Category Archives: hand coordination

Teach Your Child To Catch and Throw a Gertie Ball

 

71rwmnHGrHL._SL1500_These balls aren’t new, but they don’t get the recognition that they should.  The ability to catch a ball is a developmental milestone.  For kids with low muscle tone, sensory processing disorder (SPD) or ASD, it can be a difficult goal to achieve.  The Gertie ball is often the easiest for them to handle.  Here’s why:

  1. It is lightweight.  An inflatable ball is often easier to lift and catch.  The heavier plastic balls can be too heavy and create surprisingly substantial fatigue after a few tries.
  2. Gertie balls are textured.  Some have the original leathery touch, and some have raised bumps.  Nothing irritating, but all varieties provided helpful tactile input that supports grasp.  It is much easier to hold onto a ball that isn’t super-smooth.
  3. It can be under-inflated, making it slower to roll to and away from a young child.  Balls that roll away too fast are frustrating to children with slow motor or visual processing.  Balls that roll to quickly toward a child don’t give kids enough time to coordinate visual and motor responses.
  4. They have less impact when accidentally hitting a child or an object.  Kids get scared when a hard ball hits them.  And special needs kids often throw off the mark, making it more likely to hit something or someone else.  Keep things safer with a Gertie ball.

The biggest downside for Gertie balls is that they have a stem as a stopper, and curious older kids can remove it.  If you think that your child will be able to remove the stem, creating a choking hazard, only allow supervised playtime.

Looking for more information about sports and gross motor play?  Check out Picking The Best Trikes, Scooters, Etc. For Kids With Low Tone and Hypermobility and Should Your Hypermobile Child Play Sports?.  You could also take a look at What’s Really Missing When Kids Don’t Cross Midline?.

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DUPLO’s My First Number Train Set Is An Easy Way to Build Grasp in Toddlers!

 

 

91YccX0yt9L._SL1500_.jpgI really like this set from LEGO.  The DUPLO line is intended for children 18 months to 5 years old, but I think older kids will enjoy it as well when they combine pieces to make more complex designs.

The #1 reason I like this set is that the great majority of the pieces are easy to hold, easy to assemble, and hard to swallow.  I encourage families to remove the smaller pieces until their child is not prone to putting small things in their mouth.  But that still leaves so many pieces left for fun!

Young children struggle with asymmetrically-shaped pieces, so simple squares and rectangles are easier to manage.  The larger squares with numbers on them are especially easy to hold; they fit securely into the palm of a toddler and provide surface area for them to place their fingers securely on the sides of the blocks as they put two together.

In addition, the colors and the numbers are great for early learning.  Some of the families I work with get two sets and work on matching numbers and colors while they are working on grasp and coordination.

Oh, and the set is under $20 U.S.  Nothing like a value to make me smile!!!

BTW, the also make My First Letter Truck.  Same chunky pieces, you get a vehicle and a driver, but more of the chunky blocks that make this such a great building toy!!

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Boost Pincer Grasp With Tiny Containers

These days I am getting pretty…lazy.  My go-to items are designed so that children automatically  improve their grasp or their posture without my intervention.  I am  always searching for easy carryover strategies to share with parents too.  As with most things in life, easy is almost always better than complicated.

My recent fave piece of equipment to develop pincer grasp in toddlers and preschoolers is something you can pick up in your grocery store, but you are gonna use it quite differently from the manufacturer’s marketing plan….

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Remember these?

Enter the tiny party cup, AKA the disposable shot glass!  Yes, the one you used when you played “quarters” in school.  The very same.  These little cups work really well to teach toddlers to drink from an open cup, but they are also terrific containers to promote pincer grasp in young children.  Drop a few small snacks into these little cups and discourage them from dumping their snack onto the table instead of reaching inside with their fingers.

No matter how small your child’s fingers are, they will automatically attempt a tripod or pincer grasp to retrieve their treat.  You should’t have to say much of anything, but it never hurts to demonstrate how easy it is.  Make sure you eat your snack once you take it out of your cup.  After all, grownups deserve snacks too!

These little containers are much sturdier than paper cups.  This means that they can survive the grasp of a toddler who cannot grade their force well.  The cylindrical shape, with a slightly smaller base than top, naturally demands a refined grasp.  The cups have a bit of texture around the middle of the cup (at least mine do)  which gives some helpful tactile input to assist the non-dominant hand to maintain control during use.  They are top-shelf dishwasher safe and hand-washable, in case you feel strongly that disposables aren’t part of your scene.

Has your child mastered pincer grasp?  These little cups are fun to use in water and sand tables as well.  Mastery of pouring and scooping develops strong wrist and forearm control for utensil use and pre-writing with crayons.

For more ideas on developing grasp, take a look at Want Pincer Grasp Before Her First Birthday? Bet You’ll Be Surprised At What Moves (Hint) Build Hand Control! and Develop Pincer Grasp With Ziploc Bags.

 

The Hypermobile Hand: More Than A Strength Problem

 

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I just received another referral for a kid with “weak’ hands.  Can’t hold a pencil correctly, can’t make a dark enough mark on paper when he writes or colors.  But his mom says he has quite a grip on an object when he doesn’t want to hand something over.  He plays soccer without problems and otherwise functions well in a regular classroom.  Could it be that hypermobility is his underlying problem?

Some children display problems with fine motor skills due to low muscle tone.  Many times, their low tone is significant enough to create poor joint alignment and stability, resulting in joint hypermobility as well as low muscle tone.  But kids can also have joint laxity with typical muscle tone.  Assessing the difference between tone, strength, alignment/stability and endurance is why you get an evaluation from a skilled therapist.  And even then, it can be tricky to determine etiology with the youngest children because they cannot follow your directions or answer questions.  Time to take out your detective hat and drill down into patient history and do a very complete assessment.

