www.mcsprogram.org

Therapeutic Early Stimulation Toolkit Activity Cards Helping Young Children with Disabilities Meet Their Potential

AcknowledgmentsThis training was developed using resources from Harvard University’s Center on the Developing Child and the US Centers for Disease Control and Prevention’s Learn the Signs. Act Early. Furthermore, this training integrated components from Save the Children’s Building Brains parenting sessions and toolkit, and the Emergent Literacy and Math Toolkit.

This toolkit was developed for the United States Agency for International Development (USAID) Maternal and Child Survival Program (MCSP) in the eastern and southern Caribbean. Renee Perez, MCSP/Save the Children, was the principal writer, with contributions by Lauren Pisani, Romilla Karnati, Cassandra Scarpino, Caroline Dusabe, and Fabiola Lara.

We acknowledge our local stakeholders and partners in the eastern and southern Caribbean and El Salvador, who informed the content of the toolkit: the Ministry of Public Health in Guyana; the ministries of Education and Human Resource Development, Social Development, and Health in Grenada; the Ministry of Health and Wellness in St. Lucia; the Child Development and Guidance Centre in St. Lucia; the Ministry of Health in Trinidad and Tobago; the Ministry of Health in Barbados; and the Save the Children El Salvador country office.

We wish to thank the following colleagues for their review and contributions to providing direction on the technical content of the toolkit: Alana Shury and Mary Vandenbrouke from USAID; Jessica Williams and Stella Abwao from MCSP/Save the Children; Goldy Mazia from MCSP/PATH; and Lisa Noguchi, Brianne Kallam, Kathryn Smock, and Elana Fiekowsky from MCSP/Jhpiego. Illustrations were developed by MCSP.

ResourcesThis toolkit includes several resources to support participant learning and practice. Resources include:• A training guide• Training PowerPoint slides• Training worksheets and handouts• Therapeutic early stimulation activity cards

MCSP is a global USAID initiative to introduce and support high-impact health interventions in 25 priority countries to help prevent child and maternal deaths. MCSP supports programming in maternal, newborn, and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. MCSP will tackle these issues through approaches that also focus on household and community mobilization, gender integration, and digital health, among others.

This publications is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the Maternal and Child Survival Program and do not necessarily reflect the views of USAID or the United States Government.

July 2018

0 to

6 m

onth

sSo

cial

/Em

otio

nal

Lang

uage

/Com

mun

icat

ion

Cog

niti

veM

otor

/Phy

sica

l

SE1.

Hel

p ba

by fi

nd h

ands

an

d fe

et b

y pl

acin

g br

ight

ly

colo

red

item

(su

ch a

s so

ck

or t

ape)

on

her

hand

s or

fe

et.

SE2.

Whe

n cr

ying

, sw

addl

e yo

ur b

aby,

turn

him

ont

o hi

s st

omac

h w

hile

bei

ng

held

, and

sw

ing

back

and

fo

rth,

pro

duci

ng a

loud

, ev

en “

sh”

soun

d. H

elp

him

re

ach

his

hand

or

finge

r to

hi

s m

outh

.

SE3.

Intr

oduc

e yo

ur b

aby

to o

ther

s us

ing

nam

es,

desc

ribi

ng r

elat

ions

hip,

and

usin

g ta

ctile

iden

tifyi

ng

sign

als,

such

as

glas

ses,

long

ha

ir, e

tc.

L1. B

egin

and

end

eac

h ac

tivity

w

ith t

actil

e ex

plor

atio

n of

a

mea

ning

ful o

bjec

t (s

uch

as a

sp

oon

for

eatin

g, a

diap

er fo

r ch

angi

ng t

ime,

etc

.).

L2. S

it fa

ce t

o fa

ce w

ith y

our

baby

. Im

itate

her

sou

nds

and

gest

ures

, and

intr

oduc

e ne

w

soun

ds/g

estu

res.

L3. G

ently

tap

and

bru

sh y

our

baby

with

obj

ects

of d

iffer

ent

shap

es, s

izes

, and

tex

ture

s. M

ake

sure

to

incl

ude

all b

ody

part

s, an

d sp

end

extr

a tim

e on

her

han

ds a

nd fe

et. L

et h

er

hold

obj

ects

. Mak

e su

re t

o de

scri

be a

ll th

e ob

ject

s.

