Category Archives: Sensory Integration

Sensory Integration, Assessments, intensive blocks of treatment, children with sensory processing disorder, Autism / ASD, DCD / dyspraxia, ADD / ADHD, Down’s syndrome, sensory diets / lifestyle.

When should a child hold their pencil correctly?

What is the correct way to hold a pencil? 

These are common questions that parents ask me so I have created this visual to show typical grasping development and its connection to the whole body.

Afterall, ‘it’s all connected.’

Have a look below to see how STABILITY leads to MOBILITY for typical pencil grasp development. Immature pencil grasp development refers to when your child acquires these ‘typical’ grasps at a later age. PENCIL GRIP MILESTONES Typical

To improve your child’s pencil control for writing, buy the mini-course here: 

Help Me Improve My Child's Writing

Writing Mini-Series till 9th August, ’20

Hi Everybody.

I’m offering a writing mini-series only for PARENTS and TEACHERS to help you learn how to identify the sensory and motor skills your child needs to develop to improve their pencil control for writing through the power of fun and connection.  

I have too often seen children being given pencil grips and writing worksheets to improve their writing, which ultimately causes stress and pain in their hands. 

I want to show a better way where we can work from the child’s foundational sensory and motor skills to improve their pencil control for writing in a way that will have a bigger impact and last longer, and most importantly, whilst preserving their self-esteem and confidence.  All this in a way that is fun for your child. 

I’d love to see as many teachers as possible sign-up for this mini-series so that we can better understand why kids are struggling.  

I hugely believe that children are not lazy or not interested in writing, and we need to dive deeper to learn why they are struggling with these skills.  

This mini-series will help you figure that out. It’s only available till 9th August.  

Sign-up above! 

Munira

How Do Paediatric Occupational Therapists Partner With Parents?

Usually, when people think about paediatric Occupational Therapy, the first thing that comes to mind is dropping your child off to see an OT who will do 1:1 treatment with them.  Sometimes parents aren’t present which means that they may not fully understand what the OT is working on with their child, and more importantly, don’t know how to support their child in their daily lives.  

How do OT’s help parents support their kids? 

At ot4kids, we have always valued working closely with parents in these ways:

  • Parents or caregivers are present throughout our sessions
  • We have regular parent-ONLY coaching sessions (similar to a teacher-parent conference but not rushed and more often) to review how things are going at home, identify areas of continued concern, understand rationale behind certain ‘behaviours’ and why certain sensory tools are effective and how to use them.  
  • Some parents do only parent consultations where they learn about sensory processing and motor skills, learn simple strategies to do with their child, and review in their OT consultations
  • Sometimes even grandparents and nannies have joined coaching and / or treatment sessions which has been so fantastic

What do parents think of 1:1 coaching sessions with their OT? 

Parents often find these consultation meetings to be the most helpful to them in understanding their child’s needs, and parenting their kids in a way that supports them developmentally and emotionally versus using traditional parenting techniques.  

How do parent coaching sessions / consultations help us (OT’s) help you? 

As an OT, I find the parent consultations really effective as:

1) parents know their child best so their input and feedback are great clues into figuring out effective ways to help their child

2) it’s important to know how the child fares in their daily lives as we want them to develop skills beyond the clinic and into their ‘real’ environments for the best impact

The aim of parent consultations / coaching

Our aim is to help reduce the overwhelm that parents can feel, and to help you find simple and effective ways in helping nurture your kids.  

My message to parents is that you know your child best, follow your gut instinct, and know that we can help you to be confident in helping your child to be coordinated, calm, and connected.  

Sign up here to learn more about parent coaching / consultation sessions. http://www.ot4kids.co.uk/occupational-therapy/parent-group-coaching-sessions

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Sensory Chalk Walk Obstacle Courses

Lockdown has finally given us the impetus to create some Chalk Walk Obstacle Courses for our neighbourhood.  (See video examples below.)  I’ve always wanted to make these, and now that we have started, my son loves making them too.  

People often think these chalk walks are difficult to make, however they’re so fun and you can involve your kids in making them too.  We have now made a bunch of these during the past couple of months, including for younger and older children.  

We have done very simple ones by going down our street drawing designated areas for ‘dancing,’ being ‘goofy,’  doing ‘silly walks,’ and drawing Hop Scotch grids which even the older people on our street have loved doing.  

How chalk obstacle courses develop sensory processing and motor skills: 

  • FUN while social distancing!
  • gross motor skills
  • body and spatial awareness
  • balance and coordination
  • motor planning skills to create, plan and execute 
  • fine and visual motor control 
  • organisational skills
  • emotional regulation 

TOP TIP:  Check the weather before you draw out your chalk course.  We learned the hard way as it sadly rained the day after we made ours a couple of times. 

How to create and arrange a chalk walk obstacle course, keeping your child in mind: 

  1. Start with a more intense, heavy work component such as jumping or doing press-ups
  2. Next, do a balance and / or challenge task such as walking along a wavy line or jumping and turning
  3. Have a high energy component (running on the spot for a minute, running for the home stretch)
  4. a mindful calming section (e.g. blow out the candles, sniff the flowers, sing a song, or unscramble letters to words, or say affirmations).   

Although do just have fun, follow your child’s lead and get them involved in creating these.    

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Chalk Walk Obstacle Course Examples: 

Here are several examples that my son and I have done for our neighbourhood.  Do share your ideas.  We’d love to see them. 

 

Movement Breaks and Programs while Staying At Home

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We have been Staying At Home for 5 weeks.  We know because we have stuck it through to our 6th week doing PE with Joe now.   We usually have a very active week with swimming, yoga, skateboarding, and parks.  Currently, our top two activities have been moving and crafting.  

