Skill of the Week: The Parents' Guide to the First Year of Life

Congratulations! You just brought your little bundle of joy home from the hospital, and you are so excited to start the rest of your life. You begin to envision your child as a happy baby, growing into a feisty toddler, and beam at the thought of the two of you, hugging, on the first day of preschool. Until... Another fleeting thought... You realize that there are so many stages for your baby to first go through, and you are immediately overwhelmed at the thought of raising your child in a developmentally appropriate manner. As a pediatric occupational therapist and mommy x 3, I know that it is absolutely frightening to think of every skill that you "should" work on every day- in order to help your child meet developmental milestones. After all, not everyone has the time or energy (hello, newborn sleep-deprivation!) to go through the daily developmental checklist. After working with some of my early intervention families, I realized that many parents would truly appreciate having one skill to focus on each week, incorporating attainable goals to help their children reach milestones. "Skill of the Week" will offer families an opportunity to engage their babies, using best practices for cognitive, fine motor, gross motor, and social and emotional skill development. The series will highlight one skill per week throughout the baby's first year of life, which a family can easily incorporate into their [child's] daily routine. Toy suggestions will also be provided- to complement the skill that is being featured. You might be saying, I will enjoy my child as soon as she can sit or talk or run or go to school. Perhaps you think, "babies are not my thing." But they can be when you realize all that your child can and will do. So I say, let's work on one skill at a time, marveling in each new achievement. I promise, it really is amazing.

Handwriting: Pencil vs. iPad

The debate over the importance of handwriting is looming, as technology is gaining momentum in classrooms and households all over the country. With the increased use of keyboarding and accessibility to information- thanks to the internet, why are students demonstrating increased difficulty learning and recalling important information? And why do more and more students seem to need Occupational Therapy for handwriting problems? The WSJ article, "How Handwriting Boosts the Brain," discusses the importance of the physical act of writing in order to improve fine motor skills, learning letters and shapes (which is necessary for letter recognition), and idea expression and layout. Kids and adults alike reap the benefits of the physical act of handwriting... It is easier to learn new information when you physically sequence a task, using the visual and motoric systems. When I was in OT school at Columbia, it truly helped me to learn the information presented during classes- and in preparation of the Boards- when I wrote it out first. According to this article, the use of iPads actually mimics handwriting through the touch screen. The user must create the letters- 1 stroke at a time and in sequential order. Using a finger and/or stylus can be just like using a pencil on paper. Through this technology, improvement in the aforementioned skills can be demonstrated- including buzz words such as visual motor (control hand movements with the use of vision) and visual perceptual skills (gathering information through vision and integrating with the other senses). Although technology can be a wonderful addition for emergent skills- it should not replace "the real thing." Handwriting continues to be an important part of a child's school-aged years. Scribing notes during lessons (including copying directly from the board), taking tests, and completing in-class assignments, as well as communicating ideas, answers, thoughts, greetings, and basically, knowledge to people, are all age-appropriate expectations of students in present-day classrooms. Future requirements of students include the timed composition areas of the SATs. Good handwriting strokes (letter formation) = efficient strokes = faster handwriting... Analysis of a child's handwriting can also provide clues to developmental problems that potentially hinder classroom learning, as teachers depend on written work in order to measure how well a child is learning. An occupational therapist will look at the following components of handwriting: Demonstration of correct grasp of a pencil Spatial concepts (spacing; sizing; orientation to line) Maintaining posture (core strength and upper extremity stabilization) Copy of letters/words (near-copy from another piece of paper / far-copy from the chalkboard) Letter formation Utilization of appropriate pressure- prevent fatigue If you have any questions or concerns about your child's handwriting skills, please contact me at julie@etikids.com or by calling 813.856.9449. You can read more about the Helping Hand for Handwriting classes here.

