Sign language for disabled toddler?

[DaisyDay]

I take care of a 19-month-old child who has tracheostomy (airway tube in his neck) following a brain injury that he is rapidly recovering from. He is also exclusively tube-fed.

 

Because of the tracheostomy, he is unable to speak and it's up to me to figure out what he wants/needs when he cries. The poor guy just cries until I guess the problem.

 

I am interested in teaching him some basic communication using sign language. There are some books out there on teaching babies to use sign language but they focus on various foods and drinks (milk, juice, etc.) which this baby cannot have. 

 

Any suggestions on which signs might be beneficial and how to begin teaching them? For instance, if he needs to have his tube cleared (suctioned), sometimes I can hear it and sometimes it's less obvious. I would like to ask him if he hurts somewhere, or if something is "better" after I try to fix it. He seems very bright, in spite of his injury, and I think he'll catch on pretty quickly.

[Arcadia]

My friend's nephew and niece had tracheostomy as toddlers due to the mom being a drug addict. The kids parents are drug addicts as well as in and out of jail so my friend's mom takes care of the kids.

 

Her mom doesn't speak english anyway so they (mom, her and her siblings) invented their own signs to communicate with the toddlers. Mostly the toddlers pointed to whatever area is uncomfortable whether it is the tube or operation wound area or whatever.

[DesertBlossom]

When I taught my babies sign language we watched a lot of Signing Time videos.  When there was a specific word I wanted them to know that wasn't in a video, I found an online sign language dictionary with videos so I could learn the sign.  I found that the first couple signs took a lot of time to learn.  Over and over and over and over again. And then when it clicked that they could communicate with their hands, they started picking up new signs rather quickly.  But I also started at 11-12 months old. I think my last baby learned "milk" about 10 months. So a 19-month old baby should be able to pick it up with a lot of repetition. My oldest learned all sorts of animal signs as well as things like hot, more, book, etc. 

[bettyandbob]

I used signing time. My child watched them multiple times. He was pretty good with this communication for a while. I unfortunately did not keep it up because I thought his special education program was working on speech and not using signs would encourage spoken language. That was the wrong way to go.

[chocolate-chip chooky]

My middle daughter, now 19, had a tracheostomy for her first 5 years, due to a congenital lung condition.

Because it was from infancy, I had time to prepare and I immediately started going to sign language classes. It didn't take long for me to become quite fluent and I thoroughly enjoyed it.

 

Whenever I was talking to my daughter or reading to her, I'd sign along as I spoke and she quickly picked it up.

 

My daughter started school when she still had the trachy and we developed a communication book for her. Although this takes much longer than signing, it did mean that she could communicate her basic needs and thoughts to people who don't know sign language. The communication book was a folder of images with labels that she could point to.

 

It's hard to imagine how frustrating it must be to have receptive language but no expressive language.

Although my daughter's doctors were very much against me teaching her sign language, I ignored them and I've never regretted it. There was no way I'd leave her without expressive language.

 

So, do you know how long he will have his trachy? And how long you'll be his carer?

If it was me, I'd immediately get a communication book going, hopefully easing his frustration for the short term.

If this is a longterm thing, I'd consider going to classes if possible. I learnt a lot in a short time and it was a great skill to learn.

 

I wish you all the best. This child is clearly very fortunate to have you as a carer. :)

Edited June 10, 2016 by chocolate-chip chooky

[Rosie_0801]

 For instance, if he needs to have his tube cleared (suctioned), sometimes I can hear it and sometimes it's less obvious. 

 

For something like this, pointing and signing "fix" would work. 

 

 

 

 

In Auslan (Australian Sign Language,) we raise our eyebrows to indicate a question. Is this the same in ASL?

[chocolate-chip chooky]

I'll add that it was Auslan that I learnt and used with my daughter, much to the opposition of her doctors!

 

 

[Mama Geek]

My middle daughter, now 19, had a tracheostomy for her first 5 years, due to a congenital lung condition.

