Category Archives: child safety

Help Your Newborn Adjust to Daycare By Using Happiest Baby on the Block Strategies

ID-100108085.jpgReturning to work soon after delivery can mean putting your 3-month old in daycare.  As challenging as this can be emotionally, it can also be a struggle for your baby, especially if her only self-calming strategy has been nursing.  Should you (or could you) quit your job or just tough it out?  There is another alternative:  teach your little one to respond to  a wider variety of self-calming cues.

Self-calming at 3 months?  Well, yes and no.  Babies at this age are learning to respond to messages that we send.  This is the very beginning of self-regulation.  Actions and sensory inputs that tell their nervous system ” You are safe”, “It’s time to sleep” and “I get it; you need a little more help to calm down and I know what to do”.  They aren’t able to devise  their own solutions yet, but they can begin to self-calm if we read their behavior correctly and understand what they need developmentally and neurologically.  This is where Dr. Harvey Karp’s Happiest Baby on the Block strategies, and his other great sleep solutions, can save your sanity and your child’s sleep.  Many of the 5 S’s that worked so well in the first 12 weeks of life can be adjusted to support this transition into daycare.

The weeks between 3 months and 6 months are almost the 5th trimester (Dr. Karp refers to the first 3 months of life as the “4th trimester”).   I think it is a bridge period in which babies need more help to calm down than many realize.  At this age, they suck their fingers to self-soothe while awake.   But… they aren’t strong enough to keep their hands or their thumbs in their mouth when they are lying down and falling asleep.  Gravity pulls those heavy hands down to the crib mattress. They don’t babble their way to sleep the way a 6 month-old does, and they are barely ready to listen to lullabies. So what can you do?  Be creative and use the 5 S’s as a launching point for your new routines.

Swaddling may not be as effective, or even safe, at this stage.  Babies who are rolling could be strong enough to roll onto their bellies.  With their arms swaddled, they are at risk for suffocation.  Once your baby is in that “I’m gonna practice this rolling thing all day” stage, swaddling becomes more of a risk than a solution.

There are swaddle garments that convert to safer solutions for this stage.  The garments that still give firm pressure over the chest but leave legs and arms free are specifically designed to keep that nice calm feeling going.  They allow your child to roll freely.  Dr. Karp also suggests that swaddling in an infant swing is another safe choice for those babies that are experimenting with rolling but still need swaddling to pull it all together.  REMEMBER:  your baby needs to be put into the swing calm, and securely strapped in.  If she is too big for the swing, then don’t use it.  Just because it is calming for her is not a reason to use a too-small swaddling blanket or a tiny infant swing.

Pacifiers are recommended by both Dr. Karp and the American Academy of Pediatrics, but some babies don’t love them, and some parents are afraid of creating a paci addict.  For those nervous parents, I wrote a special post: Prevent Pacifier Addiction With A Focus on Building Self-Calming Without Plastic.  The truth is that sucking is a normal developmentally-appropriate self-calming behavior, and addiction really doesn’t become an issue until your child has nothing else that works at all.

Between 3-6 months, your little one is still benefitting from sucking, and she can learn to use a paci in daycare.  She isn’t at risk of nipple confusion, unlike a 2 week-old, and she won’t reject your breast because of paci use.  Nursing is the total package of love, warmth and nutrition.  If she says “no more” to nursing, it is likely that she would have done so without the paci.  Some babies are just ready to be done early.  Use Dr. Karp’s paci learning technique to teach a baby how to handle a paci and keep it in her mouth.  By 3 months, she has strong oral muscles, so it is a matter of practice and helping her to realize how handy pacis can be to calm a bit for sleep.  If she spits it out while asleep….well, mission accomplished!

White noise is the one HBOTB strategy that never needs to end.  But for these little guys, the new noises of daycare are so different from home that this may be the secret weapon.  Dr. Karp sells his carefully designed white noise CD.  It can be loaded onto a phone as well from iTunes. Select the track that matches your child’s state (crying, drowsy  and calm, etc.) and watch the magic begin.  Encourage your daycare to use this totally safe method of soothing.

Rocking a baby in your arms can replace the infant swing, and some older newborns still calm down when held on their sides or stomach.  Again, this is never a sleep position, just a calming position.  But if it works for your baby, feel free to use it when you hold her.

