Monthly Archives: May 2015

How To Calm Crying If You Don’t Swaddle

Yesterday I taught a Happiest Baby on the Block class, and one mother was adamant that she would not swaddle her 3-week-old daughter.  She thought it would be too restrictive for her.  Although I taught the correct safety principles, how it mimics life in the womb, and the effective techniques for a good swaddle, this mom wasn’t convinced that it was for her.  My action of choice?  Emphasize the techniques she could embrace.  She learned the technique correctly, but she gets to choose what is right for her and her child.

I do not teach a “swaddle class”, I teach THB.  It is so much more than an opportunity to learn how to swaddle.  The class teaches the neurological and behavioral underpinnings for newborn sleep and calming, and that is powerful information for parents.  Understanding what is happening, why it is happening, and how THB capitalizes on the science of development is empowering on it’s own.

There are four other techniques with their own power to soothe and organize a tiny little being.  Using a safe and firm swaddle is considered the foundation of calming in THB, but the other techniques can be effective when used together, especially with a baby that isn’t exceptionally fussy and is easier to calm.  The correct shushing, swing/jiggle movements, sucking, and side/stomach calming positions can be enough for those babies, and she was lucky enough to have a pretty calm infant (for now – plenty of time for a colicky period to erupt).

Swaddling your baby is the bottom layer of calming, and should extend periods of sleep and create a “calming barrier” of deep sleep to prevent noises in the environment, first infant stuffy noses, and other distractions from waking her up.  If you have struggled with the swaddle technique, watch Dr. Karp’s DVD, use my phone consult sessions or trainings, or try a swaddle garment.  Used correctly, they are a quicker way to an easy “A” in swaddling.

We practiced the effective distance and volume for the shush, the different forms of the jiggle/swing in her arms, discussed sucking as a natural soothing approach, and why just turning a baby onto their side or stomach to calm (never for sleep) is like clicking a sleep switch with a newborn.  And her daughter slept through just about all of it.

Safer With a Swaddle Blanket or Swaddle Garment? Research Says You are Asking the Wrong Question

As a certified Happiest Baby on the Block educator, I am often asked which choice new parents should make.  Swaddling with a blanket is cheaper (babies don’t grow too large for most blankets for months) and blankets can be repurposed after swaddling is finished.  Garments are easier to master; not everyone is willing to learn how to do a firm swaddle.  Parents with physical limitations, and parents of super-wriggly or very strong babies get a more secure swaddle with a garment.  But which is safer? There has been research on this topic.  A Journal of Pediatrics article in January 2014 found that ensuring a wide range of safe sleep practices was more important than method choice for safety.  The question parents should be asking is:  What should we do to make swaddling safe?  Safe swaddling has not been directly connected to very many documented injuries or deaths.  When unsafe sleeping practices are removed from the equation, using swaddling before a child can roll by themselves has a low level of risk.    Here are guidelines to help you make swaddling successful and safer:

  • Many preemies are allowed to sleep on their stomach while in the hospital.  Placing a baby on their stomach without the monitoring and supervision of  a NICU is dangerous.  Safe-to-Sleep recommends only back sleeping at home, swaddled or not.
  • Loose swaddling, soft bedding, rolling over on your child while co-sleeping, or engaging in the use of alcohol or drugs while co-sleeping are huge risks.  Using a co-sleeper next to your bed is much safer than having your baby in your bed.  Avoid having your baby sleep on you in a recliner chair or on the couch.
  • Swaddling your child too warmly is a risk, so learn to “summer swaddle” with muslin or a light cotton swaddle garment, or turn on the A/C.  Child still too warm?  Remove the swaddle until the room is cooler.
  • Not getting a larger swaddle garment once your child has grown is a risk for safety (velcro will not securely attach) and puts him at risk for hip injury if his legs aren’t able to move freely.
  • Once your baby can roll independently, swaddling is riskier. The American Academy of Pediatrics recommends that swaddling should stop when a child is beginning to roll independently.  If you are doing all the other Happiest Baby techniques for the older newborn, then you should have established great sleeping habits without swaddling by the time your baby starts to roll.

