Have a Child With Low Tone or a Hypermobile Baby? Pay More Attention to How You Pick Your Little One Up

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Carrying and holding kids is such a natural thing to do.  But when your child has hypermobility due to low muscle tone, joint issues or a connective tissue disorder, how you accomplish these simple tasks makes a difference.  Your actions can do more than get them from one position or location to another: they can build a child’s skills, or they can increase the risk of damage by creating excessive flexibility or even accidentally injure a child’s joints.

How could something so simple be both a problem as well as an opportunity?  Because hypermobility creates two issues that have to be addressed:  Less strength and stability at vulnerable joints, and less sensory feedback regarding pain and position sense in your child.  The ligaments, tendons, muscles and joint capsule at every hypermobile joint are more likely to be damaged when excessive force is placed on them.

Knowing how much force is too much isn’t easy without some instruction from a skilled therapist.  Depending on your child to react quickly and accurately to accidental stretch or pressure by crying or pulling away isn’t a good idea.  Their excessive flexibility reduces firing of receptors deep within all of these tissues in response to excessive force.  You may have looked at your child’s shoulders or ankles and think “That looks uncomfortable.  Why isn’t she fussing?”  This is the reason.  It means that you will have to be altering your actions to reduce the risk of harm.

As I mentioned earlier, this is also an opportunity.  It is an opportunity to teach your child about safe movement and positioning, right from the start.  Even the youngest child will pick up on your emphasis on alignment, control and safety.  They are always listening and learning from you every day, so incorporate effective movement into your handling and help your child build awareness and independence today!

Here are some strategies for you and your child:

  1. Always spread the force of your grasp over their body, and place your hands on the most stable locations, not the most flexible.  Lift a child through their trunk, not by holding their arms.  If they cannot steady their head, support it while you lift.  If you feel those little bones in their wrists and ankles moving under your grasp, support those joints instead of pulling on them.  Not sure how to do this correctly?  Ask your therapist for some instruction.
  2. Do not depend on a child’s comfort level to tell you how far a joint should stretch.   Think about typical joint movement instead.   If their hips spread very wide when you place them on your hip, think about holding them facing forward, with their knees in line with their hips, not pressed together.
  3. Give them time to move with you.  Those over-stretched muscles are at a mechanical disadvantage for contraction.  This means that when you tell a child to sit up, you have to give them time to do so before you scoop them up.  They aren’t  being defiant or lazy (I have not, in fact, ever met a lazy baby!).  This is a neuromuscular issue.
  4. Discourage unsafe movements.  Some children find that overstretching their joints gives them more sensory feedback.  It feels good to them.  This is not OK.  You will not be able to stop them every time, but they will eventually learn that their is a right way and a wrong way to move.  Knowing why isn’t necessary.  Yet.  Teach them to respect joint movement and use things like graded joint compression and vibration (your occupational therapist should be able to help you with this) to give them the sensory feedback they want.

 

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How To Spot A Gifted Child In Your Preschool Class (Or Your Living Room!)

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Bright kid: “Are there any sharks out there?” Gifted kid:  ” The most common shark in the Atlantic Ocean is the ….”

Do you have a gifted kid?  Do you teach one?  You might not be able to tell the difference between a bright child and a gifted child by the number of letters they know, or the facts about dinosaurs they can recall.  Here are some distinct signs that your child, student or therapy client is actually gifted:

  • They are not a joy to teach.  Bet you didn’t expect that!  Yes, the gifted child isn’t usually sitting there soaking up knowledge.  They are out there arguing points and doing their own experiments.  They see the subtle differences, so they are going to bring up the exceptions to ALL of your rules.  They don’t like rules and correct answers nearly as much as the bright kids.  They are interesting to teach, but they won’t be as easy to teach as the bright children who simply learn what they are told and repeat it back to you.
  • They learn fast.  Really fast.  The typical child will need 15-20 repetitions or demonstrations and practice to learn a skill. The gifted children may only need 1-2 repetitions to learn.  The bright children need 5-8 reps.  So if you demonstrate a dance move or how to write a letter and your child copies you perfectly the first time, you may have a gifted child in front of you!
  • They NEED complexity and novelty.  Note that I said “need” versus “prefer”.  These kids don’t love routines.  They learn them quickly, but they find them boring, not comforting.  They don’t want to hear a favorite book again as much as they want you to read the next book in the series.  Without sufficient stimulation, the gifted child will go find her own entertainment and probably tell you what to do with your routines!  Bright children are often happiest when they can show you what they remember.  Gifted kids like to show you what you aren’t seeing or mentioning about a topic.
  • Gifted children are intensely curious.  This is different in magnitude from a bright child, who is interested in many things and consistently pays attention to stories and lessons.  The gifted child wants to know everything, and they want to know it now.  If the questions that you are asked show a level of synthesis you would not expect based on age and exposure, you may have a gifted child in front of you!
  • They have a lot of energy.  The gifted child may not need that nap, or they may collapse suddenly due to their full-on approach to life.  They could wake up totally ready to go, and go to sleep talking as well.  This is a child that isn’t going to want to be quiet when they have something to say.  The bright kids raise their hands and wait to be called on.  Be prepared to expend some energy yourself to engage with a gifted child.
  • Their passions and ideas can result in daydreaming and preferring to work alone on their projects.  This doesn’t mean they can’t be social.  But it may mean that they see no point in gluing construction paper triangles onto a pumpkin when they could be creating a pumpkin patch and a corn maze like they visited this weekend.  They won’t passively complete your project when they have a better idea of their own.

If you have spotted a child that may be gifted, you will want to offer them the opportunity to expand and explore within your classroom or your home.  You don’t need to label them.  If you find that their abilities place them far outside the reach of your class plan or they complain about school, it may be time to pursue formal testing.  Linda Silverman, a psychologist with a specialization in working with the gifted, suggests that any child that tests more than 2 standard deviations from the the mean (statistically far from average) is in need of special educational services.  Just because gifted kids are not below average doesn’t mean that they don’t have needs.  To learn more about gifted kids, read How To Talk So Your Gifted Child Will Listen and Sensitivity and Gifted Children: The Mind That Floods With Feeling.  Some gifted kids have other issues.  Read Gifted and Struggling? Meet the Twice Exceptional Student and How OT Can Help.

And remember that “gifted” doesn’t mean “better kid”.  It just means better skills.  The gifted population has been hammered for being elitist, when in fact, they receive a lot of criticism and prejudice as well as glory.  Treating these kids fairly will allow them to thrive!

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Toilet Training For Preschool And Stuck in Neutral? Here’s Why…..

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Many of my clients are in a rush to get their kid trained in the next few weeks for school. They have been making some headway over the summer, but things can stall out half-way through.  Here are some common reasons (but probably not all of them) why kids hit a plateau:

  1. They lose that initial boost of excitement in achieving a “big kid” milestone.  Using the potty isn’t an accomplishment now, it is just a chore.
  2. Parents and caregivers aren’t able to keep up the emotional rewards they need.  It is hard to be as excited about the 10th poop in the potty as the first time.
  3. The rewards used aren’t rewarding anymore.  A sticker or a candy might not be enough to pull someone away from Paw Patrol.
  4. An episode of constipation or any other negative physical experience has them worried.  Even a little bit of difficulty can discourage a toddler.
  5. Too many accidents or not enough of a result when they are really trying can also discourage a child.
  6. Using the potty is now a power play.  Some kids need to feel in control, and foiling a parent’s goal of toileting gives them the feeling that they are the ones running the show.  “I won’t” feels so much better than “I did it” for these kids.
  7. Their clothes are a barrier.  When some families start training, it is in the buff or with just underwear.  Easy to make it to the potty in time.  With clothes on, especially with button-top pants or long shirts, it can be a race to get undressed before things “happen”.
  8. They haven’t been taught the whole process.  “Making” is so much more than eliminating.  Check out How To Teach Your Child To Wipe “Back There” and The Ten Most Common Mistakes Parents Make During Toilet Training for some ideas on how to teach the whole enchilada.

