Choosing the Right Coloring Pages

Many of the children we see in our clinics struggle with coloring skills.  Whether the difficulty is rooted in poor fine motor control, visual perceptual skills, attention or regulation, it is common to see a child begin coloring a page with good intentions, then end up scribbling or abandoning the task.  We are careful to present the children with a coloring page with a “just right challenge”, but there are an abundance of free printable coloring pages online.  Here are some of the things we look for.

• Choose a topic or character your child is interested in. He may be more motivated to color a picture of a Lego Ninjago character than a holiday themed page.
• Look for bold outlines. Children who have difficulty with the motor control necessary to efficiently direct their crayon will benefit from the extra “wiggle room” between sections, while children with visual perceptual difficulties may be able to better identify different areas of the picture.
• Find pages with little or no background detail at first. Check out the difference between these two images. Both are Lightning McQueen, but a child with decreased attention or ability to maintain a regulated state may give up on the more detailed picture before it is finished.

• Encourage your child to choose one area at a time to fill in.  If your child needs help to stay organized, ask questions like “What color should his tires be?”   Praise your child for his effort and make some room on the refrigerator for the masterpiece.

Helpful Hint – Setting the Table

Learning to properly set a table is a useful life skill. If your child needs help remembering where to place utensils, take a picture and have your child match the sample.

Nail Trimming

Distress during nail clipping is one of the everyday obstacles we hear about from many of our families. Some children have trouble tolerating the clippers, some dislike the sharp feel of the nail after clipping, or the novel tactile input on the fingertip that was previously covered by the nail. Here are some ideas to try next time the clippers need to come out.

 

• If your child likes to play with resistive materials like theraputty or play doh, have him use the materials before nail clipping as a way to “warm up” the fingers before the task. Or, let him hold a vibrating massager to provide vibration to the fingers. Offer these types of materials after the trimming as well.
• Try a lotion massage on the hands, using firm stroke with your whole hand (not just fingertips pressing into your child’s hand). End with deep pressure gently “pulling” down the length of each of his fingers, toward the nail.
• Nails will be softer and easier to trim after bath time.
• Use child-friendly terminology – don’t say you are going to “cut” the nails, use words like “trim”. Children may associate “cut” with pain.
• Have your child be in charge of counting each nail that is trimmed. Counting will help him see that the process will not take forever.
• Singing a song together may help as well. Try the tune of “Here we go ‘round the mulberry bush” and change the lyrics to “This is the way we trim your nails”.
• Some children prefer the vibration and pressure of a nail file rather than clippers.
• At first, a successful nail trimming may be one hand at a time, or even one nail. Find the level where your child can tolerate the process without being overwhelmed and build from there.
• Teach your older child to safely trim his or her own nails. Sensory input that he controls may be easier to tolerate than imposed input.

Helpful Hints – Putting on Shoes

Does your child struggle with putting her shoes on the correct feet? Try this simple trick: choose a sticker with a face, a vehicle or an animal. Cut it in half vertically. Place the left portion of the sticker inside the left shoe on the arch and the right portion in the right shoe. Teach your child to line up her shoes next to each other so the image on the sticker looks whole, like this:

Real Life “Apps”

It’s no secret that many children enjoy playing on their parents’ phones and tablets. While there are many apps that help teach problem solving skills or work on fine motor and visual perceptual skills, there are huge benefits from “real” play. Studies have shown toddlers and children learn better when actively engaged in play. You can use some of the themes and challenges of your child’s favorite apps by translating them to reality. Here are some ideas to start:

Angry Birds: save boxes from cereal, rice, and spaghetti. Weigh down the boxes by placing a baggie with a small amount of rice or sand inside the box and tape it shut. Gather small stuffed animals or socks to take the place of the pigs and use bean bags or balls to act as birds. Have your child build his own fortress for the pigs with the boxes, adding other items such as cookie sheets or plastic cutting boards for additional reinforcement. Then bomb birds away! How many birds will it take to demolish the pig’s fortress?

Mario Kart: create your own race track with obstacles. Mark a start/finish line with a beach towel on the ground and arrange garden hoses or long ropes on the ground in a large oval to indicate the borders of the track. Use placemats, Frisbees or cones as obstacles to avoid. Have your child ride his bike or push his scooter around the track and reward points based on time and accuracy.

