Fine Motor Skills: Is your Child Falling Behind?

Fine motor coordination is the capacity of the small muscles of the upper body to allow for controlled movements of the fingers and hands. They include the ability to hold a writing utensil, eat with a fork, open containers, and fasten clothing.  These small movements correspond with larger muscles such as the shoulder girdle, back, and core to provide stability for gross motor functioning and with the eyes for hand-eye coordination. Weaknesses in fine motor skills are often the result of poor hand strength and poor motor coordination.

Fine Motor Red Flags in School-Aged Children

As a former Kindergarten teacher, at the start of each school year, I welcomed an array of children in my classroom with a variety of fine motor skillsets.  Since children have such varying preschool experiences, generally, their skills will vary based on the activities to which they have been exposed. If a child has had the opportunity to practice cutting with scissors, for example, he or she will likely be able to accomplish snipping a piece of paper by 2.5. Fine motor development occurs at an irregular pace, but follows a step-by-step progression and builds onto previously acquired skills. By the approximate ages listed below, your child should be able to demonstrate these skills:

2 to 2.5 Years

  • Puts on and takes off socks and shoes
  • Can use a spoon by himself, keeping it upright
  • Draws a vertical line when given a visual example or after an adult demonstrates
  • Holds crayon with fingers, not fist

2.5 to 3 Years

  • Builds a tower of blocks
  • Draws horizontal & vertical lines when given a visual example or after an adult demonstrates
  • Unscrews a lid from a jar
  • Snips paper with scissors
  • Able to string large beads
  • Drinks from an open cup with two hands, may spill occasionally

3 to 3.5 Years

  • Can get himself dressed & undressed independently, still needs help with buttons, may confuse front/back of clothes and right/left shoe
  • Draws a circle when given a visual example or after an adult demonstrates
  • Can feed himself solid foods with little to no spilling, using a spoon or fork
  • Drinks from an open cup with one hand
  • Cuts 8x11” paper in half with scissors

3.5 to 4 Years

  • Can pour water from a half-filled pitcher
  • Able to string small beads
  • Uses a “tripod” grasp (thumb and tips of first two fingers) to draw, but moves forearm and wrist as a unit
  • Uses fork or spoon to scoop food away from self and maneuver to mouth without using other hand to help food onto fork/spoon

4 to 4.5 Years

  • Maneuvers scissors to cut both straight and curved lines
  • Manages zippers and snaps independently, buttons and unbuttons with minimal assistance
  • Draws and copies a square and a cross
  • Uses a “tripod” grasp (thumb and tips of first two fingers) to draw, but begins to move hand independently from forearm
  • Writes first name with or without visual example

4.5 to 5 Years

  • Can feed himself soup with little to no spilling
  • Folds paper in half with edges meeting
  • Puts key in a lock and opens it

5 to 6 Years

  • Can get dressed completely independently, including buttons and snaps, able to tie shoelaces
  • Cuts square, triangle, circle, and simple pictures with scissors
  • Draws and copies a diagonal line and a triangle
  • Uses a knife to spread food items
  • Consistently uses “tripod” grasp to write, draw, and hold feeding utensils while moving hand independently from forearm
  • Colors inside the lines
  • Writes first name without a visual example, last name may be written with visual
  • Only uses one hand for writing tasks, rather than switching between them

By age 7, children are usually adept at most fine motor skills, but refinement continues into late childhood.  If you notice your young child demonstrating difficulties in above “red flag” areas, it may be time to consult with an occupational therapist.

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

Resources:

Beery, K.E., & Beery, N.A. (2006). The Beery-Buktenica Developmental Test of Visual Motor Integration. Minneapolis: NSC Pearson

Folio, M.R., & Fewell, R.R. (2000). Peabody Developmental Motor Scales, 2nd Ed. Austin: Pro-Ed.

Retherford, K.S. (1996). Normal Development: A Database of Communication and Related Behaviors. Greenville, SC: Super Duper Publications

Eating Habits- Picky or Problematic?

Is my child simply a picky eater? Or should I be more concerned?

Many children go through a phase of picky eating, some longer than others, that is not usually cause for concern. Some days it seems impossible to get them to eat anything other than goldfish or cake pops, and vegetables aren’t even up for discussion! However, some children demonstrate behaviors that may indicate a feeding problem or disorder. These difficulties may present as sensory challenges, such as only eating brown, crunchy foods, or as oral-motor challenges, such as excessive drooling or food falling out of their mouth while eating.

