Indoor Activities to Release Energy and Build Imagination

By: Occupational Therapist, Laura Van Zandt, MS, OTR/L,

Container Play Activity

By using simple materials and exploring your child’s natural interests, you can ‘sneak’ in some various fine motor or speech and language development for toddlers. Remember, get down on the floor and see where they take you in play – play is the work of the child, but it shouldn’t be hard. 

Work together to put some of your child’s favorite small toys in different containers. Containers can be found all over your house or after meals. Use a (cleaned) yogurt cup, oatmeal container, cereal or pasta box, delivery package, etc. 

Watch this video for the overview, or scroll down below for more information.

For my three-year-old, I had him pick out the toys, but you can do this ahead of time to keep it more of a surprise. You can easily incorporate different developmental skills into this simple task but remember to keep it fun and easy for you both. If it is too hard (or easy), here are some other ways to update:

• Decrease or add language skills by sorting toys into different sizes or colors of containers
• Use simple words that match the action and the emotional experience paired with affect in your voice to keep your child present and engaged (e.g., hard – stuck – pull –wow – etc.)
• Explore pretend play (the options are limitless) – go to a store, have a party, have a snack, greet guests in different ‘houses,’ put bad guys into time out or jail, and more!
• Work on fine motor skills by opening different containers or using different household materials to practice wrapping them) adjust the type of container based on your child’s abilities and base how you decorate on your child’s age.
  • If your child is between 15-20 months, you may only want to have them work on removing the tape and having the lids pre-opened, so they only have to focus on pinching and pulling. You can add simple things like markers or stickers to decorate if you desire.
  • If your child is closer to 24 months, you can sneak in scissors (supervised) to snip the tape before you wrap up the container. You can also include markers and stickers but add large shapes to scribble so you can color.
  • If your child is closer to 36 months, you can do all the same things above, but you can add more of a challenge by drawing lines or circles together to decorate.

Simple Sensory Play Ideas: Dump Truck Game

Ask any specialist working with kids, and they will tell you play is the work of the child. It’s through play that a child’s life becomes alive and enriched with endless life lessons. It is through play that boundless learning opportunities unfold.

The good thing about play is it doesn’t have to be complicated or even expensive. Play should be about you connecting with your child and following their lead. A toddler’s mind is like an unread book full of adventures just waiting to be experienced if we just let it unfold. The most essential component of play is being one with your child. If you allow them to express their interest, unlimited possibilities will present themselves.

In this video, I use my son’s interests in construction vehicles to provide him with some sensory input. When the seasons start to change, and winter is upon us, most parents find themselves all going a little stir crazy being stuck inside. Kids need movement just as adults need movement. However, kids especially need an outlet for all the fun imagination developing inside their little bodies.

Materials needed for this activity:

1. You
2. Your child
3. Lots of pillows or you can use your bed for a soft landing cushion

Let your child lead you, however, here are some ideas to expand this play.

1. Count to a specific number or use a particular word that your toddler needs to listen to before he can be dumped
2. Have your child take an object with them to hide under the pillows / within the bedsheets to bring to the junkyard if pretending to be a dump truck
3. Hide people/animals under the pillows / within the bedsheets to be a rescue hero flying and going to save the people/animals -> can expand the steps of play to bringing the people/animals to their homes once safely found
4. Depending on where your child is at with his or her unique development, use less language and highlight only the key words paired with the actions (up, go)
5. Wait for your child to do something to tell you he or she wants to play (e.g., comes back to you, lifts arms up, leans closer to the pillow to fall, etc.)
6. The benefits of sensory play are endless and certainly can be enjoyed by all ages!

Make it Fun!

Remember, this is your time with your child. This activity can be as long or as short as you need it to be based on your available time. There are many ways to expand to work on speech sounds, language skills, movement, and fine motor. Sit back and
enjoy the process while the play unfolds. Have fun!

Ending Notes

For more play activities for all ages, search our blog at eastersealsdfvr.wordpress.com. If you are curious about how your child is doing or have concerns about his/or her development, we have a free screening available at askeasterseals.org. This tool looks at
key developmental areas: communication, gross motor, fine motor, problem-solving, and personal-social skills. Based on your responses, the results will help you see if your child’s progress is on track and alert you to any potential concerns.

