Changing Colors: The Blog of Spectrum Pediatrics

Archive for the ‘Early Intervention’ Category

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!

Source 1

Source 2


December 2, 2016

Trick of the Trade from Colleen Donley, PT, DPT

Crawling Up the Stairs

I love to work on crawling up the stairs with a baby that is crawling and moving around. This is an especially great activity for a baby who may have difficulty pulling to stand at their activity table or your coffee table. Sometimes those tables are a little too high to reach up from hands and knees. A stair is a much more reasonable height, most are typically less than 8 inches.

I work on having the baby practice the same motion:

  • Going from hands and knees to a half-kneel position
  • Pushing up through their arms to bring that second foot up
  • Have both hands on the top step and both feet flat in a supported standing position

You might need to be hands-on at first to teach them the motor pattern or provide a little support for their confidence since stairs are a scary place. You might also need to help them figure out how to negotiate moving their hands up to the next step or how to bring their knees up. This will help reinforce the motor pattern to pull to stand at the taller heights, such as their musical activity table, while building the strength in the legs needed for this movement. Crawling up the steps is an easy activity to incorporate into your already-busy days!


November 15, 2016

Breaking Down Language: Part 2

By: Brianna Craite, MS, CCC-SLP
  • We have already discussed expressive language and now it’s time for receptive language.
  • Receptive language is easily described as how a person listens to another person or how you respond to words.
  • As receptive language builds, we expect children to be able to listen to things that are said to them, but also to demonstrate the things they know.

When we first learn to listen as babies we use our eyes and ears together to watch and observe people and objects in our environment. A baby may indicate they are hearing a voice or noise by crying, kicking their legs, looking around, or calming down. Eventually around 6-8 months of age babies start to make connections between sounds, words, people, and actions. For example, you may be able to say, “Where’s mama?” and your child will search the room with his or her eyes to find her. Environmental sounds may be some of the first sounds a child begins to recognize such as a dog barking or an airplane flying by.

Children start to make connections between words and objects and use their body to tell you they understand. This is around the same time they may begin moving much more, possibly even starting to walk. They may be able to follow simple directions like “come here” or “give me the ball” by 1 year old. You might also be able to ask your child to identify familiar objects like ball, mom, or shoes. Children have many ways to tell you what they know. They may point to objects when you name them, look in the direction of the object, or retrieve it to give it to someone.

These skills then expand further by 2 years of age and a child is easily following more complex directions such as “take a drink of your juice” or “wipe your face with your napkin”. Children also will be able to identify many things like pointing to their body parts or finding pictures when named in books. Remember, this does not mean they will have all the words for the things they know. We expect for a child to be able to identify many objects before they attempt to say the word to identify them.

Keep in mind each child learns differently and if your child is learning more than one language they may show some differences. Stay tuned for some quick tips and tricks for building receptive language in the next post!


November 8, 2016

Trick of the Trade from Colleen Donley, PT, DPT

Making Tummy Time Not-So-Terrible

Tummy time for teeny babies is no small feat! And it can be equally as difficult a time for parents if their baby gets very upset during tummy time. Here are some tips to make tummy time not as horrible (and maybe even fun!) for your baby right after coming home:

Tummy to chest is one of the first and easiest positions for a new baby to have tummy time. Parents should choose a comfortable position, such as reclined on the couch or propped up in bed, and then lay baby tummy-down on their chest. This puts baby at a slight incline, which makes lifting the head slightly easier. And it puts them closest to see their favorite motivator, you!

I also like to have a baby lay on the floor over a rolled-up blanket right at chest level. This creates a slight incline similar to being on your chest but challenges baby a little more. Try folding a receiving blanket from the hospital in half and rolling it up tightly. These aren’t plush so they won’t give under baby’s pressure but will give baby just the little bit of lift to make tummy time more enjoyable. And always, add something fun to the floor during tummy time, like a mirror or contrasting book!

For more information on tummy time, check out our previous post about why tummy time is important!


November 1, 2016

Toe-Walking: Should You Be Concerned?

