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.

Mindfulness can be practiced during breaks at school, between homework assignments, before bedtime, and when children may be experiencing heightened feelings of stress or anxiety. Families can initiate a mindfulness session by sitting in a relaxing environment and concentrating on their sensory perceptions such as how they feel when taking deep breaths.3 This form of relaxation allows children to temporarily let go of distractions in their lives and focus only on a sensation of their choosing without overreacting or feeling overwhelmed. With practice, children can benefit from mindfulness both behaviorally and developmentally by learning how to process and understand their thoughts, emotions, and surrounding environment. The activity is a form of reflection, which can improve their well-being.4,5

Since mindfulness is an emerging topic, much of the research published evaluates adult populations. However, studies on children have revealed similar results that connect the practice of mindfulness to positive states of mind. Teaching children to be mindful can improve their:

  • Ability to manage anxiety 6
  • Executive function skills 4
  • Attention capabilities 7

One of the important executive functions children build through mindfulness is emotional control. Mindful children are more equipped to process their feelings instead of resorting to a habit or impulse response.4 A 2014 study conducted in Richmond, CA observed the implementation of the Mindful Schools program where teachers worked with children to practice mindfulness over the course of 7 weeks. Students in 17 different classrooms participated in 15 minute mindfulness sessions, and teachers used a rubric to report their behavior. Results indicated that practicing mindfulness improved students’ ability to pay attention in class, maintain self-control, respect others, and participate in classroom activities.7

The benefits of children practicing mindfulness can also be observed in very young children, possibly as young as preschool aged. Data from a 2015 study measuring preschoolers’ inhibition responses revealed that mindful yoga improved their ability to manage impulses. The study used a series of assessments including asking the children to not watch while an adult wrapped a gift, asking children to not touch the present after it was wrapped, and asking children to play ‘Head, Shoulders, Knees, and Toes’ by performing the opposite motion as the interviewer. The children who studied mindful yoga performed better on the assessments by showing a greater ability to delay gratification and control both behavior impulses and attentional impulsivity.8

Ultimately, the goal of introducing children to mindfulness is to improve their self-reflection outside of designated times when they’re focused on breathing—to gain a greater awareness about their experiences, thoughts, and feelings. Caregivers who are interested in helping their children practice mindfulness at home can follow these three tips:

  • Use mindfulness to focus on different types of sensations: Although basic mindfulness helps children concentrate on their breathing, they can also focus on how their legs or arms feel or on scents such as the smell of an orange peel. Focusing on sounds is another good mindfulness exercise. Children can concentrate on the sound of a fan rotating, birds chirping outside, or another sound that is part of the environment where they are practicing.3,9
  • Practice mindfulness during activities that require movement: This helps children incorporate mindfulness into everyday activities. Walking can be a good way to start because children focus on the physical sensation of how their legs or feet feel while moving.10, 11
  • Make time for mindfulness as a family: Families can dedicate an area of the house to practice mindfulness together and they can also set aside a time of day such as before bedtime. Both caregivers and children should talk about how they felt throughout the day or what they focused on to help become more mindful.

[1] Ginsburg, Kenneth R. “The importance of play in promoting healthy child development and maintaining strong parent-child bonds.” Pediatrics. Jan 2007; 182.

[2] Bowdon J. The Common Core’s first casualty: Playful learning. The Phi Delta Kappan. May 2015; (98)8: 33-37.

[3] Getting Started with Mindfulness. Mindful. 8 Oct 2014. www.mindful.org.

[4] Teper at el. Inside the Mindful Mind. Current Directions in Psychological Science. 3 Dec 2013; 22(6): 449-454.

[5] Satlof-Bedrick E, C Johnson. Children’s metacognition and mindful awareness of breathing and thinking. Cognitive Development. Dec 2015; 36: 83-92.

[6] Research on Mindfulness. Mindful Schools. www.mindfulschools.org. Accessed 24 Jan 2017.

[7] Black D, R Fernanado. Mindfulness Training and Classroom Behavior Among Lower-Income and Ethnic Minority Elementary School Children. Journal of Child and Family Studies. Oct 2014; 23(7): 1242-1246.

[8] Razza et al. Enhancing Preschoolers’ Self-Regulation Via Mindful Yoga. Journal of Child and Family Studies. Feb 2015; 24(2): 372-385.

[9] Chapman S. Practice Mindfulness with Everyday Sounds. Mindful. 29 May 2013. www.mindful.org.

[10] Sofer O. The Practice of Walking. Mindful Schools. 8 Nov 2016. www.mindfulschools.org.

[11] Sofer O. Mindfulness as a Way of Life. Mindful Schools. 26 Sept 2016. www.mindfulschools.org.


