Diaphragmatic breathing is essentially deep breathing. Regularly performing diaphragmatic breathing builds awareness of the deep core and calms the body, biasing it towards the parasympathetic nervous system, aka the “rest and digest” branch. It can be one of our first defenses to managing pain.

It’s the link between our conscious minds and our body’s automatic functions. Automatic functions are controlled by the autonomic nervous system. They are functions you don’t have to think about to perform, such as heart rate, temperature, and digestion. When your body becomes dysregulated, say when you have an anxiety attack, your body responds as if it is under a physical threat. Your “fight or flight” response kicks in and your physiology drastically changes. These changes are meant to keep you safe, however, in a chronic state they can do more damage than good. We can mitigate damages by communicating with our body through slow and controlled breathing.

How To Perform Diaphragmatic breathing

You can perform deep breathing exercises in any position at any time of day. If you have trouble connecting with your breath, however, initially try practicing while laying down in a quiet place to increase focus and awareness until you get the hang of it.

Setup

• Find a comfortable place to lie down on your back.
• Place one hand on your chest and one below your rib cage on your abdomen.
• Breath in deeply through your nose. Feel your belly rise.
• Exhale fully through your mouth. Feel your belly lower.
• Perform for 2-5 minutes.
• Notice how your body feels before and after.

Tips

Focus on expanding your belly. You should feel minimal movement in your upper chest. Slow your breathing by:

• Counting: Count slowly to 4 on the inhale, hold for a count of 4, then exhale for a count of 8.
• Mantra: You can use any mantra you choose. For example, inhale “I am” exhale “calm”.
• Imagery: Firstly, imagine the air entering your body and filling up all your body. Then, visualize it emptying out slowly through your mouth. Imagine a color to the inhaled versus exhaled air, such as red and blue.
• Guided Breathing: Check out your app store by searching breathing apps or google “guided breathing”. There are endless possibilities, so find what works for you. Some commonly used apps are Calm, Headspace, Liberate, and iBreathe.

Breastfeeding is a complex system, and many factors must be accounted for when concerns of milk supply arise. Although the prevalence of low milk supply is unknown, low supply or the perception of low supply, influences approximately 25-73% of mothers to cease breastfeeding early. Low milk supply is defined as producing an amount of breast milk less than the volume required to sustain healthy infant growth by exclusive breastfeeding (Sultana, 2013). Let’s take a closer look at signs of low supply and how to seek assistance if you are experiencing one of these signs.

Causes of Low Milk Supply

Low milk supply can be divided into two categories: primary and secondary. Primary causes are related to any medical issues or anatomical factors existing within the mother. Secondary causes are related to issues with milk transfer and breast drainage. Primary and secondary causes can stand alone or also co-exist. Also, keep in mind having one of these does not mean low supply will occur.

Primary Indicators of Low Milk Supply

• Maternal history of PCOS
• Previous breast surgery
• Postpartum hemorrhage
• Maternal history of diabetes/insulin resistance and/or thyroid/pituitary gland dysfunction
• Insufficient glandular tissue
• Retained placenta
• Medications affecting supply

Secondary Indicators

• Delayed initiation of breastfeeding
• Infrequent or inefficient breast emptying
• Ineffective latch/weak suck from infant and/or oral restrictions
• Premature birth

How to Help Your Milk Supply

It is important to know the root cause of low milk supply. MOSAIC highly recommends working with a lactation consultant and primary care doctor when PRIMARY indicators of low supply are present. Now, let’s explore options to increase secondary low milk supply issues.

