The Therapy Vault
Thanksgiving for Picky Eaters
For many people, Thanksgiving is a time for families to come together, focus on what they are thankful for, and eat some amazing food. However, for children with food aversions, Thanksgiving dinner can be challenging.
Aversions to foods are sometimes sensory-related. Sometimes, picky eating reflects oral hypersensitivity. Oral hypersensitivity is a heightened sensitivity to sensory input within the mouth. For example, the textures of certain foods, their temperature, the amount of food in the mouth at any given time, and certain tastes are all related to oral hypersensitivity. If children display oral hypersensitivity, they may also have increased sensitivity to other senses, such as touch (tactile) or sound (auditory) input. If children display tactile hypersensitivity, they may not want to touch food with their hands. Similarly, when children display auditory hypersensitivity, they may become easily distressed by the sound of chewing. Ultimately, when children are hypersensitive, they often avoid eating foods that cause them negative feeding experiences.
While picky eating may sometimes require feeding therapy, there are a few tips and tricks you can use at Thanksgiving Dinner to help make eating a more pleasurable experience for your child and the whole family.
- Provide different food options, both preferred and non-preferred foods. Do not force your child to finish any of their foods.
- Praise your child when they place non-preferred foods in his/her mouth. For example, you can say, “Good job trying the cranberry sauce!” DO NOT provide a reward (e.g., giving a piece of candy for trying the cranberry sauce).
- Ensure your child is positioned appropriately – feet flat on the floor, everything within reach, table surface at waist level.
- If your child refuses to eat any food, allow your child an opportunity to play with their food. For example, Simon Says (“Simon says place food on your nose”), use a paintbrush and “paint” with mashed potatoes and gravy, build a tower made out of turkey, or create a basketball hoop on a paper plate and spit peas into the basketball hoop.
- Model trying different foods in front of your child and express how much you enjoy the food.
- Verbally offer your child choices. For example, “Do you prefer corn or green beans?
While these tips work for some children, they will not work for everyone. Remember to be patient with your children. Usually, there is a reason that they do not want to eat certain foods. Forcing them to eat non-preferred foods usually only worsens their aversion to the food.
On behalf of the Washington University Neurofibromatosis Center, we wish you and your family a happy Thanksgiving.
-Madeline Scherr, MS, OTR/L
Last month, we discussed proprioception, the “sixth” sense. This month, I want to address another sensory system not often talked about, the vestibular system. The vestibular system is responsible for providing us with a sense of balance and movement. This system receives input from head movements, such as turning your head side to side, looking up or down, or rotating your head in a circular motion.
Photo from iStock
The vestibular system has an important role in the development of postural control, muscle tone, bilateral coordination, and stabilizing an object in your visual field while you are moving (e.g., signs on a highway remaining still while you are driving past them). Additionally, when this sense is not regulated, difficulties with attention, behavior, and communication can occur.
Certain movements may excite or inhibit the vestibular system. Fast, rotary (spinning), jerky movements are excitatory to this system and can help children become more alert. Examples include a “Sit and Spin”, running in circles, and jumping on a trampoline. In contrast, slow, linear (straight) movements are inhibitory to this system and usually make children feel calm. Examples include swinging, going on car rides, a rocking horse/chair, and sliding down a slide.
As an occupational therapist, “excitatory” activities are performed when a child demonstrates low sensory registration. Children may present as “daydreaming” or having extensive difficulty beginning a task, whereas “inhibitory” activities are performed when a child has difficulty sitting still.
While all of these activities serve a purpose to alert or inhibit the vestibular system, it is important to use caution and perform under the guidance of a trained medical professional. Too much excitatory input (fast, rotary) can actually cause adverse reactions, such as dizziness, vomiting, incontinence, fatigue, or headaches.
For more information on the vestibular system, please follow the links below.
Stay tuned to continue learning more about our sensory systems.
-Madeline Scherr, MS, OTR/L
If you follow the Washington University Neurofibromatosis (NF) Center on Instagram or Facebook, you know that we have briefly discussed “sensory processing” and the eight affiliated sensory systems. Since this is a complicated topic, I want to provide you with a little more detail.
