Category Archives: health

How to Get Children to Wash Their Hands

 

phil-goodwin-TxP44VIqlA8-unsplashThis season’s flu and viruses have parents and teachers wondering how to raise their game regarding infection control.  Washing your hands is one of the most important things anyone at any age can do to protect their health.  But small children aren’t always cooperative.  Getting them to wash their hands can be tough.

The families I work with know that I will not begin a session in their home, and especially that I won’t touch their child, without washing my hands first.  Not only is this to protect them, it is to model good practice for the kids.  Some children will ask me why I am washing my hands.  I always answer them by naming two things familiar to them.   I tell them that when I touch the outside of my car, my hands get dirty, and I don’t want to put dirt on our toys.

Cars and toys.  Most kids over 2 know what those two things are, and they know that one is not so clean, and the other one shouldn’t have dirt on it.  They get it.

But only a few parents insist that their child wash their hands before they begin working with me.  Some children want to share my sanitizer spray, and if a parent agrees, I will show them how to use it.

Now that we are facing both a serious flu season and a new virus, it seems like a good idea to provide suggestions to help parents out with hand washing:

  1.   Model good hand washing practices with a bit of drama.  You have to be a bit of a ham, and remember that kids need simple but dramatic explanations for information to sink in.  Something along the lines of “Oops, I FORGOT to wash my hands!  I will be RIGHT back as soon as I find some soap and water.  Do you know where it is?  Raise your vocal inflection, and use some gestures like stretching out your fingers.  Now say “That is SOOOOO much better.  My hands feel good and clean”.  Interrupt lots of things you are doing with a calm departure to wash your hands.  But make sure they hear you say where you are going and why.
  2. Get soap that they like.  Whether it smells good to them, has a character they love on the bottle, or is foamy or even tinted, soap they like is soap they will use.  Liquid soap is so much easier for young children to handle than bar soap.
  3. Make it easy.  They should be able to reach the water by using a spout extension, and possibly help you get the soap on their hands.  Paper towels that pop out of their holder ready to dry hands are easy to hold and the best way to avoid spreading germs.  Unless a cloth towel is changed very very frequently, it isn’t the cleanest choice. I treat a child whose mom is a cardio-thoracic surgeon.  There is a hands-free soap dispenser and a box of pop-up towels in her main floor powder room.  Enough said.
  4. Ask your partner and other people in the house if they have washed their hands when your child is paying attention to you and watching them respond.  Young children don’t take notice of these practices of others unless you point them out.  Hearing about who washed their hands, and hearing their enthusiastic replies, sends home the message that everyone washes their hands.  It is what we ALL do.
  5. Spin it positively.  Some children really become frightened if you message things about getting sick.  The message is to stay healthy.  Keep it that way.
  6. Make a habit of it.  Infection control staff know that making actions into habits is the best way to ensure safety.  Create new rules about washing hands throughout the day, and gently insist on them.  They will become habits.  Good ones.

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Sensory Processing and Colds: Nothing to Sneeze At!

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Here in the US, it is cold and flu season.  Most of my day is spend with kids recovering from some upper respiratory virus.  A few seem to have a continuous runny nose and cough.  They also have an increase in their sensory processing issues.  Is this connected, and if so, what can be done?

  1. Anything that affects health will make sensory processing harder.  Anyone, at any age, will struggle more when they don’t feel well.  If a child is super-sensitive, feeling ill will make them edgier and more avoidant.  If a child is a sensory seeker, that funny feeling in their head that changes when they flip upside down will probably make them do it more.  If a child is a poor modulator, and goes from 0-60 mph easily, they will have more difficulty staying in their seat and staying calm.
  2. Colds often create fluid in the ears.  This is a problem for hearing.  This is often a problem for speech and mealtimes.  It is also a problem for vestibular processing.  Fluid in the ear means that children are hearing you as if they are underwater.  Their speech may be directly affected.  They probably realize that biting and chewing open the eustacian tubes from the mouth to the ear, so they may want to chew more.  On everything.  They may also be unable to handle car rides without throwing up.  They may refuse to do any vestibular activities in therapy.
  3. Children sleep poorly when ill.  Anyone with sensory processing issues will struggle more when they are tired.  Young children cannot get the sleep they need and don’t understand why they feel the way they do.  Enough said.
  4. Spatial processing problems will get worse.  Being unable to use hearing to orient to the space and the people and objects in the room, children will roam around more, touch things more, startle more, stand still and look disoriented, and may refuse to go into spaces that are hard to process, like gyms or big box stores.  Uh-oh.

So what can you do as a parent or a therapist?

  • Understand that this is happening.  It is real.  It may not be a personality issue, a deterioration in their ABA program, or a problem with therapy.
  • Ask your pediatrician for more help.  There are nasal sprays and inhaled medications that can help, and some, like steroids, that can create more behavioral issues.  If your child needs steroids, you need to understand what effects they can have.  Saline sprays, cold mist humidifiers, soups and honey for coughs, if your pediatrician approves, are low-tech ways to help a child suffer less.
  • Alter your daily routine if needed.  Making less appointments, fewer challenges, and more rest could help.  Kids can be over-scheduled and under-rested.  Therapy sessions may have to be adjusted to both be less stressful and more helpful.
  • Your child may benefit from vestibular movement if they do not have an untreated ear infection.  Your OT can help you craft a sensory diet that moves fluid, but not if there is an infection.

