Tag Archives: pediatric therapy

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:

When to Skip the Sippy Cup

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Many parents love sippy cups- they are great for “on-the-go” days and avoiding spills and messes! However, the problem with sippy cups is that prolonged and frequent use can impact a child’s development of speech and feeding skills. Below are three reasons why you may consider skipping the sippy cup:

  1. Tooth decay: Constantly sipping on anything that is not water can lead to tooth decay because the child does not have the opportunity to rinse away the sugars from the juice or milk with their own saliva. The acid from the drink may break down the tooth enamel leading to tooth decay. If you are going to use sippy cups for anything besides water, it is best to limit to only meal times and to take breaks with water to rinse your child’s teeth.
  2. Oral-motor delays: At around 12-months, a baby’s swallowing pattern matures from a front to back swallowing pattern to a more advanced swallowing pattern where the tongue raises to the top of the mouth and starts a wave-like motion for swallowing. It is important for babies to move to this new swallowing pattern as it allows them to transition from soft solids and liquids to more advanced foods and textures. When using a hard-spouted sippy cup, the sprout rests on the front of the tongue impeding the ability of the tongue to elevate to the top of the mouth. When a child uses a hard-sprouted sippy cup for a prolonged period of time, it can impact their ability to develop a mature swallowing pattern necessary for chewing and swallowing age-appropriate foods.
  3. Speech and language delays: Prolonged use of a sippy cup can impact a child’s ability to develop a mature swallowing pattern which means that their oral-motor skills may not be well-developed. Decreased oral-motor skills may lead to a greater likelihood that the child has difficulty saying and imitating certain sounds.

Other options? A great alternative to the sippy cup is a straw cup. There are some great options for spill-proof straw cups at most stores. Straw cups can offer the same “on-the-go” convenience of a sippy cup while still promoting appropriate oral-motor development!

Claire Kakenmaster, MS, CCC-SLP
Speech Language Pathologist

Can Prolonged Pacifier Use Affect My Child’s Speech and Language Development?

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Sucking is a postnatal reflex and is a natural part of your child’s development. So it is no wonder that a large majority of infants and toddlers use pacifiers to help them self-soothe throughout their daytime and nighttime routines. Pacifiers may be helpful for comforting your child in stressful situations, distinguishing between a fussy and hungry infant, and also as a sleep aid. But how old is too old for pacifier use? And are there any negative affects from prolonged use of pacifiers?

Pediatricians recommend that babies be weaned from pacifiers around four- to six-months of age. Pacifier use is no longer needed as a calming strategy after six months, primarily because the sucking, or “rooting,” reflex has disappeared. Prolonged use may result in the pacifier becoming a habit and therefore more difficult to wean.

Speech-language pathologists also recommend discontinued pacifier use by 12 months of age for many reasons. First, your child’s oral development is changing rapidly during the first few years of life. Prolonged sucking may in fact create a raised or indented palate, resulting in an oral cavity that is too large for typical articulation. This may manifest as a speech disorder around four to five years of age, often requiring therapy to remediate. Additionally, sucking on a pacifier encourages an immature suck-swallow pattern, resulting in possible feeding difficulties and articulation concerns.

Pediatric dentists recommend that pacifier use be discontinued by 24 months of age at the latest. The constant sucking on a foreign object beyond 24 months may cause the palate, gums, and teeth to develop atypically. This is primarily seen in the atypical eruption of permanent teeth, leading to crowding and/or gaps in the teeth.

If you are ready to tackle the job of weaning your child from his/her pacifier, there are a few strategies that can ease the transition. It is not recommended to go ‘cold turkey’ at first; rather, tell your child that the pacifier is for sleeping only and keep it out of sight during the day. Once you have established this routine, remove the pacifier from nap times and eventually from bedtime. It is helpful to offer a brand new comfort item (such as a new blanket or stuffed animal) that your child can use as a replacement for self-soothing. The most important thing to remember for weaning your child from a pacifier is to remain consistent with the rules you set in place!

While there is variability in the recommended age for weaning your child from a pacifier, general consensus is that pacifiers should not be used at any time (day or night) after 24 months of age. Consult your speech-language pathologist or dentist if you have any questions about your child’s pacifier use, as well as for recommendations and support for weaning your child from the pacifier.

