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A Pediatric Perspective

Organizational Tools
October 24, 2014 1:43 PM by Wendy Spoor-Hof
I can't believe how quickly time is flying by. I know when I was younger my parents would comment on how time seems to go faster when you are older but couldn't understand how that could happen. Now, as an adult working full time, going to school full time, with a family - boy, can I totally, not just understand how that happens, but relate to it all too well.

I'm in my 3rd week of a 10 week quarter at school and had forgotten just how much reading there is involved. It doesn't help that I do most of the reading at night when everyone is asleep and I'm curled up on the couch with my dogs. I am thinking I may need to find another way to do this as the last couple of nights have found me closing my eyes "just for a moment" and waking up at 1am. This makes getting up at 5:15am a challenge. I am able so far to keep up with the work load, school load, and family needs so I won't complain too much.

I do find that I need a way to organize my "to do" list better though. I was late getting a couple assignments in because I thought they were due on a different day. A good amount of the work we do is on-line and the assignments and when they are due are all on line. I consider myself tech savvy but even for me it can get a bit confusing. I am finding I can see firsthand how hard it must be for children with dyslexia, processing skill challenges and/or ADD that have trouble organizing their thoughts and their school work.

Realizing I need something to help I did a little research and came up with the following helpful organizational tools:

Google Reminders: This is one that my 15 yr old son showed me just the other day after the assistive tech at his school showed him it. I have not had a chance yet to use it but it does look like it might be a really good tool. I like that you can talk into the microphone to set the reminder.  You can set the reminders in the Chrome browser window or on the app on your smart phone. This is the app that I currently use on my Samsung Galaxy phone. I like that it will remind me when I have to do something but also allow me to postpone that task if I need to. I can postpone it for a few minutes, hours, days, weeks. I also like that it can link up to my contacts or to the web if my task involves either one of those items, making it easier to complete the task.

Calendars: I find it hard to buy a schedule/calendar that will allow me to write down my hour visits for work and have space for me to make notes of what I need to get done each day. Although I like the tech stuff I also rely on good old fashioned pen and paper. I like to be able to look at my calendar and see what the day is going to bring. I found sometimes it is easier to just print off my own calendar sheets and put them into a notebook so I have exactly what I need on the page. This is a good site that has many free templates for calendars/schedules. We print one up for my son and post it on his bedroom door each Sunday so he knows what the week ahead will bring. As he completes tasks he crosses them off. It also serves as a good reminder of what chores he needs to complete each day. Helps with the "I forgot" reply when I ask if he has done his chores. J

We also have one huge calendar on our front door. I will write down anything that we need to remember we, as a family, will be doing. I also write down what we individually need to remember we are doing (tutor appointment, haircut, sports practices, etc.) I have when my son has gym class so he remembers to bring his shorts/sneakers. It helps to be a gentle reminder before we are out the door of what that day is going to bring. I would LOVE it if Google or Microsoft would come up with a large Bluetooth-type screen calendar that could be hung on the door or wall and that would sync with whatever events, activities, and appointments we added to our individual phones or computer calendars. The screen would do nothing else but display what was happening each day/week/month and maybe *flash* if something was marked "urgent".

Does anyone have any organizational tools that they find are particularly helpful for their children or themselves? I do find that since we put the calendar up on the door we have not had to turn the car around and go back home because we've forgotten something. I also find the frequent reminders that pop on my phone to alert me that something is due has been a huge help when it comes to work and home life. I just need to find the time to integrate my school work to it also. I would love to hear what works, or doesn't work, for you.

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The Weighted Vest Debate
September 26, 2014 1:45 PM by Wendy Spoor-Hof

A recent discussion arose in the "Pediatric Occupational Therapists" Facebook group about the usefulness of weighted vests. The writer posted that there are numerous studies showing weighted vests are not an effective intervention in the pediatric population. Several studies were posted supporting this that I'm listing here:

Pilot Study of the Effectiveness of Weighted Vests (The American Journal of Occupational Therapy)

The Use of Weighted Vests with Children with ASD and other Disabilities (Journal of Autism and Developmental Disorders)

The Effects of Weighted Vests on Appropriate In-Seat Behaviors of Elementary-Age Students With Autism and Severe to Profound Intellectual Disabilities (Sage Journals)

There is also an article to support that weighted vests do work:

Effects of Weighted Vests on Attention, Impulse Control, and On-Task Behavior in Children With Attention Deficit Hyperactivity Disorder (The American Journal of Occupational Therapy)

The blog "OT and Self Regulation" has an entry sharing two studies -- one that shows they work and one that shows they may not.

For anyone who isn't sure how a weighted vest might work, here is an article about helping a child with sensory-processing and motor-planning challenges from the website

I have used weighted vests on a few of the children I've worked with over the years and have had varying results. A couple of children really showed improvement with their ability to sit and focus on an activity. A couple other children showed no improvement at all. I know in the cases where they worked, the children were originally all over the place -- jumping up on furniture and running back and forth in the house.

We used a weighted vest on them for an hour and then off for an hour over the course of a day. It took a couple days before the parents shared that the child was slowing down a little. Then in a couple more days, they shared that the child was able to actually sit for a few moments and focus on a play activity (puzzle or shape-sorter or coloring).

