One of the challenges of working with toddlers and their independent self-feeding skills is that you are sometimes challenged to work with a toddler who doesn't have the skills to be independent but is at that age where they are striving to do it all themselves anyway.  They want to do everything themselves and are not always welcoming when it comes to hand over hand assistance or, for that matter, any kind of assistance.  I've found you need to be a little tricky so that they think they are doing it all by themselves when in actuality you are guiding them in the direction you want them to go, with a little assistance to get there.

One of the ways I have found to help a child with their finger feeding skills to to place only one or two small pieces of safe food (puffs, gold fish, etc) on their tray.  Let them first try and pick up these pieces by themselves so you can assess where their skill level is.  Do they need help closing their pincer grasp so they can actually hold the food in it or are they not even to the point of being able to make a pincer grasp and are still at the racking into their hand stage?

A good strategy to help both if they are still raking or if they are just not closing their fingers into a pincer grasp is to pick up one of the pieces of food and hold it between your thumb and finger in front of them.  Their first step is usually to tilt their head forward as they believe you are going to feed them with what is in your hand.  Slowly pull away far enough so they can't reach the food with the tilt of their head.  Hold up the food in your fingers so they can see it.  It is good to make sure that whatever you are offering is something that will motivate them.  Remember - motivation is always the key in having a successful therapy session. 

With the food in between your fingers on one hand, use your other hand to nudge the elbow of the arm you are working on eliciting the grasp from.  More often than not they will reach out to get the food from your fingers.  You should try and hold on to the food relatively well so they may have to work a little to get the food from you.  Once they start to isolate their thumb and pointer/middle fingers and reach with a somewhat accurate pincer grasp - be sure to release the food into their fingers/hand so they feel successful.  If the need is there, gently help them release the food into their mouths once they have independently moved their hand up to their mouth. I found a good way to do this is to slip a finger gently into their fisted hand and push the piece of food through their fist/grip and right into their mouth.

If you do this several times at each meal they will begin to gain strength and dexterity in their hands and become successful with their pincer grasp.  They should become comfortable enough to be able it each out and take the food from you.  Challenge them a little.  Hold the piece of food right in front of them to gain their attention and then the next time move it up and to one side or another.  This is good to make them reach across mid-line and to reach up.  Remember whatever you may be offering them needs to be something they really want.  Be sure to encourage them regardless of if they start with a more raking movement because with repetition they should be able to gain more exprience with their attempts at pinching the food and getting it to their mouths.  The more successful they become the more they will start to reach for the food in the proper way using their thumb and pointer finger consistently and spontaneously.

The key starategies are a) finding a food that is safe and motivating to them and b) helping them without being right in their face and taking over.  Let them think they are doing most of the work themselves so they can successfully start to feel independent.

Thanks for stopping by - hope to see you back here again.

~Wendy~

Hi All!  Sorry I did not post on Friday – I was a bit under the weather with a stomach bug.  Thankfully it didn’t last more than 48 hours but that is one of the “hazards” of working with children for a living – you are bound to catch something every now and again, no matter how hard you try. J

I wanted this Tuesday’s Tidbit to be a shout out to you, the readers of this blog.  Last week  posted a blog on the “spit cup” and received a nice comment from Christina Chen , a student in Los Angeles.  She was asking how we approach a child who may have both an oral tactile and an olfactory defensiveness when it comes to eating. See her comment here.

Christina brought up a very good point.  When it comes to trying to get a child to eat and get over any oral/feeding aversions they may have we do often suggest that a child be exposed to all that goes on in the kitchen.  This would include helping out with meals or, if not old enough or interested in helping out, to at least be in the area so they can hear the sounds of the kitchen and to be able to smell the food as it is being prepared and cooked.   

I will admit that I have not encountered a child yet who has a difficult time with the olfactory sense.  So I reach out and ask parents, therapists and readers – have you had any experience with a child who has demonstrated an aversion to smell along with an aversion to eating/self feeding/food?  If so, what have you done to help them overcome this aversion?  What are some strategies and/or activities you have used that have worked – and also ones you’ve tried that have not worked. 

I look forward to hearing from you!  Please feel free to comment to this blog or email me directly.  All thoughts and suggestions and comments are greatly appreciated.

Thanks!  Hope to see you back here next time.

~Wendy~

When it comes to picky eaters one of the biggest challenges we have as therapists is getting the child to even taste something.  There is, of course, an entire protocol to getting a sensory defensive child to allow food to be 1) in the room, 2) on the table, 3) on their plate, 4) on their spoon/fork, 5) near their mouth, 6) in their mouth.  In a later blog I will list some helpful seminars that will go into how to get a child from 1 to 6.  Today though, I would like to talk about a method that I have found to be very successful when it comes to working with older children.

