Please bear with me while the website is being fixed. I hope it will be back to normal soon.
Thanks,
Munira
Oct 312011
Sep 182011
I’m so excited to tell you that ot4kids now has its own office space in Southfields, southwest London.
Funnily when I first moved to London a few years ago, somebody mentioned that they worked in Southfields. I think I probably scrunched my nose as I had no idea where or what Southfields was. And now I’m working here. 
At first I wasn’t sure what to call this practice. When I was in California, we’d use the term ‘Sensory Integration Clinic’ and in New York City, ‘sensory gym’. Either way, I’ve always wanted a practice that is in a home so that it’s comfortable, a natural environment, and parents can replicate what we do in a treatment session using what they have at home. I will have specialized therapy equipment however I will also use what’s naturally available in one’s home. I hope this will be a cozy practice where kids can have fun, grow and reach their best potential.
I’m also looking forward to start some BABY groups for parents and babies who are:
- at-risk due to having prematurity or a traumatic birth
- have medical diagnoses such as Down’s syndrome
- have developmental delay or aren’t reaching their developmental milestones
Groups will be hands-on, targeted to a child’s needs, and kept very small so parents and babies can get the most benefit. Feel free to contact me at munira@ot4kids.co.uk to sign-up or for further details.
I will put up photos as soon as settled in. Stay tuned.
All the Best! Munira
Jul 262011
We know that at least 1 in 20 children have sensory processing disorder (SPD). Research has also shown that 35% of gifted and talented children have features of SPD. This is even more than the general population. Most of these children have the most common subtype of SPD called Sensory Modulation Disorder (over-responsively, under-responsively, sensory seeking) and some also have dyspraxia.
I think that this is a huge deal and should be taken more seriously. I work with many children who are so bright and intelligent, yet they struggle to cope with day-to-day activities such as tactile experiences, changes in routine, being in louder or busier environments, socialising with siblings or peers, or moving about the playground and playing physical games. Simply, their cognitive skills are beyond their age however their emotional regulation and sensory processing are well below their age. This mismatch can make it really frustrating for them. Also, because these kids are so bright and look okay from the exterior, parents are often told that they’re reading into it and their concerns aren’t taken seriously by professionals and teachers.
If unrecognised, sensory processing difficulties amongst gifted kids can negatively impact upon their social and emotional development which carries over into adulthood. It also causes difficulties in motor and cognitive abilities.
Being that 1/3 of gifted kids are found to have SPD, it would be wonderful if gifted and talented programs would screen their kids for SPD and teachers would be armed with supports and strategies to help their students.
Imagine, if this population were given the right sensory tools and strategies to help them be more comfortable with their bodies, environment and others, they would soar. Occupational therapists, parents, teachers, and the students must work together to support gifted students and make sure they can reach their fullest potential.
For more on the topic, look at this research in more detail as well as this website called Smart Kids with Learning Disabilities.
Check out the library of the Sensory Processing Disorder Foundation for more on this important research as well as other articles.
So many children have iPads, iPhones and other fancy gizmos now. The use of iPads and apps are such a hot topic in the special needs community right now. It’s amazing how many apps are available to address various skills from fine motor, visual motor and perceptual, motor planning, and organization to speech and language.
I often hear from many parents and professionals that they worry technology will take over from actual movement, learning, hands-on exploration and play. Afterall, we receive completely different sensory feedback from feeling, holding, pushing, and manipulating actual bits and bobs in our hands. Not only that, as with the TV, computer games, and other techno devices, you can really see kids’ eyes bug-out while using them, making them unavailable for engagement. I think many of us know family and friends who are the same way. J
In my treatment sessions, movement, sensory exploration, and physical play will always be the primary focus. However, I do see huge benefits from using iPad apps. As with everything else, we need BALANCE. Personally, being that I’m a traveling therapist, I struggle to schlep around all that I would like to for my treatment sessions. The iPad allows me to travel a bit lighter. I mostly use it for organizational supports and visual perceptual games (e.g. timers, visual schedules, hidden picture /find the difference and sequencing games).
