Employee Spotlight: Kristen McManus

What do you love most about being an Occupational Therapist?

I love that occupational therapy is all about cultivating success in everyday activities. Occupations for us mean anything a person needs or wants to do in his or her daily life. For kids, their most important occupation is play! There is no better job than playing with children to help them learn and have fun!

What is your favorite children’s book?

My favorite would have to be The Giving Tree. I think it has such a beautiful lesson, and Shel Silverstein’s illustrations are so unique.

What do you enjoy most about living in Chicago?

As a Texan born and raised, Chicago was quite the change for me! I love the views of Chicago most, especially those of the skyline or river. It is such a beautiful city, whether covered in sunshine or snow.

What is your favorite childhood memory?

I fondly remember playing board games with my grandmother. She played harder games with me, such as Scattergories or Scrabble, and she always had so much patience. I certainly think this is why I love incorporating games into my sessions, and why I use that same patience with the kids I work with in therapy.

Would you rather a mountain or beach vacation?

I would pick a beach vacation without a doubt. I am a fan of warm weather, and I think the sights and sounds of the ocean are wonderful.

Share a proud “therapy moment” with one of your clients.

I am a strong proponent of learning the child’s own goals. One little girl with cerebral palsy wanted to learn how to brush her own hair. One little boy on the autism spectrum wanted to learn how to make himself a snack. Some of my clients on the autism spectrum want to have a best friend. Nothing makes me more proud than to help these children achieve what is important to them.

What is your hometown?

I was born and raised in Beaumont, Texas.

What do you like to do in your free time?

In my free time, I like exploring the city. My fiancé and I will often go to a new neighborhood and walk around for hours, trying new restaurants and shops. I also enjoy reading novels, taking boxing classes, scrapbooking and crafting, and playing board games.

What is your favorite therapy toy?

I love using pretend play food or picnic sets. They encourage great imaginative play skills, along with social skills and fine motor skills.

Share a fun fact about yourself.

I can play the alto saxophone.

Kristen McManus, MOT, OTR/L
Occupational Therapist

Blankets, Vests, and Lap Pads…Oh My! A Guide to Weighted Objects

What are weighted objects, and how do they work?

In the context of pediatric therapy, a “weighted object” refers to any object or item that is worn, placed on, or carried by the body to elicit a desired sensory response. These objects work by providing deep pressure, or distributed weight over parts of the body through cuddling, hugging, squeezing, and holding, to regulate the nervous system and calm the body. Additional input is processed by the proprioceptive system, which provides information about the position and movements of our muscles and joints, to increase understanding and awareness of where our body is in space.

What are some potential benefits of using weighted objects?
Potential benefits of using weighted objects include:

1. Better attention and focus: weighted objects are often calming for children that seek opportunities for movement and deep pressure and for those that have a difficult time sitting still and attending to structured activities. As weighted objects provide the input these children are seeking, their bodies become more calm and organized, and they are better able to focus and stay on-task, especially in the classroom environment.

2. Less anxiety and improved sleep: the calming effects of weighted objects on the nervous system help to reduce sympathetic arousal, or the fight-or-flight response, and promote feelings of comfort and relaxation. For these reasons, use of weighted blankets at night has also been found to help individuals fall asleep more easily as well as improve overall quality of sleep throughout the night.

3. Smoother transitions between daily routines and activities: when children experience increased regulation and sensory organization due to the effects of weighted objects, they often feel more “in control” of their bodies and are better equipped to handle transitions and changes in their routines, leading to fewer or less intense tantrums and emotional outbursts.

What are examples of weighted objects and where can I find them?

Common examples of weighted objects include:
• Vests
• Blankets
• Lap pads
• Backpacks
• Stuffed animals

Depending on your child’s needs, weighted objects come in a variety of shapes and sizes and can be worn or held during specific activities (vest; lap pad; stuffed animal) to improve attention, carried between environments (backpack, stuffed animal) to improve smooth transitions, and placed on the body (blanket) during quiet activities, such as reading books, riding in the car, and when going to sleep, to provide comfort, reduce anxiety, and promote a calm, organized state of arousal.

Many weighted objects are available for purchase from online and in-store retailers. Weighted objects may also be created by adding weight to items already found in your home. For example, filling a long tube sock with dry rice or beans and tying off the end securely or adding these materials to one of your child’s favorite stuffed toys may work well for use as a lap pad or weighted stuffed animal. Similarly, adding books or bottles of water to your child’s backpack makes for an easy weighted adjustment during transitions to and from school. Research suggests that each object should be about 10% of the user’s body weight plus one pound to promote optimal effects, so be sure to consult with a trained therapist or doctor before trialing weighted objects with your child at home.

