Changing Colors: The Blog of Spectrum Pediatrics

Archive for the ‘Occupational Therapy’ 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!

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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November 28, 2016

Tips and Tricks for Holiday Travel

By: Katie Hoelting, OTS (Supervised by: Ashley Glasser, MS, OTR/L)
  • Holiday travel is already stressful, but some children might find it particularly challenging.
  • Sensory processing is how we take in and react to various sensory information from our bodies and our environment.
  • There are ways to help kiddos who are particularly fidgety or distracted and ways to help those who are over-stimulated and need an escape.

The holidays can be a time of hustle and bustle for many families. All this activity can be overwhelming with schedule changes, lots of people, and unfamiliar environments. It is important to keep in mind your kiddos’ sensory needs as your family enjoys this special time of year. Sensory processing is the way a person receives sensory information from his/her environment, and how they react to this information. This can be how they register movement, sense their body in space, see, hear, taste, smell, and feel everything around them. This information is relayed from our senses to our brain and influences our actions and behaviors.

When a child is able to take in and understand the sensory information around them independently or with help, they can participate in activities, pay attention, remain calm, and focus. All people process sensory information differently, for example some people love the warmth of snuggling up close to the fire under a pile of grandma’s quilts, while others may find this stifling. This variability means we have to learn to read our kiddos’ cues for when they are feeling the need for different sensory experiences. Some of these can be distractibility, anxiety, fidgeting, aggression, and disengagement. Sensory experiences are so personal, and there is no exact science, so often solutions come from trial and error. As you plan for the holidays, here are a few things to keep in mind for those loved ones that may need special sensory attention.

Tricks for when your little ones may need more sensory input: Try to bring window clings to stick to car/plane windows. It may also be helpful to give kiddos’ tasks to be Mom and Dad’s little helper, which can give opportunities to move. Create a holiday themed scavenger hunt, or bring a squishy seat for your child to sit on to allow movement. Some children may benefit from leg support during long flights (book, stool) to know where their body is in space.

Tricks for when your little ones may need less sensory input:Bring noise canceling headphones/separate music or movie to listen to. It may be helpful to find a quiet place at host’s home for the child to go if they need a break. Parents have told us that they try to make a fort in the car or at the house for a fun opportunity to reduce bright lighting or loud noises. Position the child in an area of the room or plane that is quiet and less visually busy. Also, try to take a trip to the park early in the morning with only a couple family members, in order to allow playtime in a less overwhelming environment.

Tips to keep in mind when traveling:You may need to adjust the amount of legroom based on your child’s needs. Try to build in opportunities to move by planning stops along the way to sightsee or take a quick walk. Bring familiar toys, clothing, bedding, and snacks from home to keep the routine as consistent as possible. Lastly, plan clothing ahead of time for easy navigation through airport-security, especially if your child does not like to be barefoot or remove certain items.

Safe Travels!

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October 10, 2016

Handedness:Rightie or Leftie?

By: Ashley Glasser, MS, OTR/L, CEIM
  • Hand use typically follows a predictable pattern of development.
  • Most children have a hand preference by 3-4 years old and a hand dominance by 6 years old.
  • Don’t force a particular hand. Keep an eye out and gently encourage your child to use the hand they seem to be preferring.

Our hands – two of the most important tools we use to accomplish every day tasks. Dressing, brushing our teeth, eating, typing an email, or writing a note all require our hands (in combination with multiple other skills of course) to function well. We might use one hand or both hands together. We alter our grasp depending on the size of the object and the force needed. In short, our hands are incredibly sophisticated tools that have developed that complexity starting from an early age.

Hand skills tend to develop in a pretty orderly fashion. Babies progress from using their whole hand to pick up objects to being able to use a more precise fingertip grasp closer to the one-year mark. Just as grasp patterns develop over time, so does our hand dominance. Many parents become concerned when they notice their child using both hands to complete tasks. But rest assured, this is completely normal up until a certain age.

