What is Pediatric Occupational Therapy and how would I know if my child would benefit?

Occupation refers to functional tasks or activities that bring meaning to your life. And our children’s main activity is PLAY. Did you know that kids play to learn and that play requires motor, sensory processing, cognitive, and social skills? All these skills work together for learning. However, when the necessary skills for play are observably difficult, it can make grasping new competencies challenging for kids.

Occupational therapy addresses all the skills needed for play. It works on strength, coordination, and control to support their movement. OT also helps with sensory processing difficulties by identifying the way your toddler receives or responds to sensory input and teaching fun ways for you to support your child. And finally, Occupational Therapy promotes executive function skills building on motor, attention, and regulation foundations for learning.

Though play can look different and vary from child to child, there are general toddler development skill ranges necessary for learning to happen. When these are not progressing or missing, they can inhibit engaging in and learning through play.

The development of sensory processing and motor skills begins immediately at birth. The brain is where all the magic happens. Newborns take in sensations, but their body is unable to organize them—their reflexes are neurological responses to stimulation, including the senses of light, sound, touch, or pressure input such as stroking and vestibular sensory input with sudden movement.

The sensory processing and motor skill development looks random and clumsy at first with the baby’s initial kicking of their legs or trying to find their mouth with their hand. As they continue to be exposed to the sensation and repeat the movement, it becomes more purposeful.

Babies are holding, pulling, pushing, and dropping toys as they learn about cause and effect. More and more skills work together to explore and learn through play.

For your toddler, the years from 1 to 3 are very busy. They are essential years of curiosity, trial and error, and learning about what they can do. At age one, toddlers are very active. Give them a container, and everything comes out; maybe a few things go back inside. Set something on the table, and they pull up to see if they can get it. They make sounds and babble and may tug on your heart with Ma Ma or Da Da words!

Toddlers are in a transition of building more independence. During the terrible twos, a stage that everyone stresses about, they continue to learn about their environment, manipulate things, and communicate their experiences. Their development takes all the work that the baby’s brain and body did and uses it in play to build confidence, control movement, and explore new sensations. Toddlers experience big emotions. They must learn about these feelings and how their body responds to them. How we react and support them is important.

They also learn to transition from one activity to another, even when they don’t want to.
For example, two-year-olds usually can stack a few blocks, string a few large beads on a shoelace, feed themselves with a spoon, drink from an open cup or a straw, remove/pull on clothing, brush teeth, help wash their body at bath time, jump, run, and walk up and down a few steps. They can also throw a small ball toward a target, help clean up, and put toys away. Though the terrible twos try on parents and toddlers, they don’t last long. And both parents and kids learn a great deal!

As we strive to develop more patience during these times, our toddlers are growing far more in their quest for independence. Two-year-olds should be able to attend and learn a new play activity for 4-6 minutes. Some research even suggests that this age group should be able to focus on a task for 10 minutes.

Though many toddlers can sit and play for extended periods of time with preferred toys or activities they have initiated themselves, a better learning opportunity is to give them a new task to work on to develop manipulation skills like using a tool to scoop, fill a container, feed themselves with a spoon or fork, stack or build with blocks, lace beads on a string, or roll a ball back and forth.

Notice how your child works through activities. When development is not smooth, there will be clues in how your child moves, plays, speaks, or acts. See if you observe any of these challenges:

  • unable to manipulate toys in play, they continue to dump, empty containers, or throw them around the room
  • difficulty using tools to scoop, squeeze, hammer, draw
  • unable to demonstrate repetitive play activities. May run around, only roll the car back and forth
  • moves between many play activities quickly, not engaging in any of them
  • requiring or demanding your attention and unable to initiate or engage in play by themselves for short periods
  • difficulty imitating actions in movement, imitating mouth or tongue movements, silly faces, or being unable to throw a ball at a target. Difficulty moving from sitting to moving under structures, crawling through a tunnel
  • unable or very clumsy with jumping, climbing, moving between different level surfaces, climbing ladder to slide
  • unable to take turns in play activities such as rolling ball back to you, stacking blocks
  • seems fixated on the television, tablet, or phone and unable to engage with other toys in play
  • difficulty putting things together such as connecting blocks, lacing, and beads
  • unable to tolerate play on a swing, on a slide
  • unable to play near or with other children
  • unable to tolerate tactile messy play or engagement with media like play-doh, finger paint, or shaving cream
  • difficulty removing pull on clothing from dress-up activities

Play is one of the most significant areas that can provide clues about your toddler’s development. As we’ve outlined, there is so much growth happening during this time. If you see your child struggling in any of the areas we mentioned, occupational therapy can help develop and strengthen the skills needed for learning.

