Why Meet with a Registered Dietitian?

At North Shore Pediatric Therapy, our registered dietitian, Stephanie Wells, MS RD LD, specializes in pediatric nutrition, and works with kids of all ages- preemies through adolescents. She is passionate about kids’ nutrition, and aims to alleviate parents’ concerns for their child’s nutrition status. Her background includes working in the pediatric ICU as well as a pediatric outpatient gastrointestinal clinic. Stephanie’s areas of expertise include food allergies, underweight or difficulty gaining weight, feeding difficulties, picky eating issues, specialized diets, constipation and diarrhea, gastroesophageal reflux disease, ulcerative colitis, Crohn’s disease, Celiac disease, overweight or obesity, nutrition for children with special healthcare needs, and managing gastrostomy tube feedings.Registered dietitian

Nutrition Facts:

As stated on the Academy of Nutrition and Dietetics’ website (www.eatright.org), “Registered dietitians are food and nutrition experts, translating the science of nutrition into practical solutions for healthy living. The expertise, training and credentials that back a registered dietitian are vital for promoting positive lifestyle choices. Registered dietitians draw on their experience to develop a personalized nutrition plan for individuals of all ages.”

Stephanie will spend quality time listening to what your family’s unique needs are, and then together, will create a nutrition plan that works for you. She can provide meal ideas, handouts, special diet materials, samples, and any tools or resources you need for you and your child to be successful in moving toward health.

Nutrition is a hot topic these days, especially childhood obesity. In an article published by USA Today on May 7, 2012, researchers report the country’s obesity rate will reach 42% by the year 2030 if current trends continue. Even more compelling- “ ‘If the obesity rate stays at 2010 levels instead of rising to 42% as predicted, then the country could save more than $549.5 billion in weight-related medical expenditures from now till 2030,’ says study co-author Trogdon.”* Of course, the monetary costs are not the only costs at stake with children dealing with obesity. There are also serious health consequences that can arise such as diabetes and high blood pressure, as well as the emotional effects.
Nutrition-related health issues such as obesity are often a result of daily habits over time. You may think, “My family’s diet isn’t perfect. But we are just too busy right now. Maybe next week we will make a change.” Make this week the week you meet with a registered dietitian to help make a change in your family’s diet.
*To read the full article on obesity in USA Today, go to http://www.usatoday.com/news/health/story/2012-05-07/obesity-projections-adults/54791430/1


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Trisomy, What Does It Mean?


The term Trisomy 18 has gotten significant media coverage in the last month as Rick Santorum’s daughter, who was born with the chromosomal disorder, was recently hospitalized. Santorum cites his family’s struggles with his daughter’s medical condition as a partial player in his decision to remove himself from the current political campaign. trisomyBut what, exactly is Trisomy 18 and how does this disorder and others like it effect children? The following is a brief review of three trisomy disorders, from a Speech-Language Pathologist’s perspective.

The Three Trisomy Disorders:

Trisomy 18

Trisomy 18, also known as Edwards syndrome, is a chromosomal disorder (1 in 3000 births) that results from the formation of three copies of a the 18th chromosome, instead of two. Children born with this chromosomal disorder experience significant and life-threatening medical issues which cause high mortality rates; less than 50% of children born with this disorder live past their 1st birthday. Children who do live longer require intensive medical attention to treat kidney and heart defects, digestive issues, as well as complications related to craniofacial anomalies (small jaw, small head, irregular shaped head, or low-set ears). Each child born with this disorder experience individual challenges and treatment should be provided to meet that child’s specific needs.

Trisomy 21

Trisomy 18 is just one of several disorders which result from the creation of a third copy of a specific chromosome at conception. The most common of these disorders is Trisomy 21, or Down syndrome (1 in 800 births). Children born with Down Syndrome also meet many challenges, however these children live into adulthood and are likely to require various levels of medical, therapeutic, and academic support to reach their potential and highest level of independent functioning. Children with Down syndrome experience gross developmental delays as well as a varying degree of intellectual disability. Children with Down syndrome exhibit distinct craniofacial features, including a small oral cavity which impacts speech production and feeding. Hearing concerns are also prevalent in this population of children. These children benefit from speech and language intervention to encourage both increased speech intelligibility as well as to develop higher level language skills.

