Monthly Archives: May 2016

Low Tone and Toilet Training: Transition to Using The Adult Toilet

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Once the potty seat has been mastered, the question soon becomes: How is she going to use a regular toilet?  Most younger children use a step stool and an insert to sit securely on an adult toilet.  Kids with low tone often need a little more assistance to get up there and stay stable.

Here is what your child needs to be able to do in order for her to climb up and use a regular toilet with an insert:

  1. Have enough sphincter control to “hold it” while getting clothing and positioning right.
  2. Be able to manage easy clothing independently and have awareness of their needs for clothing management.  This means that if you have to tell them what to do or how to fix their clothes, they are not that independent yet.  Will you still help them?  Maybe, but if your child is able to know when her panties are down low enough, and a boy knows that he picked up his shirt before he pees, then your child can be a responsive participant if they find themselves unstable and need to think on their feet ( pun intended).
  3. Be stable while momentarily standing, either to manage clothing, while turning around, or for boys, to pee standing up.  Some little boys will pee in sitting for a long time, others (usually the ones with big brothers) demand the right to stand.  Aim is a lot harder if you are not standing in a stable position.  The handles on the following item give young children something to hold onto.  Just like seniors, grabbing a towel bar or the paper holder is a risk.  Every time they reach too far, their balance is altered.  That can be a huge help, compared to just a step stool.

41lLLbRbbkL._AC_US160_The best support with a step that I could find anywhere is the Mommy’s Helper Cushie Step Up Potty Seat.  There are a few available models with this basic design, but this one gets the best reviews for stability and ease of use.  If a set-up is wobbly with a typically-developing child, a child that has issues with safety and control in other situations is going to be in trouble as they climb up to use the toilet.  It doesn’t do as well with an elongated seat as a rounder one.  The contoured seat grips that tushie a bit more, and the texture and softness of the seat prevents accidental sliding as well.  This is not permission not to supervise for a while.  Kids are unpredictable, so a wobbly child might need your eyes just to see what will throw them off their focus and put them at risk of falling.

52733343312610pThe Baby Bjorn footstool is an amazingly stable choice.  The legs have rubber grips all the way around, and the top is super-grippy.  Even when wet!  It is hard to tip, and it is so sturdy that adults can stand on it without any problems at all.  Easy to clean too!  If your child can use a step stool instead of a ladder, this is the one.  Little boys that pee standing up will stand on this and hold the top of the tank or the back of the adult seat to steady themselves to aim.  The biggest problem for some kids is that sometimes it isn’t wide enough for the kids that normally stand with their feet very far apart (your OT or PT will call that a wide base of support in their progress note).  Their feet might go to the edges, seeking that same wide stance.  Not safe.  Practice having them standing on it without using the toilet, so that there are no surprises about how to climb and turn in a small space.

Remember, they have to get up there first, then pull down underwear and clothes.  Trying to climb stairs with pants around your ankles is asking for trouble.  Just try it yourself some day!  That means that clothing choice still matters.  Nothing with belts, long tunics or long skirts, tight leggings or skinny jeans.  Unless you want to do all the work and slow down their learning curve.

Hint:  Having kids develop independent dressing skills when they are off the potty, i.e. getting ready for bed, dressing to go to daycare, etc. is essential.  I started writing “important”, but that is not accurate.  It is essential.

These kids need chances to build smooth and fast movements under pressure.  The only way to get there is practice and learning from repeated opportunities.  Good teaching is nice, experience is better.  The more automatic and controlled a skill is, the less difficult it will be to execute it when rushing to make it to the potty.  Being able to manage clothing without even trying to toilet train is important.  If your low-toned child is miles away from getting on the big toilet, and you are reading this for future reference, then today’s goal might be for her to to help more with getting dressed.

If your child is still struggling, you may want to install a child-height potty temporarily.  they are available online through big box stores and easy to swap out when your child grows.  Read more about how using the right height potty can help your child in Should You Install a Child-Sized Potty for Your Special Needs Child?.

Looking for more information on low tone and daily life skills?  Check out Low Tone and Toilet Training: Teaching Toddlers to Wipe , Is Your Child With Low Tone “Too Busy” to Make it to the Potty?and Low Muscle Tone and Dressing: Easy Solutions to Teach Independence.

My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is finally done!  You can buy it at Your Therapy Source (a great site for parents and therapists), Amazon or on my website, tranquil babies.  I cover all the prep you need to do for success, help you address issues like constipation and language delays, and even deal with the inevitable setbacks that arise along the path to independence.  Read more about this unique book at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

Wish you had someone to ask about toilet training a child with low muscle tone?  You do now!  Visit my website,  tranquil babies , and purchase a phone consultation to get personalized attention, and a chance to ask all your questions!

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Out Of The Swaddle And Into The Frying Pan

Those first 2 weeks of life are pretty simple:  feed, sleep, diaper.  Lather, rinse and repeat.  From about 2 weeks until 12-14 weeks, the Happiest Baby strategies for getting a baby calm and sleeping soundly really do work to keep newborns (and parents) happy.  I am a certified Happiest Baby educator, and it is relatively easy to decode the common complaints of newborns in those first weeks and months.  In fact, using The Happiest Baby techniques can make it easier to see true medical problems that fussiness and intractable crying were masking.  This is one of the best reasons to learn these techniques if you or your partner are not pediatric clinicians.  And maybe even if you are.

After that period, the swaddle is replaced by a sleep garment, side and stomach positioning to calm doesn’t have much of an effect, and the swing is put away in the garage.   Using white noise can continue, and so can the pacifier.  If so, then why is this period a minefield for accidental parenting?  Because changes in behavior that are just normal development aren’t anticipated and interpreted.  All you fans of the 5 S’s of Happiest Baby on the Block, here is what is coming down the line:  big changes that you need to anticipate and manage in a forward-thinking manner.  It won’t be so simple at 4 months.  Don’t be nervous; keep your eyes open and read the rest of this post!

