Frequently Asked Questions
Many parents have questions regarding early intervention and preschool services, as well as general child development. Below please find some information that may assist you in these areas. If you have a question that is not addressed here, please feel free to contact MKSA at (516) 731-5588 or by email and one of our professionals will be happy to answer your question.
Please keep in mind that the information below is for general informational purposes only; it is not an attempt to diagnose or treat any condition or situation. All children develop at different rates and there is a wide range of “typical” development. As always, if you have specific medical concerns, contact your child’s physician before using any suggestion or treatment.
» Child Development
EARLY INTERVENTION+Expand all -Collapse All
The Early Intervention Program (EIP) is a statewide program administered by the NYS Department of Health. The EIP provides many different types of services to infants and toddlers.
Children are eligible for the EIP if they are under three years of age and have a confirmed disability or developmental delay in one or more of the following areas of development: physical, cognitive, communication, social-emotional and/or adaptive.
If your child is under three years of age, you may contact the Nassau County Department of Health at (516) 227-8661 or the Suffolk County Department of Health at (631) 853-3100. To access EI services within New York City, contact the NYC Help Line at 311. You may also call our office and we will assist you in completing a referral to the Early Intervention Program.
MKSA can conduct evaluations either in your home or in our facility. A parent must be present at the evaluation.
All referred children receive a multidisciplinary evaluation to determine eligibility for services. The NYS definition of developmental delay means that a child has not attained certain milestones expected for the child’s age adjusted for prematurity. A developmental delay is a delay that has been measured by qualified personnel using appropriate diagnostic procedures which document:
– a 12-month delay in one functional area;
– 33% delay in one functional area or 25% in each of two areas;
– 2 standard deviations below the mean in one functional area or 1.5 standard deviation below the mean in each of two functional areas
The evaluation team or a member of the team will discuss with you their findings. The evaluation team must write an evaluation report and summary. If your child is eligible, an Individualized Family Service Plan (IFSP) is developed.
An Individualized Family Service Plan (IFSP) is a written plan for the child’s and family’s services in the early intervention program that the family develops with a team of qualified personnel and the Early Intervention Official. The IFSP includes goals and strategies to address priorities and concerns.
Your family’s IFSP will include a statement of the following:
– Child’s present level of functioning
– Family’s resources, priorities and concerns related to child’s development
– Early intervention services needed to meet your child’s and family’s needs
– Where services will be provided
– Outcome or goals expected from services
– Strategies, activities that will lead to the outcomes
Available services include: Special Instruction, Applied Behavior Analysis (ABA), Speech/Language Therapy, Feeding Therapy, Audiology services, PROMPT, Social Work services, Family Training, Occupational Therapy, Physical Therapy, Psychological services, Vision services and Service Coordination.
All services can be provided using any of the following service models:
– Home and community-based visits (family’s home, relative’s home, child care center, family day care, or other places parents go to with their children)
– Facility or center-based visits (where service provider works)
– Parent child groups (usually at an agency’s office or facility)
– Group developmental intervention (a group means two or more children who are eligible for EI services)
Service frequency and duration are determined at the EI/IFSP meeting. Since all services are individual, the amount and types of services will be written as per your child’s needs.
All service providers are licensed or certified New York State professionals. All early intervention providers must have a NYS early intervention approval letter in order to provide these services.
At various intervals depending on your municipality you will receive reports. IFSP review meetings are held every 6 months to review a child’s plan and create a new one for the next 6 months. Progress reports are reviewed at this time.
This should be reviewed with your child’s team and if appropriate, a request may be made.
The EI Program is a public program funded by New York State and local counties. Early Intervention services are provided at no out-of-pocket to families of eligible children. Health insurance may be accessed to pay for services in New York State.
Please see our transition planning page.
Strict confidentiality regulations (FERPA-Federal Educational Rights and Privacy Act, HIPPA-Health Insurance Portability and Accountability Act of 1996) are adhered to in the EIP. No information is distributed without your consent.
