Uncategorized

If you have ever been around a baby or young toddler learning to eat solids and feeding himself, then you KNOW that it is a messy situation.  There is food everywhere…on the floor, all over the high chair, all over the baby, on the walls, and even on the dog! It leaves you wondering how in the world you are ever going to clean up everything before it is time for the next mess.  And where do you start? The high chair, the baby, … the dog?! The clean up process can be quite an undertaking. Yikes!

Raising kids, it seems like there is always a mess to clean up somewhere. Trying to avoid mess in the first place becomes a parent’s daily mission.  So of course, if you can get your child fed without the mess, it seems like a no-brainer, right?! Do the math, and that’s about six potential messes in the high chair that could be avoided!  As a mom, I am screaming “Heck yeah, let’s avoid that messy face, bib, outfit, highchair, hair, ears…(you get the picture)!”, but as a feeding therapist, I have to tell you that the mess is necessary.  I know, I know…I am apologizing in advance for the many wipes, towels, outfits, and bibs you will go through, but if you want a child who eats a well balanced diet, the mess is a must.  

A vital part of eating is experiencing the food with all of the senses. When we see a child in therapy who has aversions to touch and avoids interacting with wet substances or objects, this can interfere with the development of feeding. A pilot study recently was conducted and published in OT Practice that incorporated increased sensory play with food and discussions about the sensory properties of food with children that had problematic feeding issues, and while the study sample was low, the study discovered an increase in the number of foods the children ate. So what does this mean for parents? It means we have to accept the mess, and even more than that, we have to encourage the mess. 

Encouraging the mess is opposite to the commercial trends right now. Food pouches are marketed to parents on the go as an easy way to get fruits and vegetables into their child, and it has even extended to grains and proteins. The mom in me is screaming “Thank goodness for something easy and neat!!!”, but the trend I am seeing as a therapist is that babies love these pouches too, so much so, that they don’t want to stop eating them! 

I am a pretty practical mom, so I am not saying get rid of all pouches, but what I am saying is there needs to be multiple opportunities a day for a new eater to explore his food with all the senses, not just taste or get a little feeling in the mouth. Pick a time that you know you can get that baby in the bathtub after he is done eating and playing, and maybe when your spouse or partner is home to help out with the clean up. Let the food be the entertainment, and turn off the TV or other distractions.  Offer dry foods, wet foods, sticky foods. Put a mat under the child’s chair that can be easily shaken off outside or thrown in the washing machine. Strip down the baby to only his diaper to make him easy to wipe down. And hey, if you have a dog, let the dog help with the clean up on the floor!  Find ways to make cleaning up the mess easy on you, but still allowing your child to explore and learn about foods in the messiest way possible. 

Source: Gettier, M. “Children with problematic feeding, selective restrictive eating: A pilot program.” June 2022. OT Practice. 

“Wait…you are an occupational therapist…who works with children? Aren’t there child labor laws prohibiting that kind of thing?”

This was a real question. I had been an occupational therapist for only a couple of years at the time, but I remember thinking that the guy asking me was not that smart or not that worldly. Either way, I had to figure out how to answer him to hopefully enlighten him, because SURELY he should know better! (Haha)

Over the many years I have now practiced as an occupational therapist, I have come to expect questions like this one. Some people introduce me as a speech therapist (“you do work with kids with special needs, right?!”); some people introduce me as a physical therapist (“well you are kind of like a physical therapist because you work with muscles and help people get stronger.”). To be honest, some days I feel like a speech therapist, and some days, I feel like a physical therapist, but I am neither of these. I am an occupational therapist. I also work with children. So what does that mean, and what the heck do I do?

Occupational therapists work in many different areas, and that is because the “occupation” part of our title was given to us many years ago, when an occupation was better understood as any activity that a person spent time doing. Occupation certainly could be a job, but it could also be past times, hobbies, or any meaningful activity that a person participated in. Now that occupation is synonymous with a profession or work, the profession of occupational therapy gets a little misunderstood. Hopefully, I can help shed some light on that!

