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How your infant's motor concerns may be related to feeding difficulties and tongue tie What is torticollis and plagiocephaly? Torticollis is the tightening on the neck muscles on one side, which in turn causes your child's head to tilt toward the side that is tight and rotate or look away to the other side. So if the right neck muscles are tight, the head will tilt towards the right side and rotate and look towards the left side. This rotation and tilt can cause more pressure on one side of the head and flattening of the head. This change of head shape is called plagiocephaly. Yes baby containers and spending a lot of time on their back can cause or increase the risk of these two things, but often it is from positioning or having less room to move around in utero. This conversation about the importance of having your infant experience a variety of positions is from another post though! So what does this have to do with tongue tie and issues feeding? First, what exactly is happening when a child has a tongue tie? Tongue tie is when the tissue of the tongue is connected the floor of the mouth, the gums, or lips ad restricts the movement of these structures. Signs of a tongue tie can include difficulty latching, being unsettled or tiring easily when feeding, slow weight gain, and reflux. So whats the connection? Both of these two things are a tightness of muscles in the head and neck area. Restriction of movement in the head or mouth from a tongue tie can lead to tightness in the neck, leading to torticollis. If the tightness of the tongue tie is severe enough to impact breathing, this can lead to the child turning their head to one side to breath fully resulting in a side preference that could lead to torticollis and plagiocephaly. Furthermore, often a tongue tie can lead to reflux. If the child is uncomfortable they are often positioning themselves where they are most comfortable, which can impact their full gross motor development and ability to participate in typical developmental positions that positively impact development. What does this mean for you? If you are noticing your child having difficulty feeding, preferring to look at one side, or preferring certain positions it may be worthwhile to look at what is happening with their tongue and mouth first, before going straight to physical therapy. Finding an infant feeding specialist, or a therapist that specializes in tongue tie may be the best first step to see if a tongue tie is impacting your child's gross motor development. At next steps therapies we have formed a great connection with Gurgles to Giggles who is an infant reflux specialist, and love collaborating when a child is having both feeding and and physical therapy concerns. We have done workshop together and hope to do more, so look out for our joint workshops where you can learn more about this in depth!

The ultimate guide of skills that will make back to school easier for your little one from OTs and PTs These are by no means necessary skills to start off the school year but they are the type of skills that your child will be working on all year, and depending on their class size they may be waiting a while to receive the one on one help they need. These are great skills to have on your radar to build at home. Self Help Skills Toileting: You finally got the toilet training down! All set you think! But, it is important that they can do all parts of this routine independently. Can they bring their pants up and down themselves? Can they fully wipe themselves clean? Do they know to clean up if they miss? Can they wash their hands? Mealtimes: Great they got the spoon and fork and maybe the cutting with a knife down. But there are so many other parts of being independent, which can be especially important depending on how short of a snack or lunch break your chil d has. Sometimes these breaks are as short as 10-15 minutes! How long will your child be waiting for help if every child needs helps, leaving them with almost no time to actually eat. Can they manage the zipper of their lunch box independently? Can they open food containers? Can they open their cracker food packaging? Fine Motor Skills Writing: Unfortunately writing skills needed for school don't match development, but getting your child used to the idea that they write their first name on every paper and know their last name is great middle ground. Having them know what their first and last name looks like in both upper and lower case letters. Some places will tell you that they need to hold a pencil correctly and we are here to tell you that it is okay for this skill to take up to year 6 or 7 and research is showing that a pencil grip doesn't have as big of an impact on legibility as it was thought. What to look for instead is fatigue- does your child's grip impact how long they can tolerate coloring, writing, or painting. Arts and Crafts: Thankfully there is still a lot of this, which is such a great way for kids to learn. There still may be things that you haven't exposed them to yet. Can they tolerate getting messy with glue and paint? Can they use liquid glue and a glue stick? Can they cut with scissors? Regulation and Executive Functioning Regulation: The world is telling us our children need to be able to self-regulate, but in reality regulation doesn't develop until age 7 or 8. What they do need is to be able to use coping skills when supported by an adult and being able to find an adult when they are becoming upset. Executive Functioning: At this age executive functioning looks like following a two or three step direction