I'm a believer as an OT/COTA that we should be open to trying a variety of things with the children we work with, as long as there is no risk of harm. A weighted vest won't hurt a child but may help him. It may not work on every child, but if it works on even one and helps that child and family cope better during the day, then I'm willing to at least give it a try if the family is. If it works, great. If it doesn't, no harm done and we move on to another option.

What are your thoughts on the weighted vest subject? Have you used one before? If so, what were the results? Did it work? Not work? Why type of vest did you use?

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September 22, 2014 9:49 AM by Wendy Spoor-Hof
Yesterday morning on the way to work I was listening to WWYZ, the local country music station.  The two guys on the morning show (Broadway and Don Juan) were talking about a woman who had just called in.  She was upset that she had been at the grocery store and saw a mom with her young child on a leash.  She felt that it was just inappropriate and that the mother should teach her child how to behave in public and not have to resort to putting the child on a leash.  Of course both Broadway and Don Juan were saying how they felt the caller was right and they would never have a leash for their child.  (It should be noted one is a dad and the other is a young intern without children.)

I was fuming by the time I had heard them finish talking and heard those who were calling in saying pretty much the same thing.  I believe there was only one caller that I heard who said she did not see anything wrong with it if it meant keeping the child safe.  Broadway welcomed people to call in or to post on their Facebook page to share what they thought about children being on leashes.  I tried calling several times but the phone just kept ringing.  When I got home that night I went on-line to their Facebook page to post my thoughts on this and found there was a post from a mom who said that she was surprised how judgmental people could be without knowing the full story.  Someone from 92.5/WWYZ replied that they "thought it was a good conversation.  She wasn't being called any names."

I did post something and if you want you can see my replay here.  As a pediatric therapist I do spend time trying to talk to parents about the need to have a child on a backpack type leash so that the family can get out of the house and the child is safe.  There are children who have no safety awareness, poor impulse control, cognitive and emotional challenges that can't always leave the house if there is just one parent available.  These children will often do well on leashes because they feel "grounded" and "safe".  I work hard to get parents to feel comfortable with having their children on leashes just so they can get out of the house and do some grocery shopping or go for a walk on the beach or at the park, things they would otherwise not be able to do. 

It doesn't matter how much "teaching" they offer their child on "how to behave in public."  If a child is unable to learn due to their disabilities or not able to control their impulses a leash is very helpful.  Who would want to be stuck home all day?  I work with a lot of families who are in the military and one parent is often deployed.  What are these parents to do with a child who has hidden disabilities when they need to go out - when they are miles and miles away from their families and have no support system where they are currently stationed?  The New York Times has a parenting blog that addressed this issue back in 2011 and the vast majority of comments were fine with a mom needing to use the leash - there was no judgments made, just acceptance.

It saddens me that there are people/mothers/fathers who will look at a mom with a child on a leash and not give her the benefit of the doubt that this is the only option open to her.  That they will instead look in judgment instead of look in support and awareness that there might, just might, be something going on more than what they can see with their eyes.  Maybe I support leashes because I am British.  In Europe children are often on leashes when they are little without anyone giving it a second thought.  I have pictures of my sister and I, and our cousins, on the beach with our leashes on having the time of our lives.  There are pictures of us walking down the streets smiling and looking all around - while on leashes.  Why is it so different here?  With all the recent campaigns to bring awareness to children with disabilities and the increase of children with autism -  and just plain keeping little kids safe ... why don't we first look and say a prayer or offer a word of support when we see a mom who may have more on her plate than we will ever know?  Why is it that the first thing we do is jump to the conclusion that she isn't being a good mother and that she needs to teach her child the skills needed to be in public? 

I am truly saddened by this for all the mothers out there who may have listened to that radio morning show and now feel embarrassed to take their child out because they don't want to use the leashes and be wrongly judged. I feel bad for all the moms of who have their hands full getting through each day and find the leash to be one way of giving them some sanity while they are out of the house with their child(ren)

Please share with me how you feel.  Have you used a leash with your child?  What are the reactions you've received?  Have people been supportive or judgmental?  Would you use a leash if you had to?

As I sign off for this week I am going to ask you to please do me one favor.  If you see a mom out there with a child on a leash or a child misbehaving.  Before you judge - please look past what you are immediately seeing and try and understand that there may be more going on than meets the eye.  Offer a smile and a nod of understanding instead of a frown of disproval.  You may just make some mother's day.

*I know I have said "mom" in this blog but I do not intend it to mean that this relates only to mothers.  I do understand that there are many dads out there who have been in the same situation and experience the same things I've mentioned here and who need our support and understanding as well.

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Infant Autism Study
September 12, 2014 9:24 AM by Wendy Spoor-Hof
I'm sure you've heard by now about the recent study done by researchers at the University of California regarding Autism and early intervention. Their study, called the "Infant Start" study, is showing that infants who are showing early signs of Autism had little to no developmental delays by the time they reached their 3rd birthday when given early intervention.

