Starfish Therapies

March 13, 2015

Multi-Purpose Sign-In

Filed under: Developmental Milestones — Starfish Therapies @ 9:47 pm
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At a recent staff meeting we were discussing a few of our kids who were having a challenge with regulating their emotions, such as frustration.  Our OT’s had tried discussing the zones of regulation with them but these were kids that were a little older and did not want to discuss how they were ‘feeling’ that day.  If colors were even introduced the kids would say ‘I don’t want to talk about colors.’

We decided to get creative about a way to start looking at how a child could tell us how they were feeling without us having to discuss it with them.  We decided to make a sign-in board for our kids.  We put it around the corner so they could sign-in once they were on their way to therapy and it wasn’t sitting out in the waiting room for all to see.

First we found a poster with various faces on it and we photocopied the poster onto different color construction paper.  The colors of the construction paper are the zones that most closely match the expression/emotion displayed on the face.  We then cut out each face and laminated it.  We used velcro on the back to have it stick to the surface (we may eventually go to magnets and a bigger surface but we used the supplies we had available at the time to trial this).

For kids that are open to talking about how they are feeling we use it as a tool to discuss their emotions and feelings.  We’ve had a few kids change their face throughout the session to match their changing mood.  For other kids, who aren’t as open to that discussion, we just ask them to pick a face to put by their name.  We are then noting what face they pick and seeing if it correlates with their mood that day.

Its not a complete solution but it gave us a tool to start working with some of the kids that were not as open to the topic of their feelings and emotions.  We’ll keep you posted as we adapt and grow it!

What tools do you use?

PS – In addition to working on regulation and emotions, kids are also working on their handwriting (they love to write their name on the board), as well as using two hands (including a stabilizing hand) to take the faces off and on.

February 24, 2015

Which Shoes Are Best?


As parents, you may wonder what is the best product or toy that will help your child meet their milestones or learn things quicker. I’m sure you’ve also wondered what type of shoe could be best for your new walker? There are so many shoes to choose from that will help make your child the most fashionable, but which one is going to be the best for the development of walking? There is not one right answer, but here are a few things to keep in mind when choosing a shoe that will be right for your child.

As children learn how to walk, their foot plays a huge role in their stability, shock absorption and momentum. The bottom of their foot allows them to feel where they are in space. Therefore, the type of shoe that is worn can determine their walking pattern and stability. Should your child go barefoot, wear a flexible shoe, or stiff shoe?

Some research shows (see below) that the best foot development occurs when a child is barefoot, so the best shoe would follow the barefoot model, meaning that the shoe should be flexible. Going barefoot allows the foot to feel the texture of the floor and gives them good sensory feedback to let them know where they are in space. A flexible shoe (soft material with a soft sole that allows for bending) can also allow for more sensory feedback, similar to going barefoot. However, a stiffer shoe can lead to greater stability compared to a very flexible shoe. It was seen that children keep their foot on the ground for a longer period of time when wearing stiffer shoes, possibly because they are not getting as much input and need that time to understand the environment that they are in. So if your child seems to be a little more unstable, a stiffer shoe may be best for them.

Depending on what type of shoe you decide to put your child in, they typically will adapt to it and change their walking pattern (amount of time they keep their foot on the floor, width of their feet, and speed of walking). Children are fast learners and are ‘flexible’ to any changes that come their way. As therapists, we are always trying to promote adaptability; so changing the type of shoes that they walk in can be a great way to teach them how to experience a new situation. As mentioned before, there is not one perfect shoe for all children and the need for flexibility vs. stability may need to discussed further depending on your child’s needs.

Keep in mind that the articles referred to focused on children who are developing motor skills typically, therefore, the amount of stability or flexibility may depend on the individual need of your child.

Buckland MA, Slevin CM, Hafer JF, Choate C, Kraszewski AP. The effect of torsional shoe flexibility on gait and stability in children learning to walk. Pediatr Phys ther. 2014; 26: 411-417.

Staheli L. Shoes for children: a review. Pediatrics. 1991;88:371

February 20, 2015

Doing Two Things at Once


Have you ever asked your child to walk while holding their glass of milk back to the table? “Dual tasking” or doing two things a once can sometimes be a difficult task and occasionally can lead to some spilled milk! Walking has been thought to be an automatic activity. However, recently studies have shown that walking actually requires attention and that people change their walking pattern when performing a dual task.

