Oral habits: Practical strategies to get rid of them

By: Amber Fox, MS, CCC-SLP
Oral habits such as thumb or finger sucking and prolonged pacifire use can be very tricky to extinguish! Here are some helpful tips in tackling these unwanted oral habits.

  • Gather your team- make sure all caregivers are on board and following the same plan- consistency is key!
  • Start early- straw cups can be introduced as early at 6-9 months and can help transition away from bottles and sippy cups.
  • Make a firm decision and stick with it, lean on your team for support!
  • For Pacifier: eliminate gradually in the following sequence: eliminate during day/waking hours, eliminate at nap time, eliminate at bed time, gradually cut down the tips, give away pacifiers to family or friends who may be expecting.
  • For Thumbsucking or Fingersucking: Provide a toy/fidget to keep hands busy, get a special ring to wear; teach that the ring is a reminder to keep hands out of the mouth, place a sticker, bandage, or tape on the thumb/finger; wear gloves at bed time, paint nail(s), apply lotion on hands/fingers several times a day
  • For both: create a “no suck” zone, use a reward chart (positive reinforcement can go a long way), work with a speech therapist or occupational therapist to help with additional ideas
  • Source: How to Stop Thumbsucking (and Other Oral Habits): Practical Solutions for Home and Therapy, by Pam Marshalla


    Crossing Midline

    By: Erin Haugen, M/OTRL

    What does “cross midline” mean?

    Crossing midline is the act of moving our arms or legs across the midline of our body.

    Why is it important?

  • Vital to the development of using both sides of the body together
  • Facilitates coordination and communication between the left and right hemispheres of the brain
  • Develops hand dominance
  • Promotes fine motor skills and coordination
  • Encourages use of bilateral hands
  • How can I tell if my child is struggling with crossing midline?

  • Coloring with right hand when the marker is presented on their right side and vice-versa
  • Using the left hand to color on the left side of the paper and the right hand to color on the right side of the paper
  • Turning their body instead of reaching across their body
  • Difficulty performing self-care tasks (i.e. difficulty washing body, dressing, etc.)
  • Switching hands while brushing teeth
  • What can I do to help my child?
  • Present items at the child’s midline to begin to establish a dominant hand (i.e. put a marker in the middle of the paper and encourage them to color with whichever hand they initially used to pick up the marker)
  • Play in side lying or prone where one arm is needed to support the body and the other arm has to work on both sides of the body
  • Draw figure eights or rainbows on a large piece of paper
  • Throw, catch, or kick a ball
  • Spread play items out and encourage use of one hand (i.e. have puzzle board on the left side of the body and puzzle pieces on the right side of the body)
  • If challenges persist, seek an occupational therapy screen or evaluation

    Facts about a Concussion

    By: Amber Fredrickson, DPT

    What is a concussion?
    A concussion is a brain injury caused by a direct or indirect force to the head or body that changes how the brain functions.

    General symptoms:

  • Headache
  • Dizziness
  • Nausea/vomiting
  • Sleep disturbances
  • Drowsiness
  • Poor balance and coordination
  • Visual problems
  • Sensitivity to light or noise
  • Fogginess
  • Difficulty concentrating
  • Poor memory
  • Emotional changes including anxiety, irritability or depression
  • If these symptoms occur seek emergency medical assistance:

  • Persistent worsening of drowsiness or cannot be awakened
  • Persistent worsening of confusion
  • Persistent worsening headache or neck pain
  • Persistent vomiting (more than 2x)
  • Unequal pupil size
  • Seizure
  • Blurred/double vision, slurred speech, or loss of motor function
  • Change in behavior (irritability, agitation, or aggression)
  • Recovery may be prolonged by: multiple concussions, history of migraines, learning or behavioral problems, symptoms of amnesia, fogginess, dizziness, anxiety or depression

    Recovery can be assisted by: receiving appropriate therapies, drinking plenty of water, getting 8-10 hours of sleep each night, proper nutrition, wearing noise cancelling headphones and sunglasses to help reduce sound and light sensitivity

