Author Archives: munira

5 Tips to Help Left-Handers with Writing


Last week, out of curiosity, I asked members in my Helping Kids Write FB group if their child is a rightie, leftie, or both-ie? 

Want to know the results? 


First to put things in perspective….. 
On average, 10% of people are lefties.

However, in my Helping Kids Write FB group for children who struggle with writing, the results out of 79 people were: 

42 / 79 – Rigthies – 53% 

25/ 79 – Lefties – 32% 

12 / 79 – Both-ies (I think I made this word up but it means they use either hand and don’t yet have a firm hand dominance) – 15% 

Isn’t that so interesting that much more than 32% in the poll are lefties when in the outside world, the norm is 10%? 

I’m a total brain geek! I just find this stuff so amazing.

I’d love to share some facts about hand dominance:


1) Did you know you can be left-handed to write but may use your right hand for other tasks such as cutting or playing sports.

2) We have other dominances.  We often think of being right or left handed, however, you can also have an ear, eye, or foot dominance.

So you could be left handed but right footed to kick a ball.


3) Usually, kids first develop a hand preference around 2-3 years old. Then they have a hand dominance around 4-5 years and a strong hand dominance by 5-7 years old.

Kids who are left-handed can sometimes take extra time to develop their hand dominance.

And oftentimes, if your child uses both hands, they’re most likely to be swapping hands due to tiredness or difficulty with midline crossing versus being ambidextrous. Being ambidextrous means you use both hands equally well which is very rare.

It’s important kids can use both hands together so that their dominant hand is for moving and controlling the pencil and their opposite or non-dominant helping hand is for holding the paper.

5 Tips for Lefties: 

It’s so tricky living in a world where everything is made for righties.  Even the most simplest of tasks such as shaking hands can feel awkward for a leftie.   Here are some tips to get going: 

1) Grasp and logistics –

Lefties are known for having a hooked wrist grasp because this helps them see what they are writing versus smudging their writing as their hand pushes along the paper.

Try the following:

-hold the pencil half an inch higher

-use a non-smudgy ink pen

-angle the paper to the right so that the top of the paper is going downhill

-try using an easel as this helps the wrist be in an extended (lifted) versus hooked position

2) Seating –

Make sure the teacher knows your child is a leftie.

Have your leftie sitting or positioned on the left edge of the room or table so that they can turn and look at you as turning into the writing hand is awkward.

If you are sitting beside or approaching them, do so on their right.

3) Cutting –

If they are left handed to cut, find left-handed scissors and other utensils.

There’s a left handed association here in the UK for easy access.

And remember when cutting out shapes, lefties go clockwise.

4) Writing –

When drawing horizontal lines, lefties usually go right to left.

So when crossing t, f, A, E, F, H, J, they’ll go from right to left.

When using workbooks or copying, make sure the letter image is on their right side so they can reference or copy it more easily.

5) Foundational Skills –

I’m a massive believer in working on foundational sensory and motor skills for writing so I can’t go without saying something about this.

If your child hasn’t developed a strong hand dominance or is swapping between hands, please make sure to first address the foundational skills of body and spatial awareness, core strength and endurance, balance and midline crossing, and then follow this up by building fine motor and two-handed skills. All of this will help develop a strong hand dominance.

If you want to learn more on the foundational skills, check out my Helping Kids Write mini-workshop.


Do Pencil Grips Help with Writing?

Was your child offered a pencil grip to help their writing at school? 

Usually, parents tell me that school already tried a pencil grip to help with writing? 

When I ask if it helped, most say their child finds them uncomfortable or won’t use it. 

So, should or shouldn’t we use a pencil grip? 

I find pencil grips to rarely be helpful from the get-go. And it’s not just because the child has to get used to the grip. 

Using a pencil grasp requires strength and coordination on the child’s part and is ultimately, an exercise in itself.  

Kids first need to develop sensory processing, core strength and fine motor skills for pencil control or to more comfortably use the grip.  

Once kids have had some OT support, some OT’s may then use a pencil grip as a way to further strengthen or support the fingers.  It all depends on the child.  

However, I have found most kids don’t find them to be comfortable and so we work on the skills they need for better fine motor skills and pencil control. 

There’s my two cents on pencil grips.  Hmmm…… how does that translate to London English? There’s my two pennies? Doesn’t sound the same, and I may be humouring myself now. 🙂

Munira

P.S. I am a fan of shorter, thicker, or triangular shaped pencils, Stabilos, or smoother gliding lead pencils. And if kids are ready, I love Crayon Rocks. 

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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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How is Teletherapy and Working Closely with Parents Helping Kids? 

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Can you believe we have been doing Teletherapy and parent consultations for three months now?

