children therapy

Lumiere Children's Therapy Chicago: Mastering Gross Motor Milestones

Reaching and mastering gross motor skill milestones, is vital for proper child development. The following explains the five sequential milestones (tummy time, rolling, sitting, crawling and walking) and tips to help your child achieve them.

David Precious

David Precious

Tummy Time

Tummy time is important for your child to develop strength in his neck muscles. Neck muscle strength is important for your child to begin holding his head upright and in the middle, and contributes to his ability to roll over, sit, crawl and walk.

If your child seems fussy on their tummy, this is because it is a difficult position for your child. It is similar to an adult version of a plank— very difficult! Tummy time looks different each month of development, depending on your child’s age and level of strength, call Lumiere Children’s Therapy or attend one of our parent trainings to learn more about developmental positions and motor milestones.

Where can I do tummy time?

You can do tummy time on a blanket or foam mat on the floor, over your chest facing you while you are laying down, over your lap or carrying the child on his/her tummy across your forearms.

What should my baby look like in tummy time?

Tummy time looks different at each month of age. Initially in the first month, your baby will barely be able to lift his head off the surface to rest his cheek. Then, closer to 3-4 months you child will be able to lift his up further and further until it is at a right angle to his back. By 5-6 months, your child will start to push up on his hands with straight elbow. Then, it’s time to start pivoting and belly crawling.

Tummy Time Tips

  • Always supervise your child during tummy time. Get on the floor with your child so he/she is motivated to lift his/her head

  • Use a mirror, rattles, music-playing toys, or bubbles

  • Sing to your child during tummy time

  • Begin tummy time early on, as early as a week old!

  • Start in 2-5 minute increments and work your way up to total 60 minutes a day.

  • Perform exercises when your baby is the most energized and ready to play, such as after your baby has slept, eaten, and has a clean diaper, to ensure your baby is the best mood to “exercise”!

  • Note: some babies will need to wait an hour after eating before tummy time to minimize spitting up, especially babies with reflux. Ask your doctor about specifics if your baby has reflux.

  • Use a fun tummy time mat a comfortable tummy time mat will motivate your baby to stay on his tummy, engage in the toy, and be comfortable! Fisher-Price Deluxe Kick 'n Play Piano Gym or a water mat will also motivate your baby to perform tummy time! Hoovy Baby Inflatable Water Play Mat


Rolling

When should my baby be rolling?

Babies typically roll from back to belly around 4-6 months, and belly to back ~3-5 months. However, this is a range, and every child is different!

How can I help my baby roll?

There are a few fun activities that you can do with your baby to encourage rolling:

  • Reaching for feet: Rolling from back to belly requires quite a bit of core strength, so a great place to start is by encouraging your child to reach for his feet to really engage his core muscles.  You can do this by placing rings on your child’s feet to encourage him to reach up towards his feet to grab the rings. You may have to help him at first, but once he is able to do so let him do it more and more on his own until he does it on his own.

  • Reaching to one side: With your child on their back, use a toy to guide your child to look to one side and encourage him to reach for the toy by reaching across his body and rolling to his side. Sometimes you have to move the toy farther than you think to get him to reach!

  • Assisted rolling: Once your baby is reaching across his body for a toy, you can help your baby to his side by assisting at his hip. This helps teach him how to complete the motion with both his upper and lower body together. As he continues to gain strength, you can gradually decrease your support until he rolls on his own!  

  • Tummy time: The more comfortable and strong your baby is in tummy time, the more your baby will want to roll and tolerate floor time. Read above for tips on tummy time!

When and why would my baby need physical therapy to help with rolling?

Babies are all different and can develop at slightly different times, and that is okay! If your baby is showing any of the following “red flags” listed below, it might be a good idea to ask a physical therapist for an evaluation. (However, these are child specific. Call our and ask to speak with a physical therapist with any questions):

  • Not reaching with arms for toys at 6 months on back

  • Not able to lift head up in tummy time at 3 months

  • Not rolling back to belly by 8 or 9 months

  • Only reaching with one arm

  • Only rolling to one side

Additionally, your child may have another medical diagnosis that will make meeting motor milestones tougher, and a physical therapist can educate parents on treatment ideas and home exercises to teach your baby the motor plan to roll, as well as strengthen muscles!


Sitting

When should my baby be sitting?

Babies can begin prop-sitting while leaning on hands as early as 4 months, however while having a caregiver close by to assist with balance. Babies typically can sit on their own between 6-8 months. However, this is a range, and every child is different!


How can I help my baby sit?

