Changing Colors: The Blog of Spectrum Pediatrics

June 30, 2017

Summertime Motor Fun!

By: Colleen Donley, PT, DPT

As the temperatures are rising and the days are getting longer, summer is just around the corner. After being cooped up inside all winter, I love to take advantage of nice weather and getting outside during my therapy sessions. Below are some of my most favorite summer games to foster motor development across many ages and stages:

Sidewalk Chalk

Chalk can be used with kids of all ages to address different motor skills. I love incorporating fine motor skills in with gross motor activities and sidewalk chalk is a perfect way to do that. For a toddler working on moving backwards, balance, and different locomotor movements- see who can draw the longest snake by squatting down and walking backwards while drawing a squiggly snake on the ground. Once you get to the end of the snake, you can walk or tip toe along the snake back to the beginning like walking on a balance beam. Or you can practice jumping forwards and backwards over the super scary snakes!

Water Guns

These plunger guns are great at developing shoulder strength and coordination to fill them up each time. And then think of the fun they will have chasing parents, siblings, and friends around while using different arm muscles to shoot the water and cool down on a hot summer day!

Sponge Toss

Often times, we forget we have to help our kids learn how to catch and throw. Try soaking big, squishy sponges in water buckets and play catch. It keeps everyone cool while the kiddos work on pre-ball skills. I like the use the words “catching hands” or “pinkies together” to help little ones learn how to hold their hands out and open when getting ready to catch. I work with kiddos on different throwing motions when tossing sponges: two hands overhand, one-hand underhand, one-hand overhand, or tossing it up high then catch.

Beach Trips

The beach offers great benefits for a growing toddler! You can go on a treasure hunt for the best-looking seashell. Be sure to let you child go barefoot to get the sensory experience of sand in their toes and encourage them to carry the bucket as it gets heavier with all their treasures. They can help build the biggest sandcastle on the beach that day by carrying buckets full of water, digging up sand, and dumping out buckets of sand or water.

 

Bikes and Scooter Rides

Head to any local playground blacktop or quiet, open street with ample open space with your favorite bicycle, balance bike, or scooter. All of these help teach postural control and coordination to stay upright. Bicycles work on great bilateral coordination to move the pedals. Balance bikes are great choices for younger kids who have difficulty with pedals but still works on the postural control and balance. Scooters are a great choice to address single leg balance and leg strength as a child has to push off the ground with a foot to move forward.

Enjoy a moving and busy summer!

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June 14, 2017

Feeding Friday: Tube-Free Superstar Piper

Piper is a twin who was born at 27 weeks weighing 1 lb. 5 oz. Piper had many medical complications during her stay in the NICU.  A G-tube was placed prior to heading home from the NICU after a 4 month stay. While at home, Piper was on continuous feeds and continued to refuse the bottle. Although Piper underwent swallow studies which showed that she was safe to swallow liquids, Piper continued to refuse the bottle. While at home, Piper was not tolerating the tube feeds well and her parents felt she was always suffering from reflux or throwing up her feds. As Piper continued to make progress in other areas of development after leaving the NICU, she continued to refuse any oral feedings. Piper would push away the bottle and become upset when her parents would attempt to feed her. Piper’s parents expressed constant concern with the negative consequences of tube feeding including vomiting, movement limitations as she was developing, and chronic discomfort. Despite Piper’s continued development in other areas, Piper’s oral intake continued to decrease.

Piper’s family contacted Spectrum and treatment started in Virginia location when Piper was 9 months old. On the first day of treatment, the focus was on establishing Piper’s relationship with food and working with Piper’s family on offering food or liquids without forcing. Piper showed interest in yogurt and immediately showed her independent side! Piper loved to drink from her pouches and any cup that she saw her parents using! Piper immediately wanted to try out some solid foods, as this allowed her to be independent. She was picking up puffs and attempting to eat all on her own. Piper eventually started to show interest in yogurt and oatmeal for breakfast!

Piper now loves to sit at the table with her twin sister in her booster seat! She loves putting her cup in the circle of the tray and also occasionally likes to throw the cup. Piper loves milk and pretty much all fruit and veggies (especially cucumbers). She loves to eat buttermilk biscuits! Piper’s parents are so proud of her and should be! Piper has come so far in the past year and we are SO happy to say she is our new tube-free superstar!

 

June 14, 2017

Ways to Beat the Heat

By: Krystina Burke, MS, CCC-SLP

Summer is here! It’s time to pull out the sprinkler, put on the sun screen, and enjoy time in the hot sun with your little ones! Achieving proper hydration is always important for young children, especially during hot summer months! When it is hot out, it is important to have your child drink more often throughout the day. If you know your child is going to be outside in the sun for a an extended period of time or will be participating in physical activities, offer them extra fluids beforehand to drink. In addition, it is recommended that children take a break about every 20 minutes during increased physical activity to hydrate.

