More Than Words | RTS Blog

Have you noticed that your child is walking on her tiptoes? It’s certainly not an uncommon sight, but it is one you’ll want to watch if it goes on past age 3.

It is natural for toddlers 18 months and older to experiment with toe-walking as they learn to walk and run. However, if they continue to toe-walk on the balls of their feet past age 3 and no underlying diagnoses exist, the behavior will need to be addressed. Called idiopathic toe walking, this condition can cause a child’s calf muscles to shorten making it more challenging to walk flat-footed.

Why do children walk on their toes?

The three most common reasons children tip-toe or walk on their toes include:

Sensory Processing Difficulties

Children with sensory processing difficulties may walk on their toes for two reasons due to hypersensitivity to floor textures and surfaces or desire for increased sensory input and feeling within the joints.

Underlying Medical Conditions

Underlying medical conditions like cerebral palsy or muscular dystrophy may be another reason a child walks on the balls of her feet. These medical conditions cause an abnormal increase in muscle tone, which can lead to toe-walking.

Learned Habit

A child may toe-walk simply because she prefers to walk on her toes.  And, if done continuously, toe-walking or tip-toeing can cause her calf muscles to shorten making it more difficult to walk normally.

How do I help my child stop toe-walking?

If your child’s continuous toe-walking concerns you, please contact your pediatrician to schedule an appointment for further consideration. Your doctor may refer you to a licensed pediatric physical therapist to evaluate your child’s muscles and strength by assessing her leg muscles and ankle movements.

The physical therapist may recommend an at-home exercise program targeting the calf and front leg muscles. The ultimate goal will be for your daughter to walk using a heel-to-toe pattern rather than choosing her tiptoes.

Some common stretching exercises physical therapists may recommend for toe-walkers include:

Calf Stretches

Ask your daughter to lie on her back with her knees straight. One at a time, bring her feet up towards her head while bending her ankle. 

Wall Stretches

Have your daughter put her hands on a wall with her feet pointed toward the same wall. One foot should be behind the other with the front leg bent. Instruct her to lean into the wall keeping her back leg straight. Both of her heels should remain on the floor while she stretches.

Long Sit Stretches

Ask your daughter to sit with both legs straight out in front of her while wrapping a towel around both of her feet. She should hold the towel at both ends and pull the towel back towards her body while keeping her knees flat and back straight.

Heel Drop Stretches

Have your daughter stand on a step. While keeping one foot planted firmly on the step, ask her to place one foot halfway on the step and drop her heel to feel a stretch in her calf muscle.

Please note, while simple to execute, these exercises should be initiated under the guidance of a physical therapist who will demonstrate the correct stretch positioning, the number of repetitions needed and the appropriate amount of time to hold the stretch.

  Filed under: Awareness, Physical Therapy, Raleigh Therapy Services

May is Better Speech and Hearing Month and now is the perfect time to spotlight the special role speech-language pathologists, more readily referred to as speech therapists, play in children’s lives. It’s easy to think that a speech therapist is someone who works with others to correct mispronounced words and help them speak—however, speech therapists do much, much more than that.

Speech-language pathologists are professional therapists who evaluate and treat speech, language and swallowing disorders. A pediatric speech-language pathologist may work with a child in any of the following areas:

• Feeding & Swallowing – safely eating, drinking, and swallowing
• Articulation– producing the correct speech sounds
• Voice– speaking with vocal quality, pitch, loudness, and resonance
• Expressive Language – using language to communicate functionally
• Receptive Language– understanding what is being communicated
• Pragmatics – using social language in order to convey needs and participate in conversations
• Fluency (Stuttering)– speaking using a normal flow and rhythm without interruptions
• Hearing – communicating in the presence of a hearing disorder

Preschool & Daycare Speech and Hearing Screenings

Your first introduction to a speech-language pathologist may actually be at your child’s preschool or daycare. It is a common practice for local speech-language pathologists to offer free speech and language screenings for young students at these early learning centers. With your consent, a speech therapist will conduct a brief screening to review your child’s articulation, language, voice, fluency, and hearing.

The free screening will provide a quick snapshot into your child’s speech and language skills by utilizing a research-based tool to indicate a pass/fail status. A hearing test may also be performed simultaneously. If your child fails his or her screening or hearing test, a more in-depth assessment is typically recommended to determine if a delay or disorder exists.

