Created in 1994, ABC Pediatric Therapy lives it’s mission of “creating the best life for all children” by providing the highest quality of speech, physical, and occupational therapy in a child friendly environment.
Is your child becoming bored on snowy or rainy days? These are great days to spark creativity and imagination! By allowing your child the ability to be creative without specific instructions or a model promotes independence and problem-solving skills. One way to promote creativity is through “free art”, which allows the child to create anything they desire without “rules” (except for safety, of course!). The amazing thing about free art is anything can be used to create amazing pictures, cars, buildings, etc.!
The following is a list of craft supplies likely already in your home to help spark creativity:
Paper towel rolls
The possibilities are endless!
The ability to work independently is an important skill to support development, success in the school setting, and later in life! Children do not learn independence unless they are given opportunity!
It’s is important to use the correct language to complement a child’s work. Phrases like “what is it?” or “I like your dog” may decreased self- confidence. If the child believes the creation is obvious to the observer (house, etc.) or if the final product is a cat instead of a dog, it is likely the child’s self-confidence will decrease. Asking open-ended statements or questions such as “You worked very hard!” or “Tell me about what you made!” will help boost self-confidence and social skills.
Before throwing away the paper towel roll, save it for your child’s next creative project!
If you and others are having a difficulty time understanding what your child is saying and they are demonstrating speech sound errors, your child likely has an articulation or phonological disorder. Don’t let the long names or the word “disorder” intimidate you! These are simply referring to the intelligibility (or clarity) of your child’s speech and can be remediated by a speech-language pathologist. Here is a great chart to follow:
If your child is producing some speech sound errors beyond what is typical for their developmental age, and are considered “mildy” unintelligible, it is likely an articulation disorder.
Articulation Disorder- strategies for home carryover
1) Practice your child’s speech sound being targeted in therapy in a mirror!
2) Practice your child’s speech sound in a book! This will increase their awareness of the targeted sound. Find books from your local library that have repetitive words with the appropriate speech sounds to target. (For example, if the sound is /g/, try “Go Dog GO!” by P.D. Eastman)
3) Draw attention to your mouth while speaking and use cues to your mouth so that the child can follow your cues for correct speech production on the targeted sounds.
If your child is “highly” unintelligible due to an excessive use of phonological processes that are typical for development, then it is likely a phonological disorder. Please refer to the phonological processes chart from the American-Speech and Hearing Association (ASHA) here: https://www.asha.org/Practice-Portal/Clinical-Topics/Speech-Sound-Disorders-Articulation-and-Phonology/Selected-Phonological-Processes/
Phonological Disorder- strategies for home carryover
1) If your child is deleting final speech sounds in words, make a “snake” down your arm with your pointer finger and “stop” the snake to mark the final speech sound.
2) To increase awareness of speech sounds, hide your mouth using a small piece of paper and say a targeted word (with the speech sound targeted) correctly and correctly to see if your child can hear the difference and ask them to give you a “thumbs up!” or “thumbs down” to that word with the speech sound. (pic as follows) For example, say “ship” and “sip” if the child is having a difficult time producing the /s/.
3) Minimal pair practice- using rhyming words that have the initial speech sound being substituted with the appropriate production. For example, if a child is producing the s/z, you would have the child say “sip” and “zip” or “sap” and “zap” so they can feel the difference of productions and increase their awareness of productions and practice the sounds.
At ABC, our ASHA certified and licensed speech-language pathologists can help remediate speech sound errors. Learning through play is crucial to your child’s development and we provide a sensory-enriched experience to allow for kids to target their speech sounds in a fun, play-based approach! Please visit our website http://www.abcpediatrictherapy.com for answers to your questions.
Orthotics are used for many different reasons, and can help kiddos achieve their goals. However, most parents do not know what to expect when getting orthotics for the first time. Here you will find some information that is good to know for first time orthotic users.
Ø Wear Schedule – when wearing orthotics for the first time, it is important to know that the kiddo does not wear them 24/7 right away. Their skin, feet, and sensory system needs to accommodate to this new feeling and new positioning. Therefore, it is recommended the child start off wearing the orthotics for about 1 hour, which is typically done during the therapy session when they receive them. If the child is tolerating them well and the orthotics seem to fit correctly without need for adjustments, you slowly build tolerance by adding another hour until they are able to tolerate wearing them all of the time.
