child development

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.

Parent Resources: Transitioning to Kindergarten

As the 2018-2019 school year approaches, backpacks fill with new school supplies, desks receive new nametags, and excitement fills the air. Although starting a new school year is nerve-racking for most children, beginning elementary school for the first time brings on a new level of excitement...and fear. Starting kindergarten is an adjustment for both parents and kids, so we want to help you begin the school year with ease by learning about prerequisite skills for kindergarten and how to prepare for the first day of school!

Skills Needed For Kindergarten

           Kindergarten is an opportunity for your child to develop social skills, self-care, and academic skills independently. Kindergarten allows children to explore new opportunities without relying on the constant assistance from caregivers. With that being said, the independence that kindergarten permits may be initially challenging for children. The following is a suggested guideline of prerequisite skills and activities to prepare your child for success before entering kindergarten. This list is only a guideline as kindergarten curriculums and expectations vary.

 

1. Identify some letters of the alphabet.

 

  • Start with the letters in your child’s name for motivation. For instance, if your daughter’s name is Kelly, you can point out the letter “K” in books, magazines, and advertisements.

  • Refrigerator letters are versatile toys that can be used in a variety of ways for letter recognition. Play I-spy while cooking and eating, such as ‘I spy the letter “A”’ and have your child point out the letter. Play hide-and-seek by hiding a letter and asking your child to find the letter “B” in the kitchen. Point to the letters as a point of reference while getting food out of the fridge. For instance, “I am getting broccoli; broccoli starts with the letter B”.

  • The following are enjoyable games that incorporate letter recognition; alphabet matching game, alphabet puzzle, and alphabet go-fish.

 

2. Grip a pencil, crayon, or marker with the thumb and forefinger, supporting the tip.

 

  • Improve hand muscles by rolling and forming shapes with Play-Doh.

  • Use a variety of writing instruments and coloring books to entice creativity. Crayons, markers, chalk, paint dot markers, and magnetic drawing board are all great options!

 

 3. Use art materials (scissors, glue, paint) with relative ease.

 

  

4. Write first name.

 

After learning the first two prerequisites, the next skill to practice is writing one’s name.  Make it fun by writing in shaving cream or using bath crayons during bath time!

 

 5. Count to 10.

 

6. Able to self-dress.

 

  • Although dressing your children in the morning saves time and energy, it restricts them from learning opportunities to self-dress. Aim to leave a few extra minutes each morning to let your children practice getting dressed for the day.
  • Read more about activities for tying shoes and zippering.

 

7.  Clean up toys or activities independently.

 

In kindergarten, children are expected to clean up toys, art supplies, school materials, and other activities independently. Give the expectation to clean up toys once finished playing at home to encourage this skill. Once your child loses interest in a toy, sing the clean up song together while putting each item in its respected place.

 

  8. Listen to a story without interrupting.

 

Sustaining adequate attention during stories is challenging for children. When reading a book, set a certain number of book pages or set a timer as a visual reminder for the amount of listening time. Continue to increase listening time until your child is able to listen to a full story or children’s book.

 

   9. Follow 1-2 step directions.

 

  •  Following 1-2 step directions is required for most activities during the school day.  Make following directions fun by playing Simon says with the whole family!

  • Independently use bathroom.

  • For most kindergarten programs, potty training is required. Read our previous posts on potty training tips and potty training with speech problems.

           If your child has not mastered the following skills, do not fret. The skills will continue to develop and form throughout kindergarten. Allow opportunities for your child to become more self-efficient and demonstrate their independence.

 

The First Day of Kindergarten

           Being prepared for the first day of school can help smooth the new transition. Most kindergarten programs provide an open house night leading up to the school year, allowing students to meet the teacher, explore the classroom, and greet fellow classmates. Attending the open house is highly encouraged for families, so your child can become more familiar with their new environment prior to the first day.

           Establishing a structured sleep and meal schedule prior to the first day will help your child adjust accordingly. Set a strict bedtime and morning routine so your child is well rested the first week. Regulate mealtimes at home so that lunch is scheduled at the same time every day.

           Plan a “kindergarten practice day” at home. Take an hour out of the day to walk through possible activities your child may experience. Some examples include wearing a backpack, standing in line, listening to stories, participating in a craft, and singing a song. Your child would probably love to role-play a typical day of school, and feel more comfortable knowing expected activities.

           Finally, build excitement for the first day of school. Starting kindergarten should be exhilarating for children. Involve your child in the purchasing of school supplies, packing lunch, and picking out their first day outfit. On the day of, allow extra time to spend the morning together by eating breakfast and taking some first day photographs.

 

Expectations of the First Day

 

           It is easy to imagine the first day of school to be picture perfect as a parent or caregiver. Although kindergarten is a big milestone in your child’s life, avoid setting high expectations for the first day. Children may also experience negative feelings after the first few days.

 

1.     They may cry. It is not because your child doesn’t want to go to school or is not ready; it just means they are scared of the unknown. With peer models and the support of the teacher, your child will adjust and learn how fun school can be!

