LEARNING THROUGH EVERYDAY

ACTIVITIES WITH PARENTS FOR

INFANTS WITH CEREBRAL PALSY

Family Worksheets Ve rsio n 2.0

QUEENSLAND CEREBRAL P ALSY AND REHABILITATION RESEARCH CENTRE

Th e Un ive rsit y o f Q u e e n slan d

Co rre spo nd ing a u t hor : Dr Ka t h Be n fe r

Em a il: k.be n fe r@ uq .e du .a u

W eb sit e: ht t ps://qc p rrc .c e nt re .uq .e du .a u/

 leap-cp

Baby and family strengths

LEAP-CP Learning through Everyday Activities with Parents

The LEAP-CP program includes home visits with a peer trainer every week
(for 30 visits). Visits last for about 1-2 hours each time. Peer trainers are su-
pervised by a disability specialist. We want you to try to do the games and
activities we talk about with your baby for 20 minutes each day.
Visits will include:

Yarning Games Goals

Let’s take a closer look at what we will learn together.

LEAP-CP is based on scientific evidence of what we know helps your baby’s
brain develop and grow. It works best when you do the treatment regularly
at home. It is not a cure for cerebral palsy.

Treatment is through play. Play is your baby’s
You are your baby’s best teacher. This is why
work. Play is something your baby chooses and
we teach you how to do the treatment.
has fun doing.
All babies learn; assume your baby can & will Every baby is different. They each have
learn. Learning starts from birth, so don’t wait for
unique interests and learn to do things in their
a milestone before you provide
own way and at their own pace.
enriched opportunities in the home.

Tuning in to your baby’s unique way of Your baby learns best through making small
Be present and find joy being with yourbaby. When your baby is motivated and experi-encing
communicating (watch and learn) will help changes to your everyday activities and
Your baby knows when you are enjoying, and success their brain learns more. Adding
you understand what they are thinking or trying interactions. Talk through your day to create
when you are stressed. repetition helps them learn.
to do. a rich learning environment.

Get support and connection. It’s normal to have

When your baby is doing an action, their brain is You don’t need expensive toys to play. We will
To allow your baby to do more, you need togo tough days — having support from family and
learning. Encourage your baby’s independent talk about items around your house youcan
slow — wait before you help. friend is critical for you to take care
movement and active play. use to help your baby learn.
of yourself.
 leap-cp
Getting started

Baby and family strengths

You and your baby have

unique preferences and
strengths. Building on
these provides a strong
platform for learning. You
are your baby’s first and
best teacher.

What are some of your strengths? List or draw some your top 3!

Baby strengths Family strengths

 leap-cp
Getting started

Play
Play is the most natural way for babies to explore, experiment, discover, learn
and grow. Play is your baby’s work — the way they exercise their muscles and
brain. Play should be fun for you and your baby!

Holding toys

Visual toys
Safe and clean place to play

Noisy toys

Objects and toys to play with

A quiet place with minimal dis- Adequate lighting for

Happy & alert (& not sick)
tractions (siblings, phone, TV) looking in play
Full tummy (fed recently)
Dry nappy

Can you think of ways

you can provide a play
space for your baby?
HAVE
FUN!!
Other people to help (family or friends)
 leap-cp
Getting started

Makingmy home safe

Your baby is curious and interested

to discover and investigate their
environment. This means you need
to make sure your home is safe for
your young explorer.

Check your home for these:

Inspect your baby’s toys regularly for damage, such as sharp edges and loose parts.
If a toy can fit through a toilet roll, it is too small for your baby to play with.
 leap-cp
Getting started

Aboutcerebral palsy

“There is a lot to understand about

having a baby with a disability. But I
know this. I can give my baby a
good life, and together we can find
happiness”
Parent of a child with a disability

These children all have cerebral palsy. Just because you have cerebral
palsy, it doesn’t mean you won’t be able to walk or talk.

These adults all have cerebral palsy. Just because you have cerebral palsy, it
doesn’t mean you can’t go to school or get a job.

