Monthly Archives: October 2016

When Can You Start Toilet Training?

Just like walking, children cannot be toilet trained before they are physically ready.  That usually happens around 18 months. But like walking, some children are physically ready a bit earlier.  WAIT!  Using the toilet by yourself is so much more than physical readiness.

Potty training is a complex skill, with cognitive, sensory, motor and behavioral components.  Saying that you can’t do anything at all until the child asks to be trained is as silly as carrying your infant around all day until he tells you that he is ready to walk now.  Babies spend every day from birth onward refining the skills for walking.  The same could be said of potty training, but only when parents understand how to do effective pre-training.

My new book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, helps parents learn about good pre-training as well as all the skills needed for potty use.  Pre-training is when parents expand elimination awareness, relevant language and toileting knowledge in their infants and toddlers.  No pressure, no fights and no failure.  You can’t fail pre-training!  My book is targeted to children with low tone, but every parent can use these pre-training concepts successfully.   Children with low tone are more like typically-developing children than most of their parents can imagine.

Children that have been well prepared are going to show readiness signs sooner, and be more motivated and excited to train.  This is because training readiness isn’t just biology, folks!

Will early training harm children?  I think it depends on what you mean by “early” and “training”.  Forcing a child to do anything, shaming a child, and having repeated failures is never good for children of any age.  It just doesn’t work.

Older kids can learn faster because they have more motor and cognitive skills, but they may have entered the defiant stage of toddlerhood.  That can make potty training a nightmare. They have left that perfect training period that the Baby Whisperer, Tracy Hogg, speaks so eloquently about.  Her ideal training situation is the phase in which children still want to please adults, have the physical abilities to get on and off a potty, and can now remember routines/understand rewards. This is typically 16-24 months.   If you have a spirited or shy child who is super-hesitant or easily frustrated, and always has been, then you need good pre-training advice even more than the parents of children with low tone!

I think the Elimination Communication (EC) theory has a lot to offer parents who want to learn pre-training.  Low Tone and Toilet Training: What You Can Learn From Elimination Communication Theory   But EC isn’t toilet training.  The parents that used to hold their 8-month old over the potty still have to train their toddler to pee on their own.  Adults that are positive, read a child’s cues correctly, and use consistent methods that inspire rather than frustrate children will have the best results.

If you try to potty train your child when they are more likely to fight you over any request, if you use ineffective motivators or the wrong equipment, and if you express your frustration, or worse, your lack of faith in them, you will have major problems at any age.

The last lines of my book apply directly to this post:

Be prepared, be consistent, expect to practice, and stay positive!  You can do it!

My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is now available as an e-book on my website tranquil babies, and as a clothbound hard copy in the U.S. by contacting me through my website.  

There is NOTHING out there that explains the role of low tone in the process of potty training, and gives parents real advice that works.  Books for children with autism or cerebral palsy don’t apply in most cases.  Generic toilet training books have great suggestions that often create more frustration and failure.  I decided to change all that!

My readiness checklists make it clear what you need to work on, what your child’s strengths are, and then the remaining chapters help you from picking the right potty to transitioning to the adult toilet out in the community.  You will understand why low tone makes things more challenging, and what you can do to move forward today!

 

 

Review: Kumon Sticker Books For Toddlers

Children love stickers.  Kumon has created great sticker books for the 2’s or children performing at that level.  I have the vehicle-themed book, but they have a zoo-themed book as well.  I use their scissor books every week, maybe even every day with the 3’s and 4’s.  I wanted to see what they came up with using stickers.  They impressed me again!

Like all of their products, the paper quality is excellent, and the stickers are sturdy.  No delicate stickers that little fingers can tear easily.  It is so frustrating for a child when that happens.  I am a thrifty person, so after adding the stickers, each page will become practice for cutting (cut off the instructions, please) and coloring (add a sun, some grass, a ladder, etc).  Only when the paper is this sturdy can a toddler snip with ease and success.  The slippery or thin pages of cheaper sticker books just crumple.

Kumon has done more than just make a fun book.  They have designed a workbook for the youngest learners in preschool.  They use simple graphics that are easy for little children to comprehend.  Kumon gives you ideas for discussions with your child.  This builds language  and visual-perceptual skills as you discuss the colors and shapes with them.

The designers have even tried to grow your child’s self-esteem and social skills: they encourage you to praise your child’s attempts, even if they aren’t very accurately placing their stickers on the page.

Perhaps they read the same book about the difference between a fixed mindset and a growth mindset that I did?  Carol Dweck developed the concept of “Mindset”.  It is more than just praising a child’s effort.  It is educating children to think critically without the fear of being judged.  Take a look at her work, Mindset, and see if this changes what you say to a child when they are learning and exploring.  You can start growing your child’s growth mindset when you work on this book together.  Your comments will be about their effort (or lack of it; not every child perseveres) and note their creativity and enjoyment.  The message that you are sending is that you admire effort and engagement more than perfection.

