I am a pediatric occupational therapist, but the bulk of my experience has been in Pennsylvania’s Early Intervention program. Do you know what early intervention (EI) is? I hope so, but I know that many of you don’t. I want to rectify that because if you are living in the United States and have a child under the age of 5 you may qualify for these free services. Each state’s rules and guidelines are a little different, my state is known for their excellent services, but others aren’t so much. One thing each state does have in common is that if your child is 0-3 and has a delay in any area of development, a qualified and licensed speech, physical, or occupational therapist will come to your home to work with you and your child. In our state we also have developmental therapists, which usually have backgrounds in education or development, as well as vision/hearing therapists and social workers. That is pretty awesome, right? Your child has a need, which may be minor, and the state sends someone to your home to help. You don’t even have to drive anywhere! If your child is 3-5, it may not be too late for EI, but the model is a little different. I’ll elaborate more on that briefly.
Okay, so let me back up a little here. Before you get services set up in your home, you will have a developmental screening completed. A therapist(s) will come to your home and basically “play” with your kiddo. This play will be targeted to specific skills as they evaluate if your child is meeting typical milestones for their age. This evaluation or screening is formal though, therapists are following specific tested guidelines. Of course, there is a lot of leeway here, therapists know better than anyone that development varies from child to child. The therapist evaluating will likely ask you a lot of questions as well, to fully understand your concerns and the needs of your child. They will score the evaluation and let you know the results and their recommendations If therapy is recommended, it will be up to you as the parent to continue with services, there is no pressure. Sometimes the screening is completed and your child doesn’t qualify. That is a very quick overview of EI! Now, onto some FAQ’s!
What kinds of things can EI help with?
Generally speaking EI will address any area of development that your child is delayed in, which is determined by the state and screening tool used. In most states, that means (but could include more or less):
- Gross Motor Skills (rolling over, crawling, walking, managing stairs, jumping, climbing)
- Fine Motor Skills (pincer grasp, pointing, puzzles, stacking blocks, coloring, cutting, handwriting, etc.)
- Speech/Communication (following directions, speaking, speaking clearly, participating in conversations, etc.)
- Social Skills (playing with peers, separating from parents appropriately, behaviors such as biting, hitting, headbanging, etc.)
- Daily Living Skills (dressing, using utensils, drinking from a cup, understanding caution in dangerous situations)
- Vision and Hearing..
I want to remind parents reading this list, again, that many of the milestones listed can vary. Also, some of the social skills listed may be age appropriate, some kids go through minor phases of biting or hitting. If you aren’t sure, talk to your pediatrician or call for a screening in your state. Keep in mind that you can call on your own, it’s always a good idea to talk to your doc, but if you have a nagging feeling, I would recommend giving your state a call (I’ll give you a resource for that in a minute.)
What about Feeding and Sensory Processing?
I think this comes as a surprise to most people and I wish I could send a letter to every parent across the US and let them know that YES if your child is having difficulty eating your state probably considers this a delay and will provide EI therapy in your home. Most states provide help for feeding and sensory processing difficulties. As an EI therapist, these are the skills I have worked on the most – hence this blog. Below are some of the common types of feeding and sensory processing issues that are addressed, but this list isn’t inclusive, so if you aren’t sure call and ask!
- Feeding/Eating (picky eating, difficulty transitioning to table foods, food refusal, poor nutrition, low weight, gagging/vomiting during eating, difficulty chewing or swallowing, etc.)
- Sensory Processing (refusing to touch or eat certain textures, crying or discomfort while touching different textures, excessively seeking out movement, dangerous climbing and jumping, poor attention, frequent rocking/swinging/headbanging, difficulty with hair washing or bathing, etc.) *Please note many of these behaviors may be due to other factors, a qualified therapist would be able to determine if there were sensory based.
What are other options for therapy? What if I need more help?
If your child didn’t qualify for services in your state and you want another opinion or still feel like you need help you can consider outpatient services. These services can also be used in addition to EI therapy. Pediatric hospitals and private clinics are just about everywhere now. Medical insurance is accepted at most, but paying out of pocket is possible, but not likely. Make sure you speak with your insurance provider before scheduling an evaluation.
Services for kids 3-5 aren’t available in every state and in the ones that do it is often preschool based. This really varies a lot from state to state, so it’s something you will want to look into. In this case, you may want to consider one of the the other options I described, as school based therapy likely won’t be as regular.
Why do states offer this free* help?
States are required to offer free help for children under the age of 3 because of a law that congress established in 1986 called Part C of IDEA (Individuals with Disabilities Education Act). The act requires states to establish what they consider a developmental delay is and if it puts them at risk for disabilities. Some states have managed to find ways to create minimal fees, but most are free and should be. If you are interested in more information on the law click here because I am giving you the watered down version.