Teach Toddlers Not to Hit Without Saying A Word

Toddlers hit.  Some toddlers hit out of anger, some out of frustration, and some to get your attention. I never allow an out-of-control toddler to intentionally try to injure me and not say something.  But some toddlers hit me and I don’t say a word…but I immediately DO something. Adults can make it very clear that hitting is not acceptable without saying a word.  Really.

  • Step 1 in preventing a child from hitting is never to hit a child in anger or in any other situation.  Children who have been hit learn very quickly that hitting is allowed if you are bigger and stronger.  Make sure before you spank or tap them on the arm that this is the lesson you intend to teach them.
  • Step 2 is to have clear limits on aggressive behavior every day.  Young children do not have full control of their impulses, and will work on that skill for years to come.  This is not an excuse not to impose consequences, but it might mitigate the intensity of your response.  And it means that the limits have to be MORE consistent for toddlers to help them remember what will happen if they are unable to control their behavior.  If your child knows that you will always impose the same consequence for pushing a sibling, for example, then when they do shove their sister, they should not be surprised that they will experience the consequence.  It might be a time-out, loss of a privilege, or whatever your family has decided is the consistent consequence.  If your child hits, then they will gradually expect the consequence to that act.  Feel free to state house rules, such as “We don’t hit in this house”.  It sends the additional message that the child is an integral part of something important: a family.
  • Step 3; now to the part about not saying a word.  You can use Kind Ignoring from the Happiest Toddler (see earlier post on my blog) or just a quizzical look that says “Really?  You think that is going to be successful in getting what you want?” Look at them with aggression and you will get more of what they just dished out.   If you have clear limits and the child knows them, they know what you are thinking. If their intent was to get a rise out of you, Kind Ignoring makes it clear that you are not going to be a party to this behavior.  Dangerous aggression is no time for Kind Ignoring, but then, the minor aggressions that benefit from Kind Ignoring happen so much more often in daily life than dangerous aggression for almost all children.
  • Step 4 is to teach toddlers how to manage aggressive impulses.  It comes as a shock to many first-time parents that their adorable baby has turned into a toddler with aggressive impulses.  This is the human condition, and some children seem to have a harder time managing their impulses.  Aggression is normal.  It really is.  Learning what to do instead of lashing out is so important, and not easy for any toddler.  This is where it gets tricky.  My favorite strategy is to use the Fast Food Rule from Happiest Toddler on the Block (see previous blog posts) to make it clear that I understand their message of anger, frustration or desire, and then explain what is going to happen, or how the child can achieve the goal.  If they wanted a turn with a toy, giving them the words for a request or commiserating that it is sad that the other child is not willing to share is more instructive.  Older children can absorb empathetic statements like “You don’t like it when your brother hits you, do you?” but younger toddlers really do not have the ability to fully empathize, and certainly not when upset.  Make it all about them and their needs, and you will get further.  When they reach the cognitive stage to experience full empathy, they will be so much more able to wrap their heads around that concept.

It is so much easier to set up limits and teach appropriate behavior rather than constantly correcting a child and having to use things like time-outs.  Life with toddlers is always a roller coaster but it doesn’t have to be a fight.

Preschool Handwriting Activity: The Tally Sheet

a sample tally sheet

a sample tally sheet

Preschoolers love to play games.  Take a few sheets of scrap paper and a crayon, and turn a game of chance into their first lesson in handwriting.  This activity is also very effective for older children with motor or sensory processing issues that need the extra practice on grasp, pencil control, bilateral hand use, ocular mobility, and visual-perceptual skills.  Really, it addresses all those areas of ability!

Making a top-to-bottom defined line is the beginning of your child’s handwriting journey.  Pairing it with the standard visual orientation for reading and writing English, letter recognition, and finger control makes this game so much more than just keeping score.

