Boom, Bang, Chirp: the Sounds of Summer and the Auditory System

Summertime is filled with distinct noises, like that of a fire engine in the Fourth of July parade, fireworks exploding in the sky, or the steady hum of crickets chirping in the yard. For some children, these sounds can be quite stressful. Like the other sensory systems (touch, taste, smell, sight, etc), your child’s sense of hearing, or their auditory system, takes in information, processes it, and produces an external response. Sometimes, this information isn’t processed correctly. In these cases, your child may demonstrate hypersensitivity or hyposensitivity to sound, and those fun summertime activities become a source of anxiety for your little one.

What is hypersensitivity?
If your child seems to overreact to everyday sounds or seems easily distracted by noise that you are able to tune out, she is demonstrating auditory hypersensitivity. Your child may experience an intense fear of mechanical items with “whirring” sounds, such as vacuum cleaners, hand dryers or flushing toilets in public restrooms, blender, hairdryer, and coffee grinder. She may overreact to unexpected sounds by covering her ears or crying. She may seem to be overly tuned in to background noise in the environment, such as the fan spinning or the clock ticking.

What is hyposensitivity?
If your child seems to enjoy loud noises in his environment, demonstrates difficulty figuring out where a sound is coming from (localizing), and/or has difficulty figuring out what a sound is (distinguishing), he is demonstrating auditory hyposensitivity. Your child may constantly create noises with his mouth throughout the day. He may prefer to keep the television very loud, but become upset when others speak loudly. He may have difficulty hearing and responding when his name is called, especially from another room.

What causes these kinds of sensory auditory dysfunction?
The stapedius is a middle ear muscle that contracts in response to loud noise in order to protect the small hair follicles on our inner ears. Scientists say that sensory-based auditory issues may be due to a poorly-functioning stapedius. The middle and inner ear muscle systems are also important in the function of other sensory structures, such as the vestibular system – which determines your child’s equilibrium and balance.

What can I do?
If your child is demonstrating some of the behaviors above, consider contacting one of our occupational therapists, who can provide your family with helpful tips and tricks to minimize distraction, utilize noise-cancelling items, work through difficult school-based tasks, and more! If your child is demonstrating difficulty with language interpretation, difficulty learning to read, and/or a speech delay that are accompanied with the symptoms listed above, he may be experiencing Auditory Processing Disorder (APD). APD is dysfunction in the brain’s ability to translate sounds. An audiologist can help identify the issue and provide suggestions for next steps.

Questions or concerns?
If you have questions or concerns about your child’s responses to noise, please contact us at info@playworkschicago.com or 773-332-9439.

Jen Brown, MS, OTR/L
Director of Occupational Therapy Services

Reference: Dodd, George. (2002). Distinguishing sound from noise- the significance of attention and noise sensitivity. The Journal of the Acoustical Society of America 112, 2243. 25 October 2002. https://doi.org/10.1121/1.4778910

Challenging Behaviors: Considering the What and Why

Throughout children’s lives, there may be periods of time where their behaviors seem to be challenging and difficult to manage. When looking at these behaviors, it is important to consider what purpose the behavior is serving and why the behavior is happening. While is it typical for young children to have tantrums and use occasional aggression, it becomes challenging when these behaviors are continued repeated patterns that:

  • Interfere with a child’s learning, development, and success
  • Interfere with a child’s ability to engage in positive interactions with peers and adults
  • Is harmful to the child, peers, or adults
  • Is overall challenging to manage

Examples of common challenging behaviors that are reported in young children include aggression (biting, hitting, pushing). In looking at these behaviors, it is important for caregivers to first look at the purposes of these behaviors. Is the child engaging in these behaviors to get a reaction (behavioral response) or are they trying to seek input to their bodies (sensory response)? Below are examples of the behaviors seen through both behavioral and sensory lenses:

After caregivers figure out the purposes of the behaviors, it is important to match the consequences accordingly. For example, if the concerns have a behavior response, the consequence should be behavior based. If the concerns have a sensory response, the consequence should be sensory based. Below are examples of consequences from each perspective.

It is important for the child’s caregivers (e.g. parents, teachers, nanny, etc.) to be on the same page when it comes to giving consequences. When children receive constant responses from all caregivers, the higher the changes are of the challenging behaviors decreasing.