Because it was from infancy, I had time to prepare and I immediately started going to sign language classes. It didn't take long for me to become quite fluent and I thoroughly enjoyed it.

 

Whenever I was talking to my daughter or reading to her, I'd sign along as I spoke and she quickly picked it up.

 

My daughter started school when she still had the trachy and we developed a communication book for her. Although this takes much longer than signing, it did mean that she could communicate her basic needs and thoughts to people who don't know sign language. The communication book was a folder of images with labels that she could point to.

 

It's hard to imagine how frustrating it must be to have receptive language but no expressive language.

Although my daughter's doctors were very much against me teaching her sign language, I ignored them and I've never regretted it. There was no way I'd leave her without expressive language.

 

So, do you know how long he will have his trachy? And how long you'll be his carer?

If it was me, I'd immediately get a communication book going, hopefully easing his frustration for the short term.

If this is a longterm thing, I'd consider going to classes if possible. I learnt a lot in a short time and it was a great skill to learn.

 

I wish you all the best. This child is clearly very fortunate to have you as a carer. :)

 

I am sorry my question is off topic buy why on earth would doctors be against teaching a kid how to communicate through sign language?  I am sorry that you had to go through that and stuff like that just totally dumbfounds me.   :grouphug: 

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[basketcase]

A communication book is a great idea. And I'd just decide on a couple of signs you want to use and look them up. It's not about using real sign language at this point. It makes sense to start from a real sign, but a simplified version will work. A sign the baby makes up will work. Anything that baby can and will use. Just model the sign every time you say the word. I usually include a lot of signs from the beginning with my kids, but since you have a specific need, you might start with just the urgent ones. Of course, this will work best if the family is also supporting the sign language and/or the communication book.

[Mama Geek]

Signing Time DVD's have themes for each DVD so one of them is mostly food, but most of the others are just kid related things.  There are some good videos on how to say words online.  Dd will still ask me how to sign something sometimes and we just look it up.

[zoobie]

The parents should be able to access resources through Babies Can't Wait/Early Intervention that would provide someone to teach sign language and assist communication. They might already be involved due to the brain injury? His therapists would be advocating for this too. 

 

Seconding the Signing Time recommendation. I believe there are sections on YouTube and possibly netflix or amazon streaming.

[Incognito]

Signing Time is often at the library to check out as well, so no investment on your part for trying it out.  Look for a theme that might suit.

 

ASL Pro is a good website for finding signs for specific words.  

 

My First Signs is a great book to start with.  It does have a little bit of food vocabulary (milk, cookie), but it is lots of other things and very relevant to the age you are talking about.

 

 

[Beaniemom]

I would encourage you to begin with the actual sign for what you intend such as HURT. It is expected that children's signs are a clumbsier (for lack of a beeter term) version of the actual sign. This way if the child does learn more sign it won't be necessary to relearn the correct signs.

 

Signing Time is great. We also use lifeprint as a general reference.

[chocolate-chip chooky]

I am sorry my question is off topic buy why on earth would doctors be against teaching a kid how to communicate through sign language?  I am sorry that you had to go through that and stuff like that just totally dumbfounds me.   :grouphug: 

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Their stance made sense to a certain extent, but as doctors can do at times, they had their focus on one thing and not the whole child. Their thought was that if she had another way to communicate, she'd not be motivated enough to learn to talk.

 

Because my daughter's trachy was longterm, they wanted to try to train her to breathe past it to talk. This involved a one-way valve that sat over the opening of the trachy tube. She could breathe in through the tube, but had to force air up and out the regular pathway to breathe out. This meant the air went past her vocal chords, opening up the possibility of speech. This process was HARD for a small child with an incredibly serious lung condition.

 

The doctors thought that if I taught her sign language, she'd have no motivation to ever learn to 'talk'.

 

At the time, my focus was on 'communication' as opposed to 'talking'.  As I said upthread, I've never ever ever not once ever ever regretted teaching her sign language.

