Flu Shot vs Nasal Spray Mist

Dear Melissa, 
I know you advocate the importance of getting the flu shot, but should I give my 2 year old son the Flu mist nasal spray or the traditional flu shot?

 

Flu Shot vs Nasal Spray Mist

Thanks for the question! This is something many parents will have to consider soon. The decision between a flu shot and the nasal spray is something that varies from person to person and should be discussed with your family physician. Personally, my kiddos are terrified of shots (like most kids). Therefore, I make sure to track down the sometimes elusive vaccination nasal spray to make the process much less stressful. Whichever you choose, there are pros and cons to consider.

Considerations according to R. Morgan Griffen 

(WebMD writer reviewed by Jennifer Robinson, MD)

Pros and Cons of the Flu Shot 

The shot involves an injection into the upper arm with a vaccination containing a dead virus. (1)
PROs: Can be given to a wide range of individuals, beginning at age 6 months and in my experience is easier to obtain than the Nasal Spray Mist.
CONs: Many people don’t like shots. The most common side effect is soreness at the injection site. Much less common reactions include a mild fever and achiness. (1)

Pros and Cons of the Nasal Mist 
This vaccine is sprayed into the nose. It is made from a live virus that has been weakened and can NOT cause the flu.(1)
PROs: Does not involve an injection. In addition, the CDC reports that the FluMist might actually provide better protection than the traditional shots for children ages 2-8.
CONs: Possible side effects include: slightly stronger flu-like symptoms than the shot, such as runny nose, headache, sore throat or cough. In children, side effects can also include wheezing, vomiting, fever, and muscle aches. The mist can only be given to individuals between the ages of 2 and 49 years who are generally healthy and not pregnant.(1) In addition, young children need to be able to breathe in through their nose on command in order to take the dose. In my experience, it is good to “practice” this with young children before entering the doctor’s office.

Other thoughts to consider:
As I noted before, it has been my practical experience that the flu shot is easier to obtain. Many chain pharmacies, as well as local pharmacies, offer flu shots. In addition, many employers provide flu shots. It literally can take less than 5 minutes of your time to save yourself the risk of a week in bed. On the other hand, last year I had to call several different clinics to find one who had the Mist in stock. Then I had to make an appointment and wait in the waiting room in order to obtain the Mist for my daughter and myself. But again, much better to deal with this at my convenience than a week sick in bed for either me or my daughter.

U.S. Center for Disease Control Recommendations:
Children receiving the flu vaccination for the first time will need TWO doses. Children, ages 6 months through 8 years, who need two doses of the vaccine should receive the first dose as soon as possible to allow time to get the second dose before the start of flu season. The two doses should be given at least four weeks apart. (Again, my personal recommendation is to talk to your physician.)
The CDC recommends “All persons aged 6 months and older are recommended for annual vaccination (against the flu) with rare exception." Those exceptions include individuals who:
1) Have had Guillain-Barré Syndrome OR
2) Are allergic to any components of the vaccine (such as egg)(3)

Those in particular who should receive the flu vaccination include the following:
1) Children aged 6 months to 18 years
2) Adults 50 years and older
3) People with chronic illness
4)Women who are pregnant during flu season
5) Health-care workers
6) Caregivers/family members for individuals younger than 5 years or older than 50 years
7) Caregivers for infants younger than 6 months of age (due to the inability for young infants to be vaccinated themselves).(2)

We mamas don’t have time for the flu! We don't want our children to be miserable in bed for a week, nor do we want to spend the following week sick ourselves because our child gave us the flu. So, don't just vaccinate your child, but vaccinate yourself, your spouse, and anyone else you can coerce into getting the vaccination as well. Yes, I can give you all of the scary statistics on how dangerous and even deadly the flu can be, but you can find these in last year’s blog, Flu Shot is a Sure Shot.

Want more information? Check out the resources below:
1. Flu Shot or Nasal Spray? R. Morgan Griffen, WebMD, July 16, 2015
2. Vaccination: Who Should Do It, Who Should Take Precautions, Center for Disease Control and Prevention
3. What you should know for the 2015-2016 Influenza Season, Center for Disease Control and Prevention

Healthy Classroom Snacks

Dear Melissa,
Do you have any ideas for “healthier” snacks for me to send to my daughter’s preschool?

