Category Archives: kindergarten

Three Ways To Reduce W-Sitting (And Why It Matters)

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Children who sit on the floor with their thighs rolled inward and their calves rotated out to the sides are told that they are “W-sitting”.  Parents are told to reposition their kids immediately.  There are even garments like Hip Helpers that make it nearly impossible to sit in this manner.  Some therapists get practically apoplectic when they see kids sitting this way.  I get asked about W-sitting no less than 3x/week, so I though I would post some information about w-sitting, and some simple ways to address this without aggravating your child or yourself:

  1. This is not an abnormal sitting pattern.  Using it all the time, and being unable to sit with stability and comfort in other positions…that’s the real problem.  Typically-developing kids actually sit like this from time to time.  When children use this position constantly, they are telling therapists something very important about how they use their bodies.  But abnormal?  Nah.
  2. Persistent W-sitting isn’t without consequence just because it isn’t painful to your child.  As a child sits in this position day after day, some muscles and ligaments are becoming overstretched.  This creates points of weakness and instability, on top of any hypermobility that they may already display.  Other muscles and ligaments are becoming shorter and tighter.  This makes it harder for them to have a wide variety of movements and move smoothly from position to position.  Their options for rest and activity just decreased.  Oops.
  3. Sitting this way locks a child into a too-static, too-stable sitting position.  This appeals to the wobbly child, the weak child, and the fearful child, but it makes it harder for them to shift and change position.  Especially in early childhood, developing coordination is all about being able to move easily, quickly and with control.  There are better choices.
  4. A child who persistently W-sits is likely to get up and walk with an awkward gait pattern.   All that over-stretching and over-tightening isn’t going to go away once they are on their feet.  You will see the effects as they walk and run.  It is the (bad) gift that keeps on giving.

What can you do?

Well, good physical and occupational therapy can make a huge difference, but for today, start by reducing the amount of time they spend on the floor.  There are other positions that allow them to play and build motor control:

  • Encourage them to stand to play.  They can stand at a table, they can stand at the couch, they can stand on a balance disc.  Standing, even standing while gently leaning on a surface, could be helping them more than W-sitting.
  • Give them a good chair or bench to sit on.  I am a big fan of footstools for toddlers and preschoolers.  They are stable and often have non-skid surfaces that help them stay sitting.  They key is making sure their feet can be placed flat on the floor with their thighs at or close to level with the floor.  This should help them activate their trunk and hip musculature effectively.
  • Try prone.  AKA “tummy time”, it’s not just for babies.  This position stretches out tight hip flexors and helps kids build some trunk control.  To date, I haven’t met one child over 3 who wouldn’t play a short tablet game with me in this position.  And them we turn off the device and play with something else!

For more strategies for hypermobile kids, take a look at Picking The Best Trikes, Scooters, Etc. For Kids With Low Tone and Hypermobility and How Hypermobility Affects Self-Image, Behavior and Activity Levels in Children.

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Is Your Gifted Child A “Troublemaker”?

 

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When you hear hoofbeats, maybe you SHOULD think zebras and not horses!

Gifted and talented children are frequently leaders in their schools and communities.  They often have advanced language skills and display an early and intense sense of humor. Gifted children can be the funny, outgoing, energetic kids who have deep empathy and abundant warmth.

But being gifted isn’t all rainbows and first place ribbons.  Some aspects of being gifted contribute to styles of interaction with authorities and peers that are not a cause for celebration. Gifted kids can be perceived as causing trouble, creating conflict and disrupting things wherever they go.  Super-bright children might end up with this label for the following common behaviors and characteristics:

  • They resist many rules as limiting and irrelevant.  “Because that’s the way it’s done” is not accepted when a gifted child sees the rule as useless or worse: illogical.
  • Boredom with class material they have already mastered gets expressed as anger or  criticism.
  • Their unique interests mean that they may reject their peer’s play schemes and try to convince their friends to play games their way or else.
  • They talk.  A lot.  At times, they may take over a discussion or attempt to alter a teacher’s presentation to address related issues or get more in-depth about a topic.  They may not be able to let a topic go until they have asked every question and made every point that they find important.
  • The frequent sensitivity of gifted children might make a normal level of noise, light or interaction too stimulating, and younger children especially will react in frustration or even tantrums.
  • Your gifted child may be having difficulty with an area of development that has been masked by their talents.  Gifted and Struggling? Meet the Twice Exceptional Student and How OT Can Help A common example would be the gifted child who is struggling with dyslexia, but has been able to use powerful memory and logic to fill in the blanks in a story.  They may not have read the book, but they are able to recall enough of the teacher’s description or the cover’s blurb to “fake it