Pronunciation Library

There are 44 phonemes (or speech sounds) in the English language. These speech soundsBlogPronunciationLibrary-Main-Landscape can be broken into the two broad categories of consonants and vowels. When a consonant is produced, the air flow is cut off partially or completely. When a vowel is produced, the air flow is unobstructed. In order to make this wide array of sounds, our articulators do a lot of work! Our articulators include our lips, teeth, alveolar ridge (the ridge on the roof of your mouth behind your front teeth), hard palate (the roof of your mouth), soft palate (the back portion of the roof of your mouth), jaw, vocal folds, and last but not least, our tongue. Each speech sound is made by placing these articulators in different positions, pushing through air, and turning our voice on or off.

Each sound has an age range at which it is typically emerging and mastered by. While producing these sounds comes naturally to some children, many children struggle to make certain speech sounds, and describing to a child how to make these sounds with muscles they cannot see can be even trickier! Below is a pronunciation chart of 24 early, middle, and later developing speech sounds and a description of how to make each sound:

PHONEME DESCRIPTION OF PLACEMENT OF THE ARTICULATORS
Early 8 Emerging pronunciation development between ages 1-3, consistent production around 3 y/o
/p/ Press your lips tightly together and push air up into your mouth, feeling the air build up behind your lips. Let the air push your lips apart creating a “pop.”
/b/ Press your lips tightly together and push air up into your mouth, feeling the air build up behind your lips. Turn your voice on and let the air push your lips apart.
/m/ Lightly press your lips together, turn your voice on, and let air flow through your nose, just like you are humming.
/n/ Open your mouth slightly and press the tip of your tongue right behind your front teeth. Turn your voice on and let air flow through your nose like you are humming.
“y” Lightly touch the back of your tongue to the roof of your mouth and pull the corners of your lips back. Turn your voice on and then move your bottom jaw down, pulling your tongue away from the roof of your mouth.
/w/ Round your lips and pull them close together in a tight circle. Then, raise the back of your tongue so it touches the roof of your mouth. Turn your voice on and then pull your jaw down and relax your lips.
/h/ Let your mouth rest slightly open. Quickly push breath through your throat.
/d/ Lift the tip of your tongue and place it right behind your top front teeth. Push your tongue, turn your voice on, and let your tongue drop slightly as you let the air burst through.

 

Middle 8 Emerging pronunciation development between ages 3-6.5, consistent production around 5.5 y/o
/t/ Lift the tip of your tongue and place it right behind your top front teeth. Push your tongue and let your tongue drop slightly as you let the air burst through your tongue.
“ng” Lift the back of your tongue to touch the roof of your mouth and turn your voice on, letting the air flow through your nose. Keep your voice on as you pull your tongue down away from the roof of your mouth.
/k/ Bring the back of your tongue up to touch the roof of your mouth while keeping the tip of your tongue down. Push your tongue up and then let a puff of air out between your tongue and the roof of your mouth as you pull your tongue slightly down.
/g/ Bring the back of your tongue up to touch the roof of your mouth while keeping the tip of your tongue down. Turn your voice on as you push your tongue up and then let a puff of air out as you pull your tongue slightly down.
/f/ Place your upper teeth on your bottom lip and push air through.
/v/ Place your upper teeth on your bottom lip and turn your voice on as you push air through your teeth and lip.
“ch” Touch the front of your tongue to the ridge behind your top front teeth and push your lips out (slightly rounding them). Let the sides of your tongue touch your upper back teeth to trap the air. Push a puff of air over your tongue as you let the tip of your tongue fall slightly.
“j” Touch the front of your tongue to the ridge behind your top front teeth and round your lips. Let the sides of your tongue touch your teeth to trap the air. Turn your voice on as you push a puff of air over your tongue as you let the tip of your tongue fall slightly.

