Monthly Archives: February 2015

Wean Pacifier Use by Teaching Toddlers How to Stay Cool and Collected

If I had a dollar for every toddler that greeted me at the door with a pacifier in his mouth……well, you know, I would be on an island in the sun today!  Some parents want to know how to end paci use, as they dread the crying on the day that they send their child to a no-pacifer zone, also known as preschool.  What is going on when a child can’t function for much of the day or night without a nipple in his mouth?

Happiest Baby on the Block (THB) and the Baby Whisperer both support pacifier use when needed in the first 3 months to help soothe fussy babies, and they are also totally supportive of nursing babies for the same purpose.  After that period is the best time to wean a pacifier, but that seems very rare indeed in my experience.  Something happens to a portion of babies and toddlers between the newborn biological need to suck and the near-addiction to pacifiers that some toddlers develop.  I have seen even 4 year-olds go absolutely bonkers if their paci is lost.  Parents who have decided to end paci use try the ‘paci fairy” story, the “a little baby needs yours so we sent it to them” story, and offers of just about any gift or reward.  I rarely hear of an older child that simply handed his mom the pacifier and said he didn’t need it any longer.  And this is fully years after the biological need to suck has faded away.

I did a little bit of on-line research to find out what leading pediatric websites and pediatricians are saying, and it seems that they are all at a loss to explain why it is that only some children hold onto those pacifiers so long and so fiercely.  Just about all of the medical websites warn of dental deformity and slow development of speech with prolonged use.  With my dual training as a THB educator and a pediatric OTR, I think I stumbled onto a pattern.  The kids that really need those “props” (as the Baby Whisperer categorizes them) seem to have either spirited or shy temperaments that continued to require extra help to calm during the day and sleep at night after the first 3-month period.  They also have very few self-calming tools when compared to the waves of uncertainty, moodiness, frustration, whining and aggression that comes with the toddler period.  These children experience major stressors in their days/nights and the only thing anyone has given them that works is the pacifier.

There are angel/textbook/easy kids, to use both the THB and Baby Whisperer temperament categories.  They handle changes and challenges with very little fuss.  They are in the minority by percentages.  Parents lucky enough to have one might not appreciate the day-to-day issues with spirited kids or grumpy temperaments.  There are kids with developmental delays that have more daily struggles than usual as toddlers.  But some parents are aware of potential problems and make very conscious efforts to build self-calming and self-control skills in their kids at an early age.  Like a toddler Venn diagram, I can see the perfect storm of kids with more struggles, parents with less awareness of pitfalls, fewer strategies to teach, and more stress at home and work (it is fast to pop in a paci if it works and you are exhausted) who will fall into that section of intractable pacifier use.

Developing self-control skills in toddlers is not a quick or easy business, but it can be done.  Parents are often unaware that they can teach any self-control strategies to children so young.  I won’t blame them for not having any tools to use.  The Happiest Toddler time-ins (which include kind ignoring and patience stretching) are the best strategies I have ever used to build self-control and mutual respect in my sessions.  I have seen children transform their behavior without anyone raising their voice.  These techniques respect the child’s feelings and accept that self-control is a learned skill, not something you wait to see blossom in the future.  I think that after giving a child some real strategies it is easier and kinder to take away that pacifier, and easier still to stop a pacifier dependency before it ever begins.

Start Teaching Pencil Grasp Early With Fingertip Feeding Games

ice cube trays as serving containers for snacks

ice cube trays as serving containers for snacks

Many preschoolers have difficulty holding a pencil.  Some teachers and occupational therapists don’t even suggest pencil use until kindergarten.  And the developmental progression is slowing down to reflect the limited amount of time children under 3 are getting to refine their pinch and manipulation skills that create the foundation of pencil grasp.  Standardized testing may even have to be altered to reflect the limited ability of young children to use their hands in a skilled manner.  Tapping a tablet or pressing a button on a toy doesn’t count as skilled.  Refined finger control really starts the moment they reach out for a rattle and it never ends.  Try using this easy and fun self-feeding set-up to build finger control way before your child ever reaches for a pencil.

This is an old-school game that kids from 1-4 really enjoy.  Use an ice cube tray to serve small safe bits of food in a tapas-style manner.  That means no whole grapes, large slices of hot dogs, or any other food that is a known choking hazard.  Try dry cereal and small pieces of fruit or cooked vegetables.  I recently found this tray that had great colored spaces that were quite small.  When your child fishes out a single piece of food, they will naturally find that using just their thumb and index finger make the most sense.  This is certainly an improvement over constantly telling a child how you want them to do the task.  The container does that for you.

