Monthly Archives: October 2015

Halloween With Sensory Sensitive Kids: The (Sensory) Tricks of the Holiday

Sensory sensitive kids aren’t always able to handle the excitement of Halloween without a little support.  Here are some strategies to help parents create as much fun as possible, and what to do when there are more bumps in the night (or day) than expected:

  • Costumes, especially masks and hats, aren’t always willingly worn.  Your child may put one on, and it is off in less than a minute because of how it feels.  Pick your battles.  If mask-like make-up is tolerated, go with that.  If neither is tolerated, let it go.  The real fun isn’t what you look like anyway.
  • unfamiliar clothing in unusual styles/shapes/textures are often a major stressor for kids.  Well, that is the definition of most costumes!  You have 3 choices:  pick a costume that fits and looks more like his regular clothes, slowly get your child used to the costume, or decide that accessories make the costume (sabers/wands/princess bags, etc).
  • Walking around in the dark is a real challenge for sensory kids with postural or motor planning challenges.  Consider an early schedule for trick-or-treat, or well-lit spaces.  Choose footwear that is the most stable choice he has in the closet.
  • Early schedules work well for kids who get too excited with big crowds of kids or bunches of kids at any one doorstep.
  • A nap or rest time before going out, and a full belly of her comfort food can help keep things calmer.  That being said, if your child is too excited to eat, you may want to use some of your OT sensory calmer tricks so that you don’t have an over-excited and hungry child out there ringing doorbells and being handed candy!
  • Your level of excitement can help or hinder your child’s ability to handle the situation.  If your child is a poor sensory modulator and goes from 0-60 too fast, be warm and positive, but lower your tone and volume, shorten your sentences and avoid lots of excited gestures that he absorbs and cannot handle.  It is still fun, but think “Grace Kelly at a party”, not “Katy Perry at a concert”!
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Preschool Pencils That Develop Hand Control (and with tips that won’t constantly break!)

Great pencils for preschool pre-writing fun!

Great pencils for preschool pre-writing fun!

Most preschoolers with older siblings are aware that the “big kids” use pencils for their homework.  Just like the fight to avoid the booster seat, older toddlers and preschoolers aspire to the next stage of development.  The problem with using #2 pencils before kindergarten?  Many children do not have the required small muscle strength and control to use them well, and drop into a fisted grasp.  As a pediatric occupational therapist, I am aware that a poor grip is not the end of the world, but it can make a slow writer slower and sloppier.  It can mean that a child’s hands get tired and they give up before the assignment is done.  This creates lots of arguments during homework time.  Wouldn’t it be better to spend a little more energy in preschool developing hand control so this is not an issue later?  These Crayola Easy-Grip Colored Pencils allow a young child to feel more mature by using a tool for older children, and have success designed inside.

The best features:

  • triangular shape gives small hands three flat surfaces to place the pads of their fingers.  More square footage gives more sensory feedback.
  • Short shafts discourage a fisted grip and match the smaller hands of younger children.
  • Thicker lead minimizes tip breakage, but you can still use the larger opening on a regular sharpener to get a fine point if desired.
  • coloring pictures within the lines and with the contours of the designs is terrific strengthening and motor planning for little hands!  I feel that coloring is totally underrated by most adults.  Hint: coloring with your child, describing in a play-by-play manner what strokes(vertical, horizontal, circular) you use and why, is absolutely magic.  Children really want to see what you do, see you make mistakes and deal with it, etc.  Youaren’t wasting your time, you are investing this skill with meaning and teaching without realizing it.

This box of pencils is very affordable; combined with the Melissa and Doug coloring pads (posted December 2014) it is a wonderful gift for a 3-5 year old at a very reasonable price!

