Helmet Heads!

Written by J Keenan on April 13, 2023. Posted in Infants.

Helmet Heads! Shaping Baby Inside and Out

Putting your baby in a helmet is a difficult decision for parents to make, but more often parents are choosing to put one on their baby. Are helmets necessary and why are so many babies wearing them? An explanation of why, when and how little melons are getting shaped by helmets.

A Helmet is Not Just For Vanity!

The Cranial Orthosis (CRO) or helmet does help your baby look their best by giving them a more symmetrical head, eyes, ears and even jaw. But, the CRO does so much more than making pretty babies! The skull holds and protects our baby’s most important organ, the brain. When the skull is misaligned, so is the brain. The helmet allows the skull to serve and protect allowing for the best position and shape for optimal neurological development. Sensory input from the outside world is organized in the brain. For example, if the eyes are misaligned this fires misinformation to the brain which is also misaligned and that is less than ideal for our baby’s development.

Why is Head Shape Important?

A baby’s face, ears, eyes, mouth and head should look symmetrical on both sides. Asymmetry caused by a head tilt (torticollis) or any other asymmetry noted on a baby’s noggin should be evaluated by a pediatric physical therapist. These small asymmetries now can cause big delays later. Gross and fine motor milestones and other coordination skills can be affected down the line, like playing sports, playing instruments or keeping up with their peers.

What is Plagiocephaly and What Causes It?

Plagiocephaly is a term to describe a misaligned head shape. Other names used are brachycephaly and scaphocephaly. Each of these terms describes a particular head shape deficit which is a flattening on one or more sides of the head. Sometimes a bulge is present as bones pushed on one side will cause a protrusion to another.

There are many known and unknown factors that can cause a misalignment of cranial bone plates. Here are some known reasons:

Lack of Tummy Time: Back to sleep and tummy to play! Tummy time will reduce the risk of flat spots.
Torticollis: A preference to turn to one side can cause a flat spot. Increased tummy time is recommended for torticollis.
Sleep Preference: “Back to sleep” campaign to reduce Sudden Infant Death Syndrome (SIDS) has been successful at saving lives but has caused an increase in flat heads.
Containers: Too much time in car seats, bouncy seats, or other soft bottom containers restrict babies ability to turn and move naturally.
Medical Conditions: Premature or medically fragile infants required to spend more time in certain positions early on for their safety.
Multiples or Intrauterine Constraint: Inability to move in the mother’s womb can cause muscle imbalances during development.

When Is the Best Time to Get a Helmet?

Baby’s head doubles in size within the first year! Ideally, it is recommended that a baby has a helmet between 3-6 months of age. Sometimes it is recommended earlier than 3 months depending on the child. Typically, the earlier the helmet goes on the less time they have to wear it due to the speed of head growth in the first few months. A helmet may not be recommended after 12 months because the head growth slows down which in turn slows down the changes the helmet can make. Physical Therapy is recommended before, during and after helmet treatment for exercises, positional changes and stretches can improve asymmetries and progress motor skills.

Parents Don’t Regret Getting a Helmet but Do Regret Not Getting One

This is a common phrase physical therapists hear from parents. Parents often forget their baby had a helmet until they look at old pictures because it is on and off so fast. Baby helmets have a small window of opportunity to make big changes that will last a lifetime!

Be sure to ask your PT who they recommend to evaluate and be fitted for a custom cranial orthosis. Schedule a free screening with a physical therapist at BDI Playhouse if you have any questions about the shape of your baby’s head!

Written By: Dana Bukala, PTA

Serial Casting- Casting That’s Not for Broken Bones

Written by J Keenan on February 24, 2023. Posted in Pediatrics.

Dynamic serial casting is a conservative treatment method in which skilled physical therapists apply and remove a series of lightweight casts to a patient’s leg(s) in order to improve foot alignment and increase range of motion. The goal of serial casting is to improve range of motion in order to prevent chronic skeletal issues, reduce falls, improve function and efficiency, improve the child’s walking pattern, decrease current pain or prevent future pain, and improve alignment for future orthotic use. Serial casting can help to delay or prevent the need for surgical intervention.

