Thursday, March 30, 2017

Therapy Tip: Selecting Books for Toddlers

Welcome once again to Therapy Thursday! This is the day that 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:

Selecting Books for Toddlers with Language Delays

If you have looked through the children's section of the book aisle in stores, you'll see a wide variety of options available. There are board books and regular books. There are cartoon drawings and books with real pictures. There are books on a wide variety of subjects and even some featuring familiar characters from television.

Which one do you choose?

If you have a child with language delays, then certain books may be more helpful. Here are some things I look for when selecting books for toddlers with language delays and why.

1. Books that are repetitious.
Sometimes, books that are repetitive are sort of annoying to read as parents. But, books that repeat most of the same words on every page have benefits for children learning speech and language. The repetition is great because the child can hear the same words over and over again. Some examples of these books are: Five Little Monkeys, Five Little Ladybugs, Brown Bear, Brown Bear What Do You See, and That's Not My Cat.

Repetition is extremely important for children with language delays. But, not only that, repetition word practice is necessary for children diagnosed with childhood apraxia of speech. These repetitive books often offer a way to get the child to say the same words many times, which is often the target in early therapy. Not every book you read to your child needs to be repetitive, but there are benefits to using these!

2. Books with real pictures.
I like to use books with real pictures to provide the child with a concrete visual example of the object. Over the last few years, there have been many books available for toddlers using real pictures. Some have different themes and some are designed for teaching "first words." These books are great for teaching basic vocabulary, and it helps when I can match up something in the child's environment to a picture in the book. I also like to use the faces of children in these books to work on body parts. Not every book HAS to have real pictures, but it is something I consider when choosing a book.

3. Books with touch and feel parts.
There are many books that contain different things to touch and feel on each page. I do love these books for a few reasons. For kids that may not like books, I have had good success getting them interested by having them touch the parts. They may not listen to the words on the page being read, but at least they are interacting with a book. For children with sensory issues, some of these touch and feel books provide them a nice way to stretch themselves to feel things that may be uncomfortable for them. Another reason, I like these books is that it gives an opportunity to target adjectives like soft, rough, hard, sticky, smooth.

4. Books on subjects that are meaningful to the toddler.
When you are working with toddlers that have 100 words or less, then the subject matter of a book is important. It should be meaningful to the toddler. Some books I have purchased contain pictures that are not relevant to the child's life. Take this book below for example.
I purchased this book because it was $1, so the price was right. Plus, it has some flaps on every page, which many children enjoy. I also like that this book isn't busy. Each page in the book has a theme that is presented with simply drawn pictures in rows. (Compare that to the touch and feel book with it's chaotic picture placement above.) Most of the pictures are relevant to the child's life, but some of them are not. How many toddler's first toys are yo-yos, tops, kites, and marbles? Despite some of its odd choices, I still like and use this book. I just focus on the words that are more relevant to the toddlers I am working with like ball, baby doll, and crayons. When I am working with children with delays, I rarely look/talk about EVERY picture on a page anyway, so I can ignore the pictures that I don't feel like the child needs to understand presently.

Still, it's a good idea to look at the book you are about to purchase and decide if the words/vocabulary targeted in it will be a good fit for your child.

The most important thing when searching for a "good" book is that the child will engage with it. If the toddler isn't interested, then it doesn't matter if you found a book with all the right features you are looking for. Hope this helps you find a good book for your child!

Related: Using Books to Build Language

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

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Tuesday, March 28, 2017

My Fight with Germs & Toothpicks

The last few weeks at my house have been... Which adjective to choose?

Germy would be accurate since 3 out of 4 people have had some sort of illness in the house. Exhausting would be another word to strongly describe how I have felt after taking care of my daughter Jaycee during her respiratory illness that has required many extra breathing treatments, vest airway clearance, and other medications. That leads me to stressful, which is how I felt watching numbers on Jaycee's monitor -willing them to stay high enough to prevent the hospital. Chaotic also describes the days and nights while this occurred since everything got disrupted by treatments.

Jaycee doing vest airway clearance after a breathing treatment.

After a long day in the middle of this illness situation last week, I was preparing the evening meal for my family.