With older kids, both low tone and joint laxity can lead them over time to develop joint deformity and soft tissue damage.  Like a tire that you never rotated on your car, inappropriate wear and tear can create joint, ligament, tendon, and muscular imbalance problems that result in even worse alignment, less stability and endurance, and even pain.  And yes, weakness is often observed or reported, but it often is dependent on posture and task demands, rather than being consistent or specific to a nerve distribution or muscle/muscle group.

What does the classic hypermobile hand look like?  Here are some common presentations:

  • The small joints of the fingers and thumb look “swaybacked”, as the joint capsule is unstable and the tendons of the hand exert their pull without correct ligament support.  When they slide laterally and the joint is unable to move smoothly, people say that their fingers “lock” or they are diagnosed with “trigger finger”.
  • The arches of the hand aren’t supported, so the palm looks flat at rest.  By late preschool, the arches of the hand should be evident in both active and passive states.
  • The fleshy bases of the thumb and pinky ( the thenar and hypothenar eminences, for all you therapists out there) aren’t pronounced, due to the lack of support reducing normal muscle development during daily use.
  • Grasp and pinch patterns are immature and/or atypical.  A preschooler uses a fisted grasp to scribble, a grade-school child uses two hands to hold an object that should be held by one hand and uses a “hook” grasp on a pencil.
  • Grasp and pinch may start out looking great, and deteriorate with the need for force.  Or prehension begins looking poor and improves for a while, until fatigue sets in.  This bell-curve pattern of grasp control is often seen with kids that have poor proprioceptive discrimination.  As they use their hands they receive more input, but as fatigue sets in, they cannot maintain a mature grasp and good control.
  • The typical arches of the hand that create the “cupping” of the palm when pretending to scoop water from a stream, for example, will be somewhat flattened. Unless there is nerve damage, you won’t see the “claw hand” pattern or another atypical posture.
  • Fine grasp will often be accomplished with the thumb and third finger to achieve greater stability through the MCP (knuckle) joints and to avoid full opposition of the thumb.  Another common compensatory pattern is using digits II and III together to gain greater stability.  Some kids can even wrap one digit partially around another to do this.  Now that’s hypermobility!

Don’t forget that hypermobility creates poor sensory processing feedback loops.  Reduced proprioception and kinesthesia will result in issues when children try to grade force and control movement without compensations such as visual attention and decreased speed. This can result in kids being labeled clumsy or careless.  For more on handwriting and hypermobility, read When Writing Hurts: The Hypermobile Hand

In terms of treatment, the standard strategies of strengthening and adapting equipment will be important, but I also teach joint protection to kids and parents, energy conservation and I do K-taping to hands.  It is more adaptable than splinting, parents can learn to do a taping protocol at home, and it provides the necessary proprioceptive input for learning that most splinting simply cannot deliver.  For more details on taping kids with hypermobility related to EDS, read Can You K-Tape Kids With Ehlers-Danlos and Other Connective Tissue Disorders?

Looking for more ideas to address the difficulties young children face when they have hypermobility?

I wrote an e-book for you!

The JointSmart Child:  Living and Thriving With Hypermobility Volume One: /The Early Years is my newest book, and it answers many of the questions parents of young hypermobile kids have every day!

 Filled with strategies to build control, independence and safety, it guides families in the use of seating, picking out utensils for meals, even how to make the bath and bedtime safer and easier.  It is available on Amazon.com for digital download on all platforms including iPads, and on Your Therapy Source as a click-able and printable download.  The book is designed to make parents feel empowered and to help children live happier and easier lives!

 

Here are more resources:

Take a look at For Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance and Does An Atypical Pencil Grasp Damage Joints or Support Function In Kids With Hypermobility?.  Depending on the age and skill level of the child, adaptations and education can be just as important as therapeutic exercise.  Your pediatric occupational therapist can help with more than pencil grasp; we are able to help with so many real-life issues!  For toys that support a child’s grasp and control, check out Playing With Toy Food Builds Hand Skills…Faster! and DUPLO Train Set Is Affordable Safe Fun!; both of these toys are easy to hold and easy to manipulate, but allow creativity and fun while developing coordination and control.

 

Do you need help with toilet training?  My e-book will give you the support to make this less of a struggle!  Read The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! and find out what parents have to say about the only manual on the market to address potty training and low tone.

 

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When Should You Begin To Teach Handwriting? (You May be Surprised!)

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The ability to bring two hands to midline and use fingertips to hold a block is a pre-writing skill!

Many formal handwriting programs begin at 4 years of age.  Handwriting Without Tears, Fundations, and others begin with children tracing letters and quickly progress to writing.  But the foundational skills for handwriting actually begin early.  Before your child’s first birthday.  Yes, that early.  And, believe it or not, that is when you could be teaching important skills that will eventually morph into handwriting.

No, I am not suggesting that we start teaching infants to write!  I have met a handful of very gifted children, some of whom could read before 4, but not one was writing letters before their first birthday.  The foundational skills for handwriting are grasp, reach, bilateral control, posture, ocular (eye) control and visual perception.  And every single one of these skills is developing before a child turns 1.

How do you develop these skills?  Play.  Play with small toys, play with big ones.  Play that requires a child to move.  Crawling through a tunnel and climbing over cushions to develop arm and hand control.  Play on their stomach and play standing at a table for posture and core stability.  Play that requires more than tapping a screen or pressing a button.  I love my tablet as much as the next person, but I was fortunate to grow up before it was invented.  I had something called “toys”.

