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.

It rarely fails that when I am working with a family who has a child that is struggling with eating I will eventually be asked "How much should my child be eating?".  I am lucky that I have had families who have erred on the side of serving too much rather than not enough food.  Quite a few parents will serve their children the same amount or a little less than what the rest of the family is having and not understand why they won't finish their meal.

Good news!  The U.S. Department of Agriculture has come up with a food pyramid designed just for 2-5 year olds.  The MyPyramid for preschoolers offers a wealth of information for families including but not limited to sections on picky eaters (including alternate phrases to use to encourage better eating habits), physical activity, encouraging healthy eating habits, and sample meals and snacks.  On the main "MyPyramid" page there is even a section that will allow you to come up with a plan for your child based on their age, gender, weight, height and amount of physical activity.

But wait!  There is more!  This site isn't just for toddlers.  There are sections for the whole family.  The  primary "home" site is:  Mypyramid.gov where you will find sections on: 

Menu Planning,
Pregnancy and Breast Feeding,
Steps to a Healthier Weight,
Kids 6-11 Years Old,

Today where so much emphasis is being placed on making good food choices, excercising, and being over all healthy, this is a great site to share with your families.  It has been reported that 15% of our toddlers are overweight and now there is a way to help families and children learn to make better and healthier food choices. 

Thanks for stopping by - next time I will share more strategies on feeding/oral motor issues.

http://www.yellowpagesforkids.com/

Find educational consultants, psychologists, educational diagnosticians, health care providers, academic therapists, tutors, speech language therapists, occupational therapists, coaches, advocates, and attorneys for children with disabilities on the Yellow Pages for Kids for your state.

You will also find special education schools, learning centers, treatment programs, parent groups, respite care, community centers, grassroots organizations, and government programs for children with disabilities.

First I would like to take a moment to apologize for not getting my blog out last week.  One of the "hazards" of working with wee ones this time of year is that the cold bug is often in one or more of the houses you visit.  It doesn't always matter how careful you are either, once the bug has taken a liking to you - you are stuck with it for awhile.  It was my turn last weekend to hide under my covers, catch up on my sleep, take extra vitamin C and try to convince the lil ole cold bug that it just wouldn't be happy staying with me.  After 4 days it finally left and although I'm still a bit tired and get a foggy head from time to time (some may say that is a normal state of affairs for me! LOL) I am finally feeling a little normal and ready to start blogging once again.  So, with that said let's get back to one of my favorite subjects...eating!

 Trying to figure out why a child won't eat can be an overwhelming task.  As I mentioned in my previous blog there is just so many things to be aware of.  So let's go through this from top to bottom.  The first thing I always check is to see if there is a medical condition that may be preventing the child from eating.  When was the last time they had a visit with the dentist?  Are they able to close their mouth properly to allow them to bite/chew?  Are they tongue tied?  Are there signs of reflux?  What is their muscle tone like?   How is their suck- swallow coordination?  These are just a few situations that can cause a child to be reluctant to eat though I'm sure we could all name off a few more if we stopped to think about it.

I'm going to touch on two things right now because they are often over looked but can cause quite a bit of delay with oral motor skills.  The first one is having a child who is tongue-tied.  If you have a child whose tongue is tied to the point that they cannot move it around in their mouth to help them clear off their teeth or move the food from side to side you will usually have a child who is reluctant to eat anything that would require them to need to use their tongue.  These children will more often than not stick to the types of foods they can swallow easily - yogurts, oatmeal, pudding, etc.  However, you may also find that some tongue tied children are eating all types of food but as soon as they take a bite of the more challenging food groups they will be the ones to put their hands in their mouths to help dislodge or move the food around because they are not able to do it with their tongues.  So if you hear a parent say "they always have their hands in their mouths when they eat" - one of the first things to have a look at is their tongue.  It may not even be that they are tongue tied; it could be that they have a processing disorder and need help to figure out how and where to move their tongue when they are eating.  If the child is tongue tied the parents will need to discuss with their pediatrician what their concerns are (speech and/or eating delays) and see if they would recommend having the tongue clipped.  There are been many advances in this area and several places will now use lasers to "clip" the tongue which may result in a less painful procedure and a quicker healing period.

