25 Tips for Preventing Injury in Infant Caregivers

Posted on January 27, 2013 by christiekiley

Caring for a baby is tough. Really tough. It takes a huge physical toll on the body. And sleep deprivation makes the body even more prone to injury and physical break down. The fact is, preventing injury is a challenge.

If you’re in the trenches of baby care, you know the last thing you need is an injury that could have been avoided through the use of proper ergonomics and body mechanics while caring for the little munchkin.

Since occupational therapists can help people by teaching them principles of ergonomics and energy conservation in order to better perform their daily occupations (you know, all that stuff about using good body position and “lifting from the legs, not the back”?), I thought it might be helpful to address this commonly problematic yet rarely recognized topic as it relates to baby care.

So whether you are a parent, babysitter, nanny, family member, childcare worker, or someone else who cares for babies, we want you to stay healthy! Here are 25 of my top tips (many learned from from experience!) for preventing injury in those who care for infants:

1. Lift from the legs, not the back. Car seat transfers, play time on the floor, diaper changes. Everything. Use your legs. Especially if you’ve recently given birth. They are your back’s best friend.

2. Bend your knees when stooping over to place baby on a lower surface (crib, floor, changing table, etc.). This naturally shifts your weight backward a bit and takes some strain off your back.

3. Use a raised surface for changing baby rather than using the floor. Again, it’s all about saving your back. And many Pack n’ Plays now have changing tables attached to them for your convenience. The safest option is to use something with a safety buckle rather than changing baby on top of a couch or dresser, where he could potentially roll off.

4. Keep your wrists in neutral position when holding baby, rather than using extreme flexion. Notice the way my wrist is bent in the cover photo? Big no no. Over time, those wrists will pay…for some pain pills…or maybe even a splint.

5. Keep your thumb tucked close to your hand when holding baby. This minimizes strain on two major muscles and tendons that control movement of the thumb. Again, notice the terrible thumb position in the cover photo above. Don’t do that. Ever heard of the painful condition called “Mommy Thumb”? I’m sure you have if you’ve ever developed it. It officially goes by a more scientific name (De Quervain Syndrome) and frequently occurs in new moms/caregivers (though females are more likely to develop it simply based on anatomy of their thumb/wrist). It’s basically an overuse injury caused by poor ergonomics that is often treated with a splint, occupational or physical therapy, anti-inflammatory medication and, in severe cases, a cortico-steroid injection or surgery. But let’s avoid all that. Just keep your thumb close to your hand when you carry baby, okay?

6. Keep your back straight when holding baby up to your shoulder, rather than arching back. Less arch = less strain.

7. Keep your hips and body in a straight line when holding baby on your hip, rather than sticking one hip out to the side. Are you catching on that the cover photo pretty much shows you everything NOT to do when holding baby? The more symmetrically you can stand, the better for your body.

8. Carry baby with two hands in a tucked, face out position to minimize strain on your back and arms. It’s amazing how much pressure this takes off your own body. Plus it’s good for baby, too, as it gets her body ready for rolling!

9. Keep heavy items close to your body when carrying them. Car seats, strollers, diaper bags and, oh yeah, the baby! All are heavy, and the farther away they move from your body, the more strain it puts on your back and your joints.

10. Only take what you need when leaving the house. This is a tough one. We want to get everything out to the car in one trip. DON’T DO IT. Your body will thank you. The less weight you carry in one shot, the less likely you are to hold items in an awkward, injury-prone position, and the less likely you are to drop the baby. Kind of important.

11. Take breaks when carrying heavy items. Again, super tough. I get it. You want to get all the groceries in the house or the whole box of toys across the room in one trip. YOU DON’T HAVE TO BE A SUPERHERO! Put it down for a second. Take a break. No need to pull a muscle here. And if you’ve had a C-section and are on lifting restrictions for the first 6+ weeks…FOLLOW THEM! Period.

12. Use a hands-free baby carrier that provides symmetrical support and allows baby to sit above the level of your hips. The keys here are symmetrical support and above the level of your hips. Both are important for preventing injury to your hips and back. Some goods ones that meet this criteria (and are also good for baby) are Moby Wrap, Baby K’tan Carrier, and Ergo Baby Carrier.

13. Use good biomechanics when placing baby in your hands-free baby carrier. Yes, baby carriers are awkward when you first use them. Extra fabric is hanging off your front, you can’t see what you’re doing, and baby is flailing and practically sideways once you try to get him in. So have the carrier strapped on and ready to go, sit down while placing baby in the carrier, keep baby close to your body, sit while placing baby inside, try standing with one leg propped up on a higher surface such as bench or floor of car in order to situate baby, and maybe even insert baby while standing in front of a mirror so you can see what the heck is going on. Keep yourself safe. And don’t drop your baby.

14. Adjust height of handlebar on stroller so it’s at a comfortable level, around the height of your belly button. If the stroller handle is around the height of your belly button, that should put your arms just high enough to push forward without having to hike up your shoulders and overuse the muscles in your neck and upper back.

15. Push stroller with elbows relaxed (not stiff and extended) and wrists in fairly neutral position with thumbs wrapped around handle(s). Wrapping your thumbs around the handles naturally places your wrists in a more neutral position. This makes you less likely to push with the heel of your hand which, with repetition over time, could contribute to painful nerve compression and even the development of carpal tunnel syndrome. And all you wanted was to get out of the house and walk with your baby!