• Monitor infant’s weight gain with help of lactation consultant and primary care physician
• Consume adequate calories and hydrate, and note that increasing water consumption does not increase your supply
• Check infant’s latch to ensure optimal breast drainage with support of lactation consultant
• Know infant feeding cues and limit pacifier use to ensure feeding cues are noticed
• Feed on demand by observing infant feeding cues/incorporating more feeding sessions (10-12x/day for a newborn)
• Switch nursing – Alternate breasts multiple times during a feeding

More Options

• Hand express intermittently throughout the day in between feeds and/or hand massage breast while nursing to increase transfer
• Check flange size and that pump parts are working appropriately
• Power pump 1-2x/day
  • Firstly – Let down mode x3 minutes, pump x20 minutes, break for 10 minutes
  • Secondly – Repeat starting with let down mode x2-3 minutes, pump x10-15 minutes, break for 10 minutes
  • Finally – Let down x2-3 minutes, pump x10-15 minutes – complete
• Parallel pumping – Use a breast pump to pump one breast while simultaneously breastfeeding baby on the other
• Triple feed – Trial only with help from lactation consultant as this can be a strain on a new mom
  • Feed on demand; supplement with expressed breast milk or formula if baby is still hungry;  pump 15 minutes after feed

Overall, be patient and consistent when implementing these options to increase supply. Initial results can take up to 7 days to be noticed. Always balance what approaches are attainable with your mental health, especially in the newborn stages. Balancing these is important as sometimes all the effort put into using these approaches will not increase milk production because it’s just our biology. Seek assistance from a lactation consultant and primary care physician. If you are wanting to hear parent stories or further resources, visit the Low Milk Supply Foundation.

Resources

1. Low Milk Supply Foundation. (2022). Low Milk Supply Foundation. https://www.lowmilksupplyfoundation.org/
2. Cadwell, K., & Turner-Maffei, C. (2016). Pocket Guide for Lactation Management (3rd ed.). Jones & Bartlett Learning.

When you think of physical therapy, you might think of an injured athlete, someone recovering from surgery, or someone with a chronic medical problem. However, we’re here to let you know that physical therapy can help kids, too! Physical therapists are trained to work with patients of any age. At MOSAIC, we have some that specialize in pediatrics. Here are a few things PTs can help kids with.

Coordination Disorders and Gross Motor Delays

Some children are delayed in hitting their gross motor milestones. Therefore, things like sitting up on their own, rolling, standing, walking, jumping, and running. Other children show difficulty with coordination. This can be activities like hand motions to “wheels on the bus”, moving awkwardly or slowly, or even tripping or bumping into things a lot. Physical therapists can help encourage development of gross motor skills and coordination to help these kids get back on track.

Cerebral Palsy

Cerebral palsy is the most common motor disability in childhood. The symptoms can vary from moving a little awkwardly to being unable to walk and needing assistance for most activities. There are also different types. The most common causes stiffness in the muscles, but other types affect control of movements, balance, or coordination. No matter the type or severity of cerebral palsy, a physical therapist can help with things like stretching, exercise, bracing, and equipment like a wheelchair if needed.

Physical Therapy can Help Kids with Torticollis

Torticollis is a postural issue that usually becomes noticeable shortly after birth. Babies with torticollis typically hold their heads tipped one direction and rotated towards the opposite side. This is caused by a tight neck muscle. Research has shown that early referral to a physical therapist is a VERY effective treatment. At MOSAIC, we have PTs who have tons of experience and additional training in the treatment of torticollis. Our PT will show the baby’s caregivers ways to gently stretch the neck, activities to encourage the baby to move their head into a more neutral position, how to position for sleep and other activities, and ways to encourage symmetric development of motor skills.

Pelvic Floor Issues

People might not think pelvic floor issues in children are common. But, it may be a surprise at how common they are. The most common symptom is chronic constipation. Pelvic floor problems can also show up as urinary incontinence, bed wetting, or needing to go to the bathroom frequently. A physical therapist can help with education for the child and their family and exercise. Additionally, sometimes even the use of biofeedback to help the child learn to better control their pelvic floor muscles.

Physical Therapy can Help Kids with Pain and Injuries

Although kids have a list of problems specific to them, don’t forget about regular old pain and injuries. Your PT can treat an ankle sprain, painful joint, or athletic injury in a child just with an adult.

Sometimes kids and even babies need some help with movement. From now on, when you think of your physical therapist, remember that physical therapy can help kids too!

