Changing Colors: The Blog of Spectrum Pediatrics

January 3, 2018

Trick of the Trade from Tracy Magee, MS, CCC-SLP

Potty Training

Every parent gets a little nervous, but also excited, when it is time to potty train their toddler. No more diapers! Woo hoo! It’s definitely a daunting task that can be accomplished many different ways based on the child’s personality and the dynamics of the family. When potty training my own child and with the help of this book, I learned some great tips when potty training. Here are just a few:

1. Public Restrooms: They can be terrifying for a little one (and let’s face it, the parents, too ☺). Keep a stack of post-it notes in your purse/bag to put over the toilet self-flushing sensor. The last thing you want is the loud noise and the swishing of the water as your child is doing his/her “business.”

2. On the Go: When the child let’s you know he/she has to go, that usually means NOW. Keep a travel potty in the car for those emergencies. You can also try a red solo cup or mason jar. It’s gross, but good in a pinch!

3. Bowel Movements: Most kids have an easier time learning how to urinate in the potty than using it for bowel movements. Make sure that your child’s knees are above their pelvis when they are sitting. This will physically make the act much easier for the child, and that makes learning that part of toilet training a little less intimidating for everyone.

Hope these tips help a few moms and dads with this big step! I know they helped me!

January 3, 2018

Indoor Play Spaces: A Therapist’s Perspective

By: Tracy Magee,M.Ed., CCC-SLP

I recently went to a new play space, Scramble in Alexandria with my 3 year old and 18 month old, and I just had to share about it with our Spectrum families! Not only did my kids have a ball, but also I couldn’t help but also think of all the therapeutic activities and developmental skills that a parent could encourage in a space like this!

1. Physical activity: In the winter months, it is extra difficult to make sure that kids are getting enough movement during their days due to the frigid temperatures. Obviously, in a soft playroom space, kids can move about with ease, and a parent doesn’t have to worry about every fall and tumble. With all the new sites in a soft playroom, kids are motivated to jump, climb, crawl, and more! This works on their body coordination and hand/eye coordination. Beyond that, kids need to MOVE! Movement helps all humans attain self-regulation. Self-regulation is “the ability to maintain a level of alertness appropriate to a given activity.” A space like this allows kids to achieve adequate self-regulation through movement, which in turn, is essential for development of attention, regulation of sleep/wake cycles, and control of emotions (particularly during transitions from one activity to another). This particular play space offers movements areas for various ages – a baby area to practice tummy time, toddler area with smaller obstacles and slides, and a “big kid” two-level playhouse with mazes, obstacles, and slides.

  • Parents can encourage developmental benefits for physical activity and regulation by having their child to lift heavy things, push heavy items, and use their body in different ways (climbing, crawling, etc.). All these movements work on coordination and help the child feel regulated.

2. Pretend Play: This particular play space has four separate areas for kids to pretend, including a car garage with a giant racecar, coffee shop/café, vet office, and construction zone. The large soft playroom pieces are the perfect size for kids to lift and engage their imaginations in the theme of the room. Pretend play is important because it aids kids in understanding that a symbol stands for something else. Learning this concept can help a child’s language development, as words are a symbol to represent something else, as well. Parents can encourage pretend play by modeling how to use some of the toys for their child to imitate and naming the items or actions as the parent or child uses them.

3. Social Skills: Of course, social skills are naturally a focus during many of the activities listed above. Kids have to learn to take turns and share in the “pretend play” areas and on the slides. Working together is part of the fun!  Parents can encourage social skill development by helping the child ask and answer questions with other kids that are playing. This could include using longer sentences, answering questions with an appropriate response, or formulating questions. Kids may need varying levels of adult help to work on this skill. Turn taking with the toys, balls, and slides is something every kid can always work on, too!

4. Language Development: Language development includes a child’s ability to understand the language of others and use his/her own sentences to express him/herself. Parents can encourage language development by practicing following directions. This includes using descriptors and prepositions (e.g. “Get the red soccer ball and kick it in the goal behind me.”) and practicing safety words (“Stop! Wait!”) in a contained environment. Children also have to use their own language to ask for a turn with a ball or tell their parent what they need.

