Monthly Archives: April 2020

Want Your Child to Show Hand Preference (Righty/Lefty?) Where You Place Their Spoon Matters

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I get a lot of questions about this issue, based on my experience as a pediatric OTR.  Starting at 12 months, some children show a strong hand preference and never look back.  Other kids are switching hand use long after 4.  Without the existence of disorders that directly affect hand dominance such as orthopedic disorders, cerebral palsy, or untreated torticollis, hand dominance is hard-wired and emerges naturally.  But there are situations in which it is delayed or incomplete long after the typical window of skill development.

Here is what can be happening, and here is what you can do as a parent or a therapist:

Hand dominance only emerges with the development of refined hand control and the child’s awareness that they need more skilled control for an activity.  I tell parents that I can pick up my coffee cup with either hand to drink, but that doesn’t make me a lefty.  If you paid me $100, I probably couldn’t thread a needle with my left hand.

Children that aren’t practicing refined skills like feeding or assembling blocks, or even intent on picking up every darn piece of lint on the carpet…they don’t need refined grasp, and they probably will not demonstrate hand dominance on time.  Kids that are scribbling wildly but haven’t tried to draw a circle with closure ( a 36-month skill, BTW) also have no need to develop dominance.  The self-starter, the baby and toddler that watches you intently and decides to learn all these skills?  They won’t need much help.  But the child who avoids challenge or gets help because it is easier and faster for an adult to feed them or help them build a tower?  They may lag behind in hand development.

Some kids are very tuned into adult actions, and copy the hand that a parent or teacher uses.  These are the children that are great mimics.  They can see that you are using your right hand, and even if they naturally grab with their left hand, they transfer objects into the same hand you are using.  Adults are naturally inclined to assume dominance as well.  I cannot count the number of times I absent-mindedly handed a pen to a left-handed parent into their right hand.  If you do that to a child under 5 , they assume that you want them to use that hand, and will struggle on.  This is where spoon placement matters.  I encourage parents to place the utensil in the center of the placement or tray, and watch which hand (both of the child’s hands must be free) their child chooses over many trials.

If a child is inconsistent but clearly uses their left hand more often, placing their spoon on that side of the tray should boost use, and with skilled use comes more skill and awareness.  I never pull objects out of a child’s hand.  I don’t need to.  They will drop their crayon or spoon frequently enough for me to have another chance to offer it back to them.

What if I (or a parent) picked wrong?

Dominance isn’t that easy to alter.  Ask your grandmother what the nuns in Catholic school did to alter dominance in lefties (it was considered “the devil’s hand”, and what they did wasn’t pretty).  Children will eventually simply transfer their spoon over to the other hand.

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How To Help Your Toddler Hold a Spoon

hal-gatewood-e3Y23rtVk8k-unsplash.jpgHolding a spoon or fork isn’t an intuitive skill for children.  Neither is assisting another person, of any age, to self-feed.  Parents really have struggled with this issue, and there must be many more out there who are struggling still.  This post is intended to help both parties be more successful.

Young children use a “gross” or fisted grasp to hold a utensil; see the photo above.  This continues until 3-4 years of age, when they have the hand strength and dexterity to use a mature grasp that incorporates the fingertips and thumb:

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Trying to force a toddler to use a mature grasp is almost impossible, and allowing a toddler to use an atypical grasp is also unacceptable.  It is inefficient and frustrating.  The amount of spillage almost always makes parents decide to feed a child that should be learning to feed themselves.