As I reached for the colander to drain some delicious noodles, I accidently hit an opened box of toothpicks. Before my eyes, I saw dozens of three inch tiny wooden picks fly through the air. With the colander in hand, I debated on launching it across the room momentarily. Normally, I don't throw things. But in that moment, for a second, it was a thought I had. After all, I was in the kitchen alone. No one would have seen me do it and maybe it would have made me feel better for a split second.

Instead, I took that plastic blue colander and set in gently on the counter. Then I proceeded to pick up toothpicks from the floor, counters, stove, and a few other places they seemed to have managed to settle in.

After I threw the toothpicks away, I felt God say to me, "Good job."

Excuse me?

I was steaming at the mess I made and on the verge of a breakdown because the demands of the day were just about too much. I didn't understand what I had done good.

Then I pictured myself throwing that innocent colander that was in my hand a few minutes before and how I had the self-control to set it down and not give in to anger.

It may seem small, but I had just won a battle.

As a Christian, I feel I am constantly making decisions and moves that bring me closer to God or not. A thought, that was not of God, entered my mind, yet I resisted it. I decided not to throw the colander and go on with life.

There are times when I don't give myself enough credit. I get upset that I allow a sickness to bring feelings of stress in my life. I get frustrated with fears that pop in my mind when I hear Jaycee's loud breathing. I wonder if and when I am going to handle these situations better. Even though I have work to do, I'm not doing everything wrong.

Sometimes, I need to acknowledge that a day was hard and I did the best I could.

And other times, I need to celebrate the fact that I didn't lose my cool when toothpicks go flying.

What about you? I bet you have had a small victory in your life. Take time to celebrate that moment this week.

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Thursday, March 23, 2017

Therapy Tip: When to Start Speech Therapy for Children with Down syndrome?

Welcome to Therapy Thursday! This is the day that I share a tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs. My daughter does have Down syndrome, so today's topic is near and dear to my heart. So, let's discuss:

When should speech therapy be started for babies/toddlers with Down syndrome?

With all the research that has been made over the years, it is indisputable that early intervention for babies and toddlers who are at risk for developmental delays helps the child. The question becomes when should certain therapies begin. 

But it really isn't a simple question to answer. Most articles I have read suggested an evaluation by or at 1 year of age. However, it is rare to find an article to state a specific age that all children with Down syndrome need to be evaluated by a speech-language pathologist. I believe this is because we know that the language of a child with Down syndrome will most likely be delayed whenever testing is completed. But, each child has their own family structure, health history, strengths, weaknesses, and motor abilities to take into consideration. That's why this is somewhat of a personalized decision.

First...What would speech therapy look like anyway in babies and toddlers?
If your baby with Down syndrome is under the age of 1 year old, then most likely the treatment will primarily (or only) focus on feeding and oral-motor abilities. There are babies, like my daughter, that struggle to suck, eat from a spoon, accept a variety of textures, or drink from a straw. These types of issues can be addressed with early speech-language intervention. There are some babies that nurse or drink from bottles without any concerns. Still, there may be concerns with the baby's low muscle tone and tongue protrusion. A speech-language pathologist who has taken courses with Talk Tools, for example, will know some of these strategies that can assist with these oral and feeding concerns. 

Speech therapy that begins after age 1 may start to address language delays. This may include building the child's ability to use gestures, introduction of sign language, encouragement of vocalizations or words, helping them understand familiar words, and following directions.

Libby Kumin has written many great books and articles on the development of language and treatment strategies for those with Down syndrome. You can click here for one example.