The second one is acid reflux which is often a "silent" problem that goes undetected too often.  I was called to work with one family who had a darling little boy who was continuously vomiting after he ate.  This family lived their day to day lives trying to get this young one to eat only to then have to clean up after him because he rarely kept anything down.  In order to keep him nourished they would feed him every 30-60 minutes ... every day.  They did this because they were initially told that this was something their son would eventually out grow - and when he wasn't they were told (are you sitting down for this?) by the O.T. that their son would have to "learn to live with the vomiting because all kids throw up"!!  In my very first visit I watched him take a little food.  He turned his head, arched his back and forced the swallow down.  I asked if they had him checked for acid reflux and they shared with me that it was never mentioned as a possible cause for his behavior either by their pediatrician or the previous O.T. who had been working with him.  I asked them if they could call and have him checked for that and also to have a swallow study done to see if there was anything else going on.  That week they took him in and, sure enough, he had severe acid reflux.  A swallow study was also scheduled and would come to show that he had a condition where his stomach was slow to empty.  He was put on one medication for the acid reflux and another to help his stomach empty quicker.  Within a few weeks his vomiting was down to maybe once a week (as opposed to 3-5 times a day) and within a month he was like a different child.  He began to eat more, vomiting occurred now only when he was sick and the family could finally have a day that was not focused purely on when he needed to eat and how long before he threw it up.

I've touched on just a couple of things on the physical side of what may be causing some children not to eat.  It is important to try and remember to get a complete picture of what is happening before and after a child refuses food.  It is also important to remember that one of our most basic ingrained functions is that of survival.  A child is not eating because they are "bad" or trying to "get back at their parents" but because there is something going on that is stronger than their basic need to survive - and that usually is something that is hurting or scaring them and because of that it is then causing them not to want to eat.  It is our jobs to find out what that is and how to remedy it.  Sometimes it is up to the doctors to find the cause and up to us to help the children overcome the habits and defensive behaviors they have acquired due to the medical condition. 

Next time we'll look at home routines and how they can sometimes deter a child from getting into good eating habits.   I'll also try and offer a few strategies that I have found to be successful and, as always, I welcome any suggestions, comments, observations you would like to share!

• Is the child on the Autism Spectrum
• Does the child have a medical condition that is making it difficult for tem to eat (reflux, poor oral motor processing skills, low or high muscle tone, poor vision, etc)
• Does the child's parents come from a background that is establishing difficult meal time rules to follow (many parents who grew up poor or had parents that had food rations in their childhood, are taught that they *must* clear everything off their plate regardless of what it is they are being asked to eat).
• Are there sensory issues involved (over or under sensitive to taste, texture, etc)
• How often is the child eating & drinking throughout the day
• How much food & fluids are being given at each meal/snack time
• What does the meal time routine consist of

Throughout the month of November I am going to address the above bullet points and offer some suggestions and techniques to help the children who are having a difficult time with eating and self-feeding skills.  I welcome any suggestions, concerns, feedback you have to offer.  Are there techniques that you use that have been successful and what pediatric population were they successful with (ASD, CP, MD, developmental delays, etc)?  Is there a technique that you have heard about that you would like more information on?  Is there a class that you have attended or someone you know has attended that has proven to be very useful?  Together we can find the strategies and techniques that will help.

"I once heard a story about a visit to heaven and hell. In both places the visitor saw many people seated at a table on which many delicious foods were laid out. In both places chopsticks over a meter long were tied to their right hands, while their left hands were tied to their chairs.

In hell, however much they stretched out their arms, the chopsticks were too long for them to get food into their mouths. They grew impatient and got their hands and chopsticks tangled with one another's. The delicacies were scattered here and there.

In heaven, on the other hand, people happily used the long chopsticks to pick out someone else's favorite food and feed it to him, and in turn they were being fed by others. They all enjoyed their meal in harmony." 

 ~Shundo Aoyama~

As the weather starts to get cooler children with tactile sensitivity have a hard time feeling comfortable in the coats they are asked to put on each morning. For many wearing a coat feels claustrophobic. The tightness of the fabric on their arms and body makes it hard for them to focus on anything else but the coat and how it feels.

So, what is the caregiver to do? On one hand if they attempt to put the coat on the child to keep them warm it will probably either end up with the child having a major melt down or a child who is unable to focus on anything until after the coat is taken off. On the other hand if they allow the child to go out without wearing it the child will probably be too cold to participate in playing and they could even end up getting sick.

This is where we come in! There are several things we, as therapists, can suggest to the family to do to help during the colder months:

If the child feels more comfortable in tighter clothing suggest a thin layer of clothing under the coat. This could mean a tight work out outfit (sweats & top). Some of the sporting good stores sell the underarmor type garments that fit snuggly and help keep the heat in without causing the child to sweat. These, being tight, would also help the child who enjoys the deep pressure sensation to feel comfortable with a layered "look" of clothing and then coat.

Suggest frequent tactile input during the day leading up to when the coat must be put on. This could mean rubbing in hand lotion which would also help to relieve dry skin that occurs frequently during the colder months due to the heat being on more frequently.

