Monthly Archives: March 2016

Which Spoon Is Best To Teach Grown-Up Grasp?


Using a spoon to scoop with a mature grasp (thumb on top, fingers curled under) and using a pencil to write are two preschool fine motor skills that last a lifetime.  Did you know that the design of the spoon can make teaching mature spoon grasp easier?  I had a discussion with a child’s speech therapist that caused me to take another look at the utensils that were being used in the home.  Here are the best of the bunch in their house.  Can you tell which one I liked the best?

Trick question: Minnie and Hello Kitty are the same great design!  Both the Hello Kitty spoon and the Minnie Mouse fork from Zak! have a distinctive swirly design right where the thumb should rest, and the lower handles are a bit textured for extra sensory feedback.  Although the dots on the other utensil are very good visual cues for the fisted grasp of 2 year-olds, they are not that helpful for mature grasp.  Being able to see the character or feel the swirly spot is more important to get the refinement of a grown-up grip.  The Big Bird spoon has no texture and is a bit narrow, providing less tactile information and can get slippery when hands get wet.

If you think that getting a great utensil is only going to build hand control at mealtime, then check out my popular post on how utensils affect handwriting  Using Utensils To Eat Prepares Your Child To Write.  This is the gift that keeps giving!  Children that work on utensil grip are also building the strength and control for using pencils.

The particular child that own these spoons has low tone, poor sensory registration and motor planning issues.  She is very bright,  but impulsive and highly distractible.  A mature grasp pattern is possible for her, but she almost immediately reverts to a fisted grasp out of habit, not loss of control.  She needs lots of practice to use a mature grasp, not a fisted grasp.

A fisted grasp at 4 is not an age-appropriate grasp, and it doesn’t allow graded control of a utensil.  Unfortunately, like most 4 year-olds, she is more than happy to eat finger food or shovel food into her mouth with a fisted grasp.  Just showing her what to do is not going to work.  This is what I suggested to her family:

  1. Use the spoons with the swirly spot placed right where her thumb should rest.  It is textured and the design highlights the correct placement.
  2. Remind her that she should be able to see Hello Kitty or Minnie when she eats.  This prevents the end of the spoon ending up tucked under her palm.
  3. Have her practice by feeding an adult 4-7 scoops of food.  It is fun to put food in an adult’s mouth, she doesn’t have to eat the food herself, and she needs the extra practice to develop automaticity about utensil use.  Adults do not think about how they hold a spoon.  The pattern of movement has become automatic.  It needs to be even more automatic for kids that struggle with motor planning issues.  Practice, practice, practice.
  4. Remind her about where her fingers go at the beginning of the meal, and serve the spoon-able portion first. Make it small but delicious.
  5. Here is my secret move: request the spoon repeatedly for some silly reason.  Take it from her, do whatever you came up with, then place it down on the table in an awkward position. She has to pick it up and reposition it correctly in her own hand at least 3 times in a meal.  Remind her of the correct position, but let her get it right.  Again, practice, practice, practice.
  6. Always be firm but warm and supportive.  Big girls practice this every day.  This is how adults use utensils, and of course children want to be adults as soon as they can.
  7. Find a character or design that makes using utensils a special event.  The mom immediately went online and spotted this style of toddler spoon with Rapunzel on the handle!  She ordered multiple sets!  Her daughter will be so excited to see her favorite princess at every meal.

UPDATE:  After 3 weeks of use, this little girl is getting quite good at holding her spoon the grown-up way.  She and I play a scooping game with small foam toys, and if she scoops up pieces with a fisted grasp, she has to forfeit her pieces to me!  She wants to have more points than I do, so she only has to lose her points once to pay more attention to her grip.  The mom and the nanny both report a big difference in how much of her lunch ends up on the table or on her shirt.  Yeah!!!


For more strategies to teach utensil use without tears, take a look at Teaching Children To Use Utensils to Eat: Use Good Tools, Good Food, and Good Timing.  Wondering about knife skills?  Check out How to Teach Your Child to Cut Food With a Knife…Safely! for the best choices to teach safe knife skills and still have fun!

Teaching Handwriting To Kids with ASD

Handwriting still matters, and it matters just as much to kids on the spectrum. Teaching handwriting to kids that have difficulty focusing and that learn better with individualized instruction can be a challenge for any teacher, including special education teachers in a self-contained classroom.  For teachers in an integrated classroom, it can be an overwhelming struggle.