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

Joint Attention: How to Engage in Joint Attention with Your Child

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Joint attention uses shared gaze and/or behaviors to communicate with a social partner. Joint attention is an important developmental skill that helps develop a child’s social language. This social developmental skill shows that a child is not only interested in objects in their environment, but in people too.

Joint attention usually first occurs between a child and their caretaker. A child can indicate, to their caretaker, their interest in an object or activity through gaze. A child can also use gestures such as pointing to engage their social partner in communication.

Social referencing: occurs when a child looks at an object, then back to the caretaker to see their reaction to the object

Milestones of Joint Attention

  1. 2 Months: taking turns with looks, noises, and/or mouth movements
  2. 6 Months: following caretakers gaze
  3. 8 Months: pointing
  4. 9 Months: gestures and social referencing
  5. 12 Months: point intentionally
  6. 12-14 Months: direct attention through pointing and then looking back at caretaker

Tips for engaging your child in joint attention

  • Follow your lead: Use vocal engagement to have your child share enjoyment with you. Pointing to an object such as a ball or a toy will teach your child to share in your enjoyment.
  • Establish your child’s interest: experiment with different toys, books, or movement activities (ex: tickling). Discover which activities seem to get your child’s attention best.
  • Reinforce Proximity: reinforce your child’s interest by engaging them in an activity. Place the toy or walk away from the activity a couple of feet. To reengage the child wait for them to come towards you and engage you before beginning the activity again.
  • Level of engagement: have your child increase their level of engagement with you
    1. Looking directly at you or the object
    2. Reaching for the object
    3. Pointing for the object
    4. Pointing at the object and looking at you
  • Increase the amount of time the child is engaged
  • You choose: Interest your child in a variety of activities and toys to open their interest in an activity that is something of your choosing.

 Rachel Weiser, MS, DT

Developmental Therapist

Additional References:

https://www.speechandlanguagekids.com/establishing-joint-attention-therapy-for-children-who-arent-tuned-in/

https://www.youtube.com/watch?v=1Ab4vLMMAbY

5 Dog Days of Summer Activities!

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http://brooklandpark.net/bp/2016/06/16/sprinkler-sunday-northside-childrens-house/

As summer nights grow longer I’m sure some families are looking forward to the start of the school year (or just tired of the same outdoor games). While handing over a tablet is a quick fix, Jessie highlighted research in her latest blog connecting increased screen time with expressive language delays.

 

Here are some ideas to incorporate Developmental Therapy into your summer games. (hint: you don’t need to buy all brand-new toys, use what you have!)

  1. Bubbles are great for everyone! Blow bubbles and talk with your child about size concepts (large and small). This is also a great opportunity to engage your child in joint attention and practice turn taking with the bubbles.
  2. Sights and sounds; take a trip to the zoo and make a family day out of learning. If you’ve already checked the zoo off your summer list, take a walk and discuss what you see and hear (dogs, birds, trucks, cars, and construction equipment).
  3. Lake Michigan; with our close proximity, this allows countless summer activities to enjoy with your family. Sand sculpting increase creativity, tactile sensory building, and hand-eye coordination. Building with friends and family also supports teamwork and promotes positive social interactions. Include pretend play during sand time, the more enthusiastic you are about playing the more your child will want to play! Have a kiddo who wants to keep their feet on the ground? No problem…. try boat, car, busses, and truck watching. Have discussions with your child about what you see to develop vocabulary and increase word retrieval. Incorporate colors, sounds, sizes, and anything you can think of. Don’t forget the SPF!
  4. Sprinkler/water table; a kid favorite to keep cool all summer! Grab the sprinkler out and let the kids play for gross motor and body awareness. Water table activities are great to improve fine motor skills, promote cause and effect awareness, and sensory regulation. Incorporate different objects into the table along with different friends to practice social emotional play and turn-taking. If you don’t have a water table…no problem! Use any size plastic storage container, fill it with water, and let the fun begin!
  5. Pretend play is something that can be utilized anywhere: driving in the car, playing at the playground, and at home. Use themes that your child already enjoys and has an understanding of (pirates, dragons, PowerRangers, princesses, anything!) Be enthusiastic…if you aren’t excited to use a hairbrush as a phone your child won’t be either. Don’t be afraid to talk out loud and explain what you are doing to your child (they won’t know what you are using the props for unless you tell them). Use concepts they know already, have them take their toy car and drive around to pick up grandma to make cookies in the kitchen. Using empty household items makes a child feel accomplished and proud to take part in family routines.