How can I find services in my state?
My original plan was to provide a list of each and every state with all of the needed contact info. But, I Can Teach My Child already took care of it, so I thought… why reinvent the wheel? Click here to check out their awesome and thorough list of phone numbers, addresses, and emails by state. NICHCY is also a wonderful resource.
Still have a question about how this all works? Leave a comment- I will answer! If you have experience with a particular state, PLEASE leave a comment. I would love to have more information about the quality and ease of services in each state, as well as, if any services such as feeding weren’t provided.
One of my twins (2yo) was already evaluated by EI in our state and unfortunately, they do not provide services for sensory OR feeding. He passed all areas with flying colors, which is great, but very clearly struggles with sensory processing and it greatly affects his eating and our family mealtimes. It is so frustrating that they are not able to help, but I really appreciate all of the information you are sharing and for the online webinars that have been SO helpful. Thanks so much for helping us along this journey.
Hi Alicia! Thank you for reaching out! We are so glad you’ve found our resources helpful! If you havent already, check out our free sensory workshop! Please let us know if you have any questions.
Best,
Kalyn
Hello,
Three-year-old my nephew just consumes baby fruit pouches of one sort (banana and strawberries) and refuses to eat any solid foods. I’ve tried to mash up food for him with the help of his mother, but every time it hits his mouth, he vomits. Now, all he eats is strawberry yogurt, 2% milk, and occasionally, if we’re lucky, apple sauce. Due to the fact that he has always been a picky eater, his mother is concerned about his condition. He currently attends daycare, but he doesn’t consume any food there. And he consistently feels more exhausted than other kids. We’re anxious and out of ideas, so if you have any advice, please share.
PS: His mother has four other children, and none of them were like this.
Hi Hawo! Thanks for reaching out! We know how stressful eating issues can be. Due to his age, we definitely recommend consulting with his pediatrician if possible, since they can refer you to a feeding therapist for some hands-on help. Since he’s still stuck on purées, he may need help with chewing/swallowing. In the meantime, practice with some sensory and oral motor exercises by using sensory bins, food play, and allowing him to touch/feel/play with his food. Try using a toothbrush to brush the insides of his mouth before mealtimes— this can help work those oral muscles and also desensitize his gag reflex. Other oral motor exercises include making silly faces, blowing bubbles, sipping from straws, and licking lollipops/popsicles. Try food play, where you have him feed you or feed a doll/toy. We also have a free workshop that can help more with eating solids- save your seat here!
Best,
Kalyn
My son just turned 21 months and does not eat. He touches and smells food then leaves it or throws it. The only food he likes are apples. He’s not underweight because all I do is trying to put at least bite in his mouth. He won’t have anything- no bananas , meats, breads, potatoes, no eggs , no pasta or rice . Sometimes he’ll eat 2 spoons of couscous.his pediatrician is focused on percentile and says he’s ok despite my struggles. I had tried everything and still do. Like leave him 7-8 h without food just water then let him pick from many options i make but he just looks at the food and smells and won’t eat it
Hi Sanela! Thanks for reaching out! Ask your doctor if they can refer you to a feeding therapist that can offer some hands on help. In the meantime, try using some sensory activities and oral motor exercises to help with the sensory sensitivities and oral muscles that work to chew/swallow. With food, the main thing will be to keep offering without any force or pressure. Allow him to touch/feel/play with his food and different textures. For more in-depth tips, definitely check out our free picky eating workshop— save your seat here!
Best,
Kalyn
Hi,
My bay is 14 month old and she has difficulty in feeding/eating. She has pretty much all the symptoms that you mention above: difficulty transitioning to table foods, food refusal, poor nutrition, low weight, gagging/vomiting during eating, difficulty chewing or swallowing.
We still spoon-feed puree food to her because she does not like lumpy or chunky food, she would gag or spit out. She can chew on food but does not swallow, she will spit it out and chew again and eventually swallow.
When I practice her to eat different food (watermelon, green bean, broccoli) she will squeeze the food really hard, play and throw them away. If she put them in her mouth, she spits them out right away. The amount of food that she self feed is very little, we have to give her extra puree food to make sure she gets enough nutrition.
I am not sure what to do next, is it too late to train her to self feed and eat proper amount of food?
Hi there! Thanks for reaching out! Due to her age and issues regarding her weight and eating, we strongly encourage consulting with your pediatrician, who can potentially refer you to a feeding or occupational therapist for some hands-on help! In the meantime, it sounds like she needs more help with chewing and swallowing. Oral motor exercises can help with this. Try using a toothbrush to brush the sides of her mouth + tongue a few times per day- this will help to desensitize her gag reflux. Allow her to touch/feel/play with her food and different textures. For more help, check out our free table foods workshop- save your seat here!
Best,
Kalyn