Ear infections are one of the most common ailments of young children. Unfortunately, babies (birth to two years old) are anatomically at a disadvantage for ear infections, due to their flat eustachian tubes. According to the American Speech-Language Hearing Association (ASHA), children who have more than 2 ear infections before their second birthday should be evaluated by an audiologist.
The holiday season is here! It is a busy time for everyone, filled with holiday gatherings, visits from family and friends, and shopping–but it is also the perfect time for you to maximize your child’s language skills. Here are 3 quick and easy tips for you to incorporate into the next few weeks to make sure your child continues to meet his/her speech/language goals.
1. Guess My Gift
This is a great game for children aged 6-10 and it helps with word retrieval, language processing, auditory memory, and even inferencing skills. You and your child can take turns giving each other hints about their favorite present desires. When I play, I tell the child that they will get 3 clues, and I try to give my clues in an organized and predictable way each time (category/function/descriptor). For example:
“I want something that is a pet. It likes to purr. It has whiskers.”
It is then the child’s turn to give you clues. For an added bonus, you can have the child write the items in the form of a list so that they can practice writing skills as well.
2. Catalog Browse
Somehow, I am on the mailing list for every major catalog ever. I hate to waste paper, so I like to repurpose my clothing and furniture catalogs. With younger children (age 3-5), I like to find an assortment of pictures and have the child place into categories (i.e. furniture, clothing, toys). With my 5-6 year olds, we use the catalogs to play a game of “I Spy”. My 6-8 year olds can use the catalogs to practice their descriptive language use by talking about the characteristics of the clothing/furniture on each page and by comparing different items in the catalog.
3. Cooking Projects
Children love to be helpers in the kitchen. Thanks to Pinterest, there are a million different ideas for every holiday, such as these dreidels or these reindeer. You can even use cookie cutters to talk about shapes with your little 2-3 year olds! Cooking is a great way for children to practice their sequencing skills (what comes first, next, and last)…and obviously there is a delicious treat at the end!
4. Holiday Cards
With the rise of the internet, the art of letter-writing is a dying trend. Kids LOVE writing letters, and my students can’t get enough of addressing envelopes! This is a great way for your school aged child to practice their spelling and writing organization. I like to give the child a format to follow, rather than just having them write “Happy Holidays, Love Jocelyn”. Try this one:
Dear Aunt ____________,
Question to the reader
Statement about yourself
5. Wrap Presents
This is another great way for children to use crafts and practice sequencing steps of an activity. Wrapping gifts is a very teachable skill (and a very easy task for small fingers!) Your child will love being able to help wrap gifts for their aunts, uncles, cousins, and friends. abuse contacts . You can even have your child design their own wrapping paper! Start by giving your child one step at a time (i.e. First, measure the paper around the box). If you see that they can do this, go to 2 or 3 steps at a time (i.e. Next fold each corner in like a triangle and tape upward).
Addressing your child’s speech and language goals doesn’t have to take a pause during busy season. Happy holidays to all and good luck adding some holiday cheer for your little dear.
September is an exciting time for teachers and children. Although summer vacation is nice, the new school year brings new students, goals, and challenges. Below are some tips to get back into routine the right way.
1. Set a firm bed-time
I have read and written numerous articles about the importance of high quality sleep. The Sleep Foundation recommends that school age children get 9-11 hours of sleep each night. A restful sleep leads to better attention, mood, and energy throughout the long school day.
2. Leave time in the morning for breakfast
No one likes to run out the door. Leave yourself an extra 15-20 minutes in the morning to have a healthy breakfast with your child. Use this time to talk to your child about what he/she is excited for that day and make sure that he/she has packed the day’s homework assignments and reading materials. Breakfast doesn’t have to be complex. Think hardboiled eggs, toast, and a piece of fruit.
3. Start the year with expectations for homework
The dreaded “h” word. For some kids, sitting down to do homework is a challenge but this is a great way for your kids to practice what they have learned during the school day. Teachers want to see what the kids are getting wrong so they know what concepts need to be re-taught, so don’t worry too much about having incorrect answers. A great time to do homework is right after school. Allow your child a short 20-30 minute snack/play break before jumping into the work.
