Monthly Archives: July 2015

Add Massage To Your Child’s Sleep Routine, And Both of You Could Sleep Better Tonight

Massage is a wonderful way to connect with your child, and it can be a great technique to send him off to sleep without tears or guilt.  After the books are read and the last feeding has finished, you can use a short and restful massage to relax him and assure him that it is time to go to sleep.

Dr. Harvey Karp writes about the fact that bedtime starts at breakfast:  having a calm and rewarding day in which a child feels that he received enough attention from loved ones, enough play and enough emotional support will allow him to cooperate with bedtime and separate at night with fewer issues.  Some days aren’t so blissful.  Commutes are too long, multi-tasking gets in the way of fun time, and children have their own mini-dramas in their own life at daycare or school.  One way to follow Dr. Karp’s advice to have daily “time-ins” and to support his feed-the-meter concept is to use a nighttime massage routine.  It can be something that both parties look forward to at the end of a busy day.

As a massage therapist, I teach parents custom routines that are flexible and easy to learn, but the very best massages are the kind in which both parent and child are relaxed and receptive.  Some children love back massage, some like foot and hand massage, and some relax best with a full-body treatment.  Your child’s reaction will tell you the direction to take.  The age and temperament of your child will dictate some of the choices of strokes and how long the massage takes.

A few suggestions:

  • use food-grade unscented oil until you are certain that your child’s skin is not sensitive to essential oils. Avoid lotions and oils that are synthetic.  You never know when they will lick their fingers, and if it isn’t of a quality that you would put on your food, it isn’t acceptable on your child’s skin either.
  • dim the lights, including computer/tablet/TV screens.  This isn’t the time to read the captions on your show.
  • you can use music or be quiet.  Not every child can relax with multi-sensory stimulation at bedtime. You can talk gently, or just smile and make eye contact.   Again, your child’s responses will tell you how to craft your massage environment.
  • use slow and rhythmic strokes for maximum relaxation.  If possible, try to have one stroke blend into the next without lifting both hands off your child.
  • use a full-arm, full-leg, or full-torso welcoming and finishing stroke.  It helps your child develop greater body awareness and is an elegant way to deliver your massage.
  • enjoy yourself; research has shown that the providers of massage also receive benefits such as greater oxytocin levels ( the brain neurochemical associated with attraction and attachment).
  • do not be surprised if your young infant (under 6 months) only tolerates a 15-20 minute massage, and then becomes fussy.  Massage can be a lot of stimulation for a young baby, and you will have to experiment with the quality and quantity of the strokes that bring your little one to bliss.  A brief massage may be just perfect for him!
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Ten Problems That Cause Parents to Abandon Happiest Baby on the Block

Learning to use The Happiest Baby on the Block 5 S’s can be tricky.  In addition to teaching group classes, I also teach parents privately to help them get the techniques down correctly and answer all of their questions on the spot.  I meet parents who have watched the DVD or read the book but still struggle to get the amazing results they see/read about.  Here are the biggest problems/mistakes that parents encounter when they try to use THBOTB:

  1. The Loose Swaddle.  New parents can be hesitant to use a firm swaddle, thinking that since their baby is still crying, he is crying because he hates being restrained. Why Some Newborns Look Like They Hate To Be Swaddled This is usually not the case, as newborns generally love deep pressure that simulates the womb, and parents that I work with are far more likely to do a too-loose swaddle than a too-tight swaddle.  In fact, I have never yet seen a parent that I have personally trained do a swaddle so tight that I had to gently intervene.  A loose swaddle is an asphyxiation risk when it comes undone and the fabric covers the nose and mouth.  It also allows a baby’s arms to fly up and startle a newborn, leading to more screaming.  Preemies are swaddled with their arms up to increase calm alertness and they are monitored 24/7.  Huge difference.
  2. The Too-Hot Swaddle.   Using the fleece swaddle garment in a warm apartment will sedate your child.  It looks like it works perfectly.  But newborns cannot sweat away excess heat, and if a baby is sweating, their ears and neck are warm and damp, then they need to be swaddled in something cooler.  Being overheated is a risk factor for SIDS, so if you have no A/C and your baby is too hot even with a muslin swaddle, you need to remove it.  A hot baby is a baby at risk.
  3.  Too Slow and Too Gentle Swinging.  The magic of the Swinging “S” is in the small but faster head movements that stimulate a baby’s vestibular (balance) system.  Completely different from shaken baby syndrome, this jiggling movement is calming.  Slow swing is not going to be able to stimulate a newborn’s balance system correctly.  Parents are often afraid that they will harm their baby, but if they are taught well, that little neck and brain are completely safe.
  4. Stomach/Side Positioning Errors.  This “S” is another way to dampen down the startle reflex,  so correct positioning is key.  The little secret of this move?  Every baby’s balance sense is  a little different, and yours may prefer stomach instead of side positioning to calm them, or she might need a little more of a side turn to feel “just right”.
  5. Pacifier Abandonment Out of Fear.  Many new parents are anxious that their child not become addicted to pacifiers like toddlers they see walking around town.  They are also worried that it will deform their teeth.  Well, newborns have no teeth to deform, and addiction to pacifiers is created when older children have no other ways of calming themselves down.  Parents that make a conscious plan to wean pacifier use after 6 months, well before growing cognitive skills and long-term use create a habitual need, should be OK.  Teaching a newborn to use a pacifier is easy when you get the one that fits their mouth shape and you use THBOTB training technique.  The 5 S’s can be done without a pacifier, but rejecting it out of fear is different than using different techniques for sucking.  For more information, see Prevent Pacifier Addiction With A Focus on Building Self-Calming Without Plastic
  6. Ignoring the Layer Cake Concept of the 5 S’s.  There are some babies that calm with just a swaddle and a shush.  But most need the full-on 5 S’s.  I meet more of those because parents call me when they are frantic for sleep and have tried maybe 2 or 3 of the S’s and given up.  Needing all 5 moves is not a sign of a problem.  The problem is likely that your baby is normal, has a sensitive or spirited temperament, and is right in the stage for maximal newborn crying (2-10 weeks).  Ignore this at your (sleep’s) peril.
  7. The Too-Quiet Shush.  Babies quickly calm to the right volume and pitch of shushing, but parents sometimes think that the loud shushing needed to calm them initially will harm their hearing.  Loud shush is used for a brief period when they need help to pull themselves together, and then the correct shush is the loudness of a bathroom shower.  Avoiding the loud shush is ignoring the needs of a newborn brain as it seeks organization and calm.
  8. Forgetting the Basics.  I was reminded of this when I taught my first class.  The host, a breastfeeding consultant, asked if I would mention checking whether a baby needed a feeding or a diaper change before starting the 5 S’s.  I will confess that it had never occurred to me that I would have to say that. It seemed so obvious.   I will say it here:  Before you use THBOTB to calm your crying newborn, check to see if he is hungry, soiled or wet.  First things first.  A baby that is healthy, full, and clean should be easily calmed with THBOTB.  A baby that needs those other things will not stay calm for long, regardless of your technique.
  9. Using Small Garments/Blankets for Swaddling.  The swaddle garment industry has exploded, and you can find all styles.  Blankets are often big enough for the first 2 months at least.  The biggest issue with garments, other than matching the fabric to the room temperature, is that once they are too small, they are a danger.  Outgrowing a swaddle garment means that the velcro isn’t correctly placed for a solid hold and can come undone, and the baby’s legs cannot move freely.  Legs that are stuck in an extended (straight) position are a risk factor for hip dysplasia, a condition in which the joint is not correctly formed.   If you are buying garments, better to have at least one in the next size up sitting and waiting for use.
  10. Waiting Too Late to Try HBOTB.  Some of the 5 S’s, such as white noise shushing and sucking, will help babies over 3 months calm down and sleep, but the real magic is in starting life with peace and good sleeping habits.  Parents who take a wait-and-see approach risk the development of poor sleep habits or feeding issues related to crying/poor sleeping.  Their own lack of sleep and sense of failure is a risk factor in postpartum depression.  Worst of all, they do not have the full joy of those precious first months because  they are exhausted and frustrated, struggling to calm their newborn or get just another hour of sleep each night.