with accuracy. It could be to get several items, include moving around the space, and completing something in the right order. Gross Motor Skills Playground/ Gym Class Skills: Thankfully there is still lots of playground time in preschool and kindergarten where they should be able to keep up with their peers running, jumping, kicking, and climbing. Other skills they should be able to particiapte in include standing on one foot, catching and throwing a ball, hopping, walk on tiptoes, and and skipping. Environmental Navigation: Many school buildings have stairs to get in and around the building to different rooms or activities. Kindergarteners and most preschools should be able to go up and down a few stairs by themselves so they don't have to wait for a teacher to hold their hand. There may only be three teachers for 15-25 kids, they can't hold everyone's hand at once! They should also be able to move around busy environments without tripping or bumping into people or objects. Think about if your child would be able to navigate through a busy cafeteria while holding a tray or lunch box safely. Worried or Concerned that your child is behind? Next Steps Therapies offers developmental screeners and a free initial consult. Reach out today and talk to a pediatric occupational or physical therapist to see if your child is on track, what to look out for, strategies to try, and how to work with your child's school to keep them on track and provide the support they may need. Reach out through our website or email Follow us on Facebook at Next Steps Therapies or on Instagram at nextsteps.therapies

How to balance you knowing your child and family best with all the options available to you This summer at Next Steps Therapies seems to be about our families figuring out what works best for them when given all the available options out there and what they is the right way to do something or right choice to make. Here are some factors to think about when choosing services and where Next Steps Therapies stands in relation to all the options. #1 - Knowing what Setting is right for You and Your Child There are many settings PT or OT can take place such as at school, in a clinic, at home, in the community, or virtual. Take the time to think through where you would like the most support, where your child is most engaged, and what setting would work best in your life. At Next Steps Therapies we are focused on what works best for each individual child and family, This means being there to support in the natural environment where each child may require extra support. We can travel to children's schools and daycares to provide services, go into your home, meet you in the community area you would like extra support, and provide virtual services. Our parent coaching can happen over zoom or through a phone call, and give flexible times such as during your commute or lunch break to be as flexible as you need for your life. Part of why we provide parent coaching because sometimes children don't work well with new or different adults and do best when their familiar parents or caregivers guide them naturally through their daily lives. We can suggest which location would be best for your child but we want to hear where you think would be most beneficial. Even the setting is a way to be a part of your child's therapy team. At Next Steps Therapies we want to hear from you about what your are hoping to get from the therapy location. Our values are for our services to be as accessible and as fun and engaging as possible. #2 - Philosophy Think through what your family values are and look to see if the therapists philosophy matches them. Look to see if you can find a therapists values or philosophy on their website. Do they have a clearly defined spot for it on their website or do you have a clear understanding of what their therapy philosophy is after going through their website. Don't be afraid to ask them too when reaching out about services! At Next Steps Therapies believe that part of our role is to make parents and caregivers more confident. That could be through finding peace at what your child's sensory processing looks like, knowing how to keep their child safe when navigating the community, or finding the right tools and customizing them for the child and family so they can be implemented consistently. We believe that the end goal is happy children. We want kids to be able to do whatever they want to do and be as independent as possible through increasing skills, adapting the environment, or modifying the task. We believe that when kids skills increase through meaningful and purposeful ways they are happier. We believe that when you combine those two things, that is where get the big gains. At Next Steps Therapies we also believe that you cannot have this without being neurodiversity affirming and strengths based. We help parents be confident in knowing how to see and use their child's strengths to grow ,while guiding them to see who their child is and supporting their growth without limiting or trying to change who their child is. Children cannot be happy when they are not seen in their entirety or accepted for who they are. #3 - Knowledge Look to see what education, trainings, certifications, and background your therapists have. Therapists should list their specialty areas and certifications on their website. If you don't see the area your child specifically needs help with, ask the therapist before signing up for services. Here at Next Steps Therapies we value continually building and growing our knowledge base, and we think one of the best ways to learn is on the job. Amanda