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Truths About Toddlerhood The OT Wants You To Know

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toddlerhood

The toddler years can be a struggle! From the age of one year to 3 years, toddlers grow and develop immensely. But when parents are in the midst of toddlerhood, it can seem like the never-ending tantrums, meltdowns, sometimes crazed attempts at independence, and picky eating, sleep issues, etc… never end. Not to mention learning new words (with little-to-no filter), sleep changes, appetite and eating considerations, toddler years can be a real challenge to parents. But as an occupational therapist, there is a very real developmental need for these toddler antics.

Be sure to read our resource on newborns not sleeping through the night, because sometimes sleep habits can carry over to toddler sleep issues that impact function, development, and family dynamics.

Toddlerhood gets a bad rap with terms like the “terrible twos” and the “three-nager years”. But is it all bad? Here’s what your friendly OT wants you to know…

Strategies for toddlerhood

Toddlerhood Development

So, what is it about the toddler years? These cute packages of rolly, squishy, no-longer babies are little people with BIG emotions, BIG personalities, and BIG smiles. Some of the sweetest memories I have from when my kids were younger come from the toddler stage, when little voices pronounce words totally incorrectly…but in the cutest way possible. Those big teethy smiles and non-stop play was nothing but learning and developing skills.

As a mom, I loved to watch my littles learn. I loved to kiss their sweet heads to sleep each night. Oh, there were meltdowns, demanding, whining breakdowns that these cuties experienced (daily). There were messes, spills, diaper issues, and the house was in a constant state of disaster zone.

But as the occupational therapist? I knew this was all part of the stage of development and toddlerhood means messy repetition. (i.e. Yes, we will need to practice cleaning up blocks 37 times a day. Yes, we will do it again tomorrow).

But, from that perspective of a pediatric developmental professional, there is so much more to say about the toddler years. ALL of that pushing buttons, whining, changing minds, meltdowns, carrying purses full of toys, getting into the kitchen cupboards, streaking naked through the house…it’s all essential toddler development! Really!

We have a great resource on child development that covers developmental milestones. From that blog post, you’ll discover the toddler developmental stages that occur from 1-3 years.

This developmental checklist can help to define specific milestones.

Early childhood is a critical time when children develop skills they will use throughout their lives. These areas of development include:

  • physical
  • cognitive
  • communication/language
  • emotional
  • social skills

It is during the first years of life that children show a tremendous level of growth in each of these areas.

Occupational Therapy and Toddlerhood…

As a pediatric OT, there are a few sticking points that is important to remember.

The toddler years get a bad rap for behaviors, saying “no”, tantrums, going “boneless” as we used to say about sudden tantrums where the toddler flops on the floor in refusal for some task, activity, or thing like getting dressed.

But, here are a few things about the “good” of toddlerhood…

  1. Have patience with your toddler.

Because of the tremendous amount of development, it is easy to become overwhelmed by skills (running, hopping, getting dressed, manipulating toys and materials, self-feeding…the list goes on and on!) Plus, young children want to exhibit independence in these areas. They want to do what mom or dad or big siblings are doing, but they may not have the skills to do so. Frustration ensues!

Things to remember is that the child is developing in all of these areas at once. By watching routines, listening to parents talking, watching siblings, they learn to throw, carry, put away, wash, color…these are multi-faceted skills. There is sensory, motor, cognitive, visual all happening at once with daily tasks.

Plus, the cognitive development occurring at the same time means that following directions are not always on target with what the small child wants to do. They want a piece of toast for breakfast. Then they don’t. It can be easy to lose patience as the toddler has a tantrum on the floor, but they are managing emotions, thought processes, decisions, and communication challenges all at once. It can be a lot to process! Be patient as the adult in the situation.

Patience is key as your little toddler develops skills at the rate that is right for them.

That brings us to our next point.

2. Remember that each child is different.

Toddlers grow and develop at a fairly predictable course and rate. There are general developmental expectations that happen during the toddler years, called developmental milestones. However, not all child achieves these milestones at the same time. And that’s ok!

It can be easy to become upset as a parent when a friend’s child achieves skills or abilities. Remember that each child is on their course of development. From birth to three years, a child visits the pediatrician many times.

You’ll experience many questions on development during those visits, where the doctor or staff ask about milestones. If there is a concern with development, or evident delay, this is where you can explore services to support needs.

Even through each toddler is different and development occurs in different stages, it’s all part of showing independence. This can mean picky eating, throwing food, saying “NO!” or any other aspect of showing independence.

3. Development occurs through play.

Occupational therapy practitioners use play as a tool to promote more play! And it’s through play that toddlers develop skills.

It’s through play that toddlers achieve stability, build relationships with parents, siblings, and others.

They test boundaries and explore the world around them.

Play offers opportunities to use their reflexes, transform motor skills, and distinguish refined motor skills (i.e. using their arms and legs to achieve a desired action such as getting up those stairs!)

Sensorimotor skills expand and toddlers gain control in play objects and tool use; They begin to use crayons, spoons, forks, and manage clothing. Previously, we’ve shared the best crayons for toddlers that support this development through functional play.

Young children are fascinated by mastering new skills and learning new things. You might see them drawn to activities or experiences that offer sensory experiences, are repetitious, or involve exploration. But even though novel opportunities support child development, routine is essential.

Read about the power of play for more ideas to support your toddler.

Physical Development during toddlerhood

Going back to the development aspect, you can generally expect to see the following skills developed during toddlerhood:

12-18 months

  • First steps
  • Walking
  • Climbing stairs

18-24 months

  • Running

24-36 months

  • Jumping
  • Begin to ride a tricycle

3 years

  • True run with both feet leaving the ground
  • Walk upstairs with alternating feet
  • Walk downstairs
  • Able to remove most clothing

Cognitive Development During Toddlerhood

From 1-3 years of age, so many cognitive skills are built and expanded upon. You’ll notice in the list below that many of these cognitive skill components are grounded in play. Remember that play builds skills! Let’s break down the skills by age:

12-18 months

  • Includes others at recipients of play behaviors
  • Imitates new behavior

18-24 months

  • Demonstrates invention by combining mental combinations
  • Finds hidden objects (separation skills)
  • Shows differed imitation
  • Uses toys or dolls in pretend play

24-36 months

  • Substitutes objects in pretend play
  • Integrates themes in play

3 years

  • Begins operational thinking
  • Counting words up to 5
  • Can solve nesting cup problems

Language Development for Toddlers

The first few years are a huge time for development of receptive language and expressive language. Here are some specifics:

12-18 months

  • Expresses self through jargon, sounds, cries

18-24 months

  • Understands multi-word phrases/sentences
  • Uses multi-word phrases to express thoughts (“Me up” to indicate a desire to be picked up; “Mommy go” to indicate that mommy has left the house)

24-36 months

  • Initiates a conversation with words or phrases
  • Uses 2 part sentences or phrases (“Me go home.”)

3 years

  • Understands positional terminology (in, on, under)
  • Uses more complex sentences
  • Distinguishes between images and words or text on paper or in books
  • Begins to generalize rules for verb tenses and using plurals

Toddler Social-Emotional Development

Social emotional development occurs even from the young age in toddler years. Social skill development occurs through interaction with others, play, and day to day tasks. Here are some milestones you may see:

12-18 months

  • Experiences peak of separation anxiety

18-24 months

  • Demonstrates less separation anxiety
  • Begins to show empathy for another person, animal, toy

24-36 months

  • Begins to respond with empathy to another person’s distress
  • Includes others in pretend play

3 years

  • Shows physical aggression over verbal aggression when distressed or upset

Toddlerhood Tips

So, how can you and your toddler thrive during these hectic years? A pinch of patience, play, play, and more play! We actually have actionable strategies over on our toddler play page, including fun ways to play with your toddler that inspire development.

Some quick tips (described in more detail over on that main toddler page) include:

  1. Meet the level of the child.
  2. Set up a toddler safe space.
  3. Be a balanced play partner.
  4. Enjoy & have fun with the play.
  5. Limit screens. (Or use in moderation.)

Transforming Toddlerhood With Play

Ask any occupational therapist and you’ll see that play is the way and the means to develop skills during these years. Looking for therapist-approved activities to inspire learning through play for toddlers? These are some of our favorite ideas:

Or, try making a craft with 2 year olds and 3 year olds…an easy suncatcher activity using items you have in the house!

Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.

Perineal Hygiene

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perineal hygiene and pericare tips

Here, we are covering an aspect of potty training that comes up for every parent: pericare, or perineal hygiene, and teaching kids how to wipe when toilet training. So often, a young child learns to use the toilet and other aspects of potty training, but then struggle for a long period of time with the wiping aspect. Teaching children to wipe thoroughly is a hygiene task that can be limited by many underlying areas. Here, you’ll find strategies to help wiping bottoms and interventions for perineal hygiene.

