What to Know About Toe Walking

Toe walking can be a commonly observed movement pattern that many young children display during their development, however many children will give up idiopathic toe walking (ITW) without specific intervention. Research within the scientific community suggests that ITW is sometimes a causal symptom related to other conditions. Toe walking may be a symptom of a physical condition such as spinal dysraphism or injury, myopathy, and neuropathy.1 Children may also toe walk because of low muscle tone. When children’s adnominal muscles are weak, they depend on toe walking to feel secure while moving. If the underlying reason for toe walking is not caused by physical differences, it can be an indication of motor, visual motor, and gross motor delays that are associated with neurological conditions2 such as cerebral palsy, autism and sensory processing issues. Continue reading

How Scaffolding Helps Build Executive Function Skills

Do you talk to parents about executive function? Many parents are not familiar with this term. The executive function (EF) skill set acts as a coordination center in the brain and depends on three main functions: working memory, mental flexibility, and inhibition control. 1 These crucial skills are needed to perform daily tasks, such as prioritizing, controlling impulses, filtering distractions, and accomplishing goals. Issues with executive function in children may look like:

  • Trouble with organization
  • Struggling with time management
  • Difficulty with open-ended assignments or tasks and trouble starting tasks by themselves
  • Inability to complete assignments efficiently
  • Difficulty with memorizing or remembering rules2
  • Impulsivity1

Executive function involves goal-directed behavior that not only influences success in academic achievement and daily activities, but it influences success later in life through job skills, social skills, and independent living skills.3 If a child is having issues with executive function, it is important to intervene early in order to give this child every opportunity for success.

It is important to understand that children are not born with these skills, but they’re born with the potential to develop them.1 Adults aid in the development of a child’s executive function skills in various ways including: establishing routines, demonstrating social behavior, guiding children through modeling the use of executive function skills, and maintaining supportive, stable relationships.1 If parents notice executive function issues, they should begin intervention by making adaptations at home. Using charts, checklists, and schedules on a daily basis helps children build a routine and accomplish goals. Examples of home interventions include but are not limited to the following:

  • For homework time: Set a specific time each day after school when the child will begin homework and designate a distraction-free area. This will help establish a routine and allow the child to focus on the tasks each day.
  • For managing the day: Teach the child to use a daily agenda planner to promote organization.
  • For getting ready for school: Create a morning routine with visual cues and reminders for each step of the process, such as brushing teeth, combing hair, putting on each layer of clothing, tying shoes, etc.
  • For remembering instructions: Create a mnemonic to help with recalling multi-step instructions.4

Along with adaptations to daily activities, parents should also use scaffolding as a method to teach their children and guide them through tasks. Scaffolding is a learning technique in which the adult relinquishes control of a task to the child over time. The effectiveness of scaffolding hinges on the contingency rule: when the child struggles, the adult should increase the level of support provided, and when the child succeeds, the adult should gradually decrease the level of support.5 Scaffolding allows parents to adjust their support based on the child’s needs. For example, when teaching a child to brush their teeth independently, parents can use scaffolding to help their child achieve this daily skill. The parent may first start by brushing the child’s teeth for them and then slowly decrease their amount of help over time, from being prompted with cues to complete independence.

While scaffolding and daily home adaptations are effective beginning steps for early intervention at home, clinical intervention may be necessary if improvements are not seen. For a diagnosis, refer your patients to a neuropsychologist or a child psychologist. For ongoing treatment, you should refer patients to occupational therapists or speech therapists. Occupational therapists and speech therapists will work on the underlying issues with the child that are preventing the child from developing healthy executive function skills, as well as, work with the child and family to develop specific strategies that will most benefit the child.


1 Executive Function & Self-Regulation. Center on the Developing Child at Harvard University.
https://developingchild.harvard.edu/science/key-concepts/executive-function/. Accessed October 26, 2017.

2 Morin A. 9 Terms to Know If Your Child struggles With Executive Functioning Issues. National Center for Learning Disabilities. www.ncld.org. Accessed November 6, 2017.

3 Anderson M, Brydges CR, Fox AM, Reid CL. A unitary executive function predicts intelligence in children. Intelligence. 2012; 40(5):458-469. doi: 10.1016/j.intell.2012.05.006

4 Executive Function Interventions. Children’s Hospital of Philadelphia. http://www.chop.edu/centers-programs/executive-function-consultation-education-and-skills-excel-clinic/interventions. Accessed November 8, 2017.

