Category Archives: kindergarten

A Fun Way to Help Kids With Low Tone Stand Up Straight: Stomp-Stomp!

sven-brandsma-gn-I07tTixw-unsplashKids with hypermobility or low tone are often found standing in the most dysfunctional of positions.  Toes pointing in, feet rolled in or out, feet on top of each other: take your pick, because these kids will alternate between these wobbly choices and more!  Read How To Improve Posture In Children With Low Muscle Tone… Without a Fight! and How To Correctly Reposition Your Child’s Legs When They “W-Sit” for some other ideas.  But if you want a quick idea that works to help a child stand up with better control and stability, read on.

Telling a child to “fix your feet” often makes no sense to them, or gets ignored.  Passively repositioning their feet doesn’t teach them anything, and can annoy children who feel that they are being manhandled.

What Can You Do?

Tell Them To “Stomp-Stomp”!

Have the child stomp their feet. Repeat if necessary (or because they want to).   It is simple, you can demonstrate it easily, and most kids grin happily and eagerly copy you.  It is fun to stomp your feet.  It also give kids a chance to move in place, which they often need when socially distancing in a classroom.

 

Why Does It Work?

Because in order to stomp their feet, they have to bring their attention to their feet, shift their weight from one foot to the other in order to lift them up, and their feet almost always end up placed in a more aligned position after stomping.

Many of the goal boxes their PT and your OT have on their list are checked.  Kids don’t feel controlled or criticized.  They are having fun.  Sensory input happens in a fun way, not as an exercise.

Want more help with your child, or help improving treatment plans as a therapist?

I wrote three e-books for you!

The Practical Guide to Toilet Training Your Child With Low Muscle Tone, and the JointSmart Child series on hypermobility are all valuable resources for parents and therapists.  I wrote them because there is simply nothing out there that provides an explanation for why these symptoms make life so difficult for kids (and parents, and teachers, and even therapists!) and what can be done to make everyday life better.

Learn why low tone and hypermobility both create sensory processing issues, and what kinds of social and emotional issues are understood to accompany hypotonia and hypermobility.  When parents see these issues as complex rather than only about strength and stability, they start to feel more empowered and more positive.

Read more about these books, available for purchase on Amazon and Your Therapy Source,  in A Practical Guide to Helping the Hypermobile School-Age Child Succeed, and The JointSmart Child Series: Parents of Young Hypermobile Children Can Feel More Empowered and Confident Today! as well as The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

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Try “Rainbow Tracing” to Build Pre-Writing Skills With Creativity

delfi-de-la-rua-zolFYH_ygpw-unsplashI am not a huge fan of teaching preschool children to trace strokes.  I am very interested in the use of simple drawing to build pencil control and other pre-writing skills.  But done right, tracing can be fun and useful for both the child and the adult.  Here is one way to use tracing effectively:  Rainbow Tracing.

What is it?  The child traces the same target stroke with at least 3 different colors before moving onto the next stroke.   If needed, the adult can initiate/demonstrate first, and the child can repeat with additional colors.  It isn’t necessary for the child to be incredibly accurate, but they do have to start at the correct spot and attempt to end their stroke at the correct spot.

The target tracing line has to be sufficiently wide and simple enough to allow for reasonable expectation of success.  An example would be that a three year-old is asked to trace a curved line, not a series of diagonals.  The developmental progression assumes that most threes aren’t ready to execute diagonal lines independently.

Why is Rainbow Tracing helpful?  By repeating a traced line, a child receives more practice for stroke control and grasp.  It is colorful, and the colors are the child’s choice.  This allows some creativity and agency in an activity that might otherwise be boring and produce very little motivation in a child.

What about a child who traces over their errors?  If a child’s initial stroke is wildly off the target, they are more likely to re-trace their error.  If the adult knows that this is going to be an issue for this child, they can offer another copy of the same sheet, or the adult can be the first “tracer”.  They could also offer an easier and wider stroke to trace.

What do you do with the results?  Celebrate it, of course!  Kids love to put their drawings in an envelope and mail them.  Scanning them isn’t as exciting to a young child.  They like doing things “old school”.  So do a lot of grandparents and great-grandparents!

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Should You Use Pre-Mixed Dough to Bake With Your Toddler?

food-photographer-jennifer-pallian-OfdDiqx8Cz8-unsplashOK; this is a trick question.

Using prepared dough is one of the easiest ways to introduce very young children (or special needs kids of any age that are functioning at the 18-36 month level) to food preparation.  With the right mindset, it is the beginning of a wonderful way to share practical skills, build sensory and motor skills, and enjoy the company of very young cooks.

The greatest objections to using prepared dough, whether pre-cut or just pre-mixed, are that these are high-carb/low nutrition foods, and that they include preservatives.  Both of these statements are true.  They are also true of most of the food I see served to young children and consumed by parents.  I can count on one hand the number of families I have worked with in 25 years that do not consume any foods containing either preservatives or sugar.

