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Category Archives: Development Assessments

Learning How to Play

I recently came across this article, which explains how therapists teach young children how to play and what the benefits of that training can be. Before the Bean came along, it never dawned on me that kids would need to be taught how to play. It just seemed to come naturally for any child I had ever known.  But for the Bean, playing with toys was not a skill that came naturally.  She loved to look at faces and interact socially, but had no idea what to do with the brightly coloured plastic and wooden objects we placed in front of her.  She just ignored them completely.

In the article, Penina Ryback defines play as, “the way children practice and internalize both the rules and roles they see around them. Play helps children make sense of how their world works.” If a child is developmentally delayed or has a condition such as autism that makes it difficult for them to notice the rules and roles they are supposed to be practicing, they need some prodding to play like other kids play.

I notice this when we play with typical kids.  When presented with a new toy or concept, they explore it using what they know, and then quickly branch out into other ideas as they observe others also interacting with the same thing.  But for the Bean, it’s not as smooth or effortless a process.

The Bean is more interested in sucking on her fingers than all the new toys at her birthday party, but her friends are happy to take over.

The Bean is more interested in sucking on her fingers than all the new toys at her birthday party, but her friends are happy to take over.

When other kids the Bean’s age were engaging in parallel play (age one or so), she was still just learning how to sit, so she couldn’t interact with the toys like other kids did.  It didn’t even seem like she was watching them play – she was engaged with me and any other adults who would interact with her and make eye contact.  During this time, we were getting services from Easter Seals.  The wonderful woman who came to our home for an hour each week was teaching the Bean how to interact with toys, and measuring her progress based on whether she could actually grasp a toy and pick it up, or switch a toy from hand to hand.

For her 2nd birthday, I made sure the activities were at her level, and luckily her typical friends thought it was fun too.

For her 2nd birthday, I made sure the activities were at her level, and luckily her typical friends thought it was fun too.

A year later, she was finally engaging with the toys that her friends were playing with a year previous, but they had moved on to more sophisticated activities.  So once again, she was sitting with the adults playing with the toys while the other kids were starting to actually play with each other.  Our Easter Seals therapy was focused on teaching the Bean how to stack blocks, turn the pages of board books, squeeze play doh, and matching wooden puzzle pieces to the right space on the board. She had some success, and was evaluated at about 6 months behind her peers.

At 3 years old, she was able to get around on her own with a walker.  She was thrilled to be able to move around on her feet, but she still couldn't keep up with her friends.

At 3 years old, she was able to get around on her own with a walker. She was thrilled to be able to move around on her feet, but she still couldn’t keep up with her friends.

When she turned three we were still working on stacking, nesting, colouring and wood puzzles, and had also added some imaginitive play, recognizing and matching colours, shapes, and knowing the difference between big and little.  The Bean was finally stacking one block on top of another, recognizing colours with some consistency, and could scribble a little with a crayon, but her speech capabilities were way behind, and her ability to focus on a task for very long was minimal.  Many 3 year olds are happily reciting the alphabet, counting to 10, drawing/colouring with some precision,can write their name, and are totally ready for preschool.  The Bean was being prepared for preschool as well, but it was clear that she was far from ready for integration into a regular preschool, so we enrolled her at Marindale, our County’s special needs preschool.  It was the best thing that had ever happened to our Bean.

At 4.5 years old, the Bean uses her imagination to play.  It's so much fun.

At 4.5 years old, the Bean uses her imagination to play. It’s so much fun.

Without the play therapy we received from Easter Seals, I wouldn’t have had a clue what to expect from the Bean or how to encourage the development of these skills that, in my experience, usually came naturally.  During her two years at preschool so far, she has made huge strides: now stacking large lego blocks into towers, drawing with more variety, playing with her imagination, constructing parts of more complicated puzzles, and imitating others with abandon.  She has gotten to the point where she wants to be able to do what other kids are doing, which shows that she’s paying attention and learning a lot from those kids.  Her speech is still very far behind other kids her age, but that is progressing as well.

