A Lesson in Balance

We had a beautiful lesson today in group on balancing structure within our lives.


The discussion began with having too much structure in our lives, which leads to rigidity.  We then discussed having too little structure in our lives, which leads to chaos.


Using art as our metaphor, we shared how having balance in our lives creates a beautiful picture.


For more lessons on promoting balance for your child, I suggest reading “The Whole-Brain Child”, by Siegel, MD, and Bryson, PhD.


Helping Baby with Gastroesophageal Reflux Disorder (GERD)

One problem that impacts a large number of young children in Gastroesophageal Reflux Disorder (GERD).  Statistically, babies who have GERD are at risk for feeding issues during childhood.  It is important that parents be given tools to recognize GERD, address GERD, and promote future eating habits.

When the lower esophageal  sphincter has poor closure, stomach content can regurgitate back up into the esophagus.

When the lower esophageal sphincter has poor closure, stomach content can regurgitate back up into the esophagus.

The best indicator of GERD is the infant’s symptoms, which may include reoccurring vomiting, fussiness during feedings, inconsistency with intake of milk or formula volume, gagging, swallowing with effort, arching the back or refusing to eat despite appearing hungry.  Many caregivers  of children with GERD report that they have been feeding baby while they are sleeping, since baby is refusing feedings while awake.  Medical tests cannot rule out GERD.

As an occupational therapist, my expertise is education on positioning, during and after feedings:

  • Use the log roll technique while changing babies diaper or clothes.  Many caregivers lie babies on their back and lift their bottom by their legs in order to change diapers or clothing.  This position puts a great deal of pressure of baby’s stomach and promotes stomach contents to reflux into baby’s esophagus.  Instead, roll baby from side to side like a “log”.  Avoid twisting baby’s trunk by keeping shoulders and hips aligned.
  • Feed baby on their side with head up above feet, versus flat on their back.  Place a pillow under your shoulder, ensuring that baby is on their side and with an upright incline.
  • For babies 6 months or older, feed baby on their left side.  Stomachs are positioned on your left side.  Infants have a vertical stomach, with very little curvature.  If your baby is 6 months or older (around the time most babies learn to sit upright), their stomach is beginning to be compressed  into the shape of a kidney bean.  Due to the position of the stomach, many babies who are 6 months are older, will reflux less when feed lying on their left side.  If your baby is breast feed, you can use the football hold technique in order to nurse from the left breast and keep baby on their left side.
Football Hold

The “football hold” is a great breastfeeding position to nurse from the left breast and positioning baby on his left side.

  • After baby eats, keep baby upright or on their tummy for 20 minutes.  My personal favorite was using a baby carrier after feedings.

Caregiver’s should also be aware of common feeding patterns of infants or children with GERD.  The symptoms of GERD can cause children to cycle back and forth from being in pain and refusing food, and being very hungry and overeating.  After regurgitating stomach content up into the esophagus, the area becomes inflamed, irritated and painful, and many children will avoid eating.  Then, after sometime, the physical, painful symptoms subside and the child is again ready to eat.  Since the child has been avoiding food, they are very hungry.  At this stage, many children will overeat and overfill their stomach.  This causes the stomach content to regurgitate again, which cycles back to avoiding food again.

If a caregiver suspects that a child has GERD, they should track the child’s feeding time (time of day and duration) or bottle intake.  Look for patterns of poor feedings and overeating.  The caregiver should also track the time of any observable symptoms, and look for patterns of discomfort after feedings with a larger volume.

In order to prevent this cycle, caregivers should consult with the child’s pediatrician to discuss strategies to prevent overeating.  The plan needs to be specialized for that child.

Finally, it is important to discuss strategies for promoting future healthy eating habits.  It is understandable that a child would be at risk for eating problems when their first experience with food is pain and discomfort.  While baby is nursing or bottle feeding, the caregiver should be aware of their own body language and tone of voice.  Are your shoulders tight?  Is your voice strained?  Take a deep breath.  Sing a sweet song to baby.  Coo and giggle with them.  Your calmness will carry them through a difficult time.

As the caregiver introduces solids (which is less likely to regurgitate because of their thicker texture), they should make a point to emphasize the joy of eating.  Play with food! Get messy, squeeze, paint, draw, lick, splat, make “animals”, make car noises, and most importantly SMILE while eating together.  Little ones are designed to learn and change.  Together, caregivers and children can build new, fun experiences with food.