Should you pause training? The answer is not always to take a break.  I know it sounds appealing to both adults and kids, but saying that this isn’t important any longer has a serious downside.  If your child has had some success, you can keep going but change some of your approaches so that they don’t get discouraged or disinterested.  If your child really wasn’t physically or cognitively ready, those are good reasons to regroup.  But most typically-developing kids over 2 are neurologically OK for training.  They may need to develop some other skills to deal with the bumps in the road that come along for just about every child.

Sometimes addressing each one of these issues will move training to the next level quickly!  Take a look at this list and see if you can pick out a few that look like the biggest barriers, and hack away at them today!

For kids with low muscle tone, including kids with ASD and SPD, take a look at my e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone.  Read Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!) to understand why I wrote this book just for you!   

I give parents clear readiness guidelines and tips on everything from the best equipment, the best way to handle fading rewards, to using the potty outside of your home.  It also includes an entire chapter on overcoming these bumps in the road! To learn more about what my e-book can do for you, read The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

Calm Your Toddler By Using “Tummy Time” for Emotional Modulation

 

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You don’t have to offer your child a tablet.  Try a book or a sticker activity instead!

Yes, tummy time.  It isn’t just for babies anymore.

Why?  Because occupational therapists know that the physical effects of working against gravity to push one’s head and shoulders up, and the firmness and warmth of contact with the floor are also sensory-based modulation strategies.  What helps babies build core control can also calm upset or disorganized toddlers and older kids.

The decrease in visual input can improve calmness and attention for those kids whose eyes dart everywhere.  Not everyone can handle a visual stimulating room.  Some children need more vestibular input to reorganize, but some do better with the stillness of “tummy time”.

How long do they need to be on their stomachs for this to work?  It depends.  Probably more than a few minutes, but if you haven’t seen signs of better modulation (better eye contact, slower breathing, more communication, less agitation) then you might need to layer on another technique  Help Your Child Develop Self-Regulation With Happiest Toddler On The Block or the Wilbarger Protocol Can You Use The Wilbarger Protocol With Kids That Have Ehlers-Danlos Syndrome?.

Having trouble convincing your child to lie on their belly?  Join them, or get a sibling to model it.  Make a special new book collection for tummy time, and only have it available at that time.  Get a tent, and add the effects of an enclosed space to tummy time to make it more deeply calming.

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KickStart Kindergarten: Get Your Child Ready for Kindergarten Writing The Easy Way!

 

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Starting kindergarten is so exciting for most kids, but learning to write can be challenging for those children that have fASD, SPD, fine motor or visual-motor issues.  Even though fewer and fewer teachers know how to teach handwriting well, it is still a necessary skill for young children.  Learning Without Tears has developed an amazing book that can help your child build skills faster and easier:  Kickstart Kindergarten!

Why Writing (Still) Really Matters

There are research studies that suggest that the physical act of forming letters positively affects memory and comprehension.  These studies suggest the benefits continue all the way through into college-level instruction.  Handwriting is a multi-sensory experience.  The brain is using many different areas of the brain are involved in organizing and coordinating it’s tasks to execute the ability to write.  Young brains need to practice and achieve a high level of coordinated activity before they can focus on comprehension and critical thinking.

The demands of writing create neural activity that could be considered  “brain exercise”.   I know I see it that way.  Taking notes at the high school and college level requires synthesis; the cognitive act of summarizing and condensing a lecture into a shorter message that you write down quickly.  It is a mental skill not required when you take verbatim notes on a laptop.  Oops.

Simply put, the reason keyboarding and digital access isn’t enough is simple:  by the time struggling writers are able to put their thoughts into words in a digital format, they have already developed frustration and even aversion to engaging in writing in any form.  

This is unacceptable to me.  Clever and creative kids are learning to dislike language arts because they can’t write with enough skill and speed.  I have struggling writers ask me: “How many words do I need in each sentence, and how many sentences”  This isn’t making them develop their ability to compose anything.  It is making them hate language arts.  At a time where communication skills are essential to success at any profession.

