October is AAC Awareness Month!




October is not just for costumes and candy. It also happens to be AAC Awareness Month! Our assistant director, Amy Bereiter, MS, CCC-SLP, is a LAMP certified professional and leads our AAC team here at Skill Builders. She is taking over the blog today to give us the basics on AAC!

What is AAC?
AAC stands for Augmentative or Alternative Communication (AAC). This is any system that augments a person’s existing speech (augmentative) or is replacement to speech (alternative) when speech is not possible. AAC systems can take many forms. A low tech system has no voice output, a id tech system has voice output but has a static display, and a high tech system has voice output and a dynamic display screen.

Who is AAC appropriate for?
AAC is for anyone across the age span with congenital, developmental, or acquired communication challenges. Anyone who:

*Has little to no speech
*Has speech but very few spoken words (language), or limited variety of spoken words
*Has speech but it is not intelligible
*Has speech but language is not spontaneously used or is echolalic

At Skill Builders, because we are a primarily pediatric clinic, we see a lot of children who are still developing language. AAC is a highly effective tool that we can use to help them do just that! We often work on speech simultaneously, and for those with no speech or when speech is very difficult to produce, we continue to develop language and communication skills via AAC.

There are many myths floating around out there about AAC, but here some frequently heard myths about AAC:
*It will inhibit my child’s speech development- FALSE
*My child has some words so he doesn’t need it- FALSE
*The child has to have mastered various other low tech systems before gaining access to a high tech system- FALSE
*The child has to have strong cognitive skills in order to use AAC- FALSE
*I can understand my child/know what they need so he doesn’t need AAC- FALSE
*Once a child gets an AAC system, he should immediately know how to use it FALSE

General principles:
*Communication happens in all settings across the day! Therefore, AAC systems should be available across all settings.
*AAC systems should allow access to a large amount of vocabulary from all parts of speech.
*AAC should not focus solely on requesting, but on the many communicative functions we use.
*AAC should make life easier, not stressful, and the child should not feel like it is ‘work.’
*For kids, whose occupation is play, it should be taught in a play based context and in functional activities.

There is so much that could be said, but we hope this helps to raise awareness about the value and benefit of using AAC for children with communication challenges! For more information, check out our previous post on AAC Myths. You can also check out the Center for AAC and Autism’s page about the LAMP approach. Skill Builders is proud to be the only LAMP Center of Excellence in the state of Virginia.


To talk to a professional about whether or not your child might benefit from AAC, contact Amy at amy@skillbuildersllc.com.


-Elizabeth Clark McKenzie, MS, CCC-SLP




Tips for Halloween

Halloween is almost here, and for most kids, that means getting excited about costumes, pumpkins and way too much candy. But for children with social, sensory or communication disorders, Halloween can be a stressful holiday. Here are some expert tips to help make sure your kiddo has a Happy Halloween!

person holding pumpkin beside woman

Prep prep prep

Social expectations, rules and normal routines all change on Halloween. This can be confusing or stressful! Read books, watch videos, or create your own social story about what to expect that day/evening. Help your child practice what to say, and review what is expected of him. Talk about hypothetical situations that might come up and brainstorm solutions to potential problems. I recently worked with a child who is very fearful of masks. We talked through what he could do if he encountered anyone in a mask on Halloween, and mentally prepared for the fact that it was likely he would see some masks that day. By getting ahead of these worries, we are able to alleviate some stress and come up with some realistic solutions.

Creative costuming

Kids with sensory issues might have a hard time tolerating certain costumes. It is important to test-drive a costume in advance to make sure it is going to work. Consider the fabric, fit and mobility of the costume. If you do encounter an issue, get creative. Could your child wear his regular clothing with an embellishment or two? Could you fashion a mask to a hat instead of having to wear it on his face? Could you add a tell-tale accessory (or written label!) to help others easily recognize what the costume is? Getting creative and being flexible will allow your child to really enjoy dressing up.

Rally the troops

If your child has a communication disorder, Trick or Treating and chit-chatting about costumes can be a tall order. Send out an email to friends and neighbors and offer some tips or strategies to help your child be successful. For a child who struggles with WH questions, neighbors can ask “Are you a ____?” rather than “What is your costume?“.  If your child uses an AAC device, prep your neighbors so that they know to wait for a response. The more successful interactions your child has, the more he will enjoy the experience!

Less is more

Setting realistic expectations is so important. If your child’s school makes a big fuss over Halloween, don’t hesitate to pick and choose which events to go to. If you have a child who needs routine, try not to throw too many changes at him at once. It is better to have one really fun experience than four stressful ones.

