We’ve been BUSY this month here at Skill Builders. Twice a year, we conduct screenings at local preschools. Screenings are used to determine whether or not a child presents within the average range, as compared to same-aged children. We like to think of screenings as a way of catching kids before they fall. Identifying potential areas of weakness or delays early on can help start the intervention process sooner, rather than waiting until academic or social problems arise. A screening is not a formal assessment, but a tool used to identify whether a formal evaluation is needed. Screenings are an important part of well-child health care, and can be a valuable tool for both parents and teachers

So what is a screening?

Prior to the screening, we collect a brief case history form from the parents that alert us to any pertinent medical history or diagnoses, as well as any previous therapy services. This form also allows for parents to express concerns or ask questions so we can take an extra look at certain skill areas.  

Additionally, we often collect a short questionnaire from the child’s classroom teacher to get an idea of how the child presents in class, as well as any areas of concern that the teacher might have. 

Each screening takes approximately 15-20 minutes. Clinicians will often pull children in groups of 2-3 in order to make them more comfortable. We use a combination of standardized assessment tools, as well as our own clinical observations as we engage the children in tasks that showcase various skills. The activities are play-based and fun, and our goal is for the children to perceive the experience as just “playing with a new teacher”! 🙂

After the screening is over, the clinician will write up a short report to summarize the findings. If areas of concern are identified, a formal evaluation may be recommended. Sometimes, if a skill area appears “on the cusp”, we recommend that a child’s skills be monitored, and re-screened in 6 months. If all looks age-appropriate, we recommend that children still participate in screenings once a year until they reach elementary school. At Skill Builders, we offer the option of scheduling a brief phone call with the screening therapist to ensure parents understand the results, and to address any additional questions. 

Skill Builders offers three different types of screenings:

1.       Hearing Screening

A Pure Tone Test is a “pass/fail” test that determines if a child can detect a range of frequencies in each ear. If the child passes, it is presumed that there is no hearing loss. If the child is not able to detect one or more frequencies, a comprehensive evaluation conducted by an audiologist is required. If a child is not cooperative, or does not appear to understand the task, we may recommend that he have a repeat hearing screening at his pediatrician’s office.

2.       Speech and Language Screening


*Oral Motor Skills

*Expressive Language

*Receptive Language

*Auditory Processing



*Pragmatic/Social Languag

3.       Occupational Therapy Screening

*Fine Motor

*Pre-Writing Skill Development

*Visual Perceptual Skills

*Sensory-Motor Processing


*Bilateral Coordination

*Frustration Tolerance

*Body Awareness

*Visual Attention

We love doing screenings because it allows us private practice clinicians a glimpse into classroom life, and it gives us a good refresher of what typical development looks like. Skill Builders enjoys partnering with area schools and parents to promote early identification and intervention in important areas of development. 

If your child’s preschool is interested in offering screenings, please contact Cari Syron at


-Elizabeth Clark McKenzie, MS, CCC-SLP


Graduate Student Internships

The school year has started and around here, that means a fresh batch of graduate student interns! As a reputable private practice in the area, Skill Builders feels honored to be trusted as an internship site for many prestigious universities including George Washington University, James Madison University, Gallaudet University, and Northeastern University. As our internship program has grown, we’ve made our selection process competitive and thorough to ensure that we are hosting the best of the best!

We like to think that our interns are fortunate to get to experience a practice like ours, and we know that Skill Builders offers a rigorous and unique experience. But as a parent, what’s in it for you?

Here are 6 reasons why having a graduate student on board is a wonderful thing!

   1. Students work their tails off! 

Students are eager to please, and are working hard to earn a good grade, as well as a good recommendation for future employment. They go the extra mile to plan creative activities and prepare fun, individualized materials for each client. This means your child gets to reap the benefits of that!

     2.  Your therapist works harder!

I don’t know about you, but when I have an audience, I tend to make sure that I am putting my best foot forward. I want to make sure my interns get to see all the tricks up my sleeve! Having to explain the rationale and process behind each technique really challenges me to think critically about my caseload, and helps solidify my own understanding of the approaches that I am using. Interns frequently present me with tough questions, so I really need to be extra prepared and know my stuff. This makes ME a better clinician too!

      3.  A fresh face!

It is amazing what a fresh face and a different personality can add to the mix! I find that having an intern can really shake things up- in a good way! For many of my clients, it is essential that they learn to generalize skills to use with less familiar adults, and so having a new person in the room really lends itself to carry-over. Interns are also often “young and hip”, and they bring a fun energy to our sessions. (They also seem to know about all the latest cool pop-culture references…unlike some of us old folks!)

