Monthly Archives: April 2016

Give (Some of) Your Power Away To Your Defiant Toddler And Create Calmness

One of my favorite strategies to develop a warm but equitable relationship with toddlers is to share the power.  Yes, I said it.  Adults have power in the relationship and toddlers know it.  In order for you to succeed in using this strategy with your toddler, you have to accept the fact that children long to be the powerful ones in a relationship. but they know the reality:  we make most of the decisions.

This is true even if you are a committed push-over.  Even if you subscribe to free-parenting and allowing the child to lead, you are still the one deciding when the last book is read at bedtime and when to leave the park in time for grade-school pick -up.  In fact, I will guess that children who have the power to turn the kitchen into a diner that cooks to order have the larger tantrum when they hit a situation they cannot control.  Say…there are no more goldfish crackers in the house right now.  It is raining and the pool at the club is closed.  Kids that cannot believe that this time they will not get what they want are often inconsolate.  They have no regular experience of it.  Remember, they cannot be expected to understand that there are circumstances beyond our control.  They think magically.  That is normal for toddlers, and if you think that they can comprehend the difference, you are in for some major meltdowns when events take their course.

The other extreme will also get you some award-winning tantrums.   Expecting immediate and full compliance with all your instructions will put you at odds with the natural limit-pressing that children must do, all the way into the teen years.  If toddlers do not feel that they have any power ever, they are more likely to demand it by taking hostages in the check-out line at the grocery store or in the lobby at daycare.  If you have ever been that parent with a wigged-out toddler in the grocery store, looking right at you as he twirls and kicks, you know what I mean.

I work with a child privately whose mom really argued this point with me.  She was doing a good job convincing me that her kids had equal power until she told them at the end of my session that they had to get their coats on NOW, and they would be leaving for haircuts shortly.  Who decided on haircuts today?  At that exact time?  Did they have a choice whether to go or where to go to get their hair cut?  Of course not!  Her kids knew that they were going to get haircuts then, even if they didn’t want to, and not complying would be met with consequences.  So much for “equal power”.

Adults are the managers of kid’s lives,  and most kids really want and need adults to give them confidence that the “big people” know what to do and can take care of them.  Adults being powerful doesn’t automatically crush their spirit or destroy their confidence.  Kids just want to be considered and respected.  I think ceding some power over minor situations  can show them that respect, and give them a chance to feel powerful without using whining or aggression to get there.

You may think of yourself as a very democratic parent, always offering your child freedom and choice.  I cannot argue with that, but it might not even matter that you are right.  Dr. Karp (of the Happiest Toddler on the Block) taught me that all that matters to toddlers is how they see a situation.  I am suggesting that by inserting many, many daily opportunities for tiny power moves, you create the sense in a toddler that they are respected and have enough power.  It creates easier transitions when adults have to step in and take charge, and it gives toddlers opportunities to experience what happens when they make the choices.

The low-hanging fruit of this strategy are the decisions children make for themselves that do not affect any significant outcomes.  These are the ones that all the parenting articles mention.  Give your child two choices on which shirt to wear.  Let him choose the blue or green bowl for cereal.  Well, that does works a little bit, and works better with the youngest or most compliant toddlers.  No 2.5 year old is empowered by a choice that he knows has no teeth.  You could use those magazine’s techniques all day long and still not make a dent in your defiant toddler’s demands.  Your more impact-ful power sharing technique with a controlling or older toddler?  controlling YOU!  

Which puzzle do you want US to do now?  Do you want me to sit here or there?  Can I color on your ninja picture or do you want me to stay on my own picture?  Can I go first or do you want to?  Now we are talking!  Telling you “no”,  or at least having the opportunity to do so, and then seeing you comply, this is real power!  

I weave no less than 5 little opportunities to tell me “no” into a 45-minute therapy session with a defiant toddler.  At first, they are all about shutting me down.  They love it.  This can go on for a while if a child really has perceived themselves as less powerful than siblings or has had a major life changes such as a new school or sibling.  Gradually, and sometimes it happens over many sessions, they get it:  I will give them power and respect them.  Then the magic happens.  Easier transitions, fewer defiant moments.  Life has become better.

 

 

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The Informed Parent and Happiest Baby on the Block

I read The Informed Parent recently to decide whether it would be a good resource for my clients, and found that the chapters on The Art and Science of Baby Soothing, SIDS, and Sleep Training were worth reading.  This book distills a lot, a whole lot, of research that can confuse those parents who want some clarity in a sea of recommendations. The problem?  The authors, Tara Haelle and Emily Willingham, left me wanting for some good resources to offer parents once they have made their own conclusions about the available research.  They did do something wonderful for me as a Happiest Baby educator:  they included many, many research references to the 5 S’s that support the use of Dr. Karp’s techniques to calm newborns.  If you ever wondered whether swaddling is bad for your baby’s hips or whether pacifiers would help or hurt your chances of successful breastfeeding, the authors have some science-based answers for you.