Trisomy 13

Trisomy 13, or Patau syndrome (1 in 10,000 births) is typically diagnosed before or immediately after a child is born due to the high instance of craniofacial anomalies, including cleft lip and/or palate, small head size, small eyes, and irregular ear shape. Cleft lip and/or palate will cause immediate feeding difficulties for which specialists, including a Speech-Language Pathologist or Occupational Therapist, will be involved in assisting families to ensure safe feeding, often through use of alternative bottle nipples . Many children with Trisomy 13 will have congenital heart defects, defects in the formation of their brains, as well as kidney defects. These children experience a high infant-mortality rate, and those who live through their childhood will experience significant developmental delays, for which a team of professionals including Occupational Therapists, Physical Therapists, Speech-Language Pathologists, Audiologists, Nutritionists, and others should be involved in providing a comprehensive and individualized plan of care.

It is important to note that children born with any of the Trisomy disorders do not experience this chromosomal abnormality due to any actions taken by their parents. It is a chromosomal irregularity that occurs at conception and is not the fault of either parent. Please visit http://www.trisomy.org/ for more information, and to support the children and families affected by these disorders.

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Fine Motor and Gross Motor Activities to do with Sidewalk Chalk this Summer

Summer is the perfect time to get outside with your child to enjoy the sunshine and fresh air. Summer also offers the chance for your child to unwind a bit, and take a break from all the demands placed on him at school. However, it is still important to keep your child active and engaged throughout the summer months, so that he stays in somewhat of a consistent routine and keeps his mind fresh and in tip-top-shape for the upcoming school year. Here are some fun and simple ways to incorporate fine motor and gross motor activities into your everyday summer routine using an already preferred activity, sidewalk chalk,

Here are a variety of options to explore with chalk:

  • Hopscotch: Create a hopscotch board out of chalk (typically alternating 1 square, 2 squares). This activity addresses fine motor and visual motor skills to draw the squares and write numbers inside of the squares. It also addresses trunk control, balance, and motor planning to complete single-leg hops and two-footed hops into each of the squares. You could also challenge your child to complete animal walks inside the hopscotch board instead (e.g. crab walks, bunny hops, frog jumps).
  • Tic tac toe: Have your child draw a tic tac toe gameboard on the sidewalk or driveway. Little girl playing sidewalk chalk gameThis activity addresses fine motor and visual motor skills to draw horizontal and vertical lines, turn-taking, problem solving and sportsmanship.
  • Hangman: Take turns coming up with a “secret” word for the other player to guess, and create a hangman board. This activity addresses fine motor and visual motor skills needed for handwriting, as your child has to write out the letters which appear either in the “secret” word, or get placed into the word bank. It also addresses executive functioning skills as your child has to memorize which “secret” word he chose, and has to remember how to spell the word correctly, and which order the letters go in.
  • Road: Help your child to draw a pretend road which he can then either ride his bike through or drive his toy cars through. This activity addresses fine motor and visual motor skills required for drawing (e.g. have your child create road signs as well). And if using the road for bike riding, this activity addresses motor planning to get through the road without crashing into the chalk lines, and balance and trunk control to navigate the bike. If using toy cars, this activity can focus more on imagination and possibly social skills, if your child is playing with peers.
  • Baseball diamond: Create a baseball field out of chalk (e.g. home plate, pitcher’s mound, and the bases). This activity addresses fine motor and visual motor skills to draw the diamond and circles or diamonds for the bases, and potentially letters/numbers for a team name and scoreboard. It also addresses ball skills, bilateral skills, and hand-eye coordination to play the actual game of baseball, along with sportsmanship and turn taking.
  • Four square: Draw a four square game board, which includes one large square divided into four equal squares (one for each player). This activity addresses fine motor and visual motor skills to draw the squares, and write the letters inside the boxes. It also includes ball skills, such as dribbling and bounce passing, in order to keep the ball out of your own square. Similarly, this game addresses sportsmanship and turn taking.

Note: Try making your own sidewalk chalk using 2 tablespoons of temper paint, ½ cup of water, and 3 tablespoons plaster of Paris. Directions: In a five-ounce paper cup, mix 2 tablespoons temper paint with one-half cup water. Add three tablespoons of plaster of Paris and stir until you have a creamy consistency. Once hardened (several hours), peel off the paper cup to produce a giant piece of sidewalk chalk.