Occupational therapists are experienced experts and can help identify the areas inhibiting your child’s primary occupation and introduce fun activities for successful skill development.

Children are tiny individual humans with varied interests and gifts. We embrace and work together with parents to help children reach their greatest potential.

Come in and check us out in April for Occupational Therapy month!

Author: Pamela Vasiloff, OT

How to help children on the spectrum develop friendships

In my high school, a peer known for his social awkwardness greeted me in a monotone voice, “Pratt, do you have anything to say to me?” I replied, “Yes, good morning. How are you doing today?” Satisfied with the exchange, he nodded and walked to class. He did not return the greeting, nor did I expect him to. He also never asked me how I was doing.

There is an expression that “the only way to have a friend is to be one.” But what if you struggle to read facial expressions, body language, and tone of voice? For children on the autism spectrum, making friends can be challenging. From the young child who sits alone on the playground to the high schooler who chooses to stay in the computer lab rather than interacting with their classmates at lunch, it may appear that these children have no interest in pursuing friendships. Unfortunately, this is a common misconception held by neurotypical people (not on the autism spectrum).

The child on the playground and the teenager in the computer lab may be overwhelmed by the noise and chaos of the children around them or the location where social interaction occurs. Other behaviors of children on the spectrum include lack of eye contact, fidgeting, and repetitive movements (arms flapping, rocking, etc.). Many of these actions help limit overstimulation, manage anxiety or help with focus, but they can be perceived as a lack of interest by their neurotypical peers. Neurotypical children may conclude that their counterparts with autism are disinterested. But appearances can be misleading.

Children on the spectrum often long for friendships but do not know how to develop them. The importance of peer relationships is well understood. Friendships can provide opportunities to learn important social and emotional skills, including empathy, cooperation, problem-solving, and similar prosocial skills. Unfortunately, the opposite is also true; negative peer relationships involving bullying, rejection, and manipulation result in feelings of isolation, anxiety, depression, and confusion about relating to others.

Luckily, there are many ways to support children on the spectrum. Here are some steps you can take to support your child in making a new friend:

1. Explain what a friend is:

For young children, keep things simple. For example, explain to them that “a friend is someone who is nice to you and likes to spend time with you.” Understanding abstract concepts can be difficult for young kids on the spectrum. It helps to discuss characters in a movie or tv show that the child enjoys. Ask questions such as, “Is Character X being nice to Character Y? Do they like playing together?”

2. Social Stories

Children with autism often learn better when they are provided with visual support. Social stories lead a child through specific situations using pictures and words. Each story can be tailored to the child. For example, writing a script or drawing out the course of a conversation can help children understand the basics of how to talk to a friend. ***Carol Gray is a good resource.

3. Practice is Key

The best way to try something new is to explore it first in a safe and familiar environment. Have your child practice social skills (greeting others, asking and answering questions, self-advocating, suggesting ideas for play) among people the child already knows and is comfortable with (siblings, cousins, neighbors, and other adults). Through practice and repetition, you and your child can problem solve challenges he might have before encountering them at school or on the playground.

4. Finding Your Tribe

To build friendships, children must first share common interests. Find what your child is good at or enjoys, and then find a community based on that interest. For example, if your child loves board games, find a gaming group. If your child plays an instrument, get them into the band at school. Finding a shared activity is key, and it provides the groundwork for children to further grow friendships by sharing their feelings or by sharing a positive emotional experience.

Sometimes, however, it’s not about what groups children with autism join; it’s about getting other children to join them. Some schools implement a playground ambassadorship program, where neurotypical students are tasked with engaging students who tend to remain on the periphery of the playground. These children look for peers who are not engaged and reach out to them/ask them to play. Parents may want to ask their schools if this program is already in place or can be implemented. You are your child’s best advocate.

