Monthly Archives: November 2016

Successful Swaddling May Take More Layers of Calmness

ferris-wheel

Newborn crying can make you feel like you are on a ferris wheel; around and around you go!

Swaddling is a skill, but it is also an art.  Once you have your little one snug as a bean burrito, they don’t always stop crying right away.  When I teach parents the 5 S’s as part of a Happiest Baby on the Block consultation or class, I try very hard to explain that most children need more layers of love.  Parents aren’t doing it wrong if they keep crying, and babies aren’t resisting the swaddle.  They just need more support because they have little brains and few experiences in this world.  Once you figure out what combo of moves your child needs, you have success!

Once you have done a good-enough swaddle, use the side or stomach-down calming move right away.  As a pediatric occupational therapist, this is my favorite, since it is using the neurology of the vestibular (balance) system to help your child chill out.  Really.  They aren’t thinking  “Gee, I love the view in this direction”, or ” I am much calmer looking at the floor”.  Their brain is getting some calming signals from their inner ear, diminishing that arching from the Startle Reflex and helping them pull together.  Try both positions, and make little adjustments in the exact tilt.  Everyone’s brain is a little different, so your child might need side-plus-slightly face-down to hit that calm point.

Think of it like this:  when you sleep, why do you think people curl up on their sides?  Because the bed is too short?  It is relaxing, naturally relaxing, to many people.  No one told them to sleep that way, they just do.  The number of back sleepers is far fewer, yet pediatricians insist on back sleep for safety and give you no idea how to convince your child to chill in this position.  That seems unfair, but then, many pediatricians aren’t baby care experts, they are baby health experts.  We just want them to be.

Now you can do all the gentle swinging, shushing and sucking layers you learned in Happiest Baby.  They all work well, and you will quickly learn which one is the most powerful for your unique little baby.  As your child grows, the layers aren’t as needed as much, but you may find that one of them really makes a difference.  Often it is the white noise of shushing.  Now you know why.  It’s their neurological sleep signal.

Sweet dreams, and remember to layer it on!

Advertisements

After Kangaroo Care: Infant Massage and Tummy Time on Mommy (or Daddy)!

“Kangaroo Care” is the term your NICU used for placing your newborn directly on your chest, face turned to one side, and letting her get the sensory and regulatory benefits that neonatologists believe she can gain from this position.

Then she gets stronger and you all go home.  What can you do at home?  Well, you could try to keep using this lovely position, but babies start to move, and they want to get up and go.  It’s hard to keep them on your chest when they are wiggling around.  If she navigated the NICU successfully, this is a wonderful problem to have: she is energetic and active!

Keep the love, warmth and connection going, and give her all the physical benefits of skin contact with infant massage and by placing her on her stomach on your chest while you lie in a partially reclined position, with her trying to look up at you.

Infant massage is easy to learn (I teach it in one or two 50-minute sessions) and it is easy to incorporate into your routines.  Even babies with medical issues can handle most of the standard massage moves, and a little goes a long way.  I teach unique adaptations for special needs preemies that don’t stress them out.

You won’t be massaging her for more than 10 minutes at first.  The effects of touch and movement on your newborn can support growth, sleep and focusing.  There have been a few research studies that suggest more specific benefits on health, but the secret is that infant massage is good for you too.  It will relax you and build your store of feel-good neurochemicals.  How cool is that?

Tummy time for tiny ones isn’t that complicated, but it is a bit different for NICU graduates. You may need to give her some assistance to keep those little elbows directly under her shoulders (they tend to drift out to the sides) .  Entertain her with funny faces and (interesting but not overwhelming) sounds from toys or sounds you make, and sing a little.  Babies are very forgiving and will tell you with their breathing patterns and muscle tension if you are getting it right.  Be positive, even if she is fussing, and be creative.

Tummy time for 45 seconds 10x/day is way better than 3 minutes of crying 3x/day.  There is encouraging, and there is pushing.  Be the coach she deserves, supporting her with the right moves, right from the start!!

Piddlers Make Potty Training Fun!

unknown

Your son will eagerly run for potty time!

I laughed out loud the first time I saw a toddler pee onto one of these circles.  Then he asked for more juice so that he could come back later and try again!

Piddlers aren’t a new concept.  Parents have been tossing cereal circles into a potty for “aiming practice” for a long time.  These commercially-made circles are just easier to aim for, dissolve more, and clean up easily.  Cereal has a funny way of bouncing around in the toilet, making it more frustrating, not as successful and not as much fun.

Getting children motivated to use the toilet can be a big headache.  For every totally cooperative toddler, there are 5 more that are defiant or simply uninterested.  They just won’t “go”.  Piddlers may not be a total answer, but they can get your son over these barriers to skill development.  Once a child is successful and has a routine, things are so much better!

Little boys have to control their aim if they are going to urinate standing up.  This is a totally new concept for them, and a skill.  Yes, a skill.  Since they have been using a diaper for elimination from the day they came home from the hospital, toilet training is a completely foreign concept, from beginning to end.  It’s a little bit funny: mostly the mommies are in control of toilet training, but only brothers, cousins and daddies can demo this particular skill.   Read Low Tone and Toilet Training: Kids Need To See How It’s Done to understand why a live performance can jump-start your child’s comprehension of toilet use.