If a child is old enough and cognitively aware enough to be reasoned with a "spit cup" is a good way to get them to try new foods.  Take a moment and think about the one food that you will just not eat.  Think about what you don't like about it.  Is it the texture, is it the smell, the taste?  Now think about how you would feel if someone was making you place that food into your mouth and swallow a piece of it.  Did you just shudder?  I did.  I don't like olives.  The mere thought of having to have them in mouth and swallow them makes me gag.  Now think about the children you are working with..  this is the same thing they go through if they are being encouraged to swallow a food they are not comfortable with or having sensory issues with.  But wait!  There is away to get around this...

Take a cup, any cup.  It can be as plain as a Dixie paper cup or as fancy as you want to make it.  It can be big or small.  It can be a "big boy" cup or a small toddler cup.  The actual size, shape, color of the cup doesn't matter.  What is going to matter is that you are going to encourage the parents to allow their child to spit out any food they don't like into this cup during meals.  What!  Spit out food?!  I know it doesn't sound like a pleasant thing to encourage but the most difficult part of eating something that you don't like is the moment you realize you have to swallow it.  More often than not you can keep that food in your mouth, move it around, store it in your cheek but when it comes to swallowing .. that is when the gagging and the struggle comes in.  This is also where a "spit cup" can come to the rescue.

A child who feels safe enough to be able to spit out and not have to swallow the food you are asking them to try, is a child who will be more willing to try new foods.  It has been my experience that a child is more willing to try new foods, to take bites of different foods, if they don't have to swallow it.  If a child can be encouraged to "just take a bite and then spit it into the cup", they are more willing to take that bite.  If a child is encouraged to have to swallow the bite they just took they will be less likely to want to take a bite again in the future.  What you will see is that at first the bites are quick and the child almost immediately spits out the food but they are still getting a taste of it.  The more they are encouraged to take bites and spit, the more tastes they will be willing to try.  As they feel safe that they don't have to swallow, they'll start to even do a few chews before they spit out.  As they are now taking a few chews they are swallowing little pieces of the food.  This can be a slow process and patience is important but the results are well worth the time that goes into using the "spit cup" properly.  After a while you will see that the child is taking more bites and swallowing occasionally - and spitting out less and less.

This procedure does work best, as I mentioned, with the older child who can be reasoned with.  Younger children may not understand the concept of taking a bite and spitting out but the older children will.  I will never forget the time I used this with a young boy of 8 years old whose mother told me that he only eats chicken nuggets and cereal but will not try anything else.  I suggested she try the "spit cup" and she was hesitant at first, not really liking the idea of spitting at the table, but I was able to convince her and her husband to at least try it for a couple weeks.  They agreed and when I returned two weeks later I was greeted by the eight year old at the door.  He was very excited and said "guess what! guess what my favorite food is now!!".  I smiled and asked him what it was and he replied " I tried meatloaf and I tried steak and I like the steak better!".  His mom was standing behind him with a big smile on her face.  Once he got the hang of being allowed to spit out the food he started to try more and more foods during their meals.  When I left a couple months later he was not evening using a spit cup any more but was using a napkin.  He tried almost everything on his plate but if he took a bite of something he didn't like he would pull out his paper napkin and discretely "spit" into it. 

The "spit cup" may not sound like a glamorous or high tech feeding strategy but it does work.  Give it a try, you have nothing to lose and your children have everything to gain! 

Thanks again for stopping by - hope to see you back here again on Friday.

~Wendy~

It's been raining here for the past couple of days.  Yesterday was a cold rain but today it was warmer and more of a drizzle.  I have been off on vacation in the Lancaster, PA area with my sister and mom.  We've been exploring, shopping and just having a fun time enjoying each other's company.  It's been a pleasant change but has also opened my eyes to how much the world has changed since my sister and I were kids.

We were on our way back from shopping and heading back to our hotel room when right in front of us was this large puddle.  My sister and I looked at one another, huge grins spreading on our faces, and we ran and jumped right... smack ... in the middle of .. the puddle!  *splash!!*  *splash!!*   Water every where and my sister and I in tears from laughing.  Here we are, adults, splashing in puddles.  Our mom behind us, joining us in the laughter.  As we started walking back to our room we continued to splash and kick at the water, trying to get each other wet.  There was no scolding, no one was upset that we were wet from our knees to our toes. 

