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What Is the Difference Between Occupational and Physical Therapy for Children?

Many of the parents I meet often ask why very few occupational therapist work with infants, or why an occupational therapist (OT) is seeing their child for toe-walking as opposed to a physical therapist (PT). They often wonder why one child who has balance or coordination issues would see a physical therapist while another with similar limitations would see an occupational therapist instead. Some parents think that occupational therapists only work on fine motor skills while physical therapists only work on gross motor skills.  Physical and occupational therapists work in a variety of settings, including hospitals, neonatal intensive care units, skilled nursing homes, outpatient clinics, schools, rehabilitation centers, and doctor’s offices.  Physical therapist and occupational therapist roles differ depending on the setting they work in and the medical diagnoses they work with.

In the outpatient clinic, some of these roles may overlap.  While there are some similarities between PTs and OTs in each setting, there are a few fundamental differences between OTs and PTs in the pediatric setting.

Pediatric Physical Therapy:

In the pediatric outpatient setting, physical therapists are often musculoskeletal and movement specialists. Parents can seek out evaluations when their babies are as young as 1 month old. Physical therapists have in-depth knowledge about human musculoskeletal, neuromuscular, integumentary, and cardiovascular systems. Based on our background in stages of development and biomechanics, we help children with mobility difficulties; whether they are behind on their gross motor milestones, recovering from injury/surgery, or not keeping up with other children.

Through all kinds of hands-on or play techniques, pediatric physical therapist work with children on the following:

  • Gross motor skills
  • Strength
  • Endurance
  • Balance and coordination
  • Motor control and motor planning
  • Body awareness
  • Pain relief
  • Flexibility
  • Gait mechanics
  • Orthotics training
  • Wound care

Our focus is for children to be as mobile and as independent as possible, while training their caregivers on all aspects of a child’s physical development. This includes anything that may affect a child’s quality of movement, posture, alignment, and safety.

Pediatric Occupational Therapy

Outpatient pediatric occupational therapists are trained to improve the quality of children’s participation in their daily functional tasks.  A child’s job is to play and take part in activities at school and at home. These include important endeavors such as paying attention in class, hand writing, dressing, feeding and grooming themselves, and being able to engage in age-appropriate games. Occupational therapists are also trained to help children organize and interpret information from the environment so that they can just be kids. This may include taste aversions that limit their food intake, or texture aversions that affect their clothing tolerance, or sound aversions that affect their mood.

OTs work with children on the following skills:

  • Sensory integration
  • Cognitive endurance
  • Fine motor skills
  • Hand function
  • Visual-spatial awareness
  • Hand-eye coordination
  • Attention
  • Social skills
  • Body awareness

Occupational therapists often educate parents and teachers on the best techniques to ensure children participate in learning, self-care, and play tasks.

Why do some children need both disciplines and some only need one?

So many factors can affect a child’s ability to participate in her daily life. A child may be experiencing frequent falls or may have trouble jumping due to a number of reasons.  No matter the diagnosis or underlying medical condition, any child who is having a hard time keeping up with his peers can benefit from a comprehensive evaluation by a pediatric specialist.

3 Uses for a Body Sock in Pediatric Occupational Therapy

A body sock is a therapeutic modality used in many occupational therapy (OT) sessions to address a variety of skills. ThePortrait of little blonde brown-eyed girl in bed thin, Lycra material covers the child’s body, except for the head, in a similar way to a sleeping bag. The Lycra material provides deep proprioceptive input to assist with self-regulation. This tool can help facilitate many skills for children of all ages.

Therapeutic Uses for a Body Sock:

  1. Self-Regulation-The proprioceptive input facilitated by the body sock provides deep pressure to the child’s entire body. This input is very calming and can assist with regulation of the child’s arousal level.
  2. Endurance-Due to the resistant nature of the body sock, the child will naturally work on his strength and endurance while completing activities wearing the sock. Have your child complete different activities such as board games, reading or yoga poses while wearing the body sock. Read more

4 Ways to Better Handwriting before Pencil Hits Paper

Your child’s handwriting skills will affect his performance in school, beginning as early as preschool.    How your child holds his pencil, sits in his chair, and attends to the task of handwriting can affect your child’s ability to feel successful in completing a handwriting task. 