Some kids with ASD are even discouraged from working hard to improve their handwriting.  It sounds unbelievable to think of educators discouraging learning a foundational skill, until you talk to teachers. They are pressured to prep for standardized testing and need to show progress in math, social skills and behavior management.  Handwriting instruction just doesn’t seem to be that big a priority.  Some teachers will say  “Well, he will be keyboarding next year, and maybe he could use voice recognition software soon.”   Often what they are thinking is that they mostly use worksheets and writing programs that they were never trained to use, let alone adapt for these students.  They have minimal staff who can teach keyboarding and software use.  They don’t know how to improve a child’s handwriting when they don’t know how to teach it well to begin with.  What they need is a method to teach handwriting that can adapt to each child’s needs.

My answer is the Handwriting Without Tears program, adapted to be learned slowly and with more repetition.  Children with ASD can have any of the other struggles that are seen as impediments to handwriting:  poor pencil grip, difficulty with visual-spatial skills, poor bilateral (two-handed) coordination, etc.  The colorful and abundant lines of Fundations will fail the kids that cannot focus and aren’t able to incorporate the imagery they offer.  Tree, grass and airplane lines are hard to keep straight and translate onto a page.  Top, middle and bottom are concrete and simple phrases.  Worksheets that bounce back and forth between a single baseline and two or three or even four lines are confusing. Connecting the dots?  Don’t get me started on how poor a choice that is for kids who micro-focus and miss the big picture.

HWT workbooks and concepts are simple, and the principles of good writing are clearly said by the teacher and repeated directly and indirectly all the way through to cursive.  It turns out that cursive might even be easier for some of these kids to master. Their simple form of cursive is so much like printing that they can possibly use it by the end of second grade.

Take a look at this handwriting program (you can get free downloads on their website!) and consider the possibility that handwriting could get a lot easier for kids with ASD when the curriculum supports them well.


Homeschooling? Make Learning to Write Easy for Everyone

Handwriting is a skill that powers the development of language and literacy, as well as math skills.  This is an important early foundation skill.  Keyboarding does not replace writing at any age.  If you doubt me, gather up all your pencils and pens for a day or two.  See what happens.

If they are truthful, most early education teachers will tell you that they received very little training in how to teach young children to write.  They are using the curricula that their principal or lead teacher has chosen.  It usually has not been chosen because those professionals have actually used it successfully.  Often it is a district-wide decision and teachers may not even be trained in the basics of using the program, let alone the principles of teaching any handwriting curricula to typically-developing children.

Luckily, my favorite handwriting curriculum is easy for parents to use when they homeschool.  This will be one of those situations where your children’s skills will almost immediately exceed their public school peers, and stay that way through the years.  Even if your child has learning differences.

Handwriting Without Tears is an affordable program, has easy-to-understand parent/teacher guides, and multi sensory activities that engage young children right away.  The materials for cursive and above are not insulting to the older child that needs review and support.  Most importantly, if your child has learning differences, your child can use this program successfully because the materials support children of all stripes.

HWT provides pre-writing materials like wood pieces and Mat Man that are fun for 4’s or older kids working at that level.  Their workbooks are simple and uncluttered for kids with visual-perceptual issues, and the teaching progression is developmental, not alphabetical.  Kids that have motor issues will be supported to build control before they have to work on the tricky diagonals or curves of the letters “A” and “B”.  You can still teach phonics and any other literacy program that you desire.  HWT allows you to teach writing and reading separately or together.  You get to decide.

Kids on the spectrum are often literal thinkers, and get overwhelmed with complex teaching language.  You will be using repetition and routine with this curriculum, helping them learn by supporting their strengths and their desire to have structure and familiarity.  This will not slow down a sibling that isn’t on the spectrum.  That child will simply sail ahead!  The ultimate goal of handwriting instruction is simple:  legible automatic handwriting.  For all the excitement about spontaneous and free writing for literacy in kindergarten, if your child is constantly erasing errors in first and second grade, he or she will start to write less and less.  Making too many mistakes will reduce creativity and writing output.

The program is also written in Spanish and French, which may be helpful for children learning English or desirable for families that want a multicultural curriculum.  Same excellent and easy-to-teach format.

Visit their website, where you can download some free samples and try them for yourself.  Homeschooling requires parents to make many decisions, but this is one choice that makes things easier.


