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Category: Sensory Integration Therapy

Why Is My Child Picky About Clothing?

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Is your child picky about clothing? It is common for children to have a favorite shirt, blanket, or pants, but what if they refuse to wear anything besides their one outfit of choice? In the pediatric world of occupational therapy, we often work with children who cannot tolerate wearing various clothing items. We have seen the stress of dressing tasks for children and their caregivers. The intended purpose of this blog is to educate parents on why a child may be sensitive to clothing and point caregivers in the right direction to address these concerns.

Why is My Child Picky About Their Clothing?

Every child processes sensory information differently. Children who demonstrate intolerance to various clothing textures may often have sensory sensitivities to tactile (touch) information, also known as tactile defensiveness. This indicates that the neurons responsible for processing tactile information have lower neurological thresholds, meaning more sensory information reaches their brain quicker, which can cause children to become overwhelmed by the stimulus. This results in heightened responses (ex., Crying, screaming, itching) when a child is prompted to wear clothing that feels uncomfortable to them. Another underlying reason for tactile sensitivities can be connected to retained primitive reflexes. Retained primitive reflexes often contribute to a child’s hypersensitivity to general sensory information and can make clothing items with tags or tight waistbands challenging to wear. 

When Should I Be Concerned About My Child’s Intolerance for Clothing?

It can be hard to discern when a child’s intolerance to clothing is a behavioral or sensory concern. A child who doesn’t “like” to wear a particular clothing item or texture is very different from a child who physically cannot tolerate certain textures. True sensory concerns will present with consistent behaviors across settings. For example, a child with true tactile defensiveness will have difficulty wearing a non-preferred clothing item at home or daycare. Additionally, consulting a professional is not customarily warranted if their limited clothing items do not impact a child’s performance and participation in meaningful activities. However, if a child’s clothing sensitivities are impacting their meaningful activities, then it may be beneficial to talk with a pediatric occupational therapist to determine what options or strategies are appropriate. An example could be a child who wants to play soccer but cannot tolerate wearing soccer cleats or sneakers and, therefore, refuses to play. Another example would be a child or adolescent who refuses to wear clothing to match the temperature outside, such as refusing to wear gloves or mittens in the middle of winter.

Strategies to Expand A Child’s Wardrobe

  • Keep a diary/log:
    • Children will normally demonstrate a pattern of behaviors to show caregivers what types of clothing are uncomfortable. It will be essential to keep a log of what items/fabrics are preferred to limit the child’s discomfort when presented with new clothing items to try on. 
  • Present sensory-friendly clothing:
    • There are common characteristics of clothing that can be aversive to children with tactile defensiveness. For these reasons, we have provided a list of clothing items that are often more tolerable for sensory-sensitive children:
      • Clothing without seams
      • Clothing without tags
      • Loose fitting clothing
      • Soft/smooth fabric
      • Breathable clothing: avoid clothing that holds moisture
  • Invite them into the process:
    • Providing the child with autonomy in choosing their clothing will help remove feelings of stress that surround dressing activities. One way to do this is to take them shopping and ask them what clothing they want. Depending on the child’s comfort level, it can also be beneficial to have them choose a variety of clothing to try on and have a “fashion show” in the dressing room.

 

What Other Concerns Can arise with Children Being Picky About Clothing, and How Can Carolina Therapy Connection Help?

Tactile defensiveness does not only impact a child’s ability to tolerate various clothing items. Typical areas of difficulty for tactilely defensive children include, but are not limited to, difficulty with hair brushing/washing, hair cuts, tooth brushing, nail clipping, and bathing. If your child has difficulty tolerating any of the above activities, then it may be beneficial to meet with a pediatric occupational therapist to discuss the best care plan for the child. Call our clinic at (252) 341-9944! Your child may benefit from an occupational therapy screening or formal evaluation!

 

By: Emily Britt

 

Spring Activities For All Ages!

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Join us as we welcome spring!

As the world outside bursts into color and warmth, it’s the perfect time to dive into some fun activities that celebrate the season. We’ve put together a bunch of excellent OT spring activities for all ages that you can do that are fun and help you learn and grow.

From making yummy flower-shaped snacks to crafting bird feeders and sensory bottles, there’s something for everyone to enjoy. Whether you’re a parent looking for fun OT activities with your kids at home or a teacher searching for exciting activities, you’ve come to the right place!

Join us as we explore the wonders of spring through activities that work on our fine motor skills and try new foods! Let’s make this season even more remarkable by having a blast with these therapeutic activities.

Spring Activities: Flower Snacks: 

This fun and creative activity works on fine motor skills, food play, and meal preparation skills. It is also a great way to introduce healthy snacks into your child’s diet. 

  • Beet slices flower snack– Use a flower-shaped cookie cutter to cut beet slices (or other soft fruit/veggies: pineapple, apples, thin potatoes…)
  • Mandarin orange flower– Peel an orange and open one end.  Add celery for a stem.
  • Orange with flair–  Add a grape tomato to the center of your orange to add a little color.  Other fruits could also be arranged into a flower shape: apple, pear, and banana slices would work.
  • Dried cranberry mini flowers– Arrange cranberries (or raisins) into petal shapes.  Add chickpeas for a center to each flower.
  • Tulip cucumbers– Cut a jagged line into cucumber slices.  Add a piece of the peel for stems for each flower.
  • Flower art–  Get the kids involved in this one!  Provide carrots, broccoli, red peppers, and grape tomatoes, and create a flower design as a family.  Enjoy!

Paint With Flowers: 

This is an easy and cheap activity to complete at home that only requires paint, paper or plate, and flowers. Use the flower as a brush and press it into the paint, then paint away!