These are just a few ways that you can turn an indoor playspace, such as Scramble, into an activity that aids in lots of childhood development skills, and it’s so much fun that it doesn’t feel like work for the child or the parent!

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December 11, 2017

From the Other Side of the Table: Giving Up Control with Feeding

By: Hannah Reid, Rusty’s Mom

Life with a tube-fed child is often chaotic and stressful. Each week is punctuated with doctor’s appointments, in-home therapy sessions, and medical supply deliveries. Amidst all of the chaos, it can be comforting to seek control anywhere you can find it. For me, I was able to find control in what went through my son’s tube each day. To add to this, some of his doctors were incredibly fixated on numbers. In a way, it was a huge relief to have something concrete to focus on. I knew how many calories my son needed every day, how many ounces he needed per feed, and the rate the formula needed to be pumped into his stomach. This was all simple math that helped me feel a little bit of calm in the storm that was a medically complex child, dependent on a feeding tube.

Fast forward many months and we had a tube free superstar! Within days of starting our feeding therapy program, my son had weaned off the feeding tube completely. This was truly amazing, I felt like simultaneously crying tears of joy and pinching myself every time we sat down and enjoyed a meal together. However, I no longer had ounces to divvy up, calories to count, and feeding rates to program into a feeding pump. The one area of my life that I had been controlling for so long was now officially out of my control. And for the best possible reasons! But this was pretty tough to come to grips with. I imagine many other parents are in a similar position when it comes to feeding their children (even for kids who haven’t been tube fed in the past). I thought it might be helpful to review how I was able to finally give up control and fully trust my son on his new journey as a foodie.

Ditch the Numbers!

Weeks after tube weaning, I was still obsessing about numbers. I had a little notepad that sat behind our kitchen table and I wrote down how many ounces my son took in and estimated calorie totals at the end of each day. This was probably my last ditch effort to maintain control over something, and, because I’d been so fixated on numbers for so long this felt natural. However, it quickly became useless as my son’s eating fluctuated incredibly from day to day. And the thing was: the number on the scale at the pediatrician kept creeping up. He clearly knew how to listen to his own body’s cues and I needed to respect that as well. The day that I decided to finally throw out that notepad I felt like a totally new person. Freedom to trust, and freedom for my son to eat whatever he desired!

Focus on the Child

Once I was able to kick the notepad habit to the curb, I was able to focus more on my son and his cues. Was he happy? Developing and learning new skills? Having a few wet diapers each day and tears when he cried? The answer to all of these were always YES! In the first two months after tube weaning my son went from barely knowing how to sit on his own to rolling everywhere, crawling, and pulling to stand. He was also so much happier, and exploring his own world in so many ways thanks to his new exposure to food and my new ability to let go. Whenever I started to doubt him, or myself, I would get down on the floor and play with him and notice his incredible zest for life, the biggest indicator I needed to tell me that he was doing just fine.

Seeking Stability and Regaining Other Types of Control

As my son was no longer dependent on the tube, our weekly schedule calmed down significantly. Almost immediately we no longer had a need for medical supplies or certain doctors. We also didn’t need all of the in-home therapies we had been getting in the past to help him eat, because he was now an eater! Many of the daily interruptions that made our lives feel so out of control and chaotic were just GONE. And with this, I began to regain control of our lives. Yes, I wasn’t controlling my son’s intake or his calories, but I was controlling how we spent our days. Instead of driving to the GI doctor, we could go to library story hour. Instead of waiting for feeding therapy, we could visit the local farm and pet the cows. These were all things that we wanted to do together, and this re-instilled a feeling that I had a bit of power in what was going on in our lives again.

It certainly wasn’t easy, and it definitely took time, but the above steps helped me to say goodbye to the feeding tube that lingered in my brain, long after we had stopped using it on my son’s stomach.  And when we have the occasional hard day or illness, I do my best to remember back to how I relinquished control over feeding when it felt like I could think of nothing else. I ditch the numbers, focus on my child, and seek stability in other areas of our life. Because in the end, he is happy and thriving, and it’s just as important for the parents to be happy and thriving, too.