End Toddler Biting Using Clear But Compassionate Messaging

I couldn’t resist it.  Nip. Biting. Bud.  But toddler biting is no joke.  According to one of my clients, a child can be asked to leave preschool or daycare if they are a repeat offender.  The problems that lead to biting are easy to see, the solutions are not.  Here are my explanations for why toddlers bite, and what you can do to turn this around before your child is asked to leave preschool or shunned from play dates.

I categorize toddler biting into two distinct behaviors:  biting with aggression, and biting as communication.  The first will happen with adults and peers, the second happens almost exclusively with caregivers.  Your reactions are almost the same with both, so let’s deal with the most common variation first: biting with aggression.

Children become frustrated, don’t get what they want or can’t say what they want, and they bite.  The long answer:  address their ability to manage frustration with language and build their patience.  Not easy, not immediate, but totally possible. Use Dr. Karp’s Patience Stretching and Toddler-Ese style of communication to build these skills.  My posts on both subjects will give you some tools you can use right away.

Adults have to be present when the majority of biting episodes happening order to manage them, and willing to intercede with both limits (“No biting.  Biting hurts” ) and consequences for the biter.  The victim needs to get the majority of the attention, no matter how upset the adult is with the attacker.  If the biter is old enough, it is a time-out.  If not, it is a junior time out.  At the very least, it is removal from whatever activity they were engaged in.  You put them down off your lap after they bite you.  You are sending the clear message that this is big, really big.  We don’t want this to happen.  Ever.  

The greatest mistake that a caregiver can make when dealing directly with biting?  Quickly comforting the biter after they start to cry in realization that they did something wrong.  They are so little, and they are not in full control of their behavior.  But they do have some control! Even a seven-month-old that nips on your breast during nursing can learn that they will be taken off the breast if they continue to do that, so why would you assume that a toddler has no control at all?  Because they are better at wailing with emotion, and tug at your heartstrings.  If you scoop up the biter and comfort them right away, they do not get to have the very emotion that you want them to develop: regret and remorse.

It is hard for loving parents to see their child sad.  I appreciate that.   But their child has committed a behavioral felony, and for a few moments a toddler needs to experience a negative consequence in order to understand that biting is not OK. They are concrete, literal thinkers at this age.  If all you do is tell them, in a sweet tone, not to bite, then they will do it again.  And again.  Developing the ability to use their words is going to take some time, maybe months.  Developing impulse control is going to take even longer.  There are four year-olds that struggle with impulse control, but they don’t bite even when they are upset.  They have learned that this is simply not done.

It is also hard not to be angry with the biter.  That takes some self-control as well.  Yelling, threatening, and spanking really don’t change this behavior as much as you would think.   Showing your displeasure but keeping your cool is hard for some parents.  Truthfully, one mom said she is just so tired at the end of the day that she knows she is yelling and can’t stop herself.  I get it.  But this is the reason to take care of yourself every day, and dig deep into your inner strength for these moments.  This is “showtime” as a parent.

The moment when you can warmly talk with your child is after the time-out is completely done.  For young toddlers, it is only a minute or two, but it was the most important minute of their day.  It can be less.  I watched a mom put down her 18 month-old after he nipped at her neck for attention.   She didn’t yell, she just said “no biting” firmly and put him on the floor.  He cried, and then recovered in about 15 seconds.  He walked upstairs quietly to see what Daddy was doing.  He got the message and wasn’t scarred for life.  He already knows that biting is not OK, he just didn’t know that he couldn’t bite HER.  Until that moment.  All she did was stop holding him, but he got it.  To get biting-as-communication to end, develop a toddler’s skills at positive interactions.  These biting behaviors usually happen when a child sees no difference between the consequences for positive and negative attention.  It is all attention to them.  Make them reconsider their choices by creating negative consequences for negative behaviors, and teach them how you’d like them to get your attention.  Words, laughter, and positive play.

Good luck with this one.  The magic is in the swift and firm reaction, and managing your own emotions in order to teach toddlers how to deal with theirs!

Why “Go The F**K to Sleep” Resonates With Parents of Special Needs Toddlers


I have been asked to teach a short class on sleep and special needs kids this spring, so of course this funny little book came to mind.  Truthfully, when I heard of it, I laughed out loud.  But bedtime struggles are not fun when you are in the middle of a tantrum at 11 pm.  Wrangling with a toddler that alternately cries, whines and yells about bedtime is not a joke.  It is hell.

If you have trouble sleeping, then you might be a little more sympathetic to a toddler that fights bedtime, but probably not any more capable of getting him to sleep. You just want the fighting to end so you can get some sleep too.