 

Late 8 Emerging pronunciation development between ages 5-7.5, consistent production around 7 y/o
“sh” Touch the sides of your tongue to your upper back teeth, tilt the tip of your tongue down, and push your lips out (slightly rounding them). Push air over your tongue and through your front teeth.
“zh” (as in ‘treasure’) Touch the sides of your tongue to your upper back teeth, tilt the tip of your tongue down, and push your lips out (slightly rounding them). Turn your voice on as you push air over your tongue and through your front teeth.
/s/ Put your teeth together, slightly part your lips, lift the sides of your tongue to touch the insides of your top teeth, and bring the tip of your tongue down. Push air down the middle of your tongue and out through your teeth.
/z/ Put your teeth together, slightly part your lips, lift the sides of your tongue to touch the insides of your top teeth, and bring the tip of your tongue down. Turn your voice on as you push air down the middle of your tongue and out through your teeth.
Voiceless “th” Place your tongue between your top and bottom teeth and push air through.
Voiced “th” Place your tongue between your top and bottom teeth and turn your voice on as you push air through.
/r/ Pull the back of your tongue back and up. Press the sides of your tongue to the insides of your upper back teeth and slightly curl your tongue tip up. Turn your voice on and let the air flow through your mouth and over your tongue.
/l/ Lift the tip of your tongue and place it behind your top front teeth. Turn your voice on and let the air flow through your mouth as you let your tongue drop down.

If your child is continuing to struggle with one or many sounds past the age at which the sound is typically mastered by, a speech-language pathologist can help!

[1] Johnson, C., & Horton, J. (2009). Webber Jumbo Artic Drill Book Add-on (Vol. 2). Greenville, South Carolina: Super Duper Publications.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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Tackling Haircuts with Sensory Sensitivities

Performing everyday tasks can be especially challenging for children with sensory sensitivities. Going to the grocery store, running errands, getting dressed, and using the restroom are just a short list of activities that may be particularly daunting for your child.BlogTacklingHaircuts-Main-Landscape

As a pediatric occupational therapist, I hear about the most challenging everyday tasks for children with sensory sensitivities and am asked to give suggestions on how to make these tasks achievable for children. One of the most common concerns I get from parents of a child with sensory sensitivities is a child’s inability to tolerate haircuts. This is often accompanied with words like: screaming, having a fit, and inability to remain seated. The good news is that there are things you can do to make this experience more tolerable for your child.

Here is a list of some suggestions I have given to families and that I recommend for others to try. Select items to use depending on your child’s level of sensitivity, age, and ability to follow directions.

6 Tips to Help Sensory Sensitivities with Haircuts

  1. Have your child engage in a lot of heavy work and deep pressure input the weeks leading up to his/her haircut. Heavy work includes: pushing and pulling items, jumping, performing animal walks, etc. If you aren’t familiar with heavy work, read this NSPT blog that includes some ideas for activities at home. You could also search “heavy work for sensory processing” on Google and you will find many ideas. This should be done for approximately 10-30 minutes a day, 1-2 times per day depending on your child’s age and level of sensory sensitivity. This will help “wake up” the tactile system in order to process sensation better.
  2. Write a social story with images of what the child should expect when getting his/her hair cut. This will be a step by step guide to getting a haircut. Go through each step such as arriving to the hair saloon, sitting in a chair, putting a cloth around the child’s neck, etc. Read this to your child often, going through each step of the process.
  3. Play pretend barber shop. Take turns with your child sitting in a chair, wrapping a cloth around each others neck, and pretending to cut each others hair with safety scissors. Do this saying that we are practicing for your hair cut on X day. Do this at least a few times before the child gets a haircut. When doing this, take special note of things your child may have difficulty with. For instance, if he or she has a difficult time remaining seated, experiment with some fidget toys such as a stress ball or having the child hold his/her favorite stuffed animal. Does your child respond well to use of a weighted blanket or weighted vest? If your child has a difficult time sitting still you may want to experiment with these items during play to see if it helps. Provide these same tools during the time your child gets a haircut. Time the child while he/she is seated during play and applaud them for any amount of time they are able to sit still (a visual timer is best). Build up to having the child remain seated for the approximate time the hair cut will take. Again, applaud them for any amount of time achieved!
  4. Make a sensory tool kit with your child that includes items that calm him/her. Bring this tool kit with you on the day of the haircut and practice using it while playing barber shop.
  5. Start playing with your child’s hair a few weeks before the hair cut. If your child can tolerate hair brushing, engage in play with his/her hair a few times per week. Spike it up and do another hair style that the child enjoys or comes up with. Have the child do this independently (after providing them with the tools) the first time (if possible) and see if they will let you do it the next time. This may be a slow process with you only being able to help slightly. Build up to you doing it without the child’s assistance. If the child cannot tolerate hair brushing, start with one brush with the hair brush, and move up to 2 the next day, 3 the following day, and so on.
  6. Go to the barber shop one time before the child gets his/her hair cut. Have the child meet the person who will be cutting their hair and ask if the child can look around the barber shop.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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When to Be Concerned About Your Child’s Articulation of the L Sound