The following is a list of red flags that may tell you if your child would benefit from the support of a feeding specialist:

Children develop feeding challenges as a result of negative associations with eating. These associations may be caused by various medical or sensory complications, such as sensory processing disorder, food allergies, gastroesophageal reflux disease (GERD), or motor-planning disorders.

If you have concerns about your child’s feeding skills, consult with your pediatrician and an occupational therapist or a speech-language pathologist to help you determine if your child may need additional feeding support.

Autumn Smith, MS, CCC-SLP
Director of Speech-Language Services

Story Time with Your Toddler: How to target those early language skills!

There’s no denying the benefit of books and story time, particularly during those early toddler years. As a speech-language pathologist, parents often ask for tips on how to make the most out of books and story time with their littles. Here are my three favorite tips for ensuring that your toddler gets the most out of story time:

  1. Forget about the story!

I know, I know… This sounds a little counterintuitive. But, trust me here! Instead of relying on the text in the story you are reading, place an emphasis on the pictures. Use the pictures to make up your own story. Encourage your toddler to help you identify pictures on each page. By forgetting about the actual storyline, it allows you to change the story every time you read it. This keeps the same book novel and can help to keep your toddler engaged.

  1. Keep it interactive.

Encourage your toddler to participate during every story time! Whether it be by asking your child to identify pictures, label pictures, or tell you what noise a certain animal or object makes, keep your child participating. Try to avoid asking your toddler to identify letters, this is a pre-academic skill that they will target in preschool. Instead, books with a lot repetition are fabulous because they encourage participation and interaction. Fill-in-the-blank activities are a great language strategy when reading books with a lot of repetition (i.e. “Brown bear, brown bear, what do you _____?” – encourage your child to fill-in-the-blank!).

  1. Question a little, not a lot.

On the same token, acknowledge that too many questions during story time could keep your toddler from enjoying the experience. Keep your little one engaged by asking questions, but don’t push too much. Story time should always be an enjoyable activity for both you and your toddler!

Happy reading!

Julie Euyoque MA CCC-SLP

Spring Break Speech and Language Opportunities

As spring break approaches, parents frequently ask what they can do on their various trips so their children don’t fall behind and they can help maintain progress in speech. Without their house full of toys, they are often at a loss on how to play and incorporate speech and language practice. The short answer is, pretty much everything involves language and ordinary activities can easily be turned into a targeted speech and language opportunity! With a new environment, it can present lots of new opportunities for increasing vocabulary and new ways to use language they already have.  No matter where you find yourself, from airplanes to hotel rooms, beaches to mountains, there are lots of opportunities to talk with your kiddo. Here are some specific examples:   

  • Identifying/Labeling: There are bound to be a lot of familiar as well as new and exciting things to see wherever you go. Depending on your kiddo’s goals, give them specific things to look for and identify or have them label things they see for you to look for. Make an “I Spy” game out of it for some back and forth fun that can be played in the airplane/car or exploring the new scenery.
  • Imitating actions: This can be a great opportunity for teaching new verbs. Have your kiddo imitate your actions and then see if they can identify/use them when they come up again. Whether it be swimming or building sand castles, hiking/climbing mountains, riding new rides, or even licking an ice cream cone, there are countless activities they will engage in that will present opportunities for practicing language.
  • Follow directions: Whether you’re doing it intentionally for language practice or simply trying to keep everyone together at a theme park, there will likely be novel directions given (and hopefully followed!) wherever you go. Take this opportunity to practice directions at whatever level your kiddo is practicing/performing (i.e. simple commands, one-step directions, two-step related or unrelated directions, etc.) Remember to use language at their level and one level above to ensure they understand and can be successful. Make a game out of it to make it fun while they’re still practicing goals!
  • Use your imagination! Whatever the trip entails, there are always ways to encourage language. Don’t forget to label what else you see throughout your trip to give them a language model of these new and exciting things in their environment!

Therese Schmidt, MS, CCC-SLP

Is My Child Ready for Potty Training?

All parents are looking forward to the day that diapers are no more! You may be ready for your child to be using the toilet, but is he? Here are a few things to keep in mind when asking yourself “Is my child ready to lose the diapers and start using the potty?”

