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infant physical therapy

Physical Therapy For Infants

If you have ever thrown out your back helping a friend move or torn your meniscus playing basketball at the gym, chances are you attended physical therapy somewhere on your road to recovery. So when your Pediatrician recommends that your 7 month old attend physical therapy to help with head control, you may ask yourself, “What is physical therapy for infants?”

Physical Therapy for Infants:

First off, your right to assume that physical therapy for infants is going to look at lot different than the physical therapyinfant physical therapy you received after knee surgery. While all physical therapist must attend accredited Masters and Doctorate of Physical Therapy programs, the areas you can specialize vary greatly, from an outpatient center where people go after surgeries and sport injuries, to a burn unit where physical therapist are helping patients maximize range of motion. A physical therapist who specializes in pediatrics has learned how to achieve similar strength gains, increase range of motion, and functional improvements, with children.

One of the main differences between physical therapy for infants and physical therapy for adults is the idea of parent education. In order to maximize gains, exercises must done multiple times every day. Since it is not feasible for a physical therapist to perform all of these repetitions, they must act as educators to the caregivers, teaching handling techniques and updating exercises as the child progresses. Much of each physical therapy session is spent on updating and educating this home exercise plan.

Now we come to the next major difference between infant and adult physical therapy: exercises. How can an infant exercise?? Are there baby weights they should be using?? Most of the exercises an infant does are going to be greatly different than the ones you or I would perform. Because they are growing everyday, most functional movements are in fact a form of exercise for them, allowing their muscles to get stronger and building the foundation for all gross motor skills. Each home exercise is tailored to the child’s specific needs and growth over time. So depending on what your child was referred to physical therapy for their home exercises could include play time while laying on a specific side, learning to transition into or out of sitting, or stretches while having them turn to the left.

While the differences between infant physical therapy and adult physical therapy are many, the foundations remain the same. The physical therapist is looking for physical deficits in strength, range of motion, balance, etc, that are negatively impacting a person’s performance in a specific activity, whether that be jumping and walking up stairs, or crawling and holding their head up.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview 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!

Baby Sleeping

Babies, Misshapen Heads, and Plagiocephaly Helmets: a Physical Therapist Perspective

A majority of the babies I see in the clinic are those diagnosed with torticollis and plagiocephaly. These babies are often accompanied by bewildered first-time parents with worried looks, scared by those big diagnostic words. The first questions they ask are “could I have prevented this?” and “will he need a corrective helmet?”

What is plagiocephaly and what causes it?

Since the beginning of the “Back to Sleep” program in the 1990s, which kept babies off their tummies to prevent Sudden Infant Death Syndrome, many babies started to develop flat spots on the back of their heads. Plagiocephaly and brachycephaly are two terms used to describe the abnormal head shape, depending on the degree of distortion and location of the flatness. While most parents think they were partially responsible for the flat spot developing in their newborn, an infant’s head is extremely malleable before it reaches cranial maturity. Any prolonged external force leads to some skull shape changes. Plagiocephaly and brachycephaly can be associated with many conditions, from prematurity and twin births, to torticollis (asymmetrically tight neck muscle), to developmental delay. Often times, the asymmetries are resolved with simple repositioning and stretching exercises to encourage the child to look to both sides, physical therapy, as well as nap and play time on the tummy, all with supervision of course.

How do plagiocephaly helmets work and what’s the best time to get one?

Plagiocephaly helmets are cranial orthoses made out of a hard plastic shell with Baby Sleepingfoam lining, custom made to each child, and designed to keep pressure off the flat spots to help the head naturally round itself out. They are meant to be worn for 8-12 weeks for at least 23 hours a day, during sleep and play. Certain hospitals, orthotics companies, and plastic surgeon’s offices design their own version of the helmets, but the concept is still the same.

