Will you help us help West Virginia?

Friends.

We are calling in the village.

We need your help.

If you haven’t heard the national news, our beloved state of West Virginia was tragically affected by what they are calling a 1 in 1,000 year flood on June 23rd, 2016. 8-10 inches of rain fell on parts of our state in the matter of a few hours resulting in devastation that can’t be described in words or even imagined in photos.  A state of emergency was declared in 44 of our 55 counties. Thousands of people literally lost everything. Thousands more must gut their homes and try to salvage small amounts of personal possessions. Entire roads and bridges are gone. Businesses are destroyed. Our state gem, the Greenbrier Resort, and its PGA golf course was left underwater, and it closed it’s doors to guests, while opening them to homeless neighbors. Schools and churches are destroyed. 23 of our fellow Mountaineers have lost their lives.

We are both WV born and bred. We are in love with this state and its people that raised us within the comforts of her beautiful hills. We are proud to be from this hardworking state and even prouder to own and operate a business here. And we are left feeling helpless.

Today I spent the entire day wondering what I could do…what my family can do…what our business can do. The wonderful thing about a small state is that we are blessed to have friends in every corner and within a few hours of asking on social media, I had immediate responses of tangible needs.

Monetary donations are always easy and helpful in these situations. Work crews on the ground can assess specific needs and fulfill requests without waste. Many trucks full of needed supplies are being mobilized throughout our state. Links to both options to give are listed below.

Among these links and numerous articles I found today, I came across this image (taken by Nick Scott) of a child in Clendenin, WV. My heart dropped. While adults are mourning friends, filling out FEMA applications, searching for food, and shoveling mud out of their homes, our state’s children are watching. I can’t imagine the fear an adult, yet alone a child, feels watching what is left of their home, being bulldozed to the street corner.

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Milestones & Miracles will be making a monetary donation toward flood relief efforts.  In an efforts to motivate our friends & followers to help us pick our dear state up and help her people start again, we pledge that for each copy of 1-2-3 Just Play With Me purchased by Friday, we will create and send a play pack for a child in the affected areas. 

If you need a baby shower gift in the next few months, have been eying it for a gift for yourself, or have pondered as a work resource, please consider now. We have friends taking a truck this weekend and we’d love to fill it with toys and books to provide children with an outlet for their grief and worry. If you aren’t interested in 1-2-3 Just Play With Me, we encourage you to consider giving alongside us using the links below or another credible source.

President John F. Kennedy once said, “The sun does not always shine in West Virginia, but the people always do,” Thank you for helping our state remember there is a reason to keep shining!

With love & gratitude,

Lacy & Nicole

To order 1-2-3 Just Play With Me and get a PLAY PACK donated: http://milestonesandmiracles.com/

Presbyterian Disaster Relief: http://pda.pcusa.org/situation/west-virginia-floods/

Amazon Wishlist for Greenbrier County: https://www.amazon.com/gp/registry/wishlist/D3UZKAQSII5G/ref=cm_sw_su_w

Salvation Army: https://secure20.salvationarmy.org/donation.jsp

 

The 4 Essential B’s of Early Childhood

When working in the homes of families as an EI therapist I notice many things about a family. The longer I’ve done this work in the family’s natural environment, I’ve become more accurate in picking up small cues about the family…things like, What they value. What time of day they like best. What they want to learn from me and our session. What their comfort level is with a therapist sitting on their floor and jumping into their daily routines. The list really could go on forever.

And as a self described people watcher, I’ve come to know that 1) These things really matter in helping me to do a good job, and 2) They vary GREATLY from family to family. There are very few consistent trends when it comes to my interactions with families in their space…with a few exceptions. The largest exception I see is a parent’s desire to make sure their child has what “they need.” This desire seems universal to me. I’m often asked to recommend toys, asked if they have the “right things,” and asked to make gift recommendations for upcoming birthdays or holidays. Despite family income, I see a trend in family’s feeling that their child needs STUFF. And I understand it. Because I am a mom.  And I also love toys. And because the companies that market to us as parents want us to think that MORE is MORE.

As therapists, we believe the opposite – LESS IS MORE. Here’s why. A child can more easily access and interact with fewer number or toys that are organized with their corresponding parts. Hear me – this does not mean designer toy organization (unless you want it to), but this could mean using bins and boxes or separate areas on shelves (more tips HERE). It just means that toys, which are the TOOLS for learning, have an intended purpose for the age/developmental stage and that we don’t need 50 toys that do the same thing. Note that the recommended toy age is not always developmentally correct. It’s being set by marketers not pediatricians or developmental therapists with different goals in mind. Just because that box says 3-6 months, does not mean the toy is developmentally appropriate for a 3-6 month old baby. (Interested in what real development looks like at each stage and how to pair it with purposeful play and creative materials?  Check out 1-2-3 Just Play With Me We have done that work for you.)

When discussing this, we often talk about THE 4 ESSENTIAL B’S OF EARLY CHILDHOOD. And we’ve challenged ourselves with this question:

What developmental milestone could you not achieve between 0-3 years of age with simply BOOKS, a BALL, a BABYDOLL, and BLOCKS? 

Literally we’ve sat around the room with other therapists and challenged ourselves with this question (desperately nerdy, I know) and we can’t find one single milestone.

Quick examples (But the options are endless):

BOOKS:  Early literacy, labeling of objects, visual focus, turning pages for fine motor activities, turn taking, pointing. (Some of our favorites HERE and HERE and Toddler Reading Tips HERE. (We REALLY love books!)

BALL: Hand eye coordination, grasp/release, turn taking, language, social anticipation and peer play, balance and coordination, joint attention.

BABYDOLL: Imaginative play skills, labeling body parts, fine motor strengthening with dressing, social emotional practice of emotion sharing.

BLOCKS: oral motor exploration, cause and effect (knocking down), stacking, jumping over, counting, role play when using as other objects (cell phone, people), patterning, spatial awareness. More on the importance of blocks HERE.

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As a parent, I encourage you to shed the cloak of stress that “my kid needs more.” Our kids need us. Embrace that thought. It’s quite freeing and leads to memory making experiences no toy can replace.