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Strategies to Work Through Bath Time Difficulties

As I discussed in my previous blog, typically bath time is either an extremely preferred activity or a least preferred activity for parents and children alike, as there are many sensory components involved with bath time. When bath time becomes a least preferred activity it can become a dreaded weekly event and can cause extra stress for the entire family. Here are some ways to make bath time a positive experience.

Strategies To Help Your Child Enjoy Bath Time:

  • Finger paint: incorporate bathtub paint or shaving cream into the bathing process. This will help to give more of a tactile experience for your child, in addition to the shampoo and body wash. Allow your child to paint his own masterpiece, or challenge him to draw specific shapes and letters/words on the bathtub walls. If your child is not interested in the child happy in the bathpaints or shaving cream, or demonstrates aversion to the textures, allow him to first be exposed to the paint/cream by squirting some onto the bathtub walls for him to simply look at. Next, have him use a paint brush to poke at the paint/cream, until he is eventually ready to put his finger into the paint/cream.
  • Mohawk: help your child to create silly hairstyles with the shampoo suds in his hair or play beauty parlor. Bring a mirror for him to look in to check-out all of the different crazy styles. This will ideally help your child to be more willing to have his hair washed.
  • Bathtub party: put your swimsuits on and join your child in the bathtub for a “pool party”. Or set-up a “playdate” in the bathtub with a friend, if okayed by the child’s parents. Bring a beach ball or beach toys (e.g. bucket or watering can) into the bathtub to help promote splashing and pouring water. Help your child to see that it is not a scary experience, and remind him that everyone needs to take a bath.
  • Cover his eyes: have your child hold a washcloth over his eyes to prevent soap or water from getting into his eyes (if this is a fear). Similarly, you could try having your child wear a headband, a visor, or goggles to help keep the water from dripping in his eyes.
  • Squirt toys: have your child get his own hair wet using squirt toys. Squirt toys allow for a small stream of water to come out, rather than dumping a lot of water all at once. Squirt toys also allow your child more control over the situation, which can help him to feel more comfortable.
  • Ultra absorbent towel: use a microfiber towel to help dry off the water quicker, and also to provide a softer and gentler material against your child’s skin and hair, as some towels can be scratchy and rough. This will ideally help to end bath time in a positive way.

Bath time is an activity that not only must occur each week, but that will occur the rest of your child’s life. Therefore, it is important to make bath time a smooth and enjoyable routine as soon as possible. Remember to be conscious of all of the senses your child is required to use during bath time (e.g. touch, smell, sounds), especially those which your child may have hypersensitivities to. Make sure to listen to and acknowledge your child’s fears and concerns, and help him to work through the activity one step at a time. Like many situations, patience is definitely a virtue, but when bath time is mastered for a child who has sensory hypersensitivities, it will feel like an amazing accomplishment for both you and your child.

For any additional questions or concerns, reach out to an occupational therapist for further assistance.

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Food Allergies in Children

This week is Food Allergy Awareness week (May 13-19). For many of us adults, it is surprising how many children these days have food allergies. We peanut butter allergyremember bringing birthday treats to school, and all eating at the same table in the school lunchroom. Today, many schools have banned edible birthday treats altogether, and have designated “allergen free” tables at lunchtime. The grade school my mom teaches at has signs posted on the classroom doors that read “Nut-Free Classroom.”

The answer to the question “why have food allergies become more prevalent?” is still being investigated. A food allergy involves an IgE-mediated immune response in which the immune system reacts to protein fractions in foods, producing a variety of symptoms for different people. A food intolerance does not actually involve the IgE immune response, but still produces symptoms. In either case, strictly avoiding the particular food is the best treatment.

