Monthly Archives: September 2015

Why Head Banging Doesn’t Make Your Toddler Autistic

I have worked with so many toddlers who terrify their parents with a tendency to bang their heads on the floor when frustrated.  Their parent’s first question is almost always  “Do you think he could be autistic?”.  Sometimes the answer is yes, but it isn’t because of the head banging.  It turns out that head banging is a behavior seen frequently in autism, but it can be a sign of unrelated problems or just a developmental phase.  No one likes to see their child walk around with welts on his forehead. Head banging can be stopped or at least diminished when you know why it is happening and how to turn around the cause(s).  Here are some suggestions to deal with this behavior whether or not your child is on the spectrum:

  • Watch the timing and the pattern of behavior/experiences prior to head banging. Sometimes hours before the head banging.  Tornadoes do not appear without clouds, and head banging doesn’t emerge without a trigger either.  Even the children who bang their heads to “stim” (increase specific sensory stimulation in any mode of sensory input) have an actual reason.  Usually their reasons are to exchange one sensory input for another more irritating one, or seeking input to raise their overall sensory alertness. It is hard for many parents to understand, but strong, even painful sensation can actually be calming to a person who is experiencing internal turmoil.  This appears to be the basis for another troubling symptom seen in teens and adults: cutting.  That is why head banging could be an attempt to deal with frustration or rage a child cannot control and cannot express.  Work hard on those communication, sensory and behavioral concerns.  Sometimes it can be as easy as dimming the lights or snipping the tags on shirts.  Sometimes you need a complex behavioral program as well as a sensory diet.
  • There are toddlers that bang their heads a few times and then slip a quick look to see if they are getting their way.  Is she running for the cookie, not the sandwich?  Is he turning on the DVD now?  Fewer sobs, less intense desire to bang his head, and no visible relief from the few hits he takes. That sidelong look tells you what you need to know.  He is hoping to scare you into caving in.  Don’t fall for it.  In fact, that might be the time to use the Fast Food Rule (below) and a consequence/loss of privilege.  You are being played.
  • If sleep schedules are erratic or if sleep is insufficient, that can contribute to a very short fuse and  support this behavior when frustrated or overwhelmed.  So many childhood behaviors have been linked to sleeping issues, and this is one of them.  Get help if you need to for sleep problems, and then see where you are with this issue.
  • The inability to communicate frustration and desires/needs is a huge reason for head banging in toddlers of all stripes.  And not just the kids on the spectrum or kids that struggle with sensory processing.  Build his language skills and use The Fast Food Rule from Happiest Toddler on the Block.   See my post in March 2015 ” Taming Toddler Tantrums Using Empathetic Reframing” so that your child feels that you really, really hear what is bothering him!  After that, use Dr. Karp’s Happiest Toddler technique “patience stretching” after your child is 12 months old, or with a  child who is at a 1-4 year cognitive and communication level.
  • Finally, make sure kids are safe and have alternatives that work and that they can use.  This takes practice for both of you.  Not yelling, being firm and supportive isn’t easy when your child is determined to head bang.  Some kids will be willing to bang their heads into bean bag chairs, sparing their skulls.  Some will let you massage their scalp for stimulation, also kinder and gentler. Some need to know that choosing head banging consciously instead of speaking, seeking a quiet space, a therapy toy or a hug will result in the loss of privileges.  But always equipt your child with some alternatives that work and help them make a good choice before they risk a loss of a privilege.
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Children with Autism Stop Screaming When You Use The Fast Food Rule to Communicate

Children on the spectrum who scream instead of “using their words” are often perceived as manipulative, on sensory overload, or incapable of better behavior until they learn more language.  Try using Dr. Karp’s Fast Food Rule and watch your screaming toddler miraculously find his words.  In minutes… or less.

This isn’t a guarantee, but it really can work that fast if your child has learned that when frustrated, his best approach is to scream until he gets what he wants.  The “scream-’til-I-triumph” phenomenon happens to typically-developing toddlers too.  Anyone learning language, frustration tolerance, social skills, and emotional state control at a the same time is bound to go there.  Special needs toddlers and preschoolers just stay in that situation longer than a typically-developing child, and they can scream louder and longer and in more situations.  It can become their go-to strategy.  They have a harder time understanding your non-verbal cues that indicate your attention and appreciation for their distress.  Reading social cues is often nearly impossible for them when calm.  It is almost impossible for them when upset.  Children on the spectrum or with multiple developmental delays can benefit from using the Fast Food Rule during stressful times for years and years after toddlerhood has officially ended.