There are a few fun activities that you can do with your baby to encourage sitting:

  • Prop-sitting: Hold your child around his trunk and help him lean forward onto his arms. At first, your child may only be able to do this for a few seconds at a time, but it builds arm strength! Work up to 30 seconds, then 1-2 minutes at a time, to your child’s tolerance. At first, your child will place his hands in front of his feet (around 4 months). As your child gets stronger, his arms will move closer to his knees (around 5 months), then hips, then he may place his hands on his own legs until he can sit without his arms (around 6-7 months). As your child gains strength, continue to sit close by and assist your child as needed.

  • Assisted sitting: Hold you child around his trunk and decrease your assist until your child can sit on his own. You can place toys directly in front of him to encourage him to sit up straight and lean his hands on a toy if needed.

Note: Babies do not gain the reflex to catch themselves on their arm from falling sideways until 6-7 months, and they do not gain the reflect to catch themselves on their arm from falling backwards until 10 months. Always be nearby and ready to catch your child from falling when practicing sitting exercises.

  • Tummy time: Similar to rolling, the more comfortable and strong your baby is in tummy time, the more your baby will have the core strength to sit. Read Part 1 for more tips on tummy time!



Toys for sitting

Cube activity Center: A vertical surface such as a large cube is great to provide some support for your child to place his hands on, and also encourage an upright trunk. Check it out here

Shape Sorter: A larger type toy is helpful to provide some support for your child to put his hands on as he learns to sit. Once he is sitting on his own, it encourages reaching and manipulating toys to further challenge balance in sitting. Check it out here


When and why would my baby need physical therapy to help with sitting?

Babies are all different and can develop at slightly different times, and that is okay! If your baby is showing any of the following “red flags” listed below, it might be a good idea to ask a physical therapist for an evaluation. (However, these are child specific. Call our and ask to speak with a physical therapist with any questions):

  • Not able to sit on his own by 8 months reach for toys on belly at 7 or 8 months

  • Not able to prop-sit while leaning on his hands by 7-8 months

  • Not able to sit upright when he sits (leaning to one side)

Additionally, your child may have another medical diagnosis that will make meeting motor milestones tougher, and a physical therapist can educate parents on treatment ideas and home exercises to teach your baby the balance to sit, as well as strengthen muscles!

Crawling

When should my baby be crawling?

Babies typically begin pivoting in a circle on their belly around 6-7 months, belly crawling forward on their belly between 7-9 months, and crawling forward on hands and knees around 8-10 months. However, this is a range, and every child is different!

How can I help my baby crawl?

There are a few fun activities that you can do with your baby to encourage crawling:

  • Sitting to belly: Once your child is able to sit on their own, its time to start introducing weight shifting to transition to his stomach. To do this,  start in sitting and you can lean your child to one side to lean on one arm while reaching towards a toy with his opposite arm. Then guide him up and over his leg and onto his belly.  Make sure to have him go over his side to protect his hips. This strengthens his arms and core and helps them learn how to shift his weight from side to side.

  • Kneeling at a surface: Next, help him kneel at a surface or a a low step to encourage weight-bearing on his knees in a modified crawling position. This a great place to practice lifting one arm to reach for a toy, to simulate reaching forward on all fours when crawling.

  • Rocking on all fours: You can also help him rock on all fours to help them slowly build strength in his core and arms. As he begins to get into all fours on his own (typically anywhere from 5-9 months) you can provide support at his trunk and legs to help him rock back and forth. Once he gets stronger, you can support his trunk and help him crawl forward as he moves his arms.

  • Tummy time: Similar to rolling and sitting, the more comfortable and strong your baby is in tummy time, the more your baby will want to pivot and crawl! Read Part 1 for more tips on tummy time!

When and why would my baby need physical therapy to help with crawling?

Babies are all different and can develop at slightly different times, and that is okay! If your baby is showing any of the following “red flags” listed below, it might be a good idea to ask a physical therapist for an evaluation. (However, these are child specific. Call our and ask to speak with a physical therapist with any questions):

  • Not able to reach for toys on belly at 7 or 8 months

  • Not trying to pivot on belly or move position on belly at 7-8 months

  • Not rolling back to belly by 8 or 9 months

  • Only reaching with one arm

  • Only rolling to one side

Additionally, your child may have another medical diagnosis that will make meeting motor milestones tougher, and a physical therapist can educate parents on treatment ideas and home exercises to teach your baby the motor plan to crawl, as well as strengthen muscles!


Walking

When should my baby be walking?

Babies can begin walking between 10-14 months. However, this is a range, every child is different, and this depends on their motor milestone acquisition thus far!