I am a big fan of The Baby Whisperer’s books, with her strategies for a flexible but firm routine in the first year.  Tracy Hogg’s infant routines can seem a bit rigid to some parents, but if you asked a little one, they don’t find reasonable routines (not rigid ones) to be strict.  Routines help little people know what to expect and when to expect it.  Trust me, the younger you are, the more it helps to use routines to communicate.  Without the ability to speak, babies can’t tell us what is going on for them either.  Knowing that a child is behaving inconsistently is an important way to see a leap in development or an emerging illness.  How else would you know that refusing to nurse is because of an actual problem instead of being overtired?  Without a baseline of regular behavior at regular times, it is much harder to see inconsistent reactions that signal distress once babies are more complicated.  And at 4 months and up, things get more complicated.

Take a look at the Baby Whisperer’s  E.A.S.Y. plans for eating, activity, sleep, time for you at different stages.  Beware of what she calls “accidental parenting”.  Dr. Karp does a nice job talking about this trap as well in his great book The Happiest Baby Guide to Great Sleep but I think that Tracy Hogg gives more helpful hints on schedules and real-life baby day scenarios.  Accidental parenting is like John Lennon’s famous line “Life is what happens when you are busy doing other things.” Accidental parenting happens when the solution to a heat-of-the moment problem results in habits that cause bigger problems.

A good example is a young infant that is fussy and falls asleep nursing, and after a few nights of this super-easy way to get him to sleep, now cannot fall asleep any other way.  Why is this a problem?  Because when mom is at the store, this child is exhausted and unable to nap.  He also cannot sleep in his crib or anywhere else but on his mom.  This is not a child who is experiencing the warmth of connection:  this is a child who is uncomfortable unless he has exactly one situation and one alone.  He has accidentally been taught that there is only one way to settle and sleep, by the very people that want him to feel safe and calm in his own body anywhere.   That is the problem with accidental parenting.  The actions taken were a short-term fix for a problem, not a real long-term plan for greater peace and flexibility.

Both the Baby Whisperer and Dr. Karp have similar solutions for you if you have done some accidental parenting at this young age.  Again, I am going to say that Tracy Hogg gives you more details about the solutions, but they both have good ideas. The most important things to remember about their solutions:

  1. Have confidence that your future vision of calmness and your newly-found knowledge from these experts will work.  The current atmosphere is to distrust “authorities” of all stripes, but there are people that know their way around these early months.  If you distrust everyone, you are left hoping that your guess is the right one.
  2. Learn to read your child’s cues correctly.  They both give you information that can counter there frantic sense that there is no rhyme or reason to all that fussiness.  You can only interpret these cues if you know a lot about normal development and pay attention to your child over time.
  3. Expect change, and learn what the next stage is.  Everyone changes, but babies change fast.  A 6 week-old and a 6 month-old can be so very different.  That is only a difference of a few months but it is an eternity in infant development.  Stay on your toes and anticipate this.  You are the receiver and that child is the quarterback.  Pay attention and get ready for new signals.  Sorry to confuse those of you who don’t follow American Football.  But I think you get the general idea.  Anticipate change.
  4. Don’t expect an easy fix, and don’t waiver in your commitment.  The older the child, and the stronger their temperament, the longer a habit created from accidental parenting takes to shift.
  5. Get support, and don’t try a strategy that you really resist.  Forcing a child is not what routines are about, and if you need to tweak a strategy, then do it.  If you are the parent that can’t handle even a little fussing, then switch off to your partner to help your child realize that his distress about switching from nursing to sleep to sleeping another way is habitual and can change.  Because it can.
  6. Notice when you are unrealistic about what babies can manage, or if you are so uncomfortable with any fussiness that you are qualify as a victim of Tracy Hogg’s “poor baby syndrome”, in which you feel so guilty about any crying for any reason at all that you lose your wider view of what a child needs.

Accidental parenting is nothing to be ashamed of.  This parenting thing is hard, very hard, and everyone is doing their best.  I really believe that.  Habits can change, and things can go forward successfully with a different approach!

Teach ASD and Sensory Kids How to Manage Aggression

Little boys as young as 2 use play fighting, crashing, and even pretend killing in their play, without anger or intentional destruction or injury. Is this a very bad thing?   I was challenged this week three separate times to explain why I would initiate physical play that can look aggressive (think crashing cars or our ninja pictures fighting each other) with younger boys that struggle with behavior issues in daily life.  These little boys aren’t good at managing aggressive impulses, at using words to express thoughts, or handling all the excitement that physical play brings out in them.  Their teachers often have to stop all aggressive play at school if the administration has a zero-tolerance policy.  But someone has to help all the little guys figure out how to express their desire to get physical without getting into trouble or injuring someone.

I told the parents of the boys I treat that I want to provide a safe space for them to learn how to express their aggressive tendencies, and to witness an adult modeling how to be physical, have fun, and do it all with respect and affection.  To learn all that, they needed an adult who was not automatically forbidding aggressive physical play.

If I forbid all pushing, grabbing, growling, shouting in fun, then those aggressive behaviors are almost certainly going to come out as defiance and even destructive behaviors that will require a loss of a privilege or even a time out.  Feelings and impulses don’t evaporate.  They go somewhere, and they can go to places that are much less constructive than crashing cars together on a warm spring day.

For little boys who have issues like sensory processing disorder or autism, it is absolutely essential to teach them how to manage aggressive play in order for them to succeed in the wider world.  That is everyone’s goal, to be able to play happily in a mainstreamed environment and without adults controlling the events.  These kids often don’t manage any of their emotions well, becoming overwhelmed very quickly.    They can have difficulty following what other kids are doing once the wilder play gets going.  They can’t stop their actions when another child says “stop” or change to another game.  And they don’t read subtle cues that the game is changing or that their behavior is not appropriate for the current game.