You will need:

  1. A straight edge, such as a ruler.
  2. Gray crayon for the adult, and color crayons for each child. Some children like to have lots of choices.
  3. One 8×11.5 inch paper for each player, turned in a “portrait” direction.  (Narrow ends at top and bottom)
  4. Fun game of luck with fast win-lose cycles.  I love Crocodile Dentist, but you can make your own game.  Try using limited pairs of Zingo pieces to make a “go fish” type game, perhaps.

For the youngest players who do not yet know how to write the letters in their name, make a horizontal line across the paper 3 inches from the top.  With your gray crayon, write their name in capital letters on their paper, using slightly larger spacing.  Make a small dot at the point where you start each letter.  Hint: all capital letters start at the top!  If your child has a very long name, you will want to tape two sheets together.  Using smaller letters or closer spacing is not advisable.  On your paper, write your name in a bold color while your child watches you writing. Now ask your child to trace their name on their paper.  Tracing rather than connecting dots allows preschoolers to learn the gestalt of letter formation, not jumping from one point to another, and is quickly removed as they progress to full recall.

If your child is not writing and has no experience of tracing letters, you may have to make 2 sheets with their name, and trace it with them at the same time that they are working so that they see how you start and sequence each letter.  This is also appropriate for children with motor planning issues and children with ASD that need repetition in their instruction. For children in the later part of kindergarten, you can make the line only 2 inches from the top and make only the starting dots for each letter (no tracing).  Bold the baseline to remind them that letters “bump” that line.  For advanced kindergarteners, switch to the “title case” so that the first letter of a name is a capital, and the remaining letters are lowercase.  You may add a single line at the height of a lowercase “o” as a guide for proportion.  You do not need an upper line; the top of the paper is your upper line.

Time to Play

Each time a game cycle results in a winner, that player will pick up their crayon, place the tip on the horizontal baseline, and make a vertical line down to the bottom of the page.  Stabilizing the paper with the non-writing hand is harder when it is oriented this way, and that is desirable.  Awareness that handwriting is really a two-handed skill should come early and be automatic by the time your child sits down to write in kindergarten.  When the last game is played, count the lines to determine today’s overall winner.

Have fun!!

LEGO Duplo My First Car Creations: Putting Together Cars, Building Hand Coordination


UPDATE:  LEGO has changed a few things, including the name of this toy.  It used to be “Combine and Create”.  The new version is really great as well.  They have added some fun pieces with more graphics.  The piece that could morph from dump truck to tanker trunk is gone, and the dump truck piece is not as easy to use in another way.  I still like this set much more than their specific sets.  Children grow mentally and socially when they can be creative.  When I get my new set I will post a photo of the box and give you a more complete review!

Imagine; your toddler makes a new car and cannot wait to show you the “gas station-fire truck” just invented in your playroom!  LEGOs are my favorite toddler toy, always creative and very hard to destroy.  If I was asked to jump on a plane and teach therapists in a far-away country,  these LEGOs would be in my bag.  This set is so much fun for toddlers that I just had to post it. It is more creative than similar DUPLO sets that just build one type of vehicle.  Nothing will stop your child from making any vehicle they can imagine.  You can use the set to build a small structure as well.  The enclosed poster demonstrates specific vehicles that older children can copy, but the real fun is making your own designs.

I will tell you that the youngest toddlers may have to be restricted from the smallest squares and rectangles; they are a choking hazard if your child tries to mouth them.  But the wheel bases, the tow truck hook, and most of the other pieces are chunky enough and so much fun for fingers that you might try this set out with those just under 2.  With good adult supervision, those smaller pieces can be teaching tools.

This set has a pretend gas hose that is like catnip to little boys.  Can’t explain it, but then I still don’t know why guys love the 3 Stooges.  You can connect all 3 wheel bases to form one huge vehicle, and older kids will revel in how outrageous a vehicle they can construct using every piece.

Children will enjoy this set for years, and it is at a price point that makes it the perfect birthday gift.  Confession: I bought 2 sets to double the fun.  Totally worth it!