Occupational therapists work with individuals of all ages, of all abilities. One of our superpowers is to analyze a task or activity to figure out why a person might be having difficulty with it. You can find occupational therapists in hospital settings, outpatient settings, schools, nursing homes, and also in the home health setting after an illness or injury. You may even find occupational therapists in some non-traditional places, like in dance studios working with dance teachers to assist children of all abilities; or corporations working on the ergonomics of the work environment. We occupational therapists can show up in a variety of settings, helping identify the difficulties in tasks and modifying those tasks to allow individuals to work smarter and become more successful and efficient. So that is why we work with children…to identify what their strengths are and what areas are contributing to their challenges.

Working with children, occupational therapists assess a variety of areas. Typically, the parent or caregiver will identify some concerns and/or tasks that his child is having difficulty with, and the occupational therapist will assess many factors that contribute to the child being successful with the task. Those could include, posture, strength, attention, sensory processing, visual perceptual skills, fine motor skills, gross motor skills, sequencing tasks, and much, much more. Once the underlying challenges are identified, the therapists will work directly with the child and family to help strengthen the problem areas, make modifications until the child is able to effectively complete the task independently, and help educate the child, parent, and other caregivers, such as teachers, to ensure that the child is successful in the occupations he wants or needs to participate in his daily life.

It is not new news that children on the autism spectrum typically have difficulty with communicating and socializing. This, in fact, is criteria for obtaining an autism diagnosis. Many times parents notice these differences as first signs that their child may not be developing along the typical developmental sequence. Parents may notice difficulty connecting with their child or that their child seems to enjoy playing with objects more than playing with them.

Parents notice difficulties in relationships first because having a relationship with your child is such a desired aspect of having a child! As a parent, you love your child so much, and you are always striving for him to know just how much you love him, so of course when that love seems to go unnoticed, it leaves a parent concerned and desiring to find a way to have her child be able to reciprocate.

The relationship is what drives the DIR philosophy. The R in DIR stands for RELATIONSHIP! Helping a child to stay regulated and engaged in order to interact and communicate is the foundation of the DIR approach, and it is a beautiful thing to watch a child grow and expand his interest in the people in his life. To only redirect behaviors or ensure compliance is not typically what people look forward to in the role of parent, and while it is necessary, building safe relationships with your child is what allows the child to feel safe and secure to go into the world and build relationships with other people.

So how do you work on relationships with children? One of the most important aspects of building relationships is to find common ground and shared interests. Oftentimes children who are having challenges in relationships have limited or different interests, so instead of having the child join YOU, you have to join the CHILD. Finding shared joy in an object or game that the child loves helps the child to work within a familiar, comfortable activity on skills that may be more challenging for him, such as shifting attention between his favorite object and a person or connecting facial expressions to the emotions that underlie them. If the child loves roaring like a bear, then we have to love roaring like a bear, petting the bear, feeding the bear, and all the other things that the child likes to pretend to do as a bear. If the child loves stacking books, then we can love to stack our own books, color code them, and center them on top of each other.

It can be difficult to understand why a child enjoys an activity as much as he does, especially when it is repetitive and simple, and quite honestly, boring! For whatever reason, whether we see it or not, it is the child’s love, and it is the entrance into shared joy that allows for a deeper relationship with the child. Children tend to feel safe when participating in these favored activities, and when we not only allow them to continue them, but join them, the feeling of safety is even further enhanced. So, even when it is hard to do, get down on the floor with your child and see the world through his eyes.

For more information on DIR/Floortime, visit www.profectum.org.

As early as 4 months of age, Pediatricians are encouraging parents to expose children to baby foods. This milestone is pivotal in staging the rest of the child’s feeding experience. The main goal of this exposure is not for ingestion, as calories are still predominantly from breastmilk or formula, but for exploration.

