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.

 

Equi-therapy: Therapy on horseback explained

Jun 16, 2016 by Hélène Serfontein Leave a Comment

Josie Adair is an equi-therapist. She kindly wrote this post to introduce equi-therapy to us and explain what it is about and how it works.

My name is Josie Adair, I am a South African Therapeutic Horse Riding Association qualified equi-therapist. I am in my fifth year of teaching horse riding to children and adults of various abilities, and I am in awe of the changes that I have seen in so many people through this form of therapy.

About Josie:
I was born and grew up in England, and my journey with horses began at the merry old age of 5. I rode for a few years, lost interest, got into dance classes, realised that that wasn’t for me, moved to South Africa at the age of 9 and met my instructor: Linkey Jones. That was when I fell in love with the sport all over again. I began teaching young children under Linkey’s instruction and after a year or so I found my first special needs client. She was the cutest 18 month old I’d ever seen with the curliest blonde hair; and she had cerebral palsy. She could barely hold up her own head, so she and her mum rode together. Little by little she grew stronger and stronger, and now, 3 or so years later, she walks, she runs, she sits on the horse’s back singing at the top of her lungs. And this is how I knew that I wanted to be an equi-therapist.
S&G-KidsTherapyI became more involved with the few special needs clients that we had, and met Diane, the founder of the ETHAN (Education and Training Hub for Autism Needs) project, who helped me to enroll in some short courses on neurodevelopmental disorders.
I then was asked to apply at a preschool as a teaching assistant, and my whole take on horse riding shifted once again – why just use therapeutic horse riding for children and adults with special needs and disabilities, when you can also use it for establishing school readiness and fundamental development in each and any child.
To this day my qualifications include: SATRA equi-therapist (passed with distinctions); HANDLE inst. (Holistic Approach to Neuro Development and Learning Efficiency) level one therapist; UNISA (University of South Africa) practitioners in early childhood development diploma (passed with distinctions) and EQASA (Equestrian Qualification Association of South Africa) level one and two.

The difference between therapeutic horse riding and hippotherapy:
Therapeutic Horse Riding is a form of therapy where the horse is used as a tool. The patient sits on the horse’s back, and while the horse is moving, performs exercises and games given by the equi-therapist, with a number of different apparatus and equipment. This is the means of therapy that I am qualified in.
In hippotherapy the patient is also mounted on the horse. It is conducted by a horse specialist or an equi-therapist as well as another therapist – for example this person may be an occupational therapist or a speech therapist – while the horse is moving, the therapists specialty of therapy is conducted. This is used as the movement of the horse stimulates the vestibular system and readies the senses and brain to receive information.

S&G-EquiTherapy

Why Therapeutic Horse Riding?
I love therapeutic horse riding. I enjoy my sessions just as much as my clients! First I will answer the question of why we use horses, and then we I will list some of the benefits specific to the style of therapeutic horse riding that I do.
Why horses?
Horses are incredible. That is why. But more specifically, there are a few areas that horses cannot be competed with by any other therapy.
Horses are herd animals, they communicate with each other through body language, and when a horse accepts you they communicate with you also. Although there is no way of proving this, I believe that horses have all of the emotions that people have – happiness, sadness, anger, annoyance, empathy, fear, embarrassment and the list goes on. Because of this a horse expert can see exactly what the horses are feeling. Horses have a unique ability of being able to mirror what a person is feeling. Through this, I can see the person’s emotions and feelings, without them having to tell me. This is such an amazing opportunity as a therapist, as many people don’t understand their feelings or even don’t want to tell you their feelings.

S&G-HorsebackTherapyHorses make a big impact. I have never experienced someone standing next to a horse without a big response. That response could be fear, excitement, joy; it could be internalised or shown clearly, and all of this is good.
Also, the horse’s movement is a big play into the uniqueness of this therapy. A horses movement is rhythmic and consistent, providing vestibular stimulation with these same characteristics. Rhythmic, consistent stimulation of the vestibular system calms a hyperactive person or stimulates a hypo-active person. The movement of the horses back moves a person’s hips as if they are walking, providing stimulation of these muscles, without impairment and without straining the joints. What a unique opportunity for people who have impaired gaits or are unable to walk to experience.
There is also the sensory aspect, at the stable yard and on the horse’s back there are many opportunities are sensory integration.
Lastly, horse riding is a form of exercise that puts little strain on the joints. Any form of exercise is an outlet for negative emotions and frustrations.

