Tag: <span>speech</span>

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Let’s Play: A Guide to Language in the First Year

During the first year of life, your new baby will take the journey that brings him from a crying ball of mush to his first words.  It is exciting, breathtaking…and nerve-racking as you ponder whether all this is normal.  As part of my new parenting series, I present to you the speech and language milestones and expectations for your baby’s first year.  I have also included activities that you can incorporate to maximize your child’s development at that stage.

The author and her cousin

 

The First Three Months

When you first bring your child home, you’ll get to go through the process of getting to know each other.  You will begin to discover the meaning behind each cry and will gradually adjust to your sleepless nights.  Before you know it, your baby will be smiling at the sound of your voice and making cooing sounds.  By 3 months, your child should be:

        • startling to loud sounds
        • smiling when spoken to or seeing you
        • making cooing sounds
        • recognizing your voice
        • varying cries

It is important to spend plenty of time bonding with your new baby during these early months and many of these early milestones can be achieved during simple daily activities, such as mealtime, bath time, and cuddling time. In addition, you can also incorporate:

Months 4-6

By this time, you are beginning to think this parenting thing isn’t so difficult.  Likely, you are sleeping better and you and your family have settled into life’s new routines.  You’ll begin to notice that your baby’s eyes brighten when he sees you and he is beginning to communicate with open vowel sounds, such as “aaaa” and “oooo”.  By 6 months, your child should be:

Continue playing with your child and building off of the activities  that have become a part of your daily routine.  For example, stand across the room or behind your child and have them turn towards the rattle or your voice or respond to babbling with a longer string (if baby says “ba” you say “baba”).  Toys for this age include:

7 months-1 year

You made it! This parenting thing isn’t so difficult, after all.  Development builds off the previous stage, so just follow your child’s natural progression and soon you will hear his first words.  By a child’s first birthday, he should:

        • enjoy games like peek-a-boo
        • recognize words for common items
        • babble with long and short sounds
        • imitate different speech sounds
        • begin to respond to requests (give me ball)
        • has 1-2 words

To encourage your child to speak, it is important that you continue to have eye contact and engage in playful language games with your child.  Label things throughout your environment and have your child request what he wants, either by using a gesture or a vocalization—not crying.  Games and toys for this age can include:

Further Reading

For more information on this topic, check out Baby Talk and The 30 Million Words Project.

Contact me for a free phone consultation regarding your child’s development.

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5 Reasons Why Your Child Needs Yoga

credit paper moon/flickr creative commons
credit paper moon/flickr creative commons

As a long-time yoga practitioner, I jumped at the opportunity to begin studying with Sonia Sumar, the creator of Yoga for the Special ChildⓇ.  Through her experiences with her own daughter, who was born with Down Syndrome, Sonia designed a Hatha Yoga program that was modified to meet the needs of children with a wide variety of speech, language and learning disorders, as well as those with physical disabilities and genetic disorders.  She has shaped this practice over the past 40 years, and I have had the pleasure of training with her over the past two years. So, why do I think that yoga is the perfect supplement for a speech and language program?

1.Chanting Stimulates the Brain

In a traditional Hatha yoga program, the practice begins with chanting.  Chanting is the rhythmic repetition of words, such as “Hari Om”, which means “the removal of suffering”.  From a speech and language perspective, these sounds are easy for a child to repeat and fill the body with vibrations.  In yoga, chanting is paired with clapping or body movements to create a multi-sensory connection.  These body movements help a child to organize his brain for the movements that are to come.  Studies have shown that this pairing of auditory, visual, and kinesthetic (i.e. body movement) feedback can aid a child with motor learning difficulties to begin to make vocalizations and words.  Continued practice of the rhythms and chanting will also lead to greater awareness of patterns and increased vocalizations from the internal feedback the child receives from chanting. 

Another advantage of chanting is that it leads to greater relaxation.  Limited speech production or difficulty in school can be anxiety producing for a child.  By modifying the rhythms of the chant, a trained yoga practitioner can help your child find an internal calm that will carry through the next day, or longer! 

2. Breathing is the Key

Breathing is the basis of all human function—but most people are doing it wrong! Many people are accustomed to short, shallow breaths that can lead to increased anxiety and hyperactivity.  By learning to activate diaphragmatic breathing, children (and their parents) will experience a release in muscle tension, increased oxygen to the cells and organs, and greater concentration. From a speech-language pathologist’s perspective, proper breath support is also the basis for speaking.  A child must be able to produce appropriate air flow to make any sounds or vocalizations, and well controlled breathing will help to maintain appropriate vocal volume (i.e. that perfect medium between whispering and shouting). 