This was nothing new to us.  As long as I can remember I've jumped in puddles - with my sisters, my brothers, and with my sons.  I can remember the first time my youngest son was old enough to remember jumping in puddles we were returning from a school event.  I was walking with my two boys slightly ahead of us and the youngest did a half jump into a puddle.  I looked at my oldest son, a smile spreading on my face.  I said something like "Nick!  That is not right" and then both me and my eldest son jumped high and landed with a big splash into the puddle.  My youngest stopped in his tracks, water dripping from his clothing, looking at us with at first a startled look and then a smile.  I started to laugh and then both boys started laughing.  "That is how it should be done.  If you're going to do it, Nick, you have to do it right!"  We continue to jump into the puddles as we walked to the car.

I was brought up with the knowledge that rain is water and water is okay to play in as long as it is a warm enough day.  I can remember playing outside making mud pies and jumping in puddles while it is raining and right after it has stopped raining.  I was never scolded for having wet clothes or wet shoes.  I was never scolded for coming in muddy.  When I was growing up it was encouraged.  I have continued to encourage this freedom in my kids.  We have been known to go outside in a drizzle and play on the swings or in the puddles or even in the mud.  I believe this is one reason my kids have not had the sensory issues or the picky eating issues that so many of our kids have these days.  They have been allowed to get dirty, they've been encouraged to get dirty but that is not the way with so many of our little ones these days.  I have gone into many a home where the child has been scolded for spilling food on their tray or on their clothes.  They have been told "no" and "dirty" when they've brought toys to their mouths.  So why is it not surprising that so many kids are sensory defensive and have become picky eaters?

If our kids are not encouraged to get their hands dirty and not allowed to get messy, why would they feel comfortable to allow that to happen when it is time for them to eat or to play?  A child who is allowed to play with mud and to play with their food is more likely to be the child who will try new foods and can be encouaged to get messy during play time.  A child who is scolded and told "no, dirty" is a child who will not want to touch messy food, not want to put things that are different into his mouth and will become the picky eater because of this. 

I try to encourage my families to have a messy play time set aside at least once or twice a day.  Many families are not able to do this either because of other time commitments or because of their own sensory defensive behaviors.  There are families though that will try and are amazed when they see their child suddenly becoming more willing to try new things after a couple weeks of consistent scheduled messy play.  I also encourage these families to bring out some pudding or apple sauce and use that to finger paint with.  Often a child will unknowingly bring their hands to their mouth with these food items on their hands and even though at first they may cringe or dislike what they are tasting, in time we'll see that they begin to be less defensive when it happens again.  Eventually this child will be the one who will do it on purpose because they have decided they actually like the taste of the pudding or the apple sauce.  The most important thing to do is make this messy play time consistant each day and fun!!  Be silly, be messy with them and encourage them to try and allow the food to remain on their hands for 1, 2, 3, 5 minutes ...  The more often they are exposed to it, the more often they are encouraged to have fun, the more often they will feel comfortable enough to explore and to taste.

So I say to everyone ...  don't wish the rain away - go out and play in it!  Encourage your families to go out and play in it!  Get messy!  Remember what it is like to be a kid and jumping in puddles and making mud pies and encourage your families to try it too!

Thanks for stopping by.  Do you have any fun, messy activities you use to do as a child?  I would love to hear about them! 
I hope to see you back here on Tuesday for Tuesday Tidbits.  We'll be talking about the "spitting cup".

~Wendy~

I am always amazed at how the majority of kids just love bubbles.  All you have to do is pull out a bottle of bubbles and kids seem to appear out of the wood work... waiting in anticipation for that first wave of round colorful bubbles to appear so they can chase after them and pop them.  I have found, though, that bubbles have many uses when it comes to therapy:

Encouaging vocalization/communciation -   what better way to encourage a child to say/sign "more" than to offer them a taste of bubble popping and then wait ... and wait ... and wait ...  until they either attempt to sign "more" or try to approximate the sound "mmm".  Motivation is a key in most of the therapy we do and bubbles seem to be a key motivator for many children.  Even just blowing the bubbles and consistently saying "pop".. "pop"... "pop"  as we pop the bubbles will help a child to, hopefully, eventually mimic you in actions and sounds.

Eye hand coordination/tracking - All though it can some times be hard for a child to track the course of a single bubble floating off in the air many children are able to watch a shower of bubbles as they fall down around them.  Often they will begin to just stick out a hand in hopes that a bubble might fall onto it and magically they usually will (ok, perhaps not quite magic but still with a little help by us as we gently blow them in the direction we want them to float.)  We can also blow bigger bubbles which are easier to track and reach out to pop.

