What is Torticollis?

What is Torticollis?

By Nichole Hagerty, DPT

Bringing home your precious newborn is an exciting yet nerve wrecking experience.  Parents will lay awake staring at their little girl, conscious of all their movements.  Her baby pictures will fill your walls, office spaces, and phones.  You will spend endless amounts of time hoping and praying she is perfect.

But then something seems off.  She only looks to the left.  In all of the pictures, her ear is constantly on her shoulder.  When she is placed on her stomach, she will continue to look left, but never right.  As the sleepless nights continue, you begin to notice her head shape is changing.  She begins to have a small flat spot because she is consistently looking left while keeping her ear tilted toward the left shoulder.

You become concerned.  Others may tell you not to worry, that your baby will grow out of it.  But your gut instinct is telling you something is wrong.  A pediatric physical therapy evaluation will determine if your child is affected by torticollis.

Torticollis, derived from the Latin words tortus for twisted and collum for neck, is the tightening of the sternocleidomastoid (SCM).  The SCM is a muscle that goes from the mastoid process of skull to the sternum and clavicle.  You have a right and left side SCM.  When the muscles work together, they flex the head forward.  However, when one is working alone, you bend your head sideways to the right and rotate your head to the left.  This is what occurs when a child has torticollis.  One of the muscles is tight, possibly due to positioning in the womb, birth trauma, or positioning after birth.

The incidence of Torticollis has been steadily increasing since 1997 with the introduction of the “Back to Sleep” campaign.  Not only is your child sleeping on her back, she is often times spending a lot of time in her car seat, her swing, her bouncer, and all of this wonderful baby holding equipment.  However, she is not spending enough time on her stomach.  She is not learning how her body works.  She has difficulty with being on her stomach and has not developed the neck extensors to lift her head that will allow her to explore her world.  Once these are developed, she needs to learn to play on her tummy without as much support, but still being supervised.  She needs to be able to reach and play with both of her hands equal. She needs to discover her body. The best way to do this is to spend time on her stomach.

Torticollis is typically treated with changes in positioning at home, as well as specific strengthening and stretching exercises.   A physical therapist can teach you simple stretching exercises to perform daily at home with your baby.  As time continues, physical therapy will progress to more strengthening exercises.

The best way to decrease continued pressure on the back of the head is to increase the tummy time.  For more reading on tummy time, read our blog post from Kids Place’s Teri Roberts, DPT.

Torticollis is not preventable, but it is treatable with an early referral to a Pediatric Physical Therapist and committed parents who follow the home exercise program recommended by the therapist.  Ask your pediatrician for a physical therapy evaluation if you are concerned your newborn is suffering from torticollis.



Articles referenced:

• Boere-Boonekamp M, van der Linden-Kuiper L. Postional preference: prevelance in infants and follow-up after two years. Pediatrics. 2001 Feb; 107 (2):339-43
• deChalain T, Park S. Torticollis associated with positional plagiocephally: a growing epidemic, J. Craniofac Sugery. 2005 May; 16(3): 411-8
• Do T. Congenital Muscular Torticollis: Current concepts and review of treatment. Curr Opin Pediatr. 2006 Feb; 18(1):26-9.

What is Sensory Integration and Why is it Important in a Child’s Development?

What is Sensory Integration and Why is it Important in a Child’s Development?

By: Liezel Fernandez, OTR/L

Pediatric Occupational Therapist at AZOPT Kids Place

Does your child have difficulty engaging in tasks?  Do they overreact to movement activities like swinging or even when their feet leave the ground? Maybe your child walks on their toes, dislikes textures or messy play, or covers their ears and negatively reacts to loud noises like a vacuum or fire alarms.  Do they refuse bathing, nail cutting, or tooth brushing?  Chew on pencils or other objects?  Does your child seek all kinds of movement, crash into walls, or lack safety awareness?  These are some of the possible signs that a child has difficulty in processing sensory information.

Sensory Processing/Sensory Integration is when our different sensory systems work together to process different sensations from our body and/or environment. When this occurs, we are able to identify and give meaning to the different sensations we experience to accomplish daily activities and move in a coordinated manner. Adversely, Sensory Processing Disorder is the inability to receive and efficiently use sensory information. Difficulty in processing sensory information interferes in our daily activities and impacts our functional ability to perform different tasks.

Our sensory systems tell us what is going on around us or in the environment. Our bodies absorb different sensory inputs, which our brain then interprets and translates. We have 7 different sensory systems that we must know: proprioception, vestibular, tactile, auditory, olfactory, oral and visual.

The Proprioceptive system (position sense) commands our body position in space, timing of movements and amount of force we are exerting during activities.  It is necessary to have a strong proprioceptive sense to develop good body awareness, motor planning and coordination.  Proprioceptive input helps calm a child, improves attention and boosts focus.  Heavy work, deep pressure and resistive activities can strengthen the proprioceptive sense.