Brittany Hill, MS, MSW, LCSW, DT
Licensed Clinical Social Worker
Developmental Therapist

The Benefits of Parent Involvement in Early Intervention

What is your role as a parent in your child’s therapy sessions?

As a parent of a child who is receiving Early Intervention services, you may wonder what your role is during your child’s therapy sessions. Will the therapist be working one-on-one with your child? Will you be observing the session? Or will you be actively participating?

Parents are key to the success of therapy, no matter the goals being targeted. As a parent your involvement and insight are essential for your child to make progress towards their developmental goals.  For this reason, it is recommended that parents take an active role in therapy sessions. Your child’s therapist will model and teach you strategies and techniques for achieving your child’s specific goals. These strategies can then be carried over into your child’s daily routines and activities. You will see the best outcomes when the strategies provided during therapy sessions are embedded into your child’s everyday routines, as this will provide your child with frequent and natural learning opportunities to practice the skills introduced.

Benefits of parent involvement:

  • Parents are a child’s first teacher and children will learn the most from the people who know them best!
  • Parents interact with their children everyday and offer frequent learning opportunities for their children.
  • Children generalize learned skills when they are embedded into every day routines, such as mealtime, bath time, bedtime, and play

The impact of ongoing parent involvement

As a parent you will be able to provide your child’s therapist with important information that will help with setting specific goals for therapy and how best to implement strategies for reaching those goals based on your family’s daily routines and activities. You will take an active role throughout the therapy process by reporting changes that you see in your child and subsequently working with your child’s therapist to determine what the next steps will be. As a parent you will be able to take the strategies provided during therapy sessions and incorporate them into your child’s every day activities, which will allow frequent learning opportunities for your child. You are your child’s first and best teacher and your involvement makes all the difference!

If you have any questions or concerns about joining your child’s therapy sessions, talk with your ongoing therapist to discuss a plan for getting involved. For further information on parent involvement, please contact us at info@playworkschicago.comor 773-332-9439.

Claire Kakenmaster, MS, CCC-SLP
Speech Language Pathologist

Photo Credit

Why is Play Important?

Play is a natural and important part of development that begins in early childhood. Children learn to connect with and understand their world through their play. Play contributes to cognitive, social-emotional, motor, and language growth in young children. Children learn through toys and people how to explore, discover, and play.

Sensory Exploration (3 to 6 months): A child explores an object texture by using their senses. They will put an object in their hands, mouth, or visually watching the object as a caregiver is displaying it to them. This is when a child is learning how to comprehend new experiences.

Relational Play (9 to 12 months): This is when a child use two different but related objects. For example, a child will bring a brush to a doll’s head.

Functional Play (12 to 15 months): This is when a child plays with an object according to how it works. For example, cups are for drinking or cars are for pushing.

Symbolic Play (15 to 18 months): A child is using an object for something else. For example, a child may use a block as a phone, or a straw as a toothbrush. A child can also use realistic props such as, pretend food to engage in symbolic play with realistic props.

Imaginative Play (24 to 30 months): This is when a child is starting to process their environment through play. For example, a child may act out a visit to the doctor’s office or pretend to have a birthday party.

The different stages of play help support the meeting of developmental milestones. Encouraging play in your child’s day will allow these play stages to naturally form. Playing and interacting with your child from the beginning of birth will help you encourage these developmental milestones to flourish. In each stage of play, children are learning how to interact with others in their environment. They are learning how to manipulate toys, move around the room to access activities they are interested in, how to problem solve, and how to share their ideas through communication. Play skills develop as a child develops. As a child’s understanding of the world and how it works develops so do their interests in toys and in social interactions with their caregivers and peers.

Rachel Weiser, MS, DT
Developmental Therapist

Resources:

http://pediatrics.aappublications.org/content/119/1/182

http://www.earlychildhoodnews.com/earlychildhood/article_view.aspx?ArticleID=240

https://www.naeyc.org/resources/topics/play

“My child drools A LOT. Is that normal?”

Everyone knows babies and toddlers drool, but is it possible that it’s too much? How much is too much? What does it mean if they drool excessively? These are all common questions for the families of our little ones who noticeably drool regularly.  There are times where drool is typical and times where it could be a potential red flag for something more concerning; discerning between the two is important for understanding your child’s development!