   4. Up to date information!

Interns keep us “in the know” about all the latest research and developments in our field. We love hearing about what students are learning in class, and every semester, I find myself learning something new. Who says that you can’t teach an old dog new tricks? 😊

   5. Two for the price of one!

I get excited when I have an intern, because there are certain activities that are better executed with a third person in the room. I can prep my students before the session to help create situations for learning opportunities, and use them to strategically sabotage or alter a game to allow for application of specific skills. I also love having a third person to work on conversational and social skills! These are situations that I often can’t create in the one-on-one environment. Additionally, it is pretty darn helpful to have an extra set of hands helping with set up, data collection, and clean up- this means more efficient sessions, which means more time directly focused on my client.

   6. Sending better therapists out into the world!

At one point, we were all interns! There is no way that I would be the therapist that I am without the guidance, mentorship, and support of phenomenal supervisors who really poured into me when I was a student. It is both a duty and a privilege to get to return the favor to the next generation of therapists. We hope that by providing a challenging and intensive experience at Skill Builders, our students will enter the work force more prepared, and with a passion for providing high quality services.


So if you notice a few new faces around our office- fear not! It is our goal that our internship program will only enhance the therapy process. We greatly appreciate how welcoming Skill Builders families are to the students who come through our doors. It is because of you that we have become such a popular internship site!

For more information about our internship program, contact Michael Lemieux, Skill Builders’ Internship Coordinator. (


Fall 2017 Graduate Interns


-Elizabeth Clark McKenzie, MS, CCC-SLP


Baby Talk!

I love working with babies and toddlers. It is amazing the amount of learning and change that occurs in just three short years!  Parents often ask me what they can do to help encourage their child’s speech and language skills along, and over the years, I’ve developed this list of skill areas to focus on:




  1. Playing with Sound

Infants begin exploring their mouth and playing with vocalizations at a very early age. Initially, we see babies “coo” with mostly vowel sounds, and later, this evolves into “babbling” with consonant sounds. Rather than focusing on specific vocabulary words, feel free to just play with sounds around your baby. Those “oohs,” “ahhs,” and “shhh” sounds you are making will encourage your baby to do the same. Make sound effects, blow raspberries, and sing a silly string of sounds. Show your baby that making sounds is fun!



  1. Vocalization on Command

Around the same time that babies start to babble, they figure out that they can control the sounds that they make. They start to understand the back and forth dynamic of communication, and you might notice that your baby starts to “talk back” when spoken to. You can encourage this by leaving ample pauses in your interactions to allow your baby to vocalize. I call these “windows of opportunity.” As you are playing, be sure to periodically provide windows in order to give your child a chance to chime in. You can also try waiting for a vocalization before handing your child a desired toy or snack. Don’t worry about the specific sound at this point—just wait for your baby to vocalize, and then reinforce by promptly handing over the item.



  1. Anticipation

Once your baby starts engaging more with you, he will start to figure out that language can be predictable. He will start to anticipate when you are going to say something. The best examples are “Ready Set GO” and “Peek-a-BOO.” Try leaving a long pause after “Peek….a…..”.  Wait for your child to vocalize before you say “Boo!”



  1. Bombardment

As your child starts to understand how to control her vocalizations, she will begin to imitate sounds and words that you say. The best way to encourage this is to provide repeated models of the same target, without a lot of extra “fluff.” For example, while building with blocks, simply model the word “on” each time you stack a block on the tower. While it might be your instinct to narrate every little detail (“Watch mommy put the blue block on top of the yellow block!”), your baby will actually be more likely to imitate if you give him repeated opportunities to attempt the same sounds. This is also an easy thing to do with books! Instead of reading the actual words on the page, pick a word to say, or an object to point out, on each page.


Brown Bear Brown Bear by Eric Carle

5.  Predictable Sequences

Children love predictability! As you are playing, create predictable sequences with language that is appropriate to the context. For example, while playing with a slide, model “Up, Up, Up, Up, Weeeeeeeeee, Down!” as your child (or a doll!) climbs up the ladder and slides down. This is also great to do in books! Choose books that say the same word or phrase on each page. (ex: We’re Going on a Bear Hunt by Michael Rosen and Helen Oxenbury or Brown Bear Brown Bear by Eric Carle)



  1. Verbal Requesting

Once your child has a few words, you can start to encourage him to use these words to request. Place objects on high shelves or in containers that he can’t open himself. Wait to perform a desired action or give a desired object until he verbalizes. We naturally tend to teach kids the names of things (nouns) first, but I actually recommend that we teach a “core vocabulary” of action words first. These are words that can be applied in many contexts. For example, if I teach my child the word “eat,” that can apply to many different things: “eat apple”,”eat noodle”, “more eat”,”mommy eat”, “all done eat”, etc.  If I teach my child the word “cracker”, he can request and label a cracker….and that is about it! By teaching words that can be used in a variety of contexts, we are give our child the advantage of more opportunities in a day to use that word successfully.