“I Wove You!” For young children, substitutions of the /l/ sound are common, but when should ‘wove’ become ‘love’? Blog/l/-Articulation-Main-Portrait

The /l/ sound is characterized as one of the ‘late eight’ sounds or, the later developing sounds in English-speaking children. Research has shown that 90% of children master the /l/ sound by 6;0. (Data from Templin, 1957; Wellman et al., 1931). (Sanders, 1972)

So…What Does This Mean for My Child?

In young children, these articulatory errors are developmentally appropriate and often resolve on their own. However, if you are noticing the persistence of these errors around 5 or 6 years of age, a speech and language evaluation might be an appropriate next step. An evaluation could be warranted sooner if there are other accompanying speech errors, or if you are concerned about your child’s overall ability to be understood.

How to Make the /l/ Sound:

This sound can be taught as “the singing sound”. The /l/ sound is made with the tongue elevated to touch the alveolar ridge or, the bumps on the hard palate behind the front teeth. Have your child watch your mouth as you say ‘la-la-la’, then, let her have a try.

Having your child practice in front of a mirror can be a particularly useful tool as well, giving her the opportunity to trouble-shoot her productions. Talk about the bumps on the roof of the mouth behind the front teeth as being the ‘magic spot’ where we want our tongue tip. If your child is comfortable with it, use a tongue depressor to touch the alveolar ridge if tongue placement is particularly difficult.

One of the most common errors associated with production of /l/ is called gliding, where /l/ is substituted with a glide sound (/w/ or /j/). If your child is substituting a /w/ for an /l/, it’s important to discuss relaxing the lips (or even having them in a slight smile) to avoid lip rounding.

Feel free to make this fun and interactive! Use a play dough head and make a tongue out of dough to demonstrate tongue tip elevation. Find what makes this interesting and salient to your child!

Shape the sound from one the child already has!

-Have your child prolong an ‘ahhhh’ sound and have her slowly elevate her tongue tip to the alveolar ridge.

-If your child is able to produce a /t/ or /d/, talk about having your tongue tip in the same spot for /l/ as for these sounds. Alternate between saying /ti/-/li/, /ti/-/li/.

Once your child is able to produce /l/ in isolation and in syllable shapes, begin targeting this sound in various positions in words (i.e., initial, medial, and final).

*It is worth noting that /l/ has two different placements depending on its position in a word. Light /l/ occurs at the beginning of a syllable (e.g., leaf), and dark /l/ occurs at the end of a syllable (e.g., milk).

Suggestions for Activities:

The /l/ sound is everywhere! Feel free to be creative.

Here are some activities to try out:

-Build a Lego tower and formulate two-word phrases (e.g, red Lego, blue Lego) as you build.

-Point out objects in your environment with /l/, or play I spy.

-Read a book with your child and have her produce some of the words with /l/.

