Are you thinking of getting your child a board game this Christmas? Board games can be a great tool to use to learn and have fun at the same time. There are tons of board games to choose from when you hit the toy aisle in stores. One of the go-to games in therapy is ZINGO by Thinkfun! This game is fantastic for building vocabulary, articulation and turn-taking. Another great thing about Zingo is it can also help answer yes/no questions, by simply asking your little one, “Do you have a cat?” and so forth. Who knew one game could be so interactive! It’s a very fun game, that kids absolutely love!  

Why should practicing your feeding skills at home be boring? While you don’t want to have to go out and spend too much money on a bunch of plates, cups, utensils, sometimes having a few novel items can help eating be a little more enticing. Here are a few of my favorites to use:

• Num Num Pre-Spoon by Gootensils – These pre-feeder spoons are great for early feeders. When children don’t quite have the dexterity and fine motor skills to scoop, rotate their wrists, and balance a spoon to get the food to their mouths, these pre-spoons can be very useful! All the child does is dip it in puree and the pre-spoon catches/holds food much easier than a regular spoon. They can get lots of practice with the hand-to-mouth motion of eating without too much food sliding off.
• Offer a variety of forks and spoons to use at the dinner table – For older children who are more proficient with fine motor skills, offering a variety of utensils (maybe 2-3) at mealtime might build some novelty into the meal. Kids love being independent, so if they are given the power to choose which utensil they will use, they might be more willing to use it to pick up some new foods. They might like a choice as simple as which color utensil they will use! I have also used small coffee stir straws and toothpicks as a novel way of picking up small pieces of food. It can make it new and exciting to try something on their plate.
• Dinner Winner Plate – This plate has been one of my more successful tools to date! A small portion of food it placed into each section and at the very end of the plate, the child gets a special treat of their choosing. It is so useful because the child sees a clear start and end to what they are eating, plus it is fun to know there is a “prize” at the end. You can find this plate on Amazon or at Kohl’s or Bed, Bath and Beyond!!

For Your Thanksgiving Picky Eater

Thanksgiving can undoubtedly be a stressful time for a picky eater and his/her family. A regular mealtime with familiar family foods can be difficult to get through. However, when you have a whole day centered around foods you may only serve once per year (plus the potential activity of seeing lots of family members and friends), this can cause the picky eater AND family to experience a whole different level of stress. Here are some tips to keep in mind from “All the Moms” and “Parents“ to help you get through the holiday weekend!

• Involve your child in getting the meal ready, such as setting the table and preparing some of the foods (to the best of their ability level). This could even be putting napkins on the plates or mashing up some of the potatoes. If they can have experiences around the foods without actually eating them, this can help to decrease some of the anxiety.
• As much as possible, stick to your usual meal routine. For example, if at your regular dinner time your child is only expected to try one bite of each food on their plate, keep this consistent. It would likely add stress if they are suddenly asked to completely clean their plate when it has not been the usual expectation.
• If there are some stand-by foods that help get your child through a meal (ketchup or ranch are my favorites!), then considering having those available. It might not be your idea of a traditional Thanksgiving side dish, but if your child will dip just about anything in ketchup, then they just might be willing to give that turkey or sweet potato a taste.
• As much as possible, limit pre-meal snacks. A child is far more likely to sit and eat some food at the table if they are hungry! If they are filling up on crackers, pretzels, or sweets before the meal starts, it will probably be much more difficult to keep them at the table for a meal full of foods they may not usually eat.
• Try making up fun names for the foods! “Cornell University researchers found that when 4-year-olds were served ‘X-Ray Vision Carrots,’ they ate nearly twice as much as when the food was simply labeled ‘Carrots.’” — Parents
• Keep servings small! Especially with so many foods that are typically served at a Thanksgiving feast, you may only offer a tablespoon or less of each food that you would want your child to try. It is much less overwhelming for your child to look at a plate of small portions than a heaping plate of food. Plus, they can always ask for seconds if they find something they like!
• Overall, just try to be as relaxed as possible. This is not the time to put too many expectations on one meal. If your child does not like one of the foods on their plate, give them praise for the other foods that they did try. The important part of the day is to enjoy the company around you and not to stress over finishing every last bite of food.
  Kristina Burnham, MS, CCC-SLP-Language Pathology Director

What is Proprioception and Why is it Important?

