Busy Moms' Resolutions

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Dear Melissa,

I admit that when my family gets busy, I tend to not feed my kids as well. I'm ready to start the New Year right. Do you have any tips?

 
You are not alone! I applaud you for taking the first step...being willing to change! This is a perfect time for the WHOLE family to work on goals to help promote health. When it comes to weight loss/gain, these topics should be discussed with your child’s pediatrician. However, the following are a few general strategies I use with my own kids to help prevent crankiness and promote health.

1) Eat 5 servings of fruits/vegetables every day. 

It seems as if everyone has an opinion as to what constitutes a “healthy diet”. Gluten free. Vegetarian. Mediterranean. Paleo. Low fat. Low carb. However, almost all dietitians agree that, in general, a mostly plant-based diet is best. We all know this; we need to just plan ahead and do it!

TIP: Keep a bowl of fruit and/or vegetables on the kitchen table for easy access and promote these items as snacks rather than “junk food.” 

2) Mix protein with complex carbohydrates at all snacks/meals.
This prevents blood sugar swings and either crankiness or hunger later.

TIP: Easy, quick options include peanut butter toast, apple with a cheese stick, milk with graham crackers, celery with peanut butter or cheese, trail mix with dried fruit/nuts, low fat yogurt with granola and/or fruit, whole grain cereal with milk, turkey sandwich on whole wheat bread, etc.

3) Choose drinks carefully. 

Be leery of sweet drinks. About 1 in 5 children consume excessive calories from soda, other sugar sweetened beverages, and fruit juice, with juice being the major contributor (Clinical Pediatrics). There is some debate about milk. The Choose My Plate national nutrition site from the Department of Agriculture recommends water or low-fat milk. However, recent literature suggests a possible reverse relationship between fat content and milk - children who drink 2% or whole milk actually have lower BMI than children who drink skim or 1%. 

TIP: Only drink water or milk. Avoid or significantly limit all forms of sugar-sweetened drinks/sodas/juices. 

4) Eat Breakfast. 

We have heard it a million times and it is true. Breakfast is the most important meal of the day! Make sure it is a healthy meal consisting of a complex carbohydrate and protein. NO SIMPLE SWEETS!

TIP: Steer clear of toaster pastries, muffins, sugary cereal, and donuts. Better ideas for quick breakfasts would include whole-grain cereal and milk, yogurt with granola/fruit, a cheese stick with a piece of fresh fruit, peanut butter toast, etc... 

5) Move your Body!

Yes, the weather is cold outside, but it is still important for the family to move together. Reduce the TV/video game time and MOVE! Numerous studies have shown that exercise can help mood, attention, cognitive function, and cardiovascular health. WALK places whenever you can.

TIP: Consider "imagining you are animals" (e.g., bear walking, crab walking, crawling like puppies), pillow fights, indoor obstacle courses, or moving-your-body video games. You can simply turn on some music and just dance! 

6) Picky Eater Woes? 

Prioritize reaching out to your child’s speech therapist, occupational therapist, or pediatrician for help.

TIP: For some children who are picker eaters it can help to offer several healthy options, but then give the child the autonomy to choose what he or she eats. Your goal is to achieve variety throughout the entire day, but not necessarily at every meal. 

What tips do you have for making your child healthier for 2015? Please share!

share@childrenstherapyteam.com

Resources:
Nutrient Intake and Consumption of Fruits and Vegetables in Young Children, Ramsay, Eskelsen, Branen, Shultz and Plumb, Infant, Child, & Adolescent Nutrition, Volume 6, (December 2014).

Opportunities to Reduce Children’s Excessive Consumption of Calories From Beverages, Clinical Pediatrics, Rader, Mullen, Sterkel, Strunk, Garbutt, Volume 53, (October 2014).

Food and Nutrition Information Center, Beltsville, Maryland, www.Nutrition.gov
United States Department of Agriculture, www.Choosemyplate.gov

Skip Crawling? A TEAM PT offers a follow-up

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Dear Melissa,

My 8-month-old baby girl is starting to pull up on furniture! I really think she is just going to skip crawling and move right on to walking!  

So, your baby is pulling up on furniture, but never really went through the crawling phase? My response to this question last week prompted some wonderful discussions with members of Children's Therapy TEAM's Physical Therapy Department. One of our veteran Physical Therapists, Christina Ruby, has shared a treasure trove of knowledge with me. Her advice is, "Do not panic!"

