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Social-Emotional and Behavioral Red Flags for Toddlers and Preschoolers

It might be hard to imagine what mental health concerns may look like for your toddler or preschooler. Red FlagsHowever, it is important to realize that children experience the same emotions as adults do. They experience happiness, sadness, anger, fear, loneliness and embarrassment, however, they do not always know how to express these feelings in appropriate ways, so it’s important to look for red flags. When their feelings get too big, children do not always have the words to use to express themselves, resulting in using challenging or unsafe behaviors to express these big feelings. These behaviors make learning, play and relationships at home, and in the classroom difficult and can be very distressing and frustrating for everyone involved.

Here is a list of common red flags that can help you to determine if your child needs support:

  • Separation Anxiety:
    • Extreme distress (crying, tantruming and clinging to you) when separating from you or knowing that they will be away from you.
    • The symptoms last for several months versus several days
    • The symptoms are excessive enough that it is impacting normal activities (school, friendships, and family relationships).
    • The continuation or re-occurrence of intense anxiety upon separation after the age of 4 and through the elementary school years.
  • Social Concerns:
    • Little interest in playing with other children.
    • Poor body awareness that impacts relationships with peers
    • Failure to initiate or to participate in activities
    • Difficulty making eye contact with others
  • Behavioral Problems:
    • Defiance: Failure to follow rules or listen to directions and is often argumentative with adults.
    • Overly Aggressive Behavior:
      • Temper tantrums that last more than 5 to 10 minutes.
      • Excessive anger through threats, hitting, biting, and scratching others, pulling hair, slamming/throwing objects, damaging property, and hurting others.
  • Difficulty with Transitions:
    • Difficulty focusing and listening during transitions
    • Extremely upset when having to transition from one activity to another. Before or during each transition, your child may cry excessively or have temper tantrums that last more than 5 to 10 minutes.
  • Excessive Clinginess or Attention Seeking with Adults
    • Excessive anxiety related to being around new and/or familiar people/situations.
    • Child freezes or moves towards you by approaching you backwards, sideways or hiding behind you. Your child behaves this way in most situations and no matter how you support them, they continue to avoid interacting with others.
  • Attention concerns:
    • Difficulty completing tasks and following directives on a daily basis.
    • Easily distracted and has difficulty concentrating or focusing on activities.
  • Daily Functioning Concerns:
    • Toileting: Difficulty potty training and refuses to use the toilet.
    • Eating issues: Refusing to eat, avoids different textures, or has power struggles over food
    • Sleeping problems: Difficulty falling asleep, refuses to go to sleep, has nightmares or wakes several times a night.

Children can exhibit concerns in the above areas off and on throughout their childhood. It is when these behaviors begin to impact peer and family relationships, cause isolation, interfere with learning and cause disruptions at home and in school that it is time to reach out for support.

Who can help?

  • Licensed Clinical Social workers (LCSW),
  • Licensed Clinical Professional Counselors (LCPC),
  • Marriage and Family Therapists (MFT)
  • Psychologists

Therapists will work with your child to help them to learn how to handle their big feelings and behavioral challenges. Therapists will use a variety of modalities during sessions including play, art, calming and self-regulation strategies, behavioral therapy, parent-child therapy, and parent education and support. They can also provide parent support and coaching to assist in diminishing the challenging behaviors at home. Often these professionals will collaborate with your child’s school and can provide additional support for your child within the school setting.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. 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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What are Metalinguistic Skills and What Do They Look Like in My Child?

Metalinguistic skills involve the awareness and control of linguistic components of language. Simply put, it implies the ability to thinktoddler clapping and discuss language. These skills require an awareness of others as listeners and an ability to recognize significant details that indicate changes in speech. For example, you do not usually speak to a teacher in the same way you would speak to a friend. In addition, you do not typically speak in a restaurant the same way in which you speak in a museum. Noticing what kind of speech is appropriate in various environments with various speakers is also reflective of metalinguistic skills.

