Importance: Premature infants are not prepared developmentally, physically, or cognitively with the multiple survival skills of the typical newborn. Objective: To determine whether physical activity generated spontaneously by premature infants stretching against the resistance of “prepod” garments is as effective as exercises provided by therapists in slowing bone density loss. Design: Preterm very low birth weight infants were placed in two nonrandomized parallel groups according to birth age. Setting: Infants routinely started in a traditional intense intervention setting and graduated to a special care section with private rooms that allowed parents to remain with their child. Participants: Healthy infants without medical complications, born between 28 and 32 wk postmenstrual age. Intervention: The control group received traditional exercises. The experimental group wore a prepod almost 24 hr a day. Outcomes and Measures: An ultrasound of the tibia was obtained at 31 to 32 wk and 4 wk later. Weight gain, head circumference growth, and length of stay (LOS) were also measured. Results: Although not statistically significant, the ultrasound results showed that the prepod group had less loss of bone density than the traditional therapy exercise group. The desired outcome was for pods to be as effective at reducing bone loss as traditional exercise, so the results exceeded expectations. The unexpected, and more notable, finding was a striking drop in LOS for the prepod group. Conclusions and Relevance: Spontaneous exercise by premature infants decreases bone loss and LOS. Better bone health and increased developmental maturity increase the chances of a positive developmental outcome and save the hospital significant expense. What This Article Adds: The prepod is a simple, cost-effective, noninvasive treatment tool occupational therapy practitioners can use to support a premature infant’s development. This study has considerable potential to affect how infants are served, both developmentally and financially.

Importance: Occupational therapy practitioners can play a pivotal role in supporting breastfeeding mothers as they transition to and form new routines for this occupation. Objective: To explore whether occupational therapy programming can assist breastfeeding mothers in reaching their personal occupation-based wellness goals. Design: Mixed-methods design that involved development of an occupational profile and a goal attainment scale (GAS). After the intervention, participants rescored their GAS goals and completed a semistructured exit interview. Setting: Nonprofit lactation center located in the suburbs of a large mid-Atlantic U.S. city. Participants: Women recruited through convenience sampling who had been breastfeeding an infant for <6 mo, who were not currently weaning, and who had met with a lactation consultant at least once since giving birth were eligible (N = 17). Intervention: Group occupational therapy that consisted of 10 weekly 1-hr sessions. Topics were based on occupational profiles, GAS scores, and lactation consultant input. Outcomes and Measures: Each participant created and scored three goals using the GAS before and after the intervention. Results: Data from 14 of the 17 participants were analyzed. The average postintervention GAS score was 56.50 (M = 50), indicating that most personal wellness goals were reached. Thematic analysis revealed that occupational therapy programming helped mothers persevere with breastfeeding, feel more confident as new parents, and value both themselves and their baby. Conclusions and Relevance: There is an increasing role for occupational therapy practitioners in helping new mothers reach their personal wellness goals in ways that support their ability to continue breastfeeding. What This Article Adds: Maternal wellness and breastfeeding represent an emerging area of practice in which occupational therapy practitioners can provide new mothers with physical, social, and psychological supports that help them maintain self-efficacy related to breastfeeding and other meaningful occupations. This study provides foundational evidence in support of this collaboration.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The purpose of this study was to describe the sensory processing abilities of infants and toddlers over time (10-18 months) in a medically underserved area. Neurotypical infant–maternal dyads took part in the IDAHO Mom Study. The data from this cohort of infants and toddlers is similar to the scores of the foundational sample within the Sensory Profile 2 manual and may represent increased measurement reliability of typically developing infants and toddlers. Primary Author and Speaker: Bryan M. Gee Contributing Authors: Nicki Abuchon-Endsley, Abby Prow

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. There is conflicting evidence on the influence of infant equipment for motor development. The primary purpose of this study was to examine associations between various types of infant equipment use and motor milestone achievement. Preliminary findings highlight the importance of promoting physical exploration rather than restricting movement to facilitate motor development in infants. Primary Author and Speaker: Bryan M. Gee Contributing Authors: Nicki Abuchon-Endsley, Hillary Swann-Thomsen

