Neurofibromatosis in Children: Where OT’s Role fits into Treatment

Neurofibromatosis is primarily a genetic disorder that affects approximately 1 in 3,000-4,000 individuals in the United States (2019, National Institute of Neurological Disorders and Stroke). Tumors, usually noncancerous, form and attach to nerve tissue across the body. There are 3 types of neurofibromatosis disorders:

NF Type 1: Type 1 is oftentimes displayed during childhood between birth and age 10. Obvious signs at birth can include flat, light brown spots on the skin and freckling in the armpits and the groin area. Although symptoms aren’t lethal, children with NF Type 1 can experience a wide array of extremely uncomfortable effects including: bone deformities (i.e. scoliosis, bone deformities), tumors along the optic nerve (eyesight), learning disabilities, and attention-deficit disorders.

NF Type 2: Type 2 is not as common as Type 1 and symptoms usually appear during teen and adult years. Benign tumors can form in both ears which are called acoustic neuromas and/or vestibular schwannomas. As a result, problems include: hearing loss, ringing in the ears, headaches, reduced balance. Tumors have also been known to grow in spinal, cranial, ad peripheral nerves resulting in body pain, facial droop, decreased vision and cataracts, and numbness/weakness in muscles in the arms and legs.

Schwannomatosis: Schwannomatosis is also a benign form of neurofibromatosis that is not symptomatic until the adult years (over the age of 25). Similarly to Type 2, benign tumors form on the cranial, spinal, and peripheral nerves of the body resulting in chronic pain just about anywhere in the body, numbness and weakness of any muscle groups of the body, and overall reduced muscle mass.

(Mayo Clinic, 2019)

When it comes to pediatric services, the type that occupational therapists may come across in obviously neurofibromatosis Type 1. Just like many neurological conditions, occupational therapy can play a crucial role in intervention:

Cognitive development and training: Children with NF Type 1 may have learning disabilities that become apparent during the school years. Commonly, learning disabilities negatively impact a child’s ability to perform reading and mathematics. Occupational therapy can work with children and their parents in cognitive training as well as teach adaptation techniques to improve overall academic performance.

Postural instability: Due to bone deformities, especially in the spine, a child’s overall postural stability or ability to stay upright on their own may be challenged. Depending on the severity of the bone deformity, occupational therapists can show families and children therapeutic strengthening exercises, balance training strategies, and adaptations (external supports such as canes, crutches, walkers, etc.).

Standing balance: If postural stability is an issue, then standing balance and walking are directly impacted in the child, making it substantially difficult to participate in daily activities that require either of those skills. Along with adaptations and intervention for postural stability, occupational therapists can also work with children to incorporate changes into their daily routine in order to increase their overall participation with as little help as possible.

Vision deficits and compensation: Occupational therapy does not play a role in visual correction; however, OT can provide a child with compensation techniques for visual deficits. This can include adaptations such as enlarged printing, magnification equipment, lighting changes in the home and/or in school, textured writing, etc.

Behavioral/attention intervention: In some cases, NF Type 1 can cause secondary attention deficits hyperactivity disorder (ADHD), which many pediatric OTs come well-equipped to handle. This could involve working with the child and the parents about behavioral strategies to increase attention and to reduce hyperactive behavior (i.e. possibly sensory-related) in order to participate more fully in tasks at home and at school.

Parent/caregiver education: Part of the OT therapeutic model is a heavy education piece geared towards providing knowledge to the child’s closest family members. This way, the child can receive skilled intervention during the hours in which the OT is unable to see the child directly.

Co-treatment and consultation with other medical disciplines: OT cannot be considered a go-to option to alleviate 1000% of symptoms from NF Type 1, which is also true of many clinical disciplines in the healthcare field. For example, children with NF Type 1 oftentimes experience tremendous bodily pain which can only be managed by prescribed medication. OTs need to work together with other disciplines to make sure everyone is on the same page and to provide the child with the best interventions possible.

Neurofibromatosis: Overview (2019). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/neurofibromatosis/symptoms-causes/syc-20350490. Viewed on July 8, 2019.

Destructing Structured: Baby Steps to Helping Your Child enjoy a Vacation away from Home

Every parenting blog, every childhood foundation, and every pediatric research organization has their designated online soapbox.  On top of each of those soapboxes is a block of guilt trips loudly stating that you, the parent, must provide your children with a structured day as well as a structured life.  For the most part, there is nothing wrong with this idea that your child’s day should be prepared and planned out…until you go on vacation.

Have you noticed that even though your child may be just fine at home, free of melt downs and abrasive hiccups, it all changes once you take them somewhere far away?  It’s not even the new destination that throws your child (and you) off.  It’s the new schedule! This means making time for more fun activities during the day while neglecting the activities that you have so meticulously pinned down for home to prevent an apocalyptic episode.