Start your own traditions

If your child doesn’t enjoy trick-or-treating, create a new tradition that suits your family better. I know a family that goes to the movies every year on Halloween, and I know another that does a Disney sing-a-long in the backyard. It is OK to break away from the standard Halloween festivities to make sure your family has fun.


There are many local organizations that offer Halloween festivities tailored to kids with different needs. Scope out what is available in your area. Our therapists are also ready to help you problem-solve issues specific to your child.

Happy Halloween!

-Elizabeth Clark McKenzie, MS, CCC-SLP


Encouraging Reading Time

adult baby book boy

As speech-language pathologists, we often stress the importance of providing children with access to early literacy. Research shows that reading to young children prepares their minds for success in school, exposes them to diverse content, and builds intimacy and bonding with others.  It is no secret that reading to a young child supports their development! But what do you do if your child has difficulty sitting still? Or their attention to a book is brief? Or all they want to do is close the book the second you try to open it or rapidly turn the pages? Being able to sit still and listen to someone read is a skill. For some children learning that skill can take a long time to develop. The good news is that this can be taught! I sat down with Sarah DeWhitt, MS, CCC-SLP to hear her best tips to encourage children to get the most out of reading time at home.

Here are Sarah’s 5 tips on how to make book reading more fun for a young child:


1. Think about positioning and time of day

a. Positioning: We all love snuggles from our children and perhaps you think having them sit in your lap allows you to contain their attention but snuggling or being rocked might not put your child in a “ready to learn state”. Your child might respond better if he is allowed to read books in a different position. For example, if you are working on developing articulation, you could to have your child sit across from you and hold the book near your mouth so he can watch how your mouth moves. If your child needs increased core strength or increased input to calm his body, having him lay down with his belly on the floor (prone) might be a better position for him to read. Another way to increase input to the body is having your child lay in a bean bag or rolled up like a burrito. Increasing body input can increase the ability to remain calm.

b. Time of day: As adults, we all have a time of day when we are most productive-children are the same! Perhaps your child is too tired right before bed to engage as an active participant in reading or maybe your child needs to use the morning time to run around and be active so afternoons work better for quiet activities. Observe your child and find a time during the day they seem most calm. Maybe that is right after a trip to the playground? Or maybe it is right after a bath? If your child is only calm when seated at mealtime strapped into a high chair, you might want to consider pairing reading books with mealtime.

2. Establish a beginning, middle, and end to the activity

Young children like to know when transitions are about to take place. Establishing a routine to an activity prepares the child to meet your expectations. Make a routine of saying “open book” to begin reading; “Turn page” is a helpful phrase to signify the act of reading; and “all done” lets the child know the activity is finished.  To build up towards increased attention, perhaps you only require your child to help you open the book, turn all the page, and close the book at first. The whole act of book reading would only take 1-2 mins. Once the routine and expectation of book reading are established, then you can increase the time spent looking at each page. If your child starts walking around before the book is over, try encouraging them to say “goodbye” to the characters before moving on. Ask your child to put the book away to signal that reading time is now over.

3. Add gestures, funny voices, and noises

Make the characters and pictures come to life by adding gestures, funny voices, and noises. A bunny doesn’t really make a noise but maybe you use your hand to hop across the page. Perhaps you take time to literally stop and smell the pictured roses. Pretend to eat pictures of food and have your child “eat” food too. Stomp around like the dinosaurs in your story. The Three Bears is a great story for practicing a low Papa Bear voice, a middle-sized Mama Bear voice, and a wee little Baby Bear Voice. (Bonus points-this also teaches vocal play and volume control!) Maybe your child loves cars and vehicles so you can practice the sounds of the sirens or the horn. Focusing on what your child is already interested in will help maintain attention for longer. This will also aid in your child’s comprehension of the world around them and increase their receptive (understanding) language.

4. Follow the child’s lead

Find books that are motivating to your child! Motivating books usually discuss topics of interests for your child (trucks, cars, animals, farm, getting dressed, etc). Also, consider the language level of the books. Perhaps your child would respond better to books that only have pictures and no words. Involve your little one in the process as much as possible by allowing her to turn the page or hold the book. Provide options to choose from to give some ownership over the activity. Try to observe your child’s eye gaze and comment on the pictures that she is looking at. If she points or gestures to something in the book, don’t be afraid to pause and respond!

