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

 

rawpixel-653771-unsplashIf 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!

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

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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!

Want more information on potty training?  Read my first book or call me for a consult!

 My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone is now available at Amazon.com as well as Your Therapy Source ( a terrific site for parents and therapists)  and on my website,  tranquil babies .  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!

Want 30 minutes of my time to problem-solve things?  Visit my website  Tranquil Babies and buy a Happiest Toddler on the Block session.  We don’t have to do HTOTB; we talk about whatever you need!  I can’t do OT with you, but I can give you potty training advice an behavior strategies that really work!

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!

 

 

 

 

Is Low Muscle Tone A Sensory Processing Issue?

Only if you think that sensing your body’s position and being able to perceive the degree/quality of your movement is sensory-based.  I’m being silly; of course low tone creates sensory processing issues.

It isn’t the same sensory profile as the child who can’t pay attention when long sleeves brush his skin, nor the child who cannot tolerate the bright lights and noise at his brother’s basketball games.  Having difficulty perceiving your foot position on a step, or not knowing how much force you are using on a pencil can make life a challenge.  Sensory processing issues mean that the brain isn’t interpreting the sensory information it receives, or that the information it receives is inadequate.

That is the situation with low muscle tone.  Low tone reduces the amount of joint and muscle receptor firing because these receptors need either pressure or stretch to activate.  If it is not in a sufficient quantity, the receptors will not fire in time or in large enough numbers to alert the brain that a change has occurred. Therefore, the brain cannot create an appropriate response to the situation.   What does this look like?  Your child slowly sliding off the side of a chair but not noticing it, or your child grinding her crayon into the paper until it rips, then crying because she has ruined another Rapunzel picture.

Muscle tone is a tricky thing to change, since it is mediated by the lower parts of the brain.  That means it is not under conscious control.  You cannot meditate your way to normal tone, and you can’t strengthen your way there either.  Strength and tone are entirely different.  Getting and keeping strength around joints is a very important goal for anyone with low tone, and protecting ligaments from injury is too.  Stronger muscles will provide more active contraction and therefore pressure, but when at rest, they are not going to respond any differently.

Therapists have some strategies to improve tone for functional activities, but they have not been proven to alter the essential cause of low muscle tone.  Even vestibular activities, the big guns of the sensory gym, can only alter the level of tone for a short period during and after their use.   The concept of a sensory diet is an appropriate image, as it feeds the brain with some of the information that doesn’t get transmitted from joints and muscles.    Sensory diets require some effort and thought, just like food diets.  Just bouncing on a therapy ball and jumping up and down probably will not do very much for any specific child.  Think of a sensory diet like a diabetic diet. It doesn’t make the pancreas start producing insulin, but it helps the system regulate blood glucose more effectively.

Managing low muscle tone for better movement, safety and function is complicated.  Step one is to understand that it is more than a child’s rounded back when sitting, or a preschooler that chews his shirtsleeve.  Step two is to make a multifocal plan to improve daily life.

For more information on life hacks for toilet training, dressing and play with children that have low muscle tone, please look in the archives section of my blog for targeted ideas! My post and are new posts that go into more details regarding life with kids that have sensory processing issues.

For personalized recommendations on equipment and methods to improve a child’s functional skills, visit my website and buy a 30-minute consult.  We can chat, do FaceTime, and you get the personal connection you need to make your decisions for your family!

 

 

Baby Wearing For Better Infant Sleep

Most parents use carriers/wraps for two reasons:  practical and personal. But did you know that wearing your baby can also help your newborn sleep better?

Being able to carry your baby allows you to have both hands available. Baby wearing is an intimate connection that parents usually enjoy.  Babies feel their parent’s heartbeat and listen to their voice, just like before birth.  Before I tell you how this improves sleep, here is some practical information about safety and carrier/wrap choices.

Wearing your newborn safely is essential.  Always make sure that you can see their face and that their head is not tilted forward so far that they cannot easily breathe.  An older baby can turn their head but a newborn cannot, especially against gravity.  Never lean forward without holding your baby, and never lean near a flame or burner.

My favorite manufactured carrier is the Ergobaby system.  It is well-crafted and the insert is designed to safely support newborns.  Using slings and wraps is just fine, but it is a bit more challenging to get newborns in the right position and keep them there.  Totally possible, and there are parents that are amazingly good at the traditional sling wrap styles.  I don’t take sides in the carrier/wrap debates.  Use what works for your family.

