Monday, December 22, 2014

Skip Crawling? A TEAM PT offers a follow-up

credit: envato
Dear Melissa,
My 8-month-old baby girl is starting to pull up on furniture! I really think she is just going to skip crawling and move right on to walking!  

So, your baby is pulling up on furniture, but never really went through the crawling phase? My response to this question last week prompted some wonderful discussions with members of Children's Therapy TEAM's Physical Therapy Department. One of our veteran Physical Therapists, Christina Ruby, has shared a treasure trove of knowledge with me. Her advice is, "Do not panic!"

First, Christina set me straight on the definition of crawling: 
  • Crawling is when a baby is in locomotion with her tummy and legs on the ground while using her elbows and forearms to help push her body along. This is also commonly called “Army Crawling". 
  • Creeping is the formal term for when children are in locomotion with their hands and knees on the ground and their belly lifted off of the ground. 
Creeping is actually the movement pattern I am discussing here. From this point forward in this post, I will properly refer to the type of locomotion in question as “creeping”. Christina suggests that even if children appear to be skipping the creeping phase, they can still practice the skills gained from creeping. Parents can provide frequent opportunities for their child to pull up, get back down, move to another piece of furniture, then pull up there. All of this up and down from hands and knees (creeping position) to standing will provide practice with trunk strength and control. It also helps with coordinating the right and left sides of the body. And for my two cents, even if a child is pulling up, it is still not too late to practice creeping! 

As I noted last week, creeping helps with visual development, sensory input, strength and coordination of the entire arm, and later, handwriting skills (Skip crawling and walk...Is it a good idea?). These are all things that OT tends to focus on. But, creeping helps out with so much more! Christina has offered insight based on her expertise as a Pediatric PT.

Core Strength Development
When a baby creeps with her belly off of the ground, it forces her back and abdominal muscles to work together to provide a stable foundation for the arms and legs to move. This sets up the foundation for proper posture, trunk strength, and balance later in life.

Coordinate all four extremities in a reciprocal manner 
When creeping, each arm and each leg moves at it’s own pace in a coordinated manner.  This coordination of right and left sides of the body as well as the upper and lower halves of the body takes a lot of work! This ability to coordinate all four quadrants sets the child up for successful movement patterns as they age. 

Weight shift from right to left
As we walk, we shift our weight from the right foot to the left foot and back to the right.  Same with creeping: right, left, right, left. Creeping is an important developmental milestone needed for walking.

Coordinated hip/knee/ankle/foot movements 
It is almost impossible to walk with our hips, knees, and ankles in a fixed position. We need to move! Creeping provides that rhythmical coordination of the hip/knee/ankle/foot. Practice makes perfect! As a child practices typical creeping patterns, this sets her up for success for when she takes those coveted first steps.  

Trunk rotation 
As a baby creeps, she naturally creeps for a bit, then sits to rest and look around before taking off creeping again. Every time she transitions from the creeping position on her hands and knees, to sitting, and back to hands and knees, it involves trunk rotation. As she matures, this will allow the child to not only have better balance as she is walking, but also give her the ability to reach and move in all planes, not just in a straight forward and back motion. 


Who knew creeping could do all that? Wow! Thank you Christina for sharing.

As always, I would love to hear about your experiences. 
You can both share and submit questions to share@childrenstherapyteam.com

Resources
Six Reasons Why Crawling Is Important, Joanna Bounds, Kids Spot
Effects of Sleep Position on Infant Motor Development, Davis, Moon, Sachs, Ottolini, American Academy of Pediatrics (1998)
Crawling, an OT's Perspective, Melissa Foster, Children's Therapy TEAM Blog (2014)
Tummy Time for Babies, Melissa Foster, Children's Therapy TEAM Blog (2014)
Downs Syndrome, The Importance of Crawling on the Stomach, Robert Doman, Ellen Doman, National Association for Child Development Volume 22, Number 12 (2009) 

Monday, December 15, 2014

Skip Crawling and Walk...Is it a good idea?

credit: envato images
Dear Melissa,
My 8-month-old baby girl is starting to pull up on furniture! I really think she is just going to skip crawling and move right on to walking!  

WAIT!!!  But crawling is so important!  Yes, I am thrilled with every developmental milestone of any kid at any age. Every child has their own developmental path. The time it will take for children to reach certain milestones will vary. And any time a parent is proud of their child is a reason to celebrate. 