Prepare Your Toddler Before Bringing a New Baby Home

Look at it as if your spouse announced that a new, younger, and more vulnerable wife was joining your family: ” She will need a lot of my close attention at first.  That doesn’t mean I don’t love you just as much, sweetie, but I won’t be as available to you as I used to be. She will sleep with me every night, but we will still have a few minutes together when she is resting.  I am so proud that you don’t need me as much as you used to!”.

How does that sound to you?  Not too wonderful, and yet you would realize that protesting got you criticized, and acting out got you punished.  Maybe there is another way to add a new member to the family?

If you ever had a reason to use The Happiest Toddler methods to build your toddler’s patience and develop his ability to deal with defiance and whining, now would be the time to take out that book again.  Read the chapter on the Fast Food Rule to deal with outbursts.  Then go on to the time-in section. Dr. Karp recommends the magic breathing stress reduction technique, as well as time-ins such as gossiping (about him to the baby in your belly) and “playing the boob” in which you set up situations in which your toddler is the one with the right answer, the more effective puzzle assembly skill, etc.  You are trying to shore up his self-confidence and self-calming to prepare him for the inevitable issues of jealousy and waiting longer for attention.

Toddlers love praise, but this is the time for focused, understated praise as well as chances to revert to being the baby for short periods.  It sounds silly unless you know that without being invited to cuddle like a baby for a few minutes, your toddler may insist on being a baby at exactly the moment that makes it impossible for you to comply.  As in the middle of a messy newborn diaper change.  You choose the moment, and you will get a better outcome.

Think this is the moment to move him out of the crib or take away the pacifier?  Those things are a part of his sense of security.  If you want to make these changes, you might do them well in advance of the birth or well after.  You would not want your toddler to resent the baby by associating these “losses” with your newborn.  Toddler anger and sense of betrayal is not going to last forever, but it can result in a loss of new skills such as daytime toilet training and even a willingness to walk instead of being carried.

I have heard of families obtaining a toy that the newborn can “give” to a toddler when you bring your new baby home, and I think this strategy can work for some children.  Some families like to have the toddler give a toy to the new baby as well.  Giving away anything when you are in a vulnerable state is harder than usual.  Your toddler might decide that he needs that rattle more.  If that happens, try not to criticize him for being selfish.  It is just a vulnerable toddler trying to shore up his strength in the face of changes he did not authorize and he realizes he cannot reverse.

Toddlers have a tendency to suddenly want to revert to infancy when they see you cuddling a tiny baby.  It can get ugly if that happens in the grocery store and he refuses to walk.  Instead of waiting until your toddler throws himself on the floor or insists on using only “baby talk, why not invite him to be your little baby for a short time?  By offering him the chance to pretend to be a baby, maybe hold him like a baby or babble to him, you are taking the reigns of when and how this happens.  The bonus?  Just like the magic of the Fast Food Rule, Dr. Karp’s signature plan for toddler communication, your stressed toddler sees you as someone who perceives what is on his mind with love and compassion.  Everyone wins.

Finally, practicing being helpful with the new baby, such as bringing over a clean diaper and shushing the baby, can be fun and paired with other good times such as special toddler snacks that the baby won’t be “allowed” to eat!

When to Stop Using the Infant Swing with Your Newborn

Weaning the swing can happen earlier than weaning swaddling.  Somewhere about 2.5 months old (adjust for prematurity if needed), many newborns no longer get more peaceful while swinging.  There will always be babies that prefer to be jiggled on your shoulder or in your lap from the beginning. There will also be babies a bit over 3 months old that only calm when snugly swaddled and swinging, firmly buckled in and fully reclined, of course.  If you are not talented in the blanket swaddling area, this is the time when you might want to try a swaddle garment.  It is unsafe to loosely swaddle a child when they are old enough to partially roll inside a swing.  If your child is so strong that he can undo a swaddle garment or a firm blanket swaddle, then swaddling in a swing is not for you.  You will just have to double-down on the shush/white noise, sucking and side/stomach calming.  I would also recommend the dream feed (my most popular blog post ever from January 2015) and be very careful not to put off naps until your child is over-tired.  More on that topic later this month.