 

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These pages are designed in a developmental order.  This means that the first few pages invite your child to place the corresponding stickers anywhere on the page.  As they progress in control and comprehension, there are targeted spots for the stickers.  Geometric shapes are used at the beginning, as above, and more irregular figures are shown as they progress.  In the photo The Big Dig, you can see that the triangle sticker will only fit at one angle.  At the very end of the book, there are no white targets; your child will place stickers on figures such as a bridge or a rollercoaster without a visual cue.

The way this book is bound can make it difficult for a young child to keep the book open while placing their sticker on the page.  You could carefully tear out pages (harder) or simply cut out the page (easier).

Save the finished artwork and put it up on the fridge or the cork board.  It will be that good!

CMV: The Potentially Disabling Virus Your OB Isn’t Mentioning

The New York Times ran a moving story in their October 25, 2016 issue about children who contract cytomegalovirus (CMV)  from their mothers while in utero.  CMV is a Greater Threat for Infants Than Zika, but far Less Often Discussed reminded me of the children I have treated with CMV:  multiply-disabled, with parents that didn’t know what those initials stood for until they heard them from their child’s doctor at diagnosis.

Deafness, blindness, cognitive and motor delays; sometimes the whole enchilada.  All from a virus that may not be evident in the mother or her family.  It is rampant in toddlers, those adorable beings who pick their nose and then touch every cookie on a plate, who put toys in their mouth then want a sip of your drink.

The most likely carrier of CMV in your family is your toddler in daycare.  They are bringing home more than macaroni pictures.  They may not even spike a fever and still have CMV.

The NYT reported that the American College of Obstetricians and Gynecologists does not insist on obstetricians mentioning this virus to patients because no treatment is available and no action is an iron-clad preventive.  They believe that patients should initiate the discussion and discuss what their concerns are rather than be told directly about CMV.

That’s like saying that because I cannot promise that you will never be struck by lightening, I won’t mention that sitting under a tree in a storm means that you are taking a risk!  I will let you ask me about how to prevent electrocution.

This is a bit of effort, but there are simple things you can do to reduce but not eliminate your risk while pregnant by:

  • wash your hands well after changing a child’s diaper or wiping them after toilet use.  Don’t check your phone on the way to the sink; wash first.
  • Do not share drinks or food with your children while pregnant.  Serve them a bite on their plate, not by nibbling on your food.  Cheerfully pour them a fresh cup of what you are drinking.
  • Teach your children to wash their hands well, and encourage hand washing in the adults in your home.

I wash my hands as soon as I enter a family’s home for treatment, regardless of the age of the children.  I don’t know if that mom is pregnant.  She might not know yet either.

Wash your own hands like it meant the future of your unborn child; it could.

Finger Awareness and Math Skills: Recent Research, and “Where is Thumbkin?”

 

The Atlantic magazine ran a terrific article, Why Kids Should Use Their Fingers in Math Class, and I am still blown away with the connections they make between brain activity during finger movements and during math calculation and comprehension.  Let me get out my hands and count the ways I could use this information!

They focused on research at Stanford University, and you can look at all the info Stanford has put up at youcubed.org .  Based on brain research, children who count on their fingers should not be criticized, they should be encouraged.  They should even be trained to do so!   It means that all those silly finger plays in preschool are teaching children something more valuable than words to a song, more valuable than following the teacher’s directions.

The bottom line:  When kids have better digital proprioception (awareness of their fingers when not looking at them, for everyone that isn’t an OT), they may have better math skills.  Sounds fishy?  Not if you understand how the brain maps information.  According to the researchers at Stanford, a very respectable academic institution, the same sections of the brain light up on PET scans during finger awareness games and calculation.  Children who play targeted finger awareness games score higher on math tests after finger training.  All that talk about how practicing my piano homework would help me in school might have been accurate.  Sorry I gave you a hard time, Mom!

It all starts in preschool with looking at your fingers, naming them to get greater awareness of them, then using them purposefully.  The Atlantic’s article has a link to some cool activities for older kids, such as tracing colored lines with fingertips that have corresponding nail colors.  But for the little ones, “Where is Thumbkin?” makes more sense.  Developmentally, building a brain that is wired for finger awareness is so much easier than rewiring an older brain.  And much more fun.  Try doing “Tommy Thumb, Tommy Thumb” with a 7 year-old.  He will think you are insulting him.

