Monthly Archives: July 2016

Low Tone and Toilet Training: Kids Need To See How It’s Done

Low muscle tone creates more challenges for toilet training, but that means parents need to focus on getting all the parts of teaching and practicing down right.  If your child is unfocused or inattentive when you speak about potty training, you can try books and videos. Sometimes the use of media will spark interest and generate excitement.   If you don’t see an immediate boost in interest and cooperation, then your child might need a front row seat for a live demo.  By you (or your partner).

I know, most of us want privacy for this activity, even between couples.  Most women I know aren’t enthusiastic about the idea of demonstrations.  But many kids, and almost all kids whose communication and attention skills are delayed, really need to see what’s going on when you use the toilet.  Kids that have issues like ASD may have been present for your bathroom routine but they were paying attention to something else.  It is time to make a point of having them watch this very personal but important skill.

Sometimes you pick the moment, and sometimes it picks you.  If your child happens to be around and nature calls, bring them along.  If they wander in while you are using the bathroom, don’t send them out.   You may also have to make this “appointment viewing”.  Plan for it, so that you aren’t tearing them away from an activity they have chosen.  Being dragged away from fun to stand there watching isn’t going to work.

Be descriptive, use nouns and verbs.  Saying what you are doing provides them with more language about these activities.  They need to know how to describe to you what they are feeling before and during.  If your child signs, it is time to learn the relevant signs and teach them.  Here is the place where the signs make sense, in the bathroom.

If your son thinks that peeing into the shrubs/snow outside with daddy is the best thing in the world, take the show outside, neighbors permitting. Not everyone is so open to this idea.   I know a family that said that this game was so much fun that her son begged for more juice so that he would have more urine available for the game!!

 

 

Great news!  My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is done and available!  Visit my website tranquil babies and click “e-book” on the top ribbon.  I will proudly say that there is nothing out there that explains exactly why low tone makes training so much harder, then gives you readiness checklists and real-life strategies that work!

 

Why Doesn’t Swaddling Alone Calm Newborns?

I attended a local function last night, and this question was on my mind as parents recounted their experiences with newborns and calming.  They thought that they were doing the swaddling wrong.  Or that their child was abnormal.  Not likely.  They just didn’t realize that for most babies, swaddling alone doesn’t do the deal.

As a certified Happiest Baby educator, I am aware that there are a small percentage of babies that are so mellow that they might not even need a swaddle.  These newborns just eat, poop, pee and sleep.  Anywhere, any time.  Having such a baby feels like winning the lottery.  It is, and it is almost as rare.  Dr. Karp estimates the percentage of “easy” babies as somewhere between 5 and 15%.  Enjoy it, but do not think that baby #2 will be the same.  It isn’t inherited, or your divine guidance, or that your husband is a gem.  You got lucky.

Most babies are in between as far as temperament and fussiness, and need at least some of the 5 S’s.  Swinging, sucking, side/stomach positioning (to calm only), shush-ing, and the swaddle.  They are only occasionally fussy, and it is clear to you what they need after you know the Happiest Baby moves.

And then there are the babies that he classifies as “spirited”.  You know if you have one of these.  Peals of joy, but also screams that could make the sheetrock fall off the walls.  If they are hungry, you’d think they were being starved.  If they are tired, they are hysterical.  If you don’t pick them up in time, they make it clear that you will rue the day you do that again.  They are not possessed, they are expressing a combo of lack of self-calming skills, a really immature brain, and a fiery temperament.  You need to do all the moves of Happiest Baby, and do them right.  I can help.  Read more of my posts, get Dr. Karp’s DVD, and practice the moves until you could teach my classes.

So, swaddling does work, it just isn’t the end of the story for most babies.  If you have a baby for whom swaddling isn’t enough, don’t give up.  Take a class, get a consultation from me or another educator, and don’t worry that a screaming newborn means a lifetime of this rollercoaster!

Is My Child Ambidextrous?

I answer this question from parents about once a month, on average.  Here is the better question: Is my child developing age-appropriate grasp?

