Author Archives: Tranquil Babies

About Tranquil Babies

I am a nationally certified Happiest Baby on the Block educator, a licensed pediatric occupational therapist in private practice, and a licensed massage therapist with a specialization in infant massage and special needs massage. I provide services privately in the NYC area, and I contract my services to Early Intervention agencies. Although I have worked in hospitals and outpatient centers, my passion is working with children in their homes. Home is where the most change can happen, where parents feel most comfortable asking questions, and where children can use their own toys and equipment in treatment. Learning about Happiest Baby and Happiest Toddler techniques transformed my ability to connect with babies and both respect young children and set limits that did not crush their spirits. Massage has been a powerful way to treat neuromuscular issues in children, but it also helps me to connect with those that have difficulty communicating. Finding Handwriting Without Tears totally changed my ability to evaluate and help children write legibly with ease. I want to share everything I have learned in these domains over the years, and give you the best strategies for success. Every child deserves to be the best that they can be, but that is only possible if the adults around them create a supportive environment. By offering ideas and insights, I hope to give families, teachers and therapists new ways to create that magic space.

Parents and Therapists of Hypermobile School-Age Kids Finally Have a Practical Guidebook!

 

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 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 them, all the routines, prompts, reward systems and consequences aren’t going to be very effective.

School therapists cannot test your child accurately 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 also 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, coming out on Amazon next week!

Designed for the school-aged child, it has plenty of add-ons in the appendix to help you at home and at school.  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!

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Is this recess in your house during the COVID crisis?

Using A Vertical Easel in Preschool? WHERE You Draw on it Matters!

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There are a few equipment and toy recommendations that every home-based pediatric OTR makes to a child’s parents:  Play-Doh, puzzles, tunnels, …and a vertical easel.  Found in every preschool, children from 18 months on can build their reach and proximal (upper body) control while coloring and scribbling on a vertical surface, rather than a tabletop.

But WHERE a child is directed to aim their stroke matters.  Here is why:

  • Grasp and reach have a range of efficiency.  I tell adults to imagine that they are writing on a whiteboard for a work presentation.  Your boss is watching.  Where will your writing/drawing be the most controlled?  Everyone immediately knows.  It is between your upper ribs and your forehead, within the width of your body or a few inches to either side.  Beyond that range, you have less stability and control.  Its an anatomy thing.  If you are an OTR, you know why.  If you are a parent, ask your child’s OTR for a physiology and ergonomics lesson.
  • Visual acuity (clarity of focus) is best in the center of your visual field (the view looking directly forward with your head centered).  Looking at something placed in this range is called using your “central vision”.  Your eyes see more accurately in that location, children can see an adult’s demonstration more clearly,  and therefore they can copy models and movements more accurately.  Kids with ASD like to use their peripheral (side) vision because it is cloudy, and the distortion is interesting to them.  This is not good for accomplishing a visual-motor task or maintaining social eye contact, but they find this is a way to perform sensory self-stimulation and avoid the intensity of direct eye contact with others.
  • Young children have little self-awareness of how their environment impacts them.  Until they fail.  Then they think it is probably their fault.  The self-centeredness that is completely normal in children gets turned around, and a child can feel that they are the problem.  Telling children where to place their work on an easel gives them the chance to do their best work and feel great about it.
  • Children move on when a task is too hard, or when an adult doesn’t provide enough supportive strategies.  Telling a child to try again, or telling them that their results weren’t too bad” isn’t nearly as helpful as starting them off where they have the best chance of success.
  • Using the non-dominant hand to support the body while standing is an important part of easel use.  For kids with low muscle tone or hypermobility, it is very important.  Standing to the side or draping the body on the surface to write are both poor choices that OTRs see a lot in kids with these issues.  Make the easel a piece of therapy equipment and teach a child to place their non-coloring/painting hand on the side of the easel in the “yes zone”.  Look at the picture of the older boy at the beginning of this post, then at the gentleman below.  Note each person’s posture and try to embody it.  Which posture provides  more ease, more control? 