Date Presented 04/13/21 The purpose of this study was to explore the relationship between caregiver mental illness, breastfeeding frequency and duration, and infant sleep and sensory profiles. Neurotypical infant–maternal dyads took part in the IDAHO Mom Study. The findings suggest that maternal mental health, actual or perceived, has an influence on sensory processing profiles in infants and toddlers. Primary Author and Speaker: Bryan M. Gee Additional Authors and Speakers: Rachel Allen-McHugh, Kelsey Huss Contributing Authors: Andrew Galvez, Taylor Pirillo, Sabrina DeHerrera, and Jessica Pottebaum

Date Presented 04/9/21 Development in the first years of life is often characterized by a child’s aptitude to complete discrete tasks, such as walking or stacking blocks. True participation requires the child to incorporate skills into everyday activities. This presentation will provide an overview of the Infant Toddler Activity Card Sort, the initial psychometrics, and a Rasch analysis. Primary Author and Speaker: Catherine R. Hoyt Contributing Authors: Ching-Fan Sheu

Date Presented 04/23/21 Infants discharged with gastrostomy tubes are more likely to have lower scores in all neurodevelopment outcomes than full-feed infants. A noninvasive application of vagal nerve stimulation (VNS), transcutaneous auricular VNS (taVNS), stimulates the auricular branch of the vagal nerve. Yet, the long-term impact of the application of taVNS remains unknown. Early findings from this study reveal that taVNS could have a positive impact on children's neurodevelopmental and sensory performance observed at 18 months follow-up evaluation. Primary Author and Speaker: Turki Khaild Aljuhani

Date Presented 04/23/21 This scoping review aims to identify current evidence for constraint-induced movement therapy (CIMT) protocols, clinical applications for practice, and gaps in research for CIMT in infants and toddlers with unilateral cerebral palsy. The study will provide an overview of emerging research in CIMT that is critical for providing evidence-based practice. Primary Author and Speaker: Casey Walker Contributing Authors: Danielle Lowinger, Sara Rezak

Date Presented 04/19/21 This study surveyed 137 mothers to determine the predictors of resilience, maternal attachment, and neonatal intensive care unit (NICU) satisfaction postdischarge. Statistically significant predictors for NICU satisfaction were social support and maternal attachment; for resilience, maternal attachment and social support; and for maternal attachment, resilience, NICU satisfaction, and social support. It is important for OTs to understand these relationships to better support this population. Primary Author and Speaker: Yan-hua Huang Contributing Authors: Lisa Connor, Marjorie Nicholas

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The incidence of motor, cognitive, and language delay among children who were born preterm (< 32 weeks gestation) is high. Estimated gestational age at birth appears to influence the timing of discharge, with infants born earlier being discharged later after accounting for the degree of prematurity. Postmenstrual age at discharge appears to be related to motor outcome in early childhood, shedding light on the high-risk nature of this population of infants still hospitalized after their due date. Primary Author and Speaker: Polly Kellner Additional Authors and Speakers: Jenny Kwon Contributing Authors: Roberta Pineda

Date Presented 04/12/21 OT and physical therapy students visited Women, Infants, and Children (WIC) centers to educate families on the Centers for Disease Control and Prevention’s (CDC’s) Milestone Tracker app. A pretest-posttest design using an adapted version of the Cultural Competence Self-Assessment Checklist (N = 40) was utilized. The results indicated that while students perceived the experience as a positive one that increased their knowledge of WIC, the experience did not significantly alter self-perceptions of their cultural competence. Primary Author and Speaker: Kate Barlow

Importance: Typically developing children who are sensitive to sensory stimulation appear to have more sleep difficulties than children with average sensory sensitivities; however, at what age sleep difficulties emerge and whether they extend to children outside of sleep clinics are unclear. Objective: To investigate cross-sectional and longitudinal relationships between sleep and sensory processing in typically developing infants and toddlers. Design: Observational; cross-sectional and longitudinal. Setting: Community. Participants: Children (N = 160) enrolled in a larger four-armed randomized controlled trial of overweight prevention in infancy (40 randomly selected from each arm). Outcomes and Measures: Parent-reported sleep patterns at ages 6 mo, 1 yr, 2 yr, and 2.5 yr. Sensory Processing Measure–Preschool questionnaire covering five sensory systems and higher level functions: praxis and social participation at age 2.5 yr. Relationships between sleep and sensory variables were analyzed using multiple linear regression models. Results: More problematic sleep at age 2.5 yr was associated with more difficulties in social–relational skills (p < .001), a finding supported by the longitudinal data. Longer settling times were associated with higher vision (p = .036) and touch (p = .028) sensitivities at age 2.5 yr; in the longitudinal data (ages 6 mo–2.5 yr), longer settling times were associated with more sensitive hearing (p = .042). Conclusions and Relevance: Results support a link between sleep patterns and sensory processing difficulties in toddlers that, in some, can emerge in infancy. Practitioners should be alert to this association in young children presenting with sensory sensitivity or sleep challenges. What This Article Adds: Study findings illustrate that bedtime challenges in typically developing toddlers could be related to sensory processing. A possible way to assist more sensitive children in settling to sleep is to pay attention to visual, tactile, and auditory stimuli that potentially interfere with sleep onset.