Sensory processing is our ability to organize and interpret sensory information we receive from the environment. Most people are aware of the five sensory systems – gustatory (taste), auditory (hearing), visual (sight), tactile (touch), and olfactory (smell). However, there are three additional systems that are equally important. These three include proprioception (body position in space), vestibular (balance), and interoception (perception of sensations from within the body).
As a clinician, I often see some children have difficulty processing proprioceptive input. Proprioception provides us information about where our body is in space, without relying on vision. The receptors for this sensation are in our muscles, skin, and joints. This sensory system gives us the ability to maintain posture, walk without bumping into objects or falling, and regulate our body position.
Difficulty processing proprioceptive information may cause children to accidentally bump into people or objects, struggle to attend to tasks at hand or sit still, play too rough with others, constantly move around, jump or crash into furniture, hold objects with excessive pressure (e.g., writing with heavy pressure), and/or appear uncoordinated or clumsy.
What can you do to help your child with proprioception?
Well, one way to help your child regulate his/her proprioceptive sensory system is through a “sensory diet.” A sensory diet is an individualized plan that provides sensory input, as needed, to meet the child’s needs. Below are some of my favorite activities to incorporate into a sensory diet.
- Deep pressure (e.g., bear hugs)
- Animal walks (e.g., crab walk, army and bear crawl)
- Wall push-ups
- Jumping jacks
- Trampoline jumping
- Carrying heavy items (e.g., backpack, a load of laundry, groceries)
- Helping with household chores (e.g., mopping, vacuuming)
- Eating crunchy or chewy foods
Stay tuned for future blogs about this topic.
-Madeline Scherr, MS, OTR/L
- Proske, U., & Gandevia, S. (2012). The proprioceptive senses: Their roles in signaling body shape, body position and movement, and muscle force. Physiological Reviews, 92(4), 1651-1697. https://doi.org/10.1152/physrev.00048.2011
I know the topic of “school” is not what everyone wants to discuss, as it can be exhausting and occasionally boring. In addition, academics can be extremely challenging for some children, especially for those who struggle with paying attention in class, difficulty sitting still, spelling, completing tests on time, and learning to read.
But, what if it didn’t have to be this difficult? What if there was a way to help your children overcome those academic difficulties?
Actually, THERE IS!
The Federal government has mandated public school systems have a program in place to assist children with academic challenges. This program, known as the Individualized Education Program (IEP), stems from the Individuals with Disabilities Act (IDEA). Under this Act, you, as a parent, have the right to ask your child’s school for a FREE evaluation to determine if additional educational assistance is needed. Notice that the term, “public school system” is emphasized. This is because private schools do not receive state funding. Therefore, they are not required by law to assess and provide students with additional educational assistance.
An IEP is an Individualized Education Program for students who need additional educational assistance beyond what is provided in the classroom. This legal document determines goals for your child’s academic success, assesses your child’s needs in school, and outlines how often your child should get assistance. A few examples of the types of assistance an IEP can provide include speech and language therapy, occupational therapy, physical therapy, extended time on test taking, an isolated environment for test taking, and adapting the way instructions are provided.
To qualify for an IEP, your child needs to fall into the following two categories: (1) additional academic support to succeed in school is necessary and (2) have at least one of the qualifying diagnoses. Diagnoses that usually warrant an IEP include autism, speech and language impairments, blindness or deafness, emotional disturbances (e.g., anxiety, depression, bipolar disorder), vision impairments, orthopedic impairments, and other health impairments (e.g., ADHD).
Occasionally, schools will complete the evaluation for a child and find that an IEP is not needed. This does not mean that the school is “bad.” Sometimes, it just means that further testing or diagnoses are needed. If this is the case, you, as a parent, have the right to challenge the school’s decision – this is known as “due process.” There are numerous IEP advocates that can help you navigate this process to obtain the academic assistance your child deserves! In the “Resources” section, I list a few examples of some advocates, which vary by state.