As a therapist, I encourage other therapists to spread this message. I sat with a young first time, young  mom yesterday who asked me to go through a laundry basket filled with an array of toys she had been gifted, purchased, or had been handed down. She, like many parents I know, stressed she didn’t have enough or the right things for her child. We went through that bin together and identified what he might learn from those toys at this stage of development and which might encourage him to do the next exciting thing. And she boxed up the things he had outgrown, was too young for, or had too much of. She was so relieved and I was so excited for her and her child.

Spring cleaning leaves room for new growth. That holds true for our little ones too. Shed the rest and see what fun you can experience today with our 4 essential B’s!

Stairway to FUN! (safely)

As a pediatric physical therapist working in an early intervention setting, I spend a good amount of time on the stairs. Steep stairs, wide stairs, narrow stairs, wooden stairs, carpeted stairs, baby gate, no gate, one flight of steps, steps broken into two segments, rail on left, rail on right, no rail at all, no steps at all! I’ve studied construction of steps almost as much as my contractor father. I’ve also learned that parents have as many different views on steps as they do on nutrition and discipline. Some are so fearful of their child falling down steps that they are off limits all together. Others refuse a baby gate reasoning that the steps are there so they need to learn to be safe as soon as possible. And then there is everything in between.

If you are a parent with a child ready to take off (and up and over the horizon) of the steps in your home, we have a few tips to share:

 

  • Allowing your child to learn to crawl up and down the steps is am important pre-curser to walking them. It allows for the cognitive experience of learning the depth of the step, the distance, the texture etc. through exploration of movement and touch.
  • Before you let your child crawl up all the steps, let them practice crawling up and down one small “step” in the middle of the room – diaper boxes and small plastic bins work beautifully.
  • Like stepping, crawling down is typically harder than going up. Moving backwards without relying on your vision to see where you are going is not natural but is the safer option rather than scooting facing forward! Modeling to baby (siblings or yes, you yourself) can help!
  • Children may chose to walk up and down with both hands on the wall or rail (side stepping) or one (forward stepping). One is not better than the other – allow what feels natural to the child.
  • SAFETY is essential. We encourage use of baby gates until your child is proficient and that an adult always stands below the child when practicing.
  • Often times, especially with carpeted steps, the flight of steps appears as one big ramp to children. This may be particularly true if there is any visual challenges with depth perception. Lining the steps with colored masking tape or duct tape and placing a favorite sticker in the middle of each, may help highlight each step as individual and make the task of walking down less scary (and maybe even fun).

Just yesterday I was working with a child who would walk up the steps but not down. Her mother described her as “a mule,” digging her heels in and refusing to walk down no matter what motivators the family tried. Problem is, she is getting too big to carry down the steps. I know she is strong enough to descend a step because she does so with a single step into the home and for fun off an exercise step. So we lined the steps with tape yesterday and placed a snow man sticker on each and she literally walked down on the first try!

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I hope that these few simple tips make stair climbing fun and safe within your daily routines. We devote a generous portion of our gross motor cards (the pretty green ones) in 1-2-3 Just Play With Me to stair walking. If you don’t have a copy, make sure you get yours today! We share detailed milestones in 5 developmental domains with fun, purposeful play suggestions in a simple practical format – perfect for a parent or pediatric professional!

 

Reteaching my brain and listening to my body so I can help my patients do the same: A review of TMR TOTS

“Educating yourself does not mean you were stupid in the first place; it means you were intelligent enough to known there is plenty left  to learn.” -Melanie Joy

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This weekend I spent about 18 hours on the floor in yoga clothes, on yoga mats, holding and twisting baby dolls with black electrical tape on them, and rolling, rubbing, and positioning other people (some I know, some I didn’t before Saturday). PT’s are weirdly awesome. We learn by doing. By seeing. Be feeling. By proving things to be correct…to be good enough to be worth our time, but more importantly to be worthy of making a difference for our patients.

I have be a long time internet stalker of the TMR Method – more specifically – TMR TOTS (the version for baby lovers like me!). It’s been a course that I have wanted to take for a long time, after hearing rave reviews from other therapists, and after hearing MANY refer to methods taught in this course with a sense of common vocabulary. As a PT I felt I was missing out on the secret and I wanted to see for myself.

A great slide with a great reminder!

A great slide with a great reminder!

Without getting into tremendous detail, these methods beautifully weave neurological principals long proven by science to be true, reinforcing what therapists have seen themselves to be successfully with a concept foreign and new to some (like me): making improvements in function, flexibility, posture, and showing increased range of motion without “stretching.” My brain couldn’t process this at first.

 No pain?

No “work?”

No “hold it 5, 10, 30 seconds?”

No “feel the burn?” 

I mean, they don’t call us PT’s (aka Physical Terrorists) for nothing? I was skeptical, then inquisitive, then curious (in between the 1st and 2nd days of the course, my first and favorite lab partner (my college roomie who came to take the course with me) and I assessed my children, husband, and mother in law – with a burning sense of expectation that it wouldn’t work with at least ONE of them.

Practicng at home. Sorry for the PJs - long day!

Practicng at home. Sorry for the PJs – long day!

They all improved. Every one. My mother in law could come to standing with ease and less pain. My husband and children all have increased hip motions where tight hamstrings have long limited them in various ways. So then I started questioning (long term carry over? children with neurologic tone?). And then I got to see before my own eyes and feel with my own hands one of my current patients be treated by Susan Blum – the gentle, patient, and wise PT – who teaches this career changing course. And I submitted. As I did I actually felt guilty that I didn’t have this knowledge for the past 14 years. This old dog learned a new trick and I can’t wait to practice what I learned this week and see what the results are on my patients!

If you are a therapist, I urge you to check it out. The differences we could all collectively make with this knowledge is pretty mind blowing. I’m eager to learn more and to see what we saw and felt replicated and proven in published studies.

If you are a parent with a child with challenges caused by movement – I urge you to seek out a therapist with the training. I wish every child I ever treated had the opportunity to give it a try.

A main component of TMR is to “go to the easy side,”  and “watch, listen, and feel what the body wants to do.” I sat and processed this a bit…and at a deeper level. When we feed our nervous systems with sensory input that our bodies need, we regulate, and function optionally. When we allow movement in the ways I learned about this weekend, our bodies start to correct themselves.  How many times in my life have I pushed my mind, body, and heart out of what it wanted to do? How about you?

Over worked?

Over scheduled?

Under-exercised?

Over-exercised?