Read more about sensory processing here: Does Your Child Hate Big Spaces? There is a Sensory-Based Explanation and Spatial Awareness and Sound: “Hearing” The Space Around You

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The Subtle Ways Long Term Medical Care Affects Infant and Toddler Development

 

hannah-tasker-333889-unsplashThe good news:  more and more extremely premature and medically complex babies are surviving.  The bad news: there is a cost to the extended and complex treatment that saves their lives and helps them to thrive.  This post is an effort to put out in the open what pediatric therapists know only too well goes on after the medical crisis (or crises) are over.   Only when you know what you are seeing can you change it.

This is not an exhaustive list; it is a list of the major complications of a complex medical course of treatment on behavior:

  1. Your child is likely aware that their coughing, crying, or other reactions will stop parents and even some medical professionals in their tracks.  I have had kids who didn’t get what they wanted learn to hold their breath until they turned blue.  If you have worked in medicine, you should know that if a child does this and faints, they will immediately begin breathing again.  It doesn’t scare me.  But it can terrify family members, teachers, and other caregivers.  They will stop whatever they were doing and may give in to any demand right away.  Many kids learn who will take the bait impressively fast.  It is very damaging to a child’s relationships and destroys their ability to handle frustration.
  2. Invasive treatments have been done while distracting your child and often without involving your child in any way.  This has taught your child not to attend to an adult’s actions or words in the same way a typically developing child will do naturally.  Since learning language and fine motor skills are highly dependent on observation, these skills are directly impacted by this consequence.  This pattern can be reversed, but it is highly resistant and has to be addressed directly.  Don’t think it will simply go away as your child recovers medically.  It doesn’t.  As soon as your child can be involved in self-care any way (holding a diaper, etc) you need to engage your chid and demonstrate the expectation that they respond and interact to the degree that they can manage.  All the time.
  3. Typical toddler attitudes are ignored because “He has been through so much already”  If your child is kicking you while you change his diaper ( a real question to me by a private duty nurse) then you react the same way you would if your child didn’t have a G-tube or a tracheostomy.  The answer is “NO; we don’t kick in this house”.  You don’t get into why, or what is bothering them right away.  The immediate answer is “no kicking”.  Not now, not ever.  Aggression isn’t unusual or abnormal, but it has to be addressed.  With understanding and as little anger as you can manage as your beloved child is aiming for your face with his foot.  The parents may be experiencing their own PTSD Can Your Pediatric Patient’s Parents Have PTSD? so be aware that their reactions may be coming from a place of untreated trauma as well.
  4. Children who are unable to speak to engage you or able to move around their home will come up with other methods to gain and hold your attention.  Some children throw things they don’t want and HOPE that you make it into a big deal.  Or they throw to gain attention when they should be using eye contact, vocalization or signing.  They wanted your attention, and they got it.  Without speaking, signing or any other appropriate method of communication.  This is not play, this is not healthy interaction.  This is atypical past 10-12 months, and should be dealt with by ignoring or removing the items, and teaching “all done” or “no” in whatever method the child can use.  And then teaching the correct methods of gaining attention and rewarding it immediately.  The biggest roadblock is that if one caregiver takes the “throwing” bait, the child will dig in and keep using that method.  Adults have to act as team managers, and if they fail, the behavior keeps on going.
  5. Children can request being carried when they don’t need the assistance, but they want the attention.  This can delay their advancement of mobility skills.  One of my clients has learned which adults will hold his hand even though he can walk unaided.  He likes the attention.  The clinic PT doesn’t know this is happening, even though the family brings him to therapy.  Like a game of telephone, each caregiver assumes that the child needs the help he is requesting.  He is not developing confidence in his own home, which should be the first place to feel safe and independent.  He depends on adults to feel safe.  Oops.

 

In many ways, my job as an OTR is to alter some of these behaviors to allow normal development to take place.  Long after those medical crises are terrible memories, the consequences of those days, weeks, months and sometimes years can have significant effects on learning and independence.

Looking for more ideas to help children grow and develop?  Read Need to Support A Child’s Independence? Offer to Help Them! and The Not-So-Secret Solution for Your Child With Motor And Sensory Issues: Dycem.  Do you have issues with your child’s siblings?  Read Are Your Other Children Resentful of Your Special Needs Child?

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Three Reasons Why Your Constipated Toddler May Also Have Bladder Accidents

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Kids with chronic constipation are a challenge to train.  It can often appear that withholding is the issue, and to be certain, fear and pain are real issues.  But there are some physiological problems caused by constipation that contribute to bladder problems, and they aren’t always what your pediatrician is thinking about.