    Stages to returning to activity following a concussion:

  • STAGE 1: REST! Physical and cognitive rest with symptom-guided activity
  • STAGE 2: Preparing for school and light exercise
  • STAGE 3: Back to school with accommodations; light, individual activity
  • STAGE 4: Normal school routines with some restrictions; no-contact sports practice
  • STAGE 5: Complete return to school activities; contact sports practice
  • STAGE 6: Return to full activity level; full sports/game activity
  • Children should return to school full time without symptoms prior to returning to sports (Stages 4-6). **PROGRESS TO NEXT STAGE AS TOLERATED ONCE SYMPTOM FREE FOR 24 HOURS**

    For more information about concussions, please visit: Center of Disease Control: Heads Up


    Echolalia: The facts beyond “parrot talk”, scripting, and echoing

    By: Amber Fox, MS, CCC-SLP

    What is echolalia?

    Echolalia is the literal and rote repetition of the speech of others. In young or typically developing children, echolalia presents as imitation and can be part of typical language development from ages 18 months to 30 month of age. Echolalia and scripted language are often associated with children on the autism spectrum; however, may be present in the language of children who do not have this diagnosis. As language skills in children with autism improve, echolalia decreases, much like it does with typically developing children. We may observe echolalia immediately (repeated phrases modeled by the adult) or delayed (minutes or even days later). Echolalia can be a fascinating language difference, which can hold meaning and communicative purpose.

    Is all echolalia this same?

    No! Echolalia can present in many different ways and can communicate different functions and/or meanings for the the same individual.


    Immediate echolalia:
    This type of echolalia immediately follows another’s speech. Immediate echolalia can be interactive or non-interactive, serving a range of functions (see below).
    Delayed echolalia:
    This type of echolalia occurs at a later time and may be produced without communicative intent. Delayed echolalia will often be described as ‘scripting’. This may present as words or statements provided by the child’s communicative partners or scripted from favorite TV show.
    Mitigated echolalia:
    Mitigated echolalia echolalia occurs when the child makes a change in wording or intonation made by the original speaker. As the child’s receptive (comprehension) language skills improve, an increase in mitigated echolalia may be observed.

    Why does my child use echolalia or scripting?

    A child may use echolalia to communicate a variety of messages.
    Communicative Functions of Echolalia and examples:
    Turn taking:
    -Adult: “How was your weekend?”
    -Child: “Weekend.”

    Verbal Completion: (Completes a familiar routine initiated by an adult)
    -Adult: “What do you do first?”
    -Child: “Hang up coat.” (echoed from adults completion of routine on previous occasions)

    Declaration: (Labels using an echo)
    -Adult: What kind of ice cream do you have?
    -Child: “Ice cream.”

    “Yes” answer
    -Adult: “Do you want a cookie?”
    -Child: “ Cookie”

    -Adult: “There’s a car in the toy garage here.”
    -Child: “Car in garage.” (used with gesture toward car).

    Protest (delayed echolalia remark or prohibit other’s action)
    -Adult: “Let’s do our speech work now.”
    -Child: “Don’t you dare.” (echoing remark parent made earlier)

    Directive (Delayed echolalia used to direct other’s actions)
    -Child: Time to clean up now (echoed from teacher’s previous remark; used to tell fellow student to pick up blocks).

    -Calling (Delayed echolalia used to get attention)
    -Child: All eye up here (echoed from teacher’s use of same phrase; used to get peer to pay attention to client during play interaction).

    Provide Information (delayed echolalia used to give new information not in the immediate environment)
    -Child: “Dog’s loose again (echoed from parents’ use of same remark; used to inform teacher that something anxiety producing has happened.