Parents need to teach utensil grasp, and support it with the right tools and assistance until self-feeding becomes easy and natural to a child.  Here is how to make that happen:

  1. Have the right tools.  Once a child is old enough to try to self-feed, they need toddler utensils.  Adult utensils have thinner, longer shafts.  This makes it much more difficult to hold.  Not impossible, just harder.  Make life easier on both of you and invest in toddler spoons and forks.  Infant feeding spoons have a tiny bowl and a very long shaft.  That is because they help scoop food from a jar and reach a baby’s mouth:  adults are the intended users!  Do not give them to your toddler.  They are harder for toddlers to use.  Shallow plastic bowls with a non-skid base are very helpful.  OXO sells the best bowls for this purpose, and since they are well-designed, you don’t have to get rid of them as kids get older.  They will be attractive and useful for years to come.
  2. Provide the right assistance.  In the very beginning, I encourage parents to load a fork with a safe food such as a cooked piece of carrot.  Food on a fork doesn’t fall off as easily.  They place the fork in the child’s hand and assist them in bringing it to their mouth.  Adults need to “steer” the utensil until a child develops the motor control sequence to successfully get food on the utensil.  Parents should be holding the end of the handle so that the child can place their hand in the center of the handle shaft.  Children will grasp the end of the spoon if the parent uses any other hand placement.  Young children will not automatically hold a utensil correctly.  It is the parent’s job to know how to present the utensil for grasp.
  3. Make it fun.  Feeding shouldn’t be difficult or unpleasant.  I wrote a popular post on the best way to make learning to use utensils enjoyable Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child .   This works even with children with ASD and SPD.  In fact, it might be the best way to get kids with these diagnoses to learn to use utensils.  There is an opportunity to develop social skills and turn a daily living skill into a fun game!

How Therapeutic Listening Enhances Motor Skills

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My readers know that I am a huge fan of Quickshifts in treatment.  I have had some amazing successes with Quickshifts for regulation and modulation.  Their focus on combining binaural beat technology with instrumentation, rhythm, melody and tone makes these albums effective, and it eliminates the challenges of modulated music for very young or fragile kids.  But many parents (and a few therapists!) think that if a child doesn’t have severe sensory processing issues, then therapeutic listening isn’t going to be helpful.

That indicates that they don’t understand the principles and the rationale for the use of therapeutic listening.

Since every movement pattern has rhythm and sequence, it is completely logical that enhancing brain function with an emphasis on a calm-alert state with music will affect movement quality.  (This includes speech.  Speech is a highly skilled series of very small movements in a precise sequence! )

I am currently treating a toddler who experienced encephalopathy in infancy.  A virus affected the functioning of his brain.  The residual low muscle tone and praxis issues are directly improved by using Gravitational Grape in sessions.  He is safer and shows more postural activation while listening.  Endurance while standing and walking is significantly improved.

Another client with low tone has Prader-Willi syndrome.  Her movements are so much more sequenced with the Bilateral Control album.  Her ability to shift her weight while moving is significantly better during and immediately after listening.

All of us are more skilled when we are in the calm-alert (alpha brainwave) state that Qucikshifts entrain.  For people without motor or sensory issues, alpha states can help us think clearly and organize our thought and movement for higher level performance.  For children with movement control issues, it can improve their safety and stability.  They move with greater ease.  Therapy sessions are more productive, and play or school functioning is less work.

Due to COVID-19, I have been forced to do telehealth and use therapeutic listening with more children, rather than rely on equipment or complex sensory processing activities.  The silver lining is that parents are more involved in my sessions and can see what benefits this treatment is having on their children.   When social distancing retreats, I hope that therapeutic listening will be seen for the powerful treatment it most definitely can be!

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How To Improve Posture In Children With Low Muscle Tone… Without a Fight!

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With pediatric occupational therapy going on at home using parents as surrogate therapists, it isn’t helpful to ask a parent to do too much repositioning of children with low tone.  First of all, kids don’t like it.  Second, kids really don’t like it.

I have never met a child that enjoys therapeutic handling, no matter how skilled I am, and I don’t think I ever will.  They don’t know why we are placing their hands or legs somewhere, and they tend not to like to be told what to do and how to do it.  The best you can hope for at times is that they tolerate it and learn that therapists are going to be helping them do what they want to do For Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance.