Visit https://www.health.ny.gov/publications/0532/ for more information on New York State’s EI program.
PRESCHOOL SERVICES+Expand all -Collapse All
The New York State Education Department (SED), Office of Special Education oversees a statewide preschool special education program with school districts, municipalities, approved providers and parents. Evaluations and specially planned individual or group instructional services or programs are provided to eligible children who have a disability that affects their learning. Funding for these special education programs and services is provided by municipalities and the State.
If your child received early intervention services as an infant or toddler up to age three, and may still need special education, your service coordinator will assist you with transition planning and making a referral to the Committee on Preschool Special Education (CPSE) at your local school district.
If your preschool-age child (3-5 years old) did not receive early intervention services, but has some delays or lags in development such as difficulty in talking, moving around, thinking, or learning or is facing physical or behavioral challenges, a parent or guardian may make a referral to the chairperson of your school district’s Committee on Preschool Special Education (CPSE) who will assist you in completing the referral process.
When your child is referred to the CPSE (your local school district), you will be given a list of agencies approved by the State Education Department to provide preschool special education evaluations. You will be asked to select one of the approved evaluators, then sign a consent form for your child to be evaluated at no cost to you or your family. A copy of the evaluation report, including a summary of the evaluation, will be provided to you and to other CPSE members. You will be asked to meet with them to discuss the evaluation results.
If your child has a disability that may be affecting his or her learning, the CPSE will find your child to be an eligible “preschool student with a disability.” The CPSE will also recommend the program or services to meet your child’s individual needs and where they will be provided.
If your child is an eligible preschool student with a disability, you and the other CPSE members will write an Individualized Education Program (IEP) for your child that will list the recommended services to be provided, how often, and for how long. The CPSE must consider how to provide the services in the Least Restrictive Environment (LRE), where your child can learn close to your home with other children of the same age who do not have disabilities.
If approved by the school district, arrangements will be made for your eligible child to receive one or more of the following special education programs and/or services recommended by the CPSE including, but not limited to:
Speech Therapy (ST)
Occupational Therapy (OT)
Physical Therapy (PT)
Special Education Programs:
Special Education Itinerant Teacher (SEIT) – a special education teacher works with a child in a setting recommended by the CPSE.
Special Class in an Integrated Setting (SC/IS) – a class with preschool students with and without disabilities.
Special Class (SC) – a class with only children with disabilities.
When the CPSE is planning programs and/or services for your child, they must also consider your child’s transportation needs, including the need for specialized transportation. If recommended by the CPSE, transportation will be provided by the county — once daily from the home or another child care location to the special service or program, and returning once daily from the special service or program to the home or other child care location — up to 50 miles from the child care location. Parents may be reimbursed for transporting their own child if the CPSE recommends transportation. Transportation will not be provided at public expense if the CPSE recommends special education itinerant teacher services or related services in the child’s home or another child care setting which the parent has arranged.
Contact your local school district CPSE Chairperson or Director of Special Education.
SLEEP+Expand all -Collapse All
Infants – to about 4 months – cry because of physical needs. They can’t be “spoiled” at this age, so when your infant cries, pick him up and give comfort by rocking and cuddling. When your infant wakes up at night, take care of him quickly and matter-of-factly, without much social contact or play. Then put him back in the crib and leave the room, to discourage waking up for the rewards of play and attention.
The older baby (4 months and older) must learn to relax and fall asleep without help. After the rituals of bathing, quiet play and feeding, put your older baby into the crib while he is still awake. Your baby will become better at relaxing and drifting off to sleep without help, which will also help when he wakes up in the middle of the night.
