Changing Colors: The Blog of Spectrum Pediatrics

Archive for the ‘Early Intervention’ Category

May 8, 2017

Tummy Time Tips

At Spectrum Pediatrics, we often focus on helping parents make small changes during their daily routines to help build their child’s overall development. Many people hear that tummy time is a crucial part of a child’s motor development, but often times parents are unsure why or how to incorporate tummy time into their routine. Our occupational therapist, Ashley, and our physical therapist, Colleen, are sharing some helpful tips on how to make tummy time easier! Check out the video below to hear both Colleen and Ashley discuss various ways to make tummy time less challenging and how much tummy time your child should be getting!

Stay tuned for another video full of tips on behaviors during mealtimes!

 

April 5, 2017

Is Baby-Led Weaning Right for Your Child?

By: Heidi Liefer Moreland, MS, CCC-SLP, BRS-S, CLC

Baby Led Weaning is becoming more popular as an option for transitioning children onto solid table foods.  This involves introducing the child to bigger pieces of foods that they are allowed to pick up independently and bring to their mouths.  Initially, they develop the ability to pick up large “graspable” pieces and accurately find their mouth.  As they become more skilled, they mouth the food, and eventually learn to manage small broken pieces that break off inside their oral cavity.  Once the food is in their mouth, they develop safety skills to protect their airway, including gagging and pushing pieces out with their tongue. With time and practice, they develop the control to hold the pieces still for biting, mashing, and early chewing.  Finally, their skills are mature enough to move the bites back in the mouth for swallowing.  As they develop the skills to control the smaller pieces of food orally, their hand abilities are also becoming more refined.  These increasing fine motor skills allow them to accurately pick up smaller pieces of food, which are more easily chewed and swallowed when their mouths have become ready for them.

As a therapist, I believe there are a number of factors that indicate this is developmentally appropriate method to help children learn about the properties and management of solid foods.  These factors are typically emerging or present at the age of approximately 6 months, which is when this process is recommended to begin. Of course, it is always important to discuss this with your pediatrician, as well.  The factors to consider are discussed below:

  1. Infants develop the hand control to pick up bigger stick-shaped foods before they develop the pincer grasp to pick up smaller foods or to self-feed with a spoon.
  2. Infants are experiential learners that are self-motivated, and will continue working with tasks that remain interesting and meaningful, until they appear to be mastered.  They are not designed to learn from a “teacher” or through adult-directed learning, which is what happens when an adult feeds them.
  3. Infants have reflexes and drives that facilitate this process that are no longer present at a later age.  These reflexes include:
      • Predominant oral exploration drives the child to bring things from hand-to-mouth, rather than banging or flinging.
      • Gag reflex remains at the front of the mouth at earlier ages, and this allows for important safety responses.
      • Tongue thrust is present, which helps them expel foods that are unsafe for swallowing.
      • Lateral tongue movement to stimulation is present, which will be used to develop control of the food.
      • Brain development takes place as neural connections are made during functional multi-sensory activities.  Therefore, the learning that happens on a banana pieces may be slightly different than learning that takes place on a teething toy.
  4. Brain development for motor skills also requires fine-tuning that happens with repeated   experiences that allow for on-line adjustments.  An example that many adults may remember is the experience of learning to ride a bike.  The only way to really learn balance while pedaling is to wobble around while the body learns to anticipate and adjust for the rolling and tipping movements of the bike.
  5. Because babies are “in charge” of the process, they control how much they eat.  This is consistent with the self-regulation of hunger and satiety that is developed during nursing, and has been found to be a positive influence in the prevention of obesity.
  6. Because the baby is exploring at their own pace, children frequently become less resistant and afraid than those who are presented with foods at the pace and interest of the feeder.

 

baby eating riceAlthough this approach is likely consistent with the way infants were fed long before the development of prepared baby foods, modern child-rearing dictates that we need to investigate a process, before it is recommended to ensure that it is safe and appropriate.  There is a study that is available through the National Institutes of Health (NIH).  In this study, it looked at developmental skills and available evidence of baby-led weaning, and it indicated that this is a feasible process for children who are learning to eat.