Oral Motor Exercise With Plastic Easter Eggs: 

This is a fun activity to incorporate into your routine before feeding. Adding oral motor exercises provides sensory input and “wakes up” the muscles of the mouth. Give your child a straw and ask them to blow into the straw to push easter eggs toward a target. 

Spring Animal Walks: 

This is a fun gross motor activity that can be done in the home or outside. Have your child bunny hop, bear walk, frog jump, and snake slither from one side to the other. You can even have an animal race to see who gets to the finish line first!

Homemade Bird Feeders: 

This is a great activity to improve executive functioning skills and bilateral coordination skills. You will need toilet paper rolls, peanut butter, birdseed, and spreading tools. Spread the peanut butter on the toilet paper, roll it in the birdseed, and hang it up outside!

Spring Themed Sensory Bottle: 

Sensory bottles can provide a calming sensory experience to children by focusing on the different moving objects inside. All you need is 4 ounces of clear glue, warm water, hot glue (to seal the lid), a bottle, and any desired spring-themed objects to put inside (glitter, small toy animals, flowers, etc.). 

 

Winter Activities for All Ages! 

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What are Some Winter Activities When the Weather is too Cold Outside?

Ever wonder what you can do to keep your Kiddo occupied and safe while providing the necessary sensory input when it’s too cold to play outside? It is recommended to take indoor breaks every 20-30 minutes when the temperature outside is between 13-30 degrees; however, some kiddos tolerate cold weather better than others. Here are some tips for activities that can be done indoors when it’s just too cold to go outside this winter!

A Fun Winter Activity: Play Board Games

This is dependent on your child’s age and skill set. If you have some board games tucked in the closet, break them out and have family fun! This will work on building your child’s reciprocal play skills, following multistep direction skills, coping skills, and emotional regulation. Check out our Amazon storefront for some of our recommended board games! 

Build a Pillow/Blanket Fort

Who didn’t love making a fort under the kitchen table as a kid? Build a fort in the kitchen and living room, then place some of their favorite books, toys, and stuffed animals inside. This can be a fun way to get your kids into critical thinking mode and build their visual perceptual and motor skills! 

Scavenger Hunt

Another fun winter activity is to hide some items in your house and have your kiddos find them! This can be graded according to skill level and age. For example, for a younger kiddo, have them locate items they would typically use. For older kiddos, give hints to the item they are looking for. “Find two things mom uses to stir within the kitchen (utensils)” or “Find something round and blue in your bedroom (ball).” This will work on their figure ground skills and get their body moving!

Bake/Cook

Have your kiddos help you bake/cook your favorite snack or dessert in the kitchen. Have your kiddos follow the directions given or help with the messy tasks. This can be great for our sensory-seeking kiddos and those resistant to messy play!

Dance Off!

GET MOVING with a fun dance-off! Put off some of your favorite music and have a contest to see who dances best to the song! This is a great way to work on gross motor skills, coordination, and auditory processing, and it’s just plain fun!

Watch your Favorite Movie and Act Out the Scenes.

Many kids like to watch movies; however, do you ever notice that they get bored halfway through and are on to the next thing? Get them involved with the movie. Have that pause button ready and have them act out a scene to see if they can recall what happened! 

Indoor “Snowball” Fight

Do you have some extra tissue paper lying around after wrapping those Christmas presents? Make snowballs and toss them at each other! This is a great way to get kiddos moving without fear of knocking things off tables/counters and breaking things! 

Keepie-uppie with Balloons

Everyone knows this one! Can we keep the balloon off of the ground? Try it! It is so much fun, works on your kiddo’s hand-eye coordination, and has less risk of damaging something in your home!

How can Carolina Therapy Help?

With winter in full swing, ask your therapist about tips/tricks to have fun indoors with adaptations specifically for your child’s sensory-related needs. A therapist at Carolina Therapy Connection can help adapt the activities listed above and give more ideas for your specific child! Also, check out our link for Amazon storefront to find fun toys/activities to make the indoors fun! Many great toy ideas and sensory-related tools can be used when your child needs to get some energy out!

I hope these tips have helped build some fun ideas for you and your family for this winter season! Stay happy, healthy, and warm!

By: Shelby Godwin, COTA/L, AC

Not Your Average Toy!

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Not Your Average Toy offers a transformative approach to pediatric therapy, catering to the different needs of our pediatric patients in occupational, speech, and physical therapy within our clinic. These specialized toys aren’t just playthings; they motivate children to develop essential skills like fine motor control, visual perceptual abilities, grasping techniques, following multistep directions, stimulating ‘what’ questions, fostering color and shape recognition, encouraging problem-solving, and refining hand-eye coordination. What makes these toys exceptional is their unique ability to grasp the children’s attention while integrating therapeutic goals into engaging activities tailored to each child’s journey toward progress and achievement. Check out some of our favorite “Not average toys!” 

Examples of Not Your Average Toy:

Water Beads: 

What sets water beads apart? Water beads stand out for their fun way of developmental skills. They offer an enjoyable sensory and messy play while enhancing color recognition and sorting abilities. These beads serve as a tool for reaching milestones. Children can play by using a spoon for scooping into a cup, counting exercises, and even hiding items like toy fish or other objects within the beads to engage both hands in a tactile search. These toys facilitate various developmental goals, from color recognition and sorting to refining fine motor skills, in-hand manipulation, bilateral coordination, and sensory play. They also stimulate counting skills and engage in figure-ground activities.