Teaching specific strategies and practicing them with trusted adults can go a long way to building success on the playground.  Pediatric occupational therapists who trained with the amazing occupational therapist Patricia Wilbarger and her crew of therapists that pioneered sensory diets know about “play wrestling” for deep pressure input.  That is the kind of physical activity that calms kids down and helps them gain positional awareness.  Modeling specific safe ways to engage someone else physically, what to say when you have had enough, what to do when the other guy is saying “STOP”, and demonstrating how to be silly without being physically intrusive are all important.  Simply instructing a child without modeling the behaviors and playing with them isn’t as effective.  Adults have to get in there and communicate using kid’s play, speak about emotions and interests, and have fun!

 

 

 

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Kids with low tone benefit significantly from supportive seating for eating, playing, and yes, toileting.  Picking the right training potty can make all the difference for them, and their parents. My new favorites for smaller children (smaller than the average 3-4 year-old) are the Little Colorado Potty Chair and the Fisher Price Custom Comfort Potty seat.  For older or larger children, I suggest that you take a look at my post on using the adult toilet for equipment ideas. Equipment matters, it really does. Why? Let me give you a short review of what potty seats need to provide for children, and why.

Low muscle tone makes children less stable, and when they are using a toilet, they are not sitting/standing passively. For little boys, you also have to consider standing to urinate. Although it can be easier to start teaching a boy to urinate in sitting, it seems to me that it quickly becomes natural and physically easier for all but the most unstable boys to shift to standing. This means that they may need to hold onto the raised seat for stability or hold onto the edge of the vanity cabinet or even a handrail.

Selecting a potty seat is seating them for action!  They need to be able to sit straight, get on and off independently and safely, and feel stable enough to let go.  The right seat will let them be slightly flexed forward with knees up above their hips a tiny bit.  This allows them to use their abdominal muscles more effectively to perform a gentle Valsalva Maneuver.

This position is the way traditional cultures “make”; they squat and bend forward, increasing the intra-abdominal pressure to help empty their bowels without straining or holding their breath.  Children with low tone almost always have weak abdominal musculature, and can even have poor smooth muscle contraction of the lower intestine.  That slows the timely movement of feces, contributing to constipation and straining.  Have you ever had the indignity and frustration of trying to have a bowel movement in a bedpan?  Enough said.

Learning a new skill, a skill that is not visible and involves both motor, sensory and cognitive abilities, is best done with equipment that fully supports skill development.  Children often have fears, including fears of falling in.  They get frustrated and don’t want to bother to sit when they could be playing.  The list goes on.  Pick well and a child can learn faster and become more independent.  Pick poorly and learning can be slower, more uncomfortable or embarrassing, or convince both of you to just give up for now.  Want your OT or PT to help you decide?  Read Low Tone and Toilet Training: How Can Your Child’s Therapists Help You ?  and see all the things that therapists can do to help you train your child.

And of course, my e-book, The Practical Guide to Toilet Training Your Child With /Low Muscle Tone will help you will all aspects of potty training.  Read more about this unique book, available on Amazon and Your Therapy Source here:

The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

Here is a short review of what my favorite seats have to offer:

Fisher Price Custom Comfort Potty Seat

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Pros:

  • This seat delivers a lot of support, with both a high back and armrests.  A child can feel very supported and safe.
  • Kids can use the armrests to re-position themselves independently and get on/off with less or without help.
  • Small size helps the younger or smaller child get their feet flat and have a better sense of their body position.  Even with the ability to raise the seat an inch or two, it is pretty short.
  • All-plastic construction is easy to clean.
  • A splash guard is molded into the bucket for those little boys who need some redirection.
  • Compact size is easier for travel.  Not if you have a Mini Cooper perhaps, but if you have larger car, you will be able to take your child’s comfortable potty with you on trips.  Nothing ruins a good time like accidents or constipation because a child is too anxious or unstable to “go”.

Cons:

  •  this is not one size fits all; the older and wider child could feel cramped or have their knees way too high for good posture or even comfort.  A shallow seat makes it harder for larger boys to aim accurately when peeing, and doesn’t give taller children of both genders enough input through their thighs for postural control.  Imagine sitting on a tiny little seat; you have to work extra hard to stabilize your body.
  • The short curved armrests may be angled too much to help with standing/sitting if a child really needs support.  They are not independent if they need help to get on and off the potty.

Little Colorado Potty Chair

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This natural wood chair looks like what it is: a traditional commode-style potty.  You can get it in a painted version, and I would opt for that, since the extra layers of finish should be the easiest to clean.

Pros:

  • You can get some add-ons that have benefits: a toilet paper holder and a book rack that attach on either side. The TP roll holder gives a child some independence with wiping (as long as they don’t think that rolling it out to the end is a fun game) .  I would think twice about the book rack for a child that struggles to perceive sensation from the bowel or bladder.  Lots of kids like to look at books while waiting, but for some kids any distractions hinder the ability to accurately perceive bladder/bowel information.  Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!)
  • This chair has a wide, straight back and straight armrests for extra stability and support.
  • This chair is higher, wider and deeper than the FP chair above.  For bigger kids or older children who are being trained later due to developmental delays, this is a big help.  It is hundreds of dollars less than the adapted toilet chairs that kids with more severe or multiple delays really need.  Most children with low tone are not going to need that level of stabilization, and getting more support than you need is not helpful, it slows down independence.

Cons:

  • The bucket insert doesn’t have a splash guard.  That means that little boys especially must be positioned well.  Kids with low tone often shift around more than the average toddler, so keep and eye on the position of everything while using this seat.
  • This chair is not travel-friendly, unless you drive an Escalade or a Tahoe.  It is affordable, so if you have a summer home or if you visit relatives regularly, you can pick up a pair and leave one there.

Neither chair plays music when you pee, has characters all over it, or does anything else but let your child sit there in peace, stable and ready to do the deal.  If you truly need those other things, I guess you could sing a potty song and find some stickers.  Hopefully your child will be able to train quickly and then advance to the next level:  using the adult toilet.