5. Consider the words you are saying

You don’t have to read the words of the book! You can talk about the pictures and draw connections to your own family experiences. Make up your own version of the story or sing a song about the picture. Over time, as your child’s attention increases, he will be able to sit for the duration of the story. In the early years, the most important thing is to make sure that reading time is fun, meaningful and low-pressure. Teach your kiddo to enjoy storytime now and you are helping to foster a life-long love of reading.
As a final thought, be realistic about how long you are asking your child to attend. As a minimum, a child should be able to attend to a book for double the minutes of their age: So a 2-year-old should attend for at least 4 mins; A 3-year-old should be able to attend for at least 6 mins; A 4-year-old for at least 8 mins; etc.

Check out our previous book posts here, here and here.
Happy Reading!

adorable blur bookcase books

-Elizabeth Clark McKenzie, MS, CCC-SLP

Core Stability

Did you know that core stability plays a major role in your child’s ability to swallow, eat, speak, play, write, and pay attention? The core muscles stabilize and support the spine, which creates a “stable base” and allows you to carry out fine and gross motor tasks.  The best analogy that I have heard is to try to imagine painting a wall while balancing on a ball. Think of how much more control and accuracy you would have if you were standing on a secure step ladder. That step ladder provides you with that stable base that you need to work most efficiently.

Kids who have a weak core often have a hard time keeping their body still for long periods of time, which impacts their attention, concentration and body regulation. These kids might feel the need to wiggle, fidget or move around the room which ultimately distracts them, but could also get them into trouble during more structured parts of the day.  These kiddos might be spotted hunching over or leaning on their desk, rather than sitting upright. Aside from the immediate impact on performance, a weak core can lead to postural issues and back pain later in life.

The good news? There are many easy (and fun!) exercises that you can do at home to help build up core strength. Our OT Team here at Skill Builders recommends these exercises to get you started:

  • Prone on elbows: Have him lie on his stomach, propped up on his elbows while completing a task in front of him (i.e. reading a book, playing a game, watching T.V., etc.) for 5-10 minutes to start, and then working his way up to 15 minute.


  • Tall kneel ball catch: Have him in tall-kneel position on a mat or the floor. Toss him a medium-sized ball and play catch back and forth. Repeat 20 times.


  • Wheelbarrow Walks: Have him walk on his hands while holding his feet up like a wheelbarrow.


  • Bear Walks: Walk on hands and feet around the room like a bear does!


  • Crab Walk: Walk on hands and feet like a crab. Make a game out of it and see how far each person can get before their bottom touches the ground.


  • Supine balloon kicks: Have him begin lying on his back with his knees bent in towards his chest. Toss a balloon or beach ball towards his feet and have him kick the balloon, assuring his knees extend fully. Remind him to keep his chin flexed in towards his chest so he can see when the ball is coming!


  • Quadruped Reach: Begin in quadruped position (on hands and knees; assuring hands are directly under shoulders and knees are in direct line with hips at a 90/90 degree angle). Have him lift his right arm straight out and his left leg simultaneously. Hold for 10 seconds. Repeat with opposite side.


  • Supine Flexion (Turtle Pose): Assume and maintain supine flexion posture (on back with head, arms and legs tucked into the body), for 20-30 seconds.


  • Prone Extension (Superman Pose): Assume the prone extension posture (on stomach with head, arms and legs raised of the floor) and hold for 20-30 seconds.


Of course, your child’s individual needs might vary. An occupational therapist can help determine exactly how core weakness is impacting your child’s performance and can tailor a treatment plan directly to his goals. For more information, you can contact OT@skillbuildersllc.comactive-19413_1920.jpg.


Side note: It’s the start of a new school year and that means we have a fresh group of graduate interns working with us this semester! You might be wondering how incorporating a student might impact your child’s sessions. Check our previous post about our Intern Program to learn more about why we love serving as a intern site -and what’s in it for you! 😉

Elizabeth Clark McKenzie, MS, CCC-SLP

Starting Solids

Between 5 and 8 months, your baby will be ready for you introduce solid foods. Some parents find feeding really fun, and others find it to be a little stressful! Your pediatrician will help you determine when your baby is ready, but you can be on the lookout of these “signs of readiness for solids”:

  1. Sitting up independently
  2. Showing interest in foods and mealtime
  3. Imitating eating behaviors
  4. Decrease in drooling (more control of swallowing)
  5. Accepting food when presented

There are a few different schools of thought about introducing solids to babies. There truly is no “better” way- it all depends on your baby, your parenting style, and what works best with your family dynamic.