As an example of what their book offers parents, the chapter on sleep training appeared to summarize all of the research findings by saying that bad sleepers aren’t necessarily disturbed or deficient.  The most helpful conclusion was that children whose parents were available to them emotionally during the bedtime period had fewer sleep disruptions. Parents might be feel less guilty but this won’t help anyone go to sleep.  If a parent is frustrated, tired, and distracted, and has an authoritarian approach to sleep: “Go to sleep NOW, because I said so!”, I believe that they are more likely to end up with a child that doesn’t want to go to sleep at bedtime, and screams for bottles or cuddles at 4 am.  But how exactly does this observation help anyone?  Perhaps there are parents that recognize themselves in that description and decide to change, but I suggest that most of us do not see ourselves as emotionally unavailable, even when we are.   My experience is that the parent-child pairs I have met who have an insecure-resistant mode of attachment (psych-speak for a child that desires parent contact but then reacts angrily or is resistant/fussy when given attention) are completely oblivious to how they contribute to their child’s behavior.   It is going to take more that a summary of scientific studies to have parents recognize the effect of their interactions on sleep problems.

I was disappointed that the authors included the “Purple crying” concept of Dr. Ronald Barr in their discussion of parents that shake a persistently crying infant.  Nothing in this  “approach” is scientific.  Telling parents that colicky crying is normal, but not offering more than “put the baby down and don’t shake him” is reprehensible when methods such as Dr. Karp’s 5 S’s  have actually helped so many families.  Of course shaking is never OK!  I really doubt that anyone that has had a screaming infant has ever felt that “knowing that crying is common and not abnormal” was very helpful.  What you want at that point to avoid doing something harmful is a solution, not a platitude.

Read The Informed Parent and let me know what was helpful and what just made you want some successful easy-to-use strategies for babies and toddlers!

To schedule a in-home training with me in the NYC metro area, or to buy a phone/video consult, visit my website and select the service that fits your needs.  

 

Toe Walker? Why The Problem Usually Isn’t Touch Sensitivity

Kids that toe-walk after they have fully mastered walking and running (usually 24-30 months) are often accused of avoiding the feeling of their feet on the floor.  It certainly looks that way.  The truth is usually not so simple, and the solution not so easy to achieve. Getting a toe-walker to use a heel-toe gait pattern means you have to address the reason they choose to use this pattern, and manage any loss of movement at their ankles that has developed.

The great majority of children that I have treated who toe-walk are actually seeking more sensory input, and are getting it by teetering around on the balls of their feet.  The vestibular input as they sway, and the proprioceptive input of all that joint pressure and muscle contraction is what they really crave.  Touching or not touching the floor has very little to do with it.  If a child is a true tactile avoider, it is probably not just on the soles of their feet.  Avoiders dislike the feeling of clothing on their skin, food in their mouths, even water splashing them in the bathtub.  You know if you have a tactile avoider.  Life is a real challenge.

Sensory seekers come in a few different flavors.  Some have low muscle tone and are looking for a blast of information that they don’t get when walking with flat feet.  Is Low Muscle Tone A Sensory Processing Issue? Some are more drawn to the swish and sway movement as they walk.  They love to flip upside down and spin around just for the fun of it.  A lot.

Some sensory seekers toe-walk and then intentionally crash into furniture or people.  They can use this pattern as a two-fer.  They get both the fun of the proprioceptive input and they avoid the challenge of controlling their deceleration as they arrive at their destination.  I have worked with toddlers that simply cannot walk to a chair, turn around and sit without ending up on the floor.  You can almost see the wheels in their head turning as they decide ” I usually fall anyway.  How about just crashing intentionally and making it a game? She will just catch me and I get a hug!”

Because toe-walking is normal (yes, normal!) for very young children just learning to walk and run, it can be ignored long enough to result in shortening of the ankle tendons and weakening of the muscles that move the toes up toward the knee.  At this point, a child may not be able to achieve full range of movement easily.  Enter the physical therapist for stretching and strengthening.

Here are some simple strategies to address toe walking in it’s early stages, before the Achilles tendon has shortened significantly.

Duck walking:  everybody likes ducks.  Pretending to be a duck, pointing toes up and out to the side while quacking, is a cute and fun exercise.

Squats:  Yes, squats.  You can go mega and have a child stand on a 1-3 inch thick book then squat down to pick something up.  Big stretch, plus some vestibular action as their head dips down.

Jumping:  They have to land on a flat foot with heel contact, and jumping along a path made by tape can be a really fun game.

