gaby, Author at SmallTalk

What Are Primitive Reflexes and What is Their Impact?

Educational, Featured, Occupational Therapy, Therapy | Jan 30, 2025 2 min read

The Basics

Primitive reflexes are involuntary movements that develop in the womb and are present during infancy. They help your child learn to eat, reach for objects, roll over, crawl, and explore or learn their environment. Primitive reflexes are essential for survival and development in early childhood and many are often integrated by 6 months of age. Here are some examples of primitive reflexes:

Rooting: Your baby turns toward an object when their cheek is stroked.
Sucking: Your baby automatically sucks on a nipple or clean finger when inserted into their mouth.
Asymmetric Tonic Neck Reflex: When your baby’s head turns to one side, the arm and leg on that side extend and the opposite arm and leg flexes.
Tonic Labyrinthian Reflex: When your baby looks down, their arms, hips and legs want to curl in closer to the body and when they look up, their arms and legs tend to move outward.

Retained Reflexes

In some children, these primitive reflexes remain intact and are not naturally integrated. This can impact several aspects of development including:

Motor Planning
Muscle Tone
Postural Control
Balance and Coordination
Bilateral Coordination
Emotional Regulation
Attention
Vision
Spatial Perception

In older children, retained reflexes can result in clumsiness or increased cautiousness, difficulties attending in class, challenges with remaining seated, feeling fidgety, feeling anxious, or having emotional regulation challenges.

What Can I Do at Home?

Engaging your child in a variety of activities and exercises can help integrate retained reflexes. Activities that require crossing the body midline, using both hands together, and crawling scavenger hunts that promote independent head movements are some examples. However, if you suspect that your child may have retained primitive reflexes, consult your occupational therapist. They can best determine which, if any, reflexes your child has retained and provide an individualized treatment program for them.

By Danielle Pham, MOT, OTR/L

Big Voices in Little People: Understanding Vocal Nodules in Children

Educational, Featured, Speech Therapy, Therapy | Dec 23, 2024 2 min read

What Are Vocal Nodules?

Vocal nodules, often called singer’s nodules, are callus-like bumps on the vocal folds.
Caused by repeated misuse or overuse of the voice, they prevent the vocal folds from closing completely when producing sound.
Unlike vocal polyps (blister-like growths that can form from a single event, e.g., yelling), nodules develop gradually over time.
Their size can range from a pinhead to a split pea and, if untreated, can lead to further vocal strain and damage.

Common Causes of Vocal Nodules

Vocal Abuse Behaviors in Children:
- Excessive talking for extended periods.
- Loud vocalizations like shouting, screaming, whining, cheering, or crying
- Frequent coughing or throat clearing
- Strained vocal sounds (e.g., imitating vehicles, animals, or superheroes)
Vocal Misuse and Other Contributing Factors:
- Poor breath support during speaking or singing.
- Straining the voice or using incorrect pitch or volume outside of one’s natural range
Environmental and health factors:
- Chronic upper respiratory infections or allergies
- Acid reflux
- Exposure to second-hand smoke or air pollution, which exacerbates swelling and inflammation

Healthy Vocal Practices and Alternatives

To reduce strain and help nodules heal, children should follow these guidelines:

Avoid loud talking
- Family members should take turns speaking so that the child does not need to talk over other members in the family to be heard. Also, the child should walk closer to the listener instead of yelling from a distance.
No screaming when angry
- Offer alternatives like punching a pillow or tearing paper.
Stop imitating loud sounds (e.g., animals, motors, superheroes)
- Use a gentle humming sound instead.
Refrain from talking over background noise
- Turn off TVs or radios during conversations to avoid shouting.
Replace throat clearing with a hard swallow
- This clears secretions without damaging the vocal folds.
Pause singing for now
- Encourage playing a musical instrument or using a whistle instead.
Stay hydrated
- Drink plenty of water and avoid caffeinated drinks. Caffeine causes dehydration, making vocal folds more prone to injury.

Encouraging Compliance

Positive reinforcement works best. Use tools like sticker charts to track progress.
Offer gentle reminders rather than nagging if rules are broken.

By adopting these practices with consistent effort and patience, vocal nodules will typically heal over time. Your speech-language pathologist can assist your child in regaining healthy vocal habits and preventing future issues.

By Kathleen Winger, M.S., CCC-SLP

Great Games for Gifts from a Speech Therapist

Educational, Speech Therapy | Nov 21, 2024 2 min read

…and fun ways to target speech and language

As a speech therapist, we always love to incorporate fun in games into sessions. It’s the best way to engage kids in therapy while also targeting their goals to improve speech and language. Here are some favorites and goals you can target with the game!

