Tuesday, October 23, 2012

When Your Child has to go into the Hospital

When Your Child has to go into the Hospital

Be Prepared.
What should I bring to the hospital to have a smoother admission?
The more prepared you are, the better your admission experience will be. Be sure to bring a list of your child’s medications, allergies, recent surgeries, illnesses, and hospitalizations.  If your child is receiving services such as private duty nursing, therapies, or home medical equipment – bring a list of these providers’ contact numbers and what services your child receives from them. If your child gets nursing, bring a copy of the Plan of Care. You will likely be asked the same questions by more than one member of the medical team. Rather than having to repeat yourself each time, if you have everything written down it will save you time and frustration.
Good packing is another important tool to help with you & your child’s transition. Pack things that are comforting and part of your child’s normal routine as much as possible.  Many times it is more comforting for the child to wear his or her own pajamas rather than a hospital gown.  If your child has special medical supplies and equipment, bring enough backup in case the hospital doesn’t have what your child uses on hand. If they do have what you need, use their supplies and save yours since insurance quantities are limited and you don’t want to run short. Be sure to bring something comfortable for yourself as well as toiletries, snacks, and a relaxing activity to fill quiet time.
Know Your Rights.
How do I know how much say I have in my child’s care? I feel like I have no control over what’s happening.
As a parent, you have a great deal of control and influence on your child’s care while they are in the hospital. It is very important that you talk with the medical team caring for your child on a regular basis and stay informed of the treatment plan. If you don’t understand or disagree with something, tell your child’s doctor. Every time your child is hospitalized you will be given a document called “Patient Rights and Responsibilities”. It is very important that you read this and be familiar with your rights as well as your responsibilities. This could be very helpful in understanding how much control you have in your child’s care while they are in the hospital. The best survival strategy is to keep the lines of communication open. Talk to doctors, nurses, your spouse, and your child. The more information you have, the more in control you will feel.
Who’s who in the hospital?
There are so many people involved in my child’s care, how do I know who does what?
There will be many doctors and nurses involved in your child’s care. When multiple care providers are involved, it is not uncommon for them to have different ideas and opinions about your child’s treatment. This can be very confusing and frustrating for parents, and can make parents worry that “no
one knows what is going on.” It is very important that you identify the person who heads up your child’s team. Parents have also often found that keeping a list of the different medical providers, and information about how they can be contacted is helpful.
Doctors –
Attending physicians are members of the team that determine and supervise your child's medical care. Attending physicians also teach other doctors to care for children. Your child will be assigned an attending physician.
Residents and interns are physicians completing training in pediatrics. They work under the guidance of attending physicians and fellows to provide your child's care.
Specialists are physicians with advanced training in a particular specialty. It is not uncommon for the attending physician to have one or more specialists see your child while they are in the hospital. Some specialists you may see in the hospital could be Pulmonologist, Cardiologist, Endocrinologist, Surgeons, Otolaryngologist, Neurologist, etc.  Be sure to ask if you don’t know what specialty a physician practices or why they are seeing your child. 
Fellows are physicians who have completed their residency training and are now receiving advanced training in a pediatric specialty. Fellows work with an attending physician to provide your child's care. Fellows help teach interns and residents under the guidance of attending physicians.
Nurses –
Registered Nurses (RN) and Licensed Vocational Nurses (LVN) are responsible for providing the nursing care ordered by doctors, completing physical assessments, and notifying your child’s doctors of any needs, concerns, or changes regarding your child’s condition.
·   Charge nurses are responsible for overseeing the nursing care on your child's unit during a shift.
Clinical nurse specialists are registered nurses with advanced education in special areas.
Nurse practitioners are registered nurses with advanced education in special areas. These nurses are able to write orders and prescriptions under the supervision of the attending physician.
Other –
Physician Assistants (PA) practice medicine under the direction of physicians and surgeons. They are formally trained to examine patients, diagnose injuries and illnesses, and provide treatment.
·   Patient care assistants are trained to help nurses care for your child. They work under the supervision of a nurse and provide routine care activities but are unable to give medications. In most cases, this is the person taking vital signs and doing other tasks like checking blood sugar, emptying catheter bag, etc.
 Respiratory Therapist (RT) have specialized training in the respiratory system. They perform respiratory (breathing) assessments, give nebulized breathing treatments that your doctor orders, monitor and regulate oxygen use, and work to make your child’s lungs, breathing, and ventilation are controlled.
·   Child Life specialists help meet the developmental, educational, and psychological needs of your child. They plan and provide activities and support to minimize stress while in the hospital.
Nutritionists offer guidance on nutrition to help your child to grow and heal.
Radiology technologists perform X rays, ultrasounds, CAT scans, MRI scans and other tests to help the healthcare team treat your child.
Discharge Planners / Case Managers help plan for your child's discharge, make referrals to community resources if needed, coordinate insurance coverage, and work with the home care coordinator if home care services are needed.
·   Social workers provide counseling, information, referrals to community agencies and emotional support. They can help decrease stress and guide you and your family during your hospital stay.

