Thursday, September 21, 2017

Therapy Tip: Ways to Promote Independent Eating

Welcome to therapy Thursday!
This is the day that I give a tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs.

Today's tip is:

Ways to Promote Independent Eating

As a speech-language pathologist working with the birth-three population, I sometimes come across toddlers who are really struggling to use utensils to feed themselves. These toddlers often have low muscle tone and/or fine motor issues that make holding and using utensils difficult.

When Jaycee was a toddler, she struggled greatly with this. It wasn't until she was 3.5 years old when she was able to successfully and independently use a fork and a spoon. I tried everything to help her learn to eat by herself. Ultimately, it took practice and some maturity for her to develop the skill (along with occupational therapy). From all of our practicing, I learned some things I could do to help put her in the best position to succeed. Today, I'm sharing three of these things with you.

1. Get the right plate!
You might think any toddler plate will work when teaching a child to use utensils. For those toddlers that are having issues, they may benefit from using a deep toddler plate. Here is the deepest toddler plate I have at home.





It may look similar to the ones you have in your cabinet but this one is at least an inch deep. This depth is important when a child uses the sides of the plate to help food get onto the spoon. A plate with short sides or sides that curve out will make it more challenging for the child who is working on using utensils independently. A deep plate or a bowl will provide one level of support for the child. 


2. Make sure the plate is secure.
Another thing that needs to be looked at for some toddlers is the movement of the plate. If the toddler is really working to get the food on the utensil, the plate may slide or shift around which only causes more problems for the toddler. There are many plates available with suction cups on the bottle to combat this problem. These are great for chairs with plastic trays. But, I never really had a great suctioning plate that could withstand my daughter's attempts.

Recently, I came across the Happy Mat, which I absolutely love and is pictured above! This is a place mat and plate all in one. This automatically seals to the surface you set it on which keeps the plate stable while the child is trying to scoop against the plate. The other good thing about this product is that does have deep partitions which again helps the child scoop food onto their utensil much easier.


A great alternative to the Happy Mat or other items that promise to seal or suction is simple cabinet shelf liner. You can cut a piece of liner out for your child's plate to sit on. This should help minimize the movement of the plate while allowing the toddler to be more independent. This is a relatively inexpensive way to keep any plate you have in your cabinet more stable for the new feeder.


3. Get the right fork and spoon.
There are many different spoons and forks available in chain stores and online. I have a large collection of spoons but here are a few:





Depending on your child's issue, they may have more success with a specific type of spoon. There are spoons with thicker handles while some have thin handles. There are spoons made with flatter bowls while others are typical toddler sized bowls. There are spoons with angled handles to help the toddler with limited hand and wrist movements. The differences in utensils are important for some feeding issues. For example, toddlers with Down syndrome who have smaller oral cavities in general, may benefit from spoons that have bowl sizes that are smaller. (Here's a post specifically about making spoon choices!) If your child receives occupational therapy or speech-language pathology, they should be able to observe your child eat and make a recommendation for you on which utensil might be most successful.

When I work with a child in therapy on self-feeding, I generally start with the fork. I may have to help the child stab a food in order to get it on the fork, but the child can work on rest. A fork is good because the child can turn the utensil any way he pleases and the food won't come off. Whereas, a spoon you often have to keep it positioned level to make sure it stays on. If a child won't eat any foods that can be forked, I try to select easy to stick foods that will help spooning be more successful. Examples of these include: mashed potatoes, pudding, and yogurt.



If your toddler is struggling, try some of these tips, consult your child's therapist, and keep practicing!

Therapy Thursday is for educational purposes only and not intended as therapeutic advice.

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Tuesday, September 19, 2017

How My Body Responds to My Daughter's Illnesses

I don't know what it's like to have a surgery. I'm never had one myself.

I don't know what it's like to be a small child in the hospital for an illness. I was a senior in high school the first (and only) time I was in the hospital for an illness.

I certainly don't know what it's like to be taken to the emergency room in the middle of the night due to respiratory distress. That's never happened to me.

I don't know how any of these things feel for my daughter, who has experienced them all many times, but I DO know what it's like for the helpless parent in this scenario.

Whatever I have experienced in a health crisis is nothing compared to my daughter. I want to make that clear. I can't imagine what her post-hospital thoughts and problems are. With her limited verbal skills, I can only glean from the behaviors she displays later on.