  1. The constant fullness of the colon can lead to bladder misplacement.  The bladder can be compressed and even folded, depending on exactly where the blockages exist.  This is not good for any organ, but it is especially a problem for a hollow organ that should be filling and emptying regularly.   The sensation of fullness with a misplaced bladder is therefore corrupted, so the child is not receiving correct input.  They may feel that they “have to go”, only to have nothing in their bladder, or very little.  They may fill up really fast and have to run to the toilet before they have an accident.  Too many accidents, and a child can beg for that pull-up so that they aren’t embarrassed or inconvenienced.  Even the little ones are subject to shame that isn’t from you as a parent, but in comparison to older kids or sibling comments.
  2. Chronic constipation stretches the pelvic floor, and therefore there is both less stability and less control.  The pelvic floor muscles help us to hold the urine into the bladder in time to get to the toilet, in conjunction with the sphincters.  Poor control and poor awareness go hand-in-hand.  There are physical therapists that specialize in pelvic floor rehab, but this isn’t easy to do with children that have limited language.  Not impossible, but not easy.  Letting the problem go until they are older means risking years of psychological and physical stress.
  3. Withholding due to pain or fear is a huge issue, and it can become automatic.  This means that solving the constipation issue may not immediately result in continence.  Using a wide range of approaches, including manual therapy, behavioral strategies, medications and diet control, and even core stability and sensory processing strategies, may be needed.

My final comment is that chronic constipation is nothing to ignore.  It needs to be addressed well and early.  It often doesn’t solve itself, and it may need more than a spoonful of Metamucil to clear up.  Get help and request consultations early rather than waiting to see how things “go”!

For more information about toilet training, see For Kids Who Don’t Know They Need to “Go”? Tell Them to Stand Up and The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

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Make Wiping Your Child’s Nose Easier With Boogie Wipes

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It is cold and flu season here in the states, and I have already seen my share of snot-caked little faces.  Little children get more colds than older kids and adults, and they can turn into an agitated mess when you say “Honey, I need to wipe your nose”.  These wipes are going to make your job as chief booger-wiper a lot easier!

When I first saw Boogie Wipes, I will confess that I thought it was another expensive product to separate first-world parents from their money.  After all, I grew up on dry tissues and I survived.

I was wrong.  These really work.

At first, I thought that the use of moisture was the key to their success.  Not so.  Parents told me that using a regular baby wipe didn’t “do the deal” the way a Boogie Wipe took care of the snot problem and made kids calm down about nose-wiping.  I had to find out what really made this product better.

  1. Boogie Wipes have a few important ingredients that separate them from the standard baby wipes.  The first ingredient is water.  The second ingredient is sodium chloride; good old salt.  Saline is a combo of these two ingredients, and saline softens the gluey crud that is dried-on snot.  It also thins the still-wet snot so you can wipe it away without pressing so hard on tender skin.  Yeah!
  2. The next four ingredients are aloe leaf juice, chamomile flower extract, vitamin E and glycerin.  All gentle and (to most children) non-irritating skin conditioners.  I am a huge fan of Puffs Plus tissues, but these wipes are gentler than my fave tissues.  Children’s skin is so much more delicate than ours, and the ingredients in snot are so irritating.  That is even before it becomes a dried-on coating.  Boogie Wipes leave a thin coating of skin conditioners after you wipe your child’s face.  This coating acts as a slight skin barrier for the next drip of snot.  Brilliant!

The remaining ingredients are preservatives that prevent your open container of Boogie Wipes from becoming a source of germs instead of a source of relief.  I am sure that there are children who react to these preservatives, but I haven’t yet met any families that report problems over the years that this product has been available in NY.

Unless you know your child will react to these specific preservatives, I recommend trying the unscented version first (they come in fresh and lavender scents too) and using them before your child gets a cold.  It is kinder to find out that they are sensitive to any ingredients before their skin is already irritated by all that snot from an illness.  Kids whose skin is going to react will likely do so when well, but their skin can recover from any irritation more quickly when their immune system is not also fighting a bad cold.

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The Boogie folks do sell a saline spray as well as wipes, and I am all for using saline spray to loosen up internal nose crud.  The problem with sprays isn’t that they don’t work.  They do, and they work well.

The problem is that children are naturally avoidant of us sticking things up their noses, and they are really bad at controlling the “sniff” in order to efficiently suck the spray up into their sinuses.  I teach children how to blow their noses and how to handle sprays.  It is part of my job as an OTR.  Not the best part, but nevertheless, a part of teaching ADLs.  I haven’t had much success teaching children under 3 to use nose sprays.  They just get more frightened and upset.  If you have an older child or a child that seems less afraid of nose examinations at the pediatrician, then go ahead and give sprays a try.  It can really loosen up a clogged nose.

Good luck trying Boogie Wipes, or try the generic versions that I am starting to see on store shelves.  Imitation is the sincerest form of flattery, so manufacturers are telling us that they also know that these products really work!

Parents With Disabilities Deserve Real Support, Not Pity or Praise

 

 

dawid-sobolewski-285650Parenting is hard.  Everyone that has children or works with them knows that this is true.  Parenting when you have a disability is harder by far.  Like parenting… squared.  But instead of real support, many disabled people who become parents or are thinking of becoming parents face a lot of reactions from the non-disabled.  It usually arrives in one of two packages.  First, the more positive but less helpful responses.

