what we had been told to expect by other professionals and without any limitations.

leadership meetingI hear these same stories like mine, nearly every week.  Children who have been seen for years and aren’t reaching their fullest potential.  When they find their way to Easter Seals DuPage & Fox Valley they often can’t believe what they have missed out on.  The progress their children are making so quickly surprises their families, their doctors and sometimes even us.

If you are looking for a therapy center or therapist for your child, here are the top 10 questions to ask:

  1. Is the center CARF Accredited and have a Medical Advisory Board?
  2. Is the center directly affiliated with any major research hospital systems?
  3. Who are your primary referral sources?
  4. What are the published results of your satisfaction survey and where can I find them?
  5. Is the therapist NDT (Neuro-Developmental Treatment) trained?
  6. What diagnoses has the therapist personally treated?
  7. What is the average level of experience of the therapists at the center?
  8. How many children do you treat annually?
  9. What training do you receive on a regular basis?
  10. How do you support parents and siblings?

As parents, we all want the absolute best for our kids. I found it here at Easter Seals and you can too!

Easter Seals DuPage & Fox Valley is a CARF accredited facility with a medical advisory board and affiliations with University of Chicago, University of Illinois at Chicago, Northwestern University and RIC (Shirley Ryan Ability Lab). With 87 therapists and professional staff with an average tenure of 19 years, the majority of therapists are NDT trained and are required to receive on-going training. The therapists are specialized in many specific areas including feeding, motor, sensory needs and more.

Easter Seals serves more than 1,000 families a week with locations in Naperville, Villa Park and Elgin.  Through an annual client survey, 99% of families report satisfaction with the services they receive and 98% of families report progress. The parent liaisons and social workers on staff provide support and family activities for all members of the family. Learn more at eastersealsdfvr.org. 

What is a “Sensory Diet”?

By: Laura Van Zandt, OTR/L

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

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

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

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

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

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

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

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

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

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

With help from an occupational therapist, your child can develop the ability to process sensory information in an adaptive manner and learn strategies to help him or her cope with everyday experiences. Learn more about our program. 

Resources:

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

How to Help A Clumsy Child

By: Cassidy McCoy PT, DPT

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

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

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

Meeting Challenges
Photo by Ann Mehrman

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

How does a child with DCD present?

Typical Presentation:

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

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

How to help

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

Example: GPDC

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

Other Activities

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

Some activities to improve core strengthening:

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

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

References:

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

Got Calcium?

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

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

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

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

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

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

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

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

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

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

 

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

What is Sensory Processing Disorder?

By: Laura Van Zandt, OTR/L

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

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

Overview of these sensory systems

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

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

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

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

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

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

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

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

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

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

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

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