Monthly Archives: February 2016

Get Your Toddler And Preschooler To Sleep Faster When You Use Happiest Toddler Techniques at Bedtime

The Happiest Toddler on the Block has a unique perspective to bedtime sleep training:  it starts right after breakfast.  One of the cornerstones of THTOTB is Patience Stretching.  In my post Stretch Your Toddler’s Patience, Starting Today! I wrote about Dr. Harvey Karp’s fabulous technique, and how parents have to use a little creativity and positivity to get things started.  At first, it’s hard to put on a smile and be agreeable at 3 pm when you have had a day of clingy, whiny toddler demands.  But it pays off quickly,  it really does.  You will no longer dread 3 pm.  Then you need to plan to use it at bedtime.  It is like bringing a show up to Broadway.  This is the big time.  You don’t just put the backdrops in a truck and tell the actors where to stand.  You make a plan.

Here is what you need to do to make the transition from daytime Patience Stretching to bedtime sleep training work:

  • Perfect your daytime performances.  Get your toddler so good at waiting when she is not exhausted, not ill and not totally overwhelmed that you would be willing to go on YouTube for a demo.  Yes, that good.  How To Get Your Toddler To Wait For Anything (Hint: They hear “Wait” as “No”)  That means that your child and you understand the how and why of this method.  It is 10 times harder when you are both tired.  Maybe 20 times harder.
  • Now get this working well in unfamiliar places and/or when she is a little off her game.  Night time is harder than any other situation.  She is aware that she will be without you for hours, and the fun of the day is definitively over.  She has to be able to handle that.  Try improving transitioning skills, because this is the biggest transition she makes each day:  totally away from you and away from interaction to fall asleep.
  • That piece leads to this one:  having a good day as defined by toddler terms is essential for a good night.  Your version of a good day is not exactly hers.  She has a good day if she has had enough physical activity, enough warm exchanges, and enough positive attention.  If it has been a day stuck in a small space without face-to-face warmth and lots of redirection that she perceives as negative then bedtime is when she will make you pay big time.    You know this is accurate, right?  Make every effort to plan in some physical fun, create situations where you both can laugh and hug, and get good at redirection by saying what you want her to do instead of “no!”   See my 2015 post Discipline and Toddlers: What Do You Say if You Don’t Want to Constantly Say “No”?for more details on how to accomplish this.
  • Now you are ready to give this a try.   Use a kind but convincing voice.  Try very hard not to start with “It’s OK, it’s OK”, as your child will cry harder to convince you that it is not OK with them.  Did you read my post on that topic yet? Your response should be brief and a little robotic: “Oh, you are awake.  It is night time, time to sleep”.  Some kids do better if you don’t look them in the eye.  It excites them too much.  It isn’t cruel to avoid eye contact when you know that doing so helps them sleep, and engaging with them will make it harder.  Think about that one for a minute.
  • Go to her at 3 am when she cries out.  Yup, you don’t cry-it-out.  She needs to know you are there for her, but remember the robotic and unengaged plan.  Check for true distress and diaper issues and tell her firmly but warmly that it is time to sleep.  Not a lot of eye contact and absolutely no bright lights.  You could hold her for a few moments if you think it won’t be interpreted as coming out of bed, because you are going to put her down and do Patience Stretching in just a few seconds.  You know… “oh….I have to go tell Daddy something and I will be right back….” and come back after 15 seconds.  You could come back for a sleepy chorus of your bedtime song and then do it again…oh…I just have to go potty… and leave for 45 seconds.  The excuses and her confidence that you return should be familiar from all that daytime stretching and the time gets longer and longer.  You lie her down and then you do return.  You have to.  She might still be awake.
  • But she might not!  She might have dozed off without wailing.  Everybody wins, no tears, no feeling abandoned or feeling like you are abandoning your child.  You are giving her the chance to settle herself.  She already believes you, because you always return it the daytime.  This just gives her the chance to try relaxing into sleep while you are gone.

Good luck!  If this works for you and your child, please comment and share your unique twist that made it a success for you.  Other parents that read this blog are eager to hear your success story!