If you sent me to teach occupational therapists in a developing country, I would bring a small bag of the best toys I know:  crayons, paper, scissors, LEGOs, balls of all sizes, and I would use some things that every home is likely to have:  small cups for scooping and emptying, scarves for peek-a-boo, and little pieces of food for self-feeding.  This is all you need.  Really.  Giving a child the chance to feed themselves, play in water and sand, build and scribble can do a lot to build foundational skills.

One thing that I forgot to mention as a foundational skill is……interest. Some kids are very interested in coloring.  Many are not.  Same with reading.  How do you get your child interested in writing?  You allow them access to tools, make the tools desirable, and show them that you enjoy coloring or writing.  When your infant reaches for your pen and you slide it away from them, they are showing you interest.  They can’t use a pen, but they can mess around with food puree on their high chair tray, drawing lines in the goo.  Prewriting at work.  When your toddler wants to eat the marker, remind them that these are for scribbling, and help them to make a masterpiece.  Every day.  Find fun materials.  I am a big fan of crayons instead of markers, but there are some sparkly crayons and some great markers and papers that don’t destroy your home while your child is learning to draw and write Color Wonder Paper Will Boost Creativity and Save Your Walls.  Want more information on what constitutes pre-writing?  Read  How to Help Toddlers Prepare to Write .

Not an artist?  No problem!  Fake it.  Just like you gleefully eat veggies even though you’d rather have cake, scribble and make something silly on paper.  Show how much fun it is.  You might find out that you are more creative than you thought, or that once you kill that critic in your head, you actually like to draw.

Child development experts bemoan the limited language skills of kids from families without books.  Philanthropists like Dolly Parton donate tons of books to poor families in the hopes that children will be read to and develop a love of reading.  Guess what?  Children need to have early experiences with writing and drawing as well.  The family that has no crayons, no markers, no paper and no interest in drawing or writing will not inspire their children.

Give the gift of “pre” prewriting to your child, and give them a head start today!

Looking for more information on handwriting and development?  Read Have More Fun When You Use Drawing To Develop Pre-Writing Skills and Why Dot-To-Dot Letter Practice Slows Down Writing Speed and Legibility.

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Which Improves Pencil Grasp Best: A Pencil Grip Or A Thicker Pencil?

 

kelli-tungay-324329A a pediatric occupational therapist, I am often asked to weigh in on this debate.  Not often enough, it seems.  There are a lot of kids out there using pencils with wonky grasp patterns because no one has made an effort to improve the way they hold a pencil, or they doubt that it matters.  Oops.  Although grasp isn’t often or evn usually the biggest issue with writing problems, a really poor grasp can reduce control and increase pain and fatigue.  Not every kid with poor pencil grasp is a hot mess.  Some of them just need good instruction and good materials.  For the others, it might be time to get an OT involved.

Kids that struggle with pencil grasp are often (in my opinion, too often) given a pencil grip and told to use it when they write. It may help, but it may not.  An yet, I will still hand out my favorite pencil grip if I think that it will build control and strength. The Pencil Grip That Strengthens Your Child’s Fingers As They Write.

I thought I would drill down into the ways that OTs think about the use of pencil grips, and present a few alternatives to reflexively sending kids home with a bit of plastic on the end of a pencil:

  • Change the pencil.  Triangular pencils give more sensory feedback during writing, and they offer a flat surface for finger pads.  Thick mechanical pencils still have a standard-thickness lead, but they also are easier to hold for some children.  Short pencils, including golf pencils, force more fingertip contact and can be helpful (but not if grasp is really weak or awkward).
  • Don’t jump into pencil use too early.  Until a child can manage a mature grasp, I try very hard to keep them using crayons when they are not yet in kindergarten.  I like the flip crayons from Learning Without Tears because they are so very small, but not all kids in kindergarten are ready for them.  I break a toddler crayon in two so that they get the benefits of a thick shaft but they will be unable to use a fisted grasp.
  • Like markers?  I only use them if they are the Pipsqueak markers from Crayola.  Nice thick, short shafts for little fingers.  Markers don’t give a child any resistance at all, so they don’t give enough sensory feedback or strengthening for my kids that need both.  And they make a mess most of the time.  I don’t have the time to scrub off markers.
  • Build strength and control with play.  Yes, fine motor play.  Totally outdated (just joking) but necessary.  I use the iCreate tablet stylus, bead stringing, therapy putty and lots of tiny toys like travel Connect Four games.  Even baking.     Utensil use counts too. How Using Utensils To Eat Prepares Your Child To Write    Children are spending less time with toys and more with tablets, so I insist that they use a tablet stylus with me in sessions.  They have no idea that the physical “drag” of the plastic point on the glass screen as they move objects around is creating resistance that helps their fingers get stronger.
  • Color with children, draw with children. A lot.  Coloring is less stressful to the risk-averse child who thinks he can’t write. Drawing simple shapes is directly applicable to writing letters and numbers.  Think “T” and a vertical cross, “A” and a volcano.  Watching an adult and listening to their narration, such as ” I am coloring around and around to fill in the balloon, since it is a circle shape”  is very helpful to young children who resist direct instruction.  The child that doesn’t naturally gravitate to coloring may need downloads of their fave character or stickers to add to the picture to make it exciting.  But the key is the adult interaction.

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For Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance

 

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One of my most popular posts, Why “Hand-Over-Hand” Assistance Works Poorly With So Many Special Needs Children , explains how this common method of assisting children to hold and manipulate objects often results in rejection or even aversion.  This post tells you about my most successful strategy for kids with low muscle tone and limited sensory processing:  using graded resistance.

Why does making it harder to move work better?  Because if the child is actively trying to reach and grasp an object, you are providing more tactile, kinesthetic and proprioceptive information for their brain.  More information = better quality movement.  Your accurately graded resistance is doing what weighted/pressure vests, foot weights and SPIO suits do for the rest of their body.  Could you use a hand weight or weighted object?  Maybe, but little children have little hands with limited space to place a weight, and weights don’t distribute force evenly.  Did you take physics in school?  Then you know that gravity exerts a constant pressure in one direction.  Hands move in 3-D.  Oh, well.  So much for weighting things.