I asked some other professionals to give me their opinions and experiences with special needs toddlers and sleep problems.  Their comments always mentioned the same thing:  poor self-calming.  Well, my response is that most toddlers need our help to learn this skill and they need to be calm to learn it.  It isn’t a natural ability any more than speech.  We are wired to speak, walk, and sleep, but kids need modeling, a supportive structure and emotional connections to do all three well.  They really do.

Kids with special needs, including autism, sensory differences, and developmental delays can have a harder time adopting a bedtime routine and communicating their desires.  They often benefit a lot from things like weighted blankets and aromatherapy to signal to their nervous system that they need to downshift and sleep.  White noise and achieving a calm state for sleep can do more than token economies (the kind where you get a star if you get into bed) for special needs kids because they address the biological state of sleep rather than develop a cognitive motivation.  That being said, some older kids can use tokens effectively for motivation.

The most powerful thing I know to build good sleep behaviors in special needs toddlers or kids functioning at the toddler level is patience stretching.  Dr. Karp’s amazing technique for getting kids to wait can be magic at night.  A toddler that can calmly wait for you to return to his crib is one that can let the white noise and the lavender and the weighted blanket lull him back to sleep.  The toddler that is agitated and fearful will be so upset that all the other stuff is window dressing.  Calm kids can learn to self-soothe.  Agitated kids cannot.

Think about it, and try it out.  Please post your comments once you have given it a try!

Why Do You Start (Uppercase) Letters at the Top? Speed and Accuracy

Another week, another second-grader showing me how he writes uppercase letters starting on the baseline.  You don’t have to use Handwriting Without Tears to use correct start and sequencing of strokes; no standard letter style starts uppercase letters on the baseline.  For a reason.  It is harder to achieve good control of your fingers in that direction, so letters written from the bottom are written more slowly or/and with less control.  It isn’t a visual or a perceptual issue.  It is how our hands work best and fastest.

Adults can write letters neatly with a bottom-start.  We have years of practice and good muscle control.  We could write them backward and they would still be legible.  In fact, some preschoolers have shown me that their teacher has instructed them to make an “A” by starting on the baseline, making a diagonal line up, and then another diagonal down.  Cross it in the middle, and there is their “A”, made just like a mountain.  It looks pretty good, and they are so proud to be able to do a challenging letter at 4.

There is a reason that the letter “A” is late in the developmentally-oriented sequence of teaching in Handwriting Without Tears.  Connecting diagonal lines is tough.  Kids need to be good at connecting horizontal and vertical lines first, well practiced in the skill of controlling their fingers to make accurate strokes.  By starting teaching in the beginning of the alphabet instead of looking at the developmental demands of handwriting, this “mountain style” is the easy, maybe the only way, to teach a 4 year-old to write an “A”.  As if getting early skills rather than good skills is the goal.

It can also doom them to having trouble writing the finely controlled lowercase letters next. Sometimes you have to put in the time to build skills, not run for the easy end-product.

I am teaching a class for preschool and kindergarten teachers next month.  You know that this will be one of the topics I cover.  Let’s start kids off with good skills.  They count on us to make things easier for them!

Baby Wearing For Better Infant Sleep

Most parents use carriers/wraps for two reasons:  practical and personal. But did you know that wearing your baby can also help your newborn sleep better?

Being able to carry your baby allows you to have both hands available. Baby wearing is an intimate connection that parents usually enjoy.  Babies feel their parent’s heartbeat and listen to their voice, just like before birth.  Before I tell you how this improves sleep, here is some practical information about safety and carrier/wrap choices.

Wearing your newborn safely is essential.  Always make sure that you can see their face and that their head is not tilted forward so far that they cannot easily breathe.  An older baby can turn their head but a newborn cannot, especially against gravity.  Never lean forward without holding your baby, and never lean near a flame or burner.

My favorite manufactured carrier is the Ergobaby system.  It is well-crafted and the insert is designed to safely support newborns.  Using slings and wraps is just fine, but it is a bit more challenging to get newborns in the right position and keep them there.  Totally possible, and there are parents that are amazingly good at the traditional sling wrap styles.  I don’t take sides in the carrier/wrap debates.  Use what works for your family.

