Category Archives: Parent Education

Resources for Infant Feeding and Oral Motor Concerns

stockphoto  toddler eating YAY

Quick Resources for Infant Feeding and Oral Motor Concerns: Down syndrome, Cerebral Palsy, High Tone/ Low Tone Concerns, or Tube Feedings

Contributed by Capital Area Speech Therapy Staff Speech Language Pathologist:

Dee Arp, MA.,CCC/SLP

The big day is here and you are ready to tell the world; you have just had a sweet little baby!  Then, other news arrives; the sweet little baby also has an unexpected diagnosis that might make it difficult to nurse, feed, or speak some day.  It’s a lot to consider.  There is the added context of having spent hours in preparation for this big day mentally and physically, not to mention the number of hours spent in delivery.  Next thing you know, there are countless appointments lining up with medical specialist after specialist.  Did you ever feel like tuning it all out?  Understandable!  Next comes information overload: What does this diagnosis mean for your baby?  What does it mean for the rest of the family? Will your child be on multiple medications forever? How can you help your child reach his or her best potential?  Breathe in; breathe out.

This post is here to help you find those breaths. It’s a gentle guide for you to some helpful, internet-available resources.  Explore them at your own pace. The hope is that the gathering of resources here will minimize your work in searching.  These sites are full of articles and treatment considerations as your little one develops early pre-feeding and feeding skills. These materials range in topic from the “stages of typical development versus disordered feeding/ oral-motor development” to “reasons why parent training with a speech-language pathologist is important for a baby having Down syndrome”.  Our therapists seek to help you be able to help your child.  We want you all to gain a strong, fighting chance toward realistic progress at home, as well as within therapy by increasing understanding. We encourage high value placed upon early intervention and prevention of further complications.

Resources 

One book resource is extremely helpful and worthy of first mention.  It provides parents (and professionals) with numerous checklists and orderly charts describing some of the various functional issues at hand.  It is a great guide through those earliest stages of feeding and oral-motor concerns.  It may even be a wonderful resource for your Pediatrician or Family Doctor as you enter this unexpected journey.  The book is titled, Nobody Ever Told Me (or my Mother) That! The author is Diane Bahr, a speech-language pathologist.

Here are some favorite internet resources that offer multiple recommended readings for a rich variety of topics related to infants having oral-motor and/or feeding concerns listed alphabetically:

  • Debra Beckman is a speech-language pathologist that instructs in the area of specific oral-motor interventions and has developed a specific assessment in this area. Articles cover a variety of topics including: cheek patterns, drooling, jaw & lip patterns, tooth grinding, and tooth patterns

http://www.beckmanoralmotor.com/index.php

  • Marsha Dunn Klein is a certified occupational therapist with the company, Meal Time Solutions. The articles include explanations of why its important to manage some of the sensory aspects of feeding as well as new ways to present food items to assist in these issues.

http://mealtimenotions.com

  • Suzanne Evans Morris is a certified speech-language pathologist. She and Marsha have written several helpful books together within this topic.  She is a part of a company called New Visions

http://new-vis.com/p-fym.htm

  • Sarah Rosenfeld-Johnson and Lori Overland are also two influential, certified speech-language pathologists in the areas of pre-feeding and feeding development. Lori actually offers a course geared toward Pre-Feeding skills in young children with Down syndrome.     http://www.talktools.com/resources/
  • Kay Toomey is a pediatric psychologist specializing in feeding disorders. There are several handouts included here to help determine when feeding difficulties may be out of the normal category.  Items such as, “Red Flags for Feeding Disorders”, and another one distinguishing between “Picky Eaters vs. Problem Feeders” can be found here.

http://www.sosapproach-conferences.com/about-us/about-kay-toomey#

Thank you for your time and interest.  Remember, just as babies learn to sit up before they stand, parents also go the processes of learning what is best for their children.  Take your time along the way and enjoy the process.

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Making Food Fun!

5 Playful Ideas to Try When Presenting a New Food to a Child with a Limited Diet

Heather Celkis, OTR/ Capital Area Speech & Occupational Therapy www.capitalareaspeech.com

Making Food Fun!