  1. Your child indicates that their diaper is dirty. Whether it is touching/pulling at their diaper or saying “poop!” after a bowel movement, your child needs to be able to show you that they are aware of the uncomfortable feeling “down there”.
  2. Their diaper is dry for longer periods of time (at least two hours) and their bowel movements are predictable. This shows that they are starting to have bladder and bowel control. If your child is dry after a nap, they are demonstrating bladder control during this time (overnight may take a little longer!).
  3. Your child shows an interest in your toileting. Children love imitating adult behavior! Just like playing dress up in your clothes and going to “work” or pretending to talk on the phone, they may show an interest in what you do in the bathroom. Use this to your advantage! Answer questions and allow them to join you in the bathroom.
  4. Your child can follow multistep directions. There are a few steps that go into using the toilet (go to bathroom, pull down pants, sit on potty…). Once your child demonstrates that they can follow a few directions (“pick up your toy, put it in the toy box, close the lid, and come back!”), they may be receptively ready to start potty training.
  5. Your child can pull their pants down and up (it’s ok if they need a little help!) This one is a little more obvious – if they cannot pull their pants down, they will have an accident! While you’ll be there to help at first, the goal is for your child to meet their own needs. But beware – once they figure this out, you may have a little nudist on your hands!

Remember, every child is different! It is a normal process in child development and we all move at our own pace. If you push it and your child is not yet ready, it may backfire and they may fight you on it! Look for their signs that they are ready…not your idea of when they “should” be potty trained!

Kimberly Shlaes, MAT, DT
Director of Developmental Therapy Services

Targeting Early Language Skills with Plastic Eggs!

Plastic eggs are a spring-time favorite! There are so many fun ways to play with plastic eggs, below are a few of my favorite activities with speech and language targets!

  1. Practice target words or labelling common objects: hide small pictures, stickers or objects within the eggs and have fun finding each egg and practicing the target word before racing to the next egg! Target words of “open,” “shut/closed,” “stuck,” or phrases of “Egg, where are you?” or “I found it!” are great to practice! Eggs come in all kinds of sizes, talk about fun shapes, big/small, colors or how many eggs you found!
  2. Practice early location concepts: early location concepts include “in, on, under.” Hide one egg and tell your toddler where it is using simple location concepts (“Look IN your shoe!”). You can work on following directions by telling your child where to hide the egg (“Put it ON the chair”) and have another person (sibling, friend, family member) find the egg.
  3. Practice simple questions: “Where is the egg?” “What did you find?” “Is it a cat?” If answering questions is still tricky for your child, model the question and the appropriate response, such as “Is this a cat?” “NO! It’s a dog!”
  4. Following directions: provide directions on what objects to place in the egg or where your toddler should hide it. For example, “Put the flower (sticker) in the egg!”
  5. Asking for help: plastic eggs can be difficult for tiny hands to open or close, take advantage of this moment to practice requesting “help!” “Open” or “Shut/closed.”

There are so many ways to play with plastic eggs, get creative! Please remember to monitor children with small plastic eggs and toys, as these can become a choking hazard.

Jessie Delos Reyes, MA, CCC-SLP

Language Fun & Paper Plate Farm Animals

Looking for a fun spring craft? Check out these fun paper-plate farm animals and get to work!

Incorporating speech and language into arts and crafts is a great way to target goals! Try discussing animal sounds and names. Label what you’re doing (i.e. cutting, pasting, pushing, coloring, drawing, etc.). Take turns with the crayons, appliqués and model pronoun use (I do, my turn, your turn.) Point to animals and have your child do the same (“Here’s the sheep. Can you show me the horse?”) Describe the way things look and feel (“The sheep has a soft, white coat.”) Is your child engaging in pretend play? Have the animals pretend to “eat” or go through a bedtime routine. Working on a specific speech sound goal? See if your child can say a target five times before taking a coloring turn.

Follow up this fun craft by visiting the farm at the Lincoln Park Zoo or by reading a farm book to review! I especially love any touch-and-feel farm books for a bonus sensory activity.

Contact us if you have questions about how to incorporate your child’s goals into arts and crafts!!

Credit for craft idea:

http://www.messforless.net/crafts-for-toddlers-paper-plate-baby-farm-animals/
Caitlin Brady, M.A.,CCC-SLP
Director of Speech and Language Services

Do you have a picky eater on your hands?