 

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Here is a graph of where an adult should place their demonstration on a page or board for optimal vision and motor control, and where adults should encourage a child to draw.  “NO” and “YES” refer to the child’s optimal location for drawing or writing.

The exception is for height.  A very tall child will need to draw higher on the chart, and a smaller child will only reach the lowest third of the easel.  This should still allow them to use their central vision and optimal reach.  If the easel doesn’t fit the child, place paper on a wall at the correct height.

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Egg Crayons or Fingertip Crayons: When Good Marketing Slows Down Fine Motor Skill Development

 

411VIzKWneL._AC_SL800_.jpgNow that COVID -19 is pushing EI into telehealth, I see exactly what parents have at home when they hunt around for pre-writing tools.  These egg-shaped crayons, and crayons where the child pokes a finger inside a cone-shaped crayon, are popping out of bins and drawers like little spring flowers.  I (mostly) hate them.

Why?

Because the only kids that benefit from them are infants and kids who have such limited grasp that a cylindrical crayon isn’t a realistic choice.  For absolutely everyone else, they teach kids nothing about grasp, and they make it harder to control a stroke.  They are fun to bang together and on a table, but they are really difficult to control to make more than a poorly executed mark.  This isn’t pre-writing at all.

So why are they in the house?  That is simple:  marketing.

Parents are eager to give their toddlers and preschoolers an edge, and these are heavily promoted on sites and in stores (remember when we used to go into stores?)  They are uniquely shaped and colorful, sold with excellent packaging.  A standard box of crayons gets none of this kind of love.

Please, please: don’t believe the hype.  Just like those spoons shaped like bulldozers, these crayons aren’t helping anyone but the people selling them.  They are gimmicks, not tools for motor development.  If your child is older than 12 months and has enough motor control to hold a spoon in a fisted grasp to eat, they are ready to hold a thick crayon and make a stroke.  Experience picking up and using a crayon, and watching an adult demonstrate how to make a stroke on a large sturdy piece of paper is so much more helpful.

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Need a Desk Chair for Your Hypermobile School-Age Child? Check out the Giantex Chair

 

71ASiKXBSJL._AC_SL1200_.jpgOne of my colleagues with a hypermobile third-grader told me this chair has been a great chair at school for her child.  It hits a lot of my targets for a chair recommendation, so here it is:  The Giantex chair.

Why do I like it so much?

  • It is a bit adaptable and sized for kids.  No chair fits every child, but the more you can adjust a chair, the more likely you are to provide good supportive seating.  This chair is a good balance of adaptability and affordability.  My readers know I am not a fan of therapy balls as seating for homework.  Here’s why: Should Hypermobile Kids Sit On Therapy Balls For Schoolwork?
  • It isn’t institutional.  Teachers, parents, and especially kids, get turned off by chairs that look like medical equipment.  This looks like a regular chair, but when adjusted correctly, it IS medical equipment, IMPO.
  • It’s affordable.  The child I described got it paid for by her school district to use in her classroom, but this chair is within the budget of some families.  They can have one at home for homework or meals.  Most kids aren’t too eager to use a Tripp Trapp chair after 6 or 7.  It’s untraditional looks bother them.  This chair isn’t going to turn them off as easily.
  • This chair looks like it would last through some growth.  I tell every parent that they only thing I can promise you is that your child will grow.  Even the kids with genetic disorders that affect growth will grow larger eventually.  This chair should fit kids from 8-12 years of age in most cases.  The really small ones or the really tall ones?  Maybe not, but the small ones will grow into it, and the tall kids probably fit into a smaller adult chair now or in the near future.

For more helpful posts on hypermobile kids, read Joint Protection And Hypermobility: Investing in Your Child’s FutureHow To Correctly Reposition Your Child’s Legs When They “W-Sit” and When Writing Hurts: The Hypermobile Hand.