My son is lucky to have access to OT swings since I run a clinic from home.  For others, this is a great time to explore getting either a Gorilla Gym doorway set (stays in place via strong suction) or the Rainy Day Indoor Playground (has 4 small screws to stay in place in the doorway) with swings and trapezes. 

Below are also some movement programs and videos that suit individual children. 

PE with Joe, Mon to Fri, 9-9:30, is very popular and we do this daily.  It is challenging and great for certain children …and parents. 🙂  Joe also has shorter videos for children.  

Group HIIT’s for children are great for those who need more intense sensory and movement breaks, particularly during this time where we are limited to home.  

The Kids Coach -These are really good short fitness videos developed with an Occupational Therapist

Cosmic Kids Yoga is a wonderful program where yoga is completed to familiar stories children love, such as Frozen, Minecraft or Star Wars.  She also has a wonderful Zen Den videos to support mindfulness in children, and Peace Out relaxation for kids programs.  

GoNoodle is a fantastic program I’ve recommended for years, filled with movement and brain breaks that can be searched through by school grade.  

The Little Gym UK has put out some nice children’s gymnastics videos by age ranges from infants and toddlers, to  younger and older children.  

Andy’s Wild Workouts are also lovely, slower paced, interactive, and shorter, run by Cbeebies.  These are great for younger children. 

For children who like to dance, there are many dance options right now with Zumba Kids, samba with Oti Mabuse live on Facebook everyday at 11:30, and ballet with Royal Opera House.  I have been doing Movement Warriors with my 8 year old son for the past few weeks and it has not only been great fun but really nice to be connected and doing something joyful and tricky together.  

I’d love to hear if you have found any movement games, activities, or programs you enjoy. 

 

Teletherapy Paediatric Occupational Therapy

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We have now been in lockdown for about three weeks.  Like many families, mine is also finding a new routine.  My 8-year old son and I have been doing ‘PE with Joe’ every weekday, trampolining in the garden, drawing sensory chalk walks outside, and crafting.  It has been lovely spending time together and having time to do things we ordinarily wouldn’t.  This slower pace of life is growing on us.

I’ve now been doing teletherapy, virtual Occupational Therapy sessions, with local families for a few weeks.  The OT community worldwide has been brilliant.  Thanks to technology, we have had many Zoom Catch-ups to share ideas, learn from and support each other. 

I work with amazing families and it has been great to see how well Teletherapy has been working for all of us. 

Families have said that the sessions are different to 1:1 clinic sessions, yet they are valuable and they like using what they already have at home in new and creative ways. 

Parents also feel good that they are the ones doing the handling, modifications, and putting the session into action, and the online sessions have ensured we keep progressing. 

Some families were hesitant to give teletherapy a go as they weren’t sure if it would be effective, however they’ve also been surprized how well their children have adapted to the new way of OT and are enjoying a new routine.  It’s been helpful to see family’s home space, come up with sensory strategies and obstacle courses using what’s at home, and more easily address skills that happen at home. 

For children who need preparation, this social story has been helpful and can be adapted.  

Overall, during these unpredictable and unsettling times, it has been so heart-warming to be connected with the children and their families.  I’ve finally been able to ‘meet’ their siblings and pets which is definitely a fun bonus.  It’s also been exciting to have another way of delivering therapy and partnering closely with parents, whilst providing an effective and valuable service. 

I bet that teletherapyteletherapy will be opening many doors down the road for working with families and team members. 

Teletherapy / Telehealth OT Sessions

 
 
I have been providing Telehealth Occupational Therapy sessions for families from abroad for a while.  However, due to the implications of Coronavirus, ot4kids is moving over to provide increased Telehealth (virtual) sessions.  I hope that this post will answer some questions regarding TeleTherapy and OT for your child. 
 

What is Telehealth or Teletherapy?  

 
The Occupational Therapist will guide the parent and child through their session ‘live’ in cyber space.  E.g. Skype, FaceTime, Zoom, Google Hangouts. As such, the parent or caregiver must be available throughout the session time. 

What to expect from a tele therapy virtual OT session

Telehealth sessions will differ from actual sessions with your OT, however, it will be valuable. 
 
The parent or adult must be present to support the child throughout the session. 
 

Before your teletherapy Occupational Therapy session:

Your OT will confirm details regarding which platform to use to connect, a plan of activities and goals for the session, share any necessary handouts, and advise on where to conduct the session as well as what toys and supplies to keep ready.  

During the teletherapy Occupational Therapy session: 

  • your OT will catch up with you and your child, review progress and goals
  • parents may request support regarding specific skills that take place at home (e.g. dressing, eating, organisation of the room, toys or games, setup and size of furniture).  
  • The OT will demonstrate and explain the activity, guide the parent or caregiver on how to set up and implement the activities for the session, listen and observe how the activity is completed by the child, and basically, work through the parent to support the child.  
  • The OT will likely ask the parent questions, problem-solve, demonstrate or explain how to change or modify an activity, and provide guidance and feedback as needed. 

At the end of the teletherapy OT session:

The parent and OT will provide feedback of the session, discuss strategies and hom
ework to incorporate into daily routines at home, and make a plan for the following session.  

Pros of telehealth OT sessions

-Convenience of having OT at home, anywhere in the world
-Helpful to get ‘real-time’ support to tackle what matters the most to families in their home
-Good to use the child’s own toys and resources
-Parents get to learn how to implement activities and support child’s needs by actually implementing the session.  As such, it allows more opportunities for carryover on a daily basis. 
 
