How Long Should I “Wait & See”?

It is still common practice for pediatricians to tell parents to wait and see before seeking a speech and language, occupational, or physical therapy evaluation.  After all, there is a wide-range of normal, and many children just need a little more time.  Pediatricians don’t want to alarm parents by unnecessary referrals to therapists, ENTs, and audiologists.  However, there are many children that slip through the cracks with a wait and see approach and many lose valuable time, further widening the gap.  Specific groups of children that often miss out on early referrals for evaluation include children with persistent, non-infected, middle ear fluid, girls on the autism spectrum, and children with sensory processing disorder, but there are many more.  The later children receive services, the further the gap may become.


The Center on the Developing Child at Harvard University has found, through decades of research, that 1, 2, 3:

  • The neural circuits in a child’s brain are most flexible or “plastic” during the first three years of life.  After this period these circuits become more difficult to change.
  • Early intervention services, those received between the ages of 0-3 years, that are high-quality and evidence-based can alter a child’s developmental trajectory and improve outcomes for children, families, and communities.
  • Intervention is likely to be more effective and less costly when it is provided earlier in life rather than later.


If you are concerned about your child’s development of speech, language, feeding, sensory, fine motor or gross motors skills, please see the following checklists.  We recommend printing and completing these checklists and bringing them to your pediatrician to discuss your child’s development.  You and your pediatrician can work together to find services or to set a timeline to “wait and see” that you both feel comfortable with.


CDC Milestones from 2mo to 5 years

Infant Toddler Connection of Virginia’s Developmental Checklist

MCHAT- If your child is between 16-30 months and you are concerned that your child may have Autism, take the MCHAT screener online or print and bring to your pediatrician. It is available in many languages.

More resources can be found on our website.


  1. Goode, Diefendorf, & Colga. The National Early Childhood Technical Assistance Center.
  2. Center on the Developing Child at Harvard University (2008). In BriefThe science of early childhood development.
  3. Center on the Developing Child at Harvard University. (2010). The foundations of lifelong health are built in early childhood.

Engaging Children’s Books for Ages 0-5

Welcome to our list of favorite engaging, language-rich children’s books! Before we begin, here are some tips on how to read these books (or any book) with your child:

  • Read with emotion and inflection! Get excited, quiet, and loud!
  • Read face to face so your child can see your mouth, eyes, and facial expressions.
  • If your child has difficulty sitting for books, read when your child is in the high chair, car seat, or stroller.
  • Add your own words. Sometimes the text is too wordy and loses your child’s interest. Sometimes the text is too brief and can be expanded upon. Improvise!
  • Don’t drill vocabulary. Being able to name or point to pictures like “house, car, dog, and ball” is only one small piece of language. Reading engaging stories that have emotion, repetition, adjectives, problem solving, and rhyming will have a larger impact on your child’s language development than vocabulary alone.

1. Peek-a Who? By Nina Laden

Peek-a Who? Is a sweet beginner book that has a surprise behind each page, all while working on simple sounds like whoo, moo, & choo choo!

2. All Better By Henning Lohlein and Bernd Penners

This interactive book comes with durable reusable stickers that look like Band-Aids. When the animals get a boo-boo, your child comes to the rescue to clean it, kiss it, and put a Band-Aid on it. Through playful repetition, this book can be used to work on problem solving, sequencing, and prepositions.

3. Little Bear Needs Glasses By Bernd Penners

This book is just like All Better, except the animals have glasses instead of Band-Aids. Can you help Little Bear find a pair that fit him? This book can be used to work on problem solving, colors, and size.

4. That’s Not My Snowman… By Fiona Watt

These touchy-feely books are great first books that keep your infant or toddler’s attention and grow with them, introducing adjectives like sticky, bumpy, shiny, and more!

5. Brown Bear, Brown Bear By Eric Carle

This classic book should be on every shelf in every house! Practice colors, animals, and filling in the words to this repetitive sing-song book. We also love Carle’s Polar Bear, Polar Bear and Panda Bear, Panda Bear, and The Very Hungry Caterpillar.

6. Boynton’s Greatest Hits By Sandra Boynton

You’re sure to find a Boynton book you’ll love to read over and over again. Filled with animal sounds, repetition and a often a song, Boyton keep even the busiest toddler’s attention.

7. Dear Zoo​ By Rod Campbell

This classic lift-the-flap book uses repetition and surprise to keep children engaged.

8. Where is the Green Sheep By Mem Fox

This is a great book to work on opposites like near, far, thin, wide, and actions all while searching for the elusive green sheep!