During the “teething years,” often beginning around six months of age, “a lot” of drool is expected as saliva is released from the mouth in an effort to soothe the baby’s or toddler’s gums as the teeth break through and keep the baby’s mouth healthy. There are no teeth to block the saliva stream at this point, which leaks from the mouth in the form of drool. This typically ends when children finish teething around two to three years of age. Drooling is also necessary for feeding and digestion as it begins to break down foods in the oral cavity and helps lubricate foods to prepare them for swallowing.

While drooling is part of a natural process, it becomes a concern after teething ends or if it is observed in excess, at which point it may be indicative of atypical development. It can sometimes indicate or be a symptom of feeding or swallowing disorders, decreased oral motor tone (hypotonia), decreased oral motor control and coordination, neurological impairment/disability (e.g. cerebral palsy, Down syndrome, childhood apraxia of speech, etc.), speech and language delays, fine motor difficulties (if drooling occurs during small tasks that require intense concentration), or even other health concerns (e.g. infections, sore throats, allergies, etc.).

Depending on the underlying cause(s) of your child’s drooling, an interdisciplinary team can assess and often help reduce the drooling of your child. After consulting with a physician to rule out any medical concerns, talking to a dentist may provide more insight to potential structural concerns and subsequent treatment options. For underlying neurological impairments, a team including, but not limited to, a physician, dentist, and speech-language pathologist may be able to provide ongoing treatment plans to address drooling and concurrent concerns. For decreased oral motor strength and control, a speech-language pathologist can often incorporate oral motor exercises into feeding therapy in order to improve muscle strength and movement of the oral structures in and around the mouth.  Oftentimes, drooling seen with speech and language delays may also decrease as the child’s awareness and control of oral motor functions increase. They can often benefit from speech and language therapy along with increased verbal and visual cues from caregivers and a speech-language pathologist.

If you have further concerns, contact your local physician, dentist, or speech-language pathologist to discuss if concerns are warranted, to identify potential underlying medical concerns, and to help develop a treatment plan.

Photo Credit

Therese Schmidt, MS, CCC-SLP
Speech-Language Pathologist

DO NOT TOUCH: Tactile Sensory Exploration

Messy play is an essential part of child development. Our sense of touch, or tactile processing, sends information to our brain about the properties of objects in our environment. Our tactile sense provides vital information skills such as body awareness, academic learning, motor planning, visual discrimination, and social skills. Children can discover and learn more about their world using their hands and feet, which can sometimes lead to getting dirty!

Your child may experience sensory over-responsivity, or observable behavior involving a quick or intense response to a sensory experience that others usually perceive as nonthreatening. This could include becoming upset during activities such as nail clipping, haircuts, bathing, and/or eating. When your child experiences sensory over-responsivity on their feet, you might have noticed them avoiding going barefoot in sand or grass. Helping integrate additional sensory-rich experiences into your child’s life can lead to more engagement and enjoyment with feeding, bathing, and most importantly, play!

Activities to encourage tactile sensory play with hands and feet:

Bubbles: simply having your child popping bubbles is a sensory experience for their hands (and feet!). To incorporate messy play with their feet, you can have your child “wait” until the bubbles hit the ground, and have them pop them by stepping or stomping onto them! This is a great warm-up activity to lead into more sensory-rich play experiences.

Sensory Bins: filling an empty storage bin with objects such as sand or dry beans and placing small toys inside to dig for and interact with provides a fun tactile sensory experience. For an additional sensory experience with the olfactory system, or smell, fill a sensory bin with coffee beans!

Finger Painting: Take away the paintbrushes and bring on the mess! Incorporate various textures into the paint, such as mixing sand into it. Allow your child to create pictures from both their hand and foot prints for an even sensory-filled experience!

Mess-Free Painting: for a tactile experience without the mess, all you will need is a large plastic bag, paint, and masking tape. Place a few drops of paint (multiple colors for a rainbow effect!) inside of the plastic bag and ensure it is sealed. Tape the plastic bag with paint onto a window and allow your child to use their finger to form shapes and pictures on the bag.