Sensory Retreat: Ikea Ekkore Swing

Pod Swing

Ikea Ekkore Swing

The Ikea Ekorre Swing is a great, affordable tool for creating a sensory retreat for your child.  During most of the day, I prefer to have the swing touching the floor, so that it doesn’t wobble and twist while your child is taking a break.  I’ve also tied a piece of fabric to cover the opening while allowing your child to easily get in and out.

Ikea Ekorre Swing

Ikea Efforre Swing with fabric square tied at the top to cover opening.

I suggest that an adult facilitates while the child is swinging on the Ekkore Swing.  If your goal is to help your child calm down, push them back and forth, in a rhythmical manner, without twisting or jerking the swing.  Very few kids are calmed by spinning in this passive swing.

For increased deep tactile and proprioceptive input, stuff the swing with the child’s favorite stuffed animals, bean bags, or blankets.

Introducing Solids: Food Stages

During the early stages of introducing solids, the goals are to improve oral motor skills, establish safety, maintain positive associations with eating and to develop a diet with a wide variety of foods.

Development of oral motor skills for feeding are dependent on the qualities of the foods given to the child.  The qualities of the foods (such as meltable or non-meltable) determine the level of oral motor skills required to prepare the food for swallowing.  The following is an outline of foods organized by the typical progression of feeding skills.

Typically introduced at 5 months:

  • Thin Baby Food Cereals

Typically introduced at 6 months:

  • Stage One Baby Food Purees/Single Food Item Purees
  • Thicker Baby Food Cereals

Typically introduced at 7 months:

  • Stage Two Baby Foods, Mixed Food Purees
  • Mashed Table Foods, such as banana, avocado, sweet potato…

Typically introduced at 8 months:

Typically introduced at 9 months:

  • Hard Solids that Melt, such a graham cracker, Gerber’s cereal squares, Snap Pea Crips, Krinkle Sticks, Towne crackers

Typically introduced at 10 months:

  • Soft Foods cut into Cubes, such as avocado, kiwi, cooked squash, cooked potato, peas, banana, vegetable soup ingredients without broth, Gerber Graduates fruits

Typically introduced at 11 months:

  • Soft Chews, Same Texture, such as fruit breads, muffins, small pastas, cubed lunch meat, thin deli meats in small squares, barley, scrambled eggs, soft meat soup without broth

Typically introduced at 12 months:

  • Soft Chews, Multiple Textures, such as macaroni and cheese, chicken nuggets, french fries, spaghetti, lasagna, fish sticks

Typically introduced at 15 to 18 months:

  • Hard Chews, such as cheerios (and most non-meltable cereals), pretzel sticks, ritz crackers, saltine crackers, sticks of hard raw fruits and vegetables,

It is suggested that non-meltable cereals and crackers be introduced at approximately 15 to 18 months, which is much later than popular belief.

Please note, the provided ages are a suggestion, as different children develop at different rates.  My general suggestion is to wait approximately one month before proceeding to the next stage.  Signs that a food is too difficult for your child include coughing, watery eyes, gagging, turning head away or spitting out more than 50% of the food.

If you have concerns regarding your child’s feeding development, do not hesitate to consult your pediatrician or an occupational or speech therapist who specializes in feeding.

Family Meals

One of the most essential tools for learning feeding skills is modeling, which is best done by having regular family meals at the table.  Most parents agree that sitting together for meals is important.  I would like to advocate the value further from a sensory-motor perspective, and provide tips to make family meals more successful.

Children develop their perceptions of food over time through their senses: seeing, smelling, touch and taste.  Exposure at the table to other’s plates is a great first experience to new foods.  For example, a baby or young toddler who is not yet eating mature foods, is still learning about these foods through sight and smell while sitting at the table with family.

Also, as young children are developing food manipulation skills, including finger feeding, use of fork and spoon, drinking from a cup and straw and cutting with a fork and knife, consistent modeling from caregivers is crucial.