Pop the Pig (ages 4+, 2-6 players)

Turn taking
Two step directions (e.g., roll the dice, then feed the pig; feed the pig, then press his head)
Speech sounds (e.g., say a word before every turn)
Simple “what” questions (e.g., what color did you get?; what number is it?)

Feed the Woozle (ages 3-6, 2-5 players)

Following directions
R words in phrases (e.g., chocolate covered flies, moldy macaroni, spider egg pudding)
L words in phrases (e.g., liverwurst popsicle, lemon flavored underwear, iced garlic
S words in phrases (e.g., sugar coated sardines, baseball sandwich, soggy sausage)

Zingo (ages 4+, 2-6 players)

Naming objects in pictures
Turn taking
Answering yes/no questions for facts (e.g., do you have a tree?)

Tell Tale (ages 5+, 1-8 players)

Using story telling elements
Maintaining conversation topic
Answering wh- questions
Retelling stories

I Spy Eagle Eye (ages 5+)

SP blends in phrases (e.g., I spy…)
Naming objects in pictures
Where questions (e.g., where is it?)

By Jess Wi MS, CCC-SLP

The Power of Coregulation and Connection

Educational, Occupational Therapy | Oct 28, 2024 3 min read

Have you ever had a hard day and felt better after venting and connecting with a friend or family
member? You were coregulating and it shouldn’t come as a surprise that your kids need that too!

Coregulation is a process by which adults and children regulate their emotions and behaviors
together. While adults are able to manage their emotions and “use their words”, children are still
learning this skill! When a child becomes overstimulated or overwhelmed by emotions, they
can’t access the logical part of their brain like an adult can, meaning they lose the ability to use
words or learned coping strategies, resulting in a meltdown. In a meltdown, children are not
always “hearing” what is being said to them; they respond more to body language and facial
expressions versus words or prompting. A meltdown isn’t the time to control or dictate a child’s
behavior, but instead is a time to create a supportive environment where the child feels safe and
understood. By focusing on connecting with the child, we can help them manage their emotional
and physiological state.

Why is Coregulation Crucial in Occupational Therapy?

Building Trust and Security: Coregulation provides a consistent and responsive relationship that builds trust. When a child feels secure and understood, they are more likely to be able to participate fully in therapy sessions.
Enhancing Emotional Regulation: Through coregulation, children learn to recognize and manage their own emotions. It is important for the trusted adult to model appropriate responses and coping strategies to help the child develop their own tools for managing stress, frustration, or even excitement.
Facilitating Engagement and Learning: When children are regulated, they are better able to focus, follow directions, and participate in daily activities. Coregulation helps to create an optimal state of arousal where children can be both calm and alert, making learning and skill acquisition more effective.

How Can I Use Coregulation At Home?

Modeling Calm Behavior: By remaining calm and present, you can provide a model for children to emulate.
Using Sensory Tools: Incorporating sensory activities like weighted blankets, calming music, or bubbles can help regulate a child’s sensory system.
Responding to your child’s cues: Pay close attention to your child’s cues and adjust activities to support their needs. For example, if you can tell your child is already frustrated, it’s probably not the best time to ask them to learn or practice a new skill!
Have empathy: Remember that your child doesn’t WANT to have a meltdown. It is their attempt to connect and get help the only way they know how to in the moment. They are still learning and are doing the best they can!

By Michelle Beckwith, OTR/L

The Frightful Facility

Speech Therapy | Sep 26, 2024 2 min read

A parody of Disney’s Haunted Mansion ride attraction

When asking for candy is an appropriate behavior
And fun and colorful doors decorate the halls
When you get a pumpkin sticker
Because your speech therapist said you did well
That is the time when kids are learning
Practicing their speech sounds in “ghoul”, “witch”, and “fright”.

Welcome, SmallTalk families, to our Halloween celebration. I am your speech therapist. Well,
your child’s speech therapist. Kindly reschedule any missed appointments, and call ahead for
planned absences. Please switch to a virtual session if you’re sick.

Our lesson begins here on this blogpost, where you see lists of words for some of our
frequently-targeted speech goals.

Your puzzled facial expression betrays your sense of skepticism, almost as though you think
this might be a waste of your time. Is practicing just five target words daily actually useful? Or is
it just more busywork? And consider this interesting observation: your child is motivated to say
these ghostly words this time of year…which offers you this additional challenge: to think of
more spine-chilling Halloween words! Of course, there’s always Halloween word lists published
online.