Once you have created an updated HBOTB routine that works, share it with the daycare staff.  You may find that they have rules and regulations, and some staff aren’t open to new ideas.  My suggestion is to emphasize how easily you can get her calm.  Even the most rigid care provider’s ears perk up when she thinks that there is a way to make her job easier.  These people work long hours and work hard.  Think of this as helping her and your little one have a better day!

Low Tone In The Summer: Why The Heat Affects Your Child’s Safety

If you have a child with low muscle tone, you may have seen them wilt like flowers in the sun.  Even if they are well-hydrated, even if they are having fun, they just can’t run as fast or sit as steadily when they are warm.  Add a SPIO vest or other compression garment, and the tripping and falling seems to happen more often.  What gives?

Just like a warm bath relaxes your tight shoulders after a long day, heat relaxes muscles.  It doesn’t matter if the heat is environmental or neutral warmth, the kind that is generated by your child’s own body and is held in by the SPIO or her clothes.  It is still heat.  And some kids with low tone don’t sweat efficiently, using the body’s natural method of heat reduction.  This isn’t a minor concern if you have a child that is pretty unsteady on a cool day.  Kids with low tone that are out and about in the heat can become so floppy that they stumble and get injured.  That is a problem.

What can you do?  Well, you may not be able to wear that SPIO in the heat.  Try kineseotaping instead.  (ask your OT or PT if they have been trained in it’s use).  Alternate time in air conditioning and time outside.  Offer cold drinks and ice pops if they can lick and swallow an ice pop safely.  Dress lightly and choose clothes with fabrics that evaporate body heat.  Choose shoes that offer more support, not Crocs or sandals.  This is not the time to pick the least-supportive footwear.

Most importantly, monitor them for safety and be aware that children really cannot judge whether or not they should come in and cool off.  They are counting on you to keep them safe!

Low Tone and Toilet Training: How Your Child’s Therapists Can Help You

Over the years as an occupational therapist, I have been giving parents hints here and there.  Writing my e-book  this fall, and preparing an e-course (coming soon) to support families makes me realize that some clients did not ask me very many questions while they were toilet training their child.

So….Are there aspects of therapy that can help you with toilet training?  Yes indeed!  Does getting more therapy mean that your child will automatically be trained earlier and more easily?  Unfortunately, not really.

When it comes to potty training, you can bring a child to the potty, but you can’t make him “make”.  Toilet training is a complex skill, and even the best therapy will still only prepare all of you and develop important skills needed for this skill.  Bringing it all together is still the job of the parent or the full-time caregiver that creates and executes the plan. Waiting for readiness?  Read Waiting for Toilet Training Readiness? Create It Instead!  to understand what you can do today to inspire interest and build skills. Thinking that it’s too soon?   How Early Can You Start Toilet Training?  will shad some light on what is really important when you are wondering if your child is old enough.  If you are wondering if your child’s diagnosis is part of the issue, take a look at Why Do Some Kids With ASD and SPD Refuse Toilet Training?  And finally, if you are eager to move into night-time training, read Why is Staying Dry at Night So Challenging For Some Children? for support at the finish line of toilet training.

Here is a list of what therapy can do to support you and your child for toilet training.  If you haven’t heard your therapists discussing these treatment goals/approaches, you might want to share this post with them.  They may be more focused on other very important skills right now, but always keep your discussions open and inform them that you are planning on training.  Most therapists are very eager to support families whenever they can with whatever goals the family has.