By: Colleen Donley, PT, DPT
  • New walkers often experiment with toe-walking, but it should not persist.
  • Toe-walking is not an early indicator of autism.
  • Toe-walking can become a long and vicious cycle if not addressed early.

Toe-walking refers to instances where a child is walking without their heel in contact with the ground. This includes walking on the balls of the feet or tip-toes. There are many different reasons a child may toe-walk, which may be an indicator of an underlying diagnosis, but there are also times where we see children walk on their toes for no reason. Sometimes children outgrow toe-walking on their own, but some require skilled intervention to address the problem from worsening.

Most pediatricians and baby books address toe-walking when a little one is beginning to cruise and take their first steps. I often see new walkers experiment with being on their toes and this goes away in time. Young toddlers go up on their toes for a host of different reasons, most often just to experiment with new positions and movement. Being up on their toes helps a toddler to have a more stable arch in their developing foot. Since they are experimenting with walking and do not feel secure, they are often moving quickly with a push toy or “falling” into a parent. Walking at an increased speed imposes more instability on the child and they want to feel stable at the foot/ankle. The American Academy of Pediatrics recommends that toe-walking should not persist beyond 2 years of age. Personally, I feel toe-walking is a problem before 2-years if the child never comes down to flat feet and toe-walks consistently.

As autism has become a more widely discussed syndrome, many people have begun to associate toe-walking with autism. It is true that some children who have autism do walk on their toes for a variety of reasons. Toe-walking has not been linked to autism and is not an early indicator of autism. However, toe-walking can be an early indicator of cerebral palsy or muscular dystrophy in the presence of other symptoms.

The biggest concern with toe-walking when it is not related to an underlying diagnosis, like cerebral palsy or muscular dystrophy, is that it turns into a very vicious cycle that is tough to break. When a child is up on their toes, their calf muscle and Achilles tendon are in a shortened position. If they stay on their toes consistently then the muscle and heel cord are never put on slack and, as a result, tighten up. So now we have a child with a tight calf muscle and heel cord who cannot get their heel down even if they wanted to. Alternatively, the muscles in the front of the shin are in a constant lengthened position and become weak over time due to not being used.

At Spectrum Pediatrics, we like to address toe-walking with a simple stretching and strengthening program while making it fun for the kiddo. No child will enjoy sitting still and letting me stretch their heel cords because most adults wouldn’t either. Spectrum uses a creative approach to put children in a stretched position and encouraging strengthening those-now-weak muscle during play and functional activities.

Photo 1

Photo 2


October 25, 2016

What is Childhood Apraxia of Speech?

By: Krystina Burke, MS, CF-SLP
  • Childhood apraxia of speech (CAS) is a motor planning speech disorder.
  • Each child with CAS is unique. However, there are some signs and symptoms that are commonly seen amongst children with CAS.
  • A speech- language pathologist (SLP) who has knowledge and experience with CAS is the best person to evaluate and treat children with CAS.

Childhood apraxia of speech (CAS) is a motor speech disorder. This means the child has difficulty executing sequenced, timely, motor mouth movements during speech production. These difficulties are not related to muscle weakness but rather are the result of a breakdown in communication between the brain and the muscles of the mouth. This miscommunication often results in atypical, uncoordinated moments of the lips, jaw, and tongue. The exact cause of CAS is unknown. However, possible causes in some cases include genetic disorders or syndromes, stroke, or brain injury.

CAS is sometimes referred to as “developmental apraxia” which some believe children will just outgrow. It is important to note this is not true and intervention is needed in order to make progress. There is no cure for CAS, however, with appropriate therapy, significant progress can be made. The best way to see progress is to identify early signs and to seek the input of a professional who specializes in CAS.

Although each child is different and presents in different ways, there are some common signs/symptoms that are seen in children with CAS. A very young child may not coo or babble as an infant, may start speaking very late, and may have trouble combining sounds with long pauses between sounds. An older child may make inconsistent sound errors, may understand language much better than they can speak, and may appear to make groping movements with their mouth like they are “searching for their words”.

In addition, children who have CAS may have difficulties with eating, fine motor movements and coordination, and difficulty learning to read, spell, or write.