    Tips for working with children who use echolalia:
  • Look at the type and communicative function the echolalia serving.
  • If the child is finding enjoyment through scripting favorite, teach places and times when scripting is more socially appropriate.
  • If the child is using scripting to calm and provide self reassurance, work to find additional calming and coping tools. Occupational Therapy can be a wonderful resource!
  • State requests in the the child’s “voice”; say “I want a cookie.” Instead of “Do you want a cookie?”
  • Make small modifications when modeling the child’s language to expand and change communicative messages. If the child repetitively requests, “Open window,” expand to, “Open my window.” or “Open the bedroom window.”
  • Embrace the communication milestones associated with echolalia; with greater understanding of this language phenomenon, wonderful communication and connections can be established!
  • Resources:
    Paul, R (2001) Language Disorders from Infancy through Adolescence Assessment & Intervention. St. Louis, MO: Mosby, Inc.


    Does your child W-sit?

    By: Laura Kendall, DPT

    Do your kids sit with their knees and feet out to the sides? Often in the shape of a W? W-sitting is commonly seen in children and is not recommended as a preferred sitting posture when playing on the floor. In fact, we suggest you have your child avoid this position.

    Children choose to W-sit for many different reasons. Ultimately, they have more mobility in their hips at a younger age. They often choose this position because it gives them a larger base of support. This means that they don’t have to use their trunk/core to stabilize their body. W-sitting often occurs when children have poor core strength.

    W-sitting prevents a child’s full physical potential while limiting the use of their core. When children are engaged in a W-sit, they are unable to fully rotate their body to reach toys located to their sides. As a result, these limitations to trunk mobility might prevent the normal development of “righting reactions” such as placing a hand on the floor to prevent falling. Sitting in this fashion often causes the muscles to become tight and can result in an “in-toed” appearance while walking. Long term W-sitting leads to poor postural control and can ultimately cause joint, back pain, and weakness into adulthood.

    What can parents do:

  • Encourage your child to sit in appropriate positions such as criss-cross sitting, side sitting, or long sitting (legs extended out straight).
  • Provide reminders for your child to change position when W-sitting occurs.
  • Encourage activities to promote core and leg strength such as playing outside, activities that requiring overhead reaching, and jumping or running games.
  • Provide reminders for your child to change position when W-sitting occurs.
  • Call for a free Physical Therapy screen to ensure that your child is demonstrating age appropriate strength and gross motor skills.

    How Physical Therapy Can Help with Toe Walking

    By: Holly Thompson, DPT

    Do you notice your child walking on their toes throughout the day? Do they prefer to be up on their toes rather than keeping their feet flat when they are standing and walking? By two years old, children typically demonstrate a heel-toe walking pattern. While toe walking may appear harmless, over time it can cause secondary complications that interfere with your child’s gross motor skills.

  • Decreased flexibility – with continued toe walking over time, the Achilles tendon (the heelcord and major tendon at the back of your ankle) can become tight, and your child may develop decreased ankle range of motion.
  • Difficulty with functional tasks – when a child has decreased ankle flexibility, it is difficult to keep their heels down for tasks including jumping, going up/down stairs, standing on one leg to put on pants, or squatting down to pick items up off the floor. This can make it challenging to participate in age-appropriate activities at school and in the community with their peers.
  • Why do some children toe walk? Every child is different and unique – the following are often contributing factors for why a child may demonstrate toe walking:

  • Sensory feedback – seeking the feedback from the ground and the bouncy feeling of being up on their toes.
  • Decreased core strength and decreased ankle stability – difficulty maintaining neutral alignment with their feet flat and seeking increased stability with their ankle extended.
  • Ankle injury – a recent injury that makes it difficult for them to walk with their feet flat and have full range of motion.

    The following are reasons you may want to seek out a Physical Therapy screening or evaluation for your child:

  • Toe walking for >50% of the time
  • Maintaining a tip-toe stance when doing standing tasks
  • Unable to mimic a heel-toe walking pattern when it is demonstrated for them
  • No initial heel contact on the ground when walking

    If your child is evaluated and qualifies for Physical Therapy, the therapist will look at what the underlying cause may be for your child’s toe walking and work with you and your child to create a custom plan of care. In Physical Therapy, we often work on the following areas:

  • Core and lower extremity strengthening
  • Range of Motion
  • Functional Mobility
  • Balance
  • Home Exercise Program
  • Orthotic and/or shoe recommendations
    If a child is demonstrating toe walking due to sensory seeking behavior, Occupational Therapy may also be helpful to address and treat sensory dysfunction.