If your child dislikes washing their hands and/or dislikes bathing, you can try the following activities:

Wash Station: create a “wash station” in a Tupperware container, small storage bin, or even your sink for a car wash or pet wash with soapy water. This is a great tactile sensory activity for children who don’t enjoy the suds during bath time. Introducing the soapy on a smaller scale (and embedded in play!) will allow them to become more comfortable with the sensory experience.

Shaving Cream: This can be used on a table top or even in the bathtub to contain the mess and with both hands and feet! You can belt out Frozen and build a “snow man” with your child using the shaving cream. Additional Bonus: If you are also working on handwriting or letter formation, you can take off the pressure with pen and paper and practice in the shaving cream!

Water Painting: You can simply give your child a bowl of water and a paintbrush to paint the sidewalk, the fence, and better yet, their body. This activity incorporates the tactile sensory play with water and the feeling of the paintbrush on their skin.

If your child dislikes going to the beach and/or playing in the sandbox you can try the following activities:

Kinetic Sand: Kinetic Sand is available in many themes and variations that may interest your child such as, Frozen, glitter sand, construction zone with trucks, dinosaur fossils, and more! Kinetic Sand has a texture that nearly feels “wet” to the touch; however, it is not and is easily moldable. This is a great activity to incorporate the feet as well, such as making footprints in the sand!

Sugar Castles: using brown sugar is a sweet way to introduce the rough texture of sand! Incorporate measuring cups and popsicle sticks to build sugar castles. This is also a good opportunity to introduce feet into play if your child does not like to walk in the sand at the beach or in a sandbox.

Tips:
1. Start Small: introducing these experiences might be overwhelming, so starting in small amounts can make your child more comfortable to interact with them.
2. Get Out: taking these activities outdoors can alleviate any worries about making a mess inside the home in addition to experience the sensory-rich outdoors!
3. Bring Friends: If your child has a preferred stuffed animal or toy that also has hands and feet, have them tag along! Allowing your child to immerse their preferred toy into sensory play they might initially be hesitant about can be encouraging for them.
4. Join in On the Fun: There is nothing more encouraging or entertaining than your child seeing their caregiver act like a child themselves! Modeling the very play you wish for your child to engage in can be enticing enough for them to participate!

Reagan Lockwood, MOT, OTR/L
Occupational Therapist

Reference: Kranowitz, Carol Stock. (2005). The out-of-sync child: recognizing and coping with sensory processing disorder. New York: A Skylight Press Book/A Perigee Book.

Photo Credit: Sharon McCutcheon via Pexels

Sleep Success: Establishing Effective Bedtime Routines!

Sleep is the best regulation for your child! We need sleep each night to recharge our bodies and minds. Sleep is just as important as a balanced diet and physical activity, it affects our safety, as well as our memories, moods, behavior, and learning abilities. Establishing effective bedtime routines allow your child to develop self-soothing skills which they will benefit throughout their childhood and adult life.

Consistency is key! Children thrive from a structured and predictable routine they can anticipate. Decrease and remove all electronics before dinner to spend quality time with your child during their bedtime routine.

Try these bedtime tips to set your child up for sleep success:

  • Bath/Shower/ ”Tub Time”: After eating dinner, transition your child to a bath, get creative and try new things to make the bath enjoyable for you and your child (i.e. glowsticks, cups, or toys). A bath is a great way to end the day and allow your child relaxing sensory input. After the bath, you can apply your child’s favorite lotions, pajamas, and tooth brushing.
  • Books: Read new and favorite books WITHyour child each night. When reading stories, point to different objects and items on each page. Talk about the book and identify new items you see and explain what it is to your child. Ask your child questions about the book to increase your child’s cognitive skills and language development.
  • Set the Mood:
    • “Lovey”/Self-soother: If your child is still nursing or takes a bottle at night, use this as a great opportunity to bring your child’s “Lovey” with them on your lap, sing lullabies with your child, or talk to them.
    • Atmosphere: You know your child best! Does your child like to be swaddled, in a sleep sack, or do they not like to be covered with heavy blankets? Sleep occurs best in a colder room. Have the room dark with only a dim light on for reading and soft music playing or a natural white noise (e.g. fan). Sing lullabies with your child and tuck them in.