Poor nutrition? and hydration?

Wrong choices for wrong motives?

Neglecting my people for reasons that don’t matter?

Judging myself by unfair standards?

My husband claims I have an “inner hippie,” and maybe he’s right (and maybe it’s laughable – go ahead) but I do think people and experiences come to you or are sent to you as you need them. Tomorrow my daughters return to school and as I’ve shared before, a new school year or more like New Year’s Day for me than the holiday. I love fresh starts and new chances for healthy starts….for chances to listen to what your body, mind, and soul are telling you.

As they go off to school, I will shift into working more and having more time during the day to pour into my “other kids.” Thanks to TMR, I have an incredible new skill set to practice and learn with. I also have a reminder to “go to my easy side” as I tackle the mom role of hectic schedules, a much quicker pace, and on the never ending quest for “balance” (in parenthesis because I don’t think it exists).

I am thankful that my body keeps telling me I have so much left to learn! What is yours telling you?

One of my favorite slides from the course.

One of my favorite slides from the course.

 

EXPLORE, PLAY, GROW: Our visit to see Winter The Dolphin

We are kicking off a new feature on our blog called Explore. Play. Discover, a series of blog posts sharing our reviews of fun places to play. We hope this series will help not just with vacation or field trip planning, but will also bring exposure to incorporating play into your travel fun.

For our first entry, we are sharing our recent visit to Clearwater Marine Aquarium. This marine rescue center and aquarium is located in Clearwater, Florida, and although it has been in operation for years, it was made famous by the Dolphin Tale movies. The popularity of the movies has certainly increased the number of visitors to the aquarium and has increased funds to improve the facilities and services.

Clearwater Marine Aquarium was easy to find and we were able to find (free) parking close to the entrance because we arrived early. Visitors arriving later park farther away. General Admission pricing is $21.95 for adults, $16.95 for children, $19.95 for seniors, and children under 2 are free. The kids were super excited to see the actual houseboat filmed in the movie outside the aquarium and loved pointing out the features they remembered.

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While my 9 and 11 year old were overly excited to see Winter (the Dolphin famously rescued), we were all pleasantly surprised by the other experiences offered. We got a tour of the animal hospital and the well educated volunteers showed us a huge board that tracks when animals were brought in, from where, what their injuries are, and when their expected release is planned. We saw a sea turtle brought in a few days earlier with a cracked shell that was bandaged and resting. We learned that sea turtles are at risk for a virus similar to HPV in humans and that their center is one of a few in Florida that perform laser surgery to remove harmful growths caused by the virus. Our daughters got to hold a bucket filled with the amount of fish a dolphin eats daily. We learned that anyone from the Coast Guard to boaters can call if they spot injured marine life and that Clearwater Marine Aquarium goes out to rescue them.

Next, we made a beeline for the VIPS of this place, Winter and Hope (we could hardly hold the kids back). They are in the tanks that they were filmed in during the movie and were separated at first and then joined together. Trainers on a microphone shared with the crowd the daily routines and care of both dolphin and we got to observe Winter getting therapy to help his prosthetic continue to fit. She didn’t seem to mind the stretches! The kids got to hold an examine one of Winter’s prosthetic tales, which was incredibly cool!

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Next to their tanks were sea turtles with missing limbs, damaged shells and several sea otters. One was paralyzed when hit by a car and could swim with only the top half of his body. Another was raised by a man living on a fishing boat for a year (frowned upon by marine staff) until it “got a bit out of control” and they explained this sea otter acts very odd due to it’s early experiences (See what we do in those first few years really is THAT important!). We also saw the loud and noisy bird, Ricky, that was in the video and another dolphin that had been injured similarly to Winter. There were several stations where we could touch and see small aquatic animals and plants, including sting rays (75% of us was brave enough), and ask questions There were also several tanks with a variety of fish and even some sharks.

This location also included (of course) a gift shop with a variety of souvenirs. We didn’t buy any but my favorite was a plush Winter whose tail could come on/off. We did cave to buy photos of the kids made using a green screen, which were pricey but precious at $30 for both, but too cute to pass up! Towards the entrance of the aquarium they sold limited drinks and concessions and snow cones for enjoying outside under a tent.

Fairly new to Clearwater Marine Aquarium is a second spot a few miles away where they showcase features from the Dolphin Tale movies called Winter’s Dolphin Tale Adventure. We took an open-air trolley to this location (included with the general admission) and did not have to wait long for the ride there or back. At this location, we saw artifacts from the movie (Sawyers bike, the kitchen and bedroom from his house etc.) and could walk through a simulated hurricane (full with high winds, noise, and water). This only took a few minutes but was fun! This location did have a slightly larger refreshment stand, where we enjoyed ice cream and popcorn. I believe there may have been hot pretzels and hotdog type foods too. There was a hands on area for younger children where smaller climbing structures were available and children could write a letter to Winter.   A nice surprise was that Cozi Zuehlsdorff, the actress that played Hazel Haskett in Dolphin Tale was visiting and did a Q&A session and a meet-n-greet.

I would certainly recommend Clearwater Marine Aquarium as a great option for a family activity. Here are a few details to consider:

 

TIME NEEDED: I’d allow ~2 hours if you only do the main animal hospital and ~3-4 hours if you visit the location dedicated to the movies.

 

AGES APPROPRIATE FOR: There’s really something here for everyone and I did see small babies that would enjoy the visuals, but overall, I’d say this is most appropriate for 2-3 years old and up, with 6 and up likely able to fully understand the educational component (of course we believe even babies learn from their environment).  ** The hurricane simulation might be scary for younger children.

 

ADDITIONAL TIPS: If going in prime sun hours, take sunscreen. The top deck and waiting areas for the trolley are outside. We enjoyed lunch afterwards at Frenchies with cousins we were visiting. They suggested this beachy local chain (and it was quite good). Interestingly, the kids insisted on watching Dolphin Tale that evening and noticed Frenchies is mentioned in the movie, so I guess you could say we had a fully authentic Dolphin Tale adventure.