Unfortunately, even challenging the evaluation does not always result in an IEP. But don’t fear! Luckily, we live in a country that offers what I like to call, “a back-up plan” when an IEP falls through. This alternative option is known as a 504 Plan, and falls under Section 504 of the Federal Rehabilitation Act of 1973. A 504 Plan is not as detailed as an IEP, but can provide additional support for children while at school. This support may include additional time on tests, reduced homework, and preferential seating.
To qualify for a 504 Plan, you must fall into the following three categories: (1) your child must have a physical or mental impairment that impacts one or more major life areas, (2) have record of the impairment (e.g., diagnosis or medical note indicating physical/mental impairment), and (3) be regarded as having the impairment.
I know this was a TON of information, and I don’t mean to overwhelm you. There is so much that goes into an IEP and a 504 Plan that I may add in a later post. In the meantime, please search the references and resources below for more information.
-Maddy Scherr, MS, OTR/L
We all remember summer break as children, right? Often filled with outdoor play, vacations, sleeping in, and the obvious, no school. While summertime is great, it can also result in the summer slide. The summer slide is the tendency for children to lose some of the educational and developmental achievements they had made throughout the previous year. This often occurs due to the shift in routines and decreased levels of engagement (e.g., reading, writing, physical education, etc.).
The best way to prevent the summer slide is to engage your children in structured activities. Below are eight of my favorite activities to help your children stay on target with their developmental milestones.
Easily adaptable for all abilities and ages, obstacle courses are my number one go-to activity when working on developmental skills with children. They help with balance, motor coordination, executive functioning, attention, and sensory needs.
Indoor Obstacle Course Ideas for Kids
Obstacle Course Party
2. Scavenger Hunt or Treasure Hunt
Both of these activities can help with executive functioning skills, like planning, organizing, and cognitive flexibility, as well as visual motor integration and gross motor coordination. You can also modify a treasure hunt to include a gross motor movement before providing the next clue. For example, you can have your child perform 10 jumping jacks before moving on to the next clue.
5 photo scavenger hunt ideas for kids
Treasure Hunt Clues for Kids
3. Sensory Bins
In terms of therapy, sensory bins provide tactile (“sense of touch”) input. In addition, you can also place various small items in the bin and have your child verbally identify each item with his/her eyes closed. This works on stereognosis – the ability to mentally perceive and recognize a 3D objects without visual or auditory assistance. Sensory bins can be easily assembled in a matter of minutes and are inexpensive (many items can be found at your local Dollar Tree).
Bubble Trucks Sensory Activity
Summer Sensory Bins
4. Sidewalk Chalk Direction Following
Want to get some sun? Direction following using sidewalk chalk is simple and extremely effective for improving attention, motor coordination, balance, and postural control.
5. Spray Bottle Painting
One of the simplest ways to improve your child’s hand strength is by painting with a spray bottle. You can make this more challenging by drawing targets on a board and having your child aim for certain target areas to work on eye-hand coordination.
Summertime Spray Art Activity
Painting with Water Guns: Target Practice!
6. Bean Bag Balance
Do you have Corn Hole at home? Well, those bean bags just became useful for an alternative activity for your child! You can use this as a balance and motor planning activity while your child watches television. You can even turn it into a game with other siblings (e.g., who can get the most bean bags into a basket).
Bean Bag Balance Game
7. Gross Motor Spider Web
All you need for this activity is tape and streamers. You place streamers from wall to wall throughout your hallway, ultimately creating a spider web. While this works best in a hallway, you could certainly create a design in any room of your house. Your child will have to maneuver around the web, which helps with executive functioning (sequencing and planning), motor coordination, and balance.
Lair of the Spider Queen
8. Balloon Tennis
This modified version of tennis is always a big hit with children. To begin, you could either grab some paper plates and popsicles sticks, or use a fly swatter to serve as a racket. If you use paper plates, you create an additional fine motor task for your child by having him/her design the racket. Next, blow up a balloon. I think you know what comes next! Your child and a partner can pass the balloon back and forth using the “racket” and count how many times they were able to keep the balloon from touching the ground. This game addresses eye-hand coordination, visual skills, motor coordination, and body awareness.