I have to say, I VERY MUCH DISLIKE it when my daughter comes home from Pre-K, and says that she had two different cookie snacks at school that day.  And this, at a school that tells parents not to bring in sugary snacks for birthday treats!  With Halloween coming up, I do NOT want to overload our kiddos with candy.  As an OT who often sees these kiddos in the afternoon, and as a mama who then needs to settle her own kiddos down for an evening of homework and bath time, please let’s stop the sugar overload!

Now I know there is MUCH debate as to what is the healthiest diet for kids as well as adults.  However, I think that we would all agree that the list below is healthier than a standard sugar cookie.  AND, I am not a crafty, Pinterest queen.  The following snacks were chosen because they are a good balance between cute/fun, as well as easy for busy moms to pick up and prepare for your child’s party the next day. 

Grab and Go Snacks:  Lets face it, sometimes you totally forget that it is your child’s turn to bring snacks until that morning.  The following are fun & healthy treats that can be picked up on the way to school.

• Veggie sticks & Hummus
• Apple slices and nut butter
• “Frozen Forest” Broccoli and Cauliflower “trees” with Ranch dressing “snow”.  (Hey, its all in how you sell it!)
• Cheese sticks/string cheese
• Wheat crackers and cheese slices
• Popcorn

Un-fail-able Make Ahead Snacks: These are NOT the type of cutesy snacks that require a frosting bag and glue gun.  Each of these are so easy that my 4 and 7 year old kiddos even help me with them.  Added bonus? They can be modified for Halloween parties or standard classroom snacks.

String cheese faces – Simply use a Sharpie marker to draw silly faces on the package of string cheese.  You can make them look like ghosts or just a silly face.
 
Cutie orange faces – Again, simply use a Sharpie to draw silly faces on a cutie orange.  You can make them look like jack-o-lanterns or just a silly face.  Apparently the one my daughter drew was “Elsa”. (A very loose interpretation!) 

Trail mix – have your little one help you mix up individual baggies containing pretzels, dry cereal, chewy dried fruit such as Craisins (dried cranberries) or raisins, crunchy dried fruit such as banana chips and freeze dried strawberries, and nuts (if there are no allergies).  You can even throw in a few mini marshmallows if your child craves a bit of extra sweetness. 

Fruit cup faces – See a theme here?  Once again, take a Sharpie and draw either a jack-o-lantern or silly face on top of the fruit cups.

Kid Chefs!  My daughter’s pre-K strongly encourages classroom “cooking”. They love it when we bring in the ingredients, and the kids get to be the chefs. As an OT, I love how getting kids to “cook” encourages them to try new foods, as well as encourages fine motor skills.

• Banana Wheels: The kids can slice bananas with a butter knife, and spread nut butter on the top of each wheel.
• Ants on a log: Kids can spread nut butter into celery sticks and add the “ant” raisins.
• Cheese sandwiches: Easy assembly – bread, sliced cheese, done!
• Nut butter sandwiches: Again, the children can practice their fine motor skills by spreading nut butter to slices of bread and folding.
• Fruit Kabobs: The kids can wash and pick the grapes, slice bananas, cube (already peeled) melons, etc, then string the fruit onto BBQ skewers. Again, multiple fine motor tasks in one yummy treat!

What snacks do you like to send to your child’s school?  Please share your faves here! share@childrenstherapyteam.com

Perspectives on Sippy Cups

Dear Melissa,

My son just turned 6 months old. When should I start thinking about introducing a sippy cup?

Ahhh, the great sippy cup debate.  What, you didn’t realize that sippy cups are controversial?  Well actually, they are!  And what makes this even more tricky is that each slightly conflicting view has very real and valid arguments. So, to help tease out the pros and cons of sippy cup use, I sought the advice of fellow speech-language pathologists here at Children’s Therapy TEAM, Dr. Karen Green, DDS from Pediatric Dental Associates in Fayetteville, Arkansas, and online with the American Academy of Pediatrics.   

Pediatric Dentist Perspective (Dr. Karen Green, DDS) 
The American Academy of Pediatric Dentistry recommends transitioning away from the bottle/breast when the infant is 1 year old. The reason behind this is that the child can develop severe early childhood caries (formerly known as baby bottle tooth decay).  A child who nurses on demand or is allowed to carry a cup of milk/formula around to suck on throughout the day is much more likely to develop these cavities. Milk (breast, cow, or soy) contains sugars. These are fermentable carbohydrates that are digested by oral bacteria into acids that can lead to enamel breakdown and eventually cavities. In addition, if the child uses the sippy cup like a pacifier, it can lead to tipping of the teeth (teeth shifting forward or backward).