It’s important to have a dedicated space to do homework. Even if you are in a small space, try to have a tray table where your child has access to pencils, paper, etc, without being able to view toys, games and television. Set a timer and break homework into smaller increments if you see your child getting restless. For more ideas, check out Understood, a great resource for children with learning disabilities.
4. Have open communication with teachers and therapists
Parent involvement is a very strong indicator of student progress. Make time in the first month of school to stop in and speak to teachers and therapists. If your child has an IEP (Individualized Education Plan), review the goals and services and make sure that he/she is receiving what he is supposed to be receiving. Know what the expectations are in the classroom and in the therapy room, both in class and for carryover at home. If you see a problem in your child’s academics or behavior, don’t wait until parent teacher conferences-be in touch with your team.
5. Make time to talk with your children
With so much going on during the school year (after school clubs, play dates, etc) it is easy to get lost in the shuffle. Make sure talking to your children becomes a priority. Try to avoid questions such as “how was your day?” to which you will undoubtedly get the response “fine” and focus instead on more direct questions, such as “who did you play with at lunch today?” or “what book(s) did you read during reader’s workshop? who were the characters?” Not only will this set up a comfortable dialogue with your children, but it will allow you to know what they have been doing in and out of the classroom.
Welcome back everyone and have a great first day of school!
(If you found this helpful and want more ideas on conversation starters for children, let me know and I will make a follow-up post)
A few months ago, I was engaged in a conversation with some parents about pacifier usage. I don’t have kids, so usually I receive a response such as “I am sure your feelings will be different once you have a child of your own”. There is a time and a place for everything, so below, I share with you the “science” behind pacifier usage and the OK times to use it.
You have a new baby. Ohmygod. Now what? Likely, your child cries and does not sleep through the night, so you use a pacifier as a soothing mechanism. In my book, if you are bottle-feeding, I find this to be completely OK, as long as you don’t keep your child’s mouth plugged with a pacifier all day and all night. Try not to leave your child sleeping with the pacifier, as this will set them into a habit–and those habits are hard to break, even in a little baby! If you are breast feeding, however, many recommend no pacifier until a milk supply is established–around 4-6 weeks. Sucking on a pacifier takes a lot of energy and by sucking on a pacifier, rather than a breast, a child will be excreting much less milk-thus affecting your production.
If your child is a preemie, please contact a feeding and swallowing specialist for recommendations on how and when to introduce a pacifier.
You are over that first hump. Congratulations! Your child is now much more alert, cooing more, and giving you more eye contact and smiles. Pacifier usage is still considered OK at this stage of development, and sometimes can even be a helpful tool for developing proper timing for swallowing when introducing those cool new oatmeals and purees. Again, I would not leave the child sleeping with a pacifier and would try to avoid using it for more than 5 minute increments. Remember, this is a tool to help your child learn self-regulation-not a solution to end crying.
Your child is likely beginning to babble. This is a very exciting time in a child’s life, as they begin exploring toys by sticking them in their mouth and start linking sounds together to communicate with you. Because of all this oral development, we want to keep the mouth as open as possible, so the less pacifier usage, the better. I would try to eliminate pacifier usage completely by 6 months. You may have a few days of longer crying sessions, but they will quickly disappear as your child has learned to calm him/herself over the past few months.
Around 8-9 months, many children start teething (though this can begin happening as late as 14 months). Think about this–teeth will only grow until they hit an object and are “told” to stop. Teeth are pretty interesting–they have sensors that determine when they will hit an object (i.e. your tongue) and then they stop. So, if your child has a pacifier, the teeth will reach the pacifier and stop, giving teeth that curved look that will remain until your child loses his/her baby teeth at 5-6 years old.
By now it should be clear that my argument is to eliminate pacifier usage (including nap time sucking) by 6-7 months. This is because after that point, children begin growing teeth, and the constant pacifier sucking can actually lead to elevating a child’s palate (top of mouth) which can eventually cause some airway problems and/or attention issues.