We are nearing the time when we have to decide what Kindergarten will look like for our Bean.  We are trying to be realistic and choose the options that will ensure her continued development success without overwhelming her.  Our team of teachers, therapists and administrators are so totally on the Bean’s side, that I have no doubt we’ll make the right decision together.


Leaps and Bounds

image011 (1)My Bean is growing in every way all of a sudden.  She has moved up a size in clothes, which is super exciting for me because I was getting tired of dressing her in her 12 month stuff.  For those not familiar with the Bean, she’s tiny – 3 3/4 years old and now wearing 18 – 24 month clothes.  What mom doesn’t love new clothes, even if they’re for her child and not for herself?

Walking is the Bean’s favourite hobby.  She toddles around everywhere, dancing if there is music and running (sort of) if she’s super excited.  She sure keeps me hopping when we’re in public – her curiosity knows no bounds, so she’s off the second I put her down. A whole new world has opened up to her and it is so much fun to help her explore and discover new things.

She keeps herself busy while I’m working in the kitchen by removing plastic containers from the cupboard and distributing them around the house.  She loves to “help” me wash dishes, standing on a chair at the second sink with her own bowl of sudsy water.  While it makes a huge puddle on the floor, and she keeps stealing the clean dishes from the rack and putting them back in my dishwater, it can be tremendous fun.  I still eventually get the dishes done.

Laundry is a similarly fascinating chore.  Bean likes to push the buttons on the washer and dryer, so after we load them, she closes the door and gets them started.  She recently started taking clean clothes out of the laundry basket and putting them away in her drawer. As long as I’m one step ahead of her, she manages to put the right things away in the right places and I don’t have to reorganize when she’s done.

023The challenge of communicating with the Bean is starting to get a little easier.  She attempts to copy everything we say, and it’s been a blast finally being able to teach her new words and have her respond.  With Christmas coming up in a few days, we were thrilled that she has learned to recognize and sort of say “Santa”.  We’re still working on “Baby Jesus”.  She had a Santa cupcake at her Christmas party, and since she associates cupcakes with birthdays, she wanted to blow out a candle.  I used that opportunity to remind her that it is Baby Jesus’ birthday, and we sang and pretended to blow out a birthday candle.  So cute.  However, the fact is that Santa is a much more compelling symbol for a toddler – bright colours, concrete concepts, and presents…the importance of the birth of Jesus is a little too abstract for her yet.

My favourite part of parenthood these days is playing with the Bean.  She has a great imagination and loves to make jokes and laugh.  Her jokes usually involve some sort of slap-stick comedy, and she giggles uncontrollably at her own antics.  She loves to be tickled and startled, asking for “moh” (more) over and over again.  At the playground, she enjoys climbing the structure and sliding with me down the big-kid slide.  When we get to the bottom, she pretends to be a chicken as she waddles back to the stairs again, flapping her wings and clucking, “buh, buh, buh”.

128Preschool continues to be an awesome experience for the Bean.  Her teacher is on maternity leave, but they’ve had a string of wonderful substitutes in the meantime, and the teacher’s assistants are a stable presence for the kids in their teacher’s absence.  Bean is apparently the “angel” of the class – the sweetest and least disruptive.  Of course she is – she’s her mother’s daughter!  But seriously, I feel very fortunate that her diagnosis doesn’t come with an expectation of major behavioral challenges.  She certainly gets frustrated and can be persistent about having things her way, but unlike some of the other kids in her class, she doesn’t tend to lash out physically or flop down on the ground in protest.  At her most aggressive, she’s just really loud and squirmy.  I get more resistance from her at home than they do at school, I think, but that’s pretty normal for most kids.