The statistics are against your child being ambidextrous:  only about 1% of people are truly ambidextrous.  Being able to hit a ball equally well with either arm is valued on a team, but when they sit down for supper, switch hitters probably don’t use both hands equally to twirl their spaghetti.  But….children who have poor core stability often do not reach across the center of their body and switch hands to reach what they need.  Children who have motor planning or strength/stability issues will switch hands if the become fatigued or frustrated. None of these children are truly ambidextrous. They are compensating for delays and deficits.

Studies I have read on the development of normal hand dominance suggests that some children are seen as having emerging hand dominance (consistent and skilled use of one hand rather than the other) as early as 12 months.  You know those kids; they pick up cereal bits with their thumb and index finger at 9 months and pop them into their mouths individually as if they were sitting at a bar with a bowl of peanuts and a beer!  They delicately hand you the bit of string they found while crawling, and are already trying to unzip your purse.  Those kids.  It is more common to see emerging hand dominance in the 18-24 month range.  Developmental issues often delay this progression, and issues such as cerebral palsy can result in a child whose neurology would be expressed as right-dominant requiring more left-dominance due to hemiplegia.  That’s right:  hand dominance is biological, not learned, and very likely inherited to some degree.

IMG_0934

terrific safe scissors for little hands!

In my professional career, the greatest predictor of age-appropriate grasping skills has been not core stability or even muscle tone, but exposure and interest.  I work with a child that is legally blind since birth, and his grasping skills are very delayed.  His exposure is biologically limited.  He cannot see what his fingertips are doing, and since he has some vision, he is not doing what totally blind children usually do. They increase their tactile exploration of objects because they don’t have any visual information, and in doing so, end up with generally good refined grasp and control.  This child has slowly developed his skills with carefully chosen and strongly emphasized activities in therapy.

Low muscle tone makes it difficult for infants to develop effective opposition, the rotation and bending of the tip of the thumb opposite to the tip of the index finger.  It is common to see opposition to the tip of the middle finger.  The stability offered by that finger’s placement between two fingers at knuckle-level, plus less rotation needed, explain that quite clearly.  Sadly, the middle finger doesn’t have the refined movement of the index finger, so control is lacking.  They tend to use a fist for gripping toys, and often end up dropping or breaking their goldfish crackers.  These kids often actively dislike using their hands in a skilled manner.  “Read me a book or let me run around” rather than “Give me tiny snacks and beads to string”.  If it is true pattern of avoidance and frustration, it isn’t simply a preference.  It’s an issue.

Wok and Roll!

Playing Wok ‘n Roll with Edison Chopsticks!

How can parents support the development of hand skills at all ages?

  • Infants under 12 months:  Provide safe and desirable things to pick up.  Bits of food that aren’t choking hazards.  Toys with tags firmly sewn on.  Toys with parts that spin and have textures to explore.  Show your interest and delight in this exploration.
  • Toddlers:  Even more opportunities and enthusiasm.  Let them scribble on magnetic boards, use food as fingerpaint, and introduce utensils as early as safe.  Us lots of containers that need to be opened, closed and held for filling and emptying.  Check out Easy Ways To Build Bilateral Hand Coordination for Writing for more ideas.
  • Preschoolers:  Don’t tape down that paper!  Teach the  use of the “helper hand” Better Posture and More Legible Writing With A “Helper Hand” if it isn’t being used, and double-down on toys that require both hands.

What are your best methods for refining grasp and dominance?  All you teachers, therapists and parents out there, please comment and add your ideas!

 

Why Some Newborns Look Like They Hate To Be Swaddled

Yes, I said it.  Some babies scream louder after you swaddle them, and parents assume that this means that they are horrified of being restricted.  This is usually far from the truth, but you have to know a little bit about newborn neurology to understand why this is likely not to be a case of protesting imprisonment and more a request for more layers of calming.