  1. Core stability for balance, abdominal strength and safety on the toilet.  Most kids with low tone do not have great core stability, and this is where the rubber meets the road.  A weak core will put a child at greater risk of falling or feeling like he will fall.  It is harder to relax and pee/poop if you are afraid you will land on the floor.
  2. Clothing management and hand washing.  No child is really independent in using the toilet if someone else has to pull clothing up and down.  Washing hands is a hygiene essential.  Time to learn.
  3.   Good abdominal tone.  See #1.  Helps with intestinal motility as well.  That is the contraction of smooth muscle that moves the poop through the colon and on out.  My favorite hack is the use of kineseotape in the classic abdominal facilitation pattern.  All but one of my clients have had a nice big bowel movement the next day after taping; no pain, no fuss.  Regular taping along with strengthening can improve proprioceptive awareness internally (interoception, for those of you who need a new word for the week!)
  4. Transfers and equipment assessment/recommendations.  Therapists can teach your child how to get on/off, up and down safely from a toilet or potty seat.  They can teach you what to say and do to practice transfers and how to guard them while they practice.  They can also take a look at what you already own and what you might need to obtain.  Children with significant motor issues may need an adaptive toileting seat, but most mildly to moderately low-toned kids do not need that level of support.  What they do need is safe and correctly-sized equipment.
  5. Proprioceptive awareness for balance and stability.  Some therapists use balance discs or boards, some use other equipment.  Swings, climbing, jumping, etc.  More body awareness= more independence.
  6. Sensory tolerance for the feeling of clothing, using wipes/TP, the smells and the small enclosure of a bathroom.  If your child has sensory sensitivity issues in daily life, you have to know that they are going to be issues with toilet training.
  7. Effective vestibular processing.  Children that have to turn around, bend and look down then behind their bodies to get TP or pull up their pants need efficient vestibular systems.  Vestibular processing isn’t just for walking and sitting at a table for school.
  8. Practicing working as a team and following directions.  Your child needs to be responsive to either your praise, your rewards or both.  Therapists that support independence (all of us!) and develop in your child the sense that the she is a part of the therapy plan will make it easier for your child to work with you on toileting!

 

 My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone is now available at Your Therapy Source ( a terrific site for parents and therapists)  and on my website,  tranquil babies .  I  also sell hard copies directly to parents and therapists, and will be doing lectures in the NY area for schools and organizations.  Families are telling me that they have made progress in potty training right away after reading my book!

Read The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived!  to learn how my book will help you and your child move forward today!

 

 

Vestibular Fun For Infants With Motor Delays

Picture this:  a dad swings his 6 month-old upside down, and she giggles and smiles from ear to ear.  What doesn’t daddy know?  He is stimulating her developing balance system and teaching her to love movement while they play.

When babies have motor delays, whether due to prematurity, illness, or a brain injury such as cerebral palsy, parents just don’t swing them around much.  No wonder; if your child is on a feeding tube or has seizures, you feel very protective and a bit worried about what all the movement could do that isn’t healthy.  Here is why these parents should make an effort to craft a safe but substantial vestibular program for their babies.

Every child needs movement to grow, and typically-developing babies start moving right away.  By 4 months they have figured out how to roll, and by 8 months they are crawling or creeping away from us.  This is great for mobility skills, but it also great for the vestibular system, which gives us a sense of balance and body/spatial awareness.  In fact, it is really difficult to move if you don’t have a functioning vestibular system.  Kids with motor issues  aren’t moving themselves around the house all day long.  They need adults to make a plan to be given more movement opportunities.

If all you are doing is working on exercises for mobility, and you haven’t thought about the sensory base of movement, then you haven’t given your little one everything she needs to make progress.  Let’s talk about how to create your plan.

Safety is first, so any plan has to respect the fact that a child who isn’t used to moving much can be overwhelmed by a large increase in head movement out of a neutral, vertical position.  Take it easy at first and watch for signs of neurological shutdown or overstimulation.  A child who gets red-faced, or whose skin blanches, who avoids your gaze or becomes too quiet/cries, is probably overstimulated.  Of course, some will just vomit on you.  Message received.

Your pediatrician can tell you if you should support their neck even more than you would normally at their age.  Discuss this idea with your pediatrician if you are very concerned about adding any movement to your plan.  Children with Down Syndrome need to avoid extreme head/neck rotation unless your pediatrician is certain that their neck ligaments are not vulnerable.  I treat all kids with DS as if they need that extra protection.  Kids with brain injuries of any kind can be vulnerable to seizure activity, so I start off with slow movements and avoid any too-fast movement or a lot of position switches in one play time.  Play doesn’t have to be long or intense to deliver more vestibular input.  You aren’t going for the moon.  Just add a little more vestibular input to their day than they normally receive.

What kids of movement?  This is where you need to ask your OT about a plan.  Rotary movement and inverted positions (upside down) are the most powerful.  That means the most stimulating and the most difficult to handle easily.  Linear movement, like swinging in an infant swing, is the easiest.  I cannot tell you what your child needs, but I can tell you that is worth asking your therapist about what you can do in play to build vestibular processing.