There are eight common food allergens, which the Food Allergy and Anaphylaxis Network estimates account for 90% of all food-allergic reactions:

8 Common Food Allergies:

  1. Wheat
  2. Soy
  3. Dairy
  4. Eggs
  5. Peanuts
  6. Treenuts
  7. Fish
  8. Shellfish

Diagnosing Food Allergies:

Diagnosing food allergies can be somewhat tricky, as blood tests that look for elevated IgE markers in response to certain foods can produce false positives and false negatives. Symptoms present differently depending on the individual, and can be severe as in the case of anaphylaxis. Other signs and symptoms are less obvious, and may be overlooked as a possible food allergy. Some I have seen in the clinical pediatric setting include:

Signs of a Food Allergy:

  • Rhinitis (aka “runny nose”) or general congestion
  • Chronic ear aches (resulting from congestion)
  • “Allergic shiners” which are dark and/or swollen circles under the eyes
  • Asthma
  • Eczema
  • Diarrhea
  • Blood or mucus in the stool
  • Vomiting or reflux
  • Suboptimal growth or a slowing of growth

A definitive way to determine food allergies or intolerances is through an elimination diet. A registered dietitian can educate parents and children on how to do an elimination diet successfully, which can provide clear answers and a path to better health. The elimination diet is also useful for breastfeeding mothers whose infants are showing signs of possible food allergy or intolerance.  A registered dietitian can also provide education and alternatives for infants who are formula fed and not tolerating standard infant formulas.

Once a food allergy or intolerance has been identified, a registered dietitian can also provide education and guidance for families on how to eliminate the food (and all forms of it), as well as alternatives that can be consumed.  At North Shore Pediatric Therapy,  an experienced pediatric registered dietitian can help your child feel the best he or she can, food-allergy free.

Click here to schedule a nutrition consult

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What is the Vestibular System | Pediatric Therapy TV

In today’s webisode a Pediatric Occupational Therapist explains to our viewers what the vestibular system is.  Find out more on the vestibular system from our conditions page by clicking here Click here to read a blog on Vestibular Senses

In This Video You Will Learn:

  • What the foundation of the Vestibular System is
  • What Receptors are
  • How the Vestibular System relates to our bodies

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide audience, this is Pediatric Therapy TV, where we provide experience and innovation to maximize your child’s potential. Now your host, here’s Robyn. Robyn: Hello, and welcome to Pediatric Therapy TV. I am your host, Robyn Ackerman. Today I am sitting here with Dana Pais, a Pediatric Occupational Therapist. Dana, can you explain to everybody, what is the vestibular system? Dana: The vestibular system is part of your nervous system and it’s actually located in your inner ear. It is the foundation for the sensation of gravity and it responds to changes in head position, and it also contributes to balance and equilibrium. There are two vestibular receptors. One responds to gravity and the other responds to movement. The interaction of these two receptors tells us where our body is in space and how our body is moving. Robyn: Thank you so much for explaining that, and thank you to our viewers. And remember, keep on blossoming. Announcer: This has been Pediatric Therapy TV, where we bring peace of mind to your family with the best in educational programming. To subscribe to our broadcast, read our blogs, or learn more, visit our website at LearnMore.me. That’s LearnMore.me.

Why Is My Child So Picky About The Clothes He/She Wears?

We’ve all put on a wool sweater or scarf that feels really itchy and irritating on our skin. You feel in constant discomfort all day long when you move the slightest bit, its distracting for you all day, and you promise yourself you’ll never wear it again. Kids with tactile hypersensitivities experience this on a daily basis with many types of clothing, causing them to become picky about what they put on their bodies.

A typical tactile system will feel a light touch stimulus, such as a t-shirt on your body, and will quickly adapt to the feeling, so that the nervous system and tactile system no longer notice it is touching the skin. This allows us to wear clothes all day, and not notice or feel irritated by the constant touch on our bodies. The tactile systems of children with hypersensitivities never adapt to the light touch feeling, and are, therefore, constantly aware of it, constantly irritated by it, and constantly distracted by it. Some children may be so sensitive to touch that they perceive the touch of clothing as painful. Children with tactile sensitivities may begin to be rigid about the types of clothing they will put on their bodies, tending to prefer anything that is very soft, and/or seamless, so that it is more tolerable for them and allows them to function better throughout the day.