For 9 months, a newborn has been living in a tighter and tighter space.  Baby bumps get bigger, but the uterus can only expand so far.  At the end of pregnancy, babies are a snug fit.  Really snug.  They aren’t uncomfortable, and in fact, swaddling is replicating the whole-body firm hug that they know so well.  It is diminishing the shock of the Moro (startle) reflex that scares them and makes them cry more.  It keeps them at a consistent temperature, just like the womb.

So why do some of them scream more right after you swaddle them?  Well, some babies are sensitive little souls, the kind that cry with new noises, too much talking, or even when their digestion “toots” a little or they get very hungry.  They can go straight from happy to upset after too much activity, too much socializing, or too much interaction.  By the end of the day, they are at the end of their ability to handle life.  This can be partly temperament, their unique way of interacting with the world.  It can also be that their nervous system is still very immature, and they are taking a while to develop self-calming.  That is not a medical problem.  Every baby is new at this life-after-womb thing.  Some babies just need a little more time living like they did for 9 months, cozy and comforted.

These babies need swaddling more than some others, but they find anything new to be a challenge.  Give them a chance to get used to it, and make sure that you are doing a good swaddle.  Check how toasty they are, by making sure that they are not sweating behind their neck or ears (if so, lighten up on layers and swaddle in light cotton).  They probably also need more than swaddling to pull it together.  If you haven’t read Happiest Baby on the Block or seen the DVD, you might not be aware that swaddling alone is not going to finish the job for sensitive kids.  Sucking, shushing, side or stomach positioning (for calming only) and swinging may all be needed to calm these babies down.

So for all those parents who think that their baby is the one that hates swaddling, I encourage you to make sure that your technique is solid, your blanket or swaddle garment fits correctly, and that you layer on the love moves with more than a swaddle to calm your little one!

 

Low Tone and Toilet Training: The 4 Types of Training Readiness

When clients ask me if I think their child is ready to potty train, my answer is usually “Maybe”.  There are numerous factors to consider when assessing toilet training readiness if a child has low muscle tone.

Physical Readiness

After about 18 months, most children can keep a diaper dry for an hour or more.  Their sphincter control increases, and their bladder size does too.  Kids with low tone can take a little longer, but without additional neurological issues, by 24 months many of them will be able to achieve this goal to accomplish daytime urinary continence.  Bowel control is usually later, and nighttime control is later still.  Achievement of the OTHER physical readiness skills are less predictable.  These skills include:

  • Sufficient postural control to stay stable on a potty seat or toilet, and when standing to wipe.
  • Enough mobility to get to the toilet on time, turn around to flush, and bend to pull up/slide down pants.
  • Adequate strength and coordination to manage clothing and toilet paper/wipes
  • Sensory processing to perceive a full colon or bladder, tolerate clothing movement on the body and tolerating the “sensory surround” of bathroom use.  Yes, the smells, lights and space of a tiny room can be a “thing” for some kids!

You will notice that children need enough skill, not amazing or even good skills.  They just need enough ability to get the job done.

I need to mention that issues such as constipation can derail the best plans.  Kids with low tone are more likely to have this problem than not.   Read my post Constipation and Toilet Training  for some ideas on how to manage this issue and who can help you.  The best time to manage constipation is before you start training.

Cognitive/Communication/Social Readiness

The trifecta for toilet training readiness in typical children is a child who is at the 16-20 month cognitive/communication/social level.  This child has the ability to follow simple routines and directions, can understand and communicate the need to use the toilet and their basic concerns, and is interested in learning a skill that adults are guiding and praising.

What about children with global developmental delays?  They absolutely can be toilet trained.  I have worked with children who have no verbal skills and perform tasks like dressing and self-feeding only by being prompted, but they can use the toilet.  Do they always know when to “go”, or do they simply follow a schedule?  Well, to be honest, sometimes they toilet on a schedule for quite a while before they connect the physical impulse with the action by themselves.  But they are dry all day.  The essential abilities are these:  they know what they need to do when they sit on the potty, and they know that they are being praised or rewarded in some other way for that action.  That’s it.  Have faith; children with developmental delays can do this!!

