Monthly Archives: September 2016

Low Tone and The Child Who Leans (Literally) on You: Address This Postural Problem With Warmth And Fun

Kids with low muscle tone are often described as “seeking a support surface” in therapy jargon.  These are the children who look like lounge lizards.  They recline on you, lean against the couch, prop on their hands while sitting at a table, etc.  Some kids decide that the best combination of movement and leaning is to run across the room and jump directly onto an adult.  This move avoids having to grade their approach to you, plus it lands them safely into waiting arms.  They don’t have to concern themselves with moving safely.

It also keeps them at the same level of skill that they have always had.

I think I have a way to manage this behavior with love, not criticism.  It takes a little bit of thought and creativity, but it delivers.

The next time your child barrels across the room, hold your hands out, away from your body, and welcome them there, not in your lap.  You don’t always have to say anything.  The difference in your response will say it all.  But you are welcoming them, and you can be warm and loving as well.  Variation for older kids:  say “Give me a high-5!!” and hold out your hand.  If they are barreling to you anyway, stand up while still holding out your hand.  Still warm, still fun, but no crash-and-collapse.  They are working on grading movement and controlling posture the whole time.

If your child wanders over and drapes himself on you, you can roll them onto the floor, giggling with them. Bonus Round:  Roll them onto their back, so that they have to rotate and stand up.  A little vestibular input enriches this move.  You can stand up and ask for a hug.  Always a warm move.

Can you still cuddle with your child?  Of course, but not when they land in your lap in this manner.  If you initiate the cuddle, or cuddle after the high-5 or the flip, I think that is terrific.  Love is something every child needs.  If you offer a cuddle after these moves and they wander away, they may be telling you that they were using your body and your response as a bean bag/ball pit; not for affection, but as an activity.   Don’t worry, they will come to you many other times with love, and now you won’t have to worry anymore that your back injury will reappear after you have been slammed into by a young child.

These actions become habits for young children that can delay their progress in therapy and in life.  You never want your child to think that you reject them, only that there are other ways to interact with you and other ways to move.

Want Pincer Grasp Before Her First Birthday? Bet You’ll Be Surprised At What Moves (Hint) Build Hand Control!

The image of a baby popping cereal into her mouth and grinning is commercial genius.  But what if your child is still raking them with a fist at 8 months?  Is that late or just right?  Is there a way to promote early grasp without offering a baby something tiny that she can choke on?  Only if you know the many ways grasp is developing in those first months of life.

Motor skills do not appear out of the blue.  There isn’t a switch that goes on to suddenly release the ability to roll or the ability to hold a bottle.  That’s true for my clients in Early Intervention as well.  Some have serious medical challenges, and some have yet to be diagnosed with ASD or a genetic disorder.  But no skills just pop out without foundational abilities first.

Motor skills start developing in the womb, folks. A premature arrival has medical consequences, but it also deprives a child of the motor and sensory development that naturally occurs while floating in a very active and progressively smaller apartment.  Some children catch up quickly and some do not.   What happens after birth will make a huge impact on the way movement skills are acquired and refined every single day after birth.

If you go shopping at a baby emporium, you would think that they sell toys that are absolutely essential to development.  Reading the labels, you’d think that hand control just couldn’t happen without a Whoozit or a Taggie toy.  Guess what?  Human beings have been developing pincer grasp long before Toys R Us came along, and as far as I know, infant development did just fine without them.  What makes a difference is what exposure and encouragement a child has to build his skills.  Fun toys can motivate a child, but they aren’t the most powerful tool I know to develop grasp.

Here are the great hidden things that build early fine motor skills:

  • Crawling:  I know, there is a big internet debate about whether crawling is necessary for walking.  Here is what I do know:  it is great for developing arm strength and control through the wrist.  It is amazing for building the arches of the hand that allow a child to curve the palm and bring fingers together.  Bonus Round:  crawling with objects in the palm.  Your baby will eventually move the toy toward the thumb-side of her hand so that she can put her weight on the pinky-side while crawling.  One hand, two different uses = better refined control.
  • Reaching While in Tummy Time:  Big-time hand skills develop in this position, especially when babies have to push way up while reaching.
  • Reaching Up While Lying on the Back:  All that abdominal strength is core, core, core stabilization, plus hand control without any arm support.  I make first-graders do exercises in this position before we work on handwriting.  It works.
  • Pivoting around on the Belly.  I love the pivot!!  I took a training course from a PT about 15 years ago that transformed my understanding of this move.  Your little one will be working arms, legs, core, neck, and I saved the best for last.  As she reaches and pivots, she will be using her hand in all directions as she leans on one side of her hand first the front, then the heel of her hand, etc…  Magic can happen for so many other skills using this move, but the biggest secret is how it develops hand control!