 

DEVELOPMENTAL SCORE: (we decided to add this is a potential 5 star rating system, scoring how many developmentally appropriate, hands on, movement or sensory based activities are offered). We give Clearwater Marine Aquarium 5/5 stars! ★★★★★

 

BANG FOR THE BUCK: Considering there were two locations to visit, multiple hands on experiences, major educational experiences, well educated engaging volunteers and staff, and that we were in Florida at an attraction and we didn’t stand in line or feel Closter phobic, it was certainly worth the money we spent. When you consider that part of your admission funds care of these animals — it is icing on the cake!

 

Most interestingly to me, is that in the movie many children with physical and mobility challenges, including amputees visit Winter and Clearwater Marine Aquarium. While this touched both myself (a PT) and my husband (an OT), we figured it was sprinkled in as Hollywood’s “glitter” to bring he movie full circle. I was pleasantly surprised to see for myself that it was actually true, as many times during our visit I caught myself checking out a kid’s sleek gait trainer or wheelchair and noticing orthotics.   I have to say it was even sweeter in real life to observe the look on these little warriors faces as they watched animals preserve the same ways they do. So if you are a therapist, or simply a sucker for underdogs winning big time, you may experience the same joy on your visit!

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Here at Milestones & Miracles, LLC we BELIEVE that PLAY is the way we all learn, but especially young children and most certainly when encouraged by an involved parent. If you believe in play to learn too, check out 1-2-3 Just Play With Me (the perfect resource made by therapists and moms!).

Milestone or Modern Convenience Part II: What to do when the convenience becomes a hard habit to break

Lacy recently wrote a blog for Virginia’s Early Intervention Program – specifically geared for therapists that work for that program, but the information is important for clinicians AND parents and caregivers. We have reposted it here but you can find the original HERE.

 

Written by: Lacy Morise, M.S. CCC/SLP

 
If you haven’t read it yet, be sure to check out the first blog post in this 2-part series, Milestone or Modern Convenience? – Part I: Overuse of the Sippy Cup and Pacifier, to learn important information about an infant’s need for sucking and the risks involved with overuse of the pacifier and sippy, cup!

 
Now that you are familiar with the pluses and minuses of pacifier and sippy cup use, what about when the parents are ready to help baby “give up” the sucking habit? Again, as the resource for all things infant and toddler, we can suggest the following tried and true strategies.

 
Cut back – When ready to begin weaning, cut back on the time that the pacifier and/or sippy cup is available to the child. If the pacifier has been available to the child all day, every day suggest cutting back its availability to only nap and bedtime. As for the sippy cup, cut back its use to only when the family is out and about. When at home suggest offering the child a straw or open cup in its place.

 
Go cold turkey…if the child is ready – If going cold turkey is the method of choice pass along this wisdom: if the child is not ready, he may find something else to suck on, like a thumb or fingers. However, if ready, this method may work just fine. Suggest that, if going cold turkey, it is a good idea to rid the house (or at least baby’s line of sight) of all pacifiers and/or sippy cups. If they remain in the cabinet or drawer, baby will know and will want them!

 
Provide additional comfort – In preparation of weaning a baby from the pacifier and/or sippy cup, provide him with an additional comfort item. If the child’s only “lovey” is the pacifier or sippy cup, having a back up “lovey” will still allow the child a comfort when his first choice is gone.
Understand that routines may change – Warn your families that routines may change when weaning baby from the pacifier and/or sippy cup, especially if it is used as the child’s primary comfort item. When the pacifier/sippy cup is gone, the child may need assistance with calming, temporarily; swaddling, rocking, singing and some extra cuddles may be necessary until baby learns how to calm himself without the help of his pacifier or sippy cup.

 
Give the pacifier or sippy away to a new baby – Sometimes parents can convince the child to give up these items with some incentive. However, it is suggested that the new baby receiving the child’s old pacifiers/sippy cups not live in the same house. It will be more difficult for the child not to suck on a pacifier if there is one nearby. Some parents are also able to negotiate a trade with their child: “If you leave your pacifier under the Christmas tree, Santa will take it with him and leave you a present!” If the child is ready, this trick is a gem!

 
Some tips to warn parents to not try are:
Never, ever cut the pacifier nipple and give it to the child – Yes, if there is no nipple for the child to latch onto they will be less interested in sucking the pacifier. However, the risk of choking is too great to ever recommend this as a means of pacifier weaning. Pacifiers have to pass what is called a “pull test” during manufacturing. A cut nipple would not pass this pull test and would be deemed as unsafe for a child to have.

 
Do not shame the child for wanting to suck on his pacifier or sippy cup – Toddlers and preschoolers typically do not respond to being shamed into giving up the pacifier or sippy cup. Telling the child that in order to be a “big kid” he must give up his most prized possession may just make him want it more. And who can blame him, who really wants to “grow up” anyway?!

 
Do not recommend putting something that tastes bad on the nipple of the pacifier and/or sippy cup – I have known families to dip the nipple in chili powder to convince their toddler to stop sucking on his pacifier. One sweet little guy I knew still wanted his pacifier so badly that he licked the chili powder off, little by little, chased it with water and eventually got his paci back. Again, this is a case of the parent wanting the child to make the decision to give up the comfort item. Not gonna happen! Sometimes the parent has to be just that and take control.

 
So we wish you good luck as you head into the magical world of the paci and sippy cup. It holds a strong spell on many little ones, but with the right guidance and when our families are ready, we can help them help their children kick the habit!

 
Do you have any suggested weaning methods to add to this list? What would you say to encourage your families to follow through with weaning their child?
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Lacy Morise, M.S. CCC/SLP educates families on the risks involved with over-use of the pacifier and sippy as an early intervention speech-language pathologist in the West Virginia Birth to Three Program. She guiltily confesses to allowing all of her children to abuse the use of the pacifier! She owns Milestones & Miracles, LLC a company devoted to educating families about child development and the importance of PLAY! Check out her website and blog and follow her on Facebook, Pinterest, Twitter and YouTube.

Milestone or Modern Convenience? Part 1: OverUse of the Sippy Cup or Pacifier

Lacy recently wrote a blog for Virginia’s Early Intervention Program – specifically geared for therapists that work for that program, but the information is important for clinicians AND parents and caregivers. We have reposted it here but you can find the original HERE.