My March 2015 post “Taming Toddler Tantrums Using Sympathetic Reframing” reviews Dr. Harvey Karp’s fabulous Fast Food Rule from his Happiest Toddler on the Block book/DVD.  Take a look at that post Taming Toddler Tantrums Using Sympathetic Reframing for an example of how to navigate the screams, how to deal with your emotions about being screamed at by your child, and what it looks like to implement it in real life.  Dr. Karp did not develop his approach for children with ASD, but it sure works extremely well for all that screaming.

Adaptations that you might have to make to use it effectively with developmentally-different kids:  use it very consistently, repeat the experience frequently until your response is familiar to them, and remember that sometimes the screams are real distress based on sensory, language or habitual behaviors that they use to self-calm.  Respect their comfort level with direct gaze, sound and touch as you interact while using this approach.  That means that you may have to avoid as much eye contact and perhaps not touch them while using the Fast Food Rule.  You may also have to dial your communication down to a level that is much, much lower than their chronological age or even lower than their usual receptive language level (what they can understand, not how they speak) when they are this upset.  Kids with ASD sometimes live on the edge all the time.  They need fewer words and more gestures/facial expressions to follow what is going on when times are good.  When angry or frustrated, they need even more non-verbal communication and more targeted short verbal communication so that they can follow what you say.

Children with ASD can definitely benefit from The Fast Food Rule and all of Dr. Karp’s other great Happiest Toddler tools for communication and self-control. Stretch Your Toddler’s Patience, Starting Today!  A diagnosis of ASD usually includes some type of sensory processing difficulty and frequently issues with rigidity/routines.  Kids who scream can be experiencing sensory aversion/sensitivity, become overwhelmed by multi sensory input, and will need your help to parse out all the reasons that they are upset.   Carefully watching your child’s build-up to a scream will tell you if you also need to make changes to the sensory environment or give him assistance with transitions in addition to changing your communication style.

Beyond Tummy Time: The Magic of Side Lying Play for Balance and Vision

Tummy time is terrific, but your baby cannot stay in that position forever, no matter how entertaining you make it, nor how hard he works to lift his head.  Side lying is another great position for a young infant, one that is well-known by occupational therapists to give babies unique opportunities for head control, eye-hand coordination and visual coordination in those early months of life. Yes, vision!  The connection between vision and balance is so strong in fact that every young infant should have side lying in their daily play time.

Of course, side lying is terrific for arm and head control as well as balance.  Even though your child isn’t lifting his head, he is refining movements of his head, shoulders and arms while he is looking and reaching.  That “top arm”, the one that is more free to reach, is being pulled down by gravity.  This means that he is strengthening his shoulder every time he reaches up and out.  When that happens, his body rotates just a bit and he has to coordinate that movement of the hand, the shoulder, and the ribcage.  He will be practicing the fine control needed to roll over, and might develop that skill a little sooner as well.  But the special skill that side lying supports is not rolling or reaching.

The unique benefit is that in side lying your baby can more easily bring both hands together, bring eyes and hands together, and coordinate both eyes without the normal movement reflexes interfering as much.  You know, those reflexes that swing his head and arms back or to the side just as he is reaching out.  He can independently control his head and arms to examine his hands using touch and vision, learning about these wonderful things at the ends of his arms.  And he can tilt his head just a bit to look at his hands as he plays.  Side lying supports but also stabilizes that wobbly little head, allowing him to bring both eyes into focus and helps him isolate eye movement from head movement at this early age.  Guess what?  Better eye control is known to help develop balance, and when you pick him up and he lifts his head, you will see better balancing of his head on his shoulders, and better sitting balance sooner!  The gift that keeps on giving!!

Safety concerns:  Never leave your newborn alone in side lying. He will not have the ability to clear his airway if he slides into an awkward position.  This is not a sleeping position, it is a supervised play position.  Side lying is most effective if you fold up a soft receiving blanket into a thickness that is approximately the width from his shoulder to his neck, and slide it under his head and cheek.  Leave the area near his mouth and chin unsupported.  You have reached success when you can draw a straight horizontal line from the center of his chest through the center of his chin, nose and forehead.  Everything is aligned in the center of his body.  Some active babies need a towel roll behind their whole head and back to feel stable, as they can feel that rolling movement when they reach or turn their head.  Some also need a little towel roll under that “top leg”, to keep them from rolling forward.  Again, supervised play is safest.