4 ways you can promote your child’s handwriting skills before his pencil hits the paper: 

  1. Address his posture: Your child’s posture at the table is directly associated with his fine motor control.  He Handwriting skillsdoes not just use his hand muscles to write—his core muscles are important too.  Make sure that the height of his chair allows for his feet to be placed flat on the floor.  Ideally, you want your child to be sitting so that there is a 90° angle at his knees and his hips.  This will put his body in a position that supports good handwriting.  Sitting on a wedge cushion (move ‘n sit cushion, air-filled cushion) that provides vestibular activation can sometimes help to improve his posture. 
  2. Address his grasp:  Your child’s pencil grasp can hinder or support his ability to write neatly.  Encourage your child to hold his pencil between the tips of his thumb and pointer finger.  The pencil should rest on the side of the tip of his middle finger.  Keeping the space between his thumb and pointer finger (the web space) open will ensure that he is utilizing his muscles in the most efficient manner and will reduce fine motor fatigue.  Sometimes, utilizing an adaptive grip on his pencil can help him to maintain the grasp with decreased difficulty. 
  3. Address his attention:  Your child’s attention can support or detract from his ability to accurately complete a handwriting task.  To support his attention, minimize the distractions in the room.  Your Read more

Bed Time Strategies for Children with Sensory Processing Disorder

Bed time can be a difficult time for any child.  It can be even more of a struggle for a child with Sensory Processing Disorder (SPD).   

Bed time strategies for child with SPD

Throughout the day, all children engage in various activities that excite them, including interacting with peers, playing on the playground and fighting with siblings.  It can be a challenge to calm kids down from a daytime of activity. This can be even more of a challenge for a child with SPD.

 As adults, we are able to engage in various tasks to relax our bodies after a busy day.  Children with SPD need the same input, but they are not cognitively aware of their body’s needs.  For example, if an adult has a stressful day, he or she may drink a hot cup of tea, read, or place a hot towel on their face as self-calming techniques.  A child that had a rough day may act out or refuse to go to bed because he or she doesn’t understand what his or her body needs. 

The following strategies can help your child with SPD calm down and improve the process of getting to sleep:

  • Have a Strict Nightly Routine– Completing a predictable bedtime routine decreases anxiety, gives your child control and establishes healthy habits.   A visual schedule of the routine can assist the little ones with understanding the steps.
  • Incorporate Rocking- Typically, slow linear (back and forth), vestibular movement creates a calming effect.  Rocking in a rocking chair or swing is a great activity to help your child wind down.
  • Enjoy Bath Time– Warm water is calming.Incorporating a nice, warm bath at night not only provides your child with calming sensory input, it also provides an opportunity for you and your child to bond over bath play time.  This special, nightly, one-on-one time will also ease the minds of children who may worry about separating from their parents.
  • Read a Favorite Book-Reading your child’s book of choice provides your child with some control.  It is also another great way to relax mind and body.
  • Avoid Excitatory ActivitiesAvoid engaging in alerting activities before bedtime, as this might make it difficult for your child to calm his or her system down and go to bed. Spinning and jumping movements are excitatory and alerting.  In regards to proprioceptive input or heavy work, light touch, such as tickling, is excitatory and alerting.  
  • Avoid Screen Time-Create a rule:  1-2 hours before bedtime no electronics or TV.  This will promote a smoother transition into quiet time.

If your child with SPD needs help with bed time, or if you need more information on Sensory Processing Disorder, contact one of our pediatric occupational therapists today, or download our free SPD infographic.

Household Chores for Children by Age

Children doing household choresWith school, holidays and less time to keep up with household chores, parents everywhere are looking for a few more helping hands to keep “home base” spick and span. Here is a brief overview of developmentally appropriate household chores:

Here is a brief overview of the developmental sequence of household chores:

Chores for a 13 month old:

Your child should begin to imitate you completing household chores. Pushing a pretend vacuum cleaner over the carpeting or helping you wipe up their craft table are excellent examples.