First, Christina set me straight on the definition of crawling: 

• Crawling is when a baby is in locomotion with her tummy and legs on the ground while using her elbows and forearms to help push her body along. This is also commonly called “Army Crawling". 
• Creeping is the formal term for when children are in locomotion with their hands and knees on the ground and their belly lifted off of the ground. 

Creeping is actually the movement pattern I am discussing here. From this point forward in this post, I will properly refer to the type of locomotion in question as “creeping”. Christina suggests that even if children appear to be skipping the creeping phase, they can still practice the skills gained from creeping. Parents can provide frequent opportunities for their child to pull up, get back down, move to another piece of furniture, then pull up there. All of this up and down from hands and knees (creeping position) to standing will provide practice with trunk strength and control. It also helps with coordinating the right and left sides of the body. And for my two cents, even if a child is pulling up, it is still not too late to practice creeping! 

As I noted last week, creeping helps with visual development, sensory input, strength and coordination of the entire arm, and later, handwriting skills (Skip crawling and walk...Is it a good idea?). These are all things that OT tends to focus on. But, creeping helps out with so much more! Christina has offered insight based on her expertise as a Pediatric PT.

Core Strength Development

When a baby creeps with her belly off of the ground, it forces her back and abdominal muscles to work together to provide a stable foundation for the arms and legs to move. This sets up the foundation for proper posture, trunk strength, and balance later in life.

Coordinate all four extremities in a reciprocal manner 

When creeping, each arm and each leg moves at it’s own pace in a coordinated manner.  This coordination of right and left sides of the body as well as the upper and lower halves of the body takes a lot of work! This ability to coordinate all four quadrants sets the child up for successful movement patterns as they age. 

Weight shift from right to left

As we walk, we shift our weight from the right foot to the left foot and back to the right.  Same with creeping: right, left, right, left. Creeping is an important developmental milestone needed for walking.

Coordinated hip/knee/ankle/foot movements 

It is almost impossible to walk with our hips, knees, and ankles in a fixed position. We need to move! Creeping provides that rhythmical coordination of the hip/knee/ankle/foot. Practice makes perfect! As a child practices typical creeping patterns, this sets her up for success for when she takes those coveted first steps.  

Trunk rotation 

As a baby creeps, she naturally creeps for a bit, then sits to rest and look around before taking off creeping again. Every time she transitions from the creeping position on her hands and knees, to sitting, and back to hands and knees, it involves trunk rotation. As she matures, this will allow the child to not only have better balance as she is walking, but also give her the ability to reach and move in all planes, not just in a straight forward and back motion. 

Who knew creeping could do all that? Wow! Thank you Christina for sharing.

As always, I would love to hear about your experiences. 

You can both share and submit questions to share@childrenstherapyteam.com

Resources

Six Reasons Why Crawling Is Important, Joanna Bounds, Kids Spot

Effects of Sleep Position on Infant Motor Development, Davis, Moon, Sachs, Ottolini, American Academy of Pediatrics (1998)

Crawling, an OT's Perspective, Melissa Foster, Children's Therapy TEAM Blog (2014)
Tummy Time for Babies, Melissa Foster, Children's Therapy TEAM Blog (2014)

Downs Syndrome, The Importance of Crawling on the Stomach, Robert Doman, Ellen Doman, National Association for Child Development Volume 22, Number 12 (2009) 

Skip Crawling and Walk...Is it a good idea?

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Dear Melissa,

My 8-month-old baby girl is starting to pull up on furniture! I really think she is just going to skip crawling and move right on to walking!  

WAIT!!!  But crawling is so important!  Yes, I am thrilled with every developmental milestone of any kid at any age. Every child has their own developmental path. The time it will take for children to reach certain milestones will vary. And any time a parent is proud of their child is a reason to celebrate. 

But…crawling is SO important!  I remember when both of my children were in the 10-15 month range; I was constantly asked about walking: “Is he walking yet, is he walking yet?”  As a mama with a background in child development, I don’t know how many times I felt my blood pressure rise and the need to bite my tongue, rather than get on my soap box on the importance of crawling.  “No, my 10-month-old child is NOT walking yet!  And that’s fantastic, because do you have ANY idea how important crawling is? (insert my rolling my eyes here!)”