As with many child-rearing strategies, your supervision and judgment is crucial in determining readiness and to keep the process safe.  Your child is ready when he or she is able to sit with upright head control and be stable in a chair with supports.  Although the following considerations should be addressed for all children, those with developmental delays or motor deficits may require further assistance in these areas, or might need more time to develop complete readiness.

  1. Sitting stability – If your child is very unstable, you need to wait until he is a little more steady, or make sure he is well supported.  Imagine drinking from an open cup while walking a tightrope.  It is hard to develop aim and fine oral control if you are trying hard to keep your body stable.
  2. Hand to mouth control – If your child has significant difficulty with other refined hand movements (such as reaching for objects, picking up and dropping toys, or opening and closing their hands with appropriate timing), they will likely have the same difficulty with learning self-feeding skills.  Wait until their motor control is mature enough to be a little more accurate and consistent
  3. Oral control – It is important for your child to be responsive to items in their mouth in a timely fashion, so they can expel big pieces, rather than choke.  If their motor responses are over- or under-reactive, the same is likely to be true of food items in their mouth.  Giving breakable solid foods too soon will result in a greater risk for choking, which is an obvious problem.  Additionally, too many fearful experiences with food is likely to result in more refusal later as a self-protective mechanism.
  4. Allergy precautions – If there is a high likelihood of allergies, discuss food exposure with a physician or nutritionist to determine which foods are more likely to cause allergic reactions, so you can be wise in the order of presentation.

 

child with food on faceImportant considerations in food selection:

  1. Look for foods that hold together well enough to be picked up, but are soft enough to easily fall apart in the mouth (such as baked sweet potato logs)
  2. Never leave your child alone with food items.  They are still learners, and they must be supervised.
  3. Avoid foods that become sharp when broken (such as potato chips).
  4. Avoid foods that are too sticky to be easily controlled (such as a big spoon of peanut butter).
  5. Avoid hard foods that require teeth to break down (Raw apple pieces or small raw carrots are the most frequent culprits in food related choking incidents).
  6. Avoid foods that are too slippery to be easily controlled by an immature eater (such as canned peaches).
  7. Be familiar with infant and child CPR, and to look for that in a child care provider.  It is recommended for children learning to eat solids, but also because food is not the only thing kids put in their mouth!  Here are some links for CPR information:

Looking to learn more about Baby Led Weaning? This website continues to discuss the benefits and even shares a few great recipes for your child!

Sources:

  1. How Feasible is Baby Led Weaning as an Approach to Infant Feeding? A Review of the Evidence.
  2. Web summary from book author
  3. Video
  4. Glasgow Study Reviewed

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March 13, 2017

New Sleep Guidelines: What are they?

By Tracy Magee, MEd, CCC-SLP

In October 2016, the American Academy of Pediatrics AAP released new recommendations regarding safe sleep for babies up to 1 year of age. Here are some of the suggested guidelines:

1. Remember your “ABCs”:

  • A is for Alone. The baby should sleep alone in a crib or bassinet.
  • B is for Back. The baby should always be put to sleep on his/her back.
  • C is for Crib. The baby should always sleep in an uncluttered crib (no loose blankets, no bumpers, etc.).

2. Sleeping Environments:

  • Research shows that it is safest for a child to sleep in his/her parents’ room. The guidelines recommend at least 6 months to a year. It is suggested that sleeping in a bassinet or co-sleeper (and not in the parents’ bed) is safest.
  • A baby should never sleep on a couch, as the cushions are not firm enough to keep the baby safe. The baby can easily fall or get wedged in between the cushions.
  • Make sure the child is sleeping on a firm surface/mattress.

3. Other ways to keep your baby safe during sleep:

  • Using a pacifier during naptimes and bedtimes
  • Keeping a fan on in the room during naptimes and bedtimes
  • Limiting baby’s exposure to secondhand smoke and adults that have been using drugs or alcohol

One of the newest developments with these guidelines is that fact that the AAP recognized that many parents could be so exhausted that they might fall asleep when feeding their baby. The organization suggests that the parent should sit on his/her bed with no loose bedding if they feel there is a chance that they may fall asleep. This is the safest location for the child if this scenario were to happen. Of course, as soon as the parent wakes, the baby should be placed in a crib or bassinet.