16. Use a nursing support pillow when breastfeeding or bottle feeding baby to minimize strain on back, shoulders, and wrists. Babies eat ALL. THE. TIME. Especially if they’re nursing (like, 45 minutes each feeding, every 3 or so hours). So save your joints and prop yourself. Two good ones are the popular Boppy Pillow and the not-as-well-known-but-very-good My Breast Friend Pillow (terrible name, great product, especially if you’ve had a C-section).

17. Delegate tasks to other family members, including children! Don’t be a supermom (or dad, or whatever you are). Let others help with carrying groceries, lugging the diaper bag, pushing the stroller, or carrying the baby. Conserve your energy and save your joints.

18. Be mindful of how you get baby into and out of the crib. You will face unique challenges depending on your height. But whether you are short or tall, keep baby close to you when placing in the crib, set him down in a side rolling motion (babies are stronger in this position so it’s easier for you), and pick him up in a similar side rolling position. And as an added bonus, this side rolling business is GREAT for preparing babies’ bodies to roll!

19. Minimize kneeling on the floor to change baby. This becomes especially more difficult as baby reaches birthday number one. But avoid it if you can, it’s hard on your back and your knees, even if you have no history of pain.

20. Wrap your arm around baby when holding to the side on your hip, rather than holding with arm under bottom and flexing wrist up. As always, let’s minimize strain on our joints, shall we?

21. Lick your palm and fingers before holding baby on your hip. Seriously. Do it. Much like licking your finger to turn a page in a book, this makes your hands a little more grippy and, let’s be honest, you’ve totally done grosser things for the sake of your baby. Yes, you have.

22. Switch sides you carry the baby on to give the other side a break. This one’s hard. We all naturally tend to carry on the right or left. But try to even things out. Your back, hips, and neck will thank you. Plus it’s also good for helping baby’s neck muscles develop evenly as she looks to both the left or right sides depending on which side you’re holding her.

23. Use a stool to obtain out-of-reach items rather than straining to reach up or standing on the counter. Don’t hurt your back or shoulders. Don’t fall off the counter. And ask for help if you need it.

24. Limit the amount of time you spend sitting on the floor with your back unsupported. It’s easy to just sit on the floor, legs criss-crossed, as you feed the baby, chat with friends, play with baby on the floor, or watch TV. Do your very best to sit in a supportive chair that allows your feet to rest flat on the floor. Or at least lean up against a couch or wall so your back doesn’t wear out. No need to walk like a granny after you’ve been sitting on the floor without any back support.

25. Rest when you can. I know. Yeah, right! But the body repairs itself during rest. Though “rest” can mean taking a nap (which I know is virtually impossible for most of us), it can also mean having some quiet time during the day or conserving energy simply by the way your hold or tend to the baby.

Please take care of yourself! I hope these tips will help keep you healthy and prevent injury as you care for the sweet, growing baby in your life.

*Some links in this post are affiliate links. This means if you click and wind up buying something through that link, you’ll not only get a great product, you’ll also help this mama pay the bills!

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An Appreciation of Occupational Therapists {Guest Post}

Posted on January 22, 2013 by christiekiley

Please join me in welcoming Melissa Castino Reid as MamaOT’s newest guest blogger. When Melissa first shared her daughter Rachel’s story with me several months ago, I was moved beyond words. I signed up to join her “Bus of Hope” and have been following their journey ever since. I hope her story, struggle, and triumph will inspire, inform, and move you the way it has me.

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In the summer of 2011, my beautiful, healthy daughter, Rachel, suffered a pair of strokes thanks to E. Coli at the tender age of four and a half. In order to walk, talk, and recapture her gross and fine motor skills once more, rehabilitation therapy has been a part of our new normal. In our journey as a family, a few things are quite clear: the parents and therapists are advocates, and we must work together actively and honestly if we hope to see our patient thrive and achieve comprehensive progress.

After the strokes hit, and Rachel’s condition stabilized, we moved from Children’s Hospital to Gillette Rehabilitation Center, located inside Regions Hospital in St. Paul, MN. I had never witnessed therapists first hand. They can be a unique brand of ingenuity, intellect, and inspiration. And most therapists who work with children know that fun has to be central to what is done in the sessions. I have a deep respect for Rachel’s main occupational therapists Lisa, Karen, and Leah. They have been powerfully instrumental in aiding Rachel in her recovery process.

The strokes left tremendous tone (spasticity) in both arms. I had no notion of what we had to do to get my daughter’s arms and hands working again. I’m sure I thought that a simple surgery would “make it all better.” Instead, I met Rachel’s first occupational therapist, Lisa, within the first week of living at Gillette. With her wide smile, blond hair, and twinkling eyes, she wanted Rachel to do one thing: push a button. That’s all. She accomplished this goal in about a month. Lisa also helped Rachel work on trunk control as she got her to lean on a bench, getting her hands to open and close as she played with shaving cream. From the start, all the therapists noted how hard Rachel worked, but like everything, she had good days and bad.

Stroke or traumatic brain injury recovery is laborious for the patient, but it’s not exactly easy for the family either. I always remember the joy I felt when I watched Rachel attain a goal, but I also won’t soon forget the fear that welled up inside if I didn’t see progress. One day, Rachel wasn’t pushing that button at all, and I had to step away and find a corner of the gym to let the tears fall. Lisa watched me walk away, carried on with Rachel as if nothing was wrong, and smiled at both of us with encouragement. I just wanted my healthy kid back so badly.

Lisa comforted me when the session was over. She and other therapists made it clear to me that I couldn’t measure success in increments of days. I had to widen the length to weeks, if not months. As a parent, standing at the bottom of grief’s mountain, I surely didn’t want to accept this. It meant that I had to be more patient than I already was. Guess what? My patience was shaky after nearly losing her.