Ø Monitor for Redness – as mentioned above, the kiddo’s systems need to get used to this new thing on their feet and this new positioning it puts their feet in. Therefore, it is normal that there may be mild pink or red areas that go away within 30 minutes or less once the orthotics are taken off. However, it is important to monitor these areas, especially if a deeper or more vibrant red color as this could indicate areas where the brace may need altered. This type of redness will take longer than 30 minutes to begin to fade. If this occurs, stop usage of the orthotics and give the therapist a call so we can assess what changes need to be made.
Ø Shoes – majority of orthotics are designed to be worn with shoes. However, shoes that fit orthotics can be difficult to find, especially since kids grow so fast. It is recommended that you wait to buy new shoes until you have the orthotics in person, that way you can make sure they fit in the shoe before you buy them. A wider shoe usually works better, such as New Balance. There are also shoes designed to better fit orthotics, such as Plae and Striderite. However, any shoe that fits your child’s foot with the orthotic will work; there is no one particular brand that you must buy.
If you have any questions about the ordering process, about the fit of your child’s orthotics, or if you think orthotics may help your child, please reach out to your kiddo’s therapist. We love to help and answer all questions in order to provide the best care possible.
At 0-3 months old, I will be able to start holding my head up when placed on my tummy. At first, I will be looking straight down, but with practice, I will be able to lift it even higher. Make sure my arms are under me so I learn to push up.
At 3-6 months old, I will be able to push up more through my arms so I can really look around. I will be able to reach for toys and bring them to my mouth. Make sure I have plenty of toys!
At 6-9 months old I will start to move around while on my tummy. I will pivot and I may learn to move backwards before I am strong enough to move forward. I love to explore!
At 9-12 months old I will be strong enough to push up onto my hands and knees for crawling. Watch out, world! Here I come!
Tummy time should always be supervised and done when your child is awake.
Tummy time should be done when your baby is happy – not tired or hungry.
Tummy time should not be done right after your baby has eaten. This can put pressure on a full tummy and cause your baby to spit up.
Perform tummy time for short intervals (10 minutes), several times per day.
Use a nursing pillow or small towel roll under the arms. This takes some of the weight off of the arms, making it easier to lift his head.
Use toys and music to make it fun.
Get on the floor so your baby can look at you.
Hold your baby on your chest, facing you, and recline back so you are face to face.
Babies loves to hear your voice and see your face!
When and how much?
Tummy time is needed every day and should begin the first day you bring your infant home from the hospital.
Start with just a few minutes at a time, several times per day. Gradually build up, as your baby is able to tolerate more.
Why tummy time?
Tummy time helps your baby get stronger in order to develop his skills.
Tummy time is needed to promote motor skills such as sitting up and crawling.
It strengthens the hands for holding onto toys or a bottle and helps to develop vision.
Babies who do not spend time on their tummy are more likely to have delays in their motor skills.
What if my baby doesn’t like it?
Hang in there and keep trying! With practice and toys to make it fun, your child will learn to enjoy it.
Keep that perfectly shaped head
Babies who are placed too much in swings, car seats and on their backs and not enough on their tummy can end up having a misshapen head.
Putting your baby on his tummy several times throughout the day keeps pressure off of the back of the head and keeps that perfectly round little head.
Avoid having your baby sleep in a swing or car seat, if you can. Babies should be placed on their backs to sleep on a flat surface. The flat surface allows your baby to turn his head to either side, helping to form the perfect head shape.
Tummy time should be fun and provide learning opportunities.
Remember to place your child on their back to sleep.
You may have noticed that your baby may prefer to look towards one side, they have difficulty turning their head towards one side, they may keep their head tipped towards a side or maybe they have a flat spot on the back or side of the head. If so, they may have something called torticollis or “wryneck”. Torticollis is tightness of neck musculature that typically causes them to tilt to one side and look towards the other. It can happen before, during, or after birth and can affect their development. It primarily causes the muscles on one side of the body to become tight with the muscles on the opposite side of the body becoming stretched and weakened. This makes it harder to look from side to side, to use their legs and arms normally, and ultimately affect the way they learn to sit, crawl, and play.
Effect on Head Shape
Sometimes prolonged positioning of the baby’s head in one direction cause a flat spot (this is called plagiocephaly). It can affect the shape of the rest of the baby’s head, with changes in the forehead (this is called bossing), changes in ear positioning, and facial asymmetries such as jaw recession. Some babies prefer to be on their backs but do not have a preference for turning their head towards one side, which could lead to the entire back side of the head is flattened (brachycephaly), making the head appear wide. Intervention by a physical therapist, education on positioning and supervised tummy time can help improve the shape of your baby’s head!