C1.

Arr

ange

saf

e sp

ace

with

sou

nd-p

rodu

cing

ob

ject

s in

you

r ba

by’s

imm

edia

te p

erim

eter

. D

angl

e ob

ject

s. A

s yo

ur

baby

mov

es, s

he s

houl

d co

me

in c

onta

ct w

ith

the

obje

cts.

C2.

Isol

ate

ever

yday

so

unds

from

the

in

door

s an

d ou

tdoo

rs,

and

desc

ribe

wha

t is

ha

ppen

ing.

Let

your

ba

by s

afel

y to

uch

and

expl

ore

diffe

rent

item

s.

C3.

As

you

read

a

book

alo

ud, a

ct o

ut

the

scen

es t

o br

ing

the

stor

y to

life

. Allo

w

your

bab

y to

tou

ch a

nd

expl

ore

the

book

.

M1.

Tum

my

time!

Pla

ce

your

bab

y on

her

tum

my

over

you

r ch

est,

legs

, or

on t

he fl

oor.

Mov

e to

ys in

fr

ont

of h

er t

o en

cour

age

her

to r

each

and

tra

ck

the

toys

.

M2.

Giv

e yo

ur b

aby

a w

hole

-bod

y m

assa

ge

whi

le s

he is

sitt

ing

up, o

n he

r ba

ck, o

n he

r si

des,

and

or o

n he

r tu

mm

y.

M3.

Giv

e yo

ur b

aby

gent

le

join

t co

mpr

essi

on o

n kn

ees,

hips

, wri

sts,

elbo

ws,

and

shou

lder

s by

gen

tly

sque

ezin

g an

d pr

essi

ng

your

han

ds in

and

out

of

her

join

ts.

Help baby find hands and feet by placing brightly colored item (such as sock or tape) on her hands or feet.

SEI

Help baby find hands and feet by placing brightly colored item (such as sock or tape) on her hands or feet.

When crying, swaddle your baby, turn him onto his stomach while being held, and swing back and forth, producing a loud, even “sh” sound. Help him reach his hand or finger to his mouth.

SE2

SE3

Intr

oduc

e yo

ur b

aby

to o

ther

s us

ing

nam

es, d

escr

ibin

g th

e re

latio

nshi

p, an

d us

ing

tact

ile id

entif

ying

sig

nals,

su

ch a

s gl

asse

s, lo

ng h

air,

etc.

L1

Begin and end each activity with tactile exploration of a meaningful object (such as a spoon for eating, a diaper for changing time, etc.).

L2

Sit face to face with your baby. Imitate her sounds and gestures, and introduce new sounds/gestures.

L3

Gently tap and brush your baby with objects of different shapes, sizes, and textures. Make sure to include all body parts, and spend extra time on her hands and feet. Let her hold objects. Make sure to describe all the objects.

C1

Arr

ange

a s

afe

spac

e w

ith s

ound

-pro

duci

ng o

bjec

ts in

you

r ba

by’s

imm

edia

te p

erim

eter

. Dan

gle

obje

cts.

As

your

ba

by m

oves

, she

sho

uld

com

e in

con

tact

with

the

obje

cts.

C2

Isolate everyday sounds from the indoors and outdoors, and describe what is happening. Let your baby safely touch and explore different items.

C3

As your read a book aloud, act out the scenes to bring the story to life. Allow your baby to touch and explore the book.

M1

Tum

my

time!

Pla

ce y

our

baby

on

her

tum

my

over

you

r ch

est,

legs

, or

on t

he fl

oor.

Mov

e to

ys in

fron

t of

he

r to

enc

oura

ge h

er t

o re

ach

and

trac

k th

e to

ys.

M2

Give your baby a whole-body massage while she is sitting up, on her back, on her sides, and on her tummy.

M3

Give your baby gentle joint compression on her knees, hips, wrists, elbows, and shoulders by gently squeezing and pressing your hands in and out of her joints.

6 to

12

mon

ths

Soci

al/E

mot

iona

lLa

ngua

ge/C

omm

unic

atio

nC

ogni

tive

Mot

or/P

hysi

cal

SE4.