 

Building Blocks: 

Building blocks are known for making a tower and watching it fall, but did you know that they offer various developmental opportunities? These square toys build structures with two hands, allowing a child to work towards bilateral coordination, midline crossing, and fine motor skills. Playing with blocks can also help with color recognition, shape learning, spatial orientation, and teaching concepts through block positions. 

Building blocks can also help with emotional regulation. If a task is challenging or the tower does not stay quite the way intended, this is an excellent opportunity to discuss the feelings raised and allow your child to have a voice.   

 

Puzzles: 

Puzzles are a fun, versatile learning tool for children. They can help children learn about shapes and colors, expand their vocabulary, and identify different types of animals. Puzzles also help children learn to act like put in and take out. You can add a multi-step direction to make a puzzle more challenging, like putting the cow and horse puzzle pieces together in their correct spot. For more engaging questions, ask your child, “What does a cow say?” or “Where is the cow?” Puzzle helps achieve milestones that involve enhancing visual perceptual skills, grasping technique, mastering multi-step directions, and developing problem-solving abilities. 

 

How can Carolina Therapy Connection Help? 

At CTC, we are committed to supporting our families and the child’s developmental journey and helping them achieve these goals at home. Please explore our website (https://www.carolinatherapyconnection.com/) or our Amazon Storefront (https://www.amazon.com/shop/carolinatherapyconnection). These are not your average toys; they are carefully innovative toys that can help foster growth and development. To further understand these toys’ impact, ask your therapist if you can sit in during a session. By watching the interaction between the child playing and the therapist, parents can gain insights into how effective these tools can be and bring these Not Your Average Toys into their home.

 

By: Lauren Hodges, COTA/L, and Allison Hicks

What are primitive reflexes?

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A reflex is an automatic and instantaneous response to a sensory stimulus. Remember when you were a child at the doctor’s office and they tapped your knee with a small mallet to check if your leg kicked upwards? You didn’t decide to kick your leg, it just kicked. From infancy, reflexes are vitally important for proper development of the brain, nervous system, body and sensory systems. Some reflexes are meant to stay with us our whole lives. Others are designed to be dormant after their function is fulfilled – also called integration. Check out this awesome resource from Tools to Grow to learn more about specific reflexes and how they impact a child’s function during their daily life. Primitive reflexes are adaptive responses that develop before birth and typically integrate as the brain matures. Primitive reflexes are important for survival and development early in life; however, it is also important that they become integrated as the child grows. Retained reflexes can cause sensory issues, postural disorders, decreased motor skills, and attention/behavioral issues.

What causes retention of primitive reflexes?

Some potential causes of retention of primitive reflexes include c-sections, trauma during birth, exposure to toxins, decreased tummy time during infancy, decreased time crawling, chronic ear infections, or head injuries during infancy among many other unknown causes.

Five Commonly Retained Primitive Reflexes and their Impact on Occupations

1. Moro Reflex

The Moro Reflex is known as the “startle” reflex. This reflects is a fight or flight reaction. It is present at birth and should be integrated by four months. Common effects of retention include emotional outburst, motion sickness, and difficulties with vision, reading, and writing.

2. Asymmetric Tonic Neck Reflex (ATNR) 

The Asymmetric Tonic Neck Reflex (ATNR) is known as the “Fencer’s pose”. It assists in the birthing process. It appears at birth and should be integrated by nine months. Common effects of retention include decreased eye-hand coordination, poor handwriting, poor balance, difficulty with reading and math, and difficulty focusing.

3. Symmetric Tonic Neck Reflex (STNR) 

The Symmetric Tonic Neck Reflex (STNR) is an essential foundation for crawling. It appears at six to eight months and should be integrated by nine to eleven months. Common effects of retention include poor posture, W sitting position, poor eye-hand coordination, messy eater, and low muscle tone.

4. Tonic Labyrinthine Reflex (TLR) 

The Tonic Labyrinthine Reflex (TLR) is commonly seen in children with ADHD diagnoses. It appears before birth and should be integrated by three and a half years of age. Common effects of retention include decreased balance, poor spatial awareness, toe walking, weak muscles, poor posture, and difficulty with climbing.

5. Spinal Galant 

The Spinal Galant Reflex also assists in the birthing process. It appears at birth and should be integrated by three to nine months. Common effects of retention include bed wetting after potty training, hyperactivity, postural issues including scoliosis, attention issues, and decreased endurance.

What are integrated reflexes?

Integrated reflexes are important for developing motor control. A child needs motor control to maintain proper posture at a desk in school, ride a bike, read a book, cross midline, write, and get dressed. A child with integrated reflexes has normal movement patterns to complete these functional tasks at home and at school. A child with unintegrated reflexes could benefit from skilled reflex integration therapy which will essentially train a child’s brain by establishing an efficient movement pattern that supports higher level motor skills or cognitive tasks.

How do you know whether or not your child has integrated these reflexes?

There are many common areas of difficulty that may suggest a retained reflex including the following:

  • “Bouncing” Child: Constantly moving, can’t sit still on a chair, hyperactive
  • “Noodle” Child: Leans on everything, rests head on table
  • “Shirt Chewers”: Constantly chewing on shirts or pencils, and touches everything
  • “Emotional Child”: Challenges with regulating emotions, easily frustrated or upset, difficulty with utilizing age appropriate coping strategies to calm body
  • School Performance Challenges: difficulty with reading, handwriting, language/speech, poor sitting balance and immature grasp on writing utensils
  • Coordination Challenges: Chronic body aches, poor endurance, fatigue, muscle weakness, poor concentration, fidgeting, disorganization

How do I know If My Child Has Retained Primitive Reflexes and What Can I Do?