For boys allow them to wear a warm fleece sweatshirt/hoody instead of a coat..

For girls allow them to wear a warm (perhaps even fleece lined) cape. This is my preferred garment during the winter months. I have one that is lighter which I wear during the fall and one that is thicker and warmer to wear during the winter. There are many types of stylish capes for both younger and older girls to choose from.

Buy a coat that is one or two sizes too big so the child doesn't feel so "trapped" inside it.

The following are links to different clothing sites and options to help both the sensory defensive child and a child who may need adaptive clothing due to AFO's or Wheelchairs, etc.:

www.cameronspecialt.com Cameron's Special T's - Weighted t-shirts. Washable.

www.gerbing.com Gerbing's Heated Clothing for winter.

www.sensorycomfort.com Sensory Comfort seam-free socks, underwear, bras, clothes, and tactile "wetshoes" for teens.

www.sockcompany.com Variety of smart knit seamless socks.

www.therawear.com smart knit seamless socks without latex specifically for sensory processing differences.

Under Armor: Sporty tight lycra to wear for compression: available at department/sport stores.

www.adaptationsByAdrain.com capes, mittens, boots, pants and up to very large snap bottom shirts.

www.adaptivechild.com

www.keepingpace.com Fashionable children's orthopedic footwear (socks and shoes) designed for AFO's.

Kutaways www.kutaways.com Coats for wheelchairs in motion.

www.snowshack.com seamless tops and pants.

www.special-clothes.com Brace socks, adaptive closures and styles of clothing, G-tube pockets, incontinence garments.

www.speciallyforyou.com Poncho, pants, Romper and one-piece shirts/underwear size 2 to 14.

www.minimiracles.ca Mini Miracles adaptive children's clothing:100% Peruvian cotton with adaptations sensitive to to child's sensitivities/comfort (G-tube access).

Would love to hear if anyone has any other suggestions or resources to share - remember:

It's that time of year again.  The time that parents have begun to look forward to and kids dread.  Yep, back to school time!  I always get a chuckle out of the commercial that Staples plays at this time.  It shows two kids, frowning as they walk through the store.  Their dad mean while is smiling and skipping through the store as he pushes the shopping cart.  In the background you hear the song "it's a most wonderful time of the year .."  

As much as the kids don't look forward to going to school, most of them do look forward to the back-to-school shopping.  We just went through this last weekend.  I'm not sure if the stores are busier the week or two before school starts or the week or two before the Christmas holidays.  All I know is the lines were long, both the kids and the parents were tired and I think I may have seen some Halloween decorations being readied! 

It's the time of year that our profession tries hard to get the word out about backpacks and how important it is to make sure the backpack chosen is the right size for the child that will be using it.  A couple things to share with parents to keep in mind when looking for a backpack are:

• The backpack should only weigh approximately 10%-15% of their weight.
• The backpack should be one that distributes the weight it is going to carry evenly.
• Padded straps are important as they help to distribute the weight of the backpack evenly.
• A padded lumbar area on the backpack helps with posture.
• Limit what is carried in the backpack to only what is needed that day. Try to encourage locker use between classes to allow for a lighter backpack when going from class to class.
• If using a rolling backpack be sure that it is tall enough so the child isn't stooping when they pull it.
• Try and encourage exercise to strengthen the back and abdomen muscles.

The following are a couple websites that share more information on what to look for in a backpack.  Some of the information is duplicated but there each site has a "print" option so the information can be given to parents or posted on bulletin boards or room doors:

• The American Academy of Orthopedic Surgeons backpack recommendations.
  Tips for proper use of backpacks, choosing the right backpack, and injury prevention.
• AOTA - the fund to promote Awareness of Occupational Therapy
  Very good resource - goes over some of the same things but has a great handout for parents:
  * Pack it right, wear it light
  * Backpack facts - what's the flap all about
  
  They are even offering a community toolkit to help with National Backpack Awareness Day (September 17, 2008).

It seems we should try and hold this informational day prior to back-to-school shopping to help parents buy the right type of backpack before school starts.  It would be a great insert for the back to school mailers that many schools send out with the class schedules or teacher/room assignments.  Just my 2 cents.

Often I will browse through websites to see if there is any that I can share here.  I came across an excellent one the other day and have found a wealth of resources in it.  The website is The American Academy of Pediatrics and it would take days to go through everything they have to offer us in the pediatric field.  I'll list a few of my favorite areas but please, don't stop there - go to the site yourself and browse around.  You will be pleasantly surprised at what you can find to help you in any number of pediatric areas.

Developmental Milestones ... what age children should be reaching which milestones and when to be concerned if they aren't meeting those milestones.

