1.  Before going to a loud place (sporting events in gyms, auto races, loud, echoey places with poor acoustics, musical or theatrical events, movies, etc) do some type of “heavy work” activity-pushing, pulling heavy objects, working muscles and joints against resistance.  Do some more when you get to your location.

2.  If your child can manage it, chew gum.

3.  Chew on straws or a “chewy tube” or a bandana rolled up and tied around the neck.

4.  “Necklaces” that can be chewed on are available from many therapy supply companies.

5.  Increase the amount of chewy and crunchy foods in your child’s diet.

6.  Eat a chewy or crunchy food at the event or just prior to going into that environment.

7.  Drink something through a straw top.

8.  Wear headphones with favorite calming music or no music at all.

9.  Soft wax ear plugs are available for children in most drug stores.  If your child will tolerate these, they can help to muffle the sounds.

10.  Wear a snug fitting baseball cap or a knit cap.

11.  In a loud, busy environment, provide your child with a calm, quiet place he can retreat to when he becomes overstimulated or has trouble calming down.  Often an enclosed tent or “fort” is helpful for this at home.  Many of these types of structures can be purchased at toy stores, Walmart, Target, etc.

12.  When you see your child begin to get disorganized in this type of environment, try to engage him in some type of “heavy work” activity (animal walks, pushing/pulling on mats or other furniture/heavy objects, wall or floor push ups, etc) and see if this helps him to stay calm and organized.

If you see your child covering his ears or screaming and crying at loud sounds or noises, try some of these strategies and see if it helps!  If you have strategies you’ve discovered, please share them!  I would love to learn more!

School can be difficult when the expectation in many cases is that the child must be able to sit for longer periods of time and pay attention.  Incorporating some of these activities during the school day may be enough to make a difference.  Ask teachers and other caregivers to give them a try and see what results.

1.  Hold the door open for classmates and others.

2.  Stack the chairs at the end of the day.  Unstack them in the morning.

3.  Clean whiteboards or chalkboards.  Clean desk and tabletops.

4.  Help the gym teacher, if there is one, get the mats and move them into place.

5.  Carry books to the library.

6.  Climb on playground equipment.

7.  Sharpen pencils using a manual sharpener.

8.  Do chair push ups.

9.  In the grocery store, push a kid-sized cart filled with some heavy items.

10.  Help get items off lower shelves and carry to cart.

11.  Do animal walks like bear walks or crab walks to transition between “centers” or other activities.

12.  Wear a backpack with some books in it to give it some weight.

Try some of these and let me know what you notice, if anything.  This is just a small sampling of ideas for “heavy work” at school.  What activities do you already use that work for your child?  These ideas come from a variety of sources but most especially from an excellent Advance for OT article titled “All Work and Some Play:  Working the Muscles Helps Regulate the Brain” by Elizabeth Haber-Lopez, MS, OTR/L and Deanna Iris Sava, MS, OTR/L.

1.  Play “Row, row, row your boat”.  Both you and your child or two children both sit on the floor and push and pull each other using your arms.

2.  Pull a heavy trash can or laundry basket.  Pushing it is good too!

3.  Do household chores like vacuuming, sweeping, mopping, dusting, wiping off the table after meals, helping change the sheets on the bed and throwing the linens down the stairs to the laundry room.

4.  Carry heavier items like milk when bringing in the groceries and other weighted objects.

5.  Fill a pillow case with several stuffed animals for the weight.  Let your child drag or pull it around the house, lift it, push it, etc.

6.  Use the sofa cushions on the floor to jump on, crawl under or over, squash your child in between two of them to make a “hamburger” or “hot dog” or “burrito”.

7.  Do yard work like digging, raking, pushing or pulling a wagon or wheelbarrow.

8.  Have pillow fights.

9.  Carry heavy pillows or cushions or even towels.

10.  Push the chairs under the table after meals.

11.  Fill up large toy trucks with blocks, books, other heavy objects and push them around the room.

12.  Drink thick liquids through a straw.

Please come back next week and learn more naturally occurring heavy work activities at school!