Importance: This Practice Guideline provides stakeholders with a condensed summary of a large number of effectiveness studies. It is a valuable tool for facilitating decision making related to occupational therapy interventions for children ages birth–5 yr. Objective: Early childhood (birth–5 yr) is a critical period in which the foundation of key life occupations is developed (e.g., eating, dressing, play, learning, social participation, rest and sleep, and chores). The development of cognitive, motor, social–emotional, and self-care skills is important to support these occupations. This Practice Guideline synthesizes recent systematic reviews (SRs) on these areas of development to promote decision making for and high-quality interventions with this population. Method: Four SRs related to cognition, mental health, motor function, and ADLs analyzed studies published from 2010 to 2017 retrieved from six electronic databases (MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane). Results: A total of 196 articles were included in the SRs, which served as a guide to final clinical recommendations. Case studies describe translation and application to practice. Conclusions and Recommendations: A variety of interventions within the domain of occupational therapy were found to support the development of cognitive, social–emotional, motor, and self-care skills. Although some of these interventions are typically implemented by occupational therapy practitioners, others can be implemented by parents after training or by teams working in preschool settings. These findings should be used to inform evidence-based practice provided by occupational therapy practitioners working in various early childhood settings. What This Article Adds: This Practice Guideline gives occupational therapy practitioners clear information about which interventions will be effective for specific outcomes. Better intervention choices mean better outcomes for young children and their families.

Importance: When a neonate’s sucking, swallowing, and breathing are disorganized, oropharyngeal aspiration often occurs and results in illness, developmental problems, and even death. Occupational therapists who work in the neonatal intensive care unit (NICU) need to identify neonates who are at risk for aspirating so they can provide appropriate treatment. Objective: To ascertain whether client factors and performance skills of infants ages 0–6 mo during occupational therapy feeding evaluations are related to results of videofluoroscopic swallowing studies (VFSSs). Design: Retrospective chart reviews. Setting: 187-bed NICU in a nonprofit teaching hospital. Participants: A purposive sample of 334 infants ages 0–6 mo, ≥33 wk gestational age at birth, admitted to a Level II, III, or IV NICU as defined by the American Academy of Pediatrics. Outcomes and Measures: Neonates were administered a feeding evaluation by an occupational therapist and a VFSS by a speech-language pathologist, which yielded information about client factors and performance skills. Results: Signs and symptoms of aspiration on the evaluations were significantly associated with VFSS results. Of 310 patients, 79 had silent aspiration. Of 55 infants who demonstrated no aspiration symptoms during the feeding evaluation, 45% demonstrated aspiration symptoms on the VFSS, and 55% aspirated on the VFSS but demonstrated no symptoms of aspiration. Conclusions and Relevance: Aspiration among infants occurs inconsistently and depends on client factors, contexts, and environments. Occupational therapists are encouraged to assess an infant’s feeding over several sessions to obtain a more accurate picture of the infant’s feeding status. What This Article Adds: This study provides information that helps occupational therapists identify infants at risk for aspiration and make optimal recommendations regarding safe feeding practices and appropriate referrals for a VFSS. Making appropriate referrals for VFSS is also important in preventing unnecessary exposure to radiation for preterm infants.

We explored parental feeding practices, feeding issues during the first 2 yr of life, and the relationship between feeding issues and levels of maternal distress in preterm infants. Four hundred twenty mothers (239 with preterm infants, 181 with full-term infants) participated in the study. The Behavior-Based Feeding Questionnaire for Infants With Premature History and the Parenting Stress Index–Chinese Version were used as the two outcome measures. The results indicated that preterm infants had different feeding experiences compared with their full-term counterparts. They tended to start solid food later in life and had limited experiences in food variation. Parenting stress was prevalent in parents with preterm infants and was associated with the frequency of feeding issues, especially at later ages when supplementary foods were being introduced.