If delays are identified, Easterseals DuPage & Fox Valley can offer the support needed to be school-ready and build a foundation for a lifetime of learning. Research proves that when children receive the right treatment and therapy they need before age five, they are more prepared to learn alongside their peers, build lifelong skills and achieve their dreams.

Heavy Work and Movement Activities for Sensory Regulation

By: Anna Bieschke Midwestern University Occupational Therapy Doctoral student and Linda Merry, OTR/L

Being stuck inside for this long of a time is certainly not fun, especially for little ones who are used to spending their day going to school, seeing their friends, playing at the park, or venturing out into the community with their families. When your child is cooped up indoors, they may not get as many opportunities to climb, jump, lift, pull, or move as much as they typically would. For many children, especially those with sensory processing difficulties, this heavy work and movement helps them to remain calm and alert throughout the day.

Your child’s ability to remain calm and focused during their daily activities is known as sensory regulation. This occurs when your child can respond appropriately to the information they take in from the environment through their senses (tasting, smelling, hearing, seeing, etc.). When a child is presented with too much or too little sensory input (like in the case of being stuck indoors with little exercise and movement), they may have a difficult time managing their emotions and behaviors.  This is called sensory dysregulation.

Some Signs Your Child is Dysregulated

• Becomes distressed when required to sit still
• Is easily distracted by objects or people in the environment
• Reacts defensively to certain textures, smells, sounds, or foods in their mouth
• Repeatedly and vigorously shakes their head, rocks back and forth, or jumps up and down
• Becomes frightened when they are in close contact with other children
• Runs away or becomes aggressive towards sensory input that makes them uncomfortable
• Hides or retreats to a quiet spot
• Appears extremely wild and/or engages in dangerous behavior

Why is Sensory Regulation so Important?

Helping your child stay regulated is important because it lays the foundation for the child to grow and develop new skills. As seen in the house diagram below, all the senses make up the base of the house. Without a stable base, your child’s coordination, language, attention, engagement in daily activities, and academic learning, among other skills, can be impacted. Just think how difficult it would be to sit and pay attention to an at-home school lesson if your distracted by the need to move around or are visually distracted by objects in the room.

Image Retrieved from: https://www.pinterest.com.mx/pin/75294624990224433/

Sensory Breaks with Heavy Work and Movement

One way to support your child’s sensory regulation while limited to being inside is to provide your child with sensory breaks, particularly with heavy work and movement. Heavy work is a form of proprioceptive input. Your proprioceptive sense lets you know where your body is in space and involves any activity that requires pushing, pulling, lifting, or squeezing. Proprioceptive and heavy work activities help ground the child and slow their bodies down to make them feel organized and calm. Movement activities can also be incorporated to help break up seated activities to support your child’s alertness and attention. Here are some fun ideas for heavy work and movement activities:

1. Indoor Obstacle Course
   • This activity is great because it allows you and your child to get creative. Use everyday items throughout your house to build an obstacle course that allows your child to jump on, climb over, crawl through and crash down. Pots and pans can serve as cones, pillows can be crash pads, and chairs can serve as tunnels or hurdles. Get your child more involved by having them help you choose objects and set it up. Remember, any lifting or pushing of objects can add an extra heavy work component to this activity.
     • Example of indoor obstacle course can be found here (https://www.youtube.com/watch?v=lCYBkNht_j8)

2. Build a Fort
   • Take whatever theme your child loves and run with it! Whether it’s a princess castle or a lion’s cage, have the child use their imagination to make a playful space. Help your child push furniture together, grab heavy blankets or pillows, and lift boxes or baskets to really provide them with that organizing and calming input. When the fort is made, it can also serve as a quiet and secluded place for your child to take a break if needed.
     • Example of a blanket fort can be found here (https://www.youtube.com/watch?v=ajcDcaNsFRY)

3. Catch Bubbles

• It’s pretty safe to say that many kids love bubbles. For this activity, blow bubbles towards the child and have them pop them by clapping both their hands together. Encourage the child to press their hands firmly together when clapping to increase the proprioceptive input to their joints. Blow the bubbles high to encourage your child to jump or low to encourage your child to squat down. Try to provide as many opportunities for different movements as possible.