How to teach pericare, or perineal hygiene needed to wipe completely during toileting.

What is pericare?

For the uninitiated, pericare (or peri-care) is short for perineal care. Perineal care refers to the hygiene and self-care of the perineal area following toileting, cleaning, and wiping of the perineal area of the body is the “private parts” area. Pericare is a term for the hygienic tasks involved in this part of the body, such as wiping one’s bottom.

Anyone of any age may need help wiping their bottom with their perineal care, but it is especially important to teach our little ones the proper way to manage their bottoms as they become more independent. 

This component of toileting is one that impacts overall independence and self-care with the toileting process. So often, we cheer and celebrate making it to the toilet on time, but the perineal hygiene aspect is equally as important.

Related: Potty Training Seats for Special Needs

You may be thinking, “Why do I need to teach my child how to wipe!?!”. For something that is such a natural task for many, it can feel odd to teach somehow how to do it.

However, learning how to maintain a clean bottom is important for one’s health and confidence. Wiping properly, washing gently, and wearing appropriate clothing decreases the risk of yeast infections, urinary tract infections, and odors. Plus, discussing peri-care can open the door to many other conversations about the body, health, and safety – if that’s something you are interested in exploring with your child.   

A great time to educate your child about peri-cares is while potty training. It is easier to teach the correct way first than to re-learn how to do it later. If you are stuck on potty training, we feel you there! Check out this Toliet Training Book that can help you help your children of varying needs.

Don’t be discouraged if your child is already potty trained and they have yet to learn how to take care of their bottoms independently – it can take time and practice! 

Development of Pericare

An important area to cover first is the development of pericare skills. It is so important to remember that we are talking about young children who are learning a whole new skill with toileting. There are many considerations: autonomy, body awareness, interoception, self-awareness, the sensory processing and interoception aspect, family perspectives…potty training can be very overwhelming for kids.

Then, to break it down even further, the hygiene aspect of toileting is another ball game!

In our book, The Toilet Training Book, we cover the development of potty training and really cover what underlying skills play into potty training and independence with toileting.

But, one important thing to remember is that a three year old child may be able to make it to the toilet in time to go, flush, and wash their hands, but the wiping aspect can developmentally, come with time.

Developmentally, perineal hygiene, or wiping completely after toileting, may be a skill achieved during a range of 4-6 years. This range is so wide due to the underlying skills, sensory considerations, motor skills, and cognitive growth needed for perineal hygiene including knowing when and where to wipe after a bowel movement or urination, using enough pressure on the toilet paper to clean completely, wiping enough times to clean completely, and maturity to complete the task.

The emergence of these skills takes time, but there are ways to support development of perineal hygiene.

GET COMFORTABLE with perineal hygiene

Everyone wants a clean bottom, let’s start there. It can be smelly and embarrassing to talk about, but it is an important step to understanding personal healthcare.

We want to give you the confidence to discuss this in any way that you and your family feel comfortable with because it is a “touchy” subject for some. The more comfortable you are with peri cares, the more comfortable the child will be. 

Let’s start off the potty training wiping techniques by talking about good hygiene.

Here are some ideas to talk about perineal hygiene with kids:

  • Make it silly: Some people respond best to humor but watch out for demeaning jokes. 
  • Make the conversation about pericare hygiene scientifically accurate: It becomes less embarrassing when you hardly know what is being said! 
  • Make pericare sound similar to washing hands: We have to clean away the germs; they can make us sick! 
  • Make discussions about perineal hygiene your own: You know your family best. Think about terminology that works for the individual. In what ways can you increase trust and comfort for all? 

GENERAL GUIDELINES for teaching perineal hygiene

Here are some general tips for a healthy bottom that should be shared for children and adults alike. Please speak to your family physician if you have any questions or concerns related to your child’s unique needs. 

  • Wear breathable (preferably cotton) underwear that is not too tight. Change daily or when soiled. 
  • Don’t hold it in. While it is good to wait to “go” until you reach the toilet, holding in pee or poop for too long can result in a variety of issues. 
  • If it is comfortable, sit on the toilet with elevated feet. You may have heard of the (Amazon affiliate link) Squatty Potty – placing the legs in more of a squatting position helps bowel movements pass. More importantly, children should have access to a either a smaller potty or a footstool (or a box,etc.) near the toilet so that their feet do not dangle. 
  • Wipe from front to back to reduce bacteria entering the urethra. Talk about anatomy and why wiping front to back is effective and safe.
  • Wipe gently with 3-4 squares of folded toilet paper (each household can determine the amount – some kiddos use way too much!) until clean. I always recommend to look at what you are wiping away so that you learn about how much you need to wipe. 
  • Consider use of warm or cool wipes over toilet paper.
  • When bathing, wash the genital area gently with mild soap and rinse with clean water. No soap should be entering the body through the anus or the vagina. 
  • For bathing a uncircumsized child, refer to this article for great information and consult your family doctor for personalized advice.   

Pericare INTERVENTION IDEAS

Children will not know unless we lead them, so here are some fun ways to teach pericare! 

Areas that can be broken down to increase overall self-care include:

  • Address balance
  • Pulling up and down undergarments
  • Wiping front to back
  • Wiping thoroughly
  • Wiping with enough pressure
  • Gripping the toilet paper
  • Washing hands after wiping
  • Reaching around to the back

Each of these areas can include aspects of balance, gross motor skills, fine motor skills, strength, coordination, sensory processing, executive functioning skills, and visual motor skills. It’s important to look at each individual’s area of difficulty and then break it down into the underlying areas that are impacting success with pericare.

First look at the area of difficulty. Then, consider how underlying areas are impacting that particular area. Come up with intervention strategies that support that need and create a “just right” challenge to build independence and pericare functioning.

Let’s look at each of these areas of perineal hygiene…

Pulling up and down undergarments:

  • Fine motor strength and coordination fine motor activities to the rescue! There are so many fantastically fun ways to increase this skill, but here are some that are more directly associated with potty training. 
    • Lei Obstacle Course: Grab some Hawaiian-inspired leis, hula skirts, or long necklaces and create a long pathway. As a child walks through the pathway (hopefully to another fun activity in the course), they must step inside the lei and pull it up as high as it will go. If it fits over their arms/head, they can wear it as a necklace. Pulling up the lei and wiggling their body through will strengthen the same skill as in pulling up pants. Reverse the challenge to mimic pulling pants down.
    • Silly Socks: Grab a variety of socks in fun colors and different sizes and see how many you can put on in one minute! Layering socks up the arms and legs (and removing them, too!) mimics the skill of pulling up and down undergarments. 
    • Stickers: Challenge them to peel off stickers all along the waistband of their pants. Don’t forget the backside! 

Pericare: Wiping Activities

Balance and reach are huge parts of perineal hygiene. Staying balanced on the potty while wiping is a big challenge for our core strength, flexibility, and range of motion. To practice this skill through play-based activities, see the ideas below! 

Play-pretend: Place peanut butter on the back of a disposable or washable diaper and have your child wipe it off. Any familiar paste will do – sun butter, nutella, cookie butter…anything to wipe! When they think they are done wiping, show them the diaper to see if they actually cleaned it. 

Art-based: Wipe a plastic plate with toilet paper to create an art project – the toilet paper acts as the paintbrush. They must wipe clean the whole plate! For an extra challenge, place the plate behind their backs, and the work of art in front of them. 

Play activity: Using static electricity, tape, or velcro, have your child squat to “pick up” pom-poms or other sticky and lightweight items on their bottoms (think: window stickers, damp tissues, etc.). They carry them carefully to a container and remove them one by one. You can really make this game your own!

Wiping Front to Back

There are so many ways to work on perineal hygiene to cover other aspects besides the balance consideration. Consider these strategies to teach kids to wipe front to back:

  • Use toys, books, clothing, and other items to work on teaching front and back directional concepts.
  • Teach children to count to help with wiping a certain number of times.

Reaching Back to Wipe During Perineal Hygiene

  • Clip and unclip clothes pins on the back of clothing to work on reaching back and around..
  • Use a pool noodle to reach around and through the legs to work on reach, visual attention, scanning, and eye-hand coordination. You can tap the pool noodle on a target and create a game.
  • Practice wiping the backside in the bathtub.
  • Put a handkerchief or scarf in their back pocket for the child to reach for and pull out.
  • Put stickers on the child’s back or pants for them to reach for and grab.

