Taping The Paper To The Table For Your Child? Stop!

Many young children between 2 and 5, especially children with low muscle tone or postural instability, will struggle with bilateral control.  In preschool, one way to notice this is to see the paper sliding around the table while a child colors.  The common response of teachers (and parents) is to tape the paper down.  Oops!  This  eliminates any demand for both hands to work together.  Bilateral control only develops if it is needed and practiced.

The better approach, the one that makes the brain work and builds a child’s skills, is to make it even more slippery while making the activity more fun.

Why?  This child,’s brain, as described, needs more information about what is going wrong with the activity.  You can use heavier paper, stickers in a book that need accurate placement, or fun glittery markers.  Really, anything that makes a child care more about placing marks accurately.   I select the smoothest table surface available.  Glass coffee tables are a fave at home.  The alternate choice is a bumpy surface, something that will be slightly uneven and make the paper move more with each stroke.

I have some older kids that really struggle but can use a visual cue.  I make a mark on their paper and tell them to put their “helper hand” – the one not coloring- on this mark.  This is sometimes helpful, but it is limiting the extent that this hand is providing optimal postural support.

Yup, support.  The hand that holds the paper is also performing another function.  It is stabilizing the child’s body so that the dominant hand can execute a skilled movement.

So….no more tape on that paper, OK?

Gifted at Preschool: How to Support The Young Gifted Child In Class

Gifted children often cannot wait to go to preschool.  They may follow an older sibling into their classroom and cry when they have to leave.  After all, look at all those books, art supplies, and science stations to explore!   Things can go right off the rails, however, if the teacher and the classroom aren’t prepared for everything a gifted child brings with them.  And I don’t mean the lunchbox or the fidget spinner!

Gifted children are more intense, use more complex thinking, and more driven than other children.  Even at the preschool level.  This is a child who may teach himself to read, tells wonderful stories, creates wonderful multi-media art, and practices kicking a soccer ball into a goal until it is too dark to see the ball.  At 3.  It can also make a child argue about school routines,  insist on changing the rules of every game, and constantly discuss and examine every item in the room.  Imagine the average teacher’s reaction when a gifted toddler wants to grab the story book from the teacher at circle time to determine exactly which type of dinosaur is displayed.  Is that a T-Rex, a brontosaurus, or a brachiosaurus?  She can pronounce their names and knows the difference at 2, and she wants to figure this out, while her classmates are making growling sounds or picking their noses!

Here are some suggestions for teachers to understand and manage the behavior of their gifted students without crushing their spirits or allowing them to run the classroom:

  • Learn about the child’s gifts.  Knowing who you have, who you really have in your classroom: it will help you make a plan.  What they like, what they love, and what frustrates them.  This doesn’t mean that you focus the class on them, but you know that a module on space will elicit a lot of interest, and a module on the color red will not.  Unless you talk about the red planet, Jupiter.
  • Learn about the multiple sensitivities of gifted individuals.  They are not limited to intellectual gifts.  They can include physical sensitivity, emotional sensitivity, and even spiritual sensitivity.  Some will be easier to deal with than others.  But you want to teach the whole child, right?  That way, you see a three year-old’s intense need for movement throughout the day or wanting to have a formal ceremony for the recently deceased goldfish as normal, not perverse.
  • Explain the rules, negotiate the deal when possible, and acknowledge the frustration of things that seem unfair or arbitrary.  Helping gifted individuals fit into a society that says it loves giftedness but really supports conformity, without crushing their spirit, is tricky.  You can help.  Bring their awareness to the fact that controlling the game and telling people what to do and how to do it makes other children less likely to want to play.  This is real teaching.  Even if their new rules for Candyland are truly innovative.
  • Offer real enrichment, not busywork or babysitting.  I have heard stories from parents of teachers who tell gifted children to read to their classmates, or tell them to “teach” their friends about shapes.  This alters the relationships between classmates and is not a good idea.  These kids are going to be singled out soon enough as different.  Build friendships, not mentorships.  More worksheets that they can race through isn’t better.  Find worksheets that challenge them, even if you have to look at kindergarten or first grade materials.  Better yet, make your own, following their interests.  You will be rewarded by a child that loves school and knows they are truly seen as an individual!

