Child Speech Therapy

Picture Exchange Communication System - Lumiere Children’s Therapy Chicago

Our previous post, Learning to Talk, outlined the typical development pattern for expressive language. Expressive language is the ability for one to communicate wants and needs, socialize, and interact with their environment through words, gestures, and nonverbal communication. For children with a language delay or an expressive language disorder secondary to an underlying diagnosis, a picture exchange system may assist in the development of expressive language. The picture exchange system can offer a bridge between communicating with gestures or signs to verbal communication. It may also help a child develop the necessary skills to operate a high tech Augmentative Alternative Communication Device (AAC).

Picture Exchange Communication System, often referred to as PECS, is a program of picture representations for common objects, actions, and thoughts. A person can initiate conversation using PECS to communicate their wants and needs without verbally speaking. It allows children to communicate with others even if they do not have the necessary verbal skills.



What is Picture Exchange Communication System?

Picture Exchange Communication System (PECS) was developed by Andy Bondy, PhD, and Lori Frost, MS, CCC-SLP in 1985 as a system used with preschool students diagnosed with autism. The goal of the program was to teach children how to self-initiate functional communication. Based on the success of the program, it is used with many learners with various communicative, cognitive, and physical difficulties of all ages. PECS is a six phase program that emerges from single word requests to building of sentence structures. There have been several studies that confirm that implementing PECS can help children develop verbal language, as well as decrease negative behaviors associated with language delays.



Who would be appropriate for PECS?

PECs is an approach used for nonverbal children. If your child consistently uses words, although limited, this system may not be the first choice in treatment. The following would indicate if your child would be a good candidate for a picture exchange system. 

  • Intentional communicator: In order to effectively use a communicate exchange, a child needs to want to communicate with others either through pointing, gestures, bringing caregivers to desired objects, or communicate through facial expression. 

    • Example: Jenny wants a chocolate chip cookies, so she directs dad into the kitchen and points to the cabinet with cookies. 

    • If a child does not involve the caregiver when trying to obtain an object, they may not be ready for a picture exchange program. The first step in this scenario would be to gain joint attention. Joint attention is when the child and caregiver are actively focused on the same object/activity. 

  • Preferences/motivation.  In order to understand the power of a picture exchange system, the child needs to be fully motivated for what they are receiving in return. When first teaching PECs, food, favorite toys, and motivating activities (slide, swing, etc) are most frequently used as motivation to communicate through pictures.

    • Example: Eric loves to build with legos. Parent will hold box of legos and give Eric one lego after every request. Eric is motivated to continue to use PECS to get more lego pieces. 

    • If a child has weak or no preferences, then PECs may not be appropriate. Preferences can be determined through trial and error of different foods, toys, and activities.

  • Discrimination of picture. Although picture discrimination is not a definite prerequisite of picture exchange system, it can enhance progress. As PECs continues to be implemented into daily routines, children will begin to learn which pictures correspond with the matching toys, food, activities, etc. If a child advances quickly with PECS, they may be more appropriate for an AAC high tech device. 



How is PECS implemented?

PECs is taught by a certified, trained speech language pathologist (SLP) but involves a caregiver or teacher as part of the team. The SLP becomes certified in PECS by attending a two day training. The SLP will be the primary PECS program coordinator for a child but it can be beneficial if caregivers attend the two-day training as well. Caregivers may include parents/family members, classroom teachers, and classroom assistants. Here is a list of training workshops available across states. PECS can be taught by the SLP in a therapy clinic, home setting with early intervention, and/or school or daycare. As the child and parent progresses in their knowledge and training of PECs, it should be used in all activities in their everyday activities. During phase stage, the goal is approximately 80 picture exchanges each day. 



Stages of PECS: 

In the early stages of PECs, there are three people in the training situation. The child, the person who receives the pictures (mom or teacher), and the facilitator who assists the child (speech therapist). Eventually, the facilitator is phased out of the training. 

  • PECS PHASE I: How to Communicate 

The first phase lays the foundation for exchanging single pictures for desired toys or activities. Receiver entices the child with the preferred object or food. As the child reaches for the desired object, the facilitator can assist the child to pick up the picture and hand to the receiver. The receiver does not say anything until receiving the picture. Once they receive the picture, they can say “ball, you want ball”.

  • PECS PHASE II: Distance and Persistence 

Phase II continues to target single pictures but in a variety of places, communication partners, and at greater distances from their field of view. It also teaches the child to become more persistent and consistent with communicating wants and needs. The facilitator is still present, and intervenes when necessary, but the child should be more independent in this stage.

  • PECS PHASE III: Picture Discrimination 

In this phase, two or more pictures are used at a time. The caregiver would present two or more pictures for a child to choose their desired object. The pictures are compiled into a communication book such as a ring binder for easy access by the child. 

  • PECS PHASE IV: Sentence Structure

The child learns to construct simple sentences with a sentence strip using “I want” picture with desired picture following.

  • PECS PHASE V: Answering Questions 

At this point, the child can learn to use PECS to answer questions such as “What do you want to play?” or “What do you want to eat”. 

  • PECS PHASE VI: Commenting 

The final phase of PECS is using pictures to make comments or respond to questions in their environment. They learn to create sentences starting with functional phrase strips I see, I hear, I feel, It is a, etc. 



How does PECs help develop verbal language?

In the previous post, Learning to Talk, a list of seven prerequisites to verbal language were described with at-home strategies. Three of the prerequisites align with the foundation of a picture exchange system. 

  1. Adequate attention and joint attention. Joint attention is when a child is focused on the same item or activity as the communicator or parent.

    1. Joint attention is necessary for a child to understand the concept of PECs. PECs requires the child to establish joint attention between the communication partner and their desired object or action. 

  2. Understands words and commands. 

    1. Before a child can effectively use verbal language, they need adequate receptive language skills. Receptive language is the ability to understand and comprehend language. Receptive language involves the identification of pictures. PECs encourages children to identify an action or object with a corresponding picture. It increases the child’s recognition and labeling of common objects and actions, improving one’s receptive language skills. 

  3. Communicates wants and needs with gestures and/or pointing. Children learn to communicate and engage with caregivers before verbal language typically emerges. Children may smile when they get something they want, point towards desired objects, or carry toys to caregiver. These are all forms of expressive language. PECs helps facilitate non-verbal expressive language by giving the child resources to communicate wants and needs to caregivers. It teaches the concept that requesting for an object/action results in receiving desired item. PECS encourages the concept of cause and effect. 



As a child develops these necessary skills through a picture exchange system, they are reinforcing the development of communicating for wants and needs. The caregiver is modeling the verbal production of each picture exchange providing more opportunities for modeling. For example, if Noah brings a picture of a ball to his mom, mom will state “ball, want ball”. Noah is receiving verbal modeling of the word ball to picture multiple times. 

If you feel your child would be an appropriate candidate for a picture exchange system, contact Lumiere Children’s Therapy. At Lumiere Children’s Therapy, we have therapist certified in the program to help your child communicate their wants and needs across all environments.




References:

“Picture Exchange Communication System (PECS)® |.” Pyramid Educational Consultants, pecsusa.com/pecs/.

“The Picture Exchange Communication System (PECS).” The Picture Exchange Communication System (PECS), www.nationalautismresources.com/the-picture-exchange-communication-system-pecs/.

Vicker, B. (2002). What is the Picture Exchange communication System or PECS? The Reporter, 7(2), 1-4, 11.




Lumiere Children’s Therapy: Learning to Talk

Mama, Dada, go, ball, and hi are all common first words you may hear your child say between 12-15 months old. Hearing your child say their first word is not only exciting, but helpful to be able to attend to your child’s wants and needs. Although each child develops language skills at different rates, delayed expressive language skills are usually first noticed by families.

Expressive language is the ability to communicate thoughts through words, gestures, and/or facial expressions. Expressive language allows one to communicate their wants and needs, socialize with others and interact in their environment. In order for a child to begin expressing themselves with words, there are a number of prerequisite skills that need to be mastered.

Prerequisites to talking

  • Exploration of the environment. Children should be constantly reacting to situations in their surroundings such as noises, lights, people, and activities. Reacting to others and new experiences are core features of communication.

    Strategies to try at home: Interact with your child in new ways to encourage exploration. Bang on pots and pans in the kitchen during meal prep, let your child ring the doorbell when walking in the house, or make a light show with flashlights. Be creative while incorporating music, sounds, visuals, and familiar faces!

  • Acknowledges others during play. Communication involves at least two people, so learning how to interact with another person is a necessary component. Children should want to be around others and react to interactions initiated by others.

    • Strategies to try at home: Get on the floor and play with your child! Initiate interactions by taking a turn on a puzzle, bumping your toy car into his, or stacking a block on his tower. Let your child acknowledge your interaction by imitating or responding in their own way. Continue to model interactive play with your child as often as possible.

  • Adequate attention and joint attention. Child should be able to remain on a single toy or activity for at least five minutes. Joint attention is when a child is focused on the same item or activity as the communicator or parent.

    • Strategies to try at home: To increase attention to asks, set a visual timer for two to three minutes on a chosen toy before they are able to pick a new activity. Instead of time increments, set a number of turns before moving to a new activity such as three puzzle pieces, three car races, or three items on Mr. Potato Head. In order to improve joint attention, be sure to sit at your child’s level and in their line of vision.Show your child that you are interacting with the same object by pointing, naming, and interacting with the same toy.

  • Demonstrates age-appropriate play skills. Language skills are most often learned through play in early development. Learning opportunities are frequent during pretend play, and while using interactive toys and early concept toys such as animals and play food. Playing with toys appropriately is required in order to use play to learn language. This may look like a child racing a car, pretending to stir a pot, or placing blocks on top of each other.

    • Strategies to try at home: Play with toys that require the child to interact, instead of watching it do something (i.e. light-up toys, ipads). Examples of good toys include puzzles, blocks, dolls, play kitchen and animal figurines. Model appropriate play with toys and encourage your child to imitate.

  • Understands words and commands. In order to use language to communicate, a child must understand language. This includes following simple requests such as “throw the ball” or “bring me book”, identifying pictures in books, or grabbing a named object in a group of three or more.

    • Strategies to try at home: If your child has difficulty following directions, give a verbal command first and then model the action. During routine activities such as getting dressed, brushing teeth, or leaving the house, give specific and consistent commands such as “put on your coat” or “open the door”.

  • Begins to imitate sounds, gestures, or facial expressions. Mimicking gestures teaches the concept of learning language through imitation without the pressure to use words. A child should learn to copy funny faces, clapping, waving, high-fiving, and other common gestures before being expected to imitate words.

    • Strategies to try at home: Sing nursery rhymes and do the gestures along with it such as Itsy Bitsy Spider, The Wheels on the Bus, and Pat-a-Cake. For facial expression, sit in front of the mirror and make funny faces such as sticking out your tongue. During social activities, encourage your child to wave to people they see and high-five family and friends.