So, here is my soapbox rant on the importance of crawling. In 1994, the American Academy of Pediatrics began their “back to sleep” campaign. SIDS fell by 50%, but numerous studies show that since that time, kids are slower to meet gross motor developmental milestones.Then they added “Back to sleep, prone to play”, but many parents were already so terrified of putting babies on their tummies, that the message did not really hit home. And, it seems like society is so focused on that monumental milestone of when a baby takes her first steps, that we have forgotten the importance of crawling, rolling, dynamic sitting, etc. 

Babies who go through the crawling phase will later develop better eye-hand coordination when it comes to handwriting, sports, playing a musical instrument, etc. There is even a link between a lack of crawling and ADHD (but the verdict is still out on which may cause the other, you know…kind of like the chicken and the egg). I see this in my own practice. When a parent brings a child to me for handwriting help, one of the first questions I ask is “Did he crawl as a baby?”  More often than not, the answer is “No, but he was walking by 11 months!”

Why is crawling so important?

It strengthens the whole upper extremity.  

In laymen’s terms this means the whole shoulder, arm, and hand, down to the finger tips.  Even better, when a baby crawls while holding an object (think a toy car, rattle, etc) this strengthens all of the tiny intrinsic muscles of the hand, which are so vital for handwriting skills later on. 

It improves eye-hand coordination.  

When crawling, a baby often looks toward the object as she is crawling to it, or looks to the object, then to her hands, then to the object. This switching back and forth between near/far vision helps develop a child’s eye hand coordination and visual perception skills. When do we see this in big kids? Looking at the classroom board, then looking at the paper on the desk, and back again. Same thing. Babies who crawled have an advantage when it comes to having the eye hand coordination needed in school settings later on. 

Improves coordination of the right and left sides of the body.  

Walking primarily involves the weight shift of the right and left sides of the lower body. This is especially true when a baby is walking using push toys. In crawling, FOUR different sections of the body must all work together in unison. Right arm, left arm, right leg, left leg…it's very complicated to get all 4 areas working together in a rhythmic pattern. As a therapist, it definitely sets off red flags when a child consistently uses atypical movement patterns as a primary means for locomotion. An example of an atypical pattern is when a child sits and scoots on her bottom using one hand on the ground for support. Another example is when a child “crawls” but the legs don’t take turns moving in a back and forth pattern. Rather, they move forward together in a singular motion similar to a “bunny hop”. 

Improves sensory development.  

As a child crawls with her hands open she naturally will encounter many different textures on her hands. Smooth, cold tile. Fuzzy carpet. Big brother’s prickly bristle block that was left on the floor. You get the idea. Again, it is hard to know which one came first, but it is common for children who skip crawling to later have tactile sensory defensiveness, especially on their hands, such as resisting nail grooming, hand washing, finger paint, sand play, lotion, etc.  

Worried your baby may skip crawling 

and move straight to walking? 

Here are my top four tips:

1) Get on the floor with your baby!  

She may not want to be on the floor by herself. Get down on the floor and play with your baby. At times, model crawling yourself. 

2) Try to gently put your child on her hands and knees.  

Again, model this together. Siblings present? Make it a family affair! You can even put her on her tummy over a Boppy pillow for support if her arms/legs are not quite strong enough to support her yet. 

3) Make it a fun environment.  

Make sure that there is an open space for crawling. When next to furniture the child will tend to pull herself up and walk while holding on. Provide toys on the floor and spread them out to promote crawling from one toy to the next.

 

4) Practice, practice, practice.  

If your baby has started to crawl in the past few days, but she looks like she may want to take off walking already, get as much crawling in as you can. This was the situation with my daughter, and we would pretend to be puppies (barking and all!) as we crawled the full length of the house, from one room to the other. Has your baby already started to prefer walking? No worries! You can still encourage additional crawling practice through crawling under chairs, under the coffee table, through tunnels, and...it’s always fun to pretend to be puppies/kitties!

Did your child crawl or not?  

Do you think it affected later gross or fine motor development? 

I would love to hear your thoughts!

You can send your ideas and questions to share@ChildrensTherapyTEAM.com

Resources: 

Whats So Important About Crawling, MedCentral Health System  

Crawling and Creeping: A Milestone that should never be Missed, Center for Development Pediatric Therapies

  

Parenting: Do Babies need to Crawl?, Dina Roth Port, Parenting 

Tummy Time for Babies, Melissa Foster, Children's Therapy TEAM Blog 

Early infant crawling experience is reflected in later motor skill development, McEwan, Dihoff and Brozvic, (1991), Perceptual and Motor Skills

Reduce tantrums...with music!

