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Lumiere Children’s Therapy: Autism and Physical Therapy

Happy Autism Spectrum Disorder (ASD) awareness month! Many recognize speech therapy as an important component of the overall treatment plan for ASD due to difficulty with spoken language, eye contact, facial expressions, and emotional recognition. Although language deficits are a core symptom of autism, children may also demonstrate difficulty with coordination, motor planning, and hand-eye coordination. Therefore, physical therapy can help facilitate gross motor development to increase participation in everyday activities and social activities such as gym class, sports, playing, etc.

Lecates - Flickr

Lecates - Flickr

What are the signs and symptoms of Autism Spectrum Disorder?


  • Social communication challenges

    • Difficulty with social interaction including initiating and maintaining topics during conversation

  • Pragmatic difficulties

    • Children with ASD may present with poor eye contact, difficulty gauging personal space, and decreased facial expressions

  • Difficulty identifying emotions

    • Difficulties may include recognizing one’s own emotions as well as the feelings of others. They experience trouble expressing their emotions during a variety of situations. Also, children may lack knowledge of when to seek emotional support or provide emotional comfort to others.

  • Repetitive behaviors

    • Repetitive behaviors present differently for each individual but some examples may include repetitive body movements (arm flapping, spinning), motions with objects (spinning wheels), staring at lights, and/or ritualistic behaviors (lining up toys in order)

What physical difficulties may a child with autism experience?

Children with ASD may present with the following physical challenges:


  • Developmental Delay:

    A developmental delay is when a child is lacking the age-appropriate skills in one or more of the developmental areas: cognitive, social-emotional, speech and language, fine and gross motor. If a child demonstrates a physical developmental delay, they may have difficulty rolling over, holding up their head, sitting up, crawling, and eventually walking and jumping.


  • Low muscle tone:

    Muscle tone is the amount of tension in muscles used to hold up our bodies while sitting or standing. Low muscle tone is when the muscles require more effort to move properly while doing an activity. They may have difficulty maintaining good posture when standing and sitting, and often affects their overall gross motor development.


  • Difficulty with motor planning.

    Motor planning is the ability to conceive, plan, and then execute the physical skill in the correct sequence. Motor planning assists children in attempting new tasks without the need to consciously learn the steps to each new task. Motor planning arises from organizing sensory input from the body, and having adequate body awareness and environmental perception. Children who have trouble with motor planning may experience difficulty carrying out new tasks, following physical commands when given verbal instructions, and appearing clumsy while executing new tasks.


  • Decreased body awareness.

    Children with ASD may lack awareness of where their bodies are in relation to their environment, causing children to become accident-prone or present clumsy.

Who is a Physical Therapist?

Physical therapists, often referred to as PTs, are professionals that help people gain strength, mobility and gross motor skills. They are experts in motor development, body function, strength, and movement. Pediatric physical therapists can help children with a variety of disorders gain functional physical skills so they can participate in everyday activities.

What does physical therapy target?

  • Basic skills. Physical therapists can help children develop the primary gross motor skills of sitting, rolling, standing and running if they are experiencing a developmental delay.

  • Coordination. Physical therapists focus on the necessary muscles and skills to improve balance and coordination in everyday activities.

  • Improve reciprocal-play skills. Help children use motor planning to coordination throwing and catching a ball, and other activities that involves interacting and reacting to another person.

  • Development of motor imitation skills. In order to learn new skills, a child must be efficient in imitation and following physical directions. PTs can offer strategies and practice of imitating movements.

  • Increasing stamina and fitness. For older children, physical therapy may focus on skills required to participate in play and sports such as kicking, throwing, catching, and running.

  • Parent education. PTs create home exercise programs so that family members can help facilitate building on strength, coordination, and development of specific goals into their natural environments and routines.


Why is physical activity important for children with ASD?

Physical therapy increases a child’s ability to participate in physical activities by improving strength and coordination. Once a child is able to functionally participate in physical activities, they are able to reap the many benefits of daily exercise.


  • Social skills. Gym class, playgrounds, and organized sports teams offer opportunities for children to develop friendships and social skills. For children with ASD, physical activity programs provide a fun, safe environment to develop and practice social interaction skills.