Piddlers are made of starch and food coloring, and won’t turn anything blue or orange.  You may not even need the whole package!  Once a child has success and has developed a routine, explain that you need to go to the store later to buy more (not really), but he can use the potty right now anyway without one or two Piddlers in the potty.  Eventually you won’t need Piddlers any more, but you will have a little boy that is paying attention to what he is doing in the bathroom!

Great News!  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 .  Just click the “e-book” section on the top ribbon to get your copy.  

Don’t think your child is ready for toilet training?  You need this book more than the parents of kids that are struggling with training!  Knowing how to prepare your child and yourself before you start training can make all the difference.  My book will explain in detail what you need to know and how you can start developing potty skills…today!

Is My Child Right or Left-Handed? How Handedness Emerges, And How You Can Influence Development

 

Wok and Roll!

Playing Wok ‘n Roll with Edison Chopsticks!

Parents can get worried about a lot of things, and slow development of a dominant hand is one of them.  Therapists get worried about things too, but the development of dominance is usually not one of them.  Except in one situation.  And parents can make a bigger impact than they think.

It is generally accepted that handedness is assigned by the brain during fetal development, so most children don’t actively choose which hand they will be using for skilled tasks such as writing. Hand dominance can start to emerge by 12 months in typically-developing infants, but is most commonly seen during the 18-24 month stage. This is when a child learns to use utensils independently for meals and eagerly scribbles with crayons.  Children are copying adult actions, and becoming more interested in opening, closing and manipulating small objects that require a dominant hand.

In my career, I have only worked with one child that did not demonstrate clear hand dominance by the age of 5, even after years of therapy.  He was an engaging but extensively neurologically-challenged child.  His brain may not have had the “hard-wiring” for dominance.  His parents chose to train him to be right-handed around 7, and he did become more skilled with his right hand.  I tell most concerned parents that their preschooler is likely to develop a dominant hand with targeted activities and daily play that supports it’s emergence.

Then there are the children who have major motor or orthopedic challenges from birth.  Brain injury, limb loss, or atypical development of a limb may mean that a child has only one hand that can be effectively used for feeding or writing.  This may not be the hand that the brain is wired to select for dominance.  A child with these challenges might have to work harder to develop hand skills.  Every time he picks up objects, feeds himself a meal, or puts on clothes, he is re-wiring his brain for refined and automatic use of that hand.  Parents of children with these challenges should be concerned about mobility, strength, and posture, but effective development of the less-affected or unaffected hand as the dominant side is going to happen with good therapy and lots of practice.

When do I worry?

I get the most concerned with children that actively avoid or aren’t encouraged to participate in the typical play and self-care skills that develop hand control.  When I see a 3 year-old child being fed because it is faster and neater for the adult, or watch an adult drawing a truck while a preschooler watches passively, or I see a toddler stand still in front of the TV while being dressed, then I get nervous.

Sometimes it is just easier to feed and dress a child when they are slow or resistant.  I hardly ever hear a parent (that is not a Montessori teacher) say that they created a game in which their child had to work to figure something out.  Some children are born with a persistent drive, and work hard in the face of a challenge.  Most don’t.  And some parents don’t realize that holding a bag open during “clean up” is depriving their child of the opportunity to build coordination skills, as well as self-confidence and independence.  Sure, it takes longer to pick up all those LEGOs, but building a brain takes time.

If children are not actively encouraged and rewarded for participation, and given great tools that make it fun to work on these skills, they will not have the necessary experiences that train the brain.

If you are worried that your child isn’t showing the emergence of a dominant hand, try creating more and better opportunities. Watch which hand your child prefers for skilled control.  That is likely to be the hand she will be writing with in the next few years!

 

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

photo-1445800363697-51e91a1edc73  Toilet Training Help Has Arrived!             

My most popular post,  Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!) inspired me to write a manual to help parents with potty training.  There was nothing in books or online that really helped families, just a few lines about being patient and not pushing children….no help at all!

What makes this book so unique?  Media specialists say that you have to be able to explain your product in the time it takes for the average elevator ride.  OK, here is my elevator speech on The Practical Guide to Toilet Training Your Child With Low Muscle Tone:

My book provides a complete explanation of the motor, sensory, and social/emotional effects that low muscle tone has on toilet training.  It does so without being preachy or clinical.  Parents understand whether their child is ready to train, and how to start creating readiness immediately.  They learn how to pick the right potty seat, the right clothes, and how to decide between the “boot camp” or gradual method of training.  A child’s speech delays, defiance or disinterest in potty training are addressed in ways that support families instead of criticizing them.

  • Each readiness quiz helps parents figure out what issues need to be addressed for successful training and reminds them of their child’s strengths.
  • Chapter summaries give a quick review of each section.  Parents decide which chapter they need to read next to get more information.
  • Clinical information is explained in layman’s terminology, so parents don’t have to Google “interoception” to understand the neurology that causes a child not to recognize that they have a full bladder.