Making Food Fun!

Reasons Tolerating New Food is Difficult

There are many reasons a child may have difficulty tolerating new foods. These reasons may include but are not limited to difficulty swallowing, difficulty moving the food efficiently within the mouth (oral motor skills), gastrointestinal issues, swallowing difficulties, poor postural control, respiratory difficulties and poor sensory processing. A child who has a very limited diet should be assessed by his or her pediatrician and referred for further testing by a specialist and/or therapy by a professional such as an occupational therapist or speech therapist.  It is important to rule out medical issues that may impact a child’s ability to eat.

Steps to Introducing New Foods

For many children with difficulty with sensory processing and tolerating novelty, the first step to trying a new food is interacting with it, tolerating it on a plate, smelling and playing with it. Yes! We should be encouraging these kids to play with their food!

The following are a few helpful and playful ideas for introducing new foods:

  1. Place just a few bites of food on the plate. If the child has a whole plateful of novel food they may become overwhelmed and feel that they will be pressured to eat all of the food presented.
  2. Use the food to paint a paper plate with sauce. For example, use a piece of broccoli to brush cheese sauce on a plate. Make patterns with the sauce by using the broccoli as a stamp.
  3. Use some familiar foods with a few pieces of novel food and arrange them to make a picture such as a smiley face. Take turns making the face as silly as you can.
  4. Stack the food like blocks then knock them down. Bread cubes, crackers and carrot slices are great for stacking.
  5. Have a pretend tea party and feed the animals and dolls the novel foods. This is a great way to encourage a child to interact with a new food while not expecting them to eat the new food yet.

Children are more likely to try a new food if they are allowed to explore it at their own pace so be patient and above all have fun!

Handwriting

This blog post was written by one of our outstanding occupational therapists.

writing

Occupational Therapists frequently receive referrals to work on handwriting. But why does handwriting matter? Simply put, it’s been an important method of communication for thousands of years, and continues to be important for everyday life. In school, at work, when completing application forms, and planning our days, people often pick up their pens. However, in these times of increasingly advanced technology some people wonder if handwriting is becoming obsolete. In some ways perhaps, but there are many reasons that it shouldn’t. For one thing, the simple act of writing helps with brain development. Increased brain activity occurs whenever we use this complex skill in a way that does not happen when we type. This is because writing involves fine motor skills, spatial skills, eye-hand coordination, memory, and planning. As a child, the development of neural connections through writing is incredibly important. Secondly, studies have shown that when we write things down (think classroom notes, grocery lists, and to-do lists) we are more likely to remember them. Additionally, for purposes of safety, writing can also be important. If for some reason, we become unable to communicate verbally (in incidences of injury, for example) writing can become a primary form of communication.

What does it mean to have “good” handwriting? Generally speaking, it means that the writing is legible, and there are several pieces to the puzzle when it comes to legibility, including motor skills, visual skills, and the combination of the two. Let’s take a look at this through different age groups.

Preschool and Kindergarten

At this age:

  • Kids are playing fine motor games and doing simple eye-hand coordination tasks like drawing pictures, learning to color within the lines of a shape, trace simple lines and shapes, learning to use scissors. By age 5 or 6 they are using one hand predominantly, with the other hand as a helper. In kindergarten they are learning how to write letters and draw more challenging shapes.

Things to look out for:

  • A fisted or otherwise awkward grasp on crayons or markers, from age 3 and up.
  • Difficulty copying simple shapes (lines and circles) or starting to draw features of people and common objects.

What you can work on:

  • To get little hands ready to hold a pencil (down the line), have them pick things up with tweezers, bread tongs, or clothespins; play with finger puppets; fingerpaint with a different color on each finger; play crawling games to help develop the muscles in their hands; and color with small pieces of crayon or chalk (like one-inch long).
  • To get them ready for more precise eye-hand coordination, have them put stickers onto designated spots as part of arts and crafts activities, do simple mazes, string beads with holes of different sizes, and play with constructional toys.
  • To help establish hand dominance, never force them, but have them play with games that involve using both hands together, such as toy nuts and bolts, wind up toys, and grinder or crank toys (like some play-dough toys).