The following books are heavily loaded with /l/ sounds:

Llama Llama Red Pajama, by Anna Dewdney

Five Little Monkeys Jumping on the Bed, by Eileen Christelow

Lyle, Lyle Crocodile, by Bernard Waber

The Luckiest Leprechaun, by Justine Korman

It Looked Like Spilt Milk, by Charles G. Shaw

Should you have concerns about your child’s articulation, consult with a licensed speech-language pathologist.

[1] Sanders, E. (1972). “When Are Speech Sounds Learned?”. Journal of Speech and Hearing Disorders, 37, 55-63.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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How is Torticollis Diagnosed?

Congenital muscular Torticollis should be a suspected diagnosis if your infant demonstrates a preferred head position or posture. Infants will present with reduced cervical range of motion, a potential palpable mass in the sternocleidomasoid muscle and/or craniofacial asymmetry.BlogTorticollisDiagnosis-Main-Landscape

A diagnosis is made by your pediatrician and can usually be done based on a simple history and physical examination. Physical examination findings may include:

  • Head tilt to one side
  • Reduced range of motion
  • Palpable SCM tightness
  • Absence of findings associated with non-muscular causes of congenital Torticollis

[1] Cheng JC, Tang SP, Chen TM, et al. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants–a study of 1,086 cases. J Pediatric Surg 2000; 35:1091.

[2] Kaplan SL, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther 2013; 25:348.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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My Child Vomits When I Encourage New Foods

If this describes your child, then it’s important to contact your pediatricianBlogNewFoods-Main-Landscape to rule out any food allergies, swallowing dysfunction, or other medical conditions, as these can lead to gagging or vomiting and need to be addressed. If you know that your child is not experiencing any of these challenges, then it’s likely your child struggles with oral hypersensitivity affecting his ability to tolerate different textures and temperatures of foods. Oral sensory aversion can negatively impact a child’s diet. There are many signs of oral hypersensitivity, but one sign that is concerning for many parents is vomiting or gagging with new foods. This often occurs when a child’s sensory system is overloaded, and as a result, his body perceives the new food as noxious.

When your child is a problem feeder due to hypersensitivity, mealtime often causes stress and discomfort for both the parent and child.

Here are 5 tips to reduce stress and help your problem feeder to conquer sensory aversion with new foods.

  1. Set aside a specific time each day to work on introducing new foods.

Mealtime is stressful as it is, adding new foods in the mix when you have a problem feeder on your hands can not only escalate your frustration, but can overwhelm your child’s sensory system. Setting aside a separate time to work on feeding with your child will help to reduce the demand, establish a calm and safe environment, and provide the structure of a daily routine that will help support your child in being successful.

  1. Warm-up, provide regulating oral and tactile input prior to beginning.

Your child’s sensory system needs to be in an optimal state of functioning for him to be able to accept novel foods. Providing regulating input prior to beginning feeding time can help to reduce sensitivity and also warm his system up to prepare him. Some regulating oral activities include blowing through a straw or biting on a washcloth. Consider tactile activities as well, such as finger painting, playing with dry rice or beans, or playing with putty or clay.

  1. Set the stage—Reduce additional sensory stimuli to avoid over-stimulation.

Prepare your child’s environment in order to support his success. This includes turning off the television and the tablet and reducing other visual and auditory distractions. Introducing new foods provides a lot of sensory input. By reducing additional stimuli in the room, a parent can prevent over-stimulation and help a child to more successfully interact with the foods presented.

  1. It’s ok to play with your food!

When working with a problem feeder with oral hypersensitivity, it’s very important to allow a child to feel safe playing with his food. This means that he will need to learn to interact with new foods, whether this includes eating the food or not. Start slow, with tolerating the food on the plate, working up to touching the food, and eventually bringing the food to his mouth. Children often require several exposures to a new food before they will feel comfortable trying it.