Adding routine and creating a supportive environment will greatly improve the eating experience, such as:

  • Children should sit at the table for meals, with other eaters, three times per day.  If your child is not yet sitting three times per day, gradually increase daily meals over time.  It will take time and consistency, but your dedication will pay off in the end.
  • Children 12-months-old and older should assist in setting the table and cleaning up in order to add structure to mealtimes.  Very young children can place spoons or napkins in the table to set up and can drop spoons into the sink and wipe the table for clean up.  Older children should pay a large role in setting up and cleaning after meals.
  • Starting at 6-months of age, children can be expected to sit a the table for meals for 20 minutes.  If children are learning to sit at the table for 20 minutes, redirect escape attempts with “it’s not time to clean up”.  A visual timer may be a good tool to trial with your child.  Young children who need to be strapped into highchairs or booster chairs should not sit more than 20 minutes.  Children who are sitting in regular chairs may be allowed to sit more than 20 minutes, but should not be expected to sit more than 20 minutes until early adolescence.
  • Children should be positioned so that they can observe others eating during mealtimes. I prefer smaller feeding chairs that position the child at eyelevel with the rest of the family, versus large, stand alone high chairs.
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  • Conversations and interactions should stay positive throughout.  It is essentials that the family table be associated with a positive and safe environment.  Many parents may inadvertently create a negative environment by venting about their day at the dinner table.  Also, if children are demonstrating undesirable behavior at the dinner table, redirection with a calm, yet assertive tone is best.  Time outs are not ideal since they can reinforce escaping from the task of sitting at the table.
  • Parents should focus on the enjoyment of eating instead of volume.  This is by far one of the hardest principles for parents.  In my own home, I frequently catch myself focusing on the short term accomplishment of volume.  This leads to power struggles, frustration and the child having a high arousal state.  Children’s appetites are suppressed by adrenaline (the “fight or flight” hormone) when they enter a high arousal state.  Instead, as parents, we need our behavior and parenting decision support the enjoyment of eating.  In those moments I remind myself that in the long term, children will eat more volume and have better nutritional variety if the enjoyment of eating is always the first priority.


Pyramid of Learning


This diagram illustrates how sensory processing skills are foundational for higher level development, such as social and academic skills. When a child is having difficulty with age appropriate activities or behavior, the occupational therapist conducts standardized testing and structured clinical observations to determine if there are deficits in sensory motor processing.

If there are deficits in sensory motor development, addressing those skills is more effective than solely using a behavioral or cognitive approach.

Occupational therapists use a play-based approach while addressing sensory motor skills, since play is how children naturally learn. They are experts at setting up activities that are the “just right challenge” in order to best facilitate the child’s growth.

“Do It Yourself” Weighted Blanket

Instructions for homemade weighted blanket:


Genius!  I love this idea.

Weighted blankets are one of the most versatile sensory tools. Not only can they be used while sleeping, but as a lap pad while sitting at the table or in the car.  They also make great additions to sensory retreats (see previous post titled “sensory retreats” for more information).

Putting the blanket together may take some time, but it’s much cheaper than purchasing one from a company.  Some parents put their duct tape weighted blanket in a twin duvet cover or a pillow case for easy washing.

Sensory Activities for the Home

These handouts are perfect for giving parents an extended list of sensory activities that can be tried at home.

Observe your child’s response during and after, to determine which sensory activity has the best impact on your child.  Never insist on or force sensory activities.  You’ll most likely get the best results by modeling the activity and then responding to your child’s cues.

Meeting your child’s sensory needs is a dynamic processes, and requires some trial and error.  Don’t forget to have fun in the process!

Proprioceptive Input

Tactile Input

Vestibular Input

Spandex! An essential sensory tool.



The milliskin fabric is great for tunnels and body socks.

Lycra Tunnel

Lycra Tunnel


Homemade Body Sock



Body Sock with Joint Compressions



The moleskin fabric is great for your in home sensory swing. It is much thicker than other types of spandex, and stretches in four directions (4 way stretch) versus just two directions.

Lycra Swing

Lycra Swing

Lycra Swing

Lycra Swing


This lap snake was sown by a local mom. She explained that it really helps on car rides. The lap snake provides calming weight and can be used as a fidget. It has double layers of the thicker spandex lycra, is filled with rice, and double knotted at the end. This lap snake weighs approximately 10 lbs. and is used for a 7-year-old boy.