Some signs of speech and language disorders that speech-language pathologists will watch for in children include:

Feeding & Swallowing Disorders:

• Difficulty chewing
• Choking, coughing, or gagging on food and/or liquids
• Difficulty transitioning to solids or higher textured solids like meat
• Difficulty transitioning from bottle to cup

Speech Sound Disorders:

• Incorrect pronunciation of the letters p, b, m, h, and/or w by 1 to 2 years of age
• Incorrect pronunciation of the letters k, g, f, t, d, and/or n by 2 to 3 years of age
• Unclear speech to both familiar and unfamiliar listeners at 2 to 3 years of age

Voice Disorders:

• Speaking with a hoarse or breathy voice
• Speaking with a nasal voice 

Language Disorders:

• Not smiling or interacting with others by 3 months of age
• Lack of babbling at 7 months of age
• Not using gestures by 12 months of age
• Inability to understand what others are saying between 7 months and 2 years of age
• Unable to say more than 50 words by 2 years of age
• Unable to combine words by 2 1/2 years of age

Fluency (Stuttering) Disorders:

• Frequently repeating parts of words or whole words at 2 1/2 to 3 years of age
• Stretching sounds out like “n-n-n-no” for “no” at 2 1/2 to 3 years of age
• Struggling to get sounds or words out by 2 1/2 to 3 years of age

 Hearing Disorders:

• Lack of attention to sounds
• Not responding to name when called
• Inability to follow simple commands

  Filed under: Awareness, Better Speech and Hearing, Parenting Tips, Raleigh Therapy Services, Speech and Language Development

Buttoning, zipping, gripping, eating, cutting, writing, tying—pretty much all things accomplished with the fingers, hands, and arms—are perfect examples of our fine motor skills in action.

Involving the use and coordination of these small muscles, fine motor skills are important for many life skills as well as the self-help skills children need to complete daily tasks.

Not surprisingly, these skills also support the development of literacy and numeracy for children underscoring participation in a variety of activities such as games, arts and crafts, musical instruments, and, eventually, educational exercises on digital devices.

Fine Motor Milestones for Toddlers and School-Age Children

As with all areas of child development, there are certain fine motor milestones to watch for at all age ranges.

Toddlers—16 months to 3 years:

• Stacks blocks and toys
• Draws with crayons or markers using a firm fist grip
• Uses spoon and fork to feed himself

Preschoolers—3 to 5 years:

• Manipulates buttons and fasteners on clothes
• Traces, draws and writes shapes and letters
• Uses scissors
• Establishes hand dominance

School Age—5 to 7 years of age:

• Dresses self
• Ties shoes
• Prints letters, numbers and words
• Cuts on the lines
• Colors inside the lines

Fine Motor Skill Activities for Kids

There are a variety of simple at-home activities you can introduce and implement to help your child build hand strength and hone his fine motor skills as he grows. Some activities you can do incorporate into playtime on a daily basis include:

Pompom Play

Set up an activity with small, soft pompoms from a craft store and a muffin tin. Ask your child to place the pompoms in the muffin tin. Older children can also sort them by color or make color patterns.

Get to Gluing

Put dots of glue on a piece of paper and ask your child to stick small objects such as beans, buttons, or beads on the glue dots. Watch your child closely during this activity to ensure the small objects are put on the paper and not into the mouth.

Tweezer Time

Place a variety of small items in a bowl, muffin tin or ice cube trade and ask your child to pick them out with tweezers.

Bring on the Beads

Using colorful pipe cleaners and assorted beads, encourage your child to make a bracelet or necklace. Ask your child to string the beads by size or by color. Do keep a watchful eye on your child during this creative project to make sure the beads are not placed in the mouth.   

Pull Out Playdough

Playing with playdough offers a great opportunity for children to strengthen their fine motor muscles. Ask your child to squeeze and stretch playdough into various shapes. Hide small objects in the playdough for your child to find and pick out.

Finger Painting

Finger paintings are much more than a messy masterpiece! The process of finger painting helps a child with dexterity as well as hand-eye coordination to support fine motor skills.

Broken Crayon Coloring

Brand new crayons are great, but using small, broken crayons will encourage your child to firm up his grip and hold the crayon correctly.

Fine Motor Control Concerns

If you are concerned your child may not be meeting certain age-appropriate fine motor milestones, you should consult your pediatrician. A referral to a licensed occupational therapist may be recommended to assess your child’s fine motor abilities further and determine if he could benefit from therapy to increase his skills.

  Filed under: Occupational Therapy, Parent Education, Parenting Tips, Therapy Ideas