When children are infants it is expected that they use both sides of their body together. They will typically move both sides of their body in unison and reach for items with both hands at the same time. Eventually they start to reach with one hand as they learn that each side of their body can work separately from the other. However, it isn’t until a child is 3-4 years old that they typically start to demonstrate a stronger hand preference. Though they may still alternate which hand they use to complete fine motor tasks. By 6-years-old most children have established a hand dominance, though it may still be developing up until 8-years-old. So give them time! Place an object on the table in the middle of the child’s body and see which hand they reach with first to pick it up. Gently encourage a primary hand but don’t force it – it will come!

We do worry when a child’s development does not follow this typical pattern. Reach out to a therapist if your infant is only using one side of their body or if a child in elementary school is switching hands frequently without demonstrating any preference – such as several times in one task (remember, they may occasionally switch hands but they should be demonstrating at least a preference).

Fun fact: Did you know that 85-90% of people in Western countries are right-handed and 10-15% are left-handed?

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September 23, 2016

Trick of the Trade From Jamie Hinchey MS, CCC-SLP

Category Ball

This is a creative, fun way to work on both motor and language skills. At Spectrum Pediatrics, we use a volleyball with 10 small pieces of masking tape with various category labels such as foods, animals, or drinks. I use this category ball with different clients who are all working on different goals. This could be a great way to target gross motor and language skills at the same time such as throwing the ball to a partner and identifying items in a specific category. Children enjoy this game because it includes movement, which is always a good motivator! You could make this category ball with any type of ball around the house, including a soccer or basketball.

Depending on what your child is working on, you could choose which categories to put on the tape. I have also used this ball as a way to target asking questions. For example, if your hand lands on the “food” category when you catch it, you have to ask “Ms. Jamie, what is your favorite food?” This ball is able to target speech, language, and motor milestones in so many creative ways! The next time your child is looking for a fun activity, grab a ball and some masking tape!

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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!

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August 15, 2016

Baby Container Misconceptions

By: Colleen Donley, PT, DPT
  • Where can you safely put your baby when you need a moment to empty the dishwasher or fold laundry?
  • Exersaucers, jumperoo’s, and walkers can teach babies how to stand and take steps incorrectly.
  • Often times, little ones are too little for baby containers, which makes positioning even worse.

In exersaucers, jumperoos, and walkers, a little baby learns from a very early age to lean their trunk forward against the front of the bucket seat or to sit in the bucket seat. Both of those positions are not ideal because the child now has their feet either behind or in front of the hips, not under their hips for appropriate weight bearing. The child isn’t learning how to control their posture and develop balance appropriately. In addition to learning poor postural control, babies learns to put weight through their toes rather than flat feet since they are in front of or behind their body. Typically, babies sit with their hips opened, which can cause twisting at the top of of the hip or put force on the growing bones to encourage a bowing appearance.

Walkers pose a greater concern than exersacuers and jumperoos because your child is learning to stand inappropriately and move their feet incorrectly. In order to make the walker go forward and fast, baby learns to simply lean forward and then move their feet along with the movement. They also will lean from side to side to shift their weight and take a “step” so they appear to shuffle when out of the walker. When a little one has grown accustomed to sitting in the bucket seat, they tend to have extra flexion in their hips and knees as the step forward. A final note on walkers, walkers pose a significant safety concern to our little ones. The American Academy of Pediatrics has called for a ban to the manufacture of all walkers with wheels and the US Consumer Product and Safety Commission has issued a warning discouraging parents from using these walkers due to such serious safety concerns. Infants have been found to be at an increased risk for fracture when using a walker, especially a skull fracture. Other potential injuries include burns, falls, poisoning, and drowning.

There are many great alternatives to these containers so babies can stay safe, but in a good position for motor development, such as baby play yards in your living room or a pack n play. Putting your little one in these containers when you’re in a bind or really just need a moment does not make you a bad parent. The American Physical Therapy Association’s Section on Pediatrics recommends limiting use of commercial baby containers to 10-20 minutes per day. This is not a lot of time so that is why finding an alternative is so necessary. At the end of the day, being down on the floor and learning how to move is the best position for baby!

For more information, visit Colleen Donley’s blog here!

Click here to learn more about creative ways to have your baby on the floor!

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