Suggestions to try to expand your child’s repertoire of clothing include:

  1. Wash your child’s clothing several times to achieve a “worn in” affect. Use LOTS of fabric softener.boy sensitive to clothes
  2. Purchase the softest fabrics you can find, particularly cotton, fleece, and flannel. There are also websites that specialize in extra soft clothing, such as http://www.softclothing.net.
  3. Try wearing socks inside out, or purchase seemless clothing (such as socks, shirts, and undergarments), some suggested sites are http://www.smartknitkids.com/.
  4. Take your child shopping and allow him/her to choose what you purchase. Make a fun day of it!
  5. Allow your child to choose and lay out his/her own clothing the night before school
  6. Remove all tags, embroidered emblems, cuffs and waistbands, or other potential irritants
  7. During and after the shower or bath, try doing firm rub downs to the arms, legs, back, neck, hands and feet, avoiding the stomach and face as these are very sensitive areas. Start with soap or lotion, and firm, deep pressure. When this is tolerated, move to soft washcloths, then rougher washcloths and towels, and to sponges and loofahs as your child’s tolerance increases and his/her sensitivity decreases. Doing this consistently and as often as you can, ideally several times a day, will have the greatest results.
  8. Massage with lotion after bath time. The deep pressure is calming and may help to decrease tactile sensitivities.
  9. Explore different snug fitting clothing to be worn alone or under regular clothing, such as tights, or leggings; lycra / spandex undershirt that fits very snugly; or a “compression shirt” or other compression garments, such as a SPIO. Snug fitting garments will give some calming deep pressure input, and it will also keep the “itchy” clothing off the skin directly.
  10. Messy play may help decrease tactile sensitivities- Such as shaving cream; finger paint; dry rice/bean bins; cooking with your hands, such as kneading or mixing.

If your child has tactile sensitivities which are causing disruptions and challenges to his/her daily functioning or the functioning of your family, consult an occupational therapist. Seek out an occupational therapy evaluation for expert assistance in working to overcoming this challenge.

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Why Doesn’t My Child Like Bath Time?

Typically bath time is either an extremely preferred activity or a least preferred activity for parents and children alike, as there are many sensory components involved with bath time. Bath time is supposed to be a relaxing and enjoyable experience, which can ideally calm a child down before bedtime or help to wake a child up in the morning before starting the day. boy not liking bathWhen bath time becomes a least preferred activity it can become a dreaded weekly event and can cause extra stress for the entire family. Here are some reasons why your child may not like bath time.

5 Reasons Your Child May Not Like The Bath:

  1. Tactile system: your child feels the temperature of the water against his skin (e.g. hot, cold); he uses a variety of bubbles and shampoos which can be slippery and foamy; he uses a washcloth and towel which can be rough and scratchy
  2. Vestibular system: your child tips his head back for hair washing, causing his head to be out of the midline position and a change in the position of his ear canals
  3. Auditory system: your child hears the water running and splashing, which may be amplified if the bathroom has an echo or if he takes a bath with siblings which can increase the noise level
  4. Olfactory system: your child smells the different products (e.g. shampoo, body wash, bubble bath) and different environmental smells (e.g. the blow-dryer sometimes has a burning smell)
  5. Oral motor system: your child feels the water on his lips as he blows bubbles through his mouth or holds his breath during hair washing as to not get soap or water in his mouth

Similarly, your child may also have fear of the water, just as he would at swimming lessons (e.g. putting his face into the water, getting water in his eyes, or having a “bad” experience prior and he is now scared to do the same activity again- such as slipping underwater unexpectedly or falling on a slippery surface as the bathtub or pool deck can be very slippery). If this is the case for your child, it is important to help him to work through his fear and regain confidence and control over the situation. This can be done by talking through each step of bath time with your child and gearing him up for the activity before it even begins. Stay tuned for my next blog which will address strategies to work through these bath time difficulties. Note: If any of the above qualities apply to your child, talk with an occupational therapist to work through these sensory hypersensitivities.

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Tummy Time Frequently Asked Questions

What exactly is tummy time?

Tummy time is either:

  • Supervised time when your child is laying on a firm flat surface on her tummy.
  • When your child is being in a position where she is face down and has to lift her head up against gravity.

Why does my child need tummy time? Why is it so important?tummy time

  • Studies have shown a link between slowed achievement of developmental milestones and diminished tummy time in babies.
  • Tummy time builds the muscles in your child that are necessary for advanced movements like crawling, walking and (gulp) running.

My child always cries during tummy time, what should I do?

