Sand and Glitter

One mom's understanding of childhood development

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My child needs glasses. Now what?

Jan 31, 2017 by Hélène Serfontein Leave a Comment

It is a shock to find out that one’s small child can’t see properly. I somehow thought because they are still small their eyes should be very good. Well, actually I didn’t give it much thought at all. Until it happened.

The trouble is, children don’t know what things should look like. Or, if their vision deteriorated gradually, they forget. So they DO NOT COMPLAIN of bad eyesight. They might blink a lot. (Which, incidentally, also might point to a vitamin A deficiency or uptake problem). They may sit too close to the TV. They may develop a squint. They may become less attentive of their environment. They may stop paying attention in school. Their art work may not be the best – which sometimes it isn’t in any case. They may seem bored or unmotivated. In children depression can look like boredom. And it surely is depressing when one can’t see. They may seem anxious and unsure. They may suddenly fall down a lot or become car sick. And parents may very well overlook all these subtleties. Teachers too.

So well done if you realized your child has a vision problem. That was some great parenting right there! And if you are looking around for more help, even better. This is the list I wish I had. If someone could sit me down in the very beginning and say, “Listen, here’s what you do:…,” we would have had a much easier time. But when everything turns out ok, luckily we tend to forget a lot of those pesky little details. Remember that the whole body is one unit. Vision is a function of every single part of a child. This will hopefully demonstrate that. So here is my two cents’ worth:

Image courtesy Shutterstock
Image courtesy Shutterstock

STEP 1: Have your child’s eyes tested. Find the best ophthalmologist or optometrist by reputation. It is very very difficult to get a child into their ideal glasses prescription. And they may refuse to wear it, because of the big change it creates. Work with the professionals to find the prescription that your child can tolerate initially. It can be adapted once they get used to it.

STEP 2: While you are waiting for your eye appointment, start looking at frames. The optometrist’s is a good place to go. They should be small enough so the lenses don’t have to be too thick. And very sturdy for playing and rough housing in. Get your kid excited about these glasses – even though you are still struggling with the idea.

STEP 3: Get support. Yes, it helps to see you are not alone. And to ask all those many many questions. Two wonderfully useful Facebook groups are: Little Four Eyes and: Vision Therapy Parents Unite. Vision therapy is an option in some countries.

STEP 4: Have a developmental occupational therapy assessment. If your child could not see properly for however long, they are sure to need a little bit of developmental input. The occupational therapist will look at things like vestibular and proprioception or tactile issues. They will also test for gross and fine motor delays. These skills are the foundation for school skills later on. Visual-motor perception and motor planning is greatly affected by faulty vision.

STEP 5: Young children with vision problems often have retained primitive reflexes. These reflexes create movement patterns in babies before they do conscious, controlled movements. When the higher postural reflexes start taking over as babies mature, the primitive reflexes disappear. They may reappear as a result of physical stress (like lack of vision). Or they may have been retained because of lack of tummy time and movement opportunities as a baby. To check, look at a photo of your smiling child. If they have wide, staring eyes even when smiling, they may have a raging retained Moro reflex. Some paediatric physiotherapists, occupational therapists and behavioural optometrists address these reflexes and help integrate them. It is a long term process that requires dedication and daily effort, but it pays off big time. Retained reflexes interfere with vision development, gross and fine motor skills, hand-eye coordination and general school performance.

STEP 6: Inform your child’s teacher. Getting glasses is a transition. This child might have a hard time adjusting and coping. Kindness and gentle encouragement is needed. Keep the expectations at a minimum for a while and everyone will be happy.

STEP 7: This one should actually be the cornerstone of every step. Lots of love for this brave child. Patience, love, acceptance. Your child is going to be facing hard changes. Lots of challenges. They need you on their team. Loving them, cheering for every little step forward, carrying them sometimes. Your job as a parent is to know when your child needs a break.

STEP 8: Limit screen time. Too much screen time interferes with developmental movement opportunities of body and eyes.