Sensory play - Besides the actual popping of the bubbles on their fingers or hands or as they fall onto their legs and arms - bubbles juice is great to use for sensory play.  I will pour some of the bubble juice onto a tray and then either have the child move it around with their fingers (or a paint brush/sponge depending on where they are with their sensory play).  I also have one of those small bubble animals that blows lots of bubbles at a time and I will blow these bubbles into the juice on the tray to make large bubble towers.  More often than not even a child who does not like to get "messy" just can't resist popping some of the bubbles in a bubble tower.  What is great about bubble juice is that the kids don't see anything on their hands and thus don't get so upset about being "messy".  Once a child begins to really enjoy playing in bubble juice I will start to add a small amount of color (shaving cream style or finger paints).  I don't add too much, just enough to slightly change the color when they move the bubble juice around.

For such an inexpensive item it such has a lot of uses!  What are some ways you have found bubbles to work for you in your therapy sessions?  I would love to hear them.

Well I'm off to work - thanks for stopping by.  Hope to see you back here again on Friday! 

~Wendy~

No matter who you are or what you do I truly believe that the one word that can help each and everyone of us through the challenges we may face in our lives is the word "support".   Think about it.  When you are having a tough day, when everything seems to go wrong or everything you try and do just doesn't work the way you want it to.. what do you do?  Most of us will call a friend or co-worker or relative and we will vent, or cry, or scream about how unfair the world is.  We will share the day we are having with someone we can trust to understand what we are going through - and even if they may not understand completely we still know that they will be there to listen and allow us to get it out of our system and feel better.  They will be there because we know, whether they are friend, co-worker, or relative, they care about us and will be there to support us when we need it.

Now think about what it would be like if suddenly you have a child with special needs.  Your regular support system may not be there for you to turn to any more because suddenly they don't understand ... they can't relate to what is going on in your life.  Perhaps they don't have children or their children are the ones who were talking at one and walking at 18 months and when you have a child that is falling behind or has a medical condition it is harder to reach out to someone who has a child who may seem "perfect".  And as well intentioned as that parent may be, they really will not be able to understand the frustrations and the struggle you may be going through to help your child be the best that they can be.

 This is when, we as therapists, can reach out and help in a different way.  We can supply our families, our clients, our neighbors, and friends with a list of support groups in the area and/or on the web that can understand and sympathize and offer advice because these support groups will have "been there, done that, tried this".  We don't even need to make a big deal out of offering the support.  It can be placed into a package that we can give out during one of our meetings that could include useful information like a handout on their child's diagnose/reason you are seeing them, community programs (story time, play groups), and a list of support groups.  It doesn't have to even be intensive.  A simple list of contacts - perhaps a web site that will then lead them to other sites of support, a list of local groups in the area that offer support, etc.

It is easier some times to talk to a stranger who is going through the same thing someone is going through than it is to talk to a loved one who has no clue what they may be going through.  I'm not saying that is it not still important to encourage families and friends to be a part of one's support but that it is very important to begin to build a support branch off of one's typical support tree that knows about the struggles and the success because they are going through it now or already have gone through it.

A simple "google" search can bring up a wealth of information that can then be cut/pasted and shared.  Be sure and stick to the well known larger organizations as they will then be able to offer links to the smaller and local support groups if the families decide to look further.  Don't push the subject either as we don't want to alienated our families/clients but just the fact that the family has it will be helpful.  It may take a couple weeks or months before the family comes to terms and decides they need the support - and they will then look for the pages you gave them or, hopefully if they can not find the pages, look to you again for another copy.

When it comes to our children - it does take a village..  and we are part of that village regardless of how large or small a role we may play.  A simple handout with a phone number or web link can be a life line to a family looking to find their footing along the uncertain path they have now been forced to walk. 

Thanks for stopping by - hope to see you back here again.

How many of you have used a Nuk brush when working with your pediatric patients?  Do you use it just to "wake up" their mouths or do you use it in other ways as well?  As I have gained experience in the pediatric area and especially the oral motor/feeding challenges I have found that the Nuk Brush is a very versitile tool.  Let me share some of the ways I have used it.

1) As a way to "wake up" the mouth, of course. :-)   This is the most common way, I'm sure.  We use the brush both inside the mouth (pressing and rolling it along the gum line, inside cheek area, tongue, and palate).  We can also use it on the outside of the mouth (rolling, tapping on lips and outer cheek area). 