Proprioception is the body’s ability to receive input through receptors in the skin, muscles and joints, and transfer the information to the brain through the nervous system so that the body can sense itself. To put it simply, proprioception is the sense that tells the body where it is in space. Proprioception is very important to the brain as it plays a big role in self-regulation, coordination, posture, body awareness, the ability to attend and focus, and speech. Many children with sensory processing disorders, Autism, and ADHD struggle with one or more of the areas listed above because of their body is not processing the proprioceptive input effectively. Signs of proprioceptive dysfunction or under-registration include:

• Poor Motor Planning/Coordination & Poor Body Awareness (difficulty understanding personal space or understanding boundaries when playing with others, presents with delay in gross and fine motor skills, bumps into people and objects frequently, difficulty riding a bike, difficulty going up and down stairs, difficulty with speech)
• Poor Self-Regulation Skills (emotional, difficulty attending to task, mood swings, frequent meltdowns, difficulty with sleep)
• Sensory Seeking Behaviors (plays rough, taps or shakes feet while sitting, chews, bites, likes tight clothes, pushes or hits others, writes too hard)
• Poor Postural Control (slouches, rests head on desk while working, leans on everything, poor muscle tone, unable to balance on one foot)

Children that have difficulty sensing or processing proprioception often try to self-regulate by engaging in activities and/or behaviors that provide intense or frequent proprioceptive input. Proprioceptive dysfunction can be addressed and improved by Occupational Therapy through the use of sensory integration and developing a healthy sensory diet. If your child has difficulty with sensory processing or demonstrates difficulty with any of the above signs, contact Sonoran Sun Pediatric Therapy to schedule a free Occupational Therapy screening.

Holiday Travel Tips for Kids with Special Needs

The holidays are right around the corner and for many families this means that a road trip or an airplane ride is inevitable. Some things one must understand and take into consideration when traveling with a child that has sensory processing challenges is that consistency and structure is very calming and organizing, and change causes anxiety and is very disorganizing to the nervous system. Not only is change an obstacle, but hypersensitivity to noises and/or touch as well as sensory seeking behaviors such as constant movement or craving deep pressure. This makes traveling by car or airplane especially challenging.   

Car and Airplane Travel Tips:

• Pack or purchase at the airport calming snacks that provide organizing oral input: crunchy and chewy snacks, (pretzels, carrot sticks, apples, bagels, beef jerky, fruit roll ups, gum) water bottles that have a straw or sport spout that requires sucking, use straws to eat pudding, yogurt, apple sauce or smoothies. Don’t forget personal chewies or vibrating oral tools (pack more than one)
• Pack a variety of fidget toys (stress ball, Koosh ball, Magna Doodle, Legos, spinner, Rubix cube, Thera band tied to adjacent car structure or arm rest in an airplane, etc.)
• Pack sensory tools (I pad and charger, head phones, ear plugs, weighted lap sock/pad or blanket, soothing music and I pod, compression vest, DVD player, small blanket and pillow to create a sensory retreat)
• Car Travel: Pack fresh food with allot of protein and avoid fast food and preservatives as much as possible and let your child hold and manipulate the cold pack as needed to decrease anxiety or stress
• Car Seating: If your child is sensitive to sound or touch then have your child sit toward the back of the car behind siblings if possible. This positioning is much quieter and provides for more personal space. Have a parent or someone who can provide as needed sensory input sit next to the child if possible. Position the child in the middle when possible so the child can see out the front window.
• Decrease car sickness by covering adjacent windows with a window screen
• Airplane Seating: If your child is sensitive to touch then have your child sit next to the window away from the isle and request to sit in the front to limit stress and the amount of people bothered in the event of screaming or a meltdown. If you didn’t pack one, ask the attendant for a blanket and pillow so that you can create a small sensory retreat in the event of a meltdown
• Car travel movement breaks: Take frequent sensory or movement breaks every hour if possible (stopping at parks when possible) and encourage the kids to run, jump, and really move. Don’t wait for a meltdown to stop for a break. This has the potential to start a pattern of meltdown = break vs. staying calm = break
• Airplane movement breaks: While in the airport or during a layover, encourage the kids to run, jump, and really move. When it is safe to do so on the plane, remove the child’s seatbelt so that they can reposition their body, sit cross legged, stand to stretch, and even pace the isle as needed.
• Toileting on an airplane: Avoid flushing the toilet on an airplane with your child present. The volume and sound of the flushing toilet on an airplane may trigger a meltdown. Walk your child back to their seat and then return to flush or ask the attendant to assist you in flushing once you are far enough away from the restroom.