014Mostly, these days, she feels like a delightful 2-year-old.  It seems appropriate to me that her mental age seems to fit her physical age, even if they don’t correspond with her chronological age exactly.  She’s starting to get interested in dolls and playing dress-up.  If they didn’t make her also do other activities, she would be a permanent fixture in the play kitchen at school.  At home she loves to build with and knock down blocks, pull stickers off their sheets and stick them everywhere, have tea parties with Elmo, and get dirty in her sandbox.  When I’m digging around in the garden, she joins me, although a lot of soil still goes in her mouth.

Our biggest challenge with the Bean continues to be her sleep habits.  Currently, she mostly sleeps with us in our bed.  She won’t settle and fall asleep at night time without one of us lying beside her.  If we do put her in her own bed, she wakes up an hour later and we have to do it again.  She still takes naps but if she sleeps for more than an hour in the afternoon, she’s up until 9 or 10 pm, which means that my Sweetie and I don’t get much of an evening together.  We’re working on some strategies to get her sleeping consistently in her own bed.  She is too persistent at this point for the Cry-It-Out method, and frankly, I’m too soft-hearted to be able to stand it.  I think part of it is that she’s just a very physically affectionate child.  She needs the reassurance and comfort of a snuggle – I say there are worse things in this world than that, for sure.

Potty training is in the concept stage right now.  She’s starting to make it known when she needs a diaper change.  We’re working on recognizing when she’s actually going so we can start to preempt it and get her to the toilet.  But she doesn’t like sitting on the potty or on her little toilet seat, so we’re trying to get her used to that first.  As with most things in the Bean’s life, it will take a lot more time than it does for most other kids.  That’s just the way it is for us.  And in the meantime we’re helping to keep Pampers and Tide in business.


I predict that the coming year will be one of even bigger leaps and more impressive bounds.  Our Bean will be turning 4 in March – it’s surreal to think about.  I feel like I’m finally coming into my own as a mother.  The extended infant stage was not my ideal situation…as much as I love babies, having one for 3 years while all the other kids are changing rapidly was a little disheartening and quite difficult for me.  As always, though, when I look for the silver lining it’s there.  Most mothers mourn the speedy passing of the infant stage.  I got to coddle and snuggle and baby my little one a whole lot longer than most moms before she became a wriggly wild thing.  Every milestone reached tastes that much sweeter because of the struggle it took to get there.  I don’t take anything about the Bean for granted.  I marvel at how far she’s come in the last year and I feel grateful for all the help we have along the way.

What a blessed life we live!

A Bean Update

I feel like I’m not doing a very thorough job of keeping record of the Bean’s life so far.  She’s been growing in leaps and bounds lately and I can barely keep up.  So, in the interest of just getting it down so I don’t forget, here is a list.


  1. She recently started using a 4 word sentence: “I wah moh ee” (I want more please).  When I try to coach her to say I want _____ please (like park or outside or down), she always says “moh” with utmost pride at being able to fill in the blank.
  2. She sings a lot, and more and more often I can recognize the tune.
  3. She can approximate most of the letters of the alphabet, and one of her favourite games is to sort through a pile of wooden letter magnets and guess what letter each is.
  4. She tries to count when she puts things in her bowl or when we’re reading books.  Usually, she starts with “nye” (nine) unless prompted to say “wuh” (one)
  5. She sometimes gets frustrated and just starts screaming and crying when she wants something.  When that happens, she’s almost always hungry or tired. It feels good to have figured that out.
  6. She understands so much of what we say to her.  I think once her mouth figures out how to do the talking, she will astound us with what she knows.

Her first big “boo boo”.

Physical Development

  1. She can climb to the top of the play structure at the elementary school by herself.   At preschool, she can climb to the top of their smaller structure and slide down the slide on her own.
  2. She can navigate almost any surface with her walker, and she’s starting to experiment with balancing on her own and taking a couple tiny fast steps with no help. She’ll start Physical Therapy again next week, so I expect this will start to explode for her.
  3. She recently fell down and scraped her face up pretty badly.  It was swollen for the first 24 hours, and the scabs looked terrible for a few days, but she was a champ and healed up really quickly.  Right after I cleaned up her fresh wound, tears still streaming down her face, she wanted to get back into her walker and go see the pigs we were  headed toward at the farm we were visiting.
  4. She loves to bop to music and she’s starting to do this standing up as well.  She’s been dancing sitting down for a while already.