Breathing is incorporated throughout the yoga practice by having a child pair their breath with body movements.  When a child is ready, the yoga practitioner can help to incorporate pranayama, or breathing exercises, which further detoxify and center the child.  Parents have even reported a decrease in seizure activity by consistently practicing pranayama breathing. 

3. Holy Corpus Callosum!

The corpus callosum is a strip of nerve fibers that connect the right and left hemisphere of the brain.  It is responsible for sending messages from the left brain (language dominant side) to the right brain (motor learning side) and vice-a-versa.  In children who have learning disabilities, motor planning issues, or genetic disorders, the corpus callosum is believed to be weakened, or in some cases, nonexistent. 

Right and Left Brain

By combining body movements with breathing and chanting, yoga helps to strengthen the corpus callosum.  In a yoga program, the practitioner is able to develop this area of the brain by using predictable, yet varied, patterns of movement.  For example, every session begins clapping and mudras, or hand movements, but the rhythm and sequence of these movements change from session to session.  Furthermore, the repetition of the same asanas, or body movements, from session to session can lead to better integration of the left and right brain. This increase in density, or thickness, of the corpus callosum can lead to an enhanced ability to follow directions, increased verbal output, and greater attention to the environment.

4. Turn Your Body Inside Out

When most people think of yoga, the first thing that comes to mind is a series of poses, also known as asanas.  In a Hatha yoga practice, body movements are chosen to ensure proper body alignment.  The practitioner will choose movements that will gracefully move your child through forward, backward, and lateral movements while seated, standing, supine (lying face up), and prone (lying face down).  By working the body through a complete range of motion, yoga has the ability to organize a very disorganized system. When the brain no longer has to make accommodations for our sensory profile, language can flow much more freely.  After practicing yoga, the body is functioning optimally, and children no longer have to tune into themselves to make adjustments and “fit” into the world around them.  Rather, they can now focus their energy outwards to have conversations with those around them.  This could mean greater eye contact, increased confidence in putting words together, or improved conversation with family and peers.

5. Creating Routines

All humans thrive on routine.  Although the individual movements may vary from session to session, the components of each class remain the same.  Yoga is a daily practice that can be easily incorporated into your family’s life and over time, you will see many significant changes in both your child and yourself.  As a child becomes more comfortable with the yoga practitioner and the individual movements, he will be able to open up and take more risks, both on the yoga mat and throughout the day.

Beginning in September, I will be offering individual Yoga for the Special Child sessions in Gowanus and Ditmas Park, Brooklyn.  Contact jocelyn.m.wood@gmail.com for more info or visit www.jocelynmwood.com.

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The OT-Speech Connection

The longer I work as a speech language pathologist, the more I appreciate my work with occupational therapists.  I checked in with my friend Jill Loftus at Honest OT in Denver, Colorado, to find out How Sensory Processing Impacts Speech Development.

Photo via PROLoren Kerns via Flickr Creative Commons
Photo via PROLoren Kerns via Flickr Creative Commons

It’s important to realize that the vestibular and auditory systems work together as they process sensations of movement and sound. These sensations are closely intertwined, because they both begin to be processed in the receptors of the ear.

Audition, or hearing, is the ability to receive sounds. We are born with this basic skill. The ability to hear does not guarantee, however, that we understand sounds. We learn about comprehension as we integrate vestibular sensation. Gradually, as we interact purposefully with our environment, we learn to interpret what we hear and to develop mature auditory processing skills.

Language is understanding what words mean and how we use them to communicate. Receptive language is language which we take in by listening and reading. Expressive language is what we put out by speaking or writing. Language and speech are closely related, but they are not the same. Speech is the physical production of sound. Speech skills depend on smoothly functioning muscles in the throat tongue, lips, and jaw.

The vestibular system impacts motor control and motor planning that are necessary to produce intelligible speech. Because the vestibular system is crucial for effective auditory processing, the child with vestibular dysfunction frequently develops problems with language.

How do these problems play out? Here are some common characteristics of children with poor auditory-language processing:

  • May seem unaware of the source of sound and may look all around to locate where the sounds come form.
  • May have trouble identifying voices or discriminating between sounds, such as the difference between “bear” and “bore.”
  • May be unable to pay attention to one voice or sound without being distracted by other sounds.
  • May be distressed by noises that are loud, sudden, metallic, or high – pitched, or by sounds that don’t bother others.
  • May have trouble attending to, understanding, or remembering what she reads or hears.
  • May misinterpret requests, frequently ask for repetition, and be able to follow only one or two instructions in sequence.
  • May look to others before responding.
  • May have trouble putting thoughts into spoken or written words.
  • May talk “off topic,” e.g. talk about his/her new shirt when others are discussing a soccer game.
  • May have trouble “closing circles of communication,” i.e. responding to others’ questions and comments.
  • May have trouble correcting or revising what he has said to be understood.
  • May have weak vocabulary and use immature sentence structure (poor grammar and syntax).
  • May have difficulty with reading (dyslexia), especially out loud.
  • May have trouble making up rhymes and singing in tune.
  • May have difficulty speaking and articulating clearly.
  • May improve her speaking ability after she experiences intensemovement.