Ways to Incorporate Proprioceptive Input at Home

Proprioceptive input is typically very calming and organizing to the nervous system. A child who has lots of energy or a “fast” running engine will typically be able to calm and re-focus with proprioceptive input. Proprioceptive input can also be alerting for a child who has low energy or a “slow” running engine. Experiment with your child with the activities below to see what proprioceptive activities are calming and which ones are alerting.

Activities that provide proprioceptive input:

• Hand Hugs
• Wheelbarrow Walks
• Wall Pushes
• Chair Push Ups
• Hand Presses
• Hand Clapping Games
• Animal Walks (bear crawl, crab walks, frog hops)
• Pillow Squish (stack couch or bed pillows and squish under them)
• Pillow Fights
• Burrito Roll (child rolls up in a blanket or towel with head exposed)
• Steamroller (roll a large ball or foam roller on the child’s back, arms and legs while child lays on their tummy)
• Squish Box (a box that is just big enough for your child to squeeze into with pillows)
• Stomping, Jumping, Marching, Skipping, Hopping
• Chewing Gum or Chewy foods
• Using a Straw to Drink/Eat (milkshakes, smoothies, yogurt, pudding, applesauce)
• Chewelry
• Vibrating toy or oral tools
• Hop Scotch
• Tug of War
• Safe Rough Play/Wrestling
• Heavy Ball (toss to target, play catch, pass to your partner)
• Trampoline
• Hippity Hop
• Hand Stands (against the wall)
• Climbing Activities
• Swimming
• Gymnastics
• Karate
• Bike Ride
• Carrying Heavy Objects (groceries, laundry, lunch bucket at school)
• Push/Pull Activities (shopping cart, wagon, stroller, lawn mower, friends on a sheet or blanket)
• Open Doors for people
• Hammering Activities
• Sweeping, Vacuuming, Mopping
• Wash Tables, Windows, Car, Toys
• Digging Dirt or Raking Leaves
• Rearrange Furniture (move chairs etc. to sweep or clean)
• Compression garments or tight clothing
• Body Sock
• Theraband Activities
• Heavy blanket
• Weighted Lap Pad or Lap Sock
• Fabric Tunnel
• Weighted Backpack

Eat To Succeed

As a mom, I know I am frequently needing new ideas for what food to put in front of my child and easily get stuck in a rut.  I also catch myself feeding my child when I get hungry and forget that their little bodies are metabolizing and growing at a much more rapid rate than I.  Below are some simple meal reminders, kid schedule ideas, and food ideas.  As a therapist and a mom, I hope it helps you too.

To help your child perform at his/her optimal level nutritious food is key. Our bodies need proper fuel to be able to grow our bones and muscles, build our neuro pathways, and help our brains function.

Kids need a mix of Protein (eggs, beans, meats, nuts, soy), Veggies (peas, carrots, celery, zucchini, broccoli, spinach), Fruits (berries, apples, grapes, oranges, bananas, pears), Dairy (cheese, milk, yogurt), and Grains (oatmeal, whole grains, quinoa, rice).

Some children can be sensitive to sugars and additives, possibly increasing behaviors.

You can try a variety of ways to eat fruits and vegetables.  Such as offering baked versions, freeze dried versions, canned versions, or fresh options.  Trying them as smoothies, solids, incorporated into baked goods or crunchy treats can provide a variety of texture and possibly a new favorite.  Exposure through sight, touch, play, and fun is helpful in expanding palates.