But…crawling is SO important!  I remember when both of my children were in the 10-15 month range; I was constantly asked about walking: “Is he walking yet, is he walking yet?”  As a mama with a background in child development, I don’t know how many times I felt my blood pressure rise and the need to bite my tongue, rather than get on my soap box on the importance of crawling.  “No, my 10-month-old child is NOT walking yet!  And that’s fantastic, because do you have ANY idea how important crawling is? (insert my rolling my eyes here!)”

So, here is my soapbox rant on the importance of crawling. In 1994, the American Academy of Pediatrics began their “back to sleep” campaign. SIDS fell by 50%, but numerous studies show that since that time, kids are slower to meet gross motor developmental milestones.Then they added “Back to sleep, prone to play”, but many parents were already so terrified of putting babies on their tummies, that the message did not really hit home. And, it seems like society is so focused on that monumental milestone of when a baby takes her first steps, that we have forgotten the importance of crawling, rolling, dynamic sitting, etc. 

Babies who go through the crawling phase will later develop better eye-hand coordination when it comes to handwriting, sports, playing a musical instrument, etc. There is even a link between a lack of crawling and ADHD (but the verdict is still out on which may cause the other, you know…kind of like the chicken and the egg). I see this in my own practice. When a parent brings a child to me for handwriting help, one of the first questions I ask is “Did he crawl as a baby?”  More often than not, the answer is “No, but he was walking by 11 months!”

Why is crawling so important?
It strengthens the whole upper extremity.  
In laymen’s terms this means the whole shoulder, arm, and hand, down to the finger tips.  Even better, when a baby crawls while holding an object (think a toy car, rattle, etc) this strengthens all of the tiny intrinsic muscles of the hand, which are so vital for handwriting skills later on. 

It improves eye-hand coordination.  
When crawling, a baby often looks toward the object as she is crawling to it, or looks to the object, then to her hands, then to the object. This switching back and forth between near/far vision helps develop a child’s eye hand coordination and visual perception skills. When do we see this in big kids? Looking at the classroom board, then looking at the paper on the desk, and back again. Same thing. Babies who crawled have an advantage when it comes to having the eye hand coordination needed in school settings later on. 

Improves coordination of the right and left sides of the body.  
Walking primarily involves the weight shift of the right and left sides of the lower body. This is especially true when a baby is walking using push toys. In crawling, FOUR different sections of the body must all work together in unison. Right arm, left arm, right leg, left leg…it's very complicated to get all 4 areas working together in a rhythmic pattern. As a therapist, it definitely sets off red flags when a child consistently uses atypical movement patterns as a primary means for locomotion. An example of an atypical pattern is when a child sits and scoots on her bottom using one hand on the ground for support. Another example is when a child “crawls” but the legs don’t take turns moving in a back and forth pattern. Rather, they move forward together in a singular motion similar to a “bunny hop”. 

Improves sensory development.  
As a child crawls with her hands open she naturally will encounter many different textures on her hands. Smooth, cold tile. Fuzzy carpet. Big brother’s prickly bristle block that was left on the floor. You get the idea. Again, it is hard to know which one came first, but it is common for children who skip crawling to later have tactile sensory defensiveness, especially on their hands, such as resisting nail grooming, hand washing, finger paint, sand play, lotion, etc.  

Worried your baby may skip crawling 
and move straight to walking? 
Here are my top four tips:
1) Get on the floor with your baby!  
She may not want to be on the floor by herself. Get down on the floor and play with your baby. At times, model crawling yourself. 

2) Try to gently put your child on her hands and knees.  
Again, model this together. Siblings present? Make it a family affair! You can even put her on her tummy over a Boppy pillow for support if her arms/legs are not quite strong enough to support her yet. 

3) Make it a fun environment.  
Make sure that there is an open space for crawling. When next to furniture the child will tend to pull herself up and walk while holding on. Provide toys on the floor and spread them out to promote crawling from one toy to the next.
 
4) Practice, practice, practice.  
If your baby has started to crawl in the past few days, but she looks like she may want to take off walking already, get as much crawling in as you can. This was the situation with my daughter, and we would pretend to be puppies (barking and all!) as we crawled the full length of the house, from one room to the other. Has your baby already started to prefer walking? No worries! You can still encourage additional crawling practice through crawling under chairs, under the coffee table, through tunnels, and...it’s always fun to pretend to be puppies/kitties!