  • Communicates wants and needs with gestures and/or pointing. Children will often learn to point to request objects before using words. Finding ways to express wants and needs by pointing, grabbing, or leading, is a way of nonverbal communication.

    • Strategies to try at home: If your child is wanting food or a toy, hold up two options and give the prompt, “what do you want?” Encourage your child to point by modeling the gesture. Teaching baby signs is a great way to facilitate non-verbal language as well. Start with teaching the signs for more, all done, and eat.

Once your child has developed the prerequisite skills for language develop, they will start to babble, imitate sounds, and use words for communicative purposes. The typical milestones for language develop are listed below. If your child is a late-talking, the months will vary but the hierarchy of skills will be relatively similar.



Typical Expressive Language Development


3-6 months

  • Makes pleasure sounds such as cooing and gooing

  • Smiles at familiar faces

  • Vocalizes to express anger

  • Initiates “talking” by playing with new sounds

  • Whines with manipulative purpose or cries for different needs

  • Laughs



4-6 months

  • Babbles with different sounds including p, b, and m

  • Vocalizes excitement and anger

  • Makes raspberries or gurgling sounds



6-9 months

  • Vocalizes four different syllables

  • Vocalizes two-syllable combination, example “uh oh”

  • Makes noises during play

  • Attempts to sings along with familiar song

  • Shouts or vocalizes to gain attention



9-12 months

  • Says mama or dada meaningfully

  • Repeats different consonant and vowel combinations

  • Imitates environment sounds such as car beep, animal sounds, or fire engine siren



12-15 months

  • Says or imitates between eight to 10 words independently

  • Imitates new words frequently

  • Says three animal sounds

  • Combines vocalizations and gestures when asking for an object (pointing and saying “milk”)

  • Babbles with adult-like intonation and occasional words



15-18 months

  • Child produces 15 words consistently

  • Uses words more than gestures

  • Begins to ask questions such as “what’s that?”

  • Child will name objects on request

  • Uses a variety of early consonant sounds like p, b, t, d, n, m, and h


18-21 months

  • Uses words frequently

  • Will imitate two-three word phrases such as “help me” or “want more please”

  • Child will occasionally produce two word phrases on their own


How to Encourage Language Development after First Words

After your child starts saying words, you may feel the progress of new vocabulary is slow. Modeling language, creating opportunities, and setting expectations are important to grow your child’s expressive language vocabulary. Below are a list of strategies to implement at home to improve your child’s use of words.


  • Narrate everything. During play, routines, and daily activities, narrate what you and your child are doing. Use simple, concrete nouns (dog, milk, cookie) and common verbs (go, eat, drink) in short phrases. If your child speaks in one word sentences, use two to three word sentences when narrating.

    • What does it look like? When getting dressed, mom says “Grace zips coat”. During mealtimes, dad says “I cut apple”.



  • Create language opportunities. Provide opportunities by holding toys back during play to encourage your child to request more of activities or specific items.

    • What does it looks like? Play with toys that have multiple parts such as legos, puzzles, blocks, sorting cube, and piggy bank. Parent holds the toy parts and hands each part after your child requests items with a word.  

Parent: “What do you want?”

Child: No response

Parent: “More”

Child: “More”

*Parent gives child one item*

If your child does not imitate word after two attempts, provide the toy so he or she does not become frustrated.


  • Wait. Parents know what their child wants without them having to verbally request with a word. Instead of automatically putting your child’s coat on or giving him the preferred toy, allow a period of wait time. Silently look at what your child wants, and wait for your child to request item. If your child does not say the item, give him a verbal model. If your child still doesn’t say the word after giving a prompt, give the item to your child.


    • What does it look like?

Parent: *silently looking at item”

Child: No response

Parent: “What do you want?”

Child: No response

Parent: “Ball”

Child: “Ball”

*Parent gives ball*



  • Give choices.  Providing two options to children forces them to communicate the object/activity they prefer. During meal times, hold up a preferred food (goldfish) and non-preferred food (carrot) then ask your child which one they want.  During play time, hold up two toys such as puzzle or ball.


    • What does it look like?

Parent: *Holds broccoli and goldfish*

Parent: “Which one do you want?”

Child: *Points to goldfish”

Parent: “Fish”

Child: “Fish”

*Parent gives fish*

  • Make it fun. Most importantly, make language development fun! The best way to do this is play with your child at their level. Teach them unique ways to play with your toys by making forts, pretend play, or setting up a picnic for all the stuffed animals. Children learn by imitating caregivers so continue to model phrases, play, and interaction with others.


Every child develops language at their own pace, but if you feel your child is significantly behind based on the typical milestone chart provided contact Lumiere Children’s Therapy for a language evaluation from one of our speech therapists.





References:

ChildTalk. “Child Talk.” How Many Words Should My Child Be Saying? A Quick Guide To Vocabulary Development, 1 Jan. 1970, www.talkingkids.org/2013/01/using-self-talk-and-parallel-talk-to.html.


Laura. “CHART 11 Skills Toddlers Master Before Words Emerge from Let's Talk About Talking.” Teachmetotalk.com, 28 May 2018, teachmetotalk.com/2018/04/18/chart-11-skills-toddlers-master-before-words-emerge-from-lets-talk-about-talking/.


Mattingly, Rhonda. “Typical Development .” Early Language Development . Early Language Development , 2016, Louisville, University of Louisville .


Mize, Laura. “11 Skils Toddlers Master Before Words Emerge.” Teach Me to Talk , Laura Mize, M.S., CCC-SLP, teachmetotalk.com/wp-content/uploads/2017/11/CHART-of-11-Skills-Toddlers-Master-Before-Words-Emerge-from-Laura-Mize-and-teachmetotalk.com_.pdf.

Rossetti, Louis. Rossetti Infant-Toddler Language Scale a Measure of Communication and Interaction. Pro-Ed, Distributor, 2006.

“The Effectiveness of Language Facilitation.” Leader Live - Happening Now in the Speech-Language-Hearing World, 29 May 2015, blog.asha.org/2014/05/22/the-effectiveness-of-language-facilitation/.


Lumiere Children’s Therapy: Asking and Answering Questions

“Hi, how are you doing?”

“I’m doing well, just got back from vacation”

“Where did you go?”

“Florida”

“Nice. Who did you go with?”

“My daughter”

“How did you get there”

“We drove.”


The above dialogue is an example of a typical conversation between two people discussing a recent vacation. The person asking the questions is showing interest and gaining more information by asking informative questions. The person answering questions is providing additional information about their trip by adequately answering the questions. Asking and answering questions appropriately is an important skill in order to participate in social conversation with others and build relationships.  It also aids in comprehension of spoken and/or written language by learning information through the form of questions and demonstrating understanding by answering comprehension questions.



What is Involved in Asking and Answering Questions?

Steps to adequately answer questions include:

  1. Hearing the question correctly

  2. Thinking about the meaning by deciphering the difference between who, what, where, when, why, and how

  3. Understanding the meaning or context

  4. Forming a suitable answer

  5. Articulate the answer in a grammatically correct sentence


Steps to adequately asking questions include:

  1. Determining the information you would like to receive

  2. Formulating a cohesive, grammatically correct question in your head

  3. Articulating the question to another person using adequate social skills

There is a hierarchy for answering and asking questions during development. “What” questions are the easiest to learn, use, and answer in language development. “Where” questions are next, followed by “who” questions. Lastly, the hardest questions to answer are “when” and “why”. When teaching children how to answer questions, start with “What” and “where” questions until fully mastered.


Milestones for Asking and Answering Questions

1-2 years old:

Answering:

  • Answers simple “what” questions like “what’s that?” while pointing at common objects

  • Answers simple “where” questions by pointing to objects or pictures in a book, such as “where are your shoes?”

  • Responds to yes/no questions with a nod or word

Asking:

  • Starts to add rising intonation to the end of phrases to indicate questions. For instance, “cookie?” may stand for, “Can I have a cookie?”

  • May start to ask “what’s that?” to unknown objects



2-3 years old:


Answering

  • Point to objects when described in questions such as “where do you sleep?” or “What do you wear on your feet?”

  • Answers simple wh-questions (what, where, who) logically

  • Follows directions when asked “Can you..” such as, “Can you give me the brush?”

Asking

  • Asks basic “where”, “what”, and “what are you doing”.. questions independently, “Where daddy?”



3-4 years old:

Answering

  • Appropriately answers more complex /wh/ questions such as “who”, “what”, “where”, “when”, and “how”

  • Answers questions about objects function such as “what do we do with a towel?”

  • Answers hypothetical questions. For instance, “If your sick, where do you go?”

Asking

  • Uses correct syntax while phrasing questions such as “where is sister going?” instead of “sister going where?”

  • Starts to ask “why” questions about everyday life

  • Asks the following types of questions using correct grammar:

    • Early infinitive “Do you want to go to the zoo?”

    • Future “Are we going to school?”

    • Modal can/may “Can I use the bathroom?”



4 years old:

Answering

  • At this age, children should appropriately answer all wh-questions including “when” questions. For instance, “when do you brush your teeth?”

Asking

  • Asks questions using age-appropriate structure including “ Can I…”, “Do you want to…”, and “Are we going…”


Activities to Try at Home:

  • For 1-2 year olds, asking questions should remain at the basic level. Line up favorite toys or household items and ask the child to name each by asking “What’s that?” Play with animal figurines and ask your children, “What sound does a pig make?” and so on. Books are great to use so that children can point to the answers for “What’s that” questions. First 100 Words by Roger Priddy is a favorite book of speech therapists.

  • In order to work on yes/no questions, ask preferential questions in that format. For instance, “Do you want yogurt? Yes or no?”. Nod your head accordingly while saying yes versus no so that your child fully understands.

  • Car rides provide ample time to address “wh” questions revolving daily activities. If headed to the grocery store, questions may include “Where do we go to buy food?”, “What should we buy for breakfast”, or “Where do they keep the milk?”. After school, ask more specific questions about the day, “What did you eat for lunch?”, “Who did you sit next to in class?”, or “Where did you play during recess?”.

  • Make a wh- poster board. Split the poster into thirds (what, where, who) or fourths (what, where, who, when) depending on your child’s age. Look through old magazines and cut out pictures to glue into the corresponding spots. “What” pictures may include clothing, food, or toys. “Where” pictures would include indoor or outdoor places. “Who” pictures would be people. “When” pictures can feature seasons, holidays, or time of day.

  • Create your own story books. First, decide what the story is going to be about (vacation, dance class, school, shopping, getting a pet, etc). Next, ask your child questions about the story in order to write a plot, such as “Who is the story about”, “Where are they going?”, “What are they doing there?”, “When does it take place?”, and “How does it end”. Have your child draw a picture on each page to go along with the text.

  • For older children, games can be used to encourage asking questions. The following games encourage the development of asking and answering questions.

Reading Comprehension Milestones

As children enter school-age, asking and answering question skills are applied to reading comprehension. Children begin to understand what they are reading through determining the elements of a story (character, setting, plot, main idea, rising action, and resolution). Below outlines a typical development of reading comprehension skills, and strategies to aid in development to try at home.