Most families limit their consumption of both, and that makes a lot of sense.  Nobody is going to make cookies of any kind every day of the week, and maybe not even every month.  These are treats.  The dough can be purchased, already made with very wholesome ingredients, in specialty stores.  Adults can also make their dough from scratch well before including the child, as you would do with “refrigerator cookies” and pre-slice it, so that a child only has to place circles of dough on a cookie sheet to bake them off.

The greatest benefit of using pre-made dough is the ability to have only a few steps in the entire process of baking, so that a child is introduced to the experience of making food in an easy and positive manner.  Beginning with many ingredients and many steps that only the adult can perform is a sure-fire way to create a huge mess and create a negative experience for both the child AND the adult.  Young children have no sense that food is prepared.  They aren’t often witness to any preparation or cleaning.  This is a wonderful way to introduce them to the process.  Of course, no child can be involved with the use of an oven or touching hot pans.  That is OK; we want children to build their patience and attention!

Most kids are quickly ready to progress to using pre-mixed dry ingredients and blending them with wet ingredients, and then helping to measure and mix all ingredients.  The use of pre-made dough is simply a first step in a long process of involving kids in the kitchen!

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Want Better Self-Regulation in Young Children? Help Them Manage Aggression

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You might think as a pediatric OTR, I would be writing a post about sensory-based treatment for self-regulation.  And I have in the past.  Not today.

But I have been an OTR for decades, and what I know about today’s children is that agitated and dysregulated kids often need help managing aggressive impulses and negative emotions first, in order for me to assess whether or not their behaviors have a sensory basis.

That’s right:  a young agitated child cannot be assumed to have sensory processing difficulties if they haven’t learned any self-management tools.  It is too easy to assign them a label, and I refuse to do that.  But I can and will use effective techniques to manage aggression before I jump in with all the bells and whistles from my sensory processing treatment bag.

What works for me?

I get a lot of mileage out of Dr. Harvey Karp’s Happiest Toddler on the Block strategies.  Once I learned these simple techniques, I applied them to every situation in which a young child was oppositional, aggressive, defiant, or threatening/delivering a tantrum.   That could be every session!  Toddlers aren’t known for their easy-going ways.

His Patience Stretching, Fast Food Rule, and Time-Ins are my three-legged stool that supports my therapy sessions.  Read Use The Fast Food Rule For Better Attunement With Your Child and Stretch Your Toddler’s Patience, Starting Today!  Kids aren’t born with the ability to handle frustration and manage impulses.  Adults teach them how to deal with their feelings.  When they aren’t taught what to do when they are disappointed, when they want attention, or when they are angry, things can get pretty unpleasant.  The good news is that learning can begin around their first birthday.

Job number one should never be unclear to anyone, but as time has gone on, fewer and fewer parents seem to communicate it clearly:  physical violence from anyone isn’t acceptable at any time.

Are parents committing violence against their child?  No.  It is the child that is biting, hitting, or damaging items.   “We don’t hurt people or animals in this house” isn’t always communicated clearly to a child.  I never hear a parent say that they like being smacked across the face by their child, but they also seem to struggle to clearly communicate that this behavior is unacceptable.  Resorting to responding with violence is not helpful.  Teaching how to manage aggression can be done without spanking a child or even raising their voice.  Changing their tone of voice and rapidly putting the child out of arm’s reach will make it clear to their child that they have crossed a line.  But so many parents seem hesitant to set limits, and some seem to worry that being firm will harm their child or hurt their feelings.  This is coming from,  remember, the same child that just smacked them in the face or bit them.  By not reacting clearly, parents are in fact communicating that aggression toward others isn’t a problem.

I try hard to teach parents that it is kind and loving to teach children that they can have their feelings but they cannot express them with aggression.  There are limits in the wider world, and if they act this way with people that don’t love them, the consequences aren’t going to be good.  Learning to hear “no” from someone that loves you is a lot easier.

Young children need to learn the vocabulary of negative emotions like anger, disappointment, frustration and sadness.  They need to practice waiting and need to be spoken to in a way that makes it clear that they are understood but may not get their way all the time.  Negotiation and appreciation go hand in hand.  Dr. Karp’s techniques really work for me, and they aren’t difficult to learn or use.  I wish every parent would try even one and see how easy they can be incorporated into daily life with young children!

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The Preschool Water Arcade Game You Need This Summer If Camp is Cancelled (and maybe even if it isn’t)

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I cannot BELIEVE how much fun this Step 2 Waterpark Arcade toy could be!  You hook it up to your outdoor garden hose and play.  As an occupational therapist, I want all of my older toddler and all my preschool clients to get one of these arcade games to work on visual-motor coordination and hand strength.

What kid isn’t right for this toy?

  • This isn’t a toy for a child that cannot resist the impulse to spray others, as the water flow could be pretty strong.   Almost every child is going to have some experimentation with controlling the hose.  That isn’t the same as intentionally nailing their baby brother in the face.
  • Nor is it a good choice for a child that is really unsteady on their feet.  It won’t be easy to handle a hose while sitting down, and too much failure is really hard on kids that are already stressed because of missing camp.
  • They have to have enough hand strength, even with two hands together, as shown, to squeeze the trigger while aiming.  Older kids can stand farther back from the toy and use one hand.
  • Kids with significant problems with strabismus may not be able to aim from a distance.  Strabismus will force them to use one eye to avoid “seeing double” at a distance.  Again, failure isn’t fun.  Weakening one eye isn’t a great idea either.  If this motivates a child to wear their special glasses or eye patch, on the other hand, it could help you get some compliance.