If you have a tall toddler, or your child is over 3.5 years of age, you may not have much choice.  The best system for very unsteady kids is shown in this post Low Tone and Toilet Training: Transition to Using The Adult Toilet , and I have also seen people use something call the Squatty Potty footstool for a bit higher support than the Baby Bjorn stool that I love. The area for foot placement is relatively small, so kids that pay no attention to where their feet are might not be ready for this one.  The squatty folks make a foldaway one with a tote bag that you could take when you go out and use discreetly in public toilets.  Genius.  And then there is the child-height toilet.  It isn’t difficult to find online, and even the big box stores like Home Depot and Lowe’s carry them online.  It can mean the difference between fear and confidence, so check out Should You Install a Child-Sized Potty for Your Special Needs Child?.

Want more information about toilet training the child with low tone?  I wrote a book for you!  Visit my website tranquil babies and click on the e-book section in the top ribbon. It is also available on Amazon.com and Your Therapy Source.  This book gives you extensive readiness checklists that help you make a plan, it teaches you how to navigate problems like refusals and fears, and explains why low tone is such an issue with toilet training!

Looking for seating that isn’t a potty seat?  Check out The Cube Chair: Your Special Needs Toddler’s New Favorite Seat! ,  Kids With Low Muscle Tone Can Sit For Dinner: A Multi-Course Strategy and A Simple Strategy To Improve Your Child’s Posture In A Stokke Tripp Trapp or Special Tomato Chair.

Great Mechanical Pencils Can Improve Your Child’s Handwriting Skills

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Great mechanical pencils for kids !

These pencils help students with the following handwriting issues:

  1. They use too much force while writing, and the pencil tips break frequently.
  2. They need more tactile information to achieve and keep a mature pencil grasp.
  3. They rarely notice that they need to sharpen their pencil to improve legibility.
  4. Getting up to sharpen a pencil distracts or disorganizes them so much that it extends the time to complete assignments.

I usually do not recommend mechanical pencils for the earliest writers, but that changes after the first half of second grade.  Once a child is facing the volume and speed demands of later second grade or above, it is time to be creative and think outside the box.

Working on the physical skills and the sensory processing skills that cause a child to struggle with grading force, perceiving tactile input, and monitoring their performance is still important.  They would probably take away my OTR license if I didn’t say that!

The problem is that sometimes life hacks are essential to keep a child functioning and feeling like a success.  Having the right equipment is an important and easy life hack for the child that already (at 7!) thinks of himself as a bad writer.  Using this pencil can be one of those “low-hanging-fruit” situations where performance improves while skills are developing.

PaperMate hasn’t targeted the kids with low tone, sensory processing, ASD, ADHD, or any other issues, and that is actually a nice thing.  Older kids don’t want a “special” anything in the classroom or even at home.  They might reject seat cushions and pencil grips that help them because they don’t want to look different or feel different.  Well, these are easy to get at office supply stores.  There is nothing “special” about them at all, except that they really help kids write neatly.

  • The pencils have #2 leads, a good eraser, and come with both extra lead and erasers.  We all know that running out of erasers will communicate “I don’t really need to erase that mistake” to a child.
  •  The colors are appealing to kids, but not infantile.
  • Adults know that their handwriting will immediately look better with a fine point writing utensil, but kids do not.   Children that have visual-perceptual or executive functioning issues often struggle to accurately assess what is causing their handwriting to look illegible, and then take the appropriate action.  They just shrug it off and say that they are simply “bad at writing”.
  • The pencil shaft is smooth, but the thick triangular shape adds much more tactile input than a regular pencil.  Feeling an edge, rather than a cylinder, is often just enough tactile feedback to remind kids to reposition their fingers without an adult saying “Fix your grip”.  Kids get so tired of adults telling them what to do.
  • The triangular shape limits how often the pencil rolls away or rolls off the table.  For kids with ADHD, that can be enough to derail homework without any drama!
  • Finally, mechanical pencils seem more grown-up to children than standard pencils, and you can spin it as such.  What a nice opportunity to be positive about handwriting!

What happens when your child makes a mistake and needs to try again?  They need the best eraser!  Check out Problems With Handwriting? You Need The Best Eraser , because the erasers on these PaperMate pencils are good but not great.  Having the best equipment positions your child for success!

 

 

Easy Ways To Build Bilateral Hand Coordination for Writing

Why do we need to use two hands for writing?  After all, you only need one hand to hold a pencil.  Well, did you ever injure your non-dominant shoulder or wrist? Without a hand to steady the paper and move it accurately as you write across a page, an adult will write like a preschooler or worse.  When you write, you are using one hand for writing and the other for balance, posture, paper stabilization and paper placement.  Bilateral hand coordination begins before a child’s first birthday and develops through early childhood.  Without it, handwriting is certain to be a challenge.

So many kids that struggle with crawling and walking as infants and young toddlers will continue to have difficulties using both hands together as preschoolers.  Occupational therapists like myself often observe that that they are not using one hand as a “prime mover” ( grabbing, reaching and writing) and the other hand as a “stabilizer”, i.e. holding a container or paper in a skilled manner.  What does it look like to stabilize a container with skill?  The container is held using just enough force and with the opening angled to allow the other hand to fill it without dumping the contents out. Take a look at my post  Better Posture and More Legible Writing With A “Helper Hand” to explore why that stabilizer hand placed on the table is essential for good handwriting.  Problems with bilateral control are often seen with children with ASD, SPD, and many neurological issues such as low muscle tone, but bilateral control delays can exist without any formal diagnosis.

Most handwriting programs, such as Fundations, do not pay much attention to the underlying physical skills needed for legible handwriting.  Handwriting Without Tears does an excellent job of teaching educational staff to remember the physical aspect of handwriting. Children ideally need good bilateral coordination BEFORE they begin hard-core handwriting instruction, not after.  If a child has identified neurological or developmental challenges that contribute to limited bilateral coordination, working on these skills are essential to prevent compensations and delays in handwriting.