The casting process is performed by skilled physical or occupational therapists. A soft, semi-flexible casting material is applied over stockinette that is padded to protect bony prominences (natural bony points such as the ankle bones) and wrapped in a layer of cotton wrap. The joint is carefully positioned in a neutral position to maximize alignment and gently stretch the soft tissue, with the position maintained throughout the casting process. The child wears and walks (and squats, walks up and down stairs, and stands) on the cast for several days (typically 4 days on and 3 days off), with increased movement and weight bearing allowing for increased gains throughout the casting process. This process is repeated every week for 6-12 weeks until the desired range of motion gains have been made. Notable and measurable gains can be noted in just a few casts, too!

Conditions that can be addressed with serial casting:

*This is not an exclusive list, as serial casting can benefit a wide variety of patients. Patients who are younger typically make quicker gains throughout the serial casting process; however, patients of any age can participate (and have participated) in serial casting.

Cerebral Palsy
Idiopathic Toe Walking
Club Foot
Charcot-Marie-Tooth
Traumatic Brain Injury
Duchenne Muscular Dystrophy
Spasticity (abnormal muscle tone)
Contractures

This noninvasive process is designed to make gains while having limited impact on the child’s typical daily activities. Children can play, stand, and walk within their home, school, and community and participate in after school activities and sports (with the exception of swimming and water play). It is typically not a stand alone treatment method. Casting typically coincides with or is followed by ongoing physical or occupational therapy, and a referral for a pediatric orthotic evaluation to continue to maximize the gains made throughout the serial casting process.

Check out BDI’s Serial Casting page or ask your child’s BDI physical therapist for more information.

Cassidy Bannon, PT, DPT

Put Your Best Foot Forward!

Written by J Keenan on January 31, 2023. Posted in Preschoolers, School Aged Children, toddlers.

When to see a pediatric physical therapist for your child’s feet?

How do you know if your child’s little feet are functioning at their very best? Here are 10 clear signs that you should have a pediatric physical therapist screen your child’s feet so they can put their best foot forward!

Pain

If walking causes pain in your child’s feet this is a concern that should be addressed immediately. There are a number of reasons for pain in the feet and a pediatric PT can assess and address painful walking.

Asymmetry

Any difference in one foot compared to the other foot should be seen by a pediatric PT. Feet should look and move the same at the other foot. Seek advice if you notice a difference in foot size, a heel lifted on one side, turning in or out of one foot or any other noticeable differences.

Toe Walking

Toe walking is an abnormal gait or walk at any age at any time! We often see children raise up on their toes when they are very excited, nervous or cold but only for a few steps and then come down to their heels to walk or run. The earlier a child is seen for toe walking, the faster the treatment and the better the outcome. Don’t Wait!

In or Out Toeing (Pigeon or Duck footed)

Toe inning or outing is a common foot alignment deficit. When the feet are not aligned, the knees are not aligned which can lead to pain and inflammation. Often it can be a sign of leg, hip or trunk weakness or all three! It could also be a misalignment of bones within the joints. Seeing a pediatric PTl will determine the root cause and help get those duck feet in a row!

Flat Feet / Pronation

Flat feet is when almost the whole foot makes contact with the floor while standing. Pronation is when the ankle collapses inward when standing. Both flat feet and pronation can cause similar problems. Postural deficits are usually present as well as over use and under used muscle groups. This imbalance causes poor body mechanics which can lead to premature breakdown of joints. Flat feet and pronation cause the body to move inefficiently. It will take more energy to walk, run and jump!

Tripping

Children are still developing their sensory systems and body awareness which can look a bit messy. It’s common to miss a crack in the sidewalk or move too fast for their feet causing them to trip and fall. Tripping becomes a problem when they are doing it so much they are hurting themselves. Tripping on the same thing over and over, on stairs or ramps, carpets or even nothing at all can be concerning. A pediatric PT will be able to assess why they are tripping so often and help keep them on their feet!

Fatigues Quickly with Walking

Carry me! Is a phrase often used by a child who fatigues quickly when walking. A child who has good endurance, body mechanics, postural control and strength will want to walk vs being pushed in a stroller or carried. A child who struggles with one or more of these deficits will fatigue quickly when walking and ask to be carried more often. Ask a professional if your child seems to fatigue quickly when walking vs other children their age.