Wiping with enough pressure

  • Work on tearing paper for hand strength and eye-hand coordination to pull off appropriate sizes of toilet paper.
  • Use play dough, LEGO, tong activities to develop hand strength.
  • Wipe dry erase marker off a dry erase board. Then, position the dry erase board on the ground between the feet to bend and wipe. Then, position it behind the back to reach and wipe.
  • Wipe peanut butter or washable paint from a plastic baby doll.
  • Help kids to wipe thoroughly by painting with toilet paper with having them try to wipe a blob of paint off a plastic plate and remind them to keep going until the plate was empty.

More perineal care and potty training tips

Looking for more information on underlying considerations that impact toileting? Need strategies, supports, and tools to facilitate independence with toileting skills? Need support strategies for potty training an older child, but not know where to begin?

Looking for ways to help individuals with toileting skills when cognitive, behavioral, motor skills impact participation in independent toileting? Trying to initiate or progress with potty training when a diagnosis of Down Syndrome, Autism, or a motor skills challenge is at hand? Check out the Toilet Training Book: A Developmental Take on Potty Training for Kids of All Abilities.

Resources for toilet training kids of all abilities
The Toilet Training Book: A Developmental Look at Potty Training for Kids of all Abilities

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

Early Intervention for Sensory Differences

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Early intervention and sensory differences

Our sensory system is very complicated. A lot of times when we hear about sensory, we think about our 5 senses (taste, touch, sight, smell and hearing.) This blog will take us into a deep dive of early intervention for sensory differences and the definition of different sensory processing areas. Early Intervention services provide supports for children birth through age three who demonstrate developmental delays.

These delays could be caused by a variety of reasons, from autism, chromosome abnormalities, drug exposure, prematurity, motor impairments, language delays and more. 

Early intervention for sensory differences

Early Intervention for Sensory Differences

One of the areas that is always assessed when determining if a child is eligible for Early Intervention services is the area of sensory processing. These areas include Low Registration, Sensation Seeking, Sensation Sensitivity, and Sensation Avoidance. Also addressed are the areas of Sensory and behavioral including general, auditory, visual, touch, movement, oral and behavioral differences.

We will explore these areas in more detail throughout this blog post. Sensory diets are one of the most common and impactful ways to support children with sensory differences.

This article describes sensory diets as “A sensory diet is a set of activities that make up a sensory strategy and are appropriate for an individual’s needs.  These are specific and individualized activities that are scheduled into a child’s day and are used to assist with regulation of activity levels, attention, and adaptive responses.  Sensory diet activities are prescribed based on the individual’s specific sensory needs.”

There are four quadrants in a sensory profile. This visual clearly defines the similarities and differences between seeking, sensitivity, registration and avoidance.

The infant/toddler sensory profile is a common assessment used to determine the needs of a child in the following areas If a child is over-responsive to sensory input, they would fall in the sensory seek or slow to register sensory input sections. If a child is under responsive to sensory input, they would fall in the sensory sensitive or sensory avoider sections. 

What are sensory differences and neurodiversity? This article explains.

What are sensory differences?

These areas of sensory diversity make up the term sensory differences. Beyond the four quadrants, however, there are other sensory differences to consider. These are described below.

All of these sensory differences described are part of the neurodiversity of human life. We all are different when it comes to sensory, and we are all sensory. Just like the diversity of physical attributes, personal preferences, characteristics, sensory differences are just one more difference that makes us who we are.

Sensory Seeking

This area determines if a child seeks out sensory input. If a child is scored higher than most in this area, you may see them move around more, look at items that spin (such as fans or toys with wheels) be attracted to fast paced and brightly colored television shows.

Here are some wonderful home ideas for children who are sensory seekers.

Sensory Sensitivity

This area determines a child’s ability to notice different senses. If a child scores higher than most in this area, you may see a child always needing a routine to stay calm, startle to certain sounds, become upset during routine hygiene activities (such as getting hair brushed or nails trimmed) and significant preferences on types and textures of foods.

Here are some ways to support children in a controlled way, who show needs in the sensitivity area.

Sensory Registration

This area determines how a child responds to sensory input from others or their environment. This article by the pediatric development center explains how important registration is for a child’s functioning and learning.

It describes registration as: “Sensory registration is the process by which children respond or attend to sensory input in their environments.  The nervous system must first notice the sensory information, once registered the memory compares it to things they have heard or seen, and thus gives new information meaning.  Children who fail to respond or have delayed responses to sensory information have diminished sensory registration.  Diminished sensory registration is often associated with one or two weaker sensory systems, such as the auditory or vestibular system.  Without sensory registration, no other learning can take place.”

If a child scores higher than most in this area, you may see a child miss sensory input more than others do. A child in this section may miss eye contact, pay attention to only specific tones, and ignore most sounds. These children are harder to engage or seem uninterested in activities. They may need tactile, auditory and visual cues to initiate engagement in conversation or an activity.

Here are some ways to support children with low registration.

Sensory Avoidance

This area determines how a child’s need to control the amount and type of sensations at any given time. If a child scores higher than most in this area, you may see a child resist playing with other children due to overwhelm, resist being cuddled when it’s not on their terms, frequently become upset if their hands are messy, have a hard time calming down in new settings and isn’t interested in trying new foods.

Here are some tips on how to support an avoider.

General Processing

General Processing items measure the child’s responses related to routines and schedules. This could include daily schedules, routine schedules or task related routines including how children respond to questions, others actions, busy situations, sleeping routines, eating patterns and hygiene needs, daily transitions and other schedule related activities.

These first/then visual boards are a wonderful tool in supporting routines and schedules.

Auditory Sensitivity

This area addresses how children respond to things they hear. Auditory input includes responding to their name,  how easily it is for someone to get their attention and how distracted they become in noisy settings. The brain processes the sounds in our environment and according to this article, sensitivity to sound could be a reaction to a part of our brain that pays more attention to sounds then it needs to. One article explains it this way:

“When there is no medical reason to explain the auditory sensitivity, researchers think that the brain is not processing sounds adequately. Researchers suggest that the part of the brain that receives and filters noise and sound, the amygdala, is working differently.  The amygdala decides on how important noises are.  It decides and which sounds we should attend to and which ones to ignore. When someone experiences sensitivity to sounds, it is thought the amygdala pays more attention to sounds than it needs to.”

Visual Sensitivity

This area addresses how children respond to things they see, including bright objects, such as lights and toys. It describes how they respond to reflections in mirrors and their responses to objects that spin or move suddenly. According to this article our brains interpret the light we see through our eyes, and:

“The visual system uses light to detect information through our eyes and then interprets or makes sense of that information in the brain. It works closely with our vestibular and auditory systems to help us safely navigate our environment by orienting us to where we are in relation to other objects. The ability to cognitively process information we take in through our eyes can be broken down into several categories, called visual perceptual skills. Those with trouble in one area of visual perception may present with strong skills in another area, meaning that deficits in processing of visual information can take on many forms.”

Tactile/Touch Sensitivity

This area addresses how children respond items that touch their skin. This includes bath/water play, getting their nails trimmed and hair brushed, touching different sensory rich objects, being messy and receiving hugs. When children have a tactile sensitivity, their skin reactors are feeling the object more intensely. According to this article:

The tactile system, or sense of touch, refers to the information we receive though the receptors in our skin. It alerts us to pain and temperature and helps us discriminate the properties of things we come in contact with, i.e. texture, shape, size, and weight. From very early on in development this sense plays a crucial role in helping us gain awareness of our own bodies and understand everything we come in contact with. And how frustrating it must be to learn new skills when you can’t adequately feel the objects you’re using!”

Movement Seeker

This area describes how children move within their environment, including if they enjoy movement activities, seem accident prone or clumsy, seek out spinning and/or preferring to walking on their tip toes. Movement is how our bodies know where we are in space and how we respond to a variety of movement activities. This article explains movement seekers as “someone who has a high threshold for vestibular input. The vestibular system is housed in our inner ear, and is responsible for sending messages to our brain about the position and movement of our head. The vestibular system is activated anytime our head is tilted, upside-down, inverted, if we spin, if we run fast or run slow, when we’re on a swing or going down a slide.

We need vestibular activation and an efficient vestibular processing system in order to maintain an upright position, feel balanced, have a full sense of our body in space and focus. Some people have low thresholds, in which they perceive vestibular activation at much higher rates (e.g. hypersensitive to movement). Others have high thresholds, which means that they need more intense, more frequent and longer duration of movement in order to register it and activate their vestibular system.”

Oral

This are addresses how children respond to new foods and different textures, if they tend to overstuff their mouths, how they control chewing/swallowing foods and liquids and if they tolerate their teeth being brushed. Our oral system is based on how our sensory receptors in our mouth recognize what is in our mouth. Some people have increased sensitivities for foods while others have decreased sensitivities to food. There are differences and optional interventions explained in this article:

“We have sensory receptors in our mouths that allow us to recognize information about temperature, texture (e.g. smooth like yogurt, hard like chips/pretzels, or a mixture of textures like cereal with milk), and taste (e.g. sweet, salty, bitter, sour). They may be over responsive or have increased sensitivity to oral input, causing them to be resistant to oral sensory experiences like trying new foods or brushing their teeth.

