5 Ways to Help Your Child Practice Gratitude

I love this time of year. It is a wonderful time to remember and reflect on all the things we have to be grateful for. When we are grateful, those around us are on the receiving end of our positive energy, and more inclined to count their own blessings. Gratitude can be modeled and taught to our children just like any other life skill. But why should we make the effort?

Why practice gratitude?

Having a gratitude practice can be just as important to your health and well being as a regular gym schedule, getting a good night's sleep, or any other practice that promotes well being. And, gratitude has become the study of science. According to http://greatergood.berkeley.edu/, researchers who study gratitude are finding that people who practice gratitude consistently report a host of benefits, including:

  • Stronger immune systems and lower blood pressure
  • Higher levels of positive emotions
  • More joy, optimism, and happiness
  • Acting with more generosity and compassion
  • Feeling less lonely and isolated

These benefits are not limited to just adults. Children can reap benefits from a gratitude practice as well. In a UC Davis study, children who practiced gratitude showed more positive attitudes toward their school and families, were less likely to judge others, and were more likely to share and to want to help. Here are five easy ways you can incorporate more gratitude into your children's routine.

  1. Help them Keep a simple gratitude journal : This is not limited to those children who have the fine motor dexterity to write. For my boys with special needs, I ask them to come up with three things they are happy for and I write them down for them. (They are thankful for Thomas the Train on most of their sheets and that is okay!) When my boys have trouble coming up with three things, I give them suggestions. We use these fun gratitude journal sheets ($3 for 52 weeks) from Teachers pay Teachers, but you can list them on any paper you have at home. (You do not have to be a teacher or therapist to use Teachers Pay Teachers, and they have really fun speech/language materials on there for parents, homeschoolers, and more!)
  2. Books. Books are a great way to incorporate lessons of gratitude into daily reading time. Some of my favorites are: Richard Scarry's Please and Thank You Book, and Thank you Mr. Panda.
  3. Dinner time Turns. Before eating, go around the table and have every one name one thing they are thankful for. If your child isn't talking yet, you can include them by sharing for them something you know they like, or even signing.
  4. Gratitude jar. When something good happens to your child, write it down on a small sheet of paper, and place in a Mason jar or other container. At the end of the year, take out all the slips of paper and read them.
  5. Set the example. Our children watch and listen to everything we do. When they see us be thankful or try to find the "bright side" in a situation, they will learn to do the same.

The practice of gratitude is a gift that we can give ourselves and our children; which in turn becomes a gift for others in our families' life journeys.

Katie Sullivan, M.S., SLP-CCC has been a pediatric Speech Language Pathologist for 22 years, and is a Therapy Supervisor with Theracare. She is the mother to five children, ages 7-17, including twin teenage sons with special needs. You can follow her at the My Sweet Homeschool blog, facebook, twitter, and instagram.

What to Expect at Your Child’s First Physical Therapy Appointment

There are many reasons your child's physician may prescribe physical therapy. Your child could have a recent injury such as a broken arm that needs some special attention or a congenital disease that requires extra work to achieve developmental milestones. No matter the reason for the physical therapy referral, a parent is likely to be curious about what to expect from the appointment. A little heads up can go a long way to calm the nerves of a parent for their child's first PT visit.

Come Prepared

Therapists need to know the full picture of your child's health and medical history. Bringing a copy of your child's medical procedures, health history, adaptive equipment available, and medications can help streamline the process when you are filling out the initial paperwork. It is much easier to remember the details when you have time beforehand rather than feeling rushed in the waiting room with your child.

Questions

To begin the visit, you or your child will do a lot of the talking. Some common questions that a therapist will ask to aide them in developing the most effective plan of care for your child are:

  • How long has your child been having symptoms?
  • When were they diagnosed?
  • What activities does your child enjoy doing?
  • What are your child's interests?
  • Who are your child's caregivers and support system?
  • What are your goals for your child?
  • What are your child's personal goals?
  • What concerns do you have?
  • The frequency and duration of symptoms
  • What things make them feel better?
  • What things make them feel worse?
  • Have you noticed a change in your child's symptoms/behavior?

The Initial Evaluation

The first visit, the therapist will spend some time trying to get to know you and your child. After they have asked some initial questions, they will begin the physical evaluation. Your child's therapist will assess many different things including range of motion, muscle strength and tone, reflexes, balance, and coordination. Using the information you provided and what was collected during the assessment, the therapist will develop a plan of care individualized for your child and their specific needs.

The Plan of Care

Your therapist will discuss with you the plan of care for your child. Your physical therapist will provide information on how frequently and for approximately how long your child will need PT to reach his/her goals. An overview of the types of treatment techniques, what deficits will be addressed, and how it will help achieve functional goals gives you the picture of your child's physical therapy.