Prodip completed school & now works as a Peer Support Porimol completed school and
Counsellor with Queens University (Canada). now manages his own store.
 leap-cp
Getting started

Setting goals together

Babies with cerebral palsy

learn and develop, but
may need extra time and
extra help. A goal is the
next skill you want your ba-
by to learn.

Whose brain is learning?

It is important to help your baby learn to do things for themselves rather
than having you do it for them all the time. You want to carefully choose
games and goals that will help your baby learn, and set up their
environment to help this. If you do the movement, your brain is learning. If
your baby does the movement, their brain is learning.

My baby’s first LEAP goals

You might find it helpful to take a note of your baby’s first goals you will
work on. Write/ draw/ take a photo or video on your phone; or attach
printed photos:
 leap-cp
3

Success and Motivation

Motivation and success are critical to

your baby’s learning. If a toy is not
motivating, or they don’t experience
success, they will not want to keep re-
peating and practicing the new skills.

Just right challenge

Success. Try to choose an activ- Too hard
ity that is a step harder than
what your baby can currently Just right
do. Don’t make it so hard that
they don’t achieve success or Too easy
you need to do a lot for them.  Can your baby com-
plete part of the task (eg
1 step out of 5)?
 Hands off half the time?
 Is your baby visually and
cognitively engaged?

Choosing toys:
Baby’s skills What baby enjoys Goal

Think about: size, how it feels, how it looks, 1 or 2 handed, using household items.

Make a learning box for quick access and

to help others engage with your baby!
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3

Breastfeeding
Until your baby is 6 months, breastmilk should be the only food/ drink they are having. Feed
your baby as often as they want to (on demand); usually 8 or more times in a day. You
should continue breastfeeding until your baby is about 2 years old. Your baby is probably
having enough breast milk if they:
 Have 6-8 wet cloth nappies or urine in 24 hours
 Have soft bowel motions
 Generally settle after most feeds
 Are gaining weight according to their age
 Have bright eyes and good skin tone

Breastmilk contains exactly the nutrients needed by an infant. Thesenutrients Breastmilk protects against infections: it reduces illness in your babyand
are more easily used by your baby’s body. Breastmilk pro- vides enough improves recovery from illness.
water for your baby, even in a hot climate.

Breastmilk improves your baby’s intellectual development. Breastfeeding helps you bond with your baby and develop a strong
relationship.

Breastfeeding protects your health (reduced post-partum bleeding, It’s free!

encourages contraction of uterus after birth, reduces risk of breast /
ovarian cancer).
 leap-cp
5

Helping my baby actively learn

Least support Waiting and time

(hardest for baby)

Verbal assistance

Touch cues

Task assistance

Break task into

smaller parts

Physical assistance

Most support Change toy, activity

or goal
(easiest for baby)
 leap-cp
4

How does your baby drink?

Optimal feeding is important for

your baby’s growth and nutri-
tion. Are you happy to show me
how you would normally feed
your baby drinks, so we can
problem solve any concerns to-
gether?

Seek medical support

If your baby regularly has any of these, you should talk to your doctor:
 Sensitivity around mouth, (e.g. facial grimacing )or refusal
 Gasping for air or effortful/ noisy breathing while feeding
 Coughing, choking, gurgly voice
 Skin colour changes, eyes widening and watering
 Back arching / increased overall stiffness
 Increased vomiting, gagging during meals (NB. Reflux)
 Increased effort causing tiredness and reduced alertness
 Regular chest infections or fevers
 leap-cp
5

நிமிர்ந்து இருப் பது

இருப் பது இருப்
பது

உங் கள் குழந் தை இன் னும் ச ொந்ைமொக

உட்கொர முடியொவிட்டொலும் , நிமிர்ந்து
இருக்கும் அனுபவை்த ை அவர்களுக்கு
வழங் குவது அவர்களின் வளர் சி
் க்கு
முக்கியம்