and Jackie have both worked in Early Intervention (birth to three). This brings so much value and knowledge into our services because without knowing development you cannot support a child to their fullest in a systematic, skill building way. All of our past work on the job experience supports us in being flexible and adaptable. It allows us to think critically in the moment, adapting what strategies we use in the moment based on how each child presents in each moment, and creates a large repertoire strategies we can pull from. We have also worked in settings where we have seen pre-schoolers to college age students with all multitudes of disabilities and levels of medical needs. This includes Autism, Down Syndrome, multiple complex medical conditions, and cystic fibrosis. We continually build our knowledge base through trainings and certifications including therapeutic listening, handwriting programs, SOS Feeding Program, Zones of Regulation, interoception, brain gym, reflex integration, neurodiversity affirming practice, infant massage, and kinesiotape for pediatrics. You want to make sure your therapist is board certified through APTA or AOTA. You can also go online and view if your therapist is truly certified in the programs they are using or if they have just completed a course. #4 - Communication Look to see how your therapist communicates. Are they responsive to the way you communicate best? Do they respond in a timely manner? Are they able to give suggestions and also validate the experiencing you are having with your child? Is it HIPPA compliant? At Next Steps Therapies we use a secure platform that allows for you share any medical information that is needed, message back and forth, and request or cancel appointments. We feel that communication throughout the week helps build a sense of collaboration and we love to see what is working or not working in your everyday lives. We also use a model that asks for parents or caregivers to be included as a part of the therapy process. We want you to know what is being worked on, watch us model and adapt based on how your child responds, and have ample time to ask questions and create a plan with us. If you choose a parent coaching method you get 30 minutes to an hour a week to talk through what is working what is not working, clarify strategies, and work with us to tweak what hasn't been working to better fit your child's needs or your everyday life. By being a part of your child's therapy session you have the entire time to ask your questions and problem solve how you can carryover what is happening in a session during everyday life. #5 - Collaboration Does your child's therapist look for collaboration with you or do they keep therapy separate and quickly give suggestions at the end? At Next Steps Therapies we believe that each parent or caregiver is the expert in their child and their family unit. They know immediately what strategies they can implement and which ones they can't, and we value that information. We want to collaborate with families and their honesty about what they realistically can and can't implement supports us to better help each child. Our goal at the end is for your child to be successful in everyday life, and without parents input we wouldn't be able to do that. So often we see parents feel guilty that they can't do all the perfect parenting strategies shown on social media, or are fearful to tell us they don't see themselves doing a strategy we show or talk about. We are here to support you and tweak those social media strategies in a way that best fits into your real life. Never going to be a parent that makes up an obstacle course? Great! There are so many other sensory strategies or ways to adapt our go to strategies that can meet your kids sensory needs. Look for a therapist that wants your input and values your honesty so that they can provide better more target strategies that actually work for you! Next Steps Therapies Jackie is board certified through APTA and licensed in NH and MA. She graduated with a Doctorate in Physical Therapy from Quinnipiac. Jackie has worked in early intervention, outpatient clinics, and hospital settings. She is experienced in working with children of all ages with gross motor delays, neuro-muscular diagnoses, gait abnormalities, pediatric pulmonary conditions, birth to , pediatric exercise interventions, and complex medical conditions. She is certified in infant massage and kineiotape for pediatrics. Amanda is board certified through AOTA and licensed in MA. She graduated with a Masters in Occupational Therapy from Ithaca College. Amanda has worked in early intervention, outpatient clinics, and the school setting. She is experienced working with children of all ages with multiple and complex medical conditions, sensory processing, emotional regulation, executive functioning, feeding difficulties, fine motor delays, Autism, Down Syndrome, and life skills. She has trainings and certifications in SOS Feeding Program, Therapeutic Listening, Handwriting without Tears, Size Matters Handwriting Program, Brain Gym, Zones of Regulation, Interoception, neurodiversity affirming practice, and retained reflexes. Want To Learn More? Check out our services here If home and community based therapy, parent coaching, or consultation models of service feel like the right fit for you, please reach out to us: email us at nextstepstherapies@gmail.com fill out our intake form here