Oftentimes, people think that OT has to be done 1:1 with an OT to help their child (and don’t get me wrong, direct treatment is really important and helpful).  Thanks to COVID-19, it has been absolutely amazing to see both parents and kids thriving.  Kids are calmer and building relationships, developing their motor skills, and problem-solving during play.   Parents are understanding their child’s ‘signs’ and needs, and as a result, figuring out what to do coming up with great strategies to support their kids.  

It has been a highlight building relationships, joining forces with parents, and having an impact in the kids’ natural environments. 

How do Occupational Therapists do Teletherapy?

Teletherapy sessions have taken a combination of two forms: 

  1. Directly working with the child via the parent 
  2. Indirectly by meeting only the parent and reviewing videos of child between sessions

What lessons have we learned (i.e. benefits gained) from teletherapy during COVID-19? 

Less is more

Kids have made great progress with what they have at home.  

Parents have been nicely surprised how much we are able to do with what they have at home, and as a result, they are more able to incorporate sensory strategies or motor activities into their days.  In many ways, I have found that children have made even more progress during their intensive blocks as we are so much more focused on certain areas and we use what they have.  

Empowering parents

For me, I have loved building relationships with the parents, and tag teaming with them to support their families and kids.  I feel that this has also been key to the progress we have made in sessions, and the support the parents feel that they are receiving.  Parents are empowered knowing that they can help their kids using their own hands and ideas.  

Learn by doing

I learn by doing things myself. 

These parent consultations and virtual sessions have enabled parents to ‘do’ with their kids themselves, and become confident in their own abilities to support their child.  Being mum to my 8-year old, I know how important this is.  

New future plans? YES!

So far, many families want to continue in this way to some capacity, and I’m fore-seeing positive changes going forwards in how we provide OT via supporting parents, whether it be directly, indirectly, through trainings and coaching, or a combination.  

Get in touch to discuss how tele-therapy can help your child.   

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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. 

 

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)

 

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.

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.

Therapeutic Benefits of Babywearing

 

I’ve an 8-month old baby with sensory processing difficulties and who has had a bit of a rough start from a traumatic birth.  Babywearing has been a huge part of our lives as he struggles to tolerate any seating devices especially strollers and car seats.  We started with a ring sling when he was home from the hospital, then a hop tei (a modified mei tai Asian carrier), and now as he is older, we also use a more supportive Ergo carrier. It’s our favourite therapeutic, ahem “fun, ” activity. 🙂

 

I have found many therapeutic benefits to babywearing and often recommend it to parents for these reasons:

 

SENSORY:

 

1) Deep pressure input, warmth, and comforting smell of parent are calming and organizing. This is particularly helpful for babies who are sensitive to touch, movement, or sounds, who have had long NICU / SCBU stays, or who need support settling into the big, outside world.
2) Boundaries of the carrier give body input and awareness for comfort and motor skills development such as babies with low tone, sensory motor difficulties, or prematurity.
3) Vestibular / movement input – the gentle bouncing, rocking and swaying motions provide movement input which is again soothing but also helps stimulate tone for balance and coordination and make sense of one’s body. The vestibular system is also strongly connected to the visual, auditory, and emotional centres of the brain. Movement helps kids focus, learn, and coordinate both sides of their bodies.
4) Powerful way to bond after a traumatic birth and from personal experience, so fun to interact with baby wherever you go.
You can see how it can either help decrease sensory overload for sensitive babies or provide extra input to babies who need more sensory information.  By integrating, touch, body and movement input, we are helping develop multi-sensory processing.
MOTOR:

 

1) Encourages flexed  positioning – oftentimes babies with traumatic births, brain bleeds, prematurity, low tone, or sensory processing disorder assume an extended posture due to tightness, arching their back or sensory overload.  Heathy, full-term babies are in a flexed curled-up position from the womb. Extension is a red flag. Slings and carriers can be used to help encourage this flexed position.  Have your occupational or physical therapist help with positioning.
2) For positioning, remember it is important to face inwards and assume a squatt position. See this article:

http://blog.ergobaby.com/2012/02/facing-inward-or-outward-the-physiological-aspects/

3) Alternative to tummy time – many babies struggle wit tummy time for varied reasons. Baby carrying can be a gentle step towards tummy time by holding your baby against you.
4) Upright positioning can be more comfortable for babies with reflux, gutt, or respiratory problems.
Resources:

 

UK Sling Libraries
Visit a sling library to try different carriers and find what suits you and your baby.

http://www.ukslinglibraries.co.uk/

Babywearing International

http://babywearinginternational.org/

Integrated Listening Systems therapy at ot4kids

I use Integrated Listening Systems (iLS) Therapy to improve children’s sensory processing, motor skills development, auditory processing, attention and regulation.