Back to School Tips ... a good hand-out for the school therapists (available for download in both English & Spanish!).  It shares information on how to make the first day easier, backpack safety, traveling to/from school, eating at school, how to handle bullying, before/after school care, and developing good homework and studying habits.

Immunization Information ... schedules for childhood & adolescents, supply updates, Q&A topics ...

Children's Health Topics ... numerous topics on this page including developmental stages, featured topics (ADHD, Autism, car seat safety, etc), a link to their bookstore with recommended reading, and featured health topics (asthma, behavioral/mental health, diseases and conditions, etc).. 

There is even a Parenting Center, an Advocacy Center, Bookstore & Publications and Professional Education and Resource sections.  The site is geared towards pediatricians but has articles and handouts that would be helpful to anyone who works in the pediatric field.  There are also a few advertisements which are displayed on the right hand side of the website and all pertain in one way or another to pediatrics. 

Take a moment (though truth be told it will take you more than just a moment to look over everything) and browse around.  If there is a topic you are particularly interested in or need information in you can go to the "search" box.  Type in what you are looking for and a number of different topics on that subject will come up.   This is one site that I have bookmarked so I can go back time and time again when I need help with a condition or need a handout on an activity I will be working with that day.  I'm sure you will find this site as helpful as I have found it.  Have fun browsing!

Today was a very interesting day - it was not a day I was particularly looking forward to as I had somehow managed to fill my schedule with some of my more difficult cases. This usually means that by the end of the day I am beat emotionally and physically. Today, however, did not turn out at all like I had expected it to. Instead of being tired I ended up leaving my last family refreshed and invigorated.

Have you ever gone into a therapy session expecting to work on one thing and then ending up working on something totally different? That is what happened to me today. I went in hoping to help the mom find ways to calm her little boy down. He was diagnosed with being on the Autism spectrum. She had expressed concern on how he was always on the go; running back and forth across the room and banging into the furniture. Her little guy was very shy around strangers and this would be only the third time I have seen him. I went in expecting to do my best to explain to mom how to give deep squeezes and bear hugs along with massage and joint compressions. I usually like to try and work directly with the child first but I doubted I would be able to actually touch him just yet.

Nonetheless, I sat on the ground and began a little parallel play with the leggos he was already playing with. In a short amount of time he surprised us both by actually sitting next to me. Of course it was so he could take the tower of leggos I had just built and knock them over and laugh. At one point he turned his back to me and was picking up the leggos on the ground. I started to rub his back. His mom moved to the front of the sofa bracing herself for what she was sure would be a meltdown because I had touched him. We had talked about what I was going to try and do and she was willing to let me try, but we both knew it might end with a meltdown. What a surprise it was to the both of us when he started leaning back into my rubs and within 10 minutes was actually laying on the ground allowing me to rub arms and then legs and even give a couple joint compressions to his legs. Here was a child who had been running laps and bouncing off the furniture in the living room when I first got there to laying on the ground giving me his arms and legs and then getting up, sitting on my lap and leaning into my body to get bear hugs.

Mom was shocked that he was being so accepting and calm. She quickly came down onto the ground so I could show her what I was doing and have her try it also. The little guy fussed and started to cry at first when mom started to take over and then, as if realizing that mom really could do it to, calmed and allowed her to give him rubs and massages. I was feeling really good that he took to the sensory input so well when suddenly mom looked up and said "he looked at me!" I just smiled and didn't think too much of it but then I noticed the tears on her cheeks. "Are you okay?" I asked and she smiled and said "yeah, it's just that he never, ever looks at me..."

Wow! Ok. Change of plans. Mom had never voiced this concern to me before. She had never even asked that his eye contact be a part of any of our goals. And to be honest, I never noticed that he didn't look at her because he would make fleeting eye contact with me. So instead of working just on calming the little guy I changed my tactics a bit. I asked her to stop after a few moments of massage to see what he would do. Would he cry? Would he have a melt down? Would he look at her to signal he wanted more? Would he get up and start running all over the room again?

Well, he started to cry but before he could escalate the crying further his mom called his name quietly and told him it was "ok". He stopped and looked right at her again and she started massaging his legs. After a few minutes she again stopped and when he began to fuss she again calmly called his name. He fussed a bit longer and then looked up at her. She smiled from ear to ear, her eyes glistening, and she again started the massage. This went on several times until he would just look right at her when she stopped. The look on her face each time his eyes met hers was priceless. It was pure happiness. Happiness that many of us with kiddos in our lives take for granted. We all look forward to that moment when the child in our lives will look right at us and make eye contact for the first time. It is a very special, bonding moment. Here was a mom who had not had that for almost a year. She never voiced it to anyone. She was more concerned that her little guy learns how to calm his body and to eat and to play then she was that he looked at her. It didn't stop her from secretly wanting that eye contact though. It was actually very important to her even if she didn't voice it but she felt there were more important things for him to learn and she didn't want to seem selfish by asking for it.