Other children may have decreased sensitivity to oral sensory input and therefore seek more oral input in order to help them organize their behavior and pay attention. Our brains receive further proprioceptive input from the joint of the jaw as we bite and chew on foods with different types of resistance (e.g. a crunchy carrot or a chewy sweet/gum).  Oral sensory processing also contributes to the way we move our mouths, control our saliva, and produce sounds for clear speech.”  

Behavioral Differences

This area describes children’s behaviors such as how frequently they have meltdowns, if they are clingy, how hard it is to redirect them, if they are upset in new surrounds and how hard it is to help them calm down.  Teaching children how to calm down using a variety of sensory input, will benefit every child. Soothing Sammy provides opportunity for a child to create their own behavior support tool that is tailored to their specific needs. Weather they respond better to auditory, visual, tactile or others, Sammy the Golden Dog can make redirection to a calm down corner a positive experience for the child and the adult.

Creating a sensory diet is one of the most important ways to support children with any type of sensory difference. These sensory diet cards is a must have resource if you are working with or have a child with a sensory need. 

If you are concerned about your child, you can contact an Early Intervention provider to complete an evaluation from the day they are born all the way until they turn three years old.

Early intervention occupational therapy services support children in all areas of sensory needs, and can help caregivers create sensory diets that will help children in a variety of situations. Visual, tactile, auditory, oral and movement interventions that are supported in a controlled environment, can help every child learn how to adapt and respond to different situations and environments.

Jeana Kinne is a veteran preschool teacher and director. She has over 20 years of experience in the Early Childhood Education field. Her Bachelors Degree is in Child Development and her Masters Degree is in Early Childhood Education. She has spent over 10 years as a coach, working with Parents and Preschool Teachers, and another 10 years working with infants and toddlers with special needs. She is also the author of the “Sammy the Golden Dog” series, teaching children important skills through play.

Early Intervention and Autism

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early intervention autism

When it comes to the early signs of autism spectrum disorder and potential interventions, early intervention for autism can cover a variety of areas. Here, you’ll discover strategies for parent advocates to add to their toolbox.

There are many different signs associated with autism, and research strongly shows the earlier a child receives intervention supports for autism, the more progress they make in all areas of their lives. Early intervention, a federally funded program, provides support for the youngest children, ages birth through three years old, who demonstrate developmental delays. This blog will talk about the early signs of ASD and interventions that support development in all areas. 

Early intervention and autism as well as early signs of autism and interventions to support development.

Early Intervention and Autism

Today, autism affects 1 in 44 children. According to the CDC, autism spectrum disorder is four times more likely to occur in boys. The best way to support children who are showing signs of a developmental delay is to get them therapy supports as early as possible. These supports are available from Early Intervention Programs, Health Insurance and private agencies. 

Every child is different and develops at different rates, so how are we supposed to determine if an Autism Evaluation is appropriate for a child under three years old?

The Early Intervention program is available to all children ages birth to three that live in the United States. The purpose of this program is to help identify and support children who have delays in all areas of development, with or without a diagnosis of autism.

One of the most commonly used questionnaires to determine if a child does have red flags for ASD is called “The Modified Checklist for Autism in Toddlers (MCHAT). This questionnaire can be filled out for free by a clinician or a parents. You can find the free online version here.

The five areas typically monitored when determining if a child should be referred for an autism evaluation are joint attention, social engagement, receptive language, expressive language and behaviors. I

f there are concerns in some or all of these five areas, completing the MCHAT assessment and talking to your child’s pediatrician is the first step to determining if more testing should be administered. 

  1. Joint Attention

Joint attention is a skill that affects a child’s ability to interact with others.

The definition of Joint Attention is when two people purposefully pay attention to the same thing and for the same reason.

For example, when an adult calls a child’s name, and the child responds by looking at the adult, they are engaging in the first step of joint attention. The adult would then ask the child a question and when the child responds, the adult and child are talking to each other about the same thing, in that very same moment. The same goes for when an adult points to an object and the child follows that point to see what object the adult is showing them. Together they are able to talk about the same item.

According to the UNC School of medicine, “Children who are learning social and communication skills in a typical way will often show examples of joint attention from the time they are 12 months old. Joint attention is important in helping people communicate with each other all through life. Children with autism have a hard time with this kind of communication. For these children, delays in developing joint attention skills lead to delays in developing language.”

  1. Social Engagement

As soon as a baby is born, they are in awe of their mothers voices and eyes. Infants thrive off social interaction, from playing peek-a-boo, being sung to and engaging in simple play activities.

As they grow, social skills become the foundation for other areas of development. They learn spoken words through imitation of adults and peers, babies and toddlers model behaviors of those they see around them, they get the attention of others to share their wants and needs, and they imitate other children’s play and movement.

One component of autism is a lack of social engagement, such as when a child doesn’t show interest in playing near or playing with other children or using words to communicate with primary caregivers.

  1. Receptive Language

Understanding the meaning of words is the first step to language development. Without understanding the meaning of words, children won’t be able to use spoken words to communicate their wants and needs with adults.

Children start to show understanding of words as early as 4 months old, when they look towards objects and family members when they are named. As they get older, they start following points, imitating gestures and show interest in imitating sounds and words that adults use. 

Autistic children may have a harder time engaging in social reciprocity which impacts their receptive language development. This article from Raising Children describes how joint attention directly affects receptive language development in infants:

“Autistic children might have difficulty learning language because they tend to show less interest in other people in the first 12 months of life. They might be more focused on other things going on around them. Because they might not need or want to communicate with other people as much as typically developing children do, they don’t get as many chances to develop their language skills. For example, a three-month-old baby who is distracted by a ceiling fan is less likely to tune into a smiling and tickling game with their parents. By nine months, if the baby still isn’t tuning into parents, the baby is less likely to point at things they want to share with parents. The baby is less likely to listen to their parents as they name things. This means the baby misses these chances to build vocabulary.”

  1. Expressive Language

Expressive language is the key to communicating our wants and needs with others. This can be through visuals, verbal words or using gestures.

When infants start to use gestures (such as pointing, waving “hi”, and lifting their arms to signal wanting to be picked up,) adults are able to understand what their child is wanting and respond to their requests.

From there, expressive language develops quickly into babble, jargon, word imitation and then children using one, two and three word phrases to communicate with those around them.

Children that develop early signs of autism don’t typically follow this language progression. Children might be more quiet then others, babbling less, use rote phrases (lines they hear in movies), use language that isn’t functional in nature, or label a variety of objects. This article does a wonderful job explaining the differences between a language delay and language concerns that point to Autism. 

  1. Behaviors

Behaviors associated with children who may have Autism may also be an indicator of sensory differences. An autistic child may show repetitive movements (such as rocking consistently), showing aversions to being touched or sensitivity to sounds and lights in unpredictable environments (such as the grocery store.)

Children sometimes become upset for unknown reasons and are hard to calm down. Some autistic children become fixated on objects, only wanting to complete tasks in specific ways (such as lining up toys), always wanting to hold onto specific objects or getting upset when someone else changes the play sequence. Children who show signs of ASD also tend to need consistent daily routines and become upset when their routines change. 

The most common diagnostic tool for Autism in young children is called the ADOS (Autism Diagnostic Observation Tool), a play based assessment that is completed by a clinician with the child present. This assessment can be given to a child as early as toddlerhood. There are four different modules that can be administered to young children. Clinicians determine the correct module to use based on the skill level of the child. The ADOS assessment, along with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) results will determine if a child meets the criteria that pertains to autism spectrum disorder. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a completed diagnostic tool completed by the American Psychiatric Association that encompasses different psychiatric diagnostic criteria. The diagnostic criteria for Autism in the DSM-5 is described in this article. 

“A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history. 

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history.

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.”

Interventions for children with a diagnosis of ASD:

  1. Early Intervention Services

The Early Intervention Program is a federally funded program that supports children in all areas of development, including language, cognition, motor skills, social skills and adaptive development.

The services available for children under the age of three are directly associated with every child’s individual needs. These could include feeding therapy, nutritional supports, speech and language therapy, occupational therapy, physical therapy, behavioral therapy, social language groups and more!

If a child is enrolled in the early intervention program, their parents or guardians play a key role in the implementation therapy services. Therapies usually occur at home, with parents involved. When a child turns three, their therapies are funded through the local school district Special Education Program to support school readiness, and medical insurance to support medical needs and behavior supports at home. 