Elementary school

At this stage:

  • Writing becomes an increasingly important skill, and by the upper grades the majority of the child’s work is likely to be handwritten. Kids complete worksheets, journals, answer questions about reading assignments, and later on write paragraphs on notebook paper.

Things to look out for:

  • Difficulty with letter formation, letter size, spacing between letters and words, and letters that float or sink below the baseline.
  • Messy but fast writing; or neat but slow writing.
  • Difficulty learning cursive.
  • Hands getting tired easily.

What to work on:

  • Perceptual tasks such as puzzles, spot-the-differences, and hidden pictures.
  • Precision tasks such as mazes, dot to dots, mirror image drawings, and grid drawings.
  • Adaptations to the type of paper/lines your child is using; adaptations to the pencil/writing tool

Middle school and high school

At this stage:

  • Your kids are taking notes in class, and often have worksheets to complete as well as longer written assignments.

Things to look out for:

  • All of the same signs as in the elementary age group.
  • Teachers and other people having difficulty understanding what the child has written.
  • Avoidance of work.

What you can work on:

  • Talk to an occupational therapist about adaptations that can be made to the tasks, setting, or materials used if writing is posing a significant challenge.
  • Depending on the child’s strengths and needs, it may be helpful to revisit cursive as an alternative to printing.
  • Children should start becoming more proficient with typing at this stage.

If you have concerns about your child’s writing, talk to his or her teachers about school strategies, and consider an occupational therapy screening to find out more information about what can be done to help.

References:

Handwriting Without Tears (2013). Research Review. Retrieved January 23, 2015 from http://www.hwtears.com/files/HWT%20Research%20Review.pdf

Handwriting Without Tears (n.d.). Importance of Handwriting. Retrieved January 23, 2015 from http://www.hwtears.com/hwt/why-it-works/handwriting-standards/importance-handwriting

Konnikova, M. (2014, June 2). What’s lost as handwriting fades. New York Times. Retrieved February 5, 2015 from http://www.nytimes.com/2014/06/03/science/whats-lost-as-handwriting-fades.html?_r=0

Mueller, P. A. & Oppenheimer D. M. (2014). The pen is mightier than the keyboard: Advantages of longhand over laptop note taking. Psychological Science, 25(6), 1159-1168.

The University of Stavanger. (2011, January 24). Better learning through handwriting. ScienceDaily. Retrieved January 23, 2015 from http://www.sciencedaily.com/releases/2011/01/110119095458.htm

What Does a Speech Pathologist Know About Language and Literacy?

Jamie Putnam, speech language pathologist and owner of Capital Area Speech Therapy, has been providing in-service opportunities to preschool/kindergarten programs around our area. The following is information gathered from Jamie’s lectures.

Speech pathologists are often portrayed as the ones who “fix the sounds”. There is no doubt we spend time working on the “r” sounds, a lisp, or a number of other sounds. Those sounds, however, are only a small percentage of our qualifications. 

What about language and literacy? Are they related? What do speech pathologists know about language and  literacy?

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Language and literacy is a symbiotic relationship. These skills develop together. Research shows  that children who enter school with strong oral language skills learn to read and write easier and excel in school related to their peers who struggle with language skills.

Language disorders are seen in as many as 1 in every 5 children. Research indicates that the majority of children with language disorders will go on to having reading difficulties or disorders. 

What does early language and literacy development look like?

AGE

LANGUAGE DEVELOPMENT

LITERACY DEVELOPMENT

12-18 mos.

Rapid language acquisition & word explosion

  • Enjoys books as toys
  • Likes to turn pages
  • Loves predictable stories
  • Points out familiar objects in pictures
  • Likes the same book over and over

18-24 mos.