Baby Led Weaning refers to the practice of allowing babies to self-feed table foods rather than spoon feeding purees. You offer the baby whatever foods you are eating, and allow him to determine when he is ready and how much he likes to eat. Baby Led Weaning has a lot of great perks, especially in terms of convenience. No food processors or freezer trays. No purchasing jarred baby foods. Many proponents of BLW tout that this approach encourages finger dexterity, discourages picky eating, and helps develop oral motor skills. However, for some parents, offering whole foods to young babies can be nerve-wracking because of fears of choking. Other parents complain that mealtime messes get out of hand. And some parents feel that it is difficult to gauge exactly how much the child is ingesting.

In the USA, a more traditional approach is to introduce simple purees, such as rice cereal, around 5-6 months, and then systematically introduce different varieties of pureed fruits, veggies and legumes. Once the baby has mastered these, more textured purees will be introduced, and the baby will slowly work his way up to softer solids. The drawback to this approach is that babies can get very used to those silky smooth purees, and potentially become resistant to adding more texture.

Prior to having my daughter, I swore up and down that Baby Led Weaning was the way to go, but in the end, my daughter did best with a combination of BLW and some homemade purees. It also took her several weeks to really get interested in solids- which was very difficult for her feeding therapist mother! Right around 9 months, she took off and I was able to phase out the purees pretty quickly.

If you do want to give “Baby Led Weaning” a try, here is a fantastic list of tips from feeding expert, Sarah Remmer. She lists some great parameters to keep in mind as you are introducing solids:

“Your baby will gag- and that is ok!” As babies are learning to manage different textures of foods, it is likely that they will gag or spit food out. This does not mean that they aren’t ready! It may take a couple dozen exposures of a food before a child really masters eating it. Stay calm and avoid jumping in too quickly. It is also important to understand the difference between “gagging” and “choking”. Taking an infant CPR class is a great way to give you the knowledge and peace of mind you need to be more relaxed during feedings.

“Your baby can’t eat exactly the same thing as you.”  Even though a big perk of BLW is the convenience factor, you do want to be mindful that baby’s little system is not developed enough to ingest the same levels of preservatives, salts and spices that adults might eat. Remmer suggests preparing food without seasoning and portioning out a small bit for baby prior to adding seasoning or sauces.

“The types of food matters- not just the texture.” The same nutritional guidelines apply to BLW that apply to a traditional puree approach. You want to offer your child a healthy variety of whole foods, with an emphasis on iron-rich proteins, vegetables, fruits and grains. Be wary of many prepackaged “baby” or “toddler” foods that contain a lot of highly refined and processed ingredients.

“It will be messy!” I can speak from my own experience- this is the truth! By putting your baby in the driver’s seat, you have to let her figure out how to use those little hands and fingers herself. Part of the experience is feeling and squishing and exploring the foods. Try not to clean up until the end, no matter how tempting it might be to wipe your baby’s hands and face between bites. Invest in a full-coverage bib, such as this one, or opt for a “topless meal” :).

“Teeny tiny pieces aren’t going to work.” Even though it is tempting to chop food up into tiny pieces, your baby likely does not have the fine-motor skills to pick up those little bits of food. Feeding experts recommend cutting food into pieces that are large enough for baby to grab onto, but soft enough to safely chew. Examples of appropriate portions include strips of buttered toast, a slice of peeled pear, a wedge of sweet potato, or a cooked carrot stick. Remmer reminds parents that it is normal for new eaters to miss their mouths, but as long as baby is able to pick up the food herself, it is likely the right size. Be sure to avoid foods that pose an increased choking risk like hard veggies, popcorn, whole grapes, hotdogs or globs of sticky spreads, such as peanut butter.

The most important thing is to let your baby have fun with food. You want to foster a healthy relationship with food that will last into adulthood. Stay tuned for upcoming posts about troubleshooting with picky eaters, tongue/lip tie, and kids with allergies!


-Elizabeth Clark McKenzie, MS, CCC-SLP



Camp SuperNOVA 2018


Hello! It has been a while since I’ve posted because I’ve been busy running our ever-popular summer camp! We had 17 wonderful campers join us for 2 weeks of action-packed adventure. Each day was based around a different theme, and daily activities targeted:

  • Conversation
  • Working Memory
  • Fine Motor Skills
  • Gross Motor Skills
  • Problem Solving
  • Group Work
  • Self-Regulation
  • Imagination
  • Social Language

We also provided our campers with daily specials including yoga, dance, music, art and community guests-We hosted firefighter, an EMT and a team of therapy dogs!