  • Haircuts: Why they are tough for kids with sensory processing difficulties

    By: Brianna Mittelsteadt, OTR/L

    Many people find going to the salon or barber shop a treat; scalp massages, a fresh new look, lovely smelling shampoo, maybe even a sucker when you are done. There are many individuals who have the opposite experience: children and individuals with sensory processing difficulties. Let’s quick talk about what sensory processing difficulties mean.
    Sensory processing refers to how the nervous system receives sensory information and processes or interprets it through the brain. When an individual has sensory processing difficulties, this information does not get organized appropriately. In turn, we may see maladaptive responses, such as becoming overstimulated in a visually busy environment, covering their ears or running away when hearing ordinary sounds (toileting flushing, vacuum, blender, etc.), disliking touch or tactile input to various areas of the body, seeking or exerting too much pressure when engaging with toys or peers, difficulties with balance and coordination, and trouble sequencing or performing daily tasks consistently. Sensory processing difficulties in the area of touch or tactile input can significantly impact one’s ability to successfully perform self care tasks such as brushing teeth, taking a bath, trimming nails, washing face and hands, tolerating soap, eating a variety of foods and textures and…..haircuts!

    Meet Grant! Grant is a 7 year old boy who has a diagnosis of autism. Grant is not a big fan of getting haircuts! During a haircut, Grant experiences several forms of sensory defensiveness/processing difficulties. One of these difficulties includes auditory defensiveness.

    Auditory refers to sound. We can observe Grant’s defensiveness when he covers his ears. The sounds of the salon overwhelm him. In this instance, the trimmer is the culprit. He blocks out unwanted or alarming sounds by reducing the stimuli (covering his ears), but there are likely other sounds (such as the blow dryers and other people talking) that may also overwhelm him. Another sensory processing difficulty that Grant experiences is tactile sensitivity.

    Tactile refers to touch. During a haircut, some of the tactile stimuli includes the stylist/barbers hands on his scalp, shoulders, neck, and ears. It can also be the feeling of a pokey comb, abrasive brush, squirting of water on his skin and hair, or the vibration of the trimmer. Even things as small as the cape on his neck and arms can provide tactile information that is aversive.

    Another sensory consideration is olfactory stimuli. Olfactory refers to the ability to smell. Olfactory defensiveness can occur when smells become obnoxious or unbearable. Sometimes this shows itself in the form of headaches, burning sensation in the nose, watery eyes, rubbing eyes, stomach aches after prolonged exposure, etc.

    Individuals who process sensory information typically may not “notice” all of this sensory input with the degree of detail that individuals with sensory processing difficulties do. Our (neurotypical) bodies/brains learn to expect this sensory stimuli through observation and experience. Our brains will formulate typical/predictive responses based on all the information we have taken in and processed. This leaves us with a feeling of security about the repeated experience of getting a haircut. In Grant’s case, this experience is hard work. His brain operates differently. For Grant, each time he has these sensory experiences, it is like new information to his brain each time he encounters them. When occupational therapists talk about “integrating” sensory or motor information, this is what we mean. If an experience has been “integrated” into the brain, the brain recognizes that this has been experienced before; therefore it can “ignore” irrelevant information and the experience can be calm and predictable.
    For Grant, these overwhelming experiences can trigger anxiety and fear. Sometimes, but not always, this can lead to unwanted behaviors such as attempting to flee, crying, or defiance. When Grant becomes overwhelmed with sensory stimuli, he attempts to run away, covers his ears, squeezes your arm, or avoids the situation altogether by completing a calming activity such as looking out the window.

    How do we manage or help decrease these sensitivities during the course of a haircut?