If you’ve been to physical therapy, you likely got a home exercise program. Research says that if you do your home exercise program, you’ll have a significantly better chance of meeting your goals and feeling better. Not doing your program increases the risk of recurrent injury or flare-ups with less positive outcomes long term. Even though they’re important, adherence to home exercise programs is terrible. It’s estimated that only 40 to 50% of patients do their exercises the way they’re supposed to. What gets in the way?

Barriers to Home Exercises

Many of the barriers to PT exercises are the same as barriers to general exercise. These include lack of time, busy work schedules, forgetting, lack of space, lack of equipment, etc. These can be overcome with some forethought and planning, but they regularly stop patients from completing home exercise programs.

Pain and Beliefs

If exercises cause pain, people don’t want to do them. Sometimes people are afraid to report pain from exercise to their PT. Or they think that they’re supposed to hurt. Instead of working with their PT to address the pain, they just stop doing the exercises.

Another thing that gets in the way is people’s beliefs. If people don’t understand why their PT is prescribing certain exercises, or why, the exercises can seem like a waste of time. When that’s the case, again, people stop doing them.

Lack of Support

Social support is shown to significantly improve adherence to exercise. This is why CrossFit and group exercise classes work. People who have a family member, friend, or PT who check in on their exercises are more consistent. Being accountable to someone other than yourself can be a big motivator.

Patients not doing their home exercises is a big problem in physical therapy. Understanding the issues we just discussed can help PTs and patients improve compliance. There are other strategies that PTs are using to help improve compliance as well. So, what can you do to make sure you do your exercises and get the best outcomes? Here are a few ideas.

Plan Ahead

Think about what’s going to get in your way – your schedule, that you’ll forget, or that you don’t have the space or equipment that you need. Once you figure out the problems, come up with solutions. Put your exercises in your schedule, talk to your PT about equipment, or adjusting your program to fit the time you have. If you solve problems before they start, they’re no longer problems.

Address Pain and Beliefs

You’ll need to work with your PT on these. If your exercises cause pain, you’re not going to do them. When your PT prescribes your exercises, try them out. If there’s pain, ask your PT about modifications to make them more comfortable. The other thing might need addressed are your beliefs. If you believe that they won’t help, or that they’re a waste of time, you won’t do them. Again, work with your PT to understand why they’re prescribing those exercises, and what they’re meant to do. Once you know why you’re doing them, you’re more likely to be consistent.

Get Support for Your Exercises

People who have social support are more likely to do their home program. This is why CrossFit and group exercise classes work. Find a family member or friend to help you stay consistent with your exercises. Your PT can help here too. Have someone ask if you’re doing your exercises, and how they’re going. This will keep you accountable and more likely to do them.

Use Technology for Your Exercises

If you like technology and gadgets, they can help you be consistent with your exercises. There are plenty of apps that can track your exercise. Seeing that streak of days you’ve exercised will motivate you not to break it. Smartwatches and activity trackers can fill the same role.

Doing your home exercise program will help you get the most out of PT. With a little planning and a little help, you can make sure you’re one of the 50% of the people who do their home exercises consistently to get the best outcomes.

Reference 1

Reference 2

The 4^th of July is a day most people celebrate with parties full of family and friends, and of course fireworks. However, if you’re a veteran, have a child with sensory processing difficulties, or even a pet, Independence Day might not be quite the celebration everyone else thinks it is. Crowded parties, hot weather, loud fireworks, and intense visual stimuli can be overwhelming to say the least. Don’t worry though, there are several ways to make the 4^th of July more sensory friendly for you and your loved ones.

Opting Out of Fireworks

One of the easiest things to do is celebrate without fireworks. If you live in a neighborhood that loves fireworks, prepare a safe place inside your house. This space may include a fan or noise machine. You can even have ear plugs or noise cancelling headphones on hand just in case things still get a little too loud. Then, when the fireworks start, gather the family to watch a movie or play a game together.

It’s also important to prepare your children ahead of time. Let them know there will be fireworks and what to expect. You can show videos of fireworks or provide a social story. Depending on their age, your child might even like to know how exactly fireworks work, to help calm their fears.