  • Improvement in behaviors. Physical activity may help decrease maladaptive behaviors and aggression. Children with ASD have difficulty expressing and understanding their feelings. Physical activity can aid in reducing stress and frustration in children, often helping them adjust in different activities without aggression.

  • Overall health improvements. Staying active and participating in daily physical activities can decrease the risk of general health problems in individuals with ASD, including obesity.

  • Increase quality of life. Daily activities such as climbing stairs, walking on the sidewalk, and going grocery shopping require the use of gross motor skills. Improving one’s strength and stamina can positively affect their participation in everyday chores and activities.


If your child has Autism Spectrum Disorder, and is experiencing difficulty with coordination, strength, and motor planning, physical therapy might be right for you. Our physical therapists at Lumiere Children’s Therapy can offer evaluations, customized treatment plans, and home exercise programs for carryover into the home.





References:

“Does Physical Activity Have Special Benefits for People with Autism?” Autism Speaks, www.autismspeaks.org/expert-opinion/does-physical-activity-have-special-benefits-people-autism.

Morin, Amanda. “What You Need to Know About Developmental Delays.” Understood.org, www.understood.org/en/learning-attention-issues/treatments-approaches/early-intervention/what-you-need-to-know-about-developmental-delays.

“Motor Planning.” North Shore Pediatric Therapy, nspt4kids.com/healthtopics-and-conditions-database/motor-planning/.

“Physical Deficits.” Mental Help Physical Deficits Comments, www.mentalhelp.net/articles/physical-deficits/.

Rudy, Lisa Jo. “What Can a Physical Therapist Do for a Your Autistic Child?” Verywell Health, 24 July 2018, www.verywellhealth.com/physical-therapy-as-a-treatment-for-autism-260052.

Ries, Eric. “Physical Therapy for People With Autism.” Physical Therapy for People With Autism, www.apta.org/PTinMotion/2018/7/Feature/Autism/.

“What Are the Symptoms of Autism?” Autism Speaks, www.autismspeaks.org/what-are-symptoms-autism.






Autism: Recognizing & Managing Challenging Behaviors

Did you know that a big part of your child’s behavior, positive or challenging, is a reaction to something that is happening in their immediate environment?


Sometimes we inadvertently reinforce challenging behaviors but knowing the ABCs can help prevent inadvertent reinforcement. By recognizing the ABCs of behavior, you may be able to help prevent and better de-escalate challenging behaviors with your child. 

 A) Antecedent- This is what happens just before the behavior to provoke it.  

B)  Behavior-This is what you can see your child doing. 

C) Consequence-This is how you react the behavior.  The consequence will determine whether or not that behavior will reoccur. 

When thinking about how to intervene your child’s behavior, it is important to look at why the behavior is occurring, also known as identifying thefunction.  This is much more important than what the behavior looks like.  By recognizing which function the challenging behavior serves, you can begin to understand how to intervene.  The four main functions of behavior are:

 

Sensory - These behaviors are occurring because they feel good.  Stereotypy, or self-stimulatory behavior, is a common sensory behavior that children with autism often engage in. 

 

Escape - These are behaviors occur when your child wants to get out of doing something they don’t want to do.  This is often the root cause of difficulty with transitions, with which many children with autism have difficulty.

 

Attention - These behaviors occur to gain attention from somebody.  Attention-based behaviors can be easily inadvertently reinforced, so it is important to remember that negative attention is still attention!

 

Tangible - These are behaviors that your child engages in when they are told they can’t have something they want or if something they like is taken from them. By identifying common things that provoke behavior, we can arrange the environment to prevent behaviors in the first place.  By knowing why your child is engaging in a challenging behavior, you can begin to understand how to respond to your child. 

 

General Preventative Strategies

  • Give your child choices throughout the day.  This gives them a sense of control in their environment.  You can give them a “choice” when there may not actually be one.  An example of this is, “Which shoe do you want to put on first?” or “Do you want to go potty in 2 minutes or 4 minutes?”

  • If you would like for your child to do something, present it as a choice via instruction.  It is important that instructions are followed through. An example of this is, “Are you ready to put on your shoes?” vs. “It’s time to put your shoes on.” 