Kindergarten (5 years old)

  • Kindergarteners can start to retell details of a story read out loud by stating the who, what, when, where, and why of the plot

  • Children can retell the main idea of simple stories

  • Children can arrange story events in sequential order

  • They are able to answer simple “what” questions about the story read to them

First and Second Grade (6-7 years old)

  • Children are able to read simple, familiar stories themselves

  • Answer questions about a story that requires them to think about what they have read

  • Demonstrate understanding of a story through drawings

  • Children can create their own stories by organizing thoughts in a logical sequence of beginning, middle, and end

Second and Third Grade (7-8 year old)

  • Children are able to read longer books independently

  • Able to identify unfamiliar words through context and pictures

  • Apply reading skills to writing skills by forming complete paragraphs


Fourth through Eighth Grade (9-13)

  • Able to read and explore variety of texts including narratives, poetry, fiction, and biographies

  • Identify the elements of the story such as time, setting, characters, plot, problem and resolution

  • Analyze texts for meanings, use inferencing skills, and make predictions.

Strategy for Home

Make reading a part of your daily routine, whether it is a book in the morning, after school, or before bed. Stop periodically throughout the book to check for comprehension by asking “What is happening?”, “Who is this about?”, and “What do you think will happen next?”. For younger children, fold paper into three creases and have the child draw three pictures to represent the story.

If your child demonstrates difficulty answering or asking questions or seems behind on the language development milestones, Lumiere Children’s Therapy can provide the appropriate intervention to improve language skills.

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References:

“Asking and Answering Questions.” Speech And Language Kids, www.speechandlanguagekids.com/questions-resource-page/.

Lanza, Janet R, and Lynn K Flashive. “Question Answering and Asking Milestones.” Parent Resources Blog, LinguiSystems, Inc., 2008, parentresourcesblog.files.wordpress.com/2013/05/questions-development.pdf.

Morin, Amanda. “Reading Skills: What to Expect at Different Ages.” Understood.org, \www.understood.org/en/learning-attention-issues/signs-symptoms/age-by-age-learning-skills/reading-skills-what-to-expect-at-different-ages.

“Reading Milestones (for Parents).” Edited by Cynthia M. Zettler-Greeley, KidsHealth, The Nemours Foundation, June 2018, kidshealth.org/en/parents/milestones.html.

Spivey, Becky L. “How to Help Your Child Understand and Produce ‘WH’ Questions.” Super Duper Handy Handouts, 2006 Super Duper Publications, 2006, www.superduperinc.com/handouts/pdf/110_wh_questions.pdf.

“Teaching Your Toddler to Answer Questions - Receptive and Expressive Language Delay Issues.” Teachmetotalk.com, 13 Sept. 2017, teachmetotalk.com/2008/02/26/techniques-to-work-on-answering-questions-with-language-delayed-toddlers/.

“Why Is Asking and Answering Questions Important?” ABC Pediatric Therapy, 11 Mar. 2018, www.abcpediatrictherapy.com/why-is-asking-and-answering-questions-important/.


Lumiere Children’s Therapy: Feeding Tubes

For children who are at risk for complications when eating by mouth, feeding tubes can provide necessary nutrition in a safe manner. Problems with swallowing may occur in one of the four stages of the swallow as described in a previous post,  Swallowing Difficulties in Children. There are six types of feeding tubes available to children with swallowing problems. Below explains the advantages and disadvantages of each type of feeding tube, as well as treatment for children with a feeding tube.

Nasal Feeding Tubes

Nasal feeding tubes are tubes that are entered through the nose down the esophagus. There are three types of nasal feeding tubes: nasogastric, nasoduodenal, and nasojejunal. Deciding between the three types depends on whether your child can tolerate feedings into the stomach. Nasoduodenal and/or nasojejunal tubes are recommended if a child demonstrates chronic vomiting, inhaling or aspirating stomach contents into airway, and/or does not empty feedings well since those tubes bypass the stomach.

Nasogastric Tubes (NG)

NG tube enters through the nose feeding into the stomach through the esophagus (connects the throat to the stomach).

  • Advantages

    • No anesthesia is required for insertion of tube

    • Tubes may be replaced at home

    • Feedings are usually quick

    • NG are used for shorter duration cases, usually 1-6 months

    • Stomach provides a larger capacity for feedings

  • Disadvantages

    • NG tube is visible on face

    • NG tube can be irritating so younger children may pull it out

    • Increased risk of aspiration (food or liquid entering airway) from reflux

    • Increased nasal congestion

    • Possibility to cause oral aversions and/or increase amount of reflux

Nasoduodenal Tubes (ND)

ND tubes enter through the nose and extend into the beginning of the small intestine called the duodenum. The small intestine is the location of the majority of digestion in a person’s body, therefore bypassing the stomach.

  • Advantages

    • No anesthesia is required for insertion of tube

    • Can reduce reflux. Reflux is when stomach bile irritates the food pipe by coming back up the esophagus

    • Reduced risk of aspiration (food or liquid entering airway) from reflux

    • ND are used for short term use, usually 1-6 months

  • Disadvantages

    • Feedings are given slowly over 18-24 hours

    • Child may be self-conscious with visible tube coming from nose

    • Tube may be irritating with younger children possibly pulling it out

    • Potential intolerance to feedings entering small intestine causing bloating, cramping, and/or diarrhea

Nasojejunal (NJ)

NJ tubes are similar to ND as they enter through the nose extending into the small intense. NJ tubes extend further into the small intestine called the jejunal. The tube is designed for children who demonstrate difficulty with feedings into their stomach.

  • Advantages

    • No anesthesia is required for insertion of tube

    • Reduces risk of reflux

    • Reduced risk of aspiration (food or liquid entering airway) from reflux

    • Tubes are primarily recommended for short term use (1-6 months)

  • Disadvantages

    • Feedings are given slowly over time

    • Tube is visual, so may be irritating and/or children may feel self-conscious

    • There are potential intolerances to feedings such as bloating, cramping, or diarrhea

Stomach Feeding Tubes

Feeding tubes are entered directly into the stomach instead of through the esophagus. There are three types of stomach feeding tubes: gastrostomy, gastrojejunal, and jejunostomy. The following are common conditions that may require the use of a stomach tube.

  • Problems of the mouth, esophagus, stomach or intestines presented at birth

  • Prematurity, brain injury, developmental delay, and neuromuscular conditions causing sucking and swallowing disorders

  • Failure to thrive, which is when a child is unable to gain adequate weight to grow appropriately

Gastrostomy Tube (G)

The G-tube is inserted through the abdomen directly into the stomach, completely bypassing the throat. If a child requires tube feeding for over 3 months and/or having difficulties with nasal tubes, gastrostomy tubes are usually recommended.

  • Placement of tubes: There are three types of methods for inserting G-tubes: percutaneous endoscopic gastrostomy (PEG), laparoscopic, and open surgical procedure. All procedures take about 30-45 minutes to administer.

    • PEG: most common technique for first placement of G-tube as it does not require surgery. The doctor is able to use a thin, flexible tube with a camera to insert the tube through the mouth and into the stomach

    • Laparoscopic technique: performed by making small incisions into the abdomen and inserting a tiny telescope to help with placement

    • Open surgery: Alternative for cases where a PEG placement is not appropriate

  • Advantages

    • PEG placement does not require surgery

    • Decreased clogging of tube since diameter is larger

    • Larger reservoir in stomach compared to small intestine

    • Child may feel less self-conscious since tube is not visible

    • Decreased chance of tube being pulled out

  • Disadvantages

    • Risk of aspiration due to reflux

    • Family is required to provide extra care to cleaning of tube

    • Surgery may be required depending on placement.

    • Possible skin irritation from leakag

Gastrojejunal (GJ)

A GJ tube is similar to a G-tube as the tube is placed through the skin into the stomach. The difference is a GJ tube has two feeding ports on one tube so that the food enters into the stomach and then down into the small intestine (jejunum portion). G-tubes may be converted into GJ tubes if the child is not tolerating stomach feedings.

  • Advantages

    • Reduced risk of aspiration

    • May reduce reflux

    • Less costly than J-tube placement

    • Tube is hidden, so child may be less self-conscious

  • Disadvantages

    • Potential intolerance of tube

    • Extra care required

    • Potential skin irritation

    • Tube may clog more easily due to smaller diameter

Jejunostomy (J)

A J-tube is placed directly into your child’s small intestine through the skin. This type is not as common for children.

  • Advantages

    • Reduced risk of aspiration and reflux

    • Tube is hidden

  • Disadvantages

    • Potential intolerance to placement of tube

    • Extra care required

    • Potential skin irritation from leakage

    • Tube is small and more likely to clog

    • Surgery is required for placement of jejunostomy

    • Feedings are slow


Treatment of Children with Tube Feedings

Depending on the type of tube and duration of tube feeding, children with tube feedings are at risk for developing oral aversion to food through the mouth. Oral aversion is when a child experiences a fear of eating or drinking and avoids sensation around or in the mouth. Children who are tube-fed often, develop oral aversions because many have learned that food hurts based on a history of medical issues involved with eating (reflux, aspiration, food allergies, and/or motility). In some cases, feeding tubes are used to supplement adequate nutrition but children may be able to eat orally with some limitations on foods, consistencies, textures, and liquids. If your child has been approved to eat some food orally, it is highly encouraged. In order to reduce the risk of developing oral aversion, the following is recommended by speech therapists:

  • Oral sensation. Children with oral aversions will try to avoid sensation around and in the mouth. Children with feeding tubes should continue to experience the same oral sensation in normal routines as children who eat orally, especially oral care. Adequate oral care such as teeth brushing is not only important to reduce aspiration (food getting into the airway) from reflux, but also continues to provide oral sensation. Consider getting a child-proof vibrating toothbrush for extra sensation. During nightly routines, apply lotion to the face while massaging the cheeks, place chapstick on the lips, and make funny faces in the mirror to encourage facial muscle movement.

  • Participate in mealtimes. Children with feeding tubes often miss out on the social, exploratory, playful aspect of eating. Allow your child to continue to experience the fun of eating by helping prep for dinner, setting the table, sitting with the family, and even playing with the food on the table! If your child is able to eat pre-approved food, be sure to have appropriate food available. Most children with oral aversion would prefer not to participate in the act of eating, but continues to benefit from the social aspect of mealtimes.

  • Playing with food. In many feeding therapy approaches, the first step to consuming food orally is accepting food using the other senses: touching, smelling, and licking. Create artwork using edible food by painting with pureed food, making edible play dough, and building structures with variety of food. Show children that food can be fun and non-threatening.

If your child currently has a feeding tube or is planning to receive one, feeding therapy is highly recommended to ensure your child is receiving adequate nutrition and quantity from oral feedings. Speech therapists can provide systematic feeding approaches, including but not limited to mealtime focus, S.O.S. (Sequential Oral Sensory), ABA (Applied Behavior Analysis), baby or child-led weaning, and hunger-based cues. Lumiere Children’s Therapy can provide feeding therapy for your child as well as a home exercise program to assist with carryover into the home environment.

