Monthly Archives: November 2015

Sensory Differences and Holiday Events: Simple Life Hacks for Happy Memories

Kids with sensory sensitivities may need some assistance to enjoy the holiday season.  Here are some simple ways to make it merry and bright for all!

  • Select your holiday celebrations with the spatial, sound, and visual complexities in mind.  Many children are completely overwhelmed with large spaces (auditoriums, church halls, etc.) and the multi-sensory experience of crowds, lights, and carols.  These children are so much happier out looking for the perfect tree on a tree farm or watching a favorite holiday movie at home.  Make up your own new family tradition that will be easier for your child to handle.   It can still be a wonderful family event that everyone remembers for years to come.
  • Choose the timing of group experiences.  Arriving early and leaving early may be the best plan for kids with sensory sensitivity.  If you are meeting friends or relatives, ask them to arrive early and not be offended with your “cameo” appearance.  Are you worried about looking different if you leave early? Well, if your child becomes agitated or even aggressive due to overstimulation, you will be getting a lot of unwanted attention anyway.  Better to have a happy child and a short/early experience.  Does your child beg to stay even though you know he will be overstimulated later?  Have a great second act prepared.  Follow a stimulating event with a mellow experience, such as a favorite video at home or hot chocolate at a cafe’.
  • The holidays have special foods that many kids look forward to and eagerly devour.  Your child may not want to try them, and may not even like to smell them.  When children are overwhelmed with sensory input, they can be hyper-sensitive.  Respect this if it happens.  This is not the moment to force a taste, but it might be helpful to take a bite of a new food yourself and demonstrate your enjoyment.  You may get more interest if you don’t even suggest that your child try a new food. Not even a “no-thank you” portion.   The lack of pressure that they perceive might sway them toward trying something new.  The holidays ARE a time for miracles, after all!  If it is expected that you and your child will be eating a meal, ask your hosts if they mind you bringing foods that your child will eat.  Most people will want your child to be happy, and your child will see you as an understanding and thoughtful parent that “gets” his situation.
  • Prepare for events that could be stressful with creativity and attention to detail.  If you need to bring your sensory sensitive child to a pageant or a performance that you know could be very difficult, have another adult or teen available if you need to duck out with your child.  Make sure your child is fed, hydrated, and rested.  Avoid the temptation to pile on the events that day.  Keep the daily schedule as familiar and comforting as possible.  Have snacks and toys that are comforting available if he needs to shift his focus to regroup.  It would be wonderful if your sensory-sensitive child could revel in the novelty and excitement of the season, but some kids are happier when things stay the same every day.  Respect why he has this need for routines, and celebrate in a way that makes everyone feel great!

Safe Winter Swaddling Strategies

When the weather gets colder, some parents think that they need to run out and buy a thick fleecy swaddle blanket or swaddle garment right away. Being too warm is a risk factor for SIDS, so it is worth making a thoughtful plan to swaddle safely in the winter months.  Here are some ideas about swaddling for the winter season:

  1. Your home doesn’t have to be super warm for a newborn, but they don’t regulate their temperature as well as older babies or adults.  An open window creating a breeze will cool them off too much if they are sleeping nearby, so drop the thermostat before you crack that window.
  2. We layer for comfort, so they can layer as well. Swaddling creates “neutral warmth”, the retained warmth of the baby’s body.  If you are concerned that your child is too warm, use a cotton onesie and a cotton flannel blanket, both reasonably breathable options.  The space between the layers can hold some warmth, so even though the fabrics are light, your child could be warm enough with just two light layers.
  3. Think he’s too hot?  Touch the back of his neck and behind his ears.  If he is sweaty there, then he is indeed too warm.  Use a lighter fabric for swaddling, or take off the onesie and re-swaddle in just a diaper.  If you live in a warmer locale or in an apartment with lots of heat, your baby might do much better in the summer-weight fabrics like muslin.  If the heat is unregulated and very warm, you may not be able to swaddle at all.  I used to live in a top-floor NYC apartment that allowed me to wear at tee shirt to bed in January!
  4. Think he’s too cold?  If your child’s face is cold, then that might be true.  Before you pop him into a fleece blanket or garment, think for a moment.  The fleece swaddle garments look so comfortable that they are tempting, but newborns will usually not cry when they are overheated, they just stay asleep.  The brain will try to get rid of excess heat but newborns don;t have the most effective temperature regulation wired into their brains at this early age.  A fleece pajama is loose compared with a fleece swaddle garment, and has less heat-holding fabric folds.