  1. Praise and encouragement for all improvements, no matter how small.

Remember that the new food that is causing your child discomfort or distress is noxious to his sensory system. Trying and interacting with new foods is hard work, and any progress made deserves praise. Remain positive and provide positive reinforcement for each new interaction your child has with a food.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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Applying ABA at Home

Does your child struggle with stereotypical or problem behaviors in your home? Are youBlogABAHome-Main-Landscape exhausted from constant redirection and monitoring? Do you need a change? Can parents utilize the basic principles of ABA at home with their kids? Yes! Here are some quick tips and tricks to help behavior management in your home by applying ABA.

Give Behavior Specific Praise

Always praise appropriate behaviors! Providing this type of positive reinforcement for good behavior will not only increase your child’s motivation but will also allow you to see more of those behaviors in the future. Throwing in a specific praise statement gives the child feedback on the exact behavior you want to see increased. For example, saying “Nice job!” is good, but saying, “Nice job packing your back pack!” is even better and you’re likely to see them packing their backpack the next day.

Offer Choices

Whenever possible offer your child choices. This can range from choosing when they take their bath to what shirt they wear for school and everything in between. Offering choices allows your child to be part of the decision making process, making transitions or undesired activities less of a hassle. The more choices, the better.

Provide Clear Expectations & Follow Through

Set clear, concise expectations for your child and follow through with them! Stating expectations before engaging in a specific activity gives the child a set of rules to follow. As a parent you’re able to refer back to these expectations as reminders throughout the activity. Once you set an expectation it should be followed no matter what (this is key!). Remember to provide attention and praise for followed expectations.

Don’t Prompt Too Soon

When your child is engaging in any daily living skills (tooth brushing, setting the table, tying shoes, etc.) allow them to perform the task independently before you assist them. This teaches independence and problem solving. If your child is struggling after 3-5 seconds of attempting, then provide prompting to help them complete the skill. We don’t want to see inappropriate prompt dependency.

Provide directive statements as opposed to questions

Make sure you’re communicating directions clearly. Instead of providing a question, give a directive statement that your child needs to follow. Sometimes we don’t even realize that we’re asking questions instead of directive statements. When asking a question, it gives the child the opportunity to respond with their choice; however, providing a statement only has one appropriate outcome. Changing, “are you ready for dinner?” to “it’s time for dinner” is a quick fix.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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How to Talk to Children About Death

Children suffer losses from losing a pet to a family member and how a child deals withtalk-to-your-children-about-death their first loss experience can establish a pattern in their life of how they will handle future losses. Grief is not one feeling or emotion, but rather a mix of emotions that guide the person through the healing process. Children often have questions about the finality of the loss that often times are the basis of many important and needed conversations between parents and their children. A kid’s understanding about death depends on their age, life experiences, and personality.

Preschooler’s Understanding of Death

Kids at this age have a difficult time understanding that all living things die and can’t come back. Their frame of reference might be seeing their favorite video game character come back to life over and over and not realize that this does not happen in real life.

5-9 Year Old’s Understanding of Death

5 to 9 year-olds typically begin to put together the difference between video game death and real life death, but often feel like that this could not happen to them. Often children will make up situations or other stories that put them in the hero role so they do not get hurt.

9-10 Year Old’s Understanding of Death

9 or 10 year-olds through teens have the understanding of what death means and the emotions that surround when someone passes away. Children of this age want solutions to why this could happen to them but also solutions to why they feel this way. They will look for ways to overcome these difficult times so it is best at this age to be open and honest with them and help them explore this time in their lives.

Remember, children develop at individual rates and have their own personal ways of managing their emotions.