Parents: it is possible to take your child(ren) on vacation and have fun! In order to make this happen, some serious planning needs to happen before you lock the door behind you.  Consider all of the things that your child has at home that will not be accessible while you are gone:

  • The T.V.: This is probably the worst thing to see go for a couple of weeks in a child’s eyes, but in reality the family T.V. will be staying home.
  • The bed: Some children take great comfort in sleeping in their own bed, so this might be an adjustment that parents need to think about.
  • The tub and tub toys: Yes, this should be a no-brainer but the tub and the large bucket of toys is not ideal for any trip.
  • The high chair: Although there are some portable or travel-friendly options for young children, high chairs for the most part are left at home which means the child needs to figure out how to eat sitting in a different meal arrangement.
  • Anything that can’t fit in a duffle bag: If anything, use the rule of thumb that any items that can’t fit into a tiny duffle bag should be left home.

Think of the items you can still take with consideration to how much you can carry in your car or on a plane:

  • Snacks: Keep a few fun snacks on hand for car trips and for airplane rides (according to airline regulations).
  • A few toys within reason: It is not a crime to bring one or two small toys on a trip, but don’t get carried away.
  • Blankies or other comfort items: If your child is a “blanket baby” these are still small enough and travel-friendly enough items to bring.
  • Pocket-sized electronics: Iphones, tablets, and other small electronics can be useful distractions but make sure that your child isn’t on the screen during the entire trip or else it defeats the purpose of a vacation.
  • Books or coloring books: Again, only a few that can fit in a small bag.

Have a plan B:

  • Buying things during the trip: This includes snacks and cheap knick-knack toys and books that can be disposed of after the trip.
  • Distractions, distractions, distractions!: If you are keeping your child busy and engaged in trip activities (rides, parks, etc.), then it might help them forget about their go-to comforts of home.
  • Breaks during the trip: Know that your trip isn’t going to be perfect and that unplanned breaks and stops will be made.  In order to accommodate for this, don’t back your schedule too tight full of activities that require you to be somewhere at a certain time.

Practice!

  • Go on short road trips away from home, even if it’s an hour out.  Minimize how many toys your child can bring.
  • Purposefully have your child do activities during nap-time for a few days before the trip to get used to being tired.
  • Skip baths on occasion, especially if your child expects one every day at the same time.
  • Talk about the trip with your children.  Get your child involved in planning the trip by having them look at pictures or videos of things they are going to do or see.
  • Reduce television time: Get your child away from the T.V. in order to get them to try other activities.
  • Allow your child to get bored.  If you are a parent who plans every single one of your child’s daily activities, then transitioning to a vacation will be difficult.  Letting them get bored or come up with own ways to occupy themselves helps immensely for long car rides and airplane rides.
  • Let your child try some campouts or sleepovers where they sleep somewhere else in the house besides their own bed like the living room.

If your child has a developmental condition (i.e. autism, ADHD, Down syndrome, etc.) that makes destructing a structured day even more difficult that it would for a typically growing child, consult with your pediatrician and occupational therapist.  Both professionals may be able to offer more ideas about how to prepare your child for unpredictable moments during a vacation and how to handle behavioral problems that may arise.

Teaching your Child how to Ride a Bike without Training Wheels: An OT’s Perspective

Is it that time? Has your child reached an age where you, the parent, are confident enough to teach him or her the basics of riding a bike? Well, that’s great and congratulations. You proudly wrench the training wheels off, assist your child with his helmet, and then guide him to his bike seat. Both you and your child are beaming in anticipation of what’s going to happen. You steady the bike with one hand as your kiddo starts to pedal forward. You let go and he takes off! In a matter of a few feet, gravity takes over. The child and the bike tip and with a loud thud hit the pavement, causing the waterworks to burst.

What went wrong? On the surface, nothing. This is pretty typical of a child’s early experience with operating a bicycle. However, if you and your child want to reduce the inevitable frustration that comes with learning, use some of the following tips and break down the process step by step:

Make sure your child actually wants to and is ready to learn. Whatever you do, do not rush the issue. Riding a bicycle with no training wheels is rarely an urgent milestone that needs to be met within a certain deadline. Yes, some children will learn how to ride by the time they are 3 years old but this is exceptionally rare. Typical ages usually range from 5-8 years old at the earliest.

Have an open discussion with your child and ask if he or she would like to try out the bike without the training wheels on. Remember, this should only be suggested if the child has had several months of practice using a bike with training wheels left on.

Safety first. Have all of the safety equipment in place and ready to go. Your child should always be wearing a helmet, even if the ride is only up a short sidewalk and back. Make sure your child is wearing colorful, bright clothes in order to alert drivers that may pass by. Teach your child during daylight hours because night time occludes drivers’ vision, and your child is more likely to lose steering control and stray into the road. Have the child wear sturdy close-toed shoes in order to get enough traction against the pedals and to protect the feet from injury.