Physical Activities Promote the Ability to Speak

A child with vestibular and language problems benefits greatly from therapy that simultaneously addresses both types of dysfunction. Speech and language therapists report that just putting the child in a swing during treatment can have remarkable results. Occupational therapists have found that when they treat a child for vestibular dysfunction, speech-and-language skills can improve along with balance, movement, and motor planning skills.Jill Loftus, MS, OTR/L is a practicing pediatric occupational therapist and parenting coach focused on enabling and empowering children and families. Her 15 year career working in schools, homes, clinics and the community has spurred her passion for providing child development education in a meaningful and creative way. She provides a variety of services, blogs and a weekly 5 tips newsletter that you can learn more about by visiting honestot.com or follow us on www.facebook.com/HonestOT/

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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.

Give choices, grow independence Babies need choices and this is the first way that children use language.  Babies learn to gesture toward a desired object at around 8 months old.  From this gesture, they begin to use sounds to indicate their desire, and finally, around 12-14 months, they begin to say the name of the object they actually want.  Aid this natural progression by always placing two objects in front of your little one, so that they can reach toward what they want.

Sharing is caring Turn taking is an often overlooked skill.  Children as young as 9 months can begin to learn my turn/your turn.  You can do this when doing a puzzle with your child and you each have a chance to place a piece.  The same us true for a shape sorter, or even when turning pages in a book.  By developing this skills early on, your child will be an expert by the time he reaches the terrible twos!

Get messy Even as adults, we have sensory issues, but language develops in the optimal environment, and for some children that means making a mess.  Take the time to make play doh and slime with your child, play in bean bins by digging for treasure, and draw pictures in shaving cream on your wall.  Doing these multi-sensory (i.e. involving all the senses) activities with your child will activate many more parts of his brain, leading to increased integration (connectedness).

Devices are over-rated. Talk to me. Don’t get me wrong–I love my iPhone, iPad, iMac…–but children still learn best from speaking.  The 30 Million Word Project has been revisiting Hart & Risley’s 1975 study, indicating that children from lower income homes hear 30 million less words than their upper- middle class peers by the time they reach Kindergarten.  This research shows a clear connection between the amount and diversity of language a child hears and their future success, all the way through high school.  Talk about the things in your environment, respond to your child’s questions, and have realistic conversations.

Have a question regarding early language development?

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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.

Jocelyn: Gush to me about your child. Tell me how things have been going as a new mom.

Kristi: I was born to be a mom. I love being a mom. I was waiting my entire life to have this new identify and child and it’s been amazing. I have been blessed to be home
with him since he was born and I never thought that would have ever been an option. I’m truly in love and every day that love literally grows more and more and I don’t even know how it’s possible!
He’s a complete Gemini like me and he feels very deeply as I do so he’s been a bit tougher than the “average” baby (actually, that’s an understatement) but he  has become easier (at least for me) as he is now more mobile. However, he really matched the profile of a tongue and lip tied infant in terms of temperament resulting from pain and discomfort. He really is my joy, though!
J: Did you breast feed or bottle feed?
K: We have breastfed since he was born. He latched like a champ when he was born and barely let go until he was 6-7 months old. When he was 5 & 6 weeks old he took 3-4 2oz bottles total over those two weeks but once feeding was no longer instinctual (after 6 weeks) and his gag reflex emerged, all abilities to use a bottle stopped as he just gagged on all bottle nipples continuously and would not suck unless on the breast. He also never accepted all 800 pacifiers I tried (but now that he’s 10 months of age, I am excited that he never did! He also never found his thumb).
J. When did you first realize there was a problem?
K: I first saw his tongue tie within moments after he was born or somewhere within the first 2 hours (it was such a blur!) but I knew when I saw him cry that he was tongue tied. My husband has a moderate-severe anterior tongue tie (short lingual frenulum adhered to the tip of his tongue) that was never revised. My husband’s two brothers were also tongue tied but revised as infants. As tongue ties are hereditary, I expected Neil to be tongue tied so I was looking as soon as I met that sweet face and saw him crying. Neil didn’t have the classic anterior tongue tie, like my husband, so I was a bit confused, as I was not as knowledgeable on tongue and lip ties until after I did my research once he was born, as to why he had a very slight v-shaped notch at the tip of his tongue and a dimpling of his tongue just beyond the tip. Later, I saw that his hard palate was a little higher and more narrow than I believed to be typical (but still not even moderate or severely high and narrow). I also didn’t realize initially that when he cried, his tongue tip did not contact his alveolar ridge. Instead, there was a cupping of the tongue as the sides of his tongue cupped up while crying but did not elevate higher than the corners of his mouth. He also was a MARATHON nurser. This took awhile to realize as breastfeed babies frequently feed every 45 min-2 hours (that means if they feed every 45 minutes that it is 45 minutes from the BEGINNING of the first feed) so I knew that frequent breastfeeding was typical, but Neil LIVED on my breasts. The next points are HUGE…
  • I DID NOT have ANY pain breastfeeding…EVER!!! (except for 2-3 days of thrush when he was 5 weeks old, also related to his tongue tie but not relevant at the moment) and
  • he DID NOT have ANY difficulty latching!! He only had occasional reflux.
  • He also gained TONS of weight (after losing 7% of his body weight within the first week of his life-up to 10% is normal in breastfed babies-weighing just 1oz more than his birthweight by 10 days old).