2) As a feeding tool.  I have found that many children really enjoy using the Nuk Brush instead of their spoon or fork.  They like the way the food stays on it and how they feel successful getting the food into their mouths.  Once in their mouth and they get the food off the brush, it works again to "wake up" the mouth.  It is a great tool to get the tongue moving as it follows where you place the nuk brush in the mouth (imitating how to follow a piece of food around in the mouth and moving it in order to chew/mush it properly).  It is a great way to help a child learn how to get use to self feeding because the handle is long enough that you can hold onto the end and have the child hold onto the middle and guide it to/from their mouth. When using the Nuk Brush as a feeding tool you are actually accomplishing two goals - a). self-feeding successfully and b). "waking up" the mouth in order to be more aware of the placement and movement of food once it is in the mouth. 

 3) As a sensory tool.  Often I will run the Nuk brush along a child's fingers & hands and up their arms.  This is a great activity if the child is not interested in having the brush brought near/to their mouth.  I will run it along their fingers and put a little pressure on it to give them a strong steady input while singing a song (this little finger went to the market, this little finger stayed home, etc) or counting (1, 2, 3 little fingers, 4, 5, 6 little fingers, etc).  As the child gets more use to the brush I will work on either moving it up along their arms during songs and then to the face gently tapping their cheeks, chin and some times giving them a little silly tap on their nose.  It's a good way to get them use to the Nuk brush and to be able to eventually work your way up to their mouths. 

Some places that offer Nuk brushes for sale:

Talk Tools 

Super Duper Publications

Edcetera

Beyond Play

Are there any other ways that you have found the Nuk Brush to be a useful tool when working with kids?  Is there another tool that you have found that works better than the Nuk Brush?  Please feel free to share ..

 Thanks for stopping by!  Hope to see you again next time.

~Wendy~

One of the things that interested me the most about becoming an Occupational Therapist was that we could look outside the box when it came to figuring out how to help the people we worked with.  I loved how OT's are considered to be creative and innoventive when it comes to getting our goals accomplished.  I've wanted to find a way to have this blog helpful for other pediatric OT's/Cota's and thought once a week I would start showcasing items that I've found to be useful.  Today I wanted to share with you a juice box I stumbled upon that is wonderful to use when working on straw drinking.

Recently I was working with a young child whose goal was to learn to drink from a straw.  We tried the usual methods of holding our finger over the top of the straw to keep the liquid in it and then place the bottom of the straw in the little girl's mouth to allow her to taste the liquid in the straw.  She weren't interested - didn't want that dang straw any where near her mouth.  We tried straws filled with frozen juice.  After a couple of "bites" the straws were promptly dropped on the floor.  We tried your typical juice box and if we held it she wanted nothing to do with it (did I mention she was going through the independant stage and wanting to do everything herself?) but if we allowed her to hold it - one squeeze and **wahhoooo* juice every where!

Mom purchased a honey bear from the store, cleaned out the honey and tried to put a straw in it like she saw in the catelogs.  Only problem is that when it is not the honey bear purchased from a therapy place the straw does not fit securely in the top and there is no suction for the straw to work.  We tried several different things but just could not get a good enough seal.  A couple days after the visit I was in a local Walmart looking for a water bottle for my son and found a smaller one that claimed to be "spill proof" and "squeezable".  Hmmmmm..  would this work in place of the Honey bear?  

I purchased one and brought it with me on the next visit.  At first the little girl wanted nothing to do with it but after coaxing her to place her hands on it and then placed my hands over hers we were able to get her to bring it to her mouth at which point I gently squeezed the box casuing the juice to go up the straw.   She was a bit surprised at first but after a couple more times to the mouth and a couple more gentle squeezes she began to get the idea and by the end of the session was actually taking a few sips herself.  The juice box worked wonderfully!  It doesn't spill easily but will spill if left in the hands of a typical curious what-if-I-shake-this-up-and-down-really-hard toddler.  It is easy enough to squeeze gently and have the liquid go nicely up the straw but the child can also hold them securely without the juice going everywhere. The nice thing is that the juice box is actually several dollars cheaper and you can buy them in most department/grocery straws.

Here are a few links for the Honey bear and the squeezable juice boxes:

Honey Bear cups:  Talking Child, Talk Tools, Therapy Resources  (ranging in price from $5.99 to $20.00)

Squeezable Juice boxes:  Amazon, The Container Store,

 Give it a try and let me know what you thought.  Do you have any other ways that have been successful when it comes to teaching a child how to drink from a straw? 

Thanks for stopping by.  Hope to see you again next time.