Good luck, and have fun developing great hand control before that pincer grasp emerges!!

Weaning the Pacifier From An Older Child

Weaning pacifiers can be difficult, no matter the age.  I wrote a popular post a while back on pacifier use and abuse, Prevent Pacifier Addiction With A Focus on Building Self-Calming Without Plastic , but I think that I might need to write another.  Once an older child, over 3, still uses a pacifier, it is a different game to get rid of it.  There are professionals that will tell you that if your child really needs it, she should have it.  They all agree that if it has disrupted tooth formation or contributed to ear infections, those are good reasons to let it go.  But what if her teeth and ears are great?  Should you get rid of it because her younger brother let go of his pacifier at 18 months?

Every child is different in their ability to handle daily stress and develop more mature methods of calming and organizing.  If you haven’t read The Happiest Toddler on the Block, you might want to try Dr. Karp’s terrific strategies for building self-control and handling frustration.  I highly recommend his strategies for bedtime and dealing with aggression and defiance, because those times are when kids (and parents) default to the “paci” to get a child calmed down.

If your child’s speech is delayed, then you have two good reasons to address pacifier use right away, today.  First, pacifier use is a very immature tongue/mouth pattern of movement.  Please don’t encourage the use of something that slows down/prevents them from making gains in therapy.  Second, they can’t talk and suck at the same time.  They are losing opportunities to try to use words to deal with their feelings and thoughts.  OK, I guess third would be that being unable to communicate all the complex thoughts that they have probably makes them even more edgy and whine for that pacifier.  If I had a dollar for every agitated child with a speech delay that became polite, calm, and sweet-as-pie once he could be understood just a little…….

If you haven’t introduced a “lovey”( a toy or other safe object that a child can bring to bed or cuddle with) now would be the time to try it out or try another one.  Older children can enjoy the backstory of having a princess or a superhero with them.  I have also taught Dr. Karp’s  breathing technique to promote calming to older children.  That can be very helpful to them, but they do need to see you use it and they have to practice at calmer times in order to be able to use it in the clinch.  For some parents who love yoga and meditation, this is great!  For others, they will admit that they won’t remember to breathe through someone cutting them off in traffic: they yell.  And so does their child when his TV show is shut off.

Some children will accept the idea that the pacifiers are sent to the little babies, the pacifier fairy, or some other entity.  Others cannot believe this has happened to them.

Dr. Karp’s techniques for teaching toddlers how to handle frustration and communicate their emotions make life in the daytime better, but they might just be more important for bedtime.  Kids and grown-ups are tired, and kids don’t want to leave the fun, especially if it involves a parent that they missed all day long.  Pacifiers can be how a child calms themselves down because they don’t know how to interact and manage emotion.  Totally understandable at 10 months, but if they are 3 or 4, it is time to build some emotional regulation skills.  Teaching these skills is almost impossible to do at 7 pm.  The time to work on those skills is when they are fresh as a daisy.  If this means playtime with the purpose of teaching patience stretching at 7:30 am while waiting for cereal, it is still a better idea than 7:30 pm, when they are grumpy and tired.

I am convinced that the kindest thing to do for a child, one that uses the pacifier because this child has no other effective ways to calm herself, is to teach her better skills.  Mature skills that will last for years.  The gift that keeps on giving!

Teaching Children To Use Utensils to Eat: Use Good Tools, Good Food, and Good Timing

I gave a crash course in utensil instruction to an interested dad recently.  Speaking with him, answering his questions, made me realize that I had spent years refining my approach to teaching young children how to use spoons and forks.  I had never written it all down.

Select your tools carefully.  Many parents and nannies are handing over the narrow, long-handled infant spoons to their toddler.  That would be like me providing you with my spatula.  Take a look at  Which Spoon Is Best To Teach Grown-Up Grasp?  for the best design choices for older kids.  The blue spoon in the photo line-up is a great toddler/beginner spoon.  This Gerber spoon has a non-slip handle with dots on the surface where a young child should place their palm.  Yes, toddlers use a fisted grasp.  The bowl of the spoon is not too shallow and not too large.  The handle is thick and just long enough for a toddler palm.  Why not use a plastic disposable spoon?  All of the above features are missing, plus the light weight doesn’t provide the sensory input that helps children feel what their hand and arm are doing while they scoop and place the spoon into their mouth. Those plastic spoons say they are disposable, and that is what you should do when you are done with them.