Treatment and Home Exercise

Various treatment techniques will be used to help your child improve. Stretching exercises, muscle strengthening, neuromuscular re-education, balance, and gait training are all methods of improving your child's functional ability. The therapy session will be designed to be fun and engaging for your child.  One session might involve playing on large stability balls and the next may have a fun obstacle course. In addition, the therapist will likely use hands-on techniques to work with your child such as manual stretching and joint mobilizations.

Along with in person therapy sessions, a home program will be provided. Following a home exercise program in addition to regular therapy sessions will allow your child to progress quicker and help them attain goals with greater success.

Ask Questions

Never be afraid to ask questions, especially when it comes to the care of your child. Our therapists are happy to answer any questions you may have and help to make this a wonderful experience for you and your child.

Pediatric OT Solutions to Aggressive Behavior in Children

Any parent or caregiver of young children will unanimously agree that tantrums are just a typical element of growing up. Kids test boundaries, they get to hear the word "no", and they have to be corrected in order to learn and to cope with life's expectations. Since children are irregularly obedient or accepting of new rules, adults have come to expect adverse reactions. However, there is a huge difference between temper tantrums and full-fledged melt-downs: one fades after a short while and the other completely disrupts the child's and the families' abilities to function.

Take a look at the following scenario:

Charles is a 5-year-old boy with reactive attachment disorder (RAD). His foster parents have recently consulted with doctors, psychologists, and therapists about Charles' inability to cope with change or stress. When his foster mom took him to the family practitioner after her exhibited flu-like symptoms, he had a melt-down in the doctor's office: started throwing toys at other kids in the lobby, shut himself in the bathroom when others tried to intervene, and uncontrollably screamed for 30 minutes straight. Since doctor's visits are not part of Charles' daily routine, his foster mom wondered if this incident was because of the unexpected change to his schedule.

Charles' situation represents only a sliver of how maladaptive behavior can turn the day completely upside down. Families with aggressive children count on even more damaging scenarios due to some type of disorder or dysfunction. Example diagnoses that are potentially paired with aggressive behavior (although, not in all cases) can include but are not limited to:

  • Autism Spectrum Disorder
  • Down Syndrome
  • Mental Retardation
  • Sensory Processing Disorder
  • Attachment disorders
  • Conduct Disorder
  • Rett Syndrome
  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Oppositional Defiance Disorder (ODD)

The American Psychological Association (APA) defines aggression as "Behavior that cause psychological or physical harm to another individual" (2017). Aggression can be asserted physically, verbally, and emotionally and it is specifically used to harm oneself or others https://www.healthline.com/health/aggressive-behavior#overview1. For children who struggle with managing aggressive tendencies, it could look like any of the following examples:

  • Physically attacking or injuring family members, friends, and school teachers
  • Screaming or yelling uncontrollably at others
  • Performing self-injurious behavior: biting, scratching, hitting themselves
  • Throwing objects at other people with the intent to hurt them or to get attention
  • Lying or stealing

Uncontrolled, aggressive behavior makes it almost impossible for families to go about their day in a normal manner. Meltdowns result in a limited social life, frequent loss of sleep, problems in school, and daily schedules being meticulously planned to the very last detail in order to minimize any and all behavioral triggers. It is emotionally, physically and psychologically draining for parents to see children whom they love wreak havoc on the whole family and on themselves.

Occupational therapy is one of the few clinical disciplines that can take on aggressive behavior from a pediatric standpoint.  Pediatric occupational therapists who work in home health see children at their own home which works out well for observing their behavior in a familiar environment. Although occupational therapists are not licensed to make medical or psychological diagnoses, they can provide the following for parents and families:

  • Standardized assessments to examine the child entirely in order to identify all possible triggers for aggressive behavior. Such triggers may include: food aversions or allergies, sensory issues, emotional regulation difficulties, anxiety, inability to cope with stress, change, or unpredictable changes to the schedule, and communication deficiencies that cause frustration with others to name a few.
  • Clinical observations in which the OT takes note of EVERYTHING related to the child's behavior: the home environment, all objects in which the child interacts with (i.e., clothes, toys, school supplies, house appliances, etc.), all interactions with others in the household, all aggressive incidences that occur (what time, where in the house, before or after other activities, etc.), and all unplanned occurrences during the day. There's no better place for an OT to observe the child than in their own home. Because home is often the more predictable and safe environment for the child, it will be easier to spot specific triggers to maladaptive behavior.