 

We'll never know if it delayed her speech or not, but she did learn to speak (around age 5-6) and with SP she learnt very quickly.

 

She's now 19 and doesn't stop talking :laugh:

[Daria]

Their stance made sense to a certain extent, but as doctors can do at times, they had their focus on one thing and not the whole child. Their thought was that if she had another way to communicate, she'd not be motivated enough to learn to talk.

 

Because my daughter's trachy was longterm, they wanted to try to train her to breathe past it to talk. This involved a one-way valve that sat over the opening of the trachy tube. She could breathe in through the tube, but had to force air up and out the regular pathway to breathe out. This meant the air went past her vocal chords, opening up the possibility of speech. This process was HARD for a small child with an incredibly serious lung condition.

 

The doctors thought that if I taught her sign language, she'd have no motivation to ever learn to 'talk'.

 

At the time, my focus was on 'communication' as opposed to 'talking'.  As I said upthread, I've never ever ever not once ever ever regretted teaching her sign language.

 

We'll never know if it delayed her speech or not, but she did learn to speak (around age 5-6) and with SP she learnt very quickly.

 

She's now 19 and doesn't stop talking :laugh:

 

There's a lot of evidence now that giving kids a means of communication, whether through sign language or other forms of Alternative and Augmentative Communication, improves spoken language.  It makes sense that the practice your daughter had putting together her thoughts and expressing her ideas carried over to spoken language when she was physically able.

 

DaisyDay, I think you're absolutely right to look for a solution that allows this child to communicate now.  Being able to communicate ideas is so important for a child's emotional well being, and their cognitive development.

 

Another option to consider, is a high tech AAC system such as an iPad app.  For a child who is able to hear and process spoken language, and interacting primarily with people who use spoken language, a speech output device has some advantages of sign.   It also has some disadvantages.  However, it might be worth exploring.  19 months is absolutely not too young to start with a high tech device.

[prairiewindmomma]

What about PECS? We used laminated PECS cards that we carried around in a shoebox. There was a velcro strip on the outside so that we could offer choices.  We also had a laminated sheet with the most common needs so that she had quick reference. We had PECS for pain, eye drops, etc.  as well as water/milk/crackers/banana, bathroom, bed, etc.

 

[Daria]

What about PECS? We used laminated PECS cards that we carried around in a shoebox. There was a velcro strip on the outside so that we could offer choices.  We also had a laminated sheet with the most common needs so that she had quick reference. We had PECS for pain, eye drops, etc.  as well as water/milk/crackers/banana, bathroom, bed, etc.

 

PECS can be a tool for kids who have trouble initiating communication, but the early levels only teach requesting.  There are so many other communicative functions, and sign or high tech communication allows kids to participate in all of them.

[chocolate-chip chooky]

There's a lot of evidence now that giving kids a means of communication, whether through sign language or other forms of Alternative and Augmentative Communication, improves spoken language.  It makes sense that the practice your daughter had putting together her thoughts and expressing her ideas carried over to spoken language when she was physically able.

 

DaisyDay, I think you're absolutely right to look for a solution that allows this child to communicate now.  Being able to communicate ideas is so important for a child's emotional well being, and their cognitive development.

 

Another option to consider, is a high tech AAC system such as an iPad app.  For a child who is able to hear and process spoken language, and interacting primarily with people who use spoken language, a speech output device has some advantages of sign.   It also has some disadvantages.  However, it might be worth exploring.  19 months is absolutely not too young to start with a high tech device.

 

We looked into a tech device too, but we are talking 19 years ago, so I think things may have progressed a teensy bit by now :)

 

I think there are several factors that are important here for DaisyDay and the child in her care - how long will this likely be going on? What is the status of his brain function? How long will she be his carer? Are there others in his life who would also support and consolidate the learning of sign?

 

For us, my daughter just lacked an easy way to get air past her vocal chords. She could hear, she had great receptive language and was an intelligent little cutie. Everything was going in, everything was being processed, she just needed a way to get her bit out.