Did your child crawl or not?  
Do you think it affected later gross or fine motor development? 
I would love to hear your thoughts!

You can send your ideas and questions to share@ChildrensTherapyTEAM.com

Resources: 
Whats So Important About CrawlingMedCentral Health System  

Crawling and Creeping: A Milestone that should never be Missed, Center for Development Pediatric Therapies
  
Parenting: Do Babies need to Crawl?, Dina Roth Port, Parenting 

Tummy Time for Babies, Melissa Foster, Children's Therapy TEAM Blog 

Early infant crawling experience is reflected in later motor skill development, McEwan, Dihoff and Brozvic, (1991), Perceptual and Motor Skills


Monday, December 8, 2014

Reduce tantrums...with music!

 
Dear Melissa,
I have discovered that playing the right music is the only thing that can bring my 3-year-old son out of an all-out-meltdown when all of my other strategies and approaches fail. Is this normal or crazy? 

Well, you are onto something big here. It is not crazy...it is a gem of a technique that works for many kids! While I have a large bag of tricks when it comes to stopping the dreaded tantrum, this is a technique I have watched and learned from my fellow therapists at Children's Therapy TEAM. Taking a moment to brag, I am often in awe of my colleague's patience and skill in dealing with the less-than-enthusiastic kiddo. 


Music has become an important part of my kiddo-calming repertoire. I frequently sing when I'm with my kiddos, both at work and at home. Sometimes, it feels like I'm conducting a full Broadway musical. Note that I was NOT in the high school choir. I do NOT sing in the shower and I RARELY sing with the radio. So when I sing with my kiddos, I sometimes feel silly. My coworkers have to deal with my horrible voice. But, I'm sure you agree that even bad vocals are much more tolerable than a 3-year-old’s high-pitched crying!

You noted that music helps to bring your child out of an all-out meltdown. Chances are it may also be effective at proactively preventing the meltdown in the first place. Through my own practice and careful observation of other therapists, I find that music can be a useful tool in a variety of ways. Try some of the following approaches:

For a reward:  
Why not sing? Yes, a simple “good job” is nice. But, a “good job Henry, good job Henry, good job Henry…”  to the tune of “Where is Thumbkin?” is a much more intense and more personalized reward. Don’t we all want to work harder when we feel that our efforts are truly appreciated? 

For transitions: 
A transition is any time that a child (or adult) moves from one activity to the next. Anyone who has been around a preschool child for more than a day realizes that these transitions are often a cause for a meltdown. The adult can sing the steps of the transition to help communicate to the child what will happen next. This helps to ease the child’s anxiety of the unknown. For example (again, to the tune of “Where is Thumbkin?”), sing  “Put your socks on, put your socks on, and your shoes, and your shoes. Grab your backpack, grab your back pack, off to school, off to school”.  If you haven't noticed, pretty much anything can be sung to the tune of “Where is Thumbkin?”!

For calming:  
Now when a child begins to scream/cry, it can be very tempting to scream/cry as well.  Unfortunately this just escalates the situation. Not good!  As the adults in the situation, it is our job to deescalate the situation and help promote calming. By singing to the child in a soft, calm voice, you communicate to the child that you are calm. As a matter of fact, when I practice this technique, I feel that it actually helps me remain calm. It also has the added benefit of showing the tantrum-ing child that you can stay calm, even if they scream. And if the tantrum has no power over adults, the child will learn alternative techniques in order to get his way. Win-win!

For learning: 
We all know this one! How did we learn the ABC’s? How did we learn the days of the week? Months of the year? My daughter even came home from preschool with a song describing the water cycle! We have all known about this one since we ourselves were in preschool. We just forget to use it to our advantage sometimes!

For a stop watch: 
I have found this one to be extremely useful in working with kiddos who are overly sensitive with grooming. For example, if a child hates to have his teeth brushed, he will often let me brush his teeth for one round of singing ABC’s. Most children will know this song (even if they sometimes confuse the letters) by the age of 3 or 4. Singing during an uncomfortable task tells the child that there is a definite end to the unpleasantness. In addition, I find the rhythmic songs to be quite calming.

For gaining attention:  
I totally stole this one from observing preschool classrooms! The teacher may say “shhh” or “settle down” several times to the class with no success. Then she begins to sing “Let it Go” from Frozen…suddenly, every little eye in the entire classroom is glued to the teacher’s face, and every voice is singing along! If it works, use it!