 

Written by: Lacy Morise, M.S. CCC/SLP

Although shocking to many, the sippy cup is NOT a developmental milestone. Nor is sucking on a pacifier, for that matter. But why do we (therapists,??????????????????????????????? parents and caregivers) celebrate these acquired “skills” as developmentally appropriate achievements? Why do we allow these “skills” to happen for much longer than they should? Is it just easier to always have a pacifier (aka mute button) in the baby/toddler’s mouth? Sippy cups are so easy to take along with us everywhere, how can it be harmful if a preschooler continues to exclusively drink from one?
The pacifier is a great thing for infants. It meets a physiological need to suck and allows baby a way to comfort himself. It may reduce the risk of SIDS as it appears to allow baby’s airway to remain more open and prevent baby from falling into a deeper sleep. Not to mention the other fringe benefits like quieting rowdy babes, helping them sleep longer and making outings and car rides more enjoyable for all. It certainly has a “place” in an infant’s world! And the sippy cup is an awesome convenience must-have. Drinks can be toted everywhere with baby/toddler and a sippy’s use means less spills to stain the carpet! Beautiful!
But aside from these benefits, there are risks associated with the over-use of both. Pediatricians and family physicians recommend weaning or stopping pacifier use in the second six months of life. Shocking I know considering how many toddlers we see with pacifiers in their mouths! The sippy cup can be skipped all together if natural development is occurring with no issue. Created for convenience, the sippy cup now has an entire market (and aisle in most stores) devoted to it! However a baby can transition to a straw (as early as 9 months) or open cup just as easily and drinking from both of these IS developmentally appropriate.

 

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As trusted resources on development, it is our job as early interventionists to inform families of both the positives and negatives of (prolonged) sucking. Some points to keep in mind as you discuss these “milestones” with parents and caregivers:
Prolonged sucking on a pacifier puts children at (a higher) risk for misaligned teeth. As those tiny white pearls are erupting, the pressure of the nipple of the pacifier can cause teeth to move around and shift. Also, the pressure can cause their hard palate, the roof of their mouth directly behind the front teeth, to change. It can push the palate forward, again changing the position of the teeth. In his research, J. Poyak concludes, “The greater the longevity and duration of pacifier use, the greater the potential for harmful results.”
A sippy often allows access to drinks all day long for a toddler. Not necessarily a bad thing, depending on what is in the sippy. If it is a sugary drink, the sugar increases the risk of developing cavities. The Medline Plus article titled, “Tooth decay – early childhood” states, “When children sleep or walk around with a bottle or sippy cup in their mouth, sugar coats their teeth for longer periods of time, causing teeth to decay more quickly.” Also, if a sippy is the only way a child gets liquids the developmentally appropriate skills of drinking through a straw and open cup are inhibited.
If children are allowed to have a drink (in a sippy or other cup) all the time, they may fill up on liquids and not eat meals as well, negatively impacting their nutrition. 

 

Although inconsistent, research suggests a relationship between prolonged sucking and speech delays. Barbosa et al. (2009) concluded in their research of 128 Patagonian preschoolers that, “The results suggest extended use of sucking outside of breastfeeding may have detrimental effects on speech development in young children.” When speech sound development is negatively impacted, so is the child’s intelligibility of speech making it difficult for others to understand them.
Sucking on a pacifier increases a child’s risk of developing otitis media (ear infection). The AAP (American Academy of Pediatrics) and AAFP (American Academy of Family Physicians) advocate for limited to no use of the pacifier in the second six months of the child’s life to decrease this risk.
A pacifier or sippy cup that is always in the mouth of a child, even when the child is walking around, puts him/her at a higher risk for mouth injuries. A 2012 study by Dr. Sarah Keim of Nationwide Children’s Hospital in Columbus, found that “a young child is rushed to a hospital every four hours in the U.S. due to an injury from a bottle, sippy cup or pacifier.” When little ones are just learning to walk, doing two things at once requires a bit more coordination than they are capable of!
Besides the physical risks, beyond the age of 1 a stronger emotional attachment to the pacifier (or sippy cup) makes it increasingly difficult for the child to detach. The pacifier/sippy goes from meeting a physiological need during infancy to providing emotional comfort to the toddler when scared, upset or sleepy.
However, it is our job to know and respect the individuality of each child. Therefore it is best practice to reassure parents that we recognize they know their child best. We all want our children to be happy and if using a pacifier and/or sippy is what’s best for them and their family, that is okay. Our job is to inform the families we serve the best we can. Equipping them with knowledge on why prolonged sucking may be detrimental to their child allows the family to make the final call. Education and Support, that’s what we are there for.
Have you ever had the “prolonged sucking” discussion with any of the families you serve? How might you begin this conversation with a family?
Today’s blog is Part I of a two-part series on prolonged sucking and what we can do to educate families about it. Stay tuned for “Part II – What to do When the Convenience Becomes a Hard to Break Habit” next week featuring ideas you can share with families who are ready to wean their child off of the pacifier or sippy!
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References
Barbosa, Clarita, Sandra Vasquez, Mary Parada, Juan Carlos Velez Gonzalez, Chanaye Jackson, N David Yanez, Bizu Gelaye, and Annette Fitzpatrick. “The Relationship of Bottle Feeding and Other Sucking Behaviors with Speech Disorder in Patagonian Preschoolers.” BMC Pediatrics. N.p., n.d. Web. 20 Mar. 2015. http://www.biomedcentral.com/1471-2431/9/66
EG, Gois, HC Rubeiro-Junior, MP Vale, SM Paiva, JM Serra-Negra, ML Ramos-Jorge, and IA Pordeus. “Influence of Nonnutritive Sucking Habits, Breathing Pattern and Adenoid Size on the Development of Malocclusion.” Angle Orthod.4 (2008): 647-54. Print. http://www.ncbi.nlm.nih.gov/pubmed/18302463
Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents (n.d.): n. pag. Web. 18 Mar. 2015. http://www.aapd.org/media/Policies_Guidelines/G_Periodicity.pdf
Hauck, Fern R., MD, MS, Olanrewaju O. Omojokun, MD, and Mir S. Siadaty, MD, MS. “Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-analysis.” PEDIATRICS5 (2005): E716-723. Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-analysis. PEDIATRICS. Web. 17 Mar. 2015. http://pediatrics.aappublications.org/content/116/5/e716
Keim, Sarah A., MA, MS, Erica N. Fletcher, MPH, Megan R.W. Tepoel, MS, and Lara B. McKenzie, PhD, MA. “Injuries Associated With Bottles, Pacifiers, and Sippy Cups in the United States, 1991-2010.” N.p., n.d. Web. 19 Mar. 2015. http://pediatrics.aappublications.org/content/129/6/1104.long
Natale, Ruby, PhD, PsyD. “Risks and Benefits of Pacifiers.” American Family Physician79 (2009): 681-85. – American Family Physician. Web. 18 Mar. 2015. http://www.aafp.org/afp/2009/0415/p681.html
Poyak, J. “Effects of Pacifiers on Early Oral Development.” Int J Orthod Milwaukee4 (2006): 13-6. Print. http://www.ncbi.nlm.nih.gov/pubmed/17256438
Regulatory Summary for Pacifier (n.d.): n. pag. U.S. Consumer Product Safety Commission. Web. 18 Mar. 2015. http://www.cpsc.gov//PageFiles/120645/regsumpacifier.pdf
“Tooth Decay – Early Childhood: MedlinePlus Medical Encyclopedia.” S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 17 Mar. 2015. http://www.nlm.nih.gov/medlineplus/ency/article/002061.htm
Zardetto, CG, CR Rodrigues, and FM Stefani. “Effects of Different Pacifiers on the Primary Dentition and Oral Myofunction Structures of Preschool Children.” Pediatric Dentistry6 (2002): 552-60. Print. http://www.ncbi.nlm.nih.gov/pubmed/12528948
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Lacy Morise, M.S. CCC/SLP educates families on the risks involved with over-use of the pacifier and sippy as an early intervention speech-language pathologist in the West Virginia Birth to Three Program. She guiltily confesses to allowing all of her children to abuse the use of the pacifier! She owns Milestones & Miracles, LLC a company devoted to educating families about child development and the importance of PLAY! Check out her website and blog and follow her on Facebook, Pinterest, Twitter and YouTube.
Website: www.milestonesandmiracles.com
Blog: www.milestonesandmiraces.com/blog/
Facebook: https://www.facebook.com/milestonesandmiracles
Pinterest: https://www.pinterest.com/milestonesm/
Twitter: https://twitter.com/MilestonesM
YouTube: https://www.youtube.com/watch?v=HmuWPFDcqZ4