Head shape deformity, if not treated early, could lead to the need for a helmet to modify head shape. Helmets are expensive and have to be worn for 23 hours a day. Seek help early to avoid more invasive measures.
Long term effects of head shape not treated could lead to facial deformities. Asymmetry of the eyes could affect the ability of the eyes to work together as well since they will not be in alignment. Glasses would also be a challenge to fit if the eyes and/or ears were not aligned.
Another long term problem could be the ability of a baseball, softball, or football helmet to fit correctly, which can put the child at a higher risk for concussion.
Effect on Development
Tight neck muscles can have a significant effect on child development.
An infant may have difficulty growing out of reflexes that will effect the baby’s ability to achieve skills. For example, a baby will not be able to feed himself if a reflex called the Asymmetrical Tonic Neck Reflex (ATNR) does not integrate. The baby’s ability to move the head to both sides allows this reflex to mature and go away. Tight neck muscles prevent equal movement to both sides allowing this reflex to remain and effecting the child’s ability to get their hand to their mouth.
Balanced strength on both sides of the body will be limited as the child will choose 1 side of the body over the other to use as the muscles are not tight there.
Tolerance of tummy time will be decreased as control of the head and neck will be effected by tight neck muscles. Strength of the neck, back and arms muscles will decreased if the child does not spend time on his/her belly.
Ability to cross midline or hold bottle in midline is an issue when neck muscles are tight. A child needs to cross midline to dress himself and to perform most skills.
Tight neck muscles may lead to jaw muscle imbalance which effects the seal on a nipple. Imbalances in the jaw can lead to pain in that joint.
Neglect of one side of the body is also seen when a child has Torticollis. The child whole visual field becomes the side of the body in which they see, the side where the tightness occurs, creating more imbalances and delays in motor skills.
Importance of Supervised Tummy Time
After the “Back to Sleep” program was implemented in the 1990’s, there was an increase in torticollis and head shape concerns. The program was successful and the safest place to place your child when asleep and/or unsupervised is on their backs. Many babies spend most of their awake and sleep time on their backs or in equipment such as a bouncer, a swing, a car seat, etc. With more and more time spent in these passive positions, pressure is being placed on one spot of their heads consistently, leading to a flat spot.
Encouraging the baby to look towards the other side from their preferred side will help take the pressure of their flat spot of their heads. One of the best ways to improve the shape of the head while also improving their strength is the use of tummy time while the child is supervised and awake. When a baby spends time in active floor play it encourages motor development, Tummy time especially allows them to build strength in their neck muscles. Supervised tummy time while awake is a very important part of your baby’s development! Eventually they learn how to bear weight through their forearms and extended arms, further building strength in their necks, backs, and arms. By doing so, there is less pressure on their heads and it enforces a more neutral or midline position.
How is this treated?
In many cases, traditional physical therapy can help your baby’s strength, posture, development and head shape. Treatment typically consists of is parent/caregiver education, stretching tight muscles, strengthening weak muscles, and monitoring/addressing developmental gross motor milestones (i.e rolling, crawling, and sitting). Although the physical therapist plays an important role, it is also crucial that the home exercise program be followed as well. This program typically consists of stretches, re-positioning techniques, and strengthening exercises all taught by the physical therapist and usually practiced during the session.
If your baby’s head shape does not respond to repositioning and addressing the torticollis, a cranial shaping helmet may be used to directly address the shape of your baby’s head. The use of the helmet is backed by research and has be proven to be the most effective in terms of returning the head shape towards a more normal appearance. The helmet is worn 23 hours of the day, and is changed periodically by the orthotist as they baby’s head grows.
If you have further questions about torticollis, the role of physical therapy, or the use of a helmet, contact an ABC Pediatric Therapy physical therapist for more information and to schedule an appointment. Visit our website at www.abcpediatrictherapy.com to find the nearest location near you.
There are many reasons why a child may benefit from orthotic intervention at all different ages, with and without a medical diagnosis. The use of orthotics can vary from child to child, however, the main goal is to provide stability while promoting functional ability.
Orthotics can range from shoe inserts to knee high braces and more. They can be used to assist with flat feet, toe walking, weakness, poor balance, frequent tripping, leg length discrepancies, and etc. Orthotics are made to improve a child’s walking pattern to as normal for THEM as possible to facilitate age appropriate child development.
As a physical therapist, I hear more often than not that “my child’s doctor said they would grow out of it.” This may be the case for some children, but not all children are the same. Our posture and the way we walk begin in the womb and continue to develop through infancy and beyond. The way we walk is affected by our strength, flexibility, endurance, sensory processing, balance, and more. We cannot assume that because one child grew out of toe walking, all children will. There are many factors to consider and assess with each and every individual child.