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References

“Addressing Oral Aversions.” Feeding Tube Awareness Foundation, www.feedingtubeawareness.org/navigating-life/oral-eating/feeding-therapy-oral-aversions/.



“ARK's Y-Chew® Oral Motor Chew.” ARK Therapeutic, www.arktherapeutic.com/arks-y-chew-oral-motor-chew/.



“Enteral Tube Program | Home Care Instructions after Placement of a Gastro-Jejunal (G-J) Tube | Boston Children's Hospital.” Boston Childrens Hospital, www.childrenshospital.org/centers-and-services/programs/a-_-e/enteral-tube-program/family-education/giving.



“Feeding Therapy.” Feeding Tube Awareness Foundation, www.feedingtubeawareness.org/navigating-life/oral-eating/feeding-therapy-oral-aversions-2/.



“Gastrostomy Tube (G-Tube).” Edited by Steven Dowshen, KidsHealth, The Nemours Foundation, Jan. 2018, kidshealth.org/en/parents/g-tube.html.


Mattingly , Rhonda. “Management of Pediatric Feeding Disorders.” U of L Pediatric Feeding. U of L Pediatric Feeding, 2017, Louisville , University of Louisville .


“Tube Types.” Feeding Tube Awareness Foundation, www.feedingtubeawareness.org/tube-feeding-basics/tubetypes/.


VanDahm, Kelly. “Chapter 9: The Nutritional Foundation.” Pediatric Feeding Disorders Evaluation and Treatment, Therapro, Inc, 2012, pp. 227–227.

Child Speech Therapy: Expressive Language Skills

Hearing your child’s voice for the first time is an exciting, monumental part of parenthood. As the first babbles turn into words, and eventually sentences, your child’s expressive language is developing. Receptive language is the ability to understand language, as expressive language is the ability to use words, sentences, gestures, and writing to communicate with others.

What is expressive language and why is it important?

Expressive language allows a person to communicate wants, needs, thoughts and opinions. Expressive language is the ability to request objects, make choices, ask questions, answer, and describe events. Speaking, gesturing (waving, pointing), writing (texting, emailing), facial expressions (crying, smiling), and vocalizations (crying, yelling) are all variations of expressive language. Children with poor expressive language skills may become frustrated when they cannot communicate their wants and needs. Temper tantrums may occur when they feel tired, sick or hungry and cannot express their current needs.

How do expressive language skills develop?

Expressive language is developed within the first few days after birth. Babies learn to communicate when they are hungry, uncomfortable or tired through crying and facial expressions. They learn to laugh when they are enjoying an interaction with a parent or caregiver, and smile when they are happy. These are all forms of communication. In order for expressive language skills to develop, a child also needs to have strong receptive language, attention, play, social pragmatics and motivation.

  • Receptive language skills is the comprehension of language which is an underlying skill to label objects, answer questions appropriately, and use language in the intended way.

  • Adequate attention skills is an underlying skill for all developmental tasks. The ability to sustain attention is important in order to finish one’s thought and effectively communicate to others.

  • Play skills encourage children to explore their surroundings. Play can be an intrinsic motivator for young children to communicate by requesting, interacting, and labeling toys.

  • Pragmatic skills is the way language is used day to day in social situations. Adequate pragmatic skills allows a person to participate in conversation appropriately.

Expressive Language Milestones & Activities:

The following, outlines expressive language milestones from birth to 7 years old in three categories: birth, preschool, and school age. Learn about the typical developmental stages as well as activities to try at home.

Birth- 3 years old

  • 0-1 years old:

    • Produces pleasure sounds (cooing and gooing)

    • Makes noises when talked to

    • Protests or rejects through gestures or vocalizations

    • Cries differently for different intentions

    • Attempts to imitate facial expressions and movements of caregivers

    • Laughs during parent interaction

    • Between 7-12 months, child will start to babble sounds together (mama, dada)

    • Uses a representational gesture (such as waves bye-bye, claps hands, moves body)

  • Activities to Try at Home:

    • Talk to your child. When your child is developing language, they learn through role models. Talk to your child about your day, what you are doing, and what they can see. It may feel strange at first to talk to your baby without them responding, but the more you talk, the more they learn.

    • Read. It is never too early to start reading books to your child. Point out familiar pictures in the books. If you are reading about animals, make the animal sounds associated with each animal.  

    • Imitate. Imitate all sounds, gestures, and facial expressions your child makes. Repeat a noise they make, and wait for a response. Encouraging imitation can help your child participate in social turn-taking and start to imitate your words.


1-2 years old

  • First words develop around 12 -14 months (hi, mama, dad)

  • Takes turns vocalizing with another person

  • Uses at least two different consonant sounds (early signs include p, b, t, d, m)

  • Around 18-24 months, child begins putting 2 words together (“more cookie,” “no book,” “all done”)

  • Uses one-to-two word questions such as  “go bye bye?” or “where mommy?”

  • Uses a variety of nouns (e.g. mom, dog) and verbs (e.g. eat, sleep)


2-3 years old

  • Participates in play with another person for 1 minute while using appropriate eye contact

  • Repeats words spoken by others

  • Has a word for almost everything

  • Speaks in two-three word sentences

  • Asks what or where questions (e.g. “what’s that?”)

  • Ask yes and no questions

  • Will add “no” in front of verbs to refuse activities (e.g. “no go”)

  • Imitates turn-taking in games or social routines

Activities to Try at Home:

  • Games. Simple turn-taking games help children learn how to wait and take turns which is a necessary skill in conversations. Fun toddler games include Let’s Go Fishin’, Seek-a-boo, and Hi Ho Cherry-O.

  • Expand sentences. Imitate your child’s speech and add on extra words to make it grammatically correct. For instance, if you child says “more juice”, you can repeat “I want more juice”.


Preschool

  • 3-4 years old

    • Names objects in photographs

    • Uses words for a variety of reasons (requests, labels, repetition, help, answers yes/no, attention)

    • Around 3 years, child combines 3-4 words in speech

    • Answers simple who, what, and where questions

    • Uses about 4 sentences at a time

    • Child’s speech can be understood by most adults

    • Asks how, why, and when questions

  • Activities to Try at Home

    • Yes/no game. Make a game out of yes/no questions by asking your child funny questions such as “Is your name Bob?”, “Can you eat dirt?”, “Do you like ice cream?” Then have your child make up silly questions to try to trick you!

    • Ask questions. While running errands, ask your child questions about the community. For instance, “where do we buy food?”, “who helps you when you are sick?”, or “what do you do if it’s raining?”


  • 4-5 years old

    • When given a description, child can name the described object. For example, “What is round and bounces?”

    • Answers questions logically. For example, “what do you do if you are tired?”

    • Uses possessives (the girl’s, the boy’s)

    • Tells a short story

    • Keeps a conversation going

    • Talks in different ways depending on the place or listener


  • Activities to Try at Home

    • I-spy. Describe common objects around the house by giving descriptive clues such as what it looks like, what you do with it, where you would find it, etc. Have your child guess what you are talking about! Include objects out of sight to encourage your child to determine objects on their own, and then have them go on a scavenger hunt to find it.

    • Make up stories. Build a blanket fort, grab a flashlight, and create fairy tale stories. Toys may be used as prompts to help make up a story. Incorporate each part of a story including setting, characters, beginning, middle, and end.


School age

  • 5-6 years old

    • Child can tell you what object is and what it’s used for

    • Answers questions about hypothetical events. For example, “What do you do if you get lost?”

    • Uses prepositions (in, on, under, next to, in front of) in sentences

    • Uses the possessives pronouns her and his

    • Names categories of objects such as food, transportation, animals, clothing, and furniture

    • Asks grammatically correct questions

    • Completes analogies. For instance, you sleep in a bed, you sit on a chair

    • Uses qualitative concepts short and long


  • Activities to Try at Home

    • Category games. Name 5, Scattergories, and Hedbanz are fun and engaging games to work on naming categories.

    • Simon says. Play a game of simon says using prepositions. For instance, Simon says put the book on the table. Once your child is familiar with the game, have them be Simon and give directions using prepositions.


  • 6-7 years old

    • Child is able to names letters

    • Answers why questions with a reason

    • Able to rhymes words

    • Repeats longer sentences

    • Able to retell a story

    • Describes similarities between two objects

  • Activities at Home

    • Read rhyming books. Dr. Seuss books are great to teach rhyming. Read a page and have your child identify the words that rhyme.

    • Movies. After watching a movie, have your child summarize the plot. Guide your child by breaking it up into beginning, middle, and end.


If you feel your child is developmentally delayed in his or her expressive language skills, contact Lumiere Children’s Therapy for a speech-language evaluation. Our speech therapists can formally assess your child’s expressive language skills, create age-appropriate goals, and develop a therapeutic program unique to your child’s needs.

Resources:

“Baby Talk: Communicating With Your Baby.” WebMD, WebMD, www.webmd.com/parenting/baby/baby-talk#2.

Expressive Language (Using Words and Language). (n.d.). Retrieved from https://childdevelopment.com.au/areas-of-concern/using-speech/expressive-language-using-words-and-language/

“How to Support Your Child's Communication Skills.” ZERO TO THREE, www.zerotothree.org/resources/302-how-to-support-your-child-s-communication-skills.

Mattingly, R. (2018, September 13). Typical Development. Lecture presented in University of Louisville, Louisville.

Zimmerman, Irla Lee., et al. PLS-5 Preschool Language Scales: Fifth Edition. NCS Pearson, 2011.

Child Speech Therapy: Making Social Stories

Last week on the blog, we discussed the benefits of social stories for children with autism and/or language disorders. Social stories, developed by Carol Gray, provide an easy to follow visual for appropriate behavior and conversation during social situations. They can be used for a variety of purposes including transitions, inappropriate behavior, social interactions, and new experiences. 

Shawn Rossi

Shawn Rossi

Writing a social story

The most effective social stories relate to the child’s current routine or situation. Writing your own story allows one to directly target a desired skill. There are a few points to consider when writing a social story:

·     Intent of message: What is the main idea or point of the story? The intent may be for self-regulation, self-esteem, social skills, or productive behavior.  Instead of explaining what a child should not do, create positive messages to encourage appropriate behaviors. For instance, instead of saying “do not hit when upset”,reword to a more positive behavior, such as: “we use our words when we are upset”. 

·     Complexity of language: Using simple, direct language, increases comprehension and implementation of the message. Choose age-appropriate vocabulary that the child understands.  

·     Step-by-step: Social stories are effective because they take the guesswork out of a social situation. Be sure to include each mundane step so children can effectively implement the message without having to make their own inferences.   

