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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: 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/


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.

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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/

 

 

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.

 

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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