Did you know that when practicing speech sounds, repeating target words is often more
effective than practicing a long list of new words? Here are lists of some of our commonly-
targeted speech sounds to incorporate into your regular speech practice routine at home. If you
don’t see a list appropriate to your child’s speech sound goals, try making your own!

Final /l/
candle
chill
ghoul
howl
caramel apple

Initial /k/
costume
cauldron
candy corn
coffin
cobweb

Medial K
Pumpkin
decay
licorice
Chocolate
rock candy

Final K
Shriek
Spook
Panic
Cloak
Magic

SK blends
skeleton
skull
scarecrow
scream
Skittles

SP blends
spooky
spider
spell
spirit
Spice Drops

SN blends
snack
Snickers
snake
Sneak
sneer

SM blends
smash
Smarties
smoke
smelly
smile

SW blends
swarm
swoop
swamp
Swedish Fish
SweeTARTS

SL blends
slime
slug
slash
slay
slab

ST blends
street
glowstick
sticky
stem
Starburst

Medial ST blends
Costume
Frankenstein
Gravestone
Haystack
monster

Initial R
rat
raven
robe
robot
Reece’s

R Blends
Creepy
Broom
Frankenstein
Dracula
Graveyard

“AR”
dark
carve
larva
Mars bar
hard candy

“ER”
October thirty-first
spider
wizard
Butterfinger
Hershey

“AIR”
werewolf
fairy
eclair
gummy bears
Ghirardelli

“IRE”
vampire
dire
conspire
bonfire
entire

“EAR”
fear
appear
hero
3 Musketeers
Zero

“OR”
trick-or-treat
decorate
candy corn
Lindor
Oreo

Happy Halloween from all of your friends at SmallTalk!

By Kathleen Winger, M.S., CCC-SLP

Handwriting Readiness

Activities, Educational, General, Occupational Therapy | Aug 29, 2024 2 min read

Handwriting readiness is a crucial part of a child’s development, involving fine motor and visual motor skills, which are essential for writing and dressing skills, like buttoning and zipping, that support their overall participation in school and activities of daily living.

Fine Motor Skills

Fine motor skills involve the small muscle movements in the hands and fingers that allow children to hold and manipulate writing tools effectively.

Children’s grasp of writing tools will change as they grow. By 4-5 years old, most children should be using a more mature grip. Here’s a timeline:

1-2 years: Fisted grip (holding with their whole hand).
2-3 years: Digital pronate grasp (holding with fingers pointing down, thumb up).
3-4 years: Static tripod grasp (holding with three fingers, but using the whole hand to move the pencil).
4-5 years: Dynamic tripod grasp (using three fingers with wrist and fingers moving independently for control).

Visual Motor Skills

Visual motor skills are essential for using scissors and making pre-writing lines, as they involve coordinating what the eyes see, with how the hands move.

Children typically begin using scissors around 2-3 years old, starting with simple snipping. Here’s a timeline:

2-3 years: Snipping paper and cutting along straight lines.
3-4 years: Cutting out simple shapes like circles and squares.
4-5 years: Cutting more complex shapes

Practicing pre-writing lines is crucial before learning handwriting because it helps children develop the fine motor skills and visual motor coordination needed to form letters and write neatly. Here’s a timeline:

2-3 years: Scribbling and imitating horizontal lines, vertical lines, and a circle
3-4 years: Copying simple lines, a circle, and imitating a cross
4-5 years: Copying a square, cross, triangle, diagonal lines, and an ‘X’

Fun At-Home Activities to Boost Your Child’s Visual and Fine Motor Skills

Practice drawing pre-writing lines, shapes, and letters in sensory bins filled with rice, shaving cream, or sand
Use playdough or wikki stix to create different shapes, lines, and letters
Use broken crayons when coloring/drawing to help initiate a proper grasp
Use large or small beads to string on a shoelace, pipe cleaner, or string
Rip paper to make crafts at home and practice opening and closing markers and glue sticks

By Allie Calcagno, OTR/L

OMG, it’s an OMD!

Educational, General, Speech Therapy | Jul 26, 2024 2 min read

What is an oral motor disorder?