Tips on Explaining Death to Children

  1. If at all possible, let children see the person who has died.
  2. Explain to children where they will see the person and how the person is different.
  3. Use the correct language – “Grandpa has died” or “Grandma is dead”: never use euphemisms.   Do not use phrases as Grandma went to sleep or went away. These explanations can lead young children to become afraid to go to sleep or worried when parents leave the house and “go away”.
  4. Ask someone – a relative, friend, or familiar sitter – to provide care for the children during the wake, funeral or memorial service. The designated person can keep track of the children, make sure they are fed, and answer questions they may have, take them out for a break or home if the day gets too long or they’re at the limits of their attention span.
  5. Be honest with them and encourage their questions and expressions of emotions. It is important that kids know they can talk about it (even if you don’t have all the answers) and be sad, angry, scared, or whatever emotions they feel.
  6. Kids often will repeatedly ask the same questions; it is how they process information. As frustrating as this can be, continue to calmly tell them that the person has died and can’t come back. Also, do not discourage their questions by telling them they are too young.
  7. Using the word “sickness” can be scary to young children. It is often helpful to explain to children that serious illnesses may cause death and although we all get sick sometimes, we usually get better again.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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Helping The Anxious Child Using Exposure Therapy

Anxiety and worry serves a biological purpose. It helps protect us from potential danger by pumping our body with the chemicals and energy to fight or flight. However, sometimes children (and adults) experience anxiety over situations that pose no danger.BlogExposureTherapy-Main-Portrait

What’s a parent to do in this situation? When your child expresses discomfort or anxiety over something benign, like riding a bike or the neighbor’s friendly dog, a parent’s first inclination is to do anything to alleviate that anxiety. For example, a parent with a child who begins to develop worry over sleeping in their own bed might allow the child to sleep in their bed because it eliminates that uncomfortable, anxious feeling. This approach might help in the moment, but avoiding situations that provoke anxiety often further perpetuates that anxiety. This fact is the underlying theory for exposure and response prevention therapy, a treatment approach for anxiety that has been empirically validated through multiple research studies.

How Does Exposure Therapy Work?

Exposure therapy involves creating a hierarchy of situations around a specific fear with the most anxiety provoking situation at the top. In treatment, therapists can support your child in developing this hierarchy, learning coping strategies, and providing exposure to each trigger on the hierarchy starting from the bottom. While exposure therapy is typically a short term therapy for mild to moderate cases (8-12 sessions), the goal is to go slowly and at the child’s comfortable pace. You only move on to the next step on the hierarchy when the anxiety provoked by the previous step has faded.

What is the One Simple Step Parents Can Take to Help Their Anxious Child?

Help them face their fears and not avoid them. Talk to your child about how you want to help them feel comfortable in that situation and ask them to identify baby steps to slowly work towards that comfort. Exposure therapy should only be done under the care of an experienced clinician. If your child struggles with specific fears or obsessive-compulsive symptoms, seek a skilled therapist to guide you and your child in overcoming these symptoms and improving their daily functioning.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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Zika Guidelines | What You Need To Know During The Outbreak

This Guest Blog Post was written by Dr. Kudus Akinde, MD FAAP of Glencoe Pediatrics.

Today, the World Health Organization (WHO) declared a public health emergency (AAP News). There is strong suspicion that recent clusters of fetal microcephaly are occurring in babies of infected mothers in areas where Zika virus transmission appears to be common. The CDC & the AAP have become involved in issuing recommendations to health care providers and to the general public in the matter.

Zika is a mosquito-borne flavivirus with RNA as its genetic material. It is transmitted by Aedes aegypti mosquitos. An estimated 80% of all people infected have no symptoms according to the CDC’s Morbidity and Mortality Weekly Report (MMWR) from Jan 22, 2016. The report goes on to explain that symptoms are usually mild with usually a few days of fever, rash, joint aching and pink eyes without mucus or pus buildup. No antiviral medicines exist to treat Zika virus. Treatment is supportive (acetaminophen, rest, oral fluids); avoid aspirin or ibuprofen in pregnant women.

So what’s the big deal about the Zika Virus? Infections happen all over the world. Right?