Use substitute surfaces if required. If you’re a little nervous about starting your child off on pavement or cement, maybe start with practice rounds in short-grassed lawns. Avoid using graveled or loose-rocked paths with bumps and potholes because your child will most likely not be ready to compensate and to prevent sliding out.

Focus on the hips. Yes, please teach your child how to pedal forward and to steer the handlebars because he or she can’t operate the bike without either type of skill. Just remember that the most neglected parts of the body while teaching someone how to bike without training wheels are the hips and torso. Hold your child up on the bike in a neutral, upright position. Encourage them to keep their feet firmly planted on the pedals while you cautiously tip them from left to right. Draw attention to their hips and torso. Show them what to do with their torso and buttocks when the bike starts to tip.

Modeling. Children learn a great deal by simply watching other kids. If you have another child who has already mastered riding a bike without training wheels and is not significantly older than the learner, have the child become and additional teacher. If there isn’t another child, have another parent of family member video-record the child learning how to ride. Yes, include failures too because the child can learn how to correct him or herself just by watching the video.

Let your child determine rest breaks. If your child requests a break or to stop riding for the day, allow for it. Do not force the issue because then you will accidentally make riding a bike a chore rather than a fun activity.

Brakes education. Before even taking the training wheels off, make sure your child already knows how to operate the brakes whether it’s hand brakes or pedal brakes.

Upgrade and downgrade the ride. Start the child off on a smooth and straight surface that will only take them from point A to point B. If your child can initiate, ride, and brake independently in one straight line then add challenges. Teach steering and maneuvering around obstacles (i.e. cones, rocks, etc.). Guide them on a ride over ground with variable surfaces (i.e. broken up or cracked sidewalks, driveway cutouts or thresholds, etc.).

Remember that a young child will have limited endurance, which means that taking them on an 8-mile bike ride is impractical and dangerous. Work them up to that at their own selected pace and keep them well hydrated.

Is my work schedule bad for my child’s development? An OT’s Perspective

Working parents, especially of younger children who aren’t in school, oftentimes feel guilty for having to go to work all of the time. They wonder if their time spent away from their children (especially if it’s both parents working), negatively impacts their young ones in any way. Unfortunately, in numerous family situations, both parents have no choice but to work. Financial obligations limit their schedule flexibility. There are also family structure variations to consider: single-parent homes, parents working full-time, parents working part-time, and parents working over-time. Additionally, we have to think about what the alternative care options are: daycare, full-time nanny, family members, etc.

So, is it bad for young children if parents have to work? According to the Pew Research Center, over 46% of households have two full-time working parents in the United States as of 2015. 17% of households have one full-time and one part-time working parent, leaving only about a quarter of households in the United States to have one parent who is not employed. One would hope that, based on these statistics, having both parents working outside of the home can’t be all that bad right? Let’s take a look at the research.

Hsin and Felfe (2014) examined several variable concerning maternal employment and the assumption that mothers who work are not spending enough time with their children. In fact, the research found that high-quality and educational time that parents spend with children does not seem to matter much when it comes to parental employment. Authors found that employed mothers who are well-educated are very capable of spending time with their children in the forms of structured and educational activities that benefit their children’s overall development. Employed mothers, whose highest level of education is high school, struggle with providing that high-quality time with their children. In simpler terms, working moms who are employed outside of the home can still positively raise their child because it’s the quality of the time spent and not so much the quantity.

Ettinger et al. (2018) conducted a study that involved approximately 600 children of African-American and Latino descent. The majority of participants were from low-income families and from three different cities in the United States. Researchers found that mothers who increased or changed the hours in which they worked during the preschool years increased their children’s chances for obesity. However, on a brighter note, families who performed structured activities in the home including family meals and regular bedtime routines, drastically reduced those odds.

McGinn et al. (2018) performed a study involving participants from 29 different countries in order to examine the relationship between parental employment and children’s future employment. Their results showed that daughters of working moms were more likely to be employed as adults. Additionally, daughters of working moms who have a higher education are more likely to fulfill supervisory positions and earn higher income. There wasn’t a correlation between working mothers and sons concerning employment, but researches noted that many sons grew up to spend more time caring for family members than other men.

This is only a tiny handful of studies available to anyone with an internet connection. Overall, research is limited when it comes to two working parents negatively impacting a child’s development. The only time employment becomes bad is when time takes away from nurturing a child’s overall growth. Working parents CAN raise healthy, successful, and happy children but there has to be a balance. Set your child up with excellent alternative day time care options. Make sure that you are structuring their day accordingly (meal times, naps, education, play-time, hygiene, outings, etc.). Any time spent with your child should be of the highest quality.

References
Patten, E. (2015). How American parents balance work and family life when both work. Pew Research Center. Viewed on 01/23/2019.

Hsin, A. & Felfe, C. (2014). When Does Time Matter? Maternal Employment, Children’s Time with Parents, and Child Development. Demography, DOI: 10.1007/s13524-014-0334-5.

