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:
- 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.
- 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.
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.
School has started and the homework is coming at full force. Here are some things to consider when making homework area for your child.
- Look at the potential distractions present near the homework zone. Is your child easily distracted by auditory input? An area away from the TV or a noisy window may help. What are the visual distractions? Sit in your child’s seat and see what she will see.
- Keep the homework zone stocked with supplies. Try to keep pencils, erasers, scissors, rulers or any other items typically needed for your child’s homework assignments handy in this area.
- Lighting is very important. Use a desk lamp at eye level rather than overhead lighting to reduce glare.
- Consider seating options. If your child has a hard time keeping an upright posture, he may benefit from a chair with arms and a solid surface to place his feet on. Other children may enjoy sitting on a small yoga ball. Ideally for all children, the table surface should be 2” below the height of bent elbows.
- For children who tend to wiggle and fidget, provide opportunity for controlled movement that does not interfere with the completion of homework. Tie a length of theraband across the legs of the chair for her feet to push on. Affix a material with texture your child likes on the underside of the desk – try the fuzzy or bumpy side of Velcro, a small piece of corduroy or something squishable, like an icepack at room temperature or a water-filled teething toy. This will provide your child with a textured fidget toy, without the chance of it becoming lost or getting in the way.
Many children find it difficult to tolerate haircuts. From the auditory input (clippers, hairdryers), to visual input (large mirrors and styling tools), to tactile input (light touch of scissors, water dripping or trimmed pieces of hair) to the smells of a salon, this environment is primed for over-stimulation. Here are some tips to help with the next time your child gets a haircut.
- Try to schedule appointments when the salon is the least busy.
- Bring an extra large tee shirt or soft flannel shirt from home to use instead of the stylist’s cape.
- Always plan on going straight home after a haircut so your child can wash off any stray hair clippings.
- Barber shops are often less overwhelming from a sensory standpoint, as opposed to a salon.
- Give your child a scalp massage prior to a haircut to help desensitize the scalp.
- Make a picture schedule of what to expect. Talk about the steps in positive terms (“Sometimes clippers are loud, but we’ll be OK.”).
- Ask the stylist if they would be willing to give your child breaks. Count back from 10 (sloooowly), then give a break (read a short book or let your child play for a few minutes on a handheld game). Use a timer if needed. Repeat until finished.
Summer has flown by and once again it is time to head back to school. Here are some ideas to help with this transition.
- Get back to school-year bedtimes and wake-up times at least a week before school starts. Although this may not be popular with older children, it will be worth it during the first weeks of school.
- If your child is bothered by the feeling of new clothing, do not push them to wear a brand new outfit on the first day of school. Wearing comfortable clothing will reduce the sensory demands on your child when in a new classroom with unfamiliar sensory stimuli.
- Use a calendar to set up after school routines. Having a visual aid as well as the comfort of knowing what to expect is helpful to many children.
- If your child has fine motor or motor planning difficulties, food and beverage packages may be a challenge at snack and lunch time. Give your child a chance to master these packages at home before going back to school. You can even serve snacks and lunch in your child’s lunch box to practice the motor sequences from start to finish.
How do I know if my child is ready for potty training?
- He shows an interest in the process of potty training.
- He is able to recognize the feeling of having a dry or wet diaper.
- He is staying dry for longer periods of time during the day.
- He is developing the motor skills to pull pants down and up.
- He is able to follow simple directions.
What are some ways to help my child with potty training?
- Make sure your child’s feet are flat on the floor or a step stool. Having a solid base of support is often necessary to relax the muscles involved in voiding. Some children may benefit from the additional support of arm rests if trunk control is an area of difficulty.
- If your child has a history of gravitational insecurity or seems anxious about sitting on the toilet, start by having him sit on the toilet with the lid down, fully clothed. Slowly move toward having him sit on the toilet with their clothing or diaper on, then finally transition to sitting with a bare bottom. Another modification is to allow your child to sit astride the toilet, facing the tank and holding onto the raised toilet lid for stability.