Par

ticip

ate

in

com

mun

ity a

ctiv

ities

an

d er

rand

s w

ith y

our

baby

. Des

crib

e th

e ac

tivity

ste

p-by

-ste

p an

d po

int

out

diffe

rent

si

ghts

, sou

nds,

and

smel

ls.

SE5.

Sin

g so

ngs

in fr

ont

of a

mir

ror,

poin

ting

and

tapp

ing

diffe

rent

bod

y pa

rts.

SE6.

Mov

e yo

ur b

aby

to

diffe

rent

are

as a

roun

d yo

ur h

ome.

Hel

p yo

ur

child

saf

ely

touc

h ite

ms

in t

hese

are

as.

LL4.

Whe

neve

r yo

u gi

ve y

our

baby

mor

e fo

od o

r m

ore

time

play

ing,

use

the

sign

for “

mor

e.”

Whe

neve

r yo

u he

lp y

our

baby

w

ith a

diffi

cult

activ

ity, u

se t

he

sign

for “

help

.”

L5. S

it fa

ce t

o fa

ce w

ith y

our

baby

, and

stic

k yo

ur t

ongu

e ou

t, si

ng s

ongs

, and

dan

ce.

L6. T

ake

your

bab

y fo

r a

wal

k in

side

and

out

side

. Tal

k ab

out

the

thin

gs y

ou s

ee, f

eel,

and

hear

. R

epea

t th

is a

ctiv

ity a

t ni

ght.

C4.

Pla

y pe

ekab

oo. A

t fir

st, j

ust

part

ially

con

ceal

yo

ur fa

ce. O

nce

your

ba

by u

nder

stan

ds t

he

gam

e an

d kn

ows

you

are

still

the

re, f

ully

con

ceal

yo

ur fa

ce.

C5.

Mak

e lo

ud n

oise

s in

fr

ont

of y

our

baby

. Mak

e th

e sa

me

nois

es b

ehin

d yo

ur b

aby.

C6.

Exp

lore

diff

eren

t ob

ject

s. H

elp

your

bab

y sc

ratc

h, r

ub, s

quee

ze,

poke

, wav

e, b

ang,

gras

p, tr

ace

outli

ne, a

nd t

rans

fer

obje

cts

from

han

d to

ha

nd.

M4.

Gen

tly s

tret

ch y

our

baby

’s fe

et b

y sl

owly

m

ovin

g ea

ch fo

ot u

p, do

wn,

sid

e to

sid

e, a

nd in

a

circ

le.

M5.

Rol

l tog

ethe

r! L

ay

dow

n on

a s

afe

surf

ace

with

you

r ba

by o

n yo

ur

tum

my

and

roll

gent

ly u

p, do

wn,

and

sid

e to

sid

e.

M6.

Mov

e a

soun

d-pr

oduc

ing

item

aro

und

your

bab

y. M

ove

it up

, do

wn,

sid

e to

sid

e, a

nd

in a

circ

le. D

o th

is w

hile

yo

ur b

aby

is s

ittin

g, ly

ing

dow

n, a

nd o

n he

r tu

mm

y.

SE4

Participate in community activities and errands with your baby. Describe the activity step-by-step and point out different sights, sounds, and smells.

Sing

son

gs in

fron

t of

a m

irro

r, po

intin

g an

d ta

ppin

g di

ffere

nt b

ody

part

s.

SE5

Help baby find hands and feet by placing brightly colored item (such as sock or tape) on her hands or feet.

SEI.SE6

Move your baby to different areas around your home. Help your child safely touch items in these areas.

Whe

neve

r yo

u gi

ve y

our

baby

mor

e fo

od o

r m

ore

time

play

ing

with

toy

s, us

e th

e sig

n fo

r “m

ore.

” W

hene

ver

you

help

you

r ba

by w

ith a

diffi

cult

activ

ity, u

se t

he s

ign

for “

help

.”

L4

L5

Sit face to face with your baby, and stick your tongue out, sing songs, and dance.

L6

Take your baby for a walk inside and outside. Talk about the things you see, feel, and hear. Repeat this activity at night.