Encourage your child to get messy! Show them how to smash their food, touch it with both hands, and smear it on their highchair tray. Is in in their hair? No problem! What you are encouraging is learning about the foods! Is it soft or hard? Can it break? Is it warm or cool? Does it have a big flavor or a small one? How can the child manipulate the food? Provide opportunities for children to use their fingers, a tool (such as an infant spoon), or a celery rod. The opportunity to be creative are endless!

Suggestions for messy play at home:

• Mix baby cereal with preferred breastmilk/formula
  • Can be mixed with more or less milk to alter the consistency
  • Can mix with water as an alternative
  • Can be warmed in the microwave
  • Can be cold from fridge milk
  • Can put in freezer for a few minutes before serving
• Stage 1 purees (can mix different flavors once introduced one at a time and checked for allergic reaction- consult your Pediatrician before mixing textures)
• Smashed banana
• Smashed avocado
• Smashed sweet potato
• Celery rod (at least 6 inches long)
• Carrot rod (at least 6 inches long)
• Cooked then pureed squash (Acorn squash, Butternut Squash)

What are Hard Munchables?

Hard Munchables are rod shaped food items that a child can hold independently and when inserted into the child’s mouth, it does not break apart and is long enough that a portion of the food remains outside of the mouth. The goal of hard munchables is NOT to eat, but for the child to explore the inner surfaces of their mouth and learn about this food texture. Exploring hard munchables is extra important for teaching the tongue to put foods to the back of a child’s mouth, thus enabling the child to eat more complex foods in the future, such as steak and baby carrots. Hard munchables are also useful in moving the gag reflex towards the back of the mouth as well as teaching the mouth how to accommodate for different size food objects.

When to introduce hard munchables?

– Child is mouthing toys without prompting.

– Child has neck and head control to sit independently.

– Number of teeth are not a prerequisite….. it is preferred to introduce hard munchables BEFORE children have teeth!

What are examples of hard munchables?

– Raw carrot rod

– Raw celery rod

– Raw jicama rod

– Beef jerky stick

– Hardened pizza crust/bread stick

– Hardened Twizzler stick

– Rib without meat on it

– Frozen French toast sticks

As always, only expose your child to foods under direct and constant supervision. Feeding skills vary and change frequently, so be mindful that one day a celery stick does not break apart and a few weeks later, the child is shredding pieces off!

Once your child’s molars protrude and jaw strength increases, the hard munchables are no longer used for exploration and become a food for ingestion purposes.

Happy Exploring!

“You are a speech therapist.  How can you help a child who does not speak?” When speech therapy is recommended for a non-verbal child, many people who are not familiar with the role of the speech-language pathologist (SLP), aka “speech therapist,” wonder why this recommendation was made.

In order to answer this question, it is important to understand that SLPs are communication specialists and that communication is not just verbal.  Imagine the messages you send with just a look to your loved ones.  Think about how you know what other people might be thinking or feeling, even if they don’t say anything.  How often do you point or gesture throughout the day to communicate?  Now imagine what it would feel like if you had none of these ways of communicating.  Not only is your voice silenced and your mouth motionless, but you also can’t use your hands or your facial expressions to convey meaning to others.  Try it.  You might get a sense of the frustration that some of our non-verbal or low-verbal children experience.

As SLPs, specifically those trained in DIR/Floortime, we start with the most basic form of communication, which is back and forth emotional signaling with a trusted partner. This could be in the form of eye contact and smiling—a basic human connection.  We then use techniques to  help the child explore his sound system, as well as use his body and face to gesture.  We help the child and his/her family communicate in continuous circles, even if not a word is spoken.   When children achieve this level of communication and they still can’t talk, we can introduce alternative communication devices that will give them a voice while theirs continues to develop.

“Speech therapy” is crucial to the overall communication development of a non-verbal child.  If any professional tells you that speech therapy can’t help, they are misinformed.  If an SLP tells you that he/she can’t help your non-verbal child, thank them for their honesty and find one who can.