Turn Around Toddler Defiance Using “Feed the Meter” Strategies

Tantrums, back-talk, throwing toys, hitting.  It can be an occasional episode, or it can be a daily slog through toddlerhood.  If a chronically defiant toddler isn’t having a major life change (new school, new caregiver, illness, new family stressor), then it’s possible that she has just developed a habit of relating to adults in this manner.  It can happen quite quickly and begin without much initial notice.  A few situations where she isn’t going to win a battle of wills, like buckling her into the carseat, combined with bad timing: the restaurant was very loud,her favorite snack was unavailable on vacation, or even extended cabin fever in the winter can snowball into entrenched defiance.   Now you have someone who seems to be looking for a fight over nothing, and maybe even enjoying your frustration.  New parents can’t believe that their angelic baby is actually enjoying making their blood boil.  The good news:  she isn’t going to become a psychopath, it is just a developmental phase combined with a bad habit.

Every child needs to test the rules to know that they are firm and that their caregivers reliably will help them when their toddler moods get the better of them.  Parents, teachers, nannies; everybody will be tested by a toddler over time.  If your child seems to be in a time-out multiple times a day, then you should consider a new approach.  For defiance and aggression that have become entrenched, my favorite and most successful strategy is Dr. Harvey Karp’s “feed the meter” plan.  Shaming, threatening, and physical means to get rid of defiance are not going to give good long-lasting results, and can risk establishing caregivers as fearful people to distrust.   Ignoring the behavior and hoping she grows out of it is not going to work either.  A smart toddler will double-down and it will get worse as she is able to stand her ground longer, louder, and in public places.  If this sounds familiar to you, please read on!

“Feeding the meter” is about what it sounds like.  You create or take advantage of naturally occurring pleasant experiences to share with your child, sprinkled throughout the day like putting quarters in a parking meter to avoid a ticket.  A really defiant toddler will turn down those first invitations to share their favorite snack with you, watch a favorite movie, etc.  Just set it out, start snacking or watching, and eventually make another offer for her to join you.  Laugh at a silly toddler joke, kiss her favorite doll, whatever you know is a positive experience.  This doesn’t mean you should go buy her the toy she has been screaming for all week.  You can go low-cost, low-effort, and create many short positive interactions.

Be prepared emotionally to be turned down repeatedly or even shouted at, as your toddler resists breaking her habitual defiance.  Don’t take it personally.  As the adult, you are going to have to be the one who stays cool and collected when a toddler is nasty right to your face.  That takes some strength, and it takes more out of you than you might think.  Take a breath, complain to another adult when your child cannot hear you, and treat yourself with kindness.  So many parents are so depleted by lack of sleep and ignoring their own needs that it is hard to use these mindful techniques successfully.  You have to remember your long-term goal is to steer this ship away from the rocks and get back to calm shores.

 

Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!)