  1. Carrier Phrases

After your little one develops a sizeable repertoire of words, she will start to string words together, and soon after that, use two-word phrases. You can encourage this by modeling “carrier phrases.” Take one word and pair it with many different words:

With a noun: “ball in,” “roll ball,” “kick ball,” “my ball,” “ball all gone,” “blue ball,” “big ball,” “ball go,” etc.

With a verb: “open door,” “open mouth,” “open eyes,” “mommy open,” “open please,” “don’t open,” etc.

With a preposition: “foot in,” “in house,” “mommy in,” “ball in,” “in again,” “not in,” etc.

With an adjective: “big house,” “big truck,” “big bite,” “too big,” “not big,” etc.



  1. Expansion

Now the fun begins! Once your toddler is putting two, three or even four words together, now is the time for expansion! When he makes a comment, add one-to-two words and throw it back to him. For example, if he says “Firetruck!”, you can say “Red firetruck!” or “Firetruck go fast!” You can also use this to model more complete sentences. For example, if he says “Dog run!”, you could say “The dog is running!”



  1. Connection

As all of these wonderful speech and language skills are coming together, your child will start to make connections between different concepts. You can help her with this by commenting on the things she says. For instance, if she points out an ice cream shop, you might remind her that she ate ice cream at the beach last week. This will foster conversational skills, as well as help solidify concepts such as categorization, and comparing, and contrasting.



  1. Conversation

As your child approaches the age of three, you will see that he is starting to sound more and more like a little person! Move away from “yes-no” questions, and start asking “what,” “who,” “where,” “when,” “how,” and “why?”. Try to keep your child talking about the same topic for at least three-to-four exchanges before moving on. For example, instead of asking “Did you have fun at school today?”, try asking “Who did you play with at school?”, “What did you play?”, “Where did you sit?”, etc. This strategy leaves the door open for language learning.


Of course, it is important to remember that every child is on his or her own timeline. Some kids sail through these phrases with ease, while others seem to chug along at a slower pace. These strategies are intended to empower parents to be proactive with their child’s language development. If you feel your child ‘s speech and language skills are not where they should be, a pediatric speech language-pathologist can perform an assessment, and advise whether or not therapy might be beneficial.



Happy chatting!

-Elizabeth Clark McKenzie, MS, CCC-SLP

Yoga for Children

OD2SUR0.jpgYoga Basics

People ask me how many yoga classes are necessary before benefits are experienced. Rarely, do they believe me when I answer: “One.” Positive effects of a good yoga class are felt during and after that very first class. There is a style of yoga for everyone – truly! Check out a few possibilities:

  • Power yoga and Ashtanga flow classes for those who need to move
  • Integral yoga and Viniyoga for more classical focus, with a combination of movement, breathing and rest
  • Big Yoga and Curvy Yoga for those who feel that their body types do not align with typical yoga clothing ads
  • Yin yoga with emphasis on holding supported poses to allow for deep work within connective tissue
  • Restorative yoga for anyone who would enjoy being propped in poses with pillows and blankets (very nurturing and healing)
  • Meditation classes
  • And even yoga classes for deep relaxation.

There are programs that provide yoga to people in corporate office settings, the military, in prisons, to those who have cardiac issues or diabetes, and even classes such as Chair yoga and Laugh-A-Yoga. See? Yoga is for all ages, all health conditions and all body types. There are Pre-Natal yoga classes, so why shouldn’t there be yoga for children? Children are people too!

Yoga for the Special Child was the first teacher training course that I attended, with emphasis on connection with each and every child, allowing each child to find their own inner strengths and their own inner calm. That IS the goal of yoga – to connect with that inner joy that resides in all of us. Children are still in that joyous, playful state. Yoga is perfect for children. Sonia Sumar wrote to parents in the forward of her book, Yoga for the Special Child: “By letting go of our fears and negativity, and learning to see the best in ourselves and others, we can provide a powerful impetus for positive change. It is through this ability to go beyond pre-conceived notions and external appearances that we can transform our lives and those of our children.”

Why Yoga?

Yoga is a science that provides each person with ways to experience strength in the body and in the mind, with inner peace and resilience, considered the birthright of everyone. The pretzel-like poses that most people associate with yoga do exist, but are not the primary focus of most classical yoga traditions. Children’s yoga can incorporate moving, singing, jumping, laughing, story-telling, games, art activities and rest time. Kids are allowed to experience fun and joy in yoga classes, and to learn that those great feelings come from within.

Children today live in a world where vast amounts of information bombard their vision, hearing and social observations every day and all day. Currently, children are often taught to rely on this external information, to believe that what is seen on TV, videogames and in social media is what is real and what is important. So much comes to children and adults from electronic devices and yet, a big buzz phrase in schools and therapy sessions right now is self-regulation. All of that external noise distracts us from accessing our own inner strengths and resources. Doesn’t every parent, teacher and therapist want each child to recognize their own, inner power, their own inner calm?