** These ideas are adapted from a variety of sources but especially from an excellent article by Deanna Iris Sava and Elizabeth Haber-Lopez titled “All Work and Some Play:  Working the Muscles Helps Regulate the Brain” published in Advance for OT.

Proprioceptive input comes from our muscles and joints and as we move against resistance, a message is sent to the brain that helps us understand where our body is in space, where we are in relation to other people and objects, and how our body parts all fit together or our body scheme.  This is all important to body awareness and our ability to motor plan movements like cutting with scissors, writing our name, brushing our teeth or hair, and getting dressed every day.

If our brains have trouble and do not process proprioceptive input adequately and appropriately we might have trouble and play too rough with toys and other people.  We might frequently “crash and bump” into other people and objects like furniture or walls.  We might appear clumsy or fall down often.  And we might appear to enjoy it!  We might have difficulty understanding about “personal space”.  We could also appear to dislike this type of input and avoid these activities by retreating to a small, quiet space.

Proprioceptive input is sometimes called “the great modulator” because it often has a very calming and organizing effect on the brain and nervous system.  Think about when you get a massage.  All that deep touch pressure, which is providing proprioceptive input, is so so calming and relaxing!  Same impact on our children when they engage in activities that provide them with significant proprioceptive input!  If you are ever uncertain about what type of input your child needs at a particular moment in time, try proprioceptive input.  Watch and monitor to see what impact it has.  Does it calm and organize your child?  Or the opposite?

Now that you have a better understanding of just what “heavy work” is, please come back next week for a list of “heavy work” activities that naturally occur at home!

“Body tools” include “heavy work” to muscles and joints.  “Heavy work”, also called proprioceptive input, includes any kind of activity where your child’s muscles and joints are working against resistance.  This type of input has an organizing and calming impact on the brain and nervous system and may be just the extra sensory input your child needs to give up that passy!  Here are a few fun “heavy work” activities for you to try at home that don’t require any special equipment other than a little imagination!

*  Animal walks-anytime your child bears his or her body weight on their hands and arms, it provides “heavy work” input.  Walking like bears, crabs, cats, dogs, spiders, and elephants all require your child to get in a crawling position where they bear the weight of their body on their hands and arms.  This provides “heavy work” input and can have a positive impact on how calm, organized, and focused your child can be.  And if they use the pacifier for soothing and calming, then adding in more “heavy work” may have a significant impact on giving it up!

*  Crawl up the wall-have your child position themselves so their back is facing a wall.  Have them bend over and put hands on the floor and “walk” their legs up the wall, into a handstand position with their legs propped against the wall.  This puts a significant proportion of their body weight over their hands and arms and provides a great deal of input.  Supervise your child and be sure the area is clear of hazards and obstacles.

*  Pushing and pulling heavy objects-load up the wagon or laundry basket and have your child help push or pull.  Got a big cardboard box?  Load it up with some books or toys and let your child push it around the house.  Pushing or pulling it on a carpeted surface adds even more resistance to the activity.  Take turns letting brother or sister “ride” in the box while being pushed.  Carrying groceries in from the car is another great way to get “heavy work” input.

*  Jumping, stomping, marching or hopping activities-use these during games like “Simon Says”, “Follow the Leader”, or as part of an obstacle course to provide a big jolt of “heavy work”!

*  Completing household chores-vacuuming, cleaning windows, washing the car, sweeping, mopping, and dusting all provide great ways to get “heavy work” input and allow your child to help out around the house.

*  Pillow fights-another great, fun way to get lots of input!

Just a few ideas and by no means an all-inclusive list!  Use your imagination to find creative, play-based ways for your child to get some additional, intense “heavy work” input that will hopefully help them to give up that passy without a fight!  Good luck!