4. Play a Movement Video
   • YouTube has many great movement videos for yoga, dancing, and animal walks that can engage your child in movement form the confines of your home. Clear some place in the living room and use your electronic devices to stream the videos. With this activity, it’s more about getting your child moving instead of making sure they are doing the movements perfectly.
     • Cosmic Kids Yoga (https://www.youtube.com/user/CosmicKidsYoga): This is a YouTube channel that provides yoga and mindfulness activities specifically designed for kids. This one is especially fun because many of the yoga themes follow along to your child’s favorite movies.
     • GoNoodle (https://www.youtube.com/user/GoNoodleGames): This is a YouTube channel that offers many “Get Moving” videos with silly dances for your child to follow along with.

5. Putty Play
   • Whether it’s play-doh, resistive putty, or thick cookie dough, have your child smash, pound, pull, and press the putty into various shapes. Use cookie cutters or other tools that encourage your child to press firmly down to make different shapes and cuts. To add an extra movement component, have them form the putty into balls and roll the putty to others at the table or toss it into a wide container. You can also hide small objects (beads, marbles, coins, etc.) into the putty for the child to pull out. All this pulling, pressing, and pounding will provide some heavy work to the arms and hands.
     • Here’s a video of how to make homemade play-doh! Have the children help you stir to add extra heavy work. (https://www.youtube.com/watch?v=oAIAm6BF0fs)

6. Push-O-War
   • This game follows the same concept of tug-o-war except now the children will be pushing objects instead of pulling. To play, place a piece of masking tape or painter’s tape in the middle between your child and another child to create the center line on the floor. Put an object in between the two children (could be a garbage can on its side, a large pillow, big ball, etc.) and have them both push the object at the same time to see who can push it over the center line first.

7. Wagon Rides
   • Have the child pull their smaller sibling or favorite toys in a makeshift wagon. Place a laundry basket or larger bin on a blanket and have the child fill the basket with their favorite toys (large stuffed animals, dolls, action fingers, etc.). The child can pull onto one side the blanket to slide the basket across the floor. A smaller sibling or friend can also sit in the basket to add some extra fun for all the kiddos in the house.

8. Involve the Child in Household Chores
   • What’s better than getting some household chores done while also providing your child with heavy work? Even though you’re cooped up inside, there is still work to be done. Have your child help carry and fill laundry baskets, bring the garbage down to the street, vacuum, sweep, or carry in bags from the grocery store. Cooking activities like stirring batter, tearing lettuce, and kneading dough can also be great options for heavy work and movement.

9. Other Movement Games
   • Other games including Simon Says, Ring Around the Rosie, Red Light Green Light, and Freeze Dance are also some games that can be played to promote movement when stuck at home. On nice days, take the child out onto the driveway or backyard to give them more space to run around and move.
     • Here’s a cute video for moving and freezing! (https://www.youtube.com/watch?v=388Q44ReOWE)

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

References:

Bazyk, S. (2020). Sensory and self-regulation strategies. Every Moment Counts. https://everymomentcounts.org/view.php?nav_id=204

Pfeiffer, B., Frolek Clark, G., & Arbesman, M. (2018). Effectiveness of cognitive and occupation-based interventions for children with challenges in sensory processing and integration: A systematic review. American Journal of Occupational Therapy, 72, 7201190020. https://doi.org/10.5014/ajot.2018.028233

How to Plan a Sensory Friendly and Accessible Vacation

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

Summer vacation is in full swing, along with all the stress and planning that parents feel as they try to make a great relaxing vacation for their whole family. For parents of children with disabilities, these feelings can be very overwhelming as they have to take into account how to travel efficiently and safely while accommodating their child’s needs.

To make your trips a little easier, I’ve compiled a list of resources about air travel, cruises, and US-based destinations that are perfect for a family with a child with disabilities.

Air Travel

TSA Cares is a national program through the Department of Homeland Security that offers one-on-one assistance navigating the airport and security for people with disabilities. Services include escort by a Passenger Support Specialist who can meet you at a specific point in a chosen airport, help with baggage through security, assist in security checks, and just be another support system navigating a chaotic environment such as an airport.