Camp SuperNOVA was led by an SLP and an OT, and staffed by a talented and dedicated team of 4 graduate students who are all studying SLP, OT or special education. We also had an undergraduate level intern and a high school student volunteer to help us keep the day running smoothly. This provided our campers with a really small ratio, and allowed us to give lots of individualized support! Here are some highlights from each day:

IMG_8204   8E182872-026D-4F4F-A69B-B0AA1F607AB7   XAFS9047                Outer Space Day                        Nature Day                             Wacky Wednesday

HKMZ2106    FTOR8294

    Superhero Day                                    Animal Day 

DAVB5735   71D20E21-2A21-4336-8CEE-E03E83204386   FA5E5A38-41F4-4E08-8486-B41FD83ED65D

    Construction Day                         Olympics Day                        Wacky Wednesday

BB0F2EE8-DCA0-47AE-9420-85A5902457F6   IMG_8871.jpg

Career Day                                      Beach Party

This amazing group of kiddos conquered many challenges, and it was so fun to see them form friendships along the way. We are so proud of everyone!

If you are interested in Camp SuperNOVA for next summer, keep your eyes peeled for updates on Facebook, Instagram and our website. We hope to see you next summer!


-Elizabeth Clark McKenzie, MS, CCC-SLP

Picky Toddlers

food healthy red summer

As any parent of a toddler will tell you, picky eating is pretty common between 18 months and 3 years of age. Some experts suspect that little sensory systems are developing and kids are figuring out what textures and tastes feel best. Other professionals think that toddlers crave predictability during this period of rapid development, and as a result, they tend to gravitate towards the same foods. My personal observation is that toddlers are learning to use communication to control their environment- since meals happen 3-5 times a day, this is a logical time to voice an opinion! The good news? It is usually just a phase. The bad news? That doesn’t make picky eating any less frustrating! Here are five strategies to help ease the stress of having a picky eater in your house:

*Offer Choices

Rather than saying “Do you want _____?”, try offering a choice of two items. Your child will feel that she has some control. I also like to offer options for presentation (“do want big strawberries or cut strawberries?”)  as well as options for utensils/dinnerware. (“do you want a blue plate or a red plate?”).

*Model Good Habits

Children are always paying attention! Make sure that you are modeling the eating habits that you want to see your child adopt. Talk out loud about the choices you are making, and make a point of trying new or different things with your child. (ex: “I had red bell peppers yesterday, so I am going to try yellow peppers today. I wonder if they will taste the same or different?”)

I also encourage parents and caregivers to eat with their child. Even if you are just munching on a few carrot sticks while your little guy eats lunch, you are sending the message that meal time is a fun, relaxing time to spend together, as well as to enjoy food.

*Serve Variety

It is easy to fall into the trap of “I know she isn’t going to eat that, so why bother putting it on the plate?“. The problem with that mentality is that you are sealing your child’s fate as a picky eater! I like to serve my daughter 4 items at every meal- 2 items that I know are a sure thing and 2 that are new or different.

I also make sure that I am switching things up with leftovers so that she isn’t eating the exact same dish three nights in a row. For example, I will throw some frozen peas in her mac and cheese one night, and the next, I will stir in some diced chicken. Not every variation is a smash hit, but I am gently nudging her to step outside of her comfort zone.

*Reduce Pressure

If you have ever had the pleasure of engaging in a power struggle with a two-year-old, you know that the more you push, the deeper they will dig their heels in. With the under three crowd, you will have way better success with a more subtle approach. Avoid saying things like “Take a bite” or “Eat this“.  Instead, present the plate to your child and let him decide what he wants to eat first.  Don’t hover over him as he scopes out his plate. Instead, dig into your own food and chat about a preferred topic.

Beware of making threats or doling out punishments for not trying foods. This can make the child feel more anxious about the meal time process, and result in bad behavior in the future. Don’t let your child see that you are feeling stressed or frustrated- you don’t want his eating habits to have power over the family dynamic.

*Make It Fun

Unless your child has specific concerns about gaining weight or getting the right nutrients, the goal of meal time is really to learn to eat a variety of foods and to learn to participate in the social aspect of eating. You want your child to associate meals with comfort, nourishment, and happiness. Focus on connecting with your child over a meal- play music, tuck away your cell phone, and be playful. Leave the table manners for later years and encourage your child to get messy, explore the foods, and try things in the way that feels most comfortable to them.

