A main priority of ours at C&FD, is taking a multidisciplinary approach to treat the whole child. By providing comprehensive and integrated services, we are able to support our clients and their families with efficiency. Parents and caregivers often have many questions about their child’s development. Throughout the month of November, our therapists will answer commonly asked questions and share ideas for supporting development in a number of areas.

Q: Why does my toddler have “flat feet?”

By: Abby Morton, DPT

Does your little one stand with his or her feet turned out? Does he stand with a wide step width? Do his ankles look like they are falling in? Are his feet flat with no arch? Is he a loud walker with a “slapping” sound? Pending your child’s developmental patterns, age and how long ago he learned to walk, this all may be normal.

A typically developing foot begins flexible and appears to be what most recognize as “flat feet.” Early on, the foot does not have a true arch or stable posture. As a child begins to put weight on the feet with walking, the foot responds with bone development, structural support, and musculature growth. This development typically takes about a decade of walking and growing to develop a mature posture.

So, yes, your child may indeed have a flat looking foot! Typically, intervention is not recommended unless it is functionally impacting the child – think, tripping, falling, ankles are unsteady, drags feet, delays with walking or running mechanics – or the flat foot posture continues beyond 8-10 years of age.

Q: Why is my child’s writing so messy?

By: Sam Develli, OTR/L

For adults, handwriting seems like it should be so second nature. However, for our children, there is so many factors that contribute to producing legible and effective writing. Beyond the academic concepts of knowing letters, spelling, and grammar, there are many physical and cognitive components that also contribute to success with handwriting! When we see children with illegible handwriting, we consider many, many factors. These include vision, perception, motor planning, hand strength and range of motion, pencil grasp, in-hand manipulation, attention, motivation, sensory functioning, and executive functioning. So the short answer is, it depends. And it could be a combination of several factors. So consider if this is limited to handwriting, or if difficulties are observed in a variety of activities (think self-feeding, dressing, playground play, using two hands spontaneously in play, yoga poses, reading, cutting/folding paper, and overall coordination.

A few milestones to note with handwriting:

• Early, primitive grasp matures from
  • gross, fisted grasp with the thumb and palm facing up and movement from shoulder around 12 months (palmar supinate)
  • grasps pencil in fingers rather than palm with palm facing downward around 24 months (digital pronate)
  • 3-finger grasp from fingers but movement still coming from shoulder/arm around 3 ½ years (static tripod)
  • 3-finger-dominated pencil grasp with open space between thumb and first finger and movement occurring from wrist down around 6 years old (dynamic tripod)
  • However, grasps are extremely child-dependent and depend far more on legibility and the ability to sustain writing without tiring.
• Writing progresses from
  • scribbles at 12-18 months
  • drawing simple figures at 18-24 months
  • tracing forms like a cross and drawing circles around 24-36 months
  • coloring within lines and copying simple shapes around 3-4 years
  • drawing stick figure and copies own name around 4-5 years
  • copying triangle and letters around 5-6 years
  • good hand dexterity and bilateral coordination by elementary school years
• We have a saying in the therapy world… proximal stability = distal mobility. Essentially, this means that a child must first develop good muscle strength and coordination in their trunk and core in order to effectively coordinate and utilize their distal extremities (i.e. hands and feet).

Q: What is the difference between speech and language?

By: Kelly Conner, CCC-SLP

Speech language pathologists work on a variety of different skills, but two of the skills we are most associated with are “speech” and “language;” it’s in our name after all. Many parents wonder what the difference is between speech and language, or believe it is the same thing. These are actually two very different things.

Speech is the actual production of sounds when talking, or how we produce sounds and words. Producing speech is a complicated process that involves using your voice, tongue, jaw, lips, teeth, and other structures to form the words that you speak. Speech therapy can address helping people with articulation so they can produce sounds more clearly, and be better understood by others. When working on speech we often work on “target sounds.” Speech also includes voice and stuttering.

Language is more about the meaning behind words and how we use them to share ideas and communicate with others. The American Speech Language Hearing Association (ASHA), describes language as:

• What words mean. Some words have more than one meaning. For example, “star” can be a bright object in the sky or someone famous.
• How to make new words. For example, we can say “friend,” “friendly,” or “unfriendly” and mean something different.
• How to put words together. For example, in English we say, “Peg walked to the new store” instead of “Peg walk store new.”
• What we should say at different times. For example, we might be polite and say, “Would you mind moving your foot?” But, if the person does not move, we may say, “Get off my foot!”

Language is also broken into two main parts.

• Receptive language refers to a person’s understanding of language. It includes:
  • Following directions
  • Understanding/answering questions
  • Being able to follow stories and understand what someone else is saying
  • Receptive vocabulary and being able to understand what words mean and being able to point out objects
• Expressive language refers to the output of language or what we say. It includes:
  • Verbal output and number of words a person speaks
  • Grammar and word order
  • The ability to use different beginnings and endings to change the meaning of words
  • Expressive vocabulary and being able to tell you what objects are.

Of course most parents have so many questions, but these are some of the most common we SLPs get from parents. We love to hear your questions and help you better understand your child’s speech and language development. We also love to talk about what we do and provide suggestions for home. One thing that is important as a parent is to understand typical language development, so you know if your child may need extra support. If you are concerned about your child’s speech and language, please reach out. You can contact your child’s primary care physician for help locating an SLP, or find one on your own. We can evaluate children to determine speech and language functioning and potential need for therapy.