Do weighted objects work for every child?
While research suggests that weighted objects have several positive benefits, they may not be appropriate or suitable for every child. Objects are often most effective when implemented with other sensory strategies and should be used only as directed by your child’s occupational therapist or doctor to best target their individualized needs and ensure safe and appropriate application.

Questions or concerns?
If you have questions or concerns about whether your child may benefit from using a weighted object, please contact us at info@playworkschicago.com or 773-332-9439.

Caitlin Chociej, MS, OTR/L
Occupational Therapist

References:

Chen, H., Yang, H., Chi, H., Chen, H. (2013). Physiological Effects of Deep Touch Pressure on Anxiety Alleviation: The Weighted Blanket Approach. Journal of Medical and Biological Engineering, 33(5), 463-470. doi:10.5405/jmbe.1043

Vandenberg, N. L. (2001). The Use of a Weighted Vest to Increase On-Task Behavior in Children with Attention Difficulties. American Journal of Occupational Therapy, 55(6), 621–628. doi: 10.5014/ajot.55.6.621

Photo Credit: Naomi Shi via Pexels

Planning and Sequencing for Success: A Guide to Understanding Praxis

Does your child have difficulties coming up with a plan for what they want to do, figuring out how they are going to do it, and then carrying out the task? If so, concerns with praxis may be a contributing factor. Praxis is complex and multi-step process that we often overlook, as it typically occurs on a sub-conscious level.

What is Praxis?

Praxis refers to the neurological process through which we plan, sequence, and complete the motor tasks we want to undertake. It can be through of as the way cognition directs movement actions. The planning and sequencing required for praxis are critical for completing everyday tasks such as walking, learning new routines, dressing, and even eating. For children experiencing difficulties with praxis, learning new movement patterns can be especially tricky. Challenges with praxis are referred to as apraxia or dyspraxia. These terms are often used interchangeably; however, dyspraxia is typically used to describe difficulties with planning and sequencing that are largely considered developmental.

The Four Elements of Praxis:

Learning new movement patterns is complex and involves many steps. The four elements of praxis are as follows:

  • Ideation: This involves your child generating an idea for what they want to do. For example, your child may see a bike and decide that his or her plan is to get on the bike to go for a ride.
  • Motor Planning: Motor planning involves your child figuring out how his or her body is going to carry out the plan. For example, your child may plan to stand on one foot, lift one leg, and swing it over the bike in order to mount it.
  • Execution: This refers to the body successfully or unsuccessfully carrying out the movement plan. For example, was your child able to successfully get on the bike, fall over, or get on backwards?
  • Feedback/Adaptation: This element of praxis involves your child reflecting on the feedback from the attempt in order to make changes in subsequent trials. For example, if your child got on the bike backwards, feedback/adaptation would involve your child facing the other way before attempting to mount the bike during his or her next try.

What Do Difficulties with Praxis Look Like?

Children with dyspraxia may:

  • Appear to struggle with coordination or look clumsy.
  • Require more practice than their peers to learn new movement tasks.
  • Seem to struggle with sports.
  • Demonstrate difficulty following multi-step directions.
  • Experience low self-confidence when comparing themselves to peers.
  • Benefit from frequent hand-over-hand assistance when learning new tasks.
  • Appear to be disorganized.
  • Seem to demonstrate difficulty initiating tasks or knowing what to do with novel objects.
  • Demonstrate delays in developmental milestones such as crawling or walking.

What Is Required for Successful Motor Learning?

A variety of building blocks are required for successful planning, sequencing, and execution of motor tasks. Muscular strength, coordination, postural control, and body awareness all play a role in learning non-habitual movements. Moreover, sensory processing, or the ability to register, interpret, and respond to environmental stimuli affects praxis. Executive functioning, or the higher-level reasoning and organizational skills, additionally affect your child’s ability to plan for and problem-solve issues that may arise during trial and error. A skilled occupational therapist can help target where in the process your child may be struggling and implement a treatment plan for improved motor planning and sequencing skills.

Questions or concerns?

If you have questions or concerns about your child’s planning and sequencing of movements, please contact us at info@playworkschicago.com or 773-332-9439.