Can You Incorporate This Toy Into Fine Motor or Handwriting Practice?  SURE!!!!

  1. Parents can come up with a score sheet on the sidewalk with chalk, on a white board with a marker, or use a bucket with pebbles.  Every time a child hits the mark, they get a point.
  2. They can write a hash mark or erase the previous score and write the new one, which is great for preschoolers and kindergarteners to practice writing numbers over the summer.
  3. Of course, they have to write their names and their opponent’s name as well.
  4. Counting the pebbles without writing them could be great practice for younger kids.

Looking for more outdoor fun this summer?  Read Doing Preschool Camp at Home This Summer? This is the Water Table You Want!  Worried about rainy day fun?  Read Doing OT Telehealth? Start Cooking (And Baking)!

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Child Struggling With Pencil Grasp During COVID-19? Flip Crayons Restore Skills

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All of my kindergarten clients and some of my preschool clients are using them.  None of them are backtracking into a fisted grasp with pre-writing or early handwriting.  Flip crayons from Learning Without Tears (formerly Handwriting Without Tears) are one of those simple grasp development strategies that keep on giving.

Why?  Their design does all the work for me.  Well, almost all the work.

Flip crayons have the same diameter of a standard school crayon, not a toddler crayon, or those ridiculous and useless egg/fingertip crayons Egg Crayons or Fingertip Crayons: When Good Marketing Slows Down Fine Motor Skill Development  .  They are shorter, so they do not allow a fisted grasp or even a palmer pronate grasp.  The crayon demands finer grasp, not the adult.

Selling an item to a child is important. They have to want to try these out.   I “sell” them as kindergarten crayons.  Every preschooler wants access to something they think is for older kids.  Their unique appearance is almost always appealing to kids.  I have met very few rigid kids, even with ASD, that are unwilling to give them a try.  Within a month of regular use, I see huge improvements in grasp without manhandling a child, begging them to “fix your fingers”,  or any of the other methods to address grasp issues.

COVID-19 is dragging us all down.  Why work harder than you have to?  I need children’s parents to see me as a problem solver, not someone asking them to work harder.  Flip crayons are an easy answer to a challenging problem.  I have another huge box of them sitting in my office to drop off as “gift baggies” at the end of the month!

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How To Improve Posture In Children With Low Muscle Tone… Without a Fight!

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With pediatric occupational therapy going on at home using parents as surrogate therapists, it isn’t helpful to ask a parent to do too much repositioning of children with low tone.  First of all, kids don’t like it.  Second, kids really don’t like it.

I have never met a child that enjoys therapeutic handling, no matter how skilled I am, and I don’t think I ever will.  They don’t know why we are placing their hands or legs somewhere, and they tend not to like to be told what to do and how to do it.  The best you can hope for at times is that they tolerate it and learn that therapists are going to be helping them do what they want to do For Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance.

Leaving a child in an awkward and unstable position isn’t the right choice either.  They are going to struggle more and fail more when out of alignment and unsteady.  If you know this is going to happen, you can’t let them stay that way because you also know that this will blow back in your face in the form of frustration, short attention span, and children developing a sense that whatever they are doing or whomever they are doing it with is a drag.  A real drag.

So how can you improve the posture of a child with low tone without forcing them physically into a better position?

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CPSE or CSE Review Without a Re-Eval Because of COVID-19? Here’s What You Need To Ask For

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One of my private clients just called me for some backup.  Her son, who is on the autism spectrum, may lose some of his school OT sessions due to his increased handwriting ability (thank you; we have been very working hard on it!), but no further formal testing could be done before schools were shut down due to COVID-19.  His fine motor scores were in the average range. Everyone knows he is struggling with attention and behavior in class.  Everyone.

My strategy?  I gave her the Sensory Profile for ages 3-10 (SP) to complete.  Almost all of his scores were in either the “probable difference” or “definite difference” categories.  This means that his behavior on most of over 125 different items is between one and two standard deviations from the mean.  Even without a statistics course, you can understand that this is likely to be impacting his behavior in the classroom!

Many of the modulation sections of the SP, including “modulation of visual input affecting emotional responses” and “modulation of movement affective activity level” directly relate to observed school behaviors.  Scores in “multi sensory processing” and “auditory processing” were equally low.  Think about how teaching is done in a group:  it is visual and verbal.  Kids have to sit to learn.  They have to tolerate being challenged.

This is why OT in the schools is more than how to hold a pencil.  We address the foundational skills that allow children to build executive functioning skills.  Without these skills, all the routines, prompts, reward systems and consequences aren’t going to be very effective.

School therapists cannot test your child accurately using a standardized instrument when schools are closed due to COVID-19.  But parents can respond to a questionnaire, and it can be sent and scored remotely.  The Sensory Processing Measure is another sensory processing questionnaire able to be completed remotely.  These scores will help your therapist and your district understand the importance of OT for your child.  When school does resume, related services are going to be essential services!

