Archive for April, 2015


    Walkers, Jumpers, Exersaucers: The Good, The Bad, The Ugly

    Early Childhood Interventions April 13, 2015

    Infant devices such as walkers, jumpers, and exersaucers are a frequent topic of concern in early intervention. These devices are widely marketed as helping promote a baby’s development and parents often feel they have to have them in order to meet their child’s needs. Additionally, some babies really seem to enjoy the time they spend in their devices. Research on the safety of these devices as well as on their effects on development, however, has not been as positive.

    Walkers were originally developed to provide a means of mobility for exploration before a child learns to walk. DiLillo, Damashek, and Peterson (2001) found that parents use walkers and exersaucers for entertainment, perceived developmental benefit, and easy availability.

    Concerns have arisen regarding the safety of these devices. Injuries have been reported related to the device itself such as pinching fingers and toes in device hardware and injuries caused because the child is more mobile. Increased mobility in these devices has led to burns when a child can maneuver close to a hot stove, poisonings when a child can bring themselves closer to cabinet sinks and other storage areas, and falls down stairs when a child gets too close to the edge (AAP 2001). Mandatory standards that were implemented in 1971 addressed the incidence of pinch injuries and, as a result, those injuries have decreased. Voluntary standards to address tip overs and falls were implemented in 1996, thus these injuries have decreased also.

    However, providers should be aware that many families purchase these expensive devices from second-hand stores or receive them handed down from family members or friends and therefore, a provider cannot assume that the walker a child is using meets safety standards. The American Academy of Pediatrics recommends against the use of walkers entirely due to questions around the safety of the devices. The AAP recommends that when families choose to use a device, they should select one that does not roll (an exersaucer), however, they caution that data on injuries with these devices are not yet available.

    Safety concerns have also been observed with jumper devices that hang over doorways. Concerns related to falls are common. There have also been incidents in which children gained too much momentum and swung into door frames. Generally, devices that remain stationary are recommended over the jumpers over doorways.

    The infamous Bumbo® seat has been recalled several times for safety modifications. Children have been able to tip out of the Bumbo® leading to injuries. The current recommendation is that the parent or caregiver supervise the child in the Bumbo® at all times. Also, children should only be placed in a Bumbo on the floor. They should never be placed in the Bumbo ®on top of a counter, couch, or other surface.

    The impact of these devices on a baby’s development is also concerning. Siegel and Burton 1999 found that babies who spent time in walkers sat, crawled, and walked later than the control group that did not use the devices. In addition, the babies in the walker group scored lower on the Bayley Scales of Infant Development-Mental and Motor, indicating that the devices may not have the positive impact on cognitive development as once thought.  Another study (Kauffman & Ridenour, 1977) showed that children who spent time in walkers were more likely to use abnormal patterns of movement such as tiptoe walking when first learning to walk. However, there are other studies that indicate that the use of walkers provide a child a means of independent mobility that promotes cognitive development through independent environmental exploration (Kermoian &Campos).

    The best place for a baby to learn to move their body is on the floor. There, the baby can learn to use his or her own muscles to initiate movement. Seats that help support a baby in these devices do not require the muscles to work as hard and often place the baby’s hips in a position of excessive external rotation and abduction. In addition, when babies spend less time on the floor, they lose opportunities to perform skills such as crawling that develop trunk and upper body strength.

    When families ask if it is ok to use these devices, always make sure they are aware of the safety concerns around the particular device they are using. It is best for the baby to play on the floor, but if a family’s routines indicate a device is necessary, it should be used in moderation. Parents should also be cautioned about the amount of time a child spends in a seating device such as an infant carrier or bouncer chair as these devices also inhibit a baby’s movement and can impede development. A general rule of thumb is that no more than 15-20 minutes of an infant’s day should be spent in infant devices. What explanation have you used to help parents understand this issue?

    For more information:

    American Academy of Pediatrics. (2001). Injuries associated with infant walkers. Pediatrics, 108(3), 790-792. http://pediatrics.aappublications.org/content/10J8/3/790.full

    Kermoian R. & Campos JJ. (1988). Locomotor experience: a facilitator of spatial cognitive development. Child Development, 59: 908-917.