Most parents assume that toilet training isn’t going to be easy. A child with low muscle tone often crawls later, walks later, and may speak later.  But it can affect toilet training in ways both obvious and subtle.  As an occupational therapist, I wanted to share an explanation of why one of the consequences of low muscle tone can make teaching this skill just as hard as teaching your child to walk independently.  Hint:  it isn’t something you can see, and it isn’t balance or stability. (both important but quite visible consequences of low tone)

When muscles are not “sitting at the ready” for use as they are in normal tone, it takes more time, more stimulation, more effort or all three to get them to contract and tighten.  But it also means that the receptors inside the muscles of the bladder, the rectum, and the abdomen are not firing as frequently or as strongly.  The brain’s awareness of a change from resting state to stretched receptors is known as proprioception.  The special ed teachers I work with would call it “body awareness”.  This internal awareness of a change in pressure within your bladder wall, in your rectum and against your pelvic wall is what compels you and I to get up and go to the bathroom.  This is “interoception“, proprioception’s internal version.  With low muscle tone, your toddler is honestly stating the truth when they tell you that they don’t feel like they have to “go” and then they pee on the floor right in front of you.  They may have only a very weak sensation of fullness, or it may only be perceived a few moments before they really have to go.  That is what lower proprioceptive registration is like.  All of a sudden, the level of muscle receptor firing has reached a point where it is perceived.  And now there is a puddle on your floor.

What can you do?  Well, in previous posts I have mentioned that all the strategies to develop cooperation and frustration tolerance are keys to teaching a toddler anything at all. I go into more details about readiness in Low Tone and Toilet Training: The 4 Types of Toileting Readiness .  When you are facing an issue where the feelings that you are trying to sensitize them to are fleeting and invisible, you are going to need them to be very highly motivated indeed.  That means that you work on Happiest Toddler on the Block techniques such as patience stretching and “feeding the meter”.  These create positive parenting interactions that help your toddler listen to you when you tell them it is potty time and then keep them on the toilet long enough to make things happen.  If your toddler ignores your directions unless it is something he wants to do, and engages you in defiance games constantly just to see your reaction, you have some work to do regarding his behavior before toilet training is going to be successful.

Here are specific suggestions for toilet training the child with low muscle tone:

  • They need stronger physical sensations at the time when you sit them down on the potty. A full bladder stretches, and that stretch of the muscle wall is what they don’t feel unless it is a profound stretch. That means that they should drink a larger amount of liquid at specific times, so that bladder is really full at a predictable time. Yes, it means that roaming the house with a sippy cup will not work for toilet training.  A half-full bladder isn’t going to give enough sensory input but it will empty when they bend forward or squat.   If you have done the patience stretching and feeding the meter techniques from Happiest Toddler on the Block, your toddler can handle the change in beverage scheduling and they will be fully hydrated at all times.  They are just not drinking all day long.  The same thing can be done with meals, allowing for small snacks but having real toddler-sized meals, not grazing throughout the day.  Full colon= more contractions and more sensations.  A diet with fiber makes the poop firmer, and therefore sensations in the colon are more obvious.  A higher-fiber diet is a good way to prevent constipation as well.   This is a summary of a recent comment from a parent that used these methods:  She told me that using this strategy made her life so much less stressful when taking her daughter out of the house for preschool or appointments.  She knew that her child had fully emptied her bladder and wouldn’t be taking a big drink again until lunch.  She didn’t have to scout out bathrooms constantly and keep watching her daughter for little signs that she needed to “go”.  Makes sense to me!
  • Watch your child and see what their current voiding/defecating schedule seems to be.  Not every person is like clockwork, but you need to know when they are likely to go once you have the drinking and eating schedule down.  What goes in will come out.  Kidneys are more reliable than intestines.  About 30-45 minutes after a big drink, that bladder should be filling up.  For some children it can be 20-25 minutes. Then you know when to get them on the potty.  There is no point in sitting there when they are close to empty.  Everyone gets irritated.  Is your child unwilling to drink enough?  You may need to offer a better beverage, such as a yogurt drink or chocolate milk.  Serve them with a “silly straw” and watch that drink disappear!
  • These children just don’t have that much abdominal muscle tension to help with voiding, so the physical position they are in can help or hurt their efforts.  Sitting with your knees lower than your hips and your body leaning back reduces the intra-abdominal pressure.  You want to increase their ability to push gently, so sitting on a floor potty in a slightly flexed position can help them contract their abdominal muscles and push with their feet to get some pressure going.  Heavy straining is not recommended and so do not demonstrate or encourage superhero-sized force. Read my post on selecting potty seats that help your child do the deal. Picking A Potty Seat For Toilet Training A Child With Low Tone
  • Don’t distract them from the job at hand.  You might not be comfortable with a long conversation about toilet activities, but if they are chatting about Thomas the Tank Engine while that pee is coming out, they have no idea how it happened or what it felt like just before the stream started.  They missed out on becoming more aware of the sensory experience, and low muscle tone can make that sensation very fleeting and vague for them to begin with.  If they arrived on the potty full and ready to do their thing, this doesn’t have to be an extended bathroom visit.  This bathroom trip is all about the process of using the toilet, not a rehash of what they did at school that day.
  • Last, and probably obvious to most parents, is that you cannot shame a child for not recognizing a sensation that is not easily perceived because of low muscle tone.  They didn’t cause this issue, and once they are motivated to use the toilet, they would like to please you and feel proud of themselves too.

