The Tickle Technique

Kristy Krantz, PT – Sprout Developmental Services

Working in early intervention we have to be creative and support parents to think outside the box, tailoring learning and development activities to the specific likes and interests of the child and family. As a physical therapist, I often help parents explore how to incorporate strengthening activities into existing family routines and activity settings. It might be something like a child who is drooling and needs to strengthen their oral motor muscles, or a little one who has a weak core so they can’t sit up straight to hold a marker and draw properly, or right leg weakness so a child can’t walk up the stairs with the right leg leading so they always place their hand on the step to give them that extra support they need to make it to their bedroom upstairs.

The reality of this creativity played out for me in vivid color over the last few weeks. I just started working with a new family who has an adorable little girl who is diagnosed with Down’s Syndrome.  Mom is completely invested in her daughter’s development and it’s been evident throughout the last several months. She is always thinking of ways to help her daughter continue to make gains and learn new skills.

One of the issues this little girl has is low tone and the associated weakness that often accompanies children who are diagnosed with Down’s Syndrome. I’ve noticed this lack of strength in her core and how it plays out with her standing and walking.  When I first started working with her this little girl would lower down from a standing position by going into a split, using the laxity in her joints to lower herself down to the ground because she didn’t have the eccentric muscle control in her legs to bend her knees and get down to the floor.  So, we have been working on strengthening her legs…singing songs so she would dance, bending both her legs in rhythm to the song mom was singing…placing toys next to the coffee table so she could bend down part way and reach for the toy and then resume playing standing at the table. However, there was a weakness in her hip girdle that we couldn’t quite find a way to address.  We tried bridges and squeezing a ball in-between her legs…they were helpful…but just barely…and not something that mom could easily incorporate into her daily routine. Therefore, she wasn’t doing them throughout the week. When revisiting our joint plan, I was so glad that mom shared that the activity was not working out for their family. But today we hit the jackpot with…tickles.  Mom would go in for the tummy attack and her daughter would tense up her abdominal muscles in anticipation of the pleasure that would course through her body as mom’s fingers brought giggles of delight.  I could explain the basics of what we were looking for…the tightened abdomen…and then mom was able to figure out how to make this game of tickle time the most effective for her and her daughter. She would hold off a few inches above the stomach with those wiggly fingers so her daughter would tighten her core in anticipation of the impending sensation of ecstasy that would follow.  But then Mom took it to the next level…maybe she was reading my mind…mom took the initiative to bend her daughter’s legs up so that in the squeals of laughter that came with tickle time she could also lift up her butt off the floor and strengthen her hip girdle muscles.

It was a pretty sweet moment, listening to the cackles and feeling the joy and bonding that filled the room as mother and daughter played together. And the best part was that it’s something I know they’ll do over and over in the upcoming days…weeks…months…maybe even years. It’s strengthening those weak muscles, parent-child bonding, and just plain old fun.

Today we scored with a routine based activity that can be easily incorporated into the family’s everyday life, but I also realize that the last several weeks of problem solving together were part of the process that led us to success today. Man, I love my job, especially when the family is fully invested and those days when it all clicks together!