Deciding when to Begin:
While I believe early intervention is key, I do feel that there are several factors to consider when deciding what is best for a child with Down syndrome. Some of these are:
  • Family priorities: What are the main concerns for the family? In early intervention, we as professionals are told this is the guiding force that helps us make decisions. Even if the child may show big delays in language, we aren't suppose to push for speech therapy if the mom is mainly concerned motor delays. The priorities and concerns of the family is a one thing to consider.
  • Health & Medical Status: For babies with feeding issues, any digestive issues need to be considered. Reflux and constipation, for example, need to be addressed medically and may affect progress in feeding therapy. Cardiac conditions may affect feeding as well and the energy level of the baby or toddler. This may be an important factor if the child is getting multiple therapies in one day.
  • Hearing: Ear infections and related conductive hearing loss are common with Down syndrome. A child's hearing history or concerns is a factor when considering if/when speech therapy should begin. Hearing loss or ear infections would put the child more at risk.  
  • Other delays: Global delays in development are usually found with children with Down syndrome. When deciding on starting speech services, the team and family need to look at all delays present and consider how one may impact another. Fine motor delays may impact the toddler's ability to mimic sign language. Gross motor delays in babies will affect the speech-language pathologist's decision on positioning for feeding, for example. Therefore, speech can rarely be considered in isolation. The baby/toddler's overall development needs to be considered when deciding to begin speech therapy.
  • Age: The child's age is always key. Sometimes there are agency rules, state guidelines, or program rules that state when speech-language therapy should or can begin. Some may consider 12 months too young to benefit from speech therapy that only focuses on language development as motor skills are still developing and attention spans are short. Some programs will not allow evaluations that are for language only to be completed for children under 18 months. Eighteen months is a common age to see speech therapy evaluations take place in any child without Down syndrome, since this is often the age delays become noticeable and walking is established or close to being established. It is important for parents and professionals to know the guidelines and rules that apply to them.

The take away
Every child with Down syndrome is unique. Each baby and toddler with Down syndrome needs to be evaluated while considering all the multiple factors that come in to play in order to determine when services should start. The earlier speech-language therapy starts, the better. However, therapy may be more productive when certain skills and milestones are met. It is my belief that every child with Down syndrome should receive a speech-language evaluation around 18 months of age and earlier if feeding issues (gagging, poor sucking, stuck on pureed foods) are present.

Therapy Thursday is for educational purposes only and not intended as therapeutic advice.
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Tuesday, March 21, 2017

The Story of Down syndrome For Us

It’s just an extra 21st chromosome. One piece of genetic information that seemed at one time to define my daughter. Down syndrome was a huge and overwhelming diagnosis back in 2006 when Jaycee was born and diagnosed.

Time has passed, and my attitude has changed since her birth day. Down syndrome is just part of her story and ours. It is not THE story.
Here are 21 moments from the story of my family's life with Jaycee in honor of World Down syndrome Day.

1.      First ultrasound picture…It was a glimpse of my first-born with knowledge that a daughter was in our future.  

2.       Snuggles after delivery…Before we knew about Jaycee’s Down syndrome and AV canal, there were a few hours when my husband and I just marveled at our new baby without worry. We examined every finger and smiled at every movement and sound.

3.       A doctor's announcement…After waiting 4 long hours during Jaycee’s open heart surgery, I was relieved to hear that the surgery went as planned and all was well with our infant.

4.       First wobbly steps…In a physical therapy session, Jaycee took her first little steps. All those hours in therapy sessions and hard work paid off!

5.       Walking for Down syndrome…Our family teamed up to raise money for our local Down syndrome group and participated in an awareness walk. It would be the first of many times Team Jaycee united.

6.       The Best Word Ever…Is there anything sweeter than hearing a squeaky voice say your name? Nope, there isn’t! "Mama" melted my heart.

7.       First school drop off…Taking Jaycee to pre-school as a little three-year-old resulted in tears from one of us. I’ll let you guess who.

8.       Jaycee becoming a big sister…During my pregnancy with my son, I explained to Jaycee that she was going to have a baby brother soon. Right after Elijah was born, Jaycee came into the hospital room to meet him. She signed “baby” as she peered into his bed while the nurse weighed and measured him. She instantly loved him!

9.       Self-feeding...After months of occupational therapy, hand-over-hand spoon feedings, and trials of many spoons, the day Jaycee fed herself with a spoon was cause for celebration. We could eat together as a family at the same time, and she could be more independent.

10.   Second first steps…After a long and serious stay in ICU when she was in first grade, Jaycee came home depending on a wheelchair. She could not climb steps. She could not even sit up unsupported. When her strength came back slowly and she started walking again all the time, it was a gift to watch. 

11.   Jaycee, the competitor…Jaycee loved participating in the softball throw at the track and field games for our state Special Olympics competition. She kept looking at those of us in her cheering section to make sure we were all paying attention.

12.   The 3 big words…”Love you, mama!” After weeks of breaking up this phrase into simple word approximations, Jaycee one day repeated it back. It sounded like “Uh oo, mama,” but it was the beginning of this beautiful exchange we could have.