STEP 9: Get moving, get active, get outside. Studies have shown outdoor activity has a positive impact on vision development. Work those core muscles. Head control and core stability has an effect on eye convergence. Very important for children with amblyopia (lazy eye). Ball sports are lovely and fun for improving eye tracking.

STEP 10: Nutrition. Certain foods can boost vision development. Zinc and Vitamin A deficiencies especially impact vision development negatively.

“Sucking on Sour Candies, Pickles or Lemon Pieces. Sour tastes help bring facial muscles and eyes into a more focused (aimed inward) state, called convergence. Sucking helps to bring the facial muscles, including eye muscles, into a convergent posture…After sucking on a sour food or piece of candy, encourage the child to attempt a near-vision task that was difficult for him previously, and see what happens!” – Quote courtesy of the book Eyegames: Easy and fun visual exercises by Lois Hickman and Rebecca E. Hutchins.

STEP 11: Sagging arches in the feet may affect vision development. Arch support is directly linked to eye convergence. The lumbrical muscles in the feet are responsible for arch support. They work in synergy with all the postural muscles. For children older than five with flat feet orthotics can be investigated. The physiotherapist can recommend a good orthotist to custom make these. Lumbrical exercises for feet are easy. It has been suggested that toe walking may improve the arch support in flat feet. Invest in good shoes that keep little feet more optimally aligned.

STEP 12: Reawaken the senses. You know how some people feel like they don’t hear/connect well without their glasses on? Same goes double for children. Not being able to see well does not sharpen the other senses. Rather it dulls them. With muted senses a child’s world becomes small. And they do less of the very activities that would have helped them. Practicing mindfulness on nature walks is a lovely way to help a child with visual neglect to reconnect. This could be a walk around the garden. Smells in particular raise a child’s level of awareness. Probably because the olfactory and limbic system, where emotions are seated, are enmeshed. Vestibular input helps restore proper eye movements, so running, rolling, swinging.

Enjoy this special time of rediscovering sight with your child.

 

Realigning the spine

Jan 31, 2016 by Hélène Serfontein Leave a Comment

A certain amount of ‘normal’ movement can take place between one vertebra and the next in the spine. The more lax the ligaments, the more relative movement is possible. This means that with lifting, shifting, pushing and pulling motions, a single vertebra or a number of them, can do a slight rotation relative to the vertebrae above and below. What happens sometimes is, because the spine is not meant to do too much of this sort of thing and because the body is designed to protect the spine and nerves, a protective muscle spasm could ensue.

The sequence of deviation would be something like this: You open or close a heavy sliding door. The one-sided force creates a rotation deviation in one or two of the vertebrae in the neck or low back. The local back or neck muscles go into a protective spasm to prevent too much rotation, and of course, injury. This protective spasm ‘locks’ the joints into this deviated position.

When this happens people often complain of pain or discomfort when sitting or lying down. In these positions the joints get compressed into that uncomfortable rotated position. Whereas when people walk, joints are more free to find a comfortable place. If the joints stay in the rotated position a resulting counter-rotation higher or lower in the spine happens eventually. This is the body’s way of compensating, to keep you straight and facing forwards.

In babies this same process can happen. During the birth process, the joints of the spine can be pushed or twisted into uncomfortable places. Especially with traumatic birth, also during caesarean section. Ribs can do translation movements: A shift backwards or forwards along the rib at the attachments. Ribs also do a bucket-handle up or down movement, because of their attachments to the sternum in the front and the spine at the back. So the ribs or the spine can get ‘stuck’ in any of these positions. We now know that what we understand to be colic, is sometimes actually an alignment problem in the spine or ribs. Some chiropractors address this in babies with good success.

A malalignment of the spine can carry into toddlerhood if undetected. Sometimes made worse by boisterous play. A low-grade discomfort of back or neck can keep children from wanting to jump. It can affect the alignment of the head on the neck, also alignment of the pelvis. This has a knock-on effect that creates all sorts of compensatory changes and challenges. Incorrect alignment of head on neck may result in visual disturbances.