C4

Play

pee

kabo

o. A

t fir

st, j

ust

part

ially

con

ceal

you

r fa

ce. O

nce

your

bab

y un

ders

tand

s th

e ga

me

and

know

s yo

u ar

e st

ill t

here

, ful

ly c

once

al y

our

face

.

C5

Mak

e lo

ud n

oise

s in

fron

t of

you

r ba

by. M

ake

the

sam

e no

ises

behi

nd y

our

baby

.

Explore different objects. Help your baby scratch, rub, squeeze, poke, wave, bang, grasp, trace the outline, and transfer objects from hand to hand.

C6

M4

Gen

tly s

tret

ch y

our

baby

’s fe

et b

y sl

owly

mov

ing

each

foot

up,

dow

n, s

ide

to s

ide,

and

in a

circ

le.

M5

Roll together! Lay down on a safe surface with your baby on your tummy and roll gently up, down, and side to side.

M6

Move a sound-producing item around your baby. Move it up, down, side to side, and in a circle. Do this while your baby is sitting, lying down, and on her tummy.

12 t

o 24

mon

ths

Soci

al/E

mot

iona

lLa

ngua

ge/C

omm

unic

atio

nC

ogni

tive

Mot

or/P

hysi

cal

SE7.

Lea

ve y

our

child

alo

ne fo

r 45

–60

seco

nds

by s

igni

ng o

r sa

ying

“go

odby

e” a

nd r

etur

n by

sig

ning

or

sayi

ng “

hello

.” M

ake

sure

you

r ch

ild is

in a

sa

fe p

lace

and

tha

t yo

u ca

n ge

t to

her

eas

ily. S

ooth

e he

r if

she

is u

pset

.

SE8.

Gen

tly t

ap a

bod

y pa

rt o

n a

doll,

then

on

your

self,

then

on

you

r ch

ild. A

llow

you

r ch

ild

to t

ap t

he d

oll a

s w

ell.

SE9.

Sit

face

to

face

with

you

r ch

ild a

nd a

ct o

ut d

iffer

ent

emot

ions

(ha

ppy,

surp

rise

d,

silly

, sca

red,

sad

, etc

.). D

escr

ibe

each

em

otio

n. F

or e

xam

ple,

“Y

ou a

re h

appy

whe

n yo

u se

e gr

andm

a be

caus

e sh

e le

ts y

ou

eat

all o

f her

food

.”

L7. B

efor

e st

artin

g an

act

ivity

, de

scri

be t

he a

ctiv

ity s

tep-

by-

step

usi

ng r

elev

ant

obje

cts

(suc

h as

a s

ham

poo,

tow

el,

and

paja

mas

for

bath

tim

e).

L8. A

llow

you

r ch

ild t

o ch

oose

an

activ

ity b

y pr

ovid

ing

rele

vant

obj

ects

for

him

to

sele

ct.

L9. S

how

you

r ch

ild h

is

favo

rite

toy

and

wai

t fo

r hi

m

to c

omm

unic

ate

befo

re y

ou

give

him

the

toy

. Whe

n yo

ur

child

is n

o lo

nger

inte

rest

ed

in t

hat

toy,

pres

ent

a di

ffere

nt

one.

C7.

Hel

p yo

ur c

hild

kn

ock

dow

n br

ight

ob

ject

s th

at m

ake

nois

e w

hen

they

fall.

Rep

eat

this

sev

eral

tim

es.

C8.

Slo

wly

mov

e ob

ject

s in

fron

t of

yo

ur c

hild

top

to

bott

om, b

otto

m t

o to

p, di

agon

ally,

sid

e to

sid

e,

and

in a

circ

le. U

se

larg

e, b

righ

tly c

olor

ed

obje

cts

in b

righ

t lig

ht

and

dim

mer

ligh

t.

C9.

Allo

w y

our

child

to

ban

g on

pot

s, pa

ns,

and

plas

tic ju

gs w

ith a

sp

oon.

M7.

Dan

ce t

oget

her!

Pl

ace

your

chi

ld o

n yo

ur la

p an

d ge

ntly

m

ove

him

sid

e to

sid

e,

fron

t, an

d ba

ck. T

ry t

his

whi

le s

tand

ing.

