OT at CFD

When looking at behavior, there are close similarities displayed with both children who have attention difficulties (ADD/ ADHD) and sensory processing disorder (SPD).  Co-morbid diagnoses may include Autism, Developmental Delays, and Learning Disabilities.  Common characteristics for children with both sensory seeking SPD and ADHD (hyperactive/impulsive type) are as follows: impulsivity, excessive activity, disorganization, impatience and poor self-control. 

However, more specifically, children who have SPD tend to be more in control of stopping impulsive behaviors.  They may crave activity relating to a specific sensory system, may become more organized after receiving proper sensory input and may be more patient while waiting if give proper sensory input.  They commonly poke/pull/touch others without proper sensory input.

Those who have ADHD (hyperactive/impulsive type), tend to continue impulsive behaviors, be disorganized and have difficulty waiting-even with sensory input.  They tend to crave activity not related to a specific sensory system.  They often talk a lot, impulsively interrupt, and have difficulty waiting a turn during a conversation.

It is an exciting time when your baby starts to explore the world of food. Most pediatricians recommend starting of offer rice/oatmeal cereals and pureed fruits and veggies between 4-6 months of age. Keep in mind, breast milk or formula are still your baby’s primary source of nutrition at this time. So look at this time as a wonderful opportunity for sensory exploration! Here are some tips when starting solids with your baby:

-         Does your baby still demonstrate a strong tongue-thrust reflex (pushing things out with the tongue)?  If so, he/she may not be ready.

-         Position your baby in a high-chair with a harness strap.   Be sure they are positioned upright and use some towel rolls to help prop them. 

-         Minimize environmental distractions (TV, busy room)

-         Show them the spoon- but be careful to supervise play with the spoon. At this age they will mouth anything and can make themselves gag. Typically, your child will see the spoon and move his/her head towards it with mouth open. 

-         It is good to start with rice baby cereal mixed with breastmilk or formula, then try pureed veggies and fruit. Making your own baby food is easy and healthy for your baby (steam, mash puree/blend, place in ice cube trays, and freeze). Follow your pediatrician’s guidelines about introducing new foods and allergies.

-         Go against your “mommy intuition” to clean up your child between bites. Prepare and allow for a fun and messy feeding! Feeding is a mutli-sensory experience to be enjoyed by your baby!

-         If you have concerns with your baby’s readiness to start exploring puree foods, contact your local speech therapist or occupational therapist in Charlotte for an evaluation! 

It's important to choose toys and activities for your child that will enhance overall development.  As a pediatric occupational therapist, I have heard from parents how difficult it is to know what to buy their children for the holidays that will be most beneficial to them.  So many toys these days "play for" your child rather than your child playing with them.  There are lots of bells and whistles that take away from developing fine and gross motor skills, cognitive skills, and creativity.  Here are some ideas for children 2-5 years old:

2 Years: blocks, balls, crayons, play dishes and cooking utensils, dolls/stuffed animals, easel and paper, hand puppets, musical instruments, wooden beads, child-sized table and chairs, paint, nesting boxes or cups, wagon, ride-on toy, simple shape manipulatives/puzzles..

3 years: bean bags, bouncing or rocking toys, building tools, jungle gym, floor puzzles, finger paints, materials for playing house/store, blunt scissors, sewing cards, shape manipulatives/puzzles.

4 years: simple board games, toy camera, bike with training wheels, art supplies, flashlight, garden tools, mini people, animals, food, playhouse or tent, roller skates, water play materials, jigsaw puzzles.

5 years: simple card games, simple crafts, clay/play dough, dress up costumes, jump rope, scooter, kite, science materials (magnifying glass, stethoscope, bug catcher/jar).

 

Imitating "animal walks" provide opportunities for your child's sensorimotor development building strength, motor planning skills, coordination skills, and providing organizing sensory input. They can be done at home, school, on the playground, or in the house.  Some fun "animals" for your child to imitate can include:

- Bear: arms and legs straight w/bottom in air
- Crab: belly up w/bottom off the floor; hands and feet on floor
- Cat:   on all fours arching back up high and low
- Leap frog: squat and jump high and forward
- Duck: squat and flap arms walking forward
 

Vision is one of our strongest senses.  Development starts at birth- giving the newborn information about the direction, texture, objects, and people.  Below are the stages of vision development:

Birth- 7wks: Baby can clearly see 8-10 inches away; turns toward light; primary senses (touch, vision, smell, movement) guide baby's world to development.