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Potty Training in the COVID-19 Age

 

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Parents are staying home with their toddlers and preschoolers now.  All day.  While this can be a challenge, it can also be the right time to do potty training.  Here’s how to make it work when you want to teach your toddler how to “make” in the potty:

  1. Have good equipment.  If you don’t have a potty seat that fits your child or a toilet insert and a footstool that is stable and safe, now is the time to go online shopping for one.  Without good equipment, you are already in trouble.  Children should be able to get on and off easily and not be fearful of falling off the toilet.  If you are training a preschooler and not a toddler, you really need good equipment.  They are bigger and move faster.  Safety and confidence go hand in hand.
  2. Have a plan for praise and rewards.  Not every child will want a tiny candy, but nobody should expect a new toy for every time they pee in the potty.  Know your kid and know what gets them to try a new skill.  Some children don’t do well with effusive praise Sensitive Child? Be Careful How You Deliver Praise , so don’t go over the top if this is your kid.
  3. Know how to set things up for success.  If your child is typically-developing, get Oh Crap Potty Training by Jamie Glowacki, because she is the best person to tell you how to help you be successful.  She even has a chapter just on poop!  If your child has hypotonia or hypermobility, consider my e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone.  It is inexpensive, available on Amazon and Your Therapy Source, and gives you checklists and explanations for why you need to think out-of-the-box to potty train these kids.  You don’t leave for vacation without a map.  Don’t wing this.  Just don’t.
  4. Build your ability to calm yourself first.  Exactly like on an airplane, (remember them?  We will get back on them eventually) you need to calm yourself down in the face of refusals, accidents and tantrums.  You are no good to anyone if you are upset.  Read Stress Relief in the Time of Coronavirus: Enter Quickshifts and Should the PARENTS of Kids With Sensory Issues Use Quickshifts? for some ideas.

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Stress Relief in the Time of Coronavirus: Enter Quickshifts

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My clients know that I use therapeutic music called Quickshifts and Gearshifters in many pediatric therapy sessions.  They use binaural beat technology (Binaural Beats and Regulation: More Than Music Therapy ) to induce an alpha brainwave state.  This is the brain’s calm-alert state.  Due to the unprecedented stress we are all under, I am using them myself.  Every day, twice a day minimum.  Here is why:

  1. I am no good to anyone if I am vibrating with anxiety.  There is only so much breath work can do for me.  I need brain work.
  2. The calm-alert brainwave state that Quickshifts and Gearshifters rapidly induces is effortless.  Turn it on, (they can be purchased and loaded onto your phone through the free Therapeutic Listening app) wear the headphones, and it works perfectly without me doing anything else.  I do have to stay off the screen stuff, but then, I should anyway.  Mostly I take a walk (alone) or crochet.
  3. I love music.  Most of us do.  I need music.  Most of us do.  I won’t listen to some droning boring sounds if I can listen to fun music instead.  Quickshifts have children’s music, classical music and gentle techno music that isn’t aggravatingly boring.
  4. The effects of altering brainwave states boost my immunity.  And there has never been a better time for it.
  5. I can bring it with me on a walk, so I get a double dose of healthy input.
  6. It isn’t tiring or distracting.
  7. I could use it more often than 2x/day.  There is no danger or downside, unlike modulated music.  Modulated music is a workout for your brain, and using it too close to bedtime can be a challenge.   Quickshifts and Gearshifters are designed for anxiety and even trauma recovery.  This pandemic is a trauma if I ever saw one.
  8. I can use it alone at home.  No one is getting massages, going to psychotherapy, or getting acupuncture.  There is no neurofeedback machine in my house.  I couldn’t go anywhere even if I wanted to.  Enter Quickshifts.

Quickshifts and Gearshifters are best used when selected for a client by a trained OTR.  Listening to the wrong album will not damage you or your child, but it is a waste of money and time.  Two things most of us are running out of right now.  

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