How can I help my baby walk?

There are a few fun activities that you can do with your baby to encourage walking. Always stand close by with your hands out during such exercises to catch your child from falling if necessary:

  • Assisted cruising: Once your child is able to pull to stand and stand at a support surface, you can start teaching him to move on his feet by stepping sideways to cruise along a table, coffee table, or ottoman. The surface can be about the height of your child’s chest. Once he has mastered cruising, you can encourage larger steps by having him cruise between two support surfaces at a 90 or 180 degree angle. Gradually, you can increase the distance between the surfaces to make it more challenging.

  • Reaching in standing: Walking incorporates both balance and coordination, and a great way to target this is by practicing weight shifting while standing. You can start by having your child stand with his back against a couch or wall, and practice reaching forward or sideways. You can do this by having him reach for a toy or pop bubbles, whatever interests him. You can also have him hold onto the toy as you for another way to help him gain balance in standing with decreased assistance.

  • Walking practice: Practice taking steps by holding your child around his trunk and walking/kneeling behind them. This promotes proper alignment while walking.  When your child can stand on his own >20-30 seconds at at time, he is likely ready to start taking steps. Stand a few feet away from him to encourage him to walk to you. You can start by holding his hand, or holding the same toy, then fade assist as he gains strength and confidence!

  • Squatting: When your child can stand at a surface, hold objects at the height of his knee to encourage him to bend down and pick up an object, then return to standing. Both knees should bend, and this strengthens his muscles! As he gets stronger, you can hold the object lower and lower until the object is on the floor. Make sure to do this to both sides.

  • Tummy time: Similar to rolling, the more comfortable and strong your baby is in tummy time, the more your baby will have the core strength to sit. Read Part 1 for more tips on tummy time!

Walking tips

  • Start with your child barefoot so your child can feel the ground and use his toes for balance.

  • Use positive praise and get excited for your child so he stays positive!

  • Use bubbles or a fun toy to distract him!

  • Note: Some children may need some support in their shoes to add some stability to assist in standing and walking. A physical therapist can assess your child’s foot alignment to determine if an insert or brace is indicated.


When and why would my baby need physical therapy to help with walking?

Babies are all different and can develop at slightly different times, and that is okay! If your baby is showing any of the following “red flags” listed below, it might be a good idea to ask a physical therapist for an evaluation. (However, these are child specific. Call our and ask to speak with a physical therapist with any questions):

  • Not standing at a surface by 12-14 months

  • Not cruising along a surface at 16 months

  • Refusing to bear weight through legs at 10 months

  • Standing/cruising on tip-toes

Additionally, your child may have another medical diagnosis that will make meeting motor milestones tougher, and a physical therapist can educate parents on treatment ideas and home exercises to give your baby strength and confidence to walk!

Thank you for reading our motor milestone series! If this blog post has sparked any questions about your child’s development, feel free to call our office to speak to a physical therapist! We also offer two “mom and tot” classes about teaching your child to move, listed below. Call our office at 312.242.1665 to try a class!



PARENT/TOT CLASSES

BUDDING BABIES* (ages 4-10 months)

Your baby may not be crawling yet but there’s lots they’re learning – and you can help! Learn how to position your baby to build strength and develop stability. Explore the senses and support visual and auditory development with tummy time, rolling and other key exercises. This class includes parent discussion time to help learn about your child's development.

*Parent Involvement Required

WEE WALKERS* (ages 11-22 months)

As your baby becomes vertical, a whole new world of wonder is revealed. Play environments are vital to encourage discovery, problem solving, balance and coordination. Parents learn to understand how their infant interacts and communicates with them and others.

*Parent Involvement Required

www.lumierechild.com

Lumiere Children’s Therapy: Feeding Tubes

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

Nasal Feeding Tubes

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

Nasogastric Tubes (NG)

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

  • Advantages

    • No anesthesia is required for insertion of tube

    • Tubes may be replaced at home

    • Feedings are usually quick

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

    • Stomach provides a larger capacity for feedings

  • Disadvantages

    • NG tube is visible on face

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

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

    • Increased nasal congestion

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

Nasoduodenal Tubes (ND)

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

  • Advantages

    • No anesthesia is required for insertion of tube

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

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

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

  • Disadvantages

    • Feedings are given slowly over 18-24 hours

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

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

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

Nasojejunal (NJ)

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

  • Advantages

    • No anesthesia is required for insertion of tube

    • Reduces risk of reflux

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

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

  • Disadvantages

    • Feedings are given slowly over time

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

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

Stomach Feeding Tubes

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

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

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

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

Gastrostomy Tube (G)

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

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

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

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

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

  • Advantages

    • PEG placement does not require surgery

    • Decreased clogging of tube since diameter is larger

    • Larger reservoir in stomach compared to small intestine

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

    • Decreased chance of tube being pulled out

  • Disadvantages

    • Risk of aspiration due to reflux

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

    • Surgery may be required depending on placement.