Teach Capital Letters First With Your Preschooler And Watch Writing Take Off

Teaching your preschooler to recognize and then write uppercase or capital letters is a key to early handwriting success.  Many, if not most of the commercially-available workbooks (and preschool teacher handouts) teach them at the same time.  Zaner-Bloser is a common style of handwriting instruction that uses this approach.  If your child has been identified as having visual-perceptual issues, this pattern of instruction could be the most difficult for him to use.  Here is why you teach capital letters first and exclusively for the very youngest children, regardless of whether a child has learning differences:

  • capitals are created with bold, easy-to-identify lines and curves.  They are also easier to write than lowercase letters if you are a young child or have difficulty controlling a crayon or pencil.  Lowercase letters are smaller and less easily differentiated and more easily reversed.  Example:  B, D, P, G  versus b, d, p, g.  Teaching these lowercase letters together for a child with limited visual discrimination skills will unintentionally hobble their learning from the start.
  • Your child will start to write all capitals begin in the same location: at the top. Less confusion when you are learning to write means less frustration and faster learning.  Changing poor writing habits is very difficult, even in the early grades.  Automaticity begins earlier than most parents realize.  Start with the most efficient letter formation, and you have fewer bad habits to erase.
  • Learn capitals well, and your child will recognize and write 25% of the lowercase alphabet immediately (c, o, s, v, w, x, y, z) , and there are 5 additional letters that are very similar to their uppercase counterparts ( j, k, t, p, u)  that can be recognized and written without too much additional effort.  Learning starts to snowball, and your child thinks that this handwriting thing is really easy-peasy!

If children learn to write legibly from the beginning they have more attention available to use for composition or calculation.  Give your child the gift of fast and legible writing, “write” from the start!

The Best Toddler Paintbrush Is…..A Travel Foundation Brush

Painting is so much fun for toddlers and preschoolers.  Finding the right brush that fits their little hands and also encourages a developing crayon grip isn’t as much fun.  Stores are full of all sizes and shapes, some with collars so that paint doesn’t run down their arms, some with ridged handles, some so tiny that you wonder how small is too small.  Find the right brush, and painting is a great pre-writing activity, developing hand strength and control along with creativity and touch exploration.

I shopped around for the right brushes, spending a fortune in therapy catalogs and at Target/Walmart/art stores.  Then I bought an expensive makeup foundation that provided it’s own small brush.  For the price they charged, they should have thrown in a makeup artist to apply it, but that is another blog post.  The brush was great, but not for applying my makeup ( I am a sponge girl).  It was just the right length and diameter for preschooler fingers to hold while painting!

Little hands should use small (but not tiny) diameter handles, and shorter rather than longer shafts.  A brush that has just enough room for fingertips (which discourages a fisted grip because there simply isn’t a long handle shaft) is just right.  Mine had a shiny base near the bristles that created a visual cue for finger placement.  That was a plus.

I think that a nice travel brush should work just as well, and a well-made brush can withstand the abuse a young child is capable of delivering on their way to creating a work of art!

What Makes A Child’s Handwriting Legible?

Legible and fast handwriting will allow a child's imagination and language skills to blossom!

Legible and fast handwriting will allow a child’s imagination and language skills to blossom!

For most parents, the answer to whether their child’s writing is legible is like the Supreme Court justice’s comment on pornography:  “I can’t define it, but I know it when I see it”.  For occupational therapists, it is relatively easy to identify whether a child’s handwriting is legible or not.  Does legibility still matter?  The emphasis on testing has brought new interest to teaching good handwriting as well as keyboarding skills in the early grades.  If your child has to erase and re-write too many words or sentences, it will affect how much time and attention he has left for composition and creativity in testing and in life.

If your child can recall the way a letter looks and they do not draw a blank/write another letter when asked to write an “A”, that is step 1. I have met children in middle school that cannot recall the difference between a “K’ or a “k”.  That is not as uncommon as you might think.   If he doesn’t reverse the letter, and he can correctly start and sequence the strokes to form the letter, then your child has the most important components of legibility down.  These are the basics of handwriting at any age.