Basically, Neil did not LOOK or fit the profile of an infant that had a tongue tie to ANYONE (more on that in the next question). Actually, the IBCLC in the university hospital we ended up having to deliver at due to preeclampsia at 40 week & 6 days told me that I seemed as though I was breastfeeding my 4th child (not my first like he is) based on how well everything looked!

I noticed that Neil’s latch became a bit more shallow than it had been in the hospital and the first weeks at home, but still nothing alarming to me. At 3-4 weeks, I noticed that he often choked upon my letdown which resulted in sputtering the breastmilk and coughing before latching again eagerly and seeming to manage the flow. I heard clicking while he nursed intermittently. He also had a nursing blister on his top lip and an appearance of “chapped lips” occasionally. NURSING BLISTERS ARE NOT NORMAL! Most people including pediatricians tell you that they are normal. They are COMMON (and so are tongue ties), but NOT normal. The biggest indicator of something being wrong was the incessant crying Neil did and the borderline diagnosis of “colic” he was provided. He wasn’t a true “colic” infant as he was easily soothed on the breast (whether that be that sucking was organizing for him, that he needed more time to adequately transfer milk, cluster feeds, or that the reflux he was experiencing was being soothed by the breastmilk which is like an antacid-even though he didn’t have a TON of reflux-I’m not sure which or all of the above). I don’t believe in “colic” and I believe that “colic” is often related to tongue ties and resulting aerophagia that looks like “just” reflux which infants are then overly medicated for. I also think that everything in their entire body becomes much tighter, especially within the head and neck, due to the tethers and that can create it’s own discomfort. It also took me the LONGEST time to realize that the “breastmilk” I heard hitting his tummy while actually AIR!
J: Who did you contact? What did they say?
At the hospital, I spoke to every doctor or intern that I encountered including my midwives, his pediatricians, and even the IBCLC. All told me that he was fine and there wasn’t anything.
I told my breastfeeding friendly pediatrician twice within Neil’s first 2 months that I believed he had a tongue tie and I was told that “notches in the tongue just existed for some people.”
No one seemed to care that I was a SLP or that by 2 months I had done SIGNIFICANT research on the topic. They asked me if I had pain breastfeeding…”no” then looked at his chart to see he was gaining weight VERY well (he was born “off the charts” in weight and length) but he continued to stay that way. I’m not sure if it was true for Neil because he continues to be “off the charts” but MANY breastfed babies with tongue and lip ties gain A LOT of weight because they are just consuming all of the letdown. Hormones play less of a role after 3-4 months when the breastmilk production regulates to meet the needs of the baby determined by how well the baby drains the breast at each feeding. It was also suggested that I have an overactive letdown or forceful letdown. . Babies without tongue and lip ties manage their mothers letdowns without difficulty (choking on the breastmilk at the letdown).
My pediatrician does not know about either revision that Neil had.

J: How did Neil respond to treatment? What changes did you see?

K:My husband swears within the first 3 days he saw a completely different child (it took a little longer for me to see it) but he actually began not just falling asleep at the breast when he was done feeding, but staying awake and popping off! That happened the same day as the revision took place. I was in SHOCK! I heard that babies would do that but Neil had never done that. It was amazing. He became a much happier child.

J: Were you ever told that there wasn’t a problem? How did that make you feel?