General Development

  1. She’s doing a lot more independent play.   She loves to play with her doll house in the kitchen while I make dinner.
  2. She wants to help with the laundry, dishes and food prep.  She stands on a kitchen chair at the sink and plays in a bowl of cold water that I’ve placed in the second sink for her.  But her hands and the clean dishes often end up back in the hot soapy water, which means a lot of extra rinsing for me.  It’s still fun to be able to do dishes with her instead of fighting for some time on my own to do them.
  3. The Bean loved having her hair blow dried.

    We got her hair cut for the first time recently.  She did great in the hairdresser’s chair and wanted “moe” when the hairdresser blow dried her hair.


  1. We’re finally starting to get some sleep at night.  She resists going to bed, so I often have to take her for a walk or a drive in the car to get her to sleep.  We’ve also been giving her melatonin some nights if it seems like she’s going to be wired for sound all evening.  She wakes up in the middle of the night (the time varies greatly) at which point we just pull her into bed with us.  Then she sleeps until at least 7am, which means her parents also get to sleep.  It’s been wonderful to get more than 5 hours of sleep on a consistent basis, and while it’s not ideal to have her in our bed, it’s working for us right now.
  2. She often falls asleep in the bus on her way home from school, although lately that’s happening less often.  Recently, I started trying to have her down for her nap between 1:30 and 2pm, and only let her sleep about an hour.  This seems to be helping with the going to bed end of things.


  1. The Bean LOVES school!  She has so much fun playing with the other kids and doing all the activities.  I currently drop her off at school in the morning, and then she takes the bus home.  They have 5-point harnesses built into some of the bus seats, and she really enjoys taking the bus like a big girl.
  2. We signed up for summer school, and a good friend of ours is going to be one of her teacher’s assistants for a couple weeks in the summer semester.  The Bean is going to be so surprised on Monday when she sees her there.


  1. She is starting to get excited to see her favourite friends.  It’s cute to see all the kids get excited to see her when she gets to school or daycare.  A couple of her classmates regularly give her a hug when she gets to school.  She’s starting to let them hug her – at first she resisted a little.
  2. We’ve been getting together with a couple of friends weekly.  The Bean is learning to share her toys and ask nicely when she wants something her friend is playing with.  This is a process, and we’re just at the beginning.

Three is a really fun age.  It’s fun to see how the Bean is keeping up with her peers, and also interesting to see where she still needs to catch up.  Right now, she feels like a 18-24 month old in many areas.  And yet she also feels like a baby a lot of the time.  We haven’t started potty training yet, and she still needs help with a lot of things, but she is so independent about other things.  She hates it when I try to help her with something that she wants to figure out for herself.  Our life is an exaggerated example of how every child develops on their own schedule, regardless of the average.  And it’s “awedome” (awesome).

Musings of a Mother

In the midst of the Bean’s evaluations and meetings regarding preschool, I noticed something that gave me pause. The administrators and therapists who were helping us through the evaluation process were handling me and the Bean’s “disability” with kid gloves.  They were cautious about suggesting that the Special Needs school might be the best fit, and were very diplomatic about mentioning their findings during their evaluations.  “Why”, I wondered, “would they need to be so careful?  It’s not like we don’t know that the Bean has global developmental delays.”  Then it hit me!

the Bean and her walker

The Bean loves her walker. She asks to "wah" every time she sees it.

There is still a stigma in our society about people with special needs.  I pride myself in being accepting of others regardless of differences, and even I’ve been guilty of making snap judgements about and feeling pity for people who need extra help from a device or human assistant.  I’ve tried to be very matter-of-fact about the Bean’s needs and limitations, but when we first got her walker, I resisted bringing it out in public because I didn’t want people to stare.  If she’s just walking holding both my hands, people can assume she’s a year old and just learning to walk.  But if she’s got a walker, it’s obvious that “something is wrong with her”.