Where you hold their spoon determines where they hold their spoon.  Guiding their beginning attempts at scooping and their attempts to bring a loaded spoon to their lips usually involves your physical assistance.  Some parents opt for what teachers would call “hand-over-hand” assistance.  I use that type of assist sparingly, since most young children resist it.  In my opinion, they resist it because they do not understand why you are gripping their hand.  I opt for holding the spoon, not the child.  If they aren’t actively bringing the spoon to their mouth, neither am I.  No fights.  If you hold the handle in the middle, a child will grasp the part of the handle that is available:  the tip.   Children naturally reach for the tip, they often pick up a utensil at that spot when the spoon is resting on the table. That is, however, not a functional grasp, and even an adult wouldn’t be able to successfully load a spoon with food and eat with that grasp.

Place your hand so that it covers the tip of the handle, at the end.  If your child is old enough to try to feel herself, she will reach for the shaft of the handle, not the food in the bowl part of the spoon.  Her hand is now in the right spot start eating!

Choose food that sticks to the spoon.  The dad that I mentioned in the beginning had given his son some thick ricotta-like cheese for breakfast.  Perfect.  Even when the child tipped the spoon upside down, the cheese stuck to the spoon.  There are other choices that make learning successful and less frustrating.  I am thinking of mashed avocado, mashed potatoes, especially sweet potato or yams, very thick Greek yogurt, and the old favorite, oatmeal.  The worst choices?  Peas, unless mashed, rice, and pasta.  Having your food roll away is just so discouraging.

Use a plate or a bowl?  Suction cup base or not?  I prefer a shallow bowl, so that scooping can be done against the sides of the bowl and the angle of the spoon is small.  The hardest set-up?  Scooping out of a deep cup like a yogurt cup.  Some parents buy bowls with a suction cup base.  For super-curious children, this is catnip.  They have to figure out why the bowl isn’t moving.  Inevitably it does, right to the floor.  My favorite hack is a damp paper towel under the bowl.  Grips the bowl, but not fully, is familiar enough to prevent at least some exploration, and you can use it to clean up when the meal is done.

The first 3-7 bites are key.  I suggest to parents that they prompt for spoon use when a child is eager to eat, but the first bites are provided.  Some children are so hungry that having to work to get a bit of food makes them angry.  If they have a little taste, they are willing to work on scooping to get more.  After about 7 bites, a lot of children aren’t that hungry any longer.  The ones with small appetites will stop making an effort.  The ones who are resistant to using a spoon will wait for you to feed them.  That isn’t a terrible solution for very young children, as long as you got some cooperation and practice in while they were still hungry.  After all, there are more meals coming. 

Consistency between all caregivers.  If parents, the nanny and the other caregivers know the plan, simple as it is, learning comes faster.  Make the effort to explain and even demonstrate.  Children do not appreciate different strategies.  They default to “no”.

Make it fun.  My post on fun ways to practice utensil use, Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child, gets a lot of hits because everyone wants to have fun, no one wants to “work”.  Me too, which is why OTs generally use toys and play to build skills.

Good luck, and have some fun at the table today!

Toilet Training Has It’s Costs: Don’t Be Shocked

 

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In speaking with families about their worries in anticipation of toilet training, one of the issues that rarely comes up are it’s costs.  Sure, everyone laughs about the vacation they will take when they no longer buy diapers or pull-ups.  Those huge boxes from Costco don’t come cheap.  But there are costs during the training process that are only vaguely anticipated.  Be sure that you are ready for them too!

Clothes and Underwear.  Children may need a new wardrobe.  The first reason is that a child will not be able to get those teeny hipster jeans off fast enough to pee or poop.  They move faster in wide-waisted sweats.  The second reason is that you will need multiple pairs of underwear and possibly even other clothes.  The teddy bear may wear one pair as a motivator, you may use two pair as thick training pants down the road, and then there are all the small accidents that leave your child smelling less-than-fresh.  Time to change.  The last reason is that accidents happen anyway, and some clothing is going to be so soiled that “Super-Tide” or whatever you are using just cannot handle the stains.  Into the trash they go.

Wipes, flushable and not.  One of my oldest friends says that flushable wet wipes saved her life during training.  They aren’t cheap, and kids start out taking a handful, as if they were going to wipe down the whole bathroom, not just their little tushie.  You will need to stock your go-bag with wipes as well, for trips outside the home.  And of course you may still need the non-flushable ones to help them clean things up.

Carpets, etc.  If you do a Training Intensive, sometimes known as Potty Boot Camp, there will be accidents, guaranteed.  Even with a Gradual Start approach, accidents happen.  Sometimes on a tile floor (good), and sometimes on the carpet or the couch (bad).  Some things can be cleaned and some will need professional help.  Or replacement.  Be prepared.