Sippy cups are great for learning to transition to a cup, but their use should be limited to the learning period. Once the child has the ability to use an open cup, the sippy cup should be discontinued. A cup with a lid and a straw is a good option to keep sugary liquids off of the top front teeth, but note that these liquids will still remain on the back teeth. I don’t see any reason straws should be discouraged, unless the child develops a bad habit of chewing on the straws.

In addition, juice should be limited to no more than 4-6 ounces per day. Only allow milk or juice in the cup/sippy cup at mealtimes.  Between meals, only water should be given, and NEVER put your child to bed with milk or juice. I would also advice against giving sodas/sweet tea to children in general as this is added and unnecessary sugar that can be avoided, and it should definitely never be put in a sippy cup or bottle. 

Pediatric Physician Perspective (American Academy of Pediatrics) 
The American Academy of Pediatrics recommends breastfeeding as the sole source of nutrition for your baby in the first 6 months. Once solid foods are introduced, it is recommended to continue breastfeeding until at least 12 months. Breastfeeding  can continue after 12 months if both the mother and the baby desire. For those infants that are bottle-fed, the recommendation is that bottles should be phased out between 12-24 months of age. When weaning from either breastfeeding or bottle, the AAP recommends using a sippy cup to transition. This transition to an open cup should occur as quickly as possible, preferably before 2 years of age. The AAP also cautions against “grazing” on milk, juice, sodas, or any beverages other than water, as it can lead to tooth decay.  

Pediatric Speech-Language Pathologist Perspective (Connie Clark & Amy Love-Smith) 
We agree that infants should be weaned from the bottle/breast at around 1 year of age, but not necessarily to a sippy cup. Quite frankly, sippy cups are simply a tool to keep kitchen floors clean from spilled milk rather than a necessary developmental milestone. We feel that around 12 months of age, a child would preferably be transitioned from the bottle/breast to a cup with a straw or an open cup. A cup with a straw promotes more mature lip closure and tongue retraction, whereas a sippy cup continues to promote the immature sucking pattern associated with a bottle. We also agree that cups should primarily contain water between meals with milk being reserved for meal-times. Drinking milk and juice between meals leads children to fill their caloric intake with liquids; therefore, they are not hungry for actual food at mealtimes. This can cause food battles and “picky eating” that would not normally be an issue for many children.  

Pediatric Occupational Therapist Perspective (Melissa Foster) 
I have a slightly different slant on the whole sippy cup issue. Personally, I like to introduce sippy cups a bit earlier, at around 6 months of age. In my practice (primarily with children with Sensory Processing Disorder), I find that many children become dependent on drinking from only a bottle or nursing from the breast, and are resistant to the change of drinking from a cup. The closer the child gets to 12 months, the more stubborn he can be! SO, whether it is from a sippy cup, open cup, straw cup, or simply taking sips from a straw held from Mom’s glass of ice water, I prefer for infants to begin being exposed to different vessels early. Now, I realize that this is earlier than others recommend. This is why I think it is perfectly fine to put formula or expressed breast milk in these various containers for purely experimentation sake so that the infant can learn that nutrition can come from many different sources. 

Furthermore, in keeping with the sentiment of dentists, physicians, and speech-language pathologists, I agree that milk, juice, etc. should be reserved for scheduled meal/snack times. (And soda should NEVER be used in a sippy cup or bottle!)  Water should be the only allowed drink between meals to prevent “grazing”. This creates the hunger drive necessary for the child to be a more adventurous and successful eater during mealtimes and will reduce the likelihood of the child becoming a “picky eater”.

Conclusion:  
As I warned, the recommendations differ slightly as to when to wean, and what the recommended next step is.  In studying the literature carefully, it seems that the only consensus is to stick with milk and water, and eliminate or significantly reduce any other beverages. As with all things in life, I really think this is a time to know your child, know your family, and know what your concerns are for your particular child. In my opinion, the bottom line is do what you can to try to minimize cavities and to use the sippy cup only as a short-term transition tool geared towards teaching the child how to drink from a 'standard' cup. 

