The past couple of blogs I've shared some strategies on what to do and what not to do when it comes to working with a picky eater. One of the questions that has arisen through these blogs is "how do I know if my child is just being picky and there isn't more going on?"
Dr. Kay Toomey has an excellent explanation of what qualifies as "picky" and what would qualify as a "problem" when it comes to childhood eating. Dr. Toomey is a pediatric psychologist who developed the SOS Approach to Feeding. I have attended one of her SOS workshops several years ago and found it to be very informative. I use many of her strategies still today.
So a few differences between a "picky eater" and a "problem eater" would be:
- A "picky eater" is a child who has a limited diet of about 30 types of food where a "problem eater" is a child who has a limited diet of about 20 types of food.
- A "picky eater" may eat one type of food for several meals (or several days) and then not eat it again for several days (or weeks) but after time they will eventually go back to eating it. A "problem eater" may eat a food for several meals (or several days) and then not eat it again. Period. It is very rare that a "problem eater" ever gains back a food they stop eating.
- A "picky eater" is selective about what they will eat but will allow a new food to be placed on their tray or plate. They may ignore it or pick it up and sometimes even try it. A "problem eater" will have a meltdown when they see a new food placed on their tray or plate. Sometimes even just having the new food in the same room as them will cause them to melt down.
- A "picky eater" may eat different foods than what the family is eating at a mealtime but will be able to tolerate some of the same foods on their tray/plate even if they aren't eating them. A "problem eater" will always eat different food than their family is eating and, as mentioned above, will often have a meltdown if a new food is even placed near them.
- A "picky eater" will eat a variety of different food textures, colors, and shapes. A "problem eater" will stick to the same textures, colors, or shapes. If it's not exactly the same as they are use to a certain type of food being (round crackers as opposed to square crackers) they will not eat it and often have a meltdown because it is "different" than what they are used to.
As you can see, once you know what to look for you can easily tell if your child is a "picky eater" or a "problem eater". Next week we'll look at the different ways to work with these two types of eaters. Can we use the same strategies or do we need to use different strategies? Will my "picky eater" become a "problem eater"? Can my "problem eater" become a "picky eater"? Regardless of which one my child may be, can they ever learn to eat like a typical child?
Stop back next week when I try to answer these questions and offer more feeding strategies.
Blogger's Note: When I was younger my Nana would always say "As you get older time will slip by much faster." I found it hard then to believe her because, come on, how could time go any faster? I had planned on having the next Feeding Strategy blog posted prior to Thanksgiving. I had planned to work on it last weekend and have it ready for Monday morning.
I have a feeling that somewhere between putting my house back together after having the inside rooms painted, finally getting back to feeling "normal" after being sick for a week, and preparing Thanksgiving dinner for 12, time somehow slipped away from me. I apologize for the delay. I hope everyone had a lovely Thanksgiving that was spent surrounded by the warmth of family and friends.
As I mentioned in my previous blog when it comes to helping the picky eater become more willing to eat more food and a variety of food sometimes all it takes is changing one small thing at a time. The trouble with this is that we have grown into a culture where we want things to happen right away. We seem to have lost the art of patience along the way. The consistant thing I have learned working with picky eaters is that the family who has the most patience is the family that ultimately will have the child who can go from being picky to being willing to try new foods. If strategies are rushed or not consistently followed through on the chances are higher that the picky eater will remain a picky eater.
One of the toddlers I recently worked with loved crackers and peanut butter "sandwiches". He could eat for every meal and be happy. The suggestion was to either change the peanut butter to cheese but keep the same type of cracker or change the cracker to a different type and keep the peanut butter. The family tried putting cheese in the crackers. The little guy took a bite, looked a little surprised, and looked at the cracker. We all waited to see what he would do next. Would he throw it? Would he take another bite? (breath being held) He took another bite! And then another .. and another, until the cracker was finished and he looked up for more. (breath released)
Over several months the family slowly made more changes. They changed the crackers to pieces of square toast the same size as the crackers. They slowly made the toast a little bit bigger until he was eating quarters of toasted sandwiches. Over the course of several months they have been able to introduce other options in the toast and he will now eat ham and cheese but is not a fan of peanut butter with jelly. J
Another family wanted their toddler to eat more than just noodles and spaghetti with butter. So the change was made to go from elbow noodles to smooth ziti noodles. They kept the butter sauce and after a few attempts the toddler began to eat them. They have tried using other types of noodles (colored elbows, fans, etc) but so far the will only eat either the regular elbows or the smooth ziti noodles. The next option was to chance the "sauce" so they added a small amount of garlic to the butter and he loved it. Next they tried a Alfredo sauce as it was still light in color. Again it took several attempts but he finally would eat noodles with something other than butter on it. They are now trying to use Marina sauce but are slowly adding a little of it at a time so the color of the sauce will change gradually. As I said earlier - patience ... it takes a lot of patience.
Getting a picky eater to change to a better eater also takes a good amount of observation and detective work. What flavor does the child tend to like (sweet, sour, etc.) Is there a certain type of food they will try (crunchy vs soft) or even a certain color (will eat anything green but not yellow.) There are a few good resources to go to when it comes to making small changes:
The hardest thing, and I bare being repetitive here, is encouraging our families to have patience. Teaching a picky eater to become a good eater is not going to happen over night. It is going to take several weeks to several months depending on the child. I have seen how making small changes can make a huge difference. As with any therapy there will always be some children who do not respond but the majority of young children, when allowed to explore and try new foods when combined with their "old" familiar foods, makings small changes over a period of time will prove to be a successful eating/feeding strategy.
Have you tried this strategy? I would love to hear how it worked or didn't work for you.
When you have a child who does not want to eat you may be willing to try anything to get them to eat. You will no doubt run into friends and family members who have "done this" or "done that" and it has worked for them when their child was being picky. Today I want to share some things that you may have heard worked for others but that you shouldn't really try when working to get your picky eater to eat better.