Once your Occupational Therapist suspects a retained reflex, he/she will educate the caregiver on the importance of carryover for treatment recommendations. Caregivers play an important role in seeing progression in their child’s everyday activities. It is typically recommended that the child completes a set of tailored exercises to meet your child’s needs, 5-10 minutes per day, for 30 consecutive days in order to see any progress. Your therapist may recommended a reward or sticker chart in order to keep your child motivated towards an end goal. Progress can be noted short term and over 9-12 months. In addition to exercises, your Occupational Therapist will make recommendations for modifications in the school and home environments which may include changing positioning during school work, movement breaks, sensory techniques, relaxation techniques, decreasing auditory and visual stimulation, and organizational skills, just to name a few!

In order to determine whether your child would benefit from direct treatment for Reflex Integration, it is recommended that your child be evaluated or screened by an Occupational Therapist at Carolina Therapy Connection. Give us a call at 252-341-9944 today to schedule your FREE occupational therapy screening with one of our experienced and knowledgable OT’s. 

Mealtime Tips For Your Picky Eater

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Why Is Mealtime So Important For Children?

The 3 most important things for humans to survive is: food, water and oxygen. For some parents, the concern for their kiddos health and well-being becomes heightened when they notice their kiddo isn’t eating as much food or as many types of foods as they may have at one time. Some kiddos who are referred to Occupational Therapy are considered “Picky Eaters” and others may be referred to as a “Problem Feeder”. We all know a picky eater. This is a person/kiddo who has at least 30 foods in their repertoire. Whereas a “Problem Feeder” is a person/kiddo who has less than 20 foods in their repertoire. There are many reasons this could happen such as trauma, sensory related challenges, anxiety, behavioral challenges, and more. As Occupational Therapists, we are trained to assist these kiddos by addressing these challenges which can increase their tolerance for trying new foods! Keep reading to learn more picky eater tips we have below!

So why is MEALTIME so important to assist with this?

One of the first things we will ask as OTRs or COTAs is “What does mealtime look like at home?” Some parents may say, 

“We all sit down as a family every night for dinner but we are busy or gone for breakfast and lunch”, “We are so busy that we are lucky to eat all at the same time”, or “(The child) eats all day but won’t eat the food I cook at dinner”. Of course these are just examples, but can you relate to any of them? It’s a possibility! 

Asking about mealtimes is very important to your therapist because this gives us an idea of how your child eats during the day. Kiddos need fuel to keep their bodies going. However, WHAT they are taking in and HOW/WHEN they are taking it in will make a huge difference in behavior, attention, ability to process/retain information and regulate emotions/emotional responses. To give you an idea of why the “what”, “how” and “when” are so important, I’ll follow up on the questions above.

1. “We all sit down as a family every night for dinner but we are busy or gone for breakfast and lunch”

This could be a beneficial time to incorporate feeding techniques and build interest in the foods around the table. Interest always comes before action. A child must first be interested in the food before they will interact with it. This is one reason that mealtime is so important for kiddos. It can be an opportunity to build interest in various smells, sights, and textures of foods provided by parents in a supportive and positive manner.

2. “We are so busy that we are lucky to eat all at the same time”

How can you work your schedule to have a least one meal together every other day? We understand that this busy world requires busy people to keep it going. However, when you are overwhelmed and exhausted your child may pick up on that. Children are very intuitive. Incorporating as many mealtimes as possible may assist with parent/child interaction and decreasing anxiety and overwhelming emotions in adults which can in turn make eating less stressful for a “picky eater”.

3. “(The child) eats all day but won’t eat the food I cook at dinner”

Grazing is when a kiddo eating little snacks all throughout the day. Have you ever seen a child leave a snack on the table, go play for 30 minutes, then return to finish the snack? If your child is doing this all day, it may explain why they are not eating at mealtimes. Typically, the brain lets us know when we need to refuel because the digestive system sends signals saying, “I’m empty in here!”. When grazing, a child’s brain will begin to have a hard time distinguishing when the child is hungry due to constantly having food in the digestive system. This can effect metabolism and the ability to regulate hunger. When given mealtimes, the body has time to regulate, digest and filter out what it needs for fuel. Additionally, if given processed snacks that are high in sugar or carbohydrates throughout the day, the body will begin to crave them. This can create a difficult loop to break when introducing thing like vegetables, meats and some fruits. Positive interactions at mealtimes can assist with parent/child interactions, lowering anxiety and stress levels, giving the child’s body time to process what it needs for fuel and providing learning opportunities for the sensory system. This can be a major changing factor in how your child engages with food! 

Additional Mealtime Picky Eater Tips

Picky Eater Tips #1: Don’t force foods on children

As parents, we want our children to eat a variety of foods, including vegetables, fruits and other healthy snacks to help them grow to be strong and healthy. Studies show that forcing a child to sit and eat until they have cleared their entire plate is not the best method for achieving this goal. Instead, parents should promote foods that may have not been a hit the first time around. You can model this yourself by trying a food you haven’t liked in the past, and explain that you’re giving it another chance because your tastes may have changed. We want to show kids that we are adaptable. Remember: It can take as many as 10 or more times tasting a food before a toddler’s taste buds accept it. 

Picky Eater Tips #2: Get Creative With Food Bingo

You can also put together a list of new foods for the family to try and make a game out of it—what will we try tonight? You can make it interactive and fun by doing something creative like Food Bingo. There are many free printable online similar to the image shown below. You can even make your own! Hang it on the fridge and have your child place a sticker or check off the new foods they have tried. You can even add in a reward for them getting “bingo” – a trip to their favorite place, a new toy, a play date, or something else they really enjoy!