Improve Transitioning Skills in ASD By Helping Kids Pay Attention To The Sounds Around Them

Kids with ASD often have limited auditory awareness and processing.  Imagine your life if you struggled with this:  Should I pay attention to the hum of the fan or your voice?  That ringing; is it a doorbell, a toy, or a phone?  I didn’t notice you speaking to me, and now you tell me that I don’t get snack because I didn’t respond?  Their difficulties with auditory processing can fuel a lot of the daily whining and tantrums.

Being able to transition from one activity or place to another is a huge issue for so many kids.  You can help them do a better, calmer job if you “fill in the blank spots” in their processing while they work on making progress in treatment with therapeutic listening programs and other approaches.

Kids on the spectrum often demonstrate limitations in how they attend and process auditory (sound) information.  This is more than language, although processing language is of huge importance.  The ability to attend to, locate and interpret the sounds in the environment is something that we take for granted.  It is incredibly important for a sense of safety and calmness. Our ability to know where we are in space, especially a crowded or large space, is informed by our ability to listen to sounds as they bounce off the perimeters of an enclosed space.  Ever see a child run the edges of a room before he can settle down?  That can be a spatial substitution, since auditory processing is used for spatial awareness.  Ever see a child hit out when an unfamiliar sound, not even a loud sound, is made?  Excessive aggressive responses can arise because the lightening-quick processing that should have determined that it was not an immediate threat wasn’t effective enough at that time.

When a child with ASD struggles with transitions, I am much more aware that I will need to highlight the meaningful sounds as we work together to identify them, shorten and repeat my phrases, and emphasize my words/use meaningful gestures (Dr. Harvey Karp’s toddler-ese approach works great here.)

Using this approach to support auditory processing seems simple, but it is actually a dance as the child first attends to a sound or the conversation about a sound and is then assisted to make an adaptive response instead of tantrumming in frustration and confusion.  If I do not get a response that indicates good processing of sounds and language, I will adapt my responses to boost his skill.  I will modify the environment, my body language, and my spoken language to help him stay calm and on-task.  It looks something like this:

Event:  Sound of doorbell ringing while we are playing nearby.

Desired Response:  Child attends to sound or to my words, and is able to stop playing to walk to the door without agitation.

Me:  “I just heard the doorbell.”

Child:  No glance at the door or at me, keeps playing.

Me:  ” Who IS it…at the DOOR?”  I make a sweeping gesture that ends in a point toward the door. My play actions end, signifying that I am paying attention to something else.   I pause to allow the child to process my words and gestures.

Child:  Stops playing, looks at me and my extended finger pointing, but doesn’t follow it visually to the door.

Me:  “Come….let’s see who it IS!”  I stand up and move the toys we were using away from us, just slightly.  This indicates some shift is happening.  I offer my hand and point again, very clearly at the door.

Child:  Gets up and takes my hand but starts to walk toward another toy.

Me:  “Door time. Open door.”  I  don’t pull the child, but I stand still while I speak.  I don’t want pulling his arm to confuse the message that I want to go to the door.  I have shortened my phrasing down and repeated door twice.

Child:  Stops walking away and slowly walks to the door with me.

This whole encounter could take 10 seconds.  In that time, a child with auditory processing is working and learning, not screaming and fighting.  What a difference!

If you try this and it works for you, please write a comment and encourage other parents to give it a try!


Teach Angled Paper Placement Early in Handwriting Instruction

A Handwriting Without Tears training course was the first place that I heard, as a pediatric occupational therapist, how important correct paper placement (on a slight angle) really is when you teach children to write.  Last week a mom who is also a licensed teacher reminded me.

Her son is very bright but has more than a few issues that make handwriting a real challenge.  He has been developing a better right-handed tripod pencil grasp, but she asked me how he could see the letters he was writing.  I didn’t know what to say at first, and then realized that I probably had not mentioned paper placement since I started working with him in the summer.  He had so many things going on at the time, she must have forgotten my long ago handout and brief explanation.  If she was placing practice sheets placed horizontally in front of him, his wrist and hand would obscure his view of his fingertips as he wrote.  Time for a review.  This post is for her and for all the parents and therapists that aren’t thinking about paper position, just sitting position and finger position on a pencil.

Correct paper placement is important for being able to see the letters as you write them, but also for allowing a child to use the natural and comfortable angle of the elbow, wrist and forearm.  Why wouldn’t a child turn their paper in a way that feels natural?  Well, writing is a new skill so it all feels awkward, but most importantly, kids follow our lead.  If we place a page horizontally in front of them, they assume that we know best.  They will ignore how awkward it feels.  They may just say they don’t like to write. Oops.