Rapidly expanding word base and word combinations

  • Chooses books
  • Knows that books go front to back and right side up-will orient a book
  • Loves predictable repetitive stories
  • Will fill in words

24-36 mos.

Awareness of sentence structure and vocabulary continues to explode

  • Will correct adult if story is read differently
  • Will fill in words or attempt to tell story
  • Likes repetition and predictability in stories

3-4 years

Uses complex sentences & understands word structure (tense)

  • Understands that words may be changed and manipulated
  • Rhyming and word play
  • Recognizes name in print
  • Recognizes environmental symbols

4-5 years

Clearly communicates about remote events

  • Simple sound letter correspondence
  • Letters have meaning
  • Experimental writing, spelling, and story telling

There are five predictors of literacy success.

1. Oral Language

2. Alphabet Awareness

3. Phonemic Awareness

4. Concepts About Print

5. Early Writing With Inventive Spelling

A professor in early childhood education describes these predictors in detail in this You Tube video.

 

 

 

 

What are Weighted Vests and How Do They Work?

Weighted Vests

by Capital Area Speech Therapy’s Occupational Therapists

 

If you have been attending occupational therapy sessions or learning more about sensory processing, you may have heard about weighted vests and wondered about them.

 weighted-compression-vest

So what exactly are they?

A weighted vest looks similar to a regular vest a child might wear, except that sewn into the waistline and upper back are pockets meant for holding small amounts of weight. This added weight can be a very useful tool for helping to calm and organize a child who is highly active or easily dysregulated. For these kiddos a weighted vest can provide calming input to their body that helps to keep them at just the right level of alertness and activity for learning or participating in activities.

 

How does it work?

Weighted vests provide children with proprioceptive input and touch pressure. These are essentially the same kinds of calming sensations your body receives when you get a massage, sleep under heavy blankets, or share a big squeeze with a loved one. It’s that even, calming input to your muscles. By providing this kind of input at regular intervals throughout the day, the child is better able to stay regulated and focused.

 

Getting started.

If you are interested in trying this with your child, talk to his or her occupational therapist and ask about the benefits or need for one. The therapist will discuss specific recommendations for your child, but here are some general guidelines. For starters, your child should still be able to move around freely and safely, without danger of falling over or feeling as though he or she is straining to move. Remember, the purpose of a weighted vest is not to weigh the child down, but to provide additional sensory input. Typically, the weight will start off at around 5% of the child’s body weight, and will increase only as needed. Additionally, your child will only wear the vest for a specific amount of time, then remove it, cycling through the day this way. Your OT will discuss with you how long to keep it on and off. Weighted vests are only one part of the therapeutic plan to address a child’s sensory needs, and are used best in combination with other organizational and sensory integrative techniques.

 

Is the PROMPT approach effective?

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Yay! We are back to blogging about research. You can check out what research says about other speech and language related topics over at Gray Matter Therapy. The blogger does an awesome job of rounding up speech pathologists around the nation to read research and blog about it.

This month I, along with other therapists from our office, are going through the big PROMPT training. While I hear so many good things about the use of this technique in therapy, I really wanted to know what research says about it.

PROMPT stands for Prompts for Restructuring Oral Muscular Phonetic Targets. PROMPT combines auditory input and visual cues with a tactile kinesthetic approach to therapy. So in addition to hearing and seeing, the therapists actually touches the client’s face in order to guide them to their target sound, word, or phrase. You can learn more details about PROMPT at their website.

Here is some research that I found related to PROMPT.

Dale, P. and Hayden, D. (2013) Treating Speech Subsystems in Childhood Apraxia of Speech With Tactile Input: The PROMPT APPROACH. American Journal of Speech-Language Pathology, 644-661.
These researchers examined the effects of using PROMPT with children with childhood apraxia of speech. Childhood apraxia of speech (CAS) is a speech sound disorder involving the planning and programming of movements required for speech sounds. These children are very difficult to understand.
Participants and Method: Four children who had been diagnosed with CAS were divided into two groups. Two of the children received eight weeks of full PROMPT. Two of the children received four weeks of PROMPT techniques without tactile kinesthetic prompts then four weeks of full PROMPT. Target words were chosen for each child. Standardized tests and untrained probe words were used for assessing progress.
Results: All children in the study showed significant improvement in the 16 weeks of intervention. Scores on the untreated probe words and on the articulation test showed some evidence that including the tactile kinesthetic cues results in more success.