I should mention that placing your baby in positions like side lying and prone on his tummy relieve pressure on the back of his head, reducing the chance that he will develop a flattened skull, also known as “positional plagiocephaly”.     My post was intended to explain the visual development that side lying supports, but as you can see, this position is great for so many reasons!

Will Swaddling Make it Harder to See Baby’s Hunger Cues?

This question is the one I have heard repeatedly from parents and birth educators.  Here are the facts as I know them:  Hunger is natural, hunger is strong in most infants, and hunger is more powerful than the swaddle. In fact, a great way to know if your fussy newborn is hungry or just fussy is to swaddle her and do all the rest of the 5 S’s from Happiest Baby on the Block.  If she calms for a short period of time and then really cries for you, she is probably hungry.   I am assuming you checked her diaper first.   Dr. Karp recently posted a short video and suggested that you see if the rooting reflex is super-powerful (you know, touch the corner of her mouth and she searches for the nipple?)  A baby that roots and still cries is probably fussy, not hungry.  OK, with that out of the way, there are some details about newborns to examine.

A very small number of babies, preemies and otherwise, do not have strong hunger cues.  That is not the fault of swaddling, but it is an issue that must be addressed by your pediatrician, doula or lactation consultant.  Problems with avoiding feedings or lack of interest in feeding are important to deal with as early as possible.  Children that have developmental issues or neurological issues such as very low muscle tone often struggle to maintain a level of alertness for feeding, and also work very hard physically to suck.

For these children, keeping them alert is important, but an alert-and-fussy state takes whatever energy they had away from them.  Swaddling correctly can help get them in that beautiful calm-alert state in which they can nurse or feed longer.  They will not be flailing their arms and scratching their face, or crying when they set off the Moro (startle) reflex by their random movements.  Doing a good, safe swaddle isn’t always easy.  Read The Happiest Baby on the Block or contact a certified HB educator (like myself) if you are all thumbs with those blankets and swaddle garments.  Don’t blame yourself or think that your child either hates it or cannot tolerate it.  Check out  Why Some Newborns Look Like They Hate To Be Swaddled to understand why more crying doesn’t equal swaddle fear.  You might just need a little demonstration and practical advice.  Doing a good swaddle is that important.  Here is a new post that explains why you need more than a good swaddle to calm them down:  Swaddling Success: Layers of Calmness

Babies that have difficulty swallowing can decide that the feeling of choking or reflux is so difficult that they really only cry for food when they are desperately hungry.   Again, swaddling isn’t going to dampen down the hunger that will come to them eventually.  It will help them calm and focus, especially if they are fearful.  Swaddling supports their arms and trunk, making it easier for you to hold them in the position that reduces their distress.  If your baby is finding the suck/swallow breathe pattern harder to synchronize, getting her into a calm but alert state is key.

Babies that are struggling for any reason to develop a calm state are known to develop a pattern of “snacking” because they are using sucking alone to calm down.   Baby Nursing For Only a Few Minutes Then Fussy? Use the 5 S’s to Settle And Focus your Newborn To Feed, Not Just to Sleep  Don’t let your newborn fall into the snacking trap and allow her fail to nurse fully and well during her regular feedings.  It is often the first step down the road to flipping days for nights, and sleeping only short periods of time (for her respective age).  In this situation, she is never really rested and never really full.. Imagine being always a little tired and a little hungry.  How miserable.  Using THBOTB techniques will help you help her.

The secret to knowing whether she needs to soothe by sucking or if she is really hungry is to watch her behavior.  Is the rooting reflex strongly sending her into “search for the nipple” mode?  Is she actually swallowing?  Is she showing you HER best latch-on skills, and really going for it eagerly?  Does she seem to fall into a dreamy sleepy state after nursing/feeding?  Or is she taking a few random sucks and then playing with her hands or your shirt?  Watching a baby will give you their hunger/satisfaction pattern over time, and knowing when something is wrong is often as easy as seeing a change in the pattern that doesn’t match the next developmental stage.  Your support team can help you determine what that stage looks like.  It could be your family, your pediatrician, your therapists, or your lactation consultant.

If you have fallen into the common trap of “accidental parenting”, which is possible as early as 4 weeks but more frequently seen after 12 weeks, take a look at my post Accidental Parenting at 4 Months: Out Of The Swaddle And Into The Frying Pan for some guidelines to get you back on track.  Jumping from one solution to another and creating unhelpful habits to solve short term problems isn’t a sign that you are a terrible parent; it means that you don’t have a solid plan or a way to evaluate what a good plan looks like.