Let them fill in the bubbles and JUST MOVE ON – a mother’s call to minimize standardized testing stress

I debated writing this blog.

It’s one of those situations where as a person who blogs (I still can’t publicly call myself a writer) you internally struggle with putting your family and your beliefs out there publicly, because there will likely be strong opinions and comments of all sort in return.

In the end I decided it was worth it.

So here goes…

First I want to say that children and education and parenting and politics can all be sticky topics. And while my husband and I have choices we believe in, I understand and appreciate that yours may differ from mine and I genuinely appreciate that. One thing working in the homes of families for more than 10 years has taught me is that what works for me might be awful for you and vice versa.

There you go. Now on to the important part.

If you, like us, choose public education for your children, then they likely begin the ritual of standardized testing in the 3rd grade. We believe and appreciate as taxpayers and as parents that there needs to be a way to measure accountability and progress for schools. However, we, like many American parents, aren’t super pleased with the job that the current testing process is doing. We have a current 5th grader and current 3rd grader and can say with confidence that the tests our oldest daughter has taken (and done well on)  have never been able to fully assess the incredible progress we and her teachers have seen through the years or more importantly measure the talent or work performance of her stellar teachers.

A bigger problem to us as parents is the pressure associated with the test. Because the schools here in our state (WV) are required to document to the state how they are “preparing kids to take the test” and “letting them know how important the test is,” there are lots of activities, written and verbal interactions, and general overkill (in my opinion) that this test is a big deal. Do you remember pep rallies for a standardized test when you were a kid? How about signs cheering you on? Or multiple letters sent home to your parents reminding you to go to bed early and eat a great breakfast? Yea – me neither. We showed up, got new pencils, filled in the bubbles completely (not half way now – that was the only thing stressed), and went to recess.  Is all the “hype” needed?

We enthusiastically say NO! Why? Because kids naturally know it matters and they will either try their best or they won’t. I’d love to see a study that proves the letters home about the importance of breakfast increases test scores. You know what I know for sure it does increase? TEST STRESS. You know how I know? My 5th grader started sleep walking and mumbling about standardized testing in the 3rd grade. There is nothing creepier than walking up to a zombie eyed kid mumbling about taking a test while hovering over you in bed. Worse yet, my current 3rd grader, spent the night before her first day of testing dry heaving for 90 minutes. That kind of did me in as a Mom. I’m tough, but not that tough.

My husband and I debated (passionately I might add) about what to do. My mom is a long term educator and past principal. I know the school needs test scores. I also know my kid needs to worry about riding her bike an extra 10 minutes vs. vomiting over a test at night. We want to advocate for our children AND their teachers. The question is how to do that? There’s a large “Opt Out” movement currently, with some state superintendents actually encouraging parents to opt out with the reasoning that educators can’t change legislation so maybe data will. I understand that desperate thought process (to be honest it tempts me), but I also know in the short term, right here in my corner of the world, it may hurt my precious school and teachers. So I communicated with my daughter’s teacher, prayed, and in the end she was fine the next day when she realized it wasn’t as bad as she had imagined.

And then I wrote to my elected officials. To be honest, even though I am a very optimistic person, I have little faith this will help, but I did it, because I have to do something. And when I shared it with my best friend (and co-owner of Milestones & Miracles), she immediately said, “Share it on the blog.”

So here it is. Here’s my letter. I know it will likely be met with comments of how others handled it differently or how they opted out of a test or even opted out of public education all together and like I said before, that is ok and to be expected. We choose these schools and this village for our children for many reasons not mentioned here (even with a crummy test).  This letter might not be the best option of how I can advocate for my child, her teachers, and her school, but it is the best I have right now. So it is what I offer until I have something better. I shared it with her principal and thanked her for leading educators who care about my child’s future more than a test score.

To me, the real question is, for those of us who continue to want to access public education for our children, what is the most effective way to support both our children and our schools?

Dear Senator,


I am writing to share my opinion regarding our current education system and state testing policies in WV.