For environment:  
Music totally sets the mood! Slow, quiet rhythms for nap time. Louder driving beats to help wake up. Medium regular beats during table work for attention and self-regulation. In addition, music is simply fun! It creates an engaging atmosphere. 

Do you have other ideas for using music to help improve mood/behavior? 
I look forward to hearing your ideas!

You can send your ideas and questions to share@ChildrensTherapyTEAM.com

Resources:
Introducing Preschoolers to Music, Kids Health from Nemours Children's Health System
Preschool classroom attention grabbers, by Jean Warren, PreschoolExpress.com


Monday, December 1, 2014

Great Toys

credit: envato images
Dear Melissa,
The holidays are approaching. Do you have any ideas for fantastic toys that my children will love, but that are also therapeutic?

The season of yearly gift giving has begun! I get this question frequently. Parents want their children to be excited when they open up that shiny package, but parents also want to use this opportunity to provide their children with items that will have some therapeutic and developmental benefit. Fun AND function! For this blog, I took the opportunity to enlist the help of my fantastic colleagues at Children's Therapy TEAM to create a list of exciting toys that are appropriate for a wide range of abilities. I have also included several links to products on Amazon, simply in order to provide clear examples of my descriptions. Feel free to tailor these recommendations to your child and to your favorite stores. Happy Shopping!

1) Indoor Mini Trampoline: As a sensory-based OT, this is my “most bang for your buck” item.  At around $30 (like this Stamina 36" folding trampoline), they are the perfect gift-giving price. Please note, the American Academy of Pediatrics is strongly against traditional trampolines due to the high incidence of injuries. I do NOT recommend a standard or even a small trampoline that is traditionally placed outside. My recommendation is for the mini trampoline that can slide easily under your bed, or the small “rebounder” trampoline that has a handle bar for smaller children. They are fantastic for helping children “get their wiggles out” on a cold or rainy day.  They also are so helpful for homework breaks, calming, improving attention to task, improving endurance/motor planning, cardiovascular health, etc. This gift is most appropriate for ages 3 years and up. 


2) Balls:  Baseballs, basketballs/basketball sets, dodgeballs (pictured left), playground balls and t-balls are all great. Holly Hill, a pediatric Physical Therapist at Children's Therapy TEAM, loves ANY type of ball because they serve to get children outside and moving their bodies. They help with gross motor skills, eye-hand coordination, and overall physical fitness. Depending on the ball, they are most appropriate for children who are 18 months and up.




3)  Shopping Cart:  Danielle Cunningham, another pediatric Physical Therapist at Children's Therapy TEAM, had this marvelous idea for emerging walkers. The shopping cart (such as the Step II Little Helpers Shopping Cart pictured right) fosters social and pretend play skills! You can either purchase additional pretend play food items or simply use cans and boxes from the pantry. This toy is most appropriate for children aged 10 months to 5 years (with older children generally using this item more for social skills rather than gross motor skills). 


4) Bikes/trikes/scooters:  Again, our TEAM PTs love anything that encourages a child to go outside and play! Both Holly and Danielle think that the holidays are the perfect time to splurge on the vehicle that is most appropriate for fostering the next stage of your child’s gross motor development. When children have items that make them excited to be outside, they will naturally spend more time working on their strength, endurance, and coordination. Think “ride on” toys like balance bikes (pictured left), tricycles, 3-wheel scooters, plasma cars and bicycles with/without training wheels. You get the idea. These items are most appropriate for children 1 year and up.


5) Pretend play toys:  Connie Clark, a veteran Children's Therapy TEAM Speech Therapist, loves doll houses, barns (pictured right), tea sets, puppets, etc. because of their ability to encourage pretend play skills. They also foster expressive and receptive language skills when an adult or older children play with the youngster. These types of toys are most appropriate for ages 12 months to 5 years. 



6) Art supplies:  Markers, pens, paints, crayons, chalk, clay, play-doh, glue, glitter, sequence, googlie eyes, construction paper…the list goes on and on. The great thing about art supplies is that you can obtain these in the dollar section of many stores or go more high-end with various extravagant art kits. Art supplies foster fine motor skills and creative thinking skills while decreasing sensory defensiveness. An added bonus: you have cute little projects to hang on your refrigerator! Different types of art supplies can be appropriate for ages 18 months and up.