December 8, 2017

Tips and Tricks for a Successful Holiday Season

By: Tracey Urbansok, MS, OTR/L

Just when our kiddos have settled into a good routine following back to school time, it’s already December and that means holidays and winter breaks. It’s a hectic yet very exciting time of year for kiddos and adults alike. All that the season brings, including lots of extra lights, sounds and crowds, can leave our little ones feeling over stimulated, uncertain and overwhelmed. We are here to share some tips and tricks to help make your holiday season a memorable and successful one!

• Preparation is important so plan ahead when you can: Keeping some extra snacks and drinks ready can help avoid a meltdown when that family gathering or holiday parade went a bit too long.

• Write a social story about what to expect: Social stories are short descriptions about anticipated events or activities. These stories can help your child better learn about the environment, an activity or an expected behavior before getting starting. For example: “On Friday night we will go to our neighbor’s house for a party. I can help make a snack to take with us to share with our friends. When I get to our neighbor’s house there may be lots of people there I don’t know and I might feel a bit scared. My mom will be close by and can hold my hand. When people ask my name I can tell them. There will be other kids there and I can play with them. If I need a break or I get hungry that’s okay, I can let my mom know. Going to our neighbor’s house on Friday will be fun!”

• Before going to a new place or visiting old or new friends it can be helpful to share pictures of the places you will go or people your child will meet.

• Calendars and countdowns: Using calendars and countdowns is a great way to help your excited or anxious child organize time. Especially for those kiddos who have lots of extra energy and can’t wait till Christmas morning! For a visual schedule idea check out this site!

• If you are taking a long car ride or plane flight, wrapping up an inexpensive item (such as a new coloring book) or providing your child their favorite special treat especially when they are being good is a great way to break up and celebrate the journey.

• For slightly older children, involve them in your holiday planning such as decorating, picking out gifts, sending or making cards.

• With lots going on, remember to provide simple choices. Kids do well when we provide them simple or two choices rather than just asking what they want.

• Be flexible and encourage your child to be flexible too. Speak to your child in advance that changes might happen and provide several options. Speak openly that back up plans and alternatives can be fun too!

• Most important have fun and use praise. Praise your child whenever possible and praise their siblings, peers and others. Children love to feel good about something they have done well and often will match their behaviors when they see another person getting praised too.

Still have any questions or concerns about helping your little one through the holiday season? Don’t hesitate to reach out to your therapist to help you come up with a unique plan for your child. Finally stay turned for our next Trick of the Trade and keep your eyes on the Spectrum Pediatric Instagram for some simple at home ideas to try this month!

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November 9, 2017

Trick of the Trade from Krystina Burke, M.S., CCC-SLP

Video Modeling – Keep it in the Family!

Video modeling is a powerful tool I use during my speech therapy sessions throughout the week. The children I work with enjoy video modeling activities and their parents love having the videos to use throughout the week!  Although there are many “premade” video modeling videos available, I have found that using the child and their family members as the “stars” of the video has been most effective in teaching a new skill or desired behavior. Parents can then use this strategy wherever they are because the family members are the actors, producers, and the audience!

For example, to target play skills and overall engagement, parents can film a sibling bringing a toy over to another sibling to engage in play. In addition, making and watching the videos as a family provides an excellent opportunity to build in communication and engagement with siblings and family members.

(Insert link for past blog post)

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November 9, 2017

Lights, Camera, Learning!

By: Krystina Burke, M.S., CCC-SLP
  • Video modeling is a visual teaching method.
  • Students with Autism Spectrum Disorder (ASD) learn best through visual means.
  • A recent study found that students with ASD were able learn new behaviors by watching other people.
  • Video modeling can easily be put into practice!

Smart phones are pretty bright! They wake us up, keep up on schedule, allow us to email and browse the web from anywhere and everywhere, they take amazing photographs that we can share in an instant, and oh yeah.. we can actually use it as a phone to call someone.  One thing you might not know is that you have a powerful teaching tool right in your back pocket!

Video modeling is a visual teaching method. As the name suggests, video modeling provides children with the opportunity to learn a behavior or skill by watching a video of someone else, or themselves in a certain situation or performing a certain skill! Video modeling can be used to support all children, but has been especially affective when working with children with Autism. This intervention has been used support children in the areas of behavioral functioning, social-communication, and functional self-help skills.