I also particularly love how the iPad makes so much more possible for children with more severe physical needs who have a harder time moving, grasping, pushing, pulling and even talking and communicating. I’ve read so many wonderful parent stories about how the iPad has given more opportunities to their child.
There are soooooooo many apps out there, so where do you start?
Here are some links that I found useful when I started using my iPad for more than reports and documentation…..
www.a4cwsn.com – Apps for Children with Special Needs
This is a wonderful website with video reviews of each app that has been personally reviewed and recommended by the owner.
http://www.oneplaceforspecialneeds.com/main/library_special_needs_apps.html – One Place for Special Needs has created a Guide to special needs apps that are broken down by skill set such as Fine Motor, Visual Motor, Auditory Processing, Executive Functioning and more.
http://www.inov8-ed.com/2010/10/theres-a-special-app-for-that-part-1-5-apps-to-improve-organizational-skills-for-students-with-learning-disabilities/ – A wonderful 5-part series on how to improve organizational skills for students with learning disabilities. Many of these also apply to children with executive function difficulties, dyspraxia, SPD and more.
http://www.smartkidswithld.org/news/ipad-apps-for-kids-with-ld – An article about using apps for children with dyslexia and other learning disabilities.
http://www.babieswithipads.blogspot.com/ – Babies with iPads
www.snapps4kids.com – Special Needs Apps for Kids
http://www.lilliespad.com/apps-for-special-needs/ – Lillie’s Pad
Jul 032011
Mums and dads know their child best! They are their child’s biggest advocate. In a recent post I had written to ‘Follow Your Mummy Gut’ or Daddy Gut.
Sadly, in my practice I’m often told by parents that they just knew ‘something wasn’t right’ from early on however their concerns were dismissed by their doctors, health visitors or even family members. They were often told to wait and see, let him / her (child) be a kid, or they’ll grow out of it. So, what can you do as a parent if you’re in this situation?
This article offers some great suggestions to parents including:
1) Get a second opinion
2) Keep a record of behaviours via either a log, journal, photos, or even videos
3) Research – nowadays the internet is full of resources and it can at times be overwhelming, however there are some fantastic parent groups out there with other parents who are in your same shoes
4) Don’t stop, keep asking questions and get a referral for a specialist
5) I’d like to add that if you have concerns with development, behaviour, learning, social-emotional skills, sensory processing or motor milestones, have your child assessed by an Occupational Therapist experienced in these areas right away. They can assess your child’s development, let you know how it is impacting on their functional skills and start working on these areas now versus later. It’s never to early to get help.
In my practice I work with many children with sensory processing difficulties that are identified during their school years. These children may struggle with concentrating in class, coping with transitions or changes, or playing with peers. They can be clumsy, have difficulty holding a pencil or writing, awkward with their movements, or be either withdrawn or aggressive. Oftentimes, they are very bright and as a result, their sensory processing difficulties are misunderstood. Usually, warning signs were present as babies however parents were told to ‘wait and see,’ ‘your child will grow out of it’ or that their child is misbehaving.
Early signs of sensory processing difficulties I have seen amongst babies include:
- Hates tummy time, prefers to sit or stand
- Plays while sitting still versus moving around and exploring their environment
- Tend to get ‘stuck’ with their movements, delayed milestones (e.g. rolling, crawling, clapping hands, waving)
- Cautious with movement, dislike being laid down or moved
- Fussy or irritable babies, cry easily sometimes for no known reason
- Not a ‘cuddly’ baby, resists being held
- Struggle to settle down or going to sleep
- Difficulty with nursing, transitioning to other textures
- Startles easily to loud sounds, distracted, avoids eye contact
- Very easy going, described as a ‘lazy baby’, don’t know they’re in the room
These difficulties indicate that a child’s central nervous system is struggling to process sensory information. It is a neurological problem that can impact on their movements and development, learning, and social-emotional skills.
Here’s a nice article that discusses the early warning signs of Sensory Processing Disorder amongst infants.