·     Sentence types: There are four types of sentences that are used in a social story: descriptive, directive, perspective, and control. All four sentences should be included in the story. Below are examples for each type in regard to a social story about personal space:

o  Descriptive sentences: Explain what people do in a certain social situation from a third person perspective. “It is not polite to stand too close to people. It is polite to respect others’ personal space”. 

o  Directive sentences: Positively elicit a specific response or behavior. “When I talk to other people, I need to step back and give them some space”. 

o  Perspective sentences: Explain another person’s feelings or opinions in a social situation. “My friend feels uncomfortable when I stand too close. She is happy if I give her space”. 

o  The control sentence: Is the message intent of the story. The child constructs the sentence to help them recall the targeted skills. “I remember to keep an arms’ length between my friend and I when we talk”. 

 

How to use social stories?

Create an easy to access plan for the social story. Would it be best to keep on the desk, near the door, or in their folder? Next, determine who will be the facilitators of the social story. For non-readers, a caregiver can read the story out loud, record on a device, or program the story into an assistive device and/or ipad. For readers, the teacher or caregiver may be able to simply reference the story by pointing and bringing attention to it during specific situations. As mentioned in last week’s post, social stories are only one component of therapy. For the story to be successful, the child must practice the desired skill in appropriate situations with the help of parents, caregivers, and/or therapists. As the child practices and uses the skills more often, the story is slowly faded out. Eventually the skill will be engraved in long-term memory, and the visual of the social story is no longer necessary. 

 

Examples of Social Stories

To learn how to make your own template, Autism Speaksoutlines the steps using Microsoft PowerPoint here. Below are some free, pre-made stories to try out! 

·      I Will Not Hit

·     Playing with Friends(from headstartinclusion.org)

·     How to Talk to my Friends(from Watson Institute) 

·     Seat Work(from esc20.net) 

Check out more on ABA Education Resources.  

 

LUMIERE THERAPY TEAM🖐️

 

Resources: 

Cosgrave, Gavin. “Social Stories.” Token Economy - Educate Autismwww.educateautism.com/social-stories.html.

“Social Stories for Autism, ADHD and PDD-NOS.” Epidemic Answers, 17 Apr. 2014, epidemicanswers.org/social-stories-for-autism-adhd-pddnos/.

“Social Stories.” PBIS World RSSwww.pbisworld.com/tier-2/social-stories/.

“Social Stories.” Social Stories : ABA Resources, www.abaresources.com/social-stories/.

Vicker, Beverly. “Indiana University Bloomington.” IIDC - The Indiana Institute on Disability and Community at Indiana University

www.iidc.indiana.edu/pages/Behavioral-Issues-and-the-Use-of-Social-Stories.

 

Child Speech Therapy: Social Stories

Temper tantrums during transitions? Hitting during recess? Inappropriate topics during conversation? 

Social stories provide an educational visual to address specific social situations. Verbal explanation of social interactions may be difficult for children to fully comprehend, so visuals can provide additional information.

John Morgan

John Morgan

What are Social Stories?

            Social stories were first introduced and described by Carol Gray as an intervention strategy to teach appropriate social interactions through the elements of a simple story. Social stories outline social concepts and skills in an easy step-by-step manner. They were originally developed for children with autism, but can be beneficial for any child with pragmatic and language disorders.

            Social stories can be a proactive or reactive strategy. Implementing social stories as a proactive measure involves presenting the story before an upcoming social event or situation. If a child is going on a fieldtrip, a social story can outline the new schedule for the day in order to prepare the child for the change in routine. For upcoming play dates, it can give examples on polite ways to share toys. 

            They may also be used for reactive measures, specifically for negative behaviors. For instance, if a child is hitting other kids on the playground, a social story can explain why this behavior is not appropriate while offering new, positive behaviors. They should not be the only source of intervention, especially for negative behaviors. Social stories can provided the child with positive alternatives for negative behaviors in a direct, simple fashion. After the child has been presented with the information, speech-language pathologists, teachers, and/or caregivers can help the child develop the appropriate behavior skills.   

Why do social stories work? 

            Theory of mindis the ability to understand another person’s feelings, perspective, and beliefs. Children with autism often struggle with understanding theory of mind. They can only see their perspective of the story. Consider a child grabbing a toy out of another person’s hand. The child wanted that toy and decided to take it. For a child with autism, that may be the only perspective they understand.   It may be challenging to realize that the classmate was sad when the toy was taken away. 

            Lacking theory of mind creates problems in social situations and can make social society rules seem confusing and difficult. Social stories allow children the opportunity to learn about the other person’s perspective. The stories will outline how the other child feels and why it was hurtful. It takes the guesswork out of social situations and provides strategies or skills to implement in a given situation. 

When should you use social stories?

            Social stories can be implemented in a variety of opportunities. Below are a few examples. 

·     Establish rules and expectations

·     Address negative behaviors

·     Present new social situations (birthday parties, play dates, social groups)

·     Address personal hygiene

·     Address personal space

·     Describe feelings

·     Selecting appropriate social topics

Social stories are intended for specific situations and events in the child’s life. Create or implement social stories that are relevant and meaningful in the child’s everyday activities. 

Next week on the blog, we will discuss how to create a social story. In the meantime, explore these, here.

 

LUMIERE THERAPY TEAM🖐️

 

References:

Cosgrave, Gavin. “Social Stories.” Token Economy - Educate Autismwww.educateautism.com/social-stories.html.

“Social Stories.” PBIS World RSSwww.pbisworld.com/tier-2/social-stories/.

Vicker, Beverly. “Indiana University Bloomington.” IIDC - The Indiana Institute on Disability and Community at Indiana University

www.iidc.indiana.edu/pages/Behavioral-Issues-and-the-Use-of-Social-Stories.

Child Speech Therapy: Games for Following Directions

            Last week, we discussed developmental milestones for following directionsand tips to try at home. Following directions doesn’t have to be boring; in fact, it can be a lot of fun! Games of all types require the ability to listen and follow verbal or written directions. Read below for exciting games and activities that work on direction following skills. 

Simon Says

 “Simon Says” is a great game that targets listening skills and following directions. For children struggling with following directions, play with another sibling or peer as a model.  As your child progresses, increase the difficulty of the game by adding 2-3 step directions. Take turns being Simon so your child has a chance to trick you, as well!

Obstacle Course

Obstacles courses not only work on following directions but work on gross motor skills as well.  Create an awesome obstacle course using pillows to walk across, tunnelsto climb through,  to jump on, and ball pitto end up in!  

Board games

Classic board games such asCandy LandChutes and Ladders, and Sorryare excellent ways to practice following directions and turn-taking in a fun, structured activity. Although it is tempting to let your child win every game, allow the opportunity to teach good sportsmanship after losing a round. 

Twister

 Twister targets body parts, colors, and left/right concepts all in one game! Given a verbal direction of “Right hand on blue circle”, targets following directions, working memory, and language concepts. Recommended for children 6 and older. 

Coloring books

While your child is coloring, give directions for each page. For instance, “color the hat red” will encourage your child to identify the object and color while following 2-step directions. 

Chores

What better way to make following directions functional? Household chores. Easy household chores encourage responsibility, accountability, and time-management skills at a young age. Make the chores rewarding by finding a chore chart that works for your family. Click herefor some great ideas!

 

LUMIERE THERAPY TEAM🖐️

 

References: 

“How To Get A Child Following Directions.” Speech And Language Kids, 18 Apr. 2017, www.speechandlanguagekids.com/how-to-get-your-child-to-follow-directions/.

Katie. “Five Playful Ways to Work on Listening and Following Directions.” Playing With Words 365, 19 Feb. 2018, www.playingwithwords365.com/five-playful-ways-to-work-on-listening-skills/.

 

Child Speech Therapy: Following Directions

“Wash your hands.” 

“Put your shoes on.”

“No yelling in the house.” 

These may sound like common phrases in your household. Such commands require children to interpret the meaning and follow the verbal directions accurately, which may present as a challenge for some children.  Following directions is a skill required in school, at home, and during everyday activities. Below, we’ve listed some milestones in relation to age when it comes to developing the skills for following directions.

Developmental Milestones:

Screen Shot 2018-06-04 at 11.12.37 AM.png

Tips to improve comprehension of directions: 

·     Simplify directions: Adults use complex language when giving directions such as, “Will you please get my shoes when you’re over there?” or “After you take out the trash, will you get the mail?” For children developing language skills, directions can be challenging to comprehend when using words such as beforeafterinsteadnext, andthen. Keep directions short and sweet when your child is young such as “get your shoes” and “open the door”

·     Visuals: Take pictures of common directions to use as a visual prompt. Determine the most frequent directions you give your child throughout the day. Take pictures of your child completing the tasks (such as putting on clothing, getting in the car, washing hands). Print the pictures and either hold them up when you give the directions or hang the pictures in the designated areas

·     First, then: When introducing 2-step directions, use word directions with first-then language. For example, “first put on socks, then shoes” or “first get your backpack, then go to the car”

·     First, then, last: When your child is ready for 3-step directions, use the phrase “first, then, last”. Your child will most likely catch on quickly since they are already familiar with the first two steps

 

Next week on the blog, we will provide fun games and activities to practice following directions! 

 

LUMIERE CHILDREN'S THERAPY🖐️

 

References: 

“How To Get A Child Following Directions.” Speech And Language Kids, 18 Apr. 2017, www.speechandlanguagekids.com/how-to-get-your-child-to-follow-directions/.

Katie. “Five Playful Ways to Work on Listening and Following Directions.” Playing With Words 365, 19 Feb. 2018, www.playingwithwords365.com/five-playful-ways-to-work-on-listening-skills/.

Klarowska, Beata. “Speech and Language Development (Milestones).” Virtual Speech Center, Virtual Speech Center, Inc, 25 July 2011, www.virtualspeechcenter.com/blog/37/speech-and-language-development-milestones.

 

 

 

 

Child Speech Therapy: Colors

A newborn only sees black, white and gray during the first week of life. Throughout the next 10-12 weeks, newborns slowly adjust to color vision and the full color spectrum is developed by five months old. Around 18 months, children begin to notice similarities and differences between sizes, shapes and colors. They are able to recognize the variety of colors, and are able to accurately name at least one color by three years old.  Recognizing and naming colors is an exciting development for children since so many children’s toys are brightly colored. 

Children learn colors in three steps: matching and categorizing colors, identifying colors, and finally, naming colors. Below are toys and resources to use during each stage. 

Matching and categorizing colors

·     Puzzles are a great way to work on matching colors. Some favorites include: Melissa & Doug Colorful Fish Wooden Chunky Puzzleand The Learning Journey Lift & Learn Colors & Shapes

·     Categorize by color and shape with MoTrent Wooden Educational Preschool Shape Coloror Melissa & Doug Stack and Sort Board Wooden Educational Toy.

·     Learning Resources Farmer’s Market Color Sorting Sethelps educate children on the colors of fruit and vegetables through sorting into purple, yellow, orange, green, and red baskets. 

Identifying colors

·     Have children identify colors by pointing during a game of “I-spy”.  While grocery shopping, ask your child “point to a red apple”.  Not only are you working on colors, but food recognition as well!