Sweet Dreams!

Kelly Scafidi, MSW, LCSW, DT
Licensed Clinical Social Worker
Developmental Therapist

Vestibular Sensitivities: When Car Rides, Swings, Slides, and Strollers Are a Struggle

What is the vestibular system?

The vestibular system refers to the nervous system’s mechanisms for registering and interpreting movement and relation to gravity. Structures in the inner ear (including hairs, crystals, fluids, and small organs) receive information about movement and balance to send to our brains to help us understand our relationship with gravity. The vestibular system is our body’s primary way to organize sensory information, so abnormalities in how we integrate this information can affect how we perceive information from all our other senses. Some children can’t get enough vestibular input, and actively seek out jumping, climbing, and swinging. Other children are hypersensitive to vestibular input and may become irritable, scared, or avoidant with simple activities such as being laid down for a diaper change or lifted in the air. For hypersensitive children, small amounts of movement may feel as exaggerated as riding a rollercoaster.

In severe cases, children with vestibular hypersensitivities may experience gravitational insecurity, characterized by emotional responses movements which are extremely disproportionate to a realistic possibility of falling. These children may avoid physical tasks, try to keep their feet on the ground, and become extremely upset with unexpected movements. Due to their unreliable relationship with gravity, their brains are wired to perform protective responses against the danger they perceive. These children may try to flee the situation, freeze and shut down, or fight and tantrum until the perceived danger subsides.

Children with vestibular sensitivities often have trouble tolerating the following activities:

  • Car Rides:In a moving car, your child’s eyes (and inner ears) send messages to his or her brain that imply a moving body. However, feedback from the proprioceptive (body in space) system tells the child that he or she is sitting still. This disagreement between the sensory systems can cause children to feel uncomfortable, dizzy, or motion sick. Try “dimming” the intensity of the visual input to the brain by having the child wear sunglasses in the car, helping the vestibular system feel more at ease. If your child’s feet dangle from the car seat, try building up the floor of the car with heavy books or a foot stool. Having the feet planted on the floor provides feedback to the child’s brain that he or she is grounded to one spot. Using a weighted lap pad or blanket in the car can additionally provide calming sensory feedback to the nervous system. Be sure to take plenty of breaks to stretch, move, and feel the feet on firm ground during longer car rides!
  • Stoller Rides: Hairs and fluids in the structure of the inner ear shift position with acceleration and deceleration, which provides intense vestibular stimulation. This starting and stopping is typical of stroller rides. However, the inner ear fluid stabilizes when speed is maintained. Initially, try pushing your child’s stroller at an even and steady pace, minimizing the number of times you start and stop moving. As your child becomes more accepting, try slowly increasing the number of gentle starts and stops per ride to build tolerance for vestibular changes.
  • Playing on Swings: Swinging provides changes in head position that create a variety of intense vestibular input to the inner ear structures. Children who are unable to tolerate swinging may feel left out or lonely at the park. Start by watching videos and reading books where children are enjoying swings, pointing out that swings can be fun! Feel free to sit on the swing and demonstrate gently swinging at the park. Never force your child on a swing. Instead, gently encourage the child to explore the swings with your emotional support. Going to the park at a low-traffic time may help your child feel more comfortable. Start with swings that are low to the ground and encourage your child to sit on the swing using his or her own feet to walk forwards or backwards any amount. Provide plenty of positive feedback as they try new and more brave explorations. Share your pride in the child’s success, but try not to exaggerate reactions of fear or surprise if he or she tries something unexpected.
  • Playing on Slides: For children with vestibular sensitivities, the mere thought of going to the park or using the slides can be anxiety provoking. You can ask your child’s OT to create a personalized story about going to the park, so your child knows what sensory experiences to expect. Start simple! Encourage your child just to be in the presence of a slide. Next, you can encourage the child to touch it by placing a preferred toy on the slide. Start exploring small “baby” slides before attempting big, bumpy, or spiral slides. Eventually, you and your child can sit on the slide together before sliding just a few inches to the bottom. Make sure these experiences are pleasant and reward baby steps with plenty of praise!

Natalie Machado, MS, OTR/L
Occupational Therapist

References:

Biel, L., & Peske, N. (2009). Raising a sensory smart child: The definitive handbook for helping your child with sensory processing issues. London, England: Penguin Books, Ltd.