7) Recordable toys: Paige Funkhouser, Children's Therapy TEAM Speech Therapist, loves any toys that allow a child to record his/her voice (like this Talking Tom Product). It can help a child learn to speak up, find power in his voice and articulate. There are innumerable little toy creatures and apps out there right now that fit this description!  Personally, my own 4- year-old is eyeing the talking birds. Have fun with this one! These toys are typically most appropriate for ages 2 years – 13 years. 

What beloved toys do your children have that foster developmental milestones? 
Please share!

You can send your ideas and questions to share@ChildrensTherapyTEAM.com

Resources: 


Monday, November 24, 2014

Holiday Survival Guide

credit: envato images


Dear Melissa,
Any ideas to help make the holidays run smoothly for my son with Sensory Processing Disorder?

Thanksgiving, Hanukkah, Christmas, Kwanzaa, New Year's...the holiday season is upon us!  The holidays are a time of big changes in routine for most families. These changes can be particularly difficult for children with Sensory Processing Disorder. With new foods, new clothes, new smells, new people, new routine…it can be the perfect recipe for a meltdown! Here are a few ideas to help set realistic goals & expectations for this holiday season. 

1. Keep to your standard routine as much as possible.  
Great fluctuations in sleeping habits and meal times can create hungry, cranky, tired children (and adults!). The more you can stay with your typical nap, bedtime, and mealtime routine, the better. If your child tends to sleep well in the car, it may be helpful to plan car trips during nap time or to pack PJs and toothbrush so that your child can complete the bedtime routine at Grandma’s house BEFORE you take the long trip home. It may also be helpful to keep healthy snacks handy if mealtimes get delayed. 

2. Consider clothing requirements with holiday outfits.  
Many children who have tactile defensiveness are defensive toward various textures/styles of clothing.  A child who only wears sweatpants and t-shirts is not suddenly going to be happy wearing a button up shirt tucked in with a belt, just because it is Christmas Eve! Consider choosing holiday outfits with softer fabrics...as close as possible to the style that the child prefers. A happy child in soft khaki pants and a polo-style shirt looks much more appropriate than a child throwing a tantrum in a suit. For girls, consider soft cotton dresses and avoid excess lace, taffeta, tulle, tights, and other scratchy fabrics. If you have a special outfit in mind that you think may be troublesome, try having the child wear the special outfit around the house on a calm afternoon so they can get begin to get used to it in a less stressful environment. Another good idea is to purchase 2-3 appropriate outfits (keeping receipts and tags) and let your son choose his favorite. Again, it is amazing how a bit of control can greatly improve a child’s compliance!

3. Remember special diets and food allergies.  
Make sure you inform all people preparing food of these restrictions so that you can learn ahead of time what your child can/can’t eat, and you can bring additional dishes if needed. No one wants to end up in the ER during the holidays because of a food reaction!

4. Remember your picky eater’s preferences.  
In general, it is good to encourage trying new foods. However, this is NOT the time. Simply dealing with the change in routine of the holidays is enough. Make sure that there is something on the menu that your child will eat, or just bring a lunchbox!

5. Consider alternate traditions surrounding presents.  
Many children with sensory processing disorder love routines and hate surprises. This often makes the idea of opening presents very stressful. Some of these children prefer for presents to not be wrapped.  Other children prefer to unwrap presents at a time other than in the middle of the chaos of the holidays. 

6. Set realistic expectations for social interaction with extended family.  
A child who has social anxiety won’t suddenly warm up to Aunt Susan who the child hasn’t seen in 6 months. This can be a source of hurt feelings for both the parent and the extended family member. If you think this may be a problem, it is important to let Aunt Susan know that her nephew has difficulties with social skills, and this is an area that you all are presently working on. But then actually work on it! Consider having your child practice an appropriate greeting (such as a “high five”) prior to family arriving and role play how he should interact with various family members. 

7. Set realistic expectations surrounding holiday ceremonies.  
Consider how long your child can reasonably sit in one location, the level of noise involved, how crowded the situation will be, what will be your escape strategy, etc. A little planning can help set your child up for success. 

8.  Designate a quiet “safe zone.”  
This can be a quiet closet, inside tent, or bedroom away from all of the hustle and bustle of the holiday. Line the space with blankets, pillows, and stuffed animals and allow for quiet music and soft lights.  Ideally, this is NOT a space for electronics, as they can be too stimulating. More appropriate activities for this space include books, fidget toys, or coloring. Your child should be allowed to go to this space anytime they feel overwhelmed by the chaos of the holidays. (Don’t we all wish we had a space like this!)