To parents present and future, I hope these guidelines were helpful. If you need a more specific plan for pacifier weaning, feel free to contact me at firstname.lastname@example.org
I recently signed up to do a Walk-a-Thon to raise awareness for Childhood Apraxia of Speech, a motor speech disorder that has been on the rise as of late. What does it mean to have a child with apraxia of speech and what types of resources are available to you? Below, I provide an overview to cover the most basic questions surrounding Childhood Apraxia of Speech, but I encourage you to check out ASHA and CASANA for more information.
What is Childhood Apraxia of Speech (CAS)?
When I was in graduate school, CAS was a relatively new and somewhat controversial diagnosis. Basically, it is a motor speech disorder, meaning that it affects the muscles required to create speech (muscles of the tongue, lips, jaw, etc). However, children with CAS exhibit normal muscle tone and strength. So, in lay(wo)man terms, this means that a child has something he would like to say. This message goes to the brain and the brain fires signals to the muscles in your mouth to start forming the sounds that eventually make up the words. If your child has CAS, this “signal” gets skewed and he may end up saying a word very differently than he intended (i.e. “snake” could become “tate”). The level of severity varies amongst children with this diagnosis, but usually all have normal, or above-average intelligence and are aware of the difficulty they are having. In my experience working with this population, many times these children begin to talk and then, once they begin to notice their sounds do not come out how they have intended, they stop talking (which can also be a red flag for Autism).
What are the signs of CAS?
According to the American Speech and Hearing Association (ASHA), the disorder manifests in different ways, depending on the child’s age and age of detection.
A Very Young Child
Does not coo or babble as an infant
First words are late, and they may be missing sounds
Only a few different consonant and vowel sounds
Problems combining sounds; may show long pauses between sounds
Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
May have problems eating
An Older Child
Makes inconsistent sound errors that are not the result of immaturity
Can understand language much better than he or she can talk
Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
Has more difficulty saying longer words or phrases clearly than shorter ones
Appears to have more difficulty when he or she is anxious
Is hard to understand, especially for an unfamiliar listener
Sounds choppy, monotonous, or stresses the wrong syllable or word
Potential Other Problems
Delayed language development
Other expressive language problems like word order confusions and word recall
Difficulties with fine motor movement/coordination
Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like toothbrushing or crunchy foods, may not be able to identify an object in their mouth through touch)
Children with CAS or other speech problems may have problems when learning to read, spell, and write
What is the Treatment?
Best practice for CAS indicates that the most effective treatment is frequent and intense, meaning therapy should be individual and 3-5 times per week, depending on the severity. My treatment protocol uses elements of PROMPT, a multi-sensory protocol to enhance muscle memory, as well as phonological therapy to increase oral awareness and the way that sounds are produced. Therapy should be entertaining and motivating for the child, in order to enhance success. As with any successful therapy program, parent involvement is key.
Have more questions about CAS? Looking for an evaluation? Contact Jocelyn.
Click Here To Donate or Join the Walk on October 12!
Think of adenoids as little pillows that rest between your nose and your oral cavity. These little “pillows” are one of your body’s best defenses against germs. When they become swollen, however, they can cause a variety of issues, including drooling, poor articulation, snoring, sore throats, and ear infections. As a parent, you never want to see your kid battling constant illness. The alternative, surgery, is also not very appealing. It is a difficult decision, and one that my cousin, Gavriella Lerner, and her husband had to make for their 2 year old. Gavi, awaiting the birth of her second child, agreed to pass on some information to other parents to help make a more informed choice when it comes to your child’s swollen adenoids.
Jocelyn: Tell me about your child (i.e. milestones, interests).
Gavriella: My 2.5 year old has always been somewhat low tone and has always been late when it came to physical milestones. He is very bright and eager to learn and is into typical toddler boy stuff- trucks, Thomas, Elmo etc. The low tone affects his mouth too- always hanging open, lots of drooling.
J: When did he say his first words?
G: His first discernible words came right on schedule, at around 12 months.
J: When did “adenoids” first come up in conversation?
G: The pediatrician mentioned it during a visit to treat what seemed like his gazillionth sinus infection.
J: Is there a family history ?
G: Yes. My husband had his tonsils and adenoids out at about the same age. For context, we’re in our mid-20s, so we’re not talking about the days where just about every kid got them out.
J: How long did you wait before seeking professional guidance?
