Category Archives: hand coordination

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

 

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

Why?

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

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

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

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

sara-darcaj-OZ5t_ZsfwBM-unsplash

 

Think Using Dot Markers Is Therapy for Kids in Preschool? Think Again!

 

S495361_2I had to look twice.  A private client showed me the picture her 4 year-old made in his school OT session (not the picture above!).  A picture decorated using a dot marker.  He can copy a vertical cross and a circle using a pencil.  I showed him how to draw a triangle in less than 4 minutes during that session.  He is very risk-averse and is probably intellectually gifted.   He has lots of sensory issues and mildly limited fine motor skills.

Why was he using a dot marker for anything?

I know his therapist isn’t very experienced, and I am sure the supplies budget isn’t huge.  But neither are good excuses for using tools that don’t raise the skill level of a child that is so hesitant to be challenged.  Those markers are great for toddlers under 2 or older children with motor skills under a 24-month level, especially kids with neurological or orthopedic issues that don’t allow them to easily grasp and control crayons.  Dot markers get children excited to make a mark on paper (an 11-month fine motor skill) and can be the first step to holding a tool to develop early pre-writing.

They aren’t good at all to develop any kind of mature pencil grasp due to their large diameter and large tip.  It would be like writing your name with a broom!

The ink tends to splatter with heavy quick contact with paper (fun to make a mess, but not therapeutic!), and doesn’t dry quickly enough.  Repeated contact bleeds colors together, and it is hard to keep within the borders of a design unless the target is very large.  I can assure you that the design above was done by an adult, an adult with some art training.

Dot markers aren’t building pre-writing skills for this child I treat.  There are so many options for activities that do build skills in kids at his ability level.  Their use can discourage a risk-averse child from working on pencil grasp.  Whatever the activity it was that they were doing, unless he was swinging on his belly on a platform swing or going down a ramp on a scooter (I don’t think he was doing anything nearly that intense) while using a dot marker, there were other, better choices to make.

Read Using A Vertical Easel in Preschool? WHERE You Draw on it Matters! and Deluxe Water Wow Pads Offer More Challenge And More Fun To Preschoolers and Kindergarteners for more good ideas on fun at home that builds pre-writing skills.

senjuti-kundu-JfolIjRnveY-unsplash

 

Hypermobility and Music Lessons: How to Reduce the Pain of Playing

 

kelly-sikkema-jrFNMM6K0VI-unsplash.jpgMost kids want to learn how to play an instrument in grade school.  Most parents encourage some form of musical training for the benefits of musical training: social, coordination, attention and focus, even the suggested connection between math skills and musical ability.  Hypermobile kids can struggle with the physical demands of playing an instrument sooner and more severely than a typically developing child.

There are ways to make it easier and less painful, right from the start.

  • Steer them into the right instrument for their physical abilities.  Heavy instruments are a questionable choice for kids that have back and shoulder issues, as they will be moving their instrument around a lot.  Children with very hypermobile wrists could find the positions for violin or guitar much more challenging than the positions for piano or clarinet.  There will still be a lot of fingering, but it occurs in a different plane of movement.
  • Understand that as hypermobility changes, so may the type of instrument that best fits your child.  This is a tough thing for kids to accept, but if they are experiencing repeated strains and injuries or an increasing amount of pain, they may have to switch to an instrument that is less risky.  Remember:  hypermobility syndromes don’t disappear, and most hypermobile children will not become professional musicians.  This isn’t life-or-death, no matter what.  Injuries that affect the ability to attend school and eventually affect working…that is something to avoid.
  • Positioning matters.  Just as with sitting at a desk or a table, hypermobile kids need to use the best possible postural control with the least amount of effort.  Children playing the piano may need a chair with low back support rather than a piano bench.  Seats may need to have cushions that give more support and seats should definitely provide solid foot placement on the floor at all times.  Some kids may need the support of a brace or braces.  Back, shoulder, wrist, and even finger splints aren’t slowing them down; they are supporting performance.  The biggest problem will be resistance from the artist.  Children rarely want to wear these devices, and if they aren’t well designed and fitted, you will hear about it.  Ask their OT or PT for direct assistance or find one that can do a consultation.  And don’t wait until an injury happens.  Get in front of this one.
  • Musical skills require practice, but hypermobile kids may need to break up their practice or do targeted practice to shorten the total amount of time spent and reduce the physical strain.  Targeted practice requires that their instructor knows which types of practice are the most likely to build skills, rather than just adding minutes to a practice session.  Breaks are important, and most kids don’t have the ability to know when and how to take them.  They need to be taught, and the little ones need to be supervised on breaks.