M8.

Hol

d yo

ur c

hild

an

d w

alk

thro

ugh

your

ho

me

slow

ly, t

hen

slig

htly

fast

er, a

nd s

top

occa

sion

ally.

Des

crib

e w

here

you

are

in y

our

envi

ronm

ent

usin

g w

ords

like

beh

ind,

nex

t to

, in

fron

t of

, to

the

left

of, e

tc.

M9.

Allo

w y

our

child

to

craw

l int

o an

d on

top

of

larg

e bo

xes,

mov

e ar

ound

obs

tacl

es, a

nd

mov

e ov

er fu

rnitu

re.

SE7

Leave your child alone for 45–60 seconds by signing or saying “goodbye” and return by signing or saying “hello.” Make sure your child is in a safe place and that you can get to her easily. Soothe her if she is upset.

SE8

Gently tap a body part on a doll, then on yourself, then on your child. Allow your child to tap the doll as well.

Help baby find hands and feet by placing brightly colored item (such as sock or tape) on her hands or feet.

SE9

Sit face to face with your child and act out different emotions (happy, surprised, silly, scared, sad, etc.). Describe each emotion. For example, “You are happy when you see grandma because she lets you eat all of her food.”

L7

Befo

re s

tart

ing

an a

ctiv

ity, d

escr

ibe

the

activ

ity s

tep-

by-s

tep

usin

g re

leva

nt o

bjec

ts (

such

as

a sh

ampo

o,

tow

el, a

nd p

ajam

as fo

r ba

th t

ime)

.

L8

Allo

w y

our

child

to

choo

se a

n ac

tivity

by

prov

idin

g re

leva

nt o

bjec

ts fo

r hi

m t

o se

lect

.

L9

Show

you

r ch

ild h

is fa

vori

te t

oy a

nd w

ait

for

him

to

com

mun

icat

e be

fore

you

giv

e hi

m t

he t

oy. W

hen

your

ch

ild is

no

long

er in

tere

sted

in t

hat

toy,

pres

ent

a di

ffere

nt o

ne.

C7

Help your child knock down bright objects that make noise when they fall. Repeat this several times.

C8

Slowly move objects in front of your child top to bottom, bottom to top, diagonally, side to side, and in a circle. Use large, brightly colored objects in bright light and dimmer light.

C9

Allow your child to bang on pots, pans, and plastic jugs with a spoon.

M7

Dance together! Place your child on your lap and gently move him side to side, front, and back. Try this while standing.

M8

Hold your child and walk through your home slowly, then slightly faster, and stop occasionally. Describe where you are in your environment using words like behind, next to, in front of, to the left of, etc.

Allow your child to crawl into and on top of large boxes, move around obstacles, and move over furniture.

M9

24+

mon

ths

Soci

al/E

mot

iona

lLa

ngua

ge/C

omm

unic

atio

nC

ogni

tive

Mot

or/P

hysi

cal

SE10

. Rol

l a b

all t

o yo

ur

child

and

ask

her

to

retu

rn it

. She

may

nee

d yo

ur h

and-

over

-han

d su

ppor

t.

SE11

. Sho

w y

our

child

ho

w t

o pl

ay w

ith a

new

to

y or

item

. Allo

w y

our

child

to

play

with

toy

, co

py h

er a

ctio

ns, a

nd

show

her

new

act

ions

.

SE12

. Hel

p yo

ur

child

bec

ome

mor

e in

depe

nden

t w

hen

brus

hing

his

tee

th,

feed

ing

him

self,

and

dres

sing

him

self.

At

the

begi

nnin

g, pr

ovid

e ha

nd-o

ver-

hand

su

ppor

t an

d th

en

grad

ually

fade

thi

s.

L10.

Cre

ate

a m

emor

y bo

x by

co

llect

ing

high

ly m

eani

ngfu

l ob

ject

s to

rec

ount

eve

nts

at

the

end

of t

he d

ay. L

et y

our

child

tou

ch a

nd e

xplo

re t

he

obje

cts.

L11.