People see disabled parents diapering a child with one hand or with both feet, or navigating the playground with a cane and remark on how amazing it all is.  They are either pitied for their struggle or praised for their bravery.  If you have a disability, what you could really use is to be seen as an equal.  And maybe the chance to share how to get your child to wait for more than a nanosecond for juice.  Real support and real camaraderie, the kind that other parents give and get on the playground.

Of course, there is another packaged form. These are those difficult responses that can and do happen.  Parents with disabilities may be treated like criminals (how dare you subject a child to your problems?) or idiots (“You will never be able to handle the challenges”).  I suppose pity and random praise could be better than these responses, but how about another reaction?  Support.

Sadly, one of the groups that should be actively supporting disabled parents often drops the ball.  Parenting issues aren’t always on the radar of doctors and therapists.  In fact, the act that gets you into the business of parenting may not even be fully acknowledged by professionals.  Yes, that one.  Accepting that disabled people are sexual and often (or mostly) capable of having children is so rarely mentioned in training and treatment protocols that it is a true crime.  When people with disabilities do have children, receiving equitable medical care and respectful treatment as parents isn’t a given.  Don’t believe me?  Think about how many accessible GYN tables you have ever seen, or how people with disabilities might struggle to attend the soccer game to cheer their child on.  Simple things that most of us take for granted.

I think that occupational therapists have much to offer parents with disabilities.  We are known for being the MacGyvers of rehab.  We love to solve real-life problems and use our wide range of skills to help clients achieve their goals.  Supporting people with disabilities to be the best parents they can be could be as simple as teaching a parent an easier way to hold or carry their child.  OTs are rarely consulted for this, but helping clients identify the positions, adaptations and adjustments needed to make that baby in the first place is actually in the OT skill set.  All discussed with respect and sensitivity, not pity.

OT support could be as complicated as redesigning a kitchen for safe and easy meal preparation.  Feeding your child is a wonderful way to participate as a parent.  Or as subtle as identifying how visual and auditory stimuli in the home set off sensory-based anxiety and agitation in a parent.  Being as calm as you can be is important when you are raising children. Take a look at Parents With Disabilities Need The Happiest Toddler on the Block Techniques for strategies that really work to develop calmness at home.  A few sessions with a good occupational therapist can result in less stress, less pain, more skill and more confidence for all involved.

Occupational therapy isn’t always thought of as an essential service for adults with disabilities after the initial injury (think spinal cord injury rehab) or for people with more common issues such as fibromyalgia or back pain.  Perhaps that could change.  Parenting is hard.  It is harder when you don’t get the support you need.

 

Hypermobile Child? Simple Dental Moves That Make a Real Difference in Your Child’s Health

 

 

tetbirt-salim-696162-unsplashAs the OTR on a treatment team, I am the ADL (Activities of Daily Living) go-to person.   Why then, do so few parents ask me what ideas I have about ADLs, especially dental care?  Probably because OT as a profession has developed this reputation as the therapist either focused on handwriting or sensory processing.  Maximizing overall health and building skills by improving ADLs is often pushed to the side.  Not today.

People with connective tissue disorders have a greater chance of cavities and more serious dental problems.   Knowing what to do for your child and why it is important helps parents make changes in behavior with confidence and clarity.

Here are my suggestions to support a child that has been diagnosed or is suspected of having Ehlers-Danlos hypermobility or any connective tissue disorder:

  1. Teach good dental hygiene habits early.  Why?  Habits, especially early habits, seem to be harder to dislodge as we age.  Good self-care habits can and should last a lifetime.  Automatically brushing and flossing gently twice a day is cheap and easy.  Make it routine, not optional.  I know how this can become a fight for young children.  This is one of those things that is worth standing your ground on and making it fun (or at least easy) for children to do.  Brush together, use brushes and pastes with their favorite characters, pair it with something good like music or right before bedtime stories, but don’t think that dental care isn’t important.
  2. Research on people with typical connective tissue suggests dental care reduces whole-body inflammation.  Inflammation seems to be a huge issue for people with connective tissue problems, and no one needs increased inflammation to add to the challenges they have already.  Enough said.
  3. Tools matter.  Use the softest toothbrushes you can find, and the least abrasive toothpaste that does the job.  Tooth enamel is also made from the same stuff and skin and bone, and so are gums.  Treat them well.  Water-powered picks and battery-operated brushes may be too rough, so if you want to try them, observe the results and be prepared to back off it becomes clear that your child’s tissues can’t handle the stress.  Toothpaste that is appealing will be welcomed.  Taste and even the graphics/characters on the tube could make the difference.  My favorite strategy is to give your child a choice of two.  Not a choice to brush or not.
  4. Think carefully about acidic foods.  Lemonades, orange juice, energy drinks, and those citrus-flavored gummies all deposit acids on teeth that are also mixed with natural or added sugars.  Those sugars become sticky on teeth, giving them more time to irritate gums and soften enamel.  Easy hack?  Drink citrus/acidic drinks with a straw.  Goes to the back of the mouth and down the hatch.  At the very least, drink water after eating or drinking acidic foods to rinse things out.
  5. Baby teeth count.   Because your young child hasn’t lost even one baby tooth, you may think this doesn’t apply to you.  Those permanent teeth are in there, in bud form.  Children can develop cavities in baby teeth as well as permanent teeth.  Gum irritation is no different for young children, and they are less likely to be able to tell you what they are feeling.  Sometimes the only sign of a cavity in a young child is a change in eating habits.  This can be interpreted as pickiness instead of a dental problem.
  6. Consider sealants and fluoride   I know…some people are nervous about the composition of sealants and even fluoride, which has been in the public water system here in the US for a long time.  I would never criticize a parent who opted out of either.  It is a personal decision.  But be aware that they don’t increase tissue irritation, and they protect tender enamel, tooth roots and the surrounding gums.  At least have an open discussion with your pediatric dentist about the pros and cons.  I am mentioning sealants here specifically because some parents aren’t aware that this treatment option can reduce cavity formation and gum deterioration.