For families whom tele therapy is not an option, we are offering video consultations with parent coaching /consultations, home programming, and follow-up support and check-ins accordingly.
 
For new children, although we aren’t able to complete a full assessment with testing, we are providing screenings where we can observe how the child does on specific tasks, parent consultation, and basing tele therapy sessions from there.  
 
Despite this difficult situation, we are so fortunate to have technology on our side.  Please speak with myself or your therapist so we can figure out how best to keep supporting your child.   
 

Benefits of Yoga for Children in Occupational Therapy

Last year at this time, my husband, then 2-year old and I visited Copenhagen, Denmark for 9-days. Not a holiday. I attended Sonia Sumar’s course, Yoga for the Special Child. It was my first course after becoming a mum and first time away from my son for the entire day. He had fun with his dad, and I had fun doing yoga, meditation (well, trying) and relaxation everyday. It felt like a retreat. 🙂

Sonia Sumar is an amazing teacher with lots of personal wisdom to share. I have never taken a course that wasn’t offered by an Occupational, Physical or Speech Therapist. I had no idea I was going to learn about chanting, meditation, and lots of life lessons from Sonia versus just yoga (body) exercises. It has been as good for me as it has for my son and kids I work with.

A year later, I regularly do my own yoga routine learned in the course and have felt stronger, healthier and more energetic overall. The kids and my 3-year old love it too.

There are so many benefits to yoga but some of them are:

-calming and grounding

-chanting helps with calming, joint attention and engagement, auditory processing

-breathing alongside movements encourages children to breathe while moving (many children who are weak tend to hold their breath while doing motor tasks as they are using their diaphragm, a breathing muscle, to hold their body versus to breathe)

– builds an emotional connection between yogi and student

-yoga poses build core strength, body and spatial awareness, balance and motor planning skills

-yoga flow – a sequence of yoga poses that connect from one to another – build rhythm and timing, fluidity of movements and sequencing skills

-incorporates of breath and movement of eyes whilst doing the yoga poses

-kids learn how to calm and find a ‘quiet space’

-deep relaxation – it’s amazing how many of us can’t still our bodies or minds to relax. I’m still working on this myself and it’s a tough one.

For more information, check out:

Yoga for the special child

For those who are in or near London, check out the work of MahaDevi Yoga Centre

You can also learn more from the Yoga for the Special Child Book

Om Shanti Shanti. (Peace peace peace)

 

OT for Babies – Never Too Young

Parents are often surprized I work with babies. I usually hear ‘aren’t they too young’ or ‘what do you do with a baby?’

Babies are always learning new skills and reaching new developmental milestones. As everybody says, they do mostly feed, poop and sleep, but they also, move, play and interact. These skills all develop from birth onwards.  An OT experienced in working with babies can evaluate which foundational areas the baby is struggling with and how to improve them

Here are three scenarios:

1) When a baby struggles with feeding, we would assess their tolerance for touch with their body and in their mouth, oral motor skills in their mouth for nursing or eating foods, muscle control in their core / neck / shoulders, and their body alignment and positioning for feeding.  See more here.

2) If a baby has a flat spot on their head or turns their head to one side (plagiocephaly or torticollis), we assess their core strength, body awareness on the weaker side, motor planning, eye movements, jaw alignment and oral motor skills, which muscle groups are weak or tight, tolerance for movement and motor skills using both sides of their body.

3) Another common scenario is when the child is described as a ‘lazy baby.’  Usually there’s a reason for this.  They may be sensitive or fearful of movement, have difficulty figuring out how to move their body, or have weak body strength and stamina.  Sometimes the baby could have a lower state of arousal and need more sensory input (touch, muscle / joint and / or movement input) to rev up their engines the so they feel the urge to move and play.

When we explore deeper, there are underlying areas we can develop. And as babies are changing and growing so fast thanks to brain plasticity, they have amazing potential to progress at a faster rate. Early intervention helps.

Babies whom I treat usually may have:
-Plagiocephaly (flatness on head)
-Torticollis (turn or bend their head to one side)
-Avoid moving to one side of their body
-Don’t use one arm or leg
-Dislike being on their tummy
-Have difficulties with breastfeeding or transitioning to foods
-Appear colicky or are described as a fussy baby
-Sensitive to sounds or being moved
-Not meeting motor milestones
-Feet tend to turn outwards
-Born prematurely so need extra help to catch up
-Have diagnoses such as Down’s syndrome, Cerebral palsy, Hemiplegia or other genetic syndromes

If you have any concerns about your babies’ development, feel free to contact me to have a chat and discuss further.

For more information:
Sensory and motor developmental milestones month by month by Pathways Awareness:

http://pathways.org/milestones/

What does a baby OT assessment with me look like?

http://ot4kids.co.uk/baby-evaluations-never-too-early

Infant red flags for sensory processing difficulties

http://ot4kids.co.uk/babies-early-signs-how-do-you-know

Baby Owned Movements

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Baby Owned Movements

My son crawled at 9 months, sat at nearly 10 months, and walked at 16 months. According to developmental charts, his sitting and walking are considered to be within the later range of ‘normal.’  Charts indicate that babies sit at six months when placed in sitting by an adult.  The baby does not own that movement of sitting by being able to move in and out of positions. Most are actually stuck in sitting and struggle to get ‘unstuck.’