Carriers/wraps allow your baby to experience all the movement stimulation that he got in the womb.  Babies calm to the jiggle-style swinging of the Happiest Baby on the Block for a very similar reason.  It feels amazingly familiar to them! When you wear your baby, they get so much more variety and variation in movement than just using an infant swing.  No wonder they love being carried long after you have discontinued infant swing use (usually 2-3 months of age.)  This movement is stimulating their balance system, and we all need a dose of movement input to feel good.  To sleep well, we need to have had enough, but not too much, vestibular stimulation.  Baby wearing combines movement plus some deep pressure and warmth from being wrapped against an adult to deliver an almost perfect dose of sensory input.  As a pediatric occupational therapist, this makes so much sense.

Wear your newborn safely, use all the other S’s from Happiest Baby on the Block, and you may be able to extend his sleep periods.  The gift that keeps on giving!

 

Safe Sleep Guidelines Don’t Give Parents Enough Support

I just downloaded the entire American Academy of Pediatrics’ Technical Report-SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment.   It was a large file to read, but the bottom line for me was this:  they must not have any sense what it is like to be a new parent, and maybe not what it is like for practicing pediatricians.  In other words, they say what to do and what not to do to prevent SIDS, but don’t mention how to accomplish any of it in the world of actual babies and parents, where crying and sleeping is real, not theory.  No wonder parents don’t follow the guidelines.  Without useful strategies and simple explanations, most parents wouldn’t be willing to follow their recommendations for very long.  In my opinion, the most difficult guidelines for parents are the instructions to only place newborns on their backs to sleep, and not to have a baby sleep in the bed on on the parent.  Babies should be in the room, but not in the bed, with an adult.  Simple, right?  Not.

Sleep-deprived new parents are struggling to comprehend all the things they should and shouldn’t do.  Defensive driver classes say that lack of sleep makes you drive like you are drunk.  Why should we expect the parents of newborns who get 5 hours of sleep a day to think clearly?  Because they aren’t behind the wheel?  An exhausted parent isn’t just tired.  They are less capable of judging what is safe and how to follow their pediatrician’s general recommendations.    They are going to let a 4 week-old sleep in the car seat for over 30 minutes because he slept poorly last night, pick him up from his “tummy time” right away when he cries because they are so frazzled, and use a positioning wedge in the crib.  They will be afraid to use a pacifier at 5 weeks, and will abandon swaddling when they can’t get it snug.   I can’t blame them one bit.  Babies aren’t simple.  Their crying when they are put down rips a parent apart.  No one knows how to deal with newborns without some help.

Not letting your baby sleep on you or next to you, and only placing a baby to sleep on his back means that a parent needs to be shown other good sleep strategies that leave both parties comforted and calm.  Pediatricians know that back sleepers show initial delays in motor control that disappear by 18 months on average, but generally offer no other suggestions than to “do some tummy time.” There are some great methods to make Safe to Sleep successful, but the AAP doesn’t share any specific baby management secrets (if they have them.)

The New York Times ran a story in 2005 that made me stop in my tracks before I finished reading it.  They reported on the increase in parents placing their babies on their backs to sleep after hearing about the Safe to Sleep protocol from professionals.  Turns out, their newborns had a hard time sleeping in this position.  It is well known that many babies don’t sleep as deeply or as long in this position, and for some simple reasons.  Their random arm movements wake them, they turn their heads and motor reflexes wake them, and they traded the firm support of the womb for the feeling of floating in space on a bassinet mattress.  Who could sleep well like that?

The NYT author quoted a parent that suggested that her NICU nurses encouraged stomach sleeping on discharge, even though they had to tell her officially not to do so.  A Manhattan newborn care instructor was quoted saying that “the role of a professional is to say these are the recommendations and this is why.  The role of the parent is to think critically and apply those recommendations in a way that makes their life manageable.”

I see things differently.  Professionals should anticipate the need to provide practical strategies when they teach their lifesaving guidelines.  Expecting exhausted parents to “think critically and apply these recommendations” is asking much too much from well-meaning but tired and vulnerable people.  It just seems very unfair for pediatricians to know full well how hard those first few months are, and yet not be more practically helpful.

Then again, they may not have any direct experience or even know what to do with a baby after a checkup or a treatment.  After all, they treat medical problems.  SIDS is a medical problem. Sleeping, calming and caring for babies isn’t really a medical problem.

If doctors or other professionals are not able to provide real-life instruction in ways to make the Safe to Sleep program successful in the real world, they should have resources to offer to parents. As a Happiest Baby educator and a pediatric occupational therapist, I wish that every parent had the ability to learn how to use Dr. Karp’s amazing baby calming and sleep techniques from me, and how to carry and hold their babies to develop good head control.  I wish I could show every parent how to make “tummy time” fun and easy.  I write this blog in order to reach out to parents with love and support.  They don’t have as many resources as they deserve.