Yoga practices emphasize movement, breathing, singing and rest. Resting is a vital ingredient, as rest allows the body to assimilate all the good things that have been introduced during the yoga session. We spend so much time instructing children and so much time on the road for appointments and outings, it’s easy to forget that children also need to learn the significant importance of quiet time, of silence, and of rest in between all that activity. Children need to become acquainted with their own true ability for self-regulation and self calming, and that it feels good to be calm and in control. If a child has no experience of that feeling, then how are they going to be able to find that calm when they need it? Anger and bullying could become go-to choices rather than ‘checking in’ to see what would help them to feel ‘just right’ in that moment. Many programs such as the ALERT program, Zones of Regulation and Social Thinking’s Superflex enable children to establish useful resources when they feel they are headed out of control. Yoga techniques can fit right in alongside those proven methods, and often, are integral components of such self-regulation tools.

Yoga, Bullying, and the Schools

Have you heard that some schools are now having wonderful decreases in bullying and disruptive behaviors in the classroom, along with increases in academic performance by altering their approach to problem behaviors? Instead of being sent to the principal’s office or to receive some form of negative reinforcement, the student goes to a quiet room where an adult guides them in mindfulness activities or yoga techniques. Positive outcomes can arise from positive, supportive approaches with students who act out in the classroom. Once the child experiences that feeling of calm self-control, they are more likely to know how to return to that state when needed. Improvements in sleep habits, food choices and activity level are often associated with regular participation in yoga and mindfulness practices.


  • Yoga for children provides opportunities to stretch and strengthen muscles, to improve breath support, and to foster a calm, focused mind.  Numerous research studies point out the benefits of yoga practices within schools and homes. And yes, yoga for children even has its own National Kids Yoga Conference every fall in DC, where leaders in children’s yoga from around the world meet to present latest trends and to foster continued growth in this valuable area of yoga practice.
  • The Calming Kids Yoga website offers a beautiful video clip of a child describing how “checking in” helps her to find calm during her day.
  • Yoga 4 Classrooms offers a list of research studies that detail numerous benefits of yoga and mindfulness practices for children and teens.
  • Mindful Healthy Life is a resource for those living in the DC metropolitan area, offering a calendar of activities and information focusing on yoga and positive approaches to day-to-day life.

Resources abound for yoga for children. There are numerous books, videos and apps for yoga poses, breathing and meditation. Yoga has been around for thousands of years and in America, it is IN right now!


  1. Mountain Pose – the standing rest pose. Used in yoga classes as a break or intermediary pose during standing poses, I also like to call it the “ready” pose. Stand with feet solidly on the ground, spine upright, shoulders ‘back and down,’ arms relaxed at the sides of the body, ears aligned with shoulders, hips and feet, eyes directed forward. Notice the calm energy throughout the body. Outside of yoga class, this is a great pose for children and adults to use when standing in line at the grocery store. In this pose, you are a mountain. Your physical presence indicates readiness and calm strength.
  2. Tree – great for balance and focus. While standing, gently shift the weight onto one foot, feeling the stability throughout that supporting foot, ankle, knee and hip. Hold the eye gaze on a non-moving point/object directly in front of you. When ready, lift the other foot and place the sole of that foot on top of the standing foot or against the inner ankle or leg. Some prefer to place foot within the hip crease of the standing leg. Stand upright with hands at the hips, the heart, or raised above the head. If desired, you can steady the body by placing one fingertip on the wall. Hold for a few seconds and repeat on the other side.
  3. Table – Wake up the shoulders, wrists, hips and knees, and expand the chest to become a table. From a seated position on the floor with knees bent and feet in front, place the palms alongside the hips, fingers pointing toward feet, if comfortable (re-position hands if that’s not comfy!). Breathe in and press into the feet and hands while raising the hips and straightening the elbows, creating a nice flat surface in the belly and chest regions. Keep the neck in line with the torso, eyes gazing at the ceiling. Breathe a few comfortable breaths. Have someone place a toy or beanbag on the belly and hold steady, keeping the hips and shoulders in line and the heart open. Breathe out as you lower your seat toward the floor. Rest.
  4. Child’s Pose – Take a break from it all. Sit on the floor on the heels and gently fold the torso over the thighs, resting the top of the forehead on the floor or on a pillow, and allowing the arms to come alongside the legs/body, with the tops of the hands resting on the floor, behind the hips. Exhale and let gravity be your friend, sinking deeper into this resting pose. Turn off all the noise for a bit.
  5. Elephant Twist – In standing or sitting, with arms relaxed at the sides, take an inhale, then exhale and twist the torso toward the right, allowing the arms to flop out and around the body, like elephant’s ears. Inhale back to center, and exhale to the left, allowing the body to twist, the arms to flop toward the left and the face to look left. Inhale back to center and repeat a few more times, allowing the body to reap the benefits of this cleansing and energizing pose. If you’d like, add a happy song to match the movement.
  6. Lion – This is a mood-changer! Beware: it leads to laughter! Sit on the feet/heels on the floor, if comfortable, or in a chair, and stretch the fingers out away from you, with hands on the knees. Take a big breath in and then… exhale fully while making a roar and sticking out the tongue, stretching out the fingers (claws) and opening the eyes as widely as they can go! Sit back upright. Take a regular breath. Then repeat a time or two! Hold on to your smile.
  7. Do Nothing Doll – the rest pose when positioned on the floor in yoga classes and when in yoga nidra. This has been described as the most difficult yoga pose. Even though it involves lying on the back while on the floor, with eyes closed, many of us active people today find it difficult to remain still and to enjoy silence. Yoga cards made by Imaginazium call this pose Do Nothing Doll, as a doll has no thoughts! You can begin this practice simply by closing the eyes and enjoying the quiet. Taking this rest is re-energizing for the body and mind.
  8. Belly Breathing – Ah, taking a nice deep breath is calming and organizing – we all know that! Throughout the day our breathing tends to become shallow, tight and focused high in the chest. Many children keep their breathing in the upper chest region, which is associated with the fight or flight state of being, with stress and anxiety. Remember how we are told to take a deep breath and count to 10 when we are upset? Belly breathing allows us to take a full, deep breath that begins by relaxing the belly, letting it expand as we breathe in. This enables the diaphragm to move fully, allowing the lungs to fill more completely. Begin with a nice exhale. Take a full belly breath in and then, feel the belly pulling back in toward the spine on the full exhale. Try belly breathing for awhile. Then, try it with a count: 1-2-3 on the inhale and 1-2-3 on the exhale. For deeper relaxation, try 1-2-3 on the inhale and 1-2-3-4-5-6 on the long, slow, complete exhale.