As an OT working with kids over 4, when those basic bilateral control and grasping skills should have been achieved, I have to decide whether to spend precious time in every session on handwriting or on the basic abilities (coordination, strength, visual-perceptual, and sensory processing) that support handwriting.  Usually, I end up doing both, building target skills with intensive and complex treatment plans while I am working on handwriting instruction that gets kids up to speed as quickly as possible.

I am going to guess that if some of my toddlers and preschoolers in treatment had received more daily home and school practice with the following activities, I would have more time to teach great writing strategies.  For every parent that has asked me for some effective methods for early bilateral control skills, here you go:

  1. Do not hold or stabilize toys too much for them while playing.  Let them figure out that they need the other hand to steady a soft but large object or container.  Kids will often ask adults to hold a bag for them during clean up.  Your response?  Place their “helper” hand effectively on the bag and direct them to use the other hand to pick things up.  You did help, but you didn’t enable more dependency.  Safety first, so always support a container that could shatter or injure them if it dropped and broke.  But if the contents of a safe container spills?  That is another lesson in coordination to be learned by the child.  Encourage and reward a good clean-up effort!
  2. Provide good containers that demand bilateral skills. My Ziploc post Develop Pincer Grasp With Ziploc Bags also develops bilateral coordination during snacking (one of my favorite times of the day!).  Another fave?  Store little toys in the cosmetic bags with nice big zipper pulls that the department stores include with free-gift-with purchase events. Ladies, if you love makeup as much as I do, you have a pile of these in a drawer somewhere.  If not, the local drug store probably has a selection.  When a container is soft and collapses, it is a greater challenge to stabilize and open.  Challenge is good.
  3. Encourage your child to turn the pages of a book while holding the book on their lap when sitting on the bottom step of the stairs or a low bench.  With the book resting on their lap with one hand holding it, there will be no chance for the floor to hold the book, or for you to do it.  If it is a really heavy or large book, either give them one finger’s wobbly assistance under the book, or pick a lighter/smaller book.  Some of my clients would rather let me hold the book, so I try to have something in my hands to prevent them from asking for assistance rather than working hard.  I cheer them on, and make sure they have great books to look at every time!

 

Build Pre-Writing Skills With A Focus on Scribbling

The greatest criticism an older sibling can level at a young child’s drawing is to call it “scribble scrabble”.  But wait!  If you want to develop finger control for future handwriting success, then you want more scribbling and coloring!  Random strokes aren’t going to move the needle forward for a child older than 3 years of age with typical visual and motor skills.  This is the time for good tools and materials that are selected to build skills and creativity.  Before a child writes letters, coloring and scribbling with intention and focus builds hand strength, hand control, visual-perceptual skills, and more!  Here are suggestions on  how to harness the power of the scribble with young children:

  1. Pick sturdy paper.  Young children are learning to control the amount of force they use, and if the paper tears, they can become discouraged.  Cheap coloring books have thin pages and will not survive the enthusiastic strokes of younger children.  Print out pictures from the internet on your thickest paper or buy great coloring products from companies like Melissa and Doug.  Their coloring pads use wonderfully sturdy paper.  Short on cash?  Study the quality of your junk mail.  Some of my junk mail uses nice sturdy paper, so I flip it over to the other side and use it for scribbling.
  2. Some threes and fours enjoy the possibilities of a blank page, but there are young children who color more, and color longer, on a simple graphic that is meaningful to them.  Handwriting Without Tears does an especially good job with their “My Book” and their preschool workbook pages.  I also search the internet for free coloring pages that have simple drawings with strong appeal.  In therapy, I will find very simple coloring pictures that have designs that require the target strokes a child needs for writing. Develop circular strokes and small wiggle strokes with bubbles or chocolate chip cookies, and swords or kite strings drawn on a diagonal for a child that is practicing “K” or “X”.  Coloring on a simply drawn Darth Vader or Rapunzel picture is so much more fun for these children than filling in a geometric design.
  3. The shape and coloring properties of your tools matter more at this age.  Handwriting Without Tears sells their flip crayons, those tiny two-sided crayons that require a tripod grasp.  Genius. But some of my kids, even the 4 year-olds that the flip crayons are designed for, need a thicker crayon.  They have low muscle tone or another issue that affects their ability to sense what is in their hand.  They need more “square footage” to refine their grasp in this pattern.  I break the thicker crayons in two.    Crayons are waxy, and that waxy grippy-ness helps kids feel what their hands are doing.  Markers just glide, and don’t give the kids with low tone or coordination issues enough sensory information about what is happening as they color.
  4. Look beyond the crayon.  Chalk has the same grippy input as crayons, plus the sound on a chalkboard gives another sensory reinforcer to boost attention.  Don’t buy thick sidewalk chalk and expect to build pencil grasp.  It is way too wide for little fingers.  Buy thin chalk once a child doesn’t press so hard that it crumbles all the time.  One of my clients used pastels for extra grippy input and fabulous colors.  They were super short but a little thicker than flip crayons.  He graduated to Crayola’s preschool pencils and is on his way to a standard pencil.
  5. For kids whose strokes barely registered paper when they scribble, the Magna-Doodle boards with magnetic pens can reward them with a dark mark on the screen from only light touch.  Finally, a tablet stylus (my favorite is iCreate’s stylus that looks like a preschool crayon) also gives some resistance and actually builds control while trying to drag and swipe while using it.
  6. Why haven’t I mentioned pencils?  Because until a child has a decent amount of control with their strokes, I agree with HWT and don’t bring pencils into the conversation.  Pencils require a lot of control to avoid falling into a fisted grasp.  I did review Crayola’s preschool pencils last yearPreschool Pencils That Develop Hand Control (and with tips that won’t constantly break!), and I use HWT’s pencils with the older 4’s and all kindergarteners.  This year I started using the Grotto grip The Pencil Grip That Strengthens Your Child’s Fingers As They Write.with thin colored pencils for my kids that did not progress their grasp pattern with a heavy diet of play-based hand strengthening, but had all the other components of readiness to start writing.   It has worked better than I ever thought possible!
  7. Color with a child and make your comments count.  Why?  Preschoolers don’t always want to be told how to do something, but they watch everything we do and listen to everything we say.  Describe exactly how you plan to do a good job, how you match your stroke to the shape of the design that you are coloring, and how you fill in a design without going over the lines.  Be proud of your work if you want a child to value their efforts too.  Narrate what you are doing and why with lots of details, But don’t direct the child to copy you.  They might start to do that spontaneously.
  8.  Extra Bonus Round:  Use prepositions and describe shapes that kids need to know in order to follow handwriting instruction later on.  They need to find out what is right and what is left, what the top-middle-bottom of a shape means, and what triangles, rectangles,straight lines, curves and diagonals are.  HWT teaches all that in the preschool book, but if you are using these concepts with 3.5-4.5 year olds, you never know what is going to stick.  It all adds up to writing readiness.