Be creative and thoughtful when you swaddle your newborn this season!

Low Muscle Tone and Dressing: Easy Solutions to Teach Independence

When a child says “I do it myself” most adults are thrilled.  Kids with low muscle tone want to do things like the big kids too, including dressing themselves, but they often end up in a tangle of sleeves or twisted pant legs.  Here are a few suggestions to make learning to get dressed and managing clothing for toilet training and for life in general easier.

  1. Select clothes that are easy to get on and off.  That means that they should be a little loose, a little stretchy, and not too long.  Tops that hang down over the tush have to be rolled up for a little girl to sit on the potty.  A top that ends at the waist cannot fall into the bowl.  Lycra leggings or tight jeans with zipper fasteners are harder to manage independently.  If your child is just getting the hang of pulling on/pushing off clothes, adding fasteners is making this a lot harder.  Opt for elastic waistbands over any other style, and knit fabrics with some cotton.  These don’t cling as closely.  Shorter sleeves and pant legs without a knit cuff are easier to get on and off.
  2. Kids with low tone aren’t that stable in standing without support.  They can sit on a low step stool with feet flat on the floor to get dressed, preferably with the stool against a wall so they don’t fall backwards.  No stool?  You can try sitting on the lowest stair step.  Also try leaning their back against a wall.  Sitting on the floor (with a few exceptions) is less successful than what therapists call “short sitting” for kids with low tone.  They tend to w-sit or roll their backs when floor sitting, so that they are way off balance and reasonably fearful of tipping over.  This makes it harder to slide legs into pants and raise arms up into sleeves.  Sitting on a stool can put a child’s hips in a more stable position to activate the muscles from trunk to toes for more stability.  Bonus round: these are the same muscles a child needs for walking and running!
  3. These kids are used to being dressed, sometimes well past 3 years of age, so they are going to be familiar with standing while the clothing is pulled off of them or pulled up.  They will want to just step into pants while you hold the waist of the pants.  Changing their attitude from “you dress me” to I dress myself” is huge.  Adults do not realize what goes into dressing because they have been independent for so long.  Try to imagine royalty getting those amazing gowns and tiaras on with the help of assistants, versus getting all that clothing on by themselves. Totally different execution.  They would have to pay attention and make a plan.  If your child has issues with sequencing movement as well as postural control issues, this part of learning to get dressed may be the bigger hurdle.  Your little prince or princess has to change his/her mindset, paying attention to movements and balance in a new way.  This can start in baby steps.  Just finishing the removal of his arms from the sleeves of a shirt while you turn away for a second builds awareness and practice.  Then add pulling the arm out of a sleeve that you hold taut at the wristband.  Keep adding more steps as the child builds skills.
  4. Distractions and rewards.  If a child is used to being dressed in front of the TV, that will have to change.  Learning a new skill while watching “Paw Patrol” isn’t going to work.  Watching it as a reward for learning a new skill is a better plan.

A question to my readers:  would you like an e-book on self-care skills and low tone?  My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is up on my website, tranquil babies , but low tone affects all the daily living skills:  dressing, eating, etc.

If you would like to see an e-book produced on this subject, please comment on this post and let me know!!

Stretch Your Toddler’s Patience, Starting Today!

 

I spent some time yesterday with the mother of a spirited toddler who pointed out that even though she saw that The Happiest Toddler on the Block technique of patience stretching works, she found it hard to be cheerful and upbeat after hours of her son’s whining and hanging on her legs.  At the end of the day, her toddler and her preschooler had worn her down.  She needed to fine-tune her approach and hear that her efforts would bear fruit sooner rather than later.