A study published in 2007 examined pre-school children ages 4 to 6 and their ability to perform easy and difficult dual tasks. They examined the changes in the children’s walking performance while walking normally, walking while performing a motor task (carrying a tray with or without marbles), and walking while completing a cognitive task (counting forwards or backwards). The results of this study show that in typically developing children walking is affected by carrying out a simultaneous task. Children need to create stability to carry out the dual task and therefore widened their stance, take shorter steps, spend more time with both feet on the ground and slow down their walking speed in order adjust to the task. This demonstrates that children have decreased walking efficiency and compromised balance while they carry out either a motor or cognitive task.

Walking while performing a concurrent task occurs commonly and frequently in a child’s every day life, for example walking while carrying a tray of food at school, walking a glass of milk back to the table or walking while answering a question. Teachers and parents should be aware of the cost and effort that it takes for a child to walk and perform these common tasks. This knowledge can help choose suitable activities that the child can successfully complete as well as prevent an accidental fall or spilled milk. Therefore, allow your child to walk slowly, safely and carefully the next time they are walking their glass full of milk back to the table!

Cherng RJ, Liang LY, Hwang IS, Chen JY. The effect of a concurrent task on the walking performance of preschool children. Gait Posture 2007;26:231-7.

February 11, 2015

Valentine’s Day Games and Ideas


With Valentine’s Day coming up, you can make this day special for your kids as well. Here are some fun ideas that you and your kids can participate in together, while learning, and working on some gross and fine motor skills. Have fun!

1)   Scavenger Hunt: Hide a bunch of hearts or valentines all over the house or room. Place these items in hard to reach spots so your kids will have to get on their hands and knees (quadruped position), tip toes, or run to find them. Quadruped position will help build shoulder, core and leg strength; while tip toes works on calf strength, which will allow for more power with jumping, skipping, and running!

2)   Heart Hop: Cut out large construction paper hearts and tape to them to the floor. Have your kids help so they can work on their cutting and fine motor skills. Put on some music and have them hop on to each heart. You can either have them hop with two feet or one foot. If you want to work on hop scotch, place the hearts into a hopscotch line up and hop away!

3)   Make a heart with your feet: Get some paint and use your feet to create a heart on large construction paper. This will allow your kids to work on balance with their feet close together, which makes things more difficult. To keep them in this position, add a ball and play toss, to challenge their balance to keep their feet on the floor to make a heart.

4)   Musical Hearts: This is similar to musical chairs except instead of sitting, kids will work on gross motor activities. What you will need is construction paper, scissors, and a marker. Cut out large hearts that you can place on the floor for kids to step on. Write whatever activities you would want on the hearts (5 jumping jacks, standing on one leg for 10 seconds, hop 5 times, crab walk, etc.) All these activities work on strength, coordination, and motor planning. Once you have all your hearts, place them on the floor and start some music, have your child and friends or family walk around the hearts until the music stops. Once the music stops, find a heart and perform the activity. Find the link here.

5)   Valentine’s Day glitter and sensory board: For only two dollars, Target has some great valentine’s day themed vinyl placemats that would be a great way to make a sensory board. Then, all you need is some shaving cream (unscented to avoid any allergies), glitter, and sparkles. Spray the shaving cream on the board and let your child feel the texture of the cream. Once they are comfortable with the cream, feel free to add some sparkles and glitter to make it more colorful and texture oriented. They can make different shapes, like hearts, and X’s and O’s. Find the link here.

6)   Heart straws: This activity is meant to help your child with their fine motor skills. All you need are some straws, play dough, and heart shaped pastas. Find a hard surface, like a cutting board and use play dough to make a base for your stand. Place a clump of play dough on the table or board and stick a fun colorful straw as a pole. Then have your child grab the heart shape pastas and start stacking and unstacking. This will work on your child’s finger pinching grip and hand, eye coordination.