- Force Feeding - I have worked with several families who have "force fed" their picky eater. The parents will gently hold their child's head still so the child can't turn it side to side and the parent will then place the food in the child's mouth and "close" the mouth (tilting the child's head back or placing their fingers on the childs lips) so the child has to swallow and not spit out what is now in their mouths. The parents I've worked with truly do not mean to do their child any harm they are just worried that they are not getting enough to eat to sustain them throughout the day and they feel this is the only way to get them to eat.
When I have a parent who is doing this I try to show them how "force feeding" will not work by asking them to think of the one food that they absolutely hate. The one food that they just would not want anywhere near their mouths and to then imagine someone they trust and love placing that food in their mouths and making them swallow it. I shudder just thinking about this being done to me. I try to show them that this is what is happening when they "force feed" their child and that it will never amount to good eating habits until we can make their child's feeding time a fun and enjoyable time and not an unpleasant one.
- Staying at the table until they are finished - I can remember growing up and not wanting to eat my vegetables or the type of potatoes that were made and being told I had to stay at the table until my plate was clean. When a parent makes their child stay in their highchair or stay at the table until they finish eating it turns into a power struggle. On one side you have the child who just cannot, will not, put the food in their mouths and eat it and on the other side you have the parent who feels their child has to eat their food in order to survive. This strategy really just turns into a struggle of who is more stubborn - the parent or the child. It won't make eating a positive experience and therefore won't make the child want to eat more the next time they sit down for a meal.
- Saving the plate for the next meal - If a child isn't going to eat what is on their plate before them for one meal they almost definitely won't eat it if it is served to them again at their next meal. This strategy is another "power struggle" between the parent and the child and in the long run does not help to make the child's eating experience positive or help them to stop being a picky eater.
- Serving the same food each meal - I know it is so tempting when you have a picky eater to keep feeding them what they will eat. As parents we have this desire to make sure those we love are fed and not going hungry. If our picky eater will only eat grilled cheese sandwiches then we'll serve them those sandwiches at each meal if it means they are eating.
Most children will go through food "jags" where they only want to eat one type of food. These jags may last a couple days to a couple weeks but will normally move onto another type of food after a short amount of time. When you have a picky eater you have a child that will only eat one type of food .. period. Even after months they won't try anything else. This is not a food "jag".
When we serve a picky eater only the few types of food they will eat because it is easier and less stressful, we will end up with a child who will never eat anything but their favorite foods. This will mean even when you go out to restaurants or to family get-togethers you will need to make sure you bring along something your child will eat because there is a good chance where you are going may not have the exact type of food your child will eat. It may have seemed easier in the beginning to give in but as the child gets older it will likely turn into a huge problem.
It isn't easy working with a picky eater. We need to have a lot of patience and creativity. We need to find ways to make the meal time fun and not a power struggle between the parent and the child. We need to work slowly to allow the child to feel independent with their eating skills while trying to introduce nutritious food options for them. We need to come to the realization that it is not something that is going to happen overnight but something that may take weeks, if not months to happen when the right strategies are used.
Please join me next week when I will share strategies that I have found worked in helping the picky eater try a wider variety of food options. For instance did you know that making even just one small change to a favorite food is an excellent way to start to introduce new food options? And what about hiding vegetables in other foods? Does it work or cause more problems?
"Pull up a chair. Take a taste. Come join us. Life is so endlessly delicious." - Ruth Reichl
The holidays are right around the corner and along with them come all sorts of delicious holiday foods. For most of us this is a time of anticipation. What sides will we have with our Thanksgiving dinner? What desserts will be served? What holiday cookies should we make this year? It's a time of family get togethers over the dinner table as we share food and conversation. For the majority of us it is a time we look forward to but for the parent of a child who can be a picky eater it is a difficult, sometimes even dreaded, time of the year.
In the next couple of weeks I will share some thoughts and strategies regarding picky eaters. I will try to offer suggestions that might help to make these meal time get-togethers less stressful and more enjoyable - especially for the picky eater.
There are many reasons why a child may have become a picky eater. The first thing I always ask a parent is if the child has acid reflux and if they have tried any acid reflux medication. Even if there are no obvious signs there has been many cases where the child has "silent reflux" and refuses to eat anything but a few bites of food. Once they are put on medication prescribed by their pediatrician or G.I. specialist the reflux calms down, their body starts to heal, they then start eating more. Why? Because If it hurts to swallow due to acid reflux pain then the child will stop eating. They learn quickly that one or two bites is all they can do before the pain starts. So once they have been on reflux medication it is important to try and encourage them to take that third bite, and then the fourth bite and the child slowly starts to realize it isn't hurting anymore and they begin to eat and try new things.
The second thing I will check is how much liquid is the child getting during the day. It is easy to leave a sippy cup or bottle around and just keep filling it up when it gets empty but this is not going to help a picky eater become a better eater. If they are already feeling full because their belly is full of any type of liquid (milk, formula, juice, water, etc) their body will not signal their brain that they are hungry. It is important to encourage a toddler to have 2-3 8oz servings of milk a day and 3-5 8oz servings of water a day if thirsty (the higher end during the warmer months to stay hydrated), and 1 6-8oz serving of 100% juice. These recommendations can be found in a 2006 article written in The American Family Physician. Milk/liquids should always be offered after they have had a chance to eat. If a child drinks first their belly will begin to feel full with the liquid first and they will eat less or not at all.
The third thing I will look at is how is the child eating now. Are they being fed by the parents or are they feeding themselves? More often than not a picky eater is usually fed by their parents and it is often not a pleasant experience. The parent is stressed because they know the child needs to eat. The child is stressed because their parent is. The harder the parent tries to feed them the more upset and jaw locked the child becomes. One thing I will suggest is to offer the toddler two foods you know they like. Let them point at or look at the one they want and offer that to them. Try and make it as successful as you can for them when it comes to being able to feed themselves. Toddlers go through an independent stage and more often than not, if they can feed themselves, if they feel safe putting the food into their mouths themselves, they will eat it.