 

Looking for more information on raising a child with hypermobility?

My next e-book, The JointSmart Child:  Living and Thriving With Hypermobility  Volume Two:  The School Years is coming out in March 2020!  It will have more information about kids 6-12, including sports and the hypermobile child, improving communication with your child’s teachers and coaches, and how to address handwriting and keyboarding problems.  It will have more forms and checklists than the first book, but still cover all the self-care issues like toileting and how to make your home safer for your child.

Look for it on Amazon.com and YourTherapySource.com soon!

 

clark-young-tq7RtEvezSY-unsplash.jpg

 

Hypermobility Or Low Tone? Three Solutions to Mealtime Problems

 

sara-darcaj-OZ5t_ZsfwBM-unsplash

 

Many young hypermobile kids, with and without low muscle tone, struggle at mealtimes. Even after they have received skilled feeding therapy and can chew and swallow safely, they may continue to slide off their chair, spill food on the table (and on their body!) and refuse to use utensils.

It doesn’t have to be such a challenge.  In my new e-book coming out this year, I will address mealtime struggles.  But before the book is out there, I want to share three general solutions that can make self-feeding a lot easier for everyone:

  1. Teach self-feeding skills early and with optimism.  Even the youngest child can be taught that their hands must be near the bottle or cup, even when an adult is doing most of the work of holding it.  Allowing your infant to look around, play with your hair, etc. is telling them “This isn’t something you need to pay attention to.  This is my job, not yours.”  If your child has developmental delays for any reason, then I can assure you that they need to be more involved, not less.  It is going to take more effort for them to learn feeding skills, and they need your help to become interested and involved.  Right now.  That doesn’t mean you expect too much from them.  It means that you expect them to be part of the experience.  With a lot of positivity and good training from your OT or SLP, you will feel confident that you are asking for the right amount of involvement. Read Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child and Teach Utensil Grasp and Control…Without the Food! for some good strategies to get things going.
  2. Use excellent positioning.  Your child needs a balance of stability and mobility.  Too much restriction means not enough movement for reach and grasp.  Too much movement would be like eating a steak while sitting in the back seat of your car doing 90 mph.  This may mean that they need a special booster seat, but more likely it means that they need to be sitting better in whatever seat they are in.  Read Kids With Low Muscle Tone Can Sit For Dinner: A Multi-Course Strategy for more ideas on this subject.  Chairs with footplates are a big fave with therapists, but only if a child has enough stability to sit in one without sliding about and can actively use their lower legs and hips for stabilization.  Again, ask your therapist so that you know that you have the right seat for the right stage of development.
  3. Use good tableware and utensils.  If your child is well trained and well supported, but their plates are sliding and their cups and utensils slide out of their hands, you still have a problem.  Picking out the best table tools is important and can be easier than you think.  Items that increase surface texture and fill the child’s grasping hand well are easiest to hold.  Read The Not-So-Secret Solution for Your Child With Motor And Sensory Issues: Dycem and OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues for some good sources.  Getting branded tableware can be appealing to young children, and even picking out their favorite color will improve their cooperation.  Finally, using these tools for food preparation can be very motivating.  Children over 18 months of age can get excited about tearing lettuce leaves and pouring cereal from a small plastic pitcher.  Be creative and have fun!

 

phil-goodwin-TxP44VIqlA8-unsplash.jpg

 

Does Your Older Child Hate Writing? Try HWT’s Double-Lined Paper

 

This paper has been more useful to older kids (6+) that I see for handwriting help than any other paper on the market, and almost any other tool Problems With Handwriting? You Need The Best Eraser , Great Mechanical Pencils Can Improve Your Child’s Handwriting Skills .  Why?  Regular lined paper, and almost all worksheets, are usually jam-packed with lines.  Red lines, green lines, lines with airplanes and worms.  There are papers designed by occupational therapists that are even more complex than the mass-market choices.