For more information about managing toilet training with low tone, take a look at Low Tone and Toilet Training: How Can Your Child’s Therapists Help You ?,  and The Ten Most Common Mistakes Parents Make During Toilet Training

If your child has mastered the potty seat but isn’t ready for the “big time”, read Low Tone and Toilet Training: Using The Adult Toilet for two pieces of equipment that can raise their game, and a few other strategies to help them make the switch to using an adult toilet.

Update:  My book, The Practical Guide To Toilet Training Your Child With Low Muscle Tone, is finished!

You can purchase it as an e-book at Your Therapy Source or on my website tranquil babies!  And now…on Amazon.com! The hard copy is available to families in the US by contacting me through my website.  

I am so excited to offer parents a comprehensive manual that prepares them well and explains so many of the confusing situations that they encounter.  Don’t be afraid to train….be prepared!  Learn more how my book can help you make changes in your child’s skills today by reading The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived!

For even more support with your toddler, visit my website tranquil babies and contact me directly by purchasing a phone/video consultation.  

Coping With Sensory Sensitivity and July 4th Celebrations

Happy Fourth of July!  Children with sensory sensitivity may not be in the mood to celebrate today.   Holidays in general are often tough for these kids, but this particular holiday is known for it’s cacophony of sights, sounds and smells.  Here are some suggestions to make the day as much fun as possible:

  1. Keep your usual routines as much as you can.  With all the traveling, different menus and unfamiliar visitors, your child will be comforted by the things that don’t change today.  That means the same nap times, the same snacks, and the same music in the car on the way to events.
  2. Choose events and arrivals/departures that minimize sensory overload.  You might arrive first and leave before the event gets too crowded or too loud.  You might arrive later and just have a few people around.  Skipping the fireworks and playing in the basement isn’t a loss, it’s a big win if your child is able to sleep calmly tonight.  You can still have fun today, but really try to see the day through your child’s sensory perspective.  Sudden outbursts will not be as much of a mystery if you can manage to see things his way.
  3. Use the techniques and equipment that you have available to you.  Yes, the pressure vest and the headphones look a little unusual in public, but so does a screaming child.
  4. Bring foods that your child is familiar with to a gathering.  One meal of cheerios or mac and cheese won’t be the end of things, and most hosts want your child to enjoy himself.
  5. Don’t forget some of the little sensory tricks your occupational therapist may have shared with you.  Provide a drink with a curly straw or have him snack on  a chewy bagel (unless your child chokes on chewy foods) to get calming mouth sensory input.  Have him push the wagon with the cooler for heavy work.  Ask him to climb up and down the deck stairs safely for more heavy work.  Give him napkins to count or fold, or plastic utensils to sort.  This kind of focus can be very calming.

Enjoy your holiday, and celebrate independence everywhere and for everyone!