Example of Proprioceptive activities: (Calming/Organizing)

• Deep pressure massage
• Joint compression
• Wheelbarrow walk
• Animal walks (crab walk, bear walk, seal walk, etc.)
• Chair push up
• Wall push up
• Pushing and pulling activities
• Playing tug of war
• Carrying groceries or books
• Riding a bicycle
• Swimming
• Popping bubble wraps

Our Vestibular system (movement sense) regulates tolerances to changes in movement, position in space and sense of balance.  Children with difficulties or irregularities in vestibular system are either over responsive/hypersensitive or under responsive/sensory seeker.  Vestibular input can be calming or alerting.  Slow repetitive movements tend to be calming.  Fast, jerky movements tend to be alerting.  A strong vestibular system is necessary to improve balance and postural control.

Examples of Vestibular activities:

• Swing
• Somersault
• Log rolling
• Figure eight walk
• Spinning using a swivel chair
• Bouncing or inverting on a therapy ball
• Playground slides
• Playing hopscotch or a balancing game
• Slow rocking
• Jump rope
• Jumping jacks
• Sit ups

The Tactile system (sense of touch) allows us to determine the location of touch, amount of pressure, pain and temperature.  It helps us to differentiate types of textures, size and shape of objects in the environment. Tactile system is necessary in developing fine motor skills.

Example of Tactile input/activities:

• Playing with Play doh or putty
• Sand, water, rice play
• Lotion massage
• Use of hand fidget toys
• Giving hugs
• Finger painting or messy play
• Use of vibrating toys

The Auditory system (sense of sounds) recognizes and interprets sounds in the environment and our ability to respond to it.

Examples of Auditory Input

• Listening to classical or slow music
• Use of headphones
• Singing
• Nature sounds
• Play musical instruments
• Humming
• Labeling sounds

Our Oral system processes different tastes, textures and input inside the mouth.

Examples of Oral input

• Blowing bubbles
• Use of straw when drinking
• Blowing whistles
• Exploring different taste and texture of food
• Calming:
• Sweet – lollipop, hard candy, fruits
• Chewy – bagels, gum, gummy candy
• Warm food- soup
• Alerting: Salty, crunchy, sour, spicy and cold food

Our Olfactory system processes and responds to different odors. Examples of Olfactory input

• Scented candles
• Calming scents – vanilla, lavender, sweet orange
• Alerting scents – peppermint, lemon/lime

The Visual system gives us information about what we see in the environment. Example of Visual input

• Dimming lights
• Completing puzzles, mazes, dot to dots
• Decreasing visual distractions/use of environmental modifications
• Looking at picture books
• Playing I Spy
• Putting out less toys to avoid visual overloads

If you believe that your child is experiencing any of the difficulties mentioned, then you may seek assistance from a licensed Occupational Therapist.  An Occupational Therapist will evaluate and assist in the development and/or strengthening of these areas through therapeutic interventions.

Call Kids Place at (623) 229-7808 for more information or to schedule an evaluation.

Tips For Encouraging a Picky Toddler to Eat

Tips For Encouraging a Picky Toddler to Eat

By: Colleen Riordan, M.A., CCC-SLP

Licensed Pediatric Speech/Language Pathologist

Between the ages of 2 and 3, your child will likely go through a phase of “picky eating”.  This may range from a mild resistance to trying new foods , all the way to full-out screaming tantrums at the dinner table. While frustrating, it is important to continue to encourage your toddler to eat what the family is eating, and not give in to the temptation of offering only preferred foods.

It may help to know that  we are one of the few cultures in the world where children are routinely offered  highly processed and aggressively-marketed “kid foods”, such as chicken nuggets, macaroni and cheese,  pop tarts and tiny cheese crackers. Getting stuck in this pattern can easily turn parents into short-order cooks, preparing one meal for the children and another for the adults. It can also reinforce  food  refusals; if a child knows he will eventually get the hot dog,  there is no real motivation to try anything new and behaviors can increase.

Here are some tips for encouraging a picky toddler to eat:

• Present new foods in very small amounts to avoid overwhelming your child.
• Cut food into fun new shapes.
• Offer foods with dips your child already enjoys, such as ketchup or ranch.
• Continue to offer foods that were refused in the past; it takes multiple tastes for most people to determine if they like a new flavor.
• Present foods on divided plates or plates with fun pictures/characters under the food.
• Avoid mealtime battles by giving your child choices, both of which would be acceptable.
• Expose your child to new foods in more exciting ways:  let her help with grocery shopping, look at pictures in cookbooks, plan a meal together, visit farmers markets, plant a garden!
• Avoid “grazing” ; if your child is eating or drinking throughout the day, he is less likely to be hungry at mealtime. Adhere to a 3 meal/ 2 snack schedule.
• Eat meals together whenever possible, with your toddler remaining seated for the meal.