Kindergarteners do not place their paper correctly unless one of two things has happened:

  1. They are born mimics and motivated writers, so they copy everything an adult does when writing.
  2. An adult has taught them to slant their paper when writing.

Should they slant their paper for coloring in preschool?  If they are just writing one or two letters on a page, probably not.  Some children do not have a solid pencil grasp well into preschool, sometimes closer to 5 years of age.  They are moving their whole wrist and maybe even their forearm, and can see their brief work decently.  It is the combo of mature pencil grasp and sustained writing across a page that makes it necessary to turn the paper.  If they have mad skills and have advanced to kindergarten writing early, then yes, it’s time to teach paper placement.

Lefty alert!  Some lefties need a greater paper angle and parents who are righties need to make sure they are reversing the paper angle for a left-handed child. BTW, if your child has a different dominance than yourself, you need to allow them to cross letters like “T” and “J” in the other direction if they choose to do so.  It is totally acceptable.
BLOG OP-ED:  With the advent of push button toys and daily tablet play giving toddlers less of a chance to build coordination, some OTs wonder if fine motor development milestones will need to be recalculated and skewed older!



Teach Yoga Breathing To Calm Toddler Frustration

Toddlers live lives filled with drama, but can they really learn to do deep breathing to calm down?  Yes, but you have to spin in so they can understand what to do and when to do it.  You will have to demonstrate it and show that you do it too.  Will you have to remind them to use it?  Probably.   It is still better than scooping a screaming toddler off the floor because he is frustrated and doesn’t have any skills to pull it together.

Dr. Harvey Karp calls it “magic” breathing.  For the younger kids, under 4, I use a more familiar and meaningful descriptor:  “birthday candle blowouts”.  By 2.5, most typical kids and a lot of kids with ASD and other developmental issues are very familiar with the birthday cake experience.  The songs, the candles and the cake make a real impression at an early age.  It is a positive experience for most kids, so that already sends their little minds on a positive path.  You know how meditation or hypnosis techniques ask you to go to your “happy place?”  Well, kids love, love, love birthdays.

Show them how to blow out candles by taking a big breath and pursing their lips to blow out a pretend candle.  If they do an overbite on their lower lip and it comes out as “f-f-f-f-f” then repeat your demo.  I have had success telling kids to say “Who?” and then blow.  Truth is, I think the breath part works decently even with a poorly controlled blow, but as an OT, I go for the best motor skill I can elicit.  It’s a habit.

Once they have blown, they can sing the song with you if they want, but that is just a fun addition.  They may be ready to get back to whatever they were doing, just in a calmer way.

This will not work as well when your child has fallen into the deeper holes of misery.  Illness, exhaustion and hunger will often require more than a few deep breaths.  They may need a hug, a snack, some alone time, etc.  That’s OK.  Toddlers can’t manage nearly as well under those harsher conditions.  Dealing with little issues throughout the day with yoga breathing is still worthwhile.

Frustration is often like a big bucket.  If you don’t empty out the water during the day and just allow it to fill up, one more tiny drop will cause it to overflow and make a mess.  Teach your child to use birthday candle blowouts and use Dr. Karp’s patience stretching (see my post Stretch Your Toddler’s Patience, Starting Today from November 2015), and that frustration bucket isn’t brimming over at the end of the day.


Better Posture and More Legible Writing With A “Helper Hand”


That left hand holding the green bean?  That’s his helper hand!

What is it?  Handwriting Without Tears (HWT), the handwriting instruction program, introduced me to the concept of the “helper hand”.  The helper hand is a child’s non-dominant hand.  I am a righty, so my left hand is my helper hand.  Here is why it matters more than you (and your child’s teacher) think it does.  It should be called the magic helper hand!

HWT encourages children to use their helper hand to steady their paper while writing.  They even suggest that young children give their helper hand a name, allowing you to instruct and correct the hand (not themselves) to deflect any sense of criticism and create a sense of lightness and humor.  That really works with younger kids, BTW.  It sounds pretty silly, but preschoolers and kindergarteners are silly.  They like to pretend.  Don’t try it with an 8 year-old.  He will give you a withering look.