Kickstart Kindergarten:  Fun, Well-Designed, and Easy to Teach:

This workbook is the one you want to give your new preschool graduate this summer!  Filled with activities that boost the automaticity needed to go to kindergarten.

Here are some, but not all, of the terrific features of this workbook:

  • As with all HWT books, the paper is sturdy and won’t tear with repeated erasing or careless handling.
  • The individual letter pages start with tracing and fade to independence.
  • The gray boxes help kids with consistent and age-appropriate sizing and avoid reversals.  BTW, reversals are normal at this age.  Preventing reversals is even better than correcting them.  This book does both.
  • Each sample is placed near the space available for a child to write.  They don’t need to move their hand or copy the errors they made in the previous attempt (big issue for any kid with ocular control issues or visual organization issues!)
  • Letters are grouped into developmentally-correct bunches, based on the later pre-K motor developmental milestones.  This means that an “A” isn’t the first letter learned.  Letters that are all vertical and horizontal lines are the easiest to form, so they are first.
  • There are still coloring opportunities and plenty of chances to repeat and practice.
  • They include pages for parents and teachers to use as formation references.  You can’t teach writing if you aren’t sure how a letter is supposed to be formed.  I will confess that after taking the evaluation course, I found out that I have some very bad habits that probably date back to preschool.  And never got fixed.
  • Numbers are not ignored.  Numbers are presented in order, but their formation is actually not far from a developmental progression.

Here are some shots to get you excited about this book:

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Is your child entering first grade but in need of more practice?  These books aren’t going to make them feel self-conscious about needing help.  Take off the cover if you are worried that they will be embarrassed to use a book with Kindergarten int he title.  And tell them that this is the easiest way to get better at handwriting …fast!  You have their back, as always!

Three Ways To Reduce W-Sitting (And Why It Matters)

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Children who sit on the floor with their thighs rolled inward and their calves rotated out to the sides are told that they are “W-sitting”.  Parents are told to reposition their kids immediately.  There are even garments like Hip Helpers that make it nearly impossible to sit in this manner.  Some therapists get practically apoplectic when they see kids sitting this way.  I get asked about W-sitting no less than 3x/week, so I though I would post some information about w-sitting, and some simple ways to address this without aggravating your child or yourself:

  1. This is not an abnormal sitting pattern.  Using it all the time, and being unable to sit with stability and comfort in other positions…that’s the real problem.  Typically-developing kids actually sit like this from time to time.  When children use this position constantly, they are telling therapists something very important about how they use their bodies.  But abnormal?  Nah.
  2. Persistent W-sitting isn’t without consequence just because it isn’t painful to your child.  As a child sits in this position day after day, some muscles and ligaments are becoming overstretched.  This creates points of weakness and instability, on top of any hypermobility that they may already display.  Other muscles and ligaments are becoming shorter and tighter.  This makes it harder for them to have a wide variety of movements and move smoothly from position to position.  Their options for rest and activity just decreased.  Oops.
  3. Sitting this way locks a child into a too-static, too-stable sitting position.  This appeals to the wobbly child, the weak child, and the fearful child, but it makes it harder for them to shift and change position.  Especially in early childhood, developing coordination is all about being able to move easily, quickly and with control.  There are better choices.
  4. A child who persistently W-sits is likely to get up and walk with an awkward gait pattern.   All that over-stretching and over-tightening isn’t going to go away once they are on their feet.  You will see the effects as they walk and run.  It is the (bad) gift that keeps on giving.

What can you do?

Well, good physical and occupational therapy can make a huge difference, but for today, start by reducing the amount of time they spend on the floor.  There are other positions that allow them to play and build motor control:

  • Encourage them to stand to play.  They can stand at a table, they can stand at the couch, they can stand on a balance disc.  Standing, even standing while gently leaning on a surface, could be helping them more than W-sitting.
  • Give them a good chair or bench to sit on.  I am a big fan of footstools for toddlers and preschoolers.  They are stable and often have non-skid surfaces that help them stay sitting.  They key is making sure their feet can be placed flat on the floor with their thighs at or close to level with the floor.  This should help them activate their trunk and hip musculature effectively.
  • Try prone.  AKA “tummy time”, it’s not just for babies.  This position stretches out tight hip flexors and helps kids build some trunk control.  To date, I haven’t met one child over 3 who wouldn’t play a short tablet game with me in this position.  And them we turn off the device and play with something else!