·     Books are a great way to identify colors. Some of our favorites are Brown Bear, Brown Bear by Bill Martin, Jr,Blue Hat, Green Hat by Sandra BoyntonThe Mixed-up Chameleon by Eric Carle,and Bright Baby Colors by Roger Priddy

·     If your child enjoys arts and crafts, participate in painting and coloring with your child. Ask your child to hand you different colored art materials such as blue paper, a purple crayon or a red sticker. 

Naming colors

·     Encourage naming colors during coloring activities by having the caregiver hold the crayon box, and requiring your child to request each color. Let your child reach for the requested crayon to ensure they are asking for the desired color. 

·     The Learning Journey Learn with Me Color Fun Fish Bowltargets recognition and identification of colors. The first setting identifies the color of fish inserted, and the second setting will request a specific color. 

·     Continue to ask your child about colors during play. Most toys are very colorful, so you can ask, “What color is this?” throughout the game.

·     Great colorful toys: YIRAN wooden pounding benchThe First Years Stack Up Cups, and Melissa & Dough Shape Sorting Cube.

 

LUMIERE THERAPY TEAM🖐️

 

References:

Hudson, Judith. “When Will My 2-Year-Old Know His Colors?” BabyCenter, 3 Apr. 2018, www.babycenter.com/404_when-will-my-2-year-old-know-his-colors_69360.bc.

“When to Teach Kids Colors?” New Kids Center, www.newkidscenter.com/When-Do-Kids-Learn-Colors.html.

“Your Baby's Eye Development.” Bausch + Lomb, www.bausch.com/vision-and-age/infant-eyes/eye-development.

 

Child Speech Therapy: Grammar Elements: Verbs

As your child develops language, the first few words are usually names and objects (nouns) such as Dada,ball, and dog.  Around 24 months, the child’s vocabulary repertoire starts to include verbs. Verbs are action words such as gowalk,jumpeat, and come.  Understanding and using verbs allow the child to communicate in sentences rather than 1- word phrases. 

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amg1994

Language acquisition varies among children, but by 24 months children typically express around 40 verbs. Children with an increased verb acquisition by 24 months typically have more advanced grammatical skills six months later. For children producing less than 10 verbs at 24 months, it is not a concern as long the child is learning several new verbs every month. If you are concerned about your child’s language acquisition, contact Lumiere Children’s Therapyfor a speech evaluation. 

Below are some strategies to help your child learn more verbs:

·     Books. Creating an opportunity for story time in your day, whether morning or night, is fundamental for language development. Here are some great books to introduce verbs: To Root, To Toot, to Parachute: What Is a Verb? By Brain P. ClearlySlide and Slurp, Scratch and Burpy by Brian P Clearlyand Nouns and Verbs have a Field Day by Robin Pulver.

·     Pretend Play. Imaginary play is a great chance to label everyday action verbs. Model verb phrases throughout play, for instance, feedingand changinga baby doll, flying an airplane, or cooking in a play kitchen

·     Modified Charades. Play the video Actions 2 Verbs with Lyrics, and act out the actions with your child as it pops up on the screen. Once your child is familiar with a few verbs, practice by asking “show me dance’. If there are more children in the household, have one person act out the verb while the others guess. 

·     Children’s preferences. Identify the toys and activities your child shows interest in and figure out a list of verbs that are associated. For instance, if your child likes to play soccer, auditory bombard your child with verbs associated with the sport: kickpass, and shoot.

·     Flashcards: Verb flashcards are a great tool to demonstrate pictures of unfamiliar verbs. Make your own cards by printing off doubles of each action picture to play memory! 

 

LUMIERE THERAPY TEAM🖐️

 

References:

“8 Fun Activities for Teaching Verbs .” Reach to Teachwww.reachtoteachrecruiting.com/blog/fun-activities-teaching-verbs+http://www.theroadmap.ualberta.ca/understandings/parents/25-36#1.

Gotzke, C. & Sample Gosse, H. (2007). Parent Narrative: Language 25 - 36 Months. In L.M. Phillips (Ed.), Handbook of language and literacy development: A Roadmap from 0 - 60 Months. 

Hadley, P. A., Rispoli, M., & Hsua, N. (2016). Toddlers’ Verb Lexicon Diversity and Grammatical Outcomes. Language, Speech, and Hearing Services in Schools, 47, 44–58.

Tara, and Rhonda Griswol. “Teaching Verbs with Picture Books.” Embark on the Journey, 21 Mar. 2018, embarkonthejourney.com/teaching-verbs-with-picture-books/.

“Verbs Pave the Way for Language Development.” Does Child Care Make a Difference to Children's Development?, www.hanen.org/Helpful-Info/Articles/Verbs-Pave-the-Way-for-Language-Development.aspx.

 

Child Speech Therapy: Grammar Elements: Preposition

Prepositions are words that provide information on how objects are related to the rest of the sentence. “The candy is in the bowl,” explains where the candy is in relation to the bowl. Common prepositions include inonnext toin front ofclose to, and beside. Between the ages of 24-36 months, grammar becomes more precise in a child’s vocabulary. The first prepositions comprehended areinon,andunder. By 40 months, children understand the prepositional phrase next to,and at 4 years old, children understand behindin back of,and in front of

Below are some games and activities to help your children learn prepositions. 

·     Model:

While playing with your children, model grammatically correct sentences. For example, while playing with an animal farm model, “Look, the cow is inthe barn” or “the cow is besidethe horse”. 

·     Simon Says: 

Play a fun game of Simon Says at your local playground. Use phrases such as “Simon says, go underthe slide”, or “Simon says, swing besidethe tree”. Simon says at the playground will keep your kids active while learning prepositions!

·     Egg Hunt: 

Create an Easter egg hunt around the house with your leftover plastic eggs! Every time your child sees an egg, encourage them to use a prepositional phrase, such as “the egg is under the couch” before opening.

·     Scavenger hunt: 

Hide a toy somewhere in the house. Provide clever clues using prepositions to find the hidden object. For older children, make it more challenging by having your children hide the toy and give you clues using prepositional phrases.  

·     Dice game:

Tape prepositions cards onto each side of a dice. Take turns rolling the dice, and demonstrating the preposition with a favorite toy and a chair, doll house, or box. If the dice lands on under, place the toy under the chair. 

·     Books: 

Picture books are great tools to explain and demonstrate prepositions. Some of our favorites include:

o  Under, Over, By the Clover by Brian P. Cleary

o  Around the House the Fox Chased the Mouse by Rick Walton

o  If you were a Preposition by Nancy Loewen

Prepositions are the start of our grammar series! Check next week for activities targeting verbs. 

 

LUMIERE THERAPY TEAM🖐️

 

 

Resources: 

“Best Children's Books for * Teaching Prepositions *.” Children's Books for Teaching Prepositions,www.the-best-childrens-books.org/teachingprepositions.html.

Cooper, Jennifer. “Playing with Prepositions.” PBS, Public Broadcasting Service, 3 Nov. 2015, www.pbs.org/parents/adventures-in-learning/2015/11/playing-prepositions/.

“Parent Narrative.” Handbook of Language and Literacy Development - a Roadmap from 0 to 60 Monthswww.theroadmap.ualberta.ca/understandings/parents/37-60.

“Speech and Language Milestones.” About Kids Health , www.aboutkidshealth.ca/En/HealthAZ/LearningandEducation/LiteracyandNumeracy/Pages/speech-language-milestones.aspx.

 

Child Speech Therapy: Childhood Voice Disorders

Adam Levine

Adam Levine

Does your child’s voice sound raspy, hoarse, strained, and/or frequent pitch breaks when he or she talks or sings? These are signs and symptoms of a common voice disorder, vocal cord nodules. Nodules are noncancerous growths that form on the vocal cords or the source for voicing. Nodules affect both children and adult, and are the most common voice disorder among children. 

What causes vocal cord nodules?

Nodules are developed due to vocal abuse over a period of time. Vocal abuse refers to behaviors that harm the vocal cords such as yelling, frequent coughing, crying, dehydration, or excessive singing. Children often develop nodules due to screaming during playtime, sports, or recess.

What are the signs and symptoms?

Vocal cord nodules demonstrate the following characteristics:

·      Hoarse sounding voice

·      Pitch breaks during singing or talking

·      Effortful or strained voice

·      Excessively loud or high pitch voice

·      Child may strain their neck and shoulder muscles while producing speech

·      May experience a frequent sore throat

·      Coughing due to feeling like something is “stuck” in their throat

What is the treatment of vocal cord nodules?

Treatment involves vocal hygiene to heal the voice, and voice therapy to decrease vocal abuse and sustain healthy voicing.

·      Vocal hygiene is recommend to rest and heal the voice box. Vocal hygiene includes the following:

o   Voice rest. Taking a break from excessive talking, yelling, screaming, and singing may be necessary for up to 2 weeks post diagnosis.

o   Increase water intake and avoid caffeine. 

o   Maintain healthy diet. Hydration can be obtained through a healthy diet consisting of fruits and vegetables.

o   Eliminate frequent throat clearing or coughing. Throat clearing can become habitual, so breaking the habit may be difficult. Develop a plan by taking a sip of water every time they feel like coughing.

o   Avoid whispering. Whispering puts extra strain on the vocal cords and may dry them out. Model appropriate volume level and encourage children to use their “indoor voice”.

o   Minimize screaming. Develop new ways to express feelings of excitement or anger during sporting events, playtime, etc. Encourage your children to clap their hands when they score a touchdown instead of screaming with excitement.

o   Role model. Children learn through imitation so be a role model for your children by implementing these strategies into your own life.

·      Voice therapy may be appropriate for children with chronic voice abuse. Voice therapy is a specific aspect of speech-language therapy conducted by a speech-language pathologist. Voice therapy focuses on eliminating vocal abuse by using an easy, relaxed voice. Voice therapy works on maintaining good vocal hygiene and sustaining an easy, relaxed voice in all settings and situations.

            With vocal hygiene, vocal rest, and voice therapy, vocal nodules will eventually heal and voice problems will resolve. Surgery is not recommended for children until first implementing vocal hygiene and voice therapy. For professional voice users such as singers and actors, surgery may be warranted.

 

Lumiere Therapy Team🖐️

 

References:

Philadelphia, The Children's Hospital of. “Vocal Cord Nodules.” The Children's Hospital of Philadelphia, The Children's Hospital of Philadelphia, 15 Mar. 2016, www.chop.edu/conditions-diseases/vocal-cord-nodules.

Swallow, Deanna. “Kids & Vocal Nodules: What Parents Should Know.” North Shore Pediatric Therapy, Deanna Swallow Http://nspt4kids.Com/Wp-Content/Uploads/2016/05/nspt_2-Color-logo_noclaims.Png, 27 Apr. 2014, nspt4kids.com/parenting/kids-vocal-nodules-what-parents-should-know/ 

Child Therapy: Preventing Hearing loss

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Have you ever been to a concert, firework show, or sporting event with excessively high noises? You may have covered your ears, taken a break, or moved back a few rows. Unfortunately, babies do not have the ability to communicate when a noise is too loud or walk away from the situation. One cause of acquired hearing loss is due to exposure to loud noises. This type of acquired hearing loss is cumulative and irreversible, so appropriate noise-blocking equipment is necessary.