மேற் பார்வை
உங் கள் குழந்தைதய உட்கொர தவக் கும் பபொது, அவர்களொல் இன் னும் ைங் கதள
மநிதலப் படுை்திக் சகொள் ள முடியவில் தல என் றொல் , வீழ் சி
் தயை் ைடுக்க நீ ங் கள்
அவர்கதளக் கண்கொணிப் பது முக்கியம் . உட்கொர்ந்து விழுவது கூட உங் கள்
குழந்தைதய கொயப்படுை்தும் . உங் கள் குழந் தை ஆைரவுடன் அமர்ந்திருந்ைொல் , அவர்
ச ொந்ைமொக உட்கொரக் கற் றுக்சகொள் ள முடியுமொ என் பதைப் பொர்க்க, சுைந்திரமொக
உட்கொருவதை ஒரு இலக்கொக நொங் கள் இதணை்துக் சகொள் ளலொம் .
 leap-cp
4-6 ோதங் கள்

உங் கள் குழந்தை என் ன ொப்பிடுகிறது?

அவர்கள் ொப் பிடுவதை விட அவர்கள் எப் படி வளர்கிறொர்கள் என் பதை மறந் துவிடொதீர்கள் !

அபை உணவில்
புதிய பழம்
ொப் பிடுங் கள்
 leap-cp
7 ோதங் கள்

உங் கள் குழந்தை என் ன ொப்பிடுகிறது?

அவர்கள் ொப் பிடுவதை விட அவர்கள் எப் படி வளர்கிறொர்கள் என் பதை மறந் துவிடொதீர்கள் !

அபை உணவில்
புதிய பழம்
ொப் பிடுங் கள்

½
 leap-cp
9 ோதங் கள்

உங் கள் குழந்தை என் ன ொப்பிடுகிறது?

அவர்கள் ொப் பிடுவதை விட அவர்கள் எப் படி வளர்கிறொர்கள் என் பதை மறந் துவிடொதீர்கள் !

¾
அபை
உணவில்
புதிய பழம்
ொப் பிடுங் கள்

½
 leap-cp
12 ோதங் கள்

உங் கள் குழந்தை என் ன ொப்பிடுகிறது?

அவர்கள் ொப் பிடுவதை விட அவர்கள் எப் படி வளர்கிறொர்கள் என் பதை மறந் துவிடொதீர்கள் !

அபை
jஉணவில்
புதிய பழம்
ொப் பிடுங் கள்

½
fresh fruit

½
 leap-cp
இலக்குகட்டுப்படுை்தும்
கொரணிகள் s

குழந் தை வீடு

ஊக் கம் / பயிற் சி ச ய் ய

அறிவொற்றல் வதரயறுக்கப் Limited toys, Attitudes & social
வரம் பு பட்ட பநரம் circumstances
உடல் வரம் பு materials or space

VISUAL MOTOR (muscles) ATTENTION MOTIVATION STIGMA FAMILY DYNAMICS CAREGIVER MENTAL HEALTH/
OPPORTUNITY Baby has had ENGAGEMENT
Baby is not visually attending Baby is attending but not Baby is distracted or has short Baby finds task too difficult/ limited practice Value of baby/ spending time Restrict time/ participation
to toy attempting the game attention becomes upset