Leaving a child in an awkward and unstable position isn’t the right choice either.  They are going to struggle more and fail more when out of alignment and unsteady.  If you know this is going to happen, you can’t let them stay that way because you also know that this will blow back in your face in the form of frustration, short attention span, and children developing a sense that whatever they are doing or whomever they are doing it with is a drag.  A real drag.

So how can you improve the posture of a child with low tone without forcing them physically into a better position?

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Does Your Gifted Child Interrupt You Constantly? Respond This Way For Better Results

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Gifted kids of all ages like to ask questions.  Most of the time, they have an intensity that means they frequently interrupt people.  It is one reason why they like books and online media.  They can turn the page, scroll fast, and toggle back and forth without waiting for you!

As understandable as this behavior is, it is still impolite and annoying.  This is a problem.  Gifted kids aren’t always the kids with the most friends, and highly gifted kids are so far off the developmental path of their typical friends that sometimes they have only one friend.  Or none.

Teaching a gifted child how to behave socially is important for their long-term and short-term mental health.  They aren’t trying to be difficult or rude.  They need adults to help them manage their gifts.  Here is a suggestion to manage the chronic interruptor:

Give them MORE information than they asked for, using technical terms that you think they don’t know, and more details than you would offer another child of the same age.

Why?

The gifted brain looks for three things:  intensity, complexity, and satisfaction of the drive for learning, novelty and perfection.  Giving a gifted child an answer in this way, rather than shutting them down, is like giving a thirsty man a bottle of water.

If your child sits back and thinks about your complex answer, their shoulders relax, and their tone softens, you know you hit pay dirt.  You got it right.

What if they become more aggravating?

The child that, instead, is being a real PITA, who wanted your attention but not your information, the child that wanted to jerk your chain?  They won’t react this way.  They may even get more aggravating.  When your child draws a line in the sand and baits you, that has nothing to do with being gifted.  They are defying you.  Different problem.

But the gifted child, who was simply expressing that drive, intensity and complexity?  They should be much happier, and they could even smile at you.  You understood them, you got them.  Responding this way to my clients  and getting a positive result is one way I know I could have a gifted child in front of me.  Giftedness is rarely formally tested under 5, but it emerges early.

For more information on helping gifted children thrive, read  Why Gifted Children Aren’t Their Teacher’s Favorite Students….  and  Raising a Gifted Child? Read “A Parent’s Guide to Gifted Children” For Successful Strategies To Navigate the Waters  .  One of my new posts, Gifted Child? Try “How Does Your Engine Run” For More Peace at Home and School , describes a program occupational therapists use that teaches a gifted child how to manage their drives in a positive way.

If you want to ask me questions about managing your gifted child, visit my website,  Tranquil Babies , and buy a consultation session.  You will be able to have more of an understanding of why you and your child struggle so much when they are so smart!!

Why Gifted Children Aren’t Their Teacher’s Favorite Students….

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Parents of bright children often want to have their child in programs for the gifted and talented.  Parents of gifted children want their child to make more friends and spend less time in the principle’s office.

Why?

Gifted children of any age are rarely the teacher’s pet.  Here are a few reasons:

  1. Bright kids are a joy to teach.  Gifted kids are usually the children that disrupt and challenge teachers.  Bright children learn quickly and can answer all the questions.  A gifted child learns amazingly quickly and asks more questions than the teacher raises.  They can grasp a concept or an action after 1-2 repetitions.  And then they are done with that topic.  Really done.  Bored stiff or wanting to drill deeper.   This makes them out of step with their peers in a typical classroom.  Teachers have to work harder to make their lessons effective for the gifted child while staying on the lesson plan and managing the kids who struggle to keep up.
  2. Gifted kids are passionate: passionately opposed to rigidity, passionate about fairness, and addicted to logic.  They are not fond of following baseless rules, or sometimes any rules.  In fact, pointless rules are like poison to a gifted child.  Bright kids know these rules are pointless, but they care more about the consequences of disobeying, so they go along.  Gifted kids find the illogical and often capricious nature of these rules offensive to their very spirit, and will even bait teachers to get them to admit that their rules make no sense.  This won’t endear a gifted kid to educational staff, even the teachers that initially liked the challenge of teaching an intensely inquisitive child.
  3.  Bright kids learn the correct answers and rattle them off as requested.  Gifted kids believe that there are no correct answers.  The gifted child sees all the gray areas and can see the many sides of a situation.  They can even see that math questions could have more than one answer.   For teachers that are linear thinkers, this can be maddening.  For gifted kids, it is how they see…everything!