We know summer schedules are unpredictable and feel busier than ever. That is why we are excited to offer increased flexibility of options for you this summer. You can sign up for: - one or two consultation sessions - individual PT or OT sessions/ Parent Coaching sessions in sets of 4 or 8. - There is no requirement to use them every week, and can instead be booked based on your availability. - There is a 10% discount when you buy a package of 4 sessions and a 15% discount when you buy a package of 8 sessions. This is more than $30 and $100 in savings! - You can mix and match in person and virtual sessions as well to best meet your needs when you are on vacation! These services are perfect for if you have been thinking about trying these services but were unsure about making the commitment your child did not qualify for school based summer services but you want to make sure they maintain their skills you know your child struggles with the changes in the summer and you are looking for support managing meltdowns/ picky eating/ potty training you notice that your child is more unstable and tired with all the extra physical activity of summer if you need extra scheduling flexibility during your summers not provided other places! Reach out Today and Plan Ahead for your Summer Needs! Please reach out by email at nextsteps.therapies@gmail.com or on our website here We are happy to email or talk on the phone to answer any questions and find the summer session package that works best for your family!

The Starter Guide: What You Need to Know to Make Mealtimes Stress Free There is so much information out there about healthy eating and what foods your child should and should't eat. It's hard not to worry about if they are getting enough nutrients. Eating and mealtimes can feel so emotional and personal, as it feels like one of the most important jobs as a parent. Is my child fed, are they healthy? It can be so stressful to figure out how to get your child to eat a variety foods. However, there are some simple strategies for how to talk about food and how to expose your child to foods that can easily promote positive food experiences and a more diverse diet for your child. Get Creative: prepare the foods in fun, engaging ways Sometimes children will be more interested in trying foods when given in new ways, such as the vegetables making a face or flower. Make a picture or design with the foods and allow them to play with them and make their own pictures or designs. Other times, they will be more likely to try it when it's presented not a food but as a fun activity. Make playdough with applesauce, towers with toothpicks and different fruit, or you can even let them push their favorite toys through a cold soup or pasta. Your child may surprise you when they sneak a sniff or nibble of a food they have never eaten before when it's not presented as food they have to eat! Sometimes, picky eaters reject certain foods due to their texture or appearance. Experiment with different cooking methods, flavors, and presentations to make the food more appealing. For example, if a child dislikes steamed broccoli, try roasting it or adding a sprinkle of grated cheese. You can also puree vegetables and incorporate them into sauces, soups, or smoothies. By making small tweaks to the preparation, you may find that your picky eater is more willing to give it a chance. (We do not recommended trying to hide foods in smoothies or sauces however. If your child is highly sensitive to the taste of these foods, they will be able to taste them and by hiding them, you will loosing your child's trust, as they will think you are sneaking them food in all meals.) Keep it Feeling Safe: always have a preferred food option Many parents get excited by the idea of adding new food to their child's diet and go all in, all at once. I get it, once you commit to working on something it's easy to feel like you have to fully commit. However, only giving children new food can make it a more anxious time and environment for them. Introduce new foods gradually and repeatedly by offering small portions of unfamiliar foods alongside familiar favorites, creating a safe environment for them. They know they will be fed, they know there is something they like, and it puts them at ease. It helps them think through trying a new food, because if they don't like it there will be something they know they like that they can eat instead. Stay Neutral: present all foods the same way It's easy to talk about foods as good or bad, however all types of foods are needed for our bodies (even fat and sugar!). The only rule we have at Next Steps about foods is that something sweet should be served with a type of protein. No matter what your are serving your child you say here is your food. After that, there is no pressuring for them to eat it or to try it. You can model eating it, talking about what it tastes like, it texture, or temperature. The closest we get to recommending talking about food as good is talking about how it helps your body. For example, green food helps your lungs breath better, orange foods help your eyes see in the dark, cheese has calcium which keeps our bones strong, meat has protein which makes our muscles strong, white foods have engery. Food shouldn't be a reward and we don't want children thinking they only get praise when they eat the foods you want them to eat. Food is about supporting our bodies and love and praise isn't dependent on the foods they eat. Keeping your response to all food the same will help your child see all food the same. Gradual Exposure: slowly present new foods At Next Steps we recommend introducing a new food every two weeks. Take the time to target just a few foods (no more than five) every two weeks. This allows repeated gradual exposure and builds in the expectation