Could your baby be in

Could your baby be in pain?
pain?
Strategies to trial
Step Visual
1 Give your baby a choice or look
for cues he is interested in the
toy. Think about what really
makes your baby get excited
(food, sound, movement). Try
some of these.
2 Make sure toy is in your baby’s
line of vision. The best place
for your baby to see may not
be in the centre of their visual
field. Try moving it to each
side. Take note of where your
baby seems to respond to toys
visually the best
3 Noisy toys. Shake the toy to
get the baby’s attention.
4 High visibility toys (see vision
module). Move the toy to get
your baby’s attention
5 Tactile toys. Direct your baby’s
hands or hand to mouth to
explore the tactile toy.
6 You may want to include the
Helping my baby look goal for
your baby.
7 Use a timer, count the number
Motor
Does your baby understand
what they need to do? Give
more demonstrations of the
game. Try Baby Steps 1 or 2
(one step less)
Can your baby reach the toy/
explore it? Try moving it out
wider, lower, closer, so your
baby can reach with other
body parts like feet.
Try the same game in a
different position (eg
supported sitting or side lying).
Try giving your baby more
support (eg higher on their
body).
Make the game/ goal a bit
easier (one activity earlier on
the goal sheets).
‘Modified motor’ or ‘no motor’
suggestions for the CP Game to
try to find a small step for
success and independence
Attention
Give your baby a choice or look
for cues he is interested in the
toy. Think about what really
makes your baby get excited
(food, sound, movement). Try
some of these
Give only one toy at a time, and
remove other toys/ distractions
from view.
Choose time in the day when
your baby is well, not hungry,
rested, active and alert. Can
you think of a time when
you’ve seen your baby like this?
Use noisy or colourful toys that
attract your baby’s attention.
Move the toy to encourage
them to attend.
Practice throughout the day
instead of in 1-2 longer
sessions.
Give short, lively bursts of the
activity and follow immediately
with something fun.
of turns, or say a rhyme to help
your baby know when the
game will change. Try to
increase the amount of time a
small amount next time you
practice
Try an upright or standing
position.
Motivation
Give your baby a choice or
look for signs he is interested
in the toy. Think about what
really makes your baby get
excited (food, sound,
movement). Try some of
these.
Choose a time in the day
when your baby is well, not
hungry, rested, active and
alert. Can you think of a time
when you’ve seen your baby
like this?
Give short, lively bursts of the
activity and follow
immediately with something
fun.
Start with a short amount of
time that is tolerated. Once
your baby fusses in a position,
move out of it, play some
other games for a minute,
then try again.
Show your baby how the
game works, have fun doing
it, give praise and
encouragement.
Opportunity
Practice throughout the day
instead of in 1-2 longer
sessions. Brainstorm how
activities could fit into daily
routine.
Discuss alternative materials
listed on back of CP Game
sheets.
Make toys together in session
Loan toys from toy collection
Give information to parent:
importance of the skill practice
for future skill development.
Recap perseverance vs stress
module.
Check understanding of task.
Attitudes & Social
Value of baby/ stigma
Family dynamics: see
‘Responding to challenging
situations’ in Coordinator
Manual.
Mental health: see
‘Exploring emotions”
module of Love to ensure
appropriate referrals.
Family engagement:
consider needs of
caregiver at each level of
‘Stages of Change’ model
(Coordinator Manual).
Also see ‘Responding to
challenging situations’ in
Coordinator Manual.
 leap-cp

Health check

Refer to specific section of Community Worker Handbook for details

38.50C
Don’t delay! See a doctor immediately!

Stops drinking/ feeding Looks pale Lethargic or unconscious

Vomits everything Seizures

Whites of eyes look yellow


When to continue and when to stop
Does your baby feel...
Unsettled, due to lack of experience
with the task: they are telling you
they don’t want to do the activity.
Persevere a little (small steps!). You
will need to provide lots of
encouragement and emotional
support at these times to help your
baby keep going.
leap-cp
7
Learning a new skill is not easy!
Your baby may get upset when
learning something new. Reading
your baby’s cues will help you
understand how far you can push
Stressed: baby is emotional and
having difficulty calming themselves.
It may be best to stop. You might
modify the game, choose a different
one, or stop. We will explore problem
solving in another module
 leap-cp
5

Being present
Take notice in the moment…
Use your senses and ask yourself, “What does it…”:

Taste like?

Smell like?
Look like?

Feel like? Sound like?

 leap-cp
7

Introducing solids
Helping my baby to eat

Before eating starts, show your baby their spoon, and say ‘time for eating’.
Tell your baby as food is coming. Use words to describe the food.

Give smaller meals Position your baby up- Use a small spoon Give smooth food Go slow. Your baby
more frequently (5-6 right. Their head, neck that can fit in your without lumps. It needs time to swallow.
times in a day) and body should be baby’s mouth. Un- should be a little bit Follow their interest
lined up, with chin breakable plastic is runny, but not too and stop when they
down. Hips bent and safer than metal. runny. are ready. Never force
feet supported. your baby to eat.