    Occupational therapists are uniquely trained in managing sensory processing difficulties. We provide “sensory diet strategies” to assist with decreasing defensive behaviors during daily or regular activities. Here are a few strategies that we have used (and helped families use) to make a haircut easier. Keep in mind that each child is different and some strategies may work better than others. Some visual strategies to help prepare for a future haircut may include: a social story with pictures to help them know what they will experience, in order to feel more prepared, visiting the salon ahead of time to observe the environment and examine the tools, facing the child away from the mirror, having the child watch a movie or favorite cartoon, “practicing” or simulating a haircut in the clinic and at home.

    Auditory strategies may include: Using a scissors versus an electric clippers, scheduling a time when the salon is not as busy, skipping the blow dryer, or providing the child with earbuds to watch a video.

    Tactile strategies may include: Completion of Wilbarger brushing prior to the haircut, providing calming deep pressure such as a weighted lap pad, desensitizing the scalp by providing deep pressure or massaging, simulating vibrating input to head at home or therapy with a massager in times leading up to a haircut, bringing a shirt to change into after the haircut, providing a snack or drink, and eliminating a step, such as washing.

    Olfactory strategies may include: Eliminating gel or hairspray, using unscented shampoo or conditioner, reducing other smells in the room such as perfume or air fresheners.

    Behavioral strategies may include: Allowing the child to bring a preferred task of choice (iPad, music, toy, etc.) to be a calming distraction, providing a fidget, giving the child consistent positive reinforcement.

    Environmental strategies may include: Bringing the child at a time where there are less people at the salon/barber, seeking a place that has booths with closing doors or less employees to help reduce sensory input, finding a hairstylist who is patient and has experience with children who have sensory processing difficulties.

    The overall goal is to create an experience that is positive…or if not totally positive….at least one where the anxiety level can be decreased. Often times patience can go a long way. It helps to seek out a stylist or barber who is willing to spend a little extra time to ensure that the event does not become traumatic. A positive experience can help shape a routine for future (successful!) haircuts.

    If haircuts are a challenge for your child, it is possible that they have sensory integration difficulties. Red Door offers a free screen where the family can meet with an occupational therapist to further discuss questions and concerns. Following the screen, the therapist may recommend a comprehensive evaluation to further assess sensory processing difficulties if that is deemed appropriate at the time.

    Fitness and Mental Health

    Article provided by: Mental Health America

    Does your family focus on fitness?

    Do You Focus on Fitness #4Mind4Body? Mental health is essential to everyone’s overall health and well-being, and mental illnesses are common and treatable. So much of what we do physically impacts us mentally –it’s important to pay attention to both your physical health and your mental health, which can help you achieve overall wellness and set you on a path to recovery.

    This May is Mental Health Month! Red Door Pediatric Therapy is raising awareness about the connection between physical health and mental health, through the theme Fitness #4Mind4Body. The campaign is meant to educate and inform individuals about how eating healthy foods, gut health, managing stress, exercising, and getting enough sleep can go a long way in making you healthy all around.

    A healthy lifestyle can help to prevent the onset or worsening of mental health conditions like depression and anxiety, as well as heart disease, diabetes, obesity and other chronic health problems. It can also play a big role in helping people recover from these conditions. Taking good care of your body is part of a before Stage Four approach to mental health.

    Getting the appropriate amount of exercise can help control weight, improve mental health, and help you live longer and healthier. Recent research is also connecting your nutrition and gut health with your mental health. Sleep also plays a critical role in all aspects of our life and overall health. Getting a good night’s sleep is important to having enough physical and mental energy to take on daily responsibilities. And we all know that stress can have a huge impact on all aspects of our health, so it’s important to take time to focus on stress-reducing activities like meditation or yoga.

    Red Door Pediatric Therapy wants everyone to know that mental illnesses are real, and recovery is always the goal. Living a healthy lifestyle may not be easy, but by looking at your overall health every day – both physically and mentally – you can go a long way in ensuring that you focus on your Fitness #4Mind4Body.

    For more information, visit www.mentalhealthamerica.net