- Children who are over responsive to auditory input may react negatively to the bathroom in general because of the tendency of sounds to amplify and echo off tile and other hard surfaces. Speak in a quiet voice when in the bathroom. Try hanging extra towels in the room to help absorb sound. If your child is bothered by the sound of the toilet flushing, let him use the toilet, wash his hands and leave the bathroom before you flush. When in a public restroom, place a sticky note or hold a piece of paper towel over the automatic flush sensor to avoid an unexpected flush.
- Children who are under responsive to proprioceptive input may be constantly “on the go”, seeking intense movement and crashing experiences or seem unaware of their own bodies, bumping into people and objects, unintentionally breaking toys or seem to be more clumsy than peers. These children may not notice the subtle signs that they need to use the bathroom until it is too late. Watch for those wiggles, squirms or holding onto the genital area that are telltale signs your child needs to use the bathroom. Point them out to your child and help him transition to the bathroom.
- Some children find it very difficult to transition from a desired activity to the bathroom. Use terms such as taking a “break” or a “pause” from an activity rather than telling your child he needs to “stop” what he is doing to use the bathroom. Giving 5-minute and 1-minute warnings prior to a bathroom break may be helpful. Visual timers can be useful for transitions as well. Be sure to praise your child for transitioning to the bathroom and make it a point to discuss the fact that the desired activity they left is still available to return to after he is finished.
- Use a rewards system. Some families use sticker charts, others use edible treats. Pick something that will be a strong motivator for your child. Start by giving the chosen reward for each successful attempt at using the potty, then move to extending the reward for staying dry for a morning or afternoon period and finally to staying dry all day.
- Give boys something to aim at when urinating such as Cheerios or Fruit Loops. Award points for “hitting the targets”.
- Keep in mind that it is not uncommon for children to wet the bed up to 6 or 7 years old. It may be necessary to use nighttime pull-ups or training pants for quite a while after daytime training is complete.
The doctor’s office can be a scary place. Here are some tips to make your child’s next trip to the pediatrician a little smoother.
- Talk to the doctor or a staff member ahead of time. Find out what procedures your child is scheduled for. If you are seeing a different health care provider than typical, let them know that your child has sensory difficulties and may require a little more time and explanation.
- Try to make the appointment first thing in the morning or right after lunch to decrease the chances of the appointment running late. Keep in mind your child’s natural rhythm when picking an appointment.
- Make a visual schedule of what to expect. Steps may include waiting, standing on a scale to be weighed and measured, taking temperature, waiting again in the exam room, having the doctor check eyes, ears and chest, etc. Let your child check off the steps
- Bring a large, soft button up shirt or bathrobe from home and a pillowcase or towel to sit on if your child has difficulty tolerating the paper gown or table cover.
- Have your child complete wall pushups in the exam room when waiting for the doctor to come in.
- Read children’s books about going to the doctor. Mickey, Dora and Clifford all have books about their own doctor’s appointments.
- Play doctor at home. Set up a reception desk, waiting area and examination room. Practice the steps of a doctor’s appointment so your child will know what to expect during the real thing.
Summer is the perfect time to use water games to support your child’s sensory diet. Most water games primarily provide proprioceptive input, which is often calming and organizing in nature. Activities that involve lifting, pushing, pulling, dragging, squeezing or crashing all provide proprioceptive input. However, if your child has tactile sensitivities, they may find small water droplets to be alarming, uncomfortable or even unbearable. Let your child explore water games on their own terms and be flexible with the rules and expectations.
- Play catch with water balloons. After each catch, have each person take a step backwards.
- Make a water obstacle course. Set up obstacles for your child to go over, under, around, etc., but increase the challenge (and fun) by having him carry a cup of water through the course to dump into a bucket on the other side. Continue until the bucket is full.
- Have a pool? Blow up a dozen or so balloons and place them in the shallow end of the pool. Have your child compete against a sibling, friend, or their own best record to see how many balloons they can grab and hold under their bodies in 30 seconds. (When you’re done, make sure to clean up any broken balloon pieces.)