I also tend to be an advocate of "distraction" when eating if the child is picky. A favorite TV show or video being played can go along way to having the child eat more than they would if they are sitting upset in their highchair. As the child gets more comfortable eating and is less picky the TV show or video can be slowly removed (show only a portion of the show/Video during the beginning or end of the meal - depending when the child is more picky - until it is removed completely.) I know I can hear therapists and mothers groaning everywhere right now but I'm sharing this because it does help the picky eater "forget" how much they don't like eating and can get them started on a healthier eating habit than if they are left to fuss and complain. Often a distraction they enjoy can help them begin to enjoy eating when it's combined with encouragement. Then mealtime turns into a pleasant and enjoyable experience and no longer a stressful one for the child or the parent.
These are a few things to watch for and strategies to try when it comes to picky eaters. Please join me next week when I share some thoughts on what NOT to do when helping a picky eater become a better eater. For instance the old "you'll stay there until you finish what's on your plate!" - NOT a good strategy.
Well it's that time of year again. The holidays are right around the corner. As a Birth-to-Three provider I am often asked if I have any suggestions on what gifts would be appropriate for the children I work with. My first suggestion is to think about what interests their child the most. What makes their face light up, what might cause them to giggle and laugh or what captures their attention even for just a few moments? It's important to not just have a toy that will help them learn but one that they will enjoy and want to play with. One that engages them because if it is something that interests and intriques them then they are more than likely to play with it. With that in mind, my next suggestion is to think about what skill they are working on that a toy may be able to help them with. Are they concentrating on gross motor, fine motor, or speech skills? Are they looking to help with sensory or cognitive challenges?
It use to be hard for parents to know which toys would be best suited to help in each of the developmental areas. The good news is that there are now several websites that have lists that can help families make good choices when it comes to holiday gift giving and figuring out how to find a toy that might captivate their child's interest and help them gain progress in the areas they are working on. What I like about these websites is that they explain why these toys would make good gifts - what will these particular toys help with (fine motor, gross motor, sensory integration, eye/hand coordination, etc). A few of the sites I use quite frequently are:
Parenting-10 Toys Great for Children with Special Needs.
Fat Brain Toys: Special Perspective - Toys, games, and tools for children and adults with special developmental needs. Toys are listed by health challenges (Autism, ADD/ADHD, Hearing Impairment, Hydrocephalus, Traumatic Brain Injury, Vision Impairment, etc)
Toys R Us - Differently-Abled 2013 Guide - Each year Toys R Us comes out with a guide show casing toys that "aid in the development of children with physical, cognitive, or developmental disabiliites. They also now have an "App Guide" and a "Skill Guide."
Melissa and Doug - Toys for Special Needs - "These are the top toys and trusted skill-builders that help boost developmental skills in children of all abilities, organized by therapeutic and skill criteria to create a practical resource for families with special needs."
Fun and Function - "Where Kids of all abilities learn through play" - Website has headings in 7 different developmental areas. Toys as well as therapy equipment are listed.
I am sure there are more sites out there that I am not aware of. Is there one you use as a "go to" when it comes to gift giving? I would love to hear about them and add them to the list so other parents can use them as a resource. Do you have any toys that you have either given or received that have captivated the child it was intended for? Does your child like a particular toy that you would recommend to other parents and if so, why?
The holiday season can be a stressful time for children. In the next couple of weeks I will share some strategies to help make this time of year less stressful on our children.
Until then - happy shopping!
~ I have a vision of a place where children and parents could have fun together." ~Walt Disney
There has been quite a bit in the news lately about the Walt Disney Corporation stopping their policy to allow children with special needs the opportunity to move ahead of the lines. As a pediatric therapist and a volunteer for the Make*A*Wish foundation, I have always been supportive of this opportunity. I fully realize that there will be those who truly don't need to "cut the line" who will take advantage of it, but I think that for those who it helps to make the parks a magical place and bring happiness (and less stress) to both the children and the parents, it is worth that risk. It seems Disney is not in that same mind frame and is now trying a "new" approach.
For most children Disney is the dream vacation. It is where "dreams come true" and where everyone is a child at heart. It is also a place that many parents with special needs children dread. It can be a sensory nightmare-- full of crowds and noises, smells and sights that would overwhelm even the most typical child (and quite a few parents too!) When you add having to wait in a line, even if it is a small line, a child can easily reach their breaking point.
A typical child might be able to be calmed or distracted but when you have a child with special needs it becomes a challenge to keep them from having a melt down, not just ruining the day for themselves and their families, but for others who are standing around and not understanding why those parents "can't control their child." Being able to move forward and avoid this from happening has assured many families have been able to experience the Disney parks as magical places and have left happy instead of leaving frustrated and stressed.
Disney is now offering visitors who are unable to wait in line a ticket with a return time and a shorter wait time, similar to the FastPass system that is offered to all park attendees. Families will now be required to get a DAS (Disabled Assistance System) pass from Guest Relations that will allow them to reserve return ride times at designated kiosks located around the park. Disney has shared that they are having to make this change mainly because they have been seeing an increase in "disabled tour guides" who charge families money to show them around Disney and avoid the lines on the rides.
On the Autism Speaks website, there is a letter from the Disney President explaining the reasons behind this change. They have added a page to help families understand how this new system will work and how it will affect the Autism community. They are asking families to try and wait to see how this new change will work before getting upset over it. Disney appears committed to helping all families enjoy their trip to Disney, but they need to stop the abuse that is going on right now with their current special accommodations policy.
What are your thoughts on this change? Do you feel they are doing enough? What do you feel Disney could do different to help families who have children with special needs?
Several years ago I worked with a young boy who was diagnosed with Autism. His parents were progressive thinkers and wanted to try every therapy option that was out there that might help their son. They even had a hyperbaric chamber in their home and he was scheduled to be in it 1 hour every day. They believed that it worked and that they would see changes in him. It wasn't every day but they felt progress was made in some of his skill areas from time to time. Truthfully I did not see any changes but I also only saw him 1 time a week for an hour. Still hyperbaric chamber has been and is currently being studied to see if it is a possible therapy option for children with Autism.