The earlier a child with torticollis and plagiocephaly starts a repositioning and physical therapy program, the less likely he will need a skull reshaping orthosis. As physical therapists, we usually recommend a helmet evaluation if 1) A baby has been repositioned off his flat spot and participating in physical therapy for 1-2 months without any significant changes noted to his head shape, 2) A baby has spent 1-2 months sitting independently with good head control and playing easily in tummy time, and moderate to severe plagiocephaly is still present, or 3) A baby is over 6 months of age and facial asymmetries are still obvious. Usually, helmets are not expected to be effective for kids over 18 months.  What facial asymmetries do we look for as an indication of moderate to severe cranial change? A smaller chin on the affected side, a smaller ear or an ear that’s shifted forward, and a smaller or droopy eye on one side are examples. Of course, every baby develops differently and other factors may be taken into consideration, such as if his abnormal head shape is keeping him from achieving gross motor milestones (rolling, head control, etc).

Do helmets actually help? Aren’t all of our heads a little bit asymmetrical? What happens if my child doesn’t get one?

In its early years, the infant helmet received a bit of scrutiny. The biggest push-back from some insurance companies and doctors against cranial helmets is that asymmetrical head shape in babies appears to be a cosmetic complaint that hardly justifies a costly and bulky orthosis. Parents and practitioners alike question the association between deformational plagiocephaly and long-term functional delay in kids. There has been research over the last two decades on whether helmets alone prevent long-term asymmetries, if cranial asymmetries lead to other medical issues, or if neurodevelopmental delays occur in school-aged children with plagiocephaly. While the literature is still young and long-term research is still in the works, untreated cranial asymmetries have been linked to visual defects, ear infections, middle ear malfunction, jaw bone changes, developmental delay, learning difficulties, and other psychomotor delays.

In a brand new study out of the Netherlands this month, researchers found that helmet therapy alone yields similar results to natural cranial growth. The study, however, focused only on babies with mild plagiocephaly, not torticollis, prematurity, or other associated conditions. Babies with severe plagiocephaly were also not included in the study, which limited the population to a very specific, underrepresented, group in pediatric clinics. Interestingly enough, the study found that by the time their child was 2 years old, parent satisfaction was much higher and parent anxiety was slightly lower in the group who received helmets. Even in this study suggesting the ineffectiveness of helmets, the authors referenced other studies that discussed the long-term implications of letting deformational plagiocephaly go untreated. These included researchers from different fields, such as neurology, child development, physical therapy, orthotics and prosthetics, and plastic surgery. Overall, developmental experts agree, long term consequences of untreated plagiocephaly are multi-faceted and future research is imperative.

Because physical therapists like us have no association with helmet companies, doctors’ offices, or orthotists, our recommendations are purely based on the child and family’s needs. What I always tell anxious parents trying to make this decision of whether or not to try the cranial orthosis helmet with their child is this:

Helmets are not right for every baby with cranial asymmetry. The results you can get out of a helmet depends on the fit, consistency of wear, and the baby’s growth. The most effective time period to make the most changes to a baby’s head is short. Don’t let a medical professional bully you into making a decision you aren’t comfortable with. At the same time, take on a wider perspective when trying to make this decision. Have we done all the necessary exercises and reposition changes? Have we taken into consideration medical advice from all the different health professionals involved in your baby’s care? Did the helmet evaluation (with measurements done by machines for precision) reveal moderate to severe cranial changes? Are you worried about side effects or costly interventions that might be needed down the road? These are great questions to talk out with your pediatrician or physical therapist.

In my clinical experience, I have never had a parent regret the decision they made, whether it was to seek out a helmet evaluation or to forgo helmet therapy. Though often it was a hard decision to make, we were able to work through the questions together to determine the best course of action for their precious little one’s all-important noggin.

 

Do you still have questions or have experience you want to share? Please let us know!



