Does My Child Need Therapy?

The Whens, Whys, and Hows of Pediatric OT

Libby Kasten

Does my baby have to crawl on all fours?

As she relaxed on the couch in her in-laws’ house on a lazy Shabbos afternoon, Chani’s gaze repeatedly fell on her niece, who was born the same week as her 11-month-old Ruti. The other baby crawled around the room on all fours, stopped at the end table to pull herself into a standing position, then plopped down on the floor to resume crawling. Though Chani’s baby managed to get around and into everything by pushing herself in a sitting position, she hadn’t mastered the art of crawling on all fours and was unable to lift herself into either a standing or crouching position. Was there something wrong with her baby?

When Chani asked the question aloud, her mother-in-law was quick to dismiss it. “Many babies skip the crawling stage. Even Uncle Nachum, the family prodigy, never crawled on all fours!”

Still, Chani couldn’t ignore her niggling discomfort. A few weeks later, she had her baby evaluated by an OT, who quickly identified Ruti’s very low muscle tone which affected her hands, wrists, elbows, and shoulders. That was why she could not bear the necessary weight on her arms and legs to crawl on all fours.

Crawling properly is a vital part of a baby’s developmental process, Leah Gross, OTR-L and founder of The Therapy Place, explains. Skipping the crawling-on-all-fours stage usually points to an underlying weakness with the potential to cause various issues later on. For example, failing to crawl and stand when age appropriate seems to be a transient problem, but it will likely cause a child to struggle with alphabet formation, reading, and writing in elementary school. In the same way a baby uses the left and right sides to crawl, an older child needs to use both sides of their body for reading and writing—both skills that require eye-hand coordination and midline crossing.

Is my child shlumpy or sensory?

Nine-year-old Menny’s shoelaces were always open and his shirttails out, yet his impish smile won everyone’s heart. During bedtime, though, his mother barely remembered his charming personality as she struggled to have him get into pajamas and brush his teeth. She helped him tie his shoelaces in the morning, as well.

She was unaware that her freckled, straight-A son was lacking proper motor skills and encountered multiple physical challenges throughout a typical day—challenges that can become full-blown issues when he reaches bar mitzvah and cannot independently do the daily things in his schedule like opening a water bottle, twisting a door handle, or wrapping his tefillin.

Children who are unable to self-dress at the appropriate age tend to avoid physical activity, and those who are set off into a full-blown tantrum by the slightest problem are often lacking fine or gross motor skills or have sensory issues.

Children are smart and intuitive. They want to keep up with their peers and will feel bad when they are not being successful at activities their friends are doing well. When that happens, they may not want to engage in the activity or spend time with peers at all.

Providing these children with sensory input in a sensory gym or doing activities that strengthen tactile (related to the sense of touch), vestibular (related to the sense of balance), and proprioception (helping the child get a better sense of where they are in space) can eliminate their weaknesses and heal physical, social, and emotional issues.

What is The Therapy Place?

The Therapy Place is where an expert team of OTs and STs work closely with Leah Gross to help children overcome their obstacles to success while having fun.

And—as anyone who’s been there on a Sunday or Friday will say—The Therapy Place is a family outing. While the patient has a grand time with the constantly updated equipment and skilled therapists, siblings can watch videos in the waiting room, and parents choose between participating in sessions and enjoying some peaceful waiting time.

In-network providers or high-level care?

Although Leah Gross chose the in-network route to make private-level therapy obtainable for every child, the clinic remains what it was established as: a place where every patient is treated like an only child.

Responding to the need for in-school therapy, which allows children to be assessed and guided in their daily environment, The Therapy Place is affiliated with many schools in the Lakewood and Jackson areas. The school and The Therapy Place staff collaborate to reach the goals set forth for each patient, so there are double the minds, hands, and hearts rooting for each child.

Sidebars:

(1) Are milestones really a thing?