13.   School dancer…After some bravery on my part, I signed Jaycee up to participate in the yearly school fundraiser cheer leading and dance group with her peers. Jaycee knew the moves and proved she could do amazing things if I didn’t limit her.

14.   Elsa and Anna…Jaycee was fortunate to receive a trip through Make-A-Wish, which meant she got the royal treatment at Orlando theme parks. She absolutely loved meeting the Frozen cast after a show; her joy was precious.

15.   A lifelong relationship…At a family get together, Jaycee marveled at her cousin dressed up as a deer. From then on, Jaycee fell in love with her cousin, who she referred to as “Deer” ever since.  

16.   A pep rally…Jaycee’s school held an energetic pep rally for the athletes participating in Special Olympics. Jaycee ran through the lines formed by smiling cheerleaders. Instead of bursting through the paper banner at the end of the cheerleaders, Jaycee crawled underneath it. It was such a funny moment!

17.   A friend party...When your elementary school daughter wants to have a birthday party with friends, you make it happen.

18.   A Baptism…After weeks of teaching and preparation, Jaycee went through the water baptism at church like any other child. She came up out of the water smiling, just like all of us who were surrounding her.

19.   My daughter on stage…During a pageant for girls with intellectual disabilities, I saw my little girl transform into a princess and enjoy being in the spotlight. Her abilities were celebrated, and she continues to show off her crown to visitors at our home.

20.   Water coaster Enthusiast…Water coasters exist and my daughter loves them. While I scream my head off wishing for the ride to come to the end, my daughter shows no fear and laughs all the way through.

21.   Home plate with Molina…When Jaycee won an opportunity to meet Yadier Molina during a Cardinal’s game through our Down syndrome Association, there were several seats filled with our friends and family cheering for her. Molina autographed her baseball right after she did.

Our life with Jaycee has set us on a path we did not anticipate. Then again, who could predict some of these moments we have had with Jaycee. Some of them have been extraordinary, a few have been challenging, and others have been gratefully mundane.

Time has shown us that there is a full and good life beyond diagnosis day. Happy World Down syndrome Day!
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Thursday, March 16, 2017

Therapy Tip: 6 Ways to Use Stickers

Welcome to Therapy Thursday! This is the day that 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:

6 Ways to Use Stickers in Speech-Language Therapy

If you have read some of my Therapy Thursday tips, then you know that I like to share ideas that involve items that are inexpensive and easily available. With that mind, let's talk stickers today.

I love using stickers in therapy sessions. They are usually pretty motivating for the child, since stickers aren't something that they do everyday and come in all subjects. There's many ways to achieve language goals with stickers with toddler and pre-school children, but I'll give you 6 ways today.

1. Vocabulary/Naming Pictures: This is the easiest way to use stickers and probably the one that I use the most. I like to collect a variety of themed stickers to work on building vocabulary. Animal, food, and vehicle stickers are some of the easiest ones to find. Basically, I just use the stickers to teach the specific words (chicken, sheep, cow). The scrapbook section of stores often has some very unique subject specific stickers (camping, firetrucks, sea life). Sometimes, these are helpful when you are trying to find an activity based on what appeals to your child.

2. Colors: This takes a bit more digging and planning beforehand. Go through your stickers and find ones that are basically one color. Once you have all the stickers you want sorted by colors, you can do a few different activities. You can get construction paper in the same colors as the stickers and have the child place the stickers on the right corresponding paper. You can simply tell them a color to select from several choices. If they find the right color, they can place it on paper. You can also have the child put all yellow stickers on a page, etc. then make the different colored pages into a book for them to keep. Colored stickers have lots of possibilities.

3. Spatial Concepts: For this, you will need a small empty box and stickers. Using an empty Kleenex box, you can give the child directions with the stickers targeting spatial concepts. This may be: Put a sticker on top of the box. Place a sticker on the bottom of the box. You can also target side/front/back.

4. Articulation/Speech Sound Work: Like with the colors, this activity will take some prep work for you. Depending on what sound the child is working on, you'll have to dig through your stickers and find ones that will work. In the stickers pictured above, I would use some of the stickers for /b/ sound practice such as: banana, berry, bird. This is a great way to mix up sound practice, but it does require a lot of preparation. Usually, you need a large amount of stickers to dig through to find 10 or more so the child will have enough to get enough repetitions.