I have felt the same way when people ask how old she is.  I am sometimes tempted to tell them she is 12 months old.  After all, that’s how big she is – wearing 12 – 18 month clothes. But I’m a little too honest for that, and I don’t want to deny who and what she is.  When I respond that she just turned three, people are pretty quick to add things up and realize that she’s got special needs.  Sometimes I explain; often I just say “she’s pretty small for her age”.

The thing is, in a lot of ways, she’s right on track for her age.  She’s high in the social development ratings, and understands a whole lot more than she demonstrates in standardized testing.  Sure, she’s miles behind the other “typical” kids her age when it comes to preschool tasks.  But she’s come an incredibly long way, especially in the last 6 months.  I’m so incredibly proud of her.

As the Bean gets older and starts to understand more, I worry a little about how to address these things with her.  Now that we take her walker with us everywhere we go, kids at the park DO ask why she needs it.  I tell them that she has trouble walking by herself, and needs to use the walker to get around.  I figure honesty is the best policy.  Most young kids want to try it out.  Older kids look thoughtful when I respond to their questions.

The most interesting reaction I’ve found is the difference between men and women.  If we’re in public…say walking down a sidewalk in the city while we wait for Daddy to get done at work…men glance at the Bean and look away quickly; I’m not sure what runs through their heads – perhaps they wouldn’t even have noticed us except for the walker.  Women give us genuine smiles that reach their eyes; they see how cute she is with her tiny walker, and understand that she’s just a kid learning to walk.  There may be some sympathy for our struggle, or some thoughts of “I’m glad I don’t have to deal with that” in their heads, but I don’t feel like they avoid us. Of course, this trend is not universal.  I’ve had men comment on the Bean’s determination getting up a hill, and I’ve had women glance and move on.

I think it’s different when it’s an adult who is struggling down the street.  We expect that kids are going to need some help, but we feel sorry for adults who aren’t as self-sufficient as we are.  There are people and organizations out there who are doing a great job of helping adults with special needs to integrate into society and be as self-sufficient as is possible given their limitations.  We may or may not need their services when the Bean gets older – who knows.

In the meantime, I’m just so grateful that special needs services are so readily available in our area.  With budget cuts and economic hardship looming over everyone these days, I only hope that these services continue to be available to those who need them.  I would never have known how to help the Bean reach toward her potential without the help of her therapists in her first three years.  After two weeks of preschool, I’m already seeing a leap forward in her communication skills, gross motor skills and even fine motor skills.  Without the assistance of her teachers and the example of her classmates at school, she wouldn’t be making these big strides.

I am so excited to see how things progress for the Bean in the next few years.  She’s a determined, hard-working, happy little girl, and I know she will continue to surprise us with her accomplishments.  I was recently asked about my goals for the Bean for the next three to five years.  Before having a child with special needs, I would have replied with goals around getting good grades at school, reading at or beyond her age level, and learning to play an instrument…all things I was doing from age 6 – 8.  But now, my goals for the Bean are to be able to walk without the walker (see note below), to be able to play with her friends without assistance, and to be able to communicate in small sentences.  It’s  not that my expectations have been lowered…I think I’ve just figured out what is most important.  Sure, it’s good to do well in school and become educated in music and culture.  But I think it’s even more important to be active, to be a good friend and to communicate effectively with those around you.

(Note about the goal of walking without the walker:  If the prognosis was that the Bean would always need a walker, this probably would not be a goal for her; but all indications point toward eventually being strong enough to walk unassisted.  If she needed a walker for the rest of her life, we’d make peace with that and move on). 

Back to the cautious and diplomatic handling by the evaluators and administrators in the school system.  When I realized what was going on, I was frank with them.  “I try to be very realistic about the Bean’s abilities and needs.  I want her to go to the special needs preschool so that she can get as much assistance as possible. I don’t have an ego around what school she goes to or how much help she needs”, I declared.  They were visibly relieved to hear it. “Not all parents are as open-minded”, I was informed.  “We just want to give her the best chance at success.”  Thank goodness!   Me too!