  • Prepare your child for transitions.  Instead of abruptly telling them that it is time to transition away from a preferred task, give them a visual or verbal countdown

  • Reward the positives!  Point out when you see your child making good choices.  Throw a party if they engage in a difficult and desirable behavior.  Some children with autism may not be motivated by social praise.  If this is the case, allow your child time with a favorite toy or sensory input (tickles, hugs, squeezes etc.)

  • Encourage flexibility!  Many children with autism can be rigid, so encouraging your child to play with different toys, try different foods, and pointing out when unexpected changes occur, can help prevent challenging behavior related to rigidity

  • Make sure your child has meaningful breaks throughout the day to engage in preferred activities

  • Teach appropriate behaviors when your child is calm and not engaging in challenging behavior 

 

General Consequence Strategies

 

 Sensory

  • Give your child something similar to do/have instead of the inappropriate behavior.  An example of this may be to offer your child a chewy snack instead of putting toys in their mouth

Escape

  • Be sure to follow through when an instruction is given

  • Validate your child’s frustration and let them know that you understand that they are upset, but they do need to complete whatever task is at hand

  • Try not to force your child to comply.  Have them complete the task at hand when they are calm and ready

  • Remember what the original instruction was and stick with it

  • Reward your child as soon as they complete the non-preferred task

Attention

  • Ignore attention-seeking behavior as much as possible.  Sometimes this is not 100% doable.  If you must provide your child with attention, minimize verbal attention and remain neutral

  • Do not show frustration or anger.  Children with autism sometimes think this is “funny” and may not have the social awareness to truly understand your frustration.  Emotions should be taught when your child is calm and regulated

 

Tangible

  • Not allowing the child to have access until they ask calmly or show that they are calm (if they do not have the language to ask)

  • If you are unable to provide your child access to the preferred item, acknowledge their emotion and their feelings

  • Do not go back on your word.  If you told your child that they cannot have an item, do not give your child that item, especially if they engage in challenging behavior

 

 

Tips provided by Lumiere therapist, Jacqueline M., M.A., BCBA, (Lead Board Certified Behavior Analyst)

 

 

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: Breathing Difficulties in Children

Examine your breathing for a minute. Are you breathing through your nose or mouth? Is your mouth open or closed? Is your tongue on the bottom or roof of your mouth? Optimal breathing should be effortless and quiet through the nostrils with the tongue suctioned to the roof of the mouth behind the front teeth and the lips should be gently closed. Nasal breathing positively affects swallowing patterns, chewing, speaking, voicing and body posture. If nasal breathing is compromised for any reason, orofacial myofunctional disorders and/or airway function disorders may arise. This article focuses on descriptions of airway function disorders, including pediatric obstructive sleep apnea, and treatment options.

Airway Function Disorders (AFD)

AFD occur when the airway function is obstructed at any level of the airway, affecting a range of human functions. Sleep disorder breathing such as pediatric obstructive sleep apnea, is a collapse at any level of the upper airway resulting in abnormal breathing during sleep. Pediatric sleep apnea will be discussed further in this article. Sleep disordered breathing is initially impacted by daytime breathing specifically in children who mouth breath.

Signs of mouth breathing include the following:

  • Open lips

  • Low or forward tongue posture

  • Short upper lip

  • Forward head posture (protruding from neck)

  • Frequently dry lips

  • Misaligned teeth requiring orthodontics

  • Dry mouth

  • Hyponasal speech (speech that sounds nasal like they have a cold)

  • Drooling

  • Nasal congestion or constant runny nose


Impact of AFD

Airway function disorders may impact a variety of functions in a child’s life. It may interfere with language development, learning and academics, memory, attention, socialization, and self-regulation. Children with AFD may exhibit primary behavior characteristics of excessive fidgeting, hyperactivity, decreased attention and emotional outburst.

airway

AFD may also impact a child’s speech and swallow function. Some children with AFD present with an interdentalized (tongue between teeth) on the following sounds /s, z, t, d, n, l/ as those sounds are produced with tongue elevation.  Children may also experience abnormal swallowing patterns such as tongue-thrust swallows or impaired chewing.