Well, it turns out that there are areas in the Caribbean, North and South America where children are being born with microcephaly (heads. therefore brains, that are abnormally small for their gestational age) or intracranial calcifications. This is a problem because these findings can be associated with a whole host of neurologic and developmental delays that can be lifelong in duration.

Since the outbreak is currently ongoing, it is difficult to make associations and good reliable information about infection during pregnancy is unavailable. As a matter of fact, pregnant women aren’t known to be more susceptible to infection with Zika virus than anybody else. It seems to infect people of all ages across the board. However, it can infect pregnant women in any trimester and if they are infected, the virus can be transmitted to the developing fetus in any trimester as well.

How To Prevent The Zika Virus?

All pregnant women should be screened for travel. If they haven’t traveled, they should strongly consider postponing travel to all endemic areas. If they do travel, they should practice strict mosquito avoidance. This includes:

  • Long-sleeved shirts and pants are preferred to the shorter varieties
  • EPA-approved insect repellants
  • Permethrin-infused clothing and other equipment
  • Using screens and air conditioning as much as possible

Pregnant women who have travelled to areas of ongoing Zika, dengue and chukungunya (similar flaviviruses with similar symptoms and also transmitted by Aedes mosquitos) infection should be tested according to CDC guidelines if they have symptoms consistent with Zika (fever, rash, pink eyes within 2 weeks of travel OR fetal microcephaly or intracranial calcifications after travel). Women wtihout symptoms and with normal fetal ultrasounds do not need to be tested according to current recommendations. If lab testing confirms Zika by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR), then prenatal ultrasounds to diagnose and monitor problems are recommended as well as Meternal-Fetal Medicine (MFM) specialist (high-risk obstetrics) or an Infectious Diseases specialist with expertise in the care of pregnant women. An antibody test also exists but the decision for which test to order should be made with/by the treating provider.

What Testing Can Be Done For The Zika Virus?

RT-PCR can be done on amniotic fluid but there are limitations to the testing. Amniocentesis carries higher risk of complications early in pregnancy (at 14 weeks or less) so it should be done at a minimum 15 weeks gestation. For babies born with evidence of Zika, testing should be done on available tissues (umbilical cord and placenta). In cases of fetal loss, RT-PCR should be done on fetal tissues as well (cord and placenta). There are no commercial tests available for Zika virus infection. The CDC and state public health agencies are the ones who can help with testing. ​

A Summary of the Zika Virus:

  • Zika virus infection is suspected of an association with clusters of fetal microcephaly and intracranial calcifications in many countries in North and South America as well as the Caribbean Islands.
  • Most infected people don’t even know they’re infected (up to 80%).​​
  • Pregnant women are being cautioned not to travel to areas Zika virus transmission. Pregnant women should be asked about travel at their pre-natal visits. If they have traveled and felt no symptoms of illness, they do not need testing.
  • Testing should be done for Zika virus (also dengue and chukungunya) on symptomatic pregnant women who have travelled to endemic areas.
  • ​​If testing is positive for Zika, serial ultrasounds and very specialized care with MFM or Infectious Diseases specialist with focus on pregnancy should be obtained.
  • If a baby is born with evidence of Zika virus infection, testing of the umbilical cord and placenta by RT-PCR should be done.
  • ​​If fetal loss occurs in a symptomatic mother with known travel to an endemic area, RT-PCR should be done.

*Special thanks to the CDC, WHO, and AAP for their leadership in this emerging matter.

 


Dr. AkindeDr ​Kudus Akinde, MD FAAP is the practicing physician at Glencoe Pediatrics in beautiful Glencoe, IL. Glencoe Pediatrics provides services including: sick or urgent visits, minor scrapes & bumps, annual check-ups, school physicals, camp physicals, sports physicals, pre-surgical physicals and more.  Dr. Akinde graduated from University of Illinois with a Bachelor of Science Degree in 1995. He attended the University of Illinois College of Medicine and obtained his MD in 2002. He completed his Pediatrics Residency at Rush University Medical Center in 2005.  He has practiced in various locales from small to large communities, urban, suburban and rural (including Rockford, Belvidere, Evergreen Park, Oak Lawn, Highland Park & Chicago, IL).  He has never met a kid he does not like.  His interests include newborn care, immunizations, nutrition, gastroenterology and adolescent issues.  He loves to spend time with his children when he is not at work.  He enjoys web browsing, bike riding, football, basketball, music and traveling among other things.