Wow, where have I been?

Okay, so this is the point at which I usually beat myself up for falling behind on my blogging.  I think I predicted that this would happen at the beginning, because I know myself quite well.  BUT, I’m back and raring to go, and I’ve decided to treat myself like I would treat others and be really forgiving.

The Bean at preschool

My big girl on her first day of preschool.

We recently had a BIG change in our lives: The Bean started preschool! She turned 3-years-old two weeks ago and so was at the end of her eligibility for the Early Intervention program coordinated through our local Regional Center.  She, instead, became eligible for the Individualized Education Program coordinated through the school districts. In the US, kids with special needs are legally entitled to government-funded schooling and as much assistance as they need can be afforded by the budget to meet their needs.  What services you get can also depend on how much noise the parents make, so I’ve been told by friends and therapists to fight for whatever I think the Bean needs.

Over the past few months she has been undergoing progress tests and evaluations, both with her existing therapists and with new ones that work for the school system.  The reports were studied and recommendations were made for which class and which services the Bean would participate in.  We met with a group of people to discuss and agree on the preliminary plan, and it was decided that the Bean would be best served by the special needs school run by the County instead of the default option, which would have been the integrated preschool in our school district.

So, on Monday, March 26, I walked my baby big girl into her new classroom, kissed her goodbye and managed to refrain from giggling like a maniac as I skipped walked serenely down the hallway back to my car.

I’ve heard stories of parents who cry when they drop their kids off at school for the first time.  “She’s growing up too fast”; “I’m going to miss my baby”; “I’m getting old!”.  Not me.  As much as I adore my Bean, I’ve been joined at the hip to my little girl for three years straight, and I have been dying for some “me” time.  And it’s not even just time to sit and do things I love, like writing and getting my nails done.  I’ve been wishing for time to get my house clean, update the budget, do some weeding, groom the dog, refinish the dresser I bought at a garage sale 6 months ago…the list goes on.

Now, I’m sure some children have a lot of trouble with separation anxiety when they start preschool, and so their parents are suitably traumatized by the experience.  But my Bean is pretty cool about that.  We’ve been making sure to give her experience with other caregivers since she was tiny – my parents took care of her for an entire weekend when she was just 10 weeks old.   A few months ago we enrolled her at a daycare for a day each week: to give both of us some time to adjust to the impending preschool schedule, but also to give me a break…I was breaking down.  From the first day, the Bean was (with a few exceptions) thrilled to be there and happy to see me again when I picked her up.  It’s been the same at preschool so far.

So now I have a little more time to do the things I want and need to do.  My Sweetie is happy to see things actually getting done around the house, I’m happy to be able to hear myself think for a few hours in a row, and the Bean is happy that I am able to give her my undivided attention after her nap.  Everybody wins!

Recent Beany Accomplishments

The Bean has been growing in all areas lately.  It’s been so exciting.  Some highlights:

  1. Speech– Her words have been exploding.  She tries to copy most sounds we make, and is learning new words and signs every day.  Recent words include “wah” (walk), “hah” (hat), “ooh ooh” (monkey), “baa baa” (sheep), “nana” (banana), ‘ama” (grandma), “puhpuh” (grandpa), “amauw” (animal – not to be confused with ehmauw, which is Elmo), “wawa” (water), “ow” (out), and “dauw” (down).  Some of these words she’s been able to say for a while, but she’s finally using them to communicate her needs.  It’s so much easier.

    reading a book

    The Bean LOVES to read (courtesy of Naomi Unrau)

  2. Fine Motor– The Bean has gotten very good at manipulating my iPhone.  She can select apps with her pointer finger and touch a tiny arrow to move the story or game forward.  She is starting to be able to feed herself with a spoon.  If I pierce the food with her fork, she can get that in her mouth too.

