Monthly Archives: January 2016

Preschoolers Can Welcome a New Baby With Help

Preschoolers look so grown up sometimes.  When a new baby comes home, all that can change.  They can have very strong responses to becoming an older sister or brother, and not all of their reactions are easy to decipher or deal with.  Here are a few explanations for their responses and some suggestions to make things easier on everyone.

First of all, seeing the situation through their eyes will help explain some of the behaviors.  Even though a preschooler can tell you that “There is a baby in Mommy’s tummy”, she really can’t imagine what it will be like for her to live with a newborn in the family.  Older siblings can do that, but she was the baby the last time!  Preschoolers aren’t expecting that Mommy will be less available for a cuddle while she is nursing, or that people will flock around the new baby when they come over instead of her.  She is going to realize that she isn’t the focus of adult attention when the new baby comes home.  And she did nothing wrong to lose that spot.  Being the baby of the family has it’s down sides, but it is a recognizable position that a preschooler has held for years.  With the addition of a new baby, a preschooler has to recognize that things have changed, and then figure out just where she belongs in this new family.

You heard me, new family.  It took me years of professional work and studying to really understand something simple.  When a family gains or loses a member, the entire dynamic shifts.  In reality, the family is much different after each change.  It is a new family, not just the-old-family-plus-one.  Parents change and children change.  I really saw this happen when my oldest friend had another baby after her youngest of 3 was six.   The oldest became practically a statesman for the children as a group, and the youngest lost his “baby” title.  The middle daughter became a junior mommy, which she enjoyed.  New roles for everyone.

Back to preschoolers and welcoming a baby home. As in my earlier post on toddlers and new siblings:  imagine that your spouse or partner brings home a new husband or wife, and tells you that they still love you.  You just have someone younger and cuter to compete with and you will love helping that person!  If you complain, you are behaving badly.  Toddlers actually get off the hook a bit easier because everyone expects toddlers to react strongly to everything.  Preschoolers can be expected to act like 7 year-olds, even when they are not.

Here are my suggestions for a smoother ride:

  • try not to emphasize what a wonderful thing this new role of big brother really is, since your preschooler might be less willing to talk about his feelings if he thinks that you only want to hear about how happy he is.
  • Acknowledge the change, even the negative emotions.  You might have to put words out there.  Preschoolers are still learning how to name feelings, and you can help.  Saying that he can have emotions like anger, jealousy and resentment ( or simpler explanations that explain emotions) makes it OK to feel what he feels.  Having feelings isn’t bad, acting them out aggressively is a problem.
  • Schedule one-on-one time, but prepare to be refused or rebuffed.  You may even need to ask your preschooler what he thinks would be good “me time” and when it should occur.  Remember, gaining control in some things can make a person in the middle of a sudden life change feel better.
  • offer cuddle time and even time to pretend that he is the baby again.  Make it clear that you are pretending and the this is a time limited offer, just like the store bargains.  But being able to sit on your lap and cuddle, even reminisce about the time when he was your baby, is really nice for both of you.


Self-Regulation in Autism and Sensory Processing Disorder: Boost Skills By Creating Routines and Limits

Occupational therapists are routinely asked to help young children that have poor self-regulation or modulation skills.  What do difficulties regulating alertness and arousal look like in a very little person?  Big shifts in excitement/agitation over seemingly minor events, sleep that isn’t very deep or very long for their age, and difficulty switching between locations/activities.  Often these kids are edgy/easily agitated, but they can also be lethargic and difficult to energize as well.  Poor self-regulation includes both ends of the energy spectrum.  Parents are usually more frustrated with the edgy kids than the lethargic kids, and some children will start the day lethargic but end up too agitated to sleep at night.  Their parents struggle to get even one day a week without tantrums and arguments.  They will say to me “He just falls apart over nothing!”

Big issues like autism and sensory processing disorder will often make self-regulation a daily challenge.  Children with language delays can be so frustrated with communicating that they live “on the edge” every day.  And children who have medical issues like sleep apnea, digestive or respiratory problems, or those who live in physically or emotionally unstable homes often have difficulty with self-calming.  This post’s intent is not to explain the origins or the mechanisms of self-regulation issues (post a comment if you would like to hear more on those aspects!), but to share the value of daily routines and limits for these kids.