Check out these other helpful articles on picky-eating toddlers:

• The Mayo Clinic – Children’s Nutrition: 10 Tipsfor Picky Eaters
• Baby Center – How to Handle a Picky Eater
• NY Times – Picky Eaters?  They Get it From You

We would love to hear your feedback.  What do you do to encourage your picky eaters to try new foods?  Leave your ideas in the comment section below.

Couch Potato Children – Tips to Get Them to be Physically and Mentally Active

Couch Potato Children – Tips to Get Them to be Physically and Mentally Active

By: Bobbi Michels, PT, Kid’s Place

It’s a Saturday morning, and already we can hear the kids:

“Mom, it’s my turn to play on the computer!”

           “Can I watch T.V?”

                     “No, I want to play an X-box game!”

Oh boy! How many of you hear the same from your children?

Staying active with older children is a challenging, but vital tool to maintaining a healthy lifestyle, not to mention fun! The question is - how I can stay active and avoid another electronic, couch-potato filled weekend?

First, let’s discuss the negative impact of a couch-potato filled weekend.

According to the Arizona Department of Health Services, “the lifestyle changes that accompany the current advances in technology have equated to more screen time, less physical activity and more fast food¹.” The unfortunate reality of this situation is that diabetes is on the rise. In the last ten years, the number of adults diagnosed with Type 2 diabetes has more than doubled. The report goes on to explain “diabetes is inextricably tied to obesity and inactivity and this ongoing problem is becoming a public health crisis of epidemic proportion. Nearly 1.2 million people in Arizona are obese, 477,649 more people than 10 years ago. Arizona is tenth in the nation for obesity.”

So back to the question – “how I can stay active and avoid another electronic, couch-potato filled weekend?” The answer: fun, fitness activities that challenge our children physically and mentally.

There are three basic elements to fitness: endurance, strength and flexibility. It is important to incorporate these into your activities. Currently the Center for Disease Control (CDC) recommends 60 minutes per day of exercise for school aged children.

Here are several great reasons to encourage children to exercise:

1. Children who exercise have leaner body composition, less fat and are less prone to becoming overweight or obese. Those who are already overweight can lose those excess pounds through exercise³.
2. Exercise increases bone density, which keeps bones strong and resilient.
3. Children who exercise regularly are less likely to develop diseases or chronic illness such as diabetes, allergies, heart and respiratory issues. 
4. Exercise is also linked to a decrease in mental issues like depression, anxiety, and attention deficit disorders.
5. Exercise will improve blood flow, aiding in overall growth and oxygenation of muscles.
6. Exercise stimulates new neuron growth in the brain resulting in increased cognition, focus and rapid reaction times.
7. Children who exercise often sleep better, enabling them to handle daily challenges that come their way.

Thankfully, Arizona offers several indoor and outdoor activities that will challenge our children’s physical and mental abilities. So go crazy! Try new things like hiking, horseback riding, or a fitness class. Play traditional games like volleyball, basketball, flag football and soccer. Expand the “fun” in exercising trying activities like paintball, Frisbee golf, and trampoline jumping. Or just hit a bucket of golf balls at your local driving range. Rock climbing gyms where everyone can participate can encourage a little fun family competition. In the summer enjoy a cool trip to Polar Ice for open skating. You will be glad to get back outside to the heat!

 

As a family, we have enjoyed many outings to encourage our children to get up and moving while building special family memories. Most recently, we completed the IMS Arizona Marathon 5k. Below are some more ideas of places you can take your children to encourage fitness and activity. These are just some examples. I’d love to hear some of your ideas. Leave me a comment below and tell us where you go or want to go to get your kids outside and moving.

• Hit a bucket of golf balls at Valley Golf Center
  • (623) 935-9351
  • 12247 West Indian School Road, Avondale
• Go on a  Arizona Horseriding Adventures or Old West Party Adventure
  • (623) 640-3814
  • 14629 W. Peoria Avenue, Waddell
• Explore the desert on horseback with  White Tanks Riding Stables
  • (623) 935-7455 - 20300 W Olive Ave, Litchfield Park, AZ
  • (623) 640-3814 - 14629 W Peoria Ave, Waddell, AZ
• Roller around at Skate Zone
  • (623)925-0179
  • 13550 W. Van Buren Street, Goodyear
• Everybody loves to bowl - Brunswick Tri City Bowl
  • (623) 932-3388
  • 1425 N Central Ave, Avondale
• Try some intense fitness at CrossFit Fury
  • (623) 932-4338
  • 540 N Bullard Ave #15, Goodyear
• Kids versus adults at Tempe Paintball
  • (480) 966-1900
  • 1401 S. McClintock Dr.,
Tempe
• Bounce around at  Jump Street
  • (602) 889-0081
  • 5665 West Bell Road
, Glendale
• Climb together at  Phoenix Rock Gym
  • (480) 921-8322
  • 1353 E. University Dr., Tempe
• Another kids versus adults, without the paint - Stratum Laser Tag
  • (480) 545-5500
  • 1455 S. Stapley Drive, # 11, 
Mesa
• Cool down indoors at Polar Ice Peoria
  • (623) 486-0386
  • 15829 N 83rd Ave, Peoria
• Skate, bike, play basketball, or walk around at Dust Devil Park
  • 107th & Camelback