7)   Heart themed sensory box: This is a great activity to help promote learning through sensory input. You will need, a plastic bin, rice, shredded red paper, and Valentine’s Day items. Some Valentine’s day items you could use include hearts cut out with different textures (felt, paper, glittered ), heart bracelets, balloons, and whatever else you may want. You can promote learning by having your child put in only the felt hearts, and then only the glittered, promoting categorizing. Then you can have them count how many bracelets you may have as they put them into the bin. If you have different color hearts, have them choose the pink ones, red ones, or white ones, in order to learn the colors. Find the link here.

February 3, 2015

Understanding Terminology: Ankle and Knee

Filed under: Developmental Milestones — Starfish Therapies @ 5:17 am
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legsOften in physical therapy, we use certain terminology to describe the position or alignment of the legs at rest or during activity.  You have probably seen these terms in your child’s evaluations or progress reports and they probably didn’t make much sense.  Even if your therapist explained the meaning to you, it still might not have made much sense. Hopefully this article can help clear up the meaning of these strange words and what they indicate.


Kids Advnetures
Pronation – This is a term used to describe the sum of three different motions that together cause the heel to slant inward, the arch to collapse toward the floor, and the foot to turn outward during standing and walking.  A certain amount of pronation is normal during the walking cycle. However, if there is an excessive amount present it can lead to stress on ligaments and muscles and can cause other alignment issues throughout the rest of the leg over time.  Excessive pronation is most common in individuals with low muscle tone but can also occur individuals with high muscle tone.
supinationSupination – This term is used to describe the sum of three different motions that together cause the foot to point downward and turn inward. This foot position is common in individuals with increased muscle tone and in certain diagnoses such as Cerebral Palsy.
Pronation and supination can be present during standing or during isolated times of the walking cycle.
Genu Valgum (knock knees)- This term describes knees that are touching or close to touching while the lower leg is bent outwards and the ankles are separated more than normal (see picture below). This alignment is a normal part of development around 2-3 years of age and in most cases will naturally straighten out by 5-6 years of age. However, it may persist when other impairments are involved.  It is often seen in combination with ankle/foot pronation described above. Very severe cases may require surgical intervention.
Genu Varum (bow legs) – This term describes the opposite of genu valgum.  The knees are separated while the ankles come closer to the midline of the body (see picture below).  This alignment is normal in infants and during the first year but should decrease as weight is introduced through the legs with standing and walking.
From infancy to childhood, a typically developing child should progress from genu varum during the first year of life to a relatively straight position with the onset of walking and then into genu valgum around 2-3 years.  The legs should then again realign themselves into a relatively straight position by around 5-6 years.  Females will tend to have slightly more genu valgum than males due to the greater width of the pelvis.
genu valgum and varum
From left to right, the pictures represent genu valgum (knock knees), normal alignment, and genu varum (bow legs).

January 13, 2015

Just Right Challenge

shapesorter Did you ever wonder why an infant or toddler would crawl or walk to get their favorite toy only sometimes as they are learning these skills? But at other times they’ll look, they may start moving for it, but ultimately look around and find something else to play with? We find it all has to do with their perception of their abilities and what they’d need to do to get their favorite toy.

When you are teaching or encouraging practice of motor skills by moving those favorite toys around your house, it’s important to keep in mind the idea ‘just right challenge’ or that your child perceives that they can accomplish their goal, but is still challenged to improve their skills. If they perceive the activity as something they are able to do, they go for it. If they think it’s too hard, they find another toy.

This is why you often see therapists moving furniture half an inch farther apart at time, or ‘accidently’ bumping a toy a little farther away when the child is half way there while crawling to push kids to go just a little further without significantly changing how the child perceives the activity.

If your child goes after that toy every time, would they still do it if it was a little farther away or on the couch or half way up the stairs instead of the floor? If your child looks around for something else to play with, what happens if you move their favorite toy just a little bit closer?  Have fun experimenting with finding the motivation that is ‘Just Right’ for your kiddo!


January 5, 2015

Five Ways to Use Drinking Straws


Straws are a fun and affordable way to develop fine motor skills such as cutting and stringing. Straws also can be used for fun tabletop games or for arts and crafts.