When treating babies, my main goal is for them to figure out and plan how to move their own bodies in and out of rolling, sitting, crawling, standing and walking. For example, to stand, the baby must be able to get onto hands and knees and push off the floor into standing. To cruise along the sofa, they need to crawl up to the sofa to pull themselves up and then cruise.  I do not put babies in positions that they cannot get into themselves. There are so many benefits to this including:

1) Baby uses their own muscle strength to get into a position versus being forced to hold a position that their body can’t handle which can lead to muscle strain or locking joints for stability.

2) Develops body and spatial awareness. As the child uses their own body (muscle and joint) sense to get in and out of positions, they develop an innate body awareness and sense of space around them. This is much safer as the child can get their own body not only in the position but ‘unstuck’ to get out of it. When placed in a physical position by an adult, they aren’t required to use their own body sense to move.

3) Develops motor planning skills – the baby has to come up with the idea to move, plan how to move their bodies, and then make the move. These skills are so important for motor planning and the beginning to problem-solving, sequencing, and figuring out how to do new things – all skills children need for pretend play, being independent and school projects.

4) Increases balance – by completing movements actively themselves, balance and confidence improves. Active movement develops ones movement sense and stability more than passive sensory input.  The movement system has strong links to one’s ability to calm and self-soothe, be alert and focused and much more so it’s a good one to strengthen.

In my professional and personal experience, I find that children who can move in and out of positions on their own versus being placed in positions are more safe and stable, have better posture and are less slumped over, more flexibility and variation in their motor skills, less sensitive or fearful of being moved, and are comfortable getting in and out of different positions.

As a paediatric OT, I will use sensory processing, Neurodevelopmental, myofascial, socio-emotional or play-based strategies to help the child develop the skills they need to be flexible and functional in their motor skills so they own their own movements, and can be more safe and independent in their play.

Here are some other interesting reads on this subject:

http://mamaot.com/2013/07/14/to-sit-or-not-to-sit-developing-functional-sitting-skills-in-babies/

http://www.janetlansbury.com/2012/04/sitting-babies-up-the-downside/

http://www.janetlansbury.com/2009/12/dont-stand-me-up/

http://www.janetlansbury.com/2011/03/9-reasons-not-to-walk-babies/

Sensory Swings Pre-Made Part 3/3

 
 
 
**Disclaimer:  The following are just ideas and must be used at your own discretion for safety.  Please be sure to use appropriate soft padding, measure for size in your space, and most importantly, provide supervision for your child’s safety.
 
I’d love to have more DIY skills or even a little workshop to build toys and equipment. But alas, I often resort to Amazon!
 
I’ll share some swings, trapezes and other equipment I’ve purchased from Amazon or local shops that kids really like.
 
Firstly, I’ve bought carabiner hooks and rope from a local outdoors climbing shop.  Make sure the carabiners will hold the amount of weight for your child to safely swing.  When looking for rope, consider whether your child will do better with static rope which has no give and will be less unpredictable, or dynamic rope which has some stretch and bounce to it.
 
 
If your child responds to spinning input, a rotary spinner can be found on Amazon.  This is what I use at ot4kids’ clinic:
 
I have also used aerial yoga ‘daisy chains‘ to help adjust the swings either higher or lower if kids need their feet to be close to the ground.
 
Here are some ideas of swings and trapezes from Amazon:
Please note I have included affiliate links below so do receive a little £, however all proceeds go to charity.
 
For hanging and climbing:
Twizzler – this is a fun one that also spins
 
Trapeze with gymnastic rings for hanging by arms and also hanging upside down.
 
Crow nest swing seat – add pillows and blankets here for nice calming deep pressure input.  It appears very similar to the IKEA Ekorre Swing.
 
Hammock swing – There are many different varieties and although I often suggest to parents to go to the fabric shop and feel the material and how stretchy it is (if your child likes bounce, a stretchy one may be great, if they need a calming space, a less stretchy lycra one may be more suitable). I have both a lycra hammock and a Yogapeutics hammock which has no-give for different situations.
 
Flexible Swing Seat – Try this one from different positions such as laying on tummy or sitting forwards or even sideways
 
 
Tire swing – for sitting or standing
 
Nest Platform Swing – This swing looks like it could be used from different positions similar to a platform swing, albeit, not the same. Perhaps a more economical option if you struggle with DIY like myself.
 
 
 

Homemade Sensory Integration Swings – Part 2 / 3

 
 
**Disclaimer:  The following are just ideas and must be used at your own discretion for safety.  Please be sure to use appropriate soft padding, measure for size in your space, and most importantly, provide supervision for your child’s safety.
 
 
This time I thought I’d share more on how to make some swings.
 
In my clinic, I mostly use my homemade platform and hammock swings.  Personally, I love the hammock swing after a long day and my toddler would love to nap in it.  I wish I were a bit more handy and could actually sew, I’d create a lot more.
 
Here are some ideas to guide you to make homemade swings:
 
1) Platform Swing –
 
If you’re into DIY, you could make this. Here are a few alternative ways others have made their platform swings.
 
 
 
 
2) A Hammock Swing
 
This one is so easy to make and requires no sewing or tools.
For mine I bought 4 yards of Lycra material from Fabrics Galore on Lavendar Hill in London.  I tied a knot on both ends through a ring and then attached it to my swing ropes. Here are some other more detailed guides.
 
 
 
I’d love this one!
 
3) Inner Tube Swing
I don’t have one but kids I previously treated loved playing bumper cars with these at my first job in California.
 
 
 
4)  Taco Swing
This is on my wish list along with a homemade bolster swing. It looks relatively easy to make if only I could sew.
 
 
Next blog post, I’ll share some of the swings easily available locally.
 

Installing Sensory Integration Swings – Part 1/ 3

 

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**Please note all ideas shared in this blog post are to be done at your own risk or discretion. It’s recommended to have an engineer or contractor assess your ceiling structure to determine whether it is safe and sturdy.