If paper is not stabilized by the non-dominant hand while writing, it will slide and affect legibility.  But there is something even more helpful about the helper hand than paper control.  

Since most paper is about 8.5 x 11 inches here in the U.S., placing the non-dominant hand on the edge of the paper gives a child support for good posture.  When a child has his helper hand on the tabletop and angled slightly so that he can steady the edge of the paper opposite their writing hand, he has more of a sense of midline, the center of his body.  He automatically shifts his weight slightly forward, encouraging activation of his trunk, hip, thigh and lower leg muscles for balance and control.  Make sure that this hand is not fisted, but relaxed and flat.  Why?  kids carry a lot of tension in their bodies when they are learning a new skill.  Release that tension with good hand placement.

Are you convinced now that “helper hand” is so much more than a way to steady paper?  There is more!

OTs and PTs are all about the midline.  Controlled, balanced and graded movement happens around the center of the body.  I have done a few consultations in the last 3 months in which the child has significant postural issues.  Low tone, poor body awareness, serious weakness and fatigue.  Their writing and their sitting posture while writing all improved immediately once their non-dominant hand was correctly placed and the paper was steady.  Magic.

Kids develop habitual postures just like adults, so expect even a young child to say that it feels “weird” to use that helper hand correctly.  And be prepared to see some unusual placement of that non-dominant hand.  I have seen it all:  hand on the chair seat to stiffly prop a kid up, elbow on the table, head tilted and one eye focused on the paper, hand in pocket doing nothing…..It is time for the Helper Hand to do its job(s).

Helper Hand is not just for writing.  A child will occasionally need to stabilize a plate or bowl, but if they have a very hard time getting and maintaining good posture while eating, then the helper hand can come out of the lap and be placed permanently near the plate for postural support.  Bad manners?  Maybe.  Falling off your chair or wiggling through dinner?  Worse manners.

Many children automatically use their helper hand.  There are also kids who are taught how to use their helper hand, and will use it consistently from that point forward.  I have treated many, many more kids who struggled as toddlers to assemble toys, open containers, sequence crawling and learn other two-handed skills.  When they started to scribble, they used their non-dominant hand to prop themselves up or it did nothing at all.  These are the kids that really need to embrace the helper hand concept.

Teach your child or your student to use their  “helper hand” and watch writing (and maybe mealtime) get a little easier right away!


Low Tone and Toilet Training: Teaching Toddlers to Wipe



The parent that inspired my most popular post ever, Why Low Tone Creates More Toilet Training Struggles for Toddlers (And Parents!) , suggested that I write another about the most useful advice she says I ever offered her.  Not the most glamorous topic, but teaching children to wipe their tushies is important.  Her preschool doesn’t permit teachers to assist much.  They expect full independence at 3.  Here are my suggestions to get a clean deal for all kids.  The children with low tone often have issues with coordination, balance, sequencing and safety to think about.  All that, and they haven’t even gotten off the toilet yet!  This should help.

  1. While you are still the one managing the wiping, talk about it, describe it, and explain it in toddler terms.  That means no long-winded scientific reasoning, but also don’t let them sing “I’m a Little Teapot.”  This is a learning opportunity, not a social exchange.  Make up a wiping song if you need to be musical in the potty.  Children learn tons from your narrative, they find out that you care about them gaining this skill, and that you can tell them what to do and why to do it.  Use simple language that they can absorb.
  2. Position them for success.  If your child is unsteady on the toilet, they need to get into a standing position to wipe.  Not everyone can balance on the potty and wipe.  That means that they may even need something to hold onto with their non-wiping hand while they are standing.  This is not the time to work on core stability.  They need a sense of safety.  Think about what they could hold onto to help them balance.
  3. Explain that they have to wipe their bottom with a fresh bit of TP until the toilet paper comes back unsoiled.  Yup, a little bit of poop means that you still have work to do.
  4. Little girls have a hard time learning the “front-to-back” wipe after a pee.  Anatomically, it is more physically awkward to reach down and wipe in that direction.  I told the mom who inspired my popular post to teach her daughter to “pat-pat”instead of front-to-back wiping after urination.  No inaccurate swiping, so no increase in the chance to move bacteria from the back to the front by mistake.  She reports that her daughter is the only little girl in her classroom that doesn’t get regular urinary tract infections.  I think we know why.  Yeah!
  5. Use good products.  Nice thick toilet paper that they can feel once they reach out of view and can’t crush into a ball (a tiny piece is not going to cover the target either.)  Low tone makes feeling the amount of force and the dimensions of objects much harder once you cannot see them.  The wet wipes on the market here in the U.S. are kind of small.  You might need more that one.  Be generous at first if you need to in order to get a complete clean.
  6. Make sure clothing is pushed down/tucked away. Low tone makes it harder to control hand movements when you can’t see them, and harder to maneuver around clothing to reach accurately.   Clothing that gets confused with the feel of the toilet paper “back there” or “down there” will get soiled.  Not good.  Long-tailed shirts, tunics and all manner of dresses make learning to use the toilet harder.  A child with some experience can learn to roll up a top and balance to pull up pants from their ankles.  When a child is just starting to learn, easy clothes are the best.  The perfect early learning outfit? A shirt that doesn’t extend much beyond the hip line, pants that are easy to slide below the knees, and boxers or loose-er fitting panties that slide down easily.