Due to the plasticity of a young child’s brain, there is hope and good potential for progress and improvement with Early Intervention. If you are concerned about these early warning signs, seek advice from an Occupational Therapist who specializes in working with infants and younger children, particularly those with sensory processing difficulties. It is never too early or never too late to get help.
Jun 042011
I recently watched Holly Robinson Peete share her family’s story about their son who has Autism. Her story sounds so much like the stories of families I work with. I loved what she had to say as it applies to families and children with all types of special needs, not just Autism.
Follow your “mommy gut!” Nobody knows your child like you do.
As health professionals and therapists, we should be listening carefully to what parents are saying as they know their child best and in effect, are telling us their child’s diagnosis. Early Intervention is key.
Check out the video:
Apr 162011
Isn’t it amazing that kids often love to play with what’s simply laying around the house versus a fancy toy? I often find that babies and toddlers prefer to play with a cardboard box or kitchen towel roll instead of the flashing, music-making, popping-up toy.
I love homemade toys for two reasons:
1) Recycle, Reuse, Renew! It’s great for the environment. Save those kitchen towel rolls, cardboard boxes, and empty water bottles to make fun toys or do interesting crafts.
2) For children with sensory and motor impairments, it’s oftentimes easier to make a toy that is just right for their motor abilities and coordination. For example, if a child who has limited fine motor skills, you can use larger objects such as making a giant pegboard with water bottles. To add a sensory component, make a textured board with different sponges, fabrics and materials. Using objects found at home, you can make a toy that’s just the right size, shape, or texture to suit a child’s motor, sensory and cognitive skills.
A couple of my favourite resources for homemade toy ideas are:
1) http://ohiodeafblind.org/assets/files/files/milestone_packets/0_2/hold_everything.pdf
Personal favourites are the ball board, curler board and eggs in a can.
2) The Recycling Occupational Therapist – Check out her Facebook page or YouTube videos for ideas for homemade toys.
Go buy some stick-back Velcro, magnetic tape, and start saving those cardboard boxes and empty plastic bottles. Have fun!
I’m so happy there’s a month to celebrate and raise awareness about topics related to Occupational Therapy (OT). But for me, everyday is OT day. I’m fortunate to have one of the best jobs and love working with the kids and their families.
OT is gaining much recognition and awareness over the past few years, primarily for working with adults. However, people still do often ask me why a child would need an OT or what’s a child’s job? My response is: A child’s job is to move, play, learn, socialize and be happy. As an OT, we work on the foundational skills they need to do these jobs such as their gross and fine motor skills, sensory processing, eye-hand coordination, or emotional regulation. Parents, teachers, and siblings are a key part of this process AND it’s NEVER TOO EARLY to start. The earlier a problem is detected, the earlier we can help.
Many of you know I lived in NYC for a number of years. Oftentimes, I’d walk along Broadway and look down to see Times Square and its famous big screen.
The American Occupational Therapy Association has an ad playing on the big Times Square screen throughout this month.
Also, check out the AOTA’s Top 10 Reasons to Care about OT Month.
Until next time, Happy OT Month!
Paediatricians have a huge role in identifying children who are at-risk of learning difficulties or developmental delays, and to set families in the right direction to have necessary supports in place. Early detection leads to early intervention which is crucial.
Doctors, teachers and professionals must be on alert when parents approach them with concerns, particularly about their child’s struggles at school. “Wait and see” or “every child develops differently” are NOT options. It’s important to know the signs and symptoms of learning difficulties amongst young children.
Read Kathryn Burke’s article for guiding questions for parents and children as well as early signs and symptoms of learning disabilities.
Common signs of learning difficulties that may warrant an Occupational Therapy evaluation include:
• Difficulty learning to read or write
• Poor pencil grasp or tires with handwriting
• Completes school work only with great effort
• Dislikes school
• Clumsy, accident-prone, gets lost easily
• Decreased gross or fine motor coordination
• Difficulty with new skills, sports, games
• Poor posture, slumps forward
• Easily distracted
Early school years are critical for creating a foundation for future learning. If a child struggles at school, let’s identify the problems NOW and refer these children on for the right support.