Food Bingo

Picky Eater Tips #3: Don’t Make a Second Meal

When you serve a meal to your family and your kiddo refuses to eat it, we recommend having simple and consistent back up options, such as yogurt, a cheese, nut & fruit snack pack, apple sauce, cereal etc. It’s important for children to know that if they can not eat the meal you have prepared, they will receive the standard option – rather than the usual chicken nuggets baked quickly in the oven. We should also teach kids that a meal isn’t ruined if it comes in contact with something they don’t like. Finding an unwanted pickle on your cheeseburger will not contaminate it. Children should be encouraged to push food they don’t like off to the side, or onto another plate, or offer to share it with someone else.

Picky Eater Tips #4: Involve Your Kiddo in the Meal Prep Process

Some cooking tasks are perfect for toddlers and small children (with supervision, of course): sifting, stirring, counting ingredients, picking fresh herbs from a garden or windowsill, and “painting” on cooking oil with a pastry brush. Allowing our children to interact with the foods they are going to eat will help to promote and encourage them to try it!

Picky Eater Tips #5: Food Chaining

Once your kiddo tries a new food and that food is accepted, use what one our Occupational Therapist’s favorite pickle eater tips call “food chaining” to introduce others with similar color, flavor and texture to help expand variety in what your child will eat. Children with sensory concerns have difficulty with leaping from the types of food they are willing/able to eat. Food chaining builds a bridge to get to those foods you really want your child to eat one step at a time through links to food they’re already eating. Examples include:

  • If your child likes pumpkin pie, for example, try mashed sweet potatoes and then mashed carrots.
  • If your child loves pretzels, try veggie straws next, and then move on to baby carrots or carrot sticks. Carrots are hard, crunchy, and stick shaped, but are cold and have a different taste.
  • If your child loves French Fries, then give a try to Zucchini fries.
  • Move from cookies to Fig Newtons, to jam toast, to jam sandwich, to bread with sliced strawberries, and lastly to fresh strawberries
  • If chicken nuggets are the fan favorite, try to first change the brand of nuggets, then move to homemade chicken nuggets, then to homemade tenders, and lastly to a baked chicken breast.
  • Maybe your kiddo love goldfish crackers. Next give Cheeze Itz a try, and then move on to saltine crackers, and lastly to saltines with cheese slices.

How Can Carolina Therapy Connection Help?

In addition to utilizing the tips above at home, we know that sometimes children need an extra push to expand their food repertoire. At Carolina Therapy Connection, our occupational and speech therapists provide feeding therapy that uses a collaborative approach to work closely with you and your child to determine the source of a child’s feeding difficulties, and develop specific intervention plans to make the entire eating process easier and more enjoyable. Often times, feeding therapy happens on a weekly basis and may consist of working on difficulty with trying new foods, chewing, swallowing, sensory issues, irritability at meal time and so much more. Our goals are to broaden your child’s scope of foods, teach them the benefits of healthy eating, and develop oral motor skills needed for optimal growth and nutrition.

Our Occupational Therapists take a sensory-based feeding approach to therapy.  They focus on: oral motor skills, sensory sensitivities, progressing through food textures, and using adaptive equipment and tools to develop self-feeding skills. They also use a process called food chaining, which is a child-friendly treatment approach that helps introduce new foods while building on the child’s past successful eating experiences. In this process, the child is presented with new foods that may be similar in taste, temperature, or texture to foods the child already likes and accepts. Our occupational therapists are certified in the SOS Feeding Approach, a nationally and internationally recognized approach for assessing and treating children with feeding difficulties.

Our feeding therapists have 15-20 years of experience with children of all ages and a variety of feeding disorders. They have certifications in SOS and AEIOU approaches and significant training from around the country on feeding approaches, treatment strategies, and focused plans. We also having consistent collaboration with other professionals in the community to guarantee the best care. Call our clinic at 252-341-9944 for a free phone screening with one of our feeding therapists and schedule an evaluation today!

Blog Written By: Shelby Godwin, COTA/L, AC & Morgan Foster, MS, OTR/L

 

The Vestibular System in Pediatrics

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What is the Vestibular System?

Vesti-what?!? The vestibular system is made up of the inner ear, vestibulocochlear nerve that communicates between the inner ear and brain, parts of the brainstem, and cortical areas in the brain. The vestibular system responds to head movements like when you nod your head “yes”, shake your head “no”, or tip your head to shake the water out of your ears. It also responds to movements like when you move forward or backwards when you’re sledding, move up and down like when you’re jumping, or when you spin around in circles. Overall the vestibular system helps you figure out where you are in space as you move around your environment so that you can… 

  • Maintain your gaze on a target while moving your head (vestibulo-ocular reflex)
  • Maintain postural control or balance
  • Orient yourself to your environment
  • React appropriately to your surroundings
  • Avoid falls

Check out this helpful resource from Integrated Learning Strategies, who breaks down the vestibular system as an internal GPS system for the body!

Vestibular Therapy Carolina Therapy Connection

What is vestibular dysfunction?

Vestibular dysfunction may be attributed to deficits or impairments of the inner ear, vestibulocochlear nerve, brain, or brainstem. As adults we may notice difficulties with our vestibular system due to symptoms like dizziness, vertigo, trouble keeping objects in focus while moving our head, or changes in our balance. Children who have vestibular concerns may not realize that they are dizzy or that movement of letters when reading is atypical if they have always experienced these symptoms. This can make diagnosing vestibular concerns hard and can often times be mistaken for other issues (learning disabilities, behavior problems etc.) due to a child’s inability to explain the symptoms they are experiencing.