Difficulty with the function of the muscles and structures involved in speech and feeding

May be the result of:

A physical, structural issue such as cleft palate or tongue-tie
Prolonged pacifier or sippy cup use, which interferes with natural oral development
Injury
Fetal Alcohol Syndrome
A neurological condition such as cerebral palsy and Down syndrome which includes issues with muscle tone, resulting in dysarthria

Signs of an oral motor disorder include:

Droopy or “long” face with mouth that frequently hangs open
Drooling past the age of 18 months
Speech which is difficult to understand
Lisped speech
Difficulty sticking out tongue or moving it from side to side
Difficulty producing certain consonants or deleting them past age 3
Refusal to eat certain foods, especially meat or other tough foods to chew
Frequent gagging when eating
Open-mouth breathing (may be only when sleeping) and/or snoring

Key components affected by oral motor disorders include:

Articulation: Difficulty in coordinating and controlling the movements of the lips, tongue, and jaw which can lead to reduced intelligibility
Chewing: Challenges chewing and manipulating food in the mouth
Swallowing: Difficulty with coordinated and sequential movements required for safe and effective swallowing
Facial Expression: Limited control over facial muscles, impacting facial expressions and non-verbal communication

If you suspect that your child may have an oral motor disorder which is impacting articulation and/or feeding, it is important to seek treatment with a speech-language pathologist and/or occupational therapist. We are here to help!

By Kathleen Winger, M.S., CCC-SLP

Summer Themed Activities for Speech and OT

Activities, General, Occupational Therapy, Speech Therapy | Jun 28, 2024 3 min read

Summer is finally here! We are excited to share some summer-themed activities you can enjoy with your child. These activities offer therapeutic benefits, helping your child work toward their goals while still enjoying the summer season.

Ice Cube Animal Rescue

To do this activity, put little plastic animals in an ice cube tray, fill it with water, and freeze it. Gather some tools found in your home to break the ice and rescue the animals. For example, use a small hammer to break open the ice, tongs/tweezers to pull the animals out, or an eye dropper with warm water to melt the ice. Use the tools to break and melt the ice more quickly. Once all of the ice melts, you have rescued the animals!

To target language goals, talk about the animals using descriptive language. Describe the animal’s appearance, where they live, and the sounds they make. Use language like, “Oh no, we need to rescue the animals,” “The animals are stuck,” “It feels very cold,” “This animal is really fast,” “That animal has cool stripes,” etc.

To target occupational therapy goals, use a variety of tools, as mentioned above, to work on hand strengthening, force modulation, and grasping patterns, which will contribute to your child’s overall fine motor development.

Use your imagination with this activity! If you do not have little animals, you can freeze other mini objects or toys, little craft pom-poms, etc.

Fun with Chalk

Use sidewalk chalk to draw pictures to target both speech and language goals! Draw pictures and practice speech sounds your child works on in speech therapy. For example, if your child is working on “s,” draw a sun, a bus, an octopus, ice cream, etc. Play pictionary! Take turns drawing pictures and guessing the drawing. Use language to describe colors, patterns, etc. Drawing with chalk is great for developing fine motor and visual motor skills as well!

Make a sensory path! Use sidewalk chalk to create a series of guided movements to challenge your child’s gross motor skills while providing regulating sensory input. These movements could include anything that involves running, jumping, skipping, spinning, or balancing.

For example, start with a two-foot bunny hop, then walk along a curved line, trying to maintain balance. From there, do an animal walk, such as a bear walk or frog jumps, followed by a hopscotch sequence. Then, balance on one foot for 10 seconds and end with a race to the finish line! Get more inspiration on Pinterest or Instagram!

For an added challenge, have your child create their own sensory path to work on executive functioning skills such as planning and organization. See how creative they can get!

Scavenger hunt

Get outside and look for items in nature that are a specific color, texture and/or size! For example, look for something pink, yellow, bumpy, smooth, crunchy, etc. This simple activity can target skills such as describing, following directions, and increasing vocabulary. It is also great for tactile sensory processing, for example, exploring and discriminating between textures. Scavenger hunts can also help your child develop visual perceptual skills, such as finding differences between items and scanning through a busy background to locate an item.

By Nathalie-Rose Malecot, MS CCC-SLP and Jamie Carlson, OTR/L

Poop is a funny word: Resources for Toileting

Educational, General, Occupational Therapy | May 30, 2024 4 min read

Toileting, or as more commonly known as potty training, can be a challenging endeavor for children. Toileting is a complex task which requires many skills such as executive functioning skills including sequencing, sensory processing skills such as interoception, motor skills such as reaching and grasping, balance, dressing skills and so much more. However, occupational therapists are here to help with this challenge. Throughout this post, there will be a multitude of different books to read with your child to help improve their ability to toilet!