A speech-language pathologist (SLP) who has knowledge and experience with CAS is the best person to assess and treat a child with CAS. An SLP will conduct an oral-motor assessment, a melody of speech assessment, and a speech sound production assessment. Once a child has been diagnosed with CAS, different treatment options exist. Research has shown that frequent, consistent, therapy has been very successful with children with CAS. The focus of therapy should include improving the planning, sequencing, and coordination of the muscle movements of the mouth during speech. Some additional programs that integrate tactile cueing such as PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) and DTTC (Dynamic Temporal and Tactile Cueing) are also commonly used to support children with CAS in therapy.



October 18, 2016

Breaking Down Language: 3 Part Series

By: Brianna Craite, MS, CCC-SLP
  • As a specialist in speech and language I find myself explaining many terms to parents.
  • Expressive language and receptive language are two key terms used a lot when discussing childhood development.
  • Your doctors at yearly checkups, family members, or your kids’ teachers may use these terms with you and expect you to know what they mean.

I will be breaking down the basics of expressive language below by providing some definitions and explanations for you to mull over before the series continues. Language can be broken into two main parts: expressive language and receptive language. To keep it simple: expressive is how you express yourself and receptive is how you listen. That is way too easy though, right? Right.

Let’s break down expressive language even more:

Expressive language development starts when we are babies. We learn to watch and listen to the environment around us using our basic sight and hearing senses. We communicate basic messages like “I’m hungry” using cries and gross motor movements like kicking. Eventually we grow to use gestures like pointing to point out a cup or apple to communicate the same “I’m hungry” message. Next, we start to use sounds or a single word by copying what another speaker says. Adult says “apple” child repeats “ahhh” or “apple” to communicate the message “I’m hungry, I want an apple”. Then a child begins to use single words on their own “Apple!” following soon by pairing words together “want apple” or “mommy apple!” This is how we learn to use words.

Expressive language also includes non-verbal characteristics that are equally as important as “using words”. Eye contact is a main characteristic that impacts our ability to interact with others. To use words or gestures to communicate a message, eye contact is important to tell the other person “Hey, I’m talking to you!” It also lets another person know you are focused and paying attention to them. Non-verbal communication also includes body language, facial expressions, and tone of voice. Those are all ways we also express ourselves without “using words”.

When we use non-verbal language in addition to words it gives us the ability to send a clear message to another person. Later on in this series, you’ll get some tips on how to improve both using words and non-verbal communication in case your child is having some trouble with one or both of those areas.

Stay tuned for the next post all about receptive language!

Source 1

Source 2

Photo 1

Photo 2

September 21, 2016

Hearing Screenings: What are they and why are they important?

By: Jamie Hinchey, MS, CCC-SLP
  • Research has shown that detection and intervention for hearing loss prior to six months of age results in significantly better outcomes than intervention after six months of age.
  • There are many important signs to look for in children who may have a hearing loss
  • Early detection is crucial in order to provide the most effective intervention as soon as possible

Recent data from the Centers for Disease Control and Prevention (CDC) shows that five out of every 1,000 children have a hearing loss. Within recent years, most hospitals have started to require newborn hearing screenings as part of the routine immediately following birth. If children fail this newborn hearing screening, that does not mean that the baby has a hearing loss. Infants are followed and given a second screening to confirm the results. This early detection is so important since hearing loss can have an impact on overall language development. As toddlers continue to grow, here are a few signs to look for that could possibly implicate a potential hearing loss.

  1. Lack of attention to any sounds: This includes music, parents talking to child, loud noises within the home, songs from mobiles
  2. Does not respond to name when called: This skill should start to emerge around 7 months, therefore look for this between 7 months-1 year old as your child should start to turn to their name
  3. Does not follow simple directions: As your toddler grows, they will start to be expected to follow basic directions (“Come here”, “Get the ball”). This may be a sign of a true language delay, but it is important to rule out hearing loss.
  4. Shows overall delays in speech and language development


As your child continues to grow, older children are also monitored throughout the year for their hearing. This is typically done through their schools periodically using a pure-tone test. If your child fails this hearing screening, it may be recommended that you follow up with an audiologist for a full hearing evaluation.