Good news!  This isn’t just a technique that works for the moment. It builds a child’s ability to wait.  A toddler that is used to waiting may not even start whining, he may just ask/gesture for what he wants.  You get a calmer house.  Done consistently for even a few days, combined with the Fast Food Rule (see my January 2015 Sympathetic Reframing post), and she should be able to stretch that calm waiting time at the dinner table up from 7 seconds (his current best time) to over a minute.  He showed me his potential; after a brief “top-off” reminder that his yogurt was indeed coming,  he waited another 7  seconds until she placed it on the table.  He needed a combo of patience stretching with fast food rule restatements so that he knew that I got what he was thinking: he wanted to know why there was a bowl of yogurt on the table but it wasn’t in front of him.  It was his brother’s bowl, and his brother was washing his hands. Tantrum averted, and this spirited toddler waited 14 seconds more than he did before we tried patience stretching.

Why even try it when you are exhausted?  Think about how all that whining is slowly draining the life energy out of you.  Some toddlers don’t just whine, they start to get a little aggressive to get your attention.  Think about the energy it takes to sweep up the cereal they throw on the floor in protest, and reconsider the benefits of patience stretching.  You will be expending your energy with toddlers one way or the other.  Might as well be building skills instead of sweeping up a mess made in protest.

Your delivery is key to a little person who hears how you say it more clearly than what it was that you said.  This mom admitted that she delivered her patience stretching lines without a lot of warmth, but she was truly tired of all the whining.  Time to bring on your academy award-winning performance.  Toddlers can’t tell that you are faking it.  No one is cheerful all the time, but toddlers are very literal.  If you say something good (“Let me go look for your cookies”) with a note of sarcasm or annoyance, guess what they hear?  “I am not happy with you”.  If you want a smile back from a toddler with a spirited temperament, one that can go full-ninja on you in seconds, you want to tell them that their cookie is coming with a big grin on your face and a lilt in your voice.  They will be smiling back at you without knowing what hit them.

Toddlers who have many interactions throughout the day in which they feel listened to, that they were respected and occasionally got what they wanted (eventually) are more likely to be able to hear “no” as well.  They have this bank of positive interactions with you, and a sense that you are not a pushover but that you are on their side.  Again, their perception of you is as important as what you actually feel about them.  An adult that loves them dearly but comes down hard with frustrating tones and annoyance is not going to be perceived as warmly by a toddler.

Strangely enough, if you rush lovingly to provide things for a toddler most of the time, they can still whine.  Why?  Because there will be about 10% of requests that you cannot or will not grant due to safety or lack of resources.  They must get in the car seat since you have to go pick up their sister.  You don’t have any more goldfish crackers, etc.  At that point, their expectation that you grant every single wish has been shattered, and they do not know what to do.  They get very angry at you!  By giving them what they want most of the time except in very rare circumstances, their anger when you cannot deliver is much worse than if they had been turned down a few more times in the past.  Let that one sink in…your past generosity is not appreciated, it is hugely resented when you absolutely must buckle them in to the carseat, or when you really have to leave right now.

The wish-granter that requires them to wait using the patience stretching model is more likely to get a pass when the crackers run out or time at the playground is over.  The child who has experienced calm waiting will be more capable of hearing alternatives and accepting them.

Want more support?  Visit my website tranquilbabies.com and purchase a video/phone session.  If you are in the NY metro area, you can contact me for a direct consultation session.

Defiant Kids Can Change With Dr. Kazdin’s Simple Plans

Dr. Alan Kazdin wrote “The Kazdin Method for Parenting the Defiant Child” in 2008.  He is the director of the Yale Parenting Center, and he has seen some hardcore kids.  You do not get the feeling that he has treated  a lot of children younger than 2, and based on the techniques he uses, it seems like a child would need more cognition and language than a young toddler to respond well without adaptations.   Not a problem: Dr. Karp created the Happiest Toddler on the Block, and he has done a great job dealing with defiant 18-month-olds.   But if your kindergartener refuses to go to bed or your teenager won’t do her homework, this guy has helpful ideas for you!