Balloon Tennis – Fun & Easy Activity for All Ages
-Madeline Scherr, MS, OTR/L
Mealtimes in any household with children can be challenging. Trying to get the right food on the table, at the right time, while balancing tired and hungry kiddos can turn into total chaos very quickly. Factor in a child who is picky about what or how they eat and all bets are off. Get whatever you can in front of them as quickly as possible and then move on with your day, right? Below are some tips and suggestions for a busy family with a picky eater.
Engaging your child as part of the mealtime process can benefit your child and family in many ways. Even starting with meal planning. At the beginning of your week, you can have an open discussion with your children about the foods that they like (and do not like), and let them help decide what meals should be served during the week. In this way, they are prepared for what will be on the table and feel included in the process. Including them in this planning process additionally helps them feel that their opinions are heard, and gives them the opportunity to have some power over the situation. Working together, you can help your child learn what healthy meals look like.
Next step – the dreaded grocery shopping. Whether you are going to the store in person, or ordering grocery delivery, this is another great opportunity to include your child. Giving them a list of foods to look for or remember helps them with memory and recall skills. Did we forget the broccoli or is it already in the cart? Did we need one can of soup or two? These skills are important to reinforce in children with NF1. You can even offer them rewards, like picking a favorite treat when all of the groceries are in the cart.
Finally, it’s dinner time…let the games begin! Planning your dinners in advance can definitely relieve some of the stress of meal times. Knowing what you are going to prepare ahead of time ensures that you have the ingredients on hand. Pull the recipe out and hand it over, let your child hunt for rice in the pantry. They can work on their visuospatial skills by scanning the shelves and crossing things off the list. Cooking requires a certain amount of planning and direction in order to be successful. Starting with simple meals and a lot of supervision, allow your child to be the “Master Chef” and you the “Sous Chef”. They will get to practice many of their executive function skills, such as recalling what the last step was and planning for what the next step should be. With close supervision, it is also beneficial for them to help with cutting and mixing ingredients. They can help pull apart herbs, crush up breadcrumbs, or stir the pasta in order to work on their motor skills and experience a wide range of sensory experiences. Best of all, they will be entertained while you are cooking, instead of asking, “When are we going to eat?”
Maybe, in your home, it is the actual eating of the dinner that is the most challenging. Some kids are very picky eaters. It is important to allow them repeated exposure to foods or textures that they are not comfortable with. Even if their only interaction with mashed potatoes is pushing them off the plate, they are still experiencing the textures and smells, hopefully decreasing their sensitivity to each item. Talking about what the foods look like, smell like, and feel like helps them to better understand food.
Meal times can be both the best and worst part of any family’s day. Being together and working on a project as important as providing nutrition to the whole family can foster many important life skills, as well as bring you closer to your child through conversation and quality time spent together.
Check out the Neurofibromatosis (NF) Center Facebook and Instagram pages for updates on cooking events!
-Makenzie Sledd, MPT
As a Physical Therapist, one of my least favorite topics I learned about in school involved feet and ankles. We were required to remove our shoes and socks, and allow our classmates to practice exams, take measurements, and watch us walk. What I didn’t realize at the time was how incredibly important feet are – they are literally the foundation for everything we do. And of course, no one is perfect, so many of our feet require a little help to be the foundations we need in order for us to function at our best.
There are three primary postures that we see in feet, with a wide spectrum in between. Feet can either be flat (pronated), neutral, or have high arches (supinated). Feet should move through all three of these postures while walking, but some feet have a hard time staying within a healthy range. Moving too far into either posture (from pronation to supination) can cause poor alignment of our feet, legs, and spine. Shoes can be the first line of defense in avoiding these extreme ranges. Many major brands sell versions to support flat or arched feet properly. When shoes aren’t enough, orthotics or braces can help keep feet in line. Teasing out the differences between the many varieties of orthotics and braces would take up an entire textbook. So for now, we’re just going to talk about shoes.