During OT sessions, parents often want ideas they can replicate at home, especially activities their kids really enjoy.  Swinging often falls in this category.
 
Part of classical sensory integration therapy includes using suspended equipment and therapeutic swings. Although there are lots of other effective and fun ways for children to get movement input without swings, swings are an option for the home.
 
The following are some ideas of how to install a swing for your child at home:
 
1) CEILING
 
Here is a great resource explaining different ceiling hooks. This is where an engineer or contractor will help.
 
 
Nice step by step directions from the DIY Network:
 
 
This blog post is written by a parent describing the process:
 
 
 
 
2) DOORWAY
 
This is a good alternative if you can’t access a ceiling for swings, especially if you happen to have a double doorway. 🙂  Prior to my current clinic space, I used the Rainy Indoor Playground Support Bar, however now am fortunate to have a larger area.
 
See how these two parents have used their doorway for swings:
 
 
 
I can personally recommend the Rainy Indoor Playground Support Bar. It’s so easy to install and if you move or rent homes, the holes from the screws can very easily be patched up.  For those in the UK, it can be purchased from Sensory Direct here:
 
 
Many parents have also installed a pull-up bar in their doorway from which they’ve attached a swing or trapeze.
 
 
 
For those in the US, there’s an Indoor Gym which I haven’t tried but looks interesting.
 
 
 
3) LOFT BED 
 
I’d love to do this when my son is ready to sleep in a loft bed.
 
 
 
 
4) A STRONG TREE!
 
My neighbors are so lucky to have a great tree from which they’ve hung a cool IKEA swing for their kids. If you do too, consider attaching swings there.
 
Here’s a tree swing kit on Amazon.
 
 
For all of the above ideas, be sure to put down an old mattress, crash pad or gym mat under and around the swing for safety.
 
Happy Swinging! 🙂
 
Munira

Breastfeeding & Sensory Processing Difficulties

BREASTFEEDING AS A THERAPY

This is my first blog post in perhaps two years!  I’ve been pretty busy with my now-toddler-then-baby but this is a topic very close to my heart. I lived it and breathed it for a whole year which is how long it took for my little guy, M, to become ‘functional’ at breast feeding. It is also something that many of the families I work with have or do struggle with so I wanted to share our story.

Here’s our abridged story.

Following birth, M immediately struggled to latch on and nurse. He was only 2.2 kilos so we were kept in the hospital for a few days. We received a lot of advice from the midwives of which all were conflicting and really, although my Occupational Therapy head knew better, my new-mum head was a bit overwhelmed and second-guessed myself. I always tell parents to trust their own gutt instinct.

Some feeding difficulties my son had were:

-Gagging (I hated it when the midwives or GPs would say ‘big mouthful’ and to put a lot of breast in the baby’s mouth. This did not work for my baby who was sensory defensive and couldn’t organise his body, let alone his mouth)

– difficulty latching on

-struggled to mould or ‘snuggle’ during feed and other times

– hiccups, gasped for air, guzzled liquid down while bottle drinking

– difficulty getting in a rhythm of suck swallow breathe

– took over an hour to feed

– struggled to move one side of his face, tongue, cheek, lip

– lopsided wonky smile (one side didn’t turn up or move), drooled only on one side, preferred feeding on one side

– jaws seemed to wobble

– held up his head from birth (yes, this is a red flag as he had tightness in his neck and back muscles which led him to always lift his head and arch his back. He could not relax at all when on his back. This position also brought his tongue back so he couldn’t bring it forward to latch on and suck /swallow.)

Our Team:

I contacted a speech feeding therapist of mine whom I hugely respect at day 3! We were so fortunate to have her support as the NHS speech therapist said there’s nothing to do until M eats foods. Not only couldn’t we wait but I knew better. Please know this is so not true. It was important to strengthen and develop M’s jaws, cheeks, lips, and tongue so he could nurse and later, eat foods and talk.

At 4 months, we saw an osteopath I’ve known and worked with. She worked with M using a classical approach, loosening and mobilising tight areas, so he could be more comfortable in flexion and move his body forwards, ESP his tongue. She also worked on his gutt mobility so that his body could best absorb nutrients, digest, pee and poop.

A craniosacral therapist who treated me saw M and worked wonders on his cranial system so he could be less sensitive, relax his body, and again, bring his neck and tongue forwards for nursing

A Jin shin Jyutsu therapist worked with M on relaxing his body via different Asian flows.

I, OT mummy, worked with M to become more comfortable with touch, movement, and sounds, develop his body awareness to move with more flexion and be able to bring his head forwards, move smoothly in and out of positions, and coordinate both sides of his body versus only move via one side. We also worked on positioning M’s body so he could be more comfortable with feeds. Once his body was more comfortable, his mouth followed suit.

The oral motor therapist worked with us on different feeding positions for myself and M to support his breastfeeding needs, supporting and strengthening his jaw, how to strengthen the oral muscles using specific, targeted exercises on the tongue, cheeks, lips, and jaws.

Private DAN doctor inspired by Asian medicine – He confirmed he wasn’t concerned about weight and size, continue with breastfeeding versus formula, but was more concerned about gutt absorption of nutrients. So he prescribed us some chinese herbal supplements, vitamins, probiotics and MCT oil which apparently is a natural ingredient already found in breast milk.

By 10 months of age, breastfeeding had finally become very comfortable.

Later speech and feeding therapy sessions worked on spoon feeding, emerging munching, eating different textures and building interest in foods, working on chewing tougher foods, and developing sounds of consonants and particularly lip sounds such as ‘m’ and ‘n.’