Myotatic Activation Procedures (MAP) are techniques for correcting spine and rib alignment. The techniques were designed by Fred Mitchell Sr. MAP techniques address biomechanical dysfunctions. By creating a positional gap between vertebrae or ribs, the person’s own muscles can be used to pull the vertebra or rib back in place through isometric muscle contraction or forced exhalation. This is an active process, as opposed to a passive manipulation. Gapping the vertebrae for MAP techniques are done by tilting the head or doing a side-bend, for instance.

When a vertebra is stuck in a rotation position, the segmental muscles on the one side is in a position of relative stretch – this means they get knocked out or inhibited. Thus making them unable to pull the vertebra straight again. MAP techniques re-activate these muscles from their position of stretch, to pull the spinal joint(s) straight. And because the muscles are reactivated, they can keep the spine straight again. Think of a bicep curl. It is most difficult to do with arm in the straight or stretched out position. Same for these affected joints and the muscles connecting them. MAP techniques can also inhibit the local muscle spasm on the opposite side. These positional corrections and muscle activation techniques are meant to restore specific joint stability.

MAP techniques work relatively quickly. In a single physiotherapy treatment session the rotation deviation is assessed through palpation before and after treatment. The difference is easily visible. Range of neck- or low back movement may also improve significantly. Toddlers can have MAP techniques done. If they are compliant and have a relatively good sense of their body, they can be guided step by step.

Falls, direct hits or accidents can cause rib malalignment. The mechanism of injury can guide the treatment. The way that an injury happened exactly is the important information here. Spine alignment is important for proprioception. Without proper proprioception of the spine, it is very difficult to activate and strengthen core muscles properly. The core muscles protect the spine like a natural corset.

Some physiotherapists in South Africa use MAP techniques. This can be ascertained beforehand when making your appointment. MAP is an amazing treatment; it can feel like a magic trick. Well worth looking into for back- and neck pain, especially with a history of traumatic birth; or specific injuries. A physiotherapy consultation would determine who is a good candidate for this treatment. A chiropractic consult will determine whether spine alignment is the cause for discomfort in babies.

 

10 Super eye foods for kids

Dec 23, 2015 by Hélène Serfontein Leave a Comment

We all know the saying: ‘You are what you eat.’ We now know that all sorts of physical, emotional and health problems could and should also be addressed nutritionally. Research has shown that the nutritional value of the following foods have certain benefits pertaining to vision.

1 – Salmon

Who ate the salmon? Salmon has an unusually high omega-3 fatty acid content. Omega-3 cannot be manufactured in the body. It has to be consumed in the form of fish, oils, nuts and other sources. Omega-3 has natural anti-inflammatory effects and may enhance mood and brain function (IQ). Omega-3, together with Vitamin A, has a positive effect on chronic dry eye. This study demonstrated that oral consumption of omega-3 fatty acids is associated with a decrease in the rate of tear evaporation, an improvement in dry eye symptoms, and an increase in tear secretion.

Salmon contaminants are being addressed worldwide to bring healthy fish straight to the table. The Norwegian government has gone to great lengths to seemingly successfully improve the health standards of their farmed salmon industry. Wild-caught Alaskan salmon seems to be a favoured choice, as it is naturally low in contaminants. South African non-purists mostly eat the salmon that we find in the shops – Woolies has some nice oak-smoked and honeyed versions.

2 – Eggs

Eggs are a wonderful source of very affordable protein as they contain mostly all of the essential amino acids that the body needs daily. Proteins are essential for vitamin A absorption in the body. See The importance of vitamin A for the links between vitamin A, iron and protein.

Eggs contain two significant nutrients, lutein and zeaxanthin. Lutein and zeaxanthin are two major carotenoids found as colour pigments in the human eye. Lutein is synthesized only by plants and zeaxanthin by plants and some micro-organisms. Both act to moderate light energy in plants during photosynthesis. Lutein is found in egg yolks and animal fats and gives it the yellow colour. The human retina accumulates lutein and zeaxanthin. Both lutein and zeaxanthin have light-absorbing properties and supposedly work to filter harmful blue light in the eye and prevent the production of free radicals.