Postitional Plagiocephaly

Positional plagiocephaly. Flat head syndrome- due to positioning of the infant on the back for extended periods of time. With the back-to-sleep campaign that began in the early 1990s, many parents became afraid of placing a baby on his/her stomach- and left their infants on their back, in swings, and/or carseats. Has the increase in positional plagiocephaly also caused a rise in developmental delays? According to a 2010 study that was published in Science Daily, babies with flat heads may be at a higher risk for cognitive and motor delays. It makes sense- when an infant is always on his/her back, he/she does not receive the proprioceptive input (feeling of where body is in relation to space) or the neck extension (straightening). The child could potentially be delayed in meeting milestones. After all, it is more difficult to attend to a stimulus while on your back (then on your stomach). Additionally, many babies will take longer to learn how to roll, crawl, sit, and stand, as the core muscles will not be strong enough to move against gravity. As an occupational therapist, I work with many kids that have positional plagiocephaly. During the session, I teach families how to place their babies during waking hours - as well as how to engage them - to prevent worsening of and correct the flat spot. Although pediatricians recommend back-to-sleep, I encourage families to keep babies OFF of their backs (out of the supine position) as much as possible during waking hours. What can you do? Here are three "quick" suggestions to PREVENT positional plagiocephaly. TUMMY TIME! I can't say it enough. Although a Tummy Time article on parents.com mentioned to place an infant on his/her stomach beginning "around the 3-4 month mark," I believe it should happen MUCH earlier. You can put your baby on YOUR stomach- after feeding, while he/she is sleeping, and during waking hours during the newborn stage. It is a great way to bond with your baby and can also help with burping! (In all fairness, the article DID mention this.) ***Just be careful until the umbilical cord has fallen off. Be a switch-hitter! Switch sides in your arms (after every feed) and in the crib (each night)- get your baby comfortable resting his/her head on BOTH sides. Just because it is made- does not mean it is right for your child. Meaning- just because Bumbo seats, exersaucers, jumpers, walkers, and swings (etc...) are readily available in many, many stores, they are not necessarily appropriate for your child- in his/her current stage of development. Although those items can be great distractions- extended use may NOT be recommended. It is very scary to be a parent nowadays- I TOTALLY get it. Remember that you are not alone. If your parent instinct tells your that your child may have positional plagiocephaly, speak to your pediatrician. I am also available to lend my expert opinion about positioning and engaging "activities" to do with your baby.

Entertaining the Toddler with Fine Motor Activities

You need to entertain your toddler before everything gets destroyed. I get it. I scramble for stimulating activities all of the time, since my super-precocious 2 year-old is always looking for the "next big thing." Seriously, this morning, there was 2 minutes of quiet, while I fed the baby. As I went into MY bedroom (the door had been shut), said 2-year-old came out, holding the toothpaste cap. He was painting on the floor with the toothpaste. *Sigh That being said: here are the best activities to entertain a toddler- and improve fine motor skills. 1) Chalkboard. GREAT for wrist extension and shoulder stability- two important components to improving fine motor skills. Plus, using chalk is SO much fun! Vary it and take the activity outside- write on the sidewalk/driveway. Begin writing letters- practice with large letters first! 2) WATER TABLE! It is a wonderful sensory activity that also requires balance (reaching, lifting, shifting weight) and fine motor control (control of objects in hand, as well as grasping skills). Practice pouring to/from cups of all sizes, including stackable cups, to develop the concepts of greater than and less than. Improve their play skills as (you) engage them in scenarios by modeling the behavior. Bonus** it is easy to supervise! Bored with the water- use rice or sand instead... 3) Pom pom sorting. By color. By size. With clothespins. With spoons. Talk to them about concepts such as more than and less than. 4) Collage (***With Adult Supervision***). The glue can get messy- but this is a really great way to kill 45 minutes! Rip up paper with different textures into pieces of varying size. Glue on items of all sizes, shapes and color. Perhaps dabble with scissor skills (only with absolute, 100% adult supervision!). Hopefully this helps. The toddler and I will be collaging tomorrow. As soon as I finish cleaning my bathroom. :)

Creating a Crawler. Almost.

Nature vs. Nurture. You can't always change nature, but you sure can nurture- offer tools to help your kiddo meet milestones and achieve success. My 6-month-old is crawling. Almost. Although he has been army crawling for over a week, yesterday he took four purposeful movements in quadruped position (on all fours!).

My EtiKid(s) began kicking in utero! I actually have videos of my stomach lurching side to side as the older one kicked as hard as he could -from the inside. That being said, I am an Occupational Therapist and Early Childhood Education Teacher. Having studied a lot of child development, I knew enough about the importance of positioning and environment- giving him with opportunities and motivation to meet success. I did not use hand-over-hand cuing to teach him, but he was provided with a stimulating-enough environment and appropriate positions to foster his development. Although every child develops at his/her own pace and nothing with children is guaranteed, offering developmentally appropriate tools can help your child thrive. Here are 3 QUICK tips to foster those gross motor skills. 1) Play- Someone was almost always on the floor playing with him. He was read to, shown cause and effect toys, and smiled at throughout the day. Also, there is an older sibling. I made sure that there was a lot of interaction between the two and clearly the baby now wants to be just like his big brother. (PS- big brother began crawling at 6.5 mos- and he was provided with the same "tools," minus the older sibling. *sigh 2) Tummy Time- can't be stressed enough. Some "experts" recommend 30 minutes per day to parents. I did FAR more. Pretty much every waking moment was spent on his stomach or upright in my arms (his middle name is "hold me!"). 3) Reaching- While laying on a mat, I put some bright toys that were sure to be his favorite just out of reach. This also helped to improve his grasping skills. Through our efforts to overcome shoulder dystocia, we created a crawling monster. Almost.