Going Home!

I’m so relieved to be going home, but I’m nervous too. How can I be sure we are prepared?

Going home from the hospital usually brings relief to children and parents. However, many children have trouble adjusting after a procedure or hospitalization, especially if they are still recovering or experiencing pain. Such adjustment difficulties are normal, and may last anywhere from a few days to a couple of months. It is important to return to your family routines as soon as possible, and to maintain family rules and limits regarding your child’s behavior.

Before leaving the hospital, make sure you have ALL of your questions and concerns addressed. Do you feel safe taking the child home? Do you feel that he or she is stable enough to go home? Did the hospital staff teach you everything you need to know to care for your child at home? Was there something that you wanted the doctor to address that was not done. Once you have done this and are comfortable and agree that your child is ready to go home, the next step is getting things in order to go home. Have someone at home prepare your child’s room by changing their linens and freshening up their space. It is important that they come home to a clean environment. Also, have a list of follow up doctor appointments that your child will need after discharge. If the nurse didn’t make the appointments for you, do this as soon as possible and no later than the next day after discharge. Ask your child’s doctor to send any prescriptions to your pharmacy before discharge so that they will be ready for pick up when you go home. Be sure you have a list of what medications were ordered so that you can ensure you get the correct medicines at pick up. The nurse will review the Discharge Orders with you before you leave. Make sure you understand the doctor’s discharge orders, especially regarding medicines, dressing changes, diet, activity, and any home medical equipment or treatments. If you are receiving services at home, be sure to contact these providers to ensure they are prepared to resume services. If they are not, be sure to relay this information to your child’s doctor and the discharge planner/case manager working with your child.

Friday, October 19, 2012

Utilizing Children’s Books to Develop Language Skills

Children’s books are a readily available and easy to use resource for targeting receptive and expressive language skills. Here is a look at 5 popular children’s books and how they can be used to target a variety of language goals

Age range: 3 years to 5 years

Suggested Vocabulary:


Target Language Skills:

                Contractible copulas
                Predicate adjectives
                Concrete nouns
                Pronoun usage “I” and “me”
Classifying words – land animals, sea animals, big animals, small animals
Comparative words – quick/slow, big/small, happy/sad, hot/cold, loud/quiet

Activity 1: Opposites
Happy face and sad face puppets – Direct the child in drawing a happy face on one plate and a sad face on the other. Child can then practice labeling facial features and colors. The puppets can then be used to practice pronoun usage for “I” and “me” during pretend play and for playing Simon Says targeting opposite concepts such as fast/slow and loud/quiet.
Materials needed: paper plates or paper bags and markers

Activity 2: Categorizing Animals
            Direct the child in grouping the animals by big or small, then by sea animals or land animals.
            Materials needed: felt board or poster board, felt animals, pictures of animals or toy animals

Age Range: 3 years to 5 years

Suggested Vocabulary:

Target Language Skills
                Prepositional phrases
                Interrogative pronouns (Who went on a walk?)
                Subjective case pronouns (Rosie went on a walk)
                Verb tense
                Temporal words
                Comparative word-pairs

Activity 1: Obstacle Course
Create an obstacle course outside or in the therapy room. Provide objects that will give the child an opportunity to act out the prepositional phrases presented in this story.
                Go across the sidewalk
                Go around a tree
                Go step over some flowers
                Go past a structure
                Go through the doors
                Go under the table

Activity 2: Hen on a Haystack
Provide visual instructions for making this craft to target following directions. Cover the cone with pieces of hay and place the hen on top of the haystack.
Materials needed: Styrofoam cone, hay, glue, plastic or paper hen

Age Range: 3 years to 5 years

Suggested Vocabulary:
Ice Cream

Target Language Skills
                Articles – a and the
                Prepositional phrases
                Subjective case pronouns “…he ate through one apple”
                Negative sentence type “Now he wasn’t hungry any more….”
                Infinitive phrases
                Predicate adjectives
                Spatial concepts
                Temporal concepts
                Quantitative concepts
                Qualitative concepts

Activity 1: Fruit Salad
Place fruit cocktail and coconut in a bowl. Then slice the bananas and add them to the fruit and coconut. Mix and let chill. Target following directions and vocabulary by having the child following visual and verbal directions for making the fruit salad.
Materials needed: 2 large cans of fruit cocktail, 1 can of Bakers coconut and 2 large bananas

Activity 2: Sequencing exercise – Caterpillar, cocoon and butterfly
Materials needed: 3 medium Styrofoam balls, 1 large Styrofoam ball, 4 pipe cleaners, 2 googlie eyes, markers, butterfly pattern and brown yarn.
Caterpillar - Color the 3 styrofoam balls green. Form the body of the caterpillar by gluing the balls together. Glue eyes on the face and attach pipe cleaners for antennas.
Cocoon – Wrap the large ball in brown yarn.
Butterfly – Color the butterfly pattern and attach pipe cleaners for antennas.