Choose a high-topped shoe:  Go old-school and try a high top sneaker (trainers, tennis shoes, or whatever you call them in your area).   First of all, it looks seriously cute on little kids, and it will act as a soft brace to prevent some of the toe-walking.  The hard core toe-walkers may actually need an orthotic, so if you still see a lot of pronounced toe walking, consult your pediatrician and see a physiatrist.  They can recommend corrective inserts that do more than prevent a child from coming up on their toes.  A good orthotic can help a child strengthen the muscles that he wasn’t using while toe-walking.

Give them more vestibular and proprioceptive input:  If a child really needs does more sensory information, then there are fun ways to deliver the goods.  Swinging, rolling down a hill, climbing walls, yoga, and other absolutely fun activities should be available to them.  Of course, a targeted sensory “diet” is a great idea.  Well thought-out and intensive activities created by an occupational therapist to satisfy a child’s interests and needs can result in hours of typical movement and positioning for school and play.

Parents and therapists:  please submit a comment and add activities that have worked for your children!

 

 

 

 

The Tally Sheet, Updated For End of Preschool

Fans of my simple and fun pre-writing activity Preschool Handwriting Activity: The Tally Sheet, come on back into the pool for more!  The tally sheet is a great way to keep score during a fast and fun game such as Pop-Up Pirate or Crocodile Dentist.  As this year’s group or preschoolers are approaching the stage in which they are independently writing their names in uppercase letters, thoughts turn to more challenging visual-spatial skills and grading stroke control.

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Enter the more advanced tally sheet!  The original had just a baseline at the top.  I kept the HWT smiley face as a cue for starting at the top left portion of the page.  Many kids  at this age will still start wherever their crayon lands, most likely directly in front of them.

Here is what your maturing preschooler will gain from moving up to this format:

  1. The additional line adds visual complexity on the page.  A child will have to remember that her name goes on the top line, not in the large space in between the two black lines.  It seems simple to figure out and remember, but not when you are 4.   Some kindergartens use Handwriting Without Tears, but some use much more visually complicated handwriting programs such as Fundations.  It’s time to build visual-spatial skills to navigate a slightly more complicated worksheet.
  2. Starting a tally line at the top and stopping on the bottom line demands more physical control of a crayon than just making a stroke down to the bottom of the page.  Better control of the crayon is needed to “put on the brakes”.  This prepares children for the stop-and-reverse formation of many lowercase letters such as “p” and “h”.

Good luck using the new tally sheet with kids who are preparing to graduate to kindergarten in the next month or two!

Use The Fast Food Rule to Help ASD Toddlers Handle Change

Kids With ASD can react strongly to changes in their routines or environments.  Even changing the location of furniture they don’t even use can create screaming and aggression.  Why?  Often they use their external concept of home and environment to provide internal consistency, structure, and spatial comprehension.  We all do, in reality.  Ask anyone who travels for business how nice it is to come home and wake up knowing where things are without searching for them. It is not just exhaustion from travel, but the constant reorientation to new places and looking for needed things that make business travel hard.  Kids with ASD just depend on the familiarity of their external world and their routines much more.  When faced with disruption, they don’t have a wider range of coping skills to fall back on.  They can fall into chaos.

The Fast Food Rule, Dr. Harvey Karp’s fabulous strategy for communicating with agitated toddlers, works well with kids whose ASD issues make them rigid and upset when small changes occur.  The technique is to use simple statements with slightly exaggerated emotional tone and gestures to first express what you think the child is thinking, wait for a sign of lower agitation, and then provide an explanation, alternative, or both.

Toddlers are usually not good at reading subtle language and other cues.  They need explicit interaction that says “I understand why you are upset.  I really do.  Here is what is happening, and here is what we can do.”  All upset toddlers benefit from the Fast Food Rule.  Toddlers with ASD need this kind of support throughout the day, every day.  Their world is so much harder for them to understand and handle without stress.

I worked with a family this week, and saw what can happen when an adult fails to communicate effectively.  A 2.5 year old’s trike was brought into the kitchen entry hall instead of being left in the mudroom.  It wasn’t blocking anything.  It just was not where it  is usually stored.  They were doing some repairs later that day in the mudroom, so it had to be moved.  He went ballistic.

Screaming, hanging on it but not trying to ride it, absolutely beside himself that it was out of place.  The mom tried to tell him that they would “go to the park later”, thinking that he wanted to use it.  This was not the case, as he wasn’t mounting it or doing anything that would suggest he was interesting in riding it at the moment. He screamed louder when she told him that “everything was OK”.  It was not OK to him!    She turned on the TV briefly, and then took out the tablet.  That distracted him and he quieted down.  This ended the drama but it didn’t solve the problem.  In fact, she has been trying to limit screen time because he prefers to use these devices rather than engage in social/communication/ fine motor play.  Now she would have to decide when to announce that his turn was over, face that complaint, and the trike was still sitting in the hallway instead of the mudroom.