References:

Kordestani R, Patel S, Bard D. Neurodevelopmental Delays in Children with Deformational Plagiocephaly. Plastic and Reconstructive Surgery 2006;117:1. Available from: www.plasreconsurg.org. [accessed 15 April 2014]

Miller RI, Clarren SK. Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics 2000; 105:e26. Available from: http://pediatrics.aapublications.org/content/105/2/e26.full.html. [accessed 15 April 2014]

Stevens, P. Beyond Cosmetic Concerns – Functional Deficits Associated with Deformational Plagiocephaly. April 2012. The O&P EDGE. Available from: http://www.oandp.com/articles/2012-04_02.asp [accessed 15 April 2014]

Van Wikl RM, van Vlimmeren LA, Groothuis-Oudshoorn CGM. Helmet therapy in infants with positional skull deformation: randomized controlled trial. BMJ 2014;348:g2741. Available from: http://www.bmj.com. [accessed 12 May 2014]

 

Baby crawing

Common Physical Therapy Red Flags at Pediatrician Well-Visits For Baby’s First Year

First time parents don’t quite know what to look forward to when visiting their pediatricians during their child’s first year. Other than immunizations, growth measurements, and nutritional concerns, what else is there to discuss? Each well-child visit is a brief meet-up to assess the child’s growth and development. A red flag is an early warning sign that something is not developing typically and need to be addressed by a specialist.

Below are some physical development related red flags to discuss with your doctor on each of your child’s well-visits. Any one of them could warrant a follow-up visit to a physical therapist to ensure appropriate gross motor development. Early detection and early intervention is important and many red flags should not be dismissed.

1 month

– If your baby prefers to sleep with his or her head turned to one side, be mindful of a flat spot that might start to develop. Switch the side she lies on in her crib and alternate the direction of stimuli.

– Babies at this age should hold their limbs and trunk in some flexion, with random movements here and there. If your baby prefers to lie limply on his back with every limb spread out, pushes into extension with trunk and limbs that seem to stiffen up with every movement, or show difficulties with moving his or her head side to side, bring it up with your pediatrician.

2 months

– If you continue to notice a flat spot or a head turn preference when your baby sleeps on her back at month two, it might be good to bring it up with your doctor.

-At this time, babies are gaining more and more strength in their neck muscles.  In sitting, their heads are more upright though continues to bob. If you don’t see your baby using his or her neck muscles at all, it may be a sign of slow development.

4 months

-This is the month of increased symmetry. If your baby continues to prefer to sleep, sit, and play with head only to one side, try to encourage him or her to play with their head in midline.

-A baby on his tummy at 4 month should be able to push up onto his arms and hold his head up.  Red flag behaviors to ask your doctor about include: difficulty lifting head up, stiffening in his legs with little or no movement, pushing back with his head as opposed to lifting it forward when trying to roll, and fisted or lack of arm movements.

6 months

-At 6 months, a babies are sitting up and holding themselves up in sitting. They can also roll without help.

-Red flags at this stage are signs that point to difficulties with these tasks, such as: no trunk or head control in supported sitting, increasingly stiff back and legs, or inability to bring arms forward to reach for toys.

9 months

-A 9-month-old can sit and reach for toys without falling. He can move easily from lying down on his back or his tummy to sitting on his bottom.

-If your 9-month-old sits with his trunk leaning forward, doesn’t reach out to play with toys, uses one side more than the other, seems to drag one side to move, doesn’t crawl, and cannot take any weight on his feet when you prop him up, please bring it up with your pediatrician at his 9 months well-visit.

12 month

– Of course every baby develops differently. But by 12 months, a typically developing baby should be able to pull to stand and cruise along furniture. She might be able to stand alone and take independent steps.

-What we as physical developmental experts look for is fluidity of movement. If a child has difficulty getting to standing because of stiff legs, extended trunk, weakness on one side, or pointed toes, that is cause for a more in-depth look. If your baby only pulls up to stand with his arms instead of using his legs, it is definitely good to make your pediatrician aware.

-If your child sits with weight mostly to one side, needs her hands to maintain sitting, holds any part of her limbs stiffly in extension or flexion, or has difficulty moving between positions by her 12 month visit to her pediatrician, please ask about a physical therapy follow-up.

