Okay, What is Heavy Work Again?

If you have had any interactions with a pediatric occupational therapist you have definitely heard the term heavy work. Heavy work is a term occupational therapists use when a child needs more physical exercise or input into their body, not necessarily because they are out of shape or weak, but because their body either craves it more than others or needs the input to help keep their body and sensory system calm and regulated. 

Do any of you watch Jane the Virgin? Her son, Mateo, was recently diagnosed with ADHD and the tried to implement “heavy exercise”, as they called it, to help his focus.  I believe what they were referring to was heavy work!  Which can actually be really helpful for kids with ADHD, the trick is to find heavy work that is motivating for the child.

So what is heavy work actually?

Heavy work is proprioceptive input, or input into your muscles and joints. You receive input when a muscle contracts (like a bicep curl), a joint compresses (the bones in the joint are pushing into each other) or a joint distracts (the bones in the joints are being pulled away from each other). As you know, you have muscles and joints all over your body, so there are a lot of options for heavy work.  In my experience, the best and most calming heavy work or proprioceptive input is when the upper body is involved. So maybe that is why Mateo didn’t see a lot of progress with running?  Heavy work should be completed when the child is already somewhat calm, do not wait until a meltdown occurs, because usually a child will not comply. Heavy work can positively impact the serotonin in your brain, release oxytocin and endorphins into the brain that positively impact how you respond to stress.

The main idea is to push, pull, lift, drag, or climb EVERY DAY. Here are some fun ways for a child get heavy work:

  • Fill a laundry basket with clean clothes and have the child follow you by pushing the laundry basket around the house and help you put the clothes away
  • Fill a play stroller or grocery cart with a couple bags of dried beans or cans of food to add extra weight and have the child push it around.
    • Bonus points for turning this pushing activity into an obstacle course or pretend play grocery shopping
  • Allow your child to help carry groceries inside, in fact, have them push the grocery cart at the store.
  • Take the garbage out
  • Fill a wheelbarrow full of rocks found in the yard and push and dump the wheelbarrow into a pile across the yard
  • Animal walks. My favorites are crab walks, worm crawl, backwards bear walks, wheelbarrow (not an animal), and donkey kicks – anything that puts a lot of weight into the hands and shoulders.
    • Example: Bear walk to breakfast, crab walk to get dressed, worm crawl to the door to go to school!
  • Pretend you need help getting into the house and have your child push you. Make it a little more difficult than it really is by resisting their push slightly. 😊
  • Some of my favorite community heavy work activities are gymnastics, swimming, rock climbing and parcore
  • Get a heavy and large bean bag (this one is AMAZING! and this one is more budget friendly) and hide balloons under it. Request one balloon at a time so they have to lift the bean back multiple times. Once they retrieve it have them pump it up using my favorite balloon pump. Then watch the balloon fly (this part is just for fun). Repeat until all the balloons have been found.
  • Play yoga bowling! Put a yoga card (I like yogarilla cards and yoga pretzel cards) under a bowling pin and roll a weighted ball to knock them down. Each time a pin gets knocked over you do the yoga pose under the pin!
  • Get out Mr. Potato head. Put all the pieces on one side of the kitchen table (on the floor) and sit at the other side with the potato part (also on the floor).  Have them army crawl to under the table get each piece, one at a time, until complete.
  • OBSTACLE COURSE. Make an American Ninja Warrior Course OR do something ridiculously simple. Kids LOVE rescuing stuffed animals (. Hide them or put them somewhere difficult to reach (under that heavy bean bag, on a top bunk bed, under a couch cushion, wherever). A simple obstacle course would be to crawl through a tunnel (the secret passage way), save the animal, then crab walk with the animal on their stomach (they can pretend to be a car), and then put the animal to bed so it can rest from the adventure. OH NO! The bear is stuck now! I feel like 4-6 is usually the magic number for repetitions.
  • Shucking corn before dinner!
  • Play don’t touch the floor and make it so difficult that arms have to be used to keep their balance and not fall. I love using these for this game!
  • Turn Candy Land into a heavy work game.  Each color is assigned a yoga pose or animal walk.  In order to move your player piece you have to complete the pose or walk for 10-20 seconds. Elementary aged kids love this. And yes, you have to do the poses too!

Do you have a favorite upper body heavy work activity? Please Share!

Screen Time is Okay…Sometimes!

Don’t worry. I am not going to tell you to get rid of screen time (television, cell phones, tablets, computers, laptops, video games, handheld video games).  I am however going to give you some tips to decrease screen time if needed and make sure the screen time in your home works for your family and still allows time for play, exercise, family time, sleep and social interaction.

In 2016 The American Academy of Pediatrics (AAP) released updated screen time recommendations to help families maintain a “healthy media diet”. The gist of it is:

0-18 months: No screen time besides video chatting
18-24 months: Adding small amounts of quality screen time while accompanied by an adult
2-5 years: Less than 1 hour of quality screen time per day co-viewed with a parent to explain what the child sees and how to apply it
6+ years: Create limits that work for your family and be consistent in the limits and expectations.