I went into that visit figuring that I might be able to show the mom how to calm her son down for a few minutes at best. I left that visit with the knowledge that I had shared in a special moment between this mom and her child. I also left with a reminder that was given to me with the utterance of three simple, heart felt words; words that I hope will stay with me for a long, long time. "He looked at me!" Words uttered in total amazement and joy. Words that would remind me to not just see what someone is voicing they hope will happen but to also see what someone is silently wishing will happen. Some times we get so wrapped up on their goals that we have written down on paper that we forget to step back just a little and see what goals may be written in their hearts.

Being someone who loves the outdoors my favorite ways to get messy involve being outside - and don't cost a penny.

• Jumping in rain puddles! Oh come on.. you know you want to do it. You probably use to do it when you where young and then "grew up" and stopped. The other day we had a quick rain shower and then the sun came out. My son's and I were just coming out of the library when the youngest jumped in the smaller of two puddles. In a somewhat sharp voice I said "Nick! That's not the way to do it!" Both he and his brother stopped in their tracks and looked at me, half expecting I guess, to hear me yell about how he was now all wet and messy. To their surprise and delight I jumped up and landed in the larger of the two puddles - splashing all three of us with water. Their mouths dropped open, their eyes wide in surprise and then, as I started to laugh they joined in and didn't stop talking about how silly it was that I had jumped into a puddle and got us all wet until we were home and dry. If you don't want to jump, that's ok but try and remember to remind parents & caregivers that it is actually good clean fun to jump and play in those puddles and studies show that playing in the rain doesn't cause colds... but (disclaimer here) I would not recommend this fun activity if you already have a cold, if it is a freezing cold day, or if anyone has to sit in their wet clothes for any length of time. However!! If it is a nice warm rain shower and the sun is out to help dry everyone off after you've splashed around - I say "go for it!!"
  
  
• Making mud pies. The same rules (and disclaimer) apply here as with the above mentioned activity but making mud pies is an age old activity that isn't done as much anymore. I can remember how much fun it was to get out some old pots and pans and/or dishes/cups and just play "cooking" in the mud. We would make "chocolate milk" and "mud pies" and pretend to eat - all the while getting mud from head to toe. Heck, nowadays there are spas that will charge a fortune to give a "mud treatment" and here anyone could have one for free in their back garden with the child/children of their choice and make some wonderful memories (do you remember when we made mud pies with.... Wasn't that the greatest!). Some times parents & caregivers need to be told it is okay if their child/children get messy and it is even better if they participate with them. Remind your families that they are not just helping their kids with any sensory issues they may have but they are building life long memories that everyone will cherish.
  
  
• Chalk Art. If you have a driveway available there are a number of things you can do with Chalk. You can draw your ideal city or neighborhood. You can draw play "follow the leader" with the chalk marks. You can draw a "road" that you have to follow either on foot on your bicycle. You can draw "stepping stone" that you have to jump from and to - and if you make them different colours then you can have one person calling out the colours you need to jump on. You can even add a little water and watch the designs change shapes. With a little imagination, a little encouragement and a handful of coloured chalk you can have hours of fun therapy activities.
  
  
• Obstacle Course. What could be more fun than gathering a bunch of sticks, some branches with leaves, a few pieces of wood and a pile of leaves and setting up the ultimate obstacle course?! It is even more fun if you add a rope "swing" and a mud puddle or two. One of the objects, besides getting messy, would be to encourage the kids you are working with to help build the course - carrying or dragging the needed items to their places... making the mud puddle in just the right spot ... A fun way to get everyone involved and a perfect opportunity to get messy and have fun. Afterwards, if they tire of the obstacle course, you can also grab an old blanket or a few towels and make a fort to play in, where they can have mud pies for dinner! Just think of the possibilities. J
  
  
  
• Bubble Play. When I say "bubble play" I don't mean your typical blow bubbles and run after them popping them. What I am suggesting here is a messy bubble play where the kids (and adults if they want) get bubble "juice" all over their hands and have to "catch" the bubbles instead of popping them! You may have to start with just getting a couple fingers wet with the bubble juice and then move to all the fingers and then the whole hand. See who can catch the most bubbles or who can catch the biggest. The kids get so involved with actually trying to catch one that they forget they are doing so with messy/sticky hands and end up having a blast. It is also fun to place a bowl or bucket of water nearby so that when someone does catch a bubble they can try and "release" it into the water!