Risk factors of AFD

The following is a list of risk factors associated with AFD:

  • Enlarged tonsils and/or adenoids

  • Mouth breathing

  • Nasal abnormalities such as a deviated septum (Deviated septum is when the thin wall between nasal passages is displaced causing one nasal passage to be smaller)

  • Frequent nasal congestion or allergies

  • Chronic rhinitis: set of symptoms including running nose, itchy nose, post-nasal drip, congestion, and sneezing that persist for months to a year

  • Higher Body Mass Index

  • Gastroesophageal reflux disease (GERD): when stomach acid flows back up irritating the lining of the esophagus

  • Low muscle tone

  • Craniofacial syndromes or growth alteration

  • Prematurity

  • Traumatic birth

  • Gender (Males are two times more likely to have SBD)

  • Ethnicity (African Americans are at a higher risk)

Pediatric Obstructive Sleep Apnea (OSA)

Reflect on your quality of sleep the past few nights. Did you sleep soundly through the night without any disturbances and wake up rejuvenated, or did you toss and turn all night feeling distracted and lethargic in the morning? The quality and effectiveness of a good night’s sleep impacts your mood and productivity the following day. The same holds true for children; if a child experiences disturbances throughout the night, they may demonstrate difficulties in behavior and attention during the school day. Studies have suggested that as many as 25% of children diagnosed with attention-deficit hyperactivity disorder may have symptoms of obstructive sleep apnea.

What is OSA?

OSA is an airway function disorder that is observed during sleep. OSA is when a person has repeated episodes of partial or complete upper-airway obstruction during sleep

How prevalent is OSA in children?

Studies have shown that up to 5% of children are diagnosed with OSA, with a correction between pediatric obesity and OSA.

What are the symptoms of OSA?

The most prevalent symptom of OSA is snoring. Although some children may only demonstrate habitual snoring which consists of vibration of airway tissue with no airway obstruction, studies have found a ratio between 3:1 and 5:1 between symptomatic habitual snoring and obstructive sleep apnea (OSA).

Other symptoms include the following:

  • Agitated sleep

  • Nightmares

  • Mouth breathing or open mouth posture

  • Bedwetting

  • Pauses in breathing or gasping for air during sleep

  • Audible breathing

  • Grinding teeth

  • Sweating

Treatment for Airway Disorders

  1. The first step to treatment of airway disorders is to determine the function of the nasal airway. Determining structural or physiological barriers to nasal breathing is necessary to determine plan of care. An evaluation by an allergist and otolaryngologist (ENT) is necessary to determine if medications such as antihistamines, allergy medicine or surgery is required to be able to safely breath out of the mouth.

  2. Elimination of non-nutritive sucking is important for adequate growth and formation of dental structures. Non-nutritive sucking (e.g. pacifier, finger, and object sucking) is a risk factor for future dental occlusion abnormalities. Orofacial myofunctional therapist can provide strategies to eliminate the use of nonnutritive sucking.

  3. Establishing adequate oral rest posture would be the next step of therapy. Orofacial myofunctional therapy focuses on retraining the muscles to stabilize a normal rest posture between the tongue, lips, teeth and jaw. Orofacial myofunctional therapy uses oral tactile stimulation and resistance activities to help disassociate the tongue from the jaw, improve lip closure and strengthen tongue elevation.

  4. Once the resting posture has been achieved, orthodontics may be recommended for dental stability if the child presents with a malocclusion of crossbite, overjet, or underbite; this might include braces, retainer, or rapid palatal expansion depending on the occlusion.

Pediatric Obstructive Sleep Apnea Treatment

In cases of pediatric sleep apnea, the first treatment step is typically the removal of the adenoids and tonsils. As reported by American Sleep Apnea Association, the removal of the adenoids and tonsils results in complete elimination of pediatric OSA symptoms in 70-90% of uncomplicated cases. As previously mentioned, a dental evaluation should be performed to check for hard palate development to accommodate the child's tongue. If necessary a rapid palatal expander (a non-invasive fixed and/or removable dental device) can be worn for six months to one year, to expand the transverse diameter of the hard palate.The next treatment option to consider is positive airway pressure, or PAP, which is typically used as a palliative treatment for adults with sleep apnea. A PAP machine blows pressurized air into the child’s mouth to counteract the closing of the throat during sleep. The amount of pressure is determined through an overnight sleep study.