The benefits of therapeutic horse riding include:
· Stimulation of the vestibular system
· Increase or normalisation of muscle tone
· Increase in balance and equilibrium
· Normalisation of reflexes
· Increased trunk rotation
· Sensory integration
· Bilateral motor integration
· Improved eye muscle coordination
· Improvement of speech
· Improvement of proprioception
· Improvment of fine motor skills
· Increased hand-eye coordination
· Improvement of praxis (planning and sequencing)
· Increased laterality
· Hemispheric integration
· Emotion – building of confidence and self-image, an outlet for frustration and negative emotions

There are a few disabilities and conditions that prevent a person from being able to participate in therapeutic horse riding:
• Down’s syndrome with an atlantoaxial instability (all Down’s syndrome patient’s must have X-rays before participating in therapeutic horse riding and a doctor’s declaration that they do not have this problem)
• Arthritis in the acute stage
• Brittle bone disease
• Multiple Scleroses during the acute phase
• Severe Kyphosis and Scoliosis
• Uncontrolled epilepsy
• Unhealed pressure sores
Therapy sessions are 30 minutes long (this is the norm, all my lessons are adaptable) and are very affordable. A brief overview of the lesson shows that roughly 20 minutes are spent doing therapy the other 10 are spent actually riding the horse.
As therapeutic horse riding is fun and children learn a new skill in horse riding, the course of treatment can go on for years. However a minimum of 6 weeks is usually advised. As the person improves and grows more advanced the format of the lesson can change.

For more information don’t hesitate to contact trottingalong.therapyriding@gmail.com or take a look at my Facebook page https://www.facebook.com/trottingalongtherapy/?fref=ts

Sand & Glitter would like to thank Josie Adair for this lovely and very informative article.

A weighted vest for the low tone child

May 26, 2016 by Hélène Serfontein 2 Comments

What does low tone mean?
The best explanation is by means of analogy. Imagine purchasing a mechanical arm that could wash dishes. The arm would need to be attached near the sink. Would you attach it to the curtain/drapes? Not likely. The arm might end up swinging the dishes through the window. No. The arm would need to be attached to the very sturdy wall. This is true for all movement. Arms and legs need a stable background of attachment where movement forces can be generated. Precise and coordinated movement need to come from a strong central support. Low tone implies that postural muscles are somewhat too floppy for good support. The origins of low tone based postural instability often have to do with a lack of healthy and varied movement opportunities as a baby.

How do I know if my child has low muscle tone?
The low tone child has a very real struggle to remain upright in various positions. They adopt compensatory strategies early on. Children with inadequate muscle tone display poor postural control. In other words, they slouch.
Low tone children may present with some of these characteristics:
– They fatigue easily or lose concentration
– Poor perseverance in gross motor activities
– Improper body awareness feedback
– Avoid or struggle with chewy foods
– Poor posture in sitting and standing
– Impaired balance
– Lacking in confidence or assertiveness
– A preference for indoor activities

A child with low muscle tone may use compensations such as the following to sit perfectly upright:
– Hand support on the surface with locked elbow(s)

S&G-HandSupport
– Hooking feet around chair legs for support

S&G-FeetSupport
– ‘Fixing’ shoulders by shrugging them up for fine motor tasks such as cutting or writing
– ‘Locking’ the pelvis into an anterior tilt by arching the low back

S&G-AnteriorTilt
– Leaning to one side – bearing weight only on one buttock

S&G-SittingCompensation
– Pushing the chin forward so the head ‘locks’ into compressed position on the neck, sometimes with mouth open

S&G-NeckLock
– Creating a wide base: Sitting with legs bent to one side or in reverse w-position.

S&G-WideBase

S&G-WSitting
– Folding themselves into a chair. Low tone children may appear very bendy.