Can your child place letters on the baseline?  Are all the letters in a word a consistent size, the correct size for his age, and the right size for the space provided?  Are the short letters (a, o, n, i) half the size of tall letters (h, f, k, t, b)?  Great; those aspects of writing enhance legibility.  Now, are the letters in a word (and the words in a sentence) spaced correctly?  Hint:  the space between his words should be the size of the lowercase letter “o” that is appropriate for your child’s age.  As children grow and develop better hand control, the size of their writing should become smaller.

The last feature of legibility is the level of control used.  Symmetry when needed, sharp angles and curved curves without over or under-strokes, no re-tracing, no extra loops, etc. are all hallmarks of control.

Handwriting is a complex skill, one that takes years to learn.  Only when you know exactly what legibility issues exist can you begin to help a child achieve mastery!

Massage With Your Special Needs Child

When parents hear that I am a licensed massage therapist as well as an OTR, they often ask how massage can help their child.  They seem to assume that I would recommend massage only to calm a child on the spectrum, or help a child sleep.  Actually, massage can be great preparation for getting a child moving as well, and supports focused thinking and communicating.  Massage doesn’t just have to be about relaxation.

Massage techniques range from sedating to invigorating.  Children with low muscle tone are especially helped by quick strokes and moving vibration.  They need more information about where they are in space, and where their muscles are around their joints.

Children with spasticity certainly benefit from stretching and relaxing tight tissue, but the best results are when they get up and move purposely.  Their brains note the changes in posture and range of motion, and build new neural connections for easier and efficient movement. Combining massage techniques with movement is like adding one and one and getting three!

Massage with children on the spectrum can range from quiet to more stimulating, based on their current state.  These children get extra support to learn that touch can be acceptable and enjoyable. Reducing a fear response to approaching touch from another person is a worthwhile goal.

Massage is so many things to children, and can support all the other therapies they receive.  Find a great therapist, and learn how to use massage on your own child to help them grow!

Does It Matter How Your Child Holds A Pencil?

The simple answer is: maybe.

The standard tripod or quadrupod grip that every occupational therapist teaches will give your child a solid, controlled hold on a pencil for handwriting.  Most children can learn this grip by 4 years of age. Some children watch adults and seem to copy it effortlessly.  What happens to the rest of them?

Some children end up using a pencil grip in kindergarten, and I strongly prefer to wait on recommending this choice until I have seen that hand exercises and activities have not resulted in a  stable independent grasp.  In highly academic kindergartens, there can be a high volume of handwriting.  Allowing a child in such a class to habitually use a weak or unstable grasp is simply unfair.   I prefer to support a struggling grasp with the type of pencil grip that looks, quite frankly, like the head of a cobra.  The “hood” prevents fingers from rolling over the pencil or each other.  This style of pencil grip requires a tripod position, and actually I consider it the only grip that creates more finger strength and control as it is used.  I encourage frequent reassessment of grasp to reduce and remove the use of pencil grips as soon as possible.

Current research will support both the stance that a good grip is essential for good handwriting, and the position that it is irrelevant to legible handwriting.  I see both sides.  If I had a dollar for every parent that wrote me a check for services using a “hook” grasp, I would be blogging to you from Hawaii right now.  Most of them have advanced degrees and no physical limitations (that I know of) save an unusual pencil grasp.   If your child complains of hand and finger fatigue, or you can see that his grip is making it harder for him to write certain letters, then you have to try to change that grasp pattern.  Letting a child struggle is not kind.  If your child is a neat but very slow writer, then take a look at his grasp pattern and consider whether it is contributing to his speed issue.  There may be other causes for slow writing speed, but it is worth exploring whether grasp is a part of the problem.

Final thought:  Pencil grasp usually has to be taught. Tool use is not inborn, so model it and support your child’s efforts as they grow!