For more information on how to work on OT issues at home, read Using A Vertical Easel in Preschool? WHERE You Draw on it Matters! and Does Your Older Child Hate Writing? Try HWT’s Double-Lined Paper.

If your child is hypermobile, you will need my newest e-book, out on Amazon right now!

The JointSmart Child:  Living and Thriving With Hypermobility Volume Two:  The School Years, is designed to address the challenges and needs of the school-aged child 6-12.  It has plenty of add-ons in the appendix to help you at home and at school. Learn how to pick the right chair, the right spoon, the right desk and even the right bike!  It gives you ideas to build ADL skills like dressing and independent bathing, and ways to build your confidence when speaking to doctors and teachers!

My earlier book, The JointSmart Child:  Living and Thriving With Hypermobility Volume One:  The Early Years, is also available on Amazon and at  Your Therapy Source.  It addresses development from birth to age 5.  It provides parents with all the ADL strategies to build independence AND safety, plus ways to teach your family    and babysitters how to work with your child more effectively.  Parents start feeling empowered, not overwhelmed, right away!

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Is this recess in your house during the COVID crisis?

Using A Vertical Easel in Preschool? WHERE Your Child Draws on it Matters!

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There are a few equipment and toy recommendations that every home-based pediatric OTR makes to a child’s parents:  Play-Doh, puzzles, tunnels, …and a vertical easel.  Found in every preschool, children from 18 months on can build their reach and proximal (upper body) control while coloring and scribbling on a vertical surface, rather than a tabletop.

But WHERE a child is directed to aim their stroke matters.  Here is why:

  • Grasp and reach have a range of efficiency.  I tell adults to imagine that they are writing on a whiteboard for a work presentation.  Your boss is watching.  Where will your writing/drawing be the most controlled?  Everyone immediately knows.  It is between your upper ribs and your forehead, within the width of your body or a few inches to either side.  Beyond that range, you have less stability and control.  Its an anatomy thing.  If you are an OTR, you know why.  If you are a parent, ask your child’s OTR for a physiology and ergonomics lesson.
  • Visual acuity (clarity of focus) is best in the center of your visual field (the view looking directly forward with your head centered).  Looking at something placed in this range is called using your “central vision”.  Your eyes see more accurately in that location, children can see an adult’s demonstration more clearly,  and therefore they can copy models and movements more accurately.  Kids with ASD like to use their peripheral (side) vision because it is cloudy, and the distortion is interesting to them.  This is not good for accomplishing a visual-motor task or maintaining social eye contact, but they find this is a way to perform sensory self-stimulation and avoid the intensity of direct eye contact with others.
  • Young children have little self-awareness of how their environment impacts them.  Until they fail.  Then they think it is probably their fault.  The self-centeredness that is completely normal in children gets turned around, and a child can feel that they are the problem.  Telling children where to place their work on an easel gives them the chance to do their best work and feel great about it.
  • Children move on when a task is too hard, or when an adult doesn’t provide enough supportive strategies.  Telling a child to try again, or telling them that their results weren’t too bad” isn’t nearly as helpful as starting them off where they have the best chance of success.
  • Using the non-dominant hand to support the body while standing is an important part of vertical easel use.  For kids with low muscle tone or hypermobility, it is very important.  Standing to the side or draping the body on the surface to write are both poor choices that OTRs see a lot in kids with these issues.  Make the easel a piece of therapy equipment and teach a child to place their non-coloring/painting hand on the side of the easel in the “yes zone”.  Look at the picture of the older boy at the beginning of this post, then at the gentleman below.  Note each person’s posture and try to embody it.  Which posture provides  more ease, more control? 

 

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Here is a graph of where an adult should place their demonstration on a page or board for optimal vision and motor control, and where adults should encourage a child to draw.  “NO” and “YES” refer to the child’s optimal location for drawing or writing.

The exception is for height.  A very tall child will need to draw higher on the chart, and a smaller child will only reach the lowest third of the easel.  This should still allow them to use their central vision and optimal reach.  If the easel doesn’t fit the child, place paper on a wall at the correct height.

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Young Children, Sensory Modulation, and the Automatic “NO!”

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Kids as young as 18 months can express their sensory processing issues with one word: “NO!!”  What appears to be a budding attitude issue or even oppositional defiant disorder can be a sensory modulation issue instead.

How could you possibly tell?

Well, if your child has already been diagnosed with sensory sensitivity or sensory modulation problems, you know that these issues won’t just make it harder to wear clothes with seams or touch Play-Doh.  These issues affect all aspects of daily living and create emotional regulation and biological over-activation issues as well.  Young children are learning how to express their opinions and separate physically and emotionally from their caregivers.  Saying “NO!” isn’t unusual for young kids (and a lot of older ones too!).  But refusals that make no sense can have a different origin.

So what is the giveaway?

When a child has an almost immediate “NO”, perhaps even before you have finished your sentence, and the reaction is to something you know they have liked or almost certainly would like, you have to suspect that sensory modulation is at play.  You usually sense when your child is trying to get your attention or get you activated.  This should feel different.

What do I do next?