Mealtimes can be stressful for parents when children refuse to eat the food on their plate. It is common for parents to worry about their children not eating, which often means parents will try to accommodate the children by making more than one meal. Children grow up and learn how to exercise their power by making their own decisions. With this easy-to-follow food chart, children will not only be able to choose their meals but will lend for a more consistent schedule for the entire family.

Weekly Meal Chart:

Start by creating a weekly chart including each day of the week. Begin by picking one meal to chart, which can include the most difficult meal for the child. Parents can then print off a number of foods, with the pictures, that the child enjoys. For example, if the family chooses breakfast, the parents can print out pictures of foods that the child usually eats, including oatmeal, cereal, fruit, etc. At the beginning of each week, help the child pick out which food to put on each day. This action will give the child the power of choosing the food and give the parents a visual reminder of what food will be eaten on each day.

Once the chart is filled out, put in on the refrigerator as a visual reminder for the entire family. Parents should make sure to stay consistent with the chart and only offer the food listed for the day. If the child refuses to eat the meal presented, put the food aside and allow the child to take a break. The child may become upset and need some time to calm down with some toys. Once calm, parents can remind the child that he/she can eat the food when ready. Usually, children will give in to the food after they see that the parents are only offering the one meal without other choices. It may be difficult for parents and child to adjust to the chart in the beginning, as the child is used to getting more options, but the more the parents stay consistent with the system, the faster the child will learn the routine.

Brittany Hill, MS, MSW, LSW, DT

Using Play-Doh to Target Early Language Skills

One of my favorite toys that I like to use in therapy sessions is Play-Doh. The possibilities are endless and kids tend to have so much fun! The following are several goals that can be targeted while playing with Play-Doh with your children:

1) Imitation of Play Actions: Typically, kids learn to imitate our actions before they learn to imitate our sounds and words.  You can use Play-Doh to target this early imitation skill! Demonstrate different actions with the Play-Doh and praise any attempt your child makes to do what you do. Examples include squishing, rolling, making a ball, dropping, patting, etc. You can also bring in other props such as a rolling pin and cookie cutter to make different shapes. You could also incorporate other toys such as cars and have the cars roll over the Play-Doh, run into the Play-Doh, etc. You could even pretend that the Play-Doh is a car or a train and make it move across the table. Again, the point here is for your child to attempt to imitate what you do with the Play-Doh so praise them for all attempts!

2) Requesting via signs or words: My favorite requests to use in sessions include “more” and “help”. Encourage your child to request at their current level.  If they are able to verbally request encourage them to use their words. If they are currently able to sign that is great too! Even if they are just reaching for more Play-Doh you can model the word and honor their request. To target “help” give your child a closed container of Play-Doh and encourage them to ask for help before you open the container for them. To target “more”, give them a small piece at a time and encourage them to request “more”.

3) Teaching Action Words: Model action words while playing with the Play-Doh. My favorites include open (while opening the container), take out, roll, smash, drop, squish, cut, push, put in, close (while closing the lid), etc. Any word that you can think of to model with the Play-Doh would be great to use here!

4) Following one step directions: Tell your child what to do with the Play-Doh and see if they can follow without a model. If they do not understand the direction, model for them and then ask them to do it again without the model. You can get silly with this and ask them to put the Play-Doh on their head or nose. You could also give your kids directions to make your own recipe!

The possibilities are endless so have fun with it!

Resources: Laura Mize, Teach Me To Talk

Katie Dabkowski, MS, CF-SLP

Early Pronouns: When They Should Be Acquired and How to Teach Them

Your child’s pronoun usage can be very difficult to understand and even more difficult to teach! Many parents – and therapists alike–  struggle teaching this concept to their little ones. First, you need to have a basic understanding of when each pronoun should be acquired. This way, you’ll know what is appropriate to teach and what isn’t! The research varies slightly with regard to pronoun acquisition; however, all research agrees that I and it are the first to emerge, followed by you.

Approximate Age of Acquisition:

12-26 months – I, it

27-30 months – me, my, mine, you

31-34 months – your, she, he, yours, we

35-40 months – they, us, her, his, them, her

41-46 months – its, our, him, myself, yourself, ours, their, theirs

47+ months – herself, himself, itself, ourselves, yourselves, themselves

Sources: Adapted from Haas & Owens (1985); Huxley (1970); Morehead & Ingram (1973); Waterman & Schatz (1982); and Wells (1985).