Ettinger, A. K., Riley, A. W., & Price, C. E. (2018). Increasing Maternal Employment Influences Child Overweight/Obesity Among Ethnically Diverse Families. Journal of Family Issues, 39(10), 2836–2861. https://doi.org/10.1177/0192513X18760968

McGinn, K. L., Castro, M. R., & Lingo, E. L. (2018). Learning from Mum: Cross-National Evidence Linking Maternal Employment and Adult Children’s Outcomes. Work, Employment and Society. https://doi.org/10.1177/0950017018760167

Childhood Migraines: Is it a Thing and How does it Impact Daily Function?

Migraines are not the same as your usual stress headache. Instead, migraines are accompanied by intense, throbbing pain on one or both sides of the head frequently followed by vomiting or nausea. A migraine can last several hours or even several days (Mayo Clinic, 2019). One odd fact that a lot of people don't realize is that migraines can be broken down into stages, and those affected will either go through a couple or all of these stages.

The American Migraine Foundation (2018) outlined and detailed each stage of a migraine:

  • Prodrome:  This stage can last between a few hours to a few days and present with some of the following: nausea, depression, irritability, sensitivity to light and sound, increased need to urinate, food cravings, difficulty sleeping, difficulty concentrating, and difficulty reading or speaking.
  • Aura: This stage lasts between 5 minutes to an hour and comes with visual disturbances, possible temporary loss of eyesight, and sometimes numbness and tingling on part of the body.
  • Headache: This stage is where the intense throbbing starts followed by possible nausea, insomnia, depression, burning, nasal congestion, and anxiety. The discomfort can last anywhere between 4 and 72 hours.
  • Postdrome: The last stage comes down from the headache and usually includes fatigue, difficulty concentrating, a euphoric mood, depression, and lack of comprehension.

Unbeknownst to some adults, children can experience migraines just as intense as those experienced by older persons. Although migraines are generally shorter in children, the pain is just as debilitating on daily function. According to the Migraine Research Foundation (2019), children with migraines can also have additional symptoms such as: sensitivity to odors and touch, abdominal pain, unexplainable mood changes, and dizziness. Children as young as 18 months old have been known to have migraines and approximately 10% of school-aged children suffer from migraines.

Migraines, especially if not being addressed with medication or pain management techniques can disrupt just about every aspect of a child's day including:

  • A full night's sleep
  • Participating in leisure tasks alone or with friends
  • Reading and writing
  • Academic responsibilities
  • Athletic participation
  • Eating regular meals or getting enough water

Although some migraines are unpreventable, parents can take appropriate steps and management techniques in order to reduce the risk or decrease the symptoms so that their children can get through the day as best as possible:

  • Believe your child: If your child has history of complaining about headaches accompanied by nausea and possible behavioral changes, then you child is probably in the midst of dealing with a migraine. If you or the other parent have a history of migraines, then embrace the possibility that that unfortunate trait has been passed down to your child.
  • Consult with your pediatrician: Talk to your child's doctor about your concerns if you feel that they are showing symptoms of migraines. Sometimes, children will have migraines without the pain and with nausea or vice versa. The pediatrician might notice symptoms that you haven't picked up on and can make some medication recommendations.
  • Create a calm place: Create a spot in your house where your child can go when a migraine is coming on. Wherever it is, the room needs to darkened and free of odors (no scented candles or fragrances either). Make sure your child can get away from other sounds of the household by either having the door shut and/or applying earmuffs. Set up a comfy spot with pillows and blankets for the child to rest on.

Talk to your child's teachers and school staff about their migraines and how it will impact their academics. Brainstorm ways that your child's teachers can transition them into a different room or spot in the school if a migraine is coming on.

  • Don't force food too quickly: If your child doesn't want to eat right away, don't get too worried about it even when they are very young. If your child's migraine persists past two-three days and they haven't eaten anything in that timeframe, consult with your pediatrician.
  • Find some shades: Allow for your child to wear sunglasses during the day if light (indoor or outdoor) tends to trigger their migraines. Talk to school staff to see if this is also a possibility during school hours, especially if your child is sensitive to indoor fluorescent lighting.
  • Apply cold packs: Ice packs applied to the painful portion of the head can drastically reduce the throbbing so that the child can tolerate symptoms better while they wait for the migraine to pass.  Ice packs should only be applied for about 10-15 minute intervals with a slight break in between intervals.
  • Take away screen time: Lastly, do not be tempted to hand over a phone or a TV screen so that your child can kill time while waiting for the migraine to pass. Any screen time can worsen symptoms and prolong the migraine.