Kelly Scafidi, MSW, LCSW, DT

5 Therapeutic Yoga Poses and Their Benefits for Your Child

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Many adults think of yoga as a fun form of exercise or a way to promote relaxation and balance in their busy lives. However, yoga can also be an incredibly useful and fun activity that can aid in your child’s therapy, maximize functional skills, and help your child reach his or her full potential! Yoga poses can help children build strength, increase body awareness, promote development of fine motor skills, and provide a sensory experience to calm or stimulate the nervous system.

Here is a list of yoga poses and their benefits for you to try with your child. Be sure to try yoga poses on a mat or other soft surface, like carpeting, to avoid slips and falls!

Downward Dog

Downward Dog requires weight-bearing in the hands, wrists, elbows, knees, ankles and feet. The pressure put on each joint sends information to the brain about where the body is in space. The sense of knowing your body position in space is called proprioception. Proprioception increases body awareness, which can help children to navigate environments without bumping into people or things.  Body awareness also helps with the ability to plan a movement and correctly sequence and perform each step of the process. For example, more body awareness may help your child better plan and complete the action of getting on a bicycle. For many children, proprioceptive play has a calming effect on the nervous system.

Downward Dog also inverts the head, which challenges a child’s sense of balance. Our sense of balance is also called the vestibular system Children who enjoy spinning and swinging will love the feeling of being upside down in downward dog! Many parents find that children have an easier time focusing on tasks after vestibular play.

 

 

 

 

 

 

 

 

Bridge Pose

This pose builds core and hamstring strength. Building core strength promotes fine motor development, as children need to be able to keep their trunks upright when moving their arms and hands away from the body to accomplish reaching tasks. Increasing core strength will lay the foundation for the development of complex fine motor skills that require the arms to be moved away from the body, like handwriting. Hamstring strength helps with your child’s overall stamina for skills like running, jumping, and climbing. This makes participation in the park or on the playground much easier!

 

 

 

 

CAUTION:  Children with Atlantoaxial Instability (AAI) or any condition associated with neck instability should not attempt this pose.

 

 

Cobra Pose

This pose requires children to weight bear through both arms, increasing their ability to coordinate using both arms at the same time. This is called bilateral coordination, and it is necessary for many school tasks. For example children need to coordinate both arms when using one hand to stabilize paper and another to form letters or cut with scissors.

Additionally cobra pose helps to build shoulder stability and strength. Shoulder stability needs to present before fine motor skills that require hand dexterity can emerge. Examples of skills that require dexterity include shoe tying, and buttoning/unbuttoning clothing. Pretending to be snakes and hissing in this pose is a fun way to practice deep breathing!

 

 

 

 

Note: Encourage your child to engage his or her abdominals by saying “try to make your belly button touch your back!” This will help keep pressure off your child’s lower back.

 

 

Plank Pose

In addition to engaging muscles to increase core strength and shoulder stability, this pose requires the child to bear weight through a flat palm. Bearing weight through the palms strengthens the intrinsic muscles of the hand. The intrinsic muscles are essential for grasping and pinching skills. Activities that require strong intrinsic muscles include grasping handwriting feeding utensils, buttoning and zipping clothing, and tying shoelaces.  Stronger intrinsic muscles can help your child to hold a pencil, spoon, or zipper in an age appropriate way, making these functional skills easier!

 

 

 

 

 

 

 

 

Easy Pose

Easy pose can be excellent for providing relaxation, practicing deep breathing, and putting new trunk strength to use! You can tell children to pretend their heads are balloons reaching for the ceiling, and that their hips are rocks. Then explain that their spines are connecting the rocks to the balloons. This will promote good posture and increase sitting tolerance. Postural stability is the ability to sit up straight for an extended amount of time. When the trunk muscles are strong and able to maintain posture easily, children spend less energy on simply sitting upright at their desks. This helps children be less fatigued while sitting at a desk or table, so they have more energy to spend on learning!