The study group was a small group of seven children. Six out of the seven infants were able to catch up in their language and learning skills by the time they turned three. The seventh infant went on to be diagnosed with Autism Spectrum Disorder by their third birthday. The researchers felt that it was the early intervention offered to the infants that made the difference. Another group of infants who showed the same concerns but were not offered the same "Infant Start" program showed more significant delays as they reached their third birthday party.

The Washington Post ran an article about the "Infant Start" program. In the article they explained how the program showed the parents the best ways to interact with their babies during typical play sessions in the home. The play was to be done in a way that allowed the children to be encouraged to socialize with their parents more. One of the suggestions they would offer is to sit opposite their child when they are reading to them instead of having the baby sitting on their lap.  This small change would help to get the baby to look at the parent reading the book if they stopped or when they pointed to a picture. 

Truthfully, I am not overly surprised by the findings of this study.  It has long been known that early intervention will, in most cases, help babies/children who are showing signs of developmental delays learn the skills needed to catch up.  OTA has an article titled "Occupational Therapy in Early Intervention: Helping Children Succeed" that explains what early intervention is and how it can help.

I am surprise, though, that there are so many families and pediatricians that still don't know that each state has their own Early Intervention services available for families who may need them.  In my April 18, 2014 blog I shared information on Early Intervention and on how to contact one in your state. Cecelia Cruse wrote a blog on June 19, 2013 that shared a video showing a typical child and one with possible Autism to show the differences we should be on the lookout for.

It seems to me that no matter what the delay is or when it was discovered the earlier you can get intervention started the better. This is especially true when it comes to our children as their most informative and cognitive growth years is determined to be between 1 - 3 years of age.  So if you know of a young child who may be falling behind their peers in their developmental skills please don't hesitate to talk to the parents and encourage them to get a referral for an early intervention screening/evaluation.

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Class Registration
September 8, 2014 11:21 AM by Wendy Spoor-Hof
 Last week got away from me before I knew it.  I'm not sure if it was because it had a Monday holiday in it or if it was because it was an exceptionally busy work week combined with my second research paper being due for my summer college English course.  Speaking of which, I can't believe I'm already more than half way through the class.  Time has flown.  I will start my full course load in October.  Last week was even when registration started for the first quarter of classes.

I will admit that I was a bit nervous about registering for classes.  It is all done on-line and I know from when my son goes to register for his classes at Uconn that classes can fill up fast.  As I am in the weekend program I was worried that I would not be able to get on-line in time to get the classes that I need.  Thankfully I did not have to worry.  I was able to get into all the classes I needed to with one exception.  I am scheduled to take a math/science class of my choice.  Sounds pretty easy, right?  Not quite.

I had checked through the school's courses offered and there are a couple science courses I thought would be interesting and useful.  One was "Environmental Science" and discussed how the changes and damages to the environment were affecting us and our children.  The other was "Genetics".  So I went on to register with high hopes only to find out neither one of these course were offered this quarter.  I could, however, take "Meteorology", "The History of Flight", or "Evolution of Mid-Eastern Science". Um, yeah, no thank you.

I'm not sure if it is just that I am older or that I'm paying a huge amount of money out of my own pocket for these classes that I just could not see taking anything that would not benefit me with adding to the knowledge I need for my degree/career.  I did find a class that was available and would fit into my schedule but wasn't required until quarter 3.  I went ahead and registered for it.  My thought was that I could take that now and then keep hoping to take one of the other two science classes I want to take in the next couple of quarters.  So I sort out the help of my advisor; who advised me to get permission from the Department Chair.  Off went the email finally last Friday and now I will just need to wait and see if they will allow me to deviate from the classes they are recommending for the quarters they are recommending.  (fingers crossed).

What are your thoughts on this?  Would you just go ahead and take a class that might be somewhat easy but not really fit into your degree or career path?  Would it bother you, as it does me, to pay out a couple thousand dollars for a class that doesn't "fit" just because you're required to take an elective in that area? 

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Early Intervention Resource Roundup
August 29, 2014 11:45 AM by Wendy Spoor-Hof
Today's blog is about resources for children and their families. When working in pediatrics, especially Birth-to-Three, you find that many families are struggling to make ends meet due to the additional costs it takes to raise a child with special needs. I'd like to offer you some resources you can share that may come in handy in different areas of need. 

Good Days from Chronic Disease Fund - provides assistance when families cannot afford the medication they need.

United Healthcare Children's Foundation - UHCCF is a 501(c)(3) charitable organization that provides grants to cover health-related services to families that their insurance may not cover or may not cover in full.  Children do not need to have insurance with United Healthcare to quailify for help.

Bright Steps Forward - Bright Steps Forward's website states that they are "a 501c3 nonprofit organization that provides funding for intensive pediatric therapy to financially disadvantaged children with neurological disorders such as cerebral palsy, disabilities of prematurity, autism and other congenital or acquired conditions that affect their physical functioning."

Aubrey Rose Foundation - Helps with medical bills for families who have children with a live threatening condition.  They also help with educational scholarships and assist with funding for "simple" heart procedures for needy children.

Disabled Children's Relief Fund -  Assists disabled children in obtaining wheelchairs, orthopedic braces, walkers, lifts, hearing aids, eyeglasses, medical equipment, physical therapy, and surgery.