Migraines, Benign Paroxysmal Vertigo of Childhood (BPVC), and Traumatic Brain Injuries are the most common causes of childhood vertigo. Ocular disorders, inner ear malformations, labyrinthitis (inflammation of the inner ear), and neuritis (inflammation of the vestibulocochlear nerve) are also common causes.

As a parent, here are a few signs and symptoms to watch for regarding vestibular dysfunction:

  • Head tilted to the side
  • Easily stressed, anxious, or upset with quick changes in movement or being on unstable, uneven, or taller surfaces
  • Nausea and vomiting
  • Imbalance or frequent falls
  • Vertigo or dizziness
  • Reduced cognitive performance
  • Decreased consciousness or arousal
  • Poor spatial awareness, navigation, or orientation
  • Ringing in ears
  • Spontaneous and involuntary eye movements
  • Motion/car sickness
  • Constant need for movement or taking unsafe risks for various positional changes or movement patterns

What should you do if your child is experiencing vestibular dysfuntion?

First and foremost, consult your child’s pediatrician to discuss your concerns. You may be referred to a neurologist for further evaluation and recommendations. If your child’s pediatrician or neurologist determines that your child would benefit from Physical or Occupational Therapy treatment, your child may be referred for an initial OT and/or PT evaluation.

How can a pediatric occupational therapist or physical therapist help with vestibular concerns?

  • During the initial evaluation your therapist may…
    • Assess how your child’s eye move in a variety of situations
    • Screen for abnormal eye movements
    • Assess your child’s visual acuity
    • Test your child’s balance while static or standing still, as well as their dynamic balance while on a variety of surfaces, while they are moving, or while they are performing a task
    • Assess how your child responds to various positional changes and movement patterns
    • Assess for seeking or avoidance behaviors of various positional changes or movements
  • During treatment your therapist may…
    • Use balance beams, obstacle courses, balance boards, single leg stance activities, etc. to challenge and improve your child’s balance.
    • Use stair training, climbing a rockwall or ladder, standing on a platform swing, etc. to address gravitational sensitivities and challenge balance at various heights.
    • Use swinging, spinning, rolling in a foam cylinder, sliding down slide, riding on a scooter board, etc. to help strengthen your child’s vestibular system. These activities will also potentially help delay the onset or reduce the severity of your child’s dizziness.
    • Use specific activities involving movement of their eyes and head to strengthen their vestibular system.

If you have concerns about your child’s vestibular function, motor development, sensory difficulties or anything else, call Carolina Therapy Connection at 252-341-9944 or email us at info@carolinatherapyconnection.com to get started today! We accept all major insurances and would love to help your family and kiddo maximize their independence and potential to grow healthy and strong!

Blog Written By: Joann Flaherty, PT, DPT and Jessica Reynalds OTD, OTR/L

References:

  • Casselbrant ML, Villardo RJ, Mandel EM. Balance and otitis media with effusion. Int J Audiol. 2008;47(9):584-589.
  • Christy, J., Beam, M., Mueller, G., & Rine, R. (2019). Just Screen It!! (Part 2): Developmental Disability, Vestibular Deficit, or Both?. Presentation, APTA Combined Sections Meeting.
  • Christy, J., & Rine, R. (2019). Just Screen It!! (Part 1): Developmental Disability, Vestibular Deficit, or Both?. Presentation, APTA Combined Sections Meeting.
  • Lin, C. (2019). Vestibular Rehabilitation Intervention. Presentation, East Carolina University.
  • Salami, A., Dellepiane, M., Mora, R., Taborelli, G., & Jankowska, B. (2006). Electronystagmography finding in children with peripheral and central vestibular disorders.International Journal of Pediatric Otorhinolaryngology, 70(1), 13-18. doi:10.1016/j.ijporl.2005.05.001
  • Wiener-Vacher, S. R. (2008). Vestibular disorders in children. International Journal of Audiology, 47(9), 578-583. doi:10.1080/14992020802334358
Pediatric Vestibular Therapy Greenville, NC Carolina Therapy Connection

All About Occupational Therapy

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What is Occupational Therapy? 

The main goal of OT is to increase quality of life so that the client can continue to participate in their personal interests as well as take care of their own needs. Through therapeutic use of self, a strong relationship of trust is built between client and therapist that will help the client to grow in skills leading to increased independence. Occupational therapists improve, rehabilitate, or maintain individuals’ performance to complete everyday occupations (IADLs & ADLs).

What is the role of an Occupational Therapist?

As an occupational therapy assistant, working in the pediatric setting, it is my responsibility to implement activities and tasks that will improve my clients ability to perform at an age-appropriate level. In this setting, you will commonly see OTs working on improving age-appropriate grasp and legibility with handwriting, sensory processing, oral motor skills for feeding, core strengthening for postural control, hand strengthening to increase fine motor skills, visual motor/perceptual skills for copying shapes and or letters.

What are IADLs?

IADL’s stands for Instrumental Activities of Daily Living that involve your home and community. Below is a list of different IADLs an individual may complete regularly.

  • Care of others
  • Care of pets
  • Communication management
  • Driving and community mobility
  • Financial management
  • Health management and maintenance
  • Housekeeping
  • Food preparation
  • Religious and spiritual activities
  • Shopping

What are ADLs?

ADL’s stands for Activities of Daily Living and are basic self-are tasks an individual engages in daily.

  • Bathing
  • Grooming
  • Toileting
  • Dressing
  • Feeding
  • Transfers
  • Abulation

How Can OT Benefit Children? 