Grigos, M., Hayden, D., and Eigen, J. (2010). Perceptual and Articulatory Changes in Speech Production Following PROMPT Treatment. Journal of Medical Speech-Language Pathology, 18, 46-53.
This study was to determine whether speech sound accuracy changed after PROMPT treatment.
Participants and Method: Two three year old males were participants in this study. One was a typically developing 3 year old was assessed. The other child had a speech disorder and received PROMPT treatment twice a week for eight weeks. This study differed in the first discussed in that, in addition to formal testing and untrained probe words, they used a motion capture system to receive a visual of the child’s articulatory movements.
Results: Pre-treatment, the child with speech disorder displayed severe deficits on an articulation assessment. He also demonstrated inappropriate oral motor behaviors. Results of this study indicated improvements in both articulatory movements and speech sound accuracy.

Other research about using PROMPT has been published regarding children with cerebral palsy and autism. You can also find research on the effects of using PROMPT on adults with aphasia and apraxia as well.

What is Sensory Processing Disorder?

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Here’s a story about “Johnny.” It’s morning! Time to get up and get the kids ready for school. While this can be difficult for many kids, it can be especially difficult for a child with Sensory Processing Disorder. Getting out of bed is the first challenge. Mom gently shakes him, talks to him softly, pulls down the covers. But it is hard for him to get going; he does not want to leave his bed. It takes quite some time, but eventually she rouses him. In the bathroom other roadblocks occur: washing his face, brushing his teeth, getting in the bath. Often the water feels either too hot or too cold, the water splashing against his face really bothers him, and the brush feels uncomfortable. Some days the bathroom can be a bit of a battle. Getting dressed can be challenging too. Clothing with tags or tight seams really irritates him, and socks are the worst! After he is clean and dressed, it’s time for breakfast; but this is hard for Johnny too. He tries, but some foods he just can’t stand the smell of, and others he refuses on sight. Fruit, oatmeal, and eggs are out of the question. He ends up having the same thing he’s had for the last three weeks – a few bites of dry waffle. Mom doesn’t push it, because she doesn’t want him to be upset before heading to school. Eventually they leave the house and it’s off to school. Johnny is calm and happy and ready for school, but mom worries about what the day will bring, because even a slight change in his routine at school can affect his whole day.

Does any part of this sound familiar? Kiddos with Sensory Processing Disorder have difficulty registering or tolerating different kinds of sensory information, such as touch/textures, sounds, smells, light/visual stimuli, movement, and even information from their own bodies telling them where they are in relation to others. Because of these challenges, they may seek and/or avoid different kinds of sensory input. For example, one child may be overly sensitive when it comes to textures, avoiding certain materials and messier activities, while another may constantly touch things, to the point of being inappropriate or irritating to others. Some children become extremely and inconsolably distressed by certain sounds, such as a car horn, vacuum, or even other children playing, while others (or even the same child) may not register typical sounds such as his/her name being called repeatedly. Some children may seek out lots of movement by running or spinning or constantly moving around the room, while others may be afraid to sit on a swing or climb on a play structure. Because they are working overtime trying to manage their sensory needs throughout the day, these children can often become very easily frustrated or sad, as they exhaust their resources for tolerating life’s occurrences much faster than children who do not have these challenges.

If you notice any of these challenges in your little ones, an occupational therapist can work with you and your children to figure out their specific sensory needs, and how to help them integrate these sensations and tolerate experiences more easily.

Take a look at these websites for some great information about SPD:
www.spdfoundation.net/about-sensory-processing-disorder.html
www.sensory-processing-disorder.com
lemonlimeadventures.com/sensory-processing/#_a5y_p=1260983

written by the occupational therapists at Capital Area Speech