Daily routines can be general (breakfast is always followed by brushing teeth and getting dressed) or specific (after you get dressed, you will get a chance to watch your favorite YouTube video once, and then you get milk in the Paw Patrol cup.)  The reason that routines are so helpful is that children for whom communication and calmness are hard-won experiences can have an expectation of what will be happening to them next.  They may be too agitated or too distracted to listen to our words as we explain the day’s events.  Anticipating routines supports improved attention and communication skills.  It doesn’t take the place of better speech skills, it allows them to use the skills they cannot access when upset.  Knowing their daily routines gives them the reassurance of “what” and “why”  in a world that can be confusing.  Calmer and more confident children are able to pay attention, process thought and language, and respond more effectively.

Healthy routines are not burdens, and routines do not stifle a child’s mind or soul unless they are completely rigid.  Think of daily routines as a slightly flexible scaffold to support all the challenges of the day.  A positive routine allows enough calmness for reflective thinking and listening when those little frustrations or changes come along.

Setting limits is equally beneficial for children with modulation issues.  They don’t always  look happy to know that cookies are after a meal, not before, but knowing that there is structure to their existence helps very young children feel safer and actually more in control-of themselves!  The job of children throughout childhood is to test limits and gradually develop an internal set of behaviors and values.  Children need to know what is expected of them and they develop pride in their ability to behave according to their family’s values and goals.

Rigidity and harshness are not the same as limit setting.  Limits on aggression and destructiveness are especially helpful to develop control over impulses without shaming the child.  Being able to express a feeling without acting on that feeling is a big skill, but it gives permission to have those feelings without punishment.  Setting limits may result in consequences for actions but not for emotions.  I won’t be shamed for wanting that truck and not wanting to share mine, but I am not allowed to grab your truck and run away with it without a consequence.

In my professional experience, using routines and setting limits effectively has been at least as effective as all the neuro-sensory techniques I know to address modulation issues.  For the children that do not have developmental delays, they can be very effective on their own.  For the kids with autism and Sensory Processing Disorder, it super-charges every OT treatment I use.  Needing to know how to create healthy routines and set appropriate and effective limits led me to learn The Happiest Toddler on the Block techniques.  Now I teach these techniques to any parent that struggles with these issues, then sit back and watch the peacefulness start to spread in their home!


Are Babies Addicted to White Noise? Yes….and No

White noise helps colicky newborns calm and sleep.  It can help newborns develop essential self-calming skills in the first 3 months of life.  It can help older babies tolerate teething and their first colds.  It can even help babies transition to a shared bedroom with a toddler sibling.  The magic of white noise is not lost on Happiest Baby on the Block educators.  Every time I am asked if using white noise will create an addiction, I think to myself “Deeper, longer sleep patterns are an addiction most of us should have!”  Here is why parents should add white noise to their bedtime plan, and how to calm their fears of creating a “white noise addict”.

White noise is part of the 5 S’s: the five steps in The Happiest Baby on the Block plan to quickly calm a newborn and one of the 4 that you can use for sleep.  You cannot use the side/stomach positioning for sleep.  It is only for calming.

When you use white noise at the right volume and at the right frequency, it creates a barrier to the noise a child makes when he cries and to the household sounds of doors closing and siblings talking.  Newborn hearing isn’t as developed as the hearing skills of an older baby, so the standard white noise machines are often giving you less harsh and higher frequency sounds than newborns need.  This is not as effective.

What I see when a parent has been using another white noise source is that the child is not falling asleep quickly and is not fully in deep sleep.  Some parents tell me that they think he wakes more often because he needs to nurse frequently, but this pattern often makes me suspect that he is child who isn’t sleeping deeply enough so when he wakes he wants to suck to pull himself back to sleep.  The clue?  He only nurses for a tiny,super-short time and conks out.  That, my friends, is not a hungry newborn.  The hungry ones really get into it (nursing) and fill up. Take a look at Accidental Parenting at 4 Months: Out Of The Swaddle And Into The Frying Pan to see what can happen if a good routine with a plan for aging out of the 5 S’s is forgotten.