- Car washing sponges are a great way to add some weight to a scavenger hunt. Have your child fill a sponge with water and hunt for objects you have hidden in the back yard. When she finds an object, she should “tag” it by squeezing out the sponge and soaking the object, then head back to fill the sponge again.
- Print out pictures of monsters, cartoon villains, or another character your child is interested in. Hang them from trees or a fence (try weighting them down by taping a clothespin to the back so they don’t blow too much in the breeze). Have your child use a water blaster to take aim and soak all of the “bad guys”. The tube-shaped water blasters that squirt water out by pushing a handle are great for this.
In an age of electronic entertainment and plugged-in play, many classic childhood games are being pushed aside. However, these classic games provide key benefits for child development. In this series of posts, we will explore how these “unplugged” activities are more than just child’s play.
Swimming is a favorite summertime activity for many families and is one of our most recommended activities for children who seek proprioceptive input. Being in the water provides uniform deep pressure input over large areas of the body which many children find to be organizing. Jumping into the water provides a great opportunity for more intense deep pressure and proprioception. Studies have shown that proprioceptive input causes the release of neurochemicals such as serotonin (involved in mood, sleep and appetite) and dopamine (involved in the sleep/wake cycle). Many families at the clinic have reported noticing positive changes in their child’s ability to sit through an evening meal, participate in family activities and transition to bed after a long day of swimming. The deep pressure of the water is also helpful to children who struggle with body awareness and motor planning, as the water provides a higher level of feedback than moving oneself on land. All swimming strokes, from simply propelling oneself by kicking to the doggy paddle to formal swim strokes, require efficient bilateral coordination, which is the ability to use the two sides of the body together to complete a larger task. Swimming also addresses strength, endurance and the cardiovascular system. Time to dig out the bathing suits and sunscreen!
Are you planning a plane trip for school vacation? There are many aspects of the airport and plane that can be a challenge for children with sensory processing disorder. Here are some ideas to consider as you plan your trip.
- Create a checklist of the steps involved in air travel: parking the car/being dropped off, checking baggage, going through security, finding the gate, etc. Have your child check off each step as you complete it. You may want to add bathroom stops as required steps if your child is hesitant to use the restroom.
- Talk about the security checkpoints and behavior expectations. Frame your expectations in a positive manner, “The lines may be long, but I know you will do your best to have a quiet body.”
- Have your child wear shoes that are easy to slip on and off as they go through security.
- Make sure your child understands that TSA dogs are working and cannot be pet or played with.
- Have your child carry a small backpack through the airport for added deep pressure input.
- Find a quiet corner of the terminal and have your child complete wall push ups or other proprioceptive activities.
- Pack chewy snacks for your child to eat.
- Let your child chew gum during the plane’s ascent and descent. Make sure your child tries the flavor before the trip and understands how to dispose of the gum properly.
- Bring a loop of theraband for your child to pull on during the flight. Your child can stretch it with their hands, loop it under their legs and pull upward, or loop it under their feet and press down.
Tips for the Plane:
- If you are bringing a portable DVD player or using the in-flight movie system, make sure you pick a movie or show that is shorter than the flight time. Check with the flight attendants to estimate how long before landing the pilot will require passengers to turn off electronics. Or, be sure your child understands that when the pilot says to turn off the movie, it is time to turn off the movie, even if it is not finished.
- Bring extra batteries for portable electronics.
- Keep a stash of snacks in a small bag that you can stow under the seat in front of you. If there is heavy turbulence or your child gets hungry during the plane’s ascent, you will not be allowed to retrieve anything from the overhead bins.
- Talk about the plane’s bathroom ahead of time. Look at pictures online together. Discuss that the bathroom is likely very small, the toilet water may be blue and the bathroom may have a strong air freshener. If your child is bothered by sound, let them use the restroom and wash up, then let them leave before you flush the toilet. Make sure your child uses the restroom prior to the plane’s descent, because once the fasten seatbelts sign comes on, they will not be allowed to get out of their seat.
- As the plane is descending, take a moment to remind your child that even after the plane stops, you will have to wait a few minutes for the people towards the front of the plane to gather their belongings and get off the plane.
Have a great trip!