  • Lay on the floor with your child. Babies are often frustrated because they have less ability to interact with the world when they are lying on their tummies, and if they can see your face (and your smile), they may calm down. You may also utilize mirrors or toys to distract them when they get frustrated.
  • Try a “tummy time alternative.” This can be carrying your child face down in a “superman” position or sit with them supporting her trunk and tilt her forward so her shoulders are in front of her hips.
  • As your child gets stronger (and more able to lift her head and play with toys in this position) she will enjoy tummy time more and more.

What can happen if I don’t give my child tummy time?

  • If the child is always on their back, it increases the risk of flattening portions of their head, and if they do not move their heads around in all directions, it increases their risk of developing torticollis.
  • There may be slowed attainment of developmental milestones such as independent sitting, crawling, and walking.

How much tummy time should my child be getting?

  • The goal is that by 6 months of age, your child should be on their tummy 50% of her play time (not including feeding time, bath time, or sleeping time). Remember that this is a goal to work towards and not to be expected the first day you introduce tummy time.

 How old should my child be before I begin tummy time?

  • You may introduce tummy time on day 1, as long as there are no medical complications whereby your pediatrician would recommend avoiding tummy time.

***Most importantly, babies should always be placed to sleep on their back, and supervised when on their tummy***

Click here to watch a 2 minute webisode on the Importance of Tummy TIme

Click here for a printable copy of this blog

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3 Tips For A Bed Time Routine | Pediatric Therapy TV

In today’s webisode, a Board Certified Behavior Analyst gives viewers 3 practical tips on how to get your child into a bed-time routine.    Read this blog for more bed-time routine tips:

In This Video You Will Learn:

  • What type of bed-time schedule to create
  • Why consistency matter when starting a bed-time routine
  • At what time to start your bed-time routine with your child

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide audience, this is Pediatric Therapy TV, where we provide experience and innovation to maximize your child’s potential. Now your host, here’s Robyn. Robyn Ackerman: Hello and welcome to Pediatric Therapy TV. I am your host, Robyn Ackerman, and today I’m standing with a behavior analyst, Katie Sadowski. Katie, can you please give our viewers three tips to getting a child into a bedtime routine? Katie Sadowski: Yes. In regards to getting your child into a bedtime routine, that is something that can be tricky. One thing that is very helpful is creating a schedule. With this schedule, it should be a visual schedule so that the child can see the different pictures. You want to incorporate the different things that need to be done in the bedtime routine. If the child is age appropriate, he should definitely be involved with helping create this schedule. Some things that should be in a bedtime routine schedule would be things like taking a bath, putting on your pajamas, brushing your teeth, getting a drink of water, picking a friend to go to bed with so his favorite teddy bear or maybe just a favorite doll, any kind of stuffed animal that your child likes, as well as reading a book, and then saying goodnight. With this schedule, you want to make sure that any of the activities you use, they are calming. You don’t want to be having activities that would get your child very energetic and hyper. That would defeat the purpose. Also when you are using the schedule, you want to make sure that you pick a time and stick with that time. In regards to the time, you would want to start the schedule about an hour before so that the child is actually done with the schedule and sleeping when you do want him in bed. So, for example, if you want your child sleeping at 7:00, you would start the schedule at about 6:00. Also, with the schedule, it’s very helpful if you can make it to where the kid can put a sticker or a checkmark after he completes each activity. That way, he can see the different steps that he’s completing and how that accomplishments. And one more thing that, at the end, after your story and you say your goodnights, you do then want to go ahead and let your child know that you are going to come back and check on them to make sure they’re sleeping. You don’t want to let your child think, well, mom and dad are gone, so now I can go play or I can sit up and do what I want. Give them that warning that you will be back, and if you do come back and they are up, just say, “Okay, goodnight. I’ll be back a little later.” And that’s something that can definitely help get your child in a routine. Robyn; All right. Thank you so much, Katie. Katie: You’re welcome. Robyn: And thank you to our viewers, and remember, keep on blossoming. Announncer; This has been Pediatric Therapy TV, where we bring peace of mind to your family with the best in educational programming. To subscribe to our broadcast, read our blogs, or learn more, visit our website at LearnMore.me. That’s LearnMore.me.