You also need to respond in a specific way to test your theory that sensory issues are the root of the ‘tude.  Your response should be as vocally neutral and emotionally curious as you can manage.   “Oh, really….you said no…” is a good template.  Whether it is “no” to their fave food, show, toy or an activity.  You remove all criticism and encouragement from your voice.  You don’t want to fuel the refusal fire; you want to shut it off and see what is left in the embers of “NO”.

Now you need to wait for them to neurologically calm down.  Little brains are like old computers.  They take a while to reboot.  Look at the floor, wipe your hands, etc and wait a minimum of 15 seconds, probably 30, then ask again if they want a cookie, want to go out, want to play, to eat, or whatever.  The child who needed the primitive defensive part of their brain to go offline to allow them to use their budding frontal lobes may sweetly ask for what they just refused, or respond to your exactly identical request with a cheery “YES”.

Please try to have compassion for them.

It can seem maddening to do this all day long, and in truth, if you are, you need to learn how to work with an occupational therapist in order to learn powerful sensory treatment strategies that can get your child out of this pattern.  But your child isn’t jerking your chain when their behavior fits this pattern.  They are more likely a captive of their brain wiring.   Don’t let yourself react as if they are intentionally being difficult.  That day will come…..13 is just around the corner!

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What To Say When Your Child Cries After Losing a Game

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Whether it is a board game or a soccer game, once children are old enough to wrap their minds around winning, they cannot handle losing.  Their grief leads parents to “throw” every game so that their child wins every time, or they make up games where everyone is a winner (I will admit to doing this one).  But inevitably, a child has to learn to accept that this time, in this game, they didn’t prevail.

What makes them learn to handle this without doing a “John McEnroe” and throwing the game board all over the room, or screaming in the car on the way home from the field?

  1. Model the emotions of losing, not just the noble way to lose.  Kids need to know that it is normal to feel bad about losing, just not behaving badly and not feeling devastated.  Seeing and especially hearing someone say how they feel helps children learn about their own emotions.  Play a game with your partner as well as your child, run a relay race, etc.  Just talking about it isn’t enough for young children.  They want to see the drama unfold.  If you showboat around the living room, you might want to reconsider that one.
  2. While we are speaking about showboating, you can comment to your older children on the behavior of sports figures.  Older kids can comprehend why that isn’t admirable behavior, and they need to hear why you think that.
  3. Tell children why adults don’t cry when they lose (most of the time).  It is very simple:  we know we will get another chance to win the next time we play.  We are still sad, because everyone wants to win.  They need to know that is true as well.  We also know that the best part of the game is playing, or else it isn’t really fun.
  4. If your partner/spouse doesn’t display the same equanimity about losing, you have a conversation in front of you.  Raging and bad behavior on the field or the rink has become dangerous, and you want no part of it.  Some adults were never taught these things, and some people have such limited lives that games really are that important in them.  They need help to grow up and reach for greater things.

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How Dr. Harvey Karp Helps Kids AND Adults with Regulation Issues

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Can you do DBT with toddlers?  Well, Marsha Linehan probably would say no, but the Fast Food Rule and Patience Stretching come as close as you ever could!

Many child psychologists and psychotherapists are focusing on attachment theory and the problems of poor emotional regulation in children.  The rise of self-harm behaviors in teens and aggression in children as young as 3 can be related to difficulties handling emotions and experiences that increase arousal levels but never get resolved.

Not every child who throws their book down in frustration or slams their bedroom door needs to see a therapist.  But I do wonder how many of those teens that cut themselves, starve themselves or get suspended for putting their hands on a teacher or fellow student, actually needed Dr. Karp’s techniques when they were 3 or 4.  Maybe, just maybe, if they had been helped with Patience Stretching when they wanted that toy, or if someone had used the Fast Food Rule with them when they had a tantrum Use The Fast Food Rule For Better Attunement With Your Child, maybe they would be in better shape at 13.

Why?

Because these techniques don’t just work on the child.  They work on the adult using them as well.  And adults who can self-regulate raise kids who learn to do it too.

When I use Patience Stretching( Stretch Your Toddler’s Patience, Starting Today! ) with a toddler that wants one toy while I want them to work a bit longer on a therapy task, I am actually receiving the benefits of the technique as well.  I am both teaching and experiencing the reduction in frustration and the decrease in agitation as this strategy calms down the whole situation.  Oxytocin gets released when we calm down with a child, and adults need that hit as much as children do.  If we “go there” with an agitated child, we feel worse, even if we think we won because we have the power to deny or punish.  It doesn’t feel good to do either, but it also doesn’t feel good to give into a screaming child.  Not really.  Even the most permissive adult will say no to something dangerous, and then the child who is unfamiliar with hearing “no” will really explode.

The good news is that you don’t have to get an advanced degree to use Dr. Karp’s strategies.  You have to practice them so that your delivery is flexible and confident, but anyone can do it, not just therapists.  In fact, if these techniques don’t work well once you improve your delivery, that could be one way to decide that you need to consult a child specialist.

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When Should You Tell A Child NOT to Erase Their Mistake?