It is also really important to keep in mind that toddlers have tiny little stomachs! The average toddler’s stomach is about this size of his clenched fist. Think about how tiny that is! We want our children to learn to listen to their bodies and recognize signs of both fullness and hunger. Consider your own eating habits- do you eat large quantities at every meal? Or do you tend to graze throughout the day? We tend to adjust our intake based on how we feel, our mood, and how much energy we need for that day’s activities. Teaching our kids to do this now will help foster life-long healthy eating habits.

What if this isn’t your “run of the mill” picky eating? 

There most certainly are kiddos whose picky eating habits are beyond the realm of “typical”. It can be hard for parents to know when to power through and when to seek professional help. I use these criteria to differentiate a “picky eater” from a “problem feeder”:

*Eats less than 3 foods in each major food group (vegetables, fruits, proteins, grains, dairy).

*Visible signs of distress or anxiety when presented with new or non-preferred foods (crying, screaming, etc).

*Frequent gagging, vomiting or choking during meals.

*Interference with an ability to participate in normal daily activities (birthday parties, family dinners, etc.)

*”Jagging” on preferred foods by eating them too often to the point of never wanting to eat that food again.

If you think you might need support with your child’s eating habits, contact our office to schedule a feeding consultation. Our feeding team will be happy to help.

Elizabeth Clark McKenzie, MS, CCC-SLP

adorable baby bowl child



Tummy Time



If you are a new parent, it won’t be long before you start hearing people talk about “Tummy Time”.  This catchphrase was coined in the 90’s when the Back to Sleep Campaign was launched and babies were no longer spending much time in the prone, or face-down, position. While instances of SIDS (Sudden Infant Death Syndrome) decreased dramatically, babies were missing out on time to develop foundational developmental skills. Child development professionals and pediatricians began to educate parents on the importance of placing infants on their tummies for short periods of time throughout the day. Currently, the AAP recommends that young infants spend about 90 min on their tummies per day, and research shows that babies who spend time on their tummies while awake are more likely to achieve certain motor milestones.

Most parents assume that means you put the baby on his tummy and that is the end of that, right? For many of us, the whole tummy time experience wasn’t as simple as it sounds. My daughter HATED tummy time and would scream her head off when we tried to do it. Luckily, I was able to rely on some colleagues of mine to give us some pointers. Here is the lowdown on why Tummy Time is so important, and some tips for ways to make it easier (and more enjoyable for everyone involved)!

What does Tummy Time do?

  • Develops muscles of the head, neck, shoulders and back
  • Helps to prevent motor delays and conditions, including plagiocephaly and torticollis
  • Allows for visual exploration of the environment
  • Encourages isolation of limbs from trunk
  • Allows for babies to discriminate between items that are close and items that are far away
  • Builds up strength in the upper body and hands that will lead to development of fine motor skills (such as handwriting!)
  • Helps develop the vestibular system (important for balance!)


Tips and Tricks

  • Ease into tummy time– start by holding your baby upright on your shoulder. Once she is comfy with that, try lounging back at an incline and let her try tummy time on your chest. From there, you can try to lie flat on your back and see how she tolerates that. My daughter grew to love doing tummy time on my lap, laying across my legs. I allowed her to get used to gradual position changes so that being prone on the floor didn’t feel like such an extreme change.
  • Use a prop – Some babies respond better to tummy time when using an exercise ball, rolled up towel or nursing pillow. (Do not leave baby unattended when propped up)
  • Join the fun! – You try lying on your tummy too! Face your baby and softly talk or sing to him. This might calm him, but will also prompt your little guy to work those neck muscles to better see your smiling face!
  • Set up some entertainment –  Place a couple of toys in a rainbow arc in front of your baby. Items in close proximity will be more motivating to look at than items far away, which might keep baby’s attention for longer. Down the road, she can reach and grab at toys, or even scoot towards them! I also love propping up books to look at!
  • Use a mirror – Not only are babies motivated by their own reflections, but you will also encourage some valuable social and language skills as well. Baby can work on recognizing facial expressions, imitation, and cause and effect- all while getting those tummy time minutes in!


My Favorite Tummy Time Tools:


Here is a great blog post, written by Wendi McKenna who is a pediatric physical therapist. She takes you through the progression of tummy time from birth to seven months, and does a great job illustrating all of the important skills gained along the way!


Do you have burning questions or hot topic suggestions for our blog? Send them my way at ElizabethM@skillbuildersllc.com. 

-Elizabeth Clark McKenzie, MS, CCC-SLP


Summertime Anxieties

Summer does not equate to relaxation and fun for everyone.  Even though kids with anxiety may experience less overall stress during to the break from school, these months can pose some new challenges. I asked local clinical social worker, Rebecca Goldberg,  to weigh in on some common areas of concern from children and parents regarding the summer break. She gave me some wonderful strategies that might help:

Boredom– Let it happen!