18 months

-A big indicator of need for physical therapy is if a child still cannot stand or take steps independently by 15 months.

-Red flags at the 18 months well-visit include: inability to stand and step independently, frequent falls while standing, poor standing balance, difficulty squatting, or walking predominantly on toes.

 

The warning signs and red flags mentioned above are meant as a guide to parents. If your child is showing these signs and is not achieving his or her gross motor milestones on time, do not focus so much on a medical diagnosis. What is important during the first year is that your pediatrician is aware of differences in your child’s development and recommend specialist follow-up as needed.

To see what your child should be doing at later stages in life, download our Gross Motor Milestone Checklist here.






 

When is Stiffness Problematic in Infants?

If your child seems stiff or rigid, he/she may have what is described as “high muscle tone” (hypertonia). This means that the muscles baby in towelare chronically contracted. Stiffness can become problematic in an infant when it limits the movements and acquisition of a child’s gross motor skills.

Signs of Stiffness in Infants:

  • Your child might hold his/her hands in tight fists or may seem unable to relax certain muscles.
  • He/She may have difficulty letting go of an object or difficulty moving from one position to another.
  • The legs or trunk of the child might cross or stiffen when you pick the child up as well.

How Can A Physical Therapist Help?

While limb stiffness is a sign of abnormal signals that are being sent from the brain to the body that over-activate certain muscle groups, some of these movement/coordination disorders are mild and can be treated with physical therapy. The physical therapist will help the child break out of her stiff positions, stretch out the tight muscles, strengthen the weak muscles and develop efficient movement patterns.

At times, limb stiffness is a symptom of spastic cerebral palsy; however, parents should not focus on a medical diagnosis within babies. Regardless of the medical diagnosis, the focus of therapy will be to stretch the tight, overactive muscles and guide the child to acquire motor skills and perform functional tasks in a more efficient manner.

How Can A Parent Help?

Parents should set up the environment to be motivating and organize activities so that the child can practice in a variety of ways. Both massage and Yoga can help to improve muscle length and flexibility. While Botulinum Toxin (commonly known by the brand name “Botox”) can help, it is not used in children that are younger than 18 months. This toxin is injected directly into a child’s muscles and temporarily paralyzes the muscle’s activity, giving the child the opportunity to stretch the tight muscle and strengthen the opposing muscle. Muscle relaxants may be prescribed for adults that have cerebral palsy, but they’re rarely used for toddlers as they cause drowsiness.

If you are concerned about the stiffness in your baby or if your child’s rigidity is keeping him/her from interacting with toys, contact your doctor and schedule an evaluation with a physical therapist.

Navigating Early Speech & Language Milestones: What to expect between age 1 and 2

Parents often wonder if their child’s skills are developing typically.  Between gross motor skills, fine motor skills, speech-language skills, social-emotional functioning, and overall growth, there’s a lot to keep track of!  In fact, it might feel overwhelming.  Mother communicating with infantIt’s important for parents to remember that every child develops at their own rate, with some skills emerging faster, and other skills taking more time.  When considering your child’s development, referring to developmental milestones can be an excellent guide.  In Part 1 of this blog, we reviewed speech and language milestones to expect during the first year of your baby’s life.  In Part 2, we’ll review communication milestones you might expect to see between age 1 and 2.  If you begin to feel concerned regarding your child’s development, seek help from a licensed professional right away.  A trained therapist will give you accurate information, ease your worries, and if needed, give your child any help they might need.