Click here to learn more about TSA Cares. You can also contact them with further questions at (855) 787-2227 or TSA-ContactCenter@tsa.dhs.gov

Open Taxis is a new wheelchair accessible taxi service in Chicago. It is open 24/7, so it is perfect for quick taxi rides to the airport without parking your own accessible vehicle at the airport for the entirety of your trip. You can call to prearrange a trip or call the day of the trip. You can schedule a ride by calling 855-928-1010.

Travelers Aid Chicago is a service in Chicago O’Hare that provides support and protection for “vulnerable at-risk travelers who need guidance, support, or advocacy” as well as crisis intervention for passengers with cognitive or developmental disabilities. Information desks are located in terminals throughout O’Hare.

Travelers Aid Chicago provides the option to schedule an Airport Practice Experience. You can take a “practice run” through O’Hare airport including going through security and the terminals to help children know what to expect on the actual travel day. They even have visuals to provide to families so that the child can have their own visual schedule of their trip to O’Hare.

I would especially recommend this for a child who may have Autism and/or an Anxiety disorder and has not experienced anything like flying before.

To inquire about Travelers Aid Chicago’s services or to set-up a practice day, contact them at (773) 894-2427 or travelersaid@heartlandalliance.org

Cruises

Autism on the Sea is an international organization that creates cruise experiences for children and adults with Autism, Down Syndrome, Tourrette Syndrome, Cerebral Palsy and more. These experiences are currently available on well-known cruise lines such as Royal Caribbean, Norwegian Cruises, Carnival Cruises, and Disney Cruises.

With this service, cruise members who are experienced and background checked can accompany you on the cruise and adapt activities in order to fit the special needs of your family. This organization will also collaborate with you in order to contact cruise lines to adapt your vacation to fit the dietary, physical, mental, and emotional needs of your child.

They even provide images of common used “cruise ship words” to be used as part of a child’s Picture Exchange Communication System (PECS) so that you can create a social story to prep your child for their trip.

Click here for additional information on Autism on the Sea and their services.

Disney Cruises offers many special services for passengers with special needs, such as accessible suites, access to medical equipment, sharps containers, and a variety of other accommodations. Disney Cruises also offer American Sign Language (ASL) interpreters for on-board entertainment and shows. Please contact Disney Cruises 60 days before your cruise to arrange accommodations.

For more information or to request accommodations call (407) 566-3602 or email SpecialServices@disneycruise.com

“Stay-cations” in Chicago

As Easterseals DuPage & Fox Valley is based in the western suburbs of Chicago, here are some tips for exploring the Windy City!

The Chicago Children’s Museum Play for All program offers free admission for the first 250 visitors with disabilities the second Saturday every month from 9 a.m. to 10 a.m. to experience exhibits via a private tour. You must pre-register in order to get this special offer. The museum also has sound reducing headphones, pictures for a visual schedule, and lap trays for wheelchairs so that children with disabilities can experience the museum.

For more information on the Play for All program, call (312) 464-8249 or email partnerships@chicagochildrensmuseum.org.

Calm Waters at the Shedd Aquarium offers extended hours on selected days especially for children with disabilities. They have specially designed shows with novel sensory experiences, a “quiet room” for sensory breaks, and an app in which there is information about noise levels in different parts of the Aquarium to help you plan your trip.

Click here or call 312-939-2438 for additional information on Calm Waters at the Shedd Aquarium!

Sensory Saturday at the Field Museum: The Field Museum opens early on select Saturdays in which children with disabilities or sensory processing issues can enjoy the field museum without loud crowds as well as access to hands on experiences to learn through tactile play and exploration.

Click here or email to learn more about Sensory Saturdays at the Field Museum!

Want more inclusive event ideas for children with disabilities in the Chicagoland area? Click here!

Walt Disney World

It really is the happiest place on earth. Disney World offers numerous services and accommodations for children with special needs at each of Disney’s parks.