References

  1. The Timeline of a Migraine Attack (2018). American Migraine Foundation. https://americanmigrainefoundation.org/resource-library/timeline-migraine-attack/. Viewed on July 17, 2019.
  2. Migraine (2019). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201. July 17, 2019.
  3. Migraine in kids is not just a bad headache. (2019). Migraine Research Foundation. https://migraineresearchfoundation.org/about-migraine/migraine-in-kids-and-teens/. Viewed on July 17, 2019.

Summer Ideas for Encouraging Healthy Emotional Development in Children Ages 3 to 5 years

Let's face it. Most adults struggle with emotional regulation. So, it is hardly fair for adults to expect children to independently stifle feelings that are disruptive to daily routines 100% of the time. We're just talking about children ages 3 to 5 years. This is an age group who should be past the common emotional breakdowns witnessed during infancy. However, life gets difficult to cope with and young children are still allowed to break down, cry, scream out loud, throw themselves on the floor in fury, and so on and so forth.

As time goes on and these children approach an age where they now qualify for prekindergarten or K-12 schooling outside of their own home. Therefore, tightening down on their emotional regulation is more than appropriate. In fact, many childhood experts insist on it. Children who can't regulate their emotions well at school seriously compromise their learning opportunities as well as other students in the classroom. Although many teachers have very well-rounded training, they should not be expected to dedicate abnormal amounts of time de-escalating a child's behavior as their focuses are academically geared.

Parents and caregivers, this is where you come in. Teach them the skills at home now, 2 to 3 years before school even starts so that they can spend more time learning and less time in meltdown mode. No, it's not going to be perfect and you can expect a few phone calls from the school eventually.

First things first. Set some realistic goals for your child based on their typical age group and what is expected regarding emotional development milestones. According to PBS.org (2019), here are some examples of milestones for this age group that you can reference for your own goals:

3 years old:

  • Uses familiar adults for security when playing (i.e., wanting mom to come over with the child to a friend's house).
  • Begins to develop personal preferences and a sense of ownership over things.
  • Can verbally label their own feelings as well as others based on their facial expressions.
  • Can express feelings and opinions well when things get difficult and may still fall apart when situations get stressful.

4 to 5 years old:

  • Gets better at tolerating a familiar adult's absence and starts to role model their behavior.
  • Can cope with the absence of adult by appropriately expressing their feelings through language and through drawing.
  • Increased sense of self and their capabilities and talents.
  • Increased understanding of other's emotions and what causes them to express certain feelings
  • Adopts their own coping strategies with stressful situations. Examples include talking about difficult situations through pretend play (acting out a fight with her brother with her stuffed animals).

In summary, some sample goals for your child could include: learning how to cope with stressful situations, learning how to read others' emotions, and learning how to verbally express their own emotions. The following information is a list of summer ideas in which parents could apply during those long hours at home with their children with the central focus being on emotional development:

  • Yoga. Believe it or not, yoga is not just for adults. Many clinicians are incorporating the use of pediatric yoga to teach young children how to cope with stressful situations.
  • Mindfulness. Similarly, mindfulness is not just used for adults anymore. Teaching a child how to be mindful and present in the moment works wonders for emotional regulation.  Just do your research online to locate a handful of mindfulness strategies.
  • Breathing exercises. Teach your child how to effectively take deep breaths when life gets hard. Breathing exercises only have to take up to a few seconds and can be used for times when your child is losing emotional control.
  • Reading books that focus on emotional expression. Frequently read books to your child while purposefully pointing out and describing characters' facial expressions.
  • Play dates. Your child can learn a lot from other children about what it means to express their own emotions.
  • Waiting. Incrementally teach your child how to wait for their favorite things. Start with several seconds and work your way up to a short few minutes.
  • Keep up on nutrition and sleep. It is unfair to ask our child to keep things under control when they are hungry or tired. Make sure to maintain a structured feeding and sleep schedule.
  • Quiet time. Allow for some time during the day where your child can sit and play quietly by themselves in order for them to teach themselves how to cope with and process the day.
  • My turn, your turn. Teach your child how to share their toys, whether it's with you or with other siblings or friends.

Please note that there are some children who are going to need some extra, clinical attention for emotional regulation. This can involve many children with a wide variety of developmental disorders including (but not limited to): autism, ADHD, Down syndrome, anxiety disorder, etc.  If your child has a developmental condition that negatively impacts their emotional growth, immediately consult with your pediatrician BEFORE school begins

Reference

  1. Child Development Tracker (2019). PBS Parents. Viewed on April 9, 2019.

When going outside is not an option: Activities to Occupy a Child’s time Indoors – An OT’s List of Tips

It is that time of year, when the eerie cold slithers in and the blizzards come rushing by. Or for maybe those situated on other parts of the globe, it's that time where perpetual rainfall floods the yard or the blazing hot sun melts your shoes. In any of these scenarios, serious weather implications can drastically change a child's daily activities, especially if that child lives for the outdoors.

