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NOW HIRING! Per Diem Pediatric PT

Play Works Gorge Children's Therapies in Hood River, Oregon is looking for an experienced Pediatric Physical Therapist (Per Diem) to join our team of pediatric therapy professionals. We provide care to the following age groups: Infant (30 days to 1 yr.), child (1-12 years), adolescent (13- 21 years). Discover the work/life balance you seek while living in one of the nations best small adventure towns! Top per session reimbursement. Contact Sarah McDonnell at for more information regarding this exciting opportunity, or to submit your cover letter and resume. 


• Provides pediatric physical therapy treatment to the patients in an accurate and timely manner. • Provides on-going therapy on an outpatient basis. • Communicates (to the parents as well as in reports, daily notes and in evaluations) observations regarding the patient’s progress, lack of progress, goals, etc. • Documents daily/weekly therapy for each client in the “Daily Notes”. • Responsible for maintaining good working relationships with coworkers and facilitating teamwork wherever services are being provided. • Demonstrates sensitivity to cross cultural issues. • Adheres to the regulatory and practice standards of Pediatric Physical Therapy. 

KNOWLEDGE and SKILLS: • Knowledge of neurological and musculoskeletal diseases. • Knowledge of rehabilitative treatment techniques as utilized by the generalist in treating multiple age groups. • Knowledge of orthopedic manual therapy techniques. • Knowledge of the regulations and practice standards of Pediatric Physical Therapy. • Knowledge of direct patient care of Physical Therapy to pediatric patients. • Skill in treating Pediatric Physical Therapy patients. • Skill in using applicable equipment and instruments. • Skill in assessing and prioritizing multiple tasks, projects and demands. • Skill in critical thinking in the performance of Pediatric Physical Therapy. • Skill in establishing and maintaining cooperative working relationships with others. • Skills in maintaining good working relationships with community resources, referral sources, agencies and colleagues (OT and SLP).

MINIMUM QUALIFICATIONS: • A Cleared/Clean Oregon Physical Therapy License  • Approximately one (1) year of experience working exclusively with a pediatric population. • Participation in continuing education in pediatric therapy subjects as required by the Physical Therapy governing authority.

Introducing a Story Book

When we aren't found playing, you will most likely see us with a children's book in our hands! When introducing a new book to your child, here are some strategies you can use to increase your child's engagement and wonder! 

  • Invite your child to respond to the new book by looking at the illustrations and thinking about other similar stories
  • Invite the child to share an experience that would be similar to the story.
  • Sketch the plot up to the climax, leaving the surprise untold in order to create a framework for anticipating what will occur. 
  • Develop understanding around the theme of the book. Explain any concepts or plot twists that might be confusing to the child.
  • Restate or expand the child's statements in order to maintain the interaction.
  • Prompt the child using a variety of questions and pauses such as the following:
    • Link information from pictures to the child's personal knowledge. Use questions such as, "have you done that?"
    • Pause for the child to generate an ending. The pause indicates to the child that he is to finish telling what might happen. 
    • Encourage reflection by asking questions such as, "How did you know that?" This encourages children to consider what they are thinking. 

Like everyone else, children are uncomfortable and sometimes even afraid of things that are new to them. Taking the time to introduce a new book to a child can increase his interest in reading it. 

Clinical Feeding Evaluations and Treatment;

Feeding disorders are conditions in which an infant or child is unable or refuses to eat, or has difficulty eating, resulting in weight loss, malnutrition, lethargy, impaired intellectual and social-emotional development and growth retardation. In the most severe cases, children cease oral eating altogether, necessitating nasogastric or gastrostomy tube placement and feedings.

Feeding disorders develop from a combination of medical/physiological, developmental, behavioral and psychosocial factors. Our Feeding Disorders Program at Play Works is a multidisciplinary team consisting of:

  • Registered Dietitians
  • Occupational Therapists
  • Speech/language Pathologists

Our pediatric therapists specialize in the evaluation and treatment of pediatric feeding & swallowing disorders. Specialized training includes the SOS Approach to Feeding , Talk Tools, and the Beckman Oral Motor Protocol. 

We are experienced treating children with: 

  • nervous system disorders (e.g., cerebral palsy)
  • gastrointestinal conditions (e.g., reflux)
  • prematurity and/or low birth weight
  • cleft lip and/or palate
  • autism
  • muscle weakness in the face and neck
  • multiple medical problems
  • problems with parent-child interactions at meal times

Every child has different needs, but some goals may include:

  • Increasing the types of food textures a child will eat
  • Helping the child accept new kinds of foods
  • Encouraging the child eat bigger amounts of foods
  • Assisting children who are at risk for G-Tube placement, to increase food intake and prevent the child from needing to be tube-fed.
  • Helping children who already have a G-Tube to increase oral food intake and decrease the need for tube feedings. (The long-term goal is to have the G-Tube removed.)

