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5 Tips for Language Development

Author's mother with the babies

Recently, I returned to my work with the little ones.  There is really no better feeling than figuring out the puzzle pieces of a little one and watching magic happen!  The great thing about early childhood is that once you solve the puzzle, the magic happens so quickly!  If you want to watch your little one’s speech flourish, follow these tips.

Eye contact is key Always place your child in a way that they can see your face and your mouth.  We have a tendency to place children with their backs propped on us, unless we are feeding.  Babies receive lots of social cues and signals from our eyes and focus on our mouth to try to figure out how we do that thing called speaking.  For a child 0-5 months, I like to sit with my knees bent and child leaning and propped between my knees and my thighs.  For children who are beginning to sit independently, I support the back with the heels of my feet while the child is safely supported by the circle of my legs. Read more

Tongue Tie Mysteries Revealed

Being a new mom is tough! You are getting to know your baby while everyone around you weighs in on what to feed your child, how to care for your child, and how to get your child to sleep.  Now add to this experience the fact that you know something is wrong, but everyone around you insists that you just need to relax.

Meet Kristi, a friend from graduate school and fellow pediatric speech-language pathologist.  Kristi had, like me, received some basic training on tongue and lip ties, but nothing could compare to going through the experience first hand.

Read more

Take that thing out of your mouth!

Our tongue is essential to many of our daily functions, so it’s no surprise that it is the focus of much of our earliest explorations.  Some babies have even been observed to suck their thumb while in their mother’s womb!  In our first months, it is normal to place our fingers, and for a brief time, other objects into our mouth to test out what our mouths our capable of.  New research by University of British Columbia’s School of Audiology and Speech Sciences recently tested the motor theory of speech perception.

What did the study say? Read more

Mommy, my ear hurts!

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.

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What are the causes of ear infections? Read more

Brain Builders for the Holidays!

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

Holiday greeting

Love __________________

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.

Going Back to School on the Right Foot

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.

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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)

All About that Paci Life

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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.

Birth-3 months

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.

3-6 months

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.

6-9 months

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.

9 months-Present

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 jocelyn.m.wood@gmail.com

What is Childhood Apraxia of Speech?

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.

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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!

 

Your Adenoids are Showing!

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.

My baby cousin, aged 15 months here, with the author
My baby cousin (aged 15 months here) and me

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!

Tongue-Ties across the Ages

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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.

BABIES

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.

TODDLERS

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.

 

SCHOOL-AGED CHILDREN

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.

YOUNG ADULTS/ADULTS

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!

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