Take a listen to the “shower” or “hairdryer” sounds on Dr. Karp’s Happiest Baby tracks on iTunes to get a sense of what really works for newborns.  Older babies and children can calm down with the standard white noise machine offerings.

White noise is the one “S” from THBOTB that you never have to remove.  You can load it on a phone and use it whenever and wherever.  If you are worried about creating a child than cannot sleep without it, then take a look at your entire sleep plan.  Babies that are inadvertently taught that they have to be held to go to sleep, or they should fall asleep nursing,  will cling to that white noise more because they have not yet developed age-appropriate self-calming skills.  Yes, you start this before 12 months old!  Try to build those self-calming skills and diminish a baby’s sense that good sleep requires another human.  I know, it sounds nice to be so needed and it seems so loving, but the most loving thing we do is help children build the skills so that they have the choice to connect or be independent.  If a child has no ability to calm themselves, then he is not making the choice to cuddle.  He is desperate for the only way he knows to feel better. Without it, he is lost, frightened and struggling.

“Wings and roots” from the very beginning means teaching self-calming skills.  This does not diminish a child’s love for a parent.  It is the other way around.  Parents are the people who show a child how to be powerful and cheer their independence at every turn.  That creates a bond that is strong and flexible at the same time.  It only grows stronger and is less likely to fray during the toddler and teen struggles.

To decrease a child’s use of white noise, all you have to do now is lower the volume a little at a time, or start out sleep with white noise then turn it off.  After a few days, don’t start the bedtime routine with white noise, and see how things go.  A word of advice:  never shift a bedtime routine when other routines are also shifting.  Those shifts include:  parents returning to work, siblings returning to school, holidays, toddler roommate toilet training, etc.  Changing so much in their world at the same time is asking a lot of a baby.

Want more information or answers to your questions?  Visit my website tranquil babiesand purchase an in-home session (in the NY Metro area) or a phone/video consultation.  You will get a chance to discuss your unique situation and receive new ideas you can try tonight!


When Kids Climb Into Mom’s Bed at Night

I recently chatted with a single mom who works long hours.  Her 5 year-old wakes in the middle of the night and climbs into her bed.  She wanted some suggestions and some reassurance that the “snuggle time” they got (and the loss of sleep for both of them) wasn’t a bad idea.  Her son’s behavior makes perfect sense if you look at things from his perspective.  By doing that, I had a suggestion for her that didn’t involve anyone losing more sleep and seemed to make her feel better about her situation.

Her son gets very little time with her during the work week.  He is practically still asleep when she drops him at daycare and he doesn’t see her again until 8 pm.  This schedule is not going to change due to her job and her commute.  A large portion of his desire to snuggle is probably the realization that she isn’t doing anything else ( housework, texting, etc) and so he gets her full attention in the middle of the night.  That desire for her undivided attention is not abnormal, and neither is her desire to snuggle with him.  The disruption in sleep and the loss of the opportunity to soothe himself back to sleep is the issue.

My suggestion?  Carve out an evening period, even 10-15 very specific minutes, for just him.  Plan on it, and allow him to plan on it.  Make it clear to him by saying something like “This is our time.  Nobody can call us, no one can come over during our time.  We get to have fun and it is just for us.  Even if Grandma calls, I won’t talk to her during our time.  She will have to wait until it is over.”  Saying this in a serious voice, then proving to him that she means it, night after night, should make him feel like the most important thing in her life.  And he is.

When bedtime comes, the rule about going back to his own bed if he wakes and wanders has to be stated too.  I would recommend a reminder that the sooner he sleeps, the sooner tomorrow comes and we can have another “our time” at night.  He may need some support at first to settle down, but she told me that he generally falls asleep quickly at bedtime.  The middle-of-the-night issue has been the problem.

Most children need to have enough activity, enough rest, and enough attention throughout the day in order to manage a successful night.  By giving him a small but 100% pure dose of delicious mother love she may just be able to get enough sleep to get through her very full day as well!