 

Joint Protection for Hypermobile Toddlers: It’s What Not To Do That Matters Most

 

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Do you pick up your toddler and feel that shoulder or those wrist bones moving a lot under your touch?  Does your child do a “downward dog” and her elbows look like they are bending backward?  Does it seem that his ankles are rolling over toward the floor when he stands up?  That is hypermobility, or excess joint movement.

Barring direct injury to a joint, ligament laxity and/or low muscle tone are the usual culprits that create hypermobility.  This can be noticed in one joint, a few, or in many joints throughout the body.  While some excessive flexibility is quite normal for kids, other children are very, very flexible.  This isn’t usually painful for the youngest children, and may never create pain for your child in their lifetime.  That doesn’t mean that you should ignore it.  Hypermobility rarely goes away, even though it often decreases a bit with age in some children.  It can be managed with good OT and PT.   And what you avoid doing can prevent accidental joint injury and teach good habits.

  1. Avoid stretching joints, all of them.  This means that you pick a child up with your hands on their ribcage and under their hips, not by their arms or wrists.  Instruct your babysitter and your daycare providers, demonstrating clearly to illustrate the moves you’d prefer them to use. Your child’s perception of pain is not always accurate (how many times have they smacked into something and not cried?) so you will always use a lift that produces the least amount of force on the most vulnerable joints.  Yes, ribs can be dislocated too, but not as easily as shoulders, elbows or wrists.
  2. Actively discourage sitting, lying or leaning on wrists that bend backward.  This includes “W” sitting.   I have lost count of the number of toddlers I see who lean on the BACK  of their hands in sitting or lying on their stomach.  This is too much stretch for those ligaments.  Don’t sit idly by.  Teach them how to position their joints.  If they ask why, explaining that it will cause a “booboo” inside their wrist or arm should be enough.
  3. Monitor and respect fatigue.  Once the muscles surrounding a loose joint have fatigued, that joint is more vulnerable to injury.  Ask your child to change her position or her activity.  This doesn’t necessarily mean stopping the fun, just altering it.  But sometimes it does mean a full-on break.  If she balks, sweeten the deal and offer something desirable while you explain that her knees or her wrists need to take a rest.  They are tired.  They  may not want to, but it is their rest time.  Toddlers can relate.

Although we as therapists will be big players in your child’s development, parents are and always will be the single greatest force in shaping a child’s behavior and outlook.  It is possible to raise a hypermobile child that is active, happy, and aware of their body in a nonjudgmental way.    It starts with parents understanding these simple concepts and acting on them in daily activities.

Good luck, and please share your best strategies in the comments section so other parents and therapists learn from you!

Looking for information on toilet training your child with Ehlers Danlos, generalized ligament laxity, or low muscle tone?  My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, gives you detailed strategies for success, not philosophy or blanket statements.  I include readiness checklists, discuss issues that derail training such as constipation, and explain the sensory, motor, and social/emotional components of training children that struggle to gain the awareness and stability needed to get the job done.

My book is available on my website tranquil babies, at Amazon.com, and at yourtherapysource.com.

And She Rescues Him Right Back

If you like the movie “Pretty Woman”, you will know this reference.  I have always been conflicted about this popular adult fairy tale, even though I adore the two stars and the clever screenplay.  In fact, I have wished at times that the roles were reversed.

Apparently, there is a children’s book for that (clean version).

The Paper Bag Princess by Robert Munsch is the story of a princess who rescues her prince from a dragon using intelligence, creativity, bravery, and humor.  Sort of like Nancy Drew, but in shorter book for younger children, with a dragon, and with more humor than Nancy usually displayed.

A fun book for reading/comprehension level K-2, the princess is the hero of the story for once.  In real life, we know that women are often the heroes at home and at work.  They just don’t get the recognition.  They do in this little book!  In fact, it could be the gateway to learning about Marie Curie and other real women who have done amazing things.