Services include:

• Access to Break Areas for children who need a break from the sensory overload of Disney. You can ask any cast member to help you locate a break area.
• Sensory Guides for each park’s rides and shows that have strobe lights, scents pumped in, loud noises, have a lot of unpredictability, bumps, go fast, etc. It even lists what type of restraint is used in each ride for safety as well as how long each ride is.
  This guide can help families of children with special needs decide which attractions would be most enjoyable for their child. If you are planning to go to Disney, it may be helpful to show this list to your Occupational Therapist, as they can help you figure out which rides will best suit your child’s unique sensory system.
• Resources for Children with Autism Spectrum disorders in booklet form. This booklet lists FAQ’s about Disney for children with Autism, what Disney recommends bringing to the parks (ID bracelet, a sensory toy, earplugs/headphones, etc.)
• Rental wheelchairs
• Empathetic, warm staff : Many blog posts from parents of children with disabilities rave about how warm and engaging Disney staff and characters are with their children with special needs- meeting them where they are and not overwhelming them. Click here to read our past blog, The Magic of Disney and Your Special Needs Child
• Sign Language interpreters
• Handheld captioning/video captioning
• Braille guidebook

Morgan’s Wonderland

Morgan’s Wonderland in San Antonio, Texas is an amusement and waterpark that has 25 “ultra-accessible” attractions. Opened in 2010 by parents of a daughter with physical and cognitive disabilities, Morgan’s Wonderland is the world’s first theme park designed specifically for children with special needs. This unique theme park has a variety of amazing attractions such as the Sensory Village (which is a replica small town for children to engage in imaginative play), wheelchair swings, a large sand box, a musical playground, and more!

Morgan’s Inspiration Island is a waterpark addition to Morgan’s wonderland that provides an opportunity for guests with limited mobility to experience the fun of a waterpark. They have access to waterproof chairs and compressed air operated power wheelchairs so that all children can play in the water without having to worry about ruin their personal power wheelchairs.

There are also hotels that are partnered with the amusement and water park that offer discounts and accommodations to make the entirety of your trip accessible. Morgan’s Inspiration Island was listed as one of TIME Magazines 2018 “World’s Greatest Places.” Best of all? Admission for guests with disabilities is free.

National Parks

The National Park Service has a list of the most wheelchair accessible hiking trails so that guests with limited mobility don’t have to miss out on the beauty of our national parks. There are wheelchair accessible hiking paths at the Grand Canyon, Sequoia, and Zion National Parks.

Whether you decide to go on a cruise, roadtrip, or fly somewhere this summer, bring up your vacation plans with your child’s therapists for further accessibility tips and sensory strategies that can make your trip more enjoyable for everyone involved. Happy travels!

For more information about Easterseals DuPage & Fox Valley and our services, visit: https://www.easterseals.com/dfv/our-programs/

From one mom to another: Early Intervention tips

By: Laura Van Zandt, MS, OTR/L

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

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

   

   Try calming breaths while giving your infant a massage.

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

5. 

   Photo by Pixabay on Pexels.com

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

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

 

 

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.

Older 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.

Routines 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.

Try 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 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.

Some 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.

For 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.

• From our blog: What is Sensory Regulation? 
• From our blog: How sensitive is too sensitive?
• Star Institute for Sensory Processing: Systems Checklist

 

Benefits of Outdoor Play

By: Laura Van Zandt, OTR/L

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

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

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

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

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

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

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

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

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

Activities by Age for the Great Outdoors

Infants:

Photo by Petra Ford

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

Toddlers:

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

Preschool:

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

 

School Age:

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

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

A New Perspective about the Playground

By: Bridget Hobbs, PT

Summer is finally here and your little ones are asking to go to the park.  So, pack a few snacks, slather on the sunscreen and take advantage of this free way to build confidence, make friends and gain gross motor skills at the same time.

Children learn best through play-based experiences and exploring the playground is great way for children to refine their gross and fine motor skills.  Here are a couple ideas for parents and caregivers to engage their children at the park in order to build not only bonding and fun, but to also build muscle strength, endurance and gross motor skills.

Here are some new or different ideas to incorporate to your little one’s playground fun:

Climbing up the slide

As a child, you were likely told to just go down the slide.  Of course if there are children waiting to go down the slide, climbing up it is not a good idea.  However, if the park isn’t crowded, help your child bear walk (on hands and feet with bottom in the air) up the slide.  Doing this builds great core strength as well as cross-body coordination skills.