When your baby is ready to wean swinging it may be as easy as shutting it off and putting him in the bassinet or a co-sleeper.  Wean a movement-loving baby by slowing the swing down for sleep for a few nights and then seeing if he can sleep in a non-moving swing.  If his sleep is still as long and as deep, then it could be time to put the swing on Craigslist or in the garage.

Don’t forget that the other S’s, especially shushing/white noise, may be even more important now for general calming and signaling bedtime.  This is not the time to dismantle your previously perfect newborn sleep routine.  Abandon all the signs and sounds that tell him things are quiet, safe and cozy at your own risk.  You may even add some more mature routines that can continue throughout childhood, like infant massage and story time.  Babies love to hear your rhythmic voice as you read “Goodnight Moon”.  I hope you like it too, since you will be reading it over and over…and over!

Kids With Low Muscle Tone Can Sit For Dinner: A Multi-Course Strategy

Low muscle tone can create so many different issues during mealtime.  Staying still and safe in a chair can be a real issue for these kids, and yet many are seen to be just “behaving badly”.  Here is a roadmap to navigate mealtimes when your child has issues with wriggling, sliding, falling or leaping up every few minutes.

First, understanding how low muscle tone influences behavior can help defuse some of the criticism and arguments.  Low tone creates too much information, as instability creates movement that distracts even the child who is moving.   Inadequate muscle and joint receptor stimulation doesn’t produce enough information in the form of position and movement sense for the brain to process (proprioception and kinesthesia for all you therapists out there). Add in loose ligaments around major joints (it is common to see these two issues together), and your child can really struggle to stay in her chair even with the best intentions.  Imagine yourself in this situation:  you cannot feel that your hips are sliding off the seat until you are just about on the floor, and when you do move, it seems like that is the best way to get more information about where your body is vis-a-vis the chair.  No one wants you to move, and no one wants you to fall.  If your child with low muscle tone decides that she dislikes sitting for meals but happily eats everything standing up or on the run, this could be the reason.

Kids can start out looking pretty good on a chair, especially if they have a supportive chair that is the right height, seat depth, and provides solid foot placement on the floor or on a footplate. Booster seats that aren’t buckled securely onto a chair are a huge hazard for these children.  Don’t go there.   The Tripp Trapp chair has been the go-to chair for a lot of children with muscle tone issues for years.  There are others that provide similar support without the serious sticker shock.  Look around and ask your therapist what features are important.

One adaptation I like for these chairs or booster seats with a smooth surface is using non-skid shelf liner as a seat mat.  It can be cut to your exact seat dimensions and cleaned easily.  I don;t recommend adhering it to the seat.  The mat gives a little bit of grip on clothing that limits the sliding on a smooth wooden seat.  Some children like the matting glued to the footplate as well for tactile feedback, but that makes it harder to clean, a tripping hazard at times, and it can bunch up when the adhesive loosens in spots.

I also like to make custom placemats for younger children that encourage them to place their non-dominant hand on the mat unless it is needed for bowl stabilization. I trace that hand in a location on the mat that is slightly in front of them, next to the traced line for the bowl/plate.   Hand-on-the-table is not as polite as “hand in your lap” positioning, but these children often need to use that hand in this position to shift their weight forward through their trunk and use it actively to stabilize their body  during the meal.  The usual result if their hand is left in their lap?  They slump toward one side, or that non-dominant hand will start to twist the tablecloth, bang on the table or make another action to energize or stabilize their nervous system.

Kids with low tone often try to rock while sitting or try to rock the chair to get more proprioception and some vestibular input.  Placing any chair near a wall is often the difference between a child flipping the chair backwards or not.  Banging the chair into the wall once or twice requires a conversation; flipping backward head first may require an E.R. visit!