Occupational therapy can benefit children of all ages with a variety of needs and diagnoses including:

At CTC, our occupational therapist provides screenings, assessments, consultations, and treatment for those concerned about: 

  • Cognitive skills
  • Gross & fine motor skills
  • Self-care tasks
  • Self-feeding tasks
  • Sensory processing
  • Visual processing & perception
  • Social skills

How can Carolina Therapy Connection help?

Our occupational therapists will complete an initial evaluation to become familiar with your child’s strengths, weaknesses and daily routine. Following the evaluation, they will create an individualized treatment plan and goals to address any concerns with development. We take pride in making therapy enjoyable and fun for your child, so that they can be motivated to live their life to their greatest potential.

We use evidence-based treatment approaches including:

If you have questions regarding your child’s development or want to learn more about occupational therapy, call our clinic today at 252-341-9944 or visit our referrals page HERE. We provide services in Greenville, Goldsboro and New Bern, North Carolina. One of our licensed and board certified therapists will be happy to provide you with a FREE developmental screening today! We can’t wait to begin this journey with your family!

Blog Written By: Lacey Smith, COTA/L 

Does My Child Need a Sensory Diet?

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What is a Sensory Diet?

As a COTA, during my first visit with a family for Occupational Therapy Services I am looking for and asking about ways to develop a sensory diet for home, school and/or community use.

I often get the question, “What is a Sensory Diet?”

A Sensory Diet is a personalized, organized plan that provides sensory input activities that a person needs to regulate their body throughout the day.

What does it mean to “regulate”?

Sensory regulation is easier to understand once you understand how your senses impact your body. The five senses known to most people are taste, touch, smell, sight and sound. Some people are unaware that you also have two other senses: vestibular and proprioceptive. The Vestibular System is responsible for regulating spacial orientation and providing the brain with information about movement and head position so that our body’s can coordinate movements appropriately. The Proprioceptive System helps regulate body movement by providing our brain with information about force provided primarily through our joints and muscles. Now we have seven systems to look at! To understand more about children’s sensory systems, how they affect learning and sensory integration therapy, read our blog: “Making Sense of Our Experiences.”Vestibular System Carolina Therapy ConnectionProprioceptive System Carolina Therapy Connection

What can be addressed with a sensory diet?

Jumping, crashing and or falling on purpose could look like a kiddo is being too rough or is clumsy. We want to figure out why this is happening. Could this be that the kiddo’s body is not confident about where it is in space, which is regulated by the vestibular system? Could this be because the kiddo’s body is considered “under responsive”? This means simply that this kiddo’s body may not register textures or body movements on the same scale as yours or mine. They would be considered UNDER responsive because their body is always looking for MORE sensory input. If their sensory system is not regulated, it will most likely cause them to try to find ways to do that on their own. This may come out in excessive jumping, movement, crashing into things, falling on purpose, touching everything nearby, etc. This can be frustrating and scary for a parent because the last thing you want is to see your kiddo hurt!

What sensory diet look like on a day-to-day basis?

This is where a sensory diet comes into play. A sensory diet will be comprised of special exercises that are specific to your child’s age, physical and cognitive capabilities. We will also look at your schedule for the day and what items you have at your availability. This does not necessarily mean that you will need 3-4 hours of strength training with your kiddo or a gym with equipment to complete these tasks. It can as simple as using the own body in appropriate ways to provide the input needed! For example, if you are out in the community and see a lot of high energy movements coming from your kiddo, try bunny hopping all the way down the isle at the store or have them help you care bags of groceries, etc. At home, depending on the child’s age and abilities, helping with household chores such and carrying the laundry basket, vacuuming, wiping down the table after dinner, etc. Input can also be provided by drinking thick liquids like milkshakes through a straw, eating crunchy foods/snacks and chewing gum. These simple activities provide the child with the gross motor movement, deep pressure through the joints/muscles, heavy work (as long as it’s appropriate for the age) and the confidence of knowing that they CAN feel regulated!

How can Carolina Therapy Connection help?

Each sensory diet will be very specific to each child, so it is important that you stick with it and consult with your Occupational Therapy Practitioner before making significant changes or if it does not produce the outcomes you are expecting. Please also remember that this change does not happen over night, so please don’t be discouraged if there is not an immediate change. Think of it like a weight loss diet. You cannot expect to eat healthy and exercise for one day and reach the outcomes you want. It takes work and dedication on all parts! The important element here is that the child, with your help as parents, learns helpful and appropriate strategies to regulate their body. This will help in so many more areas such as; school performance, attention, behaviorally, emotionally, etc.

Please talk to your Occupational Therapy Practitioner about a Sensory Diet today or call our clinic at 252-341-9944 to get started!

Written by: Shelby Godwin, COTA/L, AC

Shelby Godwin Occupational Therapy Assistant Carolina Therapy Connection Sensory Diet Goldsboro NC

Image References: Tools to GrowOT

Helping Children Develop Self-Care Skills

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What are types of self-care skills?

As children learn and grow, they have a drive to be independent and do things on their own. One area that an occupational therapist address in childhood development are their activities of daily living (ADLs), also known as self-care skills. Self-care skills are skills that are required to manage a person’s basic needs including:

  • Brushing teeth
  • Dressing (upper/lower body dressing, zippers, belts, shoe tying)
  • Bathing
  • Grooming (brushing/styling hair, nail cutting)
  • Self-feeding
  • Toileting

What are the building blocks necessary for self-care skills?