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I wrote a post on erasing Teach Your Kindergartener How To Erase Like a Big Kid and one on erasers Problems With Handwriting? You Need The Best Eraser , but there are a few situations in which you don’t want a child to run for the eraser.

  1. The child who stalls for time.  Some kids want to run down the clock on their therapy session or on their homework time, and realize that erasing can help them do just that.  The fun of rubbing the eraser on the paper exceeds the fun of struggling to write or struggling to answer a question.
  2. The kid that gets upset when they make a mistake.  Some children are oblivious, but some are distressed when they write poorly.  So upset that they lose some of their focus and ability to listen to your suggestions/instructions.
  3. The child who persistently traces over their original mistake.  These kids were taught with a lot of tracing in pre-K and K, and their brains have been trained to trace.  When they see the faint outline of their mistake, they have to struggle NOT to trace it.  Oops.

What SHOULD you do?

These strategies assume that an adult is helping a child directly.  You may not need to remain there for the entire homework assignment, but adult assistance is needed to get this train turned around:

  • Ask them to write the word again.  You may need to fold the paper so that their mistake is not visible, but a correct model is visible.  You may have to write a new visual model in the margins or above their work space.
  • Use Handwriting Without Tears pages.  Their workbook pages are designed to be simple but offer visual models across the page, not just at the left margin.
  • Erase the mistake yourself.  Adults can use more force and erase more effectively.
  • Make a copy (or 2) of your child’s homework so that you can ask them to start over again, but only if it is a short assignment.  No one wants to rewrite a long page.
  • Provide more instruction before they begin their word or sentence.  A reminder that certain letters are tricky or that they need to space words out How Do You Teach Word Spacing? can prevent errors.

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Secrets to Teaching Young Children to Share

 

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It is the rare toddler that eagerly gives up a desired toy or snack to share with another child.  Yup; your child isn’t any different from the great majority of kids out there.

You may even have witnessed the “grab-and-go” move, where they take a toy from another child and then quickly escape to a corner of the room.  I know it doesn’t feel great when the thief is your child, but it also doesn’t mean they are destined to be selfish or live a life of crime.  It is normal for young children to behave selfishly; they haven’t fully developed the cognitive abilities that provide them with awareness of another’s perspective, nor do they fully appreciate social norms.

So, what can you do to teach your child to share?

Well, here are a few things that don’t work:

  1. Shaming.  Telling your child that they are selfish and bad because they don’t want to share isn’t going to build empathy.  It may have the exact opposite effect.   And they may try to hide or deny their behavior from you.
  2. Bribing.  Paying off for good behavior has been scientifically proven to backfire.  Paying kids for good grades, paying employees to exercise or lose weight, etc.  It won’t create a more empathetic child, but it could create a scheming child who parlays their desire for something else into a little show for you.
  3. Begging.  Pleading with your child makes you look powerless and puts your child in an awkward-but-intoxicating position.  It won’t make you more credible when you deny them something or try to teach another civic lesson.
  4. Playing the “Your behavior makes Mommy sad” card.  Children desire love and will do almost anything for it, but making it appear that they have crushed your heart because they followed theirs?  This is a slippery slope, and shouldn’t be taken unless you think long and hard about what you are teaching.

So what ELSE could you do or say that might elicit sharing?

  • You can demonstrate sharing YOUR items, and be very clear about how you made the decision and how you feel.  Make sure that you admit that sometimes you want all of your snack for yourself, but then you remember how good it makes you feel when you share and see how happy the other person is.
  • You can also have another person say how they feel when you share with them.  Children really don’t always pick up on the subtle feelings of others, and they need to hear it out loud.
  • When your child does share, be crystal clear about how good it makes you feel when they do.  This is different from telling them how bad you feel when they don’t, and different from bribing them to share.
  • Read some age-appropriate books on sharing, and try to discuss how the characters felt in the story.  Some kids prefer to talk about characters and not about their own feelings.

Your child may still shrug and refuse to share, or they may want to try sharing, now that they know so much more about it!

How To Stop Your Toddler From Hitting You and Use The Fast Food Rule For Better Attunement With Your Child are two of my popular posts that also help you help your child manage their feelings without crushing their spirit!

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Why Injuries to Hypermobile Joints Hurt Twice

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My new e-book, The JointSmart Child: Living and Thriving With Hypermobility, Volume I, is just about ready to launch.  One of the book’s major themes is that safety awareness is something that parents need to actively teach hypermobile young children.  Of course, physical and occupational therapists need to educate their parents first.  And they shouldn’t wait until things go off the rails to do so.

Hypermobile kids end up falling, tripping, and dropping things so often that most therapists have the “safety talk” with their parents on a regular basis.  What they don’t speak about as often are the long-term physical, emotional and social impacts of those injuries.