G: We got a referral to an ENT from the pediatrician during that appointment. However, it is very difficult to get an appointment with a specialist when it’s not an emergency. Even though we called right away, it was about 3 months before we actually saw the ENT. We could not book an earlier appointment. And we tried more than one- they all had waiting lists about that long!
J: Did he get sick often?
G: He didn’t really get ear infections, but the sinus infections were constant. Every little germ he caught eventually morphed into a sinus infection.
J:Was he a noisy sleeper?
G: He was a snorer, but not a noisy one. That’s why we didn’t really notice for awhile. But the snoring definitely affected his sleep. He woke himself up from snoring several times a night, and if it happened past 5 AM, that was it, he was up for the day. Although he didn’t wake us up every time he woke up in the middle of the night, we realized it was a problem because he was not getting adequate sleep.
J: How did you end up treating the adenoids?
G: Surgical removal.
J: Was the surgery invasive? What was your child like afterwards?
G: Not really- they go in through the mouth. It does require general anesthesia. When he woke up in recovery, it was pretty bad- he was inconsolable, and they had to give him pain medication through the IV which was still in. He calmed down, and we were able to go home about an hour or so later. He was cranky the rest of the day and required a few doses of baby motrin. The next day, however, I had half a mind to call the doctor and ask if he was sure he had operated- my son was pretty much back to himself and needed no painkiller. Just some ice cream as his throat was still a little scratchy from the tube that had been in there. He was begging to go to the park (doctor had said to keep him inside a few days). He did pull at his nose a bit like there was something in there he was trying to get at, but didn’t really complain otherwise. One annoying side effect was really stinky breath (no, brushing teeth could not get rid of it)- but we were warned that would happen. The only other side effect was some constipation from the anesthesia, but even that wasn’t so bad because he was also on antibiotics (to prevent possible infection) which generally has the opposite effect, so it mostly balanced out.
J: Since treating the adenoids, what changes have you noticed?
G: It’s only been 3 weeks, and the doctor said it takes 6-8 for real changes to kick in. I have noticed definite improvements, but only in the last week or so. For instance, he is definitely sleeping better. He is closing his mouth for longer periods of time and using his nose. He caught a cold and it DIDN’T morph into a sinus infection- it just cleared up on its own.
J: Is his articulation improving? Have you noticed changing in his drooling?
G: His articulation is getting better every day. A lot of people thought he was speaking jargon- turns out, he had plenty of real words, and we’re only now just starting to figure most of them out. There is still work to be done, but the difference is there. The drooling actually got worse the first week- since we weren’t going anywhere that first week, I kept him in just a diaper because he was soaking through his shirts. The second week, he was drooling in pre-surgery amounts (which was a lot, but better than that first week). Now, this third week, we are seeing less than his usual amounts, so there is improvement, and we expect it continue.
J: Will you seek speech therapy?
G: The ENT told us he would need it, so we got evaluated and were approved for free services through the NYC Early Intervention Program. We were actually able to start before the surgery. We expect to continue for at least the next 6 months.
J: Any final thoughts to share with our readers?
G: A lot of things make sense in retrospect. For instance, he never took a pacifier as a baby, and now it makes sense- he couldn’t close his mouth! Oddly enough, this never interfered with breastfeeding or eating solid foods- he’s always been an excellent eater. We knew he was cognitively very bright and when he was evaluated for speech therapy, it was pretty clear his issues were with articulation and not language. However, I do think his language acquisition was somewhat hampered because people couldn’t understand him. I definitely spoke to him at probably a lower level than I should have simply because I didn’t understand him so well, and I suspect I wasn’t the only one. Chronic sleep deprivation probably also hindered him. He definitely takes more of an interest in his surroundings now that he’s well-rested. I just wish we could have figured this all out sooner than we did.
If this sounds like your child, make sure to get a referral to a pediatric ENT.
For more information on adenoids as they relate to speech and language development, send me an e-mail!