According to the Centers for Disease Control, Sudden Infant Death Syndrome (SIDS) is the sudden death during sleep of a seemingly healthy baby. Although there is not known cause of SIDS, there are things that parents can do to help with prevention:
– Always place babies on their backs to sleep for every sleep
– Use a firm sleep surface, such as a mattress in a safety-approved crib, with a fitted sheet
– Have the baby share your room, not your bed; your baby should not sleep in an adult bed, on a couch, or on a chair alone, with you or with anyone else
– Keep soft objects, such as pillows and loosed bedding out of your baby’s sleep area
– Prevent exposure to smoking during pregnancy and after birth as these are important risk factors for SIDS; the risk of SIDS is even stronger when a baby shares a bed with a smoker
Many older babies wake up at night for the privilege of sleeping in the parents’ bed. This desire often continues throughout childhood. Unless you believe in the family bed, avoid this attractive response to nighttime waking at all costs!
Establish daytime routines, including consistent waking times. Regular meal and activity times promote regular sleeping times. Develop bedtime rituals (a story or song, bath); routines make it easier for a child to “wind down.” Provide an environment that promotes sleep. A cool, dark, quiet room is best. Discourage excess evening fluids. Be consistent!
Don’t postpone bedtime in the hope that a tired child will be easier to put to bed. When an overtired child loses self-control, it can be almost impossible to meet the child’s needs and the child can’t fall asleep comfortably.
If your older preschooler resists going to sleep, try allowing the child to stay awake-but only in his bedroom-as long as the child wants, but without the stimulation of television or other screens. Your child feels somewhat in control, while you maintain a define bedroom time. There’s little reason to stay awake once the child realizes that further contact with the family is unlikely, and the child is likely to drift off the sleep—perhaps while playing on the floor. Eventually, the child will find that a soft bed is a better place to spend the night.
Generally, a bed is introduced at about age 2-1/2 or 3, when the child can get in and out of it easily. The American Academy of Pediatrics advises switching to a bed when a child is 35 inches tall. Other signs of readiness include if your child starts climbing out of the crib, or if he sleeps through the night and adheres to a regular bedtime routine. Some popular choices with regard to selecting a bed include:
-A junior bed: This is made for young children. It is low to the ground and has guardrails. However, as it uses a crib-size mattress, it will be good only until your child reaches age 5 or so.
-A twin-size bed: This will work, but push one side against the wall and use a guardrail on the other.
Be sure to keep the bed away from windows, and as your child will be mobile, remember to keep door and entrances to off-limit areas closed and locked, and install a safety gate at the top of stairs.
Medications can affect a child’s sleep. Many medications—over the counter and prescription-can cause or add to a sleep problem. Always check with your child’s pediatrician before administering medications of any kind.
PLAY+Expand all -Collapse All
Babies play at every stage of development. Infants learn about how the world works by looking at their own hands, grabbing rattles or hitting objects. Toddlers use play more creatively. Encouraging more complex play helps children with important thinking skills and with the social understanding of what they can do and how competent they are.
As soon as babies can grasp with their hands, they explore toys by putting them into their mouths. By 9 months, mouthing toys is not as much fun as banging, shaking, and dumping things. By age 1, babies are putting objects into containers, and they understand that pushing a button or pulling a string can make things happen. It’s exciting to watch how an 18-month-old uses objects to act out familiar activities like eating, drinking and telephoning. By age 2, children are able to use pretend objects in place of real ones. Learning how to pretend is the beginning of dramatic play and is an important first step in learning how to play pretend games with other children.
Solitary play – this is the first kind of play where children play alone with their own toys or activities and do not try to make contact with nearby children. Examples include banging, shaking, filling and dumping.
Parallel play – children play independently but near each other. Examples include manipulating a doll to do common things, and doing a series of pretend activities, such as pouring and drinking pretend milk.
Associative play – children play with the same toy but not together. Examples include building separate structures with blocks or playing with play-doh without exchanging tools.
Cooperative play – Children play with the same toy together. Examples include board games or using Legos to build one structure.