Ask your Occupational Therapist (OT) or Feeding Therapist  (FT) for suggestions on ways to introduce new foods, hide needed foods, or explore and expand your child’s palate! ☺

*Always work with or check with your doctor if you your child has allergies or special dietary or medical nutrition needs*

*Refer to Feeding Littles School Lunch Cheat Sheet for more ideas

Sample elementary school meal (portion sizes will vary depending on child’s needs and activity level this is just an example):

Breakfast: ½- 1 cup Oatmeal with fruit (berries/apple/banana) and glass of milk

Snack: 3 apple slices with cheese or peanut butter

Lunch: ¼ -½ cup peas, ½ cup strawberries, ¼- ½ quesadilla (w/ or w/o avocado), Greek yogurt

Snack: tortilla chips and beans or salsa

Dinner: ½ of a hamburger with ½ cup broccoli or green beans and a popsicle

Snack (if hungry): banana with peanut butter (or Nutella) and chocolate chips.

Sample meal ideas for a typical picky eater (hamburger, pizza, chicken nugget eater):

*allow regular opportunities for exposure (through sight, touch, play, or taste) to new foods

Breakfast: Dry cereal with freeze dried strawberries and a glass of milk

Snack: Veggie straws and apple slices

Lunch: 1 slice of pizza, 1/2 cup berries, greek yogurt, freeze dried peas or baked/crunchy broccoli

Snack: Tortilla, peanut butter, and honey roll up

Dinner: Pasta with peas, sauce (ricotta cheese mixed/hidden in) or chicken nuggets, and grapes

Snack:  Cookie or frozen banana dipped in yogurt or chocolate

Allison Heitzinger MS., OTR/L

Sonoran Sun Pediatric Therapy

Occupational Therapist

Picking/choosing your battles

As a follow up and conclusion to the two previous blog posts, this blog post is Part 3 of 3 in a short mini-series of Strategies to help with behaviors.

While the strategies presented in the 2 prior blog posts can be used in multiple situations and scenarios to help decrease unwanted behavior. We realize that the circumstances don’t always allow for this. Sometimes you as a parent or guardian are having a bad day, or are tired and while you want to be firm with boundaries, sometimes you can’t. It is understood that even with the best intentions, we all have bad days. While we may want to follow through with something we may be more inclined to give in to a child to prevent a scene or to decrease our own frustration.

In these situations, we need to do our best to stay consistent, but also, we need to pick our battles. Maybe we know that when we take our child shopping on the weekend, it is very crowded. Therefore, we are more likely to give in if a child asks for candy to prevent them from having a meltdown and making a scene. Or maybe we personally have had a tough day, so we have a lower tolerance for dealing with behavior. In this situation, we may give in to our child to prevent ourselves from having our own meltdown. That’s ok if it happens occasionally; we can’t expect ourselves to get it right all the time. Pick your battles, and more importantly – don’t feel bad when you have to do this.

Strategies to help with behaviors in the community

(As a follow up to the last blog post, this blog post is Part 2 of 3 in a short mini-series of Strategies to help with behaviors.)

There is some overlap on strategies in the home and community we can use to help with behaviors. So, some of the strategies listed in this blog post are similar to some of the strategies in the previous blog post. Regardless, they are helpful in multiple situations, and once you learn them they can help you to decrease unwanted behaviors.