Yes, tongue tie is a real thing, and for some, it is very painful. The scientific term for a tongue tie is ankyloglossia, or restricted movement of the tongue. A tie can occur in the anterior (front) or posterior (back) of the tongue. You may be surprised to learn that 10-20% of the population born in the United States have a tongue tie. If you suspect a tongue tie, you should consult with a professional (speech language pathologist, dentist, ENT, pediatrician) to assess and determine the need for intervention. There are many consequences of an untreated tongue tie that effect a person differently across the lifespan.
Very often, I will do a speech and language consultation and the parent will tell me “Johnny had a difficult time latching when I tried to breastfeed him”. Breastfeeding is very difficult for a baby with tongue tie. Due to the restrictions of the child’s frenum, the tongue is unable to make the necessary movements, such as cupping, to latch and breast feed. This causes stress not just for the baby, but also for the mother, who was looking forward to this important bonding experience for her child. At this stage, it is very important to receive input from a lactation consultant, speech language pathologist, or a pediatric ENT or Dentist trained in tongue-tie detection. For a list of trusted providers, you can consult the resources provided by the International Association of Tongue Tie Professionals.
Now your baby is a toddler. Either no one has picked up on the tongue tie, or you have decided not to have surgical intervention. At this point, your child is learning to speak. Due to restricted movements, you may find that your toddler is having difficulty forming a lot of sounds, or that what he is saying does not sound clear (although you know what he is saying!) Other issues may include difficulty accepting a wide variety of foods. Having a tongue tie means that it is more troublesome for the tongue to move food back and forth in the mouth, a necessary movement for handling more complicated textures (i.e. meats, some vegetables). Now that your child is more receptive, it may be possible to do certain exercises to help lengthen the frenum and allow for more movement. However, if the child does not respond to this type of intervention, it is important to consult with a professional about possible surgical intervention to prevent further difficulties from occurring.
Your child has now figured out to eat and speak and it is time to go to school. Although your child is bright and has a large vocabulary, he may have difficulty producing some sounds (/ch, sh, j, s, z/) because the restricted tongue is unable to make consistent contact with the upper portion of the mouth. Speech therapy can be done at this point to correct the production of the sound, but the child may continue to have a “functional lisp” because the tongue is not reaching exactly where it needs to be. Further, a restricted frenum may cause your tongue to block your airway, causing sleep disturbances and attention issues (see my previous post for more information on how sleep effects attention. It is important to speak to your speech language pathologist at this time for a referral to further assess for ankyloglossia.
At this point, you have no doubt learned to live with your tongue tie and the thought of having a piece of your tongue snipped is scary. Did you know, however, that a restricted frenum may make you a bad kisser?! This information is always helpful in convincing my more reluctant teen clients to go through with the procedure.
Check back next week for more information on Tongue Tie, and an interview with my client who had a frenectomy (tongue tie surgery) 2 months ago and is already reaping the benefits! Sign up for the mailing list so that you can see it first.
For more information on assessment and treatment of ankyloglossia (tongue-tie), contact me!
It is a well known fact that humans need to sleep. It should not be a surprise to you that in our fast-paced, go-get-em world, we do not get enough of it. According to the Center of Disease Control, close to 40% of adults aged over 16 years old reported that they get less than the minimum of 7 hours of sleep each night. The same statistic is true for children, who require a much longer amount of sleep–around 12-14 hours for preschoolers and 11-12 hours for children in elementary school. So, just what exactly are the risks of sleep deprivation?
Recently, there was an article in the New York Times which pointed to lack of sleep as a possible culprit for the overabundance of ADHD in children. In adults, lack of sleep leads to excessive yawning, sleepiness, and sometimes falling asleep on the job. In children, however, the effect is quite the opposite. Children who receive less than the recommended 12 hours of shut-eye each night tend to be hyperactive, and sometimes even aggressive. In the classroom, these kids are the ones who cannot sit still for the entirety of the lesson. At times, they are disruptive to the rest of the class. Their less than optimal sleep schedule puts them at risk for being (wrongly) diagnosed with a learning disability.
With school just around the corner, it is a great time to get your children on a solid sleep schedule so that they can have the most success this coming school year.
Maintain a Daily Sleep Schedule
Life is hectic, and with young children, there is always something going on! Try to make bedtime a consistent routine for your family. Bedtime is a great way to bond with your child by discovering a new favorite book. To begin with, get children into their routine 30-45 minutes before their actual bed time so that they have time to relax (and ask for a 2nd book!)