But I needed these therapists on my side, so I listened to every word they said, sometimes smiling, sometimes crying. Another occupational therapist, Karen, was listening to my take on Rachel’s recovery, as I was learning how to gauge success, and she told me another thing I didn’t want to consider at the time: take pictures. My daughter’s face was so vacant since the strokes, so taking pictures was the last thing on my list. But over time, my cell phone camera captured the light returning in her eyes, ever slowly. With these pictures, I now have a way of measuring how much progress Rachel has made, trading shade for sunlit possibilities for my girl’s future.

After spending four months living inside a hospital, we left Gillette Rehabilitation Center in October of 2011. At that point in her recovery, her legs were moving just a bit, she verbalized here and there, but no words, and both her arms were tight and spastic, with her hands quite fisted. We were discharged to Gillette’s outpatient clinic in Minnetonka, and the slow recovery continued. Enter Leah, our new OT gal.

Leah was new on the scene, recently hired on. With her thin frame, long brown hair, and almond eyes, she is very comfortable in her surroundings for such a newbie. And while she’s young, I must confess she’s wiser than most her age. She took on Rachel with all her knowledge, all her curiosity, and all her Midwestern heart. We started where Lisa and Karen left off, helping Rachel to learn how to move the arms and hands to perform tasks. I shall never forget a moment with Leah early on where I was flexing my newly-formed advocate muscles.

We were talking about goals for Rachel, and at the beginning of our transition to Minnetonka, I was sensing this hesitation to push my daughter. In retrospect, all the therapists were probably trying to plot out a plan of action as they sized up their newest kiddo. So Leah asked me questions about specifics, and I think I was getting a little impatient because I was spitting out my answers.

“So what is your hope with this therapy? What do you expect?” Leah asked, looking at me directly.

“I expect a full recovery,” I said, with my palms up. “Yeah, a full recovery.” The silence after only punctuated the pull of war between us. I’m a hopeful parent; she’s a well-schooled, new employee, navigating the uncertain waters of this patient’s future. Who’s right? Who’s wrong? Or isn’t that what this is about?

After that conversation, all the therapists seemed to fall into sync, and Rachel’s recovery continued to take root in the new locale. Did that happen because I spoke truthfully and clearly what I wanted? Maybe. Or was this falling-into-rhythm thing going to happen in any case? Perhaps.

As parents of kids who require therapy, we must be clear in our expectations without being overbearing. And I’ve learned that therapists and parents must be honest about what we see in the present and the future. I’m sure that Leah swallows hard when I say to her, “I want Rachel to play baseball again with me,” smiling still as she taps it into her laptop. I have learned to be (more) patient, but I also never stop asking questions, halting a conversation with my raised hand, asking for clarity. As a result, I am able to create goals with their knowledge in my head, using it as a guide.

Currently, the left arm is almost fully functional. For now, the goal in occupational therapy is to put the left hand to work while engaging the (spastic) right hand whenever possible. For example, we are getting Rachel to use the left hand to hold and make marks with crayons and markers, feed herself with forks and spoons, and navigate her speech tablet. We ask Rachel to stretch out the right arm multiple times throughout the day. I (or my mom or my husband) often reach for her right hand and extend it fully, holding it for five to ten seconds. Sometimes, I will crank it like it is a well, asking if water will come out of her armpits. This gets a big laugh.

Another thing I’ve done is gone back to playing board games with Rachel. I had trouble with doing it at first. Again, I wanted the full, healthy girl to move her own game pieces, but she isn’t quite ready to do this yet. One of the therapists along the way suggested that I move the game pieces for her, still playing the game. I wonder if I wallowed in my sadness too long, sometimes, but then I just look at Rachel and say, “Wanna play Candy Land?” A big smile spreads across her face like a bursting sunrise. Lately, she is able to pick out her own game piece and place it at the start of the game. She can point at the gumdrop and candy cane on the board. All of this points to progress.

As we begin the new year, I can’t help but dream about the warmth of summer, picnics with Rachel, and a game of catch with a whiffle ball. Better yet, I can’t wait to go on walks, holding her hand as we stroll. My dreams may not come true as soon as I want them to, but therapists like Lisa, Karen, and Leah have taught me the virtues of patience and new measurements of progress.

If Rachel continues on this path with our help as parents and therapists, I believe a full recovery is possible.

. . . . .

Melissa Castino Reid is a community college English teacher, mother, wife, and writer. She has written for the Star Tribune, Pioneer Press, Minnesota English Journal, and Hearing Magazine. She keeps an online journal about her daughter’s recovery from stroke called the Bus of Hope. In her spare time, she loves to read, spend time with family, and go for walks. Her new addiction is running and sugar free Red Bull. If you would like to read more about Rachel’s recovery, read Melissa’s blog at www.busofhope.org or send her an email at mcastino@hotmail.com and ask to be placed on the Bus of Hope.

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Valentine’s Day Fine Motor Craft

Posted on January 20, 2013 by christiekiley

Valentine’s Day is less than a month away and many classrooms have already traded in winter themes for heart-shaped crafts and activities. Here’s a simple heart-centered fine motor activity I have done with some students recently to target their goal areas while also giving them a chance to make something they can bring home to their parents. I’ve also included suggestions for adaptations in case you want to work on additional skills or change things up a bit.