Using the dividers as balance beams

There are often railroad-tie type of dividers that divide the grass from the wood chips/foam surface under the playground equipment.  Challenge your child to go across these as they would a balance beam.  They can experiment with going forward, backward, side-stepping and even doing toe taps to the ground each step.  This activity helps with control of leg and core muscles as well as coordination skills that your child will use in gym class and on sports teams in the future.

Use hills to your advantage

If you participated in track or cross-country in high school, you know that training on hills was a vital component to the big picture of a race.  Make hills fun for your little one by rolling down them like a log to help with development of the vestibular system.  You can also really challenge them by bear walking or crab walking up or down the hill.

Don’t avoid the climbing wall

Children as young as toddlers can enjoy the climbing wall with help of their parents.  Even if you have to support their body, children learn motor planning and sequencing by deciding where to best place their hands and feet to navigate the wall.   A bonus is that the small muscles in the hand are strengthened by grasping the holds, which can lead to improved ability to write and play ball sports in the future.

There is a lot of research that clearly links play with brain development, motor and social skills.  Playgrounds provide different textures, sensory experiences and motor planning opportunities for children to help build their development.  So, think outside the box the next time you are at the park with your child and try to incorporate these different ways to assist with their development.

For more information on physical therapy and play based therapy services at Easter Seals DuPage & Fox Valley visit our website.

*Above images by Molly Gardner Media

 

How Sensitive is Too Sensitive?

By Maureen Karwowski, OT

I am sure that I am not the only person to buy a wool sweater that I thought looked great.  I bought this sweater despite the fact that it might be a bit itchy.  The first cold morning of the year I decide it is time to wear this sweater, and it feels okay, but not great.  As the day progresses, I am more and more aware of the feeling of my new sweater.  After a long day of working, and a brutal commute home, my skin is crawling.  This sweater is intolerable.  For many of the children that I work with as an occupational therapist who have sensory processing difficulties, this experience may be familiar to them.   

Sensory processing challenges occur when a child has difficulty interpreting  and responding to the sensory experiences in daily life.   It is estimated that 1 of 20 children are impacted by a sensory processing deficit (Ahn, Miller, Milberger, McIntosh, 2004).   When I assess a child who has a suspected sensory processing difficulty, I look at 3 areas:

• sensory regulation
• sensory modulation
• sensory discrimination

In my last blog, I discussed sensory regulation.  It is generally understood that sensory regulation is the ability to keep ourselves at the optimal activity and alertness level for the situation.  For instance, being able to sit through a meal or story time at the library all requires a child to be regulated.   We all have tricks to keep us “regulated”.  Drinking coffee, chewing gum, or working out are just a few examples of how adults naturally regulate themselves.

Sensory modulation impacts a child’s ability to function at home, in the community and at school.  Sensory modulation refers to how sensitive a person is to different touches, sounds, sights, smells or movement. 

As I described my sweater experience, this may be similar to how some children respond to a variety of clothing.  The seams of jeans, or the texture of socks may be very hard for some children to tolerate.  We encounter textures every day, all day and for most of us, we are hardly aware of them.  For others textures such as soap suds, food textures, glue, hand sanitizer, t-shirts with writing on them, and band aids are just a few textures that can be troublesome.

Many children with sensory processing disorders can have extreme challenges in busy environments such as a family party, the school cafeteria, or even McDonald Land.  The sensory input in these situations is immense.  Noise levels are higher and unpredictable.  Large spaces, or crowded spaces can be very hard for children who are sensitive to visual experiences.  Novel foods have new smells, tastes and textures.  All of these experiences can cause an over-reaction.  Some children react by getting so revved up that they can lose control.  Other children cling to their parents or cover their ears.  Some children avoid these situations entirely.    For most children, climbing ladders, and spinning on a merry-go round at the park are delightful.  Others prefer to keep their feet on the ground as movement can be very scary and uncomfortable for them.

On the other side of the coin are the children who are under-reactive to sensory input.  These children often seek intense input in order to register it, and to feel calm.  For instance, a child may be bouncing up and down in their seat at the dinner table without even realizing that they are moving at all.  Another child may seek intense “rough and tumble” play at inappropriate times, climb or jump on furniture despite being asked to stop repeatedly.  These children may have difficulty judging how hard to touch someone or something which can impact them socially.