 

Are Babies Addicted to White Noise? Yes….and No

White noise helps colicky newborns calm and sleep.  It can help newborns develop essential self-calming skills in the first 3 months of life.  It can help older babies tolerate teething and their first colds.  It can even help babies transition to a shared bedroom with a toddler sibling.  The magic of white noise is not lost on Happiest Baby on the Block educators.  Every time I am asked if using white noise will create an addiction, I think to myself “Deeper, longer sleep patterns are an addiction most of us should have!”  Here is why parents should add white noise to their bedtime plan, and how to calm their fears of creating a “white noise addict”.

White noise is part of the 5 S’s: the five steps in The Happiest Baby on the Block plan to quickly calm a newborn and one of the 4 that you can use for sleep.  You cannot use the side/stomach positioning for sleep.  It is only for calming.

When you use white noise at the right volume and at the right frequency, it creates a barrier to the noise a child makes when he cries and to the household sounds of doors closing and siblings talking.  Newborn hearing isn’t as developed as the hearing skills of an older baby, so the standard white noise machines are often giving you less harsh and higher frequency sounds than newborns need.  This is not as effective.

What I see when a parent has been using another white noise source is that the child is not falling asleep quickly and is not fully in deep sleep.  Some parents tell me that they think he wakes more often because he needs to nurse frequently, but this pattern often makes me suspect that he is child who isn’t sleeping deeply enough so when he wakes he wants to suck to pull himself back to sleep.  The clue?  He only nurses for a tiny,super-short time and conks out.  That, my friends, is not a hungry newborn.  The hungry ones really get into it (nursing) and fill up. Take a look at Accidental Parenting at 4 Months: Out Of The Swaddle And Into The Frying Pan to see what can happen if a good routine with a plan for aging out of the 5 S’s is forgotten.

Take a listen to the “shower” or “hairdryer” sounds on Dr. Karp’s Happiest Baby tracks on iTunes to get a sense of what really works for newborns.  Older babies and children can calm down with the standard white noise machine offerings.

White noise is the one “S” from THBOTB that you never have to remove.  You can load it on a phone and use it whenever and wherever.  If you are worried about creating a child than cannot sleep without it, then take a look at your entire sleep plan.  Babies that are inadvertently taught that they have to be held to go to sleep, or they should fall asleep nursing,  will cling to that white noise more because they have not yet developed age-appropriate self-calming skills.  Yes, you start this before 12 months old!  Try to build those self-calming skills and diminish a baby’s sense that good sleep requires another human.  I know, it sounds nice to be so needed and it seems so loving, but the most loving thing we do is help children build the skills so that they have the choice to connect or be independent.  If a child has no ability to calm themselves, then he is not making the choice to cuddle.  He is desperate for the only way he knows to feel better. Without it, he is lost, frightened and struggling.

“Wings and roots” from the very beginning means teaching self-calming skills.  This does not diminish a child’s love for a parent.  It is the other way around.  Parents are the people who show a child how to be powerful and cheer their independence at every turn.  That creates a bond that is strong and flexible at the same time.  It only grows stronger and is less likely to fray during the toddler and teen struggles.

To decrease a child’s use of white noise, all you have to do now is lower the volume a little at a time, or start out sleep with white noise then turn it off.  After a few days, don’t start the bedtime routine with white noise, and see how things go.  A word of advice:  never shift a bedtime routine when other routines are also shifting.  Those shifts include:  parents returning to work, siblings returning to school, holidays, toddler roommate toilet training, etc.  Changing so much in their world at the same time is asking a lot of a baby.

Want more information or answers to your questions?  Visit my website tranquil babiesand purchase an in-home session (in the NY Metro area) or a phone/video consultation.  You will get a chance to discuss your unique situation and receive new ideas you can try tonight!

 

Another Baby Lost to Crying

There was a news story here in NY about another newborn allegedly choked to death by a father that couldn’t take all the crying.  This is a recurring story that has to end.  If that family knew how easily The Happiest Baby on the Block techniques could have calmed down their baby, he would still be here, ready to have his first Christmas Day.

Jose Feliciano has been arrested for murder after the baby’s mother took an overdose and told someone in the facility caring for her what had happened.  I have sympathy for their entire situation.  If you do not have children, or if your newborns were almost silent, you do not know the frustration and pain of constant screaming.  THB techniques are capable of more than just giving babies better sleep.  They can prevent the slide into exhaustion and depression that parents often do not admit to.   Calm babies nurse/bottle feed better and parents feel more competent.  Everyone wins.  This time in the Bronx, everyone lost.