All this is often visual noise to kids with sensory processing issues and ocular or visual-perceptual issues.  These problems are sometimes subtle and appear to be behavioral.  The kids who “hate to write”.  The kids who look away when you are demonstrating how to write a letter or spell a word.  The kids who cannot seem to remember where to start a letter, even after repeated practice.  These children often do much better with HWT’s double-lined paper.

Let’s drill down into the design of this unique paper:

  • Double-lined paper provides just two lines; the baseline and the midline.  Knowing where to start uppercase letters and tall lowercase letters is important, and this paper encourages practice and awareness while still giving some structure to writing.
  • There is a wide empty space between sets of lines.  This is intentional; children have room to place the tails of lowercase “y” and “j”, for example, without blocking the uppercase or tall lowercase letters of the next line of writing.  For many kids, not knowing what to do about crowding and spacing is a good reason to stop trying to write well, or sometimes even write at all.
  • This sturdy paper is pre-punched to be used in a 3-ring binder.  The quality of the paper is very high, which means that it doesn’t tear easily when a child erases a mistake.  Most schools provide the thinnest paper for teachers to use as handouts, creating the potential for a disaster when given to a child that struggles with grading their force on an eraser, or makes multiple errors in a word.
  • Brains get practice in sizing and proportion.  Once kids have a pattern of letter formation, it is easier to accomplish without the extra midline.  But so many kids need that “training wheel” effect much longer than scrolls recognize.  Many kids need a day or two of double-lined paper use to start understanding the way a letter “h” is twice as tall as a letter “a” and the same size but aligned differently than the letter “y”.  Of course, pointing it out is important, and so is working on other writing qualities such as letter and word spacing.
  • Kids write faster.  Because they are guided to proportion and start letters correctly, they don’t waste time thinking about it or erasing incorrect letters.  Again, this doesn’t mean their brain isn’t taking it all in.  If that were true, we would start every kid on single-lined paper in preschool.
  • There are three line sizes, so you don’t have to abandon the double-lines when your kid enter middle school.  I will admit that I wish the pre-k/K paper were thicker.  But it is still fairly sturdy.
  • You can alternate using this paper with single-lined paper to see when to “take the training wheels off” and stop using double-lined paper.  Kids should always have a chance to practice with standard paper, but when the choice is between fighting and crying, and quickly executing a homework assignment, it is no contest.

 

The best paper wins.

joao-rafael-662575-unsplash

Need to Support A Child’s Independence? Offer to Help Them!

 

irina-blok-192240-unsplashI know; it sounds like I am being sarcastic.  That couldn’t be farther from the truth.  Instead of telling children to “Give it another try” or “I know you can do it”, offering help to a young child can have the paradoxical effect of eliciting more perseverance and attention.

It really isn’t all that complicated:  think of your own responses for a moment.  If you were trying to fill out your tax forms, and ran into difficulties, you might call an accountant for help.  If their response was “Just keep trying; I know you can figure it out!” you probably wouldn’t be excited to try again.  You might feel even more agitated.  I know what I would be thinking:”If I knew what to do, I wouldn’t have called you int he first place!”

If your accountant said “Let me take a look.  Oh, I underlined some of the important numbers.  You got stuck with line 32b, right?” you could see the issue in a new light, and be able to come to a solution without having to walk away or tear up the form.  Your accountant used their advanced knowledge to set you up for success.

We need to do the same thing for children.  Telling them we have faith in them, or insisting that they need to try again when they clearly don’t know how to alter their actions, is not kind or even very educational.  It leaves them feeling abandoned under stress.  Even if we know they can solve for X, they aren’t doing it now.

For the very youngest kids, I have a special solution.  You “wiggle it”.  Young children don’t know how we understand how to do so many things well.  When they get stuck opening containers or assembling objects, I offer to “wiggle it”.  By demonstrating that the container does indeed open, or that the bead will fit on the string, I am assuring them that they could be successful.  More importantly, I am demonstrating the correct grasp pattern and stabilization method.  And finally, I am rebooting their motor plan and their frustration level.  Just handing the object over to me reduces their agitation.  When children aren’t so frustrated, they can think and create better motor patterns.’