Once OTs gather information about the child under standardized and observational evaluations, then interventions can be tailored to meet the child's specific needs with the goal in mind that treatment will reduce aggressive behavior and increase functional participation. Examples interventions could include:

  • Sensory Integration and Techniques: Pediatric OTs who are educated or certified in sensory integration could provide the child with detailed interventions addressing sensitivities to touch, taste, sight, hearing, smell, balance and movement, and internal or digestive processes.
  • Lifestyle changes: This could include modifying the child's daily habits in a slow and deliberate manner such as sleep, diet, liquid intake, medication management, and exercise.
  • Social Participation Interventions: If aggressive behavior is disrupting the child's ability to form friendships (which it almost always does), the OT can present interventions that would make the child's social participation skills more effective while reducing the maladaptive behavior.
  • Schedule Implementation: OTs can suggest and implement daily schedules for the child to follow and for the parents to carry out. This is extremely helpful for families who have children who struggle with transitions and unpredictability. On the other hand, it can be an inflexible approach when unpredictable events inevitably occur.
  • Coping techniques: OT can provide the child with tools to better cope with daily occurrences that cause them stress and anxiety. Types of coping techniques vary depending on what the child finds calming or remedial.>

Once intervention starts, pediatric OTs who work in home health will usually provide treatment in an educational format so that parents and families can carry out clinical techniques on their own without the OT present. Furthermore, OT will often consult with interdisciplinary team members who are relevant to the child's care (i.e., case workers, psychologists, etc.) in order to better understand the child's needs and to provide optimal treatment.

Using Books to Support Speech-Language Development

Books can be a wonderful way to help support your child's speech language development. Reading to your child, even if you feel they aren't paying full attention to the story, helps foster language and literacy skills while building vocabulary and joint attention. Books that offer repetitive sentence patterns on each page help improve speech automaticity, while rhyming books help increase phonemic awareness. Here are a few tips to help you use books to support your child's speech/language development.

Read to your child every day.
Studies show the benefits of reading to your child 20 minutes a day to be numerous. If your child is unable to sit for 20 minutes, read a story aloud while they are preoccupied with another activity, such as floor play or in the bathtub. Just hearing the language, words, inflection, and story will help support their speech/language development.

Choose books according to your child's developmental level, attention span, and preferences; not their chronological age.
If your child has a short attention span for reading activities, choose books with vibrant pictures, but less words per page, or shorten the story to fit their attention span. It is better to praise a child for sitting for 2 minutes (even if that meant you skipped pages), than to have both parent and child feel frustration by the end. Children with special needs, like any children, have "favorites". Reading time will go smoother, if your child is able to incorporate their preferences when picking books to read. For me, this meant I read "Thomas the Tank Engine" books for what seemed like forever, but I would just remind myself "Literacy...any way I can get it".

Acknowledge sensory needs before and during reading time.
When a child's sensory needs are met, they are more equipped to pay attention; for example, sitting in a bean bag during reading time can provide a child more grounding sensory input than sitting in a chair where their feet do not touch the floor. Doing reading following a gross motor activity, such as pushing a laundry basket filled with clothes or giving receiving bear hugs, can also improve attention. Other ideas to help meet sensory needs during reading time are using a weighted lap blanket, allowing your child to wrap themselves up in a blanket, or giving them a squishy ball to squeeze.

Vocabulary Building
Sometimes, reading time with a younger child may mean pointing at different pictures on the pages and labeling them for your child. This is a wonderful way to help your child learn new words while still practicing joint attention to the book and its pictures. For a child who has words (or signs), you can point to the picture and ask them to tell you the name. Receptively, asking your child "Where is the ____" and having them locate the corresponding picture via pointing helps build receptive vocabulary and comprehension.

Choose books without pictures sometimes.
While vibrant picture books are wonderful choices to help gain and keep your child's attention, it is also important to read stories without pictures. Reading stories without pictures allows your child to use their own imagination to picture the main character, setting, and events of the story as they "see" them, as opposed to the book's illustrator. If your child is new to stories without pictures, choose short rhyming stories or even poems.

Inferencing Happens
When we make an inference, we take clues from text or pictures plus background knowledge to make an assumption of what has happened or what is happening. You can build your child's inferencing skills during reading time by asking questions such as "I wonder what is going to happen next?", "I wonder what (character) will do now?" or "I wonder how that made (character) feel?".

Fun with sounds
Books with rhymes or strong alliteration patterns are fun to listen to! This is why "Cat in the Hat" books are so popular. But books can also be used to support a child's speech sound practice/therapy. For example, if your child is working on the /r/ sound, then reading aloud books such as "Little Red Riding Hood" or "Rotten Ralph" provide examples of the target sound throughout the reading time, which will indirectly support your child's progress towards making the sound correctly themselves.

Support Social Skills
Social skills can be indirectly introduced, taught, and reinforced through reading time stories ("How Do Dinosaurs Eat their Food" was a favorite with my boys when working on table manners.) In fact, through books, you can teach and reinforce everything from saying please (Please, Mr. Panda), how to make friends ("Peanut Butter and Cupcake") to fire safety (No Dragons for Tea). For older children, the characters in books can demonstrate the characteristic of empathy, and teach consequences of action in a safe and positive framework.

