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

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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!

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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://playworkschi.wpengine.com/toddlers-speech-therapist-playing-child/

Toy guide for babies through toddlers: http://playworkschi.wpengine.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

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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

Feeding Milestones: 12 to 18 Months

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This blog post is part two of three discussing feeding milestones that a child encounters from birth to age two. Today’s post will focus specifically on the milestones met between 12 and 18 months.

The following chart outlines general guidelines for feeding and developmental milestones that your child should reach between the ages of one year and 18 months. Skills developed between 12-18 months are variable across this age span, and not as specific as the milestones met between birth-12 months. Please contact your speech-language pathologist if you have any concerns regarding your child’s feeding abilities.

Amount of food per day

Children should be eating 46 calories per pound based on their weight. One serving of food is equivalent to one tablespoon per year of life. A serving size for a 12-month-old child would be 1 tablespoon and a serving size for an 18-month-old child would be 1.5 tablespoons.  The following chart summarizes serving sizes of each major food group that a child should eat each day.

Stay tuned for the blog post on feeding milestones for 18- to- 24-months. 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.

Katie Dabkowski, MS, CCC-SLP
Speech-Language Pathologist
Resources:

Feeding Milestones: Birth to 12 months

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This blog post is part one of three that discusses feeding milestones that a child encounters from birth to age two. Today’s post will focus specifically on the milestones met between birth and twelve months.

As an SLP and feeding therapist, I often find parents asking me:

 “What should my child be eating at this age?”

 “Is it too early to introduce solids? “

“Is it okay that I’m still breastfeeding?”

It is important to remember that there is no “magic number” for age when it comes to feeding development. While certain feeding milestones are typically reached by a specific age, many feeding therapists recommend that parents look for the presence of various developmental skills to determine if their child is ready for the next stage of feeding. In the first year of life, it’s important to ensure that a baby’s primary source of nutrition is breast milk and/or formula. During the first year, purees and solid foods should be viewed as “learning to eat” rather than a primary source of nutrition. The following table outlines the age that these milestones are typically met, and the feeding stage that is associated with each milestone:

Stay tuned for blog posts on feeding milestones for ages 12- to- 18- months and 18- to- 24- months. 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.

Sarah Lydon, MA, CCC-SLP
Speech-Language Pathologist

Resources: Toomey & Associates, Inc. 1990/2016

Photo Credit: http://wholesomebabyfood.momtastic.com/howmuchbabyeat.htm

Tips to Target Therapy Goals in Your Daily Routine

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Therapy is often compared to going to the trainer: if you go to the trainer once a week but don’t continue the exercises or healthy eating, the training session isn’t going to do much for you! It is so important to carry over activities from therapy to ensure your child makes progress and meets their goals. Everyone is so busy these days and adding additional learning opportunities to your child’s life shouldn’t be daunting. Here are a few ideas of how you can address common play therapy goals into your daily routine!

Laundry

  • Matching/Sorting Concepts
    • Have your child to match socks
    • Have your child sort clothing into different piles by color or by item
  • Size Concepts
    • Have your child compare his small t-shirt to a family member’s larget-shirt
  • Association Concepts
    • Ask your child which body parts different clothing items are put on
    • Discuss the occasion or weather you would wear certain clothing items

Meal Prep

  • Symbolic Play
    • Provide your child with (safe) kitchen utensils for them to also “make dinner”
  • Size Concepts
    • Encourage your child to explore size concepts with different sized Tupperware
  • Identifying Colors
    • Discuss the colors of the food you are preparing
  • Following Directions
    • Show your child how you follow directions when following a recipe
    • Give your child simple directions to follow during meal prep
  • Association Concepts
    • Describe the functions of the different kitchen gadgets while using them

In the Car

  • Color Identification
    • Use colors to describe what you see:
      • “That construction cone is orange”
      • “The blue truck is next to us”
    • For older children, you can play games like “I Spy”. Take turns choosing a color and encourage your child to label everything they see of that color. This not only works on color identification but also vocabulary!
  • Size Concepts
    • Use size words to describe what you see:
      • “Look at the little dog on the sidewalk”
      • “That is a big dump truck”
  • Social-Emotional Development
    • Discuss:
      • Plans for the day (where you’ll go, who you’ll see)
      • What your child did at school/daycare that day
      • Encourage your child to ask you questions

And most importantly – have fun together; make it silly and stress-free! You are your child’s first teacher and can help frame their perspective on learning! Please feel free to discuss specific ideas with your child’s therapist to ensure he or she is getting the most out of their therapy.

Kimberly Shlaes, MAT, DT
Director of Developmental Therapy Services

Image credit: https://netmums.cdn.prismic.io

Why Messy Eating Is a Good Thing for Babies and Toddlers

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Do you fear letting your baby get messy? Can’t stand the sight of food in their hair or on the floor and dread the work that it means for you afterwards? You are not alone! Lots of parents have a really hard time allowing their baby to be a complete and total mess while eating. But did you know that this mess is more than just a headache for you later on? It is actually a critical learning experience for your little one! So next time you cringe at the sight of your toddler flinging applesauce across the room or your baby dropping yet another yogurt-covered spoon on the floor, remember that you are helping their development.

Below is a list of reasons why you should let your little one get messy while eating.