Eggs contain vitamins B6 and B12, folic acid and fat-soluble vitamins A, D, E and K. Egg yolks are one of the few foods naturally containing vitamin D. Eggs also contain calcium, copper, iron, manganese, phosphorus, selenium and zinc.

3 – Lamb or beef

Both these meats contain high concentrations of iron, zinc and vitamin B12. Zinc appears to play an integral role in normal eye function (Zinc and the eye). Vitamin A needs iron and proteins to be properly utilized in the body.

Vitamin B12 is only found in animal foods, such as beef, lamb, chicken, fish and eggs. This vitamin is important for normal growth and development in children as well as healthy functioning of the immune and nervous systems in the body. A vitamin B12 deficiency has been shown to cause optic neuropathy in selective eaters with autism.

4 – Bell peppers

Red sweet peppers or bell peppers have a very high Vitamin A content; in excess of 3000 IU per 100 gram serving. They contain lutein and zeaxanthin in good quantities.

5 – Blueberries

Blueberries have relatively high concentrations of vitamin K and choline. Choline is interrelated with vitamin B12. A B12 deficiency would likely increase the demand for choline as well. Choline is an essential nutrient for humans and is necessary for the normal function of all cells. It is important for the brain development of a fetus.

Blueberries are rich in anthocyanins. These have a free radical scavenging ability in the body. Anthocyanins may improve eyesight in various ways:  They have been shown to act as a ‘sunscreen’, protecting cells from light damage. They temporarily affect the eye’s ability to adapt from light to dark. During World War II, apparently Royal Air Force pilots were encouraged to eat bilberries (the wild European form of blueberries) to improve their night vision. Studies exist to show improvement in retinopathy and weak eyesight (eye fatigue) after administration of some form of anthocyanins.

6 – Apricots

Apricots are rich in anti-oxidants, carotenoids and choline. They have a fairly high vitamin A content. Carotenoids may absorb blue and near-ultraviolet light to protect the macula of the retina. Apricots also contain catechins – very potent anti-inflammatory nutrients, as well as iron, magnesium and zinc.
It has been said that apricots may help strengthen the optic nerve.

7 – Dark chocolate

This sweet treat is chock-full of vital nutrients and has some amazing benefits. Good dark chocolate contains zinc, iron, magnesium, copper and vitamins A and K, as well as vitamin B12. Vitamins A and K are fat-soluble. This means that suspended in dark chocolate, they are already in a form that is easily absorbed in the body. Dark chocolate also contains phosphorus for strong bone and teeth formation and selenium, which is helpful for cognitive function.

8 – Melons

Also known as cantaloupe, melons have an interesting nutrient diversity. Melons contain a high concentration of beta-carotene. Beta-carotene is a precursor to vitamin A. They have anti-oxidant and anti-inflammatory properties and the seeds contain omega-3 fatty acids. Melons may improve insulin and blood sugar metabolism. 100 Grams of melon has an excess of 3000 IU of vitamin A. They contain a fair amount of vitamin C, lutein and zeaxanthin, copper, iron, zinc, and folates.

9 – Plums

Plums are a good source of vitamin K, choline, anthocyanins, lutein, zeaxanthin, and minerals like potassium, fluoride and iron. Yellow plums contain Vitamin A and beta-carotene.

10 – Pumpkin

Pumpkins contain zinc, iron, folates, magnesium, calcium and Vitamin A, among other nutrients. Pumpkin boasts these health benefits. It is one of the veggies that children eat more readily. I want to include a pumpkin recipe that is a big hit with most kids. This is a South African classic. Many people here know some version thereof:

Pumpkin Flapjack Recipe
Ingredients:
1 Cup of cooked pumpkin
1 Cup of flour
½ Teaspoon of baking powder
1 Egg
1 Tablespoon of butter
¼ Teaspoon of salt
1 Teaspoon of sugar
Cinnamon and sugar to sprinkle flavour on top

Method:
Mix the dry ingredients together.
Add pumpkin and stir well.
Beat the egg into the mixture.
Melt the butter and add. Mix well.
If the batter is not soft enough, add a splash of milk.
Bake in a pan over medium heat until golden.
Sprinkle with cinnamon and sugar.
Enjoy!