Most shoe stores are overwhelming. There are now many different shoe options available, and it’s hard to know where to start. First and foremost, you need to consider the specific activity the shoes are intended for. For example, are these shoes for school, a specific sport, or a more formal event? The wrong footwear for an activity can make the activity more difficult, but it can also be dangerous. Shoes for school or any outdoor activities should fasten with laces or Velcro, have rubber soles that provide traction, and have backs to prevent them from slipping off. Sandals or flip-flops are a great option for the pool but can be very dangerous on a playground or at school. Shoes for formal activities are not ideal for play or long days, as they are often hard-soled, and do not provide traction or support for the foot.
But are shoes always necessary? Going barefoot provides children with a wide variety of sensory experiences and allows them to develop the small muscles in their feet that provide internal support and balance. I encourage barefoot experiences that are selective and carefully monitored. Toddlers learning to walk need the feel of the floor in order to know how to navigate it. Barefoot or soft-soled shoes during early walking also allow the small muscles to develop into a firm foundation. As children get older, wearing a shoe with a sole on the bottom is important to protect them from injuries.
Probably the most important factor to consider when selecting a shoe for your child may be finding shoes that they will actually wear. You may select the top-of-the-line, greatest shoe on the market, but if it is difficult for your child to get on or off, uncomfortable, or not the right color, they are not likely to wear them. Allow your child to participate in selecting their own shoes by giving them a few options to choose from. Having them walk around the store in the shoes before buying them allows them to decide if they’re comfortable, as well as practicing putting them on and taking them off.
As a PT, I’ve grown to absolutely love shoes, both for style and for function. The right or wrong pair can have a huge impact on your daily life and your child’s motor skills. Please reach out to your child’s physician or therapist to have their feet evaluated for their own best function!
We all know that everybody is different. We relish in the thought because it’s part of what keeps our social world a bit more exciting and diverse. This is not groundbreaking news.
What might be novel, however, is how we look at our differences. It’s easy to look at those around you and identify how they look different, act, or speak differently. What’s not always easy to see
is the root of some of these behaviors: our sensory systems and how they play a role in our choices every day.
Then they get older, and many toddlers spend every waking moment seeking out every sensory experience they can get their hands on, from running full speed to touching things and putting it all in their mouths. This is how they learn about the world around them. Then as they gather this set of experiences, they learn quickly what they like and do not like and begin to pair down experiences to the things they enjoy. Then, very quickly, they begin to voice strong resistance to what they do not like.Preschoolers are taught to identify the five senses: sight, hearing, smell, taste, and touch (often left out is our vestibular system, which perceives movement). We do not always realize how these senses affect our lives and how drastically different every person experiences these senses. Children are born having spent roughly nine months in a sensory-deprived environment. We’re ready to accommodate this for them by swaddling them, keeping their environment quiet, etcetera.
From grade school on, children learn to avoid noxious stimuli and process their environment in a more regulated manner. This continues into adulthood: some of us prefer strong-smelling perfumes, while others avoid using fabric softener. Some of us become long-distance runners, and others take up video games. Each experience is carefully curated to provide the sensory system with precisely what it needs.
As children’s bodies grow and change, it can be difficult to distinguish exactly how to regulate their sensory systems. Each person perceives a sensory experience differently. Humans can be over-responsive to sensory stimuli, or under-responsive, or anything in between. We do not experience all types of senses in the same way either. For example, it is possible to be over-responsive to sounds but under-responsive to touch or movement. Sometimes, in children, these experiences may manifest in tantrums, anxiety, or the inability to accomplish tasks if their sensory needs are not met.