Beyond Time-Outs – What to do When Your Toddler Acts Out

When your child takes the crayons out of the closet and draws on the living Time-Out-Main-Landscaperoom walls, a common reaction would be to put him or her in time-out. After the time-out, your child goes back and draws on the walls again. What is happening? Sometimes, time-outs aren’t the best way to show your child what’s appropriate or inappropriate.

What is a time-out?

A time-out is a procedure that is used to decrease future occurrences of a specific behavior (e.g., drawing on the walls with crayons). There are many types of time-out procedures that can be utilized.

A time-out can be beneficial when the “cause” of the behavior is determined. A child engages in these behaviors to communicate his or her wants/needs. For example, if Jessie is playing on the playground with her peers and kicks David, Jessie may be attempting to remove David from playing on the jungle gym or gain attention from David to play with him. It’s important to pay attention to what happens right before and right after the behaviors occurs to help determine what your child is communicating to you.

Time-outs can be harmful when the person implementing the procedure overuses it and it becomes his or her “go-to” method for all target behaviors. Since time-outs are used to remove reinforcement for a portion of time, the procedure does not teach positive behaviors that the child can engage in instead.

There is evidence that time-out procedures are effective, however; other less restrictive methods, such as reinforcement, can be just as effective in isolation or in combination with time-outs.

What can you do other than a time-out?

Since time-outs can be very restrictive, interventions that include reinforcement and proactive procedures can help decrease the future occurrences of a problem behavior. They can also help reduce the need to use time-outs. Here are a few strategies that can help reduce problem behaviors:

Proactive Procedures (procedures that occur before a behavior):

  • Provide choices for activities/items (when possible): Select between two and three choices at one time to avoid overwhelming the child.
    • Example: If Johnny is about to eat dinner, you can provide him the choice of which vegetables to eat by saying, “Would you like carrots or peas with dinner?” This may decrease Johnny’s refusal behavior by allowing him to make his own choice, rather than being instructed to do something.
  • Give frequent reminders and expectations throughout the day: This can be in the form of vocal or visual displays (e.g., speaking to your child or showing him or her pictures of the expectations).
    • Example: If Debbie has a doctor’s appointment at 3 p.m., you can say, “Remember, you have a doctor’s appointing at 3 p.m., then we can get ice cream at your favorite store!” You can provide this reminder every two hours until 3 p.m.

Reactive Procedures (procedures that occur after a behavior):

  • Provide specific praise for appropriate behaviors: Specific praise includes the particular action that the child did in addition to the positive words (e.g., “Wow!” “Great job”) or actions (e.g., high fives, hugs) provided.
    • Example: If your child is politely asking his sibling for a toy she’s playing with instead of kicking her to gain access to the toy, say, “Awesome job asking your sister for the toy. That was really nice of you Billy.”
  • Ignore the problem behavior and only attend to the appropriate behaviors (if there is no immediate danger): You can help your child engage in the appropriate behavior by modeling or prompting the response.
    • Example: If your child is screaming to access the cookies on the top shelf, you can ignore the screaming and tell him, “If you want the cookies, you can say, ‘Can I have one cookie please?’” Then you can provide attention and praise when he complies with politely asking for the cookies instead of screaming.

Providing attention and praise to your child’s appropriate behaviors may help decrease the frequency of problem behaviors and need to use time-outs. To help with the use of time-outs and other intervention strategies to treat both appropriate and problem behaviors, contact a Board Certified Behavior Analyst in your area.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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