Make it not too runny, not too thick Put only a small amount on the spoon
 leap-cp
4

Tummy time

Tummy time each day helps

your baby build their head,
neck and shoulder muscles.
It is a good position for
babies to start to move.

Start with just 1-2 Put toys close for Get face to face Mirrors and being
minutes at a time. your baby to see with your baby to outdoors can be
Do this often dur- and touch. Use interact with them fun to try
ing the day. talking & looking
toys.

Start off more upright and

Head up gradually get lower

Arms forward and elbows

Support around under their shoulders Hand on hips to keep bottom
their chest to Support down as baby pushes through el-
help them prop under chest bows
on their elbows
 leap-cp
8

Reading your baby’s cues

Head: Eyes: Mouth: Breathing: Arms and legs:

‐Turning away ‐ Widening ‐ Sucking (faster, ‐ Faster ‐ Fisting hands
‐Looking towards ‐ Moving slower, stops) ‐ Slower ‐ Splaying fingers
‐ Looking ‐ Smiling ‐ Yawning ‐ Kicking legs
‐ Gazing ‐ Facial expression ‐ Hiccupping ‐ Reaching
 leap-cp
4

How does your baby eat?

Optimal feeding is important for

your baby’s growth and nutri-
tion. Are you happy to show me
how you would normally feed
your baby drinks, so we can
problem solve any concerns to-
gether?

Seek medical support

If your baby regularly has any of these, you should talk to your doctor:
 Sensitivity around mouth, (e.g. facial grimacing )or refusal
 Gasping for air or effortful/ noisy breathing while feeding
 Coughing, choking, gurgly voice
 Skin colour changes, eyes widening and watering
 Back arching / increased overall stiffness
 Increased vomiting, gagging during meals (NB. Reflux)
 Increased effort causing tiredness and reduced alertness
 Regular chest infections or fevers
 leap-cp

Learning from objects

The toys and objects around your

home provide rich learning oppor-
tunities for your baby. Objects do
not need to be expensive or spe-
cialised — use what you have in
your home.
 leap-cp

Help me grow
WHAT your baby eats is as important as HOW MUCH your baby eats. Your baby
needs energy to grow well. They also need nutrients for strong bones and mus -
cles. Water helps their body work well.

Add extra energy to your baby’s food by:

Replace some (or Add a spoonful of Mix legume, pulse or Stir in a paste made Add a spoonful
all) of the cooking milk powder after bean flour with the from nuts or seeds of margarine,
water with milk or cooking. staple flour before such as peanuts or ghee or oil.
cream. cooking. sesame seeds.
 leap-cp
10

Positioning for play

Body position
Supportive chair On tummy/ sidelying Supported by adult Face to face on knees Lying on back

Use of arm

Support elbow Use feet Knock object off surface Object very close to fingers Position target lower

Position relative to
face In the middle To the side At eye level At chest level Attach to body In a U‐shape Further away Closer

Direction of toy
Handle horizontal Hold toy steady Place in hand for use Lie baby on toy/ object Objects on an angle
 leap-cp
10

Waiting for your baby to respond

1...2...3...4...5...6...7...8...9...10 1...2...3...4...5...6...7...8...9...10 1...2...3...4...5...6...7...8...9...10

Mother shakes rattle Place in your baby’s hand and help

Move rattle/ shine light Modify task (eg make handle horizontal)
them rattle so they get feedback
 leap-cp
10

Preparing safe weaning foods

Preparing weaning foods for your baby

freshly before each meal is best
(keeping for no more than 2 hours). This
may not always be possible due to
time. It is important to keep foods clean
to prevent infection in your baby.