For those who may not be aware of what hyperbaric oxygen therapy (HBOT) is let me do my best to explain it. You may recognize the term "hyperbaric chamber" as relating to a place where divers who come up too fast are placed to combat decompression sickness. The chambers look like a butterfly's cocoon in shape. Individuals are placed in them and the chamber is closed and sealed securely. 100% oxygen is then used inside the chamber at a higher level (percentage) than the atmospheric pressure. This causes the individual to breath in pure oxygen under pressure resulting in an increased amount of oxygen circulating in the body and enhancing the body's ability to heal itself naturally. I know Wikipedia does not always have a good reputation for being accurate but in this case it does explain other ways and other conditions that the hyperbaric therapy may help. The Mayo Clinic also does a nice job explaining what it is and why it can be helpful.
The belief where Autism is concerned is that the increased oxygen will stimulate growth areas in the brain and help promote learning and awareness. There have been several small studies done in recent years but the jury is still out as to whether it truly helps or not. There is also no long term study that I'm aware of at this time that can tell us if the effects are long lasting or not.
Talk About Curing Autism (TACA) has a recent article that was written regarding the use of Hyperbaric Therapy. It is fairly in-depth as it goes into what hyperbaric therapy is, what treatments may look like, what one needs to do to get this type of treatment and even has a list of studies that have been done.
And just this past August the U.S. Food and Drug Administration put out an article asking individuals not to be "misled" by Hyperbaric Oxygen Therapy.
I searched all over the internet and asked other therapists and teachers what they thought. I found that, as with any type of treatment, there are conflicting reports and it depends on who you talk to or what website you are getting information from. Of course those companies that have an investment in Hyperbaric Chambers are going to say it works. The medical community, for the most part, is not going to say it does because at this time there are no good research based studies that show it works. There are numerous accounts from families all over the world both saying how it helped and saying how it didn't.
I believe, as with any therapy, it comes down to the child receiving it. Each child heals in their own way. As parents and therapists we truly do want what is best and we would search to the end of the world to find it and to try it. But with any therapy or medication - there are children who will see good results, children who will see small results, and children who will see no results. Depending on where you live HBOT can be expensive and, unless prescribed by a doctor for a "qualified condition", it is not covered by most insurances.
What are your thoughts? Have your tried HBOT or do you know someone who has? Has it worked? And if so, in what way?
"What good is the warmth of summer, without the cold of winter to give it sweetness."
It's that time of year once again. The days are getting shorter and the nights colder. You feel that crispness in the air that heralds in the colder weather. Out come the sweaters and long pants. The coats, hats, and mittens. And with these changes out also come the stomping feet, the tears, and the refusals to wear the warmer clothing.
Any parent who has a child with sensory challenges dreads the changing of the seasons because it often means that the routines that have worked so well all summer long will now stop working. The morning "rise and shine" will turn into "rise and meltdown". The time it took in the morning to get the kids up and ready for the day will now take twice as long. The calming evening routines will turn into frustrating evening nightmares. All because clothing that felt right and was easily put on and taken off each day has to now be changed for clothing that is "itchy", or "tight", or "doesn't fit or feel right". Long forgotten are the memories of how this same clothing they wear without a fuss was clothing that caused tears and tantrums only 6 short months ago when it was time to leave behind the warm winter clothing and step into the shorts and sandals,
Today I would like to share some strategies to try and help the transition from summer clothing to winter clothing go a little easier.
- The sooner one starts getting the kids use to the heavier, warmer, winter clothing the better. I have found one easy way to begin this transition is through dress up and pretend play with clothing. As the summer begins to draw to an end bring out some of the winter clothes and place them in a box or Tupperware container near the toys. Scarves, winter hats, gloves, boots, coats should all be part of this "dress up" attire. Once or twice a day play "dress up". Everyone can grab a couple pieces of clothing and wear them around the house. Pretend there is a snow storm in the kitchen. Ask the kids "what should we wear if it's snowing out?" and then proceed to help them pick out a few things to put on. Take a walk to the kitchen and then take them off. If it is a cooler day outside pretend to go on an artic adventure and wear a few items of winter clothing outside. It doesn't have to be for long to start with. Have the kids wear the clothing for 5 minutes and gradually move it up to 10, and then 15, and then 30. By the time winter comes around the clothing will not feel so strange anymore and having to put on boots or a warm hat to walk to the car won't turn into a meltdown.
- Make sure the winter clothes have been taken out of storage and washed. Even if they were washed prior to putting them away it is important to do it again before they are worn. This will help them to feel a bit softer and smell fresher. Have the child help with taking the clothes and putting them in the washer/dryer. The more they touch the clothing the less strange and uncomfortable they will be when it comes time to put them on.
- If the child has outgrown their winter clothes make sure they are allowed to go along with you to pick out the new clothing. Have them try everything on and choose the items that they are giving you less grief about having to wear. They might still complain a little about how it feels on them but you can start to tell what they absolutely don't like wearing and what they might not mind wearing if it just didn't feel so "itchy" to them. Most times a couple times in the washing machine to soften a new item can make a world of difference when it comes to how it feels when they put it back on.
- Many kids hate wearing hats and gloves. Dress up is a great time for them to get used to having things on their hands and heads. It doesn't even have to be winter clothing. Throughout the warmer months encourage dress up time with different hats (baseball, cowboy, knit, etc.) and gloves (can be worn when pretend cooking or cleaning, etc.). The more frequently they are exposed and encouraged to wear different feeling items during play the easier it will be when they have to actually put them on during the colder months.
- If they just will not wear a hat or gloves compromise by allowing them to wear a sweatshirt with a hoodie and have them pull the sleeves down over their hands. This may not work if they are going out to the playground or in the backyard to play but for a trip to/from the car it will work and save frustration all around.
