Floor Sitting

Do you sit on the floor at least once a day? Does your child sit on the floor for activities such as art & crafts, or for eating snacks and meals? 

Do you sit on the floor multiple times in a day? How long do you sit on the floor each time?  When was the last time you sat on the floor? I urge all young adults and middle-aged individuals to reflect on these questions. With older adults, and people with joint issues (hip-knee-ankle-low back pain), it becomes a different scenario.

Why do I emphasize sitting on the floor frequently or often through the day? The number of times you rise from the floor, with or without hand support, has a positive effect on your heart and lungs. The capacity to engage in physical work in terms of frequency and duration is known as endurance, and reflects the health of your cardiopulmonary system. The number of times you get down to the floor and rise up into standing reflects your endurance.

Multiple benefits of sitting on the floor Sitting on the floor for work or sitting on lower surfaces that are shorter than regular chairs provides a different feeling or emotional groundedness. This is something that cannot be described in words, but is an experience to be realized. 

Better flexibility in all the joints of your lower body is a huge plus in a few days after you periodically get down to the floor and later rise up. 

Regular habit of sitting on the floor positively influences your gut health and the digestive system, and provides a deep sensory input to your abdominal cavity.  

You will feel lighter in your body and supple in your general movements.

Benefits of floor sitting will take you a long way physically and emotionally.

                                              Photo Credit : Freepik.com 

Individuals who have no joint problems and wish to start floor sitting, need to do it gradually. You can start by sitting on lower surfaces such as a 12” height stool or a ‘peedah’ or ‘modha’ that are old-style furniture still seen in many Indian homes. For work, you can put your laptop on the center table or coffee table.

In my practice, I see so many children in grade school who either have difficulty with sitting on the floor or can’t sit on the floor for at least 8-10 minutes. These difficulties are either due to decreased flexibility of hips & knees or due to lack of habit (practice) or both.

 

Myth: Sitting on the floor is not important anymore, we don't need it.  In the contemporary world, we think about anything through the objective lens, trends, and scientific evidence. We quickly accept or reject something based on a bunch of papers and numbers. As a physical therapist, I wish to point out the value of sitting on the floor, it is a topic that is debatable and holds limited scientific evidence. However, when viewed in a different perspective, sitting on the floor has been a common practice across all the ancient cultures of the world. In India, we sit on the floor for all our religious functions. Although the Indian toilet that required squatting has disappeared from the middle and upper classes, the squat position is commonly used by laborers, farmers, and domestic helpers. 

Look around in your immediate environment. The domestic helpers, cooks, and gardeners may be older than you, but are able to get down to the floor with ease. It is because they do so frequently in their life throughout the day. This is called ‘practice’ or ‘repetition’ or being used to it. 

So remember to sit on the floor if you still can,  or sit on a pillow or a cushion, or sit on a lower height of 10-12”.  There is nothing wrong in taking hand support of any furniture while getting up. But do not give up on floor sitting while you are in your 30s and 40s. If you do have pain in any joints, contact a physiotherapist and take charge of your flexibility. Do not forget the habit of sitting on the floor. 

More importantly, get your children to sit on the floor for many tasks. Make it a habit - frequently throughout their time at home. They can sit on the floor in various ways, but not in W-sitting! Remember that frequently sitting on the floor provides you with a feeling of connection to gravity, to Mother Earth! It is a great feeling that is fast being forgotten. 

Moments of Learning in the Natural Environment

Just as a young child needs to learn how to take a bath, use the toilet, wash hands, feed, and dress independently; they also need to learn some basic chores at home.  I have advocated for engaging children in house chores to so many parents – regardless whether the child is on a typical progression, has autism, or has sensory processing differences, or diagnosed with attention deficit, or demonstrates handwriting issues.

Creating Opportunities  Home is the natural environment for a child, where they spend the most time with family, while engaging in daily routines. Everyday tasks that seem mundane to many of us, but yet need to be done, can provide learning opportunities for young children. These learning opportunities can be rich and varied, 2 components that are so important for motor planning and motor learning. 

The best part is that the child can learn within the house. Don’t miss out on creating opportunities of learning for your child right at home!

In the contemporary fast-moving world, doing house chores is looked down upon, under rated, or thought unessential. However, as a mother of 2 children and as a pediatric therapist, I always believed in the value of learning basic chores early on in life.  These tasks are functional, and are important  survival skills that are required to be done daily or frequently--

• ·       Carry plates and utensils to the sink after a meal.
• ·       Wipe tables.
• ·       Water the plants.
• ·       Fold clothes and towels.
• ·       Dry clothes on a rack.
• ·       Clean up own room.
• ·       Peel boiled potatoes.