5.  Choice making: For children who are working on making choices with either a point or a word, you can hold up two different stickers and ask them which one they want. If you are trying to get them to say what they want but they need help, you can say each sticker name as a cue.

6. Sentences: If you are working on saying phrases or sentences, you can have the child say a phrase to obtain a sticker. I like using rote phrases for this such as: I want the ____. I like ____.  Using rote phrases allows the child to practice the same sentence structure multiple times while only one word changes. In this case, the name of the sticker would the be word that changes. If I am using the rote phrase, "I like ___," then I might use different animal or food stickers to allow the child to choose the sticker they prefer.

Enjoy sticker shopping to prepare for your activities, and I'll see you back here next week!

Therapy Thursday is for educational purposes only and not intended as therapeutic advice.
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Tuesday, March 14, 2017

Keeping Your Faith When Life Tries to Take It

I know I can be strong. I also know I can be broken.

Life hasn't been easy since becoming a parent over a decade ago. In fact, it's been very, very challenging. Yet, I still have faith in the goodness of God and consider myself a Christian.

My faith in God was strong when my husband and I were looking forward to the birth of our first child. At that time, I would have described myself as a very carefree, optimistic, and joyful person.

When Jaycee was born, I was 25 years old, and it would be my first big crisis of belief. I was expecting to deliver a healthy baby girl and return back at my job in a school a couple of months later. But that isn't what happened.

Instead, Jaycee was born and sent straight to the NICU for 10 days. She was diagnosed with Down syndrome, AV canal heart defect, pulmonary hypertension, and congestive heart failure before we left the hospital. I came home with a baby who needed intensive care, lots of medications, and an open heart surgery.

Having a child with a life threatening condition made me a mess. At the same time, I was also hopeful. I know it doesn't make sense. In the beginning there was faith inside of me that rose up. I prayed, spoke scriptures, and even fasted over her. I leaned upon some of that optimism that came naturally. At the same time, depression started to creep in. This feeling was new to me, and I didn't recognize it right away. I was overwhelmed and shocked by my baby's diagnoses and sudden turn of events that came in my life. 

Over the course of a few months into this battle for my child's health, I became a depressed Christian. Some people may think that's impossible, but I can tell you that it is possible to love God and believe in Jesus but to be sad from an event in your life that spirals you down further than you ever anticipated. Is it Godly or right? No. But, you can have very big doubts while you try to do life.

Jaycee's first year of life left me with more questions and worries than faith. During that year, she had an open heart surgery followed by 3 months of oxygen use at home. She failed a hearing test prompting talk of tubes. She started wheezing when she was sick and asthma began being discussed. Her eyes started to turn in and cross which meant seeing another specialist who talked about a surgery in her future. Her developmental delays required home therapies every week. It seemed like every time we turned around; we got bad news.

Any hope I had in God when Jaycee was born was gone by the time she was a year old. I was worn out in every way and my relationship with God suffered. It wasn't a conscious decision I made. It was a slow process of allowing negative thoughts and doubts to infiltrate my thinking and crush any faith. I also doubted the effectiveness of my prayers. Therefore, they became shorter and shorter and done less and less often.

There were questions I had that didn't seem to have any answers for. I couldn't find justice in our situation. I cried to God about my daughter's health with seemingly no response and no miracles.

I continued my Christianity by reading scriptures, going to church, and trying to love God through so many immense emotional and mental struggles. I waited for things to get better. I waited for Jaycee's health to improve. I waited for me to see something happen in her life to know that God was still working in our lives or that He cared.

What can I say? I wanted things to be easier for me and the rest of my family as proof God was with us. But, that hasn't been the case. Struggles have continued over the years. The events the played out after Jaycee's first year of life until now are too much and too long to explain in one post. Here's a sampling of some things we have parented Jaycee through: 20 something hospital admissions for illness/emergencies, 3 heart caths, 2 open heart surgeries, daily medications, bi-pap at night for 8 years, respiratory distress at home, helicopter transports, etc.