Babies need you to talk and sing to them and provide many kinds of toys and materials for them to explore. When the baby is tired and no longer want to play, it is time to stop. Toddlers need you to play with them in games they choose. You can help by giving suggestions; withdraw from the play when your child can handle the activities alone.
For babies, it’s good to have toys that you and the baby can look at together. Talking about and playing with toes, fingers and body parts is just as wonderful as having rattles or soft animals to touch, chew on or shake. After the first few months of life, give toys that your child can use to make something happen, rather than just watch or listen to. A toy that pops back up when pushed over is better than a stuffed animal. For toddlers, manipulatives such as ring stackers and blocks are a great addition to cause-and-effect toys.
We all learn from our senses – from seeing, hearing, tasting, smelling and touching. We also learn from the sensation of movement. Your play—and your child’s—should include all of these sensations.
How can I help my child use the senses to explore and learn?
Birth to age 1 – Hang mobiles across the crib to provide new sights. Babies enjoy sound games as they approach their first birthdays. Hide musical toys so you child can locate them.
The 1-year-old explores by touching. In a special drawer, keep objects that are safe to touch and play with, such as a wooden spoon, funnel and old pan. A flashlight is another toy for this age. Sand and water play is fun too.
The 2-year-old touches and tastes everything, so keep electrical outlets protected and cords out of reach. He is able to match textures and likes to play “name that smell” game with soap, coffee and other familiar smells.
The 3-year-old is learning more about the world. Imitation is how they act out this understanding: they “bake” mud pies, “drive” a car, and “sweep” the floor. He enjoys blowing bubbles, splashing in water, and playing in sand.
The 4-year-old loves to run and chase, and to kick a ball. He loves to pretend to be someone else and enjoys dressing up. He can roll sections of play dough and form people.
The 5-year-old can climb up steps to a slide, ride a bicycle and use a monkey bar. He can learn to swim, skate, ski, dance and use a trampoline. He adds details to drawings, and may print his name.
TOILET TRAINING+Expand all -Collapse All
It is important to remember that each child is an individual and develops at his own rate. Generally speaking, you can expect your child to achieve daytime control sometime between ages 2 and 3, and nighttime control between ages 3 and 4-1/2.
Some—but not necessarily all—of the following are signs: pausing and making sounds and grimaces when having a bowel movement, being regular in bowel movements, staying dry for an hour or two in the daytime, waking up dry from a nap, complaining when wet or soiled, being aware that urine and feces come from his body, telling the parent when he has had or is having a bowel movement, wanting to imitate adults and be grown up.
During your everyday activities, point out when he is having a bowel movement or is urinating; teach him that urine and feces come from the body, teach him the words you want to use for bathroom functions, allow him to observe others using the toilet, read books about toilet training.
Accidents will happened-and are to be expected. Be relaxed about them. Express no anger or disapproval; don’t scold, shame or punish him. Clean up calmly and reassure him that “next time you’ll remember to use the potty.”
Regressions to wetting and/or soiling are not uncommon in toddlers and are usually a reaction to stress. Look for sources of pressure in the child’s life—separation from a parent, a new baby, starting nursery school, moving, etc.—and try to ease tension by providing reassurance. If this persists, speak with your pediatrician.
Think carefully about the words you teach your child for body parts, urine and bowel movements. Not only will you hear these words daily throughout the preschool years, but he is sure to repeat them often to relatives, neighbors, teachers and friends. To encourage a healthy body image, use anatomically correct names for all body parts. When an elbow is an elbow, but a penis is a “weenie,” children often wonder why one part of their body is so special that it can’t be called by its real name. On the other hand, most people don’t use terms like “urine” or “feces” to explain their bathroom needs. “Pee pee,” “wee wee,” “wet,” and “tinkle” are more commonly understood childhood descriptions of urination, while “poo poo,” “doo doo,” “BM,” “poop,” and “doody” are the usual choices for a bowel movement. In addition, simply saying “going potty” can be confusing to a child because it doesn’t differentiate urination from defecation.