Children with autism benefit from using visuals as a learning strategy. A study by Bellini and Akullian (2007) concluded that children preformed best when they were highly motivated and attentive because they enjoyed watching the videos. A study by MacDonald (2009) found that when children were given the opportunity to observe videos of their peers during social, play based, interactions these children were more likely to engage in reciprocal play interactions with typically developing peers.

So how can you put this into practice? First, identify an area of need for your child. What is most difficult for them? Is it engaging with peers during play or functionally playing with their toys at home? Is it getting on or off the bus? Once you know what you want to target, the next step is to find a video that models the behavior or skill you want your child to learn. There are many pre-made videos available to use here. Stay tuned for a trick of the trade on how to learn how to make your own!

Sources:

Bellini, S., & Akullian, J. , Exceptional Children, 73, 261-284, 2007

MacDonald, R., Journal of Applied Behavior Analysis 2009, Spring, 42 (1): 43-55.

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October 24, 2017

Responsive Feeding: Do they always have to sit in the chair?

By: Heidi Moreland, MS, CCC-SLP, BCS-S, CLC

Parenting can be tough, and it is easier to find some exact guidelines on how to help your child, or how to get them to “do the right things.” Responsive feeding is a great structure, but it can feel like there are a lot of gray areas when it comes to application.

Picture helping your child learn to walk. In the beginning you hold them upright, and even help them move their feet! As they mature in their skills, you progress to holding two hands, holding one hand or, just using a finger. Eventually, you let them walk to your outstretched hands and you catch them if they wobble. Sometimes you need to let them land on their booty in order to allow them to develop their balance independently. Once they are running on the playground by themselves, you will probably forget all of the months of practice and many steps that you went through! You can apply the same idea to other skills. Rather than giving some exact guidelines on questions such as the wisdom of making your child sit in the chair and other mealtime conundrums, here are some questions to ask yourself to help guide your reactions in the gray areas of the mealtime relationships.

Enjoyment

1. What does my child think about food (or drinking) right now? How do they communicate this?

2. What does my child think about family mealtimes (or bottle times) right now? How do they communicate this?

3. Is his or her response to mealtimes different than other areas of structure? (For example, 2 year olds often do not like to be confined, and would rather explore than eat. This does not necessarily mean that he doesn’t like food, but may dislike sitting for more than a few minutes.

Abilities

4. What do they do at about 80% of mealtimes with ____________ ? No one is 100% at anything, especially toddlers and preschoolers, so 80% is a pretty good measure of mastery. This can be any skill, such as drinking from a cup, sitting at the table, using a spoon, or just taking bites without spitting them out. It can also be behaviors, manners, and food challenges like sitting at the table or tasting new foods.

5. What do I hope they will do at mealtimes?

Shaping rules and expectations

  • If you do an assessment of their enjoyment and find that there is no enjoyment at all, you may need to back up your expectations until they are more relaxed at mealtimes.
  • Once you have some enjoyment of food and mealtimes, you can begin adding structure a little bit at a time.

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October 20, 2017

Spectrum at NPC-QIC: Lessons from a Tube-Weaning Program

Our wonderful feeding therapist and clinical coordinator of our Tube Weaning Program, Heidi Moreland, is presenting at the National Pediatric Cardiology Quality Improvement Collaboration conference in Chicago this weekend. Throughout this presentation, Heidi discusses the philosophy behind Spectrum Pediatrics tube-weaning program and provides a glimpse into what the program looks like for children and their families!

Check out Heidi’s presentation here along with helpful resources for the tube-weaning program:

References for Spectrum Pediatrics Treatment Program

Spectrum at NPC QIC Presentation

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October 4, 2017

How does Responsive Parenting Apply to Feeding?

By: Heidi Moreland, MS, CCC-SLP, BCS-S, CLC

The mealtime relationship is extremely dynamic and should evolve over time. In the beginning, the parent’s role is more permissive and supportive with food. Children are allowed to explore and branch out. This allows their tentative interests to develop and stabilize. However, we have found that being too permissive can actually lead to pickier eating and more mealtime “stand-offs,” and even impact weight gain. We also know that being too authoritative or involved can also lead to refusals and difficulty with self-regulation.

We realize this is a hard line to walk. Here are a few thoughts to help with this process.

• The child should be comfortable with saying “no” to foods if they aren’t hungry or don’t feel safe, without fear of reprisal.