Looking for more information about ADLs and hypermobility?  

I wrote two e-books for you!

The JointSmart Child:  Living and Thriving With Hypermobility  Volumes One and Two address the needs of kids ages 0-5 and 6-12 respectively.  Because their needs are similar and yet so different, I created each book with beginning chapters that explain how hyper mobility is more than a movement issue.  There are sensory processing and social/emotional developmental issues that need to be addressed to help a child achieve their greatest potential, build their independence, and maximize their safety.

Volume One teaches parents and new therapists about the best ways to carry and hold a hypermobile child, how to make good choices for high chairs, toys, even clothes that make independence easier to achieve.  Volume Two addresses school-related challenges, sports and music lessons, and building strong friendships and sibling relationships. Families that learn how to communicate with babysitters, teachers, daycare providers and even doctors have more confidence.  These books are all about empowering parents and educating therapists.

These books are available as read-on downloads on Amazon and printable and click-able downloads on  Your Therapy Source.

Want more blog posts to make things easier at home?

Take a look at Easy Ways to Prevent Skin Injuries and Irritations for Kids With Connective Tissue Disorders and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child and Low Muscle Tone and Dressing: Easy Solutions to Teach Independence.

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CMV: The Potentially Disabling Virus Your OB Isn’t Mentioning

The New York Times ran a moving story in their October 25, 2016 issue about children who contract cytomegalovirus (CMV)  from their mothers while in utero.  CMV is a Greater Threat for Infants Than Zika, but far Less Often Discussed reminded me of the children I have treated with CMV:  multiply-disabled, with parents that didn’t know what those initials stood for until they heard them from their child’s doctor at diagnosis.

Deafness, blindness, cognitive and motor delays; sometimes the whole enchilada.  All from a virus that may not be evident in the mother or her family.  It is rampant in toddlers, those adorable beings who pick their nose and then touch every cookie on a plate, who put toys in their mouth then want a sip of your drink.

The most likely carrier of CMV in your family is your toddler in daycare.  They are bringing home more than macaroni pictures.  They may not even spike a fever and still have CMV.

The NYT reported that the American College of Obstetricians and Gynecologists does not insist on obstetricians mentioning this virus to patients because no treatment is available and no action is an iron-clad preventive.  They believe that patients should initiate the discussion and discuss what their concerns are rather than be told directly about CMV.

That’s like saying that because I cannot promise that you will never be struck by lightening, I won’t mention that sitting under a tree in a storm means that you are taking a risk!  I will let you ask me about how to prevent electrocution.

This is a bit of effort, but there are simple things you can do to reduce but not eliminate your risk while pregnant by:

  • wash your hands well after changing a child’s diaper or wiping them after toilet use.  Don’t check your phone on the way to the sink; wash first.
  • Do not share drinks or food with your children while pregnant.  Serve them a bite on their plate, not by nibbling on your food.  Cheerfully pour them a fresh cup of what you are drinking.
  • Teach your children to wash their hands well, and encourage hand washing in the adults in your home.

I wash my hands as soon as I enter a family’s home for treatment, regardless of the age of the children.  I don’t know if that mom is pregnant.  She might not know yet either.

Wash your own hands like it meant the future of your unborn child; it could.

Special Needs Kids and Toothbrushing, Part 3; The Sensory-Motor Experience and the Behavioral Strategies that Support Success

Now that you know what issues your child have that made toothbrushing difficult, and you have made brush and paste/rinse choices, it is time to think about the influence of timing, the environment, and the approach to the task.

I often recommend that families practice skills outside of their natural timing.  Let’s face it; running off to school and bedtime are highly charged times of the day.  Almost any child is going to feel it, and certainly any rushed or exhausted parent.  No one is at the top of their game.  Try practice on an off-hour, make it short and if possible follow it up with something fun.  Human beings cannot help but associate events, and if brushing is followed by games or outdoor play, it is going to have a subconscious effect.  I really like the practice concept in “The Kazdin Method for Parenting the Defiant Child”.  Even though most of his techniques are more suited to a slightly older child, the idea that you can practice a skill at a calm time is a great one.  Both parties are in a different mindset.

Think of the bathroom the way a designer would.  No, you don’t have to buy new towels, but you might want to use a dimmer on bright lights and think about the noise the running water makes.  Sensory sensitive and poor modulating kids can be just stimulated enough to push them into irritability. I love the calming power of lavender, and your child might too.  There are children who cannot handle much in the way of scent, and even your plug-in deodorizer irritates them.  Move it out before starting your routine and see if that has a positive effect.  If you are not a sensory sensitive person, you might not even notice how odorous the dryer scent on the towels or the fancy soaps are.  Your child might.