Holiday Shopping Tips

As the holidays are fast approaching, we wanted to take the opportunity to offer some tips about choosing toys and games for your child. Here are some guidelines for how we choose new toys and activities for the clinic.

 1. Will it last?

o    Does the item appear sturdy? Are there small pieces to break off and get lost? If they do break off and get lost, can the toy still be used?

 2. Can it be used in multiple ways?

o    Does the toy lend itself to multiple options for play? For example, bean bags can be used for target games, scavenger hunts, hopscotch and more. Jump ropes can be used by one person or a group people, be turned into a wiggly snake, or be used as a boundary line.

 3. Does it appeal to a wide age range?

o    Is the product going to be used for a month and tossed aside by a young child who is quickly developing new skills? Can the item “grow” with your child by adjusting the height or the complexity of the task?

 4. Does it offer multiple types of sensory input (without becoming too overwhelming?)

o    For example, try musical instruments which provide opportunity to practice motor coordination while exploring auditory and tactile input, as opposed to items which play music and have blinking lights after simply pressing a button.

 5. Can it travel easily?

o    Wiki sticks, Play Doh and travel sized board games can provide structure while waiting at a restaurant or at a sibling’s sports practice.

 6. Does it allow the child to create their own play schemes?

o    Matchbox cars or barn play sets allow the child to come up with their own ideas for play. Baby dolls or other toys that “talk” may direct the play time for your child.

Happy Shopping!

Helpful Hints for Halloween

Halloween is almost here! Are you ready?

• Have your child try on his costume ahead of time. Layering tight fitting clothing, such as Under Armor, may help decrease the discomfort of novel fabrics. Be willing to adjust your expectations of what constitutes a costume. A simple pair of black sweatpants and a favorite Batman shirt could be a Batman costume.

• Face paint and masks can be difficult for children with tactile sensitivities. If your child wants to have a mask but cannot wear it, attach a dowel to the side so she can hold the mask up when she wants to.

• Canvas your neighborhood before Halloween. Avoid houses with motion-sensor decorations or warn your child ahead of time if he has auditory sensitivities.

• Role-play the social interactions required during trick-or-treating. There are many “hidden curriculum” items involved with Halloween, such as:

– skipping houses that do not have lights on

– taking one piece of candy instead of a handful

– waiting in line behind other children who arrived first

– some adults wear costumes while others do not

– other children may wear the same costume as you

– some people wear scary costumes while others do not

– if it is cold outside, you may have to wear a jacket over your costume

– if you do not like any of the candy that a person is offering to you, you can say “No, thank you” or politely take a piece to share with someone else in your family

• Children who are sensitive to smells and tactile input may be able to participate in pumpkin decorating by painting, drawing or placing stickers on their pumpkin instead of carving.

• Know your child’s limits. Some children can only tolerate trick-or-treating at a few homes. Watch for signs your child is becoming overwhelmed or over stimulated and take a break.

• Have a plan and discuss it with your child ahead of time. When will you go trick-or-treating? How much candy will your child be allowed to eat that night?

• Use sensory breaks. Bring along a drink in a sports bottle or let your child chew gum for organizing oral motor input. Have your child pull a wagon or do a quick set of wall push-ups against the car or an understanding neighbor’s house.

• As with any holiday, try to keep a reliable schedule at home during the week of Halloween.

• Most importantly, have fun! Halloween is not about making it to every house in the neighborhood; it is about the quality time your child can enjoy participating in the festivities in a way that works for them.

Pencil Grips

Gallery

Many children we see at the clinic have difficulty assuming and maintaining a functional pencil grasp, which impacts their ability to write. What do we mean by “a functional pencil grasp”? Here are a few grasp patterns that we encourage:

Tripod Grasp – this is often seen as the “gold standard” for pencil grasp, however it is not the only functional and efficient way to hold a pencil. The pencil is held between the thumb and index finger and rests on the side of the middle finger. The ring and pinkie fingers are tucked into the palm while the shaft of the pencil rests in the open webspace formed by the thumb and index fingers. This pattern requires strong intrinsic hand muscles and good stability at the joints.