I think girls need to hear about themselves as heroes, and boys need to hear it too.  Kinda helps to balance out all the Grimm tales and the Marvel comics out there.  So take a look at this book and add it to your library!

How to Teach Your Child to Cut Food With a Knife…Safely!

After a child scoops with a spoon and pierces food with a fork, time seems to stand still. No one wants to hand a young child a knife. But they should (sort of). Here are some ideas to safely explore knife skills without holding your breath or end up still buttering their toast when they are in middle school!

1. Don’t use a knife. Use a spreader instead. Yes, those little things you put out next to the brie when you have a few adults over for wine and cheese. You can find handles that fit nicely in a child’s hand, improving their control. The spreaders that have a sculptured handle add even more texture for a secure grip. With a rounded blade, these are less dangerous in the hands of young children. Butter knives and plastic disposable knives are actually capable of cutting a child’s fingers. Not a good thing. Save them for Stage 2, where your child has already developed some skills.

2. Pick the right foods for cutting practice. Children who are learning to cut will usually provide too much downward pressure. They aren’t comfortable using a sawing motion at the same time as slight downward pressure, so adding more pressure is often the output you see in the initial stages of learning. Choose foods that can safely handle their initial awkward movements. Soft solids that are familiar to them, such as bananas and firmly cooked sweet potatoes, can be sliced easily. Avocados that aren’t totally ripe or whole carrots that have been cooked in the microwave are other good choices.

3. Demonstrate cutting while cooking dinner. Children really do need to see your demonstration and hear your comments, but they may find pretend play less motivating than watching the real deal. You can absolutely let them practice with you, cutting the same or similar foods if it is safe. Even if you have to come up with a creative way to use the smashed bananas or carrots resulting from their practice, your food should go into a family meal.

4. Take this opportunity to teach good hygiene. Everybody washes their hands before and after cooking. It’s just what we do. It’s the price of admission to the fun of food preparation.

5. Create a “recipe” that allows your child to be the chef. Young children love to spread their bread or sturdy crackers with softened butter, nut butter, cream cheese, or Nutella. They can prepare some for others int he family as well. We all love to see people enjoy our cooking, right? But be creative and remember to initially use foods that they know and love. Would you be excited to cook a meal with foods that you have never eaten? Possibly not.

This is an opportunity to teach a skill while enjoying time with your child. Have fun using these strategies for beginning knife skills!

The Difference Between Special Needs and Typical Potty Training Approaches: Address Sensory/Behavioral Issues and Use Consistent Routines

tai-jyun-chang-270109.jpgAfter writing The Practical Guide to Toilet Training Your Child With Low Muscle Tone, I have been asked what was different about my book. There must be 100 books on potty training special needs kids. What did I do differently? Simple. I am an occupational therapist, so I have no choice but to use my 360 degree viewpoint to target all the skills needed to do the job. Seeing the path to independence in this way was second nature to me, but not to parents of kids with special needs. Time to offer some support!

The books I reviewed before I started writing were great, but every one lacked at least one important feature. If the authors were psychologists and teachers, they weren’t fully comprehending or directly addressing the sensory and motor aspects of a very physical skill. Oops.

OTs are always aware of the cognitive and social/behavioral components of activities of daily living, but we also have a solid background in physiology and neurology as well. That makes us your go-to folks for skills like toilet training. And that is a major reason why The Practical Guide is so helpful to the frustrated parents of children with SPD,autism, Down Syndrome, Ehlers-Danlos Syndrome, and a host of other diagnoses that result in delays or difficulties with muscle tone and potty training independence. It explains in detail how low tone creates sensory, motor, and social/behavioral problems, and how to address them. Knowledge is power, and knowledge leads to independence.

The other huge difference is that developing consistent sensory-motor-behavioral routines matter more for these kids. Tone isn’t a constant, as anyone with a child that has low tone knows all too well. Fatigue, illness, even a very warm day; these all make kids less stable and can even reduce their safety. Having a really solid routine makes movements easier to execute and more controlled when situations aren’t perfect. Kids with normal muscle tone can shift their behavior on the fly. They can quickly adjust and adapt movement in ways that children with low tone simply cannot. It isn’t a matter of being stubborn or lazy. Kids with low tone aren’t going to get the sensory feedback fast enough to adjust their motor output.