Now for the tricky part – teaching pronouns! Many children with language delays, auditory processing issues and echolalia struggle with correct pronoun use. Yet, parents often don’t understand how to practice the skill at home and facilitate generalization. Pronouns by nature are ABSTRACT, and therefore, difficult to “see” or conceptualize, thus difficult to teach to children.

Here are a few tips and activities for targeting pronouns with your toddler at home:

  • Use GesturesAlways pair pronouns with gestures! This provides a great non-verbal cue for the child to understand who you are referring to and what each pronoun represents. Point to yourself for “I” and tap your child’s chest for “you.” When you are modeling what, you want your child to say, take his/her hand and use it to pat their own chest for “I” or “my.”
    • Raise your intonation to emphasize the pronoun as you gesture to help the child make the connection
  • Modeling – Providing frequent models is important! Often times, parents and therapists simplify language and use proper nouns instead of pronouns. For example, “Mommy is eating” or “Ms. Lisa is going bye-bye.” This strategy is great for babies who are not talking or who are just learning to talk because it improves understanding and attaches meaning to the words. However, once your child is talking, it is important for them to hear you modeling the correct pronouns! For example, “I am eating” and “I am going bye-bye.”
    • Don’t worry if you forget! Simply follow-up with an emphasized model: “Mommy is eating. I am hungry.”
  • One at a time – Focus on just one pronoun at time. This can be challenging because it is natural to want to use them together. “I have blue and you have green.” Although, it may seem helpful, it can actually be quite confusing for your little one!
    • It takes time and maybe a slow process. That is okay!
  • Prompt with how the child should say it – Rather than saying, “Do you need me to help you?” prompt your child with a model of what he/she should be saying. So, for example, you would simply model, “Help me.”
    • This can be challenging because our tendency is to prompt with phrases such as, “you say” or “tell me,” which may only lead to more confusion and repetition of the wrong pronoun!
  • Look for opportunities in everyday play and routines – pronouns are best taught during normal play and interactions. Model, gesture/point and emphasize the pronoun by raising pitch, intonation and volume. Provide lots of opportunities for repetition and practice!
    • “Mine” – If your child produces the /m/ sound, mine is a great place to start! Model the word as you hold a toy (or part of a toy). Be sure to keep it light and fun and always give the object right back! It’s important for your toddler to know that you are not there to take their toy. You are simply being playful and having fun (while teaching a pronoun).
      • Tip: Do not do this with your child’s favorite toy. They will not like you saying, “mine” and will likely become very upset. If you see that your child is getting frustrated or upset, stop working on it and try again later!
    • “Me” – Look at family pictures (printed or on your cell phone) and ask, “Whose that?” Model, “me” while pointing to a picture of yourself and tapping your own chest. Model “me” again and use hand-over-hand assistance to help your child touch his/her own chest.
      • Selfies – Children love phones and they especially love taking pictures on phones. Take a few “selfies” with your child for extra engagement, motivation and fun, then use the pictures to model me!
    • “I”
      • Choosing items – Lay a few objects out in front of the child and say, “I want banana” or “I want car” as you take the object. Exaggerate “I” as you take the item.
      • Snack time – Ask, “Who wants ____?” Help your child touch their own chest while modeling “I do! I do!”
      • Actions – Use actions to practice the pronoun “I.” Children love gross-motor and movement activities and this is the perfect opportunity! Pair “I” with simple actions (i.e. I run, I jump, I hop, I sleep, I laugh, I cry, etc.) as you act out the action. For example, “I laugh” and then crack-up laughing or “I cry” and pretend to cry. Have fun and get into it! The more you are enjoying it, the more your child will too.
    • “You”
      • Playful commands and help scenarios. Create “you do it” situations where you need to ask your child for their help.
        • Roll a toy car under the table and say, “Oh no! Oh no! You get it.”
        • Wrap a toy in Play-Doh or putty a say, “Oh no! Stuck! You do! You!”
        • Think of the key phrases, “You do,” “You go,” “You get,” “You eat,” etc.
      • My” vs. “Your”
        • Practice with clothing, body parts or food. “My pants” and “Your pants” while gesturing.

Resources: Laura Mize, Teach Me to Talk

Kelly Fridholm, M.C.D., CCC-SLP