If you feel your child exhibits any of the symptoms listed above for an airway function disorder, speak with your primary care physician for adequate referrals to airway specialists. At Lumiere Children’s Therapy, our speech-language pathologist can treat speech sound disorders, swallowing disorders, and oral motor deficits associated with AFD.

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References:

Archambault, N. (n.d.). Healthy Breathing, 'Round the Clock. Retrieved from https://leader.pubs.asha.org/doi/full/10.1044/leader.FTR1.23022018.48


Capdevila, O. S., Kheirandish-Gozal, L., Dayyat, E., & Gozal, D. (2008). Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proceedings of the American Thoracic Society, 5(2), 274-82.

Children's Sleep Apnea. (2017, February 13). Retrieved from https://www.sleepapnea.org/treat/childrens-sleep-apnea/

Deviated septum. (2018, March 03). Retrieved from https://www.mayoclinic.org/diseases-conditions/deviated-septum/symptoms-causes/syc-20351710

Gastroesophageal reflux disease (GERD). (2018, March 09). Retrieved from https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940

Hayes, K. (n.d.). Coping With Chronic Rhinitis. Retrieved from https://www.verywellhealth.com/coping-with-chronic-rhinitis-4160487

Orofacial Myofunctional Disorders: Treatment. (n.d.). Retrieved from https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589943975§ion=Treatment

Positive Airway Pressure Therapy for Sleep Apnea. (2017, February 03). Retrieved from https://www.sleepapnea.org/treat/sleep-apnea-treatment-options/positive-airway-pressure-therapy/


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.

Lumiere Children’s Therapy: Holiday Toys for All Ages

It’s the most wonderful time of the year! Finding the perfect gifts for your young ones that are both fun and encourage developmental skills may seem impossible, but Lumiere Children’s Therapy is here to help!

Early Development

Throughout their early years, children develop cognitive, language and motor skills that drive their development for later years. Toys should be challenging but engaging for children at this age. Limit the amount of toys that do all the work for them, such as light-up, musical or spinning toys; instead, focus on toys that require attention and fine & gross motor skills. Here are a few examples:

Cause & effect

Cause and effect toys help children understand the concept that one action can create a reciprocating action. Understanding cause and effect is the baseline for effective communication skills. Children will understand that if they use a facial expression, gesture or vocalization, they will get something in return. Cause and effect toys also encourage the development of fine motor skills by manipulating the toy for something to happen. It also requires strong trunk control to hold oneself up while interacting with the toy.

Fine motor

Fine motor skills are necessary for eating, dressing and writing in later years. The first grasp to develop around six months of age, is the pincher grasp, which requires using the fingertips and thumb to lift smaller objects. As the fine motor skills increase, children will learn how to perfect the pincher grasp, use hands to hold bigger objects, manipulate objects by placing or retrieving from containers and play with smaller toys.  For a full description of fine motor development click here.

Animals

Animal sounds and names can promote language in small children. Often times, babies’ first few words are either an animal name or sound. Animal sounds are usually the first consonants to develop such as /n/ in “nah”, /m/ in “moo”, /w/ in “woof”, /m/ “meow”, and /t/ in “tweet”.

Imaginary Play

Imaginary play encompasses social, cognitive and language skills to emulate another person. Imaginary play skills usually develop between 18-24 months by imitating talking on the phone, driving a car or unlocking a door with a key.  By four years old, imaginary play will incorporate elaborate story plots with a variety of characters, settings, problems and resolutions.

The Arts

Music

Music aids in all areas of child development as well as preparing for school, including  intellectual, social and emotional, and language skills. Music can serve as a calming or self-regulating tool, aide in communication, and positively affect a child’s mood. Interacting with your child while playing music serves as an intimate bonding experience. Dancing along and using hand gestures (such as the “Itsy Bitsy Spider”) can improve fine and gross motor skills as well! Read our Music Magic post for more ways to incorporate music into your daily routine.