Food hygiene practices

Use bottled or boiled

Wash dishes in warm soapy Keep food preparation areas Remove food scraps
water
water clean

Keep food cool Cover food, to prevent insects Reheat food until it bubbles Boil fresh cow’s milk
to kill germs
 leap-cp
11

Learning through everyday life

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

 leap-cp
11

Introducing a cup

Cup drinking is a helpful way for

your baby to begin to take
more fluids in their day. For a
baby with a disability, it can be
better to transition from breast
straight to an open cup.

Start meals with a small
amount of fluid from a cup.
This will give your baby
regular practice, and en-
sure they are hungry .
Sit your baby upright. Use a small flexible plastic cup.
Head and body in a line You can squeeze it to help di-
and well supported. rect the fluid. A cut-out can
Make sure they are reduce your baby’s need to put
alert and ready to feed. their head back when drinking
(mouth goes on the high side).
It can be easier to begin
with thicker fluids like
yoghurt, porridge or
apple sauce. This slows
down the flow rate.

Tip the cup so the drink is at
the edge, and touching your
baby’s lips. Wait for your
baby to use their lips to
drink. Do NOT pour it in your
baby’s mouth. Give one sip,
then pause to swallow.
Encourage your baby to Let your baby help. If If your baby stops drinking or has
drink: they want to put their had enough, don’t force them.
 Show your baby what hands on the cup, this is Give a small amount at the be-
to do. great practice for them. ginning of each meal. If you are
 Make sipping noises worried they are not having
while the cup is at enough, see your doctor.
your baby’s lips.
 leap-cp
12

Do it again!

Learning takes lots of

repetitions. Just because
your baby does something
once, they will not learn until
it is practiced again and
again. Give your baby lots
of opportunities for practice.

Learning movement
Movements are learned best when:
 Practiced regularly: frequency is more important than duration
 Practicing lots of times together: practice the skill 5 times in a 10 mi-
nute play session, rather than just once and coming back hours later.

Keep some things the same and some things different!

Same Different

 Same routines (order)  Practice in the same position but

 Same words/ language
 Same position (of your
baby and/ or the toy)
with different games
 Practice the same game with
different toys
 Practice with the toys in different
positions
 4-6 months leap-cp

What does your baby eat?

Don’t forget, how they grow tells you more than what they eat!

Eat in same
meal as
fresh fruit
 7 months leap-cp

What does your baby eat?

Don’t forget, how they grow tells you more than what they eat!

Eat in same
meal as
fresh fruit

½
 9 months leap-cp

What does your baby eat?

Don’t forget, how they grow tells you more than what they eat!

¾
Eat in same
meal as
fresh fruit

½
 12 months leap-cp

What does your baby eat?

Don’t forget, how they grow tells you more than what they eat!

Eat in same
meal as
fresh fruit

½
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13

Talking through your day

Follow baby’s interest

Observe
Wait
Listen

Say less, Stress, Go Slow, Show

ball ...
Respond immediately &
consistently
... Join in/ give
Imitate
Take a turn
Roll the Interpret

Yay!
Resources from Getting to Know Cerebral Palsy Resource Guide, International Centre for Evidence in Disability

13
Talk about what is happening around your baby Get face to face Get your child’s attention before speaking

Show objects that correspond to what you’re talking Encourage but do not force communication (and Be attentive to your child’s communication attempts
about. using different modes, including speech)

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Give your child time Take time to interact with your child. Give your child choices
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Health check

Refer to specific section of Community Worker Handbook for details

38.50C
Don’t delay! See a doctor immediately!

Stops drinking/ feeding Looks pale Lethargic or unconscious

Vomits everything Seizures

Whites of eyes look yellow

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Putting weight through feet

Giving your baby opportunity

to put weight through their
feet and legs helps with future
standing, helps stretch muscles
actively and is good for bone
development.

Body straight
Hips forward

Knees Feet flat a nd

forward straight, toes
forward
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Sharing stories together

Sharing stories with your baby

helps their communication and
brain development. It also pro-
vides a time of warmth and to-
getherness with you. You might
like to share books, stories,
rhymes or songs together!
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Exploring new foods

Make thicker

Add lumps

Chewing foods

Strips of well cooked vegetables or soft fruit Foods that dissolve in mouth