that these foods are going to be served to them from now on. As you build in new foods try what is called food chaining. You want the new foods to have two of the same properties as the foods your child already eats. So the new foods can have the same texture, shape, color. Get creative! Dye foods so they now have the same color. Cut foods so they are now the same shape. Talk about how the foods are the same as you build in new foods. This is often where our families require the most support when participating in our in person or parent coaching method of occupational therapy feeding support services. Family Meals: take away the idea that your child eats differently than the rest of the family This is the first place we often start during occupational therapy in person or parent coaching feeding services, especially with children who may have learned to call themselves picky. This takes away the idea that the your child eats something different. Once a day your family has a family meal. It doesn't matter if its breakfast, lunch, or dinner, but the idea is that everyone is served the same food. If you are making your child a separate meal with the foods you know they will eat, you will take one piece of those foods and put it on everyone's plate. And your picky eater will take one piece of the foods you are eating and put it on their plate. Try to increase your child's interaction with the foods they don't like by having them serve themselves or help you prepare the meal. This builds the slow expectation that your child can have the same foods as you and takes away the idea that they eat something different or special from the rest of the family. Never pressure your child to try the foods, but you can use empowering statements like "you can try it" and talking about how the foods tastes, it temperature, or texture so if your child decides to eat a new food you have prepared them for what it might be like. You may be surprised to watch this carryover to other mealtimes with your picky eater taking new foods on their plate even if they don't try them. Questions about how to implement this with your own child? Comment below or reach out at our website to setup a phone call to talk about what services would be right for you! What has worked for you in the past, or what hasn't worked? Let us know in the comments.

High Intensity Interval Training (HITT) is something you may do at the gym, but did you know it is safe and effective for kids too? Pediatric physical and occupational therapists love this model for building health, strength, and regulation This is one of our favorite activities for all children. Jackie has been using this activity since working with children who have cystic fibrosis and other pulmonary conditions. Seeing first hand the benefits HITT exercises have on keeping airways clear, healthy, and preventing infection. Learn all the reasons why we love adding HITT exercises to our sessions and how easy they are to incorporate into play with your child! #1 - Improved strength and endurance HIIT workouts involve short bursts of intense activity followed by brief rest periods. This type of exercise helps to strengthen the heart and lungs, improving overall cardiovascular fitness. HIIT exercises often incorporate bodyweight exercises or resistance training, which can help children develop muscular strength and endurance. #2 - Supports mental health Studies have shown that regular exercise, including HIIT, can enhance cognitive function, attention, and memory in children. It can also help reduce symptoms of stress and anxiety, leading to improved overall mental well-being. #3 - Fun and engaging HIIT workouts often incorporate a range of exercises and activities, making them enjoyable and engaging for children. A common way we incorporate them into our sessions is through animal walks. Families have told us they love to engage their children in these exercises during pretend play or as a way to burn off energy during a rainy day! Check out our instagram post here where Jackie shows off how to do each animal walk. #4 - Provides heavy work and proprioceptive input Occupational therapists love animal walks because it provides increased feedback and sensory input for our sensory seekers. It is a fun way to build in heavy work and proprioceptive input for those kids who need more sensory input to understand where and how their body moves in space. Want to learn more about proprioception? Check out our instagram post about it here #5 - It's short and easy to add to your day HITT consists of doing a fun, active warm up followed by 3-4 rounds of a series of exercise for 30-45 seconds at a high intensity, followed by 15-30 seconds of rest. Kids could do a workout like this anywhere without any equipment using daily activities and in no time at all! (see example below with some of our favorite animal walks). Or, just get your kids implementing this throughout their days with short bursts of activity such as hopping on a hop scotch, jumping rope, jumping over cracks on the side walk, or running circles around the kitchen island! HIIT can be modified to any age, ranging from toddlers to teenagers. Looking to build your child's strength, endurance, or sensory regulation? We are here and accepting new clients for the summer! Please reach out to us here to sign up for a free consult to find out what services are right for you and your child. Want to learn more? Sign up for our monthly newsletter where we go in-depth on different topics each month. Tell us below how you build in HITT exercises into your child and families everyday life. We love to hear from you!