Most fathers do not commit murder, no matter how frustrated they are.  Perhaps we will hear about additional issues that made this dad take the ultimate action.  If only the mom had learned THB when she gave birth, or at a prenatal class, or at a well-baby visit.

I made some brief inquiries into teaching The Happiest Baby class to men about to be released from the prison system this fall.  Perhaps one of my resolutions for 2016 should be to teach that class for free somewhere in the Bronx, to some group of parents at risk.  This is a blog post I don’t ever want to write again.

For more information about The Happiest Baby on the Block, please visit my website: tranquilbabies.com

Good Posture for Kids With Feeding Issues Matters

Feeding challenges are a huge source of concern for parents of children with low tone, autism, and a host of other issues.  Improving how a child sits when eating isn’t magically going to solve every problem for every child, but ignoring the benefits of good positioning will make most feeding problems worse.  Even problems not immediately associated with posture can become bigger problems when a child has poor postural stability at the dinner table.

What impact does posture have on a child’s mealtime experience?

  • posture affects how safely and efficiently a child can coordinate breathing and swallowing.  Lean back and turn your head way over to the side, then try to swallow your saliva.  Imagine if you could not bring your head to the center and tilt your chin a little so that every part is aligned and fully operational.  Then imagine that you have a mouthful of food.  Scary.  Imagine if you persistently moved your head because you are a sensory seeker and you find sitting still and balanced unsettlingly dull.  You only feel awake and happy when moving.  With a mouthful of food…..If the choice is breathing or eating, most of us would refuse the food and choose to breathe.  Good positioning can prevent a child from having to make a choice.
  • posture impacts how easily a child can pay attention, stay calm, and behave in an organized manner through the whole meal.  If a child is uncomfortable, unbalanced, or trying to find a stable and comfortable position, he is not paying attention to the taste/texture of the food.  He doesn’t know exactly where it is located in the path from his lips to the back of his mouth for swallowing.  His own involuntary movements or the movements he makes to stay alert and engaged can distract him from eating well or eating at all.  He just might want to get up and leave.
  • posture affects learning and independence.  It is harder to hold a spoon, harder to hold a cup, and harder to avoid spilling or drooling when a child is not sitting in a balanced position.  Every child, no matter their issues, looks less capable and needs more time, support, or attention when they aren’t sitting well.  Children with multiple issues might decide that they really don’t care about becoming more independent.
  • posture affects the use of social and language skills.  Sitting well makes it easier to coordinate speaking, listening, and eating.  A child struggling to stay in a stable and comfortable position isn’t able to accomplish the multi-tasking demands of dinner conversation.  If social skills are an issue, sitting for meals can become a power struggle instead of an opportunity to observe and model positive interactions, then practice them with family and friends.

My parents told me to sit up straight at the dinner table. They were concerned about manners and politeness.   For a lot of kids, how they sit at the dinner table is not a deportment issue, but it makes a big difference in their mealtime experience and the overall experience of their families or classmates.

 

The Safest Crib Bumper Might Be Deeper Sleep

Most pediatricians will tell you to avoid all crib bumpers.  The American Academy of Pediatrics feels that no bumper is 100% safe. They discourage parents from using even the most breathable mesh fabric, tied onto your child’s crib.  I totally believe parent reports that a baby that isn’t swaddled can get a limb caught over the bumper edge or, worse yet, under a poorly designed bumper.  Babies move in their sleep.  What is the answer?

I wish there was a perfect solution that works for everyone.  Some babies sleep well in a sleep sack, but they can still theoretically get an arm stuck under a bumper.  Most sacks don’t restrict arm movement as much as the legs and feet.  Babies move more when they are in the lighter phases of a sleep cycle, or when they awaken from sleep.  Some “breathable” crib bumpers are not well constructed, with longer or fewer ties, leading to entanglement or the risk of strangulation.  A mesh bumper that crushes might still allow a child to get a limb under or over it.  Bumpers that don’t tuck under the mattress are even more likely to allow a little leg to poke under the bumper.

One potential answer?  Keep them in deeper sleep longer by using the Happiest Baby on the Block techniques.  Going beyond the swaddle delivers far more than just faster calming.  You are using layers of calming input that keep babies from spending too much time awake or in the light sleep phase.  Happiest Baby educators like myself are amazed that parents think Dr. Karp’s program is just about swaddling.  Doing a good swaddle is great, but it is only one of 5 essential tools in The Happiest Baby on the Block.  Knowing how to use all these techniques effectively for safe sleep is a huge reason why parents request personal consultations with me instead of just running out for a swaddle blanket.