OBJECTIVE. Our objective was to determine the extent to which young children at high risk for sensory processing difficulties differed from those who were at low risk. METHOD. We compared high- versus low-risk young children using standardized measures. High-risk participants had older siblings identified as having sensory processing difficulties after a comprehensive occupational therapy evaluation (n = 13); low-risk participants (n = 16) had typically developing siblings and no family history of sensory or other neurological disorders. RESULTS. High-risk infants scored significantly lower on the Language and Cognitive scales of the Bayley Scales of Infant and Toddler Development–Third Edition. The high-risk group presented with more atypical positions on the Toddler and Infant Motor Evaluation and fewer sensation-seeking behaviors on the Toddler Sensory Profile–2. CONCLUSION. Results suggest that sensory, motor, cognitive, and language dimensions may be associated with sensory processing difficulties. Implications exist for the design of future studies and for early intervention.

OBJECTIVE. We examined the effectiveness of modified constraint-induced movement therapy (mCIMT) in treating infants with hemiplegic cerebral palsy and compared therapy outcomes with a nonconstraining bimanual therapy (BIM) of equal intensity. METHOD. In a single-blinded randomized controlled trial, 33 infants with hemiplegia (mean corrected age = 11.1 mo, standard deviation = 2.2) received either mCIMT (n = 17) or BIM (n = 16). Both interventions included home programs encouraging the use of the affected hand during daily 1-hr play sessions for 8 wk. Outcome measures were administered pre- and posttreatment and included the Mini-Assisting Hand Assessment for babies and the Functional Inventory. At baseline, parents also filled out the Dimensions of Mastery Questionnaire. RESULTS. Both groups demonstrated a significantly large and equal improvement in hand and gross motor function posttreatment (p < .001) and high treatment compliance. CONCLUSION. mCIMT and BIM are equally effective methods for treating infants with hemiplegia.

OBJECTIVE. The aim of this study was to analyze the correlation between sensory processing and motor development in preterm infants. METHOD. We included 30 preterm and 30 term infants with corrected and chronological ages between 10 and 12 mo. We used the Test of Sensory Functions in Infants to evaluate sensory processing and the Alberta Infant Motor Scale to evaluate motor development. RESULTS. The Spearman correlation test indicated a strong positive relationship between sensory processing and motor development in preterm infants (r = .63, p < .001). CONCLUSION. Given the relationship between sensory processing and motor development in the preterm group, the evaluation of sensory processing and motor development in preterm infants was considered necessary for the effective implementation of physiotherapy assessment and interventions.

OBJECTIVE. To define neonatal social characteristics related to autism risk. METHOD. Sixty-two preterm infants underwent neonatal neurobehavioral testing. At age 2 yr, participants were assessed with the Modified Checklist for Autism in Toddlers and Bayley Scales of Infant and Toddler Development, 3rd edition. RESULTS. Positive autism screening was associated with absence of gaze aversion, χ = 5.90, p =.01, odds ratio = 5.05, and absence of endpoint nystagmus, χ = 4.78, p = .02, odds ratio = 8.47. Demonstrating gaze aversion was related to better language outcomes, t(55) = −3.07, p ≤ .003. Displaying endpoint nystagmus was related to better language outcomes, t(61) = −3.06, p = .003, cognitive outcomes, t(63) = −5.04, p < .001, and motor outcomes, t(62) = −2.82, p = .006. CONCLUSION. Atypical social interactions were not observed among infants who later screened positive for autism. Instead, the presence of gaze aversion and endpoint nystagmus was related to better developmental outcomes. Understanding early behaviors associated with autism may enable early identification and lead to timely therapy activation to improve function.

OBJECTIVE. To explore the relationship between sensory processing patterns and sleep problems in typically developing infants and toddlers. METHOD. A retrospective chart review of 177 infants and toddlers from a community occupational therapy sleep clinic included descriptive and correlational analyses of data from the Infant/Toddler Sensory Profile and Brief Infant Sleep Questionnaire. RESULTS. More than half of participants (55%) demonstrated a pattern of increased sensory processing in one or more quadrants, with sensitivity being most common (36%). We found small but significant correlations between increased seeking and shorter daytime sleep duration (r = −.24, p = .002) and between increased sensitivity and longer time to settle to sleep (r = .27, p < .001). CONCLUSION. This study adds to recent literature linking sensory processing patterns to sleep problems and is the first to demonstrate this relationship in young, typically developing children. Results support the role of occupational therapy in addressing sleep difficulties in children.