These are just a few activities that will work well on nice warm days when you have the opportunity to play outside or to give to parents of children you treat in a center so they can carry over with the messy play activities at home.  Many parents don't want to get messy in the house and look for other activities they can do with their kids besides the typical (and none-the-less useful and wonderful for sensory input) water/sand table.   

What fun ways have you thought of to "get messy"?  I would love to hear them and share them with everyone.  In the mean time, I think I see a puddle calling my name. ...

Today's helpful tidbits are websites that have recipes for making homemade playdoh and other messy substances. What makes these websites extra useful is that often the kiddos you are working with don't want to touch the play-doh or get messy when asked to sit down and given something "messy" to play with. The catch is getting them involved in actually making the substance you want them to eventually play with. When they are a part of getting the ingredients measured out and mixed together they may just end up getting messy in the process and not be as concerned about it as they would be if they were just being asked to play with the finished product. It's also a good idea to print out the recipe(s) you will be using and leave it for the family so they can try to make it at another time if they want to.

Playdoh & Goop recipes:

http://www.cooks.com/rec/doc/0,1-1,playdoh,FE.html

http://www.cooks.com/rec/search?q=goop

Simple Playdoh:

http://www.kidsturncentral.com/crafts/crecipe17.htm

Kool-Aid Playdoh:

http://www.recipesource.com/misc/kids/00/rec0076.html

Edible Playdoh:

http://www.ehow.com/how_2109277_make-edible-playdoh.html

Rubbery & Nature's Playdoh:

http://greenbabyguide.com/2008/05/27/homemade-non-toxic-play-dough-recipe/

Playdoh, Clay, Silly Putty, Goop & more craft recipes:

http://www.easy-kids-recipes.com/play-dough-recipes.html

Homemade glitter, goop, finger paints:

http://www.fastq.com/~jbpratt/education/theme/craftrecipes.html

Goop, Silly Putty, Flubber & Slime recipes:

http://www.floridatechnet.org/institute/goopinstruct.pdf

If I have missed any fun & easy messy play recipes please let me know and I would be happy to add them ..

Have fun and get messy!!

• Ask a colleague if they have heard of any openings.  You could be surprised what they may know or who they may know.  The obvious concern here is to be careful if you are actively looking and you don't want anyone to know.  Be sure the person you decide to speak to is someone you can trust.

• Look through the yellow pages or on line for companies that specialize in pediatric therapy.  Even if they are not actively hiring send them your resume and a short note asking them to keep you in mind should they have an opening.  Keep in mind that most companies don't keep a resume on file for more then a year.

• If there is a particular company/companies that you really want to work for then make sure you send them your introduction note and resume and every 3-4 months drop them a little handwritten note to let them know you are still very interested in their company should they have any openings.  If you can keep your name familiar to them it will be more likely that they will look to you for an interview when an opening comes available.

• Check your local newspapers (both the major and minor ones).  The Sunday edition is your best bet for the major paper as that will often contain the most job opportunity listings but don't dismiss the smaller papers.  The smaller papers often will have listings for local jobs- school positions, city/town positions, etc.  Many companies will even post an ad in the smaller paper first because it is less expensive.

• The Advance for Healthcare Careers on-line magazine job sections offer a good variety of jobs available.  You can also find larger companies who may have jobs available all over the United States should you be thinking of relocating.

• Check the following on-line resources:
• Therapy Jobs.com.
• AOTA's OT Job Link
• Simply Hired
• PediaStaff

One of the nice things offered by the on-line employment web sites is that you can set up an "alert" outlining the specifics of the type of job you are looking for and they will email you once a day/week/month, etc with job listings.  You don't even have to do any further work but go through your emails and see if anything they have sent is of interest!

• Job recruiters. If you do a search on-line for recruiters or look again at the Advance Job sections you can come up with several companies would be happy to take your information and the type of job you are looking for and then call you should anything open. It is important to note that many of these recruiters work with SNF but there are a few that work in the pediatric field - it is just a matter of looking to see who offers what.

No matter if you are doing the searching yourself or relying on a recruiter, it is important not to give up on what you want.  Know what you are looking for in a job and where you want to work and then make it happen.  When I decided I was going into pediatrics I sent out resumes and letters of introduction to every pediatric facility in the area I wanted to work.  I received numerous "thank you but we have no openings at this time" but I also received a couple requests for interviews and within a short time found my first pediatric COTA job!   

Don't forget to also keep up your skills.  The more classes/seminars you do and the more knowledge you gain; the more marketable and desirable you are.  Some times you may have to take a job that isn't the exact one you wanted but you can gain some worthwhile experience from it before you are able to find the job you really want. 