At Spectrum Pediatrics, we recognize that the choices about where your child sleeps are very personal to your family. Please take these recommendations when speaking with your pediatrician. Together, the doctor and your family can determine what is the best sleep setting for your specific child!

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March 8, 2017

Technology Tuesday: BabySee App

Have you ever wondered what your baby can see when they are born? We know that a child’s vision starts to develop from the moment they are born. Scientists and researchers have been studying how the brain and eyes develop to learn how babies can see clarity, color, and contrast. This app was created by REBIScan and Boston Children’s Hospital’s Chief of Ophthalmology, David G. Hunter, MD, PhD to create this vision stimulator. The BabySee app allows parents to see what their child would see as they develop.

The BabySee app uses video imaging to stimulate how a child would see at any given age, focusing on clarity, color, and contrast. To use this app you can use the camera on your mobile device, then touch and hold the screen to compare the “infant” vision with the normal adult vision. You can input your child’s birthdate for accurate age levels to show vision at different ages. Some fun features of the app include being able to share favorite images with family members through email or text, saving images to an album, and the ability to explore different scientific articles to learn more about infant vision!

A tip for parents with premature babies: Make sure to put in your child’s due date so you see through the lense of their adjusted age! To purchase the app click here!

February 14, 2017

Cup Drinking: Where to start?

By: Jamie Hinchey, MS, CCC-SLP

As a feeding therapist, I often have parents ask me about where to go next when transitioning to a cup. Finding the appropriate cup for your child can be a difficult task. Although there are a variety of sippy cups on the market today, the most important transition for your child is eventually to either an open cup or a straw cup. If your child has a specific reason for a certain cup, your feeding therapist will help you with this transition. We often recommend practicing with open cup drinking or a straw cup once your child is around 6 months old or sitting independently. This depends on where your child is developmentally and it is important to keep in mind if your baby has any difficulty with swallowing. Although these two versions of drinking may be a little messier than the sippy cup, try practicing outside or in an easy-to-clean environment so that your child can learn.

Many parents view sippy cups as a developmental milestone, but drinking from a sippy cup is not a specific milestone a child must reach. When focusing on the developmental milestones, we look at a child’s ability to transition from the breast or a bottle to an open cup or straw drinking. As a child’s oral motor skills develop, they gain more control over their lips, tongue, and swallow. As feeding therapists, we notice that children are typically most interested in the cups they see their caregivers use. At around 9 months, your child may be able to start to drink from a straw or at least start to practice. There are certain cups that can be helpful when “teaching” straw drinking, although many kids learn through practice as their oral motor skills develop. We would not expect your child to be able to pick up an open cup without assistance and drink from it, there are a few great transition open cups that we often recommend to families.

Here are a few tips when looking for a cup for your child:

Handles: Handles are important when introducing a new cup since this allows your child to easily grasp onto the cup and start to learn how to independently bring the cup towards their mouth. When a cup is hard to hold, it is difficult for a child to focus on holding the cup, bringing it to their mouth, and learning how to drink from the cup.

Focus on the “top” of the cup: The transition open cup allows for the child to learn the motor pattern of drinking from an open cup. We often recommend the Miracle 360 cup for a transitional open cup. Since the top of the cup is mainly closed, the liquid comes out at a slower pace and allows the child to have better oral motor control. This cup has a lip on the top where your child learns how to position their top and bottom lip while drinking. There are also straw cups that have “weighted” straws, which means that the straws hold liquid even when the cup is tipped up, allowing the child to be successful even if they attempt to tip the cup up. Parents have recommended the Zoli cup for a first weighted straw cup.

Allow your child to explore: It is important when introducing a new cup that you give your child the time they may need to explore the cup. This means that when you are first starting, take the time to put the cup out while your child is playing with their toys. Although they may not drink from the cup yet, they will become comfortable with how to hold the cup and bringing it to their mouth. Your child will learn best from what they see you do, therefore mealtimes are a GREAT time to model drinking from either a straw or an open cup!

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January 23, 2017

Crawling Part 3: Tips and Tricks

As I mentioned in the first edition of our crawling series, I like to encourage parents and children not to give up on crawling due to the many benefits. Here are a few tips and tricks to help both you and your child work on crawling.