Using breastfeeding as a therapy gave us the chance to work on M’s sensory processing and oral motor skills soooooo many times during and before every feed.

We were fortunate to receive a lot of amazing, private support from very early on. During times, we felt desperate so also tried many ‘wrong’ things before figuring out what they worked. But as they say, it took a village and I really believe we need to support families with breast feeding challenges using a whole body and a collaborative team approach.

What did I, OT mummy 🙂 do that helped?

-Worked on sensory defensiveness, flooding M with calm, sensory input. Deep pressure input, linear movement input, building tolerance for movement in different planes using music, rhythm and predictability, heavy muscle and joint work for added proprioception to his body and mouth, and building tolerance for multi-sensory input. ‘Baby wearing’ was a huge part of our life for all sorts of positive sensory input.

-Before every feed, we did some gentle body work to build motor skills and body symmetry and encourage flexion.

-Targeted oral motor exercises for cheeks, tongue, lips, and jaws before feeds and later, when starting solids, we had therapeutic feeding strategies.

-Used straw and open cups as no concerns with aspiration, or safety of swallow.

-Positioning – Swaddling for feeds was a huge help and he relied on this till 7 months. I laid semi- reclined so M kind of ‘fell’ into me and gravity could help.

-Music –I remember using classical 90-beat Baroque music for children feeding in the hospital so we tried this too.

-Mental stuff  – meditation, imagery, positive self-talk, trying to keep the feeds happy despite it being so stressful

-Surrounded myself by like minded and positive people

 

Resources:

Kellymom.com

-An invaluable source on breastfeeding and busts so many myths.

Dr Jen 4 kids

http://www.drjen4kids.com/

www.talktools.com

Book-

Supporting Sucking Skills in Breast Feeding Infants by Catherine Genna Watson

It’s very in depth, but I love it’s team approach and whole body outlook

 

Babies – Early Signs: How do you know?

Does my baby need Occupational Therapy?

People often wonder how soon can you tell a baby requires early intervention therapies. I thought I’d share a little bit based on my experience with my own son and babies I treat as well as common red flags from other parents.  I hope it will help others.

First of all, parents just know!  They have a gutt instinct and are always right. Sometimes as a mum, I know it’s hard to follow your own gutt especially when others around you say it’s too early or your child will grow out of it. Please know that as a parent, you know your child best.

Secondly, babies’ main daily living activities are to move, sleep, feed, and poop. Usually, if these areas are a challenge, you will have an idea that they need some support.

For my son, I knew as soon as he was born and we were moved into the maternity ward. He was the only baby constantly crying, he had a hard time with breast feeding – struggling to nurse more on one side, startled at every sound that went by, only wanted to be on his tummy being very uncomfortable on his back, had too great head control for a newborn, and was unable to fall asleep.  Everybody, including strangers on the street, always commented on his head control (which was too good for his age because of tightness) and how alert he was (due to being in an over-stimulated state of arousal).

Babies benefit from Occupational Therapy when the following red flags are present: 

Sensory processing

– doesn’t mould their body to you when held, hates baby massage

– arches back, lifts head as a newborn (newborns should be able to turn their head and clear their airway but not hold up their head yet)

– only sleeps or soothes with intense movement input

– needs to be held all of the time

– startles to sounds easily, appears on edge or in distress, doesn’t like busy places

– very alert (as in sensitive to all sounds, sights, movements)

– difficulty sleeping, takes hours to fall asleep

– unable to tolerate sitting in car seat or stroller

– difficulty with car rides

– becomes upset when laid down on their back for diaper and clothing changes

– described as ‘colicky,’ upset or unable to settle

– doesn’t move and prefers sedentary play

– does not interact or make eye contact with parents

Motor

– only wants to lay on stomach and cannot tolerate laying on back (due to strong back muscles, weak flexors, and overall imbalance of muscles on front and back of body)

-arches body backwards

– flat spot on head, turns head more toward one side

– uses one side of body more than other side – babies do not have a hand preference or sidedness

– delayed motor milestones

– moves to one side only such as rolls or comes up to sit via one side

– tightness in limbs during dressing, diaper changes, or bathing – parents may feel arms are stiff to get into sleeves, or legs do not open for diaper changes

– motor milestones are a bit delayed

– doesn’t move, described as ‘lazy’

Feeding

– nurses better on one side or unable to nurse on both sides

– pulls away from breast

– difficulty figuring out how to latch on during breast feeding

– takes excessive time to nurse

– difficulty drinking from the bottle, liquid pooling out at sides

– drools on one side of mouth, smiles a bit wonky

– difficulty transitioning to foods, refuses to eat

– does not put toys in mouth for exploration

These are just some examples. If you have any concerns about your child’s development, please see an occupational therapist right away. Do not wait and see. Start early, there’s so much to do from the beginning versus when the child starts school and skills become ingrained. Babies are like sponges due to brain plasticity. Its really so encouraging to see how quickly they respond with the right support and early intervention.

Baby Occupational Therapy Assessments – Never Too Early!

People are often surprised that I work with babies. They wonder whether it’s too early, do all babies just develop at their own pace, or how does one work with a baby.

Fortunately we now know a lot about early intervention and milestones tell us about a child’s development. Early detection and early intervention can minimize or in some cases, eliminate issues that arise. I know this both professionally and personally as a mum to a 15-month old who has thrived due to having early intervention support from his very early days.

As they say, babies mostly sleep, eat, poop and I add, move. 🙂 If any of these baby ‘occupations’ are a challenge, occupational therapy may help.