As a pediatric OT, I teach children to pay attention to their “tippies”, which is my cute term for their fingertips.  Every child knows what I mean when I tell them to put their tippies on their crayons to scribble, and when I mention that their tippies have slipped out of their scissors.  I am going to build in more finger songs into my sessions starting now.  Preschool Finger Play Songs for Hand Strengthening and Sensory Awareness  I want every child to excel at math, and it could start with finger awareness!

The Ten Most Common Mistakes Parents Make During Toilet Training

  1. Ignoring their own readiness issues.  Parents who are unaware of their own lack of readiness will not be able to be the effective coach and teacher that their child needs.  Training requires extra laundry, cash outlays and can create lots of frustration for adults.  If you don’t know how you will handle all of these issues, your reactions could make potty training harder.  Even if you have trained older children, life situations change.  A parent with a more demanding job or simply more “irons in the fire” will have to figure out how to devote the necessary time and attention to toilet training this child.  Learn more about readiness by reading Low Tone and Toilet Training: The 4 Types of Training Readiness
  2. Assuming that defiant children will be LESS defiant in toilet training.  Older toddlers and preschool children that are still in diapers can be the most difficult to train.  Developmentally, they are at the stage in which they are learning about their ability to assert control over situations and people and handling the consequences.  Some children have temperaments that make toilet training harder any age.  The shy child can be overwhelmed by accidents and expectations, and the spirited child can balk at being told when to sit on the potty and resists following a routine.
  3. Using equipment that doesn’t fit the child.  The wide range of equipment available doesn’t mean that parents will pick the one that has the best chance of success.  Children with motor or sensory issues are especially vulnerable to failure when the equipment doesn’t meet their needs.  Typically-developing children can respond negatively to poor equipment as well.  A seat insert that is wiggly can seem frighteningly unsafe to them, and a potty on another floor can result in so many accidents that they insist on a diaper for security.
  4. Ignoring the sensory processing component of low muscle tone.  Many children have low muscle tone, including children with ASD, sensory processing issues, and syndromes such as Down and Prader-Willi.  Parents are aware of the balance and stability components of low tone, but don’t recognize any of the sensory components.  The one that derails training the most frequently is a lack of interoceptive awareness, which is limited perception of internal sensory experiences .
  5. Assuming that speech delays mean training delays.  Children can learn to use the toilet without any verbal abilities at all.  They do need some receptive language skills, but the level of comprehension to master a toileting schedule isn’t as high as parents think.  Creating a good plan is the challenge.
  6. Interpreting accidents as failures.  No one likes to have an accident or clean one up.  But accidents are signals that learning is happening and/or changes in the training plan are needed.  If you or your child react dramatically to accidents or interpret their meaning incorrectly, this can create training resistance or refusal.
  7. Not knowing how to anticipate bladder fullness or bowel routines.  What goes in must come out.  If a child wanders around with a sippy cup, it will be nearly impossible to anticipate when that bladder will be full, and when sitting on the potty will be a success.  Understanding how to make early training successful by guiding a child the the toilet at the right time is key.
  8. Minimizing the importance of clothing choice for independence.  Children have the cutest clothes, but during toilet training, cute styles can spell disaster.  “Dressing for success” means clothes that can be slid on and off easily, and don’t get in the way of seeing and feeling the call of nature.
  9. Ignoring fears and withholding behaviors until they derail training.  Some children are truly afraid of the sounds, feelings and even the smells of elimination.  They can even think that they will be flushed away!  Avoiding addressing  withholding issues can create behavioral but also medical problems.  Ignore them at your own peril.
  10. Waiting until the last minute to train.  After a few years of diapers, children can assume that this is how their parents want them to eliminate.  Not using pre-training strategies that inspire and prepare children, even children with special needs, makes training harder than it has to be.  Take a look at How Early Can You Start Toilet Training?  to understand more about training readiness at any age.

Good News!  My book, The Practical Guide to Toilet Training Your child With Low Muscle Tone, is done!  The e-book is available when you contact me through my website tranquil babies.  It is the most affordable way to get all the information you will need to make changes right away with your little one once you know what you need to do!

If you want a hard copy that you can underline and hold in your hands, contact me on my site and request a mailing address.  After I receive your payment, I am happy to send you a copy by mail.

There is nothing out there that does as complete a job of helping parents succeed with toilet training children with low muscle tone.  I have provided readiness checklists and chapter summaries for quick answers to your questions.  Medical and therapy terms are fully explained so that you don’t have to run to Google to figure out what each term really means.  

My book provides parents with ideas they can use today to move forward with potty training!

 Help has arrived!

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Waiting for Toilet Training Readiness? Create It Instead!

 

 

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Fall has arrived in New York, and toddlers know the best way to enjoy it!