Children's Charity Fund - Assists disabled children in obtaining medical equipment and provides scholarships to help children further their education.

Have a Heart - Helps families with children who are fighting cancer who are experiencing financial difficulties. Have a heart will assist them with medical bills, medical treatments, therapises, equipment, transportation, and household expenses.

Healthwell Foundation - "When health insurance is not enough, HealthWell fills the gap. We assist patients living with chronic and life-altering illnesses in paying their share of prescription drug copayments, deductibles, and health insurance premiums."

Kelly Bush Foundation - Assissts individuals with spinal cord injuries afford adaptive athletic equipment.

Travis Roy Foundation - Assists individuals with spinal cord injurie by providing adaptive equipment.

Gracie's Hope - Helps provide funding for a wide range of therapies for families of children with special needs. Gracie's Hope will even help with therapies that are often over looked (hyperbaric chamber, neuro and bio feedback, Chelation, etc.)

Association of Blind Citizens - provides financing up to 50% of the cost of adaptive devices and/or software.

Faith's Hope - "Our aim is to be a safety net for critically ill patients and their families. Whether the need exists for groceries, house payments, car payments, or counseling, the desire of Faith's Hope is to be there for these families in their immediate time of need."

Gia Nicole Angel Foundation - Helps with purchasing items that will enhance the daily functioning of children with special needs.

Kya's Krusade - Helps families afford adaptive equipment as well as continue to afford physical therapy, occupational thearpy, and hippotherapy sessions.

These are just a few of many different funding sources to help families with children who have special needs or are handicapped.  If you know of others that we can add to this list please message me and I would be happy to add them so others will be aware of them. 

When/If you share any of these places with your families please be sure that they read what the requirements as each application has different quialifying criteria. The other then to watch for is when their application deadline is and how frequently they look through their applications and award them to the families chosen.

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Back to School Tips
August 22, 2014 2:30 PM by Wendy Spoor-Hof
I can't believe how fast this summer has flown by. I can remember when I was a kid and it felt like the summer went on forever. So slow that by the end of it I was ready to go back to school, if you can believe that!

My oldest started his junior year of college this past Wednesday and my youngest starts his sophomore year of high school next Wednesday. I was in the car with my youngest this morning and I mentioned that we had to start getting up early beginning Sunday so we can be ready for Wednesday. He looked at me total perplexed and asked "Why? What happens on Wednesday?" He thought he still had a couple weeks left. 

So my blog this week is dedicated to getting ready for school and sharing some strategies that may help make the transition from our more relaxed summer days to the more routine and scheduled school days an easier one.

Wakeup - If the student is used to getting up whenever they wanted to over the summer or, at least, later than they had to when they were getting up for school, it is important to start getting them up earlier now. Depending on how much time you have before school starts, begin with getting up at least 15 minutes earlier every couple of days. If you don't have as much time, begin with getting them up 15 minutes earlier each morning until you reach the typical time you would get up for school.

Bedtime - The same type of strategy used for wake up time can also be used for bed time. If the student is used to staying up later than their school-time bedtime it is important to get them ready to falling asleep closer to that time again. It is important to remember that turning off ALL electronics at least an hour prior to bedtime helps to slow down the brain and get the student ready for sleep.  Studies have shown that electronics at bedtime keep our brains functioning long after we try to close our eyes and sleep. 

Reading - As we all know school means reading. Students will have to read from their text books, from web pages when doing research, and from library books to meet their reading goals. Reading is one thing my youngest son despises more than anything else in the world right now. With dyslexia and memory processing disorders, it makes it very hard for him to read and retain what he is reading.  We use a wonderful app that is available on the computer and on his iPad called "Bookshare/Read2Go."  This application will not just read up-to-date books to him, but highlights the words as it reads so he can follow along. 

We started his summer reading right when he got back from camp. He has picked a book from the school's required reading list on the Iditarod and loves it. Try to find a book that will interest your student.  It could be one that goes along with his hobby or one that goes along with a subject he might like to know more about. The more interest they have in it, the better chance they will have of finishing it. It also helps if you set limits on reading.  A student who has a hard time reading will look at a book and feel overwhelmed so set either a time limit or a chapter limit. Break the book down to make it less overwhelming and more achievable. This will make reading time less of a chore and the student will be able to feel successful after meeting their time limit/chapter limit.

What to Expect - This is especially important for younger children or children who experience stress/anxiety about going back to school. Share with the student what their day may look like.  If possible, see if you can get a tour of the school so they will know where their classrooms are and where they will need to go for lunch, library, gym, etc. The more the child knows the more comfortable the child will be when school starts. The more comfortable they feel, the more successful going back to school will be.

Supplies - If possible, have the student go with you to get their supplies. Allow them to pick out the notebooks and pencils and pencil carriers. Let them chose the backpack they want. If they go to school with some favorite things, they will feel more comfortable. Also be careful what backpack they chose.  You can find guidelines here on what sizes are best for students. Many children go back with backpacks that are much too big and heavy for them. This can cause physical pains and injuries. It can also make it very hard for them to get from classroom to classroom.