So, what can parents do to assist their child in participating in meaningful activities inside their homes all day, potentially for several days in a row? First, consider some of your child's preferences by asking yourself the following questions:

  • How old is my child and what indoor activities are appropriate for their age?
  • Does my child enjoy completing activities alone? With siblings? With friends? With me? All of the above?
  • What types of body demands does my child tend to participate in? Heavy lifting? Wrestling or rough-housing with others? Swinging? Running? Jumping? Drawing or coloring? Reading? What's a good mix of mellow and movement-demanding activities for my child?
  • What activities do I need to be around to supervise or should participate in with my child?
  • Should I let my child get bored and for how long can they tolerate it before I need to intervene with an activity for them?

The goal of the following list is to provide parents and caregivers with ideas that pull their children away from the cop-out activities such as watching T.V. or using the I-Pad to kill time. In moderation, there is nothing wrong with letting children veg out in front of a screen for an hour or so. However, the latest research has shown the repercussions of exposing children to over-stimulating screen time, details of which we will not be discussing in this article. 
Note: before structuring your child's day with a list of activities to keep them busy while indoors, remember that it is alright to allow for some down time in which your child will experience "boredom".  As a parent or caregiver, it is not your responsibility to keep your child occupied 24/7. Allowing your child a few minutes to an hour or so of down time gives them opportunities to come up with their own creative ways to occupy themselves. With that in mind, here's some indoor activities that you may be able to apply:

  • Stairway games: Set up games that require your child to run up and down the stairs several times (i.e., retrieving balls from the bottom of the stairs and running up to place each one in a basket). It will only be a few minutes until your child gets worn out.
  • Drills: Simple army drills can be very fun, especially if your child has siblings or friends to complete routines with (i.e., push-ups, sit-ups, jumping jacks, knee lifts, squats, etc.).
  • Kid's yoga: Hop online and look up some basic yoga routines that you can participate in with your child. It will surprise you how early on in age you can start with your child.
  • Reading time: Sit down and read an enjoyable book or two with your child. If you want to go the extra mile, have you and your child dress up or act out the parts of the book.
  • Stage time: Create a small space in your house that can provide a stage setting in which your child can act out their favorite or their own original stories. Encourage them to go all out with costumes. Video record them so that they can watch their own play.
  • Drawing and/or craft time: Sift through your favorite Pinterest pages and come up with several arts and crafts activities that you and your child can do together. 
  • Fort games: Using tables and other pieces of furniture, drape several blankets to form a tent. Fill the tents with pillows, toys, and flashlights and let your child go to town.
  • Paper-shredding: Find old bills, junk mail, and other paper products that you no longer need and place them in a pile. Have your child tear up the paper and toss the pieces around.  Depending on how much paper you have, this could create quite the mess but luckily paper scraps are relatively easy to clean up.
  • Bath time games: Lengthen bath time and fill it with water games.
  • Dance and Karaoke party: Turn on YouTube or other sources for music and have a dance party with your child.
  • Board games: If your child is old enough, yank out some classic board games.
  • Messy party: Buy a cheap mat or tarp and place it on a floor surface that is easy to clean (tile, wood, linoleum, etc.). Have your child dress up in their swimsuit and bring out messy products such as finger paint or shaving cream (whipping cream for small children who put everything in their mouth).
  • Cardboard cars: Pull out saved up cardboard boxes and make a crude-shaped car for your child to race around the house in.
  • Sock skating: Have your child slip and slide around on the smooth floor in their socks.
  • Hide-and-seek: An old-fashioned game of hide-and-seek can keep your child occupied for several hours, especially if you invite friends over to join in.
  • Treasure hunt: Hide toys around the house and award small prizes for locating a certain number of objects.
  • Baking: Some kids absolutely love it when their parents let them help with baking or cooking a meal.
  • Pillow fights: Pillow fights can release all sorts of wiggles and can include other deep-pressure activities like jumping into a pile of pillow, wrapping the child in a blanket burrito, etc.

Choose activities based on your child's interests as well as what you would like to accomplish. Create a healthy mix and experiment with all sorts of activities to alleviate boredom, to create exercise opportunities, to resolve hyperactivity, or to just let your child have fun.

Am I talking enough to my Child? An OT’s Perspective

Good, proactive parents have one common fault: coming down hard on themselves because despite everything they do for their child, they feel that it's never enough. This is so true when it comes to communicating with little kiddos. Parents or guardians who are at home full time with children under the age of 3 may ask themselves some of these questions: Am I talking with my child enough? Why isn't my child talking yet? Is this normal or should I be concerned?

First off, slow down and breathe. Remember that every child is different and most of the time the words start spilling out of their mouths at different ages. If your child is not quoting Shakespeare by their 2nd birthday, then the good news is they are very typical for their age group.