- Offer massage to legs and arms to help desensitize those areas for when they have to wear the long sleeves and pants. Nice firm input while massaging will work best. After the massage try on the long sleeves or long pants and encourage them to wear them for just a short time. Again start out with just 5 minutes and keep working your way up to more. Try both tight fitting shirts and loose fitting shirts. Some kids will prefer the tighter sleeves while others prefer the loose, flowing sleeves. If the child doesn't want to wear jeans try and find a pants that are made of other lighter material. I was surprised on a recent shopping trip for my son on how many different types of fabric pants there are out there now. It isn't just a jeans or corduroys any longer. There are many pants made out of fabric ranging from light and flowing material to heavier work pant type material. It may mean a long day of shopping as the child tries on numerous types of pants but if they are able to find ones that "feel right" then it was a day well spent.
- When it comes to wearing coats there are just as many varieties to try as there are pants. Some coats are just oversized warmer sweatshirts while others are the heavier thick winter jackets that repel all kinds of weather. Again, let the child try several different types and purchase the least objectionable one. Point out the good qualities about the coats (color, feel, etc.). For girls who don't want to wear the winter coats there is always the option of wearing a type of warmer poncho or cape. I've seen several capes that have a detachable winter lining in them. I cannot stand the tightness of winter coats and have two different capes I wear depending on how cold out it is.
One of the most important things to remember during this transition time is to have patience and know that the child is not protesting and complaining because they have nothing better to do but because they truly don't feel comfortable in the clothing. With time and patience, and following some of the strategies listed above, it will become easier and easier for them to wear the warmer, longer, heavier winter clothing.
These are just a few strategies to help with the clothing changes that come when the weather changes. If you have any that have worked for you I would love to hear about them. The Sensory Processing Institute for Research and Learning has a few suggestions too. The Friendship Circle Blog (a special needs resource for parents and teachers) also has some suggestions from parents.
"There was never a child so lovely but his mother was glad to get him to sleep." ~ Ralph Waldo Emerson
I love this time of the year. The cooler evenings always seem to help me sleep better. There is nothing quite like that feeling of climbing into bed, pulling the covers up, and laying my head on my nice soft pillow. Not long after you'll find me fast asleep.
Unfortunately this isn't always as easy for the some of the children I work with. Sometimes the trouble is due to sensory challenges and other times it is due to having poor sleeping routines. Whatever may be the cause it is so important for children to get at least one nap and a good night's sleep in order for the body and brain to develop properly. Today I'd like to share some strategies that might help if you have or know of a child that is having trouble sleeping.
One of the most important strategies any parent can use is that of having a good and consistent routine. The routine should be one that is quiet and calming. It's important to remember that what might work for one child may not always work for another child. For instance a bath may be calming and relaxing for some children but for others playing in the water and splashing around wakes them up. For some children reading a book and looking at the pictures will cause their eyes to start to close and yet for others the books get them excited and the pointing and turning pages has them excitedly awake wanting to look at another book.
The best way to figure out what type of routine will work is to try switching things around until you find a routine that works. One may want to first try a warm bath with lavender bath bubbles (lavender is said to be a calming and relaxing smell), then read a book in bed, kisses/hugs, and lights out. Or try reading the book first together on a chair or sofa, then the tub, and then kisses/hugs and under the covers. In some cases I've had to suggest even moving the bath time or book reading to the morning because either of those activities can be too alerting to some children.
Other strategies that can help with sleep time are:
- A weighted or heavier blanket can help a child feel "swaddled" without actually swaddling them. It is very important to make sure that the blanket is not too heavy. They should still be able to move around and turn without difficulty. My 14 year old son actually sleeps with 3 blankets and a thick open sleeping bag each night. When he was a toddler he would sleep with several blankets and several large stuffed animals on or next to him. If he didn't have this extra input he would wake up several times at night. Again the most important thing to remember is that the child must be able to move freely in their sleep and that there is nothing that could get in the way of their breathing.
- Background music/noise - a CD playing classical music or lullabies quietly in the background can help sooth a child into sleep. Some children even like hearing "white noise" and there are actually CDs with white noise on them or you can even now purchase machines that produce white noise and yes, believe it or not there is even an App for that! Another option is a CD of the ocean. It's believed that the sound of waves can be very relaxing (though I think this may work for us adults better than for the kids.)
- Turning off the TV and/or video games/computer - Research has shown that not only do kids with computers and TVs in their rooms go to bed later but that our brains take longer to stop thinking and processing if we have been watching the TV or using the computer, iPad, video games, etc. So turn off anything electrical at least one hour prior to bed to help our children's brains also prepare for sleep.
- Clothing - be careful to watch what your child is wearing when they go to bed. Some children do not do well with nightgowns, basketball type shorts, or long PJ pants. These clothing items can be flowing and tangle or bunch around their legs as they move in their sleep causing them to feel uncomfortable and wake them up. For children with sensory needs the feeling of the cloth flowing around their legs/body can be discomforting and, again, cause them to wake up or not sleep as soundly as they might if their clothing was a little more snug fitting. These children need the tighter fitting, snug clothing options. And on the other hand you have the children who do not like anything snug and prefer the loose fitting clothing. Try different sleeping clothing and see which ones allow your child to sleep longer and with less waking during the night.
No two children are alike and the only way to know what will work for each child we work with is through trial and error. If one type of routine isn't working, try it a different way. If one type of clothing isn't working, try something different. If lullabies are keeping the child up as they sing along, change over to white noise or the sound of waves on the shoreline. Once you have been able to find a routine that works, stick to it as consistently as you can. A child who has a good bed time routine each and every night will be able to fall asleep quicker and easier than a child who has no routine and no strategies to help their bodies calm down and relax.
These are just a few strategies that may work. If you have some that you have found successful I would love to hear what they are. Next week we'll look at strategies to help children who may have trouble switching from their lighter summer clothing to their heavier winter clothing.
Shadows of a thousand years rise again unseen, Voices whisper in the trees, “Tonight is Halloween!” - Dexter Kozen
Ok, while I don't think anyone who has a child with sensory challenges will ever have a truly "sensory free Halloween", I would like to offer some suggestions that might help make it less stressful. I also have some links to some great costumes for children who use wheelchairs or walkers. Even if you don't know a child who might want to make one of these costumes take a look at how creative these parents have been when it comes to their child's Halloween costume.