9.  Create a social story.  
Your speech therapist or occupational therapist can help with this. A social story is simply a story that you create with your child to describe a setting and/or task of particular difficulty. This story book depicts a situation with your child as the main character and then describes the proper way to act.  These stories work because they help inform the child concerning expectations and proper responses to the situation. The story is stronger if it contains pictures of the child being successful in these situations.

With a little planning and preparation, the holidays 
CAN be an enjoyable time for everyone! 

 What holiday survival tips have worked for your family?  
I would love to hear your tips/ideas!
 You can send questions to share@ChildrensTherapyTEAM.com

Resources:

Monday, November 17, 2014

Mimicking Siblings


Dear Melissa,
I have two boys, ages 3 and 7. My 7-year-old son was diagnosed with Autism when he was 2 years old. My older son has several self-stimming behaviors including flapping his hands, spinning in circles, and rocking. He primarily engages in these behaviors when he is excited. During the past month, I have noticed that my younger “typical” son has also begun to flap his hands when he is excited. Should I be concerned that my 3-year-old has Autism as well?

Any time you see your child mimicking self-stimming behaviors, it can set off a firestorm of emotions. The prospect of a second child with Autism can be very confusing. I have had MANY mamas express this concern to me. Most of this blog is my opinion about sibling mimicking based on many years of working with children with Autism as well as their families and siblings.  

The basics of stimming

Let’s go back to the basics of “stimming.” Stimming is a repetitive, stereotypical behavior that is one of the diagnostic criteria for Autism. Children with Autism engage in these stimming behaviors to calm themselves and help them regulate a sensory system that is often very out-of-sync. Many common stims include flapping hands, rocking, spinning, blinking, random mouth noises, chewing non-food objects, etc. Again, these socially inappropriate activities serve a purpose in helping soothe the individual with Autism. 

Is it just a phase?
Let's not forget that kids do weird stuff. They are kids...that’s what they do! This is what makes them so much fun! If a sibling of a child with Autism begins to spin or flap his hands, I generally don’t get concerned. The behavior itself is NOT the problem. The REASON behind the behavior is more of a concern. If the sibling is truly “neuro-typical”, then he won’t really get anything out of the stimming behavior. It will simply be a quirky act that he engages in for a month or two before moving on to the next quirky behavior. In other words, it’s just a phase. 

When is there cause for concern? 

Though the data is somewhat varied, siblings of children with Autism have a 7-19% increased chance of having Autism themselves. You should contact your child's pediatrician if you: 1) observe that these stimming behaviors continue for more than a couple of months, OR 2) observe a significant regression in your younger child’s language or other developmental milestones lasting more than a couple months. I would also recommend consulting with your older child’s occupational therapist. It is likely that he/she knows your family well and has casually observed the younger sibling on multiple occasions. As someone who has been in this business for over a decade, I have learned to be observant for “red flags” in siblings, often months/years before the parent is aware there may be a problem. 


Do you have a child with Autism? How have you addressed concerns with siblings? 
Or do you have more than one child with a diagnosis of Autism? 
I would love to year your ideas/comments for this question!

You can send questions to share@ChildrensTherapyTEAM.com

Resources:
National Institute of Mental Health:  Autism Risk in Younger Siblings 

Monday, November 10, 2014

Melatonin Minute

credit: Envato images
Dear Melissa,
My 3 ½ year old daughter has no other medical diagnoses but has the hardest time falling asleep at night! We minimize TV and other electronic devices in the evenings, and we have consistent bedtime and wake-up times throughout the week. We have also tried “reward charts” and other behavior modification techniques. Even when she is “being good,” I can watch her on the video monitor just tossing and turning for an hour, even though her head is on the pillow. I have friends who use Melatonin to help their children fall asleep. Is this a good idea for my daughter? 

Confession...this is actually a question about my own child that I really struggle with! Some commentators praise Melatonin as the greatest thing since sliced bread. It not only helps children and adults fall asleep with minimal/no side effects, but its efficacy is being studied for treating and preventing certain cancers. Others say the complete opposite. Critics accuse parents of taking the “easy way out” and drugging their children to induce sleep, claiming that Melatonin has long-term side effects ranging from dependency to decreased sexual development. What is the truth? 