Being involved in the family meal is always desirable for social skills and developing family togetherness.  For kids with low muscle tone, conversation can help them stay more alert at a time of day when they may be fatigued.  Their desire for movement might be satisfied by socially acceptable actions:  help setting the table, getting up to retrieve things from the kitchen for family members during the meal, and cleaning up.  If you were looking for reward chart items or just assigning household tasks to all family members, this can help everyone.

There are many more individual strategies to improve mealtime sitting.  I invite you to share your most successful ideas!

How To Get Your Toddler To Wait For Anything (Hint: They hear “Wait” as “No”)

Telling your toddler to wait for anything can be almost counterproductive.  You say “In a minute” and they start whining more, not less.  I think that is why so many parents just hand over the cookie, iPhone, car keys (just kidding about the keys; wanted to make sure you were awake!).   Toddlers do not understand that waiting until you are done diapering the baby is actually you saying “yes!”.  Knowing that what they hear you say is the most important part of the message is key to Dr. Harvey Karp’s genius patience stretching technique.  I demonstrated it to a parent on Monday and her mouth fell open when her 2 year-old immediately stopped whining and smiled at me.  Tantrum. averted. in. seconds.

Toddlers are impatient, have very limited language skills, and are self-centered.  None of these are criticisms.  They are very little people, and do not develop patience, language, and empathy in a vacuum. These are all skills that we teach them.  Not everyone has patience even by adulthood, as a few minutes in line at Costco will tell you.  But it is a skill, not an inherited character trait.  If you want a patient toddler, you have to teach her how to be a patient toddler.  If you have a child with a spirited or tentative temperament, she might be inclined to react strongly even when you are very gently asking her to wait.  Your best strategy for teaching patience is to understand what toddlers hear and how they think.

Toddlers hear any response to a request other than “yes” as if you said “no”.  They don’t parse the details of “in just one minute”, “I just have to diaper the baby”, or even “the pan is on fire; I will be with you after I put it out”.  I repeat: any answer other than “yes” is a “no” to a toddler.  So don’t give them any other answer if you will eventually grant their request.   If you are not, you are going to respond in a different way.  That’s a different blog post.

Dr. Karp created a plan that really works.  You are going to say “yes” but then you are going to create a situation that requires them to wait for a very small period of time before you deliver the results.  The big issues are that you have to use patience stretching consistently, deliver it with warmth, and you have to be a little creative at the same time that you may be frustrated with your own multi-tasking.  If you are exhausted or stressed beyond belief, this is going to be hard to execute.  Take good care of yourself and believe that using this technique will make life at home less aggravating for you too!

This is what it looks like:  You are in a situation in which your child makes a request that you are willing to grant, and it can be accomplished reasonably quickly.  This is not the time to pick something complicated.  You are going to use the communication style that Dr. Karp designated the Fast Food Rule plus “toddler-ese”.  Your phrases are short, repeated often, and with clear gestures,  obvious facial expressions and a bit more emotion than a conversation with an older child.

Child:  Want juice!!!

Adult: You want juice right now! (Fast Food Rule first, of course)

Child: Want Juuuuiiiccee!!

Adult:  Smiling-Yes, let’s get your juice. ( start walking to fridge/counter and pause) Oh, I just have to open that cabinet over there and find the _____ then I will get your juicy-juice.  (Waste about 10 seconds).  OK, now where is that juice?  I know, it is right in the fridge! (big smile). Hand over juice.

That’s it.  First round of patience stretching accomplished.  The pause is so short, and your response is so upbeat that a toddler might not even know what just happened.  That is fine.  The next request is going to be a 15 second pause, and so on.  Previously instantaneous-tantrum toddlers have been known to stretch up to a minute in a single day.  And longer on the next day.  Don’t worry that she is going to see through the silly hunt in the cabinet.  She is not that focused on you, remember?  She is all about the juice.

Good luck, and I hope you get those angelic smiles as you require your toddler to wait for just a little bit!!