When do you stop?  I like to stop before I see signs of distress, then see if they ask for more fun with their vocalizations or facial expressions.   I will give them more movement later if they seem to be doing well.  Delayed signs that they got too much  stimulation?  Negative changes in feeding and sleeping, more fussiness.  Babies will tell you what they think if you know how they communicate.

Good luck, and feed that vestibular system!

Why Some Newborns Look Like They Hate To Be Swaddled

Yes, I said it.  Some babies scream louder after you swaddle them, and parents assume that this means that they are horrified of being restricted.  This is usually far from the truth, but you have to know a little bit about newborn neurology to understand why this is likely not to be a case of protesting imprisonment and more a request for more layers of calming.

For 9 months, a newborn has been living in a tighter and tighter space.  Baby bumps get bigger, but the uterus can only expand so far.  At the end of pregnancy, babies are a snug fit.  Really snug.  They aren’t uncomfortable, and in fact, swaddling is replicating the whole-body firm hug that they know so well.  It is diminishing the shock of the Moro (startle) reflex that scares them and makes them cry more.  It keeps them at a consistent temperature, just like the womb.

So why do some of them scream more right after you swaddle them?  Well, some babies are sensitive little souls, the kind that cry with new noises, too much talking, or even when their digestion “toots” a little or they get very hungry.  They can go straight from happy to upset after too much activity, too much socializing, or too much interaction.  By the end of the day, they are at the end of their ability to handle life.  This can be partly temperament, their unique way of interacting with the world.  It can also be that their nervous system is still very immature, and they are taking a while to develop self-calming.  That is not a medical problem.  Every baby is new at this life-after-womb thing.  Some babies just need a little more time living like they did for 9 months, cozy and comforted.

These babies need swaddling more than some others, but they find anything new to be a challenge.  Give them a chance to get used to it, and make sure that you are doing a good swaddle.  Check how toasty they are, by making sure that they are not sweating behind their neck or ears (if so, lighten up on layers and swaddle in light cotton).  They probably also need more than swaddling to pull it together.  If you haven’t read Happiest Baby on the Block or seen the DVD, you might not be aware that swaddling alone is not going to finish the job for sensitive kids.  Sucking, shushing, side or stomach positioning (for calming only) and swinging may all be needed to calm these babies down.

So for all those parents who think that their baby is the one that hates swaddling, I encourage you to make sure that your technique is solid, your blanket or swaddle garment fits correctly, and that you layer on the love moves with more than a swaddle to calm your little one!

 

Sleep Training at 2 Months: Beyond Cry-It-Out

The Wall Street Journal’s writers are known for great reporting, but they clearly didn’t do a lot of research when they wrote today’s article Can You Sleep Train Your Baby at 2 Months?  Lots of agonizing parent reports of the cry-it-out method, and professional agreement that babies 8 weeks old don’t sleep through the night normally anyway.  They totally got it right that running and picking up a waking (but not screaming) baby is not going to teach good sleep habits, but there was no mention of pick-up/put-down, using Dr. Karp’s 5 S’s for deepening sleep in newborns, not even the use of swaddling to build a precious extra hour of sleep!

Parents who do not know how to handle the screaming and/or want to develop good sleep habits will go away from this article wondering if they can truly hack listening to an infant scream for the common “30-40” minutes.  What a mistake!!  Crying like that doesn’t do anyone any good.  It isn’t good for a baby or a parent, and can lead an exhausted and demoralized parent down the path to desperation, including falling asleep on the couch holding a baby (a documented suffocation or fall risk), feeding a baby large and frequent feedings to “sedate” them, or shaking that baby after nothing works.

Creating good sleeping behaviors in the first 3 months is completely possible and much easier to do than letting them scream.  But sleep at this age isn’t a full 8 hours, it isn’t done without creating a sleep environment that supports brain development at this age.  It takes some knowledge of baby development, some patience, and a willingness to accept that the techniques that work for a 3 year-old are ridiculous for a 3 month-old.  Apples and oranges, apples and oranges.

After a few years of being a Happiest Baby on the Block educator, I am becoming increasingly frustrated and discouraged with the situations I hear out in the world of baby calming.  My grandmother from the old country knew more about handling newborns than  most professionals with doctorate degrees!  Like the story of the elephant and the blind man, many of the professionals I meet are largely concerned with protecting their piece of the authority pie than helping babies and parents.   Researchers spend more time in universities and labs than out in the field, which is to say in people’s homes, calming babies themselves.  Yes, it really builds your skills if you have actually successfully calmed babies with your recommendations, not just assembled results of research studies.  This is not “anecdotal evidence”, my friends, this is real life experience.  Get some.