Use softer tones in your voice, especially if there is an echo in your bathroom.  The same reason you sound so good in the shower could be a contributor to your child’s difficulties.  Sound bounces off tile in a different manner, and the lack of sound-absorbing carpeting and draperies could be a factor.  If your child has postural issues and is unsteady or is known to dislike his head tipped back, then re-think your position too.  A child standing on a wobbly stool with his head in your hands and tipped backward is likely to resist.  I know it sounds bizarre, but the first position and technique with a very upset toddler can be to cradle him in your arms, fully supported up to the top of his head, and use those xylitol wipes while terming it “toothbrushing”.  Do the singing, low lights, the whole deal.  You won’t be doing this when he is 12, but sometimes you have to make things really safe and comfortable to move forward.

Put a positive spin on toothbrushing.  Even if this has been a source of stress, your smiling face and positivity can help.  Do your best Oscar-winning performance if you can (another reason to practice on the off-hours).  At the very least, firmness and a sympathetic “Fast Food Rule” type response is useful.  For people who haven’t been reading my blog, that is the cornerstone of Dr. Harvey Karp’s Happiest Toddler on the Block approach.  You want your child to know that you understand what he is saying and feeling, but you don’t necessarily agree that we don’t do toothbrushing.  You acknowledge his aversion and express positivity and how there is something good at the end of the task.  If you are too emotional, even too sympathetic, you risk adding more emotion to the experience, something a sensitive and upset child really does not need.

Some children really love to hear you sing a brushing song, some like to use a sticker reward chart, some like a felt board where they move completed activities to the other side of the board.  It is risky to reward a child for something that is really a daily life skill, but at first some parents give it a try and then fade out the reward.  Every family is different.

This is my final post on the subject of toothbrushing.  I hope this helps some families turn around a common source of frustration and have a better day!

Massage With Your Special Needs Child

When parents hear that I am a licensed massage therapist as well as an OTR, they often ask how massage can help their child.  They seem to assume that I would recommend massage only to calm a child on the spectrum, or help a child sleep.  Actually, massage can be great preparation for getting a child moving as well, and supports focused thinking and communicating.  Massage doesn’t just have to be about relaxation.

Massage techniques range from sedating to invigorating.  Children with low muscle tone are especially helped by quick strokes and moving vibration.  They need more information about where they are in space, and where their muscles are around their joints.

Children with spasticity certainly benefit from stretching and relaxing tight tissue, but the best results are when they get up and move purposely.  Their brains note the changes in posture and range of motion, and build new neural connections for easier and efficient movement. Combining massage techniques with movement is like adding one and one and getting three!

Massage with children on the spectrum can range from quiet to more stimulating, based on their current state.  These children get extra support to learn that touch can be acceptable and enjoyable. Reducing a fear response to approaching touch from another person is a worthwhile goal.

Massage is so many things to children, and can support all the other therapies they receive.  Find a great therapist, and learn how to use massage on your own child to help them grow!

Baby Wearing for Premature Babies

As a nationally certified Happiest Baby on the Block educator, I think that baby wearing is a great way to nurture your preemie, and I approach this topic as I do all the Happiest Baby training: parents need to know why wearing their baby is helpful and why correct technique matters so much.  The government’s Consumer Product Safety Commission has a short list of safety recommendations for baby wearing, but they do not explain why they should be followed nor do they explain the benefits of using wraps or slings for any baby.  There are many websites that either explain all the benefits, sell you products, or help you find a trained educator in your area.  But none seem to take a look at the special needs population.  My guess is that in this litigious age they don’t want to take responsibility for accidental misuse with the most vulnerable population.  Neither do I, but as a professional, it seemed an important topic to cover.  So let me say up front that I am not instructing you on how to wrap your baby or which carrier to use, but I will highlight specific considerations for the parent of a special needs child that wants to use baby wearing safely after they have been cleared by their pediatrician to do so.

The reasons to consider baby wearing are numerous.  The deep emotional connection between adult and baby (dads and caregivers can and probably should try wearing babies), the movement stimulation for balance and self-soothing, and the support for nursing are fairly obvious benefits.  Baby wearing can even help your little one sleep better Baby Wearing For Better Infant SleepThere is substantial research that babies need the stimulation received when moving inside a progressively tighter womb, and even passing through the birth canal.  These experiences are huge sources of tactile, vestibular, and propriocpetive input (touch, movement and pressure) to the sensory system.  Premature birth with a C-section delivery deprives a growing brain of that information.  Preemies have no alternative but to gain more learning outside the womb after birth.  I think baby wearing a preemie correctly and frequently is possibly the most powerful thing that you could do to give them this missing sensory input.