~Wendy~

Thanks so much to everyone who responded via email and messages.  I'm glad to see that what is being reported by the media is also what we are all seeing out in the "real world".   Here in CT jobs in SNF are still the most available type of OT jobs out there but there are several companies that are looking for pediatric therapists as well, especially in the southeastern part of CT for the school and birth-to-three populations.  A new area that I have seen more postings for is the homecare/hospice field.

I received a couple inquiries asking how hard it was to get into the pediatric field and if I had any suggestions on getting a pediatric job when one had a lack of pediatric experience.  I can share first hand that when I was in college and working on my COTA degree I was discourage by my advisor and professor when it came to my desire to be a pediatric COTA.  It was their belief that the jobs were far and few between and once a COTA got into that field they rarely left it.  It was shared with me on more than one occassion that the pay & the openings were in the SNF field.  I had decided to return to college after working 10 years in the coporate world for the sole reason of becoming a COTA and working with children.  I knew in my heart the jobs were out there but that it might mean I had to go search for them instead of find them advertised.  And that is just what I did.  And have been continuously working in pediatrics since I graduated 6 years ago.

 So my suggestions are:

1) First and foremost do your best to get an fieldwork placement/internship in pediatrics.  I was proactive and sent out inquiries to all pediatric companies that employed OT's & COTA's in CT.  I didn't care how far I might have to drive as long as I was able to get my foot in the door and gain some experience.  I received several responses and was able to hand over the contacts to my fieldwork placement advisor who was able to secure a spot for me for my last fieldwork/internship placement.  So, if you are led to believe there are not placements out there, ask if you might be able to inquire on your own locally.  Most advisors would have no problem with this as they have their plate full already with everyone else's fieldwork placements and may not mind the extra help in getting them contacts they can use for your placement and keep to use for future placements. 

2) Don't get discouraged if you cannot find any job listings in your local paper.  Try looking in the ADVANCE's job listings as well as on-line job search engines.  I've found the following companies have had current and up-to-date listings:  Simply HIred, OT Jobs.com, Rehab Word (this is a good one to get a list of companies and what types of jobs they hire for - SNF, Homehealth, Pediatric, etc), AOTA's job search section. These are just a few and if anyone has other places they have had success with please let me know and I would be glad to share them.

3) Research and find the companies in your area that employee pediatric OT's.  Send them a letter of inquirey asking if they are currently looking for new employees, explain your desire to work in pediatrics and enclose contact information (phone #'s and email address).  When I wrote my letters I used my computer to add a clipart of an adult figure holding hands with a group of children.  I had several compliments on how that image stuck in the minds of the individuals who read it and that it was an effective way to get noticed and be remembered.  Even if you don't hear back from them don't get discouraged.  My current position was not one that was posted but one that I had send a letter to when I first started looking.  I did not hear from them until nearly a year later.  By that time I was already working and happy with where I was.  I shared with the caller that I was not looking right now but asked that they keep me in mind for future openings.  About a year later I received another call asking if my circumstances had changed and would I be interested in coming in for an interview.  I was and I did and I've been with them for over 3 years now and love my job. 

4) I have read recently where there is a new trend surfacing in the job hunting field.  The job seeker is offering to work for free for an agreed upon amount of time to show the company that they are able to handle the work load and that they are capable of completing the job requirments even if they may lack in direct specific experience (i.e. they've been working at a SNF but want to work in pediatrics).  This gives them an opportunity to prove to the company they would be a valued employee and for the company to see if they are a good fit.  I have not tried this myself but would not be adverse to trying it if there was somewhere I really wanted to work.

These are just a couple of suggestions and I hope they may help you if you are job hunting.  Above all else, don't get discouraged.  Keep on trying and finding your own unique way to make yourself noticeable... just remember to keep it professional.

Thanks for stopping by. 

~Wendy~

I apologize for disappearing for a couple months but I am now back and will be working on getting the Pediatric Perspective back to twice a week blog entries.  I thought I would start off with a couple questions I have been wondering about and I am hoping you all can answer some of them for me.

 1)  I keep reading how Occupational therapy has once again come up as one of the top growing job markets and is actually expected to grow faster than originally anticipated, especially with therapists working with the elderly.  My question to you is - what about those working in pediatrics.  How are you seeing the pediatric job market both for OT and COTA openings?  Are there jobs out there?  Do you find they are in hospitals, early intervention (Birth-to-Three), schools or a mixture of any of these?

2)  If you are a COTA are you thinking of going back to school to get your OT degree?  I ask this because recently a couple COTA's I know have decided they are going back to get their OT degree.  One is going to a college that offers weekend classes so she can still work and the other is going to quit her job and return as a typical full time student at a tradition college.  If you are thinking of going back, why and how do you think you will do it?