Speech & Language Skills Emerging Between 1 and 2 Years

1 – 1½ years

Your child might:

  • easily understand his own speech
  • use a variety of words (between about 3-20) to communicate
  • understand between 50-75 words to communicate
  • be able to point to various objects or body parts as you say them
  • be able to follow simple 1-step directions
  • use words that contain a consonant + vowel (e.g. “bo” for boat)
  • be eager to imitate words they hear others say
  • use some jargon when they’re communicating
  • request things by pointing or vocalizing
  • let you know what they don’t want, by shaking their head “no” or pushing objects away

1½ – 2 years

Your child might:

  • be likely using more true words, and less jargon to communicate
  • be asking questions by using a rising intonation
  • begin to include sounds at the end of their words (e.g. hot)
  • use more than 50 words to communicate
  • understand about 300 words to communicate
  • begin to combine words into simple phrases
  • be able to follow 2-step related directions (e.g. “open the box and give me the bear.”)
  • begin to respond to yes/no questions
  • understand location concepts “in” and “on”
  • begin using words to tell you when they don’t want something (e.g. “no bed”)

For more information about speech and language development in childhood, visit the American Speech-Language-Hearing Association at http://www.asha.org/public/speech/development/.

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Probiotics: What are they and Why are they Important?

Probiotics is the term for food and supplements that contain microorganisms that can colonize the gut, specifically the small and large intestines. We actually have billions of bacteria living in our gastrointestinal tract. We now know that these bacteria have important roles in the body. They are involved in digestion, prevent infection by other disease-causing bacteria, and maintain the lining of the digestive tract. These bacteria can be killed off by antibiotics, and up to 30% of people taking antibiotics experience the side-effect known as antibiotic-associated diarrhea (1). Some research has shown benefits to ingesting probiotics during and after a course of antibiotics to prevent diarrhea, to prevent pathogenic bacteria such a Clostridium difficile (C. diff) from inhabiting the gut and causing illness, and to maintain the lining of the gut. It is especially important for infants and children to have healthy gut bacteria, as they can be particularly susceptible to these side effects. It is also important that infants and children have a strong gut barrier as they constantly put things in their mouths and are still developing their gut-associated immune system. 70% of the human body’s immune system actually lines the gastrointestinal tract, and probiotics can help develop that.

The World Health Organization defines probiotics as “live microorganisms which when administered in adequate amounts confer a health benefit on the host” (2). The supplement industry, which includes probiotics supplements, is not tightly regulated in the United States. Therefore, it is wise to ask a doctor or registered dietitian for recommendations of brands of probiotics if you or your child needs to take them in supplement form.

Probiotics are found naturally occurring in fermented foods such as:

  • Yogurt
  • Sour cream
  • Acidophilus Milk
  • Kefir
  • Tempeh
  • Sauerkraut
  • Kimchi

Including some of these foods in you and your child’s weekly diet can help ensure healthy gut bacteria and optimal digestion. For more information on probiotics in foods or supplements, and when to use probiotics, contact a dietitian at North Shore Pediatric Therapy.

References

  1. Mack DR. Probiotics. Can Fam Physician. 2005 November 10; 51(11): 1455–1457.
  2. Food and Agriculture Organization and World Health Organization Expert Consultation. Evaluation of health and nutritional properties of powder milk and live lactic acid bacteria. Córdoba, Argentina: Food and Agriculture Organization of the United Nations and World Health Organization; 2001. [cited 2005 September 8]. Available from: ftp://ftp.fao.org/es/esn/food/probio_report_en.pdf.

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Gross Motor Milestones for your Babies’ First Year

The first year of a child’s life is full of learning and excitement. Every month brings new milestones, both for fine motor, gross motor and speech production. Knowing what is expected in each month can help you prepare as a parent, and even help you facilitate your baby standingbabies’ milestones. Below is a list of gross motor milestones to help your baby through the first year of life. Keep in mind that each milestone has a window that the milestone is expected to occur.

Gross Motor Milestones in the First Year:

1-2 months: Baby will bend and straighten legs alternately or together

2-3 months: While on their tummy, the baby will hold their head up at a 45 degree angle between their chin and chest

4.5-6 months: Baby will sit with arm support with their arms in front of them

5.5-9 months: Rolling from tummy to/from back to both right and left sides independently

6-8 months: Independent sitting without arm or trunk support

7-9 months: Kneeling on hands and knees (quadruped position)

9-10 months: Pulling to stand at a surface supported with arms.