Time and Attention.  The most precious commodities of all to parents are their time and attention.  Developing an awareness of when your child is most likely to eliminate, making it a priority to get them to the toilet for a successful attempt, and even making sure they “go” before you leave for the store is a completely different use of time from the days when you slapped a fresh diaper on them and ran out the door.  Kids take a while on the potty, and this process will consume your time and attention until they are completely trained.  Some trained preschoolers still need you to wipe them effectively, well past 4!  Again, your time and attention is required.

If this list has you backpedaling on the idea of training, thinking that it is better to delay it until they are so old that they learn in a few days, I might mention that if you miss the wonderful window of physical readiness combined with cooperation/response to praise and rewards, you may have to wait a long time.  Kids that aren’t trained, but now get stuck in the power struggle common to the 2.5-4 year-old range, realize what power withholding wields over adults.  So much less attractive than a 24 month-old who sweetly accepts their treat for a job well done!

Looking for more information?  Take a look at some of my other posts on toilet training, such as  Is Slow Progress In Toilet Training A Failure?    If your child has special needs, this might be of interest Why Do Some Kids With ASD and SPD Refuse Toilet Training?.

Want more personal support or have specific questions?  Please visit my website tranquil babies  and purchase a in-home consultation (in the NYC metro area) or a phone/video consult.

 

Which Crayons Promote Mature Writing Grasp?

It is back-to-school time here in the U.S.  Stores are pushing clothes, backpacks, shoes and school supplies.  Time for teachers to set up their classrooms and get excited about a new school year.  When I see the amazing variety of crayons on display at Target or Walmart, it reminds me to speak to the families I serve about selecting great writing and pre-writing tools.

First of all, let’s get the “giant crayons for smaller hands” thing out of the way.  My crayon gauge starts with the standard Crayola crayon, and goes up or down from there.  Mostly up, since I have rarely seen crayons that are narrower.  Pencils?  Yes, but not crayons.  Most children that cannot hold a crayon with a tripod or quadruped grasp (three or four fingers, respectively) will use a hook or fisted grasp to hold a standard Crayola crayon.  Why?  Often because they don’t yet have the strength and control to do so, sometimes because they haven’t been taught to hold crayons this way.  This is going to create problems for controlling that crayon and those pencils.  Let’s not even mention the bad habits that could continue for years.

Crayon and pencil grasp is not something that shows up naturally, like walking.  We are wired for walking, but prehension is a skill that developed later in humans.  Children that do not teach themselves by copying siblings and adults need to be taught.  If you present it as a grown-up skill and reward rather than criticize, many children need no more instruction.  Handwriting Without Tears (HWT) does an amazingly simple job of teaching mature pencil grip. Handwriting Without Tears

Kids older than 3 who cannot hold a standard crayon in the mature pattern can benefit from a large crayon that has been snapped in half.  Why break a perfectly good crayon?  To reduce the shaft length and prompt the child to use their fingertips, not their fist to hold a crayon.  Will those super-sized crayons or the triangle/ball-shaped crayons help?  Sorry, but no.  They appear to have been designed to give infants who use a cylindrical grasp (totally normal) the ability to scrape a crayon across a page.  It looks so cute to have your 9 month- old actually coloring!  If your older child has serious motor issues such as significant cerebral palsy, they might work.  If your child simply struggles to use a mature grasp, you could be setting them back by allowing them to use a less mature grasp to scribble.

Handwriting Without Tears sells their Flip Crayons.  These are very short and the diameter of a standard Crayola crayon.  Therefore they are shorter and narrower than a large crayon that you broke in half.  They will require more fingertip control because there is less space for  a child to use much more than a few fingertips.  I have had parents remark on how small they are for themselves, and then realize that their pencil grasp is actually not a standard grip either!  Not to worry, unless they struggle with handwriting as much as their child does!  Children who are adept at flip crayon use will progress quickly to the use of short golf pencils, which HWT sells with erasers, or your local office supply store sells without erasers.

Flip crayons have one color on one end, another color at the other end.  Children learn to “flip” them over in their hand to change colors.  Great coordination skill, and fun too!! Four year-olds are usually ready to use these, and if not, then they need to work a bit more on fingertip strength and control.  What if your child just palms them, even after they have been taught how to hold them?  Give them a few supervised turns, with you as the model.  If they are still struggling, they are not ready yet and should try the “broken crayon” strategy.  Don’t forget to periodically try out the Flip Crayons, since you want to raise their game rather than keep them at a pre-pencil stage if they are ready to move on.