Please check back the week of January 23rd for my next article!  And remember, your feedback is always welcome!

1.  Provide alternative “mouth tools” for your child.  Chewing on a straw, using a chewy tube, or if your child can manage it, chewing a piece of gum can serve as alternatives to the pacifier.

2.  Increase the amount of chewy and crunchy foods your child is getting in his diet.  Incorporating chewy and crunchy foods at meals and snacks is a natural way to provide more oral sensory input without having to add much to do in your day.  This will help increase the amount of sensory input to your child’s mouth and may serve to help quell the need to use the pacifier.

3.  Try adding some flavor to the foods your child eats.  He may prefer bolder, spicier, or sour flavors to help “wake up” his mouth with sensory input.  Experiment with ketchup, hot sauce, salsa, lemons/limes, etc and see how your child responds.  You can also vary the temperature of foods.  Cold foods are generally more alerting and warm foods more calming.

4.  Use straws to suck thicker liquids like pudding, jello, yogurt, applesauce, smoothies, and milk shakes.  Start off with wide straws like you can find at most fast food restaurants.  Cut them in half and then use them for meals and snacks.  This resistive sucking provides calming input that can help your child stay organized without using the pacifier to do so.  It also serves the dual purpose of strengthening the muscles around the mouth that we use for speech.

5.  Try using a vibrating toothbrush.  There are many inexpensive kid-sized versions with characters like Sponge Bob, Cars, and others.  Experiment with toothpaste flavors.  Your child might really like using a bolder flavor like peppermint or cinnamon.  A bland flavor at bedtime might also be helpful.  Be sure to use kid-friendly versions just in case your child swallows any toothpaste when brushing.  This can be another tool to provide intense oral sensory input that again, may help your child give up his passy.

Check back next week for more tips on giving up the pacifier that you may never have considered!!!!  I would love to hear your comments and suggestions for strategies you may have used to help your child give it up!

Toys for Babies:  Rattles; plush toys with appendages that crinkle, make noise, and/or squeak; teethers; stuffed animals of different textures; mobiles and bedside lights that project slowly moving colors and shapes on the wall and ceiling

Toys for Toddlers:  Pounding benches; stacking/building blocks; busy boxes; simple puzzles; large pop beads; shape sorters; large peg boards; balls; picture books; bathtub toys for pouring and sticking on the tub wall

Toys for Preschoolers:  Puppets; dress up clothes; farm and community play sets; simple construction toys; books; puzzles; craft items/sets; crayons; paints; drawing paper; easels; dolls; stuffed animals; balls; musical instruments

Sensory Play:  Fingerpaint, Floam, Playdough, clay, putty, Moon Sand, sandbox and sandbox toys for digging, scooping, pouring, building castles and forts

Gross Motor Toys:  Spring rocking horses; ride-on toys; tricycle; bicycle with training wheels; mini trampoline with handle; movement games like “Hullaballoo”

Games:  Card games like “Old Maid”, “Go Fish”, or “Slap Jack”; board games like “Candy Land”, “Balloon Lagoon”, “Don’t Break the Ice” and “What’s in Ned’s Head?”; more competitive board games like “Connect Four”, “Battleship”, “Jenga”, “Operation”, and “Trouble”

Just a few suggestions to make your holiday shopping easier!  Check back in January for my next article on strategies for giving up the pacifier.  Happy Holidays!

*  Adapted from “A Season of Giving:  Choosing Toys to Fit Needs” by Michelle Tobias and Ilene Goldkopf in the November 7, 2011 issue of Advance for Occupational Therapy Practitioners  and other sources

Playing is how children learn…about themselves, about others, about the properties (texture, hardness or softness, weight) of objects, how to use those objects in play or as tools, and how to move and organize their bodies for play.  It’s important to consider what your child’s interests are, and very important, developmentally where they are in terms of fine motor, visual motor, cognitive, and language skills.  Your 5-year-old may really be more like a 3 1/2 year old so keep that in mind and use the ages listed on toys and games to guide your choices.