Chores for a 2 year old:

Your child should demonstrate the ability to pick up and put away their toys with verbal reminders (e.g. clean-up your puzzle before lunch).

Chores for a 3 year old:

Your child should be able to carry things without dropping them; dusting, drying dishes, and gardening. They should also be able to wipe up their spills.

Chores for a 4 year old:

Your child should be able to prepare dry cereal and snacks for themselves. They should also be able to help sort laundry before washing.

Chores for a 5 year old:

Your child should be able to put their toys away neatly, make a sandwich, take out the trash, make their bed, put dirty clothes in their hamper, and appropriately answer the telephone.

Chores for a 6 year old:

Your child should be able to help you with simple errands: complete household chores without redoing them, clean the sink, wash dishes with assistance, and cross the street safely.

Chores for a 7-9 year old:

Around 7-9 years of age, your child should begin to cook simple meals, put clean clothes away, hang up their clothes, manage small amounts of money, and use a telephone correctly.

Chores for a 10-12 year old:

Your child should have the ability to cook simple meals with supervision, complete simple household repairs with appropriate tools, begin doing laundry, set the table, wash dishes, and care for a family pet with reminders.

Chores for a 13-14 year old:

Your child should be able to independently do laundry and cook meals. By expecting your child to complete daily chores before moving onto their preferred activities, it is a wonderful way to prepare them for the demands of homework and other activities when they return to school.

Children of all ages can contribute to keeping up with housework. In addition to keeping your house clean, chores are also an excellent way to instill a sense of ownership and responsibility into your child’s daily routine. Your child could be responsible for one or two chores each day, or each week, depending on the time they have available. Create your own system for keeping track of the chores your child has completed (ex. sticker chart or a marble jar). Each time your child completes their chore, reward them with one token (ex. one sticker or one marble). When they reach 10 tokens, reward them with a bigger prize of their choosing (ex. an ice cream treat or a trip to the zoo). Be sure to verbally praise your child with each attempt at completing a chore and assist them as needed, especially while they work to complete a novel duty. Your verbal encouragement paired with the reward system will only help to motivate your child to take on more and more responsibility at home.

Fleming-Castaldy, R. P. (2009). National Occupational Therapy Certification Exam: Review and
Study Guide. Evanston, IL: International Educational Resources, Ltd.

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Using Games as Fine Motor Practice to Improve Handwriting | Pediatric Therapy Tv

In today’s Webisode, an Occupational Therapist introduces us to beneficial games and tools to aid efficiency of handwriting practice for children.  For more on your child’s handwriting, click here.

In this video you will learn:

  • How certain game pieces prepare your child for writing
  • Which games are recommended to use for handwriting practice
  • Useful tools to warm up hands for writing

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’m your host, Robyn
Ackerman and today I’m standing here with a Pediatric Occupational
Therapist, Lindsay Miller. Lindsay, can you explain to us what are some
games that you can play with children to help with their fine motor and
handwriting?

Lindsay: Sure. Some of the games that I like to play with children involve
small pieces and small pegs, such as this piece right here. This is from a
game called HiHo CherryO, and you use it by holding your thumb and your
index finger and middle finger to hold onto the piece. So that kind of
mimics the way that you would hold a writing utensil, such as a pencil.
Other games include Lite-Brite and Battleship. This is a piece from Lite-
Brite, and, again, you can see that I’m holding it with my thumb, index,
and middle finger. So it’s kind of a way to warm up the hands, before we do
handwriting tasks.

Some other games that I like to use with children involve tongs or
children’s’ chopsticks or tweezers. These are tongs, and, again, you can
see that I’m using it with my thumb, index, and middle finger, which mimics
the way that you would hold a writing utensil. Some examples of games that
use tongs and tweezers would be Operation and Bed Bugs. So those are just
some of the ways that I like to warm up the hands before we do handwriting
tasks.

Robyn: All right. Thank you so much, Lindsay, 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.