Family time & Bonding  Home chores are shared responsibility where family members can work together, thus spending quality time that leads to bonding. You can use the time to communicate with your child while doing the task. For your child, the bonuses are elevated confidence, increased self-esteem, and learning to take responsibility.

While consistently engaging in tasks frequently and consistently at home, your child learns problem-solving and motor planning.  A little progress each day or week, adds up to big changes in life such as providing a sense of accomplishment and boosting self-confidence.

This may come as a surprise to many parents, that the longest study at Harvard found a strong connection between doing house chores in childhood and happiness and success in later life.

https://mcc.gse.harvard.edu/whats-new/chores-caring-kids

Value based Tasks There are logical and scientific benefits of learning basic chores - primarily the variation in movement as well as the demand to problem-solve -- factors that lead to neuroplasticity in the brain, that is the purpose of any therapy provided to children with special needs.  In other words, creating changes in the brain and building neural networks in response to experiences.  This is akin to learning a new language or playing music. Please read my blog post

https://sensoryintegrationbangalore.blogspot.com/2016/10/home-choresessential-functional-training.html

Pulling wet laundry out of a washing machine, putting the heavy wet clothes into a bucket, and pushing the bucket towards the drying rack are all examples of tasks that provide proprioceptive, vestibular, and tactile input. Combining all of these tasks becomes a house chore as a whole.

Watch the following video that shows Activ Kaarya kids engaging in various tasks at home. Each of them has autism. 

All the children in the video had motor difficulties, tactile defensiveness, repetitive stimming, restlessness, lack of sitting tolerance, and poor ability to follow commands.  After a time of 12 – 18 months of therapy at Activ Kaarya, each of them gradually started engaging in small chores at home. 

It is so heartwarming to see the children work in their natural home environment as a process of learning. 

Parents also deserve credit because they took the effort to work with their child at home based on therapist suggestions. 

• ·       pulling off dry anjeer / dry figs from its string
• ·       putting items in the refrigerator
• ·       peeling boiled potatoes
• ·       pulling clothes from a drying line
• ·       squeezing orange juice manually
• ·       organizing washed utensils
• ·       folding clothes
• ·       picking greens
• ·       cutting string beans

Children with special needs take a longer time and many more repetitions to learn any task as compared to children on a typical developmental course. 

Sensory-motor tasks practiced during therapy sessions can be carried over at home in the form of house chores.  Early on at the commencement of sessions, we encourage children to put away equipment such as pillows, scooter board, mats, heavy bean bags etc…providing some physical assistance as needed. Samples of such sensory-motor tasks during therapy sessions at Activ Kaarya are shown in the following video –

Home chores are functional, and require movement of head & body in various directions, turning the head and body, reaching, bending, squatting, using both hands together. Hence the child receives various sensory benefits while learning tasks that are functional and essential. 

Do not miss out the value of learning tasks at home!

#bodyrotation #bilateralintegration #childdevelpment #sensorydevelopment #sensoryintegration #tactile #proprioception #movement #functionaltraining #learning #homechores #housework #tasks

 

Weighted Vest

Can we use weighted jacket for my child? Is a weighted blanket beneficial? Can a body sock help?

These are questions that parents ask me frequently. But a clear answer is difficult without considering many perspectives. 

Weighted vests and compression vests have been used by therapists to provide deep pressure input to the trunk which is known to improve attention, decrease fidgety movements, and promote self- regulation in a child. All of these lead to better performance in general.

The purchasing cost of these products in India have significantly come down during the last few years. Yet, in my perspective, the affordability of these equipment for a middle-income Indian household remains low. When several sensory equipment are available now in the country, how do you figure out which one is useful or not, which one is better than another, and what would work for a particular child during a certain time period?  

There are other equipment too - swings, rocker board, therapy ball, fine motor toys, sensory fidgets. What can parents buy, what can they avoid buying, how much investment can they make, and how do you decide one versus another.

Product Picture from Amazon

This post is about the weighted and pressure vest, the body sock, and the weighted blanket.  Each of these provides deep pressure input, and in that they are similar but not the same.

The body sock is made of lycra, one can think about it as a lycra sack with openings in the centre.  A child wears it, and moves their body segments or moves the body as a whole while being in the body sock. Lycra material provides some resistance and therefore proprioceptive input to the body. Most children enjoy wearing this body sock, but there are many others who are not willing to put it on, or cry when the mom attempts to make them wear it.

Product Picture from Amazon

The weighted blanket is useful during sleep time or nap time, or for draping it for a short time during wake hours.