WebMD (2019) states that the most crucial years for brain development is during the first 3 years of life. In fact, 80% of the brain's physical development occurs during this time. Your child is making all sorts of neural connections for language, movement, emotional regulation, sensory system regulation, executive function (reasoning, problem-solving), and so on and so forth. Much of a child's brain development relies on input from their environment, and that includes parents.

The following information includes a few tips on how to better communicate with your child, especially if you are one of those parents who don't think you are doing enough.

  • Put down the phone. As adults these days, we are constantly connected to our devices: phones, tablets, laptops, you name it and we're glued to it. Put down your phone in the presence of your child, even when they are in their infancy. Additionally, reduce how much time your child spends on the phone or TV. Your job is to teach them how to interact with other human beings appropriately, and a screen may feed your child effortless information about the world, but it won't teach them about reciprocating conversation.
  • Talk out your thoughts. Are you alone at home with your child, a young child who can't stir up a fascinating conversation with you quite yet? It's difficult to be talkative during but go ahead! Talk out what you are thinking! Let your child watch you talk, even though you know they can't understand you. You are still providing them the building blocks of verbal communication through simple observation.
  • Be silly. Instead of asking yourself, am I talking enough to my child, change your question to: am I interacting enough with my child? Language development is heavily influenced by all sorts of communication outlets. Young children and infants learn so much from parents who will sit with them and make faces, play with them, etc.
  • Sing! Children are extremely receptive to songs and rhymes because the format is intriguing and easy to memorize. Don't be afraid to sing to your child, out loud and in front of other friends and family.
  • Dance! Talk and sing while you make silly movements with your own body. "Head, shoulders, knees, and toes" is not just a fun song created to kill time. It's movement-based songs that helps teach a child about words to identify basic body parts. This is a similar goal for all sorts of dances and songs, so fill your repertoire!
  • Do not excuse potential developmental concerns: Even good parents get upset when a professional, a friend, or a family member remotely mentions the possibility that there could be something WRONG with their children. Although the majority of kiddos develop at a typical rate, a handful of children have struggles. One of the worst traps a parent can fall for is believing that their child is healthy and perfect while dismissing basic developmental concerns.

Research and refresh your knowledge about child development. Then compare your child's language and social skills to those of their typical-growing age group. Remember, developmental charts are only an estimation and every child will vary. However, if you get the feeling that your child is behind in their language development seek out a professional consultation immediately. Talk to your pediatrician, an occupational therapist, or a speech-language pathologist. Get help now and as your child's first three years of life.

References

  1. How to Talk to Your Baby (2019). WebMD. Viewed on March 19. 2019.

Do Children with Autism understand Consequences? Tips for Countering Misbehavior in the Home

Typically developing children get to a certain age where they have the cognitive capacity to understand consequences of their actions. They also begin to understand that certain actions based on bad behavior leads to discipline (i.e. hitting another sibling or a parent leads to getting favorite toys taken away from a certain time). The lines are fuzzy when determining the best age range to start disciplining your child with negative consequences if you are relying on information from parent and children’s health blogs. So, we go to the evidence-based research for answers.

According to the Canadian Paediatric Society (2004), typical children between the ages of 3 to 5 years old begin to understand that bad choices or behavior leads to negative consequences. Although their language capacity is still small, they can partially appreciate basic rules and why parents discipline them with timeouts or small punishments. So, if 3 to 5 years of age range for “typically” growing children, what does this mean for children with autism spectrum disorder? Does a young child with autism understand discipline for their actions similarly to their peers?

Many parents seasoned in autism-related literature and research may already understand what impairments are featured in autism spectrum disorder (ASD) cases and how those impairments impact fully understanding rules and consequences. For those parents who are still grasping for answers, let’s first break down what it means for a child to receive a diagnosis of ASD. The DSM-5 states that a child can be diagnosed based on the following criteria:

Persistent deficits in social communication and social interaction across multiple contexts

  • Deficits in social-emotional reciprocity
  • Deficits in nonverbal communicative behaviors used for social interaction
  • Deficits in developing, maintaining, and understand relationships

Restricted, repetitive patterns of behavior, interests, or activities

  • Stereotyped or repetitive motor movements, use of objects, or speech 
  • Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
  • Highly restricted, fixated interests that are abnormal in intensity or focus
  • Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (American Psychiatric Association, 2013)

Besides social communication impairments and restrictive patterns, cases of ASD can also be paired with intellectual and language impairments which contributes to the severity of each case. In more simple terms, a child with ASD does have to exhibit symptoms laid out in the DSM-5, but each child’s severity varies thus their ability to understand things on any cognitive level will be different in each case.

What does this mean for disciplining a child with ASD who is misbehaving? If your child has ASD, you cannot expect typical punishments and durations to work. For a typically developing to understand consequences set up by parents, several factors need to line up including: the bond between the child and the parent, the child’s communication and language abilities, the child’s ability to understand what is “fair”, and the child’s ability to learn discipline from parents in order to self-discipline in the future (Canadian Paediatric Society, 2004).