Tips To Keep 4th of July Celebrations Fun

If you still plan on having a party, going to a parade, watching a firework display, or even lighting fireworks off at your house, here are a few tips that might help make the experience more enjoyable for everyone.

Firstly, prepare your family by talking about what to expect during the day/night. This will help all children, not just those with sensory processing challenges. If you are planning on going to a parade, talk about what they will see and hear.

For example, “We are going to a parade. There will be a lot of people standing up to watch cars and trucks drive by. Some people might throw candy out of their cars. There might be horses walking too and people playing music in a band. We will see firetrucks and police cars and they will turn on their sirens.” You can also show a video of a parade or pictures of what parades look like. If you’ve been to a parade before you can talk about that parade and show pictures or videos from it. The same type of preparation is also be helpful for parties and firework displays.

When celebrating, make sure your children or family members know they can take a break from the festivities. Practice using a word like “break” or a visual cue/picture to represent a break that everyone will recognize. Have a safe place designated that they can go (whether at home or away). If a family member or child is easily overwhelmed by crowds or loud noises, and you are planning on going out to celebrate, pick a less crowded place farther away from the areas you know fireworks will be going off.

Items to Have On Hand for the 4th of July

If you do plan on leaving the house for the 4^th of July, it may be helpful to have these items on hand:

• Ear plugs or noise canceling headphones
• Water/snacks
• Portable fan/water mister
• Sunscreen/sunglasses/hats
• Favorite toy
• Weighted blanket, heavy backpack, heavy stuffy

What Overstimulation may look like

It’s also important to be aware of what overstimulation may look like in children. An easy signal is seeing your child cover their ears or eyes. You may observe them becoming more irritable, crying, or becoming overly excited. Some children may even attempt to flee or run away. If you notice these signs, try to determine if your child needs a break or some other form of sensory input. These may include headphones, or a weighted blanket, etc.

Whatever your 4^th of July plans include, make sure you talk to your kids about what to expect. Keeping the lines of communication open and having a back up plan in place may help to make the day go more smoothly for everyone. Pathways.org also has some useful 4^th of July safety tips that are worth checking out before you begin your celebrations.

If you are looking for some good sensory play ideas, check out another great blog, Exploring the World Through Sensory Play.

Does your child struggle with sleep? Approximately 50% of children have difficulty with it, and difficulties in this area are more prevalent in children with chronic illness or sensory processing disorders. Chronic symptoms, such as asthma or arthritis, cause wakefulness which further worsens symptoms. Sleep difficulties can impact many areas of childhood, including academics, play, self-care, problem solving, and social emotional wellness. Not only does less sleep impact children, it also decreases quality of life for parents/families. It can also be a cause of excessive stress. Sleep is considered an important occupation. It is necessary to address difficulties in order to optimize a child’s function during day-to-day tasks.

An occupational therapist can evaluate environmental factors by scheduling a home visit. They will compile a profile on the child’s unique needs. Then the occupational therapist will work with your family to begin tracking patterns using a diary. They will evaluate schedules including nap times and nighttime wakefulness.

Ways to Improve Your Child’s Sleep Hygiene

• Consistent routines, including a regular bedtime
• Warm baths
• Utilize calming essential oils
• Limit use of electronic devices before bed
• Increase opportunities for outdoor play and exercise
• Limit intake of fluids before bedtime which may cause frequent bathroom trips
• Do not allow your child to use their bed for leisure activities or play-associate the bed with sleep
• Meditation apps/music or reading before bed
• Blackout curtains
• Establish child’s comfort for various materials and provide pajamas and sheets that match these sensory preferences, such a jersey knit or flannel
• Keep the room at a comfortable and cool temperature

Now that you have adjusted the environment and family routines, you and your child can experience a restful night. This will lead to improved behavioral outcomes, play, academic engagement, and overall quality of life. Check out Sleep for Adults to learn more about helping yourself.

Reference

1. American Occupational Therapy Association. (2017). Occupational Therapy’s Role in Sleep [fact sheet].