White noise, sucking and swaddling are your Happiest Baby moves to help babies to stay in that deep-sleep phase (the one where you really can change a diaper and they don’t move a muscle) and jump back into it faster if they do wake after a diaper change or a feeding.  The longer and more frequently your baby is in deep sleep, the less she will move when in the crib.  Older babies that are rolling can do the step-down swaddle without arms inside, or use the sleep sacks that have velcro trunk compression for cozy deep pressure.  It is this 4 to 18 month-old phase of development when the “shush” of white noise and sucking help so much to send babies back into deep sleep, and prevent them from coming out of sleep with household noises or their own curiosities.

Toddlers can usually get themselves unstuck without your help, so by 24 months your concerns will shift to whether or not he can climb out of the crib by himself!

 

Toddlers and Holiday Decorations: Another Approach to “Don’t Touch That!”

I watched a toddler laugh in unbridled glee yesterday, amazed at the garland and lights draped on his staircase.  You don’t get more holiday cheer than that sound!  He wanted to touch every nutcracker and every candle.  I had to think on my feet when answering his grandmother’s question: “How do I get him to stop touching everything?”.

My answer may surprise you.  It almost surprised me.  But here it is:  touch the objects together, with an adult completely controlling the object for the toddler’s safety as well as the safety of the treasured holiday ornament.  Hold the object and turn it around, demonstrating the best way to explore the nutcracker’s beard or the bell’s sound.  If possible, over-saturate your toddler so that he is the one to say that he’s seen enough.  I really mean it.  Once you have to put it back because he has gotten totally bored, your item may be much safer than if you had said that it was too precious to touch. That denial makes it catnip to curious children.  If the object really is very delicate and any toddler is likely to destroy it in one swipe, this might be something to save for another year’s display.  You could place it in a glass cabinet that he cannot open, or a shelf that makes it hard for a little person to see.  There will be another holiday season next year.

If your toddler is likely to grab something and throw it, then you had better have a solid grip and a plan to deal with that impulse.  My favorite strategy is a simple warning before the exploration: ” We are going to look at the  ________.  If you try to hit or throw it, I will have to put it away.”.   I don’t get any fancier than that.  I could be tempted to go on about how we have to be careful, how this is great-grandma’s so-and-so, but I think it waters down the important message.  The message is: This is not for play.  If you try, it will no longer be available to you.  Toddlers stop attending to complicated instructions very quickly, so long explanations are a waste. They can actually compel a toddler to tune you out.  Use “toddler-ese” with the smallest or special needs toddlers who need the simplest explanations with the most gestures, facial expression and repetition of phrases.  I would give this one a try:”Nutcracker.  SO soft (while touching fluffy beard). Gentle, gentle touch”.

There are toddlers who are in a big testing phase, so you might get a test of whether he can grab or throw it.  Be ready for this test, be firm, and move slowly.   Calm voice, slow but firm removal and placement into safer storage if you are tested.   Toddlers who test are often the ones who actually enjoy seeing you go ballistic from their actions.  I recommend showing them that you are slightly sad/disappointed that you “have” to put this thing away, preferably in a cabinet so that it is not even visible at the moment.  This is not the time for a long lecture on safety, respect, and care.  Warning, incident, response.  Toddlers need to see the results of their actions clearly.

Good luck with all those lovely items, and feel free to post your own successful strategies!

Safe Winter Swaddling Strategies

When the weather gets colder, some parents think that they need to run out and buy a thick fleecy swaddle blanket or swaddle garment right away. Being too warm is a risk factor for SIDS, so it is worth making a thoughtful plan to swaddle safely in the winter months.  Here are some ideas about swaddling for the winter season:

  1. Your home doesn’t have to be super warm for a newborn, but they don’t regulate their temperature as well as older babies or adults.  An open window creating a breeze will cool them off too much if they are sleeping nearby, so drop the thermostat before you crack that window.
  2. We layer for comfort, so they can layer as well. Swaddling creates “neutral warmth”, the retained warmth of the baby’s body.  If you are concerned that your child is too warm, use a cotton onesie and a cotton flannel blanket, both reasonably breathable options.  The space between the layers can hold some warmth, so even though the fabrics are light, your child could be warm enough with just two light layers.
  3. Think he’s too hot?  Touch the back of his neck and behind his ears.  If he is sweaty there, then he is indeed too warm.  Use a lighter fabric for swaddling, or take off the onesie and re-swaddle in just a diaper.  If you live in a warmer locale or in an apartment with lots of heat, your baby might do much better in the summer-weight fabrics like muslin.  If the heat is unregulated and very warm, you may not be able to swaddle at all.  I used to live in a top-floor NYC apartment that allowed me to wear at tee shirt to bed in January!
  4. Think he’s too cold?  If your child’s face is cold, then that might be true.  Before you pop him into a fleece blanket or garment, think for a moment.  The fleece swaddle garments look so comfortable that they are tempting, but newborns will usually not cry when they are overheated, they just stay asleep.  The brain will try to get rid of excess heat but newborns don;t have the most effective temperature regulation wired into their brains at this early age.  A fleece pajama is loose compared with a fleece swaddle garment, and has less heat-holding fabric folds.