As my daughter's caregiver though, I have had my own set of problems that stem from caring for a child with chronic health problems. I have been reluctant to share them because I don't want to seem like I'm trying to make her experiences about me. But, this is the side of the story I personally know. My body and mind have been changed forever from Jaycee's surgeries, emergency respiratory crises, and over 30 hospital admissions. Here's some things I have experienced from my daughter's health issues:


Hearing Beeps and Alarms
When Jaycee left the NICU after a 10 day stay, I came home "hearing" the beeps, dings, and alarms that I had been listening to nonstop at the hospital. There were no monitors at home, so there was absolutely nothing making these sounds. My brain got accustomed to the constant noises in the NICU and had to adjust back to silence. I thought it was such an odd phenomenon of hearing things that weren't real that first time, but it's happen several times to me after subsequent hospital stays with Jaycee. Now, I know that I may come home hearing beeps and alarms that aren't there, but they will leave in a day or two.

My Son Talking to Jaycee while she's in ICU on Day Time Bi-Pap Use
Nightmares
After an unplanned hospital stay, it is not uncommon for me to have nightmares about the hospital once we get home. Generally, the scarier the hospital stay the more intense the nightmares are and the longer I tend to have them. After a few days in the hospital for a less severe respiratory issue, I might have a nightmare or two within a week of being home. My nightmares aren't about serial killers or monsters. They are usually intense dreams about some aspect of the hospital.

After a few of Jaycee's very intense ICU stays that required a ventilator, I have had nightmares on and off for months. Most of them were hospital scene based. Many of them involved Jaycee being in the hospital struggling to breathe while I was lost in the hallways, trying to find her room. (If you are a dream analyst, feel free to message the meaning of that dream to me.) Sometimes, I have woken up from these dreams with a racing heart and fast breathing. Sometimes, I wake up confused about where I'm at, especially if we have just gotten home from the hospital. I have to remind myself that she and I are both safe at home.

I learned too that watching movies or television shows that are hospital based can trigger nightmares. For awhile, I was watching reruns of the sitcom "Scrubs" before bed. I started having nightmares again out of the blue. Even though nothing scary was happening in the comedic show, something about seeing the hospital scenes depicted triggered something in my brain.

Muscle Aches and Tightness
This is the most frequent and long term issue I have. The muscles in my arms, neck, and shoulders get unbelievably tight. At first, I blamed the tightness on the lifting and moving I did with Jaycee during an admission. It took me months and months (maybe a year) to realize my tight muscles were a result of the stress of caring for someone in the hospital so much. My muscles became so tight that I physically could not make them relax. I tried a technique called progressive relaxation where you tighten and relax your muscles in a certain sequence to get your whole body in a state of relaxation. I literally could not relax certain muscles no matter how focused I was.

The tightness eventually led to my left hand going numb, and that's when I started to understand I had a real problem. I lived on nightly Bio Freeze or Icy Hot applications. For a time in my life, I made weekly massage therapy appointments. These were not luxurious appointments, these were a necessity. Every therapist commented on my knots and the extreme tightness of my muscles. All of them asked me if I had stress in my life. One described massaging my neck and shoulders as pressing against a hard rock. I finally got to a place where my muscles could relax. I won't say I'm a 100% better, but I can recognize the tightness quicker now and try to take a more proactive approach.

Teeth Grinding
At one dental appointment, I was asked if I was aware of my nighttime tooth grinding. I wasn't. The dentist showed me the places on my mouth which indicated some serious grinding. After he made me aware, I did catch myself sometimes grinding when I was just starting to wake up. I ended up getting a night guard made from my dentist, because clearly I had a problem. I'm not sure when it started, but I can tell you the grinding gets worse with the stress I feel during illnesses with Jaycee.

The night guard has helped, but I don't always remember to pack it when an emergent illness arises. There have been times in the hospital that I have woken up in pain from intense grinding and jaw clenching. This is a problem for Jaycee too. When we drive to the hospital, sit in the emergency room, or wait for a doctor, she will grind her teeth SO LOUDLY!! She does this during the day while awake, but my problem happens at night when I can't control it.