 

Communication books, PECs, tech devices - these are all excellent options and I think they really are great for when there are a number of carers who don't know sign, even though these options are heaps slower.

Edited June 10, 2016 by chocolate-chip chooky

[prairiewindmomma]

That's a good point.  It's not clear from the OP whether this is a child that she babysits or a child whose custody has been placed with her.  It's also not clear whether the trach is temporary or not.  PECS can be a good short-term inexpensive solution--I know it took us several weeks to get a dynavox in place and not all families already have an iPad. 

 

I agree that AAC is the way to go if this is "her" child and if this is a longer term need.

[Pamela H in Texas]

By 19 months, Wyatt had well over 100 signs, I think.  He surprised me constantly with knowing another.  We started before a year old but he wouldn't do any.  After getting tubes, he started signing.  Strange kiddo :)  

Anyway, like many others, I'm going to suggest Signing Time. Also, Patty Shukla is good (she uses the same tune for every song and it is very calming and the kids love it.  Weird.  LOL

 

NO child is going to use every single sign they learn, at least not at first.  Some signs he might use now or in three years; but he may no longer sign by then either.  Who knows.  But we don't limit what we SAY to kids, why what we sign?

I would also consider a picture system or a "button" for certain needs.  There are four on amazon, different colors.  You could also put a sticker on them.  Have it say a simple two or three word phrase you want him to say/sign later for the need.  

 

 

 

 

[wonderchica]

I would encourage you to begin with the actual sign for what you intend such as HURT. It is expected that children's signs are a clumbsier (for lack of a beeter term) version of the actual sign. This way if the child does learn more sign it won't be necessary to relearn the correct signs.

 

Signing Time is great. We also use lifeprint as a general reference.

This! Don't expect the child to do the sign perfectly, but avoid making up signs. If the child makes one up (more likely with a slightly older child), figure out what it means and teach the correct one. If the trach/signing is long term, it'll be much harder to reteach correct signs and other people won't be able to understand. I'd sign "eat" during tube feeds, since that's the child's way of eating. Good signs to start with- more, mom/dad, eat, a favorite toy (car,ball,baby,etc), a pet if they have one (dog, cat). Any kid that age will have a hard time specifying their discomfort so I would only expect him to point to what hurts at best.

[Insertcreativenamehere]

My son had a trach from the age of 5 weeks until 3 years. He also has a g-tube. After discharge from the hospital, he immediately began receiving services through our state's Birth to 3 Early Intervention program. One of the things we focused on was sign language since he had many different caregivers (home care nurses.) We watched some Signing Time as well, but most of what he uses is what was explicitly taught to him (and reinforced by each caregiver.)

 

He has had the trach out now for a year and is still using baby signs along with a few words. Some signs that we've found helpful are:

More

All done

Suction

Book

Music

Move

Thank You

Mommy

Daddy

Brother

Sister

Play

 

Hope that helps. :)

 

Edited June 11, 2016 by poikar

[scoutingmom]

Hurt is easy... very basically putting your two pointer fingers together pointing at each other. When possible, it is done over the hurt spot... but it is best to find a video and links were put above. Please is a good one too.

 

Sent from my SM-T530NU using Tapatalk

[DaisyDay]

That's a good point. It's not clear from the OP whether this is a child that she babysits or a child whose custody has been placed with her. It's also not clear whether the trach is temporary or not. PECS can be a good short-term inexpensive solution--I know it took us several weeks to get a dynavox in place and not all families already have an iPad.

 

I agree that AAC is the way to go if this is "her" child and if this is a longer term need.

I apologize for being vague. This is one of my foster children and I'm hesitant to discuss too much but I am the primary care giver for the foreseeable future. As for his trach, it could be long term but we don't know for sure. He's already failed the first 2 attempts to cap it.

 

Please tell me more about PECS and AAC. I will also see if I can find Signing Time at the library or on YouTube.

 

Thanks for all the input so far.

[Daria]

DaisDay,

 

I would be happy to share my experience with AAC, and with ASL and PECS, although that is more limited. I am on my phone and don't know how to PM, but if you PM me I can reply or try later.