2-4 Months: Develops basic eye-hand coordination; enjoys rattles, grabbing and exploring objects with hands and mouth; enjoys early "games" (peek-a-boo).

5-8 Months: Develops basic muscle control for sitting and crawling/creeping; visual field extends to about 24 inches; fine motor movements are more purposeful (picking up a cheerio; holding bottle); eye muscle control development.

9-18 Months: Visual field up to 4 feet; increased exploration of environement due to mobility (crawling, walking, running); further develops visual motor skills (imitates scribbling; places objects into container).

19-36 Months: Visual field up to 4-10 feet; extended peripheral awareness; Motor skills expand to running, jumping, kicking, catching, simple puzzles, imitating strokes, and dressing skills.

Contact your pediatrician, opthomologist, or pediatric occupational therapist with any concerns regarind your child's development.

Many Pediatric Occupational Therapists and teachers widely use the Handwriting Without Tears (HWT) program.  This program was developed by  occupational therapist, Jan Olsen.  HWT is effective and unique because it:

- Follows a developmental sequence of pre-writing and writing skills
- Uses a multi-sensory approach (visual, tactile, proprioceptive, auditory
 

• singing songs and using puppets
• forming letters with wooden pieces and with play dough
• writing letters with chalk on small chalk board or on magnetic writing board
• forming letters in the air or on wall with finger

- Has child review and repeat for mastering letter formation/spacing
- Has child check and correct writing in workbook
- Follows learning sequence (imitation to copying to independent writing)
- Addresses all aspects of handwriting including letter formation, spacing, and line alignment.
- Can be used with children in Kindergarten through high school addressing pre-writing skill through cursive writing development.

This approach and program is widely used by occupational therapists at Child and Family Development in Charlotte, NC.  Many of the OTs on staff have been formally trained in HWT.  Please see www.hwtears.com for more information.
 

Tummy time is important for development of ALL babies. It provides opportunities for them to see things from a different point of view, develop motor skills, develop strength, and eventually mobility. Tummy time is extremely important to avoid flattening of the head/skull, which can potentially lead to developmental delays.  If you notice flattening of your baby's head, be sure to contact your pediatrician.  You may be referred to an occupational therapist or a physical therapist for evaluation and treatment.

Since the American Academy of Pediatric’s “Back to Sleep” program started to decreased the incidence of SIDS (Sudden Infant Death Syndrome), “tummy time” has been encouraged. Here are some key points for “tummy time”:

-         it benefits ALL babies

-         changes as your baby grows

-         always supervise your baby

-         great for bonding for you and baby

-         use stimulating toys that make sounds, light up, have different texture- or just use YOU! Studies have shown babies attend more/prefer human faces and expressions over other stimuli.

-         Your baby may not like it at first- but don’t give up! You can start with 5 minutes a day and build up their tolerance.

-         Plan “tummy time” during an optimal time of the day where your baby is alert and ready to play!

A good time to start introducing solids for your baby is around 6 months of age. However, keep in mind that breast milk and/or formula is the main source of nutrition for your child until they turn 1 year old. So,  this time is for exploration, experimentation, and learning for you and baby! They will make a mess, which is a great sensory experience for them so be ready for a clean up!

It is recommended that you introduce a new food every 3 days or so to be aware of any allergic reactions. More solid foods can be introduced once your baby is sitting or crawling independently. You can purchase jarred baby foods or make your own home-made baby food purees. At six months your baby should be use:

- Breast or Bottle: sucking pattern

- Open cup: use a mixture of sucking and suckling tongue pattern around 6-8 months. Swallows liquid from open cup with lips open and a bit of spillage.

- Soft spoon: recognizes a spoon by vision and/or touch, opens mouth, and quiets tongue to accept spoon. You may even see a munching pattern (up and down jaw movement).

- Suck, swallow, breathe: long sequences of sucking, swallowing, and breathing with breast or bottle. Continuously sucks when from an open cup.

Of our 5 senses, olfaction, or our sense of smell, is possibly the strongest.  There is actually a direct pathway from our nose to our limbic system in the brain, which is where emotions and memory are processed.  Isn't it amazing that a newborn child is able to recognize their mother's scent and associate it with food or a person with dementia can associate baking bread with being at home?  Many children with autism, attention deficit hyperactivity disorder (ADHD), and sensory processing disorders would benefit from using more of this sense at home, school, or in therapy sessions to affect arousal level or help with preparation of a meal.  Below is a list of scents and how they are able to change our arousal level:

Alerting:  peppermint, basil, garlic, vinegar, hot sauce
Calming: lemon, almond, cinnamon, vanilla,  chocolate.