Some children with low tone have no delays in any of these areas, but many have delays in one or more.  The most difficult situation with cognitive/communication or social readiness?  A child who has developed a pattern of defiance or avoidance, and is more committed to resisting parental directions than working together.  Toddlers are notoriously defiant at times, but some will spend all their energy defying any directive, must have everything their way or else, and can even enjoy being dependent.

If this is your child, job #1 is to turn this ship around.  Toilet training will never succeed if it is a battle of wills.  And no adult wants it that way.  Repair this relationship before you train, and both of you will be happier.  Read my posts on the Happiest Toddler on the Block methods for ideas on how to use “Gossiping” Let Your Toddler Hear You Gossiping (About Him!)and  Turn Around Toddler Defiance Using “Feed the Meter” Strategies to build a more cooperative relationship with your child.

Family Readiness

Research suggests to me that the number one indicator for training is when the parents are ready.  Sounds off, right?  But if the family isn’t really ready, it isn’t likely to work.  I worked with a family that had their first 3 children in rural Russia.  Boiling dirty diapers on a wood stove makes you ready ASAP!  Families need the time to train, time to observe voiding/elimination patterns and to identify rewards that work for their child.  They need to be prepared to be calm, not angry, when accidents happen and to avoid harsh punishments when a child’s intentional avoidance creates an accident.  They have to be ready to respond to fears and defiance, and then handle the new independence that could bring a child freedom from diapers but more insistence on control in other areas.  Many of my clients have nannies, and most parents have partners. Every adult that is part of the training process has to be in agreement about how to train.  Even if they are more cheerleader than “chief potty coach”, it is either a team effort or it is going to be a confusing and slower process.  Check out Toilet Training Has It’s (Seen and Unseen) Costs for more information about how the process of training has  demands on you that are not always obvious.

Equipment Readiness

Do you have a stable and comfortable potty seat or toilet insert?  How will your child get on and off safely?  Do you need a bench or a stair-like device?  Grab bars?  Do you have wipes or thick TP? Enough clothing that is easy to manage?  Underwear or pull-ups that also do the job?  One of my clients just texted me that having a mirror in front of her daughter seemed to help her manage her clothing more independently.   A few weeks ago we placed the potty seat against a wall and in the corner of the room so that if she sat down too fast or hit the edge of the seat with her legs while backing up or standing, it wouldn’t tip and scare her.  No rugs or mats around, so she won’t have to deal with uneven or changing surfaces as she gets to the potty.  Really think out the whole experience for safety, simplicity, and focus.  If you want to learn what your occupational and physical therapists know about these things, ask them Low Tone and Toilet Training: How Can Your Child’s Therapists Help You ?

You can see why parents rarely get a simple answer when they ask me if their child is ready to train.  I will say that since they are asking the question, they may be ready, and that is one of the four types of readiness!

Do you want (or need) more details on toilet training readiness?  

The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is available as an e-book on my website, tranquil babies, on Amazon.com,  or at Your Therapy Source ( a terrific site for parents and therapists!).  If you want more guidance to evaluate your child’s toilet training readiness and learn how to prepare them well, this is your book!  It includes readiness checklists and very specific strategies to build readiness.  Think you are ready to jump in and start training?  My book will guide you to choose between the gradual and the “boot camp” approach, and it addresses the most common stumbling blocks children experience on the road to independence.

Read my post The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived! , to learn more about this unique book and see what it can do for you today!

Summer Fun Pre-Writing Activities

Here in the U.S., summer is fully underway.   Pools, camps, and vacations!  Handwriting isn’t really on anyone’s radar.  Except mine.  Without practice, kids with learning differences, motor control issues, and visual-perceptual concerns can lose a lot of the skills that they worked so hard on all year long in therapy.

Here is a fun activity, not a boring worksheet, to keep or build pre-writing skills for preschoolers and kindergarteners.  Remember, into each summer some rain will fall, and there will be overcast days, or times when kids have to wait for a meal in a restaurant  while on vacation.  This activity can be a fun way to pass the time!