These metalinguistic skills start to develop as early as one year as your child learns to monitor their own utterances and begin to repair their breakdowns in communication when they are misheard. Before the age of two, children typically learn how to adjust their speaking to different listeners: louder vs. softer, simpler vs. complex, demanding vs. requesting and peer vs. adult. Before the age of four, children should know how to recognize signals indicating that their listener understood the message spoken (i.e., such as a nod for assent and a frown signifying confusion). Children also learn to correct their own speech as well as their conversation partners’ speech. At this age, children spend a significant amount of time exploring new sounds, new words and new speech styles. As they reach their academic years, metalinguistic development continues to improve as children gain an understanding of the specific meaningful units that are associated with language (i.e., sounds, syllables, words, sentences). As a child’s mastery of language components grows, they learn to play with humor by telling jokes, riddles and puns (e.g., “What’s black and white and red (read) all over? A newspaper!”). This indicates a desire to control the use of language that was not present in the early language of children. This manipulation of language is significantly correlated to the development of pragmatic skills or the use of language.

Development of these metalinguistic skills are essential to a child’s ability to be successful in creating enlightening conversations that will serve as foundations for further learning in their lives.

What is a Late-Talking Toddler?

Many parents may wonder, is my child normal? When it comes to speech and language development, there are certain milestones Toddlers Playing A Gamebetween birth to 1 year and 1 to 2 years that we would hope all children achieve. Some children may progress through these milestones faster or slower than others, but there is usually a typical pattern of development.

When a child’s speech and language developmental pattern is not following that of typical peers, he or she may be referred to as a “late-talking toddler.”

Warning signs that your child may be a late-talking toddler include:

By 2 years old, if a child is not yet:

  • using 50 words to communicate
  • understanding about 300 words
  • combining 2-word phrases (e.g., “more milk”)

Such children may also appear to be frustrated when unable to communicate, including having tantrums and/or hitting oneself or others.

Some parents may be familiar with the “wait and see” approach. The idea behind this is that parents will wait to see if their child becomes a late-talking toddler; however, doing this allows the gap between potentially delayed children and typical peers to grow. It is better to seek intervention when they first notice a delay.

Studies have shown that early intervention can be most beneficial for these children. When started early, speech-language pathologists can help these late-talking toddlers to “catch-up” to their peers. Research has revealed that, if untreated, these children may develop difficulties when they become of age to attend school, both academically and socially.

If any of these warning signs describe your child, a licensed speech-language pathologist can help! An SLP can conduct an evaluation to determine if there is a delay.

This evaluation would include:

  • observation: watching your child play and interact
  • elicitation: prompting your child to respond via pointing, gesturing or speech production
  • parent-reporting: learning what skills your child may be demonstrating at home, but not during their time together with a speech-language pathologist

There is so much that can be done to help these children; please contact us if you have questions!

Eat These, Not Those: The Toddler Edition

When you think of the typical diet of a toddler, there are some common foods come to mind; however, the food industry has created many toddler-suited kids with cupcakes foods that may not always have a toddler’s nutrition needs in mind.For every not-so-great toddler food, there is a better choice.

Below is a list of toddler foods that have more nutritious alternatives:

  • Say no to: Flavored yogurts packaged for on-the-go.
    • These may contain artificial food coloring and some have up tp 20 grams of sugar or more per serving.
  • Instead, tryPlain yogurt with fruit and a little maple syrup or honey stirred in. Only feed honey to kids that are older than 1 year of age.
  • Say no to: Fruit snacks.
    • These often have artificial food coloring and minimal nutritional value as they are made of sugar or corn syrup, gelatin and other chemicals.
  • Instead, try: Dried fruit. Dried fruit is a great source of fiber. Try a variety, such as cranberries, blueberries, mangoes, strawberries, cherries and peaches.
  • Say no to: Processed meats.
    • These are often high in sodium and most have nitrates. Nitrites used as preservatives can form carcinogenic compounds during digestion.
  • Instead, try: Nitrate and Nitrite-free hot dogs and lunch meat. High quality products that are made of 100% meat without additives are a better alternative to processed meats. You may also forgo the processed part and stick with whole, cooked meats.
  • Say no to: Juice, especially if it is not made with 100% juice.
    • Kids do not need juice every day for nutrition. Drinking juice displaces room for other healthy foods.
  • Instead, try: Plain milk with meals and water throughout the day.
  • Say no to: “Puffed”snacks.
    •  Again, these snack foods often do not offer much nutrition and can take-up room for other more nutritious foods.
  • Instead, try: Whole grain crackers, brown rice cakes, or whole grain cereal pieces.
  • Say no to: Processed cheese.
    • If cheese comes in a package, read the label and take caution if there is anything other than milk, salt and enzymes.
  • Instead, try: Real blocks of cheese, grated or sliced by yourself or by the deli.
  • Say no to: Peanut butter products.
    • Read labels. If you see the words “hydrogenated” or “partially hydrogenated”, the peanut butter includes trans-fats. These are particularly unhealthy fats that are highly susceptible to oxidation in the body, which leads to generation of free radicals that can contribute to cardiovascular disease and cancer.
  • Instead, try: Peanut butter or other nut butters that have only nuts listed in the ingredients.
  • Say no to: Cereals, specifically those with 10 grams of sugar or more.
    • The sugar content of some of kids-themed cereals should ultimately be categorized within the dessert aisle, rather than the cereal aisle.
  • Instead, try: Whole grain cereals with less than 5 grams of sugar per serving.
  • Say no to: Fast food, specifically the burger, French fry and chicken nugget variety.
    • Fast food, especially fried fast food, is high in sodium, calories and saturated and/or trans fats. Fast food is often chosen out of convenience.
  • Instead, try: Packing a lunch from home when you know you will be on the go.
  • Say no to: Candy, especially when given as a reward.
    • Many parents use candy as a bribe for potty training, for eating vegetables or for staying quiet in the shopping cart at the grocery store.
  • Instead, try: Dried fruit or a non-edible reward like stickers, stamps, crayons or hildren’s books.