 

Why are babies at a higher risk?

            Young children have smaller ear canals so the sound pressure entering the ear is greater. Excessive exposure to loud noises overtime can lead to hearing loss. According to Center for Disease Control and Prevention (CDC), an estimated 12.5% of children age 6-19 years has suffered permanent damage to hearing loss from excessive exposure to noise. If children are unprotected at a young age, they are at higher risk due to repetitive exposure. Babies or young children cannot communicate when the noise is too loud for them. Some babies may become fussy or cry, but others may sit contently without showing any distress.

What situations are dangerous?

            If an event or venue seems loud to the adults attending, children’s ears should be protected. A rule of thumb is if you are at an arms length and have to shout to be heard, it is too loud.  Examples of loud noise environments include:

·      Concerts

·      Sporting Events (professional or amateur)

·      Firework shows

·      Weddings with DJ or band

·      Air shows

·      County fairs

·      Neighborhood block parties or street festival

·      Race cars or horse races 

How to monitor hearing development:

Below are the developmentally appropriate milestones for speech and hearing development. If you feel your child is behind in any area, contact your pediatrician.

·      Birth to 4 months

o   Startles at loud sounds

o   Becomes alert or wakes up to loud noises

o   Responds through smiling or cooing to your voice

o   Calms down at a familiar voice

·      4-9 months

o   Smiles when spoken to

o   Notice and prefers toys that make sounds

o   Turn its head toward familiar sounds

o   Make babbling noises

·      9-12 months

o   Increased babbling and jargon

o   Understands basic requests

o   Uses voicing to get attention

For more information on speech/hearing milestones read our article on speech development.

What type of protection is best for babies?

            Earplugs are dangerous for babies because they are often too big for a baby’s ear canal and can be a potential choking hazard. Headphones are the best option for full coverage. Here are some options of appropriate baby headphones:

·      Baby Banz Size 0-2

·      Peltor Sport Earmuffs

·      Snug Kids Earmuffs

Protect your children’s ears now, so they can enjoy the wonderful sounds the world has to offer!

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References:

Cohen, Joyce. “Want a Better Listener? Protect Those Ears.” The New York Times, The New York Times, 1 Mar. 2010, www.nytimes.com/2010/03/02/health/02baby.html.

“Hearing Loss in Children.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 22 Sept. 2016, www.cdc.gov/ncbddd/hearingloss/noise.html.

Mroz,, Mandy. “Hearing Loss in Children: Everything You Need to Know.” Healthy Hearing, 8 Feb. 2018, www.healthyhearing.com/help/hearing-loss/children.

“Top 5 Noise Cancelling Headphones/Ear-Muffs for Babies and Kids in 2018.” Tech News Central, 2 Jan. 2018, www.technewscentral.com/top-5-noise-cancelling-headphones-for-babies-kids/id_11106.

“When to Protect Your Child's Ears.” Parkview Health, 31 July 2017, community.parkview.com/blog/parkview-health-2/when-to-protect-your-childs-ears.

Child Speech Therapy: Advanced Reading Skills📚

Monica H

Monica H

As discussed last week, pre-reading skills emerge as early as 1 year old. Formal reading instruction begins as children enter elementary school. By 3rd grade, children are expected to use reading skills to learn new content in all school subjects including science, social studies, language arts, and math. Incorporating reading activities into home activities can help children advance their reading abilities needed to excel in all subject areas.  

1) Kindergarten: The alphabet is learned and rehearsed daily in kindergarten. Children begin to decode the alphabetic system by knowing the sounds of each. Children can start to identify sight words by memorizing a combination of word shapes and letters.

 Strategies to incorporate at home:

  • Ask the teacher for the sight words of the week and incorporate them into games at home (I-spy, goldfish).
  • Read alphabet books, such as Seuss’s ABC, and point out words that begin with the same letter.

2) Late kindergarten-1st grade: Reading instruction begins through sound-letter correspondence (phonics) and sight words. By the end of kindergarten, reading becomes more automatic. Children learn that words can be broken down, recombined, and create new words. As children enter first grade, they learn that text explains more than the corresponding picture. Children are able to retell parts of the story including main idea, identify details, and arrange the events in sequence.

 Strategies to incorporate at home:

  • Take turns reading pages of books during story time. If your child has difficulty with a word, model sounding it out.
  • Make your own books by encouraging your children to create or tell stories. Write the story on a piece of paper as they share. They can draw pictures to go along with the story.
  • Join a local library. Motivate your child to learn to read by picking out new stories each week!

3) 2nd–3rd grade:  By age 7-8, children are competent readers with the ability to read longer books independently. They are able to use context and pictures to decipher unknown words. The shift from learning to read to reading to learn begins in 3rd grade. Children are expected to read a variety of text to learn new information in all subjects.

 Strategies to incorporate at home:

  • Pick a series to read together. Here are some great series: Henry and MudgeFrog and Toad are friendsThe Magic Tree HouseJune B. Jones, and A to Z Mysteries.
  • Look up words online or in the dictionary if your child encounters an unfamiliar word. Keep a vocabulary journal with all the new words you look up by writing the word, definition, and picture.

4) 4th–8th grade: Reading shifts to reading comprehension. Children are expected to understand and explore a variety of writing such as expository, narrative, and persuasive text. Textbooks are used across all subjects to extract and learn specific vocabulary and information.

 Strategies to incorporate at home:

  • Research topics together. Topics may range from dinosaurs, technology, dolphins, cooking, etc. Find a variety of books (fictional and nonfictional) to learn more about the topic. Discuss your findings together as well as the different types of text read.
  • Read magazines and newspaper articles. Explain how charts and graphs teach information.

For more information on school age reading, check out Reading Comprehension.

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References:

Ackerman, Shira. “The Guide to 3rd Grade.” Scholastic.com, www.scholastic.com/parents/resources/collection/what-to-expect-grade/guide-to-3rd-grade.

Ackerman, Shira. “The Guide to 4th Grade.” Scholastic.com, www.scholastic.com/parents/resources/collection/what-to-expect-grade/guide-to-4th-grade.

Becky. “Favorite Chapter Books & Series.” This Reading Mama, 11 Aug. 2016, thisreadingmama.com/beginning-chapter-books-series/.

Owens, Robert E. “School-Age Literacy Development.” Language Development: an Introduction, 9th ed., Pearson, 2016, pp. 342–347.

Quick , Carol A. “Reading Milestones.” KidsHealth, May 2013, kidshealth.org/en/parents/milestones.html#.

Child Speech Therapy: Emerging Reading Skills

Although most children learn to read between 6-7 years old, pre-reading skills emerge at as early as 1 years old. Incorporating reading into your daily routine encourages print awareness at an early age. Learn about the emerging literacy skills at each age and strategies to aide in the reading process at home.

Donnie Ray Jones

Donnie Ray Jones

1 year old: Reading development begins around 1 year old through caregiver and child interaction. Books serve as the focus point for communication. As the child begins labeling objects, caregivers can use books to facilitate conversation. For example,

  • Caregiver: What do you see?
  • Child: dog
  • Caregiver: Yes! What sound does a dog make?
  • Child: woof woof

Picture books are a great teaching tool for caregivers to introduce new objects into the child’s vocabulary repertoire. 

Strategies to incorporate at home:

  • Read picture books with a variety of nouns: everyday objects, animals, transportation, people, places, etc.
  • Point to the pictures as you are reading.
  • Involve the child by having them point and name familiar objects.
  • Instead of reading the story word for word, discuss the pictures using simple language.

2 years old: The child begins to learn that writing and text conveys information. Late into the child’s second year, they are able to follow the story of a book.

Strategies to incorporate at home:

  • Read everything to your child, including street signs, cereal boxes, toys, etc.
  • Write hand-written letters to family members. Read the letters out loud as your child draws pictures on the card.
  • Read simple picture books with large print. Follow along with your finger as you read.
  • If the story is too complicated, your child may lose interest. Shorten the text as you are reading to keep it engaging.

3 years old: Books become an integral part of daily routine, especially bedtime. Your child will start to request their favorite books. Between 2.5-4 years old, children may pretend to read books by reciting memorized words and phrases.

Strategies to incorporate at home:

4 years old: Children begin to remember and repeat new words learned through story telling. At this age, children begin to differentiate words that sound similar or rhyme. These skills are important prerequisites to reading.

Strategies to incorporate at home:

  • Identify when words start with the same sounds. For example, “Your hat is on your head. Hat and head both start with the letter ‘h’.
  • Incorporate rhyming at home. Create a rhyming game by choosing a word and seeing how many words rhyme with it.
  • Rhyming books include Goodnight Moon, Green Eggs and HamSheep in a Jeep, and Room on the Broom.

            Check out Preparing for Reading and Importance of Reading for more information on emerging reading skills! Next week, we will discuss the milestones for independent readers!

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References:

Owens, Robert E. “School-Age Literacy Development.” Language Development: an Introduction, 9th ed., Pearson, 2016, pp. 342–347.

Child Speech Therapy: Cleft Lip/Palate

Cleft lip and cleft palate are among the most frequent birth defects in the US. Cleft lip and palate occurs in 1 in 940 births in the United States according to ASHA. It is usually diagnosed at birth or within the first year and is treatable with surgical intervention. The following information will define cleft lip/palate, describe health problems associated with cleft palate, and provide appropriate treatment options.

Ashley Campbell
Ashley Campbell

Cleft lip and/or palate defined

            A child may present with a cleft lip, cleft palate, or both. Cleft lip and/or palate are caused by a combination of genetic and environmental factors. Cleft lip is defined as the separation of the sides of the upper lip on one side or both. It often includes bones of the upper jaw and/or gum. Cleft palate is an opening in the roof of the mouth caused by an underdeveloped joining of the palate in utero. In some cases, the cleft on the palate is covered by mucous membrane defined as a submucous cleft. A submucous cleft is harder to detect but common symptoms include bifid uvula, midline groove of the hard palate, and/or nasal sounding speech.

Feeding Problems

            Children with only a cleft lip usually do not experience feeding problems. On the other hand, children with a cleft palate may have difficulty with breastfeeding or bottle-feeding.  Some difficulties include,

• Poor suction
• Prolonged feeding times with decreased intake
• Milk/formula escaping through nose
• Excessive air intake
• Choking or gagging during feedings

A speech-language pathologist may provide specialty nipples and bottles to assist with bottle-feeding.

Hearing problems

Children with a cleft palate may be at a higher risk for middle ear infections. The Eustachian tube is the canal that connects the middle ear to the throat and the back of the nose. Children with cleft palates often have poor function of the Eustachian tube leading to frequent infections.  Over time, excess infection may lead to temporary or permanent hearing loss affecting speech and language in young children.