3)  Are you worried about your job as far as it being secure is concerned?  I ask this because there have been several lay offs recently at schools or schools combining OT departments with neighboring districts (where there is 1 OT supervising several COTA's) - or out sourcing their OT departments to therapy companies (thus not having to pay medical, benefits, etc and saving money in those areas). We've also had a few birth-to-three companies consolidate their areas to save in travel time and expenses.  What do you see happening in your area? 

Just a couple questions to get us started here.  I would love to hear your answers, your comments, your thoughts...  please feel free to answer one, or two, or all three - Is there anything you are wondering about or any questions you would like answered?  If you don't want to comment here on the blog please feel free to email me (whhct@comcast.net). 

Thanks for stopping by!  Hope to see you back here again.

~Wendy~

Working in the Birth-to-three population we work with a wide range of developmental disabilities and handicaps.  Autism is one of the most challenging because... well, Autism is a mystery in many ways.  There is no rhyme or reason right now which children will "get" Autism, nor why or how it happens.  There are theories and speculations but at this time no concrete, definite, absolute, positive answers.  What we do know is that early intervention is a key to helping many Autistic children be able to find strategies so that they can gain in many areas of their developmental skills. 

We, as therapists, know the articles, the text book readings, and some of us have been lucky enough to work with children who have autism..  others may only know of it through what they read and see on TV.  I wanted to share with you today an awesome video that was made by a mother of two wonderful boys, who of whom has Autism.  It is a short video but it will touch your heart as you get a chance to see Autism on a more personal level... The mom who made the video has given anyone who would like to share it permission to share it - so please, if you feel so inclined, share this video with others and ask them to share ... pass it forward .. touch a heart while learning a little more about Autism...

The video is here:  Brody Show.  It is on UTube and so worth the 4 or 5 minutes it takes to view it - there is a wonderful song accompanying it so please be sure to have your volume turned on.  Listen to the words of the song - they fit.. Oh boy, do they fit.

 Thanks for stopping by... please let me know what your thoughts/feelings were on the video and if you think you might want to pass it forward...

~Wendy~

As a pediatric COTA I find it hard to locate seminars that will be inexpensive and informative.  I have had my fair share of ones that have promised to show me how to do this and that and help with a number of different strategies and objectives that have ultimately fallen short of those promises.  I have also attended workshops that have lived up to what they promise but rarely have I attended a seminar that has not just lived up to it's promises but went above and beyond with information.  This was the case last month when I attended a seminar by Cross Country titled "Nutrition Therapy for Children with Autism Spectrum Disorder" here in Hartford, CT.

The seminar states that it will "provide the most authoritative current scientific-based information on nutritional interventions for the treatment of Autism Spectrum Disorder. Participants will leave the seminar with the knowledge, strategies and resources to help families make informed decisions regarding diet, nutritional supplements and feeding problems. "  The seminar also shares that you will learn about the following:

• Understanding how nutrient deficiencies compromise learning, behavior, mood and brain function
• Gluten Free/Casein Free Diet: Is there a scientific basis for recommendations?
• Vitamin B6: Are therapeutic doses safe and effective?
• Discuss the medical, developmental, sensory integration and behavioral factors contributing to feeding problems
• Provide practical strategies using ABA, Social Stories and Art Therapy to treat mealtime problems and food refusal
• Process to objectively assess effectiveness of nutritional interventions
• Autism Spectrum Disorder-Overview
• Treatment Approaches
• Biomedical Treatment
• Nutritional Interventions
• Gastrointestinal Disorders
• Feeding Problems

 Wow!  What a tall order to fit into about 6 hours of actual seminar instruction.  I went in thinking that I perhaps I would get a few tidbits of information that might, just might be helpful with one or two of my families, if I was lucky.  What I left with, however, was tons of informative information on the diets, the suppliments and nutritional advice that would be helpful to a number of the families I work with.  The speaker was not just well educated and informerd on the subject she was talking about but she had a good deal of personal experience with her son that she would interject and share throughout the day.  This helped to bring every thing she was sharing with us to a more personal "been there, done that" type of atmosphere.  I don't think I was the only therapist there who would have liked to have seen this seminar go longer.  There was just so much good and helpful information being shared.

I also liked that, although the seminar was titled "Nutrition Therapy for Children on the Autism Spectrum" the information that was shared could be used with any number of children who were experiencing difficulties with eating due to physical or behavioral issues.  If you get the chance, this is one seminar that I think you would find very informative and well worth the money spent to attend it.  If you do decide to attend it, please let me know what you thought and if you found it as well worth your time and expense as I did.