I have found that iLS and Occupational Therapy together make a good pair and help children progress faster.  It is also effective as part of a home program for many children.

iLS is unique in providing bone conduction in the headphones.  This is highly beneficial as it offers additional vestibular (movement) input to the child working on a neurophysiological level.

WHAT IS iLS?

iLS is built upon the techniques and theories developed by Alfred Tomatis, M.D., and has been refined by Dr. Ron Minson over many years.  It is based upon the theory of neuroplasticity, strengthening and creating neuronal maps that support sensory processing, movement, attention and learning.  iLS is a sound-based multi-sensory program that combines movement, visual and auditory input.

HOW DOES iLS WORK?

Classical music has been digitally manipulated to specific frequencies and vibrations that stimulate various parts of the brain to improve the neurological foundation for sensory integration.

Music is delivered via a portable iPod through specially designed headphones with bone conduction (a small transducer).  The bone conduction unit is inside the top of the headphones and provides specific vestibular and auditory stimulation.

In my practice, after I assess a child I determine whether iLS will benefit their program.  We then create an individualized listening program along with sensory, movement, visual and auditory exercises based on the child’s goals.  Generally, the program is administered approximately 3-5 times a week for 30-60 minutes.  For the first 15-20 minutes, the child participates in their home program exercises and for the remainder of the program, they either relax or complete fun projects.  I either use iLS during the child’s treatment sessions or offer units for rental for intensive home programs.

iLS HELPS:

Sensory processing, body and spatial awareness, motor skills coordination

Motor Planning, sequencing

Attention and following directions

Auditory Processing, sound sensitivity

Visual Motor Skills

Self-esteem

Sensory regulation, calming, sleep

iLS can be used for children who have various diagnoses including:

Sensory Processing Disorder

Autism, Asperger’s syndrome

Dyspraxia

Learning difficulties

ADD / ADHD

Neurodevelopmental delays

 

FURTHER iLS RESOURCES-

Research and case studies:

http://www.integratedlistening.com/research-science/

Free parent webinars:

http://www.integratedlistening.com/training/ils-webinars/

Online videos and talks by Dr. Ron Minson about iLS:

http://www.blogtalkradio.com/thecoffeeklatch/2011/10/24/dr-ron-minson–ils

http://www.autismsocialnetwork.org/community/72-ils/videos/video/46-ron-minson-md-a-edward-hallowell-md-qhow-integrated-listening-systems-ils-worksq

http://www.worldtalkradio.com/worldtalkradio/vepisode.aspx?aid=55628

Study by the Spiral Foundation regarding the effectiveness of home-based iLS therapy:

http://on.fb.me/S8eUjJ

How iLS influences sensory processing

http://www.integratedlistening.com/how-ils-influences-sensory-processing/

Parents’ account of using iLS and music therapy with their child:

http://www.autismsupportnetwork.com/news/feeding-hungry-brain-music-autism-2321452

Tips on introducing headphones to a sensitive child:

http://polaristherapy.com/2012/07/07/introducing-headphones-to-the-tactile-and-auditory-sensitive-child/

Sensory Processing – Early Warning Signs for Babies

In my practice I work with many children with sensory processing difficulties that are identified during their school years.  These children may struggle with concentrating in class, coping with transitions or changes, or playing with peers.  They can be clumsy, have difficulty holding a pencil or writing, awkward with their movements, or be either withdrawn or aggressive.  Oftentimes, they are very bright and as a result, their sensory processing difficulties are misunderstood.  Usually, warning signs were present as babies however parents were told to ‘wait and see,’ ‘your child will grow out of it’ or that their child is misbehaving.

Early signs of sensory processing difficulties I have seen amongst babies include:

  • Hates tummy time, prefers to sit or stand
  • Plays while sitting still versus moving around and exploring their environment
  • Tend to get ‘stuck’ with their movements, delayed milestones (e.g. rolling, crawling, clapping hands, waving)
  • Cautious with movement, dislike being laid down or moved
  • Fussy or irritable babies, cry easily sometimes for no known reason
  • Not a ‘cuddly’ baby, resists being held
  • Struggle to settle down or going to sleep
  • Difficulty with nursing, transitioning to other textures
  • Startles easily to loud sounds, distracted, avoids eye contact
  • Very easy going, described as a ‘lazy baby’, don’t know they’re in the room

These difficulties indicate that a child’s central nervous system is struggling to process sensory information.  It is a neurological problem that can impact on their movements and development, learning, and social-emotional skills.

Here’s a nice article that discusses the early warning signs of Sensory Processing Disorder amongst infants.

Due to the plasticity of a young child’s brain, there is hope and good potential for progress and improvement with Early Intervention.  If you are concerned about these early warning signs, seek advice from an Occupational Therapist who specializes in working with infants and younger children, particularly those with sensory processing difficulties.  It is never too early or never too late to get help.

Look here for links and books about sensory processing.