What are you waiting for? Get up and go have major fun exercising and staying healthy as a family!!

1. ARIZONA DIABETES BURDEN REPORT: 2011 http://www.azdhs.gov/azdiabetes/documents/pdf/AZ-Diabetes-Burden-Report_2011.pdf
2. Arizona - Number (in Thousands) of Adults(aged 18 years or older) with Diagnosed Diabetes, By Age, 1994 - 2010 http://apps.nccd.cdc.gov/DDTSTRS/Index.aspx?stateId=4&state=Arizona&cat=prevalence&Data=data&view=TOPA&trend=prevalence&id=1
3. http://www.livestrong.com/article/358542-physical-benefits-of-exercise-for-children
4. http://kidshealth.org/parent/nutrition_center/staying_fit/exercise.html

Concerned about Your Child’s Handwriting? Try These Helpful Tips

Concerned about Your Child’s Handwriting?  Try These Helpful Tips

By: Josh MacDonald, OTR/L

www.SharonsCreativeCorner.com

Increasing expectations in pre-school and kindergarten can mean children are learning to write much earlier than before.  This has the potential to create multiple issues with your child’s handwriting.  Gripping the pencil tightly, wrapping the thumb completely around the pencil, the hand becoming tired out easily, or letters appearing choppy without any smooth lines can all indicate your child has fine-motor coordination delay or weakness.

'Fine motor' refers to the development of small muscle movements of the hands which develop as your child's whole body gains mobility, stability, cognitive, and emotional/social development.   Unfortunately, the hands of 3 to 5 year old kids are often not developed enough to manage the accurate fine motor requirements of handwriting without specific warm-up and training.  The in-hand manipulation skills required to make the small, smooth circles and straight lines are often more challenging than many kids are ready for at this stage.  Nevertheless, schools have increased writing in the curriculum resulting in many kids who are struggling to keep pace.

There are solutions that can be effective for many of these kids.  If the challenges are minimal and the child is motivated, some of the following suggestions may bridge the gap and improve their performance:

Play with Play-Doh!

Improving overall hand strength, including the smaller muscles in the hand, will help prevent fatigue and increase muscular endurance.  Have your child play with Play-Doh or 3 to 4 containers of silly putty at the same time.  Making large and small balls, rolling out snakes, and using tools to ‘work’ the Play-Doh will all help strengthen the hands.

Count Your Pennies

Coordination of the fingers plays a big part in handwriting.  The ability to manipulate objects with coordination and accuracy will greatly improve the accuracy of letter formation.  Try playing with pennies and nickels, picking them up from the table and transferring them from the palm to the finger within the hand.  Using a small coin bank with a slim slot will encourage the use of finger tips for accuracy of placement.

Arts and Crafts

Cutting small items, beading or working to glue small items will all help to develop awareness and coordination of the hands and fingers.  Whether it is cutting out shapes from paper plates, or coloring in small spaces, craft time is a great way to help kids with hand skills.

Tools Make a Difference

Minor equipment changes can also help with handwriting.  Using crayons broken into 3 smaller pieces or very small pencils prevents ‘over gripping,’ and will encourage use of fingertips and result in more accuracy.  You can also try one of the many different pencil grips available on the market.  There is no one magical grip that works for everyone.  Try several of them and stick with one of it makes a noticeable difference.  You don’t want your child becoming dependent on this grip, so limit it to either only homework time, or only school time.

Each of these is offered as suggestions and may not, independently solve the problem.  Your child may need more involved help.  If this is the case, occupational therapy may be necessary.

If you are concerned with the overall development of your child, contact Kid’s Place for a Complimentary Developmental Assessment.  Our complimentary developmental assessment is a 15 - 30 minute exam performed by a licensed physical, occupational, or speech therapist to assess developmental concerns with respect to gross motor, fine motor, or speech.  Based on these results, our therapists will make recommendations for your next steps, which may include following up with a medical doctor.  Additionally, you may be shown simple exercises for the home to improve physical development.  

To schedule a Complimentary Injury and Performance Screen or for more information, simply call (623) 229-7808.  Appointments are required.