What’s involved in an Occupational Therapy Assessment with Babies? 

Generally for infants, this is what I look at in an assessment:

  • Sensory processing skills – alertness, activity level, response to touch and movement, internal body and spatial awareness for motor skills, visual and auditory processing, motor planning and problem-solving skills
  • Gross motor skills – head control, shoulder and pelvic stability, core strength, respiratory muscles activation, arm and leg movements, and transitional movements (how the baby moves in and out of positions)
  • Fine motor skills – reach, grasp, release, object manipulation, two-handed play, eye-hand coordination, how the child moves and plays with their hands at the same time
  • Social-emotional skills – how the baby calms, self-soothes, copes with multi-sensory input and either everyday or novel experiences, relates to and interacts with familiar or new people
  • Neuromuscular development – muscle tone, strength and coordination, body alignment and movement patterns, are there any asymmetries, positioning and posture in seats and equipment at home and whether modifications are required
  • Oral sensory and motor skills particularly related to feeding and daily hygiene skills

Based on the assessment findings, we do different exercises to address areas of need. I show parents various carrying techniques, positioning and therapeutic handling strategies to develop sensory and motor skills, as well as ideas of how to address sensory, emotional, motor and play skills for the baby’s age. Parents are given a home program of exercises to complete with their baby and we address skills during therapy sessions.

Prior to the assessment, I ask parents to send me information regarding the child’s birth and medical history, services to date, general concerns, any medical reports, and a completed questionnaire. I also love to see photos of the baby in various positions to help me get to know the baby and plan for the session accordingly.

If parents are concerned about their babies’ development, I suggest do not wait and see, early intervention is critical, and better to address areas of need now versus waiting till the child is older and struggling in school.

 

 

Intensive Treatment Blocks

Why we provide an intensive model of treatment at ot4kids, London? 

Traditionally, Occupational therapists treat children 1-2 times per week, oftentimes for years.  We prefer to provide intensive blocks of treatment for children receiving OT.

Research from the SPD Foundation indicates that children actually benefit more from intensive blocks of treatment.  This is the chosen model of treatment at Lucy Miller’s STAR centre in Denver, Colorado.  I am a huge FAN of this model.

Since 2011, I have also been providing intensive blocks of OT treatment sessions followed by a break, and then another intensive block.  The frequency of the intensives vary based on the individual child and family’s situation, however they can for example run from 2-4 times per week over a 3-5 week period.  Children then have a break for 4-8 weeks followed by another intensive block of treatment.  In time, the breaks tend to be longer and longer.  The break is a fantastic time for children’s to solidify their new skills and integrate them into daily life.  During this break, kids often participate in their favourite activities whether it is going to the park, swimming, horseback riding, learning to ride a bike, cooking or having play dates.

Benefits of intensive blocks of OT treatment:

Personally, this model of treatment has been beneficial in my clinic for many reasons:

  • Due to the plasticity of the child’s brain, kids are making faster progress and skills are integrating better
  • For school aged children, intensive blocks can take place during holidays and half-term breaks
  • Families from out-of-town or overseas can access services
  • Parents find it encouraging that they can do other fun activities with their kids during the breaks and continue to see progress
  • Less burn-out from therapy and kids are excited to come to OT

OCCUPATIONAL THERAPY ASSESSMENT – What’s it all about?

Parents often wonder what’s involved in an occupational therapy assessment?  This really varies amongst Occupational Therapists based on our experience and interests, what the parents want  the child’s individual needs.  In my practice, this is how it generally goes.

 

PHONE CALL:

Initially, parents call and we have a phone conversation where they tell me about their child, their concerns and reason for an occupational therapy assessment. I prefer to talk about any sensitive topics during this time versus discuss in front of children, particularly older kids.  We then determine whether or not an assessment is necessary.

 

INFORMATION AND DATA COLLECTION:

Next, I send parents information regarding scheduling, what the assessment entails, and any questionnaires to complete. For children who are in school or have other therapists and support team members, I attempt to get as much baseline information I can prior to the assessment such as:

Birth history and medical history

Report cards

Drawings or handwriting samples

Photos of younger children in various positions to give me an idea of their motor skills

Reports from other therapists including educational psychologists, consultants, and speech therapists.

Completed questionnaires or sensory profiles by parents and school.

 

ASSESSMENT:

The actual assessment varies based on each child and their needs. No two children are alike.

For the first part of the assessment, I usually chat with the child and parent to get to know each other. During this time, the child often explores the clinic and engages in free play while I make initial observations of how they move, interact, and play. For older children, I ask about their hobbies and interests, how they find school, and what they’d like to do. Both parents and children are involved in this discussion as appropriate.

We then complete formal and informal tasks (standardized testing and clinical observations) to assess the following as it applies to the child:

-*****Child’s STRENGTHS.  This is so important as we will want to continue and encourage these in the child and also, use this to build on areas that need help. We are not trying to change the child but want to embrace them for who they are.

-Sensory processing: tactile processing, body and spatial awareness, balance, motor planning, organizational skills, does the child avoid or seek sensory inputs, how do they play with and figure out new toys

-Gross motor skills (head control, trunk control, body alignment, core strength, movement patterns)

-Shoulder and pelvic girdle stability, joint stability, upper and lower extremity strength and coordination, endurance

-Postural control, bilateral integration, rhythm / timing / coordination of movements

-Fine motor skills (reach, grasp, release, object manipulation, in-hand manipulation, 2-handed use, hand preference / dominance), eye-hand coordination

-Self-help and self-care skills

-Visual motor and perceptual skills, visual processing (eye tracking, motility, convergence / divergence, how both eyes are working together)

-Auditory processing, following directions, attention and focus

-Sensory regulation, how the child transitions, manages multi sensory input, copes with daily challenges and demands, attends and focuses during self- and adult directed tasks.