There you go. Now, you know how my body has responded to my child's chronic health issues. I often wonder if she hears beeps and alarms that aren't there. I wonder if she is having nightmares about the hospital we just left. I wonder if she gets aches and pains from tight muscles after being stressed in the hospital. If I am a by-stander in this story, I wonder what all is happening to her. Perhaps, one day she'll be able to verbalize it to me. Until then, we'll just continue on and hope that the next illness is a long way off.

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Thursday, September 14, 2017

Therapy Tip: Alternatives to Sippy Cups

It's therapy Thursday! Hooray!
This is the day that I share a tip based upon my experiences as a pediatric speech-language pathologist and a parent of a child with a disability. Today's tip is:

Alternatives to Sippy Cups


After bottles, most parents offer their child sippy cups. Sippy cups are often a favored choice by parents for many reasons with the main one being that they avoid spills and leaks. But, they aren't favored by specialists like me.

But, hang on! I am a realist. I understand that sippy cups have their uses. For a child who is traveling or tends to throw things, a sippy cup is helpful. I'm not a total anti-sippy cup person, but there's something you need to know about these handy cups.

Sippy cups are not always the best for babies and toddlers who are already in speech therapy or have delays in development. When a baby is drinking from a bottle, the baby uses a suckle-swallow pattern to drink. The tongue is kept in a forward, low position to drink. A sippy cup essentially follows that same pattern. It encourages the tongue to stay in a low, forward position.

For children with low muscle tone or diagnoses such as Down syndrome, the sippy cup encourages the very thing (tongue forward position) that speech-language pathologist often are trying to discourage.

For these reasons, many therapists will offer alternatives to sippy cups. These alternatives do a few things. They encourage the toddler's tongue to retract and have more elevated movements.

A straw cup or an ordinary open cup are ideal alternatives to sippy cups that are easily found. Not every child has the motor abilities to drink from a straw or an open cup successfully. Therefore, I'm going to share some cups I have used with toddlers in my therapy practice. Below are cups that I have personally used. These cups are temporary tools to teach straw or open cup drinking. These are generally not needed long term because they are used simply to teach the drinking method to the small child. Some children work with one of these cups for a few weeks before moving on while others need more time to learn where their lips and tongue should go to drink successfully.

Reflo Cup
I found this cup this year and have started trialing it with some of the children I see in therapy. I really like this product! The cup basically has this special valve inserted inside their otherwise open cup. It slows the rate of which the water comes out of the cup. This is a great way to teach open cup drinking while the child learns how to tip a regular open cup and control the water flow rate. The top of the cup is just like an ordinary cup, which requires lip closure and tongue retraction in order to be successful.


The Honey Bear
The Honey Bear has become a staple item in my therapy practice. This is the cup I use to teach a child to drink from a straw when a child has absolutely no concept of straw drinking. I can gently squeeze this cup to assist in bringing the liquid up and in the child's mouth. You can achieve a similar effect using a standard juice box. However if a thin liquid comes out to quickly, I can put applesauce in the honey bear cup in order to teach the child to straw drink. I have used the Honey Bear multiple times to help children learn to straw drink.


Infa Trainer Cup
This cup is similar to the Reflo cup but with some differences. It slows the liquid before it comes out so that it can more easily by managed by toddlers learning to drink. By simply twisting the lid, the flow rate can be changed to a higher or lower rate. There are three flow rates to choose from. This does have a spill resistant design, so that is a plus with this cup. The children I have worked with generally have more trouble learning open cup drinking with this cup because of the spouted opening, but I still think it's a good option for some.

Recessed Lid Cup
This cup has a very simple design. The lid of the cup is, as it's name suggests, recessed. Therefore, this cup can be used for open cup training, but it can also accommodate a straw too. I like this cup because the lid is recessed, which makes the lips close on the cup as if it were a regular open cup. The flow rate is reduced by the small holes in the lid. This cup also provides handles, which is more helpful for some children. This can be another great option for children who need the water to flow out of the cup more slowly to open cup drink.



There are many widely available alternatives to sippy cups. When a child just can't simply do a straw cup or an open cup, these are some great options for training. Determining which cup is more appropriate requires one to look at what is hindering the child's progress. Your child's therapist should be able to help guide you through this process if you have trouble deciding which one to try. One of these cups could be a key to your child's progress, so don't be afraid to give one a try.