Feeding your child is emotional: It's about nurturing, bonding, love and responsibility as a parent. When feeding is challenging, it's stressful and impacts the entire family on a daily basis. Let our therapists guide you and your child through your child's individualized program. 

photo, Sean O'Connor

Occupational Therapy at Play Works!

Occupational Therapy

Our Pediatric Occupational Therapists focus on achieving functional independence through therapeutic interventions addressing perceptual motor skills, fine motor skills, strength and coordination, sensory integration/ sensory processing and self-care activities.


Occupational therapy helps children to develop the underlying skills necessary for learning and performing specific tasks, but it also addresses social and behavioral skills. It can help with the child’s self-concept and confidence. Pediatric occupational therapy helps children develop the basic sensory awareness and motor skills needed for motor development, learning and healthy behavior. These include the following:

  • body awareness (proprioceptive sense)
  • coordination of movements between the two sides of the body (“crossing the midline”)
  • fine motor control and organization
  • motor planning
  • motor movements and coordination
  • gross motor coordination
  • ocular motor skills
  • visual perceptual skills
  • self-regulation
  • sensory modulation (reaction to stimulus)

Occupational therapists not only work directly with the child, but also with the family, parents, caregivers and teachers in order to educate and reinforce specific skills and behaviors which will be used to improve and facilitate the child’s performance and functioning.


Any time a child is not functioning at an age appropriate level in any aspects of their life, they might see an OT for an evaluation. Children will benefit from Occupational Therapy if they have:

  • Poor coordination
  • Decreased balance (“clumsiness”)
  • Delayed motor skill development
  • Low muscle tone or strength
  • Difficulty with handwriting
  • Been diagnosed with a learning disability
  • Difficulty completing tasks that seem easily attained by peers
  • Behavioral challenges or social skill issues
  • Decreased attention or ability to participate in age appropriate activities
  • Decreased self-esteem and self-concept
  • Decreased visual skills including visual perceptual skills and ocular motor skills
  • Difficulties with feeding, is a picky eater or a messy eater

Preventing Obesity, Allergies, and More! The Importance of Complementary Feeding

Preventing Obesity, Allergies, and More! The Importance of Complementary Feeding:

6 Months - 24 Months

Complementary feeding: the transition from exclusive breastfeeding to family foods. It’s a vulnerable period of time in your infant’s life that can bring on frustration and picky eating. It must be timely, adequate, safe, and appropriate according to the World Health Organization, but how can we assure we’re giving them foods that fit those requirements? A few rules of thumb can help us make the best educated decisions for our little ones. By making appropriate choices, we can help set them up for a healthy future and decrease their chances of health problems down the road.

Timely: All infants should start receiving foods in addition to breast milk from 6 months onwards. Much later than this could cause nutritional deficiencies. Some choose to start their infants with family foods around 4 months, although 6 months continues to be more widely recommended. A good general guideline is that it’s typically safe to begin complementary feeding (around this age) when your child can sit up well without support, hold their head up independently, and hold their necks high. At this age they will also begin to lose the “tongue-thrust reflex” or extrusion reflex. While this reflex is important for sucking the breast or bottle when they are younger, it interferes with feeding complementary foods.  Some evidence suggests that very early introduction (at or before 4 months), rather than at 4-6 months or > 6 months, may increase the risk of childhood obesity. It has also been shown that infants introduced to solids earlier are more commonly diagnosed with food allergies by the time they are 2 years of age. Children are even more likely to be diagnosed with food allergies if they are not receiving breast milk throughout the introduction of family foods, suggesting a protective factor in breast milk. The current American Academy of Pediatrics’ allergy prevention recommendations and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition recommendations on complementary feeding are to not introduce solids before 4 to 6 months of age. The American Academy of Pediatrics’ breastfeeding recommendations also state that breastfeeding should continue while solids are introduced into the diet and that breastfeeding should continue for 1 year, or longer, as mutually desired by mother and infant.

Adequate: Complementary foods should be given in the adequate amounts, frequency, and consistency, using a variety of foods to cover the nutritional needs of the growing child while still maintaining breastfeeding. Babies need practice and experience with first feedings. Do not be discouraged if the feeding does not go as planned at first or if your child rejects the food being given. You may have to try multiple times before a food is accepted. If your infant is rejecting a certain food, wait a few days and then try again. Here are some tips on getting started:

  • Pick a time when both you and baby are in a good mood and baby is not too tired or too hungry.
  • Hold baby on your lap or sit him/her up in an infant seat.
  • Start with iron-fortified rice cereal. This is easiest on baby's stomach. A tablespoon mixed with 3 or 4 tablespoons of breast milk or formula is all you need at first. Keep the cereal very thin.
  • Use a small spoon, and put cereal only on the tip.
  • If baby does not seem very interested in eating off the spoon, let him/her smell and taste the cereal.
  • If baby has trouble swallowing, he/she may not be ready for solids yet. Wait a few days and try again.
  • Feed baby the same single-ingredient food for one week before changing to another food.
  • Thicken the consistency of the cereal slowly over a period of several weeks.