Using swaddling can really help your baby feed more calmly and feed fully.  Swaddling correctly supports successful nursing and bottle feeding.  Hunger cues are easier to separate from fussiness and fatigue.  Effective swaddling makes it easier to see what your little one really needs from one moment to the next.

For more information on The Happiest Baby on the Block, to request a consultation or a phone support session, please visit my website:  tranquil babies

Special Needs Kids and Toothbrushing, Part 3; The Sensory-Motor Experience and the Behavioral Strategies that Support Success

Now that you know what issues your child have that made toothbrushing difficult, and you have made brush and paste/rinse choices, it is time to think about the influence of timing, the environment, and the approach to the task.

I often recommend that families practice skills outside of their natural timing.  Let’s face it; running off to school and bedtime are highly charged times of the day.  Almost any child is going to feel it, and certainly any rushed or exhausted parent.  No one is at the top of their game.  Try practice on an off-hour, make it short and if possible follow it up with something fun.  Human beings cannot help but associate events, and if brushing is followed by games or outdoor play, it is going to have a subconscious effect.  I really like the practice concept in “The Kazdin Method for Parenting the Defiant Child”.  Even though most of his techniques are more suited to a slightly older child, the idea that you can practice a skill at a calm time is a great one.  Both parties are in a different mindset.

Think of the bathroom the way a designer would.  No, you don’t have to buy new towels, but you might want to use a dimmer on bright lights and think about the noise the running water makes.  Sensory sensitive and poor modulating kids can be just stimulated enough to push them into irritability. I love the calming power of lavender, and your child might too.  There are children who cannot handle much in the way of scent, and even your plug-in deodorizer irritates them.  Move it out before starting your routine and see if that has a positive effect.  If you are not a sensory sensitive person, you might not even notice how odorous the dryer scent on the towels or the fancy soaps are.  Your child might.

Use softer tones in your voice, especially if there is an echo in your bathroom.  The same reason you sound so good in the shower could be a contributor to your child’s difficulties.  Sound bounces off tile in a different manner, and the lack of sound-absorbing carpeting and draperies could be a factor.  If your child has postural issues and is unsteady or is known to dislike his head tipped back, then re-think your position too.  A child standing on a wobbly stool with his head in your hands and tipped backward is likely to resist.  I know it sounds bizarre, but the first position and technique with a very upset toddler can be to cradle him in your arms, fully supported up to the top of his head, and use those xylitol wipes while terming it “toothbrushing”.  Do the singing, low lights, the whole deal.  You won’t be doing this when he is 12, but sometimes you have to make things really safe and comfortable to move forward.

Put a positive spin on toothbrushing.  Even if this has been a source of stress, your smiling face and positivity can help.  Do your best Oscar-winning performance if you can (another reason to practice on the off-hours).  At the very least, firmness and a sympathetic “Fast Food Rule” type response is useful.  For people who haven’t been reading my blog, that is the cornerstone of Dr. Harvey Karp’s Happiest Toddler on the Block approach.  You want your child to know that you understand what he is saying and feeling, but you don’t necessarily agree that we don’t do toothbrushing.  You acknowledge his aversion and express positivity and how there is something good at the end of the task.  If you are too emotional, even too sympathetic, you risk adding more emotion to the experience, something a sensitive and upset child really does not need.

Some children really love to hear you sing a brushing song, some like to use a sticker reward chart, some like a felt board where they move completed activities to the other side of the board.  It is risky to reward a child for something that is really a daily life skill, but at first some parents give it a try and then fade out the reward.  Every family is different.

This is my final post on the subject of toothbrushing.  I hope this helps some families turn around a common source of frustration and have a better day!

Special Needs Kids and Toothbrushing, Part 2: Selecting Your Tools for Success

Once you have recognized the issues that contribute to your child’s difficulties, it is time to think about what brushes and toothpastes you are using.  The choices you make could improve or aggravate your situation.

Toothbrushes come in a wide range of styles and designs.  

Motorized toothbrushes frighten some kids but enchant others.  Sensory seekers are especially fond of the vibration of a motorized toothbrush.  Children with low muscle tone and low proprioceptive registration are next in line to sign up for a motorized brush.  They tend to like the increased sensory stimulation delivered with moving vibration.  Children who are poor sensory modulators may be overwhelmed by sensory input.  They start out enjoying the vibration but not be able to tolerate it enough to finish brushing all dental surfaces.  Sensitive children or children who do not understand that the toothbrush can be turned off or controlled tend to be frightened when you suggest they allow a moving object into their mouth.