If a child does not drink enough liquids, they may become dehydrated. Some signs of dehydration include: dry mouth, few or no tears, less wet diapers or decreased urination, a darkening in urination color, and drowsiness. It is important to contact your medical team if you become concerned regarding your child’s hydration level or state.

In addition to offering fluids before outdoor activities and taking frequent drinking breaks, incorporating liquid filled summer snacks and treats is a great way to increase hydration levels in small children during hot months. Fruits like watermelon, melons, and peaches are full of liquids and can be a great choice for a sweet refreshing snack. You may also try blending your favorite fruits, frozen fruits, ice, and water and freezing this mixture in popsicle molds for a cold and healthy summertime treat!

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May 17, 2017

Why the Push for Tummy Time?

By: Colleen Donley, PT, DPT

Often as physical therapists, we push and push for tummy time. We work with families on how to make tummy time easier. We help parents figure out how to fit tummy time into their schedule, while hitting the recommended amount of tummy time. Lastly, we educate parents and caregivers on the reasons tummy time is essential to development.

Back in the early 1990s, The American Academy of Pediatrics advised parents to adhere to the Back to Sleep program to reduce the risk of Sudden Infant Death Syndrome (SIDS). Following this start of this suggestion, there was a significant decrease in the incidence of SIDS. However, doctors and therapists have seen a rise in developmental delays, torticollis (twisted, tight neck), and plagiocephaly (flat head syndrome) since babies were spending more time on their backs and less time on their tummies. We now recommend Back to Sleep, Tummy to Play!

Tummy time is essential to integrate primitive reflexes, develop muscle strength throughout the trunk, and begin to experiment with early movement.

Integrate Primitive Reflexes

Initially, a newborn is curled in a ball because of the “primitive flexion” present at birth. Think the “fetal position” or how the newborn was curled up in the womb. Spending time on the tummy helps break up this flexion tone by providing deep input from weight bearing. This input helps relax the muscle tone of this primitive flexion and allows the baby to spread out their limbs and begin to extend through their neck and back muscles. As the flexion muscle tone continues to relax and fade, baby will begin to move their arms and legs separate of one another.

Develop Strength

When lying on their tummy, babies have to use the muscles neck and back to hold their head up or turn their head to look at parents or toys. This is the key to developing head control early on. As the baby gets stronger during tummy time, they will push up their elbows or arms and begin to hold the chest up. This weight bearing thru the arms will help develop proximal stability to hold the shoulder blade on the back. This is necessary for the baby to begin to bear weight thru one arm at a time to crawl.

Explore with Movement

As the baby gets stronger on their tummy and those muscles begin to relax, they will begin to move their arms and legs. They will continue to experiment with his movement and learn how to roll off their tummy to their back or to move towards a toy. The movement and exploration continues as they start to push up on straight arms and reach for toys. You might see they begin to kick or push their feet. As they learn to combine this reach and kick movements, they will begin to move forward in a belly crawling motion!

Tummy time should start as soon as you come home from the hospital with baby. Start off with small bursts, such as 1-2 minutes, throughout the day. Some parents find it easy to remember to fit in tummy time by making it a part of the routine after each diaper change. Gradually work up to a 60-90 minutes spread out over several increments by the time baby is 3 months old. By the time baby is 4 months old, they should enjoy tummy time since they now have full head control and push up on their elbows to play with toys. Around this time, you might see that baby sees tummy time as play time and nor work time.

Check out some of our other resources about tummy time here:

Making it Easier

Using a Boppy Pillow

Tummy Time Tips Video

May 8, 2017

Safe Sleeping Positions

By: Colleen Donley, PT, DPT

In October 2016, the American Academy of Pediatrics released new sleep guidelines for children up to 1 year of age. Our SLP, Tracy, summarized those suggested guidelines here.

As a physical therapist, I often work with families on safe and appropriate positioning for play and sleep. Frequently, I run into positions that may be unsafe, or safe but position baby improperly. Unsafe positions often put the baby at an increased risk of harm or Sudden Infant Death Syndrome (SIDS). Other positions may be considered safe as they adhere to AAP guidelines but baby’s head or body may be placed in a position that puts them at risk for other developmental issues. Here are some of the most commonly used undesired sleep positions:

  • Tummy: We always want to remember back to sleep and tummy to play. Tummy time is appropriate for playtime and a wonderful activity for baby to develop strength and motor skills. It is always recommended that you put baby to sleep by placing them on their back. Once baby learns how to roll, they may roll in their sleep from back to tummy and tummy to back. Many experts feel that once your baby has learned to roll, it is safe for them to sleep on their tummies but they still recommend starting sleep on their backs.
  • Bumpers in the crib: Bumpers serve as the purpose to protect the baby from getting their little hands or feet stuck in between the crib rails and cushioning the head should baby roll into the crib side in their sleep. AAP recommends babies should be placed to sleep on a firm crib mattress with no soft bedding or stuffed animals. Bumpers pose a serious risk of suffocation should baby roll into them or get pinned against them in their sleep.
  • Car seat: Riding in the car can be very soothing for baby and often a trick parents use to help get a fussy baby to sleep. Sleeping in a car seat poses a similar risk to sleeping on the tummy. If the baby’s head flops down, it could get pinned against the side of the car seat and put the baby at risk for suffocation. Additionally, prolonged positioning in the car seat creates uneven pressure on baby’s head, especially if this is where they sleep and their head falls to one side. Uneven pressure and the head dropping down to one side can lead to plagiocephaly (flat head syndrome) or torticollis (tight neck muscles on one side).
  • Rock ‘n Play: The Rock ‘n Play is widely popular in the world of baby gear must-haves. The Rock ‘n Play places the baby in a semi-reclined position, which goes against the firm, flat surface recommended as a safe way to reduce the risk of SIDS. Additionally, it allows gravity to help pull baby in their most preferred position, exacerbating slight preferences to one side. This can cause or exacerbate torticollis. The soft surface of the Rock ‘n Play makes it harder for the baby to move their head out of a certain position, which allows pressure to remain in a focused spot for longer periods of time. This is often why physical therapists see plagiocephaly associated with prolonged positioning in these soft sleepers.

Remember, it is always best to ask your pediatrician questions or share concerns about sleep positions. Your pediatrician will work with you to educate you on safe sleeping and determine what is best for your baby and family.

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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 25, 2017

Feeding Friday: Tube-Free Superstar Carlin

Carlin was born with a syndrome called CHARGE syndrome.  Kids with CHARGE can have a number of difficulties, including vision, hearing and heart problems.  Carlin also aspirated food and drink into his lungs making it unsafe for him to drink, so he got a feeding tube at 5 weeks old.  When he was 6 months old he could begin to take baby food purees safely, and at a year, he was finally able to drink liquids without it going into his lungs.  Unfortunately, all of the medical procedures and the inability to practice eating safely and positively had resulted in a feeding aversion.  In Carlin’s view, food was scary and frightening.  He would eat some bites of yogurt if he was distracted, but he didn’t like to drink, and his mother had to work very hard to get him to take anything at all.  His parents did everything the doctors and therapists suggested, but he made little progress in his intake.

Carlin’s family contacted Spectrum, and treatment started in the Virginia location when he was 18 months old.  On the first day of treatment, the focus was on offering food without forcing or bribing.  Once Carlin was able to initiate tastes himself, he actually swallowed a little bit more than when he was being rewarded or bribed.  By day 4, he was asking for milk and drinking up to 4 oz of at a time.  At first, most or all of the solid foods he tasted came back out of his mouth, but slowly more of each bite stayed in.  By day 6, he was using his fingers to help keep the food in his mouth and his skills got better, but he still often needed to have his shirt changed after a meal.  By day 7, he was taking enough so that he could discontinue tube use.  He sat up straighter at the table, and began putting two words together more consistently in his speech.  In the next week, his skills continued to improve.  He was willing to try most solids, and all of the foods were now staying in his mouth.   His mother commented that in a restaurant they could order him something from the menu, and didn’t need to worry about all of the food falling out of his mouth and making a mess all over the floor.

Carlin was able to have the tube taken out 10.5 weeks after the 10 day intensive treatment.  He loves to eat and will eat almost anything now.  Carlin is definitely a tube-free Superstar!

 

April 24, 2017

Exact Instructions Challenge

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

I recently saw this video on social media, and it really spoke to my “SLP” heart! We don’t often think about how we use language and the importance of the words we use. This dad created a fun game for his kids to practice sequencing, using concept words, like “First, Then, in, on top of,” etc. Watch the video to see how these kids learn the importance of the vocabulary that they use.

You can do this in your own house with your kids to work on prepositions (in, on top, next to, under), time words (First, Then, Last), and other descriptors (color words, long/short, big/small, etc.). Here are some ideas to practice sequencing in your home with this family challenge!

1. How to tie your shoes

2. How to ride a bike/scooter

3. How to put on your jacket

 

April 21, 2017

Mealtime Stress: When Professional Opinions are Conflicting

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

What happens if the medical team disagrees with you or with each other. This can sometimes feel like families are being bullied into believing one person or another, or into doubting their own beliefs and knowledge about their child. Many people report that dealing with conflicting medical opinions add a considerable amount of stress. We know that stress can derail mealtime progress considerably, so it isn’t surprising to find that any doubts and pressures from the medical team can show up and take a seat at the table, resulting in even greater stress.

