Guidelines for considering a tonsillectomy indicate:
-at least seven episodes of throat infection in a year as documented by a physician
-at least five episodes each year for two years as documented by a physician
-three episodes annually for three years as documented by a physician
Even if a child meets the criteria, it may not be in the child’s best interest to undergo surgery.
Improved sleep Minimal improvement in throat infection
Improved behavior Post-operative complications with infections and bleeding
Improved growth Post-operative pain
What this means for speech and feeding development….
Because we use the same muscles to talk that we use to eat. We often see weakness in both areas.
When there is muscle weakness or difficulty coordinating the muscle movements for speech, if a similar movement is needed in feeding, it will also be affected. For instance if a child has difficulty producing /l/ (tongue tip up sound), you may see difficulty removing food stuck on then roof of the mouth, or on the upper lip. Therefore, speech therapists often use feeding exercises to aid in development of speech sounds. For instance you may see the following:
If a therapist is working on upper lip movement on a spoon or a cup
This will aid in development of/m,b,p/
Working on movement of lower lip
This will aid in development of /f,v/
Working on straw drinking
This will aid in development of vowel sounds, tongue retraction for /k,g/ and lip rounding for /w,sh,ch/
Working on jaw strength and endurance with chewing
This will aid in overall intelligibility, production of sounds that require jaw strength and stability, such as /s,z,sh.ch/
Working on removing food from the roof of the mouth or from the upper lip
This will aid in tongue tip up sounds and sounds that require the jaw and tongue to move independently, i.e. /t,d,n,l/
Strengthening the muscles for feeding, will additionally strengthen them for speech, and strengthening them for speech, will strengthen them for feeding.
What does astronaut training have to do with your child’s therapy? Whether your child receives speech, physical, or occupational therapy, astronaut training can help incorporate appropriate sensory integration by providing input through the central nervous system. Everything we do is affected by sensory integration. The astronaut training is a type of vestibular protocol to facilitate appropriate vestibular, auditory, and visual processing.
The vestibular area of the sensory system affects movement –balance, knowledge of where we are in space, and how fast or slow our body is moving. It is located in the inner ear and acts like the “compass” to our body. It gives our brain input and understanding of the position of our head and body in relation to the pull of gravity. Vestibular deficits are usually seen in children with delayed milestones, decreased attention and ability to follow directions, language disorders, learning disabilities, and poor coordination. Other characteristics children may demonstrate include clumsiness, fearful of movement, or may bump into things often (poor body awareness). The vestibular system works with the visual system to give our body more input and meaning to our life. Along with strong core strength or stability, the vestibular system allows our bodies to focus our eyes on a target while moving. If our sensory system is not interacting appropriately together, information our brain is receiving from our environment is being interpreted improperly which makes it hard to read, write, throw a ball at a target, and other everyday tasks that are important for development.
The visual system lets our body know if we are moving or standing still, if we are close or far away from an object, and how far to throw a ball to someone or at a target. Our visual system also works closely with the vestibular system by letting our brain know our body’s position in space depending on what we see or how we are seeing things –if we are upside down, sideways, spinning around, or sitting upright.
The auditory system helps us because it gives us information about orientation by sound. It helps our brain and body in “flight or fight” responses to alert our body and muscles to be attentive. It lets our body sit upright, turn our head or body appropriately, visually locate the source of sound, and in what direction it’s coming from. All areas of the sensory system are required to work together appropriately throughout each day while we complete all day to day activities or tasks.
So how does the astronaut training work? During the astronaut training, the child lays on their side in a fetal position on a spin board. The therapist may ask the child to keep their eyes closed while the therapist spins the child in one direction for about 10-20 revolutions before stopping. During spinning, the eyes are trying to focus on objects around the room. When the child stops spinning, the eyes typically continue to move in attempt to orient the body in space. These eye movements are called nystagmus or saccades. They should be seen at half the time the child was spinning; for example 5 seconds of saccades for 10 revolutions. The therapist will then complete the same protocol with the child lying on the other side. The child is under-responsive if the eyes are not moving or do not demonstrate the appropriate saccades; and over-responsive if the eyes are moving too fast. Using the astronaut training program, we are training the brain to process movement information correctly so that our body can be more organized!
Written by: Lindsay Davidson, MOT, OTR/L
Listed are some games/activities that encourage talking and may be a fun way to practice speech sounds in conversation.
Written by: Jessica Teepen, MA, CCC-SLP
Cutting a child's nails can be difficult, especially if your child has sensory processing challenges. Below are some tips to make cutting your child's nails easier:
-Try cutting nails after bathtime. Typically a child will be calmer after a bath, and their nails are softer making them easier to cut.
-If they do not tolerate cutting, try using a nail file often to keep their nails short instead.
-Apply deep pressure to the fingertips before cutting the nails.