Dr. Alan Kazdin’s books can change the dynamic for families that feel their life is one battle after another.  If you have embraced the idea that you can target defiance through behavioral science, then he is already preaching to your choir. If not, you might be wary. The funny thing is, when you are using the program, it doesn’t feel that much like science.  You feel like you are connecting with your child’s better nature.  He has crafted strategies that really work.  The biggest drawback is that if you make too many beginner mistakes it will seem as if it is never going to work.  I recommend that parents actually read the books and understand the principles he is using to change a child’s behavior.  This in one of those techniques that you can’t learn in a 900-word article in a magazine.  You might be inspired in a short article, but you won’t learn enough to “take it on the road” and really use it.

Bonus:  understanding a child’s behavior helps us understand the impact of rewards and consequences on our bosses, our mates and on ourselves!

I liked his first book, but I don’t think it took off in parenting circles.   I am going to guess that his first book was a little intimidating for some parents, as it does a very thorough job of explaining how behavioral plans work.  Not every parent wants to think of their star chart in terms like “positive reinforcers” and letting go of the chart as “extinction of reinforcers with intermittent rewards”.  His second book, “The Everyday Parent Toolkit” is a little more user-friendly but still gets his message across.  The truth is that all of our interactions can be viewed through a behavioral lens.  When a child is refusing to do their homework, telling you that you are the worst parent ever, and then breaking the lamp, it might be time to explore a strategy that takes out some of the drama and focuses on how you really want your evening to go.

Dr. Kazdin is very focused on positive interactions and warm exchanges. He is aware that adult stressors make reacting calmly to a screaming child harder, and screaming children create stress for adults.  He has sympathy for everyone but sees parents as the agent of change in this situation.  He is like the white-coated scientist with a “Mr. Rogers” sweater on underneath!

Transition Your Toddler Without Tears

Transitioning is a huge concern for parents and educators of toddlers, both for the typically developing and special needs kids.  Struggling to get their child to leave the playground, come to the dinner table, or enter/leave the tub are very high priority concerns for a lot of the parents I meet as an occupational therapist.  Educators and therapists refer to these struggles as difficulties with transitioning.  Dr. Harvey Karp’s fabulous Happiest Toddler on the Block program has a unique perspective on the experience of transitioning, and some equally unique strategies.

Toddlers’ brains aren’t wired to switch focus quickly once they are fully engaged in something, especially something that they enjoy.  They have no real sense of time, so saying that you need time to run to the store or library has no meaning to them.  There is always more time in toddler land.  Toddlers with spirited temperaments may see 5 trucks in the sandbox, and decide that they will be playing with all of them.  Leaving after only playing with 3 is going to seem like leaving before the main course is served; he’s been cheated!  Sometimes imagining having fun at home while at the playground is impossible for the concrete toddler brain; toddlers need an actual toy in your hand that is his “transition object” to hold while leaving the playground and getting into the car.

One of the most common transitioning techniques suggested in behavior management books is to give 5-minute and 1-minute warnings.  This can work well with an easy child with good language skills, a child who simply needs a bit of advance notice.  If your child really struggles with ending something fun and moving on, this suggestion is often pointless advice.  Your child still cries.  Sometimes they cry more because they don’t understand that you are giving a warning, not making an announcement of immediate departure.  Sometimes they cry because they feel the need to protest what is clearly your choice, not theirs.  They haven’t been consulted.

The Happiest Toddler techniques of “win-win compromise”, “kind ignoring”, “toddler-ese communication”  and “The Fast Food Rule” can really help you here.  Announce firmly and warmly that you will be leaving the playground soon.  Ask if your child wants to leave in one minute or two minutes.  If your child isn’t capable of understanding that two is more than one, you need a different approach.  That could be ” Go now or more play?”.  Your child may respond “more!!!” and keep digging in the sandbox.  Your response is something like “OK, you win! A teeny tiny bit more play then home”.  This may be enough communication and negotiation for your child; he can comprehend that you know he wants to stay.