The weighted vest and the compression vest offer deep pressure input. The proprioceptive input through each is similar, but not the same. The weighted vest provides a sense of grounding to the body. The compression vest provides a sense of ‘continuous hug’ to the body.

In a nutshell, each of the four equipment is beneficial to a child with autism, ADHD, and sensory processing differences. Points to consider prior to buying-

1. Is the child going to allow you to put it on in the first place? As described with a body sock, many children are not willing to put on the weighted vest. It may take many attempts to try putting it on before the child accepting it. This requires parents to be extremely patient for many days or weeks.

2. If the child does like it and wears it, will they leave it on for 20-30 minutes prior to removing it? India is a tropical country and we don’t live in air-conditioned rooms all the time. Except for winters, a child feels hot and perspires while using the weighted vest. The compression vest has to be carefully worn, because it may affect the child’s respiration and air exchange if there is increased compression.  

3. Some children don’t like to cover themselves with a regular sheet or a blanket, which rules out the use of a weighted blanket. But if the child has serious sleep issues, a weighted blanket is highly likely to help.

4. The last and most important information I would like to share is that there is no single equipment that would be magical. It would only be helpful, but not a concrete solution. For a child to make gains in therapy, we need a variety of equipment and variety of material, as well as repetition / persistence.

5. Research findings have not reported significant behavioral changes in children using weighted vests.

Using the Indian ingenuity or jugaad, I use weight cuffs on ankles or the abdomen during therapy sessions. But I admit that most children take them off immediately or cry or refrain from allowing us to put them on. So we keep trying for many sessions, sometimes for weeks and months.

The weighted vest is viewed as a passive equipment. In order to provide active proprioceptive input, do the following frequently and consistently. These are examples of active physical work by the child; the brain always learns better during active engagement.

·       Have your child push a heavy chair frequently and make a game out of it.

·       Have them pull a weighted trolley bag in the house, and in the apartment grounds.

·       Have them wear a backpack that weighs 10% of their body weight and take them for a walk.

·       Climb the ladders and use the wall climbers in the park.

In my clinical experience in India, I use the pressure vest for infants and toddlers to achieve a better trunk control during therapy sessions…..only during cooler weather in Bangalore.  Very few parents, about less than 5% have bought a weighted vest or a body sock. And after buying, either they have not been able to use it for more than 3-4 months or used sparingly due to personal reasons.

Some parents have bought therapy equipment as suggested by other therapists, and then have complained that it was not useful. For others, there was a complain of lack of space and a sense of frustration as to ‘how much can we buy’?

Due to all the reasons discussed, I refrain from asking any parent to buy therapy equipment, particularly when cost is a factor, the weighted vest being one of them. Parents can try it out - but cost, usage, storage, and the amount of benefit it will provide to your child is debateable. 

Note: Another option is to buy an inexpensive jeans jacket which most likely has 4 pockets in front. One can stitch patches of cloth behind too. Make small sand bags and insert them into the pockets. You have made a weighted jacket in the least expensive way. A few of my parents have done this many years ago. 

Before buying a weighted blanket, maybe you can do a trial of using 2-3 blankets at a time to see if your child keeps them on. 

 #weightedvest #weightedjacket #bodysock #weightedblanket #compressionvest #sensoryintegration  #deeppressuretouch #deeppressureinput #proprioceptiveinput #proprioception #attention #focus #movement #selfregulation

 

 

Walker for my Baby?

Can we suggest a walker in babies with milestone delays as they have less lower back strength? 

This question is frequently asked to me by parents and fresh therapists alike. Walkers become an attractive toy for young parents because they offer mobility to a young child. 

  Walkers can vary in their design and therefore serve different purposes. This is one type of walker, an upright push-toy that my own kids used in the 90s. 

  Product Picture from Amazon

In contrast, the walker shown above has 4 wheels and a sling seat. Many parents use this walker because they feel that the baby will start to walk earlier. However, research looking into the walker conveys the opposite. Using a walker does not or may not help the baby to walk, but rather interferes with the development of important milestones. When this walker is used early on, starting around 7-8 months of age, muscles of the body do not get utilized the way they should be, as a part of development. And hence can sometimes have negative implications in the child’s future.

In my long experience as a pediatric physical therapist, I witnessed the time when these walkers (wheels and hammock seat) were banned in the USA in the late 80s. Much later in 2004, Canada placed a ban on all sales of these walkers including the used ones at yard sales. In the late 80s, I was working in New York city. At the time, in the world of pediatric physical & occupational therapy, there were discussions about the negative consequences of this walker.  Experienced therapists who worked with babies were quick to observe the drawbacks of using this walker. I do not remember how those walkers came back to the market, because I did not see them in the 90s when my own children were growing up in the USA.