• Have clear expectations for your child on what behaviors are allowed and not allowed, and discuss these expectations with your child. Example:
  • When Mommy or Daddy tells you to hold their hand in the parking lot, you are expected to listen and hold their hand for safety.
  • When Mommy or Daddy tells you that you cannot get any candy in the grocery store, you are expected to listen and you will not get any candy.
  • When Mommy or Daddy tells you it’s time to sit down in the car, you are expected to listen and sit in your seat.
• Stay firm with boundaries, this is essential! If we don’t stay firm with the boundaries, it teaches children that the boundaries are not firm, and they can get what they want (candy, a toy, etc.) by screaming, crying, having a meltdown, etc. This will cause more unwanted behaviors in the future.
• If multiple family members will be partaking in this outing, everyone has to be on the same team and handle behaviors the same way.
  • For example, if the consequence for not holding Mommy or Daddy’s hand in the parking lot means that the child does not get to read their favorite book with their parent/guardian when they get home. If someone lets the child read their favorite book with their parent/guardian when they have been told no to this. It will confuse the child, and teach them that all they have to do is ask Mom, or Dad, or Grandma, or Grandpa and they will get what they want. It will teach them that the boundaries are not firm causing more behaviors in the future, and causing everyone’s hard work to go unnoticed.
• If you are concerned about your child having a meltdown in a public place, consider going during a less crowded time (not on the weekends, preferably on weekdays in the morning, early afternoon)
• Use a visual timer (kitchen timer, etc.) if needed to help with transitions. A child’s sense of time is still developing, so while a verbal cue (“we will be leaving in 2 minutes”) is good. It helps to give them a visual as they are still learning the concept of time. So we can say “look this timer has 2 minutes on it, and when those 2 minutes are up, it will be time to leave, look at the numbers count down and get smaller”
• Consider using a visual schedule if there are multiple things going on during the day. This will allow children to see when things will happen and how many things need to happen before they return home or get a preferred activity; playing at the park, playing with friends, etc.
• Reward success (and good listening) with verbal praise and encouragement
  • While we need to be firm with our boundaries and follow through with consequences. It is equally important that we give our children verbal praise and encouragement when they listen to us and make good decisions. This way we are encouraging them to continue to listen and continue to make positive choices.

While these tips work in a variety of situations, it is understood that each family has to find the best routine for their own individual family. An Occupational Therapist can help you incorporate these strategies in the community to help decrease negative and unwanted behaviors in the community environment.

Strategies to help with behaviors in the home

(This blog post is Part 1 of 3 in a short mini-series of Strategies to help with behaviors)

Inappropriate and attention seeking behaviors are never fun, but they are part of growing up, and part of how a child learns about their world around them. Children use rules and boundaries to learn cause and effect, and what is and what is not appropriate and acceptable. Boundaries also help a child feel safe as they teach children that there are limits and expectations set on their behavior and there are consequences for not following those limits and expectations. There are simple things we can do in the home environment to help with behaviors:

• Have clear expectations for your child on what behaviors are allowed and not allowed, and discuss these expectations with your child. Example:
  • When Mommy or Daddy tells you “no” you are expected to listen and stop what you are doing.
  • When it’s time to have dinner, you are expected to sit at the table with the rest of the family.
  • When it is time to get ready for bed, you are expected to stop what you are doing and take a bath, brush teeth, get into bed, etc.
  • When Mommy or Daddy tell you to work on your school work, you are expected to complete school work before anything else, (playing, reading, etc.)
• Stay firm with boundaries – this is essential! If we don’t stay firm with the boundaries, it teaches children that the boundaries are not firm, and that they can get out of situations or out of doing things they don’t want to by screaming, crying, having a meltdown, etc. This will cause more unwanted behaviors in the future.
• Along with the prior tip, everyone at home has to be on the same team and handle behaviors the same way. For example, if the consequence of not listening to their parents when they say no, means the child does not get to play with their favorite toy. Everyone at home has to be on the same team, and not let the child play with their favorite toy.
  • If someone lets a child play with their favorite toy when others have told them “no” it will confuse the child, and teach them that all they have to do is ask Mom, or Dad, or Grandma, or Grandpa and they will get what they want. It will teach them that the boundaries are not firm causing more behaviors in the future, and causing everyone’s hard work to go unnoticed.
• Use a visual timer (kitchen timer, etc.) if needed to help with transitions. A child’s sense of time is still developing, so while a verbal cue (“we will be leaving in 2 minutes”) is good. It helps to give the child a visual as they are still learning the concept of time. So, we can say “look this timer has 2 minutes on it, and when those 2 minutes are up, it will be time to leave, look at the numbers count down and get smaller”
• Reward success (and good listening) with verbal praise and encouragement.
  • While we need to be firm with our boundaries and follow through with consequences. It is equally important that we give our children verbal praise and encouragement when they listen to us and make good decisions. This way we are encouraging them to continue to listen and continue to make positive choices.

While these tips work in a variety of situations, it is understood that each family has to find the best routine and options for their own individual family. An Occupational Therapist can help you incorporate these strategies in the home to help decrease negative and unwanted behaviors in the home environment.