Tummy time

Most of the time, I see babies who are not crawling simply because they hate being on their tummies. The first, and toughest, step is to get them accustomed to experimenting with movement on their tummies. Refer back to our blog post here for some ideas to make tummy time more enjoyable and easier for both parent and the baby.

Belly crawling

If your baby is stuck on their belly and reaching their hardest for those toys out of reach but just not crawling, try making that forward motion easier. You can slip your baby into long sleeve shirts and pants or a long-sleeve footie pajama suit and let them play on their belly on a slick floor. By reducing the friction, belly crawling becomes much easier. You can also let your baby kick off your hand with their foot to help get that forward motion initially. Once they begin to move forward, they will learn to pull along with their arms to help get that motion.

Blanket under the belly

A lot of the time, the core muscles that help keep the trunk upright and supported in a variety of positions is weak. We see this when the baby might have difficulty getting their belly up off the ground. Try rolling or balling up a small hospital or receiving blanket and sticking it under the tummy when playing on the floor to help teach them to bring the belly up. If your baby has longer arms, you can place your shin under than belly rather than a blanket.

Wheelbarrow walks

Sometimes, we see little ones having difficulty moving onto the next stage of crawling due to weakness at the shoulder muscles. The term proximal stability refers to keeping the shoulder blade still and supported against the back of the rib cage. Wheelbarrow walks is an easy, and sometimes fun, way to help promote more core strengthening and proximal stability. I like to start holding baby at the hips while having them wheelbarrow walk on their hands. As they get stronger, I move my hands to their thighs, knees, and then ankles.

Make crawling fun!

You can encourage crawling most easily by placing favorite toys out of reach. Other fun games include playing near a mirror or a diaper box as most babies love to see their faces or other baby’s faces. Some little ones enjoy crawling through a tunnel or over obstacles and learn or to problem solve their way around the home.

Have fun crawling!

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January 20, 2017

Trick of the Trade from Ashley Glasser, MS, OTR/L, CEIM

DIY Play Gyms

Out of all the toys and devices out there, especially for newborns and pre-crawlers, one of my favorites is a baby play gym or mat. They come in various shapes and sizes: colorful mats with two arches and multiple dangling toys or one simple wooden arch with two toys. No matter which one a parent chooses the benefits are endless. They help to promote cognitive skills, reaching and grasping, head turning, body turning, sensory stimulation, etc.

Recently I was working with a family where we decided the child would benefit from practicing overhead reaching so that he could strengthen his arms as he lifted them against gravity, in addition to working on the accuracy of his reach and expanding his play beyond mouthing (he could learn to bat, shake, turn, etc.). What better way to work on this than through the use of a play gym! Problem: the family doesn’t yet have a play gym. Solution: let’s create one!

If you haven’t purchased a play gym, don’t fret. A piece of string or rope tied between two pieces of furniture will do the trick for now! In the moment two adults sitting on couches facing each other worked just fine. A rattle was strung onto the string and the adults held the string over the baby while he laid on his back on the floor. Within seconds the baby immediately reached up for the rattle, batted at it, and pulled it down to his chest. Exactly what we wanted! A little ingenuity and the child is already developing new skills that will benefit him immensely.

Note that care should be taken in regards to what you decide to put on the string – be mindful of choking hazards for babies that are reaching and mouthing. And always monitor, but also have fun!

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January 17, 2017

Crawling Part 1: The Benefits

By: Colleen Donley, PT, DPT

As an early intervention therapist, I often start working with little ones around their first birthday because they are not crawling yet. More times than not, I hear parents ask if we really should address crawling because walking is the ultimate goal and can’t we just start there. Despite popular belief, crawling on hands and knees is still a major motor milestone!

So why do we really want to push crawling on hands and knees? The benefits of crawling extend far beyond the gross motor domain. Crawling on hands and knees stimulates virtually every area of development from gross motor to cognitive, and even, to speech and language.