It is the caregiver’s responsibility to make good nutrition choices to offer to children. Children, as they mature,  will then choose foods from the foods they are most often exposed to from an early age.  For more information on feeding toddlers or how to manage picky eating, contact one of our registered dietitians to schedule an appointment.

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Dressing Skills: Developmental Steps for Kids

Dressing may seem like a simple task, but it is actually a task that requires multiple skill sets from children. Dressing requires skills girl dressing such as fine and gross motor coordination, body awareness, bilateral coordination, right/left discrimination, postural stability, and motor planning. As a parent, it can be difficult to know at what age a child should develop certain skills in dressing.

Developmental steps of self-dressing skills in children*:

1 year:

  • Pulls off shoes
  • Removes socks
  • Pushes arms and legs through garments

2 years:

  • Helps pull down pants
  • Finds armholes in pullover shirts
  • Removes unfastened jackets
  • Removes untied shoes

2.5 years:

  • Removes pull-down elastic waist pants
  • Unbuttons large buttons
  • Puts on front button shirt

3 years:

  • Puts on socks and shoes (though it might be the wrong feet or socks upside down)
  • Puts on pullover shirts with some help
  • Buttons large buttons
  • Pulls down pants
  • Zips and unzips with help to place on track

3.5 years:

  • Identifies front of clothing
  • Snaps fasteners
  • Unbuckles belt
  • Buttons 3-4 buttons at a time
  • Unzips jacket zipper

4 years:

  • Removes pull over shirts without help
  • Buckles belt
  • Zips jacket
  • Puts on socks correctly
  • Identifies front and back of clothing

5 years:

  • Dresses alone
  • Ties and unties knots

6 years:

  • Ties bows and shoelaces

According to Jayne Shepherd (2005), achieving independence in dressing may take up to 4 years. During this time, parents gradually perform fewer of the tasks, and encourage their children to do more, with the ultimate goal of independence.

*Source:

Shepherd, J. (2010). Activities of daily living and adaptations for independent living. In J. Case-Smith, (Ed.), Occupational therapy for children (5th ed., p., 501). St. Louis, MO: Elsevier Mosby.

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Learning Through Play Time with Your Toddler

Play time provides a natural context for early language learning and is also important for the development of social communication skills. Childrentoddler playing learn through play and often practice newly acquired language skills and words during play time.

There are three stages of play development:

  1. The first stage is referred to as “self-related” symbolic play. This type of play can be observed between 12-18 months. This type of pretend play mimics daily activities using real objects. A child at this stage of developmental play typically plays alone. For example, a child will pick up a cup and pretend to drink.
  2. From 18-24 months, a toddlers’ play progresses to “other-related” symbolic play. The child is still using real objects, but will perform the action on multiple play toys. For example, the child will use the cup to give a drink to a doll, offer a sip to the bear, and finally have a drink herself.
  3. The final stage of play development is “planned” symbolic play. This stage of developmental play emerges between 24-30 months of age. Play behaviors include using one object to represent another, such as using a stick for a spoon. At this stage, the child has also begun to plan out play sequences by gathering all necessary props prior to engaging in a play routine. She might use a doll or other play toys as the agents of the play action. For example, the child will have the doll give the bear a drink.