Safety and durability are other factors to check with a toy or game.  Can it be easily cleaned?  Is it washable?  If it is a game with small parts it may be a safety hazard for a younger child or a child who puts everything in their mouth.  Look for toys that have a variety of sensory properties.  Toys that offer unlimited possibilities for play allow your child to be creative.  Toys that are easy to carry or transport make play in a variety of locations possible.

Look at the position in which the toy can be played with…does it offer many positioning options during play.  Can your child sit, stand, lay on their tummy, etc to play with the toy?  Determine what fine motor and manipulation skills are needed to operate the toy or game.  Do you use both hands to play with it?  Does it offer opportunities to manipulate small parts?  Does it have gears or wheels or knobs?  These types of toys offer opportunities for children to use their hands and fingers to strengthen all the small muscles in the hands, fine motor planning, and coordination for writing, dressing, using utensils for eating, etc.

Other things to consider when purchasing toys are does the toy offer opportunities for the child to move their body, does it require problem solving and thinking skills, and does the toy promote play and interaction with others?  Additionally, the toy should be appealing and worth the cost.

I hope this helps you narrow your search for toys for your child.  Check back later this week for more specifics on choosing toys!

* Adapted from AOTA’s TIPs for Living Life To Its Fullest  How to Pick a Toy:  Checklist for Toy Shopping

Tubular Knit Resistive Fabric Tunnel-You can find this in most fabric stores and it is much less expensive than if you purchase one from a therapy catalog company.  It is knit fabric that is knit as a tube so there are no seams holding it together.  It makes a great, stretchy, resistive tunnel that your child can crawl through on hands and knees.  It provides not only tactile (touch) input, but also proprioceptive (“heavy work”) input as your child works his muscles and joints against the resistance of the fabric to try to move through the tunnel, which also provides some vestibular (movement) input.

IKEA Ekorre Swing-A great, sturdy, and inexpensive swing that is also a chair.  Can be mounted into a stud in the ceiling.  Mount it in the ceiling away from walls so that your child can get a full wide open space in which to move the swing.  You can purchase hooks that swivel at hardware stores and then your child will be able to spin the swing.  This is available in IKEA stores and online from places like Amazon.com.

BUSA tunnel-Another IKEA favorite, this tunnel is an open tunnel and does not provide the resistance that the knit tunnel offers; however, this can be used for games, obstacle courses, forts, etc during play where your child crawls through the tunnel.  Many places sell these.  IKEA’s is sturdy and affordable.

Trampoline-No I haven’t lost my mind!  If your child is permitted to jump on the bed or better yet, on a mattress on the floor then you really do not need a trampoline!  If you really want your child to get a lot of proprioceptive  and vestibular input and hesitate to use a mattress, then a trampoline can provide those things for you.  There are many affordable versions available widely online and in stores (IKEA does not have one!).  The versions with handles that the child can hold onto and jump safely are nice.

Ball-A Yoga or Pilates ball that you may already have in your home works well.  Your child, with your help, can roll his tummy over the ball and weightbear on his hands when they are flat on the floor.  He can lay on his tummy on the floor and you can roll the ball over him like a “steamroller” providing some deep pressure and calming input as you go.  These are widely available at Target, Walmart, etc.

Beanbag chair-Another great tool for providing deep pressure and proprioceptive input!  Whether sitting in one to complete quiet, focused activities or being squished underneath one or crawling over one like it’s a mountain, beanbag chairs provide an affordable variety of things you can do with them.

Large plastic container with a lid-Fill the container with dried pinto beans, dried macaroni or other pasta, rice, styrofoam packing peanuts, shredded  paper or Easter grass, and/or water and play in it with your child.  You can hide and find objects hidden in whatever you have inside the box.  Some smaller children even enjoy sitting their entire body in the box in the tactile medium that’s inside the box!