Thanks for stopping by .. hope to see you back again ...

~Wendy~

Last weekend I had to run into Toys*R*Us to pick up a birthday present for a party my son was attending.  I am not a good shopper.  I don't like to wander around the store looking at this or that - I much prefer to just know what I want to get, go into the store, right to that item, grab it, purchase it, and leave.  1.2.3. - done!  So with a couple gift ideas in mind I walked into the toy store but before I had even gotten past the Easter toy displays my eyes were drawn to a rack holding pamphlets for toys that would be great for children with special needs. 

What a great idea!  So often I am asked by the parents I work with if I could recommend toys that would help their child(ren) with their unique sensory & development needs.  I want to be able to offer them more than just the standard swings, water/sand table, finger paint suggestions.  I have created a simple list and try to change it as new toys come out but now Toys*R*Us has made it even easier for me (and therapists & parents alike) to help out when it comes to birthday & holiday gift giving. 

I wondered if there were other places that had a list of toys that would be helpful and found a few websites with some really good toy suggestions.  I've listed a few here but if you go into Toys*R*Us you can pick up one (or two, or three) of their special toy brochures/pamphlets to share with your families and kids with special needs.

Ten Toys that Speak to Autism (Toys*R*Us)

eSpecial Needs (toys & adaptive equipment)

Fat Brain Toys (toys & resources for children with special needs)

Children Succeed - (games to help Autistic children with social skills)

Amazon Google (you can even do a search on the Amazon website under "autistic games")

Amazon Google - special needs (and even under "special needs games")

Bee Able Toys (Toys for children with special needs - Autism, Down Syndrome, and more)

Playworks (Special need toys)

Kidscope Toys (Autism, educational, special needs toys)

Toys for Special Needs Children (Nebraska even has an information page listing all the companies that offer toys with special needs in alphabetical order)

Happy Shopping!  If anyone knows of any other good sites please share and I would be happy to post the names and/or links.

Until next time 

 ~Wendy~

As we all have learned both through our studies and through experience kids are great imitators.  They learn by watching their parents, siblings and peers.  If they see someone sticking out their tongue then they will typically try to stick out theirs also.  If they hear us say something (and many times it is something we wish they hadn't heard) they will be undoubtedly be sure to repeat it at the most inappropriate and embarrassing moment for us.  Kids will be kids. 

So why is it that we often forget this fact when it comes to eating problems?  Not necessarily us, the therapists, but "us" the parents who have children with eating problems.  I have worked with parents who leave numerous plates of snack food out throughout the house so their child can find food to eat during the day because they won't eat at meal times.  Hmmm... wonder why?  I have worked with parents who will cook a meal for the family but then cook something totally separate for their child because they only eat one or two things.  Hmmm.. wonder why?  I have worked with parents who will feed their child before (or after) the rest of the family eats because they are either too messy, or too picky , or not using their utensils and have to be fed their meal.   Hmmm... wonder why?

If you have a child who is too picky or too messy or not using utensils would you not want them to watch and participate in meal times so they can watch and learn and imitate the right way to eat?  If a child is always fed by their parents because they are too messy or take too long to feed themselves they will never be able to correct this behavior if they aren't allowed to experiment and touch and feel their food.  We as therapists now how important the sensory aspect is to eating and some times we need to share that with the families who may have forgotten or not realize their child really needs to do this in order to move ahead and be successful with their meals.

If our kiddos learn by imitating then what better way to expose them to the whole routine of meal times than by having them involved in the whole experience?  Have them in the kitchen playing (or in the next room if it is not safe in the kitchen).  Allow them to smell the food cooking.  If possible allow them to help with the meals (pour food into saucepans or bowls, scoop out food from containers/bowls and place onto plates, etc.).  Allow them to watch their family eat, using utensils, trying different foods.  Encourage them to imitate what they are watching (taking bites, using utensils - even if it may get messy).  Make sure that they have on their plate what the rest of the family has on their plates.  If they don't want to take bites of unfamiliar food encourage them to touch it, smell it, even kiss it and eventually to take a bite.  They don't have to swallow it right away and should be allowed to spit it into a napkin or "spit cup" (more on this technique on a later blog). 

Sharing mealtimes as a family is so important on many,many levels but for the youngest members of the family it is a perfect time to watch and imitate and learn the skills needed to be successful at meal times.  As therapist we need to remember to not just encourage our families to do this but to explain just why it is so important in their child's development.  This is just one step in helping our picky eaters to become successful eaters.

Thanks for stopping by.  Hope to see you here again next week.