 

Dear Melissa,

I have discovered that playing the right music is the only thing that can bring my 3-year-old son out of an all-out-meltdown when all of my other strategies and approaches fail. Is this normal or crazy? 

Well, you are onto something big here. It is not crazy...it is a gem of a technique that works for many kids! While I have a large bag of tricks when it comes to stopping the dreaded tantrum, this is a technique I have watched and learned from my fellow therapists at Children's Therapy TEAM. Taking a moment to brag, I am often in awe of my colleague's patience and skill in dealing with the less-than-enthusiastic kiddo. 

Music has become an important part of my kiddo-calming repertoire. I frequently sing when I'm with my kiddos, both at work and at home. Sometimes, it feels like I'm conducting a full Broadway musical. Note that I was NOT in the high school choir. I do NOT sing in the shower and I RARELY sing with the radio. So when I sing with my kiddos, I sometimes feel silly. My coworkers have to deal with my horrible voice. But, I'm sure you agree that even bad vocals are much more tolerable than a 3-year-old’s high-pitched crying!

You noted that music helps to bring your child out of an all-out meltdown. Chances are it may also be effective at proactively preventing the meltdown in the first place. Through my own practice and careful observation of other therapists, I find that music can be a useful tool in a variety of ways. Try some of the following approaches:

For a reward:  

Why not sing? Yes, a simple “good job” is nice. But, a “good job Henry, good job Henry, good job Henry…”  to the tune of “Where is Thumbkin?” is a much more intense and more personalized reward. Don’t we all want to work harder when we feel that our efforts are truly appreciated? 

For transitions: 

A transition is any time that a child (or adult) moves from one activity to the next. Anyone who has been around a preschool child for more than a day realizes that these transitions are often a cause for a meltdown. The adult can sing the steps of the transition to help communicate to the child what will happen next. This helps to ease the child’s anxiety of the unknown. For example (again, to the tune of “Where is Thumbkin?”), sing  “Put your socks on, put your socks on, and your shoes, and your shoes. Grab your backpack, grab your back pack, off to school, off to school”.  If you haven't noticed, pretty much anything can be sung to the tune of “Where is Thumbkin?”!

For calming:  

Now when a child begins to scream/cry, it can be very tempting to scream/cry as well.  Unfortunately this just escalates the situation. Not good!  As the adults in the situation, it is our job to deescalate the situation and help promote calming. By singing to the child in a soft, calm voice, you communicate to the child that you are calm. As a matter of fact, when I practice this technique, I feel that it actually helps me remain calm. It also has the added benefit of showing the tantrum-ing child that you can stay calm, even if they scream. And if the tantrum has no power over adults, the child will learn alternative techniques in order to get his way. Win-win!

For learning: 

We all know this one! How did we learn the ABC’s? How did we learn the days of the week? Months of the year? My daughter even came home from preschool with a song describing the water cycle! We have all known about this one since we ourselves were in preschool. We just forget to use it to our advantage sometimes!

For a stop watch: 

I have found this one to be extremely useful in working with kiddos who are overly sensitive with grooming. For example, if a child hates to have his teeth brushed, he will often let me brush his teeth for one round of singing ABC’s. Most children will know this song (even if they sometimes confuse the letters) by the age of 3 or 4. Singing during an uncomfortable task tells the child that there is a definite end to the unpleasantness. In addition, I find the rhythmic songs to be quite calming.

For gaining attention:  

I totally stole this one from observing preschool classrooms! The teacher may say “shhh” or “settle down” several times to the class with no success. Then she begins to sing “Let it Go” from Frozen…suddenly, every little eye in the entire classroom is glued to the teacher’s face, and every voice is singing along! If it works, use it!

For environment:  

Music totally sets the mood! Slow, quiet rhythms for nap time. Louder driving beats to help wake up. Medium regular beats during table work for attention and self-regulation. In addition, music is simply fun! It creates an engaging atmosphere. 

Do you have other ideas for using music to help improve mood/behavior? 

I look forward to hearing your ideas!

You can send your ideas and questions to share@ChildrensTherapyTEAM.com

Resources:

10 Preschool Transition Songs and Chants to Help Your Day Run Smoothly, by Angela Thayer, TeachingMama.org 

Introducing Preschoolers to Music, Kids Health from Nemours Children's Health System

Preschool classroom attention grabbers, by Jean Warren, PreschoolExpress.com

Great Toys

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Dear Melissa,

The holidays are approaching. Do you have any ideas for fantastic toys that my children will love, but that are also therapeutic?