  1. Visual, Tactile, and Auditory Supports

Children with low social reciprocity and joint attention skills benefit from other forms of communication. These communication strategies utilize other senses and break down communication to simple and direct forms. If a child is having trouble calming down, creating a calm down corner using “Soothing Sammy Emotions Program” supports a positive calming experience with a golden retriever dog and sensory tools. 

Visual cue cards such as these First/Then choice boards and transition cards,  give children the ability to follow daily tasks and routines in a way that is easy for them to follow, without the need to look those who are talking to them.

Early intervention services can support with strategies:

  • To increase on-task behavior or social interactions
  • To teach new skills e.g., life skills, communication skills, or social skills
  • To maintain self control and self monitoring procedures to maintain and generalize job-related social skills
  • To generalize or to transfer skills from one situation or response to another (e.g., from completing assignments in the resource room to performing as well in the mainstream classroom)
  • To restrict or narrow conditions under which interfering behaviors occur (e.g., modifying the learning environment)
  • To reduce interfering behaviors e.g., self injury

As children become more comfortable with back and forth interactions with adults, first/then boards can be used as a back up option for communication. These visual schedules help children transition from one activity to the next. 

A final note on early intervention and autism

If you have  concerns about a child’s developmental progress, it is best to seek out professional assessments through a pediatrician or an Early Intervention team. If the child is over three, requesting a developmental evaluation through your local school district is also an option.

When children receive the intervention therapy they need at an early age, their skills in all areas of development improve. There are many different interventions we can do to support even our littlest family members. 

Jeana Kinne is a veteran preschool teacher and director. She has over 20 years of experience in the Early Childhood Education field. Her Bachelors Degree is in Child Development and her Masters Degree is in Early Childhood Education. She has spent over 10 years as a coach, working with Parents and Preschool Teachers, and another 10 years working with infants and toddlers with special needs. She is also the author of the “Sammy the Golden Dog” series, teaching children important skills through play.

Scoop, Pour, Transfer Activities

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scooping, pouring, transferring activities

Scooping and pouring.  Toddlers pour, and dump toys (or cereal, a cup of water, a bin of diapers…) as soon as they discover that they can. It’s a developmentally appropriate skill that happens as mobility develops.  When little ones pick up a bowl or cup and turn out the contents on the floor, it may be frustrating to a mama that’s just picked up all of the toys in the house for the third time, but it is such a great function that is the occupation of play.  

These scooping and pouring activities can also help with questions of being ambidextrous or simply having a mixed dominance present.

Today, we’re exploring how scooping, pouring, and transferring materials benefits toddlers and preschoolers, in big ways. You can use this fun fine motor and visual perceptual motor activity with children at the toddler, preschooler, and school-aged levels to improve the precision of skills, practice math, and discover skills, all through scooping, pouring, and transferring small items.  

Use these scooping, pouring, and transferring activities to help preschoolers, toddlers, and older kids develop skills.

Scooping Activities for Toddlers

There are so many benefits to scooping, pouring, and transferring materials. These scooping activities for toddlers are an easy way to help to build motor skills in toddlers and preschoolers, at just the right stage of development. It’s during the toddler years that children develop more motor control, stronger eye-hand coordination skills. They are starting to gain more control of their arms in a coordinated manner, especially when manipulating tools like scoops, spoons, cups, and bowls. It’s through play and the weight of sensory materials that the benefits of scooping, pouring, and transferring of materials builds motor control, more refined movements, and tolerance of a variety of sensory materials.

But, you don’t need to stop at the toddler years. Manipulating tools and sensory materials to pour, scoop, and transfer is great for preschoolers, too!

Ice is a great scooping activity for toddlers to work on coordination and fine motor skills.

Benefits of Scooping, Pouring, and Transfering

Fine Motor Benefits of Scooping and Pouring– By manipulating sensory materials, cups, scoops, and bowls, toddlers and preschoolers refine and build motor experience in fine motor skills. Areas of development include: pincer grasp, precise wrist movements, arch development, wrist extension, and separation of the wrist from the elbow. Development of these areas promotes a more distal motor control while using the proximal arm (shoulder and elbow) to stabilize and support the movements of the distal arm (wrist, hand, thumb, and fingers).

This separation of the proximal stability from the distal mobility is a needed motor development for coloring with the hand and fingers instead of using the whole arm to move the crayon.

Work on hand dominance and fine motor skills with scooping, pouring, and transferring activiites.

You can show a child of this age how to dump the dry cereal from the scoop into a large tray.  Kids in the Toddler range would benefit from scooping and pouring using larger scoops or small cups.

 In order to scoop food when eating or scooping like in this play activity, kids need precision of very small wrist motions.  

Moving the wrist from side to side is called radial deviation (moving the wrist towards the thumb side) and ulner deviation (moving the wrist towards the pinkie finger side).  

In addition, slight wrist extension (the wrist slightly bent back in the direction of the back of the hand) is needed to accurately and efficiently scoop and pour.

Simply holding the scoop is an activity for grasp development by refining the arches of the hands and intrinsic muscles.

Other areas of fine motor development include

Hand dominance with Scooping, pouring, transferring– Hand dominance is an area that they can be working on, depending on their age. It takes experience, or muscle memory through activities to refine and establish a dominant hand or side of the body. By scooping, pouring kids can hold the container, bin, cups, or bowls with their non-dominant hand while scooping and pouring using a spoon, cup, or bowl with their dominant hand.

As children establish a hand dominance, this refined motor coordination becomes easier to control. Toddlers can start with larger objects and larger scoops. Progressing to more fluid or smaller materials like smaller pellets, flour, or liquids can help preschoolers further refine coordination and manipulation of materials.

Self-Awareness Benefits of Scooping and Pouring– Pouring and dumping is discovery and exploration of gravity, weight, muscle control, cause and effect, and self-awareness. Not only are toddlers discover what they can do by pouring, they are learning about their environment while working on so many skills.

Motor Skills Benefits of Scooping and Pouring– Scooping small items is important in development and refinement of motions needed for managing utensils during self-feeding.  This is an important independence step in the Toddler range. The establishment of visual input and motor output results in eye-hand coordination skills.

Also needed is the muscle memory or “experience” in pouring materials. You’ll see this in action when pouring a liquid or something that really “flows”. You don’t want to pick up a pitcher of milk and pour with speed. The liquid will splash out of the cup and onto the floor. It takes motor skill development and experience to know that pouring different materials, liquids, and containers take different amount of force, accuracy, and controlled movements. 

Learning by Scooping and Pouring- Adding in learning objectives makes this play activity a bonus. You can add themed materials, counting cards, letter cards, or sensory bin cards. Add math and reading activities by counting or using sight words. Add sensory bin cards. the options are limitless when making pouring and scooping activities educational.

Scoop and Pour for Bilateral Coordination Skills- When pouring and manipulating containers, a development of bilateral coordination skills occurs naturally. A weighted material is in one hand, while the non-dominant hand stabilizes. This transfers to bilateral coordination tasks such as holding the paper while coloring or writing, using two hands in clothing fasteners, cutting with scissors and holding the paper, and the very functional task of pouring materials in cooking!

Mindfulness Benefits of Scooping and Pouring- There is a mindfulness component to sensory play too. Have you ever tried using a zen garden to rake or manipulate sand using a sand tray? If so, then you know the power of mindfully manipulating sensory materials. This mindfulness activity works with children too. Many children find a scooping and pouring activity fun and relaxing. Use the scooping and pouring activity as a heavy work activity that adds calming proprioceptive input with visual attention. Help kids to focus on the sensory material as it slowly pours from the hands or from a cup to another cup.

If kids are moving too quickly or if they become overly excited with the sensory material, add slow movement, a calm environment, a set of “rules” before beginning the scooping and pouring activity, and a broom to clean up!

Sensory Benefits of Scooping and Pouring Activities– By experimenting with pouring, scooping, and transferring materials, children gain sensory benefits. This occurs through the proprioceptive input from manipulating the materials, as well as tactile sensory input.

I’ve found pouring and scooping activities to be very calming for children.  They love to watch the beads as they fill the scoop and watch them fall into the bowl as they pour.  Other children can become overly excited by the visual stimulation of scooping beads and soon the beads will scatter all over the table.  You can eliminate mess by doing this activity in a large bin like an under the bed storage bin.  

Scooping and Pouring Activities

This post contains affiliate links, but you can use items that you already have in your home.  We used plastic scoops found in food like cocoa powder, coffee, or iced tea mixes.  For the scooping, we used plastic beads that we already had, however, this activity will work with any small item such as rice, dry beans, field corn, pebbles, or sand.  Use what you’ve got on hand to make this activity free!