OK! Having fun with yoga?

Kids Gotta Move!

Children want to explore the fullness of their muscle power, their thinking skills and their creativity. Yoga for children makes sense and it works – whether the child prefers solitary, parallel, or cooperative play. Yoga requires no extra equipment and minimal space. Occupational therapists and speech therapists understand that children perform best when they are motivated and engaged in an activity, and also, that novelty encourages attention and learning. Yoga techniques offer fresh and varied opportunities for such novelty and enticement, while providing a solid foundation for each child’s motor control skill development, self-regulation and social connectedness. As a former occupational therapist, I have always found that the yoga practices of movement, breathing and song form a perfect fit with OT goals geared toward purposeful living and quality of life. I believe that if every child practices yoga, their generation and the generations that follow will experience a great deal more peace and positivity than we now know in the world…and yoga for children is growing and growing…such a dream may become reality!

– Gina Kane, MSOT, CYT

Gina worked as a pediatric occupational therapist from 1983 to 2015, most of those years serving as the OT Director at Skill Builders. Her love for yoga began in 1995, with numerous yoga teacher trainings to follow, including: Yoga for the Special Child, Integral Yoga (Levels I and II), Calming Kids Yoga and certification in Structural Yoga Therapy.  In 2016, Gina and Dee Marie of Calming Kids Yoga, co-authored a pocket-sized booklet, Finding Calm in a Moment. Her passion for children’s yoga includes a strong belief in the importance of breathing and mindful meditation practices, as all children deserve to know that they can find their own contentment and peace.

Photo: Created by Teksomolika –

“Fun Facts” About Early Development: Mothering with an Occupational Therapy Perspective

tummy timeThe Low-Down on Tummy Time

Background: While decreasing the number of SIDS cases, the introduction of the “Back-To-Sleep Campaign” also led to an increased number of babies with flat spots on the backs of their heads and delayed motor skills due to the fact that parents were fearful of ever placing babies on their bellies. Therefore, regular “tummy time” is now recommended for infants when they are awake and in the care of an adult.

  • Significance of Tummy Time to Early Development:
    • Improved trunk stability, limb coordination, and head control
    • Necessary for acquisition of motor skills – rolling, sitting, crawling, walking
  • Significance of Tummy Time to Later Development:
    • The weight-bearing positions (pushing up on arms and later crawling) facilitate through Tummy Time are critical to future hand skills

Implications and Implementation

1. Start Early: newborns can be placed on their tummies against your chest until you feel more comfortable lying them on a blanket or play mat. If you wait too long to introduce the belly-down position, they may resist because it feels strange to them.

2. Incorporate into Schedule: aim for several 5-10 minute sessions each day. You can enlist the help of your spouse or other caregivers as well. If you each remember to make time for “tummy time” once a day, your child will get at least two sessions each day.