Start with 1-2 tablespoons, 2-3 times per day, while continuing to breastfeed. Remember, their tummies are tiny and although it may not seem like a lot, they will still be feeding on mostly breastmilk or formula at this point in time. After beginning with cereal, we can slowly begin to introduce fruits and vegetables in purée 3-4 times per day at 2-3 tablespoons and then strained meats and beans. Slowly the consistency will change to small chopped pieces of food as your little one begins to work more on their chewing control. There are a few foods that are very important to withhold until at least 12 months of age including honey and corn syrup (due to botulism risk), sugar, salt, and cow’s milk. This section will be discussed in much greater detail at our Well Child/Niño Sano Nutrition Clinic on November 4th at 6:00pm at Play Works.

Safe: Measures should always be taken to minimize the risk of contamination with pathogens. Infants’ immune systems fully develop around 6 months of age. Breastfeeding is an extremely important part of building a strong immune system in our newborns, if you are able to breastfeed, due to the immunoglobulins passed from mother to infant. When an adult contracts a foodborne illness and experiences diarrhea or vomiting, a significant amount of weight is probably not lost and we recuperate rapidly. Infants, on the other hand, can lose a large percentage of their body weight through diarrhea and vomiting, landing them in the hospital. It is important that proper hygiene and sterilization of all foods and appliances is followed to protect your infant from foodborne illnesses that could cause serious harm.

Appropriate: Appropriate means that foods are of appropriate texture for the age of the child and that we apply responsive feeding following the principles of psycho-social care. Responsive feeding refers to a reciprocal relationship between a child and their caregiver characterized by the child communicating feelings of hunger and satiety through verbal or nonverbal cues, followed by an immediate response from the caregiver. The response includes the provision of appropriate and nutritious food in a supportive manner, while maintaining an appropriate feeding environment. Eating strictly for nourishment (versus emotionally or for enjoyment) is where infants strongly differ from adults. It is important to respect responsive feeding principles in order to develop healthy eating behavior and optimal skills for self-regulation and self-control of food intake in our children, preventing obesity and it’s complications in the future. This will also be discussed in further detail at our Well Child/Niño Sano Nutrition Clinic.

Please attend our Well Child/Niño Sano Nutrition Clinic Friday, November 4th at Play Works at 6:00pm. We will have a 45 minute informational presentation on Complementary Feeding and plenty of time to respond to individual questions and concerns. We will be weighing and measuring each child (if desired) and providing a brief nutritional evaluation. If private nutritional counseling is recommended at this point in time, you will be able to receive appointments at a discounted rate. Cost for the Clinic is $25/family. We hope to see you there!

Caitlyn Witte, B.S. Nutrition Counselor

Gratitude --> Happiness

"We all know that certain babies are just born more cheerful while others are born a little bit on the grouchy side. But it is more productive and scientifically more correct in some ways for us to think of happiness as being like learning a language. Some kids are going to be really good at picking it up quickly, other people are going to struggle a little bit with it. But we all need to be taught the basic grammar. And we all need to practice that grammar in order to become fluent. So we can teach our kids to be happy by teaching them the skills that will lead to happiness and by practicing those skills with them." - Christine Carter, PhD.

Following the Science of Happiness, one of the methods which allows for greater happiness levels is the practice of gratitude. There is no one single way that this exercise needs to look, and can remain flexible throughout your (and your child's) practice. 

The benefits of practicing gratitude are nearly endless. Families who regularly practice gratitude by taking the time to notice and reflect upon the things they're thankful for experience more positive emotions, express more compassion and kindness, and have stronger immune systems! 

Studies show that simply keeping a gratitude journal (regularly writing brief reflections on moments for which we're thankful) can significantly increase our well-being. For the youngest members of our families, we can get creative in our gratitude "journaling". Here are just a few ideas on how we can encourage this practice at home:

Keep a Gratitude Jar

Gratitude Jar Ingredients

  • 1 jar/box
  • Ribbon to decorate
  • Paper for writing Gratitude Notes on
  • Gratitude

Draw your Gratitude

When we draw what we are grateful for (or paint, sculpt, mold) we get the extra benefit of tapping into the happiness which comes from being in our creative space. Depending on the age of our child(ren), this may be a more age appropriate activity. And even more, it's messy and fun. This routine allows us the opportunity to hold space for our child, and opens up the conversation of what you are thankful for as well. Maybe even join in the creative fun!