Be Silly.
Being silly during reading time (making different character's voices, over emphasizing inflection) is a great way to increase your child's engagement in the story. Over emphasizing inflection helps support the acknowledgement of tone of voice and their different meanings which many children with special needs have difficulty understanding. This also helps show your child that reading can be fun and not a chore; a life skill that will continue to serve them through their school years.

I hope these suggestions have given you some ideas on how you can support your child's speech/language skills during reading time, while making it go more smoothly for those of you with younger children.

Katie Sullivan, M.S., SLP-CCC has been a pediatric Speech Language Pathologist for 22 years, and is a Therapy Supervisor with Theracare. She is the mother to five children, ages 7-17, including twin teenage sons with special needs. You can follow her at the My Sweet Homeschool blog, facebook, twitter, and instagram.

Self-feeding for Picky Children: What Pediatric OT can do for you in your home

The time has come for your little one, who has surpassed the baby phase, to transition from milk/formula to actual foods. The steps can be meticulous and slow, as it should be for a child who is experimenting with foods for the very first time. After the parents spend months on introducing the purees and dissolvables, comforting the child when teeth start cutting through the gums, toying with a variety of spoons and sippy cups, and discovering the child's allergies and preferences, the light at the end of the tunnel appears and parents can pat themselves on the back for a job well done. Their young toddler is now feeding themselves!

If only it were so easy for all parents of young children. Some kiddos are not given the luxury of such smooth transitions through the self-feeding process. Conditions or disorders create unexpected obstacles, which include: sensory processing difficulties, dysphagia, nervous system deficits (i.e., cerebral palsy), muscle weakness, respiratory complications, and cognitive/behavioral difficulties to name a few. As a result, the child does not develop a typical feeding pattern which can result in malnutrition and dehydration.

That's where occupational therapy (OT) comes in, as well as clinical input from speech and language pathology (SLP). Take a look at the following scenario which provides context from a home health stand point:

Clarissa is the mother of 3 children, 2 of which attend elementary school during the day. Her youngest, Emma, is 2 years old and has Down's syndrome. Clarissa pursued therapy services soon after Emma was born, thus she has been seeing early intervention therapists in her home. Due to Emma's overall, low muscle tone, she has trouble manipulating and chewing solid foods in her mouth. OTs and SLPs from the early intervention program have been tag-teaming it, OT addressing oral muscle strengthening for self-feeding while SLP has been mainly focusing on Emma's language development. Clarissa would like to see Emma attend preschool in a couple of years, so her goal is to have Emma catch up on eating and talking well enough so that she is comfortable around her classmates.

Let's extract OT's role and describe what this particular therapy can offer for self-feeding tasks with children. The following list is not all-inclusive, but it does provide some of the common issues that OT is equipped to remedy:

  1. Therapeutic exercise: If it is a matter of muscle, tongue, or joint control, OT can offer exercises for the child to complete in order to improve movement required to chew, manipulate, sip, and swallow food. Of course, no child is going to voluntarily sit for several minutes of the day completing a rote exercise schedule. OT would introduce activities in the form of play so that the child will have joy and motivation while not realizing what exercise benefits they are automatically receiving (i.e., chewy candies, bubble-blowing, making faces, etc.).
  2. Sensory Challenges: Some children are beyond "picky" to the point where their food aversions make every mealtime a dramatic feat. OTs can evaluate children for specific sensory processing deficits and then set up the child on a detailed feeding schedule combined with relevant interventions. The process is slow and complex, but it can be easily carried out by parents/guardians at home if the OT provides proper training and resources. OTs who are well-versed or even certified to address sensory processing disorders are the most suitable to consult with regarding this area of self-feeding deficits.
  3. Behavioral difficulties: Childhood diagnoses or conditions often come with misunderstood cognitive or behavioral elements. Examples include atypical aggressive behavior, meltdowns, reduced attention span, and language impairments, all of which have a devastating impact on meal time participation. OTs can offer interventions or programs that reduce maladaptive behaviors in order to allow for productive feeding. Examples include developing consistent feeding schedules, locating and implementing effective environmental cues, introducing coping techniques, eliminating distractions, etc.
  4. Parent/caregiver education: Any type of home health therapy is going to heavily emphasize the need for parent/caregiver/guardian education. Although the therapists provide the intervention, it is the at-home parents who will be responsible for carrying it out when therapy is not around. This includes therapy providing sufficient and comprehendible resources for the parents, parents implementing schedules, routines, or habits consistently at home with the child, and parents educating other caregivers who may interact with the child (i.e., babysitters, respite care providers, teachers, other family members, daycare workers, etc.).