Try to keep in mind that the student may take some time to adjust both at home and at school with the new routines and demands placed on them. The first few days they may even go home and fall asleep before dinner. When possible it is a good idea to allow more open communications between teachers, therapists, and parents the first couple of weeks so each one knows what is going on. If something is not working well everyone will know and hopefully be able to share strategies to fix what isn't working well. 

"Tell me and I forget.  Teach me and I remember.  Involve me and I learn."  -Benjamin Franklin

Childhood Depression
August 15, 2014 9:00 AM by Wendy Spoor-Hof
When I heard that Robin Williams had passed away my heart broke.  When I learned that he had been suffering from severe depression and committed suicide my heart shattered. 

Depression - an often misunderstood disease.  A disease that is not easy for those who are suffering from it or for those who love someone suffering from it.  It's not just an adult disease either.  Did you know that as many as 1 in every 33 children suffer from depression?  Because of this it is important to be aware of the signs of depression in children and to make sure parents are also aware and know what to do if they think their child may be depressed.

The National Association of School Psychologists has an article that shares information on depression in children.  In their article they share that parents and educators should be aware of the following characteristics of a child suffering from depression:

  • A lack of energy and enthusiasm
  • Being withdrawn and not appearing to be able to enjoy what is happening in their life
  • Inability to concentrate or focus on day to day activities
  • Performing poorly in school
  • Poor appetite - no interest in eating
  • Frequent sadness, crying,
  • A major change in eating and sleeping habits
  • Irritability and acting out

As I was doing research for this blog I couldn't help but think that many of the kids I work with exhibit several of these symptoms at any given time.  I'm guessing you're thinking the same thing, right?  What is important to keep in mind is that many children will show one or more of these symptoms as they grow but it becomes a concern when they are unable to move past them. Kids Health offers help understanding depression in children and shares that it is normal for children to be sad or depressed as they grow and go through their developmental stages.  It becomes a concern when they get stuck or their sadness/depression persists for more than a month or two and they begin to show a lack of interest in playing or doing anything at all day after day after day. 

The good news is that in the majority of cases depression can be treated successfully.  This is why it is very important to get a doctor or therapist involved to help.  Often with children the therapy will consist of both individual and family sessions.  When working with children Play Therapy is a common therapeutic approach that is used to treat depression.  Children learn through their play and they can express themselves better, often without realizing it, through their play. 

So what should a parent or educator do if they suspect a child is going through an extended period of depression?  Get help as soon as possible.  This may require starting with a referral from their pediatrician to a child psychiatrist, child psychologist or other mental health therapist who specializes in child mental health issues. Boston Children's Hospital has an excellent section on the web site that lists what to look for and where to turn if you suspect a child may be suffering from major depression.

It's hard to believe that our little ones could suffer from depression.  I mean after all, they're just kids... but even some children can fall into a place of such sadness they don't know how to get back out again.  If you suspect a child, or anyone for that matter, may be in such a place please try and get them help.  With the right help they can often find their way out and go on to live a happy, good life. 

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Bedtime Routines
August 8, 2014 10:02 AM by Wendy Spoor-Hof
We all know the importance of what a good night's sleep means to a child.  It allows their body to heal and repair itself.  It gives the brain time to grow and develop. A good night's sleep will also result in better behavior during the day and better ability to concentrate during school. Yet some children are not getting as much sleep as they should to stay healthy and be open to learning.

Your typical infant will sleep between 15 - 16 hours a day.  heir sleep is usually broking up in 2-4 hour "naps" during the day and night. Often waking to eat before falling back asleep again.  As they get older they will begin to stay awake for longer periods of time to play and learn.  As they reach their 1 year birthday the typical child should be sleeping through the night as well as taking 1-2 naps a day with each nap lasting between 1-3 hours.  As they grow into a toddler they should be getting between 10 to 14 hours of sleep each day with 1 nap during the day lasting 1-2 hours. As children near the 30 month mark they begin to give up their naps and stay awake for the whole day.  They will sleep usually for 12 hours a night (go to bed, for instance, around 7:00pm and wake up at 7:00am).

It is important to get children into good sleeping habits as early as possible.  Sleep for Kids has an excellent article on understanding children's sleeping habits and how to get them into good sleeping habits at a variety of different ages.  One recurring theme in each group is the importance of establishing a consistent before bed routine to help calm and get the child ready for bed.  The other is that children should not be using any type of electronical device before bed (TV, iPad, computer, etc). WebMD has an article explaining why it is so important to turn off the electronics in order to get into good sleep patterns.  An article on the CNN website explains how the light from our electronics gives our bodies the wrong message that it is still "light" out and we should be awake.  This is why it is so important to turn off any electronics at least 1-2 hours prior to bedtime to get a good solid sleep.

When it comes to getting a bed time routine that works for your child be sure to try a few different things so you can find what works and what doesn't work.  If you find that a child is more awake after bath time it might be best to give the bath in the morning when they wake up or after their afternoon nap.  If a child is more awake after reading books then switch the time you read books to the morning or before lunch.  Just because you've read or been told that a bath or reading books prior to bed is the best way to start a bedtime routine does not mean that it will work for every single child out there.  Some children will find bathes and book reading more arousing than calming.  Some children will find a nice lullaby or classical music selection played when they sleep works best.  Others may like nothing more than the sound of white noise. 