Photo credit: Sarah Pflug via burst.shopify.com

How to Expand Your Child’s Play!

Play is highly correlated to your child’s cognitive and speech and language development and is a great way to bond with your little one! Many parents are challenged by how to play with their little one and get involved in their world. Not only is learning to play important, but equally important is the expansion of your little one’s play.

Some toddlers get “stuck” in wanting to play with a toy in only one or two ways. Toddlers who play with a toy in a limited number of ways are showing us that they do not quite understand the function or multiple functions of a toy. Take for example a child who only moves a car back and forth on a table. This little one is showing us they understand that the car can move, but they are not yet aware of all the other things we can do with that same car. We can drive the car up the couch, it can crash or fall, the car can get gas or a car wash, pick up pretend toys and animals, or take us to different places like the grocery store or to see friends and family.

Why Do We Want to Expand Play?

Expanded play shows us your little one’s expanded understanding of the world. Play allows adults to label and model actions that your child is completing, in turn, helping your child’s speech and language skills develop.

The higher levels of play your little one demonstrates, the more they understand their world and the more language they have. If a child is playing with an object in just one way, there is a limited amount of words we can use to talk about that play interaction. For example: Your little one hands you a ball. You could say: “Ball!” “Look, ball.” “Red ball.” “Big ball.” If your child throws a ball to you, you can add “Throw ball.” “Bounce!” “Go ball!” “My turn!” “Your turn” and so much more. By expanding from showing to playing, there are SO MANY more words we can use to support your little one’s vocabulary development!

Tips for Expanding Play:

  1. Get on your child’s level:Sit on the floor or at the table together so you are physically at the same level as your child. Being on the same level also increases your eye contact and is easier to share attention with your child.
  2. Follow their lead:If your kiddo is playing with a car, you play with a car too! Try finding another of the same toy so you each have a toy and you don’t have to take turns.
  3. Add ONE play idea at a time:Sometimes we get a little over-zealous showing our kids 50 different ways to do something—it can be overwhelming. Remember expanding play is a gradual process and each child learns at their own pace. Your little one might need you to show something once or they might need some more help to copy your play—that is okay. Start by adding ONE step. Your child shows you a ball. You roll the ball back to them. Once your child is imitating one action, show them something new (try bouncing the ball)!
  4. Keep your language simple: We want to say one word above what our child is saying. If your little one says, “Ball” add an action word to describe how you are playing: “Ball go!” “Bounce ball.” etc. If your little one isn’t saying anything yet, just label the object or the action, or even just make a silly sound (slurping if you’re playing with a pretend cup)!
  5. Don’t force it:If your little one is getting frustrated that you are changing their play, show them one more time and move on. We want to keep play fun, exciting, and enjoyable for both of you! If your little one abandons an activity, move with them or take a short break and join them later to play again.

For more info on play and play milestones, check out some of PlayWorks’ previous blog posts:

Play in speech and language therapy: http://playworkschicago.com/toddlers-speech-therapist-playing-child/

Toy guide for babies through toddlers: http://playworkschicago.com/toy-guide-babies-toddlers/

Jessie Delos Reyes, MA, CCC-SLP
Speech-Language Pathologist

Image: https://www.sheffield.ac.uk/news/nr/want-to-boost-your-toddlers-development-put-a-toy-chicken-on-your-head-1.485117

Feeding Milestones: 18 to 24 Months

This blog wraps up a three-part series on feeding development in infants and toddlers. The last group of milestones to be outlined are those for children aged 18 months to two years. Similar to the post below, the skills developed between 18 to 24 months are variable, and not as specific as the milestones met between birth to 12 months. Please contact your child’s speech-language pathologist if you have any concerns regarding feeding milestones.

We hope that by reading this three-part series, any concerns with your child’s feeding skills have been put to ease, or if concerns persist, you feel confident in asking questions. With that out of the way, you can focus on fun at mealtimes!

If you have questions or concerns about your child’s feeding development, feel free to contact us at info@playworkschicago.com or 773-332-9439.

Ana Thrall, M.S., CCC-SLP 
Speech-Language Pathologist