Looking for more information?  Read my post on potty seat selection  Picking A Potty Seat For Toilet Training A Child With Low Tone to understand why choosing the right seat makes a difference!

Toddlers Too Young For Time Out Can Get Simple Consequences and Kind Ignoring

Children under 2 or special needs kids with cognitive and language skills under the 2 year-old level usually aren’t capable of understanding what a “time out” really is.  It isn’t punishment, it is making a point that the behavior they just exhibited isn’t acceptable and that they need to take a break and cool off.  Under 2, most toddlers just get up and run around, or cry because they see you upset.  No lesson learned, nothing accomplished.

If you tell an 18 month-old that she “needs to think about what you’ve done and apologize”, then I have a bridge to sell you!  She’s too young to mentally understand that smacking her brother when he took the toy she wanted could have hurt him badly.  Anticipating injury is beyond her.  Understanding that we don’t hit, and that she needs to calm down before going back and playing again is not beyond her.  Seeing that if hitting will result in losing the toy, not retaining it, is also something she can grasp.

Natural consequences are just what they sound like:  what will naturally happen if you take a certain action.  You whined too long and now there is no time to go to the park.  You threw your cookie and it broke into 20 pieces.  You don’t get another.  Simple results that you point out to make it clear that this kind of thing will happen.  Natural consequences are still consequences, so be prepared for some sadness on the part of your toddler.  That isn’t cruel, that is preventing him from developing the idea that he can do anything he feels like and not pay a price.  It is possible to understand consequences between 1 and 2 years of age.  It is not possible to always ignore the impulse to hit or throw.  That is OK.  Receiving a consequence is a good way to gradually learn impulse control.  You don’t wait until they have full impulse control to impose gentle consequences.  Brain development needs experiences to grow.  Don’t deprive a child’s brain of learning opportunities.  This is the beginning of developing empathy and frustration tolerance.

Kind Ignoring is Dr. Harvey Karp’s Happiest Toddler strategy to just divert your gaze and rotate your body in a way that makes it clear that you are not deeply engaged with the minor transgressions of a toddler.

Note the word minor.  Physical aggression and destruction of property is not minor.  A consequence, natural or otherwise (we are leaving the playspace right now!) is appropriate for those actions. Kind Ignoring is best for whining, gentle tossing of toys to get your attention, or all the small acts that your child knows will get a rise out of you but are not rule-breakers.  Your diverted gaze and slightly turned back are a message that says ” What you doing right now is not acceptable and I am giving you a chance to try another way to get my attention.” You may need to get up and move away a foot or two.  Leaving the room is overkill and will confuse them.

It really can work!  A very young child can work out that saying “please help”, touching your shoulder, etc., is going to immediately elicit a warm direct gaze from you, warm voices, and maybe even a hug.  Yes, you want to exaggerate a bit for the smallest toddlers or special needs kids, who need a clear yes/no message to understand that they chose wisely this time.  Special needs toddlers may need more practice and more obvious actions on your part to get the message, but they may benefit the most.  I find that some parents do not think that their special needs child is ready for this junior time out approach, but they might need it more than a typically developing child.  Being able to understand what is acceptable and what is unacceptable can be hard to learn.  This is a kind way to help them navigate and build social skills.