As each child is unique so might their bedtime routines be unique to them.  The most important thing, as shared above, is to establish a routine that works and that is consistently followed every night.  Children do best with routines and this includes at bedtime.  The sooner you can establish a routine that works, the sooner your child should be able to sleep soundly through the night.

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Sleeping Problems
August 1, 2014 8:43 AM by Wendy Spoor-Hof
There seems to be an overwhelming number of children on my birth-to-three caseload who are having trouble sleeping lately. Their parents are saying that they are having a hard time falling asleep and staying asleep. The children will either keep getting up and not be able to fall back asleep (and this goes on every couple of hours, every night) or they can't fall asleep to begin with and cry for hours. It's not just the older children either who are having trouble. There are several infants who are having trouble too.

The web site The Future of Children has a good journal article on what to expect when a child has been born exposed to drugs in utero. Sleeping problems are mentioned several times throughout the article. The American Academy of Sleep Medicine has also written about the sleep problems in children exposed to prenatal drug use and offers suggestions on how to try and help a child sleep better. They recommend that children under 1 year of age should get between 14 and 15 hours of a sleep each night. Children who are 1-3 years of age (toddlers) should get between 12 and 14 hours of sleep. Preschool children should get between 11 and 13 hours and school aged children should get between 10 and 11 hours of sleep.  As we all know, getting the correct amount of sleep helps is essential to help a child better be able to develop and learn properly during their waking hours.

So what are some strategies to help a child who is having trouble sleeping?  The University of Michigan Health System has a detailed article regarding sleep problems and offers a variety of strategies to try and help attain better sleep.  WebMD has an article from Exceptional Parent Magazine titled: "Put Sleep Difficulties to Bed: Advice for Parents of Children with Autism." The Mayo Clinic has an article to help parents of preschool children fall asleep called: "Child Sleep:  Put preschool bedtime problems to sleep." These articles discuss the growing concern of children not getting the right amount of sleep and what might be done to help them.

Today I have shared a quick overview on childhood sleeping problems by posting a few web sites and articles relating to sleeping and sleeping strategies. Please join me in the next couple of weeks as I go into more detail on why there seems to be an increase in children having sleeping problems and the strategies I have found to be most effective in helping to establish healthy sleeping habits.

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Equipment Resource Lists
July 25, 2014 9:56 AM by Wendy Spoor-Hof

One of the most frustrating parts of my job is being able to get the items the families I work with need when insurance won't cover it or the family can't afford it. Sometimes families need pieces of equipment to help their child be more mobile. Other times it could be something as simple as a knob puzzle or a simple shape sorter to work on fine motor and eye/hand coordination skills. When I can I purchase the smaller items.

Occasionally we might have a stander or a walker that a family is no longer using and they have given to us to share with families who may need it. More often than not though we just don't have the resources to help. I'm sure we are not the only ones who face this struggle. 

Here in Connecticut we are lucky that we have a place called NEAT (New England Assisted Technology Resource and Education center) in Hartford.  NEAT offers a service for Birth-to-Three providers that allows them to borrow pieces of equipment families may need. The equipment has been donated to NEAT by families who no longer need it. I have borrowed wheelchairs, standers, bath seats, and even corner chairs. If the family still needs it after they are exited from Birth-to-Three they just need to give NEAT their name, number, and address so NEAT can keep track of where the equipment is. Once the family no longer needs it they are asked to return it to NEAT. NEAT will even send over a van to drop off/pick up the equipment.  I do not know if other states offer something similar. If you have a location like NEAT in your town please let me know so I can share it here.

Another place to look is Facebook. Special Needs Gently Used Medical Equipment For Sale is one group where you can list or look for items ranging from eye glass frames to tumblers to car seats and wheelchair adapted vans. It is a "closed group" so you do have to request to join it. Another similar page for Canadian families is Zachslist Pediatric Equipment Exchange.  Both groups offer a chance for its members to post items they are trying to get rid of or that they are ISO (In Search Of). 

There are also numerous "mom's groups" which are more localized to the area where the mom's live. A simple search using the terms "moms" and where you are located will help you to find a group in your area. These groups will not just offer items for sale or items being searched for but they will often also offer support for families who may need it. 

Outside of Facebook there is always Craigslist and I know quite a few people who have success finding things they need on there but I wouldn't feel right if I didn't tell you to be careful. As useful as Craigslist might be there are numerous stories of people who have been ripped off when responding to an add. If you are going to answer a listing here please use caution and never, ever go alone to pick something up or drop something off. There are good and decent people out there but there are also people who will try to scam you.

Another site I have used frequently is the site. Once again you can search by location and then narrow the search by what it is you are looking for.  I have also heard quite a few families have had success using Freecycle websites. With Freecycle you have to become a member and then you can search for free items that others are giving away. This site is not just limited to pediatric equipment and toys. There are listings for everything and anything on here so it can be overwhelming at times when you are looking for something.  A couple other web sites are:

Rehab Equipment Exchange  - a website that lists programs that are available in each state that loan out rehab equipment or that allow people to buy, sell, exchange rehab equipment. The list may not be complete but it does have a decent amount of programs listed. 