Aversion to changing shoes

New shoes or any new clothing item can be stressful to a developing sensory system. Our children who are more sensitive to change will often break down their favorite pair of shoes to a thin sole, or wear shoes that lack proper support such as slip-on type shoes. A professional can help get children into good quality shoes that support the foot properly, helping them to move with better posture and efficiency. Let’s make shopping for new shoes fun!

Sprained or twisted ankles

This painful injury literally stops you in your tracks. It’s common once in a while but abnormal if it happens over and over again, especially when doing everyday activities. Ankle weakness, misalignment or even vision could be the cause of ankle sprains. A PT can assess and address the reason for this very painful problem.

Abnormal gait / walk

Any abnormality of a child’s gait should be addressed as soon as possible. Sometimes it’s hard to put your finger on it because the smallest thing could be affecting their gait or it comes and goes. Listen for your child’s steps on a hard surface. It should be an even beat most of the time. Rubbing the top of their foot while walking can be a sensory movement that is affecting their gait. Running instead of walking. Gait abnormalities can easily be addressed in PT.

High Arches

High arches do not always need to be addressed but if your child has any other deficits such as any problems above, then high arches may need extra support. A PT can assess their gait and determine if treatment is necessary.

Pediatric Physical Therapists assess the cause of these symptoms and use conservative interventions to improve their everyday function on their feet! They will also refer you to the appropriate healthcare professionals when extra attention is required for the best care of those little feet!

Set up a free screening with a pediatric PT to ensure your child is putting their best foot forward!

Written By: Dana Bukala, PTA

COVID Babies – Impacts of Quarantine on Development

Written by J Keenan on January 27, 2023. Posted in Uncategorized.

The Global Pandemic of 2020 has left its mark on our lives in a variety of ways. It has changed the way we shop, the way we work, and even the way we learn. The lives of our kiddos have also been changed, especially for our “COVID Babies.” Babies born just before, during, or shortly after the global pandemic do not know anything different than the lives we live now.

So how has this new “normal” affected the way they learn and grow? Has it even affected them at all? Here’s what the latest research shows: “COVID Babies” were less likely to “wave” to greet others, point/use gestures, and say their first words prior to their first birthdays.

So, how can we support these “COVID Babies” and make sure they are on the right track? Meaningful play and reading together can be great ways to work on development. Exposing your child to as many different experiences as possible can create new environments for them to learn. It doesn’t have to be big and expensive. Something as simple as packing a snack and heading to the park can create new and unique learning opportunities for your little one. Click HERE for a list of more ideas.

If you have concerns about your kiddos development, click HERE for a link to our milestones page resources or schedule a free screening with one of our skilled therapists at BDI Playhouse. It’s never too early to make sure your little one has the skills needed to grow!

REFERENCES

Byrne, S., Sledge, H., Franklin, R., Boland, F., Murray, D. M., & Hourihane, J. (2022). Social communication skill attainment in babies born during the COVID-19 pandemic: A birth cohort study. Archives of Disease in Childhood. https://doi.org/10.1136/archdischild-2021-323441

Emily Francis, M.S. CCC-SLP

Visual Schedules

Written by J Keenan on January 10, 2023. Posted in Preschoolers, school, School Aged Children, toddlers.

Importance of Schedules and Routines

Just like adults, children feel more confident and secure when their daily activities are predictable and familiar. Consistent daily schedules and step-by-step routines give children a predictable, safe day. Schedules and routines help children:

Feel in control of their environment
Feel safe, secure, and comfortable
Know what is happening now and what comes next
Know how to do an activity or task

However, what happens when you have a change in schedule or routine? Does your toddler or child melt down or show big behaviors? An unexpected schedule change or a change in their routine can be upsetting and stressful. If your child is struggling when transitioning between tasks or with changes in schedule or routine, BDI Playhouse recommends you use simple visual schedules to make those transitions and changes smoother.

What is a visual schedule?

A visual schedule is an image-based tool that helps support children of all ages. It presents a sequence of events for what is going to happen during a specific task, during an activity, or throughout the day. Visual schedules help individuals complete a sequence of tasks or activities, attend to tasks, transition from one task to another, or maintain emotional regulation in various settings.

A visual schedule may use a sequence of photographs, videos, illustrations, or other visual elements that help your child understand what they are expected to do. The visual schedule can be virtual on your phone or printed on paper.

