The Therapy Vault

Let Us Eat!

Boy and girl eating healthy snacksMealtimes 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.

Family meat sauce together

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

Feet Are Neat!

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!  

Makenzie Sledd

Sensing Your Senses

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



Building Blocks for Life: How to Build Confidence in Your Child in an Ever-Changing World

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