Best Preemie Toy? Try An O-Ball Toy For Easy Grasping And Playing

 

Preemies often wait a long time to start playing.  NICU life isn’t about fun, it is about survival.  Once your preemie is home, you will want to get the party started.  If she has a weak grasp or isn’t coordinated enough to easily hold every rattle and toy that you got for your shower, you might want to consider the O-ball to develop visual-motor skills.

O-ball

The Original O-Ball!

This is the basic O-Ball, a great toy that I recommend for my 1-4 month clients.  I also recommend the next generation O-ball toys, such as the O-ball car, for equally easy grasp with my slightly older preemie or developmentally delayed kids.

Why do I like this ball over cloth balls or those bumpy sensory balls?  

  • The web-like design allows a child to hold it with almost any type of grasp.  Low muscle tone, spasticity, or weakness reduce a baby’s ability to grasp and retain a toy.  It just isn’t fun if your toy keeps falling out of your hand.
  • Texture, but not too much texture.  The plastic is a little bit grippy, so it doesn’t fall out of her hand like a smooth plastic ball, but not so textured that a sensitive infant would find it overstimulating.  Preemies sometimes leave the NICU a little overwhelmed by sensation, and yet many need the extra touch input to really feel what is in their hands. This ball is a good balance of tactile inputs.
  • Fun at a fraction of the weight.  A baby that has strength or tone issues needs lightweight toys to pick it up easily and continue to hold it as gravity pulls the ball down and out of his hand.
  • The O-ball is large enough and light enough for 2-handed grasp, an important developmental milestone.  As an OT, we know that using two hands at midline (the center of your body) supports all the other movements that require a sense of moving around a center…rolling, crawling and walking!  Start now to develop awareness of midline and two-handed activity.
  • Second and third generation O-balls have built-in rattles and are more colorful than this one.  None have sharp edges or pieces that can fall out.  Safety first.
  • Did you say “Spit up”?  Wipes clean in an instant.
  • It is a bit squishy, which means it will bend, not break.  If your child drops it on her face or on the floor, she might cry from surprise but not from injury.
  • It will still be fun to play with next year.  This ball will still be fun to roll and throw later on in life, unlike those rattles that will be tossed out in a few months.

Here is another great post for parents of NICU graduates: Baby Wearing for Premature Babies

Is your preemie hypermobile?  I wrote an e-book just for you!

The JointSmart Child:  Living and Thriving With Hypermobility Volume One:  The Early Years is finally out!  I include techniques to hold and carry your child, how to use infant exercisers and how to do “tummy time”  with a hypermobile baby.  There are chapters on how to talk with your family, babysitter, and even how to talk to your pediatrician about your child’s needs.  You can buy it on Amazon.com today!  Don’t have a Kindle?  NP!  You can read it on any screen or desktop.  Want a printable copy?  Buy it on Your Therapy Source today!

Live in the NYC area and want to learn infant massage for your preemie?

Visit my website tranquil babies and make an appointment for an in-home lesson designed just for preemies today!

Working Parents, Weekends, and Toddlers: Have a Better Weekend With These Strategies

I have been asking my colleagues about why so many working couples seem to be struggling with toddler behavior issues.  Initially, I was thinking that the shift between nanny/daycare routines and parent routines was creating inconsistencies.  But I found too many situations where that wasn’t the case.  There is a common speed bump for dual-career parents, for whom the evenings and weekends are both desirable and stressful.  It is the same issue for long-distance dating couples.  No one wants to have conflict when they are together, and yet giving in to whining and demanding inevitably sets up greater conflict.  I would like to share a solution that is not a quick fix, but it is an easy fix.  You just have to accept that juggling work and family means that how you react to toddler demands will determine how much fun you have at night and on the weekends.

Toddlers are 100% reliable in that their ability to self-calm and change routines is limited by their brain development.  Just like you can’t toilet train a 6 month-old (you get trained instead), disrupting a toddlers nap routine to go have a full weekend of fun will give you a brain that cannot and will not go easily to sleep.

Now combine that with the difficulties that toddlers have with limits and patience.  They don’t have to greatest ability to wait or to handle “no” unless they have been taught to do so, and practiced this skill frequently.  Setting limits or building a toddler’s patience is possible, but it isn’t usually fun, and it definitely is work for a parent.  Just at the moment that you wanted some hugs and smiles, you are doing the hard work of parenting, not getting the good stuff.  It is sooooo easy to just give in and hand over the phone so your child can play on it.

You can choose to use your long game at that moment to teach patience stretching  Stretch Your Toddler’s Patience, Starting Today! , self-control, and communication skills Turn Around Toddler Defiance Using “Feed the Meter” Strategies. Or play your short game, and give in to avoid conflict.  When you can no longer give in, because the pool is closed or it is time to leave the park, you may witness the mother of all tantrums.