SmallTalk wants your children to “find their tribe” and make long-lasting connections with peers. Therefore, SmallTalk offers small social skills group sessions at each clinic location to help teach your children the foundations of social skills and offer guided practice of engaging in different social scenarios with peers. If you are interested, please call us at (619) 647-6157 to schedule an appointment.

Feeling the LOVE

February is here! And so are our themed therapy activities. We love thematic learning – it is relatable and helps kids make meaningful connections within their everyday lives.
Here are some of our favorite ideas to try incorporating at home:

Books about Feelings and Love

Themed books are a great way to teach vocabulary, encourage early literacy, and promote positive relationships and acceptance. When reading books with your child, we recommend using the “PEER” approach.

P: Prompt your child with a question about the story. Prompting your child focuses attention, engages the child in the story, and helps the child understand the book.
Point to something in the picture, for example, a balloon. “What is that?”

E: Evaluate your child’s response.

“That’s right! That’s a balloon.”

E: Expand on what your child said.

“That’s a big, red balloon! We saw one of those in the grocery store yesterday.”

R: Repeat or revisit the prompt you started with, encouraging your child to use the new information you’ve provided.

“Can you say big, red balloon?” Each time the book is reread, the expanded vocabulary words are verbalized again.

Here are some books worth checking out:

  • Froggy’s First Kiss, by Jonathan London
  • The Day it Rained Hearts, by Felicia Bond
  • Guess How Much I Love you, by Sam McBratney
  • Love Splat, by Rob Scotton
  • Love Monster, by Rachel Bright
  • Love You Forever, by Robert Munsch
  • The Giving Tree, by Shel Silverstein
  • Llama Llama I Love You, by Anna Dewden
  • No Matter What, by Debi Gliori

Making Valentines

Arts and crafts activities are a great way to work on making choices, requesting and describing during play. Here are some useful strategies to incorporate during the craft at home:

  • Provide two choices during card-making: “Do you want the heart or the lip sticker?” or “Do you want the purple or red crayon?”
  • Model the use of adjectives: “Ooo, I pick the sparkly, red and white heart!” or “I’m going to draw a big chocolate candy.”
  • Teach location concepts: “Do you want to put the sticker in the middle or on the side?” or “Let’s write your name on the front.”
  • Practice “who” questions by asking who your child wants to make the card for.
  • Sabotage. Give your child an unsharpened pencil or a glue stick with the lid still on it so that they need to ask you for help.

Trip to the Post Office

Once your Valentines are complete, we recommend taking your kids on a trip to your local post office. Here are some ideas on how you can incorporate speech and language skills into the outing:

  • Teach related vocabulary: stamps, envelope, delivery, etc.,
  • Model comments: “I see a mail truck!” or “Wow, look at all of those mailboxes!”
  • Verbally sequence the steps to mailing a package: “First you fill the box, then you tape the outside, next you write the label…”
  • Take turns dropping mail into the mailbox and discussing who the mail is for.
  • Practice ordering stamps at the counter.
  • Bonus: Let your therapist know if you went on the outing, that way it can be a topic of conversation in their speech session. :)

We wish you a Happy Valentine’s Day and look forward to hearing how your activities go! We LOVE meaningful activities, making connections, and all of our wonderful families at SmallTalk.

Author: Julia Navarra, M.A., CCC-SLP, Speech-Language Pathologist

Does my child need Occupational Therapy?


What is Occupational Therapy? Does that help my child get a job? No! “Occupations” are daily activities, so that means playing and learning for your child. Children develop daily living and self-care skills through actively exploring their environments and playing with others. Occupational therapy addresses sensory processing, motor delays, and social-emotional components that may be impacting your child’s ability to develop independence at home and school. If any of the following characteristics resonate with you, your child may benefit from occupational therapy!