Raising My Advanced EtiKid

My son started crawling at 6 1/2 months and walking at 10 1/2 months. Although that is no small feat, I am even more excited (and proud!) that he is extremely social and loves to interact with other people. I am WELL aware that most of his abilities are due to nature (he was very active in the womb, frequently causing the need for repeat ultrasounds!). I will say that I did recognize signs that he was ready and provided him with opportunities that encouraged him to develop his skills. As I have friends asking me what I have done to promote his development, I thought I would share some tips (not just as a parent but from an Occupational Therapist's perspective). 1) TUMMY TIME! From the time he was born, I would hold him across my arms or on my lap on his belly. Once he got a little older (2-3 months), I placed him onto a mat on the floor- on his tummy. He definitely did not like it at first, but I always started floor time in this position. Toys that made noise were placed in front of him - encouraging him to extend his tolerance of tummy time. This helped him to get a sense of his body in space, as he received a lot of sensory input from his stomach and arms being on the floor. It also helped him learn to lift his head and upper torso off of the ground, promoting neck extension (straightening). He became more aware of himself and his surroundings once he was able to look at objects and happenings around him. Sheryl Berk from Parents Magazine has additional tips for Tummy Time. 2) Lots of playtime... Many people mistakingly believe that a child who doesn't move can be left alone on the mat. I feel that it is even more important to engage, talk to, read to, and just generally sit on the floor with the infant. As a parent, OT, and child development specialist, this time is especially formative in a baby's life. Demonstrate how to use toys and give the infant the freedom to explore the objects as well. Make sure that the toy is "developmentally appropriate" (more about that to come in future posts). Additionally - just because a toy is in the store does not always mean that it is right for your child. Use your gut instinct. If that is not working at the moment- perhaps due to extreme sleep deprivation, call/email me. 3) Model social behavior - your baby is NEVER too young to learn social interactions. Smile, respond to their sounds, and use LOTS of language to foster their own speech communication skills. Providing and modeling interactions as soon as possible can only help the child learn how to engage with others. The more engaging a baby is, the more likely others will respond to him/her. 4) Be consistent. It is definitely too early for punitive measures. However, after 6+ months, a child can begin to learn safe vs. unsafe. Redirection is the BEST method for preventing unwanted behaviors. Yes it is exhausting, but it will make it easier to raise a polite little person in the not-so-distant future. For example, when my child wants to play with electric outlets (he looks at me and smiles as he touches them because HE KNOWS HE SHOULD NOT BE NEAR THEM!), I immediately say (in a stern voice), "Not safe." I then redirect his attention to his toys (on the other side of the room), and sit with him as we build the simple blocks or read a book. This list can go on and on (I will share more tips in coming weeks). I firmly believe in the adage that it "takes a village to raise a child." Therefore, I am sharing my wisdom as an Occupational Therapist (and parent!) and welcome any other tips you may have. Of course, if you have any questions, you can call me or email me. I look forward to hearing more stories about your own EtiKids!

Teachable Moments

Social skills are the building blocks to a preschool education. While children may learn letters, numbers, shapes and even the beginning stages of reading, it is here that they develop the most important skill of all: social relations. Children learn these skills through observations of others, including parents, friends, and relatives. As children need frequent reminders of appropriate social behaviors in the early stages of making a learned behavior seem innate, they may require assistance from you. Fellow occupational therapists and teachers like to use the term: Teachable Moments. A teachable moment is unscripted and unplanned. When the grownup is observing the child/children engaged in play, an opportunity may arise to positively redirect the negative behaviors or reward desired behaviors. By helping the child/children recreate the scene and identify what was correct vs. what could be changed, you are helping them develop awareness of their own pro-social behaviors. For example, Henry is playing with blocks in the middle of the floor. Charlie is in the corner with his favorite puzzle. Once completed, Charlie puts away the puzzle and sits down in front of Henry’s castle and says, “That’s a big building. Can I play blocks with you?” Henry quickly responds, “You are stupid, it’s a castle!” Dejected and angry, Charlie walks away, accidentally tripping on the rug and causing the demise of the castle. Henry starts screaming and crying. The teacher has observed the entire episode and sits the two boys down to discuss the incident. They review classroom rules, how words can hurt and apologies are made. Although the boys are upset, Henry learns that calling people “ugly names” – or using the “S” words are not acceptable social behaviors. With the teacher’s guidance, he recognizes that hurting someone’s feelings makes everyone sad. Charlie learns that you can let someone know you are angry without damaging property. To redirect attention and enhance social skills, the teacher presents the boys with a book to to share about different types of buildings. A castle is a building and there are many types of buildings: big, small, commercial, castles, high-rise condominiums and offices. As the next activity begins, the boys decide they will try to build the biggest building in the world! To make the most of a teachable moment: 1. Listen more and speak less. Observe behaviors and listen to conversation before jumping to conclusion and interfering in children’s activities. If there is no danger, allow the children to resolve their issue without intervention. 2. Following the incident, offer praise for using their best manners to resolve differences and not hurting anyone’s feelings. 3. Trust children to mirror the behaviors they see. Patience, kindness, respect and understanding can make a difference in the way people are perceived. In EtiKids classes, teachable moments are used because they are the most meaningful to the child. If you have any questions about how to incorporate this method into your daily parenting routine, please do not hesitate to contact Julie. Teachpreschool.org has even more examples of teachable moments for you to check out!