Buy and Sell Used Home Medical Equipment - you can search the site by zip code and look for items within a certain radius of where you live. 

Equipment can be expensive and just like clothing and shoes, children may outgrow the equipment quickly.  Being able to find a place to purchase the equipment at a less expensive price or, better yet, borrow it, can be financially helpful to the families we work with. If you know of any other sites that would be useful to the families we work with please let me know about them and I will share them here. 

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Loan Forgiveness
July 18, 2014 9:26 AM by Wendy Spoor-Hof
As many of you may already know I have decided to return to school and earn my Master's degree. Next Tuesday is my first class. It will be an English class on writing.  I'm actually very excited about it. I love to learn and the fact that my first class is going to be on writing makes it even more exciting. It will just be the one class over the summer and then come October I will start full time with classes on Friday afternoon and all day Saturday. Right now I can't wait to begin - check with me again around the holidays and it might be a different story.

One of the more challenging things I'm up against is finding a way to pay for college. Unfortunately the company I work for does not participate in any type of educational reimbursement or cost matching program. I have applied for financial aid and placed applications in for numerous scholarships. While researching options for payments I did come across the "student loan forgiveness" program that is being offered to many students by the government. AOTA recently succeeded in getting occupational therapists who work with children, teens, and the elderly eligible to receive loan forgiveness.  The National Education website has a list of loan forgiveness programs offered to a variety of occupations.  Another information website with a list of loan forgiveness programs is the FinAid! Website.

The overlying theme for the loan forgiveness is that one is pursuing a career working in a non-profit field, working with children/teens/elderly/veterans, or in a field that provides specific public services or is in a low income area. Most also require you to have made 120 on-time payments before you will even be considered for the program. 

Has anyone taken advantage of any of these programs?  I would love to hear how the process went and if you were able to receive a partial or full refund on any of your student loans. If you were not aware of these programs, do you think you will try and apply for one now that you do? 

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The Importance of Recess
July 11, 2014 9:17 AM by Wendy Spoor-Hof
We all know that if we ask a young child what their favorite class in school is most wil say "recess!" I can recall how important recess was when I was growing up. It was a time to meet up with friends and share the latest school news or join in a game of kickball or jump rope. We would race one another up the monkey bars (Yes!  We had monkey bars back then) or see who could swing the highest on the swings and then jump off and land the farthest distance away. Recess was a time to get out all the energy we had stored sitting in classes all morning and prepare for the afternoon of classes that were coming. 

As first a mother and then someone working in the O.T. field I could never understand the concept of taking recess away from the children who misbehaved or the children who needed to be pulled from the classroom for a short amount of time to work on special education needs. It seemed to me that these were the children that needed and would benefit the most from all the recess had to offer. When my son was in grade school and had to be pulled several times during the day for special education instruction I always made it a point during his P.P.T's to stress that I did not want him taken out of gym or recess. These were areas he needed to help him make it through the rest of the day. 

There have been numerous articles about the rise in ADHD in our country. Many doctors and parents feel this is happening because of the chemicals/preservatives we put in our foods and/or the increased amount of sugar the children are ingesting either through candy or sodas. Therapists, on the other hand, have a more simple explanation. Our kids are not getting the opportunity as much as they use to to get up and move around.  Children are not allowed to go outside and play all day as they use to when I was a child. It's just not as safe a world as it used to be and these days the chance of something happening to our child is just too great a risk.  Plus with both parents working and more and more children in preschool/daycare settings our children don't have the opportunity to experience free play as much as they use to. The only opportunity most children have to get out and play is often the time they get for recess. An article in Scholastic even explains how important recess is and how it helps give our children a chance to be more focused and open to learning.

Tim Walker recently wrote a great article about his experience teaching in Finland and how he was skeptical at first about their approach to teaching (45 minute sessions, 15 minute breaks - all day long). He even tried to incorporate the American way of teaching (longer sessions with only 1 or 2 breaks all day) thinking the children would learn more but came to realize that those frequent breaks were not hindering the ability of the children to learn but were actually giving them what they needed to stay seated and focused during the lessons. 

The Washington Post also ran an article sharing how author Angela Hanscom, a pediatric occupational therapist, felt that the increase in ADHD was actually due to our children's lack of opportunity to get out and move around. She feels that the reason our children have such a hard time sitting down and focusing is in part due a decrease in their core strength and balance abilities. She feels that many of our children who are diagnosed with ADHD may in fact have an underdeveloped vestibular system because they no longer have the opportunity to get out and roll down a hill or swing from monkey bars or climb trees. Come to think of it, I can't remember the last time I've seen a child climbing a tree or hanging from one of the lower branches. I can remember my nana often calling my sister and me in for lunch only to find us sitting in the branches of one of our trees or crouching down and crawling around playing hide and seek in the tall grass that often took over the bottom half of our yard.