I love working with gifted children.  They can be the most fun I have in a day!  I love helping them handle their sensitivities and helping their parents understand their needs.

Looking for more ways to help your gifted child?

If you are the parent of a gifted child and would like to learn more about how to approach everyday issues with confidence and compassion, visit my website Tranquil Babies and purchase a consultation session under Happiest Toddler on the Block.  Even if your gifted child isn’t a toddler, that will be OK.  You will get a 30-minute session focused on you and your child!

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Screen Time for Preschoolers? If You Choose to Offer Screen Time, Make it Count With These Apps

Parents have to make the decision to offer or restrict screen use to their youngest kids.  I won’t take sides on this, as it is a decision that is made by knowing the child, the family    dynamics and the risk/rewards at the moment.  I believe that if young children are going to use screens, that they should be using them with an adult and they should have well-designed apps that build skills rather than simply entertain.  Easier said than done.  There is a lot of poor material out there.  It may keep a child quiet for a time, but it isn’t teaching them anything except that if they protest loudly enough, their parents might cave.

Two app designers that I can strongly recommend are Tiny Hands and Duck Duck Moose.  Both have fun apps that require a child to think and listen.  Nothing happens by randomly tapping a screen.  The graphics are fun but not so intense that they are overwhelming for kids with visual processing issues.  Tiny Hands has apps for younger toddlers and older toddlers, and Duck Duck Moose starts out with simple games and progresses to math and reading apps.

For older toddlers and preschoolers, THUP has Monkey Preschool Explorers, Monkey Preschool Lunchbox and Monkey Math Scholastic Sunshine.  All very well designed and impossible to play without paying attention.   Filling the aquarium with sharks is totally fun!!

My readers may know that I like to pair screen use with a tablet stylus to build pencil grasp and control.  Want A Stronger Pencil Grasp? Use a Tablet Stylus Make sure that it is a stylus that doesn’t have any metal, or your glass screen will not survive.  Young children can break off the rubber tip, so they need some initial supervision and instruction.  Since I highly recommend that screen time is done with an adult, that shouldn’t be a problem!

A Practical Guide to Helping the Hypermobile School-Age Child Succeed

 

The Joint Smart Child.inddThe JointSmart Child series started off in 2019 with Volume One:  The Early Years.  It is finally time for the school-age child to have their needs addressed!

Volume Two:  The School Years is available now on Amazon as an e-book, filled with information to make life at home and at school easier and safer.  This book is equally at home on a parent’s or a pediatric therapist’s shelf.   Filled with clear explanations for the daily struggles hypermobile children encounter, it answers the need for a practical reference guide for daily living:

Section I reviews the basics:  understanding the many ways that hypermobility can affect motor, sensory and social/emotional development.  General principles for positioning and safety are presented in easy-to-follow language.

Section II addresses daily living skills such as dressing, bathing and mealtime.  School-age kids may not be fully independent in these areas, and they need targeted strategies to improve their skills while boosting their confidence.

Section III looks at school and recreational activities.  It covers handwriting and keyboarding, playing sports and playing musical instruments with less fatigue, less pain, and more control.  When parents and therapists know how to select the best equipment and use optimal ergonomics and safety guidelines, kids with hypermobility really can thrive!

