Tag Archives: pediatric occupational therapy

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

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

Self-Stimulatory Behaviors (“Stimming”) in Children

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What is stimming?

“Stimming” is a term which is often used to refer to self-stimulatory behaviors in children. These are repetitive behaviors that children engage in to stimulate their various sensory systems. Common forms of stimming may include hand flapping for increased proprioceptive (body awareness) input, rocking back and forth for increased vestibular (movement) input, lining up toys or staring at spinning objects for increased visual input, and humming or making other repetitive noises for increased auditory input. In extreme instances, stimming behaviors can be self-injurious (such as head-banging, self-scratching, or biting).

Self-stimulatory behaviors are often used by children to help them regulate their bodies and make them feel calmer or more engaged in certain situations. When children under-stimulated by their environments, they often participate in self-stimulatory behaviors for extra sensory input that may help them feel more engaged in the moment. When overstimulated, repetitive stimming behaviors can provide extra sensory input that many children find calming.

Is stimming bad for my child?

Self-injurious behaviors can be dangerous and may require you to intervene to physically stop the behavior before your child hurts him or herself. However, most self-stimulatory behaviors are simply socially inappropriate. In these situations, you can try to meet your child’s sensory needs through other activities, so he or she feels less of a need to seek out additional sensory information.

What can I do to help?

For children seeking out extra visual input, try playing with bubbles, balloons, or other toys which are easy to visually track. If your child seeks out additional proprioceptive input through hand flapping, you can try wheelbarrow walking, encouraging the child to sit on his or her hands, or providing hand squeezes to provide extra pressure in his or her joints. Try playing music, using a white noise machine, or playing with bubble wrap if your child engages in auditory stimming behaviors. If your child rocks or spins, try swinging in a blanket, climbing playground equipment, or rolling on the ground for increased vestibular input.

Natalie Machado, MS, OTR/L

Toddlers in the Classroom: Strategies for Teachers

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Are you a teacher of two- or three-year-old children? Do you struggle with feeling like your classroom is hard to manage at times? You’re not alone! Many teachers strive to create an environment in which the class is following their direction, but aren’t sure what strategies to put in place to help maintain control.

The following are some easy tips to really make a difference in your classroom:

Tip #1:
When children understand exactly what is expected of them, it provides much-needed consistency. Setting expectations also frees you to engage with the students more, rather than attempt to “put out fires.”

Strategies:
• Print and laminate a visual aid, such as pairs of feet, for the children to line up at the door.
• Create a job chart to hang on the wall with the children’s photos pasted onto popsicle sticks – they can choose their job for the week and move their stick to the correct spot during Monday’s circle time.
• Make sure that all of the children have the same rules, and follow through as best as you can. For example, if one child gets to perform jobs throughout the week, they should all have jobs. Please do not remove any children from group activities such as circle time in order to perform special jobs with the teacher – consistency is key!

Tip #2:
Use words and non-word prompts.

Strategies:
• Tell the children what will come next as they are engrossed in an activity. For example, as they are having snack, tell them, “Ok, everyone, when you are done with snack, you can go to the ____ (or play with ____) before we start ______.
• Use a NON-WORD prompt for transitioning; such as a bell or a certain part of a song, rather than frequently telling them “Time to clean up! Time to line up!” Breaking out of the pattern of consistently telling them with words generally encourages children to pay attention to those non-verbal cues.

Tip #3:
Help the children decrease impulsivity and learn to attend to task.

Strategies:
• Some children really benefit from sensory input while they are attending to a seated task. Examples include: a sit disc or cube chair at circle time, an exercise band wrapped around their chair’s legs (so they can kick or stretch against it), and fidgets for keeping hands busy during reading time.
• Allow for plenty of options for independent and teacher-led movement throughout the day. Examples include: animal walks during transitioning, teacher-led songs or activities such as Simon Says and “Going on a Bear Hunt,” reducing sitting time throughout the day.

With these strategies in place, your classroom will be calm rather than rowdy!

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

What’s the Problem with W-Sitting?

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W-sitting is a way of sitting on the floor that is preferred by many children. When W-sitting, a child sits with his or her bottom on the ground, with both knees and the feet positioned outside of his or her hips. When viewed from above, the line of the legs and body appear to make a W shape. As a parent, you may have been told that this position is “bad” and that you should immediately have your child change sitting positions. It is perfectly normal for children to move in and out of a W position for brief periods of time as they play. However, there are negative effects associated with prolonged W sitting, particularly if it is your child’s primary sitting pattern.

Firstly, W-sitting can put unnecessary strain on a child’s hip joints. If a child has orthopedic issues or is prone to high muscle tone and tightness, excessive W sitting can further tighten the major muscle groups that allow for outward rotation of the legs. This can lead to problems with coordination, balance, and in the most severe cases, hip dislocation.