  • Executive functioning skills (i.e. attention, sequencing, initiation of task)
  • Fine motor skills (hand & finger strength, object manipulation)
  • Receptive & expressive language (comprehension and alternative forms of communication to communicate wants, needs, thoughts and ideas)
  • Sensory processing (tolerating sensory stimulation in the environment, such as grooming or dressing tasks for tactile processing)
  • Coordination & motor planning (moving body through space in a functional way)

What age should my child be able to engage in self-care tasks?

It is important to understand that all children develop at their own pace and that is okay! Remember — there is no penalty for being cautious about your growing child, and if there is a problem acting early can make all the difference. Self care skills are the every day practice of the foundations skills for academic performance and not just life skills. According to the CDC and American Academy of Pediatrics, below are a few of the developmental milestones pertaining to self-care skills in early childhood development.

6-12 months

  • Drinking from a cup
  • Holding a bottle or cup independently
  • Using tongue to move food around mouth
  • Feeding self small crackers or other small pieces of food

1-2 years

  • Settling themselves to sleep at night or during the day
  • Attempting to brush teeth
  • Removing own socks
  • Cooperating with dressing by extending an arm or leg

2-3 years

  • Using toilet with assistance and having daytime control
  • Attempting to manipulate large buttons
  • Distinguishing between urination and bowel movements, and names them correctly
  • Using a napkin to wipe face and hands
  • Feeding self simple meals using a fork or spoon
  • Taking socks and shoes off

3-4 years

  • Unbuttoning and buttoning large buttons
  • Feeding self without difficulty
  • Tolerating different clothing textures, seams, tags etc
  • Toileting independently
  • Brushing teeth independently or with supervision only
  • Dressing and undressing self (only requiring assistance with laces, buttons, and other fasteners in awkward places)

4-5 years

  • Choosing weather appropriate clothes
  • Dressing self independently
  • Attempting to bathe and groom with supervision only

5-6 years

  • Dressing independently
  • Able to manage morning and night time routine with supervision only
  • Settling independently for sleep
  • Able to manipulate more difficult fasteners and tie shoes

6-7 years

  • Showering or taking a bath independently
  • Independently toileting during the day and at night
  • Preparing simple meals (i.e. cereal)
  • Independent grooming (combing hair, brushing teeth, flossing)

7-8 years

  • Showering independently
  • Taking on more responsibilities (i.e. chores)
  • Preparing simple meals and helping with more complex meals (i.e. making a sandwich, using the microwave, spreading condiments, pouring from a larger container into a cup)
  • Interest in taking on more complex grooming tasks – nail cutting, tolerating hair cuts, styling hair

How can an occupational therapist help address self-care difficulties?

Create a routine: Developing a consistent routine with a child can help them know what is expected of them and when to complete their self-care tasks throughout the day. Creating a routine may require a visual schedule or reward chart, something that an occupational therapist can help your child and family plan, develop, and implement in the home!

Improve fine motor skills: Almost all self-care skills require adequate fine motor skills, such as brushing teeth, using utensils, buttons, zippers, tying shoes, and more! An occupational therapist can help improve your child’s fine motor skills to increase independence of their self-care tasks.

Sensory integration: some children may have difficulty tolerating grooming or dressing tasks which can indicate a challenge with tactile processing. They may also have difficulty with tolerating hair cuts, nail cutting, or teeth brushing. Seeing an OT to address these sensory processing concerns can help your child to improve their ability to register and tolerate tactile input to improve their ability to complete these self-care tasks using a variety of treatment strategies.

Adaptation & modification of tools and the environment: An occupational therapist can recommend different types of adaptive equipment (i.e. button hook, weighted utensils, shoe horn, etc.) to help increase independence in self-care skills. They may also get creative by providing tips for adapting the environment to promote independence in the home.

Executive functioning skills & attention to task:  If your child has difficulty with their higher level cognitive skills then self-care may be difficult. Seeing an OT could be helpful by implementing and utilizing a variety of treatment strategies for increasing attention, initiation of tasks, sequencing steps of an activity and more!

Caregiver/parent training: An occupational therapist may be able to provide tips and strategies to parents in the home for carryover of self-care skills into daily routine.

How can Carolina Therapy Connection help?

Through demonstrated excellence in clinical, school, and home-based practice, Carolina Therapy Connection’s occupational therapists provide screening, assessment, consultation, and treatment to children having difficulty with a wide variety of needs, including difficulty with self-care skills. We believe it is critical to make therapy as fun and motivating as possible by celebrating the small victories as well as major achievements. We have a strong focus on helping your child develop the skills appropriate to their age and current stage of development. We also use a holistic approach and evidence-based practices to help your child develop and grow to their greatest potential. If your child is having difficulty with any of the skills discussed above, call our clinic today at 252-341-9944 for a FREE occupational therapy screening! We currently provide occupational therapy services in Greenville, Goldsboro and New Bern, NC!

References

Holland, B. (2017, February 14). Top 10 ways occupational therapy can help children with self-care. Chicago Occupational Therapy. Retrieved November 2, 2021, from https://chicagooccupationaltherapy.com/articles/top-10-ways-occupational-therapy-can-help-children-with-self-care/.

Admin, K. S. W. (2016, November 27). Self care skills. Kid Sense Child Development. Retrieved November 2, 2021, from https://childdevelopment.com.au/areas-of-concern/self-care/self-care-skills/.

Centers for Disease Control and Prevention. (2021, January 22). CDC’s Developmental Milestones. Centers for Disease Control and Prevention. Retrieved November 2, 2021, from https://www.cdc.gov/ncbddd/actearly/milestones/index.html.

 

Carolina Therapy Connection Occupational Therapy Greenville, Goldsboro, New Bern North Carolina Help with Self-care skills