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

Feeding our Senses: What is a Sensory Diet?

Does your child love to run, swing, and jump? Engage in messy play with finger paint and shaving cream or seek out hugs and cuddles? Or perhaps they prefer to watch other children navigate the rock wall at the playground or quickly wipe their hands clean when dirty? Our sensory systems are responsible for how we take in sensory stimuli from our environment, process and interpret the information internally, and produce appropriate responses. We rely on proper functioning of eight senses (yes, eight!) to maintain a regulated state, in which we are better able to understand, interact with, and grow within our environments.

What are the eight sensory systems?

  1. Sight: helps us process what we see
  2. Hearing: helps us detect and process sounds, beats, and frequencies
  3. Smell: helps us detect and process scents and odors
  4. Taste: helps us process and distinguish between different tastes
  5. Touch: helps us process and understand how things feel on our skin, such as soft or hard, hot or cold
  6. Vestibular: provides us with a sense of balance, movement, and an awareness of orientation in space
  7. Proprioception: provides information about position and movements of our muscles and joints, including pushing, pulling, and deep pressure sensations
  8. Interoception: provides an internal sense of how our organs feel, such as hungry or thirsty, our sense of temperature, our feelings of pain, and when we need to use the bathroom

What happens if our sensory systems do not process stimuli correctly or efficiently?

When our brains are unable to make sense of the information our bodies receive, we often respond to the environment in inappropriate or unexpected ways. While the reactions formed in this disorganized state, often referred to as deregulation, present differently for every child and depend on both the type and number of sensory systems affected, responses often aim to find more of (seek) or stay away from (avoid) input. Examples include but are not limited to:

  • Sight: excessively looking at moving, spinning, or shiny objects; appearing bothered by bright lights
  • Hearing: appearing to ignore people when spoken to; becoming distracted in noisy settings; covering ears in response to loud noises
  • Smell: showing heightened sensitivity or aversion to scents and odors; may impact feeding routines
  • Taste/oral: preferring a limited variety of foods; difficulty trying new foods; excessive drooling
  • Touch: difficulty tolerating having nails trimmed or wearing certain clothing textures; refusing to touch or play with various textures, such as grass, sand, finger paint, or Play-Doh; wiping hands clean immediately after getting dirty
  • Vestibular: appearing to excessively enjoy or look for movement opportunities (running, jumping, rocking, etc.); seeming clumsy; appearing fearful of ordinary movement, such as when both feet are off the ground (e.g. swinging)
  • Proprioception: biting or chewing on non-food items; excessive bumping into, pushing, or hitting peers or objects in the environment
  • Interoception: not feeling full after eating; missing the urge to use the bathroom at the appropriate time

These sensory responses may lead to overarching difficulties with a child’s ability to attend to academic activities in the classroom, maintain balance and coordination, plan and sequence novel tasks, build social relationships, perform self-care activities, such as dressing and feeding tasks, and participate in family routines and schedules.

Sensory diet: what is it and how can it help?

A sensory diet is a carefully designed series of sensory-based activities in which a child is encouraged to participate to increase regulation and attention throughout the day. Much like we eat healthy foods to give our bodies the nutrients they need, sensory diets are made to meet the specific sensory needs of each child. While sensory diets typically incorporate touch, movement, and proprioceptive input, strategies targeting any sensory system can be included to promote optimal regulation. Sensory diets are often organized into schedules based on a child’s daily routines, activities, and family plans to maximize participation and success and can be easily modified as the child’s needs change over time. See below for an example of a sensory diet:

If implemented correctly, sensory diets provide consistent access to specific amounts of sensory input needed throughout the day and result in more appropriate responses to environmental stimuli over time. When successful, children are better able to participate in meaningful activities and daily routines, develop important foundational skills, and more effectively understand and engage in the world around them.

Questions or concerns?

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

Caitlin Chociej, MS, OTR/L
Occupational Therapist

References:

Bodison, S., Watling, R., Kuhaneck, H.M., & Henry, D. (2008). Frequently Asked Questions About Ayres Sensory Integration. American Occupational Therapy Association. Retrieved April 14, 2019 from http://www.aota.org/Consumers/WhatisOT/FactSheets.aspx.