The best way to use these are to have a room that can be set up and maintained as a sensory room.  This way you can set it up for safety as well as so that your child can be more independent in completion of sensory integrative activities throughout his day!  However, if you don’t have the space or extra room to designate, it’s OK to set it up as you need it!  If you have other ideas that you have seen or been able to incorporate into your own home, please let me know about them!!!  I am always on the look out for new and creative ways to make sensory motor activities available at home!

Coming next week….more holiday toy information!

It can take multiple exposures to a new food before a typical child will try it so don’t give up on your child, even if he has sensory difficulties.  Listed below are just a very few tips to teach your child what to do with foods he does not want on his plate and with foods that he tries but does not want to swallow.  Empowering your child with strategies that help him deal with food in case he is not able to tolerate it is extremely beneficial in helping him willingly try new foods. Remember to keep it fun!  Playing with your food is good!

Start working on these strategies before a big family gathering so that your child is hopefully better able to tolerate the celebratory meal as well as daily mealtimes.

• Remember, there is more to eating than just putting the food in your mouth.
• Before sitting down to eat, do a sensory motor activity including movement and “heavy work”.  Can you visit a playground or park?  Is there an indoor play area you can visit just before meal time?  Or create an indoor obstacle course in your living room or playroom.

• If putting on a bib is a battle, don’t do it!  You want a calm child when it is time to eat, not a fussy, angry, adrenaline-pumped child who is no longer hungry once the battle is over…let him get messy.  Get a T-shirt large enough to slip over whatever he is wearing.  This can be his bib and is easily removed and washed when all done.  Let him go shirt-less during meal time and do water play or bath time afterwards.
• Provide a wet washcloth, a paper or cloth napkin, or a paper towel for your child.  Teach him how to use it to wipe his hands.  Teach him how to place it on his lap or the back of his chair.  If his hands get messy while eating and he has difficulty handling it, remind him about using his washcloth, napkin, paper towel for hand wiping and where he can locate it (back of chair, on lap).  Do this for every meal and snack.
• If you have a very young child who resists hand washing or wiping, let him get messy and then do water play activities in the kitchen sink after a meal to wash off.

• Work on tolerating new foods on the plate.  Teach your child how to cover an unwanted food item on the plate by using a napkin or paper towel.
• If unable to tolerate covered food on the plate, teach your child how to touch the food using his fingers or a utensil, if able, and move it to a different bowl, plate, or cup.  If necessary, teach your child how to cover that up.
• Teach your child how to spit out a bite of food into a napkin (different from his hand wiping napkin) if he is not able to swallow it or does not like it or…

• Provide a “spit cup” or bowl for your child to use to spit bites into when not able to swallow them.
• Food smells might be bothersome to your child.  Use an empty mineral makeup container with the little plastic “sifter” type top to create an aromatherapy canister with a scent that is pleasant or calming for your child.  Dip a cotton ball into essential oils or scented extracts and place inside the container covered by the sifter top.  Keep the top screwed on until you need for your child to smell it in order to tolerate the noxious smell.  Calming scents include lavender, vanilla, and chamomile.  Peppermint and citrus can be alerting.
• Provide your child with familiar favorites along with 1 or 2 new foods.  Don’t pressure your child to take a bite.  At a large family gathering, playing with food is probably not something you want your child to do.  At home however, remember that playing with your food is important to learning about and tolerating a variety of foods.

Many of these suggestions are from Kay Toomey’s SOS Approach to Feeding and are meant to be used in conjunction with the SOS feeding approach administered by a trained therapist.  Work with your trained OT or ST to try some of them out!  Remember; don’t give up if you don’t have success the first time.  Multiple exposures paired with positive eating experiences (i.e. no pressure from Mom or Dad to eat a particular food) will help your child be able to better tolerate new foods.  Remember, for some kids just tolerating a food in the same room is success!  Happy Thanksgiving!