Blowing instruments:

Hand instruments:

Art

Art is just as important to development and school readiness as music. Dexterity skills are developed while creating art by learning how to grip a writing utensil, manipulate scissors and glue paper together. For younger children, art can also serve as a platform for language development and identification of colors, shapes and actions.



Board Games

For older children (4+), board games can serve as a way to indirectly teach educational concepts in an engaging manner. Board games can target letter, shap, and color recognition.  It also encourages social and cognitive skills such as attention, sportsmanship, turn-taking and listening.

Letters:


Shapes:


Color:


Following directions/listening games:

The most important aspect of gift giving is interacting and playing with your children, nieces/nephews and grandchildren! Children learn best from adult models and they will cherish your time spent together more than any toy. Take time away from the busy holiday schedules to enjoy time with your family.

Happy Holidays!

From the Lumiere Children’s Team.




Resources:


Children and Music: Benefits of Music in Child Development. (n.d.). Retrieved from https://www.brighthorizons.com/family-resources/e-family-news/2010-music-and-children-rhythm-meets-child-development

ExpectEditors, W. T. (2014, October 20). Pretend Play. Retrieved from https://www.whattoexpect.com/toddler/pretend-games/

Lynch, G. H. (2012, May 25). The Importance of Art in Child Development. Retrieved from http://www.pbs.org/parents/education/music-arts/the-importance-of-art-in-child-development/

Staff, S. Z. (2015, April 28). Teaching baby animal names, sounds, and habits builds important skills. Retrieved from https://www.schoolzone.com/blog/teaching-baby-animal-names-sounds-and-habits-builds-important-skills



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 Therapy: School Therapy

The beginning of the school year may seem overwhelming for parents, with navigating bus schedules, after-school activities, and new classroom expectations. To make the beginning of the year a little less hectic, we answered all your questions about the IEP process as well as  taking a look at speech therapy services in the school.

What is an IEP?

An IEP, Individualized Education Program, is a legal document for each child in public school who qualifies for special educational services. The IEP documentation process is a team approach consisting of caregivers, classroom teacher, special education teacher, and specialized therapists (speech therapist, occupational therapist, vision therapist, psychologist, etc). The IEP outlines the appropriate and necessary special educational services available to your child to help them become most successful in the classroom.

 

What is included in an IEP?

The Individuals with Disabilities Education Act (IDEA) is a federal law requiring specific information in the IEP, but does not mandate a specific format. Therefore, each IEP may look different depending on the involved professionals and school district. The main purpose of the IEP is to outline the necessary support and services provided to your child inside and outside classroom instruction. It includes the type, amount, and frequency of services. An IEP will include the following information:

 

  • Current performance level. The IEP will outline your child’s strengths and weaknesses academically, socially and behaviorally. If appropriate, it will include an analysis on language and speech development, sensory needs, fine motor development and gross motor development. Standardized assessments will be explained with scores and severity level. Each member of the IEP team will communicate specific information about their area of expertise such as progression with current goals, strengths and weaknesses, and type of support provided.

 

  • Measurable goals. The second piece of information included in an IEP is the goals. Goals are created based on your child’s current needs. Goals are specific, measurable, attainable, realistic and timely. Progress on goals should be observed and documented throughout the year by the attending professional. During annual IEP meetings, goals will be modified, upgraded, and downgraded based on your child’s progress.

 

  • Appropriate services. The final piece of information included in an IEP is the action plan, such as recommended services, start date, location (in classroom or out of classroom), and professionals involved. Services may include extended testing time, reading intervention, speech therapy 1x/week, qualification for a communication device, and so on. The type, frequency, and implementation of services will be specific to your child’s needs.

 

What should you expect in an IEP meeting?

 

IEP meetings occur annually to discuss progress, concerns, and make necessary updates. If necessary, IEP meetings can occur more than once a year to discuss changes or modifications to the current plan. Prior to the annual meeting, team members will re-evaluate skills through standardized and/or non-standardized assessments, observe behaviors and participation in the classroom and analyze data collected on goals.