Materials needed:
♥ Red and pink construction paper (one sheet of each)
♥ Marker for adult to draw lines and dots
♥ Kid-friendly scissors
♥ Glue stick
♥ Short red crayon
♥ Bottle of squeeze glue
♥ Red tissue paper

Appropriate age level:
♥ Preschool and above

Skills challenged:
♥ Cutting, coloring, pasting, gluing, crumpling
♥ Fine motor strength and dexterity
♥ Bilateral coordination (coordinating the use of two hands)
♥ Visual motor skills (hand-eye coordination)
♥ Visual perceptual skills (scanning, tracking)
♥ Overall attention
♥ Sequencing steps
♥ Sensory processing (grading pressure, touching glue)
♥ Crayon/pencil grasp

Step 1:
Give child a piece of red construction paper folded in half and prepped with half a heart for them to cut out. The thicker the paper, the more strength required to cut it, and the more sensory feedback provided to the child’s hand and arm while cutting.

Step 2:
Have child cut out the half a heart. They can either cut on the line or, if that’s too hard for them, you can draw a “road” for them to cut on so they just have to try and stay in the general vicinity of the line. The road visual seems to really help kiddos who either have poor visual attention to regular lines or who are highly perfectionistic and tend to meltdown if they don’t cut absolutely perfectly on the line. If the road isn’t enough of a visual prompt to guide their cutting, try using play dough or Wiki Stix as a physical boundary for their road.

Step 3:
Have the child open up the heart, paste the back of it with a glue stick, and mount it on the sheet of pink construction paper. Be sure they are extending that index finger to pinch and control the glue stick (rather than tucking it in and using their knuckle to hold it). Encourage them to hold the glue stick like a pencil as much as possible (pinching between thumb and index finger while resting it on the middle finger) rather than grabbing it with their fist or somehow holding it with all their fingers.

Step 4:
Have the child color the heart with a short red crayon. The short crayon encourages them to pinch it with a tripod grasp as pictured below, with thumb and index finger controlling the crayon while the “web space” (that fleshy part between those two finger joints) remains open in an “O” shape. If they have a hard time coloring only on the heart, you can again try using play dough or Wiki Stix as a physical boundary to help them color inside the lines. And if you have a child who could use a little extra sensory input while coloring the large heart, you can always place a sheet of sandpaper (found at most home improvement stores) or plastic embroidery canvas (found at most craft stores) under the paper to provide some additional resistance and vibration to the hand and fingers. It should make a pretty cool pattern as well!

Step 5:
Draw dots all over the heart to indicate where the child will dot their glue. You can either draw all the dots at once and cover the entire heart, or you can only give them a few to do at a time. It all depends on the child’s attention and visual processing skills. The more dots you give them to do at once, the greater the challenge as they must visually scan and attend to all the dots until they finish them. Or instead of randomly placing dots on the heart, you can intentionally draw them so the student must glue top to bottom, left to right, just like we want them to do when they are learning to form their capital letters! When I work one-on-one with students, I like to give them 3 or 5 or 10 dots at a time and then see how they respond. It’s a nice challenge not only for their visual perceptual and hand-eye coordination skills, but also for their fine motor skills as they must twist open the glue bottle and then “grade” their pressure so they squeeze it just enough to get the glue out but not so much that they drown the poor dot.

Step 6:
Time to crumple some tissue paper! Give the student squares of red tissue paper that are about one- to two-inch squares so they are just large enough to crumple into tiny balls and press onto the glue. Up the challenge by having students tear the tissue paper themselves. Show them how to crumple the tissue paper using both hands together or, if they’re really good, ask them if they can crumple it using only one hand (pictured below)! Depending on how they do it, this challenges their bilateral hand skills as well as their fine motor dexterity and the strength of those tiny muscles in the fingers and hands.The more paper to crumple, the more practice those little hands get! And, much like when they had to search for the dots during the gluing phase, the student must continue to visually scan across the heart to find every last dot of glue.

While some children may only be able to realistically cover their heart with ten or so pieces of tissue paper, others may want or be able to cover virtually the entire heart. Feel free to challenge your kiddos as much as you think they can handle with this Valentine’s Day craft. You don’t want to bore them with a totally easy project, but you also don’t want to push them so hard that they just shut down because the challenge is too great. Some may need a visual model of a completed project in order to really get a sense of what they’re working on. Adapt and modify as necessary so they can be successful. Happy Valentine’s Day!

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Use a Pullover Bib to Practice Pre-Dressing Skills

Posted on January 15, 2013 by christiekiley

Yesterday morning my 17-month-old son was wearing a pullover bib (something I had never heard of until my mother-in-law gave us one) and, all of a sudden, he pulled it up and over his head just like he was taking off a shirt. As soon as I saw him do this, a light bulb went off in my OT head and I thought, Aha! What a perfect way to teach kids to pull a shirt up and over their head! Check out the video below to see what I mean (please excuse the mess!).

We pediatric occupational therapists often work on self-care skills with young children who struggle with them, including tasks such as feeding, grooming, and dressing. I’ll be honest, teaching kids pre-dressing skills such as learning to take off their shirt is not my favorite goal to work on in therapy because it can be really, really tough! For kids who have developmental delays, language delays, attention difficulties, or overall difficulties with coordination, sequencing, and body awareness, taking off or putting on a shirt probably feels like trying to wrestle an octopus. They can barely see what they’re doing and there are a lot of parts to keep straight — literally.

But by giving them a pullover bib (which can also be used as a pretend superhero cape!), you are naturally breaking it down into simpler parts so they can be successful one step at a time. Brilliant! And I have to say, just a few hours after I took this video, my son all of a sudden started trying to pull off his own shirt…it really works! Pullover bibs can be found for purchase online by clicking here.