S&G-LowTone

 

Why is this important to know? How would my child be affected if she had low muscle tone?
Low tone children struggle in school. Poor central trunk and head control has many implications.
Good head-on-neck control is necessary for:
– Efficient speech
– Directing the gaze, eye contact, reading skills
– Hand-eye coordination, drawing and writing skills
– Direction and redirection of attention
– Concentrating on tasks
A raised fixed shoulder girdle interferes with normal breathing. Diaphragmatic breathing is impaired in this position, affecting breath control during speech. Impaired diaphragm movement also affects core muscle activation – causing the low tone and core instability situation to perpetuate itself.
Muscle imbalance creates malalignment of spine and joints. Malalignment leads to strain and pain.
If a child has trouble maintaining postural muscle control, the head is not properly aligned for good eye tracking movements on a page. Reading gets harder to do.
Proximal stability (good shoulder control) is needed for coordinated and effective distal movement (hand grip and movements). Writing takes more effort.
The ability to sit still is an active process of maintaining reciprocal balance between muscle groups. It is compromised in low tone kids. Paying attention becomes more difficult.
Social interaction is affected by attention and eye contact.
Sports participation is affected by balance, posture and coordination.

Having to work at maintaining an upright position leads to fatigue and impaired concentration. Postural control and balance should be automatic and ingrained long before school age, allowing kids to deal with the tasks at hand.

Low tone with poor postural control create anxiety and feelings of inadequacy in children who fail to perform to their academic, social and sports ability as a result. The social and school pressures on children are very real.

Why would a weighted vest help?
Deep pressure is very calming. Wearing the vest is like being enveloped in one long continuous hug. Kids love it. A weighted vest has a snug fit with pockets designed to house little weights. It creates a downwards pressure on the joints of the spine, which stimulates extension responses.

Deep pressure is useful for down-regulation of heightened sensory states. Wearing a weighted vest enhances proprioceptive and sensory feedback. This increases body awareness, tactile integration with improved posture and balance. Automatic balance reactions develop with sufficient postural control.

Wearing a weighted vest should be part of a sensory diet as prescribed by an occupational therapist. Always have a paediatric physiotherapy or occupational therapy assessment for any suspected developmental challenge.

Supplier information available upon request.

A pet for my child: Why caving in is good

Apr 3, 2016 by Hélène Serfontein Leave a Comment

When our children wanted a dog we had to think about it long and hard. We know. It’s a job. They wore us down and we started researching breeds. We did not do a good job in our research and ended up with a Beagle.

This first pet of ours was a force of nature. He demanded 200% from all of us and we just couldn’t keep up. He had the biting force of a hyena – determinedly chewing his way through the irrigation system as a result of our non-performance. He assaulted guests with a gusto: Taking running leaps at them reclining with drinks on the couch. Barking and jumping at small children – showing them who’s boss. Digging up great big dinosaur bones and building rubble in the back yard whilst tunneling to China. Attacking offending new plants. And loyal to a fault. The cleaning lady was his absolute favourite. She was greeted with great romping enthusiasm, jumping and scratching at her; and her ever smiling, loving him patiently – being made to feel so welcome.

image

We tried and tried and tried. The dog went on very many outings. An 8 metre long lead was used. We employed various disciplinary techniques with painstaking consistency. Dog whisperers got involved. Still we failed. So we started preparing the children. Long conversations about the dog’s happiness and our sanity ensued. Bargains were struck. We were all finally prepared mentally and found him a new home; complete with another Beagle friend. And owners dedicating focused and disciplined attention to him. People who could appreciate our lovely little dog fully, because they could meet his needs.

The second time around each child chose their perfect pet. A tiny little handbag puppy whose feet hardly ever touch the ground. And a gentle, lively little rescue. A quick learner who gives so much affection.

Oh the things we learnt from these pets of ours.
We learnt that a friend can become your boss if you don’t assert yourself.
We learnt that affection breeds affection. The more love goes around, the more love there is for everyone.
We learnt to put another’s needs before our own.
We learnt about training: Giving instruction and taking responsibility is a great confidence booster.
We learnt that stroking a pet can soothe the most anxious mind.
We learnt about slog. Picking up poop and puke is disgusting. It is not all hugs and roses.
We learnt about the joy of constant companionship. From a being who never judges. Who always forgives. Who is joyful in abundance.

So go ahead. Give in. A word of caution, though: Choose responsibly. The wrong pet…oi.

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