What is Melatonin?
Melatonin is a hormone found naturally in the body. It is produced in our brain's pineal gland. Melatonin appears to be linked to the body's sleep/wake cycle or circadian rhythm. The release of Melatonin is stimulated by darkness and suppressed by light. The levels of Melatonin in your blood are highest just before you go to sleep. Melatonin used in medicine is usually made synthetically in a laboratory. It is most commonly available over the counter in pill form, but Melatonin is also available in forms that can be placed on the cheek or under the tongue. This allows the Melatonin to be absorbed quickly into the body. 

Effective...Yes!

There are many quality research studies which have deemed Melatonin to be quite effective in helping children fall sleep. Not only children with various disabilities such as ADD/ADHD, Autism, Cerebral Palsy, Cognitive Impairments, and Blindness, but typically developing children as well. In most cases, it is recommended that you administer Melatonin 30-60 minutes before bedtime. It helps a child to fall asleep but is much less effective at helping a child stay asleep. As a whole, I can find little question that Melatonin works. 

It is sold over the counter...but is it safe? 

Many people have commented to me that melatonin (and other supplements) are “all natural” and therefore are safe. To that I reply “Marijuana and psychedelic mushrooms are ‘all natural’ but I would hope that you would not deem THOSE products safe to give to your child!” The problem with “all natural” products is that they are not regulated by the FDA. I like the FDA. I know that there are many conspiracy theorists out there, but it is the job of the FDA to keep us safe. The FDA is in charge of making sure that all drugs are both safe and effective. This includes regulating potency and ensuring there are no added/unreported ingredients. One of the major known problems of taking melatonin is that one can never be completely sure of the dosage. As with all non-FDA approved supplements, there is little outside regulation. Therefore, the consistency, potency and outside contaminants can vary from company to company and from bottle to bottle within the same brand.   

My Recommendations
1. Start with good sleep practices. This includes consistency of bedtime routine, sleep/wake time, minimizing electronics, etc. 
2. Assess your child’s individual sleep needs. Each child is unique. If your child goes to bed later but wakes up on time and thrives during the day, she may need less sleep than her peers. Though annoying, this is OK and causes no need for further intervention. 
3. Add behavior modification techniques when necessary. Think about your personality, your child’s reasons for not sleeping well, and the personality of your child in order to find the best technique for your family.  
4. Use an infant video monitor. This can help you assess what might be contributing to your child’s sleep difficulties. I have found this information to be tremendously valuable as a mama when working with my own children on sleep. Is the child getting up and playing, or is she tossing and turning with her head on the pillow? These two scenarios require different interventions. 
5. Talk to your pediatrician. When you have tried all of the recommendations above and your child is still having sleep difficulties, it is time to take the next step. In my opinion, a “wait and see” approach is not good enough. Work with your pediatrician, teachers, occupational therapist, child psychologist, and other professionals who might be involved in your child’s care to determine the best approach.  

Parent detective work
Don’t forget to be a detective first! This will allow you and your pediatrician to have an informed discussion about the problem. Your doctor's recommendations will rely heavily on your day-to-day observations. Go to your pediatrician equipped with knowledge gleaned from your own observations. For example, be able to answer questions such as the following:    
  • Does your child have a problem with falling asleep or staying asleep? 
  • Does your child appear restless? 
  • Does your child have problems with naps (if they are still necessary) or just at bedtime? 
  • Does your child snore? 
  • Does your child have nightmares? 
  • Does your child have specific fears with falling asleep?   
My final word on Meletonin
Yes many of the sleep medications and supplements have potential negative side effects. However, we KNOW that a sleep-deprived child will have the negative side effects of irritability and decreased attention. In addition, many studies have also linked a lack of sleep with decreased academic performance, obesity, depression, and behavior problems. In general, I tend to embrace non-pharmaceutical approaches first, but don’t hesitate to do what is necessary to help your child achieve the quantity and quality of sleep she needs. 

What are your thoughts on Melatonin?  Have you found it to be a wonder-drug for your family?  Did you or your child have negative side effects? I would love for you to weigh in! In addition, I have posted a TON of resources this week due to the complexity of this issue. Sweet dreams!

Also, if you have a question you would like me to address in my Weekly Blog,

Resources:
Safety and Efficacy of Melatonin in Children, The Natural Medicine Journal
Melatonin, American Cancer Society
Melatonin, National Institutes of Health