If I have forgotten something or if there is something you may have done or know of that helped to get you or someone you know a job, please let me know about it and I would be happy to share it with everyone on here!

What would you do if you had a child who kept spiking a fever of 104-105 degrees for four to five days only to have it disappear and then reappear again in four to six weeks? What would you do if you went to several different doctors and still could not find a reason for the fevers? What would you do if no medication helped to bring down these fevers?

For many families this is a scenario they have been living with for years. Some will be lucky and find a doctor who is aware of PFAPA syndrome and if they are even luckier they will have a doctor who has read about a recent break through when it comes to treating this syndrome.

PFAPA or periodic fever, aphthous ulcers, pharyngitis and adenitis syndrome is a little known syndrome that is characterized by frequent fevers of unknown origin. Children with this syndrome will get a fever ranging from 104 to 105 degrees but the usual fever reducing remedies don't seem to work. These fevers appear without warning or other symptoms. In some cases the fevers have also resulted in the child having seizures. The fevers will usually go away by themselves after four or five days but will then reappear in four to six weeks. It is not known exactly how many families suffer through these frequent and unexplained fevers but for the families that do, help may now not be so difficult to find thanks to a study that was recently completed at Boston Children's hospital.

A report in the February edition of Archives of Otolayngology and Head and Neck Surgery shares information on a study that ran from 2004-2006 of 27 children diagnosed with PFAPA. The report states that a fairly simple and well known surgery has been found to cure 26 out of the 27 children studied. These children, ranging in age from 19 months to 12 years, had suffered through these frequent fevers for years. After the surgery all but one child from the study had no further reoccurrences of PFAPA.

What is this amazing surgery that is having such wonderful results with children suffering from frequent, unexplained fevers? Believe it or not, the surgery that was being preformed was a tonsillectomy. The reason why removing the child's tonsils cures them is not known at this time but for families of children with PFAPA the reason why is not important. The fact that there is no reoccurrence of the fevers is all that matters. It is important to note that before the families can consider requesting the surgery they must rule out several other possible causes of the fevers.

For families who have had nowhere else to turn in the past now have hope thanks to doctors at Boston Children's hospital and the 27 children and their families who participated in the study. For more information on this study and the doctors who performed it you can go to the Children's hospital link listed here: Surgery found to cure mysterious, unexplained fevers.

Please share this information with your pediatrician and with other therapists. The more people who are aware of this breakthrough and spread the word will hopefully result in more children who won't have to continue to suffer through these fevers month after month.

Today's tidbit is a listing of internet social support groups for Occupational Therapists.  MySpace and FaceBook are two popular social sites but they are not just for finding or meeting new friends - they can also be a source of social support for and by OT's.  Whether you want to join or to just browse through them I think you will find that they have a lot to offer - whether you are gaining knowledge from them or sharing your knowledge with other therapists and families.  There are times when I may get tired of a particular activity or I may know it won't work with a particular child/family and I will look to these support groups for new and fresh activities. I have also posted questions to other therapists when I have a tough child or a medical condition I am not familiar with.  I will also try and spend at least an hour or two during the week to browse the questions posted by other therapists and families to see if there is something I might be able to help them with. There is a great deal of information available but you may need to look through the different groups to find one that works the best for what you are looking for or for what skills/knowledge you have to offer.

Facebook groups:

I'm Tired of having to explain what occupational therapy is!

Facebook Occupational Therapy Association

Handprintz

School, Dyslexia, & other LDs

AOTA

Myspace group:

Pediatric Occupational Therapy Group

Misc. gropus:

OT Advantage

OT Now

When you work in pediatrics you are usually working with children who have challenges that prevent them from being able to keep up with their peers. This is not always the case but when it is it can break your heart. Our job is to help the kiddos we are working with to reach their potential - to help them be the best they can be at whatever it is they want to do. Children can be cruel though. I don't think they always mean to be but when they see a child that is different it may just be that they don't know how to act so instead they act out and don't include the child in what it is they are doing. We tend to hear stories about these types of things happening more then we do about the children that see past the challenges and see just a child, like them, who wants to belong.

I guess that is why I am a huge fan of inspirational stories. They help me to believe that there is hope and that there are parents who are able to teach their children acceptance and tolerance and there are children who have open minds and big hearts.

So, it is with that in mind that I submit this story for your reading pleasure. I thought it would be a great one to share with everyone as we go into the long Memorial Day weekend. I hope you enjoy it as much as I did.