An important but less obvious benefit is that the baby who is worn correctly is one more baby that isn’t resting his head flat on a mat or strapped into a carrier for more than 30 minutes.   As an occupational therapist, I have treated too many toddlers whose infant siblings have been wedged in carriers for my whole session.  Every session.  And they are probably in there much longer and more frequently than those 45 minutes.  When I am the occupational therapist treating a child, the physical therapist and I often struggle to figure out how to get special needs children into safe and dynamic  positions that do not put them at risk for positional plagiocephaly (flat head caused by positioning).  You just cannot do tummy time all day.

The family of a special needs infant can still use baby wearing and foster all those wonderful experiences.  But please consider the following issues and get professional advice if possible:

  • Position your baby tightly, so that she doesn’t slide around as you move.  Recheck and re-position after nursing.  Many wrapping fabrics stretch, so that must be considered.  But tight doesn’t mean compressed.  If your child has a history of respiratory problems, difficulty expanding their ribcage or filling their lungs when lying flat, you really need to clear any tight wrapping with your pediatrician first.
  • Make sure you can see your baby’s face and your baby can see you.  You would never cover her face with a cloth in any other position, and so make sure that the wrap/carrier never covers her face.
  • Preemies and low-birthweight newborns may be too small for the structured front-facing carriers, or take a while to develop the necessary head control.  Use a wrap for a more custom fit, and one that fits both of you well.  Never use a back carrier for a medically fragile infant.
  • Only use the upright or vertical position with their chin up; the cradled or horizontal hold puts a medically fragile or very young child at greater risk for struggling to clear their airway.  A word about seeing your child struggle to breathe: they can be getting less air but not gasping at all!  Compression of their ribcage or airway can be just enough that they slowly become unresponsive.  This means that you watch their face, their color, their respiratory rate, and their activity level.  If you are really tuning into them, you know what “bad” color looks like, and what is normal for them.
  • Baby wrap advocates often recommend the warmth of wrapping, but just like swaddling, you want to match the fabric, your activity level and the length of time you wrap with the environment.  Medically fragile babies lose heat rapidly but they also cannot get rid of excess heat, and sleeping too warm is a risk for SIDS (sudden infant death syndrome). Choose your wrapping based on logic.
  • Think before you move.  Even with a well-wrapped infant, bend from your knees and be very aware of your movements and anything else you carry.  But that is not where movement concerns end with NICU graduates.  Special needs infants can sometimes become overwhelmed with the normal movement of a busy parent, or the common noises of daily life.  Sensory sensitivity doest just disappear once they are out of the NICU.  Some babies just can’t handle being that close to the blender to make your smoothie or listen to lost of talking.  A child who can’t handle the typical stimulation from an all-day wear deserves respect.  Watch for signs that he is shutting out stimulation or becoming fussy after lots of movement or location changes.  Your baby will still get the benefits of baby wearing for shorter or quieter periods, and his tolerance should increase over time.  And don’t fear swaddling, even though some baby wearing sites will show an awful swaddle with the legs jammed together.  A correct swaddle doesn’t restrict any leg movement and is approved by the American Pediatric Association.  Again, if you understand the swaddle and use it correctly, it is as safe as well-planned baby wearing.
  • If you are exceptionally concerned about using baby wearing techniques, ask either your pediatrician or an occupational or physical therapist that works with your child for some advice that pertains to your baby before beginning to use a wrap.

Healthychildren.org Has AAP Tips And An E-zine For Parents

There are so many sites out there, and busy parents aren’t sure what to look at first when researching health issues.  The American Academy of Pediatrics (AAP) has a website with a newsletter and an e-zine that can be a place to start.  They write a monthly newsletter on a wide range of subjects, and the e-zine is published much less frequently but goes into more depth on the issue’s theme.  Their advice sounds like the responses you would receive from your seasoned pediatrician, if they had the time to answer all of your questions.  Sometimes with a fussy child you just need to get in and out before things get truly ugly.

Do not expect in-depth research or much of a mention of alternative health ideas.  This is mainstream medicine.  But they do a nice job of organizing their information and the pieces are short and to the point.  When you have a quick question, that can be enough!

Epigenetics and Infant Development

The Wall Street Journal ran a short piece last week on recent research into epigenetics and the effects of childhood poverty. Alison Gopnik was the author of “Poverty’s Vicious Cycle Can Affect Our Genes”. Some scientists believe that the chronic limited security and support many children experience in poverty changes their genetic makeup to bias them for depression and difficulty handling everyday stress later in life. This is different from saying that you didn’t learn effective coping skills to manage stress, this is saying that your biological ability to deal with stress is impaired by your early experience. And that your altered genes get passed onto your children. And their children. The thought that only poverty affects genetic responses is short-sighted. The effect of interpersonal stressors, absent of poverty, has to have strong effects as well.

If you haven’t heard of the field of epigenetics, then expect to hear about it soon. The study of how our genes change with the effects of our environment and our experiences is new, exciting, and a bit frightening. Simply put, there are scientists working on studying how positive nurturing can change our ability to turn on or turn off genes that control important functions like protecting us from toxins. They are also looking at how exposure to environmental toxins and stress in the womb affect the development of disorders such as autism. Epigenetics is huge.

The WSJ piece reported on the research, and did not offer recommendations for living. But it does make me think that my diet, my exposure to chemicals, and my behavior could change more than my appearance or my attitude. It makes me reconsider my choices for the very long run.