Here's what I want you to understand. Life hasn't gotten magically better for my daughter. She hasn't become verbal enough to speak in sentences. She hasn't gotten off her medications. There aren't less doctors involved in her care. She hasn't stopped having scary health emergencies although they are becoming less frequent. The respiratory problems haven't been outgrown. She can't get rid of the medical equipment in her room. There wasn't a "miracle" in any of these areas, but we have seen God's hand on her life in times of serious illness and other situations. I realized the proof of God I wanted came in other ways, not just "healthy" times.

Despite all of this, my relationship with God is strong. After struggling for awhile  when Jaycee was younger without exactly knowing how to pull out of the place of shaky faith I found myself, I changed. I transitioned from a struggling Christian to a Christian with a renewed love and heart for God and her life. It wasn't easy. In fact, it was really hard at first. But it became easier. I believed the things I originally felt about God, and prayed with the faith that God did listen and hear. Something changed in my heart.

Have you been struggling? Here's my advice on how to rekindle your faith while your circumstances are challenging.
  • Connect with God. I kept going to church and reading the Bible even when it was hard. Faith for me some weeks was just showing up at church saying, "God, I believe in you even if I don't understand my life right now." Other times, I read a chapter looking for anything that would speak into my situation. I still tried to show a commitment in some way.
  • Continue to pray. Here's where I messed up. I started to believe the thoughts from the enemy which said my prayers were pointless. But, prayer is always the key! I wish I would have recited the Lord's Prayer if nothing else to keep the habit. Whether you believe God is hearing or not, pray through it.  
  • Find a friend who listens. This is hard when you're struggling. You believe no one will understand or no one has gone through what you have. You may know no one in your situation, but I hope you know someone with faith. That's all you need, someone with ears and faith. Maybe you tried to open up to someone and that ended badly. Try someone else. Isolation is not good! Find a friend who will listen and give Godly counsel when you are struggling. Keeping your doubts to yourself with only allow them to get bigger and stronger.
  • Focus on the good things. There has to be SOMETHING good that has happened in life. Maybe you made it through the day without getting emotional. Perhaps someone took time to mail you a card. Maybe you got 8 hours of sleep. Sometimes, you have to be grateful for the little things and celebrate the small stuff. When life is hard, it is nearly impossible to find something positive. Find something everyday to be thankful. If your ratio of complaints far exceeds your thankfulness, then you need fresh eyes for your circumstances.
  • Be patient. I know some days will be tough. You may feel like staying in bed all day or giving up on your responsibilities. Don't beat yourself up if you had a day full of anxiety or tears. Have patience with yourself but don't allow yourself to stay in an unhealthy emotional place. You deserve better than that.

There is hope in life. Even when things don't turn out the way you prayed, God is still God. Without faith, we have nothing, so fight to keep yours if life is trying to steal it away. Blessings!
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Friday, March 10, 2017

Not Excited for Spring Break? Me Neither...

Going to the beach for spring break?  Great for you.  We have another destination in mind....the hospital. Read all about it on my post on the site Comfort in the Midst of Chaos

When Spring Break Plans Aren't Glorious
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Thursday, March 9, 2017

Therapy Tip: Why Puzzles Are Great for Toddlers

It's Thursday! That means it is time for another tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs. Today's tip is:

Why Puzzles Are Great for Toddlers

I love using puzzles in my speech therapy sessions. One reason why a puzzle is such a great therapy tool is that it targets many skills in different areas of development.

Puzzles work on:
-hand-eye coordination
-problem solving skills
-fine-motor abilities as the child uses their fingers to place pieces in
-vocabulary/concepts as the child can learn these through the subject matter of the puzzle
-memory as the child sifts through the pieces and tries to place them correctly
-task completion since there is a beginning and a definite end to the task
-matching or shape recognition

The cognitive, motor, and language benefits are all there when a toddler is completing a puzzle. The key to success is finding a puzzle that is on the toddler's developmental age. To help you discover where this is...

Here are some things I think about when I am choosing puzzles for toddlers.

-Number of pieces:  The number of pieces is pretty self explanatory. The fewer the pieces; the easier the puzzle will be to complete. I typically start with a puzzle that has 10 pieces or less with a toddler. If a child is closer to 12 months old, I usually start at the chunky 3 piece puzzles.