All this from a little “wiggling”.

To read more about building confidence and coordination, read For Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance and Why Telling Your Child “It’s OK” Doesn’t Calm Him Down (And What To Do Instead)

When Writing Hurts: The Hypermobile Hand

IMG_1145

Many children resist doing their homework, but most kids say “Its so BORING!” not “My hand hurts too much”.  If a child is complaining of pain, and they don’t have a joint disease such as JRA, the first thought is hypermobility.  The good news is that there are a few fast fixes that can decrease or even eliminate hand pain.

It is rare that hypermobility in the hand is directly addressed at the preschool level unless it is generalized throughout the body or severely reduces pencil grasp.  Many children have atypical grasp patterns when they cannot achieve the required stability for a standard pencil grasp.  Children with mild instability and no other developmental issues may still be able to write legibly and even fast enough to complete assignments in the early grades.  It is when the volume of work increases or the joint stability decreases that therapists get a request for service.

Here are a few strategies that can support hypermobile kids to write with less pain:

  1. Use a tabletop easel.  These can be foldable or static.  They support not just the wrist and forearm, but also the shoulder and trunk.  The angle of an easel both supports correct wrist positioning and decreases strain on the wrist and hand.  Some easels come with clips that hold the paper, but they should be placed on an angle to mirror the natural arm position.  This will require more table space, so be aware that the size of the easel could be an issue.  Simple hack:  use a three-ring binder as an easel.
  2. Enlarge the width of the pencil shaft.  My favorite pencils for grades 1+ (see photo above) have a standard #2 lead, but a wider shaft. Joint protection principles tell us that avoiding a closed joint position should lead to less strain on joints and supporting ligament structures.  You could use some of the adaptive pens available, but I find kids reject these as looking strange.  Of course, if you enlarge the shaft oo much you will find that it is more awkward, not less.  Think of those novelty pencils you buy in gift stores on vacation.  Cute but useless.  Nobody really writes with anything that thick.  Match the child’s hand size to the pencil.
  3. Increase the texture of the pencil shaft for easier grip, less pain, and more endurance.   Everyone has seen the rubbery grips you slip onto a pencil.  You can slide 3-4 onto the entire shaft, or add some tape to create a non-slip surface.  I have been adding kineseotape or Dycem to handles this year, with good results.  You are battling grasp stability, but also fatigue.  A hand that is tired is a hand that experiences more pain.  Adding texture reduces the amount of force needed for proprioceptive registration (a fancy way of saying that kids need to squeeze to fully feel what is in their hand).  Reducing force reduces pain and fatigue.
  4. Teach pacing.  Kids think that the faster they write, the faster they will be out of pain.  Breaking up the work can have better results, but it isn’t natural for children to pace themselves.  In fact, I have never seen a young child do so.  You have to teach this to kids who likely will have joint instability throughout their school years.  A schedule, a timer, organizing assignments and breaking them down into heavy writing choices and light writing choices all help.
  5. Splinting can be a real option.  Not a heavy plastic or metal splint (usually).  A neoprene splint can be a lightweight supportive choice.  These splints are comfortable and washable.  These are affordable without insurance for most families, and your OT can help you decide if this is a worthwhile pursuit.  They are durable but easily lost by younger children, so not all families send one to school.  But the support is real, and kids that have been told for years to “fix your fingers” can feel relieved that they can now focus on writing and composing on the paper.

For more information on hypermobility, read The Hypermobile Hand: More Than A Strength Problem and For Kids With Hypermobility, “Listen To Your Body” Doesn’t Teach Them To Pace Themselves. Here’s What Really Helps.

Looking for more assistance with hypermobility?  My new e-book is coming out this summer, and it will address the issues of the early years (0-5).  The series will continue with school age kids and teens.  But you don’t have to wait; visit my website tranquil babies and request a consultation to discuss your child’s treatment plan and make a better plan that works for everyone…today!