Figuring out what to "be" on Halloween is hard enough without adding in sensory challenges. A few strategies to use when it comes to making or buying a costume:
If you have a child who doesn't like to wear costumes, use some of their own clothing to make a costume. A few ideas would be:
- Nerd (use comfortable pair of pants, shirt, tie borrowed from an adult, and a pair of fake glasses. You can even pop out the lenses in the glasses if the child does not like wearing the glasses),
- Movie Star (use any favorite dress, add a little make up, play glasses can be used (minus their lenses if needed), a hat, and if they will allow it a feather or fluffy boa),
- Dog or cat (wear favorite pair of black, brown, white colored pants/shorts/skirt, use matching colored top, and purchase or make a pair of ears (usually on a headband). If the child will allow you can use a little make up on the face to help with the dog/cat look).
- Student (very easy if your child already goes to a school that has a uniform - they can wear that and carry their backpack or hold books in their hands. If no uniform then they can wear whatever they are comfortable in an use their backpack or books. "Nerd" glasses (with or without lenses) can be used to add to the student look.).
- Sports figure (if the child is into sports they can use their sports uniform. If not, a comfortable pair of pants/sweats with their favorite teams sweatshirt).
- Along with sports a cheerleader costume could be done by simply using a favorite skirt and top and buy/make pom poms.
- Photographer (the child can wear anything they feel comfortable in and just bring along a camera (or make a fake camera) and they can now be a newspaper photographer or member of the paparazzi.)
- A few other ideas for the internet can be on Pinterest here (Pinterest ideas), or 40 awesome costume ideas from the Jenney Evolution blog, or 52 easy to make costume ideas.
The best thing to do when it comes to a child who doesn't like to wear store bought costumes is to figure out what they might want to be and see what you can use out of their own wardrobe. You can then add to the costume idea by adding props that can be made or purchased and/or applying make-up. It is also a good idea to allow your child to wear the costume/make-up a couple days before Halloween so they can get use to how it feels and it will be easier to put on when the actual day comes to wear it to go trick or treating or to a Halloween party or family event.
If you have a child who doesn't like to go Trick or Treating door to door check with your local recreation department to see if there is going to be a neighborhood Halloween party. Many towns have a PTA/PTO or town sponsored Halloween "party" at the common area that allows the kids to get together to play games and receive treats. Sometimes these types of parties can be overwhelming for the sensory challenged child so it may be best to look into where it is being held and how crowded it might be before you go there.
Another event that is becoming more and more popular is "Trick or Trunk". This is usually held in a parking lot an sponsored again by PTA/PTO or a local neighborhood committee where cars will park and open their trunks for trick or treating to the neighborhood children. If you can't find if one is held in your neighborhood but you might want to put one together (it's really quite easy) Google "Trick or Trunk" and your town to see what neighboring towns may be holding one and call the sponsor to see how you can set up one in your town. The nice thing about this event is that they are held outside usually in a lit parking lot and the kids can run from car to car safely. It is also not as overwhelming for the sensory challenged child who might not like walking in the dark from house to house or being in a crowded noisy room for a Halloween party.
If you have any sensory free Halloween ideas I would love to hear them and be able to share them here with others. Feel free to email me your suggestions or comment here. In the meantime I wanted to share some really awesome costume ideas for children who use wheelchairs or walkers. There are some very creative parents out there. Take a look at these from the Christopher and Dana Reeve Foundation, and these from Pinterest, and lastly these from Google images!
"My spelling is Wobbly. It's good spelling but it Wobbles, and the letters get in the wrong places."
- A.A. Milne, Winnie-the-Pooh
Spelling can be a challenge for children of all ages. The English language is not an easy language to learn. We have many words that sound the same but are spelled differently and who among us knows all the rules of English grammar? Today I'm going to share a few resources to help school aged children with spelling and grammar.
One of the best ways to learn spelling at an early age is to use the multi-sensory approach. I cannot even begin to count the number of times our kitchen table was covered in shaving cream as my youngest son worked on learning his spelling words each week. We would use shaving cream one day, chalk or paint another day, flash cards another day, and finally writing it down on a piece of paper just like he was expected to do on the day of the spelling test. Allowing all senses to have a part in learning each week's spelling words works well because it allows our entire body to work together to memorize how the words feel, smell, and look when we write them.
The Proteacher and Teaching First websites both have very comprehensive lists of ways to help make learning spelling words fun. I have used numerous games, flash cards, and sensory play activities over the years to help my youngest son with his spelling and vocabulary assignments.
When it comes to having to type homework and reports today's students have it easy. Most word programs have spell checker programs that work really quite well. The one thing they don't always do though is pick up incorrect grammar or incorrect word usage (as in "There", "Their", and "They're" or "to", "two", and "too".) A student might write "I to want two go too the concert" and the spell checker will not catch the error.
If you have the newest version of Microsoft Word there is now a grammar check option which will also list the definition of the words it suggests you may want to consider using. A very helpful feature as there are many words that sound similar but have different meanings which students struggle with (affect, effect for example.)
If you have an older version of Word, Ginger Software is a great downloadable program that will catch your grammar errors. I've been using this program now for several years and can't even begin to share how happy I have been with it. It has also made homework so much easier for my son.
When you have dyslexia it is very easy to mix up words that sound similar. Ginger software catches the spelling and grammar errors and offers options if there is more than one way to write the sentence. They offer a free version as well as both a basic program ($4.90/month or onetime payment of $39.00) that offers the spelling and grammar checks and a premium version (onetime payment of $89.00) that offers everything in the basic as well as an option to have the text read to you in a human voice. Again, a great feature for those students who struggle with reading.