Speech Problems

Depending on the severity of the cleft, speech sound disorders may present. To produce most speech sounds (with the exception of nasal sounds such as ‘m’ and ‘n’) the soft palate elevates and moves to the back of the throat. This movement stops air from escaping into the nose. Cleft palates affect the movement and efficiency of the soft palate causing more air to escape through the nose. The speech may sound hypernasal like the child is talking through their nose. Cleft lip and palate may also affect dental alignment affecting certain speech sounds such as ‘s’, ‘sh’, ‘ch’, and ‘j’.

Treatment

            A Multidisciplinary team determines the most appropriate treatment for your child. The core team typically consists of a plastic surgeon, orthodontist, and speech-language pathologist. Additional professionals include pediatricians, nurses, ear-nose and throat doctors, audiologists, psychologist, social workers and nutritionists. Surgery to repair the cleft lip and/or palate is usually completed in the first year. The speech-language pathologist will assist with feeding during infancy. As the child develops speech and language, the speech-language pathologist may provide articulation therapy. If speech problems are related to structural deficiency, speech therapy is only appropriate after surgical or orthodontic intervention.

            If your child demonstrates difficulty with speech and language after a cleft lip and/or palate repair, please contact Lumiere Children’s Therapy for a speech-language evaluation.

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References:

“Cleft Lip and Cleft Palate.” American Speech-Language-Hearing Association, ASHA, www.asha.org/public/speech/disorders/CleftLip/.

“Cleft Lip and Palate.” Edited by Rupal Christine Gupta, KidsHealth, The Nemours Foundation, Oct. 2014, kidshealth.org/en/parents/cleft-lip-palate.html#.

Meredith, Amy Skinder. “Speech Sounds Affected by VPI Amy Skinder Meredith.” SpeechPathology.com, www.speechpathology.com/ask-the-experts/speech-sounds-affected-by-vpi-1103.

Vissing, Amy. “Cleft Lip and Palate: The Role of the SLP

Child Speech Therapy: Teaching Feelings

Phillip Dean
Phillip Dean

Identifying one’s feelings and emotions can be challenging for children, sometimes resulting in inappropriate reactions such as hitting or biting. The strategies below aim towards education and identification of common feelings to help provide the appropriate language to express one’s emotions.

1. Label your child’s feelings. As your child expresses a type of feeling, narrate what they are experiencing to help develop a stronger feelings vocabulary repertoire.

  • If your child lost a soccer game, comment that it is normal to feel sad after losing a game.
  • On the way to a movie or amusement park, describe that your child is feeling happy and excited.

    2. Children’s literature. Identify and discuss the different feelings experienced by the characters in your child’s favorite story. Other books to teach feelings include:
  • When Sophie Gets Angry—Really, Really Angry by Molly Bang
  • The Way I Feel by Janan Cain
  • Lots of Feelings by Shelley Rotner
  • Today I Feel Silly: And Other Moods that Make the Day by Jamie Lee Curtis

    3. Feelings Sort. Create a fun card game by printing off a variety of facial expression pictures (anger, sad, happy, silly, surprised, scared). Before starting, discuss each type of feeling and imitate the different faces in front of a mirror. Scatter the pictures on the table for your child to divide into groups or create a game by assigning each person a feeling and seeing who can collect the matching pictures first!

    4. Charades with feelings. Practice acting out feelings with a family-fun game of charades. Use the same picture cards from feeling sort game or this free feeling cube to determine which feeling to act out. The other members in the family get the chance to guess.

    5. Movies and Youtube videos. Inside Out is an animated film highlighting the core feelings of joy, sadness, anger, fear, and disgust. It will soon become a family favorite! There are also kid-friendly videos on YouTube that can provide a visual representation of feelings. Some favorites include:
  • Elf Feelings Video
  • The Feelings Song
  • If You’re Happy

            Continue to discuss feelings with your children during experiences. Children will begin to associate innate feelings with expressed emotions. Once the child can identify their own emotions, they will begin to develop theory of mind to understand the feelings of others.

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References:

Chambers, Yanique. “9 Ways To Teach Children About Feelings.” Kiddie Matters, 14 Dec. 2017, www.kiddiematters.com/9-ways-to-teach-children-about-feelings/.

Katie. “4 feelings activities for kids.” Gift of Curiosity, 3 May 2017, www.giftofcuriosity.com/4-activities-for-teaching-kids-about-feelings/.

Child Speech Therapy: Teaching Body Parts

There is nothing cuter than watching your child point to their button nose after the prompting, “where is your nose?” Between 3-4 months, your baby discovered their hands for the first time but when can they identify body parts on command? Children learn about body parts between 1 to 5 years old.

Gordon
Gordon

Typical Development

  • 1 ½ years old: Able to identify one to three body parts on command.
  • 2- 2 ½ years old: Identifies basic body parts: head, arm, legs, nose, hands, mouth, eyes, ears, and feet.
  • 5 years old: Draws a person with at least 6 body parts.
  • 5-5 ½ years old: Identifies advanced body parts: elbow, forehead, eyelashes, eyebrows, knees, wrists, and ankles. Understands the functions of basic body parts (e.g. eyes are for seeing).

            Chances are your toddler is already exploring your face as you hold them in your arms. As your child touches your facial features, name the body parts as well as the function to help your child distinguish. For example, “That is Mommy’s ears; ears help you hear”.  The following are more ideas to encourage learning body parts.

  • Sing a song. There are so many catchy and fun songs that work on identifying body parts. Start with this simple song to encourage imitation, “This is the way we touch our nose, touch our nose, touch our nose, this is the way we touch our nose, so early in the morning”. ‘Head, shoulders, knees, and toes”, “Hokey Pokey”, and “If you’re happy and you know it” are all great songs to get active while practicing body parts!
  • Utilize props. Props are a great way to indirectly target body parts. Play dress up with gloves, socks, sunglasses, earmuffs, and hats. Start with identifying where the objects go such as “the hat goes on your head” or “ put sunglasses on your eyes”. Next, incorporate direction following and color identification by giving commands such as “put the pink socks on your feet”. Finally, ask the child where the clothing pieces go, “what do you put gloves on?” or “where do you put the gloves?”
  • Friendly quiz. Simply ask your child to identify body parts by pointing. Incorporate other family members by asking, “Where is Dad’s ears?”

A great way to address learning body parts is through play. The following toys are excellent for identifying basic body parts.

  • Baby doll: Pointing out body parts on a baby doll is a great way to integrate language into pretend play. Narrate while your child is playing to encourage imitation, “Put pants on baby’s legs. Hat on Baby’s head. Baby’s eyes are blue.”
  • Potato Head: Create your own Mr. Potato head with crazy noses, mustaches, hats, and glasses. Let your child request different body parts to add to his or her Potato head.
  • Fisher-Price Laugh and learn: Not only does your child learn parts of the body with this stuffed animal dog, but it also targets A-B-Cs, counting, and colors.

Children’s Literature to teach Body parts:

            Make learning body parts fun for you and your child! If you feel your child is delayed in language acquisition, contact Lumiere Children’s therapy for a consultation with one of our speech therapists.

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Resources:

“Learning Body Parts.” What to Expect, WhattoExpect, 27 Feb. 2015, www.whattoexpect.com/toddler/toddler-growth-and-development/learning-body-parts.aspx.

Zimmerman, Irla Lee, et al. Preschool Language Scales. fifth ed., 2011.

Child Speech Therapy: Auditory Processing Disorder

Easily distracted. Falling behind in school. Struggles to follow verbal directions. These are common signs of auditory processing disorders (APD) and attention deficit/hyperactivity disorder (ADHD). Although ADHD and APD have similar symptoms, they are not the same and are frequently misdiagnosed. Auditory processing disorder or central processing disorder (CAPD) refers to how the central nervous system processes auditory information.

ElizaC3
ElizaC3

What is Auditory processing disorder?

            APD is a brain-based condition affecting the way the brain interprets and recognizes sounds. For example, distinguishing differences in the sounds that make up words. APD impacts receptive and expressive language.

How is APD different than a hearing impairment?

            There is no hearing loss associated with APD. The problem lies within discriminating sounds, not difficulty hearing the sounds.

How does it differ from ADHD?

            Children with ADHD have difficulty understanding verbal information due to lack of attention not neural processing. Children with APD may also experience articulation difficulties by confusing similar sounds such as three instead of free. Articulation problems in children with ADHD are caused by extraneous factors unassociated with ADHD.

What are other signs/symptoms of APD?

  • Difficulty understanding speech in noisy environments.
  • Frequently asks for clarification.
  • Frequently asks for speakers to repeat themselves.
  • Demonstrates difficulty rhyming.
  • Easily distracted by loud or sudden noises.
  • May experience problems in school such as spelling, reading, and understanding information presented verbally in the classroom.
  • May prefer reading stories independently, rather than listening aloud.

Who can diagnose APD?

            Although many professionals including speech language pathologists are involved in the treatment process, only Audiologist may diagnose APD. Auditory processing disorder cannot be diagnosed through a symptom checklist alone, and requires careful and specific diagnostic measures. Most auditory processing disorder tests require the child to be at least 7 or 8 years old.

What is involved in the treatment of APD?

Treatment for APD is individualized towards the child. Treatment usually focuses on three areas: environmental modifications, developing higher order skills to compensate, and remediation of the auditory deficit.

  • Environmental modifications may include the use of electronic device (FM system) to reduce background noise and amplify the speaker. Extended time for reading and writing, preferred seating in class, quiet work space, use of pictures and gestures to enhance spoken word, and classroom notes are other examples of environmental changes in school.
  • Higher order skills are recruited to assist and compensate for auditory deficits. These skills include language, problem solving, memory, and attention to help aid with cognitive tasks.
  • There are a wide variety of treatment activities to help remediate the disorder itself. Treatment is individualized for the child and may include computer-assistance, one-on-one training with a therapists, or home-based programs. There is no one-size fits all treatment strategy for APD.

Will my child grow out of APD?

            With appropriate intervention and therapy, children with APD can be successful in school and life by becoming active participants in their own listening, learning and communication. The auditory system is not fully developed until age 15, so many children can improve auditory skills over time before the auditory system fully matures. While some children may experience complete improvement, others may experience some lifelong residual degree of deficit.

Contact Lumiere Children’s therapy for additional information on auditory processing disorder, as well as a consultation with one of our speech language pathologists.

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References:

“Auditory Processing Disorder.” Edited by Thierry Morlet, KidsHealth, The Nemours Foundation, Sept. 2014, kidshealth.org/en/parents/central-auditory.html#.

Bellis, Teri James. “Auditory Processing Disorders (APD) in Children.” American Speech-Language-Hearing Association, ASHA, www.asha.org/public/hearing/Understanding-Auditory-Processing-Disorders-in-Children/.

Rosen, Peg. “The Difference Between Auditory Processing Disorder and ADHD.” Understood.org, www.understood.org/en/learning-attention-issues/child-learning-disabilities/auditory-processing-disorder/the-difference-between-auditory-processing-disorder-and-adhd.