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.

Case-Smith, J., & Clifford O’Brien, J. (2015). Occupational therapy for children and adolescents (7th ed.). Canada: Mosby, Inc.

Photo credit: Photo by Jordan Sanchez on Unsplash.

Baby Boot Camp: The Importance of Tummy Time

Tummy time promotes development, strength, and a new visual perspective for your baby. Growing babies require many hours of sleep, which means your baby spends a large amount of time on his or her back to maintain a safe position while sleeping. Tummy time is pivotal during waking hours to strengthen the head, neck, and shoulder muscles and promote head control. Tummy time also gives your baby a fresh new perspective on the world as they can interact with toys and reach for objects in the environment. Tummy time is fundamental to your baby’s development and builds skills that promote later milestones of rolling over, crawling, and playing.

Getting started with Tummy Time

Tummy time can be started at any age, it is even recommended for newborns! Tummy time should always be a supervised activity. Gradually introduce your baby to tummy time by placing them on your stomach or chest in a reclined position such as laying on the couch. This allows your baby to continue bonding and interacting with you and may help them tolerate this new position. Start with short intervals on a safe and firm surface, such as the floor, for two to three minutes per day. You can progress up to 20 to 30 minutes of tummy time per day depending on your baby’s tolerance. Aim for tummy time at a time of day when he or she is alert, such as after nap time. Remember to always pay attention to your baby’s needs and look for signs of tiredness, such as crying or laying their head down on the floor.

How can I promote a successful tummy time experience?

  • Provide extra support with a bolster
    • Try rolling up a thin towel or blanket to make a bolster
    • Place the bolster under your baby’s chest with his or her arms positioned over the roll and hands in front
    • Always keep your baby’s chin in front of the roll to ensure their airway remains open
  • Promote weight bearing
    • Make sure your baby distributes his or her weight to both sides of the body in order to equally strengthen
  • Promote reaching for play
    • Get down on the floor with your baby to promote engagement and motivation
    • Hold a toy in front of your baby to encourage head control and reaching
    • Place toys in a circle around your baby to promote reaching in all directions
  • Try out other positions
    • Side-lying: Lay your baby on his or her side and support their back with your hand or a rolled towel. Place your baby’s arms out in front to promote reaching and play in this position.
    • Airplane: Lay down and hold your baby in your arms while he or she is on their belly. This a fun and motivating new perspective for babies with head control.
  • Make tummy time a routine
    • Incorporate tummy time during everyday tasks such as diaper changes, songs, toweling off, or reading a book.
    • Try burping your baby with him or her laying across your lap on their tummy
  • Make it a multi-sensory experience
    • Use a visually stimulating blanket or towel
    • Try placing your baby on a variety of textured blankets or mats
    • Use a mirror to motivate your baby to lift his or her head to see their reflection and encourage self-recognition
    • Alternate between various safe surfaces in your home such as carpet, tile, or wood

What are red flags to look out for? 

  • Pay attention if your baby shows a head preference. For optimal development, your baby should look to both sides equally. Does he or she have a strong preference towards one side?
  • Does your baby have difficulty weight bearing on one side of the body? For development, it is important that your baby strengthen both sides of the body and weight bear equally through both hands and arms.
  • Does your baby have a flat patch on the side or back of the head? Is your baby’s head asymmetrical? Flat patches may develop due to a strong head preference or increased time spent on their back.

If your child is demonstrating some of the observations above, consider contacting one of our occupational therapists or the Illinois Early Intervention system for more information.

Questions or concerns?

If you have questions or concerns about your child, please contact us at info@playworkschicago.com or 773-332-9439.

Robyn Geist, MS, OTR/L
Occupational Therapist

Reference: Pumerantz, Christa & Zachry, Anne (2018). Tips for living life to its fullest: Establishing tummy time routines to enhance your baby’s development. American Occupational Therapy Association.

Photo Credit: Moswyn via iStock.com

The ABCs: Strategies for Handwriting

Despite our ever changing world of technology, handwriting remains an essential part of school curriculums and mode of daily communication. Legible and efficient handwriting allows your child to participate in school tasks and keep up with their homework load. Your child may be reluctant to participate in handwriting tasks if it is difficult or if it takes him or her extra time to complete the task. Handwriting doesn’t have to be only copying letters or sentences. Let’s learn how to make handwriting more motivating for your child, so it is less like “work” and more like “play!”

What are the underlying components of handwriting?