Messy eating…

  1. Provides important sensory experiences
    • Messy eating is a form of sensory play! It is an opportunity for your little one’s brain to receive feedback from their food regarding different textures, temperatures, colors, quantities and the difference between solid and non-solid foods. This sensory play promotes exploration and helps build a positive environment around their food.
  2. Leads to greater acceptance of foods
    • Once children are familiar and comfortable with the sensory information of their food, they are more willing to eat it. Sensory play and exploration helps kids overcome their fear of new textures and flavors and results in eating a more diverse diet.
  3. Promotes appropriate self-feeding skills
    • Allowing your little one to explore their food builds confidence and promotes independent eating.
  4. Develops fine motor skills
    • Self-feeding involves pinching, picking-up, reaching, holding a spoon and a number of find motor skills that your kiddo may be missing out on if you are always the one in control of the food container and spoon.

Tips to help the messy eating routine:

  1. Prepare for a mess by feeding your baby or toddler in a room with hard, easy to clean surfaces (i.e. tile, wood) and avoiding carpeted areas. Use placemats, floormats or even lay a towel or sheet down under the highchair.
  2. Ditch the nice clothes and opt for an old t-shit or onesie instead. You can even let your little one eat in only their diaper to avoid excess laundry! As long as it is a comfortable temperature in your house, your baby will not be too cold and it will save you a lot of time and hassle.
  3. Embrace the messy eating. Remind yourself that this GOOD and fun! Enjoy these moments and capture one of those classic-baby-moment pictures.

Kelly Fridholm, MCD, CCC-SLP

Speech-Language Pathologist

Additional resources/related articles:

https://www.reuters.com/article/us-food-fears-children/playing-with-food-may-help-preschoolers-become-less-picky-eaters-idUSKBN0O41MD20150519

Picture: Shutterstock

School Behavior Vs. Home Behavior

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Sometimes, parents ask us why their child is able to behave more appropriately at school but not at home. Parents can become confused and frustrated as to why the teachers do not report any concerns for their child but yet the child is having more difficulties managing their behaviors at home. Here are some tips for parents to implement into their homes to help mimic the school environment:

1. Create house rules-knowing that the classroom has set rules for the children to follow, we want to make sure there are also house rules to help mimic the sense of consistency and expectation for the child. House rules will not only help the parents be on the same page but also give the child a visual reminder of behaviors that are not acceptable in the home. Examples of house rules may include:

  • No hitting
  • Clean up toys before bedtime

*It would be best if the parents could write the two- to three- rules on a piece of paper and post it on the refrigerator to serve as a reminder for the entire family. After these are written down, talk to the child about the rules and what will happen if he/she is unable to follow them, such as resulting in a time-out.

2. Reinforce turn taking and sharing-knowing that children are expected to share and take turns with their peers at school, we want to make sure they are also expected to practice these skills at home. Here are some fun ways to incorporate these skills:

  • Play a board game with your child and use turn-taking. You take a turn and then have your child take a turn.
  • Engage in your child’s favorite activity and incorporate sharing. For example, ask your child if he/she can share the toy with you and then give it back after a couple of minutes. Continue to practice asking your child to share toys throughout the day.

*The child may show resistance to turn-taking and sharing outside of the school environment. The best way to implement these skills is to be consistent. Even if the child becomes upset over taking turns or sharing, it is important that the parent continue to follow through with the request in order to establish expectations for the child.

Brittany Hill, MS, MSW, LCSW, DT
Licensed Clinical Social Worker
Developmental Therapist
Photo Credit:
http://iloveboardgames.com/family-games/
https://www.wikihow.com/Run-a-Household

Should I be working on pre-academic skills with my child?

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Although pre-academic skills such as letters, numbers, shapes and colors are important to learn, these skills should not be targeted until a child is able to functionally use language.  Can your child ask you for “more” of a preferred item? Can your child tell you what toy they would like to play with or what food they would like to eat? Can your child ask you for “help?” If the answer to these questions is no, then save working on pre-academic skills until your child has a stronger grasp on using language functionally.

What is functional language?

Functional language can be thought of as your child’s ability to make their wants and needs known. This includes core vocabulary words that are relevant in everyday life, such as names of important food items, toys, people, etc. It also includes words such as “more,” “help,” “all done,” and other requests that allow your child to communicate what they want or need. Working on these core vocabulary words is key in teaching your child to communicate with you. For language to be considered “functional,” it should be used for a communicative purpose such as requesting, commenting, or interacting with you rather than just labeling words.

Why is it important to have functional language before teaching pre-academic skills?

We want children to be able to say words that are important for everyday situations before they can say their colors, numbers, shapes, and letters. We want children to be able to converse with you meaningfully and ask you to have their needs met before they learn pre-academic skills. Of course it is great if a child can say “green,” “two,” or “circle,” but if they are not able to ask you for “more milk” it is time to take a step back from learning pre-academic vocabulary and focus on increasing your child’s ability to use language functionally.

When is it appropriate to work on pre-academic skills?

Pre-academic skills are concepts that are typically learned in the pre-school setting. If your child is using language to functionally communicate with you, it would be appropriate to learn pre-academic skills together if this is an important topic for you and your family.

Katie Dabkowski, MS, CCC-SLP
Speech-Language Pathologist

What’s the Deal with W-Sitting?

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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