Yes, injuries have more than immediate physical effects on hypermobile kids.  Here is how this plays out:

  • The loss of mobility or function after an injury creates more dependency in a little person who is either striving for freedom or unsure that they want to be independent.  Needing to be carried, dressed or assisted with toileting when they were previously independent can alter a child’s motivation to the point where they may lose their enthusiasm for autonomy.  A child can decide that they would rather use the stroller than walk around the zoo or the mall.  They may avoid activities where they were injured, or fear going to therapy sessions.
  • A parent’s fear of a repeated injury can be perceived by a child as a message that the world is not a safe place, or that they aren’t capable in the world.  Instilling anxiety in a young child accidentally is all too easy.  A fearful look or a gasp may be all it takes.  Children look to adults to tell them about the world, and they don’t always parse our responses.  There is a name for fear of movement, whether it is fear of falling, pain or injury: kineseophobia.  This is rarely discussed, but the real-life impact can be significant.
  • Repeated injuries produce cumulative damage.  Even without a genetic connective tissue disorder such as Ehlers-Danlos syndrome, the ligaments, tendons, skin and joint capsules of hypermobile children don’t bounce back perfectly from repeated damage.  In fact, a cascade of problems can result.  Greaster instability in one area can create spasm and more force on another region.  Increased use of one limb can produce an overuse injury in the originally non-injured limb.  The choice to move less or restrict a child’s activity level can produce unwanted sedentary behavior such as a demand for more screen time or overeating.  Read more about how to prevent injuries here: Why Joint Protection Solutions for Hypermobility Aren’t Your Granny’s Joint Protection Strategies  
  • Being seen as “clumsy” or “careless” rather than hypermobile can affect a child’s self-image long after childhood is over.  Hypermobile kids grow up, but they don’t easily forget the names they were called or how they were described by others.  With or without a diagnosis, children are aware of how other people view them.  The exasperated look on a parent’s face when a child lands on the pavement isn’t ignored even if nothing is said.

Do you have a hyper mobile child under 6?  

I wrote an e-book for you!

The JointSmart Child:  Living and Thriving With Hypermobility  Volume One:  The Early Years is a totally unique book.  It is both a manual for finding the right equipment and using the right techniques as well as an educational book for parents who are trying to figure out why loose joints create so many difficulties in daily life.  It even has chapters on building relationships with babysitters, family members, teachers and medical professionals!

Visit Amazon to buy a read-only copy, or Your Therapy Source for a click-able and printable version.

 

In this new book, I provide parents with a roadmap for daily life that supports healthy movement and ADL independence while weaving in safety awareness.  Hypermobility has wide-reaching affects on young children, but it doesn’t have to be one major problem after another.  Practical strategies, combined with more understanding of the condition, regardless of the diagnosis, can make life joyful and full for every child!

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How To Get Your Kid To Share (Hint: The Fast Food Rule Will Be Used)

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Not a week goes by that a parent or nanny asks me how to get a young child, usually under 3, to share.  I get it; it is embarrassing when a toddler rips a toy away from another child, or has a death grip on a toy car while growling at their playdate friend.

Sharing isn’t something that comes naturally to most kids.  The rare child that hands over a toy when asked isn’t the average child.  You have to teach this behavior, and you have a couple of choices.  Only one is going to give you any peace:

  1. Threats:  Telling your child that if he doesn’t share that he will lose his valued toy.  This may work in the short run, but like spanking, you teach a child that violence or the threat of violence is the way to power.  We have too much of that already.
  2. Shame:  Telling a child that they are not nice people because they don’t want to share isn’t any better.  It doesn’t make it much kinder to say “You aren’t being nice right now”  because you still haven’t acknowledged the child’s feelings. Don’t we all carry around more shame than we can handle?  I know no one thinks they are shaming their child by saying this.  Stop now.  Make a better choice.
  3. Empathy followed by reality:  Using the Fast Food Rule, you tell the child what you think they are thinking “You don’t want to share; you want that car only for you” or an even simpler version “You say NO SHARE”.  When the child nods or in some physical or verbal way indicates that they understand you and agree that this is their opinion, you add sympathy to your voice and say something like “I am SO sorry, but it is XXX’s turn now.  You will get another turn later”.  Many times the child will hand over the car.  Sometimes you will have to take it, but they might not flip out.  Your empathy and their intelligence (if they are over 18 months old, they have had experience with sharing) will help them accept the reality.  Read Stop The Whining With The Fast Food Rule for more details on Dr. Harvey Karp’s excellent strategy.

Of course, if your child is exhausted, hungry, ill, or going through a change in routine, home, caregivers, new sibling, etc. all bets are off.  They are living on the edge, and thing could fall apart.  What do you do then?  You feed, give a nap, a hug, and remember that asking a stressed child to share isn’t going to go very well.  But you also use all Dr. Karp’s positive strategies, the ones he calls Time-Ins.  Things like Patience Stretching Stretch Your Toddler’s Patience, Starting Today! and Gossiping Let Your Toddler Hear You Gossiping (About Him!).

The altruism that gives birth to sharing should not be expected in children under 2.  We ask them to follow our sharing rules, and have to help them grow to an age and a place in which they can comprehend what sharing is really about.  You may have to wait until 4 or 5 to see your child really understand how the other child is feeling and why sharing with them works better than being selfish.  At a very young age, it is enough that they know we understand where they are coming from and we will help them follow this important social rule.

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

 

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

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

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

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

 

The best paper wins.

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What To Say When Your Child Says “I Hate You!”