How do you know how much force to use?  Just enough to allow the child to move smoothly.  Its a dance in which you constantly monitor their effort and grade yours to allow movement to continue.

Where do you place the force?  That one is a little trickier.  It helps to have some knowledge of biomechanics, but I can tell you that it isn’t always on their hand.  Not because they won’t like it, but because it may not deliver the correct force. Often your force can be more proximal, meaning closer to the shoulder than the hand.  That would provide more information for the joints and muscles that stabilize the arm, steadying it so the hand can be guided accurately.   If a child has such a weak grasp that they cannot maintain a hold while pushing or pulling, you may be better off moving the object, not the hand,  while they hold the object, rather than holding their hand.

Still getting aversive responses from the child?  It may be because the child doesn’t want to engage in your activity, or they don’t realize that you are helping them.  They  may think that adults touch them to remove objects from their grasp or otherwise stop them from exploring.  Both can be true.  In that case, make sure that you are offering the child something that they want to do first.  Remember, we can’t force anyone to play.  The desire to engage has to come from them, or it isn’t play.  Its just adults making a kid do something that we think is good for them.

Want more information on how to help children build hand skills?  Read Using A Vertical Easel in Preschool? WHERE You Draw on it Matters! and Egg Crayons or Fingertip Crayons: When Good Marketing Slows Down Fine Motor Skill Development.

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One of the most amazing places I have ever seen:  Australia!

OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues

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Does your child knock over her milk on a daily basis?  Do utensils seem to fly out of your son’s hands?  I treat kids with hypermobility, coordination and praxis issues, sensory discrimination limitations, etc.; they can all benefit from this terrific line of cups, dinnerware and utensils.

Yes, OXO, the same people that sell you measuring cups and mixing bowls: they have a line of children’s products.  Their baby and toddler items are great, but no 9 year-old wants to eat out of a “baby plate”.

OXO’s items for older kids don’t look or feel infantile.   The simple lines hide the great features that make them so useful to children with challenges:

  1. The plates and bowls have non-slip bases.  Those little nudges that have other dinnerware flipping over aren’t going to tip these items over so easily.
  2. The cups have a colorful grippy band that helps little hands hold on, and the strong visual cue helps kids place their hands in the right spot for maximal control.
  3. The utensils have a larger handle to provide more tactile, proprioceptive and kinesthetic input while eating.  Don’t know what that is?  Don’t worry!  It means that your child gets more multi-sensory information about what is in her hand so that it stays in her hand.
  4. The dinnerware and the cups can handle being dropped, but they have a bit more weight (thus more sensory feedback) than a paper plate/cup or thin plastic novelty items.
  5. There is nothing about this line that screams “adaptive equipment”.  Older kids are often very sensitive to being labeled as different, but they may need the benefits of good universal design.  Here it is!
  6. All of them are dishwasher-safe.  If you have a child with special needs, you really don’t want to be hand-washing dinnerware if you don’t have to.

For more information about mealtime strategies, please take a look at Which Spoon Is Best To Teach Grown-Up Grasp? and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child.

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Teach Utensil Grasp and Control…Without the Food!

Therapro has just published my latest guest post! There are some situations that almost require occupational therapists to separate mealtime from utensil manipulation, at least at the earliest stages.  Check out my post Teaching Utensil Use Outside of the Mealtime Experience to find out if your child or client would benefit from this approach!

If you haven’t already read this very popular post I wrote earlier, make learning to use utensils an opportunity to bond emotionally,  take the pressure of self-feeding off the table and help an avoidant child engage in food play with Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child.

Therapro has been one of my go-to sources for quality therapy equipment for years.  Take the time to review their catalog online and explore their unique bowls, plates and utensils that can help children with developmental delays achieve independence in self-feeding.

Helping Little Kids Cut With Scissors

 

 

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terrific safe scissors for little hands!

I am very proud to share my latest post on Therapro, a terrific company that I have used for years to find quality therapy equipment.  They were nice enough to allow me to be a guest blogger this month, and so I wanted my readers to have the chance to go over there and check out my scissors post.  Here it is: Helping Little Kids Cut .

Therapro sells a wide variety of scissors for use in therapy and at home, so if you are not sure what you need, ask your occupational therapist for some advice.  My best suggestion is safety first; don’t buy a scissor that will cut skin unless you know that your child will be able to respond to your safety guidelines.  After that, some kids need a scissor that opens back up for them after they close it, and some need more physical assist to close the scissor as well.  The best scissor is the one that your child will use and will assist them to be successful.

To learn any skill, it helps if a child is interested and engaged.  Getting them there can be a problem.  That is what this post is all about; the preparation and presentation that makes kids want to learn.  So take a look at  my post on Therapro’s site, and let me know what you think!!

Why Eating From a Pouch Isn’t Helping Your Child As Much As You Think

 

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Sucking food from a pouch has become a common way to funnel fruits, veggies and even protein into young children.  Few kids are eating them because they have oral motor or sensory processing problems that don’t allow them to eat solid food.  Most of the pouch kids are picky eaters or eating a pouch “on the fly” in between activities and locations.

I know very well what a food fight looks like with a picky eater.  All that whining, food flying onto the floor, and fears that your child will either starve or be nutritionally deprived.  It can get ugly.  I know.  But when pouches are more than an occasional emergency ration, they aren’t without some costs.