Important things to remember with screen time, as recommended by the AAP:

  • Make sure screen time does not interfere with sleep, physical activity, or other activities/routines essential to health
  • Create designated media free time (such as meals or driving) and media free locations (such as bedrooms)
  • Have ongoing conversations about online screen time including online safety and treating others with respect online and offline
  • Choose quality screen time that is educational, such as shows on PBS
  • Avoid screen time one hour before bedtime

The AAP does not state this, but I would like to note that these screen time recommendations are stated for children of all abilities.  Screen time limits do not apply if a child uses a communication device.  This is the child’s voice and time spent using this should not be limited!

The AAP has created an awesome online tool (in Spanish and English) to help families make a media plan for each family member as well as a media calculator.  I highly recommend going through the online tool and if you don’t intend to use the tool, it will at least give you a couple of ideas to carry over at home.  I completed it for my 15 months old and selected the age range 18-24 months.  It gave me great ideas on how to organize screen time for when he gets older.

Disclaimer: I do admit, I allow my son to watch an Elmo show in the morning every now and then, because those blessed 15 minutes give me a little extra time to wake up before I have to move at full speed ahead to keep up with him.  While I feel like I should probably not allow him to watch this, I feel good about my choice because I’ve seen the episodes that play so I know what he is watching (since we watch them on repeat) and he gets no screen time other than this. This means the TV is off anytime he is up (98% of the time) and he does not play with my phone (unless he digs it out of my purse while I’m not looking!).  I do know that when he gets older it is going to be hard not to use the television, especially when he drops his last nap! This is one reason I want to stay up to date on what the AAP recommends!

Setting limits on when and where screens are allowed can be very helpful! It is one thing to know what screen time recommendations are, but putting that knowledge into practice can be much harder. I know many families who have fallen into the routine of using screen time all the time to help them catch their breath or get things around the house done.   It can easily get out of hand and become part of your daily routine to have screens in use all day or the entire evening after school. As I recently told a family, screen time is one area where “free range” is not a good thing.  On a random occasion, I don’t think there is anything wrong with some extra screen time – such as on a flight, a long road trip, or when the family is under the weather.  Just don’t let this be the norm for daily life. I also think there are situations that might call for more screen time on a daily basis than is recommended, such as if your child has a long hospital stay, healing time from surgery or other situation that really gives you no other options.  In this case I would try and watch educational shows when possible and continue having ongoing conversations about what the child is watching.

Here are some ideas for your kids to do instead of screen time:

  • Listen to an audiobook – there are tons of websites with recommendations of great audiobooks for kids
  • Play music for fun background noise – Pandora is a great app for free music and you can play whatever kind of music you want.  Our favorite channels are Caspar Babypants (a local Seattle-based kids band) and Indie Folk Revival (this is my favorite calm music station!)
  • Plant a garden in your yard or in pots and do some gardening crafts!
  • Go to a nearby playground
  • Create a coloring station at the table or at an easel
  • Make an obstacle course using stuffed animals or an inset puzzle.  I LOVE doing this in OT sessions.  You can put 6-8 stuffed animals somewhere, say they need to be saved one at a time and brought back home or to school or to the zoo…where ever! And the fun happens getting the animals from point A to point B.  Choose 3-5 things that really work the child’s body and make it fun and pretend! – Put the animal in a laundry basket (in the boat), push it under the kitchen table (go under the bridge) , crawl over the couch cushions placed on the floor (cross the mountains), and jump over 5 kitchen towels (hop across the rivers), then the animals is safe and sound at home!
  • Make a fort
  • Read books
  • Play don’t touch the floor and pretend the floor is lava
  • Play eye spy
  • Do simple chores – wipe off the table, clean the windows, vacuum (don’t pay too close attention to quality cleaning if your children are younger, just let them have fun trying)
  • Play a board game (Caribou Island and Pop the Pig are my current favorites)
  • Help make a meal
  • Bake together
  • Pretend play grocery shopping or coffee shop
  • If you have a safe yard to play in, play outside
  • Play with shaving cream (Barbasol is my favorite brand to play with) on a sliding glass door – kids LOVE to draw with their fingers in shaving cream or just get messy.  Maybe do this one before bath time…or in the bath!
  • Play legos
  • Jump rope or jump on a trampoline (indoor or outdoor)
  • Swing (you can set up a door jam swing so you can do this all year round!)
  • Play in a lycra silly sack
  • Create fun sensory bins

Every child is different, so playing to their interests and strengths will be helpful to keep them engaged.

Change in routines can be hard for kids, so giving them a heads up a couple days in advance can be really helpful if you are planning on decreasing house hold screen time.  Initially the change might be rough, but if you stay consistent, the kids will get used to it and be better for it!  Consistency is the key! Following screen time recommendations decrease chances of obesity; increase play opportunities where children increase social interaction and family connection; and provide opportunities to learn fine motor skills, visual motor skills, and improve problem solving skills needed for later in life.

If you do a little work using the media use tool provided by the AAP, make choices of when and where screens are allowed, and use some of my recommendations to replace screen time you’re children still can have screen time and you can feel good about the screen time they get.