Lilly, a baby gorilla, gets Occupational Therapy! Trainers noticed she had a weak grasp for climbing and self-feeding, her left side lagged behind, and she struggled to latch on while nursing. Medical experts found nothing. Disney switched their emphasis from diagnosis to quality of life.
I found this to be such a great story with good reminders for health professionals and parents:
1) Paying attention to normal developmental milestones is very important. If concerned that a child is struggling to meet milestones, it’s important to get an evaluation.
2) The earlier we detect a problem, the sooner we can help and the easier to correct or minimize. Early Intervention is critical.
3) Treating the cause not the diagnosis – I treat many children who have no diagnosis. We identify the child’s strengths and areas of difficulty, and then determine why are those areas a challenge. For example, a child may have a weak grip for many reasons. Perhaps they have weak core strength and can’t hold themselves up. Are their shoulders loose or stiff causing them to have difficulty lifting their arms to reach? Or does the child lack sensation of their body parts related to each other? Do they have limited eye-hand coordination so that tasks requiring a precise grasp and dexterity are challenging? Labels don’t matter— As Occupational Therapists, we assess the cause of actual areas of difficulty versus the diagnosis.
It’s fantastic that Lilly’s caretakers follow through with her home programs twice a day and are encouraged by her good progress. Hooray!
Jan 142011
1 in 20 children have sensory processing difficulties! Clearly, this is very common and impacts on childrens’ behaviour, motor skills development, learning and confidence.
As an Occupational Therapist, I specialize in treating infants and younger children. I’m often asked ‘what can you do with a baby’ or how do you know a baby has sensory processing difficulties?
Meet Ryder from Pathways Awareness’ newest video!
Ryder’s sensory processing difficulties were noted at FIVE months of age. He had difficulty lifting his head, hardly moved, tired easily, and was anxious during new situations. He was overwhelmed by sensory input leading to sensory overload. Later on, this also impacted on his ability to communicate with peers, play with other children, and keep up with his motor milestones.
With Early Intervention therapies (OT, PT, and SALT) and a home program from very early on, Ryder showed improvements in his coordination, behaviour, confidence and ability to organize and respond to sensory information. He was able to be in group settings, keep up with peers, multi-task, and have fun with age appropriate activities. Hooray for Ryder.
Another great video by Pathways Awareness. I admire their efforts in advocating for early detection and Early Intervention as well as raise awareness about sensory processing.
Whose mood and behaviour isn’t affected by their sleep? We are generally much happier and focused after a good night’s sleep. For some, it takes ages to fall sleep while others zonk out right away. Myself, I can’t exercise before going to bed as I’m too awake. However, I have friends who say exercise helps them sleep faster and deeper.
Many babies I work with, particularly those born prematurely, also have sleep problems. Parents will try any and all strategies to help soothe their baby to sleep. Rocking, nursing, heartbeat sounds, swaddling, bathing before bedtime. Parents themselves are exhausted. Oftentimes, these babies are labeled as ‘colicky’ which technically refers to when a baby has abdominal discomfort however ‘colicky’ now seems to be overused to suggest a ‘fussy’ baby.
***It is critical to rule out gastrointestinal problems, food allergies, reflux, sleep apnea, ear infections, and medical issues.
Sleep is a regulatory process where a baby learns how to change and monitor their arousal level to self-soothe and fall asleep. Babies and young children with sleep difficulties likely have sensory processing or regulation difficulties. A baby who is HYPERsensitive to sensory inputs will have difficulty soothing or regulating themselves to sleep. This baby may not tolerate sucking on their hands to self-soothe or being rocked, and may wake up to the quietest of sounds. They are in sensory overload. On the contrary, a baby who is HYPOsensitive or seeks out sensory inputs may only be able to fall asleep after they’ve been swaddled tightly, bounced up and down, and patted firmly on their back. They need more sensory information to help them regulate their arousal level for sleeping.