8-13 months: Creeping on hands and knees with belly off the ground

9-13 months: Cruising along a surface

10.5-13 months: Independent standing

12-14 months: Independent walking

Growth and development occurs differently in every child and there is a window where milestones traditionally occur. If you are concerned about your child’s development, speak with your pediatrician or schedule a physical therapy evaluation.

References: Piper MC and Darrah J. Motor Assessment of the Developing Infant. W.B. Saunders Co. Philadelphia. 1994

Peabody Developmental Motor Scales, second edition. PRO-ED, Inc. 2000

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Oral-Motor and Feeding Difficulties in Young Children

All children are born hard-wired to eat. However, some children with poor oral motor skills may present with many challenges while feeding. Some children may appear to be “messy eaters”, but in reality, they may not have the strength to successfully close their lips around a spoon. Other kids may tend to rush through meals, however their oral awareness may actually be reduced and they may not even be aware of how much food is actually in their mouths. Therefore mealtimes may Young Girls Is A Messy Eaterprove to be difficult and frustrating for children, and equally as stressful for mom and dad.

Oral Motor And Feeding Red Flags

  • Lack of oral-exploration with non-food items as an infant
  • Difficulties transitioning between different textures of foods
  • Weaknesses sucking, chewing, and swallowing
  • Frequent coughing and/or gagging when eating
  • Vomiting during or after meals
  • Refusal to eat certain textures of foods
  • Rigidity with diet
  • Avoidance of touch on face and around mouth
  • Loss of food and liquids when eating
  • Obvious preference for certain textures or flavors of foods
  • Increased congestion during and after meals
  • Grimacing/odd facial expressions when eating
  • Consistent wiping of hands and face during meals
  • Pocketing of food in cheeks, or residue observed after swallow
  • Irritability and anxiety during mealtime
  • Excessive drooling and lack of saliva management
  • Sudden refusal to eat previously tolerated foods
  • Excessive weight gain or loss

Oral-Motor Skill Improvement

Fortunately, there are also many activities you can easily incorporate at home to facilitate improvements with oral-motor skills.

  • Blowing activities (blow-pens, instruments, whistles, etc.) help to improve posture, breath control, lip rounding, and motor-planning skills.
  • Infant massage may also help to increase oral-awareness and facial tone.
  • Straws, sour candies, and bubbles may help with drooling.
  • Constantly exposing your child to a variety of new foods will help to avoid food jags, and increase their tolerance to different textures and tastes.

If you notice that your child presents with some of the above-mentioned characteristics and does not seem to be improving, it would be advantageous to speak with a Speech-Language Pathologist about your concerns.

 

5 Tips For Improving Your Child’s Language And Social Skills During Your Everyday Routine

When it comes to improving language and social skills, and evolving cognitive behavior in children, it is natural that a Young Boy Reaching For Toybehavior analyst will  look for environmental variables that may impact behaviors that influence these areas of learning. There are various studies  showing that children’s early life experiences can play an important role in language development. There are also various educational models that result in improvement in language and other cognitive and social skills. However, there is also evidence  suggesting that any gains or advantages can diminish over time, especially in children of poor and working-class families.

Through their book Meaningful Differences in the Everyday Experience of Young American Children (1995), Hart and Risley found that the quality and frequency of speech between parents and infants (6 to 8 months of age) have a direct impact on their vocabularies. They were also able to teach parents at home, and on the job to say more to their children and be more reinforcing (as opposed to primitive and discouraging in nature) when their children imitated and took notice to their examples.

The following are some strategies that can assist you in improving your child’s verbal and overall social skills.

Tips For Finding Everyday Moments To Teach Verbal And Social Skills

Identify a few learning goals that you want to focus on with your child (e.g. establishing eye contact, asking for a preferred item, etc.)

  • To start out with, it may be helpful to choose some activities in which to focus on (e.g. looking at your child’s favorite book, playing with a preferred toy)

Look and plan for “Teachable moments”

  • Can include daily routines (e.g. meals, playtime, car trips, getting dressed, watching TV, etc)
  • Take time to plan your events (e.g. During a community outing you can work on one word exchanges with others, gross motor imitation, or eye contact). This may help eliminate trying to think of what to do while you are in the middle of doing it.