Therapy Thursday is for educational purposes only and not intended as therapeutic advice. Please consult your child's speech-language pathologist if you want specifics on how to use these cups. 

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Tuesday, September 12, 2017

Am I Being Real?

"Don't you ever struggle?"

I was surprised I was asked this question, because I thought everyone knew I have struggled. I've questioned my faith, I have fought post-partum depression, and have wanted to throw in the towel. I have cried many tears after every diagnosis my child received, and experienced uncontrollable anxiety in response to some of her delays and illnesses.

I have hinted at some of these issues in my writing. But, I suppose that much of my writing does focus on the positives instead of the negatives. There's a few reasons why I don't often talk about my ugly feelings and struggles that pertain to my daughter's diagnoses. The first being that even though I still have occasional struggles mentally and emotionally, I have grown so much. If I would have been writing during the first 3 years of my daughter's life, I guarantee you that I would have won the world's most depressing blog award. I was completely overwhelmed by Down syndrome, the heart defect and surgery, the medications, the developmental delays, therapy appointments, doctor's appointments, and feeling like I was never doing enough. Yes, I struggled.

My daughter and I have been together for 11 years now. I know the Jaycee beyond the diagnosis. Let me tell you, she's a pretty great child! Initially, I had a hard time finding Jaycee in the all the labels and medical problems at the beginning. But, my feelings are much different now. I am not overwhelmed by Down syndrome, her delays, and her Intellectual Disability. I'm just at a different place where the struggles are not front and center.
I may have dressed up as Barney a few times for Jaycee while she was growing up. That's love folks!
The other reason I don't share all my ugly feelings on here is that I know for a fact that some people who are considering abortions look at my blog. I don't want negative post after negative post on my blog, because I don't think that would represent how I really feel about my daughter. I would choose my daughter a million times over. After all, every parent has times that are hard for their child. A typically developing, healthy child can be bullied at school, be unbelievably disrespectful to parents, and cause all sorts of heartache and headaches for parents. Nearly every parent has some problem with their child, but I do feel that fact is overlooked by some outsiders looking into the world of disability. No child is guaranteed to excel academically, socially, or athletically-Down syndrome or not.

Still, there have been some rough patches in my parenting journey. Sure, it wasn't fun changing a 4 year old's diaper. Yes, I use to break into a sweat with the thought of taking my daughter out in public by myself because she was going to run off from me. And to be honest, the lack of babysitters and respite care has been a real problem for years. Please don't get me started on the medical bills! I think my family could have taken a dozen or so trips to Disney on what we've spent.

So I ask myself, "Am I being real on here?"

If I am not honest about ALL of my feelings, am I alienating some people? Are there some struggling parents who read my blog who think every parent is always happy? Do they read my posts and feel alone? I hope not.

I recall a few years ago being in an online Down syndrome group of moms. One mom commented that she often "forgot her son had Down syndrome." Another mom bravely wrote, "I can think of nothing else but my son's Down syndrome." Then all hell erupted on this online Down syndrome community. Moms took sides. Some claimed that a "good" mother should be able to see the past the diagnosis. Others (like myself) defended the mother because there are some times in life when the diagnosis does seem to take center stage of life though no one intends for it to be that way. The group was never the same after that heated discussion.

That online feud has stuck with me years later. I never want to be the person who causes a mom to feel bad about their feelings. I don't want to come across as someone who seems to say, "I'm doing great. Why aren't you?"

The truth is that I have struggled. I've had moments when I have wanted to throw the covers over my head and stay in bed all day. I've envied other parents whose "big" problems would be a piece of cake for me.

But you know what?

I DO get out of bed every day. I face the problems we have and try to learn something from them. I love my daughter fiercely (and my husband and son). I experience short lived heartache, and then I experience tremendous joy! We have a rough patch, and then we have some very calm weeks and months. I can't imagine my life without her nor do I want to! Yes, there are hard times, but there are really, really good times too.

That is the REAL me!


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Thursday, September 7, 2017

Therapy Tip: Spoons for Feeding Issues

Welcome to Therapy Thursday! This is the day I share a tip based upon my experiences as a pediatric speech-language pathologist and a mother of a child with special needs. Today's tip is:

Spoons for Toddler Feeding Issues

Working with toddlers, I run into a variety of feeding related issues that require intervention. Most of my feeding clients need help moving through textures. These kids may be orally defensive, gag easily, and even vomit with dietary changes. I also see kids who have a very restrictive diet. These children generally eat from one or two food groups (grains), and their problems are much more serious than just "picky eating." These kids too may have gagging or some other response when a new food is introduced. Other children I see may have low muscle tone or lack a chewing response that requires intervention as well.