Materials for this scooping and transferring activity include:

  • Recycled plastic scoops (We do love our recycled materials activities around here!)
  • Small Plastic beads OR other materials to pour and scoop (Toddler-aged kids can use dry cereal or edible items. See below.)

This activity is very easy to set up.  

  1. Simple set out a bowl or tray of beads and scoops in different sizes.  
  2. Show your child how to scoop, transfer, and pour the beads into another bowl.
  3. Play!  

Precautions for Pouring and Scooping Activities with Toddlers

Just be sure to keep a close eye on your little one. Materials like dry cereal are great for starting out. However, if you try scooping activities with other materials like beads, toys, corn, dry beans, etc, it can be easy for them to forget they are scooping beads and not cereal!  

As with any activity found on this blog, use your best judgement with your children.  This activity, while beneficial developmentally, is especially a choking hazard for young children.  Always stay within hands-reach of young children with a developmental activity like this one.

If you are concerned with your child placing beads in their mouth, simply don’t do this one and put it on hold for a few weeks of months.  

Development of Scooping and Pouring skills in Toddlers

Note: Use edible materials for this activity with Toddlers.  Dry baby cereal or broken up finger foods (like Cheerios) are great.  For Toddlers, they will be focusing on simply scooping and pouring with accuracy.    

Grasping pellets (bead-sized items) is a fine motor skill that typically develops around 11 months.  Children at that age can grasp small pellets with their thumb and the pad of their pointer finger, with their arm positioned off the table.  Holding a scoop with either the dominant or non-dominant hand typically develops around 13 months of age.  

Toddlers will use an exaggerated elbow motion when they first begin an activity like this one and until those small wrist motions are developed.  

At around 15 months, Toddlers will be able to scoop and pour from a small scooping tool, although as soon as 13 months, many children are able to complete this activity.  

Managing a spoon during self-feeding happens around this age, as well, as children scoop food and bring it to their mouth.  It is messy, but they are able to get food to their mouth.

Using a scoop to move beads or spoon to eat develops with more accuracy at 15-18 months.

At around 12-13 months, children will begin to develop unilaterality in hand dominance.  They will begin to show a preferred hand that manipulates as the other, non-dominant hand assists in holding the bowl or tray.  

(Other kids don’t define a hand dominance until later.  You can use this activity in the preschool years to work on hand dominance!) You will want to use a wide tray or large bowl for improved accuracy in both scooping and pouring.  Try using a spoon for scooping the cereal pellets, too.  

Scooping, pouring, transferring beads and developing fine motor skills and hand dominance in Toddlers, Preschoolers, and school-aged kids. Plus learning ideas to use in scooping activities. From an Occupational Therapist.

Scooping and Pouring Preschool Activity

In the preschool years, sensory bin play with a concentration on scooping, pouring, and transferring is very powerful. It’s at the preschool age that motor skills become more refined. The dominant hand becomes stronger in preparation of pencil grasp and handwriting. The muscles of the hands are used in coloring and cutting activities.

Preschoolers can use scooping, pouring, and transferring activities for functional tasks and learning activities, but also development of motor skills needed for tool use like pencils, scissors, crayons, etc. Use crayons based on development, as we covered in a resource on the best crayons for young children.

Helping kids establish a hand dominance can be a pivotal moment for addressing fine motor skill development concerns. Kids can refine motor actions by using a preferred hand consistently.

Preschool aged children can refine their scooping and pouring activity using beads.

there are many benefits of scooping, pouring, and transferring. Include scooping activities for toddlers and preschool.

Hand preference in Preschool

While Toddlers begin to show a hand preference, a true hand dominance doesn’t typically develop until 2 to 3 1/2 years.  That is such a huge age range!  That is because while a toddler can show a hand preference, hand usage is experimented with during different activities throughout the Toddler and Preschool years.  

There is typically variability in hand preference as toddlers and young preschoolers poke, pick up, throw, color, and play.  Another consideration is that often times, kids of this age are influenced in which hand they choose by position of toy, location of the adult or playmate, method materials are presented, and sitting position of the child.  True hand dominance may not be completely integrated in the child until around 8 or 9 years of age.   

Knowing all of this, use this activity to practice and play while working on a hand preference.  If your child shows a preferred hand, set up the activity to work on scooping with the typically used hand.  If your kiddo uses their right hand most of they time in natural situations (You will want to watch how they do things on a normal day and in a variety of activities.), then set the bowl of beads on the left side of the child and the scoop on the right side.  

When using pouring and scooping activities in preschool, try these strategies:

  • Show them how to scoop from left to right.  A set up like this one also encourages the left-to-right motion of reading and writing.
  • Use a variety of materials: dry beans, rice, beads, dry cereal, flour, sand, shaving cream, water, etc.
  • Use a variety of scoops: spoons, coops, small bowls, cups, pitchers, mixing cups, measuring cups, etc.
Use beads, scoops, spoons, and bowls to work on scooping for toddlers, preschoolers, and kindergarten to develop fine motor skills.
Scoop words for a multi-sensory learning activity that uses scooping and pouring in kindergarten.

Kindergarten Scooping, Pouring, and Transferring Activities

For children in kindergarten and older, scooping, pouring, and transferring activities are powerful as well! You can use this pouring and scooping activity in math, learning, and sensory play-based learning.  

  • Work on measurement
  • Work on reading, spelling, and letter awareness. This sight word scooping activity is a great multisensory reading activity for kindergarten.
  • Use scooping in math to add or subtract scoops
  • Count the number of scoops it takes to fill a container
  • Use letter or word cards in reading or handwriting activities
  • Work on prediction- Ask them to predict how many scoops it will take to fill different sized cups and bowls. They can count the number of scoops and see if their prediction was correct.  
  • Incorporate addition and subtraction as they move scoops of beads from one container to another.  
  • Address motor skill development- Scooping works on important skills like bilateral hand coordination, including using the non-dominant hand to assist as they would in holding the paper in writing, coloring, and cutting with scissors.
Work on hand dominance, bilateral coordination, motor skills, and more by scooping, pouring, and transferring activities.

Pouring, Scooping and Transferring Activities

Try these various pouring scooping and transferring activities with each age range to develop specific skill areas depending on the individual child:

Use a variety of materials for scooping besides beads to work on fine motor control and dexterity.  Other ideas include wet sand (heavier and great for coordination and strength) and a light material like foam pillow filler (for more coordination and dexterity).

Water Sensory Bin Ideas– Use a bin and water, along with some scoops and other materials to work on motor skills, coordination, and refined movements. Scooping water takes precision and control, but it’s a great functional task for children.

Scoop Nuts– Use seeds or nuts to scoop and work on scooping different sizes, different weights. This is a great activity for graded precision, sorting, and eye-hand coordination.

Scoop Ice– This simple scooping and pouring activity uses just ice, water, and scoops. Children can work on eye-hand coordination skills to scoop up ice within a bin of water to work on controlled motor skills, utensil use, visual tracking, and more.

Scoop, pour, and transfer dry corn– Grab some un-popped popcorn and some bins or spoons to transfer materials from one container to another. This simple scooping and pouring activity is easy to set up and works for all ages.

More fine motor activities you will love

Use these Fine Motor Kits for hands-on activity kits to develop fine motor skills, strength, dexterity, and manipulation. Kids LOVE these fine motor kits for the motivating activities. Therapists love them because it’s fresh, fun ways to work on pinch, grip, manipulation skills, and much more. Try some of these themed therapy kits:

fall fine motor kit
Fall Fine Motor Kit
winter fine motor kit
Winter Fine Motor Kit
Spring Fine Motor Kit
Spring Fine Motor Kit
Summer fine motor kit
Summer Fine Motor Kit
Pumpkin activity kit
Pumpkin Fine Motor Kit
Outer Space Fine Motor Kit
Space Fine Motor Kit

Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.

Retained Primitive Reflexes & Child Development

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Retained primitive reflexes

This post is all about retained primitive reflexes, what retained reflexes look like, and how they impact child development. You’ll find specific strategies to integrate retained primitive reflexes as well. In a recent blog post, we discussed what are primitive infant reflexes, and why they are so important to infant development. Now, it is time to discuss what can happen if these reflexes hang around for too long. Remember that every case is unique, and if your child matches these characteristics, that does not necessarily mean that they have retained that reflex. If you are concerned about your child’s abilities and how they may relate to retained reflexes, we recommend talking to your pediatrician.

For more information on primitive reflexes and their impact on child development, be sure to check out some of these books on primitive reflexes.

Retained primitive reflexes

retained Primitive Reflexes

The term “retained primitive reflexes” might be a phrase you’ve heard before. But what does that mean and what do retained reflexes look like in children? Well, there is a lot to cover.