    • Possible skin irritation from leakag

Gastrojejunal (GJ)

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

  • Advantages

    • Reduced risk of aspiration

    • May reduce reflux

    • Less costly than J-tube placement

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

  • Disadvantages

    • Potential intolerance of tube

    • Extra care required

    • Potential skin irritation

    • Tube may clog more easily due to smaller diameter

Jejunostomy (J)

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

  • Advantages

    • Reduced risk of aspiration and reflux

    • Tube is hidden

  • Disadvantages

    • Potential intolerance to placement of tube

    • Extra care required

    • Potential skin irritation from leakage

    • Tube is small and more likely to clog

    • Surgery is required for placement of jejunostomy

    • Feedings are slow


Treatment of Children with Tube Feedings

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

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

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

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

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

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References

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



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



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



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



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


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


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


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

Child Speech Therapy: Expressive Language Skills

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

What is expressive language and why is it important?

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

How do expressive language skills develop?

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

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

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

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

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

Expressive Language Milestones & Activities:

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

Birth- 3 years old

  • 0-1 years old:

    • Produces pleasure sounds (cooing and gooing)

    • Makes noises when talked to

    • Protests or rejects through gestures or vocalizations

    • Cries differently for different intentions

    • Attempts to imitate facial expressions and movements of caregivers

    • Laughs during parent interaction

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

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

  • Activities to Try at Home:

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

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

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


1-2 years old

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

  • Takes turns vocalizing with another person

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

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

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

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


2-3 years old

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

  • Repeats words spoken by others

  • Has a word for almost everything

  • Speaks in two-three word sentences

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

  • Ask yes and no questions

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

  • Imitates turn-taking in games or social routines

Activities to Try at Home:

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

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


Preschool

  • 3-4 years old

    • Names objects in photographs

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

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

    • Answers simple who, what, and where questions

    • Uses about 4 sentences at a time

    • Child’s speech can be understood by most adults

    • Asks how, why, and when questions

  • Activities to Try at Home

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

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


  • 4-5 years old

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

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

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

    • Tells a short story

    • Keeps a conversation going

    • Talks in different ways depending on the place or listener


  • Activities to Try at Home

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

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


School age

  • 5-6 years old

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

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

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

    • Uses the possessives pronouns her and his

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

    • Asks grammatically correct questions

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

    • Uses qualitative concepts short and long


  • Activities to Try at Home

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

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


  • 6-7 years old

    • Child is able to names letters

    • Answers why questions with a reason

    • Able to rhymes words

    • Repeats longer sentences

    • Able to retell a story

    • Describes similarities between two objects

  • Activities at Home

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

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


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

Resources:

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

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

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

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

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

Parent Resources: Transitioning to Kindergarten

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

Skills Needed For Kindergarten

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

 

1. Identify some letters of the alphabet.

 

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

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

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

 

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

 

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

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

 

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

 

  

4. Write first name.

 

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

 

 5. Count to 10.

 

6. Able to self-dress.

 

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

 

7.  Clean up toys or activities independently.

 

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

 

  8. Listen to a story without interrupting.

 

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

 

   9. Follow 1-2 step directions.

 

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

  • Independently use bathroom.

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

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

 

The First Day of Kindergarten

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

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

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

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

 

Expectations of the First Day

 

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

 

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

 

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

 

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

 

Happy first day of school!📚😄

 

LUMIERE THERAPY TEAM🖐️

 

 

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Resources:

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

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

 

Physical Therapy: In-Toeing and Out-Toeing

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

Andrew Seaman

Andrew Seaman

In-Toeing or “Pigeon Toe”

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

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

Tibial Torsion

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

Metatarsus Adductus

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

Femoral Anteversion

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

Femoral retroversion

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

Out-Toeing or Duck Feet

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

Flat feet

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

Hip contracture

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

Treatment for In-Toeing and Out-Toeing

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

Children may require intervention if the following persists:

·     Not improved by the age of three

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

·     One foot more turned than the other

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

·     Gait abnormalities (deviation from normal walking)

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

 

LUMIERE THERAPY TEAM🖐️

 

References: 

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

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

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

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

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

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