Your pediatric occupational therapist can help you decide when the best time to utilize these various scents throughout your child's day as part of his/her sensory diet.

Working in pediatric occuaptional therapy, I have come across many parents that have told me their children were "late walkers" and realized once they decreased using "containers", their children started to walk!  Amazingly, there are thousands of convienient devices that we can put our young children in from cribs, playpens and carseats to play yards, exersaucers, jolly jumpers, bouncy seats, swings, slings, and high chairs.  I would encourage parents to stear clear of certain devices your great-grandmother would not recognize.  All of these "containers" should be used in moderation and for thier designed purpose.  It is necessary for child development to have floor time building strong muscles and going through the various milestones- they each have thier purpose! It also encourages self and environmental exploration.  Many of these "container" devices allow for upper or lower body activity- what about the middle??  The core, the trunk, our center- it keeps us together- keeps us upright and is vital to movement.  Many of these devices may also cause too much stimulation to a young child- such as excessive jumping or vibration.  So, baby-proof the house and set your children free... at least for most of the day.

As a mother, I know that we all want the best for our babies.  One of the major activity of daily living (ADL) for infants is feeding.  Most newborns need to be fed every 2-3 hours and can take anywhere from 10-30 minutes.  Recently, I read an article about breastfeeding statisics and healthcare(http://health.yahoo.com/news/ap/us_med_breast_feeding_savings.html).
We often hear about the nutritional benefits to breastfeeding, however, we don't hear too much about the benefits of child develoment.  Sucking is a child's first oral motor skill, which must make it very important!  It facilitates bilateral skills (both sides of brain and body), provides tactile (touch), vestibular (movement), and proprioceptive (muscle/joint) sensory input, which can be considered primary sensory systems.  It also stimulates olfactory (smell) and taste.  Breastfeeding requires strong sucking and uses both long and short oral motor muscles, which is also important for promoting verbal skills later in development.  Many mothers choose not to or are unable to sucessfully breastfeed thier baby for various reasons.  If you bottle feed your child, keep some of these things in mind to promote the same developmental and sensory experiences:
1. Continue to spend skin-to-skin time with your newborn during or outside of feeding time to promote bonding, tactile, and olfactory- your baby knows your smell!.
2. Change positions during feeding or change sides every other feeding.  We tend to hold with our dominant side and hold the bottle with the other.
3. Choose a nipple that is shorter and slow flow.
4. Hold your baby close to you during feedings.
 

Throughout college and my career, it is always interesting to hear response to, "I'm an occupational therapist."  Some people get excited because they are familar with the profession where as many others are stumped.  They may think we help people find jobs- that's not quite it- but closer than one may think.  Occupational therapists are in the business of the job of life.  We help people of all ages and physical, mental, or developmental needs.  At Child and Family Development in Charlotte, we provide pediatric therapy for children with autism, ADD, ADHD, and developmental delays, to name a few.  The "occupation" of children is play and school-related skills.  The goals we work on are to help children best participate in thier occupations- whether it be handwriting, wheelchair mobility, catching a ball, tying shoes, or feeding skills.  what a cool job!
 

Outdoor activities such as swimming, going for walks, using playground equipment, and playing in the back yard encourage child development with the opportunities to be active and master movement.  Daily opportunities for movement are especially important for children who have sensory needs such as children with autism, Attention Deficit Hyperactivity Disorder (ADD/ADHD), and Sensory Processing Dysfunction.  During these colder days of the year, parents may feel limited. 

Here are some tips to stay warm and provide opportunities for children to get the sensory input they need without depending on the outdoors:

1. Be creative!  Make an indoor obstacle course or playground using household items (couch pillows, sheets, blankets, chairs, bean bag chairs). 
2. Ask for indoor sensory equipment for the holidays for your child (ride-on toys, indoor swings, mini-trampoline, bean bag chairs, shaving cream, play tents, play tunnels, whistles, bubbles).  Many of these items are under $30 and can be found at stores like Ikea, Walmart, Target, and dollar stores.
3. Make use of public indoor playgrounds in local malls. 
4. Check for local activities for your children online. 
-Autism Society of North Carolina (www.asncmeck.org) 
-Autism Speaks (www.autismspeaks.org)
-Park & Recreation of Mecklenburg County (www.charmeck.org/Departments/Park+and+Rec/)