Here is the good news:  what your child wants more than anything is your entire attention when you are home.  All that 90’s stuff about quality time is true up to a point.  If you aren’t around for the “pick-up game” opportunities during the day that allow you to share a laugh or a sweet moment, that means you have to engineer then from 6-8pm and weekends.  Yes, you engage with your child doing fun things that also intentionally build patience, empathy, and mutual respect.  It isn’t agony, it is fun!!  But it is something that you have put a little planning and creativity into.  I promise you, this is an investment that will pay off before your child gets to college!  It means that next weekend will have less whining and more smiles.  For both of you!

It also doesn’t mean you have to spend every one of those hours together, but it does mean that you have to be really present and really work to weave your connections together at that time.  Those “Feed The Meter” strategies have to be in there, because they give you the biggest bang for your buck.  How do I know?  I use no less than five relationship-enriching mini exchanges in any session with every challenging toddler I treat, every session.  I have 45 minutes to get a toddler to do therapy with me, and I cannot waste a minute of it on defiance or testing.  I won’t be back for another therapy session for a few days.  Once you understand what these relationship-building interactions are, you hand them out like candy.

Many toddlers can handle limit-setting and even consequences for defiance without a tantrum if they have had enough “Feed the Meter” enrichment in a day.  Setting those limits and handing out consequences is essential to build skills too.  Taming Toddler Tantrums Using Sympathetic ReframingToddlers Too Young For Time Out Can Get Simple Consequences and Kind Ignoring .Toddlers need to know what not to do, and when not to do it.

If you are a working couple and you have tried these strategies, please comment and tell other families what worked for you!

 

 

 

 

Sleep Training at 2 Months: Beyond Cry-It-Out

The Wall Street Journal’s writers are known for great reporting, but they clearly didn’t do a lot of research when they wrote today’s article Can You Sleep Train Your Baby at 2 Months?  Lots of agonizing parent reports of the cry-it-out method, and professional agreement that babies 8 weeks old don’t sleep through the night normally anyway.  They totally got it right that running and picking up a waking (but not screaming) baby is not going to teach good sleep habits, but there was no mention of pick-up/put-down, using Dr. Karp’s 5 S’s for deepening sleep in newborns, not even the use of swaddling to build a precious extra hour of sleep!

Parents who do not know how to handle the screaming and/or want to develop good sleep habits will go away from this article wondering if they can truly hack listening to an infant scream for the common “30-40” minutes.  What a mistake!!  Crying like that doesn’t do anyone any good.  It isn’t good for a baby or a parent, and can lead an exhausted and demoralized parent down the path to desperation, including falling asleep on the couch holding a baby (a documented suffocation or fall risk), feeding a baby large and frequent feedings to “sedate” them, or shaking that baby after nothing works.

Creating good sleeping behaviors in the first 3 months is completely possible and much easier to do than letting them scream.  But sleep at this age isn’t a full 8 hours, it isn’t done without creating a sleep environment that supports brain development at this age.  It takes some knowledge of baby development, some patience, and a willingness to accept that the techniques that work for a 3 year-old are ridiculous for a 3 month-old.  Apples and oranges, apples and oranges.

After a few years of being a Happiest Baby on the Block educator, I am becoming increasingly frustrated and discouraged with the situations I hear out in the world of baby calming.  My grandmother from the old country knew more about handling newborns than  most professionals with doctorate degrees!  Like the story of the elephant and the blind man, many of the professionals I meet are largely concerned with protecting their piece of the authority pie than helping babies and parents.   Researchers spend more time in universities and labs than out in the field, which is to say in people’s homes, calming babies themselves.  Yes, it really builds your skills if you have actually successfully calmed babies with your recommendations, not just assembled results of research studies.  This is not “anecdotal evidence”, my friends, this is real life experience.  Get some.

Parents, please, please, do not read the WSJ article and redouble your efforts at cry-it-out with young infants.  Read Dr. Karp’s book The Happiest Baby on the Block, watch his video, contact me or another certified educator, just do not think that this is all there is out there.

BTW, Dr. Karp’s book The Happiest Baby Guide to Great Sleep will take you all the way into the kindergarten year, with good advice about toddlers and preschoolers!

 

10 Easy Ways to Prepare Preschoolers to Write

Standardized testing has pushed the demand for handwriting down, down, down into preschool.  The great majority of preschool children by the end of the 4’s will not have the physical control of a pencil to write lowercase letters correctly, but some teachers tell me that their administrations require them to teach kids to write their names in title case (first letter in uppercase, remaining letters are lowercase) in preschool, in preparation for kindergarten!

Children that cannot write lowercase letters correctly because they cannot perform the reversals and back-tracing that this case requires will almost always figure out a way to “cheat”.  Not a criticism of children at all; these kids want to please.  So the”p” becomes a straight line placed next to a circle.  An “m” becomes two humps.  If not corrected quickly and effectively, I will be getting a call in a year or two for private tutoring.  I spend a lot of time doing home-based private work for families that paid for an expensive preschool, and it resulted in a child that created their own way to write lowercase letters.  Those adapted letters look cute when you are 4, even “advanced” to the uneducated eye, but they are just sloppy writing when you are 8. OOPS!

I cannot change the administrators’ attitudes about curriculum, but I can offer my very best suggestions to teachers of the 3’s and early 4’s who want to do right by these kids.  If you are being asked to teach lowercase letters this early, then your whole approach to writing needs to be well thought-out and comprehensive.  It’s like losing 50 pounds before a wedding: everything you do should contribute to your goal!  Yes, I said teachers of the 3’s.  Again, if a child is going to learn lowercase letters correctly at 4, that child needs skill development in the 3’s to get there.

This is a long post, and I am hoping that it will become an e-book so that teachers around the world will get solid advice that helps them.  Just telling you to buy a workbook or tiny crayons is not enough, not if you are being asked to bloom these little flowers early.

This does not mean that all you do is write.  If you have the HWT preschool teacher’s manual in front of you, you have a year’s worth of fun and multi-sensory activities to add to your lesson plans that incorporates language, social skills, pre-math awareness, and more.  The best pre-writing activities sometimes have no actual writing involved.  Small group play with wood pieces can be so much fun that kids don’t want to put them away!