1.  Blowing bubbles: Who remembers blowing bubbles in a glass of milk as a child? Blowing bubbles are a great way for improving oral motor skills as well as improving muscle tone in cheeks and lips. An easy fun activity is adding a couple drops of dish soap with some water into a large bowl. To make it extra exciting, food coloring can be added. Have your child blow as many bubbles as possible by exhaling through the straw. A trick to make sure your child does not inhale any soapy water, is to cut a small hole near the top of the straw so the child is able to exhale but not inhale water!
2.  Cutting: Cutting different sized straws is a great way to develop scissor skills. Cutting straws helps to develop ability to snip and open/close scissors because straws are easy to hold and align. Plus there is the added fun factor that the pieces fly when cut!
3.  Stringing: Using cut up straws to string onto pipe cleaner or yarn is a great fine motor activity to increase pincer grasp skills, and bilateral hand use. Different beads can be added for color and they can make great bracelets or key chains.
4.  Painting: Place different colored washable paint dollops on a large sheet of paper and have your child blow air through a straw to create a masterpiece! The same technique can be used for blowing bubbles, cut a small hole near the top of straw to prevent ingestion of paint.
5.  Maze: Glue straws to the top of a cardboard box lid to create a maze. You can use shoe box lids, or old soda cartons. Feel free to get creative and it can be simple or complex. Place a marble in the maze and have your child hold the lid using both hands to move box in order to have the marble travel through the maze. This is a wonderful activity that addresses bilateral hand skills, motor planning, and force modulation.

December 31, 2014

Top Ten Posts of 2014


Happy New Year everyone!  Thank you for continuing to enjoy our blog as much as we enjoy producing it.  Here are the ten posts that were the most popular over 2014.  We can’t wait to see what 2015 produces!

10.  Encouraging Rolling – From Back to Stomach

9.  What Does Low Tone Mean?

8.  Core = More Than Just Abs

7.  My Child Isn’t Rolling Over:  Should I Be Concerned?

6.  Easter Egg Hunt for Motor Skills

5.  A Glossary of Sitting

4.  Having a Ball with Core Muscle Strength

3.  A Multi-Tasking Activity

2.  Motor Learning:  Stages of Motor Learning and Strategies to Improve Acquisition of Motor Skills

And the number one post this year was this amazing Guest Post from the folks over at Milestones and Miracles!

1.  Avoiding the ‘Container Shuffle’ with your Baby

November 21, 2014

Should You ‘Walk’ Babies?

Filed under: Developmental Milestones — Starfish Therapies @ 5:32 pm
Tags: , , , ,

beach walking

We have had some families bring this article, 9 Reasons Not to Walk Babies, to our attention.  It was generally a response to some of the things we were working on in therapy with their child, and confusion because this article to them seemed to be saying the exact opposite of what we are asking them to do.  I have to admit when I first read it I thought the author was completely wrong.  Then I took a step back and read it again.  What I realized was that the first time I read it, I was reading it with the bias of how it related to the specific child we were working with.  In actuality, what the author is promoting is independent exploration and development of the child.

I am a big proponent of allowing children the chance to independently explore and facilitate their own motor development as their bodies are ready.  Unfortunately, not all children are able to do this on their own and they need assistance with how to explore and move, and sometimes they help practicing and repeating skills, such as walking, so that they can master them.

Going back to the families that have asked about this article, the challenge was that due to busy lifestyles, other children, and ease of getting around, many of them were using carrying devices like carriers and strollers, or physically carrying or holding their child an overabundance of the time and not providing them the opportunity to explore their environment, thereby limiting their ability to figure out how their body works, trial certain movements, register the feedback, make adjustments and gradually refine their movement until they were masters of the skill.  This is the ideal way kids learn movement, opportunities to practice with trial and error.  By carrying their child everywhere, they were in fact putting the same constraints on their child as this article was attempting to steer them away from.  They weren’t allowing their child to develop at his own rate.

Its interesting that I have read two other posts that talk about the overuse of equipment in society today and how it limits children in this same way.  One was a guest post on our site about avoiding the ‘container shuffle‘, and the other was by Pink Oatmeal on baby items you don’t need.  This topic is also related to the Bumbo Chair.  Again its a convenience that can have specific benefits, but when its used to teach a child to sit before they are physiologically ready, it is not being used to the child’s benefit.  In that same way, when ‘walking’ your child is being used to teach your child to walk before they have even mastered standing, then it may be that they aren’t ready for it.