While in this position, ask your child to take slow deep breaths. The child can pretend to smell a birthday cake while inhaling, and blow out birthday candles while exhaling. Try to encourage your child to focus on this type of breathing for at least 1 minute with the child’s eyes closed. Deep breathing can be a great “calm down” strategy for when your child is overwhelmed!

 

 

 

 

 

 

 

 

Natalie Machado, MS, OTR/L

References:

Heffron, C., & Drobnjak, L. (2017). Therapeutic benefits of yoga for kids. Retrieved

from http://www.kidsyogastories.com/therapeutic-benefits-of-yoga-for-kids/

Spencer, J. (2016). The therapeutic benefits of yoga for kids. Retrieved

from http://mamaot.com/therapeutic-benefits-of-yoga-for-kids/

Attention: What is Appropriate?

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All parents are concerned with their child’s attention span. As therapists, we always hear “His attention is so short!” “She bounces from toy to toy all day long!” “He is just so busy!”So, what really is a typical attention span?

Below is a loose guide to think about when considering attention in small children when they’re playing independently. They should be expected to attend for a bit longer when engaging with an adult, as we help keep their attention!

0-12 months: The littlest of babies should be able to play with a single toy for at least a minute or two (if you’re lucky!). Remember, they’re soaking in their new environment, so they’ll have the shortest of attention spans!

12-24 months: These exploring toddlers should be able to attend to a toy or activity for at least two minutes. As these new walkers start to explore and get into EVERYTHING, this may be a bit shorter, but two minutes can be expected once they’re sturdy on their feet.

24-36 months: These older toddlers should be able to attend for three to four minutes. Again, this should be longer when playing with peers or an adult.

3-5 years: These kiddos should be able to attend and play for about five to ten minutes without adult supervision.

 

Tips on increasing attention:

  • Encourage structured activities* at least once a day…after some movement!

Get those wiggles out before a structured activity! The best time to complete a learning activity would be when the child is well regulated. Being expected to sit all day and focus is difficult for an adult – it’s even harder for a child wanting to explore this whole new world!

*A structured activity is something that has a clear beginning and end: reading a book, completing a puzzle, or simple board games.

  • Limit distractions

No wonder these kids bounce around the room – many children’s toys tend to take over the ENTIRE room! Help your child clean up and put things away to limit distractions of other toys. You may need to hide away highly preferred toys, as needed, while completing your structured activities.

  • Turn off the TV and limit use of tablets and phones!

Screens aren’t the enemy- however many tv shows and videos on YouTube are so fast moving, the children don’t want to slow down for toys. Not only do screens impact children’s language development (see Jessie’s blog from last week!) but it also impacts their attention span.

For more information on attention and TV exposure: https://usatoday30.usatoday.com/educate/college/healthscience/articles/20040411.htm

  • Is a task too hard?

Is the activity at hand too difficult? While it is up to us as caregivers and your child’s first teachers to introduce new activities and skills, we need to build upon the skills they already possess. A child can’t be expected to sort objects by color if they are unable to match colors! Take skills they already have mastered and just push a little more, providing modeling, as well as visual and verbal cues.

  • Children should want to get up and explore!

It’s perfectly normal for small children to not want to stay in one place for a long time – period. They are curious, want to explore, and move – this is how they start to learn about the world! Just like anything else in life, balance is key. Get out there and explore with them!

Kimberly Shlaes, MAT, DT
Director of Developmental Therapy Services

“What is auditory processing? Does that mean my child can’t hear?”

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“I think my child has a hearing problem. They don’t always follow directions and often need me to repeat things.”

There is a common misconception among the families in the speech and hearing world that a child who presents with an auditory processing disorder can’t hear or that a child who has difficulty answering questions or following directions has a hearing impairment.  While the term may sound confusing as both issues concern the auditory system, they are in fact very different from one another. Below are some fast facts on what auditory processing is and is not.