Carriers/wraps allow your baby to experience all the movement stimulation that he got in the womb.  Babies calm to the jiggle-style swinging of the Happiest Baby on the Block for a very similar reason.  It feels amazingly familiar to them! When you wear your baby, they get so much more variety and variation in movement than just using an infant swing.  No wonder they love being carried long after you have discontinued infant swing use (usually 2-3 months of age.)  This movement is stimulating their balance system, and we all need a dose of movement input to feel good.  To sleep well, we need to have had enough, but not too much, vestibular stimulation.  Baby wearing combines movement plus some deep pressure and warmth from being wrapped against an adult to deliver an almost perfect dose of sensory input.  As a pediatric occupational therapist, this makes so much sense.

Wear your newborn safely, use all the other S’s from Happiest Baby on the Block, and you may be able to extend his sleep periods.  The gift that keeps on giving!


Too Fussy to Breastfeed? It May Not Be Latching-On Issues

Latch-on is a big deal when you nurse.  Getting a newborn to achieve that solid seal and then synchronize the suck-swallow-breathe rhythm is essential.  When I was a younger occupational therapist, I was all about the mechanics of achieving oral control and teaching that rhythm.  Some babies have medical issues that make it harder, but some are just fussy bussies.  They react to everything, and their own crying fuels even more crying.  I realized that if a baby is agitated, they aren’t in a place where they can learn the rhythm.  Of course!  Fussy babies are lousy learners, and therefore they are often lousy feeders.  What could get a fussy, uncoordinated baby calmer to focus and learn one of the most important skills of this period of their lives? That was one of the questions that lead me to become a Happiest Baby educator.  Dr. Harvey Karp’s Happiest Baby on the Block techniques deliver just the right combo of sensory input to get a newborn calm and focused to nurse, not just calmer for sleep.

Some lactation consultants have suggested to me that the 5 S’s of Happiest Baby interfere with nursing.  I really have no good response.  If they decided that getting babies calmer with Happiest Baby is bad for breastfeeding, what could possibly be going on in their minds?  I found that they didn’t know all the steps, just the swaddle, thought that it would work so well that babies wouldn’t be awake enough to feed (it is rare indeed that a healthy baby doesn’t wake when hungry), or mistakenly thought that good calming with any other technique would dissuade a mom from nursing her baby.

I haven’t met one, not one, mother who thought that nursing should end because she had a better way to calm her baby.  Quite the other way around.  Moms that can get babies calm and focused faster enjoy nursing and are encouraged to keep going.  They do not incorrectly assume that a fussy baby is “done” with nursing.  Thinking that fussiness equals dislike is a big error of judgement, and an actual reason that mothers give when they are asked why they stopped breastfeeding.  Happiest Baby techniques could have helped them see what their babies needed:  some calming sensory input to help them get down to business!

Why Cutting Nails Is Such a Challenge for Autistic and Sensory Kids


Most children resist nail trimming.  But kids on the autism spectrum, kids with sensory sensitivity, and children with significant language delays can turn this simple grooming task into an epic contest of wills.  Understanding why they fight you is the first step in solving this problem.

There are some good reasons why cutting your child’s nails can be so difficult for them to handle.  If you can identify the “why”, you can adapt the experience to help a child handle this grooming task.  Even if your child doesn’t immediately calm down, you may be calmer and more compassionate when they squirm.  And a calmer parent can inspire calmness in their child.

BTW, even though some of my links are to previous posts with the word “toddler”, these techniques work equally well for older kids with ASD or with SPD.  In fact, they work well with any child who is upset or demanding during grooming, haircuts, etc.

Here are some good reasons why your child is so distressed:

  • Most typically-developing young children do not enjoy nail trimming.  They don’t see the need for it, and they really don’t like leaving a fun activity to do a not-fun activity.  A child with ASD or SPD may not be so unlike their sibling or cousin.
  • Typical kids put up with nail care because they have the following abilities:  they understand your explanation, they tolerate the frustration of sitting passively, and they tolerate the awkwardness of having their finger held by another person and don’t mind the pressure applied to each nail.  In addition, they do not see the nail as an essential part of themselves, and they do not fear that you will injure them by accident.  If your child still doesn’t yet have some of these skills, then you are going to have problems when you want to trim your child’s nails.
  • Children with ASD,SPD, global developmental delay, or significant language delays do not have most or all of the above skills.  Sometimes they have only one or two. They may genuinely find your touch irritating, and they often have very little frustration tolerance for the things that they do not want to do or struggle to understand.
  • Nail trimming is usually an occasional event, not a daily part of a familiar routine.  Parents of children who fight nail trimming often leave this task until it is unavoidable,  Rare events are almost always seen as unwelcome or even threatening.