Ice Cream Cones

I picked this theme because ice cream is a food that most kids love, and the strokes/shapes needed have pre-writing value.  Your child will have no idea that she is building the visual-perceptual and finger control needed for handwriting instruction!

For the youngest pre-writers:  Draw an ice cream cone as below, at least 4-5 inches tall, and have your child aim for the “scoop” to wiggle their crayon, making sprinkles. I lightly colored in the scoop and drew lines on the waffle cone.  Younger children don’t always recognize a figure in a line drawing as easily as a completed one.  Their scribbles will be large, but demonstrate that our scribbles stay inside the scoop and are reversing vertical or horizontal lines, or a circular scribble.  The important thing is that they are attempting to stay inside the scoop and they are reversing the direction of their stroke.

IMG_1180

For children that are beginning to trace letters:

  1. Write the letter “V” in gray, about 3-4 inches tall.  Why gray?  So that your child can use a bolder color to trace over your lines.
  2. Have them trace your letter in a brighter color, then use your gray crayon to make a line across the “V” from left-to-right (for righties.  lefties will be more comfortable tracing right-to-left).
  3. Let them trace that line as well.
  4. Draw an arch, starting at the beginning of your “V”, curving upward and ending at the end of the “V”.
  5. Let them trace that line.
  6. Demonstrate how to keep your crayon tip barely moving as you “wiggle” to create a tiny sprinkle.  Ask your child to copy you.

IMG_1182

 

For kids that are writing their own letters with demonstration:

  1. Write the letter “V”on your paper, placed directly above theirs.  Ask them to copy you.
  2. Make a line across the “V” from left-to-right( for righties; lefties cross from right-to-left).  Ask them to copy you.
  3.  Make an arch to form the scoop, starting from the beginning of the “V”, curving upward and ending at the end of the “V”.  Ask them to copy you.
  4. Demonstrate how to wiggle your crayon tip slightly to create sprinkles, and even add little lines for drips of ice cream falling off the scoop.

 

BONUS ROUNDS:  Use sturdy paper and have your child cut out his ice cream scoops.  Have him ask everyone what kind of ice cream flavor and how many scoops they would like him to make for them.  Grab the toy cash register, and use the cones to play ” ice cream shop”. 

Why Writing An “M” Like a Mountain Slows Handwriting Progress

IMG_1179

 

I had this conversation with a very sharp grandma this week.  She was curious about why I did not teach her granddaughter to write an “M” this way, since it is so much easier than the standard formation.  Here is my answer:

  1. Teaching it incorrectly? No! None of the common handwriting styles (Zaner-Bloser, D’Nealian, Handwriting Without Tears or HWT) use that formation.  She will be expected to use standard formation later in kindergarten or first grade.  Teaching her a formation that isn’t correct then changing it later, especially for this little girl, (who resists even gentle redirection) is likely to frustrate everyone later.  She may never make this letter correctly.  At the very least, teaching her one way now and another next year is a waste of my time.
  2. Automaticity. Teaching the standard formation, in which she is required to write a long vertical line and then move her crayon back up to the top of that line, reinforces the automaticity of what HWT calls the “starting corner capitals”.  These are the letters such as “E”, “N”, and “P”.  There are 11 capital letters and one number that start with this long straight line, and 8 of them jump back to the top of that line.  Teaching similar letter start and sequence builds automaticity and speeds learning.  One of the hallmarks of people with legible handwriting is automaticity.  They don’t have to think about how to make letters, they can think about what they want to say in their compositions.  It is not a good idea to slow down the development of automaticity in writing.
  3. Time saved in the future for educators.   A child can certainly learn an immature style and then learn that there is a grown-up way, but Common Core and all the testing have turned classrooms into testing training rooms.  Teachers are not able to take the time to evaluate each child’s handwriting and do spot corrections.  They will say it once and then move on.  Learning correctly now will save everyone time later.