Your child’s sensory needs can often be identified by looking at how they respond to different sensory situations. For example, a child who enjoys running, jumping, swinging, and climbing, may have an under-responsive vestibular or movement system. This causes them to need more input to achieve a sense of movement. For example, they may wiggle and move without even knowing that they are doing it. Other children may appear afraid of playgrounds or scooters, or some even seem to experience motion sickness. These are often children who have over-responsive vestibular systems and can sense even the slightest movement. Children who seek out sensory experiences, no matter which sense, may have an under-responsive system. On the other hand, children who avoid specific experiences, such as getting dirty, or being in loud environments, may have an over-responsive system.
If we can identify our children’s sensory needs, we may be able to help them have better days, better sleep, and even better behavior. For example, a child who has an under-responsive tactile or touch system may need a lot of input before settling down for bed at night. They may benefit from hugs, snuggles, or a weighted blanket. Children with an under-responsive vestibular system may benefit from a few minutes on the swing before sitting down to dinner. Children who have an over-responsive sense of sound or sight may benefit from wearing headphones or sunglasses in overstimulating environments. These are just a few of many adaptations that can be worked into your child’s day to provide them with the tools they need to accomplish daily tasks with fewer distractions.
I encourage you to look at your child’s daily experiences with all your senses and talk to them about what they feel. Children will get or avoid the sensory input that they need every day. Sometimes these sensory needs may get in the way of things that we need them to accomplish. Carefully accommodating their individual needs and planning for them can help them be the best versions of themselves and help them move through their day with less stress for both of you. Please reach out to your child’s physical, occupational, or speech therapist for more information about the sensory system and your child’s own specific needs.
– Makenzie Sledd
For years, health professionals and parents have established and reiterated a narrative that participation in team sports improves psychosocial functioning, social support, self-worth, and quality of life. It has also been shown to enhance cognitive performance in a school environment. This is achieved not just with physical activity, but also through social interactions when your child collaborates with other children who share similar interests.
Participation in adaptive sports similarly improves emotional regulation and self-esteem through peer interaction and learning social skills, and also supports positive body imagery and physical health. Engaging your child in programs, on or off the field, where they can develop friendships and social skills benefits the entire family.
As adults, we naturally build relationships with friends and families who share our interests and values. They are our “safe place”, allowing and encouraging us to be comfortable and confident in ourselves. As parents, we must give our children opportunities to grow these healthy relationships with their peers. Even at a very young age, relationship building is crucial to developing self-confidence and emotional resilience. Determining what interests your child, and adapting that activity to your child can build the framework for a healthy, happy, and self-confident person. Trying to adapt a child to an exercise often leads to frustration and anxiety, but what if we adapted the exercise to our child instead?
Children do not currently have all of the social opportunities we had when we were young. Being limited to virtual meetings and events create challenges for children to feel engaged. By engaging the members of your household, I believe that we can give our children many of the benefits of team sports and social activities from the safety of our own homes.
- Board games allow children to learn turn-taking, fine motor, and visual perceptual skills.
- Creating a backyard obstacle course with simple items from around the house (towels, sidewalk chalk, empty plastic bottles, and jump ropes) encourages children to take turns, while building social and motor skills.
- Working together to see how quickly you can match all of the socks while doing laundry builds teamwork, visual perceptual skills and helps get chores done.
- Perhaps most important, if your child hears you cheering them on, it will only improve their confidence to hear how proud you are of their hard work.
Programs such as Beat NF, Club NF, and Teen NF can similarly provide your child with experiences to foster self-confidence and create a sense of community. Having that community network around you and your child can help even in the most challenging times. Even though these programs remain virtual for the immediate future, we believe that they provide your family with tools to bring confidence-building activities into your home. Our goal is to work with you and your child to find out what they need to grow into confident, healthy, and happy kids.
How to Make a Backyard Obstacle Course for Kids
– Makenzie Sledd
Sahlin KB, Lexell J. Impact of Organized Sports on Activity, Participation and Quality of Life in People with Neurological Disabilities. PM R. 2015; 7(10): 1081-1088.
Logan, K. Cuff, S. and Council on Sports Medicine and Fitness. Organized SPorts for Children, Preadolescents, and Adolescents. Pediatrics Jun 2019, 143, (6) e20190997; DOI: 10. 1542/peds.2019-0997