There are practical and simple things that parents can do to make nail trimming less aggravating:

  • Build your child’s frustration tolerance for other small events and annoyances with Patience Stretching, Dr. Harvey Karp’s wonderful technique from Happiest Toddler on the Block.  I wrote a post on this technique, Stretch Your Toddler’s Patience, Starting Today!, and it gives you some insight into the how and why of this simple strategy.
  • Use Dr. Karp’s “toddler-ese” language and Fast Food Rule techniques when you get some push back; see  Taming Toddler Tantrums Using Sympathetic Reframing.  Simplifying what you say, and empathizing but not agreeing with a toddler who balks at nail trimming can reduce the resistance.  Children will then understand that you get their point of view: they don’t want to do this.  Most kids are well aware that they will be asked to do things they do not want to do.  Diaper changes, clothing changes, tooth brushing (see my series of toothbrushing posts for specifics on that subject.)  Just hearing that you know they don’t like it is sometimes enough to help them allow you to trim their nails.  They feel heard.  Most kids will not assume that you understand them by reading your tone and body language alone, and ASD kids struggle with this more than the average child.  You are giving them information about your mindset that they cannot understand unless you spell it out in this manner.
  • Don’t go wild when they ARE cooperative.  I know you are excited to see progress.  Keep most of it to yourself.  Sensitive kids need some finessing when it comes to praise.  Here’s how to handle it so it doesn’t backfire on you: Sensitive Child? Be Careful How You Deliver Praise
  • Choose a comfortable position for both of you.  Some kids really like beanbag chairs as they feel cradled while the chairs also supporting them.   All that deep pressure helps them stay calmer and they can’t squirm as much.  Some prefer to be lying down, and some want to be watching Paw Patrol.  I don’t know that using distraction is such a terrible idea.  You might even sweeten the deal with a special DVD like home movies that feature them!
  • Use good technique and equipment.  There are nail cutters that protect children’s fingers better than the standard clippers you buy for yourself.  Clippers that are easy for you to hols steady are essential.  Buy them today!

Hammacher Schlemmer sells these well-designed clippers.  Expensive…but worth it!

  • Make it clear why their nails need attention.  One of my clients had a great idea to show her child that his nails were too long:  she asked him to run his nails along his own upper thigh and see if they were “scratchy”.  Scratchy nails need to be trimmed.
  • Try a little hand massage.  Nothing too hard, but never ever use light, flighty touch.  Light touch is always stimulating to the nervous system, and light moving touch is even more stimulating.  Don’t add fuel to the fire.  Use firm grasp that doesn’t roam on-and-off their hand during nail trimming.  If you don’t believe me that light touch is irritating, imagine getting a massage of flighty fingers running up and down your back. Can you feel that?  It is alerting, and a bit annoying, right?  Certainly more stimulating than relaxing.  Well, when you hold a child’s fingers loosely, and then grasp/release their hand over and over….their brain perceives it as light touch. Oops.  I use my skills as a licensed massage therapist with my OT skills to create a calming pattern of hand and finger massage either prior to or after nail grooming.  Usually after, as I can use lotion then (lotion before trimming creates slippery hands for both of you!)
  • Pair the experience of nail trimming with something your child enjoys.  You could try offering a healthy but tasty snack right after nail trimming.  Read a beloved book after nail trimming.  Something that they like and can look forward to.  My trick: have it visible but out of reach, so that an upset child who is more literal and less likely to understand your words will see evidence of the positive experience he will have immediately after nail trimming.  You might be surprised that even though your child is calm enough to speak, his response to nail trimming is so much better with the visual cue of the actual treat.
  • Some children need to do nail filing before they can tolerate trimming.  Daily filing can be less scary and still keep things well groomed.  This really works!  Once filing is well tolerated, you may be able to move to clipping.  If not, a calm child that can handle filing every other day is a lot happier than a squirming, screaming child who learns to fear your grooming routines.  i like the foam filing rectangles rather than the emery boards.  If a child suddenly becomes agitated, I am not as worried about accidental eye injuries.
  • I will use a distraction such as a video on a tablet at times while I do nail filing/cutting and massage.  It’s not a bribe.  Really,  I try to pick really short videos and definitely move back and forth between letting them watch and bringing their attention to their hands.  I directly discuss a child’s nails and hands with them, naming the fingers and talking about whether their nails are smooth or bumpy.  Why?  Zoning out totally doesn’t reduce overall anxiety over time, but being able to toggle back and forth between targets of attention is active use of the frontal lobes, the ones that can stay calm and think things out….!
  • Try to do a small trim on a weekly basis (or even every other day) so that it can be expected and part of a routine.  Familiarity really helps all of us.  That is why tax time can be stressful.  It only comes once a year.  And here in the U.S., we are about to enter into the least happy time of the year!  So make nail trimming part of a routine and it could be less of a surprise.