Resources: (accessed August-October 2015)   

Pediatric Dental Associates, Fayetteville, AR 
What to Expect: Introducing a Sippy Cup
From baby bottle to cup: Choose training cups carefully and use them temporarily, American Dental Association 
Get It Done in Year One, American Academy of Pediatric Dentistry  
Weaning Your Baby, American Academy of Pediatrics 
AAP Reaffirms Breastfeeding Guidelines, American Academy of Pediatrics 
Discontinuing the Bottle, American Academy of Pediatrics
What Kids Should Drink. Melissa Foster, Children's Therapy TEAM Blog

What kids should drink.

Credit: Envato Images

Dear Melissa,
I hear a lot of debate amongst my mama friends about kids drinking milk, 100% juice or water. They all seem to have opinions as to what is best. What are your thoughts?

Only Water and Milk. Some of each every day. Wow! That was easy! Now, off to read a book on the patio! Oh, wait, my editor probably would not appreciate a blog that is only 9 words long. So, let's visit the literature. First according to the Nemours Children's Health Foundation (Kidshealth.org), the current beverage recommendations for milk for children are as follows:

• Kids ages 2 to 3 should drink 2 cups (480 milliliters) every day.
• Kids 4 through 8 should have 2½ cups (600 milliliters) per day.
• Kids 9 and older should have 3 cups (720 milliliters) per day.

In addition the American Academy of Pediatrics states that boys and girls aged 9-18 years old should be drinking the equivalent of 4 ½ glasses per milk (or servings of milk products) per day, but that little more than half of teens report drinking milk daily. And this, at such a crucial time when calcium is imperative for building strength for growing bones.

When kids drink too much juice, juice drinks, sports drinks, and soda, these beverages can crowd out the milk they need. Sugary drinks also can pile on the calories which contribute to weight gain. 

As for water, the Academy of Nutrition and Dietetics reports that the daily amount of water that a child or teen needs will depend on factors such as age, weight and gender. Other factors such as air temperature, humidity, a person's activity level and his or her overall health affect daily water requirements, too.  So, what are some rough estimates on how much water your kiddo needs? 

• Kids ages 4-8 years need approximately 6-7 cups per day
• Kids ages 9-13 years need 7-8 cups per day
• Kids ages 14-18 years need 8-11 total cups of water per day.

This may seem like a lot, but keep in mind the numbers listed above are for total water, which includes tap water, water from other beverages, and water from solid foods such as fruits and vegetables. 

The Academy of Nutrition and Dietetics also stresses the importance of children (and adults!) keeping hydrated during physical activity. Pay close attention to your child to make sure that he drinks plenty of water before, during, and after physical activity, especially during hot weather. The goal is to drink ½ to 2 cups of water every 15-20 minutes while exercising. Furthermore, the American Academy of Pediatrics states that water (not sports drinks) should be the primary method of hydration for children. 

So, if both milk and water are good, then when should you give your child which? Does it matter? Actually it does matter!  In my work with many “picky eaters” as well as attending many advanced courses on this subject; milk or other caloric beverages between meals often sabotages a child’s hunger drive for good, healthy foods and leads to negative eating habits. Milk should be given in the appropriate amounts listed, but only at scheduled meal and snack times, and not constantly in the sippy cup between meals. Only water should be allowed between meals.  Save the milk (and the occasional juice) for meal times. In addition, Dr. Karen Green, DDS, also stresses the importance of only drinking water between meals to help reduce the incidence of cavities.

Other important beverage facts from the American Academy of Pediatrics:

• Soft drink consumption is associated with negative behaviors in 5 year old children.
• Sports drinks and sodas contain extra calories that children don’t need and could contribute to obesity and tooth decay. 
• Fruit juice offers NO nutritional value over whole fruits and children 1-6 years old should be limited to 4-6 ounces of juice per day.
•  Fruit juice (even 100% juice!) should not be given to children under 6 months of age unless directed by the pediatrician. 
• Children (and adults) who drink water containing fluoride are less likely to get cavities. (American Dental Association). 
• Avoid drinking caffeinated beverages (sodas, iced tea) for hydration. Caffeine is a diuretic, meaning the child might have to urinate more, causing him to lose more fluid and become dehydrated even more quickly.