Mothers often wonder whether milestones are important to keep track of, or if they’re just another way of keeping up with the Katzes. Leah Gross clarifies that if a child does not reach age-appropriate milestones or is not up to par with peers, it is usually a sign of an underlying issue such as poor motor skills, lack of hand-eye coordination, or sensory issues, all of which can be resolved or strengthened by a competent OT.

It may be your baby failing to produce babbling sounds at 10 months old, your toddler unable to spoon-feed herself, your six-year-old struggling to get into pajamas on his own, or even your anxious fifth grader. After medical reasons are ruled out, children that are struggling to keep up with peers of their own age should be evaluated.

Does therapy help?

When the first-grade morah called to say that Yehudis is unable to push the steel classroom door open, her father rolled his eyes, and later, her pediatrician confidently shook his head. But her mother observed her daughter, who was a preemie at birth, closely. Perhaps they were wrongly assuming that their oldest daughter’s physical capacity was normal?

An evaluation confirmed that Yehudis had a weak core, the cause of her difficulty bearing weight and lack of interest in outdoor activities.

After enjoying various exciting activities in the state-of-the-art gym, Yehudis was physically up to par with—and even ahead of—her peers and thriving from the one-on-one relationship with her fun-loving therapist. Not surprisingly, the previously anxious and preferring-the-sidelines girl metamorphosed into a calm social butterfly, opening the door to both her classroom and future achievements.

Observing her progress, Yehudis’s mother also invested in some of the toys and activities her therapist uses, and the entire family now enjoys a fun core-strengthening corner in their playroom.

What are normal milestones?

By age 2 the child can build a tower of a few small blocks, scribble, turns knobs, brings a spoon to their mouth, and turns a few pages of a book at a time.

By age 3 they can string four large beads, snip with scissors, and eat without assistance.

By age 4 they can roll balls with clay, use the non-dominant hand to assist with the use of objects, and build a nine-block tower

By age 5 they can write their name, copy letters, and cut on lines.

By age 6: they can draw basic pictures, colors within lines, and cut out complex shapes.

By age 7 they can learn to tie shoes, write on the line, and build with Lego.

(2) A therapist speaks

When I began practicing OT at The Therapy Place, not only were my patients being treated by a young, vivacious therapist who loves being around children, they were also getting Leah Gross’s sought-after advice and hands-on guidance.

You see, at The Therapy Place, it’s about building greater providers just as much as it’s about building stronger patients. By subsidizing further education for therapists on the team, providing weekly team supervision meetings with Leah, and working together on each detail of every patient’s therapy plan, no child or technique is overlooked.

Working with the children at schools, I am constantly awed by the level of collaboration between the school and The Therapy Place staff. Everyone is available and ready to do anything a student needs to succeed. Often, this means incorporating specific classroom activities or planning specific treatments with teachers after hours.

(3) Sensory issues DIY activities:

Here are some ideas you can implement to reduce your child’s sensory integration difficulties:

• Have your child guess what objects are by feeling them.
• Play “I Spy.”
• Use soft colors in their room.
• Have them taste and describe the different textures and tastes of foods.
• Have them engage in age-appropriate heavy work, wheelbarrow walks, scootering, biking, running, and tons of movement.
• Create a “sensory corner” in the playroom using large, soft cushions, a mattress, or a bean bag. Hanging a swing is a great idea and less difficult than it seems. They can be purchased at Ikea or Amazon.

(4) Terminology explained

Fine motor skills: skills that require the use of the smaller finger muscles, like using pencils, scissors, Lego, or Duplo and opening and closing buttons

Gross motor skills: everyday physical activities like running, throwing, lifting, kicking, jumping, hopping, climbing monkey bars, and riding a bike

Weak core strength: signs of a child with weak core muscle strength:

• avoiding gross motor games and activities like climbing monkey bars and playing outdoor sports
• difficulty focusing in class and at home
• inability to bear age-appropriate weight; difficulty with walking, running, and navigating the playground; falling often

Muscle tone: The amount of tension (or resistance to movement) in muscles