There are many articles online that discuss the pros & cons of this walker. Some favorable arguments state that besides mobility, putting the child in the walker provides some respite to the mom. Others speak about the safety hazards when young children use the walker.

Being a pediatric physical therapist, I would like to speak about developmental concerns when an infant is placed in a walker for prolonged time periods.

When parents use the walker for a 9-10 months old child with  typical development, you are taking away the opportunities for tummy time, crawling,  tall-kneeling, and pull-to stand, all of which hold multiple benefits.  Frequently missed opportunities of these crucial movements result into compromised trunk muscle stability and core activation. Weight-bearing on the feet may not be adequate and can possibly lead to toe-walking. Furthermore, the muscle work that occurs numerous times during transitions between various body positions – lying to rolling over, sit-to-all fours, crawling to sitting, sit-to-kneel, pull-to-stand……that is so important for sensory & motor development…..is missed out. (Hence the importance of a moving infant spending time on the floor; today it is called as floor time. Traditionally, floor time was amply provided to babies so that they could roll over, come to sit, and progress to crawling that would lead to exploration of the environment).

Amongst children with developmental delays, prolonged use of this walker is likely to cause abnormal tightness in hip abductors, hip external rotators, and the tendo-achilles muscles. Other likely consequences would be decreased proprioception through the lower trunk and the lower extremities. Hence trunk strength, weight-bearing through the hands & upper body, cross crawling, trunk rotation, all do not develop adequately and lead to deficits in vision perception, vestibular processing, and reflex integration. All of this is sensorymotor development that occurs during the first 2 years of life. When the child has developmental delays, you are causing further deprivation of sensory-motor components by using a walker with wheels and hammock seat.

I am not trying to project that only after crawling, a child can walk. Rather, in early intervention session, I include many positions in parallel -- prone, all 4s positions, weight-bearing in supported standing if possible.  And gradually progress to walking with pushing a heavy chair (any chair with weights on it), while I facilitate the lower extremities as needed.

The consequences of using a walker may look different for different children, and are likely to be realized only after a few years. I have many children starting grade 1 in regular schools who have been referred to me for handwriting and attention. They have a history of not crawled or used the walker in early childhood. And now at 6 or 7 years of age while in grade school, they have poor core strength, weak hands and finger strength, thus leading to issues with handwriting and attention. I believe that young parents need to be educated about the role of tummy time and crawling and the value of transitioning between positions frequently as an infant. 

I absolutely agree that we need early mobility for our children with developmental delays, but not at the compromise of trunk stability and weight-bearing through various joints. The early mobility can be provided to the child in other ways.

Watch the following video; this walker was used more as a play item, months after the child has achieved independent walking. This child is using the push-toy walker just as if it was a cart. He steers it, pauses to bite on an apple while holding on to the walker, and uses the walker to run fast. This is a 22 months old child. He is learning how to steer the walker, turn it around, pull it and push it with the right force required. In the process he is learning so much  – body-spatial awareness, force gradation, and sense of direction.

There are Indian versions in wood material that children of my generation had used decades ago.

 

 

Product Picture from Amazon

However, we did enough crawling, prone, rolling, and pull-to-stand prior to using these. And that made all the difference in development as well as learning!

#childwalker #babywalker #walking #balance #trunk #hip #crawling #sensory motor #childdevelopment #movement #mobility #injuries 

Many Facets of Feeding Part 2

In the last post, I had emphasized on why it is important for a young child to self-feed. Eating independently provides ample opportunities for touching, feeling, and exploring various food textures. Consequently, tactile sensory input is received, processed in the nervous system, and leads to learning about the texture and other characteristics of the food.

Self-feeding is important for development of hand-mouth coordination in the first 2 years of life. When a child touches food with their fingers, they also look at it. There forms the foundation of neural connections between the hand, eyes, and mouth; which is so much needed throughout life. In India, we are used to eating with our fingers. We are adept at breaking pieces of roti or dosa using only one hand, and picking up morsels of mushy foods like daal-chawal and khichdi without making a mess. But all of this requires ample practice in early childhood.

Some guidelines that will lead to improvements in your child’s feeding habits. 

Everyone understands the importance of eating meals as a family. This seems difficult in our busy life where parents are working and multitasking. There is a need to sit together as a family and eat, which can be done at least on weekends.

Dinner is a time when everyone is at home. However, the key to dinner time is around sunset which is quite early for urban families. Plan dinner for children around 700 pm. Early dinner will also lead to better sleep patterns. 