-Social skills – how the child initiates interactions, joint play / reciprocal interactions, recognizes their own feelings and how to manage them

-Organizational skills and executive functions for child’s age

-Consider adaptations, strategies, sensory supports for home or school

-Provide ideas of useful and meaningful sports, extra curricular activities and games are provided according to the child’s individual needs

 

Throughout the assessment, parents are involved and present. I provide suggestions of exercises and activities to try at home. We will try some exercises and activities together.

 

Summary and recommendations: Towards the end, we review findings of the assessment, prioritize concerns of parent and child, discuss home exercises, and come up with a plan of what to do and how to work together with the child’s home and school team.

Based upon the child and parents, the initial assessment can take from 1-2 hours.

Finding an Occupational Therapist or Health Professional

As a mum of a little guy who has needed some extra help, I know it’s hard finding the right support for your child.  Parents often ask me how to find a good occupational therapist and make sense of their qualifications.  Here are my suggestions from both personal and professional experience:

1)   ****FOLLOW YOUR GUT*****:   You will have a feeling by talking to a therapist whether they are right for you.  Personally, I prefer to talk via phone to potential therapists for my child versus emailing or texting as it has given me a good feel for them.  Also, by watching my child interact with the therapist and see how comfortable they are, I just know! 🙂

2)  BASIC REGISTRATION:

In the UK, occupational therapists must be registered with the Health Professions Council.

In the US, occupational therapists are registered with the National Board for Certification in Occupational Therapy.

3)    ADVANCED CERTIFICATIONS:

Pediatric occupational therapists can go for many higher level intense accreditations based on their special interests.  Personally, my treatments and assessments became much more thorough and effective after undergoing these certifications, resulting in faster progress.  Two main certifications to look for are:

-Sensory Integration – In the UK, there are a series of four courses offered through the Sensory Integration Network.  In the US, these courses may be offered by either Western Psychological Services or Sensory Integration International.  Have a look here to learn more.   It can take years to complete the coursework and all the requirements to pass and become certified in Sensory Integration.

-NDT (Neuro-Developmental Treatment) Certification also known as Bobath Approach.  This is an 8-week course for children with Cerebral Palsy or any motor impairment.  For me, the course was a labour of love & rather intensive.  Therapists often make some sort of life compromise to complete the certification such as temporarily moving to the town where the course is being held, or leaving their families for long periods of time.  For therapists who are NDT certified in the US, this requires a continuous process of updating information via ongoing continuing education and professional development.  You can learn more here

Personally, I moved to Chicago to complete my coursework and had a brilliant time exploring the city and enjoying stuffed pizza whilst studying during every other spare moment. 🙂

– NDTA Advanced Baby Course – 2 to 3 weeks – This certificate course can only be taken after the 8-week course above and is an add-on to specialize further into baby treatment.  I took mine in what felt like the boonies, Allentown PA, however it was completely worthwhile to have spent this time with baby guru, Lois Bly.

4)    CONTINUING PROFESSIONAL DEVELOPMENT – I would look to see that the therapist takes ongoing continuing education courses in a variety of areas.  I list most of my CPD on my ‘About Me’ section under CV for others to see how I stay current.

5)    EXPERIENCE:  What’s their experience?  How long?  Where?  What population do they work with?

6)    SPECIAL INTERESTS:   Do their special interests relate to your child’s needs?  E.G. Baby treatment, pediatrics, splinting, kinesio taping, seating and wheelchairs, assistive technology, home modifications, oral motor / feeding therapy, listening therapies, yoga, brain gym and so much more.

7)  LISTENS TO YOU:  I find it encouraging when our team members listen to and involve us.  After all, parents know their child best.

8)  CREATIVITY:  Fancy clinic equipment is great however I have seen great therapists do so much while working in a shoebox or with very little.  Creativity goes a long way.

9)  COST – Personally, I have found it so worthwhile to have fewer sessions with a more skilled therapist versus more sessions with less skilled ones.  It’s important to look at the therapist’s credentials, approach and personality to find a good fit.

 

Holiday Presents

When I moved from NYC to London, half my boxes must have been full of toys and books!  Whenever I see a new toy shop I must see what’s inside. Usually, I love the old classic toys mostly in thrift shops or on eBay now.

Occupational therapists love toys, activity analysis, figuring out what skills toys are working on, or how to adapt them to suit a child’s individual sesorimotor needs while offering just the right challenge.  We also love finding interesting ways to use these games such as via an obstacle course, combined with therapy ball exercises, or from various gross motor positions. Talk to your OT to learn how best to adapt games to address your child’s goals.

I often use games from my childhood. 🙂 How many of you remember playing thumb war, French skipping, throwing balls against the wall, playing Jax, or making cootie catchers and cats cradle.

For birthdays and holidays, parents will often ask me for gift ideas that will address their child’s areas of need and that they will find fun. I love doing this. It’s like making a secret special super wish list for the child.

I have now created an Amazon store open to everybody.  Toys and equipment are broken down by age group into the following categories with my anecdotes:

Sensory Processing
Gross Motor
Motor Planning
Fine Motor
Visual Motor and Perceptual
Prewriting

I receive a little something should you buy from my store.  All proceeds will be used for charity or therapy toys for those in need.

Have a look. I’d love to hear if you have any favourites.

http://ot4kids.co.uk/therapy-toys-shop