Good motor planning on a “bad day” occurs for these kids when they have well-practiced routines that support safe and smoothly executed movements. What makes the difference isn’t intelligence or attention. It is recalling a super-safe routine effortlessly. This is completely attainable for kids who have speech or cognitive issues as well as issue with low tone and instability. It may take them longer to learn the routine, but it pays them back with fewer accidents and fewer tears.

To learn more about my book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, visit my website, tranquil babies.com, or view it on Amazon.com!ferris-wheeltai-jyun-chang-270109

Teach Kids With EDS and Low Tone: Don’t Hold It In!

People who have read my blog are aware that I wrote a book on toilet training, The Practical Guide to Toilet Training Your Child With low Muscle Tone. This comment didn’t make it into the book , but perhaps it should have. Children that have issues with muscle tone or connective tissue integrity, or both, risk current and future issues with incontinence if they overstretch these structures too far. We teach little girls to wipe front-to-back to prevent UTIs. We need to teach all children with these issues to avoid “holding it in” in the same manner that we discourage them from w-sitting.

I am specifically speaking about kids with Ehlers Danlos Syndrome, Down Syndrome and all the other conditions that create pelvic weakness and control issues. But even if your child has idiopathic low tone, meaning that there is no identified cause, this can still be a current or future problem.

The effects of low tone and poor tissue integrity on toilet training are legion. Many of them are sensory-based, a situation that gets very little acknowledgment from pediatricians. These children simply don’t feel the pressure of their full bladder or even a full rectum with the same intensity or discomfort that other children experience. They are “camels” sometimes, with no urge to pee, and have to be reminded to void. It can be convenient for the busy child to keep playing rather than go to the bathroom, or it can save embarrassment for the shy child who prefers to wait until she returns home to “go”.

This is not a good idea. The bladder is a muscle that can be overstretched in the same manner as the hip muscles that are the concern of children who “W-sit”. Don’t overstretch muscles and then expect them to work well. The ligaments that support the bladder are subject to the same sensory-based issues that affect other ligaments in the body: once stretched, they don’t bounce back. A weak pelvic floor is nothing to ignore, and age doesn’t help anyone. Ask older women who have had a few pregnancies how that is going for them. The stretch receptors in the abdomen that should be telling a child with low tone that it is time to tinkle just don’t get enough stretch stimulation to do so when they have been extended too far. The time to prevent problems is when a child is developing toileting habits, not when problems have developed.

So….an essential part of toileting education for children is when to head to the bathroom. If your child has low muscle tone or a connective tissue disorder that creates less sensory-based information for them, the easiest solution is a routine or a schedule. They use the bathroom whether they feel they need to or not. The older ones can notice how much they are voiding, and that tells them that they really did need to “go”. Understanding that the kidneys will fill up a bladder after a large drink in about 35-45 minutes is helpful. But it can be a trip after a meal, before leaving the house, or when returning home. As long as it is routine and relatively frequent, it may not matter how a toileting schedule is created. Just make sure that as they grow up, they are told why this is important. A continent child may not believe that this could prevent accidents, but a child who has a history of accidents may be your best student.

The good news in all of this? Perceiving sensory feedback can be improved. There are higher-tech solutions like biofeedback, but children can also become more aware without tech. There are physical therapists that work on pelvic and core control, but some children will do well with junior Kegel practice and some education and building awareness of the internal sensations of fullness and urgency.

Good luck, and please share your best strategies here for other parents!!

If you are interested in purchasing my book, please visit my website, tranquil babies.com, and click on “e-book” at the top ribbon. You can also buy it on Amazon.com. My e-book is designed to help parents, not just offer statements like “Don’t push your child” and “Look for signs of readiness”. That doesn’t help anyone! The book has useful readiness checklists and detailed strategies for every stage of training!