This is a common problem for many young children. They often are very sound sleepers and have small bladders that can’t hold all of the urine made during the night. Suggestions include:
– Limit the amount of liquids your child drinks 2 hours before bedtime
– Have your child try to use the toilet just before going to bed and as soon as he wakes up
– Cover the child’s mattress with a rubber pad
– Praise him when he stays dry
– Respond gently when he does have an accident; getting angry doesn’t help either of you
– Tell him to use the toilet if he wakes up in the middle of the night; remind him he can come and get you for help
No More Diapers! By Jo Graham Brooks, MD
Once Upon a Potty by Alona Frankel
Going to the Potty by Fred Rogers
Potty Time! By Betty Reichmeier
Everyone Poops by Taro Gomi
Uh Oh! Gotta Go! By Bob McGrath
I Have to Go: Featuring Jim Henson’s Sesame Street Muppets by Anna Ross
SPEECH AND LANGUAGE+Expand all -Collapse All
Not yet. A child at age 2 ½ is only expected to be approximately 65-70% intelligible when speaking. The “s” and “th” sounds are later developing sounds.
Normal speech and language development can proceed at very different rates. It is common for most 2 year-olds to have a 40-50 word vocabulary and to be just starting to put 2 words together. Others may be able to carry on a conversation. An evaluation would be recommended for 2 year-old children in the following situations: no spoken words or fewer than 40 words, not imitating words, or difficulty understanding language. An audiological evaluation is also recommended to rule out a hearing component present.
Between ages 2½-5, when children are learning how to speak, 25% of children will display dysfluencies. It is best addressed by not bringing any attention or saying anything about the dysfluencies present. If your child develops what we call “secondary characteristics” such as eye-blinking, foot stamping or facial grimaces or if the stuttering gets worse, the dysfluencies should be addressed by a speech therapist.
Talk to your child about everything! Talk about things you are doing: washing dishes (plates, bowls, silverware), setting the table (forks on napkin, spoon next to knife), bath time (reinforce naming body parts), dressing the child (body parts and spatial relationships, i.e. leg in pants), laundry (name socks, shirts, pants). Provide new experiences for your child by taking him to new places: supermarket (name fruits and vegetables); playgrounds (talk as you push your child on a swing); television (talk about shows with your child, like Sesame Street); airport (see planes arrive and depart); zoo (animals, what they eat).
Try expanding what your child says (adding 1-2 words to what he said), providing a good verbal model for the child to follow, commenting on the actions of yourself and your child, having the child imitate words after you, providing associations/additional vocabulary words to the child’s words, and repeating the same new words in front of your child in many different situations.
Model language by talking in short sentences that your child can imitate. Your child needs practice hearing speech in pieces he can do. Your child’s language can be hard to understand. Replying with expressions such as “really” or “show me” will encourage more language. Take notice of where your child is looking. Most of the time he is talking about something within his/her view.
No. Your child learns to speak clearly in small steps. Encourage him to change by coming a little closer to you. Be very careful not to make him feel failure if he does not say the word just like you do. Come to appreciate small changes in your child’s speech; when you show you do, he will regards you with even more changes.
Both are important! Learning to speak clearly involves coordinating the brain and muscle in very complex ways. It requires a great deal of practice. The more you and your child communicate in ways that let him take the lead and talk frequently, the more likely he is to speak more like you.
NUTRITION+Expand all -Collapse All
Try to offer liquids in a cup at about six months old. Offer about ¼ of an ounce of liquid in small, open plastic cup. Hold the cup while your baby learns how to adjust his lips to the edge. If your child is having difficulty drinking from a cup, try the suggestions below:
1. Use thicker liquids – Your child’s little mouth needs practice to drink from a cup. Try using thick liquids or purees at first. A jar of strained pears makes a great shake; it’s a familiar taste and the puree is easier than milk or juice for your child’s mouth to control. The puree moves more slowly, and is heavier, making it easier to control.