Has anyone else tried this before? What are other ways you’ve learned to help children to learn to put on or take off a shirt? I’ve tried using visuals, including this one, but I don’t feel like they’ve been too effective. Please share your wisdom with us all!

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4 ways to get babies moving

Posted on January 9, 2013 by christiekiley

Babies need to move just like grown-ups do. The only problem is, they can’t. Sure, newborns can wiggle. And, yeah, pre-crawlers can roll. But it’s not the same as big time movement through space.

Did you know that a baby’s movement sense (called the vestibular system) lives in the inner ear and is developed by the end of the FIRST trimester of pregnancy? So before mama has even said good-bye to morning sickness, baby has said hello to the sense of movement. So cool!

That being said, babies are primed for movement the moment they are born! Ever noticed how happy and/or calm babies often become when they are carried, bounced, or swung? And the more comfortable they can become with being moved through various positions and directions in space at a young age, the more likely they will be to “integrate” those movement experiences in the brain so they can apply that information to later sensory and motor development.

So how do you help babies move before they are able to move and crawl on their own? Here are four ideas:

1) Wear your baby. Often touted for its ability to promote bonding with parents and free up a grown-up’s hands, wearing your baby in a sling or baby carrier also provides baby with lots of opportunity to experience the natural movement and rhythm of everyday life: walking, sitting, stopping, etc. Some baby carriers that are okay for baby’s body include over-the-shoulder slings, Moby Wrap, K’tan Baby Carrier, and Ergo Baby Carrier.

2) Play with your baby on an exercise ball. Pre-crawlers are fully capable of enjoying movement provided on an exercise ball! Not sure what I’m talking about? Exercise balls are a great way to introduce tummy time, especially for the baby who despises it (find out how by clicking here), and they are also a fun way to give baby the chance to bounce, rock, and roll back and forth. Not sure how to play with baby on an exercise ball? No worries, check out my post, “How to Play with Your Baby on an Exercise Ball“, and be sure to watch the video demonstration!

3) Dance with your baby. Turn on some music or simply hold your baby and waltz or spin around your house. Try holding baby in different positions such as airplane, cuddle out, or side lying (pictured below). Bounce, move, and spin while holding your baby and then FREEZE! every 30 seconds or so to give baby’s vestibular system and brain and chance to process all that movement and then “reset” in order to get ready for the next set of dance moves. Dancing with baby is actually one of my top 10 tips to help baby learn to roll! Check out all 10 tips for helping babies learn to roll by clicking here.

4. Let your baby bounce himself. As a pediatric OT, I tend to shy away from recommending baby equipment such as swings, saucers, and jumpers because they can impede babies’ development by restricting their movement opportunities or placing their joints in compromising positions. However, I tend to be okay making exceptions when it comes to baby bouncers such as the one pictured to the right. The reasons I’m okay with them are 1) baby is the one who initiates the movement (as opposed to a mechanical swing) and, thus, is able to control and “integrate” the movement experience, and 2) these bouncers don’t necessarily place baby in a compromising position. Try not to let baby spend more than about 10 minutes at time in these bouncers, and check baby’s head to make sure a flat spot isn’t forming on either side from spending too much time with the head turned one direction while bouncing. If you notice a flat spot, mention it to the pediatrician at the next visit and be sure to encourage baby to spend time with his head turned both directions when in the bouncer and when spending time on his back. When used appropriately, baby bouncers such as these can be a great way to give those active babies (and you know who they are!) a chance to move their little bodies as they kick, bounce, and coo in delight!

Any other suggestions for ways to get babies moving?

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Hide Puzzle Pieces to Promote Fine Motor Skills {Photo Friday}

Posted on December 29, 2012 by christiekiley

Welcome to Photo Friday, a place where I share photos of therapeutic tools and ideas that can help boost your child’s development. Please give me feedback on my ideas — I love hearing how they go over with other kids!

. . . . .

Looking for a way to make puzzle time more engaging and challenging for both you and your toddler? Try hiding the puzzle pieces in a pillow case or small box with a lid.

By hiding the puzzle pieces partly or fully from sight, you are kicking puzzle time up a notch by challenging your child’s tactile perception, tactile discrimination, and visual memory skills.

Tactile perception is challenged when your child reaches into the container without looking, and he must feel around to locate the puzzle pieces.
Tactile discrimination is challenged when he begins to feel around and try to identify the differences (a.k.a., “discriminate” the differences in shape, size, etc.) between puzzle pieces without looking. For example, the elephant piece is kind of round and fat, while the giraffe piece is relatively tall and skinny, and he must be able to remember and identify all of that through touch alone. Tactile discrimination is a HUGELY important part of the development of fine motor skills such as fastening buttons, coloring, and writing.
Visual memory is challenged when you ask your little one to “Find the elephant.” He must remember what the elephant looks like in order to know whether or not he found the matching piece once he pulls it out.

As we played this game earlier this week, my 16-month-old correctly selected seven out of eight puzzle pieces from the box or bag. At first I thought he was just lucky, but then he kept getting them right! You might be amazed at how proficient your toddler is at this challenge…I know I was.

You could increase this challenge for preschoolers and older by placing the puzzle pieces in a bucket filled with dry rice, beans, or pasta and then burying them so they are partly or fully out of sight. This challenges their tactile discrimination skills even further and is great for both the child who is sensitive to touch input as well as the child who craves it.

Try it out and have fun!