Resources
This was a research heavy blog! If you want the full scoop, please check out these resources/articles below. 
Healthy Drinks for Kids, American Academy of Pediatrics (accessed August 2015)

Snacks, Sweetened Beverages, Added Sugars and Schools, (Feb 23, 2015)

Soft Drinks Consumption Is Associated with Behavior Problems in 5-Year-Olds, Journal of Pediatrics (2013)
Kids Should Not Consume Energy Drinks, and Rarely Need Sports Drinks, American Academy of Pediatrics (accessed August 2015)

Where We Stand on Fruit Juice, American Academy of Pediatrics (accessed August 2015)

Flouride Supplements, American Dental Association (accessed August 2015)

Calcium: The Teen Bone Builder, American Academy of Pediatrics (accessed August 2015)

How to Hydrate your Active Child, WebMD (accessed August 2015)

Water: How much do kids need?, Academy of Nutrition and Dietetics (accessed August 2015)

Do you have a question you would like me to address? 

Please don't hesitate to share: www.share@childrenstherapyteam.com

Focus on Down Syndrome

Dear Melissa,

You write a lot about children with Autism Spectrum Disorders. Do you serve children with other pediatric disabilities and developmental delays as well?

My professional colleagues at Children’s Therapy TEAM work with a wide variety of developmental delays including, but not limited to, Down Syndrome, Cerebral Palsy, Spina Bifida, Prematurity, various genetic disorders, and general developmental delays. Even though I personally work almost exclusively with children who have Autism Spectrum Disorder, ADHD, and other mental health illnesses, I'm very aware that October is National Down Syndrome Month. It is all part of our TEAM approach to care! Given this approach, I have decided to focus this post on Down Syndrome Awareness. 

Meet one of our TEAM children with Down Syndrome:

Berkley says she loves coming to the clinic to work with Miss Bridget (Children's Therapy TEAM Occupational Therapist) because she likes to build with blocks and play with baby dolls. 

TEAM OT Bridget Glynn and Berkley

Meet one of our TEAM therapists who serves children with Down Syndrome:

Bridget Glynn (pictured above) works with many children who have Down syndrome. She says, "I love working with children with Down Syndrome! I have so much fun teaching them different ways to achieve their goals, whether it be brushing their teeth independently, putting on a shirt, writing their name, or taking turns playing a game with their friends. There is never a dull moment among the laughter, sass, a little stubbornness, and of course celebration of milestones achieved.  I love teaching my kiddos ways to be independent and to thrive in their everyday lives, and I love how they teach me to be a more creative, patient, and compassionate therapist.” 

Facts about Down Syndrome: 

Let's look at the facts (taken from the National Down Syndrome Society):

1.     Down syndrome occurs when an individual has a full or partial extra copy of chromosome 21.  This additional genetic material alters the course of development and causes the characteristics associated with Down syndrome.

2.     1 in 691 babies in the U.S is born with Down syndrome, making it the most commonly occurring chromosomal condition.

3.     Down syndrome occurs in people of all races and economic levels, but the incidence increases as the age of the mother increases.

4.     Some of the common traits of Down syndrome include low muscle tone, cognitive delays, small stature, and an upward slant to the eyes. 

5.     People with Down syndrome have an increased risk for certain medical conditions, such as:

·         Congenital heart defects

·         Respiratory & hearing problems

·         Alzheimer’s Disease

·         Childhood leukemia

Yes, individuals with Down syndrome have many obstacles to overcome, but they can also contribute so much to the community!  Many attend school/work, volunteer, participate in decisions that affect them, and contribute to society in many incredible ways. Quality education programs, stimulating home environments, good health care, and positive support from their community can enable individuals with Down syndrome to develop their maximum potential and lead rewarding lives. 

Ways YOU can help:

YOU can help these fantastic individuals to meet their fullest potentials. The 2015 Buddy Walk will be held on Saturday,October 10, 2015. The Buddy Walk features live music, food, vendor booths, arts & crafts, games and more! Participants will gather for a fun, 1-mile walk around Arvest Ballpark in Springdale, AR. The main purposes of this wonderful event are to raise awareness and to raise funds for the Down Syndrome Connection of Northwest Arkansas, so they can continue to develop the programs and services that help individuals with Down Syndrome, both locally and nationally.

This year, as every year, many of the therapists and staff from TEAM will be in attendance, walking and cheering on our friends. Hope to see you there!