9. The Cow Loves Cookies By Karma Wilson

The author of the Bear Wants More series bring you an endearing story full of rhyming and repetition.

10. If you give a Pig a Pancake By Laura Numeroff

One of many books in this series, this book is wonderful for making inferences (what will happen next?), talking about emotions, and action words.

Want more ideas? Ask your child’s therapist for suggestions to help target their specific speech or language goals.

Little Hands Pediatric Therapy Holiday Toy Guide 2018

Looking for the perfect children’s gift this holiday season? Little Hands Pediatric Therapy has you covered! Check out our therapists’ top picks below, including the skills that it can work on and how we play with it.

Speech-Language Pathologist, Kelli Atangan’s Pick:

Toy: Veterinarian Kit 

Works On: Pretend play, following directions, emotions, early language skills, preschool language, asking questions, and more.

How We Play with It: Toddlers through preschoolers will enjoy this open-ended toy set. Practice early language skills using 1-2 words like “open, more, night-night, boo boo, all-better”. Bring your other stuffed animals and practice animal sounds (moo, woof, meow) and environmental noises (beep, mmmm, weee). Play with a grown-up or friend and take turns asking questions and following directions. Is the puppy sick? He must feel sad. Now he’s all-better. How does he feel?


Occupational Therapist, Katelyn Black’s Pick:

Toy: Squigz

Works On: Fine motor/hand strengthening, color recognition, matching, direction following, forming shapes and letters, the list goes on!

How We Play with It: These are most commonly used by suctioning them to any flat surface (windows, doors, hard surface floor) and pulling them off. You can also stick them to each other! I have used them in many different ways, anywhere from creating “road ways” for obstacle courses, to finding them inside a sensory bin and sticking them to the window before pulling them off.


Speech-Language Pathologist, Amanda DeAngelis’ Pick:

Game: Race to the Treasure

Works On: Cooperative play, taking turns, articulation (“th” in “path,” “r” in “ogre,” “k” in “key,” among many others!), executive functioning, problem solving, letter and number identification (A-F, 1-6), expressive language

How We Play with It: My kids just love this game! We work hard at beating those dreaded ogres to unlock the treasure. This is a really great game to learn that playing games can be fun, whether we win or lose. Players work in a team so it’s an all or nothing kind of game. It really makes kids think about the best way to get from point A to B (executive functioning) and it’s great to talk about what we could have done differently if we lose the game to the ogres (problem solving). We talk out the actions as the game progresses (expressive language) and always use our best sounds when doing so (articulation)!


Occupational Therapist, Kristina Wilk’s Pick:

Toy: Lite Brite

Works On: Creative way to work on fine motor coordination, in – hand manipulation, sequencing, visual motor and visual processing skills.

How We Play with It: Build pictures that light up! You can use templates to make pictures, follow a pattern, and make letters or use your creativity and make your own design. More than one player can use this toy to work on social interaction skills such as turn taking. This old classic is still a lot of fun!


Speech-Language Pathologist, Angie Cloud’s Pick:

Toy: Food toy sets and sandwich sets

Works On: Imaginative play, following directions (especially sandwich), category knowledge, naming, cooperative play

How We Play with It: Child can decide to make a meal or even a picnic by him/herself or with a peer or adult. Food items can be what they are meant to be or something similar (ex a circle bread can be a cookie even!). The child can exercise control over what he/she chooses to make and “eat”. If playing with someone else he/she can participate in teamwork to make items or set a “table”. While playing with your child you can describe and/or categorize foods by type/group, color, taste, or whatever you want! You can even practice giving directions verbally or by making “recipes” to follow. Skills practiced in food play can carry over into helping make real meals! Playing with toy food can, in some cases, help picky eaters become more comfortable with new and different foods.


Occupational Therapist, Lindsay Borda’s Pick:

Toy: Hippity Hop Ball

Works On: Helps improve core stability, body awareness, and balance.

How We Play with It: The hippity hop ball’s sole purpose is for sitting on it, grasping its handle and hopping around, however, you can do many different things with this ball! The ball can be:

*used to hop around an obstacle course using pillows/cushions/chairs, etc.
*used as a chair when coloring at a table, watching t.v., reading, etc.
*you can roll over the ball on your tummy, push off with your feet and stop yourself with your hands on the floor, rocking back and forth.
*you can have someone roll the ball over your back, arms, and legs providing calming deep pressure and body awareness
* you can sit on the floor, reach hands back for support, raise your feet and kick the ball to a partner using both feet to work your core.