2. Choose the right cup – Be sure the mouth of the cup is not too big. There are a variety of lidded cups available. For most children, a spouted cup is fine. If your child needs to learn more oral skills, consider using a lidded cup with no spout. This provides your child’s mouth with the same feeling as drinking from the cup lip, and prevents spills.
This can be discussed with your child’s pediatrician, and is based on your child’s age, weight and height. Keep in mind that milk contains as many calories as most solid foods. Drinking too much milk can fill up children and dull their appetites.
Children need to snack throughout the day—in addition to being offered regularly scheduled meals. However, try to discourage large snacks or beverages other than water around mealtimes. This way, your child will be hungry enough to eat with the rest of the family. Some snacking suggestions are: yogurt (low-fat or nonfat), dry cereal (low sugar), crackers (whole grain, low fat), plain mini bagels or whole grain breads with jelly or peanut butter, fruit, graham, crackers, pretzels, and carrot or celery sticks with low fat yogurt dip. Provide a variety of foods, giving your child practice with foods with different textures.
The main way to prevent feeding struggles is to teach your child how to feed himself at as early an age as possible. You can wait for your infant to show you when he is ready to eat (by leaning forward, for example) and allow him to pace the feeding himself (by such indications as turning his head). Do not insist that he empty the bottle, finish a jar of baby food, or clean the plate. By the time your child is 6-8 months of age, start giving finger foods. Such foods allow him to feed himself at least some of the time. By 12 months, your child will begin to use a spoon, and by 15 months he should be able to feed himself completely. This is your child’s first step towards independence.
Put your child in charge of how much he eats. Trust your child’s appetite center. The most common reason many children never seem hungry is that they have so many snacks that they never become truly hungry. Drinking too much milk can reduce a child’s appetite as well.
Children need smaller portions than adults. Approximately 1 tablespoon of each type of food for every year of the child’s age is an ample portion size in most cases. For example, a three-year-olds’ plate might contain 3 tablespoons of chicken, 3 tablespoons or rice, and 3 tablespoons of vegetables.
BEHAVIOR AND DISCIPLINE+Expand all -Collapse All
Discipline and punishment are not the same—discipline is guidance and teaching that promotes positive behavior; punishment is a penalty imposed in reaction to unacceptable behavior. Positive discipline is a discipline model that focuses on the positive points of behavior, and is more effective than punishment because desirable behaviors that last a lifetime must come from within the child rather than be imposed by external force.
Frustrated parents often describe a child’s personality with words like rebellious, lazy and selfish. Behavior can be altered, but personality is more resistant to change. When efforts are focused on behavior, goals are more likely to be reached. For example, don’t say, “That’s a good girl!” which sends a message that being good all the time is the goal—an impossible expectation. Say instead, “I like the way you spoke to Grandma just now.” No amount of “good boy” or “good girl” will build a positive self-concept unless the child receives specific feedback on his actual good behaviors, because his self-image is composed of his accomplishments. The most effective way to build good behavior is to shape it with praise.
The more specific your praise is, the better the child will understand what he’s doing right and the more likely he will be to repeat it. To increase desirable behaviors, you must emphasize the specific behaviors that please you. One morning, for example, you notice your child has made his bed. At that moment, he’s brushing his hair. If you simply say “Looks nice,” he won’t know whether you are referring to his bed or his hair. Instead, you can say, “I really like the way you made your bed so neatly this morning. Thanks.”
Start praising every little step toward the target behavior, making a point of catching the child at being good. Suppose you have told your child he must clean up his toys when he’s through playing with them, though he’s never done this before. Praise every bit of progress, however minor. At first, praise him for picking up one toy even though he’s left three others on the floor. You might say, “It was great the way you picked up your truck and put it in the toy box. Let me help you pick up the others.” The next time, praise him for picking up two items, and so on.