What Are Primitive Reflexes and What is Their Impact?

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

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

…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

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

Handwriting Readiness

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!

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

Poop is a funny word:  Resources for Toileting

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

Childhood Occupations and How OT Supports Them

April is Occupational Therapy Month!

April is occupational therapy month! It is a month to celebrate occupational therapists and their work to make a difference in the lives of their clients. In pediatrics, occupational therapists support kids in the various occupations that they engage in. 

In occupational therapy, occupations are anything clients value and spend their time doing to make their lives more meaningful. In pediatrics, these occupations generally fall under the following categories: 

Activities of Daily Living (ADLs)

ADLs are basic self-care activities that include feeding, bathing, getting dressed, toileting, and more. The expectations regarding these activities change as a child grows. Still, through play and fun activities during our sessions, pediatric OTs work on supporting a child’s independence in age-appropriate activities. 

Instrumental Activities of Daily Living (IADLs)

IADLs support independent living skills in the community. These activities include meal preparation, chores, and transportation, to name a few. Supporting the skills needed to complete these activities is essential for a pediatric OT. 

Rest and Sleep

Rest and sleep are essential occupations that support children and their development. If they aren’t getting appropriate sleep, they can struggle to maintain a proper level of arousal to support engagement with their other occupations. Occupational therapists can help families set up a sleep routine and meet sensory needs for appropriate sleep, among other things. 

Education

Education consists of being able to engage in a variety of learning activities. OTs support skill-building and environmental adaptations to allow children to access their education to the fullest extent possible. 

Play

Play is the primary occupation for young children. They learn through play and build a majority of their skills through play. Occupational therapists help children engage in meaningful play and support their self-regulation skills through play. As pediatric OTs, play is the primary way we treat and engage with children. 

Social Participation

Social participation is another primary way children interact with their environment. It is how they interact with their peers and those around them. OTs support a child’s regulation and skills to engage in appropriate social participation. 

Occupations are not just work; they play a significant role in everyday life for everyone, including children. During April, if you encounter an occupational therapist, thank them for helping their clients engage in meaningful occupations and activities. 

References: 

American Occupational Therapy Association. (2002a). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, 609–639. https://doi.org/10.5014/ajot.56.6.609

By Erin Christensen, OTD, OTR/L

Nine Key Points for Understanding Your Insurance Coverage

Parenthood is a rewarding journey, but it also comes with its fair share of responsibilities. One
crucial aspect of ensuring your family’s well-being is understanding your insurance coverage.
Here are key points parents should know about their insurance:

1. **Check Your Insurance Plan:**

Start by looking at your insurance plan to see if it covers speech and occupational therapy
for your child. This information is usually in the benefits section of your plan. Contact your
insurance if you have any questions about what is covered and what is not.

2. **Kid-Friendly Therapists:**

Find out if the therapists you’re considering are approved by your insurance. This helps you
save money because in-network therapists often cost less.

3. **Get a Doctor’s Opinion:**

Talk to your child’s doctor and ask them to make a referral. Sometimes insurance needs this
information before they allow for session coverage.

4. **Know the Limits:**

Some insurance plans have rules about how many sessions your child can have or the
length of time a child can attend. Check if there’s a limit so you’re not surprised later.

5. **Ask About Pre Approval:**

Before starting therapy, ask your insurance company if you need pre approval. It’s like
getting a green light before you go.

6. **Money Stuff:**

Check if you need to pay anything upfront, like copayments or deductibles, before insurance
kicks in. Knowing this helps you plan financially.

7. **Fixing Denials:**

If insurance says no to a claim, don’t panic. There’s often a way to fix it. Find out how to
appeal so your child can keep getting the help they need.

8. **School Services:**

Check with your child’s school. Sometimes they offer therapy too. It might be a good option
and could have different insurance rules.

9. **Keep Talking:**

Communication is key. Talk to your insurance, the therapists, and your child’s doctor.
Everyone working together helps make sure your child gets the best care.

Understanding insurance coverage for speech and occupational therapy might seem tricky at
first, but taking these steps can make it easier for you and your child to navigate. It’s all about
making sure your little one gets the support they need to shine!

By Shauna Oakes, Administrative Director

Valentine’s Day Activities for Speech and OT

As Valentine’s Day approaches, we’re excited to share some heartwarming and therapeutic activities that not only celebrate the season of love but also contribute to the growth and development of our clients. Join us on this journey of combining affection with effective therapy!

Speech and Language Therapy

Valentine’s Day provides a unique opportunity to explore the language of love. Speech and language therapy can be both educational and enjoyable as we engage our clients in activities that focus on expressing emotions, social interactions, and building meaningful connections through communication.

Activity Ideas:

  • Love Letter Writing: Encourage clients to express their feelings by writing or dictating love letters. This activity enhances language skills and emotional expression. 
  • Conversation Hearts Challenge: Use conversation hearts candy with words or phrases related to communication goals. Clients can create sentences or engage in conversations using these sweet treats.

OT- Sensory

Occupational therapy often involves sensory activities that stimulate and enhance sensory processing. This Valentine’s Day, let’s explore sensory-rich experiences that promote engagement and development.

Activity Ideas:

  • Scented Sensory Bins: Create sensory bins with Valentine-themed scents like roses, chocolate, or strawberries. Clients can explore different textures and engage their senses.
  • Heart-shaped Stress Balls: Make heart-shaped stress balls filled with different textures to provide tactile stimulation. This activity is great for hand strength and stress relief.

OT- Fine Motor Fun

Fine motor skills are crucial for daily activities, and what better way to practice than with Valentine-themed fine motor activities?

Activity Ideas:

  • Valentine’s Day Crafts: Engage clients in crafting activities like making heart-shaped cards, cutting out paper hearts, or creating tactile crafts. This enhances fine motor coordination.
  • Cupid’s Arrow Game: Use a bow and arrow game to target various objects. This activity improves hand-eye coordination and fine motor precision.

Valentine’s Day is not just about chocolates and flowers; it’s about fostering growth, connection, and joy through therapeutic activities. We invite you to join us in celebrating the language of love and the development of essential skills that make every day special for our clients. Happy Valentine’s Day!

By Amy Rawlings, MA, CCC-SLP

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