6 Piece Chunky puzzle from Melissa & Doug with no pegs

-Pegs Versus chunky pieces: Some puzzles have chunky pieces so that the toddler can easily grip the piece. Other puzzles like the one below have a tiny piece of plastic or wood in the center which the child can grasp. The pegs can make the puzzle a little more challenging as the child is forced to use a pincer grasp instead of using their whole hand to manipulate the piece. A word of caution with pegs: I have noticed that some children, especially those with autism, can get too distracted by using the peg to twist and spin the pieces instead of completing the puzzle.
9 Piece Peg Puzzle from Melissa & Doug with Pictures to Match Under the Shape

-Picture cues underneath: Some beginning puzzles have pictures underneath the piece that allows the child to match pictures to complete it. The shape puzzle above is an example of one that helps the child see what piece should go in each spot by providing a picture. Those that do not have pictures underneath are more difficult since the child has to do shape recognition to find the right piece rather than simple picture matching.

Simple Scene Puzzle from Melissa & Doug

-A scene puzzle Versus individual pictures: The shape puzzle (2nd picture above) is an example of a puzzle with one theme but individual pictures. These type of puzzles are much easier than scene based ones. The other two puzzles pictured here are examples of scene based puzzles. These are visually more distracting since the child has to look through and decipher where the piece goes in the scene. The bear puzzle pictured above is a more difficult scene picture because for it to be completed, pieces must be placed in a specific order to make the next one fit.

Overall, puzzles for toddlers can have a range of possibilities and options. Sometimes, parents will buy a puzzle for their child and discover that it is too difficult for them. They may not understand why. I hope by explaining the 4 main things I look at when choosing puzzles, you will be able to select a puzzle that is most appropriate for your child or understand why one puzzle might be harder for your child than another.

All puzzles pictured here can be purchased from School Specialty.

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

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Tuesday, March 7, 2017

My Emotional Attachment to Stuffed Animals

I have a problem. It's a strange one.

I have an emotional attached to several of my daughter's stuffed animals.

There. I said it. Now, let me explain.

I was cleaning Jaycee's room recently. I noticed her pile of stuffed animals was seriously getting out of control. The problem was that I couldn't bear to part with any of them for one reason or another.

There's this one.

What's so special about this dog in a pink nightgown? My husband and I "made" this puppy for Jaycee at a store in a mall that allowed you to stuff your own teddy bear. Jaycee was a few days old and in the NICU when we purchased this. We left the hospital to take a much needed break and decided on a whim to build this dog for her. When we picked out a heart to place inside the dog, I remember I wanted to cry. It held such meaning to me because we had just learned Jaycee had a large hole in her heart and was in congestive heart failure. We both said a silent prayer for her heart as we placed it inside. How can I say bye to this dog?

This soft little panda bear is another item Jaycee received as a newborn. A sweet lady of faith named Betty brought this to Jaycee after she got home from the NICU. Betty also had pizza for us which we ate together. Jaycee loved looking at this bear as a baby. This bear has stayed with us all these years. Betty has went on to Heaven, but her gift remains with us. 

And there's this one. Yes, it is a bit on the ugly side, but his body is shaped like the heart. His name is Snerdlihc, which is Children's spelled backwards. Jaycee received this from the hospital when she was 3 months old and having her first open heart surgery. Because it's a reminder of her mended heart, I have not been able to let go of this little guy.

This cute little teddy bear is another one that I just can't part with. Jaycee's grandma Ramona, who passed away a few years ago, bought this for Jaycee during her hospital stay for her first open heart surgery too. I had mixed feelings about this bear at first because it reminded me of the hospital, which I wanted to put behind us. Over the years, there have been so many hospital admissions that this bear became more a tribute to the doctors that have helped Jaycee time and time again.

This little puppy is from one of Jaycee's hospital stays for a respiratory illness. I played Bingo for Jaycee in the hospital to win this green puppy, which is Jaycee's favorite color. I felt so good winning this after having such a crummy day watching Jaycee struggle. And for that reason, this green puppy is still around.

Isn't this praying little lamb sweet? A friend of mine named Brandi came to visit Jaycee while she was in the ICU once. She sat this lamb on Jaycee's bed and explained that her daughter wanted Jaycee to have this lamb. She told how the lamb had been with her daughter when she was in the NICU. Not only that, the lamb had comforted her nephew in the ICU too. This lamb has helped three kids who left the ICU, so I can't let go this special stuffed animal either.