Let me start by sharing that as a daughter of a life long educator (most of those years in WV) and a parent who is beyond pleased with the education and experiences my daughters have received, I am a supporter and believer in public education. I have seen my mother change and inspire countless lives. I have witnessed teachers pouring their talents into my daughters and their classmates and not just caring but putting concern into action with students who are unsafe at home. When I speak of their creative projects, their involvement with the First Lego League, and the personal relationships with school staff that have fostered a deep love of learning for my children, people assume I send my children to private school. I beam with pride when I can correct them by saying my children actually attend public school in one of the poorest states in the country. The teachers and administrators we have encountered here in Berkeley County can and often do bring me to grateful tears.

Today is the first day that my 9 year old will take a standardized test. She is a confident and bright child that does well in school and has never complained about a test, an assignment, or going to school. On the contrary, she cries when she is sick and has to miss school! Last night, she shook, hyperventilated, and dry heaved for 90 minutes before bed – because she is “scared of the test.” This is a child that competed individually at the state gymnastics meet, played a main role in the school play, and speaks at our church in front of hundred of adults without even a mention of nervousness. My confident bright child was physically ill last night…because of a test.

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As I helped her take deep breaths, reassured her she was well prepared, and promised her that this test will have no affect on her future, I became quite frustrated and angry. What are we doing to our children?

I work for a federally and state funded program (as a Physical Therapist for WV Birth To Three) and so I understand the need for accountability. As a taxpayer I expect it. When we force our teachers to give tests that do not test true knowledge, we place them in a hard position. They feel the pressure and without ill-will pass that pressure on to our children. When we require administrators to document what they are doing to “motivate students to try hard/do well on the test,” we create unneeded stress on children. I would be curious to see if this well-meaning requirement actually hinders their scores. I understand that many children in our state do not have parents at home who are prioritizing or supporting education, but I’m not sure pep rallies for tests, signs cheering students on, and notes and constant verbal reminders on what to feed our children and when to put them to bed will solve that. The extra hype creates hysteria for my child and others. I firmly believe if she could come in and take the test with a good ‘ol “do your best” parents would not be seeing these clear signs of anxiety in our children.
As a home provider of early intervention in many of these at risk homes, might I suggest that working to change that culture in the home 365 days a year vs. the week before testing with community and school support that involves families might be more effective? There are better ways to do what needs to be done. If you haven’t read “The Smartest Kids In The World And How They Got That Way” by Amanda Ripley. I strongly encourage you to. It opened my eyes to the countries that are doing great things with fewer resources than we have here in the US.

I also work as a small business owner dedicated to providing educational support to families, reminding them what typical child development looks like (as a nation we are forgetting this), supporting a child’s need and right for free and safe unstructured play, and encouraging movement and sensory based learning experiences. One way my business partner and I do this is by going into schools and providing continuing education on how the young brain learns best and then problem solving ways for teachers to do this while still meeting state standards.

As a business owner I will continue to do this.

As an early intervention therapist I will continue to try to attempt to strengthen WV families and empower them to be involved with their children’s learning from the start.

As a parent, I will continue to advocate for my child and others, pray for their impressionable minds, and reassure my child that her individualized learning can’t be appropriately measured by one current standardized test. I will also support my child’s hard working and underappreciated teachers and administrators.

What will you do?

Respectfully-

Nicole Sergent

Martinsburg, WV

What does READY for Kindergarten really mean?

Yesterday I volunteered at Kindergarten Registration at my daughter’s elementary school.

As I sat there watching the children march from station to station (either proudly or with nudging) with their parents behind them, I had a rush of mixed emotions. I was excited for the journey they are all ready to start at such an incredible place to learn. I couldn’t help myself from sharing, “Do you know you are going to come to the BEST SCHOOL EVER!? Waves of nostalgia passed over me as I remember exactly what my oldest wore to her Kindergarten Registration and how she went from station to station collecting documents and shaking hands like a 5 year old executive. Small pains of sadness and emotional gratefulness were in the mix too – my youngest will leave that incredible nest in a few months. Where has the time gone? I am going to have a child in middle school next year. Virtual hugs accepted.

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A child’s (and a parent’s) first step into an elementary school is a big deal. I know it and I felt it for those parents yesterday. That first impression plays a large role in a parent’s impression and expectations for their child’s school experience. And we all know that our expectations as parents play a large role in our child’s expectations for themselves.

I have to say that our elementary school does a really great job of this. Friendly smiles. Calm voices. Squatting down to greet kids eye to eye. Fun and festive decorations. These professionals got it going on! But this does not surprise me. They do an incredible job day in and day out so it is natural to share their gifts with families on their first special day.

As a pediatric Physical Therapist, I have a genuine interest in development, and through our work with Milestones & Miracles, I’ve become specifically interested and fascinated with the benefits of developmentally appropriate learning through play or hands on/multi-sensory activities with a purpose.  Lacy & I are so passionate about this that we developed a lecture to support schools with the good work they are already doing, with ideas to feed a student’s nervous system with the movement and activities they need to learn.

At the table next to me, was our school’s reading specialist. She is young, fun, and good at what she does. The little girls idolize her and the boys have big time crushes on her. She’s an elementary rock star. She was handing out a booklet yesterday to help parents prepare their children for Kindergarten. It quickly caught my eye because I remembered it. And when I remembered it, I also remembered my feelings absolute panic….WHAAAT? She has to do this BEFORE KINDERGARTEN? She’s not ready? Maybe I should wait a year? Will she ever succeed?

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When it was our turn to step into that school, I’ll admit this list clearly stressed me out. The self imposed challenge of teaching my child all of this information by September overwhelmed me and to be honest I didn’t want to spend our last summer before school stated drilling her to learn to write her name. To my knowledge she wasn’t doing most of these things at 4. She had gone to a play based preschool and we didn’t do worksheets or flashcards at home. (Side note: After she started school a few months later, her new teacher proudly shared she actually DID know/could do these things….shocking my husband and I…and starting the precious trend she has for refusing to learn most things we try to overtly teach her).

In solidarity with those parents coming to collect the list and learning sheets, I had a wonderful conversation with the reading teacher. It went a lot like many of the valued conversations I’ve had with my children’s teachers over the years…teachers know concepts they must share are often presented too early or in a format they don’t feel confident with…but the national trend for education and policy making is what it is. I shared that brain research tells us that children’s brains are often not ready/wired to read until closer to 7 years of age. She confirmed that she sees this often with students she work with. I shared as a parent of a first time student, that list made me nervous.  We both agreed our shared thoughts that expecting them to do things their brain isn’t ready for isn’t exactly fair (please note I am in no way saying a Kindergarten student should not learn, be challenged, be introduced to literature concepts etc. Just that there is a need to recognize ALL kids are biologically ready for site words the instant they turn 5).