 


USEFUL LINKS

The influence of dietary lutein and zeaxanthin on visual performance 

What is choline?

Vitamin A and Retinitis pigmentosa

 

 

 

Retained Primitive Reflexes

Dec 7, 2015 by Hélène Serfontein 2 Comments

What are primitive reflexes?
Movement stimulates brain connections. Neonatal reflexes are present in the womb and the early stages of life and occur in a specific sequence to wire the brain for optimal sensory and motor function. These primitive responses originate in the brain stem and cause automatic, repetitive movements. Babies were designed to do reflex movement patterns until more sophisticated neural connections start to form. These allow babies to have conscious control over their movements. The reflex is triggered by a specific internal or environmental stimulus, and always cause the same response. The knee-jerk reflex in adults is an example of a healthy adult reflex pattern.

The primitive reflexes are systematically integrated and replaced by the higher postural reflexes, starting with head control. A developmental sequence is triggered where postural control, gross motor function, balance and coordination and sensory integration are perfectly orchestrated.

What happens if something goes awry in this harmonious sequence? Where do things go wrong? And how does it affect development? What would interfere with this process of primitive reflex integration?

To begin: The primitive reflexes are integrated once they have served their purpose and before children turn one. If a certain reflex is retained for some reason, it keeps creating uncontrolled reflexive movement patterns, which interfere with more age-appropriate postural control and skilled movements.

Causes of retained primitive reflexes
The birth process is a key factor: Traumatic birth or caesarean section, breech or induced birth may all cause retained reflexes.
Injuries or trauma, lack of tummy time, too little healthy developmental opportunity for movement, chronic ear infections, chronic stress, environmental toxins and neurodevelopmental toxins like heavy metals (mercury) may lead to non-integration of primitive reflexes.
Reflexes that were completely integrated may reappear at any stage of life due to any of the reasons above.

What causes primitive reflexes to integrate?
Movement. Babies do stereotypical movements when starting to reach, grasp, roll or be more upright. These movements, when repeated enough times, create new brain connections to replace the primitive pre-programmed brain stem reflex loops. The new connections override the old. But the primitive connections remain dormant. If something causes harm to the brain control centre at any stage of life, it will revert back to the default primitive reflexive patterns of movement.

It is important for babies to spend time on the floor, and on their tummies. Inhibition of free movements by using strollers, bouncers and baby seats, or time spent in front of the TV may interfere with the natural order.

imageRetained reflexes in children and adults can be integrated through therapy. Neuroplasticity is the brain’s ability to reorganise and establish different neural connections through intervention. Rhythmic movement training is a therapy method where rhythmic movements are used to establish connections between the three main brain areas: The prefrontal cortex (the control centre), the midbrain or emotional brain and the cerebellum (balance, coordination and muscle tone). It also connects other areas of control like speech and vision. The rhythmic movements are used to inhibit primitive reflexes. Other therapies all include specific sequences of repetitive developmental movements to integrate reflexes. Slight isometric pressure techniques can be combined with inhibition movements to compound the effect.

What effects do retained primitive reflexes have?
The more skilled, higher patterns of learning and development are affected by retained reflexes. The postural reflexes and balance and righting reactions are disturbed. Without these higher brain automatic responses children expend a lot of energy trying to stay upright. Incomplete integration of reflexes may contribute to developmental delay, feeding and eating challenges and learning challenges. Speech and vision development may be influenced. Potty training takes much longer when children have retained reflexes. Emotional self-regulation becomes much more difficult under these conditions, causing anxiety or behavioural issues. When the primitive reflexes are not inhibited, they interfere with normal organisation and functioning of the nervous system in very specific ways. The type of interference depends on which reflex is retained. The sooner a primitive reflex is integrated, the better.

If not inhibited, primitive reflexes can be retained throughout life: A pronounced gag reflex (which is a normal adult reflex), may point to retained reflexes in adults.