 

daiga-ellaby-699111-unsplashIt happens to almost every parent.  It could happen when your child is a fuming preschooler, or a haughty tween.  Doesn’t matter.  It still hurts.  A lot.  Even the sweetest child can hurl one of these statements out when they don’t get what they want or aren’t allowed to do something.

The biggest question isn’t “Why are they saying that?” but “How do I respond?”  There are a few choices I can think of that don’t involve nasty threats or violence.  Let’s drill down and see if there is one that rises above the crowd:

  • “But I love YOU!”  Hardly ever a winner.  Said with a warm smile or through gritted teeth, this rarely works well to alter a child’s attitude.  It seems that they work harder to explain why they are so annoyed/disgusted/irritated with you.
  • “Don’t you ever speak to me that way again!”  Well, you have drawn your line in the sand.  Let’s hope you have a consequence that you are willing to administer, because it is likely that you will be hearing this again.  Maybe soon.
  • “Wow, that hurts me”  OK, that sounds heartfelt and honest.  The problem is that at this moment, your child may be trying to hurt you.  You have just informed your child that success has been achieved.  In the long run they probably aren’t sociopaths, and they probably will regret hurting you.  But right now?  They aren’t in a place in which they care about your feelings as much as you’d like.

 

And the answer that might just work?

  • ” You are really, really mad at me right now”  Stating how they feel using a fraction of the energy and emotion that your child is spewing is, wait for it….The Happiest Toddler on the Block’s Fast Food Rule.  Yes, the same strategy you use when your two year-old’s cookie falls on the floor can help you with this situation as well.  Because making it clear to the upset person that you “get” them, even if you don’t agree with them, can dissipate some of the indignant venom fast.  You might have to repeat it again after you hear more words about what an idiot you are, or what a bad mommy you are.  Only after you see that they have dialed down some of the venom can you offer a solution, a trade, or a bit of commiseration.  Why?  Because jumping in too soon sends the message that what you’d truly like is to shut them up.  That will not be good.

Want more information on THTOTB strategies?  Read Help Your Child Develop Self-Regulation With Happiest Toddler On The Block and Stretch Your Toddler’s Patience, Starting Today!.

When Writing Hurts: The Hypermobile Hand

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

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

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

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

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

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

Are Your Other Children Resentful of Their Special Needs Sibling?

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This is something that is hardly ever spoken of, but it happens in many, if not most families.  The good news is that it is normal, it doesn’t predict future behavior, and you can address it without sending everyone to a psychiatrist.

The time and energy demands of a special needs child aren’t always in proportion to a child’s delays.  Surgeries or therapy intensives can pull you away for weeks.  The little things, like therapy always being at the same time as someone’s soccer games, are actually harder for siblings over time.  Even sharing lap time can be tough for a toddler who was, until recently, able to climb into your arms anytime.

Remember, toddlers naturally see the world as theirs, and assume that they and their actions are a part of everything that happens to them, good or bad.  They will not be able to fully comprehend why their sibling may take a long time to be able to play with them.  Older children may perceive that it isn’t “nice” to complain about their perceived lack of parental attention, but they feel it.

What can you do?  I believe that quality time is the answer, but only part of the answer.  When you are planning, engaging in, and reminiscing about the quality time that you spent with your child, regardless of whether they are 18 months old or 18 years old, you approach it as if you were in a long-distance love affair.

If you were dating someone across the country, you would talk about the upcoming rendezvous with excitement, you would savor every short minute of it, and you would reconnect afterward, reminding your beloved of the wonderful time you had, and what you hope will happen the next time.

The twist that I learned from Dr. Harvey Karp’s wonderful book The Happiest Toddler on the Block is to put into words exactly how you FEEL about your child and the terrific plans (or event that just passed).  Saying “I am SO, SO, looking forward to reading our special book tonight!” with a smile can mean that a child will put up with your absence at that soccer game.  Reminding a child “Remember when we went out for ice cream alone, nobody else?  That was fun!” helps them handle the fact that they are bathing with the nanny or big sister while you bathe and dress your special needs child.  Even responding with sympathy:”I know…I am sad too that I can’t go with you to your playdate because I have to take Jonah to PT” and using a tone of voice, facial expression and body language that messages real regret; this will help your child handle their feelings without becoming aggressive or shamed for their feelings.

I think this works extremely well with your special needs child’s siblings.  Kids need to hear how happy you are to be with them, that you look forward and backward with pleasure.  They know on some level, even as toddlers, that they don’t get all your attention.  But they really want and need to hear that you love being with them as much as they love being with you.  It could be an ice cream run just with them.  A game of catch just with them.  Reading a new book together.  Almost anything will work, as long as you elaborate on your feelings as well as talking about the event itself.  Mentioning your excitement or good memories during a calm time works better than wedging the comments in between correcting actions and giving consequences.  A casual mention of your future plans can smooth out a lot of feathers!

Looking for more information on parenting when you have a special needs child?  Read How An Aging-In-Place Specialist Can Help You Design an Accessible Home for Your Child and Universal Design For Parents of Special Needs Kids: It’s Important for You Too! and also The Cube Chair: Your Special Needs Toddler’s New Favorite Seat!

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