The packet also included some great and relevant follow up information that expanded on the list..including helpful and reassuring information that these things did not have to be mastered by the first day of school (I don’t remember this part of the list when I received it?! So glad it was added).

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But in addition to those tips, I think it’s important to share with parents that PLAY BASED learning is still developmentally appropriate for 4 & 5 year olds….and beyond that, it is this type of learning that makes those essential concepts, imperative building blocks for advanced learned, concrete and real and strong. Without fully understanding these early learning concepts, our children don’t have a sturdy foundation. And yes some students prefer pencil and paper (even at 4 years old), but we know that the more senses (including movement) we involve with learning, the more our children will learn.

Experiencing is learning.

Purposeful Play IS learning.

Just because he/she doesn’t come home with a worksheet doesn’t mean learning didn’t occur.

Because we are so passionate about this for children and their parents, and because we have been so fortunate to have a unique and strong relationship in partnering with my daughter’s elementary school, I felt comfortable creating a short resource that could be shared to back up these principles.

And because I’m sharing it with that rock star teacher today, I thought why not share with you?

If you are a teacher, parent, therapist or just anyone interested in the topic feel free to share this document with anyone who might benefit. You have our permission to print it. You can find it by clicking the PDF link at the end of this essay. We only ask that you respect our time in creating it and cite us as the source. It is short and sweet but provides practical suggestions for developmentally play based in context learning for those getting ready for Kindergarten.

We can all work together to make change by advocating for developmentally appropriate learning and advocating for play as an essential need for all children.

Is he/she ready for Kindergarten is a question we will all ask ourselves as parents. We believe that defining what “ready” really means makes it a much easier question to answer. We hope this list helps you do just that.

Kindergaten Here I Come – Ideas To Learn PDF

 

Have an infant or toddler? Want to support them with purposeful play – check out 1-2-3 Just Play With Me! 

COMMUNICATION FOR ALL – How AAC Helps Children Find Their Voice

This post was originally written for Child Guide Magazine. Check out the many resources Child Guide offers as well as this article and others HERE.

 

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What comes to your mind when you hear the word “communication”? Do you think of talking? That is what most people consider to be communication. But what if you don’t have a voice to talk? Or if when you talk no one can understand what you are saying? How do you communicate then?

 

Speech-language pathologists help those without an audible voice find their “voice” by introducing them to AAC. What is AAC? Augmentative and Alternative Communication (AAC) is just that; other ways, using high or low technology, to communicate. AAC includes something as simple as a head nod to something as high tech as a speech generating device.

 

The American Speech-Language and Hearing Association defines AAC as all forms of communications, other than oral speech, used to express thoughts, needs, wants and ideas. AAC can be aided or unaided. Unaided AAC is using body language, gestures and/or sign language to communicate. Aided AAC is when tools and/or equipment are used, such as pictures and speech devices.

 

Communication is a right of all people and it is the job of a Speech-Language Pathologist to help children access that right in the absence of the ability to speak. But how does one decide which AAC approach is best for the child? There are recommended criteria that typically have to be met for the child to be considered as an AAC candidate.

 

  1. Does the child understand cause and effect? Cause and effect is the foundation of communication; I do something and get something in return. Sometimes cause and effect can be taught using an AAC device.

 

  1. Manual dexterity and fine motor skills. To be able to access sign language as a means of communication the child must have the fine motor skills to perform two-handed signs. Also, to be able to push a button to activate a speech device, the child must be able to control the motor movement of the arm and hand. Tilt switches (a simple head tilt) and eye gaze systems exist to allow children with minimal controlled movement to access AAC.

 

  1. Motivation! The child has to be motivated to communicate to be successful with any type of communication option. A highly desirable reward just might motivate any child to use their AAC!

 

So what does AAC look like for real kids? How does their voice sound? Meet Claire and Ethan, two AAC user success stories!

 

Claire

Claire Elias, daughter of Mark and Melanie Elias of Frederick, Maryland, is an adorably sweet 4-year-old girl. Claire loves the color pink and hugging her stuffed animals. She loves to watch Minnie Mouse and Sophia the First and her best friend is her twin brother, Chase. Claire has an incredibly happy disposition and a smile that lights up a room. Claire uses AAC to express herself. At the age of 2 she began using an iPad with a communication app to request toys and answer yes/no questions. The fine motor movements necessary to operate the iPad proved to be a difficult for Claire. Now she uses a PODD (Pragmatic Organization Dynamic Display ) book to communicate. A PODD book is a picture system that allows Claire to use visual gaze to make requests, ask questions, comment, etc. Claire will be 5 in June and will attend Kindergarten next fall. Her PODD book goes with her everywhere, just like her voice.

 

 

Ethan

Ethan Judd, son of Christy and Jeff Judd of Inwood, WV, is a 6-year-old kindergartener at Bunker Hill Elementary. Ethan has an awesome sense of humor and a determined mindset. His favorite colors are green and orange and he loves, and often wins, playing UNO. Because of his tracheostomy, Ethan was unable to access his voice during his infant, toddler and preschool years. During this time Ethan used a combination of sign language and an iPad with a communication app. Since then Ethan has gained respiratory strength and now mostly relies on his voice to communicate. Sometimes he accompanies his speech with sign language to increase his intelligibility (the clarity of how he is understood). Ethan’s story is an example of how AAC bridged the gap for him until he was strong enough to vocalize. AAC gave Ethan a voice when his wasn’t available to him.

 

Claire and Ethan’s stories are just 2 of many, many AAC success stories. If you know a child who has yet to “find” their voice, contact an SLP close to you to help. Communication is a right of all individuals, no one should be denied!

 

Lacy Morise, M.S. CC/SLP, better known as Miss Lacy, is a Speech-Language Pathologist with the WVBTT and Loudoun County Schools. She is co-owner of Milestones & Miracles, LLC (www.milestonesandmiracles.com), a company dedicated to educating families about the importance of PLAY. She loves to use verbal and nonverbal language approaches to help kids access their right to communicate!