When babies are unable to figure out how to soothe themselves they become fussy and irritable, more commonly described as ‘colicky.’ As this article says, there is no such thing as “just” a fussy baby.
A baby needs to regulate their arousal and sensory information for sleep. An OT can help parents sort out what sensory strategies to support sleep. According to Maria Anzalone, an occupational therapist from the States, “either way, they’re (babies are) out of sync.” They need to learn to regulate their arousal, sensations and emotions, and relationships. All of this impacts upon their sleep.
This is not something that parents should feel guilty about!
When a baby has sleep problems, it is important to also consider whether they may have sensory processing or regulation difficulties. An Occupational Therapist who specializes in treating infants can help to determine the baby’s sensory profile, which soothing strategies can help regulation based on the individual child’s needs.
Dec 082010
ot4kids is now on FB where I’m sharing information and resources to support families and professionals re: children with developmental delays. Do come on over.
I had planned to put up this post for National Premature Awareness Day on 17th November. Oh dear, it’s already December.
As an Occupational Therapist, I screen, follow-up and treat premature babies due to their risk of developmental delays as a means of prevention and Early Intervention. This allows me to work closely with parents and provide therapy input early to prevent problems from escalating.
In this post, I wanted to share some of my favourite resources for premature babies. However, please keep in mind that as every premature baby is different and has varied needs, this does not replace the advice provided by their medical professional. Also, an OT or PT experienced with babies is better able to provide individual advice and support geared toward individual children and families
March of Dimes has an excellent interactive program called “Understand Your Premature Infant” to help others recognize a premature babies’ signals and understand how they respond to their world.
Baby First has a nice article on promoting motor development for babies born prematurely following their NICU stay. These are general guidelines regarding positioning and recognizing the baby’s cues.
CDC has a developmental chart where you can track a child’s movement, social-emotional, fine motor, cognitive, hearing and visual milestones from 3 months to 5 years of age. These milestones can offer important clues regarding a child’s development. Be sure to adjust for a premature baby’s age, however parents should follow their gut, they are the expert on their child.
Premature babies are also at-risk of having sensory processing difficulties due to having an immature nervous system. Check out Sense-Ablebaby for more information as well as this article on sensory stimulation and premature babies.
Here is an article written by myself regarding ‘red flags’ that can indicate a delay amongst babies and toddlers.
***Premature babies should be screened early on to determine whether there are possible motor, neurological, sensory processing, orthopaedic, or cognitive delays. It is never too early to start therapy input. Early Intervention is key!
Infants and children must have good posture while laying down, sitting or standing so they have a good foundational base from which to move their arms and manipulate objects as well as attend and learn at school. If a child has to concentrate on holding up their body, this will take away from their ability to grasp and manipulate objects and concentrate and learn at school.
Therefore, it is critical for babies and children to be well supported at their chairs and tables at home, daycares and schools during feeding, reading, writing and learning tasks.
If a child is unable to maintain good posture while sitting in their chairs at home or school, it’s important to consider whether these difficulties are contributed to by poor balance, body awareness, trunk and upper body strength, or sensory processing difficulties.
Here is a great article which describes how a child should be sitting in their chair, alternate sitting positions, and ideas for movement breaks. Do share with teachers, family and friends.
October is National Sensory Awareness Month created by Kathleen Morris from Sensory Integration Focus.
You can download a free poster of 10 signs and symptoms of SPD from SensoryStreet to raise awareness, thanks to Ida Zelaya.
Do share with doctors, teachers, nursery schools, family and health professionals. The more people are aware about Sensory Processing, the earlier children can get help they need.
Sensory Processing Disorder (SPD) is a real neurological problem affecting 5 to 13% of children entering school. With help from an Occupational Therapist trained in Sensory Integration, children with SPD show improvements in attention, learning, movement, socialization, coping and self-esteem.
I often work with parents who are concerned that their baby or child is not making eye contact, struggling to meet their motor and learning milestones, or doesn’t respond to their name. Oftentimes, the wonder whether the child has Autism.