Quadrupod Grasp – this pattern is closely related to the tripod grasp, however, the pencil is held by the thumb, index and middle finger and it rests on the side of the ring finger. The pinkie is tucked into the palm and the pencil shaft rests in the open webspace just like a tripod grasp. This pattern provides slightly more stability but does not sacrifice control or joint positions.

Modified Tripod Grasp – Although this pattern looks quite a bit different than a standard tripod grasp pattern, the pencil is held the same way by the tips of the thumb and index finger. The difference is that the shaft of the pencil rests between the index and middle fingers. This pattern may be beneficial for children who lack stability of their webspace and arches of the hand. The movement of the pencil remains unimpeded and the joint positions are ergonomically correct.

Chances are if you are reading this article, your child does not use one of the patterns listed above. Some children tuck their thumbs under their index fingers, which is referred to as a thumb tuck.

Others place their thumb on top of their index fingers for added stability, which is referred to as a thumb wrap.

Then there are a wide variety of other dysfunctional grasp patterns like this one:

Perhaps a teacher or other professional has suggested the use of a pencil grip but with so many different grips available, how do you know which one is right for your child? Speak with your occupational therapist to investigate the need for a grip. Here are some of the common grips available. Click on the pictures below for a larger image.

GROTTO GRIP — GOAL: Promotes a tripod grasp pattern and helps prevent incorrect thumb placement PROS: Easy to place the fingers correctly on the grip; Can also be used by a child with a quadrupod grasp pattern; Blocks thumb wrap and thumb tuck ; Promotes an open webspace and supports the arches of the hand; Used by righties and lefties without changing the orientation of the grip CONS: It is rather large and children who are reluctant to stand out in the classroom may not accept the grip; Relatively costly at about $2 each

STETRO GRIP — GOAL: Promotes a tripod grasp pattern without adding bulk to the pencil; PROS: Small and inconspicuous, therefore it may be accepted by older children who do not want to use a “therapy tool” in the classroom; Inexpensive at about $0.25 each CONS: Does not prevent thumb wrap or thumb tuck; Can be confusing to place fingers correctly – arrow on grip points down for righties and up for lefties, thumb is placed on the star

THE PENCIL GRIP — GOAL: Supports an ergonomically correct grasp pattern; PROS: Soft, comfortable material; Wider at the top to promote an open webspace; Can work for children who prefer a quadrupod grasp; Available in many colors, including glitter, which may act as a motivator for use; CONS: Does not prevent thumb wrap or tuck; Fingers can be placed incorrectly; Material is hard to clean; Relatively costly – about $2 each

TRIANGLE GRIP — GOAL: Creates a broader shaft of the pencil and encourages a functional pattern in an unobtrusive manner; PROS: Easy to place on the pencil, since the uniform shape has no appropriate up vs. down and fingers can be placed on any of the sides; Supports an appropriate grasp pattern without extra features a child with a mild grasp issue does not need; Inexpensive at about $0.25 each; CONS: Does not prevent thumb wrap, thumb tuck or other less functional patterns

CUSHION GRIP — GOAL: Decreases pressure on joints; PROS: Can help alleviate pain for children who grasp their pencil too tightly; Inexpensive at about $0.20 each; CONS: Does not actively assist with finger placement or prevent less functional patterns; Does not “fix” the problem of holding the pencil with excessive force

PENCIL WEIGHTS — Although pencil weights are not actually an adaptive grip, they can be useful for children with decreased body awareness or mild hand tremors GOAL: Increase stability of the pencil; PROS: Improves awareness of the movement of the hand; Offers stability for mild hand tremors; CONS: May lead to fatigue in children with poor hand strength; O-rings may be a choking hazard to younger siblings

A Word of Caution Regarding Any Pencil Grips:

• Whenever exploring the potential use of a pencil grip, the following must be considered:
  • Does the grip support participation in handwriting tasks or does it cause more of a distraction?
  • Can the child consistently place their fingers correctly on the grip or do they need assistance each time they pick up the pencil?
  • Is the child willing to use the grip or will they hide it in their desk or “lose” it?
  • Is the child working to develop the intrinsic musculature of the hand in order to transition away from needing a grip?
  • What are the other factors impacting their writing? How is their trunk control? Are the seat and desk heights appropriately matched for the child? How is their proximal stability at their shoulder? What is their wrist position? Does the child efficiently separate movement between the two sides of the hand? How do their visual perceptual skills impact their writing? How does their regulation impact their attention and ability to sit long enough to master grip and graphomotor skills?