So as we move into summer I offer all the parents, therapists, and teachers out there to take more time out of the day to allow our children an opportunity to get up and move. Instead of sitting inside and watching the TV - have a race to see who can roll down the hill faster. Instead of a therapy session inside, if allowed, take it outside and build an obstacle course in the grass or swing on a swing on your belly with legs dangling or dragging in the dirt. When school gets back in session stand up and fight for your child's right to participating in recess. Let's help our kids get up and move more!

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Unexpected Help
July 3, 2014 10:16 AM by Wendy Spoor-Hof
Help can sometimes come from the most unlikely place. I have been working with a child who has a "habit" of rocking back and forth before falling asleep at night. Sometimes the rocking will take 10-15 minutes and other times it may take as long as 45-60 minutes. The rocking is usually done as they are sitting in their bed and they will rock and rock and rock. Mom has even padded the crib railings because they have rocked so hard that they cause bruises up and down their spine. Mom has tried other ways to comfort and get the sand man to come but nothing has worked. This little one can be rocked in a rocking chair by mom, fall asleep in another room, have books read to them, take a warm lavender bath ... you name it, they've tried it and the rocking will always be the one thing they do before falling asleep.

We have researched and researched. Suggestions that were offered by other O.T.s and therapist ranged from a vestibular seeking need to not having the right chemicals in the body to be able to fall asleep to having a desire to hit the "fight or flight" center located on the spine up near the neck. We have tried offering sensory input both tactile and vestibular but the rocking has persisted. We have tried no TV, iPads, radio or other electronics before bed but the rocking has persisted. We have tried soft lullaby music and dimmed lights but the rocking has persisted.

Then, miracle of miracles, I was on Facebook when a post came up from the Pediatric Occupational Therapy group I am a member of about a sleep disorder called RMD (Rhythmic Movement Disorder.) I read it from beginning to end and found myself nodding my head and thinking of the little one who rocked. I was so excited about it that I even sent the link to one of the other team members and asked them what they thought. She agreed that it sounded like we may have found a reason behind the rocking.     

I had never expected to find an answer to a case that has been puzzling me for so long on Facebook. I enjoyed being a part of the Facebook Pediatric Occupational Therapy group because of the variety of topics that are brought up and discussed. If you haven't had a chance to join them yet I highly recommend you do. You never know when an answer to something that has been puzzling you may unexpectedly show up.  

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Sensory Friendly 4th of July
July 1, 2014 10:38 AM by Wendy Spoor-Hof
This upcoming weekend can be a very difficult one for children who have sensory integration challenges.  Some children love the colorful explosions of the fireworks as they burst open in the air and the loud *bang* that, although they knew it is coming, still scares them. For other children the bright colors hurt their eyes and the loud noises their ears.  The crowds that gather to watch the fireworks are too loud, too close, and too sensory overwhelming for them to enjoy anything about the event. Thankfully there are things that can be done that would allow for a sensory friendly 4th of July experiences.

The first option is to, of course, stay home and enjoy the firework displays that are shown on T.V. You can dim the lights in the room you're watching the television and, depending on your child, turn up or turn down the volume. Several TV stations will usually offer viewing of the firework displays going on in different cities. Check your local TV listings for which ones are being offered in your area. 

If you want your child to experience the fireworks outside of the home be sure to bring along items that will help them to enjoy them. If they are sensitive to loud noise, bring along ear plugs or headphones. You don't need to be too fancy. There are a variety of inexpensive ear plugs to choose from that will help drown out the loud noises. Some kids prefer the bigger headphones. (Disclaimer: I use Amazon in links for no other reason than they offer a variety of options in one screen shot. Doing a Googlesearch will come up with other options for purchasing the particular one you may choose.)

If your child is more sensitive to the light you can bring along a pair of fun sunglasses for them to wear when the firework display starts. If they don't like wearing sunglasses a wide brimmed hat or a baseball cap would work to shield some of the display when worn down lower on their heads. Some of the younger children prefer their favorite blanket to cuddle with so they can bring it up over their eyes during the "scarier" light displays.

In years past several movie theaters have offered a sensory friendly viewing of fireworks in one of their theaters.  Just like when they show their sensory friendly movies the fireworks are offered in a theater that is dimmed slightly and with a lower noise level than typical. I have tried searching to see if I can find any listings for this year but sadly I have not been able to come up with any options to offer here. I would suggest, however, to call your local movie theater and see if they may be offering a sensory friendly fireworks viewing.

Social stories to share what to expect and trying to visit the place where the fireworks will be held before hand are also ways to help children who may have a hard time get more comfortable with the experience. As crowds can vary it is hard to say if getting there first and finding a quiet place to sit will work or if getting there later and finding a spot that isn't already crowded (on the fringe of the crowd) may be more effective. Regardless of where you may end up watching the display please be sure to have a game plan to leave if the experience becomes too much for your child. There is nothing worse than getting stuck somewhere with a child who is overwhelmed and melting down. Thankfully if you take the steps before hand to try and prevent this from happening you may just end up with a lovely evening spent watching the fireworks with your family - whether it is being outside and part of the crowd or being inside in your own home in a dark room and watching the display on the T.V. -

May your 4th of July be a sensory free one of beautiful and colorful fireworks that light up your evening.

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