3. Troubleshooting: if your child does not like the position, try propping them up with rolled towels or blankets under their chests. Slowly decrease this support as they get stronger. You can entertain/distract your child with toys, mirrors, and your own face at their eye level.

Fine Motor Skills – Busy Little Hands

The FUNdamentals: from toddlerhood through the preschool years, building strong shoulders, arms, and hands is the key to future success with fine motor skills, such as writing, drawing, and using tools like utensils and scissors. Make sure your children get to play on playgrounds, squeeze play dough, string beads/use lacing cards, and use tools like tongs, turkey basters, tweezers, and squirt bottles in their play.

Writing: Drawing Tools

  • early drawers ages 2-3: use markers, crayons, etc. that are wide to open up their hands and encourage wrist extension
  • later drawers ages 4-6: use short pieces of chalk/crayons to encourage the desired three-finger grasp (thumb, index finger, and middle finger)

Writing: Drawing Surfaces

  • Drawing, painting, or writing on a vertical surface (i.e. chalkboard or easel) is excellent for young children. This position strengthens the shoulder girdle, encourages better hand position when using tools, and is less taxing for their eyes.
  • Drawing on chalkboards offers additional feedback for young artists because of the resistance of the chalk against the surface of the board. This is also true of using chalk on the sidewalk outside.

Sensory Exposure – Let’s Get Messy!

WHY: It is important for young children to experience a wide variety of textures so that their systems learn to accurately identify and respond to these textures appropriately.

Our High Tech, Low Mess World: While as mothers our lives are made easier by certain products, such as glue dots/sticks, paintbrushes connected to tubes of paints, pumpkins made of foam that can be carved just like the real thing, etc., we need to make some time to allow our children to experience “messy” things.


  • shaving cream in the bathtub
  • play dough
  • cooking/baking together
  • pudding on the highchair tray
  • sandboxes
  • finger paints
  • a bin of rice or beans to hide things in

We’re all busy these days and always looking for a “quick fix” but it’s important to set an appropriate foundation from which to build and contribute to the successful development of our kids!

– Jennifer Laun, OTR/L

Put Down the Pouch

food pouchesIf you have a child under the age of five, you are probably quite familiar with the popular “pouches” of pureed foods that have taken over the grocery store shelves! This modern convenience has totally revolutionized on-the-go snacking. It is easy to see why they are so popular – blends of fruits, veggies, legumes, and even meats are packaged in single-serving pouches that have a long shelf life, don’t need to be refrigerated, and are easily sucked through a neat little spout at the the top. Kids can slurp down 1-3 servings of healthy goodness in no time at all!

But before you jump on the “pouch bandwagon,” let’s pause for a moment. As a pediatric speech-language pathologist and feeding therapist who specializes in children under five (and a toddler-mom myself), I recommend taking a few points into consideration:

1. Oral Motor/Fine Motor Development

  • Babies and toddlers acquire very important oral motor skills while learning to eat solid foods. If a child is mostly eating purees, the mouth is not having to do very much work. We want those lips, tongues, and jaws learning how to move in different ways to chew and swallow a variety of textures of foods. Sucking through the spout of a pouch promotes an immature oral pattern, similar to that used with a sippy cup or a pacifier. Additionally, eating solid foods allows the child to practice picking up foods with fingers, and later with utensils. These skills take practice!

2. Sensory Diversity

  • Purees in pouches are a silky smooth texture that is easily swallowed with minimal oral manipulation. Lack of exposure to a variety of textures could result in decreased tolerance of more textured foods down the road. If you notice that your child already tends to gag or grimace when eating more textured foods, it is important to give him exposure to a variety of textures, and not have him get too used to smooth purees.

3. Picky Eating

  • Purees in pouches advertise themselves as being filled with a variety of flavors, but in reality, they are all fairly bland and it is difficult to tease out individual tastes. I can’t tell you how many children I have evaluated who will eat a food in “pouch-form” but not in any other preparation. We want to expose our children to a variety of flavor profiles early in life to promote a well-rounded diet and willingness to try new foods. Furthermore, pouches are often “sucked down” quickly, without much time for tasting/savoring flavor. It is important that children explore and taste foods to develop a diverse palate.

4. Overeating

  • With so much emphasis on fighting childhood obesity, it is important to consider the habits we are teaching our children. Pouches pack anywhere from 60-200 calories a pop. Children may get accustomed to quickly downing a pouch for a snack, and not necessarily factoring that in when choosing foods later. For older kids, pouches aren’t very filling, and therefore, it is easy to overeat.

5. Social Skills

  • Meal time is more than just nutritional intake. It is a social experience. Taking time to eat a snack bite-by-bite lends itself to sitting with a friend or family member and chatting. Children learn manners and social norms surrounding meals, and watching others eat can encourage more adventurous eating.