Here is what you risk when pouches replace solid food:

  1. Your child’s digestive system needs the physical fiber to learn how to handle it well. A colon that has very little fiber isn’t capable of dealing with regular food as well.  You risk constipation and then you have to treat that problem.  And your child feels awful when “backed up”.  Don’t let them suffer that belly pain when they are capable of eating foods with fiber.  Natural fiber.
  2. If your child is young enough to be still learning to speak (and some sounds, like “th” don’t fully emerge until 3.5-5 years old), eating, chewing and even swallowing still counts as exercise and motor learning for all the structures/movements that accomplish this amazing task.  Sucking on a nozzle doesn’t support learning anything unless you are under 6 months old.  Oops.
  3. Eating is a social activity, done over time and with other humans.  Not with tablets, not with screens.  With people that model language, social and feeding skills.  Sucking down a pouch is a one-and-done experience that sends a child off their chair and back to playing too fast to absorb much of anything.
  4. Eating is a fine motor activity, from finger feeding to spoon use with soup.  Miss out on all that work, and you might find that your child is the slowest writer or even hates to write and draw.  They haven’t spent the first 3 years of life refining finger movements in the most rewarding way possible.  Food in: successful hand use.  Food on the bib/table/floor?  Recalculate and refine finger use.

What do those pouches really provide?  An easy way to feed a child nutritious food ingredients without an argument.  The problem is that all that work for kids and parents when they eat real food with their fingers or utensils is actually an investment in current and future skills that too many children need today.

Looking for more information on building self-feeding skills?  Read Teaching Children To Use Utensils to Eat: Use Good Tools, Good Food, and Good Timing for some hints on how to make things easier, and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child for the most fun and easy way to practice holding a spoon.

Taping The Paper To The Table For Your Child? Stop!

Many young children between 2 and 5, especially children with low muscle tone or postural instability, will struggle with bilateral control.  In preschool, one way to notice this is to see the paper sliding around the table while a child colors.  The common response of teachers (and parents) is to tape the paper down.  Oops!  This  eliminates any demand for both hands to work together.  Bilateral control only develops if it is needed and practiced.

The better approach, the one that makes the brain work and builds a child’s skills, is to make it even more slippery while making the activity more fun.

Why?  This child,’s brain, as described, needs more information about what is going wrong with the activity.  You can use heavier paper, stickers in a book that need accurate placement, or fun glittery markers.  Really, anything that makes a child care more about placing marks accurately.   I select the smoothest table surface available.  Glass coffee tables are a fave at home.  The alternate choice is a bumpy surface, something that will be slightly uneven and make the paper move more with each stroke.

I have some older kids that really struggle but can use a visual cue.  I make a mark on their paper and tell them to put their “helper hand” – the one not coloring- on this mark.  This is sometimes helpful, but it is limiting the extent that this hand is providing optimal postural support.

Yup, support.  The hand that holds the paper is also performing another function.  It is stabilizing the child’s body so that the dominant hand can execute a skilled movement.

So….no more tape on that paper, OK?

How to Teach Your Child to Cut Food With a Knife…Safely!

ksenia-makagonova-274699After a child scoops with a spoon and pierces food with a fork, time seems to stand still. No one wants to hand a young child a knife. But they should (sort of). Here are some ideas to safely explore knife skills without holding your breath or end up still buttering their toast when they are in middle school!

1. Don’t use a knife. Use a spreader instead. Yes, those little things you put out next to the brie when you have a few adults over for wine and cheese. You can find handles that fit nicely in a child’s hand, improving their control. The spreaders that have a sculptured handle add even more texture for a secure grip. With a rounded blade, these are less dangerous in the hands of young children. Butter knives and plastic disposable knives are actually capable of cutting a child’s fingers. Not a good thing. Save them for Stage 2, where your child has already developed some skills.

2. Pick the right foods for cutting practice. Children who are learning to cut will usually provide too much downward pressure. They aren’t comfortable using a sawing motion at the same time as slight downward pressure, so adding more pressure is often the output you see in the initial stages of learning. Choose foods that can safely handle their initial awkward movements. Soft solids that are familiar to them, such as bananas and firmly cooked sweet potatoes, can be sliced easily. Avocados that aren’t totally ripe or whole carrots that have been cooked in the microwave are other good choices.

3. Demonstrate cutting while cooking dinner. Children really do need to see your demonstration and hear your comments, but they may find pretend play less motivating than watching the real deal. You can absolutely let them practice with you, cutting the same or similar foods if it is safe. Even if you have to come up with a creative way to use the smashed bananas or carrots resulting from their practice, your food should go into a family meal.

4. Take this opportunity to teach good hygiene. Everybody washes their hands before and after cooking. It’s just what we do. It’s the price of admission to the fun of food preparation.

5. Create a “recipe” that allows your child to be the chef. Young children love to spread their bread or sturdy crackers with softened butter, nut butter, cream cheese, or Nutella. They can prepare some for others int he family as well. We all love to see people enjoy our cooking, right? But be creative and remember to initially use foods that they know and love. Would you be excited to cook a meal with foods that you have never eaten? Possibly not.

This is an opportunity to teach a skill while enjoying time with your child. Have fun using these strategies for beginning knife skills!

Prevent the Summer Slide in Handwriting By Making It Fun To Write

“The Summer Slide” is the phenomenon of losing academic skills during summer vacation. With the exception of the children who insist on you buying them workbooks and those that read a book a day by choice, all summer long, summer slide will happen to most children.

Here are some strategies to limit it’s effect on your child’s handwriting skills by using fun activities, not rigid homework:

* If you must use a book, use Handwriting Without Tears workbooks and limit practice to one page a day. Five minutes of work is better than 30 minutes of stalling and avoiding a page filled with poorly designed assignments. HTW’s pages are so targeted and organized that they get the job done fast.