Here’s what parents are saying about The Practical Guide”:

The Practical Guide has truly been heaven sent!  Although my globally delayed 5-year old daughter understood the idea of toileting, this skill was certainly not mastered.  Our consultations with Cathy and her guide on how to toilet train have given me the knowledge I’ve needed to understand low tone as a symptom that can be tackled.  Morgan has made visible advances, and I am so encouraged and empowered because I know what piece we need to work on next.  Thank you, Cathy, for writing this book!”      Trish C, mother of Morgan, 5 years old

“I would often say to myself “Cathy has to put all of her accumulated wisdom down into a book”.  I am happy to say-here it is!  You will find no one with more creative and practical  solutions.  Her insights and ideas get the job done!”     Laura D. H., mother of M., 4 years old 

Cathy has been a “go-to’ in every area imaginable, from professional referrals to toilet training.  I can’t say enough positive things about her.  She has been so insightful and helpful on this journey.”  Colleen S. mother of two special needs children

How do you buy my book?  Three ways:  Visit my website  tranquil babies and click on “e-book” at the top of the homepage, Buy it on Amazon.com, or visit your therapy source, a wonderful site for parents and therapists.  Just search for The Practical Guide to Toilet Training Your Child With Low Muscle Tone!

HELP HAS ARRIVED!

 

 

Should Your Child Use A Pencil Grip?

I will be asked about pencil grips every time I teach a workshop or lecture on handwriting.  My popular post, The Pencil Grip That Strengthens Your Child’s Fingers As They Write. , partially explains when and why I would recommend the use of this excellent pencil grip with older kids.  I have a message for preschool teachers that see awkward or clumsy pencil grasp in their 4 -year-olds:  don’t use a grip until you have worked on grasp!  The reason?  The other grips will not develop better grasp, and pencil grips are too frequently lost or used improperly with young children.

Pencil grips can be a huge help for older children or children with specific muscular or neurological issues.  Kids with low muscle tone or too much joint mobility in their fingers can really benefit from their use.  Children with mild cerebral palsy and muscular dystrophy can also benefit from the use of a good grip and the correctly-sized writing tool.

For typical kids who aren’t using a tripod or quadruped grasp but are writing letters, the better choice is to get creative with crayon and marker dimensions.  Short crayon pieces, Flip crayons from Handwriting Without Tears (HWT), and writing with a tablet stylus from iCreate can strengthen muscles and increase tactile and proprioceptive awareness.  Finally, teach grasp actively.  HWT does a fabulous job in their teacher guides.  These books, especially  the pre-K book, are underutilized.  They are fantastic resources for any preschool teacher and pediatric occupational therapist.

Pencil grips can help some children, but don’t jump into a grip until you have addressed the reasons you were thinking of using a grip in the first place!

Bringing Home Your Preemie: What Your Therapists Would Like You To Know

Discharge day for a preemie is special, but it is just the beginning of a journey that often includes therapy at home.  As an Early Intervention therapist, I thought parents could use some insights into what your team is really thinking when they begin to work with you and your baby.

  1. We know that you are nervous.  This is your first experience with a medically fragile child, but it isn’t ours.  Most of us have worked in hospitals before, and are well-acquainted with universal precautions, shunts and feeding tubes.  We are always looking for signs that things aren’t going well, and we will do everything we can to ensure your child’s safety at all times.  That may mean that we will tell you that things like placing a Bumbo chair on a table is a risk, and those chairs do not give your child the correct support for growth.  Regardless of what your sister-in-law said about her child.
  2. We aren’t doctors, so we will not give you a diagnosis, even if we suspect something.  Legally, we can’t diagnose, so even though we suspect that your child may have cerebral palsy or another issue, you won’t hear it from us.  In the past 15 years, I have seen neurologists in NY delay diagnosing conditions such as CP for well over a year after birth, even when there isn’t any alternative diagnosis that fits.  Parents are left waiting and wondering, hoping that it isn’t so.  The internet allows parents to learn quickly what all that muscle rigidity and terms like “leukomalacia” can indicate.  I suspect that medical liability issues are at the heart of this delay, and it is tearing parents up inside.  But we aren’t allowed to tell you our suspicions.
  3. You are the greatest determinant of therapy success.  We can only guide you, demonstrate techniques, positioning, and give you therapeutic activities.  What you do every day is essential and will determine much of the success of our work.  If we suggest that you hold your baby in a manner that builds head control, reduces arching or encourages reaching, we know that your actions will determine if it works.  If you ignore our suggestions without discussing your concerns, or worse, tell us you are doing them when you aren’t ( we can actually tell),  you aren’t getting very much from your child’s therapy or your therapists.
  4. Babies can feel fear or confidence, so ask questions and get more reviews and guidance if you don’t really understand what your therapists have suggested.  We do this all day long, and most of us have been handling premature babies for years.  We know this is all new to you.  No judgements!