Every child in feeding therapy is unique. Each has their own preferred foods, reactions to new foods, and physical responses to changes. Feeding therapy is very individualized and requires lots of brainstorming and trial-and-error. There are many, many things that go into feeding therapy, but today I'll address just one aspect-spoons.

The utensils that are used with a child may have a role in feeding intervention. Utensils are never THE fix to a solution, but they CAN be one tool or factor in helping a toddler. Today, I'm going to share a few of the types of spoons I commonly use in feeding therapy.
-The Maroon Spoons
Maroon spoons look simple, but they are unique. They have a very flat bowl. This flatness does a couple of things. First, there is no edge on the spoon, which benefits some children. Some toddler spoons are very deep and require strong lip movements to remove the food. The design of this spoon makes this much easier for children who have poor lip closure to eat successfully. The smaller maroon spoon, which is what I typically use with toddlers, limits the bite size that a feeder can give, which may be important for those who gag easily.

I personally used this spoon when my daughter with Down syndrome was eating baby foods. The difference between standard baby spoons and the maroon spoons was remarkable. With her low muscle tone, poor lip closure, and tongue protrusion, these spoons made meal times easier for her.  

If a flat bowled spoon is what you are seeking, there are some cheaper options that can be found in stores. I have found that the Kroger and Wal-Mart "take and toss" spoons have very flat bowls that meet the needs for some of my clients. The quality isn't as good because you get what you pay for, but it is another option. 
I love, love, love textured spoons! There are a few different options for textured spoons, but the ones pictured above are my favorite. Like the maroon spoon, they have a very flat bowl. Therefore, they are useful for the same types of children as the maroon spoon, but offer one additional feature. On the bottom of the spoon, there are small ridges or bumps that provide the tongue with a new feeling during feedings.

The texture on the spoon does a couple of things. First, it provides more feedback for the tongue giving more intra-oral awareness. Secondly, it provides a way to work on texture transitions. This is the reason I use textured spoons in therapy most often. If I have a child who eats Stage 2 baby food without incident but has a major negative response (gagging, vomiting) to the next stage, then I like to use textured spoons to fill in the gap. By keeping the child on Stage 2 foods but changing to a textured spoon, the child can get accustomed to a new texture via the utensil while their known food does not change. Generally, the toddlers will notice the change and sometimes gag with the change in spoon, but I can use this spoon to desensitize them. Sometimes, I can only use the textured spoon for a few bites because the reaction is so severe, but I can keep working to build up to a full feed using these spoons. 

Like maroon spoons, the manufacturer cautions using these spoons on children who will clamp down and bite on these spoons because they could potentially break them. I have never had a problem with this, but it is something I warn parents about. I never allow a toddler to use a textured spoon without adult supervision. 

If you have a DnZ vibe, then the spoon tip option is another handy tool to have in feeding therapy. Again, these tips have a flat bowl. (See a pattern in what I like?) By attaching these tips to a DnZ vibe, you can then use vibration as another way to provide a different input for the child who is struggling with oral aversions or texture changes. I have had some children who had no problems with the textured spoon but did exhibit a negative response when this tip was added with the vibration from the DnZ vibe. Therefore, the vibration gave me a transitional method when bridging the gap between two different texture phases. The vibration also gives the inside of the mouth more input, increasing the oral awareness on the tongue, lips, and cheeks during feeding. This oral awareness is important to achieve for those with low muscle tone. 

-Angled Spoons
Sometimes in feeding therapy, things progress to the point where a child needs to work on self-feeding. Spoons and forks that are angled do sometimes help a child be more successful with scooping food and placing it inside their mouth. The toddler's wrist does not have to make as many movements when a spoon is already angled, which can be helpful for children that have delays in fine motor skills. There are many angled spoons on the market and some options are available in common stores like Babies-R-Us. However, the spoons may all be slightly different.