Basically, as infants develop into toddlers, their primitive reflexes should do what health care professionals call “integration”. The response that comes with the primitive reflex should integrate into a more mature or voluntary movement. When primitive reflexes are retained, those instinctive actions, movements will remain past the typical age range…they continue to exist. They are retained.

If primitive reflexes are still present long after they should have integrated, the child will display certain characteristics specific to the retained reflex, many of which limit their development and academic skills.

Just to add some background information, when we say that primitive reflexes are integrated, that means that the movements (or reflexes) are absorbed and contributing to characteristics, actions and neurological responses. To put it in other words, a reflex moves along a neurologic arc and when integration of those reflexes occurs, a process where specific stimulus results in a predictable response (or lack of that predictable response) so that movements are more efficient. This occurs so the neurologic system is connected and communicating efficiently. It’s all part of the nervous system.

PALMAR REFLEX

The palmar reflex is important for the development of purposeful grasping, something that an infant is learning throughout their first year of life. The palmar reflex can be seen when you place your finger in the palm of an infant’s hand and their reflexive response is to hold on to your finger. What an adorable reflex, right?

This is not something we want to see in an older infant or child, though. While the response is necessary for a newborn to learn how to use their hands, it limits an older infant or child to only using their hands and fingers for a strong grip.

retained palmar reflex

Children with a retained palmer reflex may:

  • Get fatigued very easily with handwriting or fine motor tasks, like stringing beads.
  • Have a sensitive or “ticklish” palm
  • Open and close their mouths while using their hands for tasks like writing or cutting with scissors.
  • Have difficulty in speech articulation

The mouth and the hands are connected via neural pathways in infancy, and that connection is still strong in those who have the palmar reflex. This is why the movements of the mouth and speech may be involved in the retained palmar reflex.

How to integrate the Palmar Reflex:

  • Tasks that encourage separate use the fingers
    • Squeeze a ball with one finger and thumb, alternating fingers to squeeze
    • Stringing Beads
    • Playing with small Legos or similar toys

MORO REFLEX

The Moro reflex is also called the startle reflex – it can be seen in a frightened infant up to about 4 to 6 months old. The reflex causes a baby to stretch out their arms and legs, and quickly bring them back in, in jerky movements. This is in response to the feeling of falling, a loud sound, or a drastic change in temperature.

Retained Moro Reflex

Children with retained Moro reflexes are often very sensitive to stimuli – sounds, tags on clothing, lights, etc. They tend to lack emotional and self-regulation skills and have a difficult time paying attention in class. Without an integrated Moro reflex, their fight or flight response can be activated very easily causing them to have deficits in many areas of life.

How to integrate the Moro Reflex:

  • Starfish Exercise
    • While seated, open up into a big “X” shape with straight arms and legs.
    • Cross right ankle over left & Cross right arm over left
    • Open up to big “X”
    • Cross left ankle over right & Cross left arm over right
    • Repeat
  • This is also how you can test for its presence! If a child has a very difficult time completing these actions, without another known cause, they may have a retained Moro reflex.

TONIC LABYRINTHINE REFLEX

The tonic labyrinthine reflex (TLR) is used for head and postural control. We know that baby has poor control of their head and neck when they are born, and this reflex is part of what helps them gain control over this part of their body.

Retained Tonic LABYRINTHINE reflex

This reflex typically integrates around 4 months old, but if it persists, the following may occur:

  • Difficulties judging space, speed, depth, and distance.
  • Toe walking
  • Discoordination in simultaneous movements, such as walking or swimming.
  • Avoiding lying on their stomach.

Children with retained TLRs tend to be perceived as clumsy and often have a difficult time sitting upright and still in their chairs. This can decrease their ability to pay attention in the classroom setting. When posture exercises in kids don’t work, sometimes it’s easy for teachers or parents to wonder what is going on, when a look at retained reflexes may be in order. In some cases, integrating the TLR reflex can support posture.

How to integrate TONIC LABYRINTHINE REFLEX

  • Incorporate activities on their stomachs as much as possible, or for as long as they can manage each day.
  • Try reading, watching TV, or playing with a toy while on their tummies
  • Daily practice will strengthen their muscles and correct this response.

ASYMMETRICAL TONIC NECK REFLEX

This reflex is important to the initiation of crawling, as the arms and legs move as a baby turns their head while on their belly. While infants are on their bellies, and while crawling, they are exposed to a ton of visual stimulation by looking at their arms moving, looking and grabbing toys, etc. Tummy time is so important for this reason and more!

The ATNR should disappear around the time an infant is gearing up for crawling, around 6 months old.

Retained ASYMMETRICAL TONIC NECK REFLEX

If asymmetrical tonic neck reflex doesn’t integrate, the following may occur:

  • Poor Coordination during movements like skipping or riding a bike
  • Trouble crossing midline
    • Example: Moving right arm to left side of the body to buckle a seat belt.
  • Poor visual tracking = academic issues
    • Difficulty reading and writing

A quick test for a retained ANTR starts with having the child stand with both arms directly out in front of them. Ask the child to slowly turn their head all the way to the left. Their left arm will remain straight and their right arm will bend if the reflex is still present.

How to integrate the ATNR

  • Lizard Crawling Exercise
    • Start on the stomach
    • Look to your left, and bend your left elbow and left knee
    • Look to your right, and bend your right elbow and right knee

There are many more primitive reflexes, as well as postural reflexes, that are important to child development and student success. We have not covered everything here, but we hope to have given you a nice place to start building your understanding of what may happen when primitive reflexes are maintained over time.

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

Messy Eating

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Benefits of Messy eating for babies and toddlers

Have you ever noticed that small children eat meals with recklessness? Bits of food covers the face, cheeks, hands, lap, floor, belly, and even hair. Part of it is learning to use utensils and manage food on the fork or spoon. But there’s more to messy eating too! Messy eating for a baby or toddler is actually a good thing, and completely normal part of child development. And, letting a small child get messy when they eat, and even playing with their food as they eat is OK!

Messy eating in babies and toddlers has benefits to developing tactile sensory challenges and fine motor skills in young children.

Messy eating

I’m sure that your mother never told you it was okay to play with your food at the dinner table, but I’m here to tell you otherwise. Playing with food is not only okay, it is vital to development of self feeding skills and positive engagement with food. When young children play with their food they are engaging in a rich, exploratory sensory experience that helps them develop knowledge of texture, taste, smell, changing visual presentation of foods and oral motor development.

When play with food is discouraged it can lead to food texture issues, picky eating, oral motor delays and increased hesitancy with trying new foods later on.

Eating with hands- Messy benefits

When solid foods are introduced to baby, it is often a VERY messy ordeal. There is food on the chair, the bib, the floor, you…everywhere but the baby’s mouth. Often times, parents may feel discouraged or don’t like the mess that is the result, but it is OK. In fact, the messier the better.

Exploring food textures with the hands provides tactile experience to the hands, palm, and individual fingers. Are foods sticky, chunky, goopy, or gooey? All of that exposure to the hands is filed away as exposure to textures.

Picking up and manipulating foods offers fine motor benefits, too. Picking up and manipulating bits of food offers repetition in pincer grasp, graded precision, grasp and release, eye-hand coordination, bilateral coordination, crossing midline, and proprioceptive feedback. All of this is likely presented in a baby seat or high chair that offers support and stability through the trunk and core. When that support is offered to babies and toddlers, they can then work on the distal coordination and dexterity. At first, manipulation of food is very messy as those refined skills are developed, but it’s all “on-the-job training” with tasty benefits!

Research shows that a child moves through a series of exploratory steps before successfully eating new foods. This process involves messy play from the hands, up the arms, onto the head and then into the mouth. The steps of this process cannot happen unless the child is encouraged to touch, examine and play with their food. In today’s culture of sterilization and cleanliness, this often counterintuitive to parents and a hard pattern to break.

Promoting Play with Food

Mealtimes can be rushed affairs, making it hard to play with food, but they are not the only times we engage with food throughout the day.

Cooking and meal prep are two of the most common opportunities for play and engagement with food. These activities present perfect opportunities for parents to talk about color, size, shape, texture, smell and taste of the foods that are being prepared. Use of descriptive words,
over exaggeration when talking about and tasting foods, along exploration opportunities develop a positive interest in foods.

Babies can be involved in kitchen prep as they play with appropriate utensils and kitchen items like baby-safe bowls or pots. Toddlers enjoy being involved in the food preparations and can wash, prep, and even chop soft foods with toddler-safe kitchen tools.

Explore these cooking with kids recipes to get small children involved in all the benefits of the kitchen.

Here are more baby play ideas that promote development.