Here is a list of some of the neonatal primitive reflexes and their effects:

Fear paralysis reflex (FPR)

The FPR is a withdrawal reflex, established in the second month after conception. The withdrawal reflexes are characterized by rapid withdrawal from stimuli and ‘freezing’ and is a protective response. During a stressful pregnancy, the FPR can cause foetal immobility when triggered, preventing the very movements that would have inhibited the reflex. When the FPR is retained, children and adults have a limited stress tolerance and are overly sensitive to sensory stimuli. They may be extremely sensitive to smells and tastes, as well as vestibular input. The reflex triggers the release of stress hormones. In some children it presents as withdrawal and shyness or seemingly irrational phobias, while others may act out. In adults it can result in panic attacks and social phobias. Children and adults with an active FPR find eye contact stressful, as it may trigger the reflex. The reflex is usually active in autism. The FPR and the Moro reflex go hand in hand. If the FPR is not integrated, both the Moro and Tonic Labyrinthe reflexes stay active.

Moro reflex

This reflex is activated by loud noise or sudden movements, causing baby to throw her arms wide open. It is also referred to as the startle reflex. A baby’s own cry may trigger this reflex. The moro reflex begins to function in utero. If the moro reflex does not integrate within ages 3-6 months, it becomes an uncontrollable overreaction to sudden stimuli, overruling the frontal lobe or higher control centre of the brain. It over-stimulates the sympathetic nervous system, causing continuous fight or flight response. It may cause vision and reading or writing difficulties. When this reflex is integrated through treatment it may cause temporary developmental regression with cranky or demanding behaviour. Both the Moro and FPR cause anxiety and exhaustion.

Rooting reflex

A light stroke to a baby’s cheek or corner of the mouth activates this reflex for feeding. It causes baby to turn her face in that direction, open her mouth and extend her tongue for feeding.
When retained it causes problems with excessive dribbling, speech and articulation, difficulty with chewing and swallowing, gagging and hypersensitivity around the face and lips.

Juvenile sucking reflex

This reflex only starts developing around 32 weeks gestation and becomes fully developed around 36 weeks. Premature babies may have weak feeding ability as a result. Touching the roof of a baby’s mouth stimulates the sucking reflex. Babies push their tongue forward for latching and sucking. When the sucking reflex becomes integrated, the tongue moves more to the back of the mouth for pushing food down the throat.
Problems with this reflex may cause reflux, food texture sensitivities, excessive dribbling, speech and articulation problems.

There is a link between hand and mouth movements in early life (Babkin reflex). If this reflex is not integrated, children tend to stick their tongues out while writing.

Both the rooting and sucking reflexes may be active in picky eaters.

imageAsymmetrical Tonic Neck Reflex (ATNR)

When a baby turns his head to one side, the arm and leg on that side extend away from the body. Once the reflex is integrated, baby can start to reach and have functional ability around the body midline. To cross the midline with arms or legs is very difficult with retained ATNR. If unintegrated, it creates difficulty with coordinated movement, balance and writing skills. A retained ATNR may interfere with establishing hand dominance. The role in vision development is especially important: The ATNR influences vision tracking, hand-eye coordination and object- and distance perception. Integration is sometimes necessary to improve eye movement for reading (saccades). A very strong retained ATNR may result in scoliosis.

Tonic Labyrinthe Reflex (TLR)

The TLR is important for head control. It involves the vestibular system. It is triggered by forwards and backwards tilting of the head of babies. In infants it helps with development of posture, coordination and the proper head on neck alignment. Head alignment is vital for vision and eye tracking, balance, auditory processing and motor planning.

When unintegrated, children have trouble maintaining good posture in school and paying attention. They fatigue easily. They may have poor spatial awareness, depth perception and difficulty with climbing a rope or hanging from monkey bars.

Neurodevelopment and the presence of retained primitive reflexes are assessed and treated by pediatric occupational and physiotherapists.


 

WITH THANKS FOR USEFUL LINKS

Comprehensive overview of primitive reflexes

Home tests for primitive reflexes

Yoga poses for primitive reflex inhibition

Mind moves: Moves that mend the mind

 

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