We can all identify some sensory “quirks” that we have.  I know that the sound of Styrofoam makes me cringe.  My co-worker cannot stand the smell of my peppermint tea (crazy right?).  We all have things that are “triggers” for us, certain noises, textures or smells.  When a child has enough of these “triggers” that it is interfering with their ability to learn at school, socialize with other children, and function at home, an evaluation by an Occupational Therapist may be appropriate.

The good news is that a skilled OT can work with you and your child to help them with these sensory issues.  The key is a comprehensive evaluation, using parent interview, observations of your child, and a standardized assessment.  Once that is complete, treatment sessions are typically enjoyable for your child while they are working towards their goals.  You can work with your child’s OT to problem solve the sensory situations that are challenging at home, and when in the community.

For more information about Easter Seals DuPage & Fox Valley and Occupational Therapy please visit EasterSealsDFVR.org.

Sensory Regulation, What Is It?

By Maureen Karwowski, OT

As I sit at my desk typing this blog on my laptop, I am regulated enough to focus on this task.  I am able to filter out the sounds of the lights buzzing, my coworkers typing, the feeling of my clothing, and the light coming in from the window beside me.  I will admit that some times I am able to do this, and not others.  For a child with sensory processing challenges, the interpretation and responses to the  sensory experiences I described can be ineffective.  These ineffective responses can impact a child’s overall regulation and can affect many areas of development.  It is estimated that 1 of 20 children are impacted by a sensory processing deficit (Ahn, Miller, Milberger, McIntosh, 2004).

I have worked with many children with sensory processing challenges as a pediatric occupational therapist.  I know from my work that every person presents with their own unique sensory profile.  Since every child is so unique, I am required to closely assess each client to be sure that I understand where their challenges are and what I can do to assist them.  A skilled occupational therapist will use a variety of assessments, some are standardized evaluations, and others are from observations of the child.  A thorough assessment will address three areas of sensory processing: sensory regulation, sensory modulation, and sensory discrimination.  Today’s topic is sensory regulation.

Sensory regulation refers to a person’s ability to keep their arousal at the right level for the situation.  Adequate self-regulation is essential to the development of attention, regulation of sleep/wake cycles, control of emotions, as well as the daily transitions that make up a child’s routine.  Sensory regulation is necessary for social interactions and learning.

One of my clients, who has significant challenges with this skill described a story about how at school, he loves to run around on the playground at recess.  He told me that the problem is that all of the other kids can slow down after recess, line up and then go back into school.

“I get so revved up that I can’t control myself anymore.”

His teachers stated that he ran into the building, bumping into other kids at times, and did not respond to verbal directions.  This is a great example of how regulation issues can impact transitions and school.  This story ends well for this little boy.  His mother and I worked together and identified what were the factors that were impacting his regulation challenges.  For this boy, he was sensitive to movement and visual input.  He was correct in his statement that running around on the playground “revved” him up.  In occupational therapy sessions, and at home with his parents, we worked to address his challenges with movement and with visual input.  This in turn assisted him with his transition from running around to lining up to go back inside the school much easier.  We also worked on using some “tools” to help him with this transition, such as being given an earlier warning than the other kids from the teacher, he blew the whistle which gave him a chance to take a deep breath, and was in charge of carrying the bin of recess equipment into school which gave him some heavy work.

We all have strategies that assist us in keeping our arousal level where they need to be.  People chew gum, drink coffee, fiddle with objects, all in an effort to keep alert.  We also have strategies to calm ourselves down such as deep breaths, working out, knitting, herbal tea.  It is very important for children with sensory regulation challenges that we identify what are the regulating strategies that they can use to assist them.  Something as simple as chair pushups, sucking on a piece of candy, squeezing a stress ball, or rocking in a rocking chair can be useful.  It is important to customize these strategies to your child, as everyone responds differently.

I find that my occupational therapy sessions are the most effective when the parents and I are working together to identify the child’s sensory processing challenges and how those challenges are impacting daily life.

Stay tuned, as my next blog post will discuss sensory modulation.  Sensory modulation is the amount of sensitivity a person experiences towards a sensory experience.

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.