• Before a child enters Kindergarten, there is little need to use pencils or grips. Encourage the use of short crayons or pieces of chalk instead. A child’s grasp patterns continue to develop into a “mature” pattern around the age of 5-6 years old, so it is not uncommon to see a child alternate between functional and less functional grasp patterns up until this time.

Is It Picky Eating? Or Something More?

Are you concerned about your child’s eating habits?  Avoidance of new foods is a typical part of child development, most often seen in 2-3 year olds, but for some children, this pattern continues further into childhood. How do you know if your child is a just a picky eater or if there is a need to seek out assistance in this area?   Here are some brief guidelines to help differentiate between picky eaters and problem feeders:

Picky Eaters:

• Are reluctant to try new foods, but can typically tolerate them being nearby, touching them or looking at them.
• Have at least 30 accepted foods.
• Will typically accept the food again after a break from eating it for a period of time
• Will eat at least some food from most food groups or texture groups.
• May frequently eat a different meal than the rest of the family, but typically sit with the family at mealtime.
• May slowly “warm up” to a new food after 10 or more presentations.
• May eventually agree to try a new food if they are hungry enough.

Problem Feeders:

• Become excessively distressed when a new food is presented – may gag, vomit or cry after looking at a new food.
• Have a significantly limited food repertoire – typically less than 20 foods.
• Will not accept a food again once a food is lost from the diet, even after a break.
• Avoid whole categories of food groups or texture groups.
• Are frequently unable to join the family for mealtime.
• Continue to have strong negative reactions to foods even after 10 or more presentations.
• Will ignore hunger cues from their body and refuse to eat a non-desired food, even if this results in malnutrition or dehydration.

If you are concerned about your child’s diet, talk to your pediatrician about nutritional concerns and to rule out physical or medical reasons for feeding difficulties, such as swallowing difficulty, food allergies/sensitivities or reflux. Your occupational therapist can also help by examining your child’s food preferences for patterns in texture, flavor or other factors, and help make suggestions about how to introduce new foods into your child’s diet.

Sleep

How much sleep does my child need? Here are some general guidelines for the amount of sleep children should be getting.

3-6 Years Old: 10 – 12 hours per day

7-12 Years Old: 10 – 11 hours per day

12-18 Years Old: 8 – 9 hours per day

What are some signs my child is not getting enough sleep?

• Difficulty waking in the morning.
• Awakening in an irritable mood
• Decreased attentiveness and alertness during the day.
• Frequently falling asleep during the day outside of normal napping hours, or frequently falling asleep during the day after naps are no longer part of the daily routine.
• Taking more than 30 minutes to fall asleep at night.

How can I help my child improve their sleep patterns?

• Studies have shown that children (and adults) who watch TV, play video games or use other electronics before bed took a longer time to fall asleep than those who avoided screen time.  It’s always easier said than done, but try to avoid screen time 1-2 hours before bedtime.
• Dim the lights.  Turn off some of the lights or use table lamps in the 30 minutes before bed.
• Create a bedtime routine that can be completed in 30 minutes or less.  Give your child some control over the routine, such as choosing a book to read or what PJs to wear.
• Provide calming and organizing sensory input.  Taking a bath, getting a lotion massage, or providing deep pressure via “pillow squishes” can help a child with a high arousal level transition to sleep.  To safely do pillow squishes, have your child lay on a solid but comfortable surface on their belly.  With a couch cushion, large body pillow or several smaller pillows, provide firm pressure to their back, arms and legs for the duration your child desires.  Always be sure his face is not covered and his breathing is not impeded.
• Some children benefit from a supplement called Melatonin.  If your child is still having sleep difficulties after trying bedtime routines and sensory strategies, you may wish to discuss potential use of Melatonin with your pediatrician.