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Mama OT’s Top 5 Favorite Holiday Gifts from 2012

Posted on December 28, 2012 by christiekiley

My toddler was so blessed by the fantastic gifts he received from friends and family this year for Christmas. While we really, truly appreciated all of them, I want to draw your attention to five in particular that touched my Mama OT heart. Maybe they will inspire you in your future gift-giving endeavors.

1. Personalized photo book
family book text One gift-giver went above and beyond by putting together a 8″ x 8″ photo album of objects and family members my son interacts with on a regular basis. He is in a stage right now where he points to everything he sees in print, so this was right up his alley. He likes to point to every single picture in the book as we name it for him, and he also loves to search for certain people or pictures as we ask him, “Where is _____?” He exclaims and points to Mama, Daddy, Nana (banana, his favorite food), and many others. This scrapbook-style photo album came ready-to-fill and now contains photos of familiar family members, toys, and animals. It has become his prized possession and he has been walking around the house with it EVERYWHERE! What a fantastic way to promote communication and relational skills while personalizing and capitalizing on a child’s love of books.

2. Toy phone

Like many toddlers these days, my son loves to play with phones, especially if it belongs to Mommy or Daddy. So this gift is a perfect way to give him opportunities to expand his pretend play and language skills!

3. Push and go toy
My little guy is still learning the concept of “push” when it comes to operating toys and container lids, so this is a great one to help him develop that cognitive/language-based skill while also encouraging his upper body strength as he pushes down on the driver’s head.

4. ABC Melody Maker

We are in a big button-pushing phase and, boy, does this toy offer lots of buttons to push! And not only that, there are a variety of settings that will last us for at least a couple of years as they encourage skills such as visual scanning, visual and auditory memory, and following a sequence of verbal directions. Settings include the following: 1) music and sounds associated with each letter, 2) letter and number identification 3) find the letter/sound and 4) follow the sequence. Additionally, this toy also comes with a “music book” that shows how to play several different children’s songs on the “piano” by pairing a number (1, 3, 7, etc.) with real music notes, and then sequencing the notes number by number so you can play out the song. It’s so cool! I now know how to play Row Row Row Your Boat and Old MacDonald Had a Farm…score! Hopefully my little guy will learn how to play them someday, too.

5. Multi-bin toy organizer
This couldn’t have come in more perfect timing. Our cardboard boxes that were filled with toys and shoved under side tables just weren’t cutting it anymore. Plus, my little guy is starting to understand the concepts of “clean up” and “put away”, so this gives him the opportunity to develop some more independence in these areas since he has easy visual and physical access. Just yesterday he decided he was done playing with his ring stacker and, without any prompting, he started putting all the parts back in the empty bin. I was so proud! In addition to the natural categorization of toys that comes with having several storage bins, you can further encourage clean-up independence by taking a picture of the toys that go in each bin and then taping each photo onto its respective bin. This way, each toy/bin combination has its own “parking spot” and your child (plus anyone else who helps with clean up) knows exactly where everything should go. Many pediatric therapy clinics use visuals like these as a way of enhancing children’s language and cognitive skills, so why not carry that strategy over into the home to help your own child as well?

Thank you to friends and family who so generously gave such wonderful holiday gifts. Wishing all you readers a safe and happy new year!

*Some of the links in this post to recommended products are affiliate links. That means if you click them and wind up purchasing through Amazon not only will you get a great product your child will love, you’ll also be helping Mama OT pay back her grad school loans!

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Toddler Fine Motor Skills: Pipe Cleaner Colander {Photo Friday}

Posted on December 21, 2012 by christiekiley

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Looking for a way to work on fine motor skills and hand-eye coordination with your toddler? Or, here’s a better question…looking for a way to keep your toddler busy? Give them a colander and some pipe cleaners (both of which I found at the Dollar Tree), demo how to use it if needed, and let them go to town. You might be amazed at just how entertained they will be.

This activity is an ideal challenge for the child who is able to grasp objects with their whole hand or with thumb and index finger, but isn’t quite ready for more refined fine motor activities such as lacing beads on a string. As with many activities, taking the pipe cleaners out is easier than putting them back in, so it provides a natural grading of challenge for kids at a variety of skill levels. However, you might be surprised at how interested your little one may be at trying to place them back in the holes after they have been quickly ripped out.

Putting the pipe cleaners in encourages precise hand movements and higher level hand-eye coordination than lower level play skills such as stacking two blocks or placing pegs in a board. Encourage your child to hold the pipe cleaner with their fingers pointing toward the tip (toddlers aren’t expected to have a mature tripod grasp like the way adults hold a pencil at this point), as opposed to grasping with their fist and turning their arm in so the thumb-side of their hand is facing down.

Depending on your child’s age and skill level, you can add all sorts of educational challenges to this activity by involving your child in identification of colors, sorting and matching colors or sizes, and more. Try this activity out, save it for a rainy day, and prepare to (hopefully) be amazed by your toddler’s newfound fine motor skills!

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Reusable Baby Food Pouches: Squishy Snak Paks! [Product Review]

Posted on December 12, 2012 by christiekiley

I love baby food pouches! They are practical, healthy, and easy-to-use. I first discovered them when my son was eight or nine months old, and it made picnics in the park and coffee dates with Mommy so much easier…and less messy! Not only that, baby food pouches also taught him how to drink from a straw (he never mastered the bottle or sippy cup, so that was a huge accomplishment). Like I said, I love baby food pouches. You can read my review of them here for more info and ideas on how to use baby food pouches to promote the development of baby’s feeding/oral motor skills.