All that being said, there is no doubt that pouches are a convenient and easy way to get some fruits and veggies in your kids. They are especially great for on-the-go snacking!  As a busy working mom myself, I have certainly been known to appease my screaming toddler with a fruit pouch in the Target checkout line – I totally get it! My professional recommendation is to use them in moderation and prioritize eating solid foods as much as possible. I suggest keeping pouches reserved for snacks outside the home and avoiding them at meal times. Fostering a love of trying different foods will promote life-long, healthy-eating habits. For more ideas of ways to encourage trying new foods, check out our previous post on picky eating.

Happy Snacking!

– Elizabeth Clark McKenzie, MS, CCC-SLP

Cause and Effect

One of the earliest developing skills and interests of a child comes with cause and effect. We talked about some important toys that assist in children’s development previously, but wanted to delve a little deeper into these toys that have all the “bells and whistles” that may be so interesting to your child. These are toys such as ball poppers,
door poppers, and anything that makes noise or does something “exciting” once a button or switch is activated. It has been noted that these toys decrease interaction between parents and children since the kids can play with them on their own. But we have some ideas on how to make these toys more interactive and reciprocal.

cause-and-effectIn December 2015, a study was published that cautioned parents against the use of cause and effect toys for language development. The study (from JAMA Pediatrics) was conducted on 26 families with children ages 10 months to 16 months. The families received a variety of toys, which included a set of noisy, flashy cause and effect toys; wooden puzzles, shape sorters, and blocks; and board books with basic concepts. Results yielded information that suggested books were the most interactive and language-rich activity, followed by traditional toys (puzzles/blocks). Least interactive were the cause and effect toys. As SLPs, we are definite advocates of book reading at a very early age – start right away! Books have the power to teach concepts, character and story development, sequencing, and so much more. What a great way to get started on early literacy! But we’re not always able to sit with our kids and read all day. Playing with a variety of toys is great too. Traditional toys definitely teach great skills, including problem solving, turn-taking, fine motor development, and others. So what about those noisy, flashy toys that you already own and your child absolutely adores? Here are some suggestions for more interactive play:

  1. Turn taking: facilitate a back and forth play with a turn taking routine. You can use language, like “your turn!” and “my turn!” to start this concept early. Of course, with the little ones, it doesn’t have to be such a rigid back and forth; instead, be playful!
  2. Eye contact: wait for your child to look at you before turning the toy back on (most of them have an on/off switch that you can manipulate and control). Eye contact often indicates some form of communication and an awareness that you can give them what they want – another turn!
  3. Requesting: to work on early-developing sounds, you can practice “ah” (for “on!”) and “m” (for “more”).
  4. Problem solving: give your child wait time and see if they can figure out how to operate a button/switch or to pick something out (I’ve seen kids exhibit very nice fine motor skills this way).
  5. Narration: depending on the toy, you may be able to talk about an object. For example, in a toy that has different animals you might be able to say where they live, what sounds they make, what they look like, and other attributes.
  6. Increased utterance length: once your child has begun to use one word at a time, you can model phrases: “want more” “ball in” “go ball” “go in.” Typically, children begin to combine two words around 18 months.
  7. Prepositions: in, on, under – all these represent locations that are likely possible to talk about with any toy.

The aforementioned suggestions will take some degree of modeling. Don’t just expect your child to do it independently. Some cues include gestures (like pointing), verbal cues (like short, easy directions – “ball in”), and hand over hand assistance. You may need to work hard to make a cause and effect toy be more effective for language development, but the most important thing to remember is to have fun! They’ll only be this little for so long. Enjoy!

Too Many Toys!

As a parent, it is easy to fall into the trap of buying millions of toys for your precious little one. The market is filled with expensive toys with words like “educational” or “learning” on the packaging. Unless you have unlimited storage space (not to mention an unlimited budget), and children who miraculously put away their own toys in a perfectly organized manner, too many toys usually just leads to clutter! What if you could pare down to just 10 toys? Here is a list of 10 favorite essential toys that will stimulate your toddler’s language skills and keep them entertained:

  1. Ball Popper (or any cause and effect toy)

I usually gravitate toward the “low-tech” toys that do not make noise and do not require batteries; however there’s always an exception to the rule and for that we have the ball popper!  This toy teaches cause and effect, which is an early basic developmental skill. The music and vibrant colors keep this activity motivating for both babies and toddlers. A trusty “on-off” switch allows adults more control between turns!

ball popper

Recommended language uses: turn-taking (my turn/your turn), sequencing (take pictures of your child completing the activity, print them out, and have them put the pictures in order), targeting concepts (on/off, up/down, in/out), identifying colors, counting, expanding utterances (on…turn on…turn balls on, etc.), targeting sounds (ie. /g/ in “go”), and overall engagement.