Be creative and thoughtful when you swaddle your newborn this season!

Low Tone At Preschool: How Tone Affects Safety and Play

Low muscle tone can create safety issues and difficulty using toys at school.  Here are some reasons why things can fall apart (literally, sometimes!) and how small changes make the difference between success and failure at school.

First, there are good reasons that children with low tone struggle to sit, stand or move around the classroom safely and independently.  It is easy to see the loose-limbed elbows and the w-sitting, but the less visible components of low tone are the sensory information that is lost and the child’s behaviors as she tries unconsciously to give herself more vital sensory input.  When a child is at rest, low tone means it will take a longer time (usually fractions of a second) for the brain to generate adequate muscle contradiction to initiate movement.  Fewer and slower muscle fiber contractions while moving creates an incomplete message regarding the muscle’s degree of stretch and amount of the contractions.   Less force from muscles on joint receptors gives inadequate position sense information.

Children with low tone are not receiving the correct amount of sensory information at the right time to create smooth and accurate movement or to be accurately aware of their body position without using vision or getting additional sensory information from another source.

We do not realize the rapid delivery of information in our brain that is necessary for safe and effective movement.  Those fractions of a second can be the difference between a child sliding off the chair or catching herself quickly.  Adults sometimes blame a child for being inattentive, but very young children do not compensate by checking their position before they start a movement or while they are moving.  As a child gets a little older, they can use those strategies.  In preschool, it would be like reminding them to check for nearby exits on a plane when they board.  Pointless.  The part of the brain that can monitor and anticipate potential problems is undeveloped for this task at this age.

A child may use too little force when they are scribbling with a crayon, or so much that the crayon breaks.  That happens as she tries to perceive position and movement, no matter how frequently the teachers tell her to “be gentle”. This is a sensory-motor issue for her.   It would be as if you were wearing oven mitts and holding a raw egg.  Try not to break it,  but don’t drop it!  Another child may not perceive that his foot is sliding off a step on the playground, and instead of moving it forward, he slides off the step completely.  “Being careful” is harder for young children when they do not have the impulse control to check foot position or remember to place their feet in the center before climbing up.  Using tools such as a toy hammer is very difficult when just standing in a stable position is a challenge.  Hitting a plastic nail head with a hammer requires a stable core so that the swing is accurate and powerful (golf, anyone?).  Most children with low tone struggle every day to establish enough core stability for seemingly simple tasks.

Low muscle tone will create a few familiar postural patterns with most children.  The “seated asymmetrical slouch” so that one hand is holding up his head and one hand is playing, the “full-body belly flop onto the play table” so that both hands can push trains, and the “draping over furniture or people” without any awareness are all familiar to the families of low-toned children.  Maintaining a stable posture for a few seconds isn’t difficult, but staying there for a while or staying stable while thinking and talking can be too great a load for the brain.  Something has to go, and it is often postural control.  Your child isn’t conscious of his choice, but if he is having fun, he is going to choose the position that is the least demanding.  Unless he decides to get up and run…….

The other effect of low tone in the preschool classroom can be “the child with ants in his pants”.  Children learn very early on that changing positions, especially moving very quickly or landing hard into surfaces, will raise their muscle tone briefly, give them more body awareness information and help them stay alert.  None of this is appreciated at most schools, especially when a child launches himself into/onto other children for fun.  If a child has only mildly low tone and no other diagnosis, it is easy to attribute this to behavioral or attentional problems.

What can teachers and parents do?