 

2.     They will be tired. Adjusting to a full school schedule is hard for children. The first few weeks will be a transition. Expect your child to be tired and sometimes cranky, at home.

 

3.     They may not want to go back. Kindergarten places responsibilities and expectations on children. Following classroom rules and listening to the teacher can seem intimidating to them. As they become more comfortable with the routine of the classroom, they will begin to enjoy attending school on a daily basis.

 

Happy first day of school!📚😄

 

LUMIERE THERAPY TEAM🖐️

 

 

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Resources:

Herzog, Danielle. “What to Expect When Your Child Goes to Kindergarten.” The Washington Post, WP Company, 7 Aug. 2015, www.washingtonpost.com/news/parenting/wp/2015/08/07/what-to-expect-when-your-child-goes-to-kindergarten/?noredirect=on.

“Kindergarten Readiness: What Skills Your Child Should Have.” Scholastic Publishes Literacy Resources and Children's Books for Kids of All Ages, www.scholastic.com/parents/school-success/school-life/grade-by-grade/preparing-kindergarten.html.

 

Physical Therapy: In-Toeing and Out-Toeing

The first year of life is full of new beginnings, between crawling, pulling up to stand, and finally walking! Watching your child take their first steps can be both exciting and nerve-racking. The first steps may look different for each child.  While watching your children explore the world on their feet, you may observe that their toes point inward or outward. Learn more about the causes and treatment of in-toeing or out-toeing below.

Andrew Seaman

Andrew Seaman

In-Toeing or “Pigeon Toe”

            In-toeing, commonly known as “pigeon toe”, is when the toes face into each other while walking or running. This is commonly seen in infants and young children. In-toeing may be caused through hereditary genes or the baby’s positioning in the womb. If a parent demonstrated in-toeing as an infant or child, it is likely they will pass down the gene to their children. An infant may also develop in-toeing due to small feet movement and positioning in the womb. In-toeing is typically not painful for children and does not lead to arthritis.

There are three types of in-toeing: Tibial Torsion, Metatarsus Addactus, and Femoral Anteversion. 

Tibial Torsion

When the shinbone (tibia bone) is tilting inward causing the feet to point in. It is the most common cause of in-toeing in infants and young children typically under the age of two years old. It is typically due to positioning in the womb, and is noticeable at an early age. Tibial torsion frequently straightens out once the child begins to walk, but may take up to 6-12 months to fully correct. Although tibial torsion does not typically require intervention, surgery may be recommended after the age of eight for more severe shin rotations.  

Metatarsus Adductus

When the front half of the foot, or forefoot, is turned inward. Studies have shown that metatarsus adductus may spontaneously recover without intervention in the majority of cases. Manual stretches of the forefoot can improve metatarsus adductus and may be provided by the child’s pediatrician, nurse, or physical therapist. In the rare case that metatarsus adductus does not correct on its own, feet casts can stretch the soft tissues of the forefoot to straighten out the foot. 

Femoral Anteversion

When the upper end of the thighbone (femor), close to the hip, has an increased twist causing the feet to turn in. It is usually not detected before 4-6 years old. A common symptom of femoral anteversion is sitting in the “w- position”. Treatment may include physical therapy to teach the correct positioning of walking, and occasionally, braces to shift the bone. 

Femoral retroversion

The thighbone (femur) is angled backwards relative to the hip joint, resulting in outward feet positioning. Femoral retroversion is less common than femoral anteversion.

Out-Toeing or Duck Feet

Out-toeing is when the child’s feet point outward as they are walking and running. Out-toeing occurs less frequently than in-toeing and may be due to fetal positioning, abnormal growths, and/or underlying neurological problems. Unlike in-toeing, out-toeing may result in pain over time. There are three causes of out-toeing in children: Flatfeet, Hip Contracture, and Femoral Retroversion. 

Flat feet

A child is considered to have flat feet if they do not have an arch in their foot. If an arch does not form, the foot may appear to turn outward. Out-toeing due to flat feet does not require medical intervention and rarely causes pain. 

Hip contracture

An infant’s hip may be externally rotated due to their positioning in the uterus. The external hip contracture may cause hip tightness as they begin to walk resulting in out-toeing. Hip contracture will spontaneously resolve on its own, so out-toeing does not require treatment if it’s due to hip contracture. 

Treatment for In-Toeing and Out-Toeing

 In the majority of cases for in-toeing and out-toeing, braces, special shoes, and surgery are not required. Most children will spontaneously recover if their condition is not associated with an underlying neurological disorder.

Children may require intervention if the following persists:

·     Not improved by the age of three

·     Complaining of excess pain (especially for in-toeing)

·     One foot more turned than the other

·     Other developmental delays such as fine motor, gross motor, and/or language development. 

·     Gait abnormalities (deviation from normal walking)

            Physical therapy can help provide awareness of correct foot positioning when walking. Physical therapy may be recommended if the issue does not resolve on its own in a reasonable amount of time. If you feel like your child would benefit from a physical evaluation for in-toeing or out-toeing, contact Lumiere Children’s Therapy.