Monkey Bar Mania

It is time. Lunch is over and the weather is finally allowing our children to break free of their heavy winter coats and boots to enjoy the warm, fresh, and invigorating air on the playground. Antsy children struggle to contain their excitement as they take their final steps to the great outdoors- slides,Little girl climbing on monkey bars teeter-totters, swings, and kickball fields galore. Only the bravest of the brave dare take on the tall metal intimidators commonly known as the monkey bars.

Monkey bar climbing has been right of passage for children all across the playground. Conquering their cold frames take time, practice, and determination. Here are the developmental steps to achieving the ultimate goal: swinging from one end to the other without touching the ground as our ape-like friends seem to do so effortlessly.

  1. First, ask your child to reach for the monkey bars and let their feet dangle. Cheer them on and encourage them to hang on as long as they can. This will help them to strengthen the muscles in their hands and upper body.
  2. Next, encourage them to swing their legs back and forward while maintaining their tight hold on the bar. This swinging will in turn, give your child the burst of momentum they’ll need to eventually move across the bars.
  3. Next, help them coordinate the swing of their legs with the movement of an arm to reach for the next bar. Keep in mind that your child may need you to support them at their waist in order to complete the first few swings. It may also be a good idea to encourage them to first reach with their dominant hand as they may have an increased rate of success at grabbing the bar.
  4. After successfully completing one swing, talk your child through bringing their other arm to same bar that the first is holding. Once your child can successfully cross the monkey bars one at a time, they may then practice alternating hands on sequential bars. Once they’ve mastered the monkey bars, they can move on to eventually skipping one or two bars at time!

For other playground tips and tricks, see Amanda Matthews’ blog suggesting tips to work on motor skills at the park.

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Daily Activities to Improve Fine Motor Strength

Decreased hand strength can make participating in fine motor activities very difficult for a child.

Here are some activities to help improve hand strength:

  1. Stirring batter or dough with a large spoon: This activity will help improve your child’s grip strength in both hands; one holding the bowl and one stirring with the spoon. The child will be motivated by the desirable end product, which could be brownies, cookies, or even play-doh.Child pressing a paint glue
  2. Squeeze, roll, and play with play-doh or silly putty: Play-doh and silly putty can be used to encourage pinch and grip strength by having your child make balls, pinch them into pancakes, squeeze them into a long snake, etc.
  3. Climbing up ladders or playground equipment: Holding on to ladders, monkey bars or climbing equipment will help improve functional grip strength, as the child must support their body with their hands.
  4. Buckles and snaps on clothing, helmets, etc.: Encourage your child to learn and complete difficult fasteners on their clothing and accessories. This will help promote independence and hand strength for everyday tasks.
  5. Tennis ball friend: Cut a slit in a tennis ball and draw eyes on it to make a puppet. Have your child ‘feed’ the tennis ball different small objects by squeezing the tennis ball with their hand to open the slit.
  6. Craft projects with hole punchers/ staplers: Using hole punchers and staplers are difficult hand tasks that require a lot of strength. Challenge your child to create a whole art project using only these two items.
  7. Cutting different thicknesses of paper: Using different thicknesses of paper will turn a cutting activity into a strengthening activity. Challenge your child to progress from thinner to thicker papers (for example, computer paper, to construction paper, to poster board, to cardboard, etc).
  8. Squeezing a glue bottle: Create a raised maze with glue and when it is dry, have your child color it in. Another option is to put paint in old glue bottles and have your child squeeze the paint out to make a picture.
  9. Putting together and taking apart Legos: Legos are a great activity for strengthening all fine motor skills. To add an extra challenge, push two legos together very tightly and then have the child try to pull them apart.
  10. Play with clothespins: This will promote the strengthening of small muscles in the fingers for improved pinch strength. Some ideas for clothespin use are: hanging things on a string, moving game pieces, and picking up small snacks.

Performing these activities will help encourage proper finger strength, which promotes independent self-care, academic success, good play skills, and overall improved function on a daily basis. If you have concerns regarding your child’s finger and hand strength or fine motor performance, please seek out an occupational therapist for a consultation or an evaluation in order to help your child achieve their potential.

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