Read more

Games are wonderful developmental learning tools for children.  They challenge many developmental areas simultaneously, requiring communication among different areas of the brain. So which skills need to come together to effectively play a game? Here are at least 6 of the things we observe/ work on when helping children learn how to play games:

1.  Understanding game etiquette.   This means you have to know when to take your turn and when to wait,  accept losing, maintain your “cool” when things don’t go your way, be gracious when your friend gets lucky and joke/have fun in a non-offensive manner.
2. Following multiple steps.    Setting up a game usually requires at least 3 steps, and even the simplest games require at least 2-3 steps to play, all at different levels of difficulty.  Some games might require picking a card and putting your token on the matching color square (i.e., Candy Land). Others might require spinning a wheel, determining the rule that is associated with that spin, then acting out that step (such as in Hi-Ho Cherrio!).
3. Working with contingencies and being flexible.    Even simple games like Chutes and Ladders or Candy Land require players to deviate from the standard of counting and moving, if certain things happen.  More complex games like The Game of Life and Monopoly require decision-making and a variety of money transactions, in addition to spinning, counting, and moving.
4. Sustaining attention and remaining in one spot.  Two-(or more)-player games are only fun for all parties if each person is invested in the game and can sustain attention.  An inability to sustain attention to the game could be related to the difficulty level of the game, the child’s impulse control, their need to move around, or a host of other reasons.
5. Making precisely graded movements.  Games often have small pieces that need to be put in precise locations in order to maintain order in the game. When kids have difficulty grading the amount of pressure they put on something or lack precision in their movements, they may inadvertently mess up the whole game board, upsetting themselves and others.
6. Exercising Cognitive and Language Skills.  Some of these skills include one-to-one correspondence, quantity concepts, counting, matching, reading for meaning, following directions, communicating with play partners, remembering, and many, many more!

Games are a wonderful way to support your child’s development, but can be frustrating if your child struggles with any of the skills above.  Modifications can be easy and fun and can support your child in their challenge areas.  In future blogs, we will discuss modifications for a variety of games. Meanwhile, take a look at some of our favorite games by clicking here, and scrolling about half-way down the page.

The truth is all children need the principles on which DIR/Floortime® is based. It is a way of interacting with your child that improves their ability to engage, relate, communicate, and think logically and flexibly. All children (actually, all people)  can become better communicators, given coaching by a more competent communication partner.  Children with sensory-based communication impairments need particular focus and coaching in these areas of development by their parents, instructors, and caregivers.

The vast majority of the children we see in our clinic have sensory-based communication impairments. This means that their ability to engage, relate, communicate, and think logically and flexibility has been limited, at least in part, by sensory system challenges.  Engaging Autism is one of our most frequently recommended books to parents and caregivers. It is also a good introductory book to DIR/Floortime® for clinicians, teachers, and caregivers who are not trained in the approach/technique.

Here are the reasons we think you should read Engaging Autism by Stanley Greenspan, M.D., and Serena Wieder, Ph.D. (even if your child doesn’t have an autism diagnosis):

1. The book is easy for non-professionals to read. Drs. Greenspan and Wieder use language that is easy to relate to and give interesting examples to make the principles understandable.

2.  It is inspiring.  When  reading this book,  parents are often relieved because they realize that someone is actually addressing the real concerns they had for their child’s development, and that the approach makes sense intuitively.  It is an approach that parents can learn and implement themselves.  It gives parents a way to better understand their child.  With that increased understanding,  Floortime users learn that behavioral approaches can be limiting because they don’t always reach the child in his/her place of joy or understand the biological needs that may be limiting their child’s functioning.

