Thursday, September 5, 2013

Help for Infants and Toddlers: Early Intervention

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. 

If you have more questions about sensory processing, click this link or see the tab in the menu at the top. Also, note that even states that offer services up to age 5 usually cut off feeding and sensory at age 3.

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.

I offer private consultations at a very affordable price via phone, skype, or facetime as well.  Many families have used this in conjunction with their EI services or before their services have begun because the process can take a few weeks to a month or two. Also, in some remote locations outpatient services can be difficult to reach. More information is in the top menu under the tab Consulting Services.

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.


  1. Thanks for sharing all this info in a post! I got early intervention for my son when he was 2 he is now 4 & has done a complete turn around! I love sharing info with others who may not know about these types of services.

    1. Thanks Jenny, that is such a helpful comment! What state are you in? Just want people to know where services are covered.

  2. Just to clarify, across states- the Early Intervention coordination is free but many states have to charge for the therapies that are usually contracted out. Assessment and evaluation are required to be free. Therapies are not. Wish all states covered these!

    1. Thank you Frannie- that is my understanding as well. At a minimum the screening or eval is done, which I hope will give families some direction.

  3. Yes, our EI therapy (in AZ) does have a cost, dependent on one's income. But's it less than private therapy, they come to our house(!), and we're very happy with our therapist. :)

    1. Thank you so much Eileen- helpful information!

  4. Thank you for sharing this information. I was lucky in that when my son started showing red flags for developmental delays I had a lot of people in my life that explained EI and its benefits to me but I know a lot of parents have no idea and can find it intimidating. I still found it intimidating. But as a parent I can't agree enough what a difference EI can make. I know it has helped my son (and me) so much over the past 8 months. I would encourage any Mom (or Dad) who is on the fence about whether to have their child evaluated or not to go ahead and do it.

    In the state of Massachusetts, all services (as of March/April 2013) are not charged to the parents but to your health insurance and to the State Department of Public Health (I think...) I received a bill when I first enrolled but haven't received one since and was told that Massachusetts residents no longer pay out of pocket for services.

    In addition to EI - blogs like yours offer tremendous support. I have referred a lot of Moms to your site - as it was a tremendous help getting my son past his sensory challenges with table food. Thank you.

    1. Thanks so much Lindsey for your comment, I'm sure it will help parents reading this post! I'm so glad Your Kid's Table has been a resource for you!!!

  5. I have 6 month-old boy/girl twins. They were born a bit early, and because my partner had complications from the birth, her milk took a very long time to come in, so the the babies were bottle fed initially. We worked with lactation specialists to get both of them breast feeding, and my daughter got the hang of it first. Then, when they were about a month old or so, she started refusing the breast--crying hard when offered. We again worked with lactation specialists, and eventually they concluded that she had just developed a strong preference for the bottle and that we really couldn't do anything about it. Then, she started having issues with the bottle. She'd push the nipple out of her mouth, or clamp her mouth shut, even when she had to be hungry. By 3 months, we found that she would eat more readily if she was swaddled, and most reliably if she was swaddled and in her swing.

    Now at 6 months, she still is really finicky about the bottle. She'll make a gagging sound as we approach her with it--it seems to indicate that she doesn't want it. She also gags or chokes and coughs while drinking pretty frequently. Now that we're introducing solids, she is exhibiting some of the same signs in reaction to the spooned food. (Cereal, various pureed vegetables and fruits). Her brother is enthusiastically gobbling up the food and has no problems with the bottle.

    I'm not sure if she really has issues of concern, or if she just seems difficult in relation to him. So one question is whether her issues seem like they are in the realm of normal, or are concerning? Her doctor says not to stress about it as long as she's gaining weight. (She's in the 20th percentile now after being as low as 7th as a newborn). I also don't know whether I should "trick" her into opening her mouth by getting her to smile so that I can get the spoon in, or try to get her to actually open for the spoon? I don't want to cause additional problems by doing the wrong thing.

    Any other advice?

    1. I would definitely not trick- I know it's tempting, but your instincts are right- in the long run it can cause more damage. I hear that response from doctors often- they are usually only concerned with the bottom line. I don't want to freak out, but I would get her evaluated, just to make sure nothing else is going on. Silent reflux is jumping out at me -see the article index at the top menu for more on this. However, there are a variety of issues that could cause that behavior. In the meantime, keep meals as positive as possible. Try to just let her explore the food, keep it light and fun through play. Let me know if I could be of more help.

  6. Just stumbled upon your page. I have a ten month old boy who hasn't learned to self-feed. We do lots of practice and I offer him finger foods, but he really only wants puréed food. He is breastfed, and all other milestones seen to be on track. Wondering if I should pursue an evaluation. Also feeling silly because I have a masters in special education but know nothing about early intervention with babies/eating! His ped says not to worry, but something seems off to me. Thank you!!

    1. Hi Bryana, please- feeding is truly a specialty all in itself, I'd be more surprised if you were expert! You know, he could grow out of it, but I all too often see this as a first red flag. One that docs often blow off, if there is a problem it will continue to get worse. Because, your gut is telling you something else is going on I would definitely get an eval- at the very least it will give you peace of mind. Make sure you read my posts on transitioning to table foods- see the article index or popular posts in the side bar. Let me know how it goes.

  7. Update: my little stinker waited until our EI rep came and then decided to start finger feeding the next day! Too funny. He has his favorites but he's trying much more now and also mouthing toys. Learning new tricks everyday, I feel so much better! Thanks for your support and I'll be sure to keep the blog bookmarked!

    1. Thanks so much for getting back in touch! I'm glad you were able to get an eval quickly and that things are turning around quickly! Yay!!!

  8. I'm in the process of getting my 22 month old screened for a speech regression issue as well as a eating sensory issue. Just a FYI: West Virginia has a FREE (both the evaluations and the therapies) Birth to Three program.

    1. Thank you so much for sharing that information! It is very helpful!

  9. Just stumbled onto your sight today desperate to help my son. Hadn't thought before reading through your articles that he almost definitely is a problem eater. Unfortunately, he has missed the age bracket. He is three and a half. I first started seeing signs that he was a problem eater when he was two, but at the time we were living out of the country, in France. I think all of the transition internationally has aided in his eating dilemma significantly, as before we left for France he was the better eater of my two kids and displayed no overly irrational signs of picky eating. We are currently living in Ohio, but only till the end of of the summer. Possibly California after that. I tried to follow the string of linked websites to see if either of these states offer free help for kids under five but couldn't find any clear information. Maybe I wasn't looking in the right places? Nevertheless, I couldn't find any concrete resources. Any help or advice you have to offer would be wonderful. This is completely new territory for me!

    1. I don't want to be the bearer of bad news but from my understanding California's services aren't very good even for kids under 3. I would look into it still, though. Of course, if your insurance covers it private therapy is always an option. Here is all the info for Ca and OH:

      Part C Coordinator
      Children and Family Services Branch
      Department of Developmental Services
      1600 9th Street, Room 330, MS 3-8
      Sacramento , CA , 95814
      (800) 515-2229
      (916) 654-2773

      Bureau of Early Intervention Services
      Ohio Department of Health
      246 N. High Street, 5th Floor
      Columbus , OH , 43215
      (614) 644-8389

      Please let me know if you need more help. This info is from the I Can Teach My Child website.