Age Range: 4 years to 6 years

Suggested Vocabulary:

Target Language Skills:

                Verb tensing: -ed marker
                Pronouns: they, he, him
                Prepositions: in, over, under, into
                Prepositional phrases
                Interrogative pronouns
                Infinitive phrases
                Contractible copula
                Narration and role playing
                Comparative word pairs
                Comparative and superlatives
                Quantitative terms
                Qualitative terms
                Temporal concepts

Activity 1: Sequencing
Instruct the child in making goat puppets. First you color the goat, then you put glue on the bag, last you put the goat on the bag.
Materials needed: 3 paper bags, 3 patterns for goat (small, medium, large), markers, glue

Activity 2: Narration and role-playing
Have the child act out the story using the puppets.

Age Range: 4 years to 6 years

Suggested Vocabulary:

Target Language Skills:
Prepositions: in, into, on, across, out, down
Prepositional phrases
                Comparative concepts
                Temporal concepts
                Verb tensing: -ed marker
                Negative sentence types
                Narration and sequencing

Activity 1: Baking Gingerbread Boy Cookies

1 cup of shortening
1 cup of sugar
1 egg
1 cup molasses
2 tbs. vinegar
3 tbs. baking soda
5 cups flour
1 ½ tsp. salt
3 tsp. ginger
1 tsp. cinnamon
1 tsp. ground gloves

Cream shortening and sugar together. Beat in the egg, molasses and vinegar. Set this mixture aside. Sift together the dry ingredients. Blend the dry ingredient mixture with the first mixture and chill for 3 hours. Roll dough out to 1/8-inch thickness on a lightly greased cookie sheet and cut with cookie cutters. Bake at 375 degrees for 10 to 15 minutes. Cool slightly and remove from the cookie sheet. Allow the cookies to cool completely before decorating.

Activity 2: Narration
Retell the story using a gingerbread boy puppet. Create the puppet using the cookie cutter from activity 1, brown construction paper and sequins.

Karran Morris M.S. CCC-SLP
Speech-Language Pathologist
MedCare Pediatric Rehab Center - Northshore

Thursday, October 4, 2012

Tips to Make Halloween Enjoyable for Children with Autism Spectrum Disorders

We received this email from the Autism Society of America and think it's great information to pass on to our friends and families!

Tips to Make Halloween Enjoyable for Children with Autism Spectrum Disorders

The very things that can be so exciting to some people — wearing a costume, being outside with other kids also wearing costumes, knocking on doors and getting treats — can cause anxiety for children with autism spectrum disorders.
Wearing a costume is unfamiliar, as is going from house to house to ask for treats. New routines and behaviors can be enjoyable for kids on the spectrum when they are approached with planning, and the necessary supports are identified and provided. Following are some things you can do ahead of time to help your child enjoy this occasion:

1. Begin early (even a month before) to prepare your child for Halloween activities. Read a story about Halloween and the activities that surround it, like carving pumpkins, wearing costumes and trick-or-treating. Teach your child the skills involved in participating—knocking on the door, holding out the bag, saying “trick or treat” or using assistive technology (a picture or device) to communicate the message, and then saying “thank you.”

2. Help your child choose a costume that will reflect his or her interests. Let him or her practice wearing the costume around the house while practicing Halloween activities. If wearing a costume is irritating, give your child the option of wearing face paint, a scarf, or a hat on Halloween. No costume is also OK.

3. Write a social narrative describing what your child will do on Halloween. Include in this story information about wearing the costume or face paint, and carrying the trick-or-treat bag. Identify which houses your child will visit, what your child will say at each house, and what he or she will do with the treats she receives. Read more Halloween tips.

Share Your Halloween Advice for Children, Teens and Adults:

Do you have great advice to share regarding costumes, trick-or-treating, handing out candy, parties, haunted houses or any of the other spooky activities that take place during October? Please submit your tips and ideas below. The Autism Society will compile a list and share them in the October 18 edition of the Autism Society e-newsletter, ASA-Net. Submit your tip now!


For our friends and families who need to be cautious with halloween candy due to special diets, there is a GREAT list of GFCF candy that can be found here: http://surefoodsliving.com/2011/10/gluten-free-halloween-candy-quick-list-2011/

Myofascial Release

Myofascial release is a technique that therapists can perform to improve muscle movement.  Fascia is a three dimensional web that surrounds muscles, nerves, and bones and that lends support and separation to all the body systems.  Fascial restrictions can occur for a variety of reasons such as birth trauma, inflammatory processes, poor posture, muscle weakness, and abnormal movement patterns. 

The primary purpose of myofascial release is to remove these restrictions and improve structural alignment.  Myofascial release is a form of stretching that allows for improved muscle relaxation and movement.  As the muscle softens, it allows for improved muscle elongation and elasticity which will allows for improved movement and posture.  Myofascial release can also help relax scar tissue which often causes restrictions as children grow. 

There are certain conditions in which myofascial release cannot be performed and your therapist will be aware of when myofascial release will be beneficial.  If you’d like to know more information about whether or not myofascial release might be beneficial for your child, please ask your therapist!