Sensory Processing

  • Overly sensitive or heightened reactivity to sound, touch, or movement
  • Under-responsive to certain sensations (e.g., high pain tolerance, doesn’t notice cuts/bruises)
  • Constantly moving, jumping, crashing, bumping
  • Easily distracted by visual or auditory stimuli
  • Emotionally reactive
  • Difficulty coping with change
  • Inability to calm self when upset

Social Interaction Skills

  • Difficulty interacting socially and engaging with family and peers
  • Difficulty adapting to new environments
  • Delayed language skills
  • Overly focused on one subject (e.g., space, universe, dinosaurs, trains)
  • Can’t cope in the school environment

Play Skills

  • Needs adult guidance to initiate play
  • Difficulty with imitative play
  • Wanders aimlessly without purposeful play
  • Moves quickly from one activity to the next
  • Does not explore toys appropriately
  • Participates in repetitive play for hours (e.g., lining up toys)
  • Does not join in with peers/siblings when playing
  • Does not understand concepts of sharing and turn taking

Oral Motor/Oral Sensory

  • Excessive drool
  • Chews food in the front of the mouth, rather than on the molars
  • Difficulty using a cup at an age-appropriate time
  • Difficulty with drinking from a straw at an age-appropriate time
  • Lengthy bottle or breast feedings
  • Tiredness after eating
  • Baby loses excessive liquid from their lips when bottle or breastfeeding
  • A child loses excessive liquid or food from his or her mouth when drinking or chewing
  • A child appears to be excessively picky when eating, only eating certain types or textures of food
  • A child excessively mouths toys or objects beyond an age-appropriate time

Fine Motor Skills

  • Manipulating toys and puzzles
  • Holding a pencil
  • Using silverware or straws at an age-appropriate time
  • Using scissors
  • Using zippers, buttons, shoelaces
  • Coloring, drawing, tracing, prewriting shapes
  • Poor handwriting, letter/number formation
  • Not developing a hand dominance at an age-appropriate time
  • Avoiding tasks and games that require fine motor skills

Gross Motor Skills

  • Going up and down stairs at an age appropriate time
  • Coordinating both sides of the body
  • Understanding the concept of right and left
  • Poor ball skills
  • Poor balance
  • Fear of feet leaving the ground
  • Not crossing the midline of their body during play and school tasks
  • Avoiding tasks and games that require gross motor skills

Visual Processing

  • Difficulty with the spacing and sizes of letters
  • Difficulty with recognizing letters
  • Difficulty with copying shapes or letters
  • Difficulty with visual tracking and crossing midline
  • Difficulty finding objects among other objects
  • Difficulty with copying from the board or another paper
  • Difficulty with the concept of right and left

Learning Challenges

  • Unable to concentrate and focus at school
  • Easily distracted
  • Difficulty following instructions and completing work
  • Tires easily with school work
  • Poor impulse control
  • Hyperactivity or low energy
  • Not keeping up with workload at school
  • Difficulty learning new material
  • Makes letter or number reversals after age seven

Do you feel like your child has difficulty in any of the areas as mentioned above? Are you questioning whether an Occupational Therapist should see your child? If so, our SmallTalk therapists are here to help strengthen these skills and answer any questions through structured and unstructured table and gym activities with weekly/bi-weekly therapy sessions. Please call to schedule an evaluation today!

Authors: SmallTalk Occupational Therapists

SmallTalk’s gifts for goals!

The Holidays are upon us, and we’ve heard the question…. “What toys do we recommend?!” We LOVE all questions, but this one, in particular, is FUN to answer! In general, most novel items or toys are a great way to teach your child new skills! Like all other moments of the year, FAMILY TIME is the best gift. Break out a family photo album, cut back on screen time, make a “family dance party” playlist, bake together (recipes are great for reading comprehension and following directions), or go explore the great outdoors (play “I spy” on a walk to work on visual-motor integration and describing).

Get Retro!

Think back to a toy that you received as a kid to share with your mini-me! Ditch the expensive electronic light-up toys and go for “old school” blocks, train sets, or pretend musical instruments. Bring back family game nights; with Pictionary, you can work on fine motor skills and labeling. Board games that you played as a child, like Candyland or Hungry Hungry Hippos, are awesome to work on taking turns, following directions, and fine motor skills.

Get Building!

We already know many of our SmallTalk family loves Legos, but did you know how great they are for therapy goals? To work on therapy targets, you can talk about what you’re building, give directions, or give only a few blocks and have your child ask for more. Try larger blocks Lincoln Logs, or magnet building sets if Legos are too small. Puzzles are also a go-to, working on fine motor skills, picture matching, and labeling.

Get Creative!