Besides the angle, you need to look at the spoon bowl depth and handle thickness. Here a deeper bowl may be more beneficial as things won't spill off of the spoon before getting it to the child's mouth. If you are working on sticky, easy to scoop foods like pudding or mashed potatoes, then a flat bowl will still be appropriate. A thick handle may be easier for some children to hold but possibly too large for those with small hands or fingers. Trial-and-error may be necessary to find the perfect angled spoon, but these can be helpful for aiding in self-feeding.


In short, spoons are just ONE aspect of feeding therapy I consider in my practice, but sometimes they can be a very crucial piece that leads to success. I hope that you have some new things to consider when choosing a spoon for your toddler who has a feeding issue.



Therapy Thursday is for educational purposes only and not intended as therapeutic advice. Please consult your child's therapist before trying these spoons, and always follow the manufacturers' instructions on use.
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Tuesday, September 5, 2017

A Bundle of Joy For A Diagnosis

Thanks to technology and social media, it is easy to meet people all over the world on a journey similar to your own. I came across Melanie Gomez through a writing group on Facebook. Like me, she was passionate about sharing her experiences of caring for a child with a disability as a person of faith. When she announced to our little group that she would be publishing a book and was looking for some volunteers to read and review it, I gladly volunteered. 

It has been 11 years ago since my daughter was diagnosed at birth with Down syndrome and an AV canal heart defect. The diagnosis was initially a shock as I was preparing for a healthy baby girl. As you can imagine though, in 11 years, I have worked through many emotions and thoughts. Things that seemed overwhelming back then are just not now. But, I didn't want to read Melanie's book for my daughter's diagnosis. I wanted it for my son's. 

For a year I lived with the idea that my son could have Ehlers-Danlos syndrome. A local doctor suggested the diagnosis but it took slightly over a year to get into a genetics doctor who could officially diagnosis the syndrome. I spent that year reading, having a range of emotions, talking myself out of the diagnosis, and then convincing myself that he probably had it. Three months ago, my 8 year old son was officially diagnosed. I had a year to prepare for the diagnosis, but it was final at that point. I had a second child with a diagnosis, so this book came at a timely moment for me. 

Bundle of Joy: A Devotional to Accompany Your Child's Diagnosis is a short book comprised of two parts. In Part 1, Melanie tells the story of how her son Nicolas was diagnosed with medical issues and a genetic condition as a baby. (I'll let you read the book to learn the specifics.) Melanie tells how her son was finally given a surprising diagnosis, the fears she had, and the thoughts that came while waiting for the answers. She, like me, bounced between thinking everything was fine and worrying that they weren't during the waiting time.

Melanie's son is now 16, so her family is well beyond those scary first few years of adjustment and tackling unknowns. As I read through her book, it is evident that the author writes as someone with the wisdom and perspective that only time can give. When you have a baby with a diagnosis, there are many worries and fears you have for the future. When you are told your child may have severe limitations, you wonder what your child may be able to do and if/how you will be able to raise this child. These questions in your head can be almost paralyzing, which is what Melanie tries to address in Part 2. 


In the second and last part of the book, there are 14 chapters or devotionals. Each chapter is 2.5-3 pages long, so they are short enough for a busy mom to digest in a relatively small amount of time. The length of the book is a positive for me because when your child is diagnosed, you are often given lots of information to read. I often got overwhelmed by the stack of helpful pamphlets and books that came home with my daughter. The longer the book was; the longer I put it aside. The length of these devotionals should not overwhelm a new mom who has other things on her mind.

Each devotional has a short scripture listed first followed by Melanie's thoughts on various subjects such as Peace, Why, or Choose. Though the chapters are short, there were several times I read a very thought-provoking line that made me say, "Wow!" Again, the wisdom that comes from a person who has been on this journey for 16 years is something that new moms need to read. Each chapter ends with an opportunity for reflection where Melanie asks the reader to think about one aspect within their current situation in a new way.

While Melanie's book title may indicate that it is geared towards moms of babies who are diagnosed, I feel this book is appropriate for any mother whose child receives a life-changing diagnosis. I appreciated reading this book when I did. I needed to be reminded of things that I was sure of at one time. I also needed to hear another mother's story that reminded me that I am not alone in my thoughts, feelings, and worries, but I don't have to let those negative things overpower the good. Every child truly is a bundle of joy, and it's important to not let a diagnosis steal the joy a child brings.