5 Mermelshtine R. Parent-child learning interactions: A review of the literature on scaffolding. British Journal of Educational Psychology. 2017; 87(2):241-254. doi:10.1111/bjep.12147

Mindfulness to Improve Children’s Wellbeing

As more children adopt demanding schedules with increased academic work loads and an abundance of extracurricular activities, some react by showing signs of increased stress and anxiety.1 Our academic system has accelerated so children are now expected to complete school work previously given to children in higher grade levels. Early education has become less play focused and children receive a more academically rigorous curriculum. This change is evident by the amount of time children spend preparing for 3rd grade exams that measure performance in math and reading.  On average, 77% kindergarteners received 90 minutes of daily reading instruction in 2010 whereas only 32% received daily reading instruction in 1998.2 With increased academic demands and busy schedules, children may need to take an intentional break in the day to relax and recharge. The practice of mindfulness is quickly gaining recognition as an activity to help children manage feelings of stress and anxiety. Continue reading

Feeding Difficulties in Infants with Tongue Tie and Lip Tie

Ankyloglossia, also known as tongue tie, is a congenital condition that can affect infants and children due to having a short lingual frenulum that restricts tongue movement and impacts the function of the tongue. The incidence of tongue tie affects at least 4% of infants and is most commonly diagnosed in males by a 2-3:1 predominance.1 Around 50% of infants with ankyloglossia experience feeding difficulties because of the condition.2Continue reading

Helping Families Choose Age-Appropriate Extracurricular Activities

Many parents encourage their children to become involved in extracurricular activities as a way to promote their development. Extracurricular activities help children develop motor skills and improve physical fitness, while also building their cognitive and social skills, all of which can enhance children’s sense of wellbeing.1 To help children receive the most benefits from extracurricular activity involvement physically, emotionally, and socially, they should participate in the right amount of activity for their age level and abilities. Adults facilitating children’s extracurricular activities can learn how to make the activity more developmentally friendly and recognize when it may not be appropriate for a child. Continue reading

Differences between Maternal and Paternal Book Reading to Children

Reading aloud helps children expand their vocabularies while also building their ability to think, analyze and ask questions. It can also inspire a love of reading and learning for life. A 2014 study published in the Journal of Fathering suggests fathers and mothers may have different styles of reading to their children and both can be beneficial for development. In the study, researchers observed mothers and fathers while reading to their children. The study showed mothers asked their children more factual questions while labeling and categorizing objects, whereas fathers used language to talk about concepts extending beyond the images and wording in the book.1 When parents use different styles of reading aloud to their child, they are providing a variety of learning experiences that foster language and cognitive development and can support literacy achievement in later years.2 To promote these positive outcomes, healthcare professionals can provide caregivers tips to make reading time an enjoyable and educational experience for children. Continue reading

Importance of Play in Children’s Development

Play is critical for children’s development because it providkids_playing_dress_upes time and space for children to explore and gain skills needed for adult life. Children’s playtime has steadily decreased due to limited access to play spaces, changes in the way children are expected to spend their time, parent concerns for safety, and digital media use. Between 1981 and 1997, the amount of time children spent playing dropped by 25 percent.1 During this same time period, children ages 3-11 lost 12 hours a week of free time and spent more time at school, completing homework, and shopping with parents.2Continue reading

Augmentative and Alternative Forms of Communication

Pathways.org produces content (like the article below) for health publications and newsletters that discuss issues related to children’s development. Our content features information for healthcare professionals on talking to families, recognizing delays, and early referrals.

For children with severe expressive communication disorders, augmentative and alternative communication (AAC) can improve their ability to interact with others in everyday settings. AAC promotes wider social interaction by offering different functions from supporting existing speech to providing an alternative for verbal communication. Individuals with autism, cerebral palsy, genetic syndromes, cognitive impairments, hearing impairments, and head injuries use AAC to enhance their communication abilities.1Continue reading

Children’s Executive Function Skills

Executive function is a mental process that allows us to understand our past experiences with present action. As you know, the brain uses this skill to guide behavior toward accomplishing a goal, prioritizing tasks, controlling impulses and focusing our attention. Doctors can explain to parents that children are born with the potential to gain these abilities through their experiences with caregivers, family members, teachers and other influential persons impacting their development.1Continue reading