K: Yes, but that just energized me to PROVE to myself that I was right. I was right that the tongue and possibly lip tie were causing severe gastric distress resulting in “colic” and needing to breastfeed frequently. He had a moderate-severe posterior/submucousal tongue tie and a moderate lip tie. I am fortunate the hospital did not determine the tie because they would have tried to use scissors only and not have done a complete revision. The tongue and lip tie resulted in Neil having a weak latch and difficulty moving his tongue for adequate and safe milk transfer. He was taking in way too much air at each feeding. At 2.5 months of age I met other mothers who had similar stories. They put me in touch with Dr. Scott Siegel, one of the two preferred providers for oral tethered issues in New York. I was given all of the validation I needed. We had his first revision when he was nearly 3 months old. This was important to me because if he was not adequately transferring the milk out of my breasts that my milk supply could seriously decrease after 3-4 months when Neil became relevant in regulating my breastmilk production and supply.

J: What made you pursue the second surgery?

Baby Neil trying solids

I noticed at 6 months when he began solids that his tongue was not elevating to accept food he was placing in his mouth. As a SLP, I knew it did not look right. I was concerned that their had been reattachment in the healing process even though at our follow up Dr. Siegel said there was not reattachment. We found out he had what they call a tie that was not visible, and  was not evident until after the release of the posterior/submucousal tie. The second revision occurred while Neil was held in my husband’s lap (again he nursed within 5 minutes of the procedure.) This revision was AMAZING to see just how much more Neil’s tongue could move and ELEVATE. I was so happy!

J: Can you describe the tongue tie revision procedure? I know a lot of parents worry about this!

K: The revision itself was simple and quick (less than 2 minutes). He was awake and in his infant bucket seat. A laser was utilized and he wore goggles. He was provided with a topical numbing agent. I know many babies are swaddled if out of their infant bucket seat. Discomfort (or pain) was more from having hands in his mouth for the procedure. I know adults who have had the procedure done and said they did not even feel the laser but had soreness within 6-24 hours after the procedure for a few hours maximum. He breastfed within 15 minutes after calming down (that’s the longest I’ve heard of a baby taking to breastfeed after, most are even sooner than him) in the office. 
J: What is your advice for parents who suspect a tongue or lip tie?
K: My advice is never to listen to a pediatrician about tongue and lip ties (or breastfeeding) as most are not educated enough in this (these) area(s) (or many areas beyond general health and wellness). The general recommendation by a pediatrician will be (if they even suspect or identify tongue and lip ties) to do nothing unless it’s the classic anterior tie with tip restriction incredibly obvious. It is crucial to meet with an internationally board certified lactation consultant (IBCLC) and possibly even more than one IBCLC to find one who is super knowledgeable in tongue and lip ties (not all are). I also believe it is IMPERATIVE to find a preferred provider (specialist) for tongue and lip ties in your state (New York has only two) who will correctly identify and release the tethers via laser instead of scissors which often do not fully release a tie. ENT doctors are also not necessary to see UNLESS they are a preferred provider for tongue ties, as well or are recommended by a preferred provider who believes their education in tethered oral issues is superb.
We hope that by getting the word out there, more parents can identify tongue and lip ties and get the appropriate care for their child.
For more information on tongue and lip tie, contact me or find providers here.
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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?

Basically, what this means is that when the tongue is not able to move, it is more difficult to distinguish between speech sounds.  When children were given teething toys, which restrict the tongue tip’s movement, the babies were unable to distinguish between two similar but distinct Hindi-language sounds.  When the teether was removed, the babies were able to make the distinction (ASHA, 2015).

What does that mean for me? 

The message here is not necessarily that you should never give your child a teething toy.  On the other hand, we want to give our babies the most tongue movement possible, so some general guidelines are:

  • limited pacifier usage after 4 months, unless medical feeding issues are present
  • if you think your child has a tongue tie, seek a professional opinion and follow through with recommendations so that tongue tip has free movement
  • eliminate thumb/finger sucking if present after 2 years
  • get rid of bottles by 1 year; switch to an open cup, like the Oxo training cup

Speech Pathologist’s Tip: make sure the sippy cup is used as a transition–not a “forever” cup!

For more tips to help your baby thrive, contact me! I’d love to chat.

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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.

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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!
Blog blogging • • • • • • • • • • • • • By Jocelyn 0 Comments

Tongue-Ties across the Ages

babyboy-thumb

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!

Blog blogging • • • • • • • • • • • By Jocelyn 0 Comments

Everybody Does It, Nobody Talks About It!

 

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!)

Limit Electronics

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.

Eliminate Caffeine

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.

For more information on Childhood Sleep Disorders, visit Kids Sleep Disorders Awareness.

 

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