  1. If you are going to expect pencil grasp this early, you must provide early and substantial opportunities for small object manipulation to build refined motor and sensory skills.  What does that mean?  As soon as they are not likely to swallow little items (use food pieces if you are not certain about this), have kids picking up tiny items and sorting/gathering/assembling them creatively. Expand this beyond just fingertips by using tweezers, chopsticks and all manner of tools.Take a look at Teaching Pencil Grasp Can Start with Edison Chopsticks
  2. Teach pencil grasp, don’t just expect it or wait for it.   HWT does this well, giving teachers easy group instructions.  Don’t let a really awkward grasp go by.  You are doing a disservice to the child.  If your teaching tricks don’t work, ask an OT for a screening.  You might need help in more areas than just grasp.
  3. Require a mature grasp by limiting the use of a fisted grasp with those giant dot markers, giant chalk, etc.  This is the time to care about materials.  Use small crayon pieces that are still a large enough diameter to support a fingertip grasp.  Find short brushes for painting, fun lacing activities that require a fine tip grasp, use q-tips for spreading glue, and more.
  4. Teach and practice the use of a mature spoon grasp as early as 3.5 years.  See my blog post Which Spoon Is Best To Teach Grown-Up Grasp? on the best spoon style and activities to build this grasp Using Utensils To Eat Prepares Your Child To Write.  Why?  Because you want every opportunity to build hand control.  Don’t serve spoon-able snacks in preschool?  Use real toddler spoons for tactile play and scooping manipulative.  Those plastic disposable spoons don’t encourage the stable grasp and provide a non-slip surface the way good toddler spoons can. This is what I do in therapy, since I can’t always have a snack session in OT.    Use them consistently and wash them at the end of the day.  Better yet, have your kids do it.  Manipulating soap, water and towels are great, and they build a sense of personal responsibility to maintain the classroom.  A win-win, in my opinion.  The spoons can go right in the kitchen area so that dolls get fed with them and pretend meals are served with them.  The fun never ends.
  5. Use the prepositions and stroke descriptions that are needed to follow letter formation instructions when you speak to children.  Explain what you are doing as you write, and what each stroke is called.  Young children have no experience with the language of writing.  None.  It would be like not knowing the vocabulary of cooking.  Knowing the difference between “whisk” and “fold”  in baking is important if you are going to be a good baker.  Teachers, this is the same thing.  Handwriting Without Tears has the simplest instructions, so that is one good reason to adopt this program for teaching young children.  Games with wood pieces and roll-a dough incorporate the language of directionality and naming of stroke shapes in group instruction.
  6. Guess what builds comprehension of spatial prepositions like “up”, “across”, “down”, etc?  Movement, and lots of it,enjoyed by children and described by an adult.  It is the difference between saying to a 3 year-old: “Wow, big jump!” and “Wow! You jumped down to the ground and then popped right back up so-o-o fast!”.  Research tells us that children from families with higher levels of education use more words and more descriptive words when they communicate with young children.  By the time these children have entered preschool, they have had this subtle education in prepositions that give them an advantage when handwriting and reading are taught.  Let’s give that advantage to all children.
  7. Handwriting is a bilateral skill.  Ask anyone who has had their wrist and hand in a cast how difficult it is to steady the paper with one hand!  If schools are going to teach writing as early as possible, it means that more targeted bilateral (two-handed) play activities in your classroom have to be offered.  Montessori teachers do this really well.  Carrying those trays, sorting and dumping containers, stringing and snipping with scissors all develop coordination with both hands working around a center, one hand stabilizing and supporting, the other performing the target action. You can get scissors into the hands of young children if you choose the kind that don’t injure them.  Lakeshore Scissors for Toddlers That Only Cut the Paper, Not the Toddler
  8. Body awareness and postural control are essential.  HWT uses Mat Man for body awareness and drawing, but there are other fun things too.  Toys that require balance are nice, but so is standing on one leg, hopping on one leg, walking on a masking-tape balance beam.  Of course, being a ROBOT on one leg is more fun, and so is being a DANCER on one foot.  Why wait for the day your kids go to “movement class”?  The free play time in the gym could be so much more than chasing each other or fighting over the pedal cars.  Small groups doing fun movement is good for teachers too.  We all need to move.
  9. How to sit at the table used to be taught at home with mealtime manners and such.  Even the kids in the 1% ( some of whom who live in the fanciest part of my own town!) sometimes haven’t been taught to sit at the table by 3.  It is time to teach it at school.  Teaching kids that sitting on their behinds with their feet flat is the way to get their bodies steady for writing would help.  Are your chairs too large for the 3’s to do this?  Hunt the school for a chair that fits the child.  Again, the Montessori people are really good at realizing that you can’t sit a 3 year old on a chair built for a 5 year-old and get good posture.  They have well-designed furniture in their classrooms, and it isn’t for decoration.  It is for function. Go online and see if you can get some for your class.  Tell the administration that it is an investment.  It is.
  10. Use coloring activities that build strength and control.  The single most important thing you can do to make coloring a pre-writing skill with young children?  Color together!  Even the kids who ignore you when you tell them to copy your actions will watch what you do.  My favorite move is to narrate my work, even make some mistakes and say out loud what I did wrong.  I get to model frustration tolerance but I also make an emotional connection and then I do a good job and show pride in my work.  We have to be showing genuine enthusiasm for writing and coloring if we want to transmit that value.  Select coloring pictures with simple backgrounds or none at all.  Young children simply cannot see the difference between the focal design and the background.  It is like those weird paintings that you have to look at twice to see the hidden items embedded inside.  Kids just won’t color on something like that.  They just scribble across the page.  Choose themes that are meaningful.  My most popular coloring page?  Darth Vader.  Very few little boys don’t want him to look good, and by good I mean menacing. And by menacing I mean all black except for the light saber.  OK with me!