….Except for one of my more clever clients, whose dad said it took the 14 month old only a week to realize that if he dumped the entire thing onto his high chair tray, it became very easy indeed to scoop his food up with a fist!

Discipline and Toddlers 2.0: Using Kind Ignoring with Defiance and Mild Aggression

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I have had a lot of interest in my first blog post on “What to say if you don’t say “no?”.   Parents have  tried my suggestion, and sometimes their child responds by following the directions.  And sometimes their child smiles and hits them.  What do you do next?  Most parents would try out my first suggestion again.  They could also be offended or angry.  But they might have more luck with some kind ignoring and then some time-ins.

“Kind ignoring” is Dr. Karp’s term for choosing your battles and deciding to verbally, visually and physically remove yourself from the situation.  After all, it is very common for a young toddler to gently hit to get attention, once they have noticed the strong reaction it gets from you.  Most toddlers do not have the language or social skills to engage you easily, but they want your focused attention.  The smart ones quickly learn that they become the center of your attention once they hit you.  Try teaching them that the opposite is true.

Just turn away, walk away, or put them down.  As in off your lap, out of your arms.  But no drama.  Be as calm as a millpond.  That alone should get their attention.  They are expecting a big to-do.  Don’t go there.  Hint: one of your most powerful tools in the parenting toolbox is your tone.  Quieter-than-normal tones really get their attention, in a way that yelling never will.

Should you say something?  My guess is usually yes, and it should be developmentally appropriate.  A short: “We don’t hit.  Hitting hurts” can be more than enough for most toddlers.  The older ones might hear: “In this family we don’t hit.  I go away from people who hit me”  but that is too much information for an 18-month old.  The big message, like all HTOTB techniques, is in your actions.

For a young child or a milder temperament, they may have forgotten what they were doing, and come back and engage you warmly.  Receive them lovingly and start playing with something you know they like.  You are rewarding their better choice of behavior with your attention and conversation.  If they haven’t come over, you can smile and indicate openness, but having the child seek you out appropriately affords more learning for them.  Their new strategy worked.  For an older child, you may decide to mention the hitting, but maybe not.  I know that is controversial, but you cannot make a federal case out of every misdeed.  You can compliment the new strategy, maybe saying “I really like it when you ask me to play LEGOS with you”.  Pick your battles.

What do you do if he escalates the situation, and goes to hit the cat or throw the lamp?  It is time for a fine, some consequence that he can relate to.  That may mean moving him to another room, a brief time-out, removal of the toy that was thrown. You will know what sends home the message to your child that he has gone too far.  Then you have to think about his day, and why things escalated.  Is he hungry, tired, ill, under or over-stimulated?  Cabin fever from the winter that seems never to end (at least here in NY)?  Follow up by using your time-ins like gossiping (an earlier blog post ) and patience-stretching to build your child’s self-esteem and self-control skills.

When Should Your Child Use a Stylus on an iPad?

Earlier I wrote a post on the App Crayon stylus to develop pencil grasp in preschoolers.  But should all preschoolers and even toddlers use a stylus?  The issue is more complicated than you might think.

The App Crayon is still my favorite stylus for older toddlers.  The triangular shape and the boldly colored, non-slip grasping surface use tactile and visual cues to tell your child where to place their fingertips.  It is entirely plastic, not metal, and the tip is strong (but not indestructible).  Thinner metal shafts with an unprotected opposite end can be dangerous to your tablet or your toddler if used incorrectly.  And as always, children who would even consider chewing on the rubber tip aren’t encouraged to use any stylus.

If your child is not ready or nearly ready to use a mature pencil grasp, then using any stylus without lots of support and training could actually slow down their development of the control for handwriting.  A stylus requires a level of force and grading (controlled pressure) of force that demands more of a child, not less.  If the do not have that ability, then they will usually press harder to tap or drag an icon, and in the process their grasp will deteriorate to a fist.  Tablets are so enticing that being unable to play on an app after one or two attempts will make toddlers very frustrated.  This could lead to less participation and effort to achieve a mature grasp, not more.  If it isn’t fun then most children will reject it.