The best way you can support your child’s motor development is to give them plenty of floor time with the opportunity to explore.  Use yourself or engaging toys to motivate them to move.  If they are trying to move and getting frustrated its okay to give them a little boost, just make sure you are not always doing it for them, their is benefit to not succeeding every time, that’s how their bodies make refinements and adjustments so that they can become more efficient with their movements.

On a slightly different note, but on the same topic, for children who are already experiencing delays for one reason or another, and are engaged in therapies, the therapist may give you things to work on that are meant to support your child’s development because at that time, they are behind and they need that extra push.  If walking is one of them, its probably because your child needs your help in creating opportunities to practice the skill and learn from those trials, and they are not creating those opportunities for themselves.


November 11, 2014

Avoiding the ‘Container Shuffle’ with your Baby

Filed under: Developmental Milestones — Starfish Therapies @ 4:24 pm
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movement exploration  IMG_1734  problem solving3

Guest post by: Nicole M Sergent, MPT

As a new parent, I was there. Giddy excitement over the news of a baby on the way followed by showering love from family and friends in the form of gift, and gifts, and more gifts. At the time I was touched (and am still forever grateful for their generosity) but shortly after the baby came I quickly fell into a routine many new moms do. As a physical therapist, I like to call it, “the container shuffle.”

“The container shuffle” goes something like this. Sleep (crib), eat (highchair), play (exercsaucer), calm down (bouncer seat), sleep (crib), eat (highchair), play (positioning seat), calm down (swing) etc. As a mother, I related to the thoughts many of my patients’ parents have. Everyone buys us all this stuff…and baby likes them and is happy…so why not use them? As a therapist, I’d like to tell you why.

I can’t tell you how many children I have assessed with general motor delays without significant medical histories or orthopedic or neurologic impairments. These babies are very stable in an upright static position. They often even sit really well, without ever rolling, crawling, creeping, kneeling, or standing. After I have carefully assessed to make sure, nothing more significant is going on, I’ll delicately share my diagnosis: CONTAINER SYNDROME.

I realize it is not rocket science but think of it this way. When a baby plays on the floor, he/she has the ability to wiggle, squirm, and move. Each tiny movement that may seem insignificant is actually exercise. They are beautiful diagonally directed movements. And they are needed. Because our moving transitions from one position to another (floor to sit, sit to stand), require that motion. How can we expect a baby to be able to move and explore if we always have them strapped in a container? Research tells us that babies who spend less time on their tummies on the floor, have delayed motor skills in the first year of life.

In addition to the ability to practice motor coordination, allowing a child to play outside of a “container,” has additional benefits. Play on a baby’s tummy, aids in digestion, assists with hand eye coordination, and promotes typical skeletal development. The hips have the ability to develop into a more stable, mature position and the skull, free from pressure from resting against a surface, has freedom to develop typically. Did you know that 20% of all infants now have plagiocephaly (flattened appearance of the head/face)? While free play time may not prevent all of those cases, I believe the increase in “container syndrome,” plays a significant role.

I once attended a continuing education lecture, where the OT speaking suggested that infants should spend 80% of waking hours on the floor. As a therapist, I could see the benefit of this time well spent. As a mother, I felt myself slumping with guilt. My daughters did not spend that much time on their tummies, especially my youngest that had severe acid reflux. A practical balance must exist for families. And while I realize “containers” are helpful with a fussy baby and so that one can actually shower, I recommend promoting floor time throughout the day. I tell the parents of my patients, “If you find yourself going to put your baby down, choose the floor or pack-n-lay first.”

Many of those children I have evaluated that had delays with mobility and transition skills that I felt came from “container syndrome,” ended up catching up to typically expected gross motor milestones in just a few short weeks by allowing more free play time on the floor. It can be argued that it is not rocket science. My mother (and yours) might argue it is common sense and “what we did with you.” But in a commercialized world where more = better, maybe we do need a dash of common sense to help keep our infants happy and healthy as they develop and grow.

Nicole M. Sergent, MPT is a pediatric physical therapist and co-owner of Milestones & Miracles, LLC. She co-authored a unique developmental tool for therapists and parents that pairs detailed development with interactive play skills, called 1-2-3 Just Play With Me. It is available in digital and print and can be found at,, and select retailers. Follow Milestones and Miracles online for developmental support & fun



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