The photos below are of a child whose mom had concerns about her foot position as soon as she began walking. Her primary care provider told her that she would grow out of it. She is now 9 years old and has significant ankle pain with running, jumping and long distant walking. With the use of custom orthotics and physical therapy services her pain has improved significantly. She will occasionally still have pain with higher impact sports, however, it is less frequent and she is now able to enjoy playing with her friends.
A child’s medial column of their foot, which means the middle of their foot (arch), does not fully develop until the age of 7-8 years old. This means that the forces we place upon our feet during this time frame will significantly impact the structure of them. If a child is compensating in the way they are standing, walking, running it could lead to foot abnormalities when they get older which could potentially lead to pain and/or decreased function in their day to day lives.
It is also important to note that because orthotics promote function, if a child is having difficulty learning to walk, jump, run, hop, or any gross motor activity that orthotics could be beneficial in helping facilitate those motor milestones.
If you have concerns about your child’s foot position, posture, walking, and/gross motor development I highly recommend consulting with your pediatrician, as well as, a physical therapist to make sure that there are not underlying deficits and to determine if your child would benefit from orthotic intervention. There is not one specific type of orthotic for any given diagnosis or deficit. There are so many options of orthotics available and a good physical therapist will help you determine what is best for your child.
What do I want everyone to know about autism? Well, a lot. But there is one idea that I think if we could all understand and practice, we could change the world.
Autism is an incredible gift.
Yes, it’s hard. It’s overwhelming and frustrating and scary and sad. It’s expensive. It’s difficult for family and friends to wrap their brains around. There’s not a ton of support. It can be isolating and heartbreaking. There’s sickness and suffering and pain.
And there’s incredible beauty.
Jakob has made it undeniably clear that he is who is is and no matter how hard anyone pushes him, he’s not going to change. He doesn’t react to force except to dig in his heels and refuse to comply. He is the ultimate nonconformist. He has come to this earth 100% nonconformable.
But he does react to love. Shower him with it. Love and accept everything he does without judgment. Meet him where he is. Go into his world and join him there. Show him that his world is not just ok but a very cool place to be. And then slowly, when he’s ready, show him what we having going on in our world. Show him the places and things and activities that before were too much. Do it with patience and love and care and a sense of adventure. If he says no, respect his decision. Try again on a later date in a different way. And all along the way be present. Be curious as to why he does things the way he does them. Listen to him, really listen. And celebrate. Celebrate every big thing and every little thing. Every look in the eye, every word spoken and request made. Every time he reaches out for help or a hug or to hold his hand. Celebrate him, just as he is. Love him, fully, wholeheartedly, and unconditionally all day every day.
Ultimately, he is teaching me how to be in the world. How to find the compassion in myself for others and for me. He teaches me every day that I can’t know why anyone does what they do unless I investigate and ask them. Whenever I do take the time to ask, I learn that they have very good reasons for doing it. At least in their mind they do. If the things they do cause others pain and suffering, force won’t get them to change, but love will. So I’m doing my best to love.
What if we could take the same unconditional love and patience and understanding that we have for our loved ones with autism and be that way with everyone? What if we could all see each other through the eyes of acceptance and nonjudgment? What would the world look like if everyone did that? It would take work. We’d have to slow down, pay closer attention, be present, be aware of our own thoughts and feelings. Be honest with ourselves and others. Be vulnerable.
I know for myself, it’s been worth it. It’s a minute-by-minute practice and the journey is constant. It’s been the only path to peace that I’ve found. It’s changed my life in so many ways and I know that it’s changed Jakob’s. He too has found peace in all of this. A peace that was not there in the beginning but is so apparent now in his smile, his laughter, the sparkle in his eyes, and just how he is in the world.
What a blessing it’s been for me to have him as my teacher. There are so many like him out there and it’s as if they’re screaming at at us through their refusal to conform to see them, listen to them and learn. We’ve been given these amazing teachers to show us the way back to love. All we have to do is let go and let them.
I bought it all. Every single thing I could find for years. Puzzles, books, puzzle books, blocks, toys, board games, wall art (big and small, framed and unframed), building blocks, refrigerator toys, magnets, stickers, art supplies, stuffed animals. And more. Literally hundreds of items that in some way or another featured the alphabet.