Speech-Language Pathologist, Gillian Lavigne’s Pick:

Tool: Chewy Tube (yellow, red, or green)

Works on: All kinds of feeding skills – chewing, biting, oral-facial stimulation, straw drinking. If you already have one from therapy- below are some new ideas for it!

How We Play with It: Place it on the molar area to promote chewing; dip it in something cold, sweet, sour, spicy and chew it, taste it, lick it, suck on it; tap it on your lips, cheeks, tongue, teeth for to improve sensory skills; work on correcting swallow postures & oral control by pretending to be a dog holding a bone and play tug of war! But no drooling doggy!; blow through the end of it to make it whistle, then suck something up with it, while working on straw drinking!


Occupational Therapist Brittany Simco’s Pick:

Game: Stack Up by Peaceable Kingdom

Works On: Fine motor skills, motor-planning and coordination

How We Play with It: This game one of my favorites to get kids playing together. It is a cooperative game, kids play as a team to build a block tower using a small dowel with a peg. This takes teamwork and coordination to complete and they are often tasked with simultaneous motor actions (sing Happy birthday while stacking, hold one hand in the air while stacking with your other hand). Lots of fun for kids to work together, practice coordination and fine motor skills to build the tower before “stack smasher” knocks it down. Peaceable kingdom makes great kids games, other favorites include Sneaky Snacky Squirrel and Sophie’s Seashell Scramble!


Speech-Language Pathologist, Katie Egan’s Pick:

Toy: Legos

Works On: Colors, matching, prepositions, fine motor skills, problem solving

How We Play with It: Legos can be used by preschoolers through school-age children. Work on following directions and prepositions: “pick up, put on, put next to, touch color, stack, look for a…”. Sort by color, size, and shape to work on descriptive vocabulary. Write letters on single blocks to work on building simple words. Add prefix or suffix to build bigger more complex word. Also a way to introduce letter pairs or welded letters. Pacing boards for smooth speech or increasing utterance length- tap on one lego per word or syllable.


More ideas for play with a purpose! Stocking Stuffers:

Learning Resources Jumbo Tweezers Set Of 12

Crazy Aaron’s Thinking Putty

Spot It

Story Cubes


Should My Child Be Able To Say The __ Sound?

Speech-Language Pathologists (SLPs) hear this question daily. Should my three-year old be able to say the /g/ sound?  How about the /r/ sound?  Speech sound production is only one piece of the equation.  In order to decide whether a child is “on track” with his or her sound development or needs remediation, we must look at several areas:


1.   Sound Productions-The chart in our resource section HERE shows when 85% of children can produce certain speech sounds at the beginning, middle, and end of words. Some children will develop sounds much sooner than this chart and many will be later.  A wide range exists with sound production.


2.   Phonological Processes-A child may be able to produce sounds, but does not use them all the time.  For example, a common process for young children is called final consonant deletion (FCD).  In FCD, a child may say “boa” for “boat”, and “da” for “dad”.  The chart in our resource section HERE breaks down all of the phonological processes by age.


3.   Intelligibility-This is how well your child is understood by both familiar and unfamiliar listeners.  This can be measured in words, sentences, and conversation.  A typically developing 4-year old should be 100% intelligible, but may still have sound errors.  According to Coplan & Gleason, 1988 and Flipsen, 2006, To an unfamiliar listener, children should be 25% intelligible at 1-year of age, 50% at 2 years of age, 75% at 3-years of age, and 100% at 4-years of age.


4.   Hearing-If your child has not had a recent hearing screening, we will highly recommend getting one.  Most pediatricians and pediatric audiologists can perform screenings.  Speech sounds fall along a spectrum of frequencies from around 200-4500Hz and a slight dip in hearing ability at one or more frequencies can impact the child’s ability to hear, and thus produce, those sounds.


A licensed Speech-Language Pathologist will be able to properly assess your child’s sound productions, phonological processes, and intelligibility and determine if therapy is necessary.

In-Home & In-School Therapy Sessions

One of the great opportunities we have at Little Hands Pediatric Therapy is that we can provide services in the child’s natural environment, be that at home, at school, or in the community. Therapy that takes place in natural environments utilizes the child’s daily routines, materials, and considers their cultural differences.