  • Fine motor coordination: Handwriting requires the coordination of our small hand muscles and the ability to use both hands for two separate tasks (i.e. holding the pencil and stabilizing the paper).
  • Visual motor and visual perceptual skills: Copying or creating letters requires hand-eye coordination, or using visual input to guide hand movements. Visual perceptual skills also include our ability to discriminate between letters, as well as remember the letters written on the board in order to copy them to our paper.
  • Motor planning: Our ability to use the information in our environment to create, execute, and carry out the motor action of creating letters or sentences. If your child has motor planning difficulties, they may have difficulty with letter formation and legibility.
  • In-hand manipulation: The skill of “shifting” consists of moving the pencil up and down, using your fingers to make small adjustments to your pencil grasp. In order to erase with a pencil, “rotation” is utilized by rotating the pencil to use the eraser and then back to resume writing.
  • Proprioception: The sense of knowing where his/her body is in space allows your child to use the appropriate force on writing utensils.

What can I do to help promote handwriting skills with my child?

  • Promote visual perceptual skills:
    • Mazes
    • Dot-to-dots
    • Word finds
    • Scavenger hunts
  • Do the “Wet-Dry-Try” method:
    • Write a letter on a chalkboard
    • Provide your child with a small wet sponge and a small dry sponge
    • Have your child write the letter using a wet sponge, then using a dry sponge
    • Finally, have your child use chalk to create the letter themselves
  • For older children, try these functional handwriting activities:
    • Write a letter to Santa, the Tooth Fairy, etc.
    • Write a grocery list
    • Help create the family calendar by writing down events
    • Write out a packing list for a trip
  • Promote fingertip grasping patterns by breaking crayons in half. This makes it difficult for your child to grasp the crayon with their whole hand, facilitating a more age-appropriate grasp with fingertips.
  • Facilitate grasping with hand-strengthening activities:
    • Hide beads or coins in Theraputty or PlayDoh and have your child retrieve the small items by pulling apart and pinching the putty
    • Have your child pick up items with a tweezer such as cotton balls, pom poms, or beads. You can also have your child place these items into an egg carton or cut-up foam pool noodles to address fine motor precision
    • Have your child place different sized clothespins on a picture or board
    • Make a 2-inch slit in a tennis ball. Place small items (beads, coins) inside of the tennis ball and have your child retrieve the small items by using their whole hand to squeeze the ball and retrieving items with the opposite hand.

Ways to encourage sensory-based learning with handwriting:

  • Practice forming letters in shaving cream! You can also use food coloring to die the shaving cream.
  • Try sensory bags: You will need a gallon freezer bag. Fill the freezer bag with clear hair gel, then add a few drops of food coloring. Feel free to add glitter! Mix the contents and apply tape over the top of the Ziploc bag. Have your child practice letter formations by tracing over the sensory bag, you can also place a piece of white paper underneath the bag to increase their visual feedback.
  • Write letters on foam sheets for increased sensory input by requiring your child to firmly press their writing utensil into the foam.
  • Encourage letter formation with motivating sensory media: Create letters with Wikki Stix, PlayDoh, beads, or pipe cleaners.
  • Use motivating visual input: Practice letters with a Lite Brite game or using rainbow scratch paper.
  • Turn out the lights and practice forming letters in the dark with a flashlight.
  • Use sidewalk chalk or washable window chalk.
  • For a movement break, have your child attempt to form letters with their body.

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.

Robyn Geist, MS, OTR/L
Occupational Therapist

Feder, K.P. & Majnemer, A. (2007). Handwriting development, competency, and intervention. Developmental Medicine & Child Neurology 49, 312-317.

Photo Credit: Robin Brenner via brooklinelibrary.org

Why OT?: Destigmatizing the Need for Therapy

“Why was my child recommended for occupational therapy, they don’t have a job!” You might have many questions if your child has completed an occupational therapy evaluation and was recommended to receive occupational therapy services. What does this mean, exactly?

What is occupational therapy?

The term “occupational” does not refer to one’s employment, in this instance. Occupationscan be defined as activities that support the health, well-being, and development of an individual (American Occupational Therapy Association, 2014). An occupational therapist’s job is to increase the engagement and participation in meaningful daily activities that support your child’s learning, growing, and most of all, fun! There are a wide variety of circumstances that may affect your child’s optimal engagement in day-to-day activities at home, at school, or in the community.

How is occupational therapy going to help my child?