The premium version also offers the option of having personalized practice sessions that are aimed at helping you learn to spell and use grammar correctly. (Please know that I am not affiliated with Ginger Software in any way and they have not asked me to advertise their product. I actually stumbled upon it several years ago when I was looking for help for my son and have sworn by it ever since.My brother who is a writer, and who is also challenged by grammar and spelling, begun using Ginger this year and is surprised and pleased with how well it works.)
These are just a few resources that can help in schools and colleges when it comes to spelling and grammar errors. I am sure there are more out there that I am not aware of yet. If anyone knows of any that they have found to be helpful please let me know and I will be happy to share them here so that others can utilize them too.
Join me next week when I look at ways to make Halloween fun for our sensory challenged kids.I have also collected some wonderful Halloween costume ideas for children who are in wheelchairs or use walkers that I will share as well.
Having a child with learning disabilities has opened up a whole new world of resources that are available to school aged children. I have come across different strategies and resources to help in reading, writing, sensory, and overall learning. In upcoming blogs I will share different tools and web sites in each of those areas. Today I will start with reading.
I know reading may not seem like a typical Occupational Therapy concern but when we break down what it takes to be a successful reader there is actually quite a few activities that can be looked at and helped with OT. Reading requires good visual tracking and eye/hand coordination to trace the words in the sentence as you read along or for younger kids to be able to isolate their index finger and point to pictures in a book. Learning to read is often a multi-sensory activity and the ability to tolerate sensory play has always been helpful when it comes to the beginning stages of reading and recognizing the letters and forming them into words.
My son was diagnosed with Dyslexia in grade school. He is now in 9th grade and continues to struggle with reading. Testing has shown that he can either read the words on the page but not understand what he is reading or he can have the words read to him and be able to comprehend the story. As we are all aware the typical school day is full of opportunities where reading is a necessity. Our kids are luckier today than in the past because they have a good deal of technical resources available to them. A couple of the ones I have found most successful are:
Read2Go App - This is an application available on the iPad, iPhone, iPod that will read out loud books that can be downloaded from it's library. They offer over 190,000 ebooks to download. What I really like about this particular application is that you can choose the option to have the words highlighted as they are read to you. For someone who struggles with reading this is an excellent way to see the word, hear what it sounds like, and hopefully remember it over time. You can also control how fast or slow the reading is. There is cost of $19.00 for this application but we have been using it for the past 3 years and have been very pleased with it.
Google Chrome - Speakit! - This is a feature available to any computer that has Google Chrome downloaded. A student who is doing research and tires quickly from reading can now highlight the words they want read and Speakit! will read them. This has been a huge time savings resource for my son when he has a project or research to work on. He feels more independent as well as he can now "read" the research results on his own and does not have to wait for a family member to read to him. Speakit! will read any words that are outlined/highlighted on the computer as long as Google Chrome has been used as the search engine. Speakit! can also be used to read Gmail and documents if you have used Google Documents to create them.
Non-technical resources I use frequently are found on the ReadWriteThink website. Here you will find printable handouts that can be used to help make reading fun. What I love about this site is that there is such a wealth of information available free (!!) and that it is separated by grade level starting at kindergarten and going up to and through 12th grade. Each grade option focuses on what children at that age would be interested in to help engage them in reading. There are options that include incorporating sensory play, fine motor, visual and auditory strategies.
Another good resource if you aren't sure where a child should be in their pre-reading and reading skills is the booklet Reading: Birth to Five by Learning Point Associates. This is a great booklet to have for your own reference or to offer to parents so they will know where developmentally their child should be with their reading skills from birth to age 5. The booklet offers information on what a typical child should be doing as at each age level as well as activities to help a child reach those developmental milestones. The booklet can be downloaded/printed right from the website link.
As a parent of a child who struggles every day with reading I can see the importance of using all possible strategies and incorporating all the senses to help awaken the skills needed to learn to read. I can't tell you how many times the kitchen table has been full of shaving cream as my son has worked on that week's spelling words. We have used play-doh, magna doodles, and paint to work on pre-reading activities. As he has gotten older we've used the Read2Go app and now as he enters High School and will have more projects due, and he won't want his mom to help as much, we'll be using the Google Speakit! tool. Reading may appear at first not to be an area that needs OT help but there are so many ways OT can help with and enforce the skills needed to be a successful student who is a good reader or has the tools to be a successful student even if they are not a strong reader.
Next Wednesday we will look at ways OT can help a child be a successful writer. I'll share strategies and tools not just for help with writing but also a wonderful tool I use all the time when it comes to grammar and spelling assistance.
I wanted to take today's blog to share with you a little bit about who I am, where I've come from, and where I'm hoping to go. I'm hoping this little insight may make you feel a little more comfortable in asking for advice, sharing your stories, or just coming back here to see what is being shared each week.
First and foremost I am a mom of two wonderful boys. One is in his sophomore year of college and the other just started his freshman year at high school. It's not always been easy. We've had our share of challenges. My oldest had sensory challenges throughout elementary school and my youngest was diagnosed with an alphabet list of learning disabilities (ADD, Auditory Processing, Memory Processing, and Dyslexia). He also has a rare condition where his body is unable to regulate his body temperature properly when he exerts himself too much. I can empathize with all the parents out there that have banged their heads against their walls trying to find doctors who would listen and teachers who would care. It's not always been easy but we have been lucky often.
Secondly I am a pediatric occupational therapy assistant who works in Birth-to-three. I wasn't always a COTA. I was actually a corporate travel agent until about 13 years ago, when at the age of 37 I decided to return to school to pursue my desire to work with children. It wasn't easy being a full-time mom, wife, employee, and a part time (weekend) student but I did it.
I was very fortunate to find a job in pediatrics right after graduating and I've remained in the pediatric field for the past 10 years. I love my job and find it challenging and fulfilling. I work with a great team of teachers and therapists. The other day on the television a commercial came on that said "if you are lucky to find a job you love doing you will find that you will not work a day in your life." My youngest son looked over at me and said "That's you, right mom?" It made me happy that he recognized that I loved my job because there were more days than I care to admit that I've come home later than expected and feeling a bit frustrated and exhausted.