As a therapist, it is essential that hearing loss is ruled out as a possibility as to why your child may be exhibiting these signs. It is important that parents are educated on what to look for starting at birth for potential hearing loss. Often times, parents will express concerns with an overall language delay that includes using words as well as following directions. At Spectrum Pediatrics, we will always ask about the child’s hearing prior to completing a full speech and language evaluation. If a child fails a hearing screening, a full audiological evaluation is typically recommended with an audiologist. Speech-language pathologists and audiologists work very closely with each other to provide the most effective treatment.

If you have any other questions regarding your child’s hearing or next steps check out these helpful websites from the American Speech and Hearing Association:

Source 1

Source 2


Photo 2

September 15, 2016

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

Calming Sensory Strategies for Bedtime

Some children have difficulty falling asleep at night. This can be stressful for the child as well as the caregivers involved with the bedtime routine. There are a few sensory strategies that may be helpful for calming your child before or during their bedroom routine. As an occupational therapist I often talk about proprioception and vestibular processing. Deep pressure and rhythmic, slow input such as rocking helps people gather information about their environment while in a stressful situation. Neurologically, these movements are calming and soothing. These can be difficult terms to understand so here is how I typically explain this vocabulary to parents:

Proprioception: The sensation that orients us to our surroundings and lets us know how heavy things are. These receptors are in our joints, connective tissue and muscles.

Vestibular processing: The receptors in our inner ear that provide us the sensation helps us understand movement.

Here are a few proprioceptive and vestibular sensory-based strategies that can help a child calm down at night during their bedroom routine:

1. Hugs and snuggles are a natural deep pressure sensory strategies.

2. Use a weighted blanket. The increased weight provides more proprioceptive input.

3. Allow the child to sit or be rocked in a rocking chair.

4. Use a cuddle swing or a hammock to provide extra proprioceptive input.

5. Engage in joint compression activities right before bedtime such as: yoga poses (downward dog), hanging from monkey bars, somersaults, and other weight bearing activities.

6. Wrap the child up like a burrito.

Hopefully these strategies help calm your child during their bedroom routine! Sweet dreams!



September 15, 2016

“Low Tone”: What does it mean?

By: Colleen Donley, PT, DPT
  • Low muscle tone is a widely-used term but is not always explained fully to parents.
  • Low muscle tone does not mean weakness.
  • We cannot change a child’s muscle tone but we can help them grow stronger.

We hear pediatricians, therapists, and other parents toss around the word “low tone.” But do we really know what that means and its implications? Interestingly enough, there is no standard definition or diagnostic criteria to qualify someone as low tone. Muscle tone is defined as “resistance to passive stretch while the patient is attempting to maintain a relaxed state of muscle activity.” Common words I hear or sometimes use with parents to help explain low muscle tone include: floppy, loose, flexible, and soft. I have also likened low tone to a stuffed animal- Think of the “muscles” in a teddy bear that are not constantly firing at a resting state so the bear must work harder to make the muscles move.

Unfortunately, there is no true diagnostic criteria for low muscle tone. We often hear a child described as being low tone based on qualitative assessment and how they are presenting. A recent survey of physical therapists and occupational therapists came to a consensus of 7 characteristics that often are related to low muscle tone.

1. Decreased strength                                    5. Leaning on supports
2. Hypermobile joints                                     6. Delayed motor skills
3. Increased muscle flexibility                    7. Decreased activity tolerance
4. Rounded shoulders

Many times, we see that kiddos who are delayed in their gross motor development have low muscle tone. But the reverse is certainly not true…having low muscle tone does not by any means lump a child into the category of having delayed motor skills. Kiddos with low muscle tone have to work harder to move for a variety of reasons- their muscles have to work harder to get stronger, they might have poor position sense due to their joints being hypermobile, and they might fatigue easier since they have poorer activity tolerance. While we cannot change a child’s muscle tone, increasing muscle strength will help compensate for the low muscle tone.