Benefits of Using Visuals

Provides clarity and predictability in routine which allows a feeling of control (reducing anxiety or confusion)
Provides concrete visual information for (can make something abstract feel concrete, such as the length of time before an activity will be over).
Reduces behaviors caused by frustration, confusion, anxiety.
Provides a critical avenue for visual learners to understand and retain information.
Serves as a virtual “contract” for completing expectations and delivering rewards.
Assists in building independent routines with better success (such as packing a backpack, washing hands, or cleaning up after snack).
Helps children know what to expect and/or what the expectation is so that they don’t have to fear what will happen or become impatient and frustrated.

How to create your own visual schedule

Identify your Target/Routine for the schedule
Choose the type of visual that will be most meaningful to the child:
- Photographs of the child/child’s environment
- Real life images
- Line drawings
- Clipart
- Text writing only
Keep language simple and direct
Involve the child in preparation
Involve other caregivers

Easy Resources for Visual Schedules

Lessonpix – online resource to create custom printable materials (clipart, upload personal photos or use photos from the internet)
300+ Editable Daily Rhythm Cards
Teachers Pay Teachers
Iphone Apps:
- Choiceworks
- Visual Daily Schedule

If you find that your child is still having difficulty when you have a change in schedule or routine or need help learning how to use a visual schedule, contact BDI Playhouse to set up a free screening with one of our pediatric occupational therapists or speech language pathologists. We can help you help your child!

AAC Winter Activities

Written by J Keenan on December 9, 2022. Posted in Uncategorized.

Do you know what AAC is? It’s all the way someone communicates besides talking. AAC stands for Augmentative and Alternative Communication. Augmentative means to add to someone’s speech. Alternative means to be used instead of verbal speech. AAC is used when individuals have trouble with speech and language skills. AAC can look like an iPad/tablet with an app and a voice or a picture board. Here at BDI, we have many AAC users!

It’s so important to model on your child’s AAC device. This is the best way for them to learn about their device. Modeling requires a communication partner with SLP’s typically begin by modeling core words. Core words refers to words that are in an individual’s vocabulary that make up most of an individual’s daily communication. Core words help AAC users to express their basic wants and needs. Examples include: help, stop, more, want, in, on, up, open

The best way to model is to use the device while you’re talking. For example, you can model “help me” by pressing “HELP” on device (or pointing to HELP on a low tech device) at the same time you say “help me”.

With winter here, here are a few activities that you can do with your child with some tips on how to incorporate AAC!

Snowman craft

Supplies: Paper plate, construction paper (black, orange, brown, red, child’s favorite color), scissors, glue, pen/pencil

CORE WORD	Phrases to Incorporate
MORE	“More glue”, “more paper”
WANT	“Want glue”, “want paper”, “want black”, “want scissors”
HELP	“Help me”, “help open”, “help cut”, “help glue”
ON	“Put on”, “on top”, “on head”
OPEN	“Open glue”

Sensory bin

Supplies: Bucket, snow (real or fake!), shovel or scooper, bowls, cookie cutters, mini objects (i.e., snowflakes, christmas tree stickers, penguins, candycanes)

CORE WORDS	Phrases to Incorporate
MORE	“More snow”, “More snowflakes”, “More scoop”
HELP	“Help scoop”
ON	“On top”, “Snow on”
IN	“Put in”, “Go in”
GO	“Ready, set, go”, “You go”, “I go”, “Go snow”
UP	“Pick up”, “go up”

We hope you enjoyed these activities with your child! We’d love to hear how it went.

Written by: Shannon Okland, M.S. CCC-SLP

Winter Swimming

Written by J Keenan on November 29, 2022. Posted in Preschoolers, school, School Aged Children, toddlers.

Shake Off Winter Blues in the Pool!

Consider your local pool or aquatic park this winter for all it’s amazing benefits!

Welcome winter and all it’s fun activities like ice skating, sledding and SWIMMING! The joy of swimming doesn’t have to end when winter begins. Indoor pools are the ultimate good mood booster along with so many other benefits! Open swim, swim lessons, aqua therapy and aquatic parks are amazing ways to get some exercise and a splash of the summer feels during the cold winter months.

Winter swimming has even more benefits than summer! Here are some cool pool perks!