Many children sit in a W position because it widens their base of support. This is a very stable position that doesn’t require much weight-shifting or core engagement to stay upright. For this reason, it is often the preferred seating choice of children who are very flexible or have low muscle tone. Because this position is so stable, children do not use their core muscles much as they are playing, which limits the development of trunk strength. Developed core and trunk strength is necessary to reach the arms away from the body to participate in fine motor activities like writing, coloring, or using scissors. Children with poor trunk strength may fatigue easily and demonstrate more difficulty remaining seated upright at a desk as they grow older.

Additionally, W-sitting does not allow for much trunk rotation while playing. Trunk rotation helps children develop the ability to cross midline (reach their arms across their bodies), which is an essential skill for differentiating between and coordinating the two sides of the body.  Because the W position is so stable, it is relatively easy for children to complete tasks with either hand when seated this way. This can delay the development of hand dominance. Therefore, excessive W-sitting can affect the core strength, postural control, and coordination necessary to develop precise fine motor skills, and should therefore be discouraged.

To help your child break the habit of prolonged W-sitting, you should try to anticipate when they are about to W-sit, and encourage a different position. Sitting in a “criss-cross” position or with the legs out in front of a child’s body promotes core and trunk development. Sitting with both legs to one side is also an appropriate position. If you find your child already seated in a W position, try giving them a verbal reminder to “fix your feet”, and help them move into a different position. You can also try letting them sit on a cushion or an inflatable disc as an alternative to sitting on the floor.

Natalie Machado, MS, OTR/L
Occupational Therapist

References:

Pathways.org. (2017). What is W-sitting? Retrieved from https://pathways.org/blog/what-is-w-sitting/

ADHD and the Classroom: Strategies for a Successful Day

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An Environment for Success

How can teachers setup their classroom to create a positive learning environment?

An organized classroom promotes organization habits among students and makes the teacher’s job easier.

  • Ensure that the children’s chairs and desks are arranged in a way that allows for flexibility to fit group instruction as well as small group work.
  • It is helpful for students to have a supply center, which allows them to independently prepare and manage their materials. It may contain items such as scissors, hole punchers, pencil sharpeners, etc. Provide visual cues for gathering materials needed for projects. Keep containers, such as shower caddies, handy to transport materials back and forth to the supply center.
  • A homework center allows for a designated area where homework-related activities to be centralized and turned in.

Homework Management

How can teachers develop effective systems for managing homework?

A clear routine and system for assigning, collecting, and storing homework will make managing homework assignments easier.

  • Designate a regular place for recording homework, whether a portion of the chalkboard, whiteboard, or online so that it is easily accessible to all students.
  • Establish a regular time for assigning homework. It may be beneficial to assign homework at the beginning of a lesson, so that students are not writing the assignment down as class is ending. This also allows for time to answer any questions regarding the assignment and can greatly increase homework completion rates.
  • Keep a master planner and homework log in which all assignments are recorded by the teacher or a responsible student. This can be a class resource for students who are absent or are missing assignments.
  • Extra handouts can be kept in a folder, a file organizer, or online. This way, students who miss or lose assignments have the responsibility of obtaining the necessary papers.
  • Designate a physical structure, such as a paper tray, to collect homework rather than using class time to collect papers.
  • Establish a regular time for collecting homework. Consider using a “5 in 5” reminder, requiring students to complete 5 tasks in the first 5 minutes of class, such as turning in homework and writing down new assignments.
  • File graded work in individual hanging folders to decrease class time devoted to handing out papers.
  • To encourage organization, have students designate sections of their binder for (1) homework to be complete, (2) graded work, (3) notes, and (4) handouts. Consider periodic checks and provide feedback.
  • Have students track their grades on grade logs to provide them with the opportunity to calculate grades and reflect on performance.
  • At the end of a grading period, encourage students to clean out their binders, and discuss which papers are worth keeping and why. Encourage them to invest in an accordion file or crate for hanging files to keep important papers.

Time Management

How can teachers structure classroom time efficiently and teach students time management skills?

  • Timers (such as the Time Timer or sand timers) provide students with a concrete visual reminder of the amount of time remaining for a task. They are a great tool for group work, timed tests, or silent reading.
  • Post a daily schedule in a visible place to establish the day’s plan. Present the schedule to the students, and refer to the schedule when making modifications to model time management skills.
  • Display a monthly calendar to provide students with regular visual reminders of upcoming events. These calendars are also beneficial for modeling backwards planning.
  • Carve out time for organization. Devote a short amount of time for students at the end of the day to reflect on their learning, manage their materials, prioritize homework assignments, and make a plan for their completion.

Materials Management

How can teachers help students manage their materials?

  • Designate a short amount of time once a week for students to dump out and reorganize backpacks and clean up lockers.
  • When students finish tests or tasks early encourage them to use the downtime to organize their materials.
  • Have students use labels, racks, or dividers to keep items clean and organized.

 

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

Resources:

Rush NeuroBehavioral Center. (2006, 2007). Executive Functions Curriculum.