Ask the Expert: Lorene Janowski, Occupational Therapist, Answers Questions About Physical & Behavioral Development in Children

by Lorene Janowski
Lorene Janowski, Occupational Therapist

Q1. My 18 month old has problems with holding small objects and tends to drop the objects a lot. Is that normal or are there any exercises he can do to improve his hand strength?

At 18 months of age, a child is starting to master their fine motor skills which involve the thumb and pointer fingers.  For example at this age, they are scribbling with crayons and stacking blocks.  If you see a tendency for frequent dropping of small objects, I would recommend an occupational therapy evaluation to pinpoint the reason.  It can be a physical (grasp maintenance), behavioral (child doesn’t want to), or a sensory issue (child is dropping certain items with different textures).  After an individual evaluation is complete, the OT can suggest specific exercises for your child.

Q2. I have a 5 year old who uses both hands to write. Is there a way to get him to just use one hand to write?

By about 3-4 years of age, a child is starting to develop hand dominance.  It is important to note, however that true hand dominance can take up to 6-7 years of age to truly form.  Many times when parents ask me about this I ask the parent what they did as a child and many responses have been that one or both parents are ambidextrous.  If you see a child preferring one side more than the other I would strategically place objects on that side such as pencils, markers and utensils for functional use.

Q3. My 3 year old won’t feed herself and wants her dad or me to feed her. How can we get her to feed herself?

Make meal time fun!  Working on picking up small objects such as Cheerios and eating small finger sandwiches that are cut into a variety of fun shapes would be a good place to start.  If your child is having a difficult time scooping food on a spoon you can try the following: take turns (i.e., parent eats one bite and child eats one bite), have child practice scooping sand in a sandbox to simulate scooping food on a spoon, feed a doll pretend food, or partake in imaginary play (i.e., have a tea party).  This can help to foster more independent feeding skills.  Motivation is key for kids!  Once your daughter develops this skill, she will have a greater sense of independence.

Q4. My 5 year old walks on her toes. How do I get her to walk normally?

Toe walking can be a physical and/or a sensory issue.  It is important to determine which one of these issues or both is the driving force.  From a physical aspect, tight heel cords make it difficult for the child’s heel to make full contact with the floor.  In this case the child would benefit from working with a physical therapist who will work with you and your child on daily stretches to help loosen the tight muscle.  Practice walking up an inclined surface.  This can help to distribute more weight in the child’s heels.  If the toe walking is a sensory issue, in which either the child is adverse to different sensations on their feet or becomes overly stimulated, the child would benefit from working with an OT.  The OT would work on having the child become more comfortable with different types of sensations such as wet/dry grass, grainy sand, etc. (all different types of  textures that the child may experience on a daily basis).  Also, completing heavy work activities can help the child ground their bodies and help with self organization.  Being that your child is 5 years of age, it would be best to have an evaluation performed.

Q5. I have a teen daughter with CP. In preparation for college, is there anything specific that I can request her OT focus on? She will be transitioning to doing many everyday tasks on her own.

OTs are best known for working on a patient’s personal goals, especially goals that include self-care skills such as activities of daily living.  OTs listen to what is meaningful and important to each individual.  It would be best if the OT and your daughter personally discuss the preparations for college and your daughter’s personal concerns.  If your daughter plans on going away to school, issues such as accessibility of the dorm room are important factors.  Getting around the campus and campus activities to get involved in would be great ideas to discuss with your OT.

Topics: Facebook Notes, Pediatrics, Rehabilitation and Fitness
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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

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