Why Low Muscle Tone Affects Pencil Grasp


Low muscle tone can cause a child to struggle with holding crayons and pencils.  Those little fingers wrap around them, fold over them and sometimes ball up into a fist to hold a pencil.  How a child holds a pencil does not automatically mean that his handwriting will be illegible, but it almost always makes learning to write more challenging.  A grasping pattern that cannot easily control the movement and force of a stroke will make beginning writers work harder.  Here are some reasons why this happens, and a few ideas to help kids develop a stable grasp:

Low tone reduces the sensory feedback from grasping and writing.  Without enough information from the muscle and joint receptors in the arm and hand, a child may use the wrong amount of force (either too little ,or more likely, too much) when writing.  Unless a child is looking at his pencil, he may not be able to write.  As adults, we do not realize the amount of time we look away or cannot see what we have written until our fingers move out of the way at the end of a letter or a word.  That can be too late.  Children with low tone are making writing errors and don’t know about it until they can see them.  If they don’t look, then they start the next word without correcting an error.

Low muscle tone will result in quicker fatigue and the poor legibility that comes with forcing other muscles to compensate.  Children who substitute extra muscles to get control of a pencil and achieve the typical pattern of movement, or have squeezed too hard on their crayon, will honestly tell you that their hands are tired.  This will cause them to adapt their grip into an even more awkward pattern.  If they have generalized low tone and aren’t sitting with support, then their shoulders and back are probably tired too.  They  might just refuse to continue to do their writing at all.

What can be done?

  • Good positioning reduces some fatigue and improves control.  When body parts are well-supported and aligned, fatigue will be delayed.  Make sure that a child has a chair that gives him a writing surface that is supportive.  The best idea that got lost in handwriting?  The slanted desk.  Why was it so helpful?  In days gone by, writing was a valued art, and the Palmer Method style was the standard.  This was a demanding style, and the angled desk supported a writer’s shoulder, wrist and hand so that control was achieved without as much fatigue.  Now we have to improvise with writing easels.  My favorite hack?  Turning a large 3-ring binder on it’s side and affixing the paper in a horizontal or “landscape” orientation.
  • Don’t forget the benefits of having feet on the floor.  As I write this post, I have one foot on the base of my office chair, bar room style.  I am sitting comfortably so that I can keyboard for a while.  A child with his feet wrapped around the legs of a chair is a big billboard announcing “I need more support for sitting, please!”
  • Consider using the pencil grip that actually strengthens finger muscles (see my post in August 2015), gradually increasing the amount of time a child can write with this grip.  Why gradually?  Using weak muscles in a new way will create rapid fatigue at first.
  • Work on holding utensils for meals.  My post Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child is great for the younger toddler, but if you have a child that is over 3 and is able to use their fingertips to neatly pick up cereal and can scribble with more than a fist, then you need Which Spoon Is Best To Teach Grown-Up Grasp? to find a good spoon to teach a mature grasp (the kind where his thumb is on top of the handle and fingers are curled under).  Why should you care about self-feeding when this is a post about pencil grip?  Because children eat longer and more regularly than they scribble, and every scoop is giving them direct feedback about their progress.
  • Make sure that the pencil or crayon suits a child’s grasp.  I like triangle crayons for their extra sensory feedback from flat sides for finger placement.  Some kids need short crayons but thicker diameters, so snap thick crayons in half.  I have found automatic pencils with thick lead for older kids who snap the tips off of the #2 pencils.

Not sure that the problem is loose joints?  Read The Hypermobile Hand to learn how to spot a child with hypermobility and get a better sense of the anatomy and physiology of hypermobility.

Want more information about hypermobility?  

I wrote some e-books for you!

The JointSmart Child:  Living and Thriving With Hypermobility  Volume One: The Early Years and Volume Two: The School Years are designed to empower parents and inform therapists.  Filled with practical strategies and novel concepts, they prove that hypermobility is complex but understandable.  And understanding is key:  it is more than loose joints.  The sensory processing and social/emotional effects of hypermobility must be handled for children to live their best lives.  These books explain how to manage life at home, at school, with extended family , and even manage doctor’s appointments and speaking with teachers.

Forms and checklists help parents find the right chairs, bikes, clothes, even the right bathroom setup for optimal safety and independence.  I include fun things like cooking activities that build fine motor skills, and important strategies to handle questions from friends and families.

Volume One and Two are available on and today!