If you can, start clearing away all the fun toys, maybe putting them in a box or behind you.  Your child will see less fun available and see you cleaning up.  All these are signals that the fun is ending and that you mean business.  If you receive a bit of whining or throwing of a toy in protest, rephrase your original statement, “teeny bit more play then home” and even use a little of the kind ignoring technique (where you briefly don’t make eye contact and turn slightly away from the protestor while you tidy up).  You aren’t rejecting him, but you are sending the message that minor defiance is not impressing you or changing your mind.

If whining or tantrums begin after you announce that it is time to leave, you can pull out the Fast Food Rule.  Remember, from my January 2015 blog post on Tantrums and Sympathetic Reframing?  The biggest problem with using the 1 and 5-minute warning technique with temperamental toddlers is that it presents a plan to your rigid or touchy toddler before laying the communication groundwork.  Such a child might even complain or explode a bit more with those warnings, because laying out a plan before acknowledging his point of view seems like being mis-understood and dis-respected!   Telling him how much fun he will have at home, how tired you are of all this whining, how he did everything he likes already, or threatening consequences isn’t going to work until your child is certain that you know what he wants.  Which is to stay at the sandbox!!

To use the Fast Food Rule here, you are going to use the toddler-ese language format of short phrases, repetition, and reflect 1/3rd of his emotional tone/gestures/facial expressions .  Tell him what you think he is saying to you by repeating:  “you say “No GO, stay and PLAY!!!”a few times.   Your child will probably make some eye contact, maybe even stop crying and nod.  He gets it that YOU get it.  You are not agreeing with him, just confirming his message.  Now you can commiserate, offer that transition toy, remind him what fun comes next, etc.  This can dial down or eliminate a tantrum in most cases.  Better yet, it teaches a bit of negotiation, mutual respect, and uses emotional warmth, firm limits and understanding of the language and emotional needs of toddlers.

When won’t it work like a charm?  Complete over-exhaustion, hunger, illness, or a major life change like a new sibling.  Sometimes toddlers are at the ends of their ropes too.  But the garden-variety whining and dawdling can be completely evaporated by this approach, and many erupting tantrums can be nipped before they get going.

If you think this is way more work than just dragging a screaming child to the car, try this.  Close your eyes and imagine the draining feeling inside you as you fight him into the carseat and dodge the sandy sneakers being thrown at your head.  Everybody loses, everybody feels oppressed.  Some toddlers can bring this fight into the house and not even nap, totally disrupting the rest of the day and the night.  Just envisioning this scenario may make you motivated to try this new strategy.

It takes a long time for the toddler brain to become good at advance warnings, shift emotional and attentional gears, and communicate well.  Using the Happiest Toddler techniques can build those skills and get you out of the playground faster and with fewer tears!

Low Tone At Preschool: How Tone Affects Safety and Play

Low muscle tone can create safety issues and difficulty using toys at school.  Here are some reasons why things can fall apart (literally, sometimes!) and how small changes make the difference between success and failure at school.

First, there are good reasons that children with low tone struggle to sit, stand or move around the classroom safely and independently.  It is easy to see the loose-limbed elbows and the w-sitting, but the less visible components of low tone are the sensory information that is lost and the child’s behaviors as she tries unconsciously to give herself more vital sensory input.  When a child is at rest, low tone means it will take a longer time (usually fractions of a second) for the brain to generate adequate muscle contradiction to initiate movement.  Fewer and slower muscle fiber contractions while moving creates an incomplete message regarding the muscle’s degree of stretch and amount of the contractions.   Less force from muscles on joint receptors gives inadequate position sense information.

Children with low tone are not receiving the correct amount of sensory information at the right time to create smooth and accurate movement or to be accurately aware of their body position without using vision or getting additional sensory information from another source.

We do not realize the rapid delivery of information in our brain that is necessary for safe and effective movement.  Those fractions of a second can be the difference between a child sliding off the chair or catching herself quickly.  Adults sometimes blame a child for being inattentive, but very young children do not compensate by checking their position before they start a movement or while they are moving.  As a child gets a little older, they can use those strategies.  In preschool, it would be like reminding them to check for nearby exits on a plane when they board.  Pointless.  The part of the brain that can monitor and anticipate potential problems is undeveloped for this task at this age.