Playing in the water makes us happy! Water is a natural anti-depressent. Prevent “SAD” (seasonal affective disorder), a common syndrome in the winter months. Water submersion stimulates our sensory system, exercise releases endorphins and decreases anxiety.

Master those swim skills! Practicing safety and swimming skills in the winter months will improve skills over the summer. Motor planning for treading water, breath control, floating and swimming takes practice. Those skills are lost during the winter months and need to be reintroduced for water safety and proficiency.

Create joyful memories! The family that plays together stays together! Exercising with family is not only fun but promotes a healthy lifestyle for your children to follow as they grow older. Promote year long family fitness and a lifelong healthy lifestyle.

Water is magic! Water play improves mobility, flexibility, balance, coordination, strength, posture, spatial awareness, endurance, circulation, attention, sensory motor integration and confidence. It decreases pain, muscle spasms, abnormal tone, rigidity, joint compression and stress.

Concerns of increased illness from winter swimming are common. Check out these pool facts that address common miconceptions of winter swimming.

Only a virus can cause a cold or flu. Viruses are more common in winter months from school and being indoors. Any indoor activity during the winter months increases the chances of catching a virus.
Risk of illness is greatly reduced from a properly maintained pool.
Illinois Department of Health enforces rules and regulations for water quality in public pools.
Several studies have shown that wet hair along with cold exposure has not been linked to increase illness.
Indoor pool water temperatures must be kept at 77-84 degrees and warm water pools are between 86-92 degrees for safety all year long.
Prevent chills or risk of hypothermia by drying off properly, wearing a hat, and dressing appropriately for the cold weather after a fun winter day at the pool!

Aqua Therapy is a great way to get started with a life long love of the water in a safe and accepting environment. Ask your pediatric therapist how aqua therapy can benefit your child! https://bdiplayhouse.com/aquatic-therapy/

Written By: Dana Bukala, PTA

The Power of Pragmatic Language

Written by J Keenan on October 17, 2022. Posted in Infants, Language Development, Preschoolers, School Aged Children.

Social Language Milestones

Pragmatics is the way we use our language in social settings. For example, how to start a conversation, interpreting body language, understanding different perspectives, and using sarcasm. Pragmatic language is typically learned incidentally (learned through experience) but with some children, it may need to be directly taught. Pragmatic language begins to develop as an infant and continues to grow and form until the high school years. Below is a list of “milestones” to expect along with activities/strategies to enhance social language.

Infant (3-12 months)

Starts making eye contact

Reaching

Participates in parallel play (playing next to caregiver, sibling)

Participates vocal turn taking

Uses vocalizations to request, protest, express feelings

Activities: Peek-a-boo, stacking blocks, waving, songs, nursery rhymes

Toddler (12-36 months)

Imitates routines

Imitates other children

Uses words (12 months)/phrases (18 months)/sentences (30 months) to request, protest, express feelings

Asks questions

Begins at 18 months

Initiates pretend play (ex: playing in toy kitchen, pushing trucks/cars, playing with baby doll)

Begins at 18 months

Takes two turns in conversation

Begins to describe/retell events

Begins to return/initiate greetings by waving

Activities: Ask questions during pretend play (“What’s baby doing? Where are they going?”), “sabotage” by putting toys out of reach, shared reading activities, scrapbooks to encourage retelling

Preschool (3-5 years)

Uses language for teasing, joking, fantasies

Starts to share with others

Joint play with peers (participating in others play schemes, including self in play)

Theory of Mind: Understanding that others have different beliefs

Begins at 4 years

Produces narratives as “chain”

Takes 4-5 conversational turns

Improves describing skills to repair communication breakdowns

Begins to inference/predict

Participates in turn-taking games

Activities: Sequence 3-4 pictures and retell story, give simple riddles (i.e., “This is an animal that lives on the farm and says ‘Moo’”), play “Go Fish” or “Bingo”

School age (5-11 years)

Invites others to play

Initiates conversations with familiar topics (ex: school, weather, weekend)

Problem solving (individually and in a group)

Begins 6-8 years old

Gives and responds to compliments

Tells and understands jokes of greater complexity

Politely interrupts

Responds to and uses facial expressions (ex: smiles, frowns, looks of surprise)

Recognizes spatial boundaries

Activities: Practice multiple meaning words, Apples to Apples, Emotion charades, Red Light Green Light

Middle/High School (11-18 years)

Recognizes if listener is interested or bored

Shifts topics during lulls in conversation

Understands difference between friends/acquaintances

Engages in collaborative discussions

Activities: Would You Rather questions, book club, Let’s Talk Conversation Starters

If you notice delays in the way your child is using social language such as having difficulty making friends, understanding body language, or maintaining age-appropriate conversations, schedule a screening with an SLP at BDI Playhouse today!