Resources:

Down Syndrome Connection of Northwest Arkansas, accessed October, 2015

Center for Disease Control: DownSyndrome, accessed October, 2015

National Down Syndrome Society, accessed October, 2015

Shining Star: Molly Ivy

With encouragement from my colleagues at Children’s Therapy TEAM, I am beginning a Shining Star series in my blog. Periodically, I will spotlight individuals in our community who I think are inspiring. The lives of these individuals affirmatively answer the question, "Is there hope?" This week I’m highlighting 22-year-old Molly Ivy (diagnosed with Autism at the age of two) and her mother Nancy Wells. 

Having treated Molly several years ago, I could not be prouder of the young woman she is today. Molly finds particular joy in expressing herself through writing. She feels that her Autism actually helps make her more creative. She shares, “Frankly, I like going for what people don’t expect in stories like writing about magic and creatures of other worlds.” Molly drew on her creative gifts to publish her own book, “A Journey Long Magic.” Molly’s mother shares, “There are no limits to Molly’s abilities as a writer.”

However, long before Molly’s mother Nancy ever felt a sense of peace about her daughter’s well-being, she recalls her tendency to “worry and obsess about what had yet to be accomplished.” Before she embraced what she refers to as the “magic” of having a child with Autism and the wonder of each phase of life, she was relentless in her mission to find answers.

When Molly was a toddler she seemed to go through what her mother observed as an “overnight change.” She had loss of speech, sensitivities to almost everything, sudden meltdowns and sleeplessness. She ate dirt to the point that Nancy had become concerned about possible lead poisoning. She would sometimes hurt herself or others when she was in settings that she found unfamiliar or uncomfortable. Leaving the house, no matter where the destination, was overwhelming for Molly, and as Nancy noted, “disastrous for everyone” in the family.   

At the age of two Molly began speech therapy and occupational therapy. Nancy contacted Dr. Ivar Lovaas from UCLA after an area psychologist recommended “The Me Book”.  Dr. Lovaas and Nancy had weekly conversations which helped Nancy troubleshoot adapting a space to work with Molly in the home. Dr. Lovaas created a modified version of his ABA (Applied Behavioral Analysis) program for Molly. This program included a team of therapists to help family members and caretakers implement the program. 

Continually seeking out new options, the family enrolled Molly in Auditory Integration Therapy as well as mental health counseling when she was 4 years old. Nancy shared, “We did see improvements. The Auditory Integration Therapy really helped her hearing and light sensitivities.” When I asked Nancy about her biggest worries for Molly as a child with autism, Nancy commented on her concerns about Molly’s safety and vulnerability. She shared, “She was non-verbal until 5 years old and an easy target for harm of all kinds.”

With ongoing progress in her therapies, Molly blossomed. As her communication improved, she was able to articulate her thoughts and feelings. This opened up a whole new world of insight for her family. Nancy vividly recalls when her then 17-year-old daughter shared, 

“I think I will become an adult and 

will never have had a friend.” 

Convinced that local high school options were not a good fit, the family contracted an education consultant to search for a better option. They discovered a private Massachusetts boarding school for individuals with disabilities called Riverview School.

Molly’s time at Riverview proved to be what Nancy referred to as “the best four and half years of her daughter’s life so far.” Reflecting on her time at the school, Molly shared, “They taught me about all kinds of things and we went to lots of places. Before I went there I was isolated. Riverview gave me a normal life with lots of good friends. I still keep in touch with them on Facebook.” 

Now back in Northwest Arkansas, Molly is a student with the AbleTalks Pilot Program. Through this program, Molly hones in on her career planning and goal setting. She also has regular opportunities to continue developing her language skills through work with a speech therapist. Reflecting on how far Molly has come, Nancy shares, “Molly has achieved a feat that many others chase their entire lives: the career of her dreams. She loves what she does and who she has become. What better blessing can a mother experience?” 

Want to read Molly’s latest book? It’s definitely a magical page-turner!

It is available at Amazon on paperback or Kindle.

Resources:

AbleTalks
Auditory Integration Therapy (American Speech & Hearing Association)

Lovaas Institute
Molly’s Monters
Riverview School

IEP vs. 504

Dear Melissa,

I am a parent of a 10-year-old son with Sensory Processing Disorder (SPD). I recently discovered on an SPD parent chat group that some children have IEPs and others have 504 plans. What is the difference?  

Ahhh, this one gets pretty confusing. Though they have different definitions, I will admit, as a private-practice OT rather than a school system-based OT, it seems as if these two documents look a lot alike at times. So let's break it down into black and white.