Here are my Top 10 reasons why not to skip crawling:

1. Development of arches in the hand: All babies are born with fat pads in their hands. While these pudgy hands are super cute, the fat pads need to disintegrate in order for muscles of the hand to develop. Weight bearing through the hands is the most effective way to help those fat pads disintegrate while encouraging all the tiny, but important, muscles in the hand to develop.

2. Integration of primitive reflexes: Maintaining and crawling in a hands and knees position provides input all throughout baby’s body to help primitive reflexes integrate. Two reflexes are key players during crawling- the symmetric tonic neck reflex (STNR) and the asymmetric tonic neck reflex (ATNR). ATNR is present shortly after birth and is seen when baby lays on their back and turns their head to one side, that same-side arm will extend out to the side while the opposite-side arm will bend at the elbow and come up to the shoulder. We see the STNR emerge around this time and help with crawling. With the STNR, baby’s arms will extend in response to neck extension while the legs will bend. This is seen very easily when baby is on hands and knees and looking ahead.

3. Development of visual system: The visual system actually develops in multiple ways with crawling. Baby will learn to keep their eyes fixed while moving and move separate from their motion. As baby is moving, they must be able to stabilize their gaze on an object and hold it steady or else they will just see blurry images as their weight bounces from side to side.

4. Development of the thumb: Shifting weight from hand to hand when crawling helps elongate the space between the thumb and the index finger. This creates more room for toys to be held with maturing grasp patterns. It also promotes development of the muscles of the thumb.

5. Trunk strength for basic activities: With all this hands and knees positioning, the belly is lifted off the ground and muscles of the trunk and core are in constant contraction/relaxation, or co-contraction. Developing muscles of the trunk have massive implications on feeding, talking, and play skills in sitting.

6. Proximal stability: Crawling helps strength and stabilize the muscles close to the center of the body, like neck, shoulders, hips, and back. The muscles close to the joints that help keep them strong and stable are given constant input to contract and thus strengthen. As these joints and muscles strengthen, baby has a stronger base to move and learn new motor skills, both gross and fine.

7. Motor planning: As baby begins to move more in their environment, they will undoubtedly encounter many obstacles. Obstacles can come in all shapes and sizes and can be put in baby’s way intentionally or not. The brain will be stimulated to help baby problem solve how to move around these obstacles. This is one of the first times we see baby begin to motor plan movement strategies, but it is just the very beginning of motor planning.

8. Bilateral coordination:  Remember up top where we talked about what reciprocal crawling looks like? Hint: right arm and left leg move at the same time. This shows us that both sides of the brain and working at the same time and communicating. Activating both sides of the brain at the same time is huge for cognitive development.

9. Exploration of environment: Tied in with motor planning, crawling on hands and knees provides baby with a new independent form of mobility and allows them the opportunity to explore their environment. Babies still learn best at this stage through exploration and experimentation! Let them have the run of the place and see what they get into. So break out those baby gates while encouraging exploration!

10. Of course the best reason for any new skill is to give baby new opportunities for play! We begin to see expansion of baby’s concept of cause and effect with crawling. They begin to engage in more social play, such as peekaboo or hide and seek, now that they can move and find a familiar face around the corner or behind the sofa. Babies also begin to grow their reciprocal interaction skills as they play ball and chase after rolled balls.

Not sure if what baby is doing looks right? Having trouble or feeling frustrated in helping baby master crawling? Stay tuned for parts 2 and 3 on crawling for what typical crawling looks like and how to make it easier to master!

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January 10, 2017

W-Sitting: What’s the big problem?

By: Colleen Donley, PT, DPT
  • A w-sit is often seen as a very preferred position for play
  • W-sitting can be harmful to the hip and knee joints as well as muscles throughout the legs
  • W-Sitting can have a negative impact on little ones developing appropriate trunk strength and postural control

A w-sit is when a child is sitting on their bottom with both knees bent and their legs turned out away from their body. If you were to look with a bird’s eye view at your child sitting, their legs would make a W.

Before the age of 3, the bones in little ones are still very malleable (aka flexible) and can twist, turn, etc. due to the stresses put on their body. If we let them sit in a w-sit all day, the ball of the femur bone that goes in the hip joint can actually rotate to a more forward position. This ends up looking like the classic “knock-kneed” position when your child stands, their thighs angle inwards so their knees almost touch. Additionally, a w-sit position puts a child at an increased risk for hip dislocation.