 

LUMIERE THERAPY TEAM🖐️

 

References: 

Children's Hospital. (2014, August 24). Metatarsus Adductus. Retrieved from https://www.chop.edu/conditions-diseases/metatarsus-adductus

Children's Hospital. (2014, August 24). Femoral Anteversion. Retrieved from https://www.chop.edu/conditions-diseases/femoral-anteversion

Gupta, R. C. (Ed.). (2015, February). In-toeing & Out-toeing in Toddlers. Retrieved from https://kidshealth.org/en/parents/gait.html

Intoeing - OrthoInfo - AAOS. (n.d.). Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/intoeing/

Media, H. M. (n.d.). Out-Toeing. Retrieved from https://www.chortho.com/common-conditions/out-toeing

Pigeon Toe (In-toeing). (2016, November 07). Retrieved from https://uichildrens.org/health-library/pigeon-toe-toeing

Child Physical Therapy: Treatment for Toe Walking

As children learn to navigate walking, they may initially learn to walk on their toes while cruising along furniture. Toe walking is developmentally appropriate until the age of three. If your child persistently walks on their toes in the absence of any underlying neuromuscular or orthopedic condition, it is considered idiopathic toe walking. 

Kristal Kraft

Kristal Kraft

Idiopathic toe walking is defined as habitual toe walking with no known cause. Idiopathic toe walking may lead to tightened calf muscles, decreased range of motion of ankles, and eventually, shortened Achilles tendon. 

 

What is the treatment for toe walking?

            Treatment options vary on the degree and duration of toe walking. It also depends on the flexibility of the Achilles tendon. As with any habit, the longer it persists, the harder it is to break. In extreme instances, surgery to lengthen the Achilles tendon may be most appropriate. For most cases, ankle foot orthosis (AFO) and/or physical therapy are recommended. AFOs are removable braces worn during day and night to help maintain the foot at 90-degree angle. 

Physical therapy creates a program designed for your child’s needs by incorporating a combination of stretches and strengthening. In order to increase the effectiveness of physical therapy, daily home exercises are crucial. Below are a list of at-home stretches and activities you can incorporate into your weekly routine. 

 

At-home Stretches: 

·     Manual calf stretch: This stretch requires help from an adult. Your child will sit on the floor with his/her knees straight. The adult will cuff the child’s heel with their hand as the foot rests on the adult’s forearm. Slowly apply pressure on the child’s foot so their foot points up and towards the child’s body. Hold for 30 seconds on each side. 

·     Wall stretch:  The child is standing for this stretch. They should place their hands on a wall and point both feet at the wall one behind the other. Lean into the wall as the front leg is bent and the back leg is straight. Hold both feet on the ground flat for 30 seconds.  

 

Activities to strengthen muscles: 

·     Sit to stand: While your child sits on a chair or bench, place your hands below their knees with moderate pressure downward to provide tactile cues to keep heels on the floor. With the steady pressure, your child will stand up with heels remaining on the ground. Complete 5 repetitions. 

·     Basketball stretch: Encourage your child to sit on a small ball such as basketball while keeping both heels on the ground. Practice squatting by standing and sitting back down on the ball while keep heels down. 

·     Bear walks: Animal walking is great for stretching and strengthening leg muscles. For a bear walk, place hands and feet on the floor while hips aim towards the air. As one foot moves towards the hands, the other leg stays back while actively pushing the heel to ground. 

·     Penguin walk: Pretend to walk like a penguin by keeping the toes in the air and walking only on the heels! 

·     Crab walk: Start in the bridge position and propel forward by using hands and feet. Keep feet flat on the floor! 

·     Bozo Buckets: Line up three buckets in a row to play bozo buckets. Instead of throwing the beanbags into the buckets, place the beanbag on top of the feet and fling the bean bag by kicking. 

·     Scooter races: Race a friend or sibling on the driveway! Sit on the scooter with feet in front and use the heels to propel forward. 

·     Slide: With parent supervision, have your child climb up the slide. Climbing up a playground slide targets range of motion, strength and weight bearing. 

 

LUMIERE THERAPY TEAM🖐️

 

 

References:
Beazley, Elizabeth, et al. “Activities for Children Who Walk on Their Toes.” University of Rochester Medical Center, www.urmc.rochester.edu/MediaLibraries/URMCMedia/childrens-hospital/developmental-disabilities/ndbp-site/documents/toe-walking-guide.pdf.
SickKids hospital staff. “Toe Walking, Idiopathic .” AboutKidsHealth, 11 Apr. 2011, www.aboutkidshealth.ca/Article?contentid=946.
“Toe Walking in Children.” DINOSAUR PHYSICAL THERAPY, 5 May 2018, blog.dinopt.com/toe-walking/.
“Toe Walking in Children.” Mid-Maryland Musculoskeletal Institute, 8 Oct. 2015, mmidocs.com/media/blog/2015/10/idiopathic-toe-walking/46.
http://blog.dinopt.com/toe-walking/