Why we took this leap into our next step We are Amanda and Jackie and we are so excited to introduce you all to Next Steps Therapies, a pediatric physical and occupational therapy private practice in Massachusetts. We were both born and raised here, and after Jackie returned after several years in Colorado a dream was formed about helping her local community and the families that live here. Her next step if you will. At the same time Amanda was beginning to wonder about what were the best ways to help families as the world began to open back up following the pandemic. Working in a school, she was seeing the difficulty parents were having carrying over what is done in the classroom or clinic to their everyday lives. She began to dream of how her next step could involve supporting caregivers in making their daily routines easier and more enjoyable. Yes, we are here to support children's literal next step and their next steps towards independence, but we are also here for our communities next step, where care and support is embedded into their everyday lives. Next Steps is currently enrolling new clients for occupational and physical therapy, as well as planning Spring/ Summer community groups and parent workshops, providing parents with the skills to be confident, kids to be happy, and families to make big gains. Confident Parents, Happy Kids, Big Gains We believe that by providing services in the home and the community we can work with parents, giving them the tools to be confident in supporting their children. Instead of just working with a child and assuming they will carryover those skills and ideas after a 15 minute chat with a parent at the end of a session or a yearly IEP meeting, we want to work with caregivers to show them, in their natural environment, how to support their child and help them grow their skills and independence. When we work with parents we believe that they become more confident supporting their child within their every day lives. When parents have the confidence, they are more likely to use those strategies to support their child promoting faster growth towards their next skill and overall growth. We believe that therapy sessions should be fun! We want children to enjoy their therapy sessions and we want to support them in being happy kids. We also believe that when we make strategies engaging, using each child's individual strengths and preferences, they are not only more likely to be happy but also make faster progress. At Next Steps we presume competence in each child and believe in their potential. When we start each session with respect and joy for what child prefers we can build trust and build skills together, all while having fun. We believe that when you combine supporting parents and using whatever brings your child joy the result is parents who feel confident helping their child make big gains. With our in home service model, no longer do you need to wait for the carryover from a treatment space to your real lives. The gains are made in the home right away, where parents can be confident in knowing how strategies can be implemented immediately, allowing for big gains. Looking Ahead So what are our Next Steps? We can't wait to take our next steps together where we can support our community, bringing confidence, happiness, and big gains to your family. Besides in home therapy our next steps include upcoming groups we are hosting in our communities ( keep an eye for more info soon!) and upcoming parent modules, where you can learn on your own time while also building community and support with like minded families who may be wondering about the same things as you. We are also excited by our next step of expanding what our parent coaching model can do for you. This is the perfect service if you feel progress is slow in translating into your everyday life or you don't know how to translate a therapy session into your life. We will coach you through exactly what to do and say in the moments of difficulty. Things we most often help with include meltdowns during transitions, mealtimes and feeding, and dressing. We would love to hear from you! Check in to our website for updates on groups and parent modules on our Website or on Facebook. We are also on Instagram @nextstpes.therapies where we also share tips and tricks, breakdown complex ideas you may be seeing or hearing related to development or sensory regulation, and teach about overall development. Email us at nextsteps.therapies@gmail.com or signup for our newsletter for more in-depth learning and ideas here