Section IV reviews the communication skills in Volume One, and then expands them to address the more complex relationships within and outside the family.  Older children can have more complex medical needs such as pain management, and knowing how to communicate with medical professionals empowers parents.

The extensive appendix provides informational forms for parents to use with babysitters and teachers, and checklists for chairs and sports equipment such as bikes.  There is a checklist parents can use during IEP meetings to ensure that their child’s goals include issues such as optimal positioning, access, and endurance in school.  Therapists can use the same materials as part of their home program or in professional presentations to parent groups.  There are even simple recipes to use cooking as a fun activity that develops sensory and motor skills!

I believe that this e-book has so much to offer parents and therapists that have been looking for practical information, but find they have to search around the internet only to rely on other parents for guidance instead of health care professionals.  This is the book that answers so many of their questions and empowers children to reach their highest potential!

for more information on how to help your hypermobile child, read Need a Desk Chair for Your Hypermobile School-Age Child? Check out the Giantex Chair and Should Hypermobile Kids Sit On Therapy Balls For Schoolwork? plus Should Hypermobile Kids Use Backpacks?

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CPSE or CSE Review Without a Re-Eval Because of COVID-19? Here’s What You Need To Ask For

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One of my private clients just called me for some backup.  Her son, who is on the autism spectrum, may lose some of his school OT sessions due to his increased handwriting ability (thank you; we have been very working hard on it!), but no further formal testing could be done before schools were shut down due to COVID-19.  His fine motor scores were in the average range. Everyone knows he is struggling with attention and behavior in class.  Everyone.

My strategy?  I gave her the Sensory Profile for ages 3-10 (SP) to complete.  Almost all of his scores were in either the “probable difference” or “definite difference” categories.  This means that his behavior on most of over 125 different items is between one and two standard deviations from the mean.  Even without a statistics course, you can understand that this is likely to be impacting his behavior in the classroom!

Many of the modulation sections of the SP, including “modulation of visual input affecting emotional responses” and “modulation of movement affective activity level” directly relate to observed school behaviors.  Scores in “multi sensory processing” and “auditory processing” were equally low.  Think about how teaching is done in a group:  it is visual and verbal.  Kids have to sit to learn.  They have to tolerate being challenged.

This is why OT in the schools is more than how to hold a pencil.  We address the foundational skills that allow children to build executive functioning skills.  Without these skills, all the routines, prompts, reward systems and consequences aren’t going to be very effective.

School therapists cannot test your child accurately using a standardized instrument when schools are closed due to COVID-19.  But parents can respond to a questionnaire, and it can be sent and scored remotely.  The Sensory Processing Measure is another sensory processing questionnaire able to be completed remotely.  These scores will help your therapist and your district understand the importance of OT for your child.  When school does resume, related services are going to be essential services!

For more information on how to work on OT issues at home, read Using A Vertical Easel in Preschool? WHERE You Draw on it Matters! and Does Your Older Child Hate Writing? Try HWT’s Double-Lined Paper.

If your child is hypermobile, you will need my newest e-book, out on Amazon right now!

The JointSmart Child:  Living and Thriving With Hypermobility Volume Two:  The School Years, is designed to address the challenges and needs of the school-aged child 6-12.  It has plenty of add-ons in the appendix to help you at home and at school. Learn how to pick the right chair, the right spoon, the right desk and even the right bike!  It gives you ideas to build ADL skills like dressing and independent bathing, and ways to build your confidence when speaking to doctors and teachers!

My earlier book, The JointSmart Child:  Living and Thriving With Hypermobility Volume One:  The Early Years, is also available on Amazon and at  Your Therapy Source.  It addresses development from birth to age 5.  It provides parents with all the ADL strategies to build independence AND safety, plus ways to teach your family    and babysitters how to work with your child more effectively.  Parents start feeling empowered, not overwhelmed, right away!

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Is this recess in your house during the COVID crisis?