The bummer about baby food pouches though is that, at $1-$2 per pouch depending on where you get them, they can get expensive over time (although WIC does cover the ones that are 100% fruits and veggies, which is most of them).

So you can imagine my excitement when I received an email from Michelle at Squishy Snak Paks, letting me know she has created REUSABLE baby food pouches!! Michelle — a stay-at-home-mom to four little ones (the two youngest being twin boys) and self-proclaimed “Mompreneur” — created this product to allow her toddling twins to be able to enjoy her homemade purees while still being able to be independent. She graciously agreed to send me a free two-pack so I could try them out and let you, dear readers, know what I thought.

First, the specs. Squishy Snak Paks:

are made of non-toxic plastic and are free of BPA and Phthalates.
are durable and safe for freezing.
are dishwasher safe (place opened end on a prong on the top rack and put the cap in the silverware basket).
hold up to 1/2 cup puree.
come with a heavy duty zip seal (Michelle has had no reports of Squishy Snak Paks bursting open while being used or transported in, say, a diaper bag).
fit perfectly with baby food dispensing spoons, which are little spoon tips that screw onto baby food pouches so you can have portable puree-on-a-spoon (read my post about them here). You have to make sure there are no lumps in the puree, though, so that it will dispense through the little hole in the spoon without clogging.

Next, ideas for use. You could use Squishy Snak Paks with your infant (at least 6 months old/able to eat Stage 1 puree) or toddler by:

filling with store bought puree (Stage 1 or 2), yogurt, applesauce, etc. for increased convenience when eating with your little one outside the home.
filling with homemade smoothie if baby is not ready to drink from an open cup.
filling with homemade puree that is just straight-up fruits and veggies (recipe listed below!) in an effort to help your little one get more fruits and veggies without all the flavor they dislike. Hello, blueberries, apples, and broccoli! Have you seen those crazy combinations in the store?. You could even throw some quinoa or oats into that blender/food processor to give it some protein/added fiber. Just be sure the freshly-made puree gets consumed within the hour or goes in the fridge in a sealed container and is consumed within 24 hours. This may be a REALLY good option for those of you with kids who are picky eaters. You could send them to daycare or Grandma’s house with this and know they’ll still get fruits and veggies.
making a large batch of puree and freezing portions in an ice cube tray, much like you can do with regular homemade baby food or expressed breast milk. When you are ready to use, simply place two frozen cubes in the Squishy Snak Pak, set it in a bowl of warm water to defrost, or just put it in your diaper bag and go. This is definitely the most efficient and cost-effective way to do it!

Michelle shares three quick and tasty recipes on the Squishy Snak Pak website (Apple & Pear with Cinnamon, Avocado & Banana, Blueberry & Banana), but I was excited to experiment with my own basic recipe.

Mama OT’s Pear Spinach Puree for Squishy Snak Pak

All I did was toss a pear, a handful of spinach leaves, and a tiny bit of water into the food processor to help keep it smooth. I pulsed it for several seconds until it was smooth enough to dispense (much like a Stage 2 puree) and then went to work scooping it out. I scooped with a spatula from the food processor to a baby-sized bowl, then to the Snak Pak one spoonful at a time until the bag was full.This recipe made about one and a half bags full, and my 15-month-old LOVED it!

I knew he liked it because he kept signing for “more”!

I was brave enough to try some and, I’ll admit, it was good. Tasted like pear applesauce and I couldn’t even taste the spinach or feel its texture. Would definitely recommend this combo!

Three critiques of Squishy Snak Paks:

I wish there was a cleaner or more efficient way to get homemade puree from the blender/food processor to the bag. Not sure if a funnel would make things easier or trickier at this point.
I wish they stood up like the store bought ones when they are filled. This is a minor critique, but I like being able stand them up when I put them in the fridge as opposed to laying them on their sides. Like I said, a minor issue.
The Snak Pak does include a “fill line” so you know how much puree to put in there. However, my husband and I both missed it the first time because it is pretty faint and kinda blends in with the pattern on the bag. I also found that my bag overflowed a little even though I respected the fill line. Maybe it depends on how thick your puree is. So just be careful when filling and zipping your Snak Pak.

Would I recommend this product?

YES! Whether you are savvy enough to make your own puree, or you throw in something that’s store bought, I think Squishy Snak Paks could be a great addition to any family who wants their baby or young toddler to be able to eat healthfully while minimizing mess and maximizing portability. You can add on a dispensing spoon for the baby who can’t yet suck from the spout, you can use a Snak Pak to teach your baby or toddler to drink from a straw without spending a fortune on individual baby food pouches, and you can freeze large batches of puree in order to increase both the variety and volume available to you.

You can order Squishy Snak Paks by visiting Michelle’s website, http://squishysnakpak.com. They come two-at-a-time and would be a great gift for stocking stuffers, baby shower gifts, or even baby birthday gifts. Stop by and check them out!

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Holiday Survival Tips for Families of Children with Special Needs

Posted on December 9, 2012 by christiekiley

The holiday season is often filled with shopping, unique food, and special time spent with distant loved ones. For many families, this is no big deal — chaotic, but manageable. But for families of children with autism and/or special sensory needs (especially sensory sensitivities), these events may often be met with dread, stress, and major meltdowns.