First Signs is a wonderful organization dedicated to educating parents and professionals about early signs of autism and the importance of Early Intervention.
They have great pages on:
- Red Flags
- Hallmark milestones from birth to three years
- How to share your concerns with your doctor?
- Screening, Diagnosis, and Treatment
I love how they emphasize that paediatricians should better screen children during routine visits and the importance of partnership between parents and healthcare providers. Parents know their child best and have a gut instinct when there is a problem. It’s our job as healthcare providers to listen carefully to what parents are saying and make a proactive action plan. Rather than wait-and-see, let’s act early and make the most of a child’s early years when they are constantly learning and growing. Let’s use prevention versus trying to remediate a problem later. It’s never to early and Early Intervention is key.
Sadly, plagiocephaly (flat-head syndrome) is often dismissed as being just a cosmetic issue or one that babies will outgrow. Finally, studies done at the Children’s Institute in Seattle, Washington, US, show that there may be an association between plagiocephaly and developmental delay.
In this study led by Matthew Speltz, PhD, 472 babies between 4-12 months were screened for cognitive and motor development. Half of these babies had been diagnosed with plagiocephaly from Seattle Childrens Hospital’s Craniofacial Centre and the other half were a “normal” control group.
It was discovered that babies with some degree of plagiocephaly were more likely to perform worse on the Bayley Scales of Infant Development III than the control group.
These findings indicate that there may be an association between plagiocephaly and developmental delay or that children with existing motor problems are at risk of developing flatter heads due to lack of movement.
I find that babies with plagiocephaly often have other underlying problems such as:
- low muscle tone
- poor strength and coordination
- sensory processing, movement sensitivities
- motor planning
- organizational skills
- poor regulation
- …….and more
Research shows the following babies can be at-risk of developing plagiocephaly:
- those born prematurely
- multiple births
- torticollis (tight neck muscles on one side)
- developmental delay
- certain syndromes
- eye muscle problems.
****Babies with Plagiocephaly should be screened early on to determine whether there are possible motor, cognitive, neurological, orthopaedic, or cognitive delays. Definitely worthwhile catching a problem early!
People often think of strokes for adults, however they occur amongst children too.
http://www.telegraph.co.uk/health/children_shealth/7907230/The-child-victims-of-stroke.html
Approximately 5 children a week in Britain have a stroke. 2/3’s of those that survive suffer long-term disability that affects their movement. 1/3 of those that survive have no lasting impairment. Oftentimes, there’s already another pre-existing condition such as congenital heart disease.
Due to lack of public and medical awareness of childhood stroke, kids are being diagnosed too late. It is critical to have faster diagnosis and earlier treatment for a better outcome!
Some common signs that indicate strokes can be: headaches, unable to feel or move right side, floppy, and difficulty speaking. Clumsiness and an alteration in consciousness may also be noted.
Do share with family and friends to raise awareness so others can get support and access to appropriate services faster.
HemiHelp in the UK is a great organization supporting children with hemiplegia.
I have been wanting to write a follow-up to my last blog post about premature babies being at higher risk of disability and how important it is to know the early signs which can indicate a delay.
Just in time, March of Dimes has posted about an excellent interactive program called “Understand Your Premature Infant” which is designed to help educate parents and professionals and explain how premature babies respond to their world.
Premature babies communicate to their parents and caregivers how they feel and what their needs are using SIGNALS. Due to having immature nervous and motor systems, their signals may be different than a term baby. They may communicate using their bodies, through movement, crying and fussing, and by how they respond to various sensations. These cues help you know when the baby is ready to feed or interact, when they are stressed, when they need a break, or what is soothing to them. It’s critical to be able to recognize these behaviours and signals and understand what they mean to best support the baby.
The program reviews a premature baby’s sleep and awake cycles, their development of senses, feeding, and how to interact with the baby.
I highly recommend this program to any parent, family member, or professional who works with premature babies.
P.S. ot4kids is now on Facebook where I post more regularly. Feel free to share with others who may benefit. :)