Suggestions for Toys:

  • 12-18 monthstoy kitchen set, toy garage set, zoo animals. All of these toys provide multiple opportunities for parents to sequence a variety of play time routines for the child to imitate. This is where we as parents and caregivers must dive into our inner child and start using our imagination!!
  • 18-24 monthspuzzles, farm set, pretend painter’s/doctor set. These toys provide the child with multiple opportunities to start acting out and initiating their own play routines and to use their own imagination, as well as allowing for multiple play partners and toys to be used. Be prepared to clean up a big mess!

Following these guidelines should  help you use age-appropriate play with your child. Developing play skills will expand your child’s language and social communication.

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Is it okay for a Baby to Waddle with Feet Outward? What is “Toeing Out”?

In my continued effort to expedite information for parents, it is ok for your baby to waddle with their feet outwards up to the age of 2, or until the child has been walking for 4-6 months. Toeing out in new walkers is very typical up to the age of about 2, or once they have become proficient walkers.Waddling Baby

And here is why toeing out is normal in toddlers who have been walking for 4-6 months…

Babies walk in this pattern for several reasons, primarily because they are trying to maintain their balance by keeping a wide base of support due to their nervous system and their overall architecture.

New walkers are working with immature nervous systems so they need repetitive practice to build the nerve pathways.  In addition, they are learning what to do with the sensory input that they are receiving from their vestibular system (inner ear), as well as the somatosensory proprioception (feeling where their body is in space).  There are motor development theories that say that children walk not when the stepping pattern is mature, but when the balance control system matures.

Structurally, at the time children begin to walk, their center of mass is around the base of their ribs.  As they grow (and the head to body ratio changes) that center of mass lowers to around their belly button.  This high center of mass early on makes it more difficult to balance, leading to the need for an increased base of support to avoid falling.

New walkers often fire a lot of their hip muscles in order to stabilize themselves as they learn to balance on two feet.  EMG (neuromuscular studies) of children with 6 months of walking experience have also shown that they will fire their outer hip muscles (specifically the muscles that outwardly rotate their legs, and that move their legs apart) for stability.  In doing so, the hip outward rotators over-power the inward rotators, which brings their feet and legs out.

The anatomy of the feet of new walkers also facilitates their out-toeing gait pattern.  Newer walkers have large fat pads on the bottom of their feet and do not have the muscle strength or ligament stability to create a stable structure.  This capability of stabilizing at the foot typically comes with practice and age.

Since new walkers have had little weight-bearing through their legs, the shape of the thigh bone promotes a wide stance.  As the child bears weight on their legs, the shape of the bone begins to more closely resemble the mature alignment.

New walkers will often keep their arms at either chest or shoulder height to help with their balance.  This wide balance reinforces toddlers’ wide stance.  Once these children begin to swing their arms when they walk, then each step begins to promote a more narrow foot placement.

If you ever have concerns about how your child is walking, address it with your pediatrician.  If your child has been walking for 6 months or more and they continue to walk with a wide foot placement and arms at shoulder height, you may have legitimate concerns that could be addressed.

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Getting Ready for Summer: Toddler Strider Bikes

Spring and summer are a great time to take your children outside to play, swim, and ride bikes. Physical therapists get asked often about bikes for younger children. Recently, a new trend has evolved: strider bikes for young children. These “pre-bikes” are great alternatives to tricycles or two-wheelers with training wheels. strider bikeStrider bikes teach a child the balance and coordination that is required for riding a two-wheeler without training wheels.

What is a Strider Bike?

Strider bikes are simply smaller bikes without pedals. To use the bike, the child simply sits on it similar to a normal bike, and propels themselves forward with their feet. Once a child feels comfortable and has established the balance necessary, they will lift their feet off the ground and coast for a few seconds. This is using the same muscles and coordination needed to ride a “big-kid” bike.

Why are Strider Bikes are good for Balance?

But what about the pedaling part of riding a bike? Teaching a child the pedaling motion of a bicycle is usually easier than the balance portion. Striders take the pedaling away so the child can focus on the balance part first. Once the child is coasting comfortably and safely on a strider, they are probably ready for a bike with pedals.

When is my child ready for a strider bike?

If your child is able to walk and maneuver their environment safely, then they are ready for a strider bike. They can be used between ages two and five. Some brands come with weight or height limits. If your child is too big for a strider bike, you can bring a normal bike to your local bike store and ask them to remove the pedals. My experience is that most stores are willing to do this.

A bike ride with your child (or children) is a fabulous family activity that promotes fitness and healthy lifestyles while still having fun. Strider bikes provide an enjoyable alternative to tricycles and training wheels, while also promoting gross motor development in your child.