If she had used the Fast Food Rule, she could have had a chance to explain and support him in accepting that the trike was there until work was done in the mudroom.  Is this a guarantee that he’d be perfectly calm?  Not at all.  But it would have been an opportunity to use language and emotional connection to develop self-calming, methods of communication that he needs for success in school, at home, well, everywhere.  It would have acknowledged his feelings and his perspective while helping him to accept a change in the routine/environment.

If you have tried the Fast Food Rule with your Toddler, please write a comment and share your success or your struggle!

 

 

Is Low Muscle Tone A Sensory Processing Issue?

Only if you think that sensing your body’s position and being able to perceive the degree/quality of your movement is sensory-based.  I’m being silly; of course low tone creates sensory processing issues.

It isn’t the same sensory profile as the child who can’t pay attention when long sleeves brush his skin, nor the child who cannot tolerate the bright lights and noise at his brother’s basketball games.  Having difficulty perceiving your foot position on a step, or not knowing how much force you are using on a pencil can make life a challenge.  Sensory processing issues mean that the brain isn’t interpreting the sensory information it receives, or that the information it receives is inadequate.

That is the situation with low muscle tone.  Low tone reduces the amount of joint and muscle receptor firing because these receptors need either pressure or stretch to activate.  If it is not in a sufficient quantity, the receptors will not fire in time or in large enough numbers to alert the brain that a change has occurred. Therefore, the brain cannot create an appropriate response to the situation.   What does this look like?  Your child slowly sliding off the side of a chair but not noticing it, or your child grinding her crayon into the paper until it rips, then crying because she has ruined another Rapunzel picture.

Muscle tone is a tricky thing to change, since it is mediated by the lower parts of the brain.  That means it is not under conscious control.  You cannot meditate your way to normal tone, and you can’t strengthen your way there either.  Strength and tone are entirely different.  Getting and keeping strength around joints is a very important goal for anyone with low tone, and protecting ligaments from injury is too.  Stronger muscles will provide more active contraction and therefore pressure, but when at rest, they are not going to respond any differently.

Therapists have some strategies to improve tone for functional activities, but they have not been proven to alter the essential cause of low muscle tone.  Even vestibular activities, the big guns of the sensory gym, can only alter the level of tone for a short period during and after their use.   The concept of a sensory diet is an appropriate image, as it feeds the brain with some of the information that doesn’t get transmitted from joints and muscles.    Sensory diets require some effort and thought, just like food diets.  Just bouncing on a therapy ball and jumping up and down probably will not do very much for any specific child.  Think of a sensory diet like a diabetic diet. It doesn’t make the pancreas start producing insulin, but it helps the system regulate blood glucose more effectively.

Managing low muscle tone for better movement, safety and function is complicated.  Step one is to understand that it is more than a child’s rounded back when sitting, or a preschooler that chews his shirtsleeve.  Step two is to make a multifocal plan to improve daily life.

For more information on life hacks for toilet training, dressing and play with children that have low muscle tone, please look in the archives section of my blog for targeted ideas! My post and are new posts that go into more details regarding life with kids that have sensory processing issues.

For personalized recommendations on equipment and methods to improve a child’s functional skills, visit my website and buy a 30-minute consult.  We can chat, do FaceTime, and you get the personal connection you need to make your decisions for your family!

 

 

Active Baby? Active Mom? It May Be Epigenetics Again….

This week’s New York Times ran a story  Does Exercise During Pregnancy Lead to Exercise-Loving Offspring? that echoes what I told a mom last month during a Happiest Baby consult about how her behavior during pregnancy “taught” her son to love movement.  She is an athletic woman, a pediatric physical therapist, and her baby really didn’t calm down fully unless he was jiggled or swung.  He just craved movement.  I am not sure if she really bought my explanation about needing to recreate his womb environment to help him feel calm.  After all, she was just doing her normally active life while pregnant.  After delivery, she went back to work almost immediately.  He was laying at home in the pack n’play, trying to tell everyone (by being fussy at times) that he relaxed best by being more active too!

This article is a little complicated, and they spent a lot of time explaining rodent research.  The coolest part?  Much more of the totality of life “in utero” and immediately after birth might directly influence the DNA of a baby!  The authors did mention that this isn’t an opportunity to lay guilt on mothers, something that is done much too often.  Parents don’t need that.  This little article briefly highlights research that suggests the possibility that the entire experience of the pregnancy is important, not just prenatal vitamins and avoiding raw milk.

I wish, of course, that they had mentioned how important it is to understand the need to support newborns by providing the “4th trimester”, as Dr. Karp calls his amazing baby calming techniques.  It is entirely possible that lots of babies progressively need less movement as they develop other ways to self-calm.  And some may have had their DNA tweaked so that they simply can’t wait to get up and move.  Right from the start.

I told the mom at her consult that she had better prepare for her son joining a travel team in the future.  But knowing her, I think she will be totally OK with that!