Hands-on activities and craft sets are awesome for all kids! We recommend Play-Doh, sticker books, puppet theaters, Kinetic Sand, water tables, or make your own jewelry activities. You can work on verbs in all of these activities and following directions. Costumes or dress-up items are fantastic to work on making narratives (telling stories) and pretend play. Make reading more interactive with books that have craftivities.

Get Moving!

Gifts to get our bodies moving are always wonderful, especially for our sensory-seeking friends or if gross motor skills are a challenge. We’d recommend small trampolines, swings, sports equipment, Twister, or Spike Ball. A simple ball can be used to roll back and forth to work on turn-taking, use to work on saying names, or can be thrown at a hoop to work on coordination. For our smaller movements, check out the 50 Piece Fidget Popper set on Amazon or stretchy toys like Goo Jit Zu characters.

Before you buy…

Before buying a new toy, think about your child’s specific way of PLAY! For example, avoid small pieces if your kiddo is still exploring with their mouth often, and avoid toys with gel or slime inside if they may love to bite, squeeze, or stomp.

Prepare for Changes in Routine!

  • As always, it is important to talk about changes in routine, such as visitors or traveling to new places.
  • Discuss how your child is feeling about changes in routine and ask how you can help them (i.e., bring a familiar toy to new places or show pictures of where you are going or who is coming over).
  • Remind family and friends about how best to greet your child- do they prefer high-fives or big bear hugs?

If this year has been hard on your family, like so many, check out this link to see local resources to help with the holidays.

We wish you and your families a fun and festive holiday season!

Kendall Harrington, M.S., CCC-SLP

Surviving the holidays with picky eaters

The holidays are times of family and traditions, many of which involve food and eating. However, when your child eats very few foods, the holidays can bring frustration and stress as you navigate the changes in routine, new foods and the expectations of eating them, and the abundance of desserts and sweets.

We’re sharing some recommendations to help you decrease stress surrounding mealtime so that you can enjoy the holidays with your loved ones.

  • Limit changes in routine. Holidays can often mean traveling, time changes, and lots of familiar and new faces. These changes can be overwhelming. Try to keep your child’s mealtime routines, including the time of day they eat and any cleanup routine, the same. If possible, bring familiar plates, utensils, and cups too!
  • Have your child eat a typical meal or snack before the big meal, especially if the big meal is later than the child’s usual mealtime. Then, keep a preferred snack at the ready for your child to eat with the whole family. The focus of the holiday meal should be family, not a struggle to explore new and tricky foods. If available, you can always bring some leftovers home for food exploration at a later time.
  • Prepare your child and set expectations. Explain to your child what activities may be happening and show pictures of who they can expect to be there. If there is going to be food present that may be tricky for your child to tolerate, try exploring the food through play the weeks before the holiday at home, where they will likely feel the safest.
  • Limit sweets! The holidays are filled with desserts that are sometimes hard to resist. Sugar can suppress appetite limiting consumption of nutritious foods. Try to keep sweets until the end of a meal; however, avoid making the availability of dessert dependent upon how they ate the rest of their meal.

Try these suggestions so you can focus on enjoying your time with loved ones.

The SmallTalk family wishes you and yours a very Happy Thanksgiving!

Lauren Fong

SmallTalk’s spooktacular Halloween tips and tricks!

October has officially arrived, triggering a return to school, apple picking, frolicking in the pumpkin patch, tractor rides, and the delicious aroma of pumpkin spice coffee. Of course, fall also stirs up the ghosts, goblins, and witches of Halloween!

While Halloween can be a memorable and exciting time for children all over the country, it is also a time of uncertainty, confusion, and stress for those who experience communication and sensory challenges. For these children and their families, Halloween can prove to be a difficult and overwhelming experience to navigate.
At SmallTalk, parents and families often ask how we can help prepare their children for the holiday seasons.

Below is a list of tips and tricks to help our families and emphasize the treats as opposed to the tricks of Halloween.

Prepare for Unexpected vs. Expected Situations

If Halloween brings discomfort to your child, discuss what they might expect to see, hear, or feel around or on that costume-filled night.