Below are some examples of skills we may work on in different environments:

  • For a child working on feeding skills such as expanding their diet, we may provide feeding therapy at home in the child’s kitchen. This allows the child to help prepare foods that the family would typically eat and try them at their own kitchen table with parents or caregivers, just as they would at mealtimes.
  • For a child working on fine motor skills or visual-motor integration, we might see them at their pre-school or private elementary school where they are having difficulty with play or writing tasks. We will work with the teachers, giving them strategies and suggestions for accommodations for the child.
  • For a child working on sensory processing skills, we may see them for some sessions at home, others at school, and others in the community. We may run errands with the family and help them navigate challenging transitions.
  • For a child working on early language skills, we may see them at home with their parent or caregiver and work on requesting their toys and snacks, pointing to pictures in their books, and following their routines.

As you can imagine, young children who receive therapy in natural environments may generalize those skills more quickly. The child working on feeding be more apt to try the food again once the therapist leaves, since they have ate it at home once before. The child working on fine motor skills at school will continue to practice with the same materials and support all week. The child working on sensory processing will continue to practice skills while moving through all environments each day. And the child working on early language skills will be able to practice strategies learned with their own toys, snacks, and books all week long.

Back to school tips Sensory Integration Disorder

Back to School Tips for Children with Sensory Integration Disorder

Reduce anxiety and create smoother routines with some routine adjustments!

  • Create a Schedule – And stick to it! Make a visual schedule using images and colors and print many copies. Keep one in the kitchen pantry, the mudroom and their room. You will be surprised how often they check it. Some parents find one schedule for the school day and one for after-school activities is best.
  • Prep the night before – Clothes, lunch, backpack, library books, water bottles, etc. If you know clothes or shoes are the trigger than have multiple choices available. If mealtimes are difficult, have a set menu for each day of the week posted.  Preparing for the melt-down before it happens will save you time and stress.
  • Talk – Tell your children the night before what to expect the next day. Talk during breakfast about what the day will look like. Discuss anything you know might create anxiety when they hear a word like party. Talking with help alleviate concerns and help them feel prepared to face the day.
  • Sleep – The most important part of the puzzle! Start the new sleep schedule a week before school starts with 15-minute increments getting you to the school year bedtime. No screen time 1 hr. before bed. Give enough time for bedtime routines and some complaining and water breaks! Stay patient.. this task requires a lot of parental patience but is worth it.
  • Communicate – If your child had a rough night of sleep or a difficult morning, let his teacher know.  Sometimes a few extra minutes of a calming activity upon entering school can make a big difference.

speech therapy advice for parents

What Our Parents Say They Wish They Knew…

What our parents say they wish they knew before they started speech:

  • Your pediatrician might tell you to wait and see, but if you feel something isn’t right, have your child evaluated by a speech language pathologist.  It is easier to close a smaller gap than a larger one.
  • Don’t wait on the school system to pick your child up for speech. If it isn’t impacting their education and academic performance, the school is not required to provide services.
  • Participate in therapy sessions and learn from your therapist! Be prepared as a parent to do daily speech practice with your child in a creative way. Get the whole family involved and make it fun!
  • Speech therapy takes time.  Every child is different and some need more time than others to reach their goals.
  • There will be ups and downs along the way. Stay focused on the goal and use incentives (rewards, charts, toys, etc.) to keep your child interested.
  • Don’t under-estimate the social impact your child might be dealing with if their peers and teachers can’t understand what they are saying.
  • Know that you can help shape the goals for therapy. The speech therapy process is a collaborative one between families and the therapist.

What does occupational therapist do

What does an Occupational Therapist do?

Pediatric Occupational Therapists (OT) help children gain independence while strengthening the development of fine motor, sensory motor, visual motor, and feeding skills needed to function and complete daily routines.

Occupational Therapists address the following areas:

  • Fine Motor Skills: grasp and release toys, button clothing
  • Gross Motor Skills: Core stability
  • Visual-Motor Skills: hitting a target, batting a ball, copying from a blackboard
  • Handwriting: letter formation
  • Self-Help Skills: bathing, getting dressed, brushing teeth, feeding themselves
  • Sensory Processing & Self Regulation
  • Feeding & Swallowing

At Little Hands Pediatric Therapy, our occupational therapists work with children as young as one month of age through the teenage years, with most of our clients falling between 1-10 years of age.  Our OTs work the child and the family during home visits, and the classroom teachers during school visits.  Parents actively participate in sessions so that they can carryover techniques at home.