I just watched a therapist on YouTube tell parents how to look for toilet training readiness signs.  From her limited description, you would have a better chance of finding truffles in France!

The signs of readiness in special needs children can be subtle, so do not ignore moves such as going behind the couch before having a bowel movement (if they can anticipate it, they can do it in the potty, too) and jumping around a bit before urinating into a diaper.   A lot of signs are not that hard to see.  Low Tone and Toilet Training: The 4 Types of Training Readiness  Other than the physiological ability to keep a diaper dry for 1.5-2 hours, which is reached around 18-24 months, most of the other types of readiness can be facilitated.  Even in special needs kids.    And I am not taking about forcing any child to use the toilet.  Ever.

The good news is that you can create more readiness without force.  You shift their awareness, give them vocabulary, engage them in elimination events, and through it all, you inspire them.  Sounds simple, but it takes some thought and effort.  It is totally worth it, from the savings on diapers to the decreased stress on you and your child when you do start training.

Not every child needs your help to become ready for toilet training.  I know plenty of parents who say that at least one of their children really self-trained.  Sounds hard to believe, but a motivated and attentive toddler that has been watching an older sibling…well, they have been taking notes!  They just need a little bit of encouragement, and off they go.  “Go” as in go to the bathroom.

Creating more readiness in toddlers that aren’t self-starters isn’t hard.  When you diaper them, you narrate and explain.  It sounds silly at first to do so, but children are sponges and absorb more than you think.  You are inviting them to attend, not encouraging them to watch the TV while you wipe them off and strap a diaper on them in standing.  Have them participate by holding wipes or clean clothes, go get a clean diaper for you, and when they are ready, have them toss out a well-wrapped dirty diaper.

Let them see how it’s done.  I wrote a post on this, Low Tone and Toilet Training: Kids Need To See How It’s Done  so I am not going to go into the details here.  Let’s just say that a picture is worth a thousand words.  The less language a child has, the more your demo helps them to understand the process.

Read those potty books, watch those potty videos.  Not just your child, but you too.  If you are watching and reading with them, you are communicating that you value the idea of their participation. Speak about their eventual independence in terms that inspire.  Not pressuring them, inspiring.  We talk about how they will go to school one day, be a mommy or a daddy one day.  This is something closer to the horizon, but if it is spoken about as a far-away event, well, it will be.

Help has arrived!  My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is available on my website, tranquil babies, and as a clothbound hard copy when you contact me through the site.  Read The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived! to learn why my innovative book design and detailed information on toilet training will help you make immediate progress, regardless of your child’s current abilities.

Why “Hand-Over-Hand” Assistance Works Poorly With So Many Special Needs Children

This method of teaching fine motor skills has never worked well for me in Early Intervention.  In my professional experience, it has been the cornerstone technique for many special educators.  Very often, the scenario is as follows:  I get a call from a concerned parent, telling me that the teacher is wondering if their child has sensory aversion, since he or she resists the teachers’ touch during sessions.

Sometimes that is indeed the case.  More of the time it is not.  The true reason why “hand-over-hand” assistance is not accepted or working well is a little more complicated.  Here are the two situations in which sensory aversion is not the biggest problem, but there are  other good reasons for the failure of this method of support:

  1. Children with low muscle tone.  Holding a child’s hand and guiding them, even moving their hand and arm, limits the necessary proprioceptive and kinesthetic information that is required to learn.  The tactile sensation from an adult’s hand masks this subtle information.  The brain cannot process and learn if it isn’t receiving correct and useful information.  One strategy that does work for me is using the weight of my hand to create “drag” or more proprioceptive/kinesthetic information as the child moves intentionally.  It cannot be too much drag, restricting their movements, and it cannot be too little, which the brain interprets as offensive light touch.  This takes practice to learn, and it helps if you are good at perceiving your own subtle movements.  Think Feldenkrais or Tai Chi.
  2. Children with cognitive and/or communication delays.  A child that doesn’t realize that “hand-over-hand’ assistance is helping them perform a task, or doesn’t want to perform that task, will resist the physical contact of an adult.  Imagine if the person sitting next to you suddenly grabbed your partially paralyzed hand and brought it off the table.  You would jerk it back.  Except if you realized that a spider was crawling toward your hand!!   If a child is unaware or uninterested, it makes sense for them to resist physical intervention.  So many globally-delayed children are handled all day long without their full awareness or even their consent.  They may have no interest in stacking blocks or scribbling.  There are other ways to assist them.  Creativity and excellent observations of a child’s motivators is the key to improving their participation.

I hope this clarifies why I rarely use this method of assistance with my clients.  It can work, but usually it works better with older special needs children, and children without sensory processing issues.  Unfortunately, that population is hardly ever on my Early Intervention caseload!