The first few books cover the science behind using the bathroom, exciting stuff, right? Well, using books to break down a basic task can help a child understand the process a little bit more and why it is important for our bodies.

“From Chewing to Pooing: Food’s Journey Through Your Body to the Potty” by Lauren Gehringer & Dr. Natalie Gehringer

The first book is called, “From Chewing to Pooing: Food’s Journey Through Your Body to the Potty” by Lauren Gehringer & Dr. Natalie Gehringer. This book talks about digestion in a fun way for children to understand. A child may feel fear surrounding using the bathroom, so learning more about the task can ease toileting anxiety.

“See Inside Your Body” by Colin Daynes and Katie King

The second book titled, “See Inside Your Body” by Colin Daynes and Katie King is a book to help children understand the organs involved with digestion. The more children can understand the process of digestion, the less pressure there may be surrounding using the bathroom. It also contains a lot of fun flaps to lift up and down to learn a little bit more about the body. Through learning more about the body, children can better understand interoception. Interoception is the sensory information people receive from their organs that lets them know if they are hungry, thirsty, sick, or need to use the bathroom.

“My Body Sends A Signal: Helping Kids Recognize Emotions and Express Feelings” by Natalia Maguire

The next book helps children learn more about interoception. The book titled, “My Body Sends A Signal: Helping Kids Recognize Emotions and Express Feelings” by Natalia Maguire teaches about the body sending us different messages and what these messages might mean. While this book focuses a lot on bodily cues related to emotions, it is still a valuable book for children to explore to learn more about how their body can send different signals such as their belly hurting or feeling like there are ‘ants in their pants’.

“It Hurts When I Poop: A Story for Children who are Afraid to Use the Potty” by Howard J. Bennett, M.D.

The last two resources or children’s book shared in this blog post focus more on constipation, which is the build up of hard stool inside the colon that is difficult to pass. Constipation is a common problem that affects a lot of children. Some children may find using the toilet aversive because of constipation. So here are a few books below to help a child defeat the potty time blues.

The first book is titled, “It Hurts When I Poop: A Story for Children who are Afraid to Use the Potty” by Howard J. Bennett, M.D. In this book it follows a main character who experiences constipation in an easy to understand format for kids. It also includes a “poop program” for parents to help their child through this process.

“I Don’t Want to Go To the Toilet” by B. Annyne Rothenberg, Ph.D.

The last book included in this post is titled “I Don’t Want to Go To the Toilet” by B. Annyne Rothenberg, Ph.D. which is a great guide for parents to use throughout the process of potty training, especially if there is a youngster who is having a hard time with this skill.

For more specific information regarding your child’s toileting success, reach out to your child’s occupational therapist. We are here to help, even if it stinks!

By Kat Danella, OTD, OTR/L

How SLPs Make a Difference

Speech Therapy | Apr 30, 2024 2 min read

Raising awareness, changing lives

May is national speech, language and hearing month – a time to celebrate and acknowledge the profound influence and dedication of speech-language pathologists (SLPs). We are so grateful to all of our SLPs for their unyielding commitment, and the remarkable impact they make on the lives of so many families. Here are some of the areas that SLPs in pediatrics focus on:

Speech sounds—A child may substitute one sound for another, leave sounds out, add sounds, or change a sound. It may be hard for others to understand them.
Spoken and written language—A child may have trouble understanding what others are communicating to them and may have problems explaining what they are thinking or feeling. They may also have difficulty with reading and writing.
Stuttering (fluency)—A child may get stuck on certain sounds or words. They also may have tension or negative feelings about talking. This tension can get in the way of how they talk to others.
Cognition—A child may have problems with long- or short-term memory, attention, problem solving, or organization.
Social communication—A child may have difficulty understanding how others feel or following the rules of conversation, such as knowing how to take turns.
Voice—A child may lose their voice frequently or use a hoarse or breathy voice. They may also speak with strain or effort.
Augmentative and alternative communication—A child may need to find other ways to communicate besides talking, such as using a picture board or a speech-generating device.
Feeding and swallowing—Problems with feeding and swallowing can make it hard for a child to participate in their school day. Speech-language pathologists help students eat and drink safely during the school day so that they have the energy to learn.

At SmallTalk, we asked some of our SLPs why they love their field. They responded:

“I love being a speech-language pathologist because….”

“I get to help kids become more confident with communicating.” – Miss Sara
“I get to play all of my favorite games. My childhood spirit will never die!” – Miss Amanda
“I get to work hands-on with families and see the difference we make first-hand” – Miss Hannah

By Julia Navarra M.A. CCC-SLP