I discovered early on that Jakob was in love with letters. He was probably a little over a year when it became obvious that the alphabet was his thing. At three, he would spend hours filling up blank floor pad after blank floor pad of nothing but letters for hours on end. He loved the Leap Frog Letter Factory video. He would watch it over and over and laugh hysterically. If a letter from a puzzle was missing or if he saw letters out of order, he’d freak out and fix it. There was no doubt that he was emotionally attached to letters. He may have been disconnected from us but he was in love with A-Z.
When I began to see the alphabet as the doorway into his world, I went on a bender. I was on high alert everywhere I went and if I spotted the alphabet, I paid for it and took it home. Everywhere we turned, there were letters. To see and to touch and to feel and in all my hopes and dreams, to facilitate an interaction. Something, anything. A look in the eye, a smile, a laugh, a sound, a word, a sign of affection.
I thought I hit the jackpot when I found alphabet bedding. Each letter along with a picture lined the sheets. The comforter was colorful and adorable. Pottery Barn Kids. Quality stuff. Unfortunately, I didn’t really think that one through. It was probably around midnight on one of the first nights that I heard noise coming from his room. He had woken up, turned on the light and had thrown everything off the bed. He was wide awake and mesmerized by his fitted sheet. I had to strip the bed to get him to go back to sleep. And that took hours. Whoops.
I’m now in the process of going though all this stuff. We’ll be moving in the fall and it’s time to purge. We’ve been in our home for 16 years and I have never done any purging at all so I am coming across these hundreds of letters. Some he never touched, some that were well-used and well-worn and some that have made me cry. I remember the hopes and dreams I attached to all those letters. The way I felt when I purchased each one, thinking “this might be the one, the one that gets him to talk to me.” I remember the depth of those feelings. And the intense fear that came along with it. The desperation that I felt believing that it was up to me to reach him, to help him, to show him that the world I was living in was benevolent and can be just as much fun as the world that he was living in.
Now, after all the years and looking at it from a calmer, wiser, less fear-based and desperate perspective, do I think it worked? Yeah, I believe it did. Reading and writing are such a big part of Jakob’s life and continue to bring him so much joy. Writing letters to the president and other important political figures is something we do together on a regular basis. And I have no doubt that his love for letters and the sounds that they made helped to inspire him to speak.
All those toys and puzzles and magnets were a doorway, no doubt about it. But it was the unconditional love, acceptance, and joy that I took in the letters alongside him that got him to walk through the door.
And that’s the truth in everything, isn’t it? Accept where we are, find the joy, and love unconditionally.
Because if we can do that, the possibilities are endless.
For a child, getting themselves dressed is a big accomplishment and can boost their self-esteem. There are many skills that are needed to get dressed including fine and gross motor skills, bilateral integration (the ability to use both sides of your body together with coordination), sequencing (putting skills together to achieve a final task), strength, motor planning (the ability to determine and carry out a series of motor actions), and sensory processing.
Children can begin assisting with dressing before their first birthday and gain independence in the upcoming years before being able to fully dress themselves at age 5.
What dressing skills should my child be able to do and at what age? The answers are below. Encourage the skill prior to the age it should be mastered. At first you will have to completely do the skill for your child. Talk to your child telling them all the steps to complete the skills. Progressively ask your child to help you with each step. Praise your child for their help with the task and successful completion. You will be teaching your child pride, sense of accomplishment and trust that you think they can. Great job parent!
By the time a child is 1 years old:
Your child should be able to take his shoes and socks off.
He/she should push their arms in sleeves once the shirt is placed over their head.
A 1 year old should push legs into pants when the pants are held for them.
By the time a child is 2 years old:
He/she should be able to help pull pants down.
A 2 year old should remove their own jacket.
By the time a child is 3 years old:
A 3 year old should be able to take off pants.
He/she can button and unbutton large buttons.
Your child will unzip and zip jacket once zipper is started.
Three year old’s put on socks and shoes by themselves.
By the time a child is 4 years old:
He/she should be able to put on shirt and pants independently.
A 4 year old can take off his/her own shirt.
At this age, your child can snap, button, zip, and buckle a belt.
Putting socks on correctly is a skill at age 4.
By the time a child is 5 years old:
Your child should be able to dress and undress himself including all fasteners and tie his shoes! You now have extra time for you!!
Continue to challenge your child now that you know what skills they should be doing and when. Push their potential to be independent. Praise their successes!
This is the way to raise a happy, confident child!!
If you need help teaching your child skills reach out to ABC Pediatric Therapy Network. We are here for you! If you have questions, call us or visit our website at http://www.abcpediatrictherapy.com.