Smith Roley, S., Mailloux, Z., Miller-Kuhaneck, H. & Glennon, T. (2007). Understanding Ayres’ Sensory Integration. OT Practice 12(7).

STAR Institute for Sensory Processing Disorder. (2018). Your 8 Senses. Retrieved April 14, 2019, from https://www.spdstar.org/basic/your-8-senses.

Photo Credit: Sharon McCutcheon via Pexels

Home Bodies: Gross Motor Activities You Can Do at Home

What are gross motor skills?

Your child’s gross motor skills allow them take their first steps, play their favorite sports, and sit upright in their chair at school. Gross motor skills involve stabilization of our large muscle groups and active movement of our whole body to carry out these meaningful activities. In order to develop age-appropriate gross motor skills your child will utilize the following body mechanisms: muscle strength, muscle tone, activity tolerance, motor planning, postural control, body awareness, balance, coordination, and proprioception (our sense our body position and body movement).  If your child is having difficulty with their gross motor skills, they may appear to be clumsy, have difficulty completing activities of daily living such as dressing, or avoid physical activity.

Laying the Foundation

In order to develop more refined skills, such as fine motor skills, your child will need to build a foundation of age-appropriate gross motor skills. For example, in order to complete fine motor tasks at school, your child must first demonstrate appropriate trunk strength and postural control in order to sit upright in their chair. Once your child develops appropriate trunk strength and postural control, he/she will need to develop gross motor shoulder stability in order to prevent his/her shoulder from moving when engaged in writing activities. It is when these gross motor abilities of trunk strength, postural control, and shoulder stability are present when your child is able to develop more refined skills. Our gross motor skills lay the foundation for the more sophisticated and intricate small muscle movements.

Home Work

In a literature review of fundamental movement skills conducted, researchers found a positive relationship between children’s development of gross motor skills and health benefits such as increased physical activity and decreased sedentary behavior*.

At-home gross motor activities are just a jump, skip, and a hop away:

  • Obstacle Course: indoor obstacle courses are a wonderful way to get your child crawling through tunnels, jumping over “lava,” and running to the finish line. This also provides additional opportunities for supplemental sensory input for increasing overall regulation!
  • Yoga: yoga is excellent for incorporating whole body movements, core strengthening, and increasing our sense of proprioception. In order to further develop our body awareness, have your child imitate yoga poses in front of a mirror in order to increase his/her understanding of how his/her body is positioned in space. Yogarilla cards are a great resource for various yoga poses in a fun format for your child.
  • Dance Party: join in on the fun with your child and throw a dance party! Choose action-based songs, such as “I’m Going on a Bear Hunt.” Incorporate action-based songs that involve activities requiring the use of both the upper and lower extremities to utilize your child’s motor planning and coordination skills.
  • Play Catch: a simple back and forth game of catch with either a ball, balloon, or bean bag can facilitate development of motor planning, body awareness, and bilateral coordination. Additionally, with the balloon allowing more time to move throughout space, encourage your child to keep it off the floor utilizing different body parts, such as their feet or even their elbows.
  • Simon Says: have your child participate in a gross motor version of Simon Says. For example, you can state, “Simon says jump up and down. Simon says touch your toes. Simon says stand on one leg.”
  • Animal Walks: completing animal walks such as bear walks, frog jumps, crab walks, etc. Your child might even want to create their own kind of animal walk!
  • Bubbles: blow bubbles and have your child pop them with a body part that you designate. Try to blow the bubbles on each side of his/her body in order to promote crossing their body.
  • Tummy Time: If your child is not yet walking, encouraging him/her to spend time on his/her stomach will allow him/her to bear weight onto their arms. For example, you can place your infant’s desired toys around them in a circle so he/she has to bear weight onto his/her arms to reach out for them. If your child is walking, increasing the amount of time your child is bearing weight on his/her arms such as in a crawling position or lying on his/her stomach strengthens his/her shoulders, arms, and hands for the development of more precise fine motor skills. This can be done by playing games or completing puzzles in an all-fours position or army crawling during transitions.
  • Clapping Games: using both hands in coordination to complete clapping games such as patty cake are a material-free way to practice gross motor skills such as bilateral coordination and motor planning.
  • Stand Up: create a vertical surface for your child’s arts and crafts activities. When standing and using a work station in front of him/her (such as a piece of paper taped on the wall) instead of below them, your child is actively engaging and strengthening the muscles in his/her shoulders, arms, and wrists to promote gross motor development.