* Think beyond workbooks. Write a book with your child on a topic they love. Use drawings and photos to illustrate it. Pretend play may need restaurant menus or store signs. Pretend garages or hair salons need price lists or bills-of-sale filled out. Be imaginative and have fun.

* Find or make notecards to send mail to relatives. It is often more fun to get mail back from them, so make sure grandparents have something fun to send back, even if it is a blank coloring page. Even though we are a digital society, everybody loves receiving personal mail, and children really love seeing their name on an envelope.

* Arts and crafts projects aren’t cop-out activities; they have real value. While creative craft play teaches many pre-writing skills for the younger kids, they can also preserve or develop skills in older kids. Look for fun kits, such as building a rubber band racing car or rhinestone mosaic picture kits, if your child isn’t the kind that grabs your empty egg carton and a glue stick and emerges with a masterpiece. Buy colorful writing tools, decorative craft scissors, and definitely make something crafty yourself. Seeing parents writing and creating is probably the best motivator for children to engage in these activities that prevent the summer skills slide!

Can HWT’s Flip Crayons Transform Pencil Grasp in Preschoolers?

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I gave a mom a few of Handwriting Without Tear’s flip crayons this week. She was amazed at what her son did with them. He picked them up, examined them and proceeded to figure out how best to hold them without a word from me. He automatically achieved the mature grasp that we had been talking about all spring. Bingo!

Will that happen with every child? Probably not, but flip crayons are a popular tool in my OT arsenal for a reason. They work more often than they fail. There is less effort from an adult, less redirection, which is often perceived as criticism by young children. Remember, children often hear “wait a second…” as “you did it wrong”. These small two-sided crayons are very visually appealing to young children, and become even more so when I introduce them as “kindergarten crayons” that I think a child might try. Every child wants to be seen as older and more skilled, even the anxious ones. I “sell” the use of these crayons as an advanced writing tool that we can use in therapy and at home.

Then I offer to show them how the older kids use them, and flip them from one color to the other while holding the crayon’s center between my thumb and index finger. This is actually an exercise and an evaluative tool for me. A child that doesn’t have the control and coordination to flip the crayon may not be able to achieve the stable tripod grasp needed to use a flip crayon.

The next step is demonstrating HWT’s wiggle stroke on paper. I use their preschool pages, but I created my own as well. Most of my clients need more practice than the 3-4 pages in the book.

Now it is time to trace the gray shapes and color in the shape pages in the workbook. Again, I created my own pages to expand and enrich. I could only do this because I took the HWT course (twice) and understand the principles behind the pages. If your teacher is riffing off of the workbook but her pages don’t have the same immediate success as the HWT workbook, that could be the reason. Knock-offs that aren’t true to the concept won’t work as well, or maybe even at all.

Order some flip crayons from HWT today at Handwriting Without Tears, and watch the magic happen!

Want A Stronger Pencil Grasp? Use a Tablet Stylus

 

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The trick? They need to use a short stylus and play apps that require primarily drag-and-drop play. Stop them from only tapping that screen today, because tapping alone will not make much of a difference in strength and grading of force.

Why will drag-and-drop play work? The resistance of the stylus tip on the screen builds strength and control at the same time. They gain control as they get the immediate feedback from game play. Too much force? They get stuck and can’t move the styluses the target. Too little force? Again, the target doesn’t move. Could they revert to a fisted grasp and accomplish this? Sure, but that is exhausting, and you are within view of them anyway….right?

For this to work, young children need supervision, but not helicopter supervision. And they need to know that how they hold any utensil matters to you. My best approach to build grasp awareness is to appeal to their desire to be older. Tell your child that you have been watching them, and you believe they are ready to hold a stylus like an older kid. Oh, and you can explain to them how to hold the stylus the easy way. They just have to watch your example and play some games for practice. Yup, you ASK them to play on a tablet!

Best drag-and-drop games for young children? I like the apps from Duck Duck Moose, especially the Trucks and Park Math. Every app has some tapping, but you can select and “sell” the games that require drag-and-drop. There are apps that little girls can play to dress up princesses, mermaids, etc. Pick the ones where they have to drag the items over to the characters. Same with wheels on trucks, shapes into a box, etc. The Tiny Hands series of educational apps have a lot of drag-and-drop play.

Finally, mazes are wonderful, and so are dot-to-dots that require drag-and-drop play.

Have a really young child, or a child who struggles to keep their fingers in a mature grasp pattern without any force? Then apps that require just a tap are fine. I set the angle of my tablet at various heights (my case allows this) to prompt more wrist extension (where the back of the hand is angled a bit toward the shoulder, not down to the floor). When a child’s wrist is slightly extended, the mechanics of the hand encourage a fingertip grasp without an adult prompting them.

Try drag-and drop play with a stylus on your tablet today, and see if your child’s grasp strength starts improving right away!

Child Writing Too Lightly on Paper? It Might Not Be Hand Strength Holding Him Back

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If your child barely makes a mark when he scribbles or writes, most adults assume that grasp is an issue. Today’s post suggests that something else could be the real reason for those faint lines.

Limitations in postural and bilateral control contribute far more to lack of pressure when writing  than most parents and teachers realize.  For every child in occupational therapy that is struggling to achieve good grasp, I see three whose poor sitting posture and inability to get a stable midline orientation are the real issues.

Think about it for a minute:  if you sat with your non-dominant (not the writing hand) hand off to the side and you shifted your body weight backward in your chair, how would you be able to use sufficient force on a pencil or a crayon?  Try this right now.  Really.  You would have to focus on pressing harder while you write and hope your paper doesn’t slip around.  That would require your awareness and some assessment of your performance.  Children don’t do “awareness and assessment” very well.  That ability comes from frontal lobe functions that aren’t fully developed in young children.  But they can learn where to place their “helper hand”, and that sitting straight and shifting forward is the correct way to sit when you scribble or write.