  • Learning that they are loved despite the fact that they said “no” is extremely important. However, it doesn’t mean that they shouldn’t experience the consequences of “no,” such as being hungry.
  • They may show interest or refusal in a variety of ways that will change over time. You will need to pay attention now and as they mature.
  • If the child is consistently refusing, the adult may need to re-consider the environment or expectations, so that they are both appropriate and achievable.

• The adult should also be comfortable with saying “no” to behaviors and requests

  • If the situation isn’t safe, it is always appropriate for you to set limits. Playing with knives, standing on the table, or eating non-food are clear examples of appropriate limits. There are others that are less clear, but still important. Eating only at the table is a tricky one, but if that is the rule, it is important to reinforce it.
  • As hunger and trust are more established, mealtime expectations should begin to line up with expectations outside of meals. Ask yourself, “what would I do if this wasn’t food?”
  • There are very valuable lessons that children learn from consequences. Protecting them from consequences of “no” by always setting up the situation so the answer is “yes” deprives the children of learning important lessons. ▪ For example, getting the child to eat every day by only serving highly preferred foods deprives the child of learning the feeling of hunger, as well as the possibility that some new foods are good.

• Just as you wouldn’t expect an infant to drive a car or read a book, you would be disappointed if your teenager waited for you to change their clothes or put food in their mouths. It is appropriate to change your expectations as children mature.

  • If your child is a new or hesitant eater, their abilities with food may look different than their abilities in other areas.
  • Until their trust of food and eating becomes more stable, you may have different sets of expectations for food and for other areas, but it helps to be aware of the discrepancy and make very small steps to make them more similar.
  • If a behavior is new and fragile, it needs more support. Taste, variety, volume, texture, situation, etc., may time to stabilize.
  • Once a behavior is more established, parents and caregivers can begin to shape it or incorporate it into an expectation. For example, in the beginning, the “eating only at the table” rule, may be suspended, but once that behavior is more stable, eating at the table should be consistent and not open to negotiation except for special circumstances.
  • Patterns of interest and response will help you make future choices and determine when your child is ready for the next step.

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Darling, N., & Steinberg, L. (1993). Parenting style as context: An integrative model. Psychological bulletin, 113(3), 487.

Hughes, S. O., Power, T. G., Fisher, J. O., Mueller, S., & Nicklas, T. A. (2005). Revisiting a neglected construct: parenting styles in a child-feeding context.Appetite, 44(1), 83-92.

Landry, S. H., Smith, K. E., & Swank, P. R. (2006). Responsive parenting: establishing early foundations for social, communication, and independent problem-solving skills. Developmental psychology, 42(4), 627.

August 23, 2017

Trick of the Trade from Tracy Magee,M.Ed., CCC-SLP

Visuals for Toddlers in Their Everyday Lives

All people benefit from visuals. Just think of how your daily planner or agenda helps you feel less anxious about your day if you can see all that needs to get done. Toddlers are no different than adults. Visuals aid them in feeling calmer about what is ahead, particularly since they may not understand all the language adults are using. Here are two visuals that I find helpful with the toddlers:

1. Visual schedules: Visual schedules can be cumbersome, but they don’t have to be. Pick a few categories that can give your child a general idea of the activities depicted. An example would be: 1. Breakfast 2. Bathroom (represents shower, brushing teeth, etc.) 3. Play 4. Snack 5. Park 6. Nap

Visual schedules can be used for a whole day, part of a day, or just an activity. Kids feel a sense of accomplishment when they take off the sticker card for each activity and “complete” the task. It’s a win-win for the child and the parent!

2. Sand Timers: I have been using sand timers for quite some time with the kids I work with and my own kids. We use it as a visual way to give kids an idea of time. My own children try to “beat the clock (sand timer)” when cleaning up their toys at night. I also use it before we are about to leave the house. I will put out a three minute sand timer to mentally prepare them for the upcoming transition. A parent could just use words, but the visual of seeing how much sand is left is so much more powerful to a toddler. You can order sand timers here ) or check out a local teacher-resource store.

Check out our post on SoundingBoard, a great app for visual schedules here. We also shared a favorite visual timer app that all of our therapists love! Check it out here!