W-sitting can also shorten or tighten muscles in the hip and legs. The hamstrings and hip rotators are most at-risk to become tight in kids who prefer w-sitting. Their knees are always bent so the hamstring is put in a shortened position for a long period of time. This can negatively impact a child’s coordination, balance, and mastering other gross motor skills such as galloping or skipping as they get older.

Most often, I see kiddos prefer to w-sit when they are getting tired and especially those with low muscle tone. W-sit can be considered a “lazy position” because the child does not have to use their trunk muscles to sit upright and not fall over when they want to reach for a toy. W-sitting takes away the hard part of sitting and playing! We do not see children rotate through their trunk to reach for toys when w-sitting. This also discourages crossing midline, which is an amazing skill to develop for the growing and learning brain. Also, splaying the legs out in a w-sit creates a very large base of support so the child doesn’t have to worry about falling over when reaching for a toy. Their legs are going to make sure that doesn’t happen but this does not let them develop the trunk stability and postural control to learn how to balance appropriately. Think…if a child cannot balance appropriate in sitting then they will have a harder time learning how to balance in standing as their center of gravity is raised higher.

At the end of the day, it is likely virtually impossible to follow your busy infant or toddler around the house for all awake moments. As they move from crawling to sitting to rolling and back to sitting, it would be exhausting to correct every instance of w-sitting. Of biggest concern is when you might see your little one sitting in this w-position for an extended period of time while playing with toys or hanging out there during story time or a movie break. This would be the perfect time to ask them to “fix your feet!”

Here are some alternative sitting positions to encourage during playtime: Criss-cross applesauce, long-sitting, side-sitting.

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December 12, 2016

Nonverbal Language: What is it and why is it important?

By: Jamie Hinchey, MS, CCC-SLP
  • Nonverbal language starts from the moment a child is born.
  • There are many different forms of nonverbal communication including eye contact, gestures, body language, and facial expressions.
  • Young babies respond to nonverbal communication from their parents starting at a young age.

We have talked about receptive and expressive language, but nonverbal language often gets mixed in with that conversation. As a speech therapist with young children, I often find myself speaking with parents about the way their 2-month old is attempting to communicate. Many parents are confused by this and often ask “How is my child communicating without words?”. When talking about a newborn baby, a recent study found that there are two forms of nonverbal cues for infants and toddlers: engagement and disengagement cues. Engagement cues often include eye contact towards the caregiver, smiling, reaching for the caregiver, or eyes wide open. Disengagement cues could include crawling away, lack of eye contact, or hands over eyes. Eye contact is often included in this conversation, since this is a very powerful way for a child to communicate with their caregivers from the time they are born. As this child grows, eye contact is expected to continue to grow and develop into an effective form of communication.

As your child develops, their nonverbal language may become more obvious. This is the stage prior to developing words, but the need to communicate their wants and needs is important. Fore example, a baby sitting in their highchair may wipe their hands on the tray or throw their food to communicate that they are all done. When their parent takes the food away or gives more, that child is starting to learn how to effectively communicate. As your child enters their toddler years, they may start to link these nonverbal communication skills with words. We know that it is easier for toddlers to learn large motor movements (reaching, pointing) than more fine motor skills such as making sounds or words. With this in mind, toddlers may rely on nonverbal language to communicate their basic wants and needs. Some of these skills may be obvious such as a child pointing to an object that they want such as a food item. This may come before the child can use the word to specifically request that food. Another common form on nonverbal language I see is when a child pulls their parent over to the kitchen to show them that they are hungry.

Throughout my therapy sessions, I work with families on a variety of different strategies to help build nonverbal language before expecting the child to use their words. We typically see this nonverbal communication continue throughout toddler years, into elementary school, and even into adolescence/adulthood. While working with children 0-3, I encourage parents to give choices to encourage their child to use their nonverbal skill of pointing or reaching. This is teaching the child that they must do something in order to get something. I often coach the parents on ways to link these nonverbal language skills with words/sounds. For example, as your child is pointing to their preferred food item, label the item that they are pointing to.

For more information on expressive and receptive language check out our post here!

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