Summer is intended to be unstructured but not all kids do well with little to do.  A common concern from both parents and kids is the need to be entertained or having a short attention span.  Like any new skill, leisure skills need to be learned, expanded and practiced, especially for anxious kids.  Kids are used to instant gratification and constant inbound stimulation in our digital world and school environments.  Even though protesting (“I can’t do it!”) may occur, letting boredom happen is important. Boredom has been touted as an important skill in childhood that leads to expanded creativity, problem-solving skills and benefits to overall mental health as we age.

Try these ideas:

–      Work with your child to create a leisure, quiet, solo activity list. This can include art projects (be specific, take the trip to a craft store and buy a few kits or find some projects online), listen to music, read, garden, color, draw, journal – to name a few. Put these items in a central location. 

–      Make a visual list and have it posted somewhere in the house where your child is most likely to engage in the activities.  A common space in the house may be best.

–      Have quiet time near one another.  This allows for connection and closeness even if you aren’t engaging with one another directly.  This also models these skills for your child and shows that you too make leisure a priority and can practice what you preach.

–      Have your child practice solo skills for a few minutes a day and build up as they go; it can be a good practice for the whole family.  Start with 5 minutes and stick with it; don’t save them no matter how much they complain!

–      Praise your child for spending quiet time on their own. Notice if they seem calmer or accomplished and reflect on that specifically.  Help kids see the merit in quieting their mind, disconnecting and trying new activities.

–      Explain the why.  Lots of kids do better knowing “the why” behind something.  Let kids know how important it is to explore and come up with creative ways to spend their alone time.  When kids don’t want to try it, frame it is as an “experiment” to see how it goes.  This strategy can often feel less overwhelming to an anxious kid who thinks their whole world is now going to change.


Vacation– Always relaxing?

Not for everyone!  Vacations involve leaving your job, house and other responsibilities which is bound to cause stress on parents.  We all want to get the most out of our time away so it’s important to plan ahead and manage the stress proactively.  Your children will absolutely feel your stress around getting out the door, unless you plan accordingly.

Try these ideas:

–      Make sure you have enough time to plan, prepare and talk with your partner well in advance to make the transition out of town as smooth as possible. Let kids know what they will be responsible for, i.e. packing their own bag, preparing a car/plane/train activity bag, etc.

–      Get acclimated to the vacation spot beforehand. If this is a new place you are vacationing to, do some online searches together as a family and look at photos, activities and start to generate ideas, and excitement, for the trip.  Even if your child gets nervous about going, remind them that even though the travel time or leaving their friends may be hard, it will be worth the vacation experiences. 

–      Set expectations ahead of time.  Allow everyone to have ideas about activities to do while away and write them ALL out, everyone’s ideas matter.  Vote on these activities as a family and plan accordingly.  Set up a calendar of the vacation so kids know what to expect and on what days; post this somewhere central like the kitchen.

–      Not everyone vacations the same.  If you are traveling with another family, be cognizant of the differences in what each family may need.  Make sure you set time aside for your own family’s needs to be met.  Additionally, some kids and their parents vacation differently!  By allowing the needs of your children to be met, the vacation will ultimately will be more enjoyable for you too, so take that trip to the arcade, bowling alley or have a quiet board game day.


Camp & Sleepaway Camp– A big step for any child, let alone one with anxiety!

Whether it’s down the street or across the country, going to camp can be a hard thing to do for some kids.  Once signed up and registered, kids often experience increase anxiety and may refuse to go.  My typical response is “let’s try to find a way to work through it, even though it’s hard”.  Establishing that even though camp may feel scary, it is not a reason not to go – just a reason to get more prepared.  

Try these ideas:

–      Amplify being brave.  Focus on how this is scary AND your child can be brave.  We want to teach children that we can do something, even when we think we can’t at first.

–      Remind your child of other times they have been successful. Has your child been afraid of doing something before and then tried it, and it turned out fine?  Remind them of that and be specific, “Remember when you did swim team for the first time and it was so scary and you thought everyone was going to be a better swimmer than you? Do you remember what happened? You were able to face your fear and now you love to swim.  You would have really missed out on something awesome if you listened to your worry that time and let’s not let worry control us this time either.”