A child may use too little force when they are scribbling with a crayon, or so much that the crayon breaks.  That happens as she tries to perceive position and movement, no matter how frequently the teachers tell her to “be gentle”. This is a sensory-motor issue for her.   It would be as if you were wearing oven mitts and holding a raw egg.  Try not to break it,  but don’t drop it!  Another child may not perceive that his foot is sliding off a step on the playground, and instead of moving it forward, he slides off the step completely.  “Being careful” is harder for young children when they do not have the impulse control to check foot position or remember to place their feet in the center before climbing up.  Using tools such as a toy hammer is very difficult when just standing in a stable position is a challenge.  Hitting a plastic nail head with a hammer requires a stable core so that the swing is accurate and powerful (golf, anyone?).  Most children with low tone struggle every day to establish enough core stability for seemingly simple tasks.

Low muscle tone will create a few familiar postural patterns with most children.  The “seated asymmetrical slouch” so that one hand is holding up his head and one hand is playing, the “full-body belly flop onto the play table” so that both hands can push trains, and the “draping over furniture or people” without any awareness are all familiar to the families of low-toned children.  Maintaining a stable posture for a few seconds isn’t difficult, but staying there for a while or staying stable while thinking and talking can be too great a load for the brain.  Something has to go, and it is often postural control.  Your child isn’t conscious of his choice, but if he is having fun, he is going to choose the position that is the least demanding.  Unless he decides to get up and run…….

The other effect of low tone in the preschool classroom can be “the child with ants in his pants”.  Children learn very early on that changing positions, especially moving very quickly or landing hard into surfaces, will raise their muscle tone briefly, give them more body awareness information and help them stay alert.  None of this is appreciated at most schools, especially when a child launches himself into/onto other children for fun.  If a child has only mildly low tone and no other diagnosis, it is easy to attribute this to behavioral or attentional problems.

What can teachers and parents do?

  • Hands work better when hips and shoulders are stable and/or supported.  Encourage children to sit rather than stand to perform coloring, cutting, and toy or block assembly.  They may even be safer and more successful lying on their stomach on the rug. The exception would be coloring on a vertical slanted easel, every OT’s favorite position for preschool coloring with low-toned kids.  Children benefit from placing their “helper hand”, the non-dominant one, forward at about chest height on the easel to give more trunk and shoulder support to the hand that is coloring.
  • Find a chair that allows a child to place their feet flat rather than on their tiptoes or sliding out under the table.  Remember that changing her chair height is going to mean that the table surface may not be right either.  Most preschoolers don’t manage booster cushions well; they slide around and play on them.  If a child is too distracted by a booster seat, it is better to find a solid and stable seat for sitting.
  • Choose toys and tools that have extra sensory input built in.  Thicker crayons can handle more pressure, textured handles give a bit more touch information, and sometimes even a slightly heavier toy is easier to feel and manipulate than a lighter one. Smooth surfaces and tiny clasps are harder to manipulate for children who aren’t perceiving slight changes in joint and muscle position.  Making fasteners larger or even demonstrating a more powerful grasp pattern can help.  Most children love sensory input, so even children without low tone will benefit from a wider range of materials and textures.
  • Fatigue and illness will exaggerate problems with tone.  Being tired makes all of us a little unsteady, but it really hits low-toned kids hard.  The same is true when they have a cold.  If they have an ear infection or fluid in their ears, their vestibular system is not functioning well either.  This is the time to stand closer to them on the playground and even avoid the use of slides and climbing activities unless you are within a fingertip’s range to catch them.  It is also the time for less criticism of all their compensations such a leaning their chin on one hand to keep their head up at the table.  They may be trying as hard as they can on that day.
  • Create a purposeful reason to get up and move around after sitting still.  Just a little bit of muscle contraction, joint pressure and vestibular input can be enough to recharge the nervous system for better performance.  Preschoolers like to be useful and there are lots of “jobs” you can give a child that build self-esteem instead of complaining that they are slouching.  Just tossing out their napkin and returning to their seat can be enough, or handing out cups for snack.  Almost any small task would work, including cleaning up toys.  Everyone is happy to instill that habit in children!