Manual toothbrushes come in standard styles at the drug store, but there are specialty brushes that can work well for special needs children.  Often your child can eventually “graduate” to a standard brush after developing confidence and skill with a brush that has some adaptations.

  • Handles: Brushes with longer handles are available for parents to reach easily into another person’s mouth for toothbrushing without setting off sensory aversion.  Imagine a child who dislikes your hand pressing intermittently on his face and lips as you brush his teeth.  Longer handles limit the excessive light and unpredictable tactile contact that is known to be the most alarming to sensory sensitive children.  Some toothbrush handles have texture (not a smooth plastic shaft)  that helps weaker or unsure hands grip firmly.  Triangular or loop handles can prevent a child from placing the bristles too far back into the mouth and triggering a gag reflex.  This style is safer for the child that insists on holding his own brush.  If your child has a bite reflex or is likely to bite you while you brush, you need a thicker, firm-surfaced brush to place on the opposite side of the jaw to maintain your child’s mouth open while you brush your side.
  • Brushing surface:  You can find a 3-point bristle pattern on Surround or DenTrust brushes that make brushing faster.  All tooth surfaces get brushed in one swipe.  Bristles that are soft or extra-soft are usually tolerated more than any other bristle stiffness.

Toothpastes and mouth rinses for children tend to have less floride than adult toothpastes.  There is a reason for that:  children swallow more paste as they practice swishing and spitting.  Floride in larger quantities is known to stain teeth.  There are floride-free pastes and rinses that minimize this risk.  Xylitol is a sugar that is known to decrease bacteria build-up.  Some toothpastes/rinses will use xylitol, and you can buy mouth wipes for infants and older children that contain xylitol.  A child who is so agitated with toothbrushing may only tolerate having their teeth and tongue wiped.  I don’t believe is as effective as brushing, but it might be the first step in achieving the ultimate goal of toothbrushing.  The only concern I could find regarding xylitol is that it is known to contribute to gas and bloating.

Next:  Positioning and creating a positive environment

Kids With Sensory Differences and Toothbrushing, Part 1: What You Need to Know

Brushing your child’s teeth and/or teaching them to brush can seem overwhelming.  Toddlers with special needs are even more likely than typically developing kids to throw monumental fits when the toothbrush comes out.  Parents can tell themselves that this isn’t the issue to battle over tonight.  Or the next night.  Or tomorrow morning.  It can get to the point that dentists have to pull toddler teeth due to decay or kids have pain from dental cavities.  If a child cannot communicate, it is hard to know if the tears are from the brushing or the discomfort of dental problems.

I thought I would write a single “helpful hints” style post, but then I did some thinking.  This might need to be a short series.  Sometimes a little trick like singing a song while brushing will work, but sometimes the situation calls for more adaptations.  Once you figure out what the issues for your child might be, then can you make a plan that saves everyone’s sanity.  Take a look at the specific brushes, toothpaste choices, timing, sensory environment and the positive spin you need to put on this experience to help your child.

Children with sensory differences are as different as their fingerprints, but there are some commonalities among them.  Not every child has all of these issues, but here are some of the major stumbling blocks that interfere with getting those teeth brushed:

  •  Children that have aversion to putting food into their mouths often dislike and fear toothbrushing as well.  Seeing a toothbrush loaded with paste coming into their mouth can be as alarming as a fork with food.
  • Sensory sensitive kids can resist the texture of the brush, the flavor of the paste, the touch on their face as you help them, the bright lights, the towels and water splashing, or the head and body positioning for brushing.  Bet you never thought about toothbrushing in that much detail!
  • Children who transition poorly often resist doing a task they don’t value in any way at a time when they are stressed.  Brushing is usually done at times that can be minefields for them (getting ready for school and bedtime).
  • Children with balance and movement issues, even the kids who are just a little unsteady, can be fearful of being held with their head tipped back or while standing on a footstool.
  •  Kids that have issues around control, who feel more comfortable and safe by dictating what happens and when, will either struggle with the task demands or the scheduling of toothbrushing.
  • Toothbrushing can become a power struggle for typical kids as well as special needs kids; it’s an opportunity to “draw a line in the sand ” after a day in which a young child feels (right or wrong) that they haven’t been able to make decisions and allowed choices.  Special needs kids often have full days of therapy and home programs.  Their day is regularly filled with things they must do.  At times a desire for autonomy will be expressed as refusal to participate in daily living tasks such as toothbrushing.

Next:  How your choice of brushes, toothpastes, and other equipment can improve the experience.