Questions or concerns?

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

Reagan Lockwood, MS, OTR/L
Occupational Therapist

*Reference: Lubans, D.R., Morgan, P.J., Cliff, D.P. et al. Sports Med (2010) 40: 1019. https://doi.org/10.2165/11536850-000000000-00000

Photo Credit: Photo by Julia Raasch on Unsplash

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

Sitting Up Straight: The Importance and Impact of Postural Stability

Whether sitting at a desk at school, eating at the dinner table, or simply playing with toys on the floor, seated activities are an integral part of your child’s life. While we may not think of sitting as a complex task, it provides your child with a stable base to develop essential fine motor, visual-motor, and self-care skills. If you notice your child slouching frequently, propping his or her body against a desk or table, or fatiguing easily during seated activities, your child may be struggling with postural stability.

What is Postural Stability?

Postural stability refers to your child’s ability to achieve and maintain an upright and unsupported sitting posture against gravity. While seemingly simple, unsupported and stable sitting is dependent on a variety of factors, including muscle strength and tone, joint range of motion, the alignment of the body against gravity, and the support your child’s body receives from contact with surface they are sitting on. Core and trunk strength are essential for postural stability. If your child has a weaker core, you may notice slouching, propping of his or her head in the hands, heavy leaning against the back of a chair or the top of the desk, or sliding/falling out of chairs.

Why Does Postural Stability Matter?

While children are often on the move, a majority of their learning time takes place in a seated position. When children have to devote an excessive amount of energy to merely sitting up, the resulting fatigue can affect their ability to focus on classroom learning. Moreover, a strong and stable core allows your child to reach the arms away from his or her body in order to use the hands. Therefore, handwriting, scissor use, table-top crafts, self-feeding, and toileting tasks can all be negatively impacted by poor postural stability.

What Does Poor Postural Stability Look Like?

Some common signs of postural instability include:

  • Extreme or exaggerated slouching when sitting in a chair.
  • Leaning heavily or laying torso on the table or desk.
  • Frequently falling or sliding out of chairs.
  • Sitting in a “W” position.
  • Walking with a wide-legged stance.
  • Leaning against walls or holding onto rails for increased support.
  • Excessive fatigue following prolonged sitting (e.g. after school).

What Can I Do?

You can try to help improve your child’s postural stability through the following activities:

  • Knee walking: Try walking, playing catch, or playing “keep it up” with a balloon with your child standing on his or her needs. This helps to build the trunk muscles necessary for sitting balance.
  • Wheelbarrow walking: Encouraging your child to wheelbarrow walk helps him or her to engage their core and trunk, as well as build upper body strength. If provide support further from the core (e.g. holding the knees instead of the hips), your child will get a more intense core workout!
  • Animal walks or yoga poses: Encouraging your child to bear walk, crab walk, or perform other animal walks promotes core and trunk strengthening. Additionally, a variety of yoga poses (e.g. plank, boat, candlestick, etc.) promote overall strengthening which is great for postural stability!
  • Set your child up for success: Observe your child’s sitting environment. If your child’s feet are dangling in the air when sitting in chair, try providing a step stool or even a pile of books to rest his or her feet on. This will provide your child with a more stable base of support from the sitting surface.
  • Wedges or inflatable discs: There are a variety of tools available to help develop your child’s sitting posture. Sitting on a wedge or inflatable disc encourages your child to engage his or her core and prevents some slouching from occurring.

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

Natalie Machado, MS, OTR/L
Occupational Therapist

Reference:

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

Photo Credit:

Anissa Thompson via freeimages.com

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