-Give the child a hand massage with lotion or Vaseline before cutting nails.
-Sing a song or allow the child to watch a video to distract them while cutting their nails.
-Allow your child to choose the day of the week or time of day that you will do the nail cutting. Allowing them to have soom control might make the process less of a challenge.
Written by: Hilary Lee, MPH, MS, OTR/L
Despite your best efforts, at some point your toddler will break the rules. Consider using these parenting tips to encourage your child to cooperate:
Whatever consequences you choose, be consistent. Make sure that every adult who cares for your child observes the same rules and discipline guidelines. This reduces your child's confusion and need to test you. Also, be careful to criticize your child's behavior — not your child. Instead of saying, "You're a bad boy," try, "Don't run into the street." Never resort to punishments that emotionally or physically harm your child. Spanking, slapping and screaming at a child do more harm than good.
Set a good example
Children learn how to act by watching their parents. The best way to show your child how to behave is to set a positive example for him or her to follow!
Mayoclinic.com has some more good resources and tips for toddlers behaviors.
I often hear my parents express concerns about their children having temper tantrums or negative behaviors and they aren’t sure how to deal with them or just discipline them. If your child has Sensory Integrative Dysfunction they are often unable to tolerate certain types of stimulation. Think of some common situations when children often get in trouble: over excitement or overstimulation while in a large group of people (e.g. holiday gatherings, birthday parties); or at the dinner table when they don’t want to eat what the family eats or cannot sit still.
These activities can place a lot of demands on an individual’s sensory system and cause them to lose control because they are either sensitive to sounds, crowds, too much touching by loved ones or strangers, and/or smells.
Tips to help your child:
No child is perfect and all children require discipline at some point. First, focus on reinforcing good behavior. Children with sensory integrative issues may have low self-esteem and should not be criticized. You should also be aware of how your discipline techniques affect your child’s sensory system. Be realistic with your expectations and understand that not all children have the same capabilities. Finally, be consistent in handling inappropriate behaviors so as not to confuse your child.
For a toddler that is learning to talk, it is vital to create a fun learning environment by simply embedding opportunities into their daily routines. There are many things you can do throughout the toddler’s day to help elicit language skills.
Dressing time/Bath time:
1) Offer choices of things to wear (e.g. “Do you want the blue shirt or the red shirt?”) This creates an opportunity for your toddler to not only hear more words, but also verbalize (or point) to a choice.
2) Comment on what you are doing while dressing, describing the items of clothing/body parts. This will elicit imitation of functional words.
3) Label body parts in the bath tub/while dressing.
4) Discuss “on” and “off” and “in” and “out” (e.g. shoes on, socks off) concepts
5) Make lots of sounds/expressions while in the bathtub, describe what is happening, splash the water, use bubbles etc.
1) Give the child less food than usual, to encourage requesting “more” (e.g. “more crackers”) You can try giving the child two crackers instead of the entire bag.
2) Comment on what he/she is doing during the mealtime, be descriptive. Again, this creates an opportunity for the child to imitate words he/she hears.
3) Keep favorite snacks or items out of the child’s reach so that he/she can point or ask for the snack (i.e. up on a shelf/out of reach)
1) Comment on what you are reading, describe the “actions” (e.g. “Look he is eating!” mmm! Yummy apples, he likes apples! Do you like apples?”
2) Encourage the child to turn the pages, have the child follow the direction of “turn the page”
3) Label pictures to encourage imitation of words.
1) Get down on the floor and PLAY! Be expressive, interact, and over exaggerate words and make lots of sounds to elicit imitation of simple sounds and words (e.g. “Weee! up-up-up goes the plane, wow!”) It is ok to act silly, toddlers love it!
2) Participate in turn-taking, stating, “my turn!”
3) Comment on what you are doing, using lots of words to encourage imitation.
Written by: Christina Sanford, MA, CCC-SLP
What is speech?
Speech is made up of oral motor skills, respiration (airflow), and phonation (voice).
What are oral motor skills?
Oral motor skills are the complex and coordinated movements of the lips, teeth, tongue, jaw, and cheeks that your child uses for speech production.
How can whistles help?
Participation with whistles facilitates the skills required for adequate articulation skills in a fun and motivating way.
Let your child play with and explore all the whistles. Some of them will come easily at first and some will be more difficult. Your therapists will explain how difficult whistles can be modified and how to encourage your child to participate in a variety of ways with all of the whistles.
ABC Pediatric Therapy Network sells whistle kits at our Centerville office (8000 Miller Farm Lane). Or, you can buy whistles at a store. The current cost of the basic kit is $5.00. You may purchase individual whistles or more whistles to supplement your kit. These costs can be acquired at the front desk. Thank you for providing your child the tools and support needed to succeed in therapy.