Tis the Toy Season- Toy Guide

Written by J Keenan on October 12, 2022. Posted in Holiday, Infants, Preschoolers, School Aged Children, toddlers.

‘Tis that time of year again! And all your kids want are toys, toys, toys! This can feel overwhelming when adding to an already large pile of toys in the home setting. Especially when the kids don’t even seem to play with the toys already available!

Below are some tips and ideas for bringing new toys in this Holiday season.

1. Balance of educational and choice toys; balance of seated and movement activity gifts

- Teach your kids from a young age that they may not get everything on their wish list.
- Provides them with opportunities to learn about toys they may have never seen before.
- Encourages seated attention or physical activity.

2. Hide toys and rotate them

- Hide old toys before new toys come out.
- When child appears bored of toys that are available, switch toys out with the hidden box of toys. Children will forget about some toys they have, making them feel new and exciting again!
- Continue this toy rotation as child displays readiness with multiple boxes as options. Allow child to peek into boxes and choose box, if they wish.

3. Incorporate multiple skills per toy

- Challenge the child to create different ways to use the toy.
- Model your own creative ways to use the toy
- Encourage exploration of new toy.

4. Use toy in obstacle course

- Toys that appear more challenging for a child are great to incorporate into a fun movement activity. This helps break up the challenge and decrease frustration.
- Great for toys with multiple pieces.
- Encourages physical activity, especially in those cold months!

5. Keep toys simple

- Simple toys encourage creativity and imagination!
- Toys don’t need to have a lot of lights or songs to be fun. These can actually become over-stimulating for a child.
- Allow child independence for exploring toys with only interrupting activity if unsafe.

6. Favorite educational toy companies

- These websites allow you the ability to choose toys based on age range so you know what activities are developmentally appropriate for child
  - Fat Brain Toys
  - Learning Resources

If you want some more ideas check out our website or amazon idea page!

Preschool: Top 5 Reasons Why Preschool is Important

Written by J Keenan on October 6, 2022. Posted in Preschoolers, school, toddlers.

Questioning whether or not to send your child to preschool? From a therapist perspective, preschool is such an important piece to practicing skills required later down the road. It facilitates structure, independence, social-emotional learning, and the foundation for higher level skills.

1. PLAY AT PRESCHOOL

Play is how kids learn! They learn to use their imagination, be creative, socialize with others their age, share, and problem solve when an obstacle arises. It also provides various play experiences through structured and unstructured activities, all of which allow children to build confidence, a sense of self, and critical thinking skills.

2. STRUCTURE

Preschool is where children start to participate in more structured routines like stations, lining up, singing a morning song, or learning the days of the week. Consistent routines are important for understanding expectations, predictability, and at the same time adapt to any changes that may arise.

3. FOUNDATIONAL SKILLS

Preschool helps you develop:

- - Fine motor skills (pre-writing strokes, grasp, stringing beads, scissor skills)
  - Visual motor skills (building block structures, coloring)
  - Gross motor skills (catching, jumping, playing on the playground)
  - Communication skills (having conversations with others, identifying colors, asking questions)

4. INDEPENDENCE

Preschool instills independence and provides an opportunity for children to develop self advocacy skills and personal interests. Within preschool, children start learning how to take responsibility for their actions and provide numerous occasions to complete simple tasks on their own.

5. SOCIAL-EMOTIONAL LEARNING

The preschool environment gives children the chance to engage with others, navigate conflict, understand their own emotions, and learn about empathy. Building on these skills at a young age provides children opportunities to grow and reach their full potential and beyond.

If you find that your child may have trouble in one or more of these areas, reach out to the BDI Playhouse office to schedule a free OT, ST, or PT screen.

Written By: Kiersten Robertson, MOT, OTR/L

Author: J Keenan