Here are some tips for helping children with special needs survive the holidays:

1. Minimize kids’ time spent in stores and malls. It’s a jungle out there right now — stressed out crowds, lots of overwhelming sounds, weird smells, long lines, and more kid-tempting merchandise than any other time of year. If at all possible, avoid sensory overload and leave the kids at home or with a sitter while you do your shopping. You could devote one entire day to getting all your in-store stuff done. Or, better yet, do your shopping online. There’s still time to ship before the holiday and you can avoid the madness. If you’re looking for kiddie gift ideas, check out MamaOT’s list of Holiday Gift Ideas for babies, toddlers, and preschoolers. And if you’re not sure what to get for the child with special sensory needs, check out this great list of holiday gift ideas from AbbyPediatricOT.

2. Prep your kids. All the people and events involved in holiday festivities can be overwhelming for kids in general, but this is especially true for kids with autism/sensory difficulties. One of the best things you can do is prep them for what to expect. You can familiarize them with who they will see by going through photos with them online (yay, Facebook) or creating a special photo book (nothing fancy) so they can look through it with you in prep for the big day. You can make your own version of a Social Story by helping your child put together a basic book (pieces of paper stapled together) with stick figures and descriptions of what will or may happen in different aspects of the upcoming festivities. If you’ll be traveling a long distance, you can prep them for what will be involved with transportation and include that in your social story (going to the gas station, standing in line, security checks, special seat belts, cabin pressure, loud railroad noises, etc.). The more you can prep them for what’s to come, the better.

3. Prep your family. If you’ll be spending time with family and loved ones who may not be in the loop with your child’s needs, you may want to fill them in a bit so they know what to expect and won’t be offended if little Johnny cries when Aunt Marge tries to give him a big hug and kiss or sweet Susie won’t eat Grandma’s homemade ham. This can be a touchy subject for some families, especially if they don’t feel comfortable letting others know their young child has a diagnosis yet (such as autism). Only share as much as you are comfortable. All you need to say is that Johnny is more comfortable with high fives than hugs and kisses (which you know is due to tactile sensitivities), or Susie is still learning how to try new foods (which you know is due to oral sensitivities), and leave it at that. But please make sure you communicate something so your sweet family gathering doesn’t turn into a day of raised eyebrows and hurt feelings.

4. Maintain routines. Many children with autism/sensory challenges have major difficulties when it comes to change, especially changes in routine, diet, or sleep schedule. Their bodies and brains often don’t adapt as well, and this may result in over-arousal, disorganized behavior, increased sensory seeking/avoiding behaviors, and/or meltdowns. If your child is one who heavily relies on routines to maintain their sense of organization and emotional regulation, then you know what I mean. So amidst all the school plays, errands, and travels, try your very best to keep your most critical routines as much the same as possible. If your child follows a special sensory diet created by an occupational therapist, then make sure he or she is engaging in those special sensory activities as regularly as possible in order to maintain their level of physical and emotional regulation.

5. Maintain diet. I mentioned diet in the previous point, but it’s so important that I’m giving it its own section. Food fuels our bodies and our brains. Some bodies and brains can continue to function in an optimal (if not slightly hyper or lethargic) level despite temporary changes in diet such as increased sugar, fat, red food dyes, wheat, or carbonation. Other bodies, however, get totally thrown off kilter when holiday foods are introduced, and it can put kids with sensory challenges into a whole new level of struggle. You know your child and what his or her tolerance is to changes in diet, so it’s ultimately up to you on how to navigate the holiday offerings of cookies, fudge, marshmallows, candy canes, etc. But just be aware that holiday foods have the potential to greatly influence and alter a child’s ability to function in their day-to-day, especially if they have special sensory or dietary needs.

6. Bring your own food. If you know food will be an issue for your child, consider providing food you know he or she will eat. Loud, stressful holiday family gatherings are NOT the time to try and introduce new foods to your selective eater. This is why it’s important to at least minimally prep your family in advance of mealtime, so they won’t make a big fuss about why your child isn’t eating what everyone else is eating. If they’re eating chicken nuggets while everyone else is enjoying prime rib and mashed potatoes with gravy, that’s fine! Again, you know your child best, so do what you think will work. But please don’t stress about how they will respond to all those new foods. They don’t have to eat them.

7. Make a plan for “escape”. What are you going to do if and when your child has had enough sensory input for one day and is teetering on the point of meltdown (or has already zoomed past that point into total meltdown)? If you know where you will be on the big day, try to create a “safe space” where your child can retreat before he or she gets to the point of explosion. It could be a spare bedroom with video games/movies, a small tent or fort with pillows/blankets/preferred toys, or even the car or garage. Or on the opposite end of the spectrum, what are you going to do if your sensory seeker has been cooped up in a car or airplane and is now expected to sit still as a guest in someone’s house all day. Not gonna happen! Try to find ways to give your seeker opportunities for vestibular input (spinning, swinging), proprioception/heavy work (running, crashing, carrying heavy things), and/or tactile experiences (play dough, fidget toys) before they end up in trouble. Like I said, the more communication you can have with family in advance, the better chance you have at successfully navigating your time together.

8. Have a support team. Enlist at least one other person or family to be on your “team” during your gathering. This could simply be someone who makes sure the “safe space” is all ready to go, or it could be an adult or older kid whom your child trusts and is able to hang out with while you try to eat and socialize. Whatever you do, don’t do it alone!

There are so many aspects of the holiday season that can be difficult for families of children with special needs that I couldn’t possibly cover all of them in one post. So please visit these other helpful links on similar topics if you are looking for more information:

Special Needs Parenting: 10 Tips for Holiday Stress Reduction, from GoodTherapy.org
Surviving the Holidays with Your Sanity Intact, from One Place for Special Needs
Downloadable Holiday Survival Guide for Families with Special Needs, from AbilityPath.org

Happy holidays to you and your family!

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