Do Fathers Matter? NYT Reviews the Question

The NYT has reviewed a new book, “Do Fathers Matter” by Paul Raeburn. The assumption is that they make unique contributions to their children’s lives before, during, and after conception.

This book explores the science behind this belief. Some researchers are studying the benefits that come from having involved and caring men in children’s lives. Equally interesting are the effects of paternal age and health at conception. New studies suggest that male health is an important consideration in fertility and risk for a wide range of issues. The effects of a fathers’ parenting style in early childhood to affect behavior in adolescence and adulthood is worth considering. No one doubts this, but seeing the research clarifies why we should care deeply about a father’s role in a child’s life.

This book appears to bring social, psychological and biological research together in a readable form, so I will be eager to take a look this summer!

Eating Fish in Pregnancy and Beyond: Eat This/Not That

The FDA has made an additional recommendation to pregnant and nursing women: eat at least 8 but not more than 12 ounces of certain fish for your baby’s health. Don’t eat too much albacore tuna but eat some light tuna. Specific choices they recommend are the fish most likely to have low levels of mercury. Their recommendation is based on a study that correlates higher IQ with greater fish consumption. This is not the same as causation, but they are confident enough to issue the recommendation. Previously they only warned of eating too much fish with mercury. Their new guidelines seem to be a response to the fact that many mothers interpreted the message as “Fish are dangerous”.

Other blogs are filled with questions about whether this is an elitist mandate for people who can afford wild salmon at $20/lb, or a governmental attempt to confuse women at their most vulnerable. No one seems to know why fish is a good idea for health in general. A specific type of Omega-3’s, a lower-fat source of protein, etc all are suspect. It could be that women who eat fish are not eating processed food. Everyone agrees that people are eating less fish in developed countries, and that fresh fish is either expensive everywhere or suspect when caught in local waters due to pollution fears. Vegetarians are eating algae to get the same type of omega-3 benefits.

What is a mother to do? Some take supplements to simplify and eliminate the risk of mercury, but there is no firm indication that supplements provide the same benefits that foods provide. Some carefully monitor every ounce that they eat and source their diet carefully.

The decision is so personal that the best anyone can do is get reliable information and choose a path that seems based in logic and not in fear. We will all be looking for the next government recommendation. Hope it involves chocolate!

Welcome to Your Child’s Brain: Book Review

Ever wonder if all the recommendations and “new” ways to raise your children are based on anything scientific? Well, “Welcome to Your Child’s Brain” will explain the current research behind popular recommendations such as eating fish during pregnancy and teaching your child another language while still in diapers.

Authors Sam Wang, PhD. and Sandra Aamodt, PhD. have written a book that is filled with useful information about brain development from the fetal stage all the way through the teenage years. Ever wonder what your 3-month old really sees? It’s in here. Why does your toddler son enjoy block play so much more than your neighbor’s toddler daughter? It’s in here. If you love science, you will love this book. if you just want to know how to get your toddler to eat spinach or whether watching baby videos will harm your child, you will love this book.

Issues like autism and ADHD are covered, as well as current research on language and math education. This book includes plenty of detail about regions of the brain understood to support all manner of thought, action and emotion. But just when you have had enough of the brain science, they give you a “Practical Tip” section that distills down the research into some information that you can really use today.

“Welcome to Your Child’s Brain” is worth the reading time. You will be amazed at what current neuroscience knows about your child!

Nap Nanny Death; A Preventable Tragedy

The infant recliner called the “Nap Nanny” had already been recalled, but another death was reported in NJ this weekend.  The story involves an 8-month old child who was belted in and trapped between the nap nanny recliner and a crib bumper, as per reports in USA Today and other news media.

 Infant recliners are popular and plentiful, but they are not foolproof. Sleepless parents will continue to buy these infant seats and use them in ways that are unsafe due to frustration and lack of awareness. No device is sold with bold warnings about the number of children that die in seats and carriers each year. No parent thinks it will be their child. Until it is.

The American Academy of Pediatrics has clear but poorly publicized warnings about avoiding keeping babies in infant carriers and seats for any extended periods of time. Families need sympathy for the stress they are experiencing, realistic expectations about baby sleep patterns, and specific instruction to avoid placing their babies at risk.
 
There is a two-part solution: position your a baby in a swaddle or in a sleep sack and nothing else in the crib. Learn to quickly soothe and calm your baby. As a Happiest Baby on the Block educator and pediatric occupational therapist, I teach the Happiest Baby protocol, which includes SIDS prevention and support for parents. Direct instruction with the opportunity to ask questions and practice techniques with an instructor can be invaluable.

Babies older than 4 months benefit from Dr. Harvey Karp’s suggestions for older children in “The Happiest Baby on the Block Guide to Great Sleep”.

The pain this family must be experiencing is unimaginable. My heart goes out to them tonight.

Link

Toddlers and Ritalin: When Does Behavior Warrant Medication? Toddlers are known for being impulsive, inattentive, and even aggressive at times.  But is that ADHD?  The NYT has written an article suggesting that the frequency of medication prescription to toddlers and a family’s financial status/insurance coverage are connected.   Take a look at the article   http//nyti.ms/1gQdd4M