A child who can use either a palmar pronate (thumb and fingertips pointed down when holding a crayon) or a quadrupod grasp (thumb on one side and four fingers on other side of the shaft of the crayon) is demonstrating some emerging hand control, and a child who is trying to use three fingers to hold a crayon is probably completely ready to build skill and control with a stylus.

You can introduce a stylus and see amazing growth in your child’s hand control, but introduce it when his pencil grasping skills are just about to blossom!

Move Your Baby Into a Shared Bedroom Using The Happiest Baby on the Block

One question I usually hear when teaching The Happiest Baby on the Block (THB) classes is “Can this help me when I want to move her into her sister’s room?”.  The answer is: absolutely!  Strategies that keep your newborn calm and sleeping more deeply will smooth the transition to shared bedrooms later on.

Most parents use either a co-sleeper or a bassinet for the first few months after birth. They can hear and see the baby more clearly, and the frequent feedings and diaper changes are less disruptive to everyone’s sleep.   Unless they use the “family bed” concept, they often plan to move their newborn to a separate room after 4 and 6 months.  I think every family should decide for themselves when and where they want their babies to sleep.  But if you want two children to share a room, you need to have a plan.  Twins can be a bit easier, but it is not a guarantee that they will have identical sleeping and feeding schedules.  When you have an older child already sleeping in a bedroom, moving your infant in with them is even more complicated.  Parents are generally worried about waking the infant when the toddler goes to bed later, or worried that the infant will wake for a feeding and then wake up the toddler.  They envision nights with one or the other crying, and nobody getting a decent night’s sleep.  It doesn’t have to be that way.  And it can be done without anyone crying.

My favorite saying about sleep issues in infants is that a good night’s sleep starts in the morning.  Using THB, you have strategies to calm your baby all day long, through naps and stressors like noise that other children make.  A baby that has spent the day being quickly calmed, had deep refreshing naps, and knows that their caregivers can calm them quickly is much easier to put to bed at night.  Parents who are no longer swaddling have asked me what they can use.  Well, swaddling isn’t the only THB technique.  In fact, it is only one of 5.  Parents can use sucking without risk of dental deformation or habitual dependence through month 6, and white noise is great for the whole first year.  Some children will use the adjustable swaddle garments to get the firm chest/abdomen swaddle input after they start rolling.

It helps if you use techniques like the dream feed to extend and deepen sleep at night (see my post on the magic of dream feeds).  THB techniques can be done by dads and nannies, so moms aren’t the only ones who have to get up at night.  Sometimes babies need to nurse, and sometimes they aren’t hungry but have a stuffy nose or need a diaper change.  Getting them back to sleep quickly is very important to preserve the concepts of day and night difference.  Recent research in the UK indicates that the circadian rhythm of naturally seeking sleep at night is developed in the second and third months of life, and is not entirely biological.  Their research suggests there is an interplay of brain development and the way babies are supported to sleep that promotes that circadian pattern.  It can be disrupted; ask any insomniac.  Give your baby the best chance at solid sleep patterns right from the start!

Babies that have grown accustomed to always nursing or bottle-feeding to get back to sleep, or expect to play a bit before going back to sleep are going to be the most difficult to blend into room sharing.   A baby that is quickly calmed by THB techniques at the earliest age is practically asleep by the time you put them down.  They can save the fun for the times when the sun is shining.  They are so sleepy when you use THB that they will not develop habits that work against getting their precious nighttime sleep, even in a shared room.

Kumon Learn to Cut Books: Paper Truly Worth Snipping Up

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Learning to cut with scissors isn’t easy.  Kumon’s well-designed books make it fun and successful!

As an occupational therapist, I evaluate fine motor skills in young children and help children develop hand control.  After finding preschool scissors that do not cut fingers, hair or clothes (Lakeshore Learning’s own brand of safety scissor with the beige plastic blades and colored handles), I needed good paper for cutting.  There are many choices, at many price points.  Some nice books are even sold by therapy catalogs, but these are available online and in stores and use higher-quality paper and very appealing graphics.

Kumon’s books are made of stiff paper that is easy for little hands to hold without crushing, and they use colorful graphics with images that capture the interest of preschoolers.  They have two series of cutting books that are far and away the best value and the most engaging for preschoolers.  I recommend them frequently to parents.