If a child has sensory processing or neuromuscular issues such as cerebral palsy, Ehlers-Danlos Syndrome or Down Syndrome, achieving adequate postural stability may take some effort on the part of the therapists and the teacher.  Well worth it, in my experience.  There are easy hacks that help kids; good equipment and good seating that won’t cost a fortune or inconvenience the class.  Every child can learn that posture is important for writing.  But the adults have to learn it first.  Kids take their cues from what adults appear to value, and if they figure out that they are allowed to slump or lean, they almost always will.

I am doing a lecture on pre-writing next week, and I intend to make this point, even though the emphasis of my lecture is on the use of fun drawing activities to prepare children to write and read.  Why?  Because it may be the only time these preschool teachers hear from a pediatric occupational therapist this year, and I want to make a difference.  Understanding the importance of postural control in pre-writing and handwriting could help struggling kids, and make decent writers into stars!

 

For more information, take a look at For Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance and Better Posture and More Legible Writing With A “Helper Hand”.

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Does An Atypical Pencil Grasp Damage Joints or Support Function In Kids With Hypermobility?

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As a pediatric OTR, I am often asked to assess and teach proper pencil grasp.  Once you start looking, you see a lot of interesting patterns out there.  When a child clearly has low muscle tone and/or hypermobile joints, the question of what to do about an atypical pencil grasp used to puzzle me.  I could spend weeks, or even months, teaching positioning and developing hand strength in a child, only to find that they simply couldn’t alter their grasp while writing.

Now I triage grasp issues by determining if it is a problem for the child now or in the future.  An atypical pencil grasp can be an acceptable functional compensation or it can be a contributor to later joint damage.  What’s the difference?  You have to know a bit about hand anatomy and function, how to adapt activities, and how to assess the ergonomics of writing.

Children aren’t aware of most of the problems that low tone and/or hypermobility create when they hold a pencil.  They just want to write or draw.  Teachers and parents don’t know what is causing issues either.  The effects of their unique physiology often results in grasp patterns that cause parents pain just to observe; fingers twisted around the shaft of the pencil, thumb joints bent backward, etc.  The kids aren’t usually complaining; their lack of sensory receptor firing at the joints and muscles gives them no clues to the strain they are inducing.  None.  Occasionally children will complain of muscular fatigue or pain after writing a few paragraphs or completing an art project.  For the most part, they are unconcerned and unaware of what is really going on.  For a more detailed explanation, please check out Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children,

Do these funny grasp patterns reduce legibility?  Only sometimes.  There are atypical grasp patterns that are good choices for children with hypermobility.  One is to place the shaft of the pencil directly between the index and third finger, and allow the thumb to support the side of the pencil.  The knuckle joints of those fingers provide more stability than the standard tripod grasp.  This grasp pattern is illustrated at the beginning of this post.

I allow preschoolers who need to keep more than 3 fingers on the shaft of the pencil to do so, and wait to see what happens as they develop more overall hand control.  This is especially beneficial for the child with sensory discrimination issues or joint hypermobility.  Forcing a tripod grip isn’t always in their best interest now or for the future.

What can be done?  My favorite method to help children with low tone or hypermobility is to look at the problem with both a wide-angle lens and with targeted analysis.  I think about changing overall posture, altering any and all equipment, and examine the mechanics of movement.

Does handwriting instruction matter?  I think so.  The best writing program teaches children quickly, so that they don’t have to write 100 “A”s to learn how to write.   The only program I use is Handwriting Without Tears.  The high-quality materials and the developmental progression make learning easier and faster.  Read KickStart Kindergarten: Get Your Child Ready for Kindergarten Writing The Easy Way! to see some sample pages and understand how this particular book can work for ages 4-8.

Wondering if there are issues beyond writing that your OT can address?  Check out   Hypermobility and Music Lessons: Is Your Child Paying Too High a Price for Culture?Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children and Three Ways To Reduce W-Sitting (And Why It Matters) for more information.

Atypical pencil grasp can be a problem, but it can also be a solution to a child who is struggling to write and draw in school.  If you have concerns, ask your OT to evaluate and explore the issue this week!

Looking for more information on raising (or treating) a hypermobile child? 

I wrote 2 e-books to help you!

The JointSmart Child:  Living and Thriving With Hypermobility Volume One:  The Early Years

is filled with practical strategies to help parents of children 0-5 build safety, skills, and independence.  Written in easy-to-understand language and designed with chapter summaries that help busy parents find the answers they need, this book is unique in the world of special needs resources!  Therapists will find easy ways to boost ADL skills, safety awareness, and early fine motor skills with an awareness of the sensory processing needs of the hyper mobile client.

My e-book is available as a read-only download on Amazon and as a clickable and printable download on Your Therapy Source.  Worried that you don’t have a Kindle?  No problem:  Amazon’s downloads are totally supported on iPads and iPhones.

The JointSmart Child:  Living and Thriving With Hypermobility Volume Two:  The School Years

is my newest e-book for parents and therapists of kids 6-12.  Older children may still need to build their ADL independence and safety, but they also need to write and keyboard, and they play sports and musical instruments.  This book is larger and more comprehensive than Volume One, filled with forms and checklists to find the right chair, desk, bike, even the best way to arrange a bedroom for sleep.  Parents and therapists will have forms and handouts they can use in CPSE and CSE meetings with the school district and information on how to become an empowered consumer in doctor’s appointments.

It is available as a read-only download on Amazon  and as a printable download on Your Therapy Source ,and just like Volume One, Amazon doesn’t require you to have a Kindle to download my book.  They make it easy!

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Strengthening A Child’s Pencil Grasp: Three Easy Methods That Work

 

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Dreaming of summer fun!