  • Read a non-threatening Halloween book/social story, watch a fun Halloween movie, listen to upbeat Halloween music or make a trip to a Halloween store.
  • Prepare and practice a written script for how and what to say for trick or treating interactions with neighbors and friends.
  • Review with your child a Halloween social story or sequence of events that will occur on Halloween while trick or treating.
  • Share your trick or treat route and script with your neighbors before Halloween night.
  • Discuss how your child is feeling about Halloween- excited, scared, happy, etc.
  • Anticipate and talk about some unexpected situations that could occur.
  • Reassure your child that friendly faces will be by their side throughout the night.

Augmentative/Alternative Communication

Create a Halloween page on your child’s AAC device with various Halloween icons and answers to possible Halloween questions such as “What is your costume?” “Are you having fun?”

  • Practice using the device’s Halloween page with your child, so they feel comfortable using it on Halloween night.

Articulation/ Phonological Delays

  • Suggest Trick or Treating in a small group of familiar people.
  • Consider a group costume with friends/family (i.e., Ninja Turtles, Power Rangers, circus, etc.) to help your child feel more included.
  • If Halloween trick or treating is too overwhelming for your child, many communities, local churches, and schools provide Trick or Treating options.
  • Encourage your child to attend/participate in a Halloween party at school or local community.
  • Try an alternate Halloween plan.
    • Allow your child to hand out candy to trick or treaters and practice asking “Wh” questions to trick/treaters (i.e., What is your costume? Where did you get that?).

Sensory Challenges

  • Provide a Halloween craft or carve a pumpkin to expose your child to different textures.
    • Create a Halloween sensory bin.
  • Trick or treat before it gets dark.
  • Before Halloween night, walk around your trick/treating route and observe your neighbors’ decorations and lights.
  • Schedule sensory breaks while trick or treating or at Halloween festivities to avoid possible overstimulation and provide distance from foreseeable stressors.
  • Bring headphones to block out overwhelming/loud noises.
  • Try tasty candy alternatives if you have a “picky” eater.
  • Allow your child to pick a costume that makes them feel comfortable.
    • Try on the costume on several different occasions before trick or treating to make sure it is comfortable.
    • Allow it to hang in a visible spot days before Halloween to familiarize your child with the costume.
    • Create your own costume out of preferable fabric if a store-bought costume cannot be tolerated, and invite your child to be a part of the process.

We wish you a fun-filled and SPOOKTACULAR Halloween season. We cannot wait to see your costumes and hear your children tell us about their experience!

by Pamela “PJ” Baragona, MA CCC-SLP

How to get the most out of online therapy

As we move into our second week of school closures and other life disruptions, I want to remind you that SmallTalk is open and functioning with our full staff. We are hoping to help our kiddos and families get through this difficult period of uncertainty supporting your child’s needs and helping him/her maintain a sense of normalcy in their lives. To do that, we are leveraging our online speech therapy and online occupational therapy sessions—just as frequently as any other week.

Our seasoned speech and occupational therapists blend their skills and experience with an expanding array of online games and tools. Our online speech therapy and online occupational therapy services provide the same high-quality therapy that we’re known for in our clinics! Here’s how to get the most out of your teletherapy sessions:

  • First, email or call our front desk to schedule your sessions:
  • After going through the introductory paperwork, you’ll be emailed a link that you’ll need to connect to prior to the session
  • Download Google Chrome on a device (computer, iPad) with a camera and microphone– iPhone users, Safari is the suggested browser
  • Using Headphones or ear buds is recommended, to help block out peripheral noise
  • Please test your device prior to each session to make sure the microphone, speakers, and camera are connected
  • Keep the room as quiet and free from distractions as possible
  • For the best internet connection, discontinue other teleconferencing or Wi-Fi demands
  • For children under 5 years, or with behavioral concerns, a parent or adult should accompany them during the session

Free screenings

Wondering if your child could benefit from speech or occupational therapy?

Here’s a fast, free way to find out—just contact shauna@smalltalkspeech.com, and she can schedule a free 15-minute screening with one of our therapists. In the screening, our therapist will employ some basic tests to instantly assess your child’s development and determine whether or not a full evaluation is recommended.

SmallTalk also provides free screenings to preschools and private schools throughout San Diego County. It’s a service to the community that enables schools to support the complete development of their students by ensuring that their speech language and social skills are age appropriate.

If you’re interested in a free school screening, contact us.

Link copied to clipboard!