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10 Ways to Help Your Toddler Acclimate to a New Caregiver

Many toddlers receive care from a caregiver other than their parent at some point, whether this is a grandparent, family friend, babysitter, nanny, therapist, or other professional caregiver. Some children go to daycare, while others receive care in their home. Each situation can be difficult for the toddler and her parent. These tips will give you the tools necessary to deal with the separation, and help your toddler and new caregiver get it right from the start.

10 Ways To Help Your Child Adjust To A New Caregiver:

  1. Separation begins long before the actual event. Make yourself familiar with the childcare setting and routine in advance. A few days before starting childcare, talk to your toddler about what she will do while she is there, the caregivers, and other mom and babysitterchildren that will be part of the child care experience.
  2. Introduce your child to the caregiver and new setting before child care actually begins.
  3. Discuss with the caregiver your child’s preferences, strengths, vulnerabilities, your values and your approach to discipline. It’s also a good idea to share special events and recent milestones with the caregiver, which can later be discussed and will enhance the relationship between the caregiver and child.
  4. Build strong communication with the caregiver that will lead to a solid partnership on behalf of the child.
  5. Give your child something from home or that reminds her of you to take with her to child care. Transition objects provide the toddler with a tangible, concrete representation of the parent and home. This could be a photo or letter from you, a toy, or something that is meaningful within the family.
  6. If at all possible, start with a brief separation and progressively increase the time apart from your toddler as she adjusts to the new setting.
  7. Arrive at childcare with enough time so that you can stay for a while as your toddler settles in. Dropping off and leaving right away can be unsettling and upsetting. On the other hand, parents who have trouble leaving can be persuaded by the child’s pleas to “stay a little longer.” Doing so, particularly when the parent really needs to leave, can be confusing to the child because of the contrast between what the parent says and does. Staying longer is appropriate if it is planned and when the time is spent talking about the separation or helping the child transition to the caregiver, to a peer, or to a fun activity.
  8. Talk about the feelings of separation and the pleasures of being together with your child. Separation anxiety is normal and intensifies between 12 and 18 months of age. Acknowledging these feelings directly and sympathetically is the best way to cope with them. Calmly assure the toddler that she will be well cared for and will have a good time. Stress that you will return. Plan what you will do when you are together again.
  9. Be prepared to encounter signs of ambivalence or stress from your toddler after the reunion. This may also be accompanied by clinging or refusal to let the parent out of sight. Recognize your child’s fear of separation in unusual forms such as night awakenings, toileting accidents, tantrums, or low threshold of frustration. Awareness that such responses may occur can help reduce the parents’ stress and promote a calm and sympathetic response to the child.
  10. Play games that build mastery of separation experiences, such as hide-and-seek, peek-a-boo, and hiding/recovering objects. These playful games strengthen the child’s sense of object permanence (the knowledge that people and things continue to exist when they are out of sight).Direct experiences with reunion after separation promotes the toddlers’ developing ability to understand that even though their parent is not physically present, they will return.

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When Should You Take A Pacifier Away | Pediatric Therapy TV

Pediatric Speech and Language Pathologist explains when a parent should take a pacifier away from a baby or toddler.

In this Video You Will Learn:

  • If there is a specific age to take the pacifier away
  • How sucking on a pacifier can cause feeding and speech difficulties
  • What kind of pacifier a child should be using

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. Today, I’m standing with speech and language pathologist, Allison Raino. Allison, can you tell us at what age a child should stop using a pacifier?

Allison: Sure. Unfortunately, there’s no definitive age but what I can talk about are the limitations that pacifiers have on oral development. The first reason why pacifiers can become problematic is the amount of time the baby has a pacifier in their mouth, and the second being the size and the shape of the pacifier.

As the baby transition into chewing, jaw strength and stability is very important developmental growth, and sucking on a pacifier drastically limits the amount of jaw movements, reducing the strength and stability which could cause future feeding and speech difficulties.

The second being the size and the shape of the pacifier. The pacifiers that are rounded on the top and flat on the bottom, they’re too big for the baby’s mouth. The pacifiers that are rounded on all sides, those are preferred because it puts the tongue in a more natural position.

So, my two suggestions would be to limit the amount of time the pacifier is used as well as using the pacifier that is rounded on all sides.

Robyn: All right. Thank you for those suggestions and thank you to all of our viewers for watching. 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.