Instead of showing a screen during meal times, talk animatedly or narrate a story to your child, as young as when they first start solid foods. Perceive this as an opportunity to form an emotional connection with your child. 

Allow children to feed themselves in early childhood, as soon as they start on solid foods and then progress to table foods.  If you do so at home, they will not have difficulty with eating independently later in preschool. 

A young child will be messy during meals, it is acceptable, and will lead to many benefits such as tactile learning, development of hand-eye-mouth coordination, and more importantly satisfaction (as my grandmother used to say). It is hard for parents to clean up after every meal where a child is messy. However, look at it as a good trade-off. You spend time and effort in cleaning, but gain many benefits when your child eats independently, leading to learning about foods in near future. 

Watch the following video --

  https://www.youtube.com/watch?v=LfJVDbG6AxY

A preschooler who self-feeds will quickly learn the names of vegetables, fruit, and various dishes that we consume as a part of our daily meals. Have you ever thought as to why children know the names of junk foods so well?  Not only these are heavily advertised; children being fond of pizza, burger, namkeen, know their names because they pick up these items to self-feed.

As they grow, involve the child in small kitchen jobs such as peeling boiled potatoes, mashing boiled potatoes, plucking on leaves of mint, and shelling peas. There are many tasks in the kitchen where children as young as 3 to 4 years can participate. This becomes a way of spending time together with your child in addition to what your child is learning.

Take your child to the Indian market or street bazaar. Looking at heaps of vegetables, fruit, and flowers is a visual treat. There are sarees and fabric hanging in front of the stores, steel utensils visible in the store window, and the smell of fried items sold on the curb side. This is a sensory rich environment. It can be chaotic, but a child needs this experience. Learning is all about experiences. Provide a shoulder bag to your child and let them carry light loads with which they can walk home with you. Indian markets are in close proximity to many of us. Hence walk, buy the needed items, and return with comfortable loads. Such experiences not only provide learning in the short -term, but also prepare the child for lifelong skills.

Children are highly likely to choose and eat healthy foods if they are involved in food preparation. This includes food shopping too. 

Children with special needs

When it comes to children with special needs, foods and feeding pose certain challenges. Children with autism and other diagnosis commonly present with oral sensitivities, as well as difficulties with chewing and swallowing. Picky eating is another challenge that many children demonstrate. Tactile issues become a barrier in touching, feeling, and exploring food textures with use of fingers. Hence a child with sensory difficulties must play and mess with material that is similar to foods. Many children with autism demonstrate touch aversion to mushy foods.

When it comes to self-feeding, most parents of children with special needs report that their child picks up and feeds on pieces of biscuit, chips, namkeen, and papad. To me as a mother and a therapist, these are not ‘real’ foods and hence do not matter. I want to know whether the child is touching, picking up, and feeding on table foods that are a part of our daily meals while providing appropriate nutrition.

Chewing and swallowing difficulties with certain food textures are highly likely in children with special needs. Be careful in trying out new foods so that the child does not gag or choke.

1.         Communicate with the occupational therapist, or sensory integration therapist, or speech therapist, about feeding habits or issues that you are facing with your child.
2.       . Professionals will help you with ‘what’ and ‘how’ to introduce new foods to your child. Your child may also require stimulation of the oral area or special interventions such as oral placement therapy.
3.       To improve processing ability in the oral area, activities / exercises that address the trunk are crucial. Also important is the role of the ‘movement’ system or the ‘vestibular’ system. There is a scientific rationale for the same, which is beyond the scope of this post.
4.        Provide opportunities for tactile exploration with a wide range of material in the form of play. This material can be finger paint, edible items such as curd, or rough textures such as raw beans or rice.
5.        Let your child sort raw vegetables and fruit that every kitchen seems to have – potatoes, onions, tomatoes, brinjal, garlic. This kind of sorting activity will not only lead to improved tactile processing, but becomes a cognitive task as well.
6.        One way to introduce touching a new texture is to expose the child to the same. For example, if a child is averse to touching mushy food, it is fine to let them use a spoon.
7.       . Make small balls of rice-daal or rice-ghee. Initially it will just be a visual exposure. After days or weeks, it is likely that the child will start touching these rice balls.
8.      .  Tangy and sharp foods stimulate the oral receptors. These can range from soup, rasam, sucking on citrus fruit, and small gratings of vegetables such as radish, cucumber, carrot.

In summary, feeding is neither a single system or approach, nor is only accomplished with fingers. There are many facets to feeding that need to occur as a part of the child’s developmental journey.  

#self feeding # handmouth coordination #tactile input # tactile sensitivity #oralmotor #oral sensory