The season of yearly gift giving has begun! I get this question frequently. Parents want their children to be excited when they open up that shiny package, but parents also want to use this opportunity to provide their children with items that will have some therapeutic and developmental benefit. Fun AND function! For this blog, I took the opportunity to enlist the help of my fantastic colleagues at Children's Therapy TEAM to create a list of exciting toys that are appropriate for a wide range of abilities. I have also included several links to products on Amazon, simply in order to provide clear examples of my descriptions. Feel free to tailor these recommendations to your child and to your favorite stores. Happy Shopping!

1) Indoor Mini Trampoline: As a sensory-based OT, this is my “most bang for your buck” item.  At around $30 (like this Stamina 36" folding trampoline), they are the perfect gift-giving price. Please note, the American Academy of Pediatrics is strongly against traditional trampolines due to the high incidence of injuries. I do NOT recommend a standard or even a small trampoline that is traditionally placed outside. My recommendation is for the mini trampoline that can slide easily under your bed, or the small “rebounder” trampoline that has a handle bar for smaller children. They are fantastic for helping children “get their wiggles out” on a cold or rainy day.  They also are so helpful for homework breaks, calming, improving attention to task, improving endurance/motor planning, cardiovascular health, etc. This gift is most appropriate for ages 3 years and up. 

2) Balls:  Baseballs, basketballs/basketball sets, dodgeballs (pictured left), playground balls and t-balls are all great. Holly Hill, a pediatric Physical Therapist at Children's Therapy TEAM, loves ANY type of ball because they serve to get children outside and moving their bodies. They help with gross motor skills, eye-hand coordination, and overall physical fitness. Depending on the ball, they are most appropriate for children who are 18 months and up.

3)  Shopping Cart:  Danielle Cunningham, another pediatric Physical Therapist at Children's Therapy TEAM, had this marvelous idea for emerging walkers. The shopping cart (such as the Step II Little Helpers Shopping Cart pictured right) fosters social and pretend play skills! You can either purchase additional pretend play food items or simply use cans and boxes from the pantry. This toy is most appropriate for children aged 10 months to 5 years (with older children generally using this item more for social skills rather than gross motor skills). 

4) Bikes/trikes/scooters:  Again, our TEAM PTs love anything that encourages a child to go outside and play! Both Holly and Danielle think that the holidays are the perfect time to splurge on the vehicle that is most appropriate for fostering the next stage of your child’s gross motor development. When children have items that make them excited to be outside, they will naturally spend more time working on their strength, endurance, and coordination. Think “ride on” toys like balance bikes (pictured left), tricycles, 3-wheel scooters, plasma cars and bicycles with/without training wheels. You get the idea. These items are most appropriate for children 1 year and up.

5) Pretend play toys:  Connie Clark, a veteran Children's Therapy TEAM Speech Therapist, loves doll houses, barns (pictured right), tea sets, puppets, etc. because of their ability to encourage pretend play skills. They also foster expressive and receptive language skills when an adult or older children play with the youngster. These types of toys are most appropriate for ages 12 months to 5 years. 

6) Art supplies:  Markers, pens, paints, crayons, chalk, clay, play-doh, glue, glitter, sequence, googlie eyes, construction paper…the list goes on and on. The great thing about art supplies is that you can obtain these in the dollar section of many stores or go more high-end with various extravagant art kits. Art supplies foster fine motor skills and creative thinking skills while decreasing sensory defensiveness. An added bonus: you have cute little projects to hang on your refrigerator! Different types of art supplies can be appropriate for ages 18 months and up.

7) Recordable toys: Paige Funkhouser, Children's Therapy TEAM Speech Therapist, loves any toys that allow a child to record his/her voice (like this Talking Tom Product). It can help a child learn to speak up, find power in his voice and articulate. There are innumerable little toy creatures and apps out there right now that fit this description!  Personally, my own 4- year-old is eyeing the talking birds. Have fun with this one! These toys are typically most appropriate for ages 2 years – 13 years. 

What beloved toys do your children have that foster developmental milestones? 
Please share!

You can send your ideas and questions to share@ChildrensTherapyTEAM.com

Resources: 

A Pediatric Occupational Therapist’s Favorite Toys, Kara Corridan, Parents.com

Best Toys for Toddlers, MamaOT.com

An Occupational Therapist’s Favorite Toys for Every Age, Grow Thru Play, LLC