–      Bring an item to camp that helps them remember you, home, or whatever helps them feel calm, safe and grounded.  This can be something small like wearing a piece of jewelry of Mom’s, bringing an item from home (photos, small pocket item), a favorite fidget or squishy, etc.  Sensory based items can also help with grounding a child when they become dysregulated with anxiety – try something soft (rabbits foot, etc.), something that smells good (essential oil cotton ball, wearing Mom’s perfume, etc.), or something special to eat for lunch.  It’s always nice to get a note from a loved one in your lunch or in your camp backpack, too – it is the little things!

–      Wear a watch or create a count down.  Help kids know that even things that feel uncomfortable do come to an end.  

–      Reward your child for being brave.  Give your child tons of positive feedback, make it bigger and use a reward after camp to help them stick with it, ice cream is a good one for the summer or a trip to the pool for a night swim.  

–      Make a backup plan.  If camp is hard, let the child know you will be available to help them work through it. The camp can call you and you can talk with them but the goal is to stay at camp – do not swoop in to rescue your child and manage your own anxiety around your child’s distress.  We only beat anxiety by facing it.  Your child is in control, not their worries.

–      Stick with it and don’t cave.  It may be easier for both of you not to push through something like camp, which creates so much distress, but it is worth it.  If you don’t do it now, it will keep happening.  Don’t teach your child that when its hard, we stop or give up and that you also, don’t believe they can do it.  It may take hours to get your kid out that door but stick with it.  Take care of yourself in the process and if you need a break or the conversation is going nowhere, let your child know it’s time to pause and you will come back to this issue later.

–      What are the mini steps?  If your child is not able to make it through a full day at school, setting up the expectation for a full day camp can be a set up for failure.  If this is new, try the mini steps to get there – having a parent stay there for the first hour (you can sit in the car if the camp does not allow parents to stay), staying for the morning, morning and lunch, and then working up to the full day.

–     What are the stuck thoughts?  Anxious kids have stuck thoughts that maintain the anxiety.  “No one will play with me” or “There will be too many bugs” or “What if my parents don’t pick me up?” are all thoughts hear.  Talk through these with your child and help them see that these stuck thoughts are worry talking to them and are not true. Counter these with evidence and work to reframe the thought to something more accurate and helpful.  Make these visual and fun for your child – let’s be detectives to find the evidence, let’s be lawyers and argue our case, etc.:

  • “No one will play with me.”       “Even though meeting new people is hard, I can do  my best to say ‘hi’ and make new friends.  If I feel left out, I can ask a counselor for help joining in. I have been worried about making friends before but it took a few days and then I felt comfortable.  I just need to give myself some time to adjust.”
  • “There will be too many bugs.  I will get stung.”      “I might not like bugs but they are part of summer.  I can wear bug spray, wave them away or ask to take a break inside if I feel overwhelmed.  Even though I don’t like bugs, they are not putting me in danger. It is unlikely that I get stung because I have been outside thousands of times and I have not been stung most of those times [calculate the percentage if that’s helpful for your child].  If I get stung, there is a camp nurse that will help it feel better. Every time I have been hurt in the past, the pain does go away.”
  • “What if my parents don’t pick me up?”      “It’s unlikely that my parents won’t pick me up because they do for everything else.  If for some reason they were running late, the camp staff could call them to make sure they were on the way.  I won’t be left alone until they get there to pick me up. My parents are always thinking about me and would not leave me behind.”


Before you know it, it will be time to head back to school.  For school transition anxiety, or starting a new school in the fall, give your child chances to visit the new school over the summer, play on the playground and set up playdates with classmates.  If it helps for your child to have a walkthrough, call the administrators and set this up privately.  Even though heading back to school is hard, remind your child what they can to reward themselves for being brave –special dinner or activity and getting to share about their first day with you.

Being anxious isn’t fun for anyone – children or parents, or siblings.  If your child is not able to work through their challenges and find enjoyment in everyday life, it may be time to get some additional help.  Especially if you work on this with your child and it affects your relationship negatively, it may be time to outsource this work.  Anxiety is difficult and it is something that can be managed but does take work.


Rebecca Goldberg, LCSW, RPT is a Licensed Clinical Social Worker and Registered Play Therapist in private practice in McLean, VA.  She specializes in working with children and adolescents who experience mental health issues and a large majority of her clients present with anxiety related issues.  The above information is adapted from her years of clinical work, experience in the field of anxiety and from the many other qualified professionals, she has trained with.  Feel free to contact Rebecca directly or see more about her work on her website: www.rebeccagoldberglcsw.com.


-Elizabeth Clark McKenzie, MS, CCC-SLP