The new IEP is written with updated goals and services. The annual IEP meeting will be scheduled in advance to ensure each member of the team is present. During the meeting, each team professional will communicate progress and modifications of current goals and services. After each member of the team has discussed their area of specialty, caregivers will be able to discuss current concerns observed at home. In preparation of the meeting, write down noticeable areas of improvement and weaknesses to discuss during the meeting.

The meeting may seem overwhelming with excess amounts of educational jargon, so being prepared with specific questions or concerns will ensure you have all your questions answered. If you feel rushed during the initial or annual meeting, feel free to ask for a copy of the IEP to review at home before signing off on the current plan. Once you are comfortable with the current plan for services, your signature will allow for the IEP to become effective.

 

Speech Therapy in School

 

In order to determine eligibility for speech therapy services through the school, the speech therapist must obey the federal regulations of the Individuals with Disabilities Education Act (IDEA).  Eligibility is determined through a multi-step process including observation, teacher reports, screening, standardized assessments, work samples, and parent reports.

The speech-language pathologist will determine if there is a language or speech disorder. In order for the child to receive services in school, the disability must be adversely affecting educational performance. The following can be used to determine adverse academic impact: teacher’s reports, work samples, grade and therapist’s observations in the classroom. Due to caseload capacities, mild speech and language disorders may not qualify for services in the school. If you are concerned with your child’s speech and language development but your child does not qualify for services in the school, you may obtain services through a private practice.

If your child qualifies for speech therapy services, it is important to establish a good rapport with the speech-language pathologist. Parent involvement is crucial for carryover of skills into the home environment. Below are questions to ask your speech therapist in the beginning of each school year.

 

5 Questions to ask your speech therapist:

 

1. What will be the type of service?

 

There are two types of service methods: push-in or pull-out. Push-in is providing speech services in the classroom. The speech therapist collaborates with the teachers and classroom staff. This method allows the speech therapist to target social interactions within the classroom setting. Therapy in the classroom is most beneficial for children demonstrating difficulty with participation in the classroom. It is a great way to work on social skills, reading comprehension, or other language goals that may be impacting one’s academic success. Benefits include peer models, not missing instructional time, collaboration between classroom staff, and addressing specific academic concerns. Disadvantages include classroom distraction and limited one-on-one instruction.

Pull-out method performs speech therapy in the designated speech room. Services may be conducted in a group or individual setting. Pull-out method is recommended for children with articulation goals or specific language concerns. Advantages of pull-out allows specific instruction and intervention in a small group setting. The lesson can be child-specific and independent from the classroom curriculum of that day. The disadvantages of pull-out is that the child is taken away from peer models and may be pulled out during classroom instruction.

 

2. What will be the group size?

 

Group size varies depending on grade, speech goals and time of day. Most school groups fluctuate between three to five students in a group.

 

3. How will be the groups be divided?

 

Groups can be divided in a variety of ways: grade level, type of speech therapy (articulation, language, social), or ability level. Knowing how the group is divided is important to make sure your child is receiving the adequate amount of personalized instruction.

 

4. What will the weekly schedule be?

 

Each school speech therapist creates their weekly schedule differently. It is important to know how often and the amount of time your child will be receiving services. Will it be once a week for 20-30 minutes or three times a week for 15 minute increments.

 

5. What are the goals of therapy?

 

This is the most important question to ask your speech therapist. The speech therapist will have long term goals for the length of the IEP, as well as short term goals she/he will be targeting during sessions. Ask the therapist what goals to work on at home to facilitate carryover into the home environment.

 

For more information on speech therapy services outside school, contact Lumiere Children’s Therapy at 312.242.1665 or www.lumierechild.com.

Lumiere Blog Signature.png

 

 

 

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Resources:

School Services Frequently Asked Questions. (n.d.). Retrieved from https://www.asha.org/slp/schools/school-services-Frequently-Asked-questions/#ed2

School-Based Service Delivery in Speech-Language Pathology. (n.d.). Retrieved August 14, 2018, from https://www.asha.org/SLP/schools/School-Based-Service-Delivery-in-Speech-Language-Pathology/

Baumel, J. (n.d.). What is an IEP? Retrieved August 14, 2018, from https://www.greatschools.org/gk/articles/what-is-an-iep/

 

 

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/