Their activities in the “Let’s Cut Paper” series are developmentally organized.  The first pages are very easy, and the design demands get progressively more challenging. I would suggest that a typically developing 3-4 year old will be able to independently cut out 50% of the pages, but will usually need help to assemble them as directed.  There are two generic books, a “food” themed book and an “animals” themed book.  Since the books are a bit more expensive than some others, and much more expensive than just snipping scrap printer paper, I like to ask the child to cut off the directions to get another chance to cut across a page and derive more value from each page.  They can then snip wildly at that cast-off piece if they want to.  Some kids just like to do their own thing.

Assembling the activity page itself is fun and a chance to develop perceptual-motor skills as well.  The book suggests using glue, but I like tape.  Not as messy, and the child can play with the page immediately.  You can be finished at that point, or incorporate the completed page into imaginative play or a larger play scheme.  For example, the food can be placed on a plate he makes or a stove that the child draws.  The animals might need a nest, a forest or a barn to live in.  This gives you the opportunity to boost language skills as well.

The “Paper Playtime” books are not developmentally designed, but they are really fun for children all the way into kindergarten and first grade. Some developmentally delayed children may need to work on scissor skills but the first series’ graphics might be too immature for them to find interesting.  This series has mature, detailed graphics that can equally inspire post-cutting creativity, visual-perceptual and language development.

The Paper Playtime” pictures can be independently cut out by most typical 4 to 4.5 year olds.  The series’  two themes are “animals” and “vehicles” .  I know many little boys who cannot resist the vehicle choices, and want to make as many of them as we have time to assemble.  Most children well into first grade will need assistance to assemble these into interactive objects.  In the above photo, the firetruck’s ladder appears to raise and lower when the flap is folded in either direction. I have used these books with much younger children, but then most of the cutting and all of the assembly is either assisted or done by an adult.  Some young children are hesitant to try scissor use at all, and seeing what wonderful things they can create can motivate them to explore their first real school tool!

Teaching Handwriting to Toddlers Isn’t as Easy as Connecting the Dots

An exercise in frustration for your child!

An exercise in frustration for your child!

I recently saw a preschool homework sheet with dots forming the child’s first name.  My initial thought was “Not again!”.  And then I decided to be a bit more kind.  Preschool teachers aren’t given any solid instruction in how to teach pre-writing.  They are trying their best, and hoping that the workbooks they have in the classroom or the websites they visit will help them.  Sadly, most aren’t up to the task.  I have trained preschool teachers in workshops and they are usually eager to learn techniques that make handwriting lessons easy and successful.  Most admit that they had little or no instruction in how to teach toddlers to write.

If you are a parent of a preschooler or a teacher, and you want to support pre-writing with your child, here are some suggestions based on established neuropsychological research on fine motor and visual-perceptual development.

  • Reading and writing are two different skills.  Seems obvious, right?  One is primarily language based, with auditory and visual-perceptual components.  The other is related to hand strength and coordination, motor planning, sensory processing and visual-perceptual skills.  You can teach them together, but I think teaching them apart makes more sense and is less stressful for children.  Most children have the ability to recognize letters before they can write them.  Tracing a letter that you don’t recognize seems like a waste of time at best.
  • Uppercase letters are easier to recognize and easier to write.  They are all the same size, writing begins in the same location for each letter (at the top, not necessarily at the top left), and the easier muscle movements do not require tracing back. Tracing back on a line is much harder for little hands.  Use letters that are easier to identify and copy from a visual-perceptual and visual-motor perspective, not the hanging alphabet strips.  Start teaching uppercase letters first, and  begin with the letters composed of vertical and horizontal lines.
  • Demonstrate the sequence of movements to write a letter clearly, which means writing upside down if the child is sitting across the table from you.  Use simple descriptions of those movements.  Handwriting Without Tears excels in this approach.  Imagine learning to dance with either simple directions or with complicated French terminology.   And then imagine copying dance moves directly or trying to reverse them as you dance in front of the instructor.
  • Use writing tools sized to fit small hands and developing coordination.  Crayons have some “grip” on the paper and give more pressure and touch feedback than thin pencils or smooth markers.  Again, Handwriting Without Tears does a great job with tiny little flip crayons and short pencils that both support good grasp but also promote the use of mature grasp.  Triangular crayons and the app crayon stylus have appeared on this blog in the past because they also support the development of a controlled pencil grasp.