Dur

ing

a ro

utin

e ac

tivity

, su

ch a

s ea

ting,

sudd

enly

sto

p th

e ac

tivity

and

wai

t fo

r yo

ur

child

to

give

you

a s

igna

l be

fore

con

tinui

ng. R

epea

t th

is

for

diffe

rent

act

iviti

es.

L12.

Hel

p yo

ur c

hild

fill

thre

e co

ntai

ners

or

bags

with

one

ob

ject

in e

ach

bag.

The

n, h

elp

your

chi

ld r

emov

e ea

ch o

bjec

t. R

epea

t th

is a

few

tim

es. M

ake

sure

to

desc

ribe

eac

h ite

m

and

let

your

chi

ld t

ouch

and

ex

plor

e.

C10

. Hel

p yo

ur c

hild

sta

ck

and

knoc

k do

wn

item

s. R

epea

t th

is s

ever

al t

imes

w

ith d

iffer

ent

obje

cts.

C11

. Fill

a c

onta

iner

with

ob

ject

s of

diff

eren

t si

zes,

text

ures

, and

col

ors,

and

enco

urag

e yo

ur c

hild

to

inde

pend

ently

tak

e ite

ms

out

of t

he c

onta

iner

and

pu

t th

em b

ack

in. M

ake

sure

to

use

only

item

s la

rger

tha

n yo

ur fi

st;

anyt

hing

sm

alle

r is

a

chok

ing

haza

rd.

C12

. Sho

w y

our

child

th

ree

cups

or

clot

hs a

nd

hide

her

favo

rite

toy

und

er

one

of t

hem

. Enc

oura

ge

her

to fi

nd t

he it

em.

M10

. Mod

el s

afe,

eve

ryda

y ro

utes

(su

ch a

s fr

om t

he

bedr

oom

to

the

kitc

hen)

by

wal

king

ahe

ad o

f you

r ch

ild a

nd e

ncou

ragi

ng

your

chi

ld t

o w

alk

ahea

d oc

casi

onal

ly.

M11

. Use

you

r ch

ild’s

foot

to

tra

ce s

hape

s in

the

sa

nd, d

irt,

and

wat

er. F

irst

, tr

ace

the

shap

es w

ith y

our

child

’s he

el d

own

and

then

w

ith h

is t

oes

dow

n.

M12

. Lift

you

r ch

ild

over

head

, pau

se, a

nd b

ring

he

r ba

ck d

own.

Rep

eat

this

se

vera

l tim

es a

nd c

ount

al

oud.

SEI0

Rol

l a b

all t

o yo

ur c

hild

and

ask

her

to

retu

rn it

. She

may

nee

d yo

ur h

and-

over

-han

d su

ppor

t.

Show

you

r ch

ild h

ow t

o pl

ay w

ith a

new

toy

or

item

. Allo

w y

our

child

to

play

with

toy

, cop

y he

r ac

tions

, an

d sh

ow h

er n

ew a

ctio

ns.

SElI

Help your child become more independent when brushing his teeth, feeding himself, and dressing himself. At the beginning, provide hand-over-hand support and then gradually fade this.

SEI2

Create a memory box by collecting highly meaningful objects to recount events at the end of the day. Let your child touch and explore the objects.

L10

During a routine activity, such as eating, suddenly stop the activity and wait for your child to give you a signal before continuing. Repeat this for different activities.

L11

L12

Help your child fill three containers or bags with one object in each bag. Then, help your child remove each object. Repeat this a few times. Make sure to describe each item and let your child touch and explore.

Help your child stack and knock down items. Repeat this several times with different objects.

C10

Fill a container with objects of different sizes, textures, and colors, and encourage your child to independently take items out of the container and put them back in. Make sure to use only items larger than your fist; anything smaller is a choking hazard.

C11

C12

Show your child three cups or cloths and hide her favorite toy under one of them. Encourage her to find the item.

M10

Model safe, everyday routes (such as from the bedroom to the kitchen) by walking ahead of your child and encouraging your child to walk ahead occasionally.

M11

Use your child’s foot to trace shapes in the sand, dirt, and water. First, trace the shapes with your child’s heel down and then with his toes down.

Lift your child overhead, pause, and bring her back down. Repeat this several times and count aloud.

M12