Food Art

Free play with foods like yogurt, jello and applesauce are also great opportunities to promote messy play and creativity. Utilize these foods for finger painting, or painting with other foods as the brushes. This activity challenges tactile and smell regulation, along with constant changes in
the visual presentation of the food.

Creativity with Food

When presented with food for free play, or at the dinner table encourage their creativity–carrot sticks become cars or paint brushes, and raisins become ants on a log.

The sillier the presentation, and more engaged the child becomes, the more likely they are to eat the foods you have presented to them. Especially, if these foods are new, or are non-preferred foods. High levels of over exaggeration also leads to increased positive experiences with foods, which in turn leads to happier eaters, and less stressful mealtimes
down the road.

Ideas like these flower snacks promote healthy eating and can prompt a child to explore new textures or tastes in a fun, themed creative food set-up.

Messy Eating and Oral Motor Development

Not only does play promote increased sensory regulation and positive engagement with foods, it also promotes oral motor skill development.
Oral motor skill development is promoted when a variety of foods are presented and the mastered skills are challenged.

Here is more information on oral motor problems and feeding issues that are often concerns for parents. The question of feeding concerns and picky eating being a sensory issue or oral motor motor concern comes up frequently.

Foods that are long and stick like such as carrots, celery and bell peppers, promote integration of the gag reflex, along with development of the transverse tongue reflex that later supports tongue lateralization for bolus management.

Foods such as peas, or grapes promote oral awareness and regulation for foods that “pop” when bitten, and abilities to manage multiple textures at one time.

Messy Eating and Positive Mealtimes

Whether you have a picky eater, or are just trying to make mealtimes fun, play is the way to go!

Play with food is critical to development of oral motor skills and sensory regulation needed to support positive meal times. Through the use of creative play, exposure, and over exaggeration these milestones can be achieved.

Although the goal is for your child to eat new foods there are many steps we need to conquer before getting there. Don’t worry, these can be fun and stress free! 

Let me ask you a question. If you were presented with a new food, something so new and anxiety provoking that you don’t want it near you and you definitely don’t want to touch it; do you think you would want it anywhere near your mouth? About in your mouth? Even more, how about swallowing it? The answer for most would be NO WAY! 

Well, we can’t expect the same from our kids. If they don’t want to look at or touch a food, they most definitely will not want to eat it! So before getting kids to put new foods near or in their mouth, we need to take several steps back and learn how to interact with it. This is where the fun can come in! 

This week we are going to experiment with various ways of play or interacting with foods. Remember, the goal in not to eat it. The goal is simply to interact with it and hopefully to start getting messy with it! Let’s kid you child comfortable with touching food and have fun doing it. This will not only get them a few steps closer to eating it, but it will also build positive associations with the food and also make them more comfortable with various aspects of it. This can include the color, texture, shape, smell, etc. The more foods we play with, the more of these they are feeling comfortable with. So in short, let’s start our food journey with our hands and our eyes by getting messy! 

10 Ways to Support a Child’s Milestone Development at Home!

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Support milestone development in natural environments at home

Every home is different, but here are some options for you to be able to swiftly encourage milestone development during your normal, everyday life. While they do have their benefits, child growth and development doesn’t require fancy play centers, playgroups, and activity centers. Here you will find easy ways to integrate child milestone development right into the daily family life at home. Here is information on child development to get you started.

Use these easy ways to support milestone development at home when getting out of the house is difficult.

If you just read the word “milestones” and still aren’t so sure what that means, you are not alone! You can also pop on over to The Child Mind Institute to learn more about what milestones are.


You don’t need a bunch of fancy equipment to help your child reach their milestones, even if they show signs of delay. I hope that this list of ideas will spark ideas of your own so that your family’s needs can be met in ways that work for you.

That is really what the natural environment is all about. Contrary to its name, it isn’t about green trees and blue skies or organic fruits and vegetables. The natural environment is wherever your child spends their time. Often, it is considered their home, but it could be the library, or the park, or grandma’s cabin. The point is that the natural environment is somewhere that is a recognizable, comfortable, and safe place for your child.

It just so happens that this magical place is where most of their development takes place, and that is why it is so important to use these spaces effectively for the naturally-occurring learning opportunities they provide!

These strategies to support milestone development can happen in the home.

How to Support Milestone development at home

For starters, I would like to kick off this list with a few overarching ideas to support development right in the day-to-day tasks of everyday life at home. There is so much development to be had by involving your child in things that are done in and around the home.


ONE: PUT THEM TO WORK
Playing and chores alike help your child reach their developmental milestones. In order to reach fine motor milestones and gross motor milestones, those little muscles need to be challenged!


TWO: INTEGRATE INTO YOUR LIFE
If you are doing laundry, your kiddo can help push laundry baskets to develop their gross motor muscles. If you are making pancakes, they can pop little chocolate chips in one by one to work on fine motor skills. Setting aside extra time for your baby’s milestones is not always necessary.


THREE: SHARE WITH YOUR BABY
In some ways, treating your infant or toddler to a friendly conversation is all that it takes to give them a little extra boost in communicative and cognitive development. Talk to your baby, share your interests, show them your work. This will strengthen their understanding of your spoken
language, and encourage them to use their mouths and faces for communication, too!

5 WAYS TO SUPPORT YOUR CHILD’S MILESTONES IN THE
NATURAL ENVIRONMENT

1. Support your child’s Development with family workouts

Family workouts are a great way to support milestone development and health and wellness of the whole family! Use at-home workouts to ensure that your baby gets in their tummy time (and more!) is to encourage your baby to work out with you. If you lift weights, your mischievous 18-month-old can lift his stuffed animals, books, wooden blocks, or whatever else may be around.

Or, maybe you are more of a yoga mom, and you and your toddler can work on balancing poses or squats like chair pose or goddess pose. You’ll feel great not only because you got in some exercise time – but also because you are helping your child become stronger!

2: Support developmental milestones in the kitchen

Use meal preparation times to your advantage! Cooking with kids in the kitchen offers powerful experiences for child growth and development. If you like to bake, offer your little one some dough to smash and squeeze between their fingers. Their blossoming fine motor skills, like handwriting, will thank you.

Baking is often rich in sensory experiences as well; the smells, the
textures, the tastes! Sensory-rich experiences like these are integral to the healthy development of the sensory system.

There’s more; cooking offers opportunities to develop direction-following and other cognitive development as well.

The next time your game-day guacamole needs smashing, you’ll know who to call.

3: Support motor skill development with chores

We know how much of your days are filled with laundry. It feels like it’s a never-ending cycle (no pun intended). Why not recruit some help? Your little one can help you out at their level. If they are able to distinguish between colors and reach, grab, and place objects, then they can
separate your whites from your colors. Maybe that is a bit too advanced: instead, they can take your sorted piles and throw them in the washing machine. When you’re done, have them push, pull, drag, carry – whatever they can manage – that laundry basket to its destination.


This strengthens so many skills. We’re talking fine motor, gross motor, cognitive, and sequencing skills. Plus, you can make something as dull as laundry day a bit more interesting.

4: Promote child development with day-to-day tasks

Supporting cognitive milestones can be done right in the home. Anytime you need to get some grown-up desk work done, your child can do their work, too! Offer them a pencil and paper – I am sure they would love it if they got to use something from your work bag – and let them get to it! Now they are kept busy so that you can have a few
moments to complete your schedule, email your colleagues, or document your tasks that week.

Allowing them the opportunity to use various writing utensils, instead of just one kind of chunky crayon, gives their little hands and fingers a challenge.

Strengthening their grasp will improve handwriting outcomes as well as things like dressing ability (hello, buttons and zippers!) and independent skills in achieving feeding developmental milestones. Not to mention the visual motor development that coloring can offer.

5. Support child development with downtime

Some days, all you can do is keep everyone alive. Maybe it’s putting on some Bee Gees and dancing to their classic hits because if you didn’t, mental breakdowns would ensue.

Dancing is great for growing bodies! Or maybe you just need time away inside of a good book, and your baby can cuddle your chest while you read. They can also peruse a book of their own while you take your escape. No matter their age or abilities, don’t overwhelm yourself, do what you need to do to keep your family safe and happy.

Looking for more? Click here to learn more about occupational therapy for babies!

For more ideas on milestone development and child development, head over here to get ideas for play based on your child’s age.

References

  1. Woods, J. (2008). Providing early intervention services in natural environments. The ASHA
    Leader, 13(4). https://doi.org/10.1044/leader.FTR2.13042008.14
  2. Butcher, K. & Pletcher, J. (2016, December). Cognitive development and sensory play. Michigan State University Extension. https://www.canr.msu.edu/news/cognitive_development_and_sensory_play
  3. The Center for Vision Development. (2020). Visual motor integration.
    https://www.thecenterforvision.com/visual-motor-integration/

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

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