  • Hands work better when hips and shoulders are stable and/or supported.  Encourage children to sit rather than stand to perform coloring, cutting, and toy or block assembly.  They may even be safer and more successful lying on their stomach on the rug. The exception would be coloring on a vertical slanted easel, every OT’s favorite position for preschool coloring with low-toned kids.  Children benefit from placing their “helper hand”, the non-dominant one, forward at about chest height on the easel to give more trunk and shoulder support to the hand that is coloring.
  • Find a chair that allows a child to place their feet flat rather than on their tiptoes or sliding out under the table.  Remember that changing her chair height is going to mean that the table surface may not be right either.  Most preschoolers don’t manage booster cushions well; they slide around and play on them.  If a child is too distracted by a booster seat, it is better to find a solid and stable seat for sitting.
  • Choose toys and tools that have extra sensory input built in.  Thicker crayons can handle more pressure, textured handles give a bit more touch information, and sometimes even a slightly heavier toy is easier to feel and manipulate than a lighter one. Smooth surfaces and tiny clasps are harder to manipulate for children who aren’t perceiving slight changes in joint and muscle position.  Making fasteners larger or even demonstrating a more powerful grasp pattern can help.  Most children love sensory input, so even children without low tone will benefit from a wider range of materials and textures.
  • Fatigue and illness will exaggerate problems with tone.  Being tired makes all of us a little unsteady, but it really hits low-toned kids hard.  The same is true when they have a cold.  If they have an ear infection or fluid in their ears, their vestibular system is not functioning well either.  This is the time to stand closer to them on the playground and even avoid the use of slides and climbing activities unless you are within a fingertip’s range to catch them.  It is also the time for less criticism of all their compensations such a leaning their chin on one hand to keep their head up at the table.  They may be trying as hard as they can on that day.
  • Create a purposeful reason to get up and move around after sitting still.  Just a little bit of muscle contraction, joint pressure and vestibular input can be enough to recharge the nervous system for better performance.  Preschoolers like to be useful and there are lots of “jobs” you can give a child that build self-esteem instead of complaining that they are slouching.  Just tossing out their napkin and returning to their seat can be enough, or handing out cups for snack.  Almost any small task would work, including cleaning up toys.  Everyone is happy to instill that habit in children!

When to Stop Using the Infant Swing with Your Newborn

Weaning the swing can happen earlier than weaning swaddling.  Somewhere about 2.5 months old (adjust for prematurity if needed), many newborns no longer get more peaceful while swinging.  There will always be babies that prefer to be jiggled on your shoulder or in your lap from the beginning. There will also be babies a bit over 3 months old that only calm when snugly swaddled and swinging, firmly buckled in and fully reclined, of course.  If you are not talented in the blanket swaddling area, this is the time when you might want to try a swaddle garment.  It is unsafe to loosely swaddle a child when they are old enough to partially roll inside a swing.  If your child is so strong that he can undo a swaddle garment or a firm blanket swaddle, then swaddling in a swing is not for you.  You will just have to double-down on the shush/white noise, sucking and side/stomach calming.  I would also recommend the dream feed (my most popular blog post ever from January 2015) and be very careful not to put off naps until your child is over-tired.  More on that topic later this month.

When your baby is ready to wean swinging it may be as easy as shutting it off and putting him in the bassinet or a co-sleeper.  Wean a movement-loving baby by slowing the swing down for sleep for a few nights and then seeing if he can sleep in a non-moving swing.  If his sleep is still as long and as deep, then it could be time to put the swing on Craigslist or in the garage.

Don’t forget that the other S’s, especially shushing/white noise, may be even more important now for general calming and signaling bedtime.  This is not the time to dismantle your previously perfect newborn sleep routine.  Abandon all the signs and sounds that tell him things are quiet, safe and cozy at your own risk.  You may even add some more mature routines that can continue throughout childhood, like infant massage and story time.  Babies love to hear your rhythmic voice as you read “Goodnight Moon”.  I hope you like it too, since you will be reading it over and over…and over!

Why Head Banging Doesn’t Mean Your Toddler Is Autistic

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I have worked with so many toddlers who terrify their parents with a tendency to bang their heads on the floor when frustrated.  Their parent’s first question is almost always  “Do you think he could be autistic?”.  Sometimes the answer is yes, but it isn’t because of the head banging.  It turns out that head banging is a behavior seen frequently in autism, but it can be a sign of unrelated problems or just a developmental phase.  No one likes to see their child walk around with welts on his forehead. Head banging can be stopped or at least diminished when you know why it is happening and how to turn around the cause(s).