The benefit of occupational therapy is that practitioners are equipped for focusing therapy on a widevariety of skills required in your child’s daily life, such as:

  • Fine motor skills
    • Your child uses fine motor skills to write their name on their school work and to tie their shoes before heading out to play!
  • Visual motor skills
    • Your child utilizes visual motor skills when playing catch in the park and to copy written work from the chalkboard in the classroom.
  • Self-help skills
    • Self-help skills help get your child out the door in the morning! Your child needs to eat, get dressed, and use the bathroom to start their day.
  • Gross motor skills
    • Gross motor skills are required to walk to the front door and down the stairs safely to begin your child’s commute to school.
  • Sensory processing and regulation
    • Your child’s body is constantly processing sensory information in their environment to attend to and enjoy their world.
  • Executive functioning skills
    • When recalling the steps of their favorite family board game and following their teacher’s instructions, they are using their executive functioning skills, i.e., working memory, sequencing, and problem solving.
  • Social interaction skills
    • Your child utilizes their social interaction skills to make new friends and keep familiar ones.

What does it mean if my child was recommended occupational therapy?

Receiving a recommendation for therapy can be difficult and may bring about many questions and concerns regarding your child. Common concerns after receiving a recommendation for your child to receive therapy are “Will my child be singled-out from their peers?” or “Will my child always need therapy?”  When your child receives a recommendation for therapy, it does not necessarily mean that there is something wrong. A recommendation for occupational therapy does mean that a trained therapist has noted suspected concerns that warrant further evaluation. As an occupational therapist, many times I am asked, “Do you work with children with disabilities?” and my answer is, “Yes I do, but not exclusively!” Just as pediatric occupational therapists work on a wide variety of skills, we also work with a wide variety within the pediatric population. An occupational therapist will utilize a holistic approach to empower your child and your family so they can live their life to the fullest in their daily routines, school activities, and excitement within the community.

Questions or concerns?

If you have questions or concerns about your child’s engagement in meaningful daily activities, please contact us at info@playworkschicago.com or 773-332-9439.

Reagan Lockwood, MOT, OTR/L
Occupational Therapist

Reference: American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain & process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006

Photo Credit: Photo by Thiago Cerqueira on Unsplash

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

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

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

What’s the Deal with W-Sitting?

W-sitting is a familiar term for many parents, teachers and clinicians, and most of them could tell you that it is not good for a child to sit this way. But what is the real issue with this seated position that so many children demonstrate?

What is W-Sitting?

W-sitting is when a child sits on their bottom, with both knees bent and their legs pointing out and away from their body. When looking from above, the child’s legs appear to form the letter “W.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Why is W-sitting so common?

W-sitting is a very common and often preferred position for children. Many children find this to be a comfortable position because it provides a wider base of support and lowers their center of gravity, which provides more stability through their hips and trunk and compensates for any weakness in these areas. This allows a child to engage in play without having to concentrate on keeping their body upright and balanced.

Why is W-sitting a problem?

-Muscles of the hips and legs can become shortened and tight, resulting in muscle weakness as well as back and pelvic pain as a child grows.

-In this position, a child’s hips are internally rotated, which can lead to bone malalignment and abnormalities during development. This can result in pigeon-toed walking, which increases a child’s risk for falls.

-Trunk rotation and weight shifting are limited when in this position. A child needs to engage in these movements to develop balance reactions as well as to cross midline (reach across their body) with each arm.

-The wide base of support created by W-sitting provides too much trunk stability and control, meaning the child is not properly engaging and strengthening their core muscles.

-The W position puts increased strain on a child’s joints and can increase the likelihood of hip dislocation

How can we address W-sitting?

The best thing a parent, teacher or clinician can do when a child is W-sitting is to redirect by verbally cueing or physically assisting them into a different position. You can practice using a verbal cue that works best for your child, such as “Fix your legs/feet” or “Fix your sit.” You may also need to physically assist the child in adjusting their posture. Other positions you can encourage include:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

There are many ways you can encourage participation and play while in these various positions. And though it may be difficult for a child to break the “W” habit and challenge their trunk strength and balance, it is one small change that can have a big impact on a child’s development.

Ashley Heleine, MS, OTR/L

Occupational Therapist

Photos sourced from:

www.dinopt.com

https://www.childsplaytherapycenter.com/w-sitting-correct/

http://activebabiessmartkids.com.au

https://pathways.org