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.2

There are two different types of tongue tie that can make feeding problematic for infants and young children. An infant can have a tongue tie that’s attached anteriorly toward the tip of the tongue, posteriorly at the base of the tongue, or both. Unlike an anterior tongue tie that is easiest to view because the frenulum attaches closer to the tip of the tongue, the posterior tongue tie is a form of akyloglossia that is less visible when the tongue is lifted. The frenulum may appear short and thick, or may not be visible because it’s often hidden by the mucosal covering of the tongue.3 This type of tongue tie may not look atypical upon first glance, but the tongue lacks the ability to lift from the floor of the mouth for proper feeding.4 Anterior tongue ties can be viewed more easily. The infant may appear to have a flat tongue that is heart-shaped at the tip, and it may only extend past the alveolar ridge slightly.3

Similar to tongue ties, lip ties can also be the cause of feeding difficulties for infants. Upper lip tie forms from a tight maxillary or labial frenum and can cause infants to have difficulty latching, because it limits the upper lip’s movement. The lip should be able to flange upward to latch along the upper portion of the areola and the nipple, or form a proper seal around a bottle. Lip ties of the maxillary or labial frenum can look like a small string attachment or fanned piece of tissue and sometimes, infants with the condition develop a callus on the upper lip.5,6

Caregivers may notice their child with tongue tie or lip tie is not meeting age appropriate feeding milestones or is exhibiting atypical feeding behaviors. Possible warning signs of these conditions include:

  • Difficulty latching and feeding-when infants breastfeed or bottle feed, their lower jaw is raised during suckling, and they use their top gum and the tip of the tongue (which rests on the lower gum) to hold the nipple/bottle in place. Tongue tie and lip tie may prevent the infant from taking enough breast tissue into the mouth to properly latch for feeding as the latch is often very shallow. Some infants may be able latch but are unable to achieve the proper suckling motions. Tongue tie may also inhibit peristaltic tongue movements—the tongue’s wave-like motion needed to move food from the front to the back of the mouth before swallowing. This can result a poor suck, swallow, breath pattern.4,5,7
  • Mother experiences pain while nursing-as a result of the restricted and atypical tongue movements or improper latch, the mother may experience additional friction while the infant nurses. This can result in pain and nipple soreness, and bleeding.4,6
  • Frequent pattern of feedings-occurs because the infant consumes less milk during each feeding than typically developing infants. The infant may also show signs of hunger shortly after a feeding. Another common warning sign is poor weight gain even though the infant feeds for extended periods of time.4,6
  • Fatigue during or immediately after feeding-the strained feeding experience requires the infant to expend more energy for milk removal. She may become frustrated during feedings or fall asleep within one to two minutes of beginning a feed. 4,6
  • Dimpling of cheeks or clicking sound while feeding-this is specific to tongue tie, and occurs as a result of the atypical latching and sucking motions. Jaw tremor may also be present. Infants with tongue tie are sometimes fussy and/or pull away from the breast or bottle frequently.4

If you suspect a child may have tongue tie or lip tie, referring to a specialist can help determine the proper treatment and support for the family. Specialists who evaluate these conditions and feeding issues include:

  • Lactation consultants
  • Speech language pathologists with specialized knowledge in tongue tie or lip tie
  • Nurse-midwives
  • Pediatric dentists
  • Oral surgeons or Otolaryngologists (ENTs) 3,4

After a diagnosis has been made, there are multiple treatment options for families to consider. A frenotomy is one form of treatment for tongue tie that involves snipping the short or tightened frenulum. Other surgical procedures involve using lasers to revise the frenulum. If surgery is not an appropriate form of treatment, a specialist can work with the mother and infant to adjust feeding techniques for either breast feeding or bottle feeding.  Caregivers must learn how to listen to their infant’s swallows and monitor the infant’s weight closely.4 Similar treatment options also exist for infants with lip tie, and for either condition, caregivers should always follow post treatment advice from their physician. If families are interested in learning more about tongue tie, they can read the Pathways.org blog on tongue tie. They can also view our feeding brochure to learn about feeding milestones and age appropriate foods.

[1] Brookes A, Bowley D. Tongue tie: The evidence for frentonomy. Early Human Development. Nov 2014; 90(12): 765-768

[2] Buryk, at el. Efficacy of Neonatal Release of Ankyloglossia: A Randomized Trial. Pediatrics. Aug 2011; 128(2): 280-288.

[3] Potock Melanie. Tip Back that Tongue! The Posterior Tongue Tie and Feeding Challenges. The ASHA Leader Blog. 26 May 2015. www.asha.org.

[4] Henry Lydia, Hayman Rebecca. Ankyloglossia and Its Impact on Breastfeeding. Nursing for Women’s Health. Apr/May 2014; 18(2): 122-129.

[5] Kotlow, Lawrence. Diagnosing and Understanding the Maxillary Lip-tie (Superior Labial, the Maxillary Labial Frenum) as it Relates to Breastfeeding. Journal of Human Lactation. 2013; 29(4): 458-464.

[6] Potock Melanie. Just Flip the Lip! The Upper Lip-tie and Feeding Challenges. The ASHA Leader Blog. 10 March 2015. www.asha.org.

[7] Edmunds at el. Tongue-tie and breastfeeding: a review of the literature. Breastfeeding Review. Mar 2011; 19.1: 19.

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

Promoting Safer Sleep

While the incidence of SIDS has decreased since the launch of the Back to Sleep campaign in 1992, the number of infant deaths resulting from accidental suffocation, asphyxia, and entrapment has increased in recent years1. In 2011, the American Academy of Pediatrics expanded its recommendations to promote a safer sleep environment for infants. Continue reading

Introducing Solid Food

Parents often rely on their child’s healthcare provider for information and support regarding infant feeding practices and nutrition. The American Academy of Pediatrics recommends introducing solid food to an infant’s diet around 6 months of age.1 However, the results of a 2013 survey, which included 1,334 new mothers, indicated that 40 percent of respondents introduced solid foods to their infants much earlier – prior to 4 months of age.2 Given the short-term and long-term risks associated with early solid food introduction, it is essential for healthcare providers to give clear and accurate feeding recommendations at early well-child visits. Continue reading