For more strategies for hypermobile kids, take a look at Picking The Best Trikes, Scooters, Etc. For Kids With Low Tone and Hypermobility and How Hypermobility Affects Self-Image, Behavior and Activity Levels in Children.

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Is Your Gifted Child A “Troublemaker”?

 

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When you hear hoofbeats, maybe you SHOULD think zebras and not horses!

Gifted and talented children are frequently leaders in their schools and communities.  They often have advanced language skills and display an early and intense sense of humor. Gifted children can be the funny, outgoing, energetic kids who have deep empathy and abundant warmth.  Wondering if your young child might be gifted?  Read How To Spot A Gifted Child In Your Preschool Class (Or Your Living Room!).

But being gifted isn’t all rainbows and first place ribbons.  Some aspects of being gifted contribute to styles of interaction with authorities and peers that are not a cause for celebration. Gifted kids can be perceived as causing trouble, creating conflict and disrupting things wherever they go.  Super-bright children might end up with this label for the following common behaviors and characteristics:

  • They resist many rules as limiting and irrelevant.  “Because that’s the way it’s done” is not accepted when a gifted child sees the rule as useless or worse: illogical.
  • Boredom with class material they have already mastered gets expressed as anger or  criticism.
  • Their unique interests mean that they may reject their peer’s play schemes and try to convince their friends to play games their way or else.
  • They talk.  A lot.  At times, they may take over a discussion or attempt to alter a teacher’s presentation to address related issues or get more in-depth about a topic.  They may not be able to let a topic go until they have asked every question and made every point that they find important.
  • The frequent sensitivity of gifted children might make a normal level of noise, light or interaction too stimulating, and younger children especially will react in frustration or even tantrums.
  • Your gifted child may be having difficulty with an area of development that has been masked by their talents.  Gifted and Struggling? Meet the Twice Exceptional Student and How OT Can Help A common example would be the gifted child who is struggling with dyslexia, but has been able to use powerful memory and logic to fill in the blanks in a story.  They may not have read the book, but they are able to recall enough of the teacher’s description or the cover’s blurb to “fake it”.  The resulting failure and frustration, even with high overall test scores, builds their resentment and avoidance.

What can you do to transform a gifted troublemaker into your family’s champion or star?

  • The first step is to recognize where the ‘trouble” is coming from.  Your child’s early developmental skills and rapid acquisition of new information could be fueling their behavior.  Seen through this lens, many of the frustrating reactions and interactions with gifted children become understandable.
  • Explore ways to create a more enriched environment for your child.  It doesn’t have to be classes and microscope sets.  It could be more trips to the library or more craft materials to allow all that creativity to be expressed.  Children that are fulfilled are less crabby, less demanding and less resistant.
  • Be willing to take the time to answer questions and discuss the origins of rules.  A rule that is in place for safety can be accepted if it is explained.  A rule about social behavior, such as allowing everyone to have a turn in order, is an important lesson in navigating a world in which the kids with the fastest brains aren’t always the ones who get the first turn.
  • Consider the possibility that your gifted troublemaker is “twice exceptional”.  There may be issues like dyslexia or sensory processing disorder that need to be addressed.  Other issues don’t have to be cognitive.  Your child may be struggling with anxiety or coordination.  Giftedness doesn’t discriminate or remove all challenges to learning.  But remember that these do not minimize their profound gifts in other areas.  They complicate them.
  • Share your awareness of their gifts with them.  Kids who know that their frustrations and responses have a source other than being a difficult person have higher self esteem.  A gifted kid who thinks badly about themselves?  Yes, it does happen.  Feeling different from their friends, knowing that their ideas aren’t always welcomed, being told to be quiet and go along with the flow.  All of these can make a gifted child question themselves.  When you explain that their brain works differently, and that you will help them navigate situations successfully, your support can make a tremendous difference!

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