Pay attention to what your child wants. The best “teachable moment” is when your child wants something (e.g. food, toy, attention, a break, etc)

  • Let your child select the activity
  • Let your child initiate the interaction by requesting assistance from the adult
  • Requests can be verbal and nonverbal e.g. calling your name, crying, stretching for an object, asking for food, play material, or information

The “teachable moment” should be just that – a moment. Keep it brief and enjoyable. If it goes too long it may become unpleasant to the child. In this case stop and go on to another activity.

Start small and set a goal – “Today I will look for 3 “teachable moments”

  • As you get used to this it will start to feel more natural and you can increase your goal
  • Keep planning to make sure you are reaching your goals

 

Encouraging Your Infant to Communicate

Promoting speech and language development from the start

Your infant may not be using words yet, but they are communicating in big ways! In fact, children begin to communicate long before they start talking. Eye gaze, crying, listening, facial expressions, gestures, turn-taking, and vocalizations are all foundations of speech and languageHappy Baby Talking To Mom. The first year of life is a critical time in language development as children learn the building blocks of communication. There are many things parents can do to help their child’s language skills blossom!

Tips to encourage your infant’s communication:

  1. Play with your baby! Face to face interaction with your child may be the most valuable tool you have. No high-priced toy or well-researched program can compare to the benefits your child will gain from face-to-face time with loved ones.
    For grown-ups, play is what we do after a long day of work. For children, however, play is their job! Play is the backdrop for child learning and developing. It provides opportunities to explore, problem- solve, learn cause -and -effect, and communicate. As you play with your child, follow their lead. Pause before jumping in to assist your child. Give them opportunities to ask for a favorite toy by placing it just out of reach. If something unexpected happens (e.g. a book falls off the table), pause to let your child react or communicate before fixing the problem.
  2. Reinforce your child’s communicative attempts by responding to and imitating their facial expressions, vocalizations and babbling. Maintain eye-contact as you imitate the sounds your child makes.
  3. Encourage your child to use different vowels and speech sounds such as “oo”, “ee”, “da”, “ba” or “ma”. Engage your child in sound play, pairing different sounds with silly actions. You might knock over a block and exclaim “uh oh!” or tickle your baby’s toes and say “do do!”
  4. Pair gestures with words to help convey meaning as you communicate with your child. For example, if your child wants to be picked up, you might reach your hands up high and say “up!’. Wave your hand as you say “bye bye!” Point to objects as you label them (e.g. “ball!” or “milk!”).
  5.  Encourage your child to imitate your actions. Play finger games such as “Itsy Bitsy Spider”, “Wheels on the Bus”, and “Pat-A-Cake”. You might also play “Peek-A-Boo”, clap your hands, or blow kisses.
  6. Make environmental noises during play (e.g. “car says beep beep!” or “cow says moo moo!”). Encourage your child to imitate various sounds as they explore and play.
  7. Sing to your child! Songs are an excellent way to engage your child in a meaningful and language-rich context. Add gestures to your songs, and create anticipation as you vary your facial expressions and intonation. The repetition of a familiar song will provide opportunities for your child to anticipate and even join in!
  8. Narrate what is happening in the environment. Use simple language to describe actions and events to your child as they are happening (e.g. “Mommy is putting shoes on!” or “Mommy is washing your hands!”).
  9. Read to your child! Choose books with large and engaging pictures that are not too detailed. Point to and label various pictures (e.g. “ball!” or “cow…moo moo!”). Ask your child “What’s this?” and encourage them to name pictures. A young child may not be able to attend to a book for very long- that’s okay! Follow your child’s lead and don’t feel pressured to finish a whole book. Instead, focus on keeping literacy activities fun and engaging, and enjoy the few pages that your child reads.

Click here for even more tips to encourage speech and language development in your child.