Remember to be patient with yourself as well. The challenges of parenting a child with sensory sensitivity and modulation issues can really affect how you see the world.  It is important to acknowledge how you feel, as well as how your child feels.  If you feel angry or hopeless, talk to your partner, a friend or a counselor that can help you maintain your focus and positivity about caring for your child.

Need more information to make things like nail trimming, bath time, dressing and mealtime easier?

I wrote 2 e-books just for you!  The JointSmart Child:  Living and Thriving With Hypermobility Volume One: The Early Years and Volume Two: The School Years give you strategies that you can use TODAY! Even if your child’s hypermobility isn’t their biggest issue, my strategies will make life easier for you and your child…I promise! My books provide simple guidelines for picking the best equipment like chairs and strollers, building independent dressing and grooming, making bedtime easier, and even how to communicate better with your family, teachers, and even doctors!

Knowing how to help your child develop independence and safety awareness isn’t intuitive; parents deserve skilled guidance.  These books are filled with practical information and insights from my 25 years as a pediatric occupational therapist.  It is time that parents know all the tricks and techniques that therapists use to find good equipment and select the right strategies for success.  Parents need to feel empowered…today!

Read more about these books: The JointSmart Child Series: Parents of Young Hypermobile Children Can Feel More Empowered and Confident Today! and A Practical Guide to Helping the Hypermobile School-Age Child Succeed

They are available on Amazon as read-only downloads, and on Your Therapy Source as  printable and clickable downloads.  Your Therapy Source also sells my other books (see below) bundled for an amazing deal!

  My e-book, The Practical Guide To Toilet Training Your Child With Low Muscle Tone, also helps children with sensory processing issues and ASD make faster progress with potty training.  

Read  The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! to learn more about how the pre-training strategies in The Practical Guide will help your child speed up potty training at any age, and why understanding how low tone impacts your child’s sensory, motor, and social skills will make a huge difference for both of you.  To purchase my e-book, visit Your Therapy Source or Amazon .


Will Swaddling Affect Newborn Sleep?

The short answer?  It almost always gives them a slightly longer sleep cycle.  The longer answer:  many babies need more than a good swaddle to add that extra hour or so to their sleep cycle.

Interestingly enough, research and the American Academy of Pediatrics have suggested that swaddling makes a newborn’s sleep lighter.  Lighter isn’t necessarily worse.  Stomach sleeping is often deeper sleeping.  The risk for stomach sleeping is that if their nose and mouth are pressed into the mattress, they can’t or won’t turn their heads to breathe. That is why SIDS prevention guidelines say they should never sleep on their stomachs.  As a health professional, you know where I come out on that argument.  Be smart and use effective techniques for good sleep rather than use a risky move in sleep-deprived desperation.  It may be the action you regret for the rest of your life.

So if you swaddle and back-sleep and still have a fussy newborn, what do you do?  You layer on the love; those other moves from The Happiest Baby that soothe newborns and let them sleep.  That means that using the pacifier/soothing nursing, swinging, white noise are more important for sleep.

I just did a consultation with a family whose 6 week-old is already a tribute to his athletic, high-energy mom.  He calms best with movement, lots of it.  That isn’t a problem, or a sign of anything bad, but it means that to get him to sleep on his back they are going to have to give him more movement to lull him almost fully asleep before putting him down. They may even need to use the swing, filly reclined and belted in, at a higher speed for sleep.  There was some chatter about him getting “addicted” to it, but the good news is that the need for speed decreases as brain development increases. I recommended that he get some practice with the pacifier ( see my June 4, 2015 post on how to use and wean pacifiers) and that they use the harsher white noise.  It may be too soft or too far away to have enough of an effect for him.  She should, however, be prepared to sign him up for a travel team in about 10 years!

If you would like more support with your newborn but you don’t live in the NY metro area, visit my website,, and purchase a phone or video consultation session.