There is a time and a place for technology. The bedroom is not one of them. Limit video games to 2 hours before bedtime, and if possible, eliminate the television, computers, cell phones and other electronics for your child’s bedroom. By eliminating the light transmitted from these devices, children will have an easier time falling asleep.
If properly fueled by sleep, children do not need external energy!
Make it Cozy
The bedroom should be a place your child wants to go to to relax after a long and tiring day. Make sure the bedroom is dark, quiet, and cool by covering windows with opaque curtains and by running fans and heaters to maintain an optimal temperature.
By setting the foundation early, you will put your child on a path to success both at school and at home.
As a speech therapist who works in feeding therapy, I have very strong opinions about cup drinking. Yes, teaching your toddler how to drink from a cup is a precursor to speech development, and making a smooth transition now will prevent problems down the road.
How Bottle Drinking Effects Tongue Position
We live in a bottle obsessed society. Bottle feeding, rather than breast feeding, has become the norm. As a result, children are having difficulty developing “natural” tongue patterns. When breast feeding, the tongue presses upward to elicit liquid from a nipple. During bottle feeding, the child’s tongue moves down. So, from a very early age, children are being reconditioned on where to place their tongues.
Then come teeth…
Parents are very familiar with the mouthing and gnawing associated with teething. But did you know that teeth come equipped with “sensors” that tell them when to stop growing? Teeth will only grow until something disrupts their path (i.e. gums, other teeth, tongue). So continuing to provide a bottle after teeth begin making their appearance may effect the growth of baby teeth.
But you said it can effect speech development?
So, bottle fed babies move their tongues down, bottles block teeth from growing to their full potential…down the road, children with prolonged bottle feeding may develop immature speech patterns that require a full course of therapy. Because the child spent so long “mis-learning” tongue position, intervention is now required to retrain the tongue and strengthen lip, jaw, and tongue muscles.
Introducing Cup Drinking
This is where cup drinking comes into play. Parents often ask when they should begin to introduce a cup and when I say “around 8-9 months or when the first teeth erupt”, they think I am crazy. Cup drinking is MESSY!
Yes, cup drinking is messy for a few days. But open cups are much easier to clean than sippy cups and straw cups. By introducing an open cup so early, children are able to discover correct tongue positioning through a natural learning environment (drinking!) and avoid tooth and dental problems caused by cup drinking.
My clients have had the most success with the Oxo Training Cup, which can be found here.
For more information on infant and toddler feeding, contact me at email@example.com or join the mailing list!
One of the benefits of working in a school is the interaction between the various disciplines. I work with a fabulous team of occupational therapists, physical therapists, psychologist, social worker, and special educators. We are able to look at a child and each use a different perspective to help aid that child’s ability to learn. Frequently, I find myself asking the physical therapist for advice on positioning and going to the occupational therapist for ideas on how to have a child better focus on reading and writing tasks. They come to me to learn about speech and language milestones and how to phrase questions to get better responses from their students.
This week, I had the opportunity to visit another important member of the multi-disciplinary team: the audiologist. I am sure you remember your hearing screenings throughout the school years, but how many of you have actually been to an audiologist? A visit to the audiologist is an important first step for any child with speech and language delays. Just imagine what it sounds like to listen to someone’s voice when you are underwater–hearing muffled voices can make learning to speak a very difficult task for a 2-year-old! Recurrent ear infections, build-up of earwax, and reflux should all be followed up with a visit to an audiologist.
During my visit with audiologist Dr. Shirley Pollack, she walked me through the entire process of an audiological exam. She takes a thorough case history, builds rapport with children, and makes test results “real” for children and their families. Her office also provides Central Auditory Processing Disorder (CAPD) testing for children over 5. I’m glad to have added another member to my multi-disciplinary team!
Look out for future postings with interviews with my team members!
For more information on audiological exams or language delays, contact Jocelyn M. Wood
I'm a New York based psychologist and I was born and raised in New Jersey. I completed my Masters in Clinical Psychology from Rutgers University, New Jersey in 1987, and have a diploma in Cognitive Psychology and Neurosciences.