How the process works: 

Our office manager Kimberly will complete your intake and match you with a therapist that would be a good fit for your child.  One of our occupational therapists will come to your home and complete the initial assessment with you and your child. Often parents are asked to complete a Sensory Profile during the assessment, to give the therapist more insight into the child’s sensory processing.  Based on the child’s age and areas of need, the therapist will give a standardized test and observe the child during play and daily activities. After your child’s evaluation, the therapist will write a written report for the family, which includes recommendations and a treatment plan.  An evaluation is a starting point and a snapshot of the child’s performance from that day.  While we use evaluations to begin therapy and measure outcomes, we are constantly making informal assessments and adjusting our treatment plans accordingly.

How long a child needs occupational therapy depends on many factors including diagnosis, behavior, frequency of services, supports in place at home and school, carryover of techniques.  Families who regularly receive occupational therapy services and embrace a team approach between home and school, may make gains more quickly.

speech language delays

Bilingualism & Speech-Language Delays

By: Amanda DeAngelis, MA CCC-SLP
Bilingual Speech Language Pathologist

Q: If my child has a speech or language delay, should I only speak one language so I don’t confuse him?

 A: No. Exposing any child to more than one language at a time will not confuse them. It can make them that much more able to process information. 

Key points!

  • PEOPLE: It is suggested that specific people keep to a specific language. So if Mom’s native language is Spanish and Dad’s native language is English, then each parent could keep to their native language.


  • NATIVE EXPOSURE: Try to speak to your child in your native language and/or the language you feel most comfortable in so they have the best example of the language possible.  So if Mom’s native language is Spanish and Dad’s native language is English, then each parent could keep to their native language. The ability to acquire a language in a native manner is particularly available to us before the age of 7.


  • LANGUAGE: Bilingual children with delays can adapt more than we give them credit for and are often able to sort out which language is used when. It just may take some extra time for us to see this result.


  • FAMILY: If a child has a language delay and seems to have a difficult time acquiring language, down the road, you might regret not giving your child the opportunity to speak to a large part of their family. The issue of the possibility of “confusion” is a myth. There are plenty of individuals who have learned to speak more than one language even with an underlying disorder.


  • MULTIPLE WORDS:Exposure to two languages in a simultaneous fashion will often lead to a child having two words for one object. For example, they may see a dog and know to call it a “dog” or a “perro” depending on their audience. They quickly learn to code switch so that they can speak to different people. Sometimes bilingual children take a little longer to speak their first words, but this is not always cause for alarm. However, if you are concerned or suspect that your child may be delayed, it is advised that you consult with a licensed speech language pathologist to rule out any underlying difficulties that could be impacting your child.


  • TESTING:A bilingual child tested on monolingual norms-based standardized tests will often appear behind their peers. Yet, their vocabularies are increasing at a similar rate and are just not able to be measured the same by a monolingual test.

Summer Travel Tips!

Have a long car trip planned this Summer? This is a great opportunity to strengthen Speech and OT skills!  A little planning will go a long way!


Fill a plastic pencil box with small items!

  • Our favorites are little erasers that look like food and animals
  • Play Guess What?! Have your child describe the new items to you and you guess what they are! Ask questions: What does it feel like?  How big is it?  What color is it?  What does it taste like?  Switch roles and have your child ask you the questions and guess!
  • Sort the toys into categories like fruits, vegetables, things you can ride on or animals. Or classify them by color, shape, use – the conversation is endless!
  • Buy two of each item.  Using only their sense of touch, have your child close their eyes and feel around in the box for a match.  Describe how the object feels in their hands.


Fill a plastic pencil box with Sensory items like a squishy, finger trap, Jacob’s Ladder or tangle. This is also a great box for any child to bring along to dinners out.


Fill a plastic box with a tennis ball with a slit, beads, pom poms, and clothespins.

Hungry Tennis Ball:

This activity helps improve hand and finger strength.

  • Carefully use a knife to create a slit in the tennis ball.  Then let your child decorate a face using the slit as the mouth and give the tennis ball a name. Have your child squeeze the tennis ball so the mouth opens up.  To make it fun, play puppets or have your child pick up small items (e.g. cotton balls, marbles, dry pasta, etc)

For an added challenge:

  • Count how many seconds your child can hold the mouth of the tennis ball open or how many items they can get before they get tired.  Try to beat the record from the day before!

Helpful Hint: The smaller the slit the harder it will be to squeeze the “mouth” open.  Start with a 1 1/2” inch slit and make it bigger if your child is having difficulty.

Clothespin Numbers:

This activity helps improve hand and finger strength.

  • Write the numbers 1-10 on index cards.
  • Using thumb and pointer finger, pinch clothespins open and attach to cards.