    tea party

    All dressed up for a tea party (personal photo)

  3. Gross Motor– We’ve been walking around together for a couple of months, with me holding her hands and walking behind her.  She’s started to be able to walk on the treadmill at therapy holding onto a bar without being supported or helped by her therapist.  She can also walk pushing her walker ahead of her.  Standing is now her preferred position and she loves to play, read books or watch TV while cruising up and down the side of the coffee table.  In addition, she has started lying down on her stomach and pushing herself around with her hands and knees.  It’s not quite crawling – more like a frog swimming motion – but it gets closer to crawling every time.


    Farmer Beany had a cow, EIEIO (personal photo)

  4. Social– The Bean loves to play with other kids.  She has always loved being around other people, but it seems like she’s starting to notice the difference between hanging out with adults and playing with kids.  I’ll be sending her to daycare once a week to have more opportunity to play, and also to give myself a break; we have found a local playgroup, so we’ll be playing there after speech class on Tuesdays;  on Wednesdays, we go to a Mommy and Me music class, which we both enjoy immensely; and we still try to get to playgroup with our Southern Marin Mother’s Club playgroup on Fridays.


    A little music appreciation with friends (personal photo)

  5. School– on March 21, 2012, the Bean will start prescho0l five mornings a week.  We’re hoping to get her into the Special Needs preschool in San Rafael because they have a lot more resources to help her out.  The default preschool option will be an integrated school in Novato that has typical and special needs kids together in the same class.  That wouldn’t be so bad, except that I think she’s still going to need a lot of physical help, and they don’t really have the resources for that.  So I’ll be advocating to get her into the more extensive program, at least for the first year.I am both anticipating and dreading the start of preschool.  On the one hand, I am very much looking forward to having a few hours to myself every day to get things done without interruption.  On the other hand, I’ve spent 2.5 years spending most waking moments with my daughter, and I think I’m going to feel a little weird (and maybe a  bit lost) without her.  Still, for the most part, preschool spells F-R-E-E-D-O-M for me, and I can’t wait for the opportunity to explore some of my own interests again.

Oral-Motor Therapy – In the Beginning

When I was first put in touch with the Golden Gate Regional Center, I expected my daughter would need Physical Therapy, but I had no idea that Oral-Motor Therapy (OMT) even existed.  The coordinator that met with me noticed that the Bean tended to stick her tongue out (called tongue protrusion) and suggested that we get her evaluated by an Oral-Motor therapist.  She said that tongue protrusion can have a negative effect on feeding, development of mouth shape and speech.  Let the education begin!  I felt overwhelmed, all of a sudden, with what I didn’t know about infant development and my daughter’s condition. 

We set up a meeting with the OMT office and a wonderful lady evaluated the Bean’s needs.  When I think back to that time, it amazes me how far we’ve come.   She was 7 months old when we started OMT.  I was having trouble introducing solid foods because everything just ended up coming back out of her mouth.  She wasn’t able to hold her own bottle, and still drank her milk lying back in the crook of my arm.  She was barely 15lbs, was still feeding at night, and her bottles were taking an hour to finish. 

The Bean had a lot of gross motor issues, which translated into problems with feeding.  When she sat up, she would hold her chin up and arch her back too much (extension), which made swallowing more difficult and made it easy for her tongue to protrude.  Her cheeks and lips were also very tight, which made her mouth look small and made it hard for her to babble and form new sounds. 

The Bean at 7 months

At 7 months, she wasnt able to sit on her own very well. In this picture you can also see how tight her smile was.

One of the first things we worked on was her body position in her high chair.  We stuffed towels behind and around her body so that she could sit more upright.  We put a rolled up washcloth behind her head so that her chin would tilt downward, and more washcloths beside her head so she wouldn’t tilt her head to the side too much.   All of this served to help teach her body not to arch back, and also helped her tongue to start learning not to stick out all the time.  To get a sense of this, try this exercise: 

  1. Stick out your tongue. 
  2. Tilt your chin up so that your head tilts back.  Feel the way your tongue actually pushes forward.
  3. Now tilt your chin down so it touches your chest.  Your tongue should pull back, and if you try to keep it pushed out, you’ll probably feel a bit of a cramp in your neck. 