I feel that it is because of my personal experience with children with special needs that I can empathize with the families I work with and am better able to find the help they need as a therapist. I am also lucky enough to be able to call some of the parents who have since had their children "graduate" from birth-to-three friends. t's wonderful to be able to watch the little ones I've worked with continue to grow and make their own paths in the world.
It is also because of my youngest child that I have become an "advocate." I have come to learn first hand how difficult it can be working with schools that are on tight budgets and trying to get the help you feel your child needs to be successful. I have found resources that have worked well and others that have not worked at all. I have also attended classes/seminars where I've found myself filling up notebook pages of useful information and others where I've found myself staring at the clock wondering why it was moving so slow. I'm sure many of you can relate and share similar experiences.
So here I am - writing for Advance's Pediatrics blog and sharing what I've learned so far in life to hopefully be able to help others in their journey. I've always loved writing and have felt that I've had a story or two in me trying to get out. I am presently in the process of finishing a book on Developmental Delays that I hope to soon have published. One of the things I found I was often asked when I'ld first meet a family who was new to having a child with delays was "what do we do now?" and that became the basis of my book. From those I have shared it with so far I have received positive feedback. Many expressing how they wish it had been around when they first received their child's diagnosis. I'm hoping it will help many others find where to turn and what to do to get the help they need for their child(ren).
Now that you know a little more about me I hope that you will stop back again next week when I share with everyone some useful websites and resource pages to help school-aged children. I have some great ones when it comes to the dreaded reading and writing challenges many kids face.In the meantime, please, feel free to introduce yourself and tell me a little bit about who you are and what you would like to see shared here. What is it you are struggling with? What have you found to be useful when it comes to working in pediatrics?
Here in New England the leaves are starting to turn colors, there is a nip in the air, and the apples are ready for picking. Fall is just around the corner!
As much as I love this time of year I know that there are many parents right now who are looking at their kids wondering what the heck has gotten into them. Their sensory needs, which they thought were once under control, seem to be making another appearance. Suddenly the sensory seeking or sensory avoidance behaviors are back in full swing. What has happened?
I have found that with the changing of the seasons from warm to cold and then again cold to warm comes a resurgence of sensory behaviors. The good news is that these sensory behaviors don't seem to take as long to get back under control as they may have been the first time. Getting back into a good sensory diet routine would be the first step. Remembering which activities worked well the first time and bringing them back to help out again this time. A good handout to offer to families is Advance's Sensory Diet handout that was featured in August. There are several good strategies listed on it regarding all the senses and how to help with seeking and avoidance behaviors.
For those working in schools there is a good article by Elizabeth Rosto Sitka in Advance for OT's August On-Line Extra section that shares a wealth of activities to help students while they are in school. Many of these activities are easy to do and low cost. The article is titled: Sensory Strategies for the Classroom. One of the most important thing to try and remember when working in the schools is that many of the students are coming from their summer vacation where they were outside a good amount of the time, running errands with their parents, and/or being able to get up and move around whenever they needed to during the day. We are now asking them come September to sit and learn so those movement breaks are going to be essential to helping keep them focused.
More good news is that the temperatures are cooler during the fall and this allows for more outdoor time and what better way to get sensory input than to play outside? Jumping in leaves, swinging on the swing, going for walks in the woods, and picking pumpkins or apples are all great sensory activities. What's even better is that they are great family and/or friend activities! So get out there and enjoy the fall colors while taking part in some fun sensory play.
I, for one, do not know where this summer has gone. I don't know if it seemed to fly by because we had so much going on each weekend or if it was actually shorter due to the number of snow days we had to make up for this year. Whatever the reason there is only a little over a week left before the kids return back to school. I know for many parents this can be a difficult time as it means getting their children back to school time routines. There are a few things we can do to try and make the transition from summer to school a little easier.
- Start the "early to bed, early to rise" school schedule the week before school actually starts. This will allow everyone in the family to get into a routine that will become easier as the actual first day of school approaches. If it is too difficult to get them to bed early and up the next morning early do it in small time increments. Start with 15 minutes earlier and every other day move it up 15 minutes until you are going to bed and getting up the next morning at the times you need to be.
- Discuss what items need to be in their backpacks and get them ready. Decide what outfit is going to be the "first day back" outfit. Don't forget to make sure you include socks and shoes. I know my son has several pairs of sneakers and it can take him quite a while to decide which ones match better. J If the clothes are new have them try them on and wear them for a couple hours to make sure they "feel right". They may look great but once they are worn may feel uncomfortable and this can be distracting at school. This is especially important for children with sensory concerns.
- If possible walk to the bus stop at the time you would need to meet the bus. This would be a great time to talk with your child about any concerns or worries they may have about going to school. They can also share what they are looking forward to. If they are driven to school you might want to do a couple dry runs to the school just to get use to how long it may take (both getting to the school and getting your child from the house into the car. Some days for us the house-to-the-car time takes longer than the drive to the school.)
- Talk to your child about what they may expect that first day. Will their teachers greet them as they get off the bus and walk with them to their classrooms? If not, do they know where their classroom/homeroom is? Will they be bringing their lunch or buying lunch? Ask them if they have any questions about their first day back and if it something you can't answer for them contact the school and try and get an answer. Most schools have their front office open for limited hours the week prior to school starting. Call and get answers to any concerns your child has before school starts.
Just like anything "new" the first few weeks of school can be a tiring and trying one for both the student and their parents. Know that many children will do everything they can to "keep it together" while they are in school and then the minute they step through the door "it" is released and you find yourself with a child that is talking non-stop or running around in circles trying to release all the energy they've accumulated during the school day. Allow them some extra time outside or, if time permits, go to the park/playground or go for a walk to help them get rid of this energy. Trust me, not much homework will get done until their body is able to relax a little and their mind is able to focus. Allowing them extra time when they get home to burn off the worries and energy that have built up will only benefit the both of you.
"Tell me and I forget, teach me and I may remember, involve me and I learn."
- Benjamin Franklin