Parents, please, please, do not read the WSJ article and redouble your efforts at cry-it-out with young infants.  Read Dr. Karp’s book The Happiest Baby on the Block, watch his video, contact me or another certified educator, just do not think that this is all there is out there.

BTW, Dr. Karp’s book The Happiest Baby Guide to Great Sleep will take you all the way into the kindergarten year, with good advice about toddlers and preschoolers!

 

Toe Walker? Why The Problem Usually Isn’t Touch Sensitivity

Kids that toe-walk after they have fully mastered walking and running (usually 24-30 months) are often accused of avoiding the feeling of their feet on the floor.  It certainly looks that way.  The truth is usually not so simple, and the solution not so easy to achieve. Getting a toe-walker to use a heel-toe gait pattern means you have to address the reason they choose to use this pattern, and manage any loss of movement at their ankles that has developed.

The great majority of children that I have treated who toe-walk are actually seeking more sensory input, and are getting it by teetering around on the balls of their feet.  The vestibular input as they sway, and the proprioceptive input of all that joint pressure and muscle contraction is what they really crave.  Touching or not touching the floor has very little to do with it.  If a child is a true tactile avoider, it is probably not just on the soles of their feet.  Avoiders dislike the feeling of clothing on their skin, food in their mouths, even water splashing them in the bathtub.  You know if you have a tactile avoider.  Life is a real challenge.

Sensory seekers come in a few different flavors.  Some have low muscle tone and are looking for a blast of information that they don’t get when walking with flat feet.  Is Low Muscle Tone A Sensory Processing Issue? Some are more drawn to the swish and sway movement as they walk.  They love to flip upside down and spin around just for the fun of it.  A lot.

Some sensory seekers toe-walk and then intentionally crash into furniture or people.  They can use this pattern as a two-fer.  They get both the fun of the proprioceptive input and they avoid the challenge of controlling their deceleration as they arrive at their destination.  I have worked with toddlers that simply cannot walk to a chair, turn around and sit without ending up on the floor.  You can almost see the wheels in their head turning as they decide ” I usually fall anyway.  How about just crashing intentionally and making it a game? She will just catch me and I get a hug!”

Because toe-walking is normal (yes, normal!) for very young children just learning to walk and run, it can be ignored long enough to result in shortening of the ankle tendons and weakening of the muscles that move the toes up toward the knee.  At this point, a child may not be able to achieve full range of movement easily.  Enter the physical therapist for stretching and strengthening.

Here are some simple strategies to address toe walking in it’s early stages, before the Achilles tendon has shortened significantly.

Duck walking:  everybody likes ducks.  Pretending to be a duck, pointing toes up and out to the side while quacking, is a cute and fun exercise.

Squats:  Yes, squats.  You can go mega and have a child stand on a 1-3 inch thick book then squat down to pick something up.  Big stretch, plus some vestibular action as their head dips down.

Jumping:  They have to land on a flat foot with heel contact, and jumping along a path made by tape can be a really fun game.

Choose a high-topped shoe:  Go old-school and try a high top sneaker (trainers, tennis shoes, or whatever you call them in your area).   First of all, it looks seriously cute on little kids, and it will act as a soft brace to prevent some of the toe-walking.  The hard core toe-walkers may actually need an orthotic, so if you still see a lot of pronounced toe walking, consult your pediatrician and see a physiatrist.  They can recommend corrective inserts that do more than prevent a child from coming up on their toes.  A good orthotic can help a child strengthen the muscles that he wasn’t using while toe-walking.

Give them more vestibular and proprioceptive input:  If a child really needs does more sensory information, then there are fun ways to deliver the goods.  Swinging, rolling down a hill, climbing walls, yoga, and other absolutely fun activities should be available to them.  Of course, a targeted sensory “diet” is a great idea.  Well thought-out and intensive activities created by an occupational therapist to satisfy a child’s interests and needs can result in hours of typical movement and positioning for school and play.

Parents and therapists:  please submit a comment and add activities that have worked for your children!