  1. Barn with Farm Animals

You can’t go wrong with farm animals. It is preferable to have animals and barns that do not make sounds so that the child and parent can do all the narrating (you can still buy one that makes sounds – just take out the batteries or never put them in!). Most kids love to play with animals and will delight in this activity. You can model actions with the animals and then follow your child’s lead.

barn with animals

Recommended language uses: learning prepositions (put the cow in/on/under + {place}), animal sounds, vocabulary (ie. barn, tractor, farmer, hay), responding to wh-questions (Who is it? Where does he go? What is he doing?), categories (all farm animals vs. sea animals, for example), and pretend play (a great time to role play, give voices to “characters,” and establish a story line).


  1. Stacking Blocks/Stacking Cups

stacking blocks

Most kids love building and will delight in the dramatic effect of a “crash” of the tower. Here’s where stacking blocks or cups can be both fun and educational. Have your child help you build a tower and anticipate as you say knock the tower down. Hide items under or in the cups to make a fun hide-and-seek game.

Recommended language uses: prepositions (in, on, off, out….), blocks and cups allow children to learn problem solving, collaborative play, sequencing and following directions


  1. Baby Doll and Accessories

baby dollGirls and boys alike enjoy playing with baby dolls. Dolls are a great way to teach pretend play as well as show your little one how to be affectionate and gentle. Caring for a baby doll also lends itself to using lots of functional vocabulary that will help your child talk about his own daily activities!  (eat, drink, wash, sleep, hug, brush, cup, etc)

Recommended language uses:  pretend play, vocabulary (both nouns and verbs), expanded utterances and word order (ie. baby eat, baby hungry, baby want eat)


  1. Play Kitchen/Food/Dishes

The possibilities are endless with a play kitchen and pretend food. Make dinner, have a tea party, throw a birthday bash, open a restaurant, or even concoct a magic potion! play kitchenPlaying with food and talking about food helps foster healthy eating habits. Children will learn many practical skills and, hey, they may even develop an interest in helping with the dishes!

Recommended language uses: sharing, following directions, symbolic play, sequencing (eg. recipes), role play, kitchen vocabulary, expanded categories (food vs. fruit/vegetables/drinks)


  1. Car Ramp/Cars

Fisher-Price-Little-People-City-SkywayReady…Set….GO!” Toddlers love making things go, and the sky is the limit with a simple car ramp and a few cars. I love using car ramps to teach

Recommended language uses: turn-taking, verbal requesting, vocalizing on command, expanded utterances (Go car!), articulation of k/g, cause and effect

*Fisher Price at Toys R Us

  1. Wooden Puzzles

wooden puzzleYou’d be surprised at how early young children will start showing an interest in puzzles. They love figuring out how to turn the pieces in order to get them to fit just right. I love puzzles for many reasons but one of my favorite aspects is the task completion! It is exciting for a child to learn to stick with a task until she gets the job done – a skill that will serve her well for the rest of her life!

Recommended language uses: task completion, basic problem solving, vocabulary (depending on the puzzle you choose – the sky’s the limit!)


  1. Toy Instruments

little tikes drumInstruments are such a fun way to encourage children to play together. Instruments foster imitation, following directions, and motor control. Music is also a great way to engage your brain. The possibilities are endless with instruments – you’ll never run out of songs!

Recommended language uses: following directions, engagement/participation, production of multi-syllabic words (tap out the syllables on a drum!), and even fluency (think of a slow movement on a drum to help the child feel the beat)


  1. Puppets

puppetsI love a good puppet! You can feed them play food, make them talk, make them dance, or even knock down that block tower you built! Kids love watching Daddy or Mommy get silly while making a puppet talk, and I find that puppets can be very motivating when trying to encourage a child to imitate.

Recommended language uses: role play, pretend play, articulation (eg. final /t/ in “eat”), expanded utterances, narration


  1. Potato Head

potato headThis toy is a classic for a reason. Mr. Potato Head’s features are the perfect size for little hands. Toddlers will learn to construct a face and label all the different parts. This is a perfect activity to work on following directions or requesting. Once Mr. Potato Head is built, he can have a tea party in your play kitchen with your baby doll and puppets! 🙂

Recommended language uses: body part labeling/vocabulary, following directions, requesting, pretend play

*Playskool at

Of course, this list is in no way all-encompassing, but if you are looking for a simpler approach to play, this is a good start. Remember, some of the best toys are non-toys! (Think cardboard boxes, pillows, wooden spoons, pots and pans, etc). The most important thing for your child to learn at this age is to try new things, and the best way to encourage that is to get out there and PLAY TOGETHER. Have fun!


-Elizabeth Clark McKenzie, MS, CCC-SLP