IEP vs. 504

In practice, an IEP and a 504 are quite similar. Both are legally-binding documents which outline modifications the school will make to help the child achieve academic success.  Modifications need to be “reasonable” (meaning that they pose no undue hardship on the public school) and “education-based” (meaning that modifications need to have a direct link to a child’s academic goals).

So which one does your child need? To over-generalize: If your child’s disability is more physical/medical in nature and your child is otherwise well-served in a regular education classroom, then the 504 is your document. However, if your child has more cognitive, emotional, developmental, or behavioral concerns, then you probably need the additional special education services that the IEP provides. In addition, all children under an IEP are also automatically covered under 504 as the IEP is the more robust of the two documents. 

Background

The IDEA (Individual with Disabilities Education Act) was first enacted in the United States in 1975. It ensures children with disabilities have “free appropriate public education” in the “least restrictive environment”. In this “least restrictive environment,” children with disabilities should not be separated from their non-disabled peers simply because of their disability. Rather, they should only be removed from their peers for portions of the educational day which cannot be adequately met in a mainstream classroom. The law defines “children with disabilities” as between the ages of three and twenty-two and having one or more of the following conditions:

• Intellectual impairment
• Speech and language impairment
• Visual impairment (including blindness)
• Hearing impairment
• Orthopedic impairment
• Traumatic brain injury (TBI)
• ADHD/ADD
• Other health impairments
• Autism Spectrum Disorder
• Specific learning disabilities (this is often how children with visual/motor/handwriting difficulties qualify)

IEP (Individual Education Plan)

An IEP is a document that details the special education and related services that the child should receive based on input from the educational team, the parents, and, when appropriate, the child. It is a legal, written, binding document and is based upon the evaluations of the school professionals as well as other special consultants (private therapists) when necessary. The formation of an IEP should be a collaborative effort and is created at a meeting at a mutually-agreeable time. It is important to remember that the parent is an equal partner (by law) in the IEP process, meaning that no part of the IEP can be carried out without the parents’ approval. A parent can also call a meeting at any time to discuss the need for revisions to the child’s current IEP. 

504  

This educational plan is called a 504 because it refers to Section 504 of the Federal Rehabilitation Act (1973), which requires all agencies that receive federal monies to provide access to individuals with disabilities. In the school setting, if a child does not qualify under IDEA, he may be deemed eligible for services under Section 504. This usually means that a child does not qualify for special education services but that he requires some type of modification in order to achieve his or her full academic potential. The school will evaluate eligibility based on:

• Whether the child has a physical/medical impairment
• Whether this impairment hinders the child’s access to the physical/educational environment
• Whether this impairment hinders the child’s learning
• The types of accommodations the child requires to receive a public education. 

Possible modifications listed in an IEP or 504 could include:

• Additional time for homework/test taking
• Shortened assignments
• Sensory breaks
• Picture schedules
• Preferential seating
• Use of typing device instead of writing by hand
• Use of specialized communication device
• Behavior modification plans
• Special education classroom setting
• The number of minutes the child spends in a special education vs. typical classroom
• School-based OT, PT, Speech, or Counseling
• Assistance with agenda books
• Communication tools between school and parents
• Provision for regulating sensory input such as earplugs, fidget toys, headphones, study carrels, etc. 
• Oral test taking or having test questions read aloud to a child
• 1:1 assistance at difficult times of the day including the lunch room and transitions
• Have the teacher provide paper/digital copies of lecture notes
• Pair the child with a “positive peer”

This is just a sample of possible modifications and is by no means a complete list of modifications. It is important to work with the child and the school to find out which modifications work best in each situation. Keep in mind that IEP’s and 504’s are individualized documents and should reflect the needs of each individual child. 

Resources:

Parent Advocacy: IEP Steps, Children's Therapy TEAM Blog, Melissa Foster, (Posted Sept. 2015)  

Link to 9/14/15 blog

Effective Parent Advocacy, Children's Therapy TEAM Blog, Melissa Foster, (Posted Sept. 2015)  

Arkansas Support Network

Steps in the IEP Process, Education.com, D.D.Smith, (Accessed August 2015)

A guide to the Individual Education Program, US Department of Education, (Accessed August 2015)

Special Education Unit, Arkansas Department of Special Education, (Accessed August 2015)

What is the Difference between IEP vs 504 Plans, University of Washington, (Accessed August 2015)