What can you do to help them?  All the great activities that develop hand control.  Scissors  Lakeshore Scissors for Toddlers That Only Cut the Paper, Not the Toddler, dough, tape  Melissa And Doug Tape Activity Book Is Reusable Fun, and especially spoon and fork use with a grown-up grasp  Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child.  Check on them after a month of finger control “boot camp” at home, and see what has happened to their pencil grasp!

 

Frustrating Homework? Adapt Children’s Worksheets For Success

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Frustrating homework?  Adapt it and make homework work!

The new school year is beginning here on the east coast, and kids will be getting new workbooks and worksheets for homework.  Over the years, I have seen a staggering variety of mass-produced assignments that could only be designed by adults who spend very little time with young children, and none with kids that have learning challenges of any type.  There are a number of potential writing minefields for these kids:  tiny spaces to write their name, multiple formats for writing (triple lines, single lines or no lines), all jumbled on a single page, empty spaces that don’t leave enough room for the use of grade-level letter sizing, and more.  It’s not just the writers who struggle with controlling their pencils that lose out.  Kids who have oculo-motor issues have to work harder to scan for the correct line to write a response, and move their eyes back and forth between the question/paragraph and the answer space.  Kids who cannot write smaller than their grade level but understand the material try to shorten their responses instead of explaining their thinking.  Kids with executive function issues see a complex worksheet as a big hot mess, not knowing where to start.

It makes me a bit angry that no one seems to have thought about creating worksheets that make homework easy for every child.  Then there are teachers and parents that worry about any accommodations preventing gifted children from learning in a class with mainstreamed kids.  Creating worksheets that support all kids doesn’t make it less stimulating for gifted children.  They can learn 5 letters while some of their classmates are working on one.  They can do two worksheets or write a haiku poem about the subject matter.  Everyone can win when formats are thoughtful and well-designed.  There are children with visual limitations, learning differences, and motor control issues that have been successfully placed in mainstreamed classrooms.  We demand ramps and integrated classrooms, but we put up pointless roadblocks to true success in other ways.  Asking these kids to do their homework when they know very well they will struggle to fill in the answer seems so unfair.  Until the companies that create these workbooks and worksheets change their ways, it falls on parents and therapists to adapt them and teach kids strategies for success.

What can you do to help your child navigate a poorly-designed worksheet?

  • Small spaces for their names or answers?  Check out the sample above.  Extend the line if you can, and explain that older kids and adults have a solution:  they start writing on the far left edge of the line in order to have more room for them to write.  This makes your strategy sound like sharing a “secret” instead of giving another order.
  • Single line for kindergarteners to write their name?  Create a midline (the line that small letters like “a”, “o”, and “c” start on) for them.  I don’t use a top line, and you may not need it if the space for the name is at the top of the page.  Create a starting dot for the uppercase first letter of their name, then start the midline for them.  The result?  Much neater writing.  Writing their name is the first automatic writing they will develop.   Let’s try to make it good by improving support for early writers.  If not, it will be one more thing to work on with an OT or a writing tutor.
  • Confusing layout?  Take a super-fine Sharpie marker and underline the sections, or even trace the titles of the sections so that they stand out when your child is scanning the page.  For younger children, this could involve highlighting the single-line baseline for them in the space where they are to enter their name or their responses.
  • Too many lines for writing?  Some worksheets bounce back and forth between a single line provided for a child’s name, and three lines (top line, midline, baseline) for writing.   These lines can help some kids, but they can also lead to using the midline as a top line.  If you bold the baseline of every section as described above, that could help some children.  Some kids benefit more from having the first letter of a response, including their name, written for them.  This tells them about the sizing expected, and where letters should fall within these lines.  Some kids just need a starting dot.  I think the designer of the sample page must have low vision, because that dot is so large as to make writing a letter with a pencil much harder….
  • Use a blank paper under each section to limit viewing the entire page.  Some kids find a complex page overwhelming and struggle to take things one step at a time.  Covering up the bottom of the page, then the top can help.
  • If they are copying from a list, such as a spelling list, writing the list on a separate page in large letters so that they are scanning to the next page instead of the full page can help.
  • Sympathize.  If you explain that this assignment page really is a bit confusing, children are less likely to hold in their frustration or let it out by crumpling up their paper.  The sample has each item numbered, and then asks the child to look at the number of shapes.  Not confusing for an adult, but it can be very confusing for the child.  They could have used alphabetizing for the list,  a., b., c., and so on, and let the numbers refer only to the answer.  What children really need to know is that you can help them make sense of it.