Children with ASD not only have limited or different understanding of discipline, but they also “misbehave” for completely different reasons as compared to their peers. Poor behaviors such as self-inflicted injuries, hitting other family members, throwing toys, spitting out food, screaming at the top of their lungs, or refusing to complete tasks set up by parents and/or teachers often stem from internal processes that aren’t obvious. This may include: pain, sensory processing disturbances, anxiety, and stress. Typical methods for discipline not only may NOT work, but could also worsen the child’s behaviors.

Occupational therapy as well as many other disciplines can assist parents and their children with ASD by providing tailored plans for their family to counter poor behaviors. Consult with a specialist (i.e. pediatrician, psychologist, behavior specialist, occupational therapist, speech therapist, etc.) if your child is struggling with behaviors that you are at a loss for how to resolve on your own.

References:

Effective discipline for children (2004). Canadian Paediatric Society. Paediatric Child Health, 9(1): 37-41. www.ncbi.nlm.nih.gov. Viewed on Feb. 4, 2019. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

Food Allergies: How a Pleasant Eating Experience for a Child May Have Hidden Adverse Effects on Behavior

Self-feeding should innately be a pleasant experience for any human being. Ingesting foods and liquids nourishes the body and mind, jumpstarting a person to continue on with their day and to participate in other activities that matter to them. For children, having healthy diet plans provides them with energy to complete school work, to play outside, to take part in sports, to finish their chores, and to participate in other daily living tasks (i.e. dressing, toileting, showering, sleeping, etc.).

Unfortunately, self-feeding doesn’t always have happy results especially if parents and caregivers are unaware of finely masked problems with food: food allergies and food intolerance. According to WebMD (2018), the terms “food allergies” and “food intolerance” have very different meanings and are often mistaken for each other. A food allergy occurs when the immune system is actively fighting against something in the body when it doesn’t need to. Food intolerance produces symptoms of discomfort (i.e. indigestion), but the immune system isn’t actively doing anything (Food Allergy Intolerances). Of course, food allergies and food intolerance produce a long list of symptoms depending on the child’s body type and can include: skin reactions (i.e. hives, rash), respiratory problems, flu-like symptoms, indigestion, headaches, and other body aches to name a few. These reactions can range from very mild to extremely severe. In this article, we will be focusing on the connection between childhood food allergies and changes to behavior.

Physical reactions to food allergies and intolerance can rightfully make a child very moody or angry due to discomfort or pain. Common foods that children struggle with may include: dairy, wheat, gluten, barley malt, sugar, soy, nuts, shellfish, and eggs. Additional elements found in food that may be a cause for problems include preservatives, food dyes, foods high in salicylate (i.e. which is found in aspirin), and pesticides.Dr. James Greenblatt (2017) wrote an article regarding dietary elements that influence behavior in children, particularly those with ADHD. He discusses and references several studies about how the following food compounds increase behavioral problems: sugar, casein (a milk-based protein), gluten, and food dye. Some of these compounds, when ingested, have been found to increase the likelihood of an ADHD diagnosis in children as well as the following: anxiety, brain fog, hyperactivity, inattention, impulsivity, aggression, and delinquent behaviors.

Health Day News (2018) references a study that involved almost 200,000 children in the United States from ages 3 to 17 years. One finding emphasized how children with autism were more likely than their typical peers to have food allergies (Allergies More Common In Kids With Autism ). Another article referenced a renowned naturopath and acupuncturist, Duane Law, who has heavily researched food allergies causing inflammation and a stress response (Dunckley, M.D., 2013). He made a connection between inflammation in the digestive system and sending the body into fight-or-flight mode. For children with autism, this inflammation and stress response can be a cause for endless behavior problems especially because some of these children are unable to verbally communicate or describe their symptoms or reactions.

As far as food allergies go, what does this mean for parents and caregivers?

Food allergies and food intolerance are issues that all parents and caregivers should consider for their children, even in the absence of other medical diagnoses. For parents of children with developmental or psychiatric disorders, consider that your children may be at higher risk for having food allergies and intolerances. Observe your child. Make note of what their behaviors are like before and after meals. Write out a daily log about foods and liquids that your child ingests, the portions, and the subtle behavioral changes. Some behaviors may not be food-related at all, but it is best to log everything. Do your research. If your child does have a diagnosed medical, psychiatric, or developmental disorder then read up on highly reviewed material about allergy risks associated with your child’s condition. Consult with a professional, particularly an allergy specialist, before making drastic changes to your child’s diet. Appropriate testing may reveal information about your child that you would not have seen otherwise in regards to their diet.

Reference: Greenblatt, J. (2017). Dietary influences on behavioral problems in children. Viewed on Nov. 12, 2018. Stephens, K., Dunckley, V.L. (Ed). (2013). Food, Inflammation, and Autism: Is there a Link? Viewed on Nov. 12, 2018.