What it is/may present with:

  • Auditory processing disorders are conditions where children have difficulty processing the meaning of the sounds they hear.
  • A disconnect between what the ear hears and the brain processes
  • A breakdown in receiving, remembering, understanding, and then utilizing auditory information
  • The inability to interpret, organize, or analyze what they’ve heard.
  • May have difficulty following directions, especially more than one direction/step at a time
  • May often need information repeated/rephrased
  • May need extra pause time for processing before responding
  • May look confused, give a blank stare, or often ask “huh?” or “what?”
  • Appear easily distracted or bored, especially when conversations/activities don’t include visuals
  • May become upset, angry, or frightened by loud noises and noisy environments
  • Increased difficulty understanding speech in noisy environments
  • Display poor memory for words and numbers
  • May have difficulty with complex language such as word problems, riddles and jokes, or a long story
  • Struggle to hear the difference in similar sounding words
  • Have difficulty paying attention for appropriate amounts of time
  • Have difficulty expressing complex speech
  • Struggle with language skills, including reading/reading comprehension, spelling, vocabulary, and understanding information presented verbally

What it is not:

  • A hearing impairment; all the parts of the hearing pathway are working well.
  • ADHD, Dyslexia, or Sensory Processing (although many children with these disorders struggle with auditory issues as well)
  • Not the result of more global deficits such as autism, intellectual disabilities, attention deficits, or similar impairments.
  • Not defiance or laziness in a child
  • It is not rare-research suggests it is in 2-7 percent of U.S. children
  • Not a lack of intelligence

Diagnosing either hearing loss or APD requires a multidisciplinary team:

  • A pediatric ear, nose, and throat (ENT) doctor will assess any medical problems with the hearing pathway (e.g. ear infection, fluid in the ears, etc.)
  • An audiologist will test hearing sensitivity to determine if there is a hearing loss and administer the series of tests that will determine if APD is present.
  • The speech language pathologist (SLP) will test developmental milestones in speech and written language.
  • The teacher or an educational expert will look at/identify academic difficulties (as well as implement modifications to the classroom after diagnosis)
  • A psychologist will evaluate cognitive functioning.

Things to remember:

  • Even if your child has multiple symptoms of APD, only careful and accurate diagnosis can determine if APD is actually present.
  • Although a multidisciplinary team approach is important in fully understanding all difficulties/aspects associated with APD, the diagnosis of APD can only be made by an audiologist.
  • Treatment of APD is highly individualized. There is no one treatment approach that is appropriate for all children with APD.

For further information, call us at PlayWorks Therapy, Inc. for a language evaluation or ongoing therapy after your child has been diagnosed!

Therese Schmidt, MS, CCC-SLP

Making Transitions Easier for the Child and Caregiver!

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Are you having trouble getting your child to transition between activities, tolerate a diaper change, or simply cooperate in his/her daily routine? Children’s early learning experiences are created through their caregivers, requiring the children to navigate their worlds through imitation and by following their caregivers’ specific directions. Around the age of 15 months old, children attempt self-direction and prefer to exercise independence and control. With that said, children often become more defiant of adult direction and may start to experience more difficulties with transitions. As caregivers, we want to make sure we continue to offer children control in order to help them better adjust to the demands placed on them. Below are some suggestions to use for helping your child in a transition process:

  1. Give your child verbal warnings before moving to another activity (e.g. putting on their shoes)
  • For example, give children a two-minute warning before they need to stop playing and put on their shoes. Even though they won’t understand the concept of two minutes, it will get them used to a verbal warning, which will precede the transition. Caregivers can also then give a second warning of one minute, offering the child a total of two warnings in total before they are required to transition.
  1. Give your child options during the transition.
  • Once you begin the process of putting on their shoes, caregivers can ask the children which pair of shoes they want to wear, ultimately offering two pairs that are acceptable to wear. This not only has the children comply with adult direction but also gives them the control back in choosing the options.

Caregivers can apply these two strategies to every transition! It is normal that children will require some time to adjust to the guidelines but stay consistent and changes will come!

Brittany Hill, MS, MSW, LSW, DT