When a child makes fast progress from a fisted grasp to a mature pencil grasp in therapy, parents notice.  This isn’t easy to accomplish, but it is possible.  I spent the first decade of my pediatric OT career thinking that finger exercises were the answer.  Nope.   Here are my three favorite strategies to see quick improvements in children ages 3-5:

  1. Crayons.  Yes, I suggest you go old-school and use crayons, not markers, for scribbling and drawing.  The tackiness of wax on paper  creates slight resistance that builds strength.  Feel free to provide paper with a bit of texture, such as watercolor paper; it is worth the investment!  Just like when you go to the gym, all muscles will respond to resistance by recruiting more fibers and building more strength.  Yeah!
  2. Easels.  Every pediatric OT recommends an easel, and there is a good reason why.  Easels work.  I take if further, and make sure that the paper doesn’t slip at all, and that the target for a child’s scribbling is in the middle 1/3 of the easel surface.  Why?  Unless a child is very tall or very tiny, this will result in a more effective shoulder and wrist angle that allows a mature pencil grasp.  How do I ensure that a child uses the target area?  I color in the top  and bottom 1/3’s, creating either good demos of shapes/designs, or just scribbling away, having fun.  What I draw depends on the child’s needs at the moment.
  3. Tablet Stylus.  I am well aware that some therapists are recoiling in horror at the thought of using a tablet.  They might have to reconsider their stance after reading what I have to say.  Children are using them daily in their homes, many have their own, and sport a newer model than I drag around for work!  Tablets aren’t going away, so use them to your advantage.  Using a stylus (my fave is the iCreate stylus)  produces the tacky resistance that we like about crayons, but on a touchscreen.  When children have to drag-and-drop objects, they are using more muscle strength and better control to maintain a stable yet mobile grasp.  A few years ago, I worked with a very weak child who was dealing with a life-threatening illness.   No one was going to force him to do anything, and all he wanted to do was play on a tablet.  He was told to use the stylus while playing, and 6 weeks later he was eagerly coloring with crayons on paper.  His improved pencil grip was amazing!  As always, my apps are educational as well as fun, and tablet use in therapy is neither a reward nor the focus of my sessions.  I make it clear that lots of fun can be had without it.

As with any therapeutic exercise, I monitor fatigue and adapt my set-up and activities to maximize use of a mature grasp with minimal compensation.  The rule is:  if it looks like a bad grip, it probably is!  If your child insists on using a fisted grasp even with these strategies, you need to use some behavioral motivational tools in addition to good equipment.  Your OT can help you with that!

If your therapists have mentioned that your child has low muscle tone or ligament laxity (loose joints) take a look at Does An Atypical Pencil Grasp Damage Joints or Support Function In Kids With Hypermobility? for some clarity on addressing pencil grasp with these issues.

Tried all these strategies and still seeing your child struggling?  It could take more time to develop the stability and control needed, or you may have to go beyond writing tools and the surface your child is writing on, and take a look at the seating you are providing.  Your occupational therapist should be able to help you figure out what an optimal seating position should be, and how to set things up for success!

Avoiding Letter Reversals In Preschool

Are letter reversals in preschool normal?  Yes.  Can you avoid them, and thus speed up the accuracy and automaticity that are hallmarks of successful handwriting?  Sure!  This post will explain why reversals are slowing kids down unnecessarily and how to limit letter and number reversals right from the start.

Writing letters backward is very common in preschool, and is not considered abnormal if a few letters or numbers are reversed if a child is under the age of 8.  So why bother even thinking about how to teach letter formation without reversals?  Common Core, PARC, and all the other achievement tests have contributed to less classroom time made available to focus on handwriting, while demanding independent writing skills earlier and earlier.  Teachers in grades 1 and up expect that learning to write letters and numbers has been accomplished, and now it’s all about content.  That means that preschool and kindergarten teachers need to spend time on writing instruction, and they need to choose the most effective methods to do so.

That sounds so simple, but understanding how to avoid reversals without doing constant drilling is hard.  That is how your grandma’s learned to write: kids practiced daily and knew that good “penmanship” was a thing, a thing that mattered.  Today’s preschool teachers generally don’t have much (or any) instruction in how to teach handwriting, and certainly don’t review research on how to teach it the most efficiently for the fastest results.  They are asked to teach kids with learning differences, some of which make it difficulty for kids to perceive that they have reversed a letter, even when it is pointed out to them.  Their budget includes glue and posters, not training programs on something as targeted as writing instruction.  For some teachers, the best they get is a thick packet and some worksheets from their director.  That’s it.

Handwriting Without Tears does a terrific job of attacking reversals where they begin, with the start and the sequence of strokes.  To simplify it:  They start letter instruction with the letters that are easy to write and begin in the same manner without risk of reversals, use a style of writing that is less easily reversed, and they have great beginner tools which replicate the same cues throughout the program.  Their smiley-face icon for orientation while writing is a good example.  The repetition on workbooks and writing materials remind children where to start so many letters supports correct orientation right from the beginning.  They also use meaningful but simple directions.  No tree line, no worm line and no dangly tails that could go either way.  Letters such as “S”, “J”, and “Z” have specific cues to help children prevent reversals.  They are also among the last letters taught.

Kids have lots of practice with start and sequence before they hit the harder letters.  The kids with perceptual issues learn a motor plan that is so automatic that they may write a letter perfectly even if they struggle with object manipulation.  Their hands are telling them how the letter is made, not their eyes!  Should they still get practice with these skills?  Yes, but they need to be successful writers now.

In my opinion, the push for increasing demands in early grades is here to stay.  The smartest thing teachers and parents can do is to pick materials that fast-track kids toward handwriting independence and then use them consistently.  It is also the kindest thing to do.  Kids don’t need more pressure, they need more success!