3. Engaging Autism helps you become a better advocate for your child by giving insight into developmental steps that are not on a standard developmental chart.  Most people are familiar with developmental milestones which include when a child should roll over, sit, babble, and say their first words.   Fewer people have had exposure to developmental stages such as 1) Shared Attention and Regulation, 2) Engagement and Relating, 3)Purposeful Emotional Interactions, and 4) Shared Problem-Solving.   Understanding these stages described in this book will help you to advocate for your child when standard measures done by physicians and/or school systems say “Let’s wait and see.”

4.  This book can be read many times and the reader will learn something new each time.   As their child overcomes challenges and moves up the developmental ladder, parents can continue to refer to Engaging Autism to help them address higher level needs. Also, the person engaging with the child may refer back to the book to continue to hone his/her skills.   I, personally,  often look back at chapters in this book to help me refocus.  Also, I may refer parents, teachers, or clinicians to a specific chapter in this book.

5. There is a special section devoted to  “Overcoming Difficult Symptoms.”  This section gives insight into scripting/echolalia, self-stimulation, sensation craving, overactivity, avoidant behavior, activities of daily living (such as eating or toileting), behavior problems, coping with feelings, meltdowns and regressions.  Although there are no easy answers to these difficult symptoms, readers can understand what may be going on in their child’s brains and bodies in order to support them.

The emotional well-being of children and families is a huge priority when choosing how symptoms should be addressed.  Being able to understand our children at a deep level plays a huge role in the way we respond to situations, and the way that the child ultimately learns to see and value himself.  Engaging Autism will help you learn many wonderful things about your child and the immense value you can add to his/her life.

 

 

1.  DIR® parents and therapists don’t have to force children to perform tasks that are unnatural, unmotivating, or lack meaning for the child.

DIRFloortime builds on the intrinsic motivation of the child. We look for the “gleam in the eye” and when we find it, we use it to motivate the child to move forward in all aspects of his/her development.  Supporting the child’s emotional health and well-being, while improving engagement, communication, and problem-solving are key elements of this model.

2. DIR® looks at the child as an individual.  

We as providers are highly motivated and obligated to understand the nuances of each child’s development and outward behaviors. We look for patterns that help to understand how they communicate, why they communicate, what motivates them, what increases their connectedness and level of joy, and what overwhelms them.  We need to understand when a child needs a break and when the child needs to be pushed.   Every child’s sensory profile is different and every child’s threshold is different.   It is our job to work with parents so that together we can identify those patterns and understand what those patterns mean in terms of everyday life functioning and intervention options for each child.

3.  Our DIR® kiddos learn to think and solve problems.

Imagine being stuck in sameness because you know if you deviate from your normal patterns, you will have no idea how to get back on track or how to get out of a “sticky” situation.  Many of our children are rigid. The may not like the ball pit because they don’t know how to get out of it.  Or maybe they are scared of new situations, such as ordering their own food at a restaurant, because if something unfamiliar happens, they won’t be able to adapt and solve the problem.  Change brings too many unknowns and our kiddos often lack the skills to come up with new ideas or solve problems.  

DIRFloortime, along with sensory integration theory, guides us in helping children to improve their thinking and independent problem-solving in meaningful and fun situations.  This improves their flexibility and helps support a strong foundation for academic or vocational learning.   

4.  We can help children from a very young age, when parents begin noticing something different, but pediatricians may not yet be concerned.  

Sometimes a child technically meets all milestones, but parents know that something is different.  DIRFloortime gives us an intimate understanding of development from a very young age.  We can observe a child’s interactions with other people and with his/her environment to know if he or she is at risk for developmental challenges.

5. “DIRFloortime® has the strongest research of any intervention to support its effectiveness in improving the core challenges of autism including relating, interacting, and communicating while decreasing caregiver stress and improving parent-child relationships. “  (Quote taken from www.icdl.com/research)

DIR positively affects things that are hard to measure, but that are arguably the most important things in life–connecting to others, thinking flexibly, and solving problems.  It’s hard to measure how happy a child is , how connected he feels to others, or how empowered his family feels because they understand their child better.  But parents and children feel these changes deeply.