We changed the bottles she was using to the kind with a bend in it, so that she could sit upright to drink her milk, thereby training her tongue to suckle the nipple while inside her mouth instead of between her lips.  It also helped a lot with her swallowing and she started to drink her bottles much faster. 

Tri Chew tool

The second thing we started working on at the beginning was teaching the Bean’s tongue to lateralize – to move from side to side.  In order to eat or talk, you need to be able to move your tongue in all directions in your mouth.  The Bean’s tongue only moved forward and back.  To train her tongue to do more moves, we used a tri-chew – a triangular teething tool with different textures on each side and at each point.   She loved chewing on that thing and it really worked!

The third thing we did was facial massage.  Since her cheeks and lips were so tight, I used a pen-like vibrating massager to loosen up those muscles.  I also massaged her soft palette (the top of the inside of her mouth) to make sure that it stayed smooth and rounded instead of getting a high peak in the middle from all the tongue thrusting she was doing.  Before she got teeth, I was also asked to encourage her to bite on my fingers by pushing down on her lower gums and then releasing.

Task number four was teaching her to eat from a spoon.  As it was, every time I brought a spoon to her mouth, I would scrape the food off the spoon using her top lip, and then she would promptly stick out her tongue and all the food would run down her chin.  We used a technique called parallel feeding to teach the Bean to use her lips to clear the spoon, and also to swallow with her tongue inside her mouth and with her mouth closed.  Stop again for a second and try this:

  1. Stick out your tongue
  2. Part your lips a little bit
  3. Try to swallow – it should be impossible
  4. Now close your lips around your tongue and try to swallow again – easier, right, but still not comfortable?
  5. Now pull your tongue back into your mouth and swallow again – ahh, now that’s what swallowing is supposed to feel like. 

Parallel feeding is a skill that takes some time to master.  It is also tough to explain in writing.  Basically, you feed from one side of the spoon, then flip the spoon around so they get the food on the other side of the spoon, and then flip it around a third time.  The idea is to switch sides quickly enough that the child learns to swallow the first bite before she can stick her tongue out again, in order to get the second bite when it comes.   I really wanted to include a video to illustrate my point, but my account doesn’t include video, so maybe I’ll add it at a later date.  In the meantime, if you are my friend on Facebook, you can see the video here

I have to tell you that all of these changes were a lot to incorporate into our lives.   I did my best to keep up, but feeding was hard enough without adding all the awkwardness of the different techniques, body positioning, chewing homework and massage.  I understood that in the long run, all the work would make everything easier, but I emotionally resisted the Oral Motor therapy right from the beginning.  I didn’t WANT everything to be this hard.  It seemed like I needed at least three hands to do what I was being asked to do on my own at home.  Feeding took up a large portion of our day, and it was embarrassing to have so much fuss around feeding when we were out in public.  At that time, I think I was still in denial that the Bean really had a serious problem.  Now, looking back on the pictures and videos, I can very easily see how different she was from other babies her age.  I just didn’t want it to be true. 

There is more to the OMT journey that I’ll go into in upcoming posts, but first, I’ll give you a sneak peek into the future.  Things got a lot better.  I got really good at parallel feeding, and so did the Bean.  We don’t have to do the parallel feeding anymore because she can clear a spoon with her top lip and swallows with her mouth closed and her tongue safely tucked inside.  The Bean’s tongue is rarely outside her mouth anymore, unless she’s doing her Tazmanian Devil impression.  It moves from side to side and up and down just fine now, and she pushes food onto her molars with that tongue, no problem.  Her facial muscles have also relaxed.  She has a huge, wide smile that shows up often on her face.  But the Oral Motor Therapy homework is still my least favourite.