Here are some suggestions to deal with this behavior whether or not your child is on the spectrum:

  • Watch the timing and the pattern of behavior/experiences prior to head banging. Sometimes hours before the head banging.  Tornadoes do not appear without clouds, and head banging doesn’t emerge without a trigger either.  Even the children who bang their heads to “stim” (increase specific sensory stimulation in any mode of sensory input) have an actual reason.  Usually their reasons are to exchange one sensory input for another more irritating one, or seeking input to raise their overall sensory alertness. It is hard for many parents to understand, but strong, even painful sensation can actually be calming to a person who is experiencing internal turmoil.  This appears to be the basis for another troubling symptom seen in teens and adults: cutting.  That is why head banging could be an attempt to deal with frustration or rage a child cannot control and cannot express.  Work hard on those communication, sensory and behavioral concerns.  Sometimes it can be as easy as dimming the lights or snipping the tags on shirts.  Sometimes you need a complex behavioral program as well as a sensory diet.
  • There are toddlers that bang their heads a few times and then slip a quick look to see if they are getting their way.  Is she running for the cookie, not the sandwich?  Is he turning on the DVD now?  Fewer sobs, less intense desire to bang his head, and no visible relief from the few hits he takes. That sidelong look tells you what you need to know.  He is hoping to scare you into caving in.  Don’t fall for it.  In fact, that might be the time to use the Fast Food Rule (below) and a consequence/loss of privilege.  You are being played.
  • If sleep schedules are erratic or if sleep is insufficient, that can contribute to a very short fuse and  support this behavior when frustrated or overwhelmed.  So many childhood behaviors have been linked to sleeping issues, and this is one of them.  Get help if you need to for sleep problems, and then see where you are with this issue.
  • The inability to communicate frustration and desires/needs is a huge reason for head banging in toddlers of all stripes.  And not just the kids on the spectrum or kids that struggle with sensory processing.  Build his language skills and use The Fast Food Rule from Happiest Toddler on the Block.   See my post in March 2015 ” Taming Toddler Tantrums Using Empathetic Reframing” so that your child feels that you really, really hear what is bothering him!  After that, use Dr. Karp’s Happiest Toddler technique “patience stretching” after your child is 12 months old, or with a  child who is at a 1-4 year cognitive and communication level.
  • Finally, make sure kids are safe and have alternatives that work and that they can use.  This takes practice for both of you.  Not yelling, being firm and supportive isn’t easy when your child is determined to head bang.  Some kids will be willing to bang their heads into bean bag chairs, sparing their skulls.  Some will let you massage their scalp for stimulation, also kinder and gentler. Some need to know that choosing head banging consciously instead of speaking, seeking a quiet space, a therapy toy or a hug will result in the loss of privileges.  But always equipt your child with some alternatives that work and help them make a good choice before they risk a loss of a privilege.

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Lakeshore Scissors for Toddlers That Only Cut the Paper, Not the Toddler

terrific safe scissors for little hands!

terrific safe scissors for little hands!

Lakeshore Learning sells their own brand of plastic safety scissors, and I like then so much that I wouldn’t recommend any other brand for children under 4.  Toddlers are just too curious about how scissors work and too excited to listen to safety precautions.  These scissors mean that they can develop solid hand skills earlier and without bloodshed.

Scissors are the second actual tool a child masters (eating utensils are first) and the earlier a child understands how scissors work and how to handle them, the safer they are when using them.  I wouldn’t give anyone under 2 a pair of scissors unless they impressed me with their maturity and fine motor control.  Before 2, most children do not have the requisite coordination to make snipping on paper a success.  Toddlers with older siblings immediately earn a slightly earlier-than-usual first lesson from me, as I know that older children often leave regular scissors on a table without thinking. I want them to understand correct grip, correct carrying and that using scissors is a “big kid” privilege.

One of may favorite work memories is a child to whom I offered a pair of these scissors and tried to help him put his fingers into the handles.  He resisted me, and with a combination of derision and fear, uttered “Dane-ge-wous!!”.  Apparently he had heard about scissors from someone else! This version will prevent you from shrieking and grabbing a scissor away from a child just as he is really learning how to cut.

Lakeshore’s own brand of safety scissor will break easily if a child tries to twist the blades apart.  Luckily they are very affordable, and I generally encourage parents to buy a few at a time in the same color when shopping.  They will not cut skin, hair or clothing, but they will pinch fingers. Of course, if your child tries to stab someone in the face they will cause injury.  Just because they are not going to cut a child doesn’t mean that they cannot be used as an intentional weapon or create some accident.  Supervision is essential, and not just for injury prevention.  I always bring 2 scissors with me so that a child can see me demonstrate cutting without having to rip a pair out of his hands.  You know that the toddler commandments include “If I am holding it, it is mine” .  If I have only one pair of scissors, toddlers are so intent to retrieve that pair that they cannot watch my demonstration.

Combine these great scissors with the high-quality paper and creative designs of the Kumon cutting books (see earlier post) and you have hours of fun and solid preschool skill development!