Here are a few things to consider:

  • Have they considered the facts? Many people, even professionals, have an emotional response to novel approaches then look for the facts to back them up. Feeding has an additional layer of emotion that makes it difficult to separate feelings from facts. However, once them emotion is addressed, it is almost always helpful to address medical professionals factually, rather than emotionally.
  • * Do they need a paradigm shift? This can be true in many areas, but there is a particular need for a change in perspective regarding feeding tubes. Many medical providers view them as a positive factor, or at the worst a “neutral” factor in child development. However, that is far from the truth. It is true that they can start as a positive, but they can often become a negative.
  • Is this their area of expertise? The gastroenterologist specializes in the GI system, but isn’t really trained in feeding development, swallowing, or how to progress in feeding therapy. Pediatricians likely get a two hour lecture during their training about nutrition, and even less about feeding therapy.
  • Do they feel that they have failed?: Professionals are also people. When patients seek other input, it can feel like they have failed, making it difficult to separate emotion from facts.
  • Do they offer this service? Everyone has a lens through which they view information. Many big hospitals believe that their programs and personnel are the best. If they offer this service themselves, asking for them to refer out is actually a conflict of interest, or at least a conflict of philosophy.

Once you realize the direction of their hesitation, it may help you to prepare for the most positive interaction. Here are a few more general tips:

  • Remember that most medical providers want to help. Come to them and state clearly that pressure from any direction will have a negative impact on eating. Ask for their support in decreasing pressure around food and in strengths-based care. See our previous post on how to build a medical team!
  • Bring your own team to the appointment – If you are fearful that you will be entering into a confrontation with a medical bully, it is almost always helpful to bring someone with you. Both parents making a united front can help the conversation stay on task and become less emotional
  • Send advance information: Find out the best way to get your question or findings to the provider in advance of the appointment.
  • Try to remain positive and factual, and tell them specifically what you would like their input to be. For example, “Because we have made no progress with traditional treatment, we have decided to that we are pursuing this for our child and would like some parameters to ensure that we are being safe” Or you could try saying something like, “We have been successful with our treatment so far, but would like some help with monitoring future progress. We hope that together we can minimize the stress about weight, which will allow him to develop and grow on his own.”

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April 13, 2017

Mealtime Stress: Adding Fuel to the Fire

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

When you have a child with a feeding problem, it can be very difficult to find people who understand how tough it is, and how pervasive the fear and pressure can be. It is tempting to talk about the problem you are having with everyone around, in hopes of finding someone who can help. However, we have found that there are some people who can make the problem worse instead of better. We have also added a few strategies or phrases on how to handle some of these personalities to avoid increased stress.

Well-meaning friends and family: People who are genuinely concerned, but keep asking about how the feeding is going can unintentionally increase stress levels around parenting a child who struggles with eating. Whether the questions induce guilt, anger, frustration, or just fatigue, these emotions will not be helpful if added to your own stress.

  • Re-direct the conversation to other topics.
  • If you do have a “safe” person in the family, you may talk to them about being a go-between so that the rest of the family can stay updated, without interfering.
  • Have an honest conversation with the person or people that you need to take a break from thinking and talking about eating: “This is a tough time for us, it helps me to take a break from talking about it so much.”
  • Reassure them that you are seeing help: “I appreciate your concern, we are working through this with our feeding team.”

Fellow worriers: People who may not add negative emotions, but are more than happy to worry with you. If you know someone is prone to worrying, it won’t be helpful to bring up your concerns to them.

  • Avoid going to eat or feeding your child when they are around
  • Tell them you are struggling with worry around your child’s eating, and ask them to help you re-direct your own thoughts when you become too anxious: “I know I worry too much. Can you help me practice re-directing my thoughts?”

Bullies: People who make negative comments about eating or feeding, or your approach to either one. It can be unintentional, but often has an element of superiority. It can be from people who feel strongly about topics such as parenting, nutrition, breastfeeding, feeding or discipline

  • It rarely seems helpful to argue, as bullies usually don’t have an interest in meaningful dialogue. Their main concern seems to be making sure that you understand their approach and why they believe they are right.
  • If possible, avoid interaction with them, especially around feeding.
  • Be prepared to tactfully change the topic.
  • Remember the truth about what you believe so they gain less emotional leverage over you.
  • You may say that you appreciate their input, but that they don’t have the full story or you have differing philosophies: “I’m glad that worked for you, but we find that those strategies actually didn’t work in our house.”
  • Sometimes a neutral, factual comment can help: “That’s interesting, because there is a lot of research that shows that adult pressure around mealtimes can actually make food struggles worse, instead of better.”

Stay tuned for next week’s post on what to do when the bully is part of the medical team!

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