At a  fundraising dinner for a school that serves children with learning  disabilities, the father of one of the students delivered a speech that would never be forgotten by all who attended. After extolling the school and its dedicated staff, he offered a question:

'When not interfered with by outside influences, everything nature does, is done with  perfection. Yet my son, Shay, cannot learn things as other children do.  He cannot understand things as other children do.

Where is the natural order of things in my son?'

The audience was stilled by the query.

The father continued. 'I believe  that when a child like Shay, who was mentally and physically disabled  comes into the world, an opportunity to realize true human nature presents  itself, and it comes in the way other people treat that child.'

Then he told the following story:

Shay and I had walked past a park where  some boys Shay knew were playing baseball. Shay asked, 'Do you think they'll let me play?' I knew that most of the boys would not want someone  like Shay on their team, but as a father I also understood that if  my son were allowed to play, it would give him a much-needed sense of  belonging and some confidence to be accepted by others in spite of his  handicaps.

I approached one of the boys on the field and asked (not expecting much) if Shay could play. The boy looked around for guidance and said, 'We're losing by six runs and the game is in the eighth inning. I guess he can be on our team and we'll try to put him in to bat in the ninth inning.'

Shay struggled over to the team's bench and, with a broad smile, put on a team shirt. I watched with a small tear in my eye and warmth in my heart. The boys saw my joy at my son being accepted.

In the bottom of the eighth inning, Shay's team scored a few  runs but was still behind by three.

In the top of the ninth inning, Shay put on a glove and played in the right field. Even though no hits  came his way, he was obviously ecstatic just to be in the game and on the  field, grinning from ear to ear as I waved to him from the stands.

In the bottom of the ninth inning, Shay's team scored again.

Now, with two outs and the bases loaded, the potential winning run was on base and Shay was scheduled to be next at bat. At this juncture, do they let Shay bat and give away their chance to win the game?

Surprisingly, Shay was given the bat. Everyone knew that a hit was all but impossible because Shay didn't even know how to hold the bat properly, much less connect with the ball. However, as Shay stepped up to the plate, the pitcher,  recognizing that the other team was putting winning aside for this moment  in Shay 's life, moved in a few steps to lob the ball in softly so Shay  could at least make contact.

The first pitch came and Shay swung clumsily and missed. The pitcher again took a few steps forward to toss the ball softly towards Shay. As the pitch came in, Shay swung at the ball and hit a slow ground ball right back to the pitcher.

The game would now be over.

The pitcher picked up the soft grounder and could have easily thrown the ball to the first baseman. Shay would have been out and that would have been the end of the game. Instead, the  pitcher threw the ball right over the first baseman's head, out of reach  of all team mates.

Everyone from the stands and both teams started yelling, 'Shay, run to first! Run to first!'
Never in his life had Shay ever run that far, but he made it to first base. He scampered down the baseline, wide-eyed and startled.

Everyone yelled, 'Run to second, run to second!' Catching his breath, Shay awkwardly ran towards second, gleaming and struggling to make it to the base. By the time Shay rounded towards second base, the right fielder had the ball .The smallest guy on their team now had his first chance to be the hero for his team. He could have thrown the ball to the second-baseman for the tag, but he understood the pitcher's intentions so he, too, intentionally threw the ball high and far over the third-baseman's head.

Shay ran toward third base deliriously as the runners ahead of him circled the bases toward home. All were screaming, 'Shay, Shay, Shay, all the  Way Shay'

Shay reached third base but only because the opposing shortstop ran to help him by turning him in the direction of third base, and shouted, 'Run to third! Shay, run to third!'

As Shay rounded  third, the boys from both teams, and the spectators, were on their feet  screaming, 'Shay, run home! Run home!'

Shay ran to home, stepped on the plate, and was cheered as the hero who hit the grand slam and won the game for his team.

'That day', said the father softly with tears now rolling down his face, 'the boys from both teams helped bring a piece of true love and humanity into this world'.

Shay didn't make it to another summer. He died that winter, having never forgotten being the hero and making me so happy and coming home and seeing his Mother tearfully embrace her little hero of the day!

We all have thousands of opportunities every single day to help realize the 'natural order of things.' So many seemingly trivial interactions between two people present us with a choice: Do we pass along a little spark of love and humanity or do we pass up those opportunities and leave the world a little bit colder in the process?

I think that we, as therapist, have already made the choice to make the world a little warmer because of what we do. We may not always be able to accomplish what we originally set out to do or hope to do but as long as we never stop encouraging and never stop trying we will be just like Shay's teammates that day - we will be helping the kiddos we work with to run the bases to the best of their ability, with the support and encouragement of their friends and family and watch, smiling, as they reach home base!

Have a wonderful weekend everyone!