We picked up these two friends during Jaycee's Make-A-Wish trip to Florida. These were gifts to Jaycee while we stayed at Give Kids the World Village. That trip was absolutely amazing!! Mickey represents the Disney portion of our trip while the bunny (Mayor Clayton) reminds me of the village. I have many, many keepsakes from that trip two years ago, and I suspect that these will be around for awhile.

Meet dog and cat. When Jaycee was in the ICU once, she looked really sad. There was absolutely nothing for her to do but lay in bed and watch movies. Since we left for the hospital in a hurry due to her illness, I did not pack anything for her to cuddle. Off I went to the hospital gift shop to buy an animal for her to hug on while in bed. I picked up the cat, since we had cats at home that she loved. Jaycee's grandma Diana came in to visit bringing the dog. I told Jaycee she would have to keep the dog and cat from fighting and pretended to make them fight. Over the next few days, she would have the cat and dog fight each other in her hospital bed. It was super sweet to see her repeat this action. These two fighting animals are still around causing trouble.

I am guessing that I have provided adequate evidence as to why my odd emotional attachment to certain stuffed animals exists. These are just a sampling. Sadly, there are more in our home that have a story or memory tied to them. So, I keep filling drawers, toy boxes, and shelves with these treasures as they represent challenges she has overcome, people who have showed her love, or moments that brought joy. Who knew stuffed animals could do so much?
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Thursday, March 2, 2017

Therapy Tip: 5 St. Patty's Day Language Ideas

Today is therapy Thursday! This is the day that I share a tip based upon my experience as a speech-language pathologist and a mother of a child with special needs. Today's tip is:

5 Language Ideas for St. Patrick's Day

Holidays give opportunities to focus in on language skills in new ways. St. Patrick's Day here in America is celebrated with children by decorations of leprechauns and clovers while wearing green.

Photo By jpmpinmontreal [CC BY 2.0 (], via Wikimedia Commons

With this in mind, here are 5 simple language activities for toddler and pre-school aged children.

1. Green/Not Green: Gather a variety of objects that are green in color. Choose a few things that are not green as well. Sort through the items in a game of green/not green to reinforce colors. I like to have two containers marked so that the children can see what they are sorting. This activity is great for a group of small children too. I like to go to dollar stores to look for inexpensive green items in the holiday section to find some unique things for the children. Here's some things I have used for my green items: play food lettuce, a cup, necklace, bow tie, toy car, toy train, socks, and fake leaves from a flower.

2. Move the Shamrock: This activity works on following directions. Again, this can be used in individual or group therapy sessions. Print off some green shamrocks and get them ready to go for this activity. For this, you will give directions with the shamrocks ranging from easy to hard depending on the child's ability. Examples of directions are: Put the shamrock on top of your head. Find a book, and put the shamrock inside it. Trade shamrocks with a friend and then sit down.

3. Guess What's Green: In this activity for older pre-school children, find some green objects that you will keep hidden from the child (or class). Choose one object to give a couple of clues about to the child to see if they can guess the hidden item. For instance, if it is broccoli, then you can say it is a food, and it is a vegetable. If they guess it, you can reveal the object to the child. This works on attributes, naming, and categories. If the child is working on questions, you can have them ask questions in order to figure out what the mystery object is.

4.  Green Collage: Gather up all your green crafting materials and make a poster collage of green items. You can gather green markers, crayons, and colored pencils for the child to make drawings with. Other items that the child can glue or tape on to the paper/poster board are: green streamers cut up in small strips, green feathers, green pipe cleaners, green construction paper cut up into different shapes, green stickers, etc. While creating the collage, you can target phrases "green feather." You can also target adjectives as you talk about big feathers, little feathers, bumpy streamers, and soft pipe cleaners. This is a good way to get rid of odd craft items you have laying around.

5.  Shamrock Sizes: Print off green shamrocks (or leprechauns) of various sizes. Depending on the child's skill level you can target big/little, small/medium/large, big/bigger/biggest during this activity. You can use containers to place the shamrocks in while sorting through the sizes.

Have fun getting ready to build language for this holiday!

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