If you have a child who was recently diagnosed, then please consider buying this book. This would also make a great gift for a family member in your life who finds themselves dealing with a diagnosis as well.

You can read more of Melanie's writing at https://redefinespecial.com/. If you want to purchase the book from Amazon, click here.

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Thursday, August 31, 2017

Therapy Tip: To Sign or Not to Sign

Welcome to Therapy Thursday! This is the day I share a tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs.

Today's tip is:

To Use Sign Language or Not To Use Sign Language



Sign language is sometimes brought up in my work with toddlers with language delays. Parents seem to have different points of view on the subject.

Some parents are interested in learning sign language to help their toddler who is not yet speaking. They see sign language as a temporary tool that can help their child communicate. These parents seem to understand that sign language allows a child to learn to express a word in sign and use it meaningfully. This is opposed to a child who merely grunts and points at random to mean a variety of things. The message becomes clearer when the child can sign "eat" or "drink" or "cookie" or "milk." They can start to build an expressive vocabulary that is taking a sign form rather than a spoken form.

Then I have other parents who have serious reservations. Some believe that signing may prevent the child from wanting to use words. They worry that successful signing may lead to the child not wanting to speak instead. Other parents see signing as an inefficient use of therapy time. They don't want me "wasting" time in sessions teaching the child signs when I should be teaching spoken language instead. Some families find learning signs overwhelming and confusing. The family may have a very busy life, and learning sign language may be too much for them.

As a speech-language pathologist, I do consider the parent's preference on signing. However, I do share the positives about signing. Plus, there is plenty of research on this subject. There is no need to fear if signing is appropriate. The research is clear. (Signing Time has a list of many research links.) Sign language does NOT hinder the acquisition or use of spoken language. In fact, it sometimes helps a child understand words or concepts. Here's another great article on this subject.

As a speech-language pathologist, I'm pro-signing. However, I don't necessarily teach sign language to EVERY child I see in speech therapy. A child with a language delay doesn't always need to learn sign language. Sometimes, picture communication is another alternative form that is more appropriate. Other times, the toddler has a good spoken base vocabulary of 20-30 words and doesn't necessarily need to learn sign since they have a good foundational vocabulary.

There is one particular type of child in therapy that I am reluctant to teach signing to in sessions. This child is very quiet but uses many gestures and pointing to get their message to others. In this case, I am reluctant to start signing right away because this child likes to gesture and NOT try to speak. I, personally, have seen these children flourish with sign language but make no effort to use their voice in any way. Therefore, I choose not to do sign language with these children or at least in the beginning. My first objective in therapy would be to get the child to start vocalizing in any way in an effort to teach him to use his mouth first.

Still, there are many children with delays that benefit from using sign language. Adding sign language to speech therapy routines requires minimal changes to the session and takes relatively no time if incorporated naturally.

Here's some important things I try to remember when using sign language with toddlers with language delays:
-This should be obvious, but maybe it isn't. Whenever you are signing with your child, you will say the word you are signing. Doing both ensures the child will see the sign and hear the actual word. We always want to sign a word and say it as they are learning signs.

-If a child begins saying a word, then I don't care if the sign is used. Spoken words are the goal, so that is the driving force. Once in a while a parent will insist that the child do the sign for the word they are saying. Nope, nope, nope! If they drop the sign once they say a word, that's what we are hoping for.

-If you have a child with a diagnosis known to have language delays, sign language is a good communication to use in additional to verbal speech. Sometimes, pairing a word with a sign helps a child "see" the word and thus have a new way to comprehend it. Children with Down syndrome, for example, have been known to do well with sign language acquisition before they are able to verbally communicate. This was the case for my daughter.

-I don't care if a child imitates the sign perfectly. Some signs are challenging because they require finger dexterity that a toddler does not yet have. My daughter could not replicate signs exactly because of her Down syndrome as a toddler, but I recognized her sign approximations and didn't correct her attempts. As her fine motor skills improved, her signs naturally got more accurate.


Sign language is one tool that is used in speech therapy as a temporary method of communication for children with language delays. Like any therapeutic method, sign language has its pros and cons, but it may prove to be a positive way for children to begin communicating with their families. If you feel like sign language could help your child, talk to your child's speech-language pathologist.

Therapy Thursday is for educational purposes only and not intended as therapeutic advice. 
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