Gratitude Table Talk

Research suggests that having dinner together as a family at least four times a week has positive effects on child development. By engaging your children in conversation, you teach them how to listen and provide them with a chance to express their own opinions. This allows your children to have an active voice within the family. What better time than to share what we are grateful for this day. 

Incorporating gratitude into your life is an easy practice- and fun too!

Sarah McDonnell, MA CCC-SLP


Meet Caitlyn Witte, B.S. Nutrition Counselor

Caitlyn Witte received her B.S. in Clinical Nutrition from Francisco Marroquín University in Guatemala in 2016. While in Guatemala, Caitlyn obtained extensive clinical experience with pediatric patients with complex nutritional needs. Her experience includes outpatient pediatric care and inpatient pediatric hospital settings. Following completion of her formal education in Guatemala, Caitlyn relocated to Hood River, Oregon.  She is passionate about continuing her love for pediatric medical nutrition therapy and making a difference through nutrition. Caitlyn is fluent in Spanish and excited to offer bilingual and accessible nutritional counseling and education in association with the wonderful SLPs of Play Works.

Caitlyn will be offering Well Child (Niño Sano) Nutritional Clinics on the first Friday of every month, focusing on some of the most broad-spectrum and important nutritional topics necessary for the adequate growth and development of children. The first Well Child Nutritional Clinic will be held on October 7th and will focus on breastfeeding and nutrition for mom, so bring all of your breastfeeding questions and concerns! The Well Child Nutritional Clinics will also include a brief evaluation and measurements of your child, plotting them on their growth curve, and identifying any nutritional needs at that time. You will then have the opportunity to schedule private nutritional counseling at a discounted rate. The Well Child Nutritional Clinics will be provided at an accessible cost of $25 per patient, requiring a minimum of 4 patients per session.

We are thrilled to have Caitlyn join our team of pediatric therapy professionals. Please help us in welcoming her to Hood River!

Sarah McDonnell, MA CCC-SLP


Play Works Offers Nutrition Counseling!


Our nutritional counselor, Caitlyn Witte, B.S.,  specializes in evaluation and treatment of various pediatric nutritional needs. Caitlyn has experience with complex nutritional needs. Many patients with feeding and swallowing disorders may benefit from the collaborative and complementary approach of pairing feeding therapy sessions with a nutritional counseling appointment.

If you or your healthcare provider has identified any of the following in your child, you may benefit from a nutritional counseling session:

  • Not following growth curve
  • Inadequate weight gain
  • Weight loss
  • Above the 95th percentile for weight or BMI
  • Food aversion or rejection
  • Unable to begin complementary feeding at 6 months of age
  • Unable to breastfeed
  • Food allergies
  • Diarrhea or vomiting with food intake
  • Requires supplemental feeding (ie. Total Parenteral Nutrition or tube feeding)

The goal of nutritional counseling will be to identify and evaluate your child’s nutritional needs, specific to your child, based on height, weight, age and biochemical makeup. Once evaluated, nutritional problems and areas for improvement will be identified. A nutrition plan will be made for your child taking into account the manner in which your child will be consuming their nutrients, whether orally or through tube feeding or a combination of the two. Calories, protein, carbohydrates, fat, vitamins, and minerals will be determined based on your child’s specific needs to thrive and develop as appropriate for their age.

In addition, group nutritional education workshops will be offered at least once monthly. These Well Child/Niño Sano nutritional clinics will cover topics including, but not limited to: breastfeeding and nutrition for mom, complementary feeding for infants 6 months to 1 year of age, toddler nutrition for children 1-3 years of age, healthy mealtime habits and nutrition for preschoolers 3-5 years of age, gastrostomy tube care and home tube feeding, food allergies, and childhood obesity. You will also have the opportunity to receive a brief nutritional evaluation of your child at these clinics.

Spanish Interpreted Evaluation Services

Emily Mashburn, M.S.Ed CCC-SLP pairs with interpreter, Alma Gaeta, to provide Spanish interpreted speech-language evaluations at Play Works. Emily has worked in multicultural and diverse populations for over 6 years, giving her the experience and passion to provide culturally responsive services to families here in the Gorge. 

Via parent interview, case history review, and direct interaction with your child, Emily evaluates and develops a treatment plan to best meet the needs of your family. Emily will work directly with your child and help your family learn strategies you can implement in your home to promote speech and language development. If speech-language therapy is deemed appropriate, it is recommended that your family continues to talk to your child in the language you are most comfortable with. Research has shown that many children with delayed speech and language skills growing and learning in a dual language environment go on to develop new communication skills in both languages. 

Signs of speech and language disorders can be seen as early as infancy. To learn more about these signs, Spanish resources can be found on our website at If you have concerns about the speech and language or feeding development of your child or are not sure whether an evaluation is right for your child, you may contact your child’s primary care physician, give us a call, or email Emily at to find out more.