 

In the meantime, can I suggest that if you are on FB you look for a page called "Hold My words". It is a wonderful example of a homeschooling family using AAC with toddler (now preschooler) who was adopted from foster care.

[prairiewindmomma]

Because of the TBI, I assume that the child qualifies for services--either through rehab with a physiatrist & team or through Early Intervention.  This really is the domain of professionals, and you should be getting a consult with a SL-P in order to know what your end goal aim should.  If there are any motor control issues, full signing may not be appropriate in which case using more technology is appropriate.

 

PECS are picture cards. There are a variety of software programs that can generate the cards; Boardmaker is one of the most popular.  PECS are portable, inexpensive, and it's easy for a wide variety of people to use them with the child.  Unfortunately, PECS are also limiting in terms of communication.  You are limited to the cards, and having rich conversation with them is really really difficult.  (edited out personal story) With a toddler, it's a bit more challenging when words can't be used. I really think it's important to give medically complex kids a means of voicing concern because they generally know their bodies well and they often need immediate attention.  (And, having had a suction device in the mix and dealing with mucus, he needs a way to communicate that.)

 

Dynavox or other photo to speech apps are one of the technologies available. Here's an example: http://www.tobiidynavox.com/compass-app-overview/  I see that there's a free 30 day trial on the one I linked; if you have an iPad, you can try it out.

 

Signing is awesome. Signing time is a great program, but if this is possibly a long-term thing, I highly recommend working with a speech language pathologist.

 

I wish you the best; feel free to pm me.

 

 

Edited June 12, 2016 by kbeal

[Daria]

I agree with everything Prairiewindmomma says, especially about the importance of giving all kids, but particularly kids with complex medical needs, a way to express themselves.

 

The one thing I'll add is that the term PECS is used to mean two different things in the world of alternative and augmentative communication.  The word PECS refers to a very specific curriculum, the Picture Exchange Communication System.  It is a curriculum designed for children with severe developmental disabilities who need to be taught explicitly how to communicate.   It is a curriculum with pros and cons, and I would advise parents to be thoughtful about deciding whether it's right for their child.  

 

However, many many people use the word PECS informally to refer to any small square laminated pictures with symbols or photos that are used to communicate, often with some velcro on the back.  These little pictures can be used in all sorts of ways -- for example, they can be used to build schedules, and offer choices.  

 

I would have a lot of hesitation about starting the PECS curriculum with a child unless I had very strong evidence that the child couldn't use a more natural and robust system like sign, a communication book, or a iPad or speech generating device.  I could go into the reasons why, but I won't unless someone wants details.  

 

However, none of those issues apply to using pictures or symbols in more informal ways.  I think that even kids who speak or sign or use AAC devices well, can benefit from using pictures in lots of different ways, and pictures can be a great tool for a toddler to use while you're figuring out the next step.  

[DaisyDay]

Thank you Daria and prairiewindmomma for the excellent info!

 

The baby does have a speech therapist waiting to start working with him but there's an insurance snag at the moment. I will ask her about these things when she gets approved to begin.

 

I will pm you as needed once we get going.

[Daria]

I'm glad you have someone to help!

If you can find some sign language videos, maybe at the library or on youtube, or print out some pictures of favorite things for him/her to point to, it might be an easy way to help with his frustration.  

[Lecka]

You might be able to request an AAC evaluation. You might be able to qualify through EI, and get specific suggestions.

 

I think you have gotten great advice here, and I hope it goes well!

 

I read a book with the author's personal ideas about what to choose.

 

She liked sign bc it can be used with swimming and jumping on a trampoline.

 

She didn't like that many people out and about would not know sign, and so it would be limiting that way.

 

But I think she recommended seeking an AAC consult, bc I guess there are so many factors involved.

 

If it might be longer-term, I think you need to think long-term, too, about what can be consistent and accessible in the future, and the AAC specialist would have an informed opinion.