    DiLillo, D., Damashek, A., Peterson, L. (2001). Maternal use of baby walkers with young children: recent trends and possible alternatives. Injury Prevention, 7, 223-227.

    Kauffman, I.B., Ridenour M. (1977). Influence of an infant walker on onset and quality of walking pattern of locomotion: an electromyographic investigation. Percept Mot Skills, 45, 1323–1329.

    Siegel, A.C., Burton, R.V. (1999). Effects of baby walkers on motor and mental development in human infants. J Dev Behav Pediatr, 20,355–361.

     

    — Jamie Holloway

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    What Does Early Intervention Have to do With School Suspension?

    Early Childhood Interventions April 01, 2015

    Greater, Greater Washington featured an article highlighting the suspension of children from pre-kindergarten classes and how local early intervention and special education services may be part of the solution.

    According to a report from the Office of the State Superintendent of Education (OSSE), 181 children in DC public and charter pre-kindergarten classes were given out-of-school suspensions in 2012-2013. (Note: This is just for certain types of suspensions required to be reported to the federal government. The actual number of pre-kindergarten suspensions was likely much higher.) A similar report from DC Lawyers for Youth found that one DC charter school pre-kindergarten program suspended more than 10% of their students in 2011-2012. Often, children are suspended for offenses like temper tantrums, toileting incidents and other developmentally appropriate behavior for 3- and 4-year olds.

    The Greater, Greater Washington reporter raises the question of whether some of these suspensions may be due to undiagnosed disabilities and special needs. These young children may have significant developmental needs that cannot be adequately addressed by 1 teacher in a classroom of 15 or 20 students unless she is provided with support.

    Ideally, children with special needs should be identified prior to starting pre-kindergarten, through the city’s Strong Start , DC Early Intervention Program or Early Stages, the DC Public Schools Child Find program. Eligible children can then receive supportive services at home and in school. But many children are not being identified early enough or may not qualify for services despite their challenges. Despite expanding the eligibility requirements for the DC Early Intervention Program and increasing access to eligibility evaluations for preschool through Early Stages, many are still unaware of these supports and services for children who have developmental delays or disabilities.

    DC is poised to further expand access to services for young children with developmental delays and disabilities, by lowering the threshold for developmental delay. New legislation will require Strong Start, DC Early Intervention to lower the eligibility requirements and to decrease the evaluation time for determining eligibility for pre-school special education through the DC Public Schools.. While there are some questions about Strong Start DC’s or the DC Public School’s ability to handle the potential influx of newly eligible children, we can all agree that identifying children in need of early intervention services or preschool special education services earlier and getting them the support they need will benefit DC’s children and schools. There are few reasons why a 4-year-old should be suspended, but many reasons why the child and their family may need extra support to succeed in pre-kindergarten and beyond.

    Lindsay Ferrer GU Certificate in Early Intervention Student

    References:

    Rothschild, A. (2014, September 22). Wondering why a preschooler would ever need to be suspended? Here’s an explanation. Greater Greater Washington. Available at http://greatergreaterwashington.org/post/24282/wondering-why-a-preschooler-would-ever-need-to-be-suspended-heres-an-explanation/

    District of Columbia, Office of the State Superintendent of Education. (2014). Reducing out-of school-suspensions and expulsions in the District of Columbia and Public Charter Schools. Washington, DC: Author Available at http://osse.dc.gov/sites/default/files/dc/sites/osse/publication/attachments/OSSE_REPORT_DISCIPLINARY_G_PAGES.pdf

    DC Lawyers for Youth (2014). District discipline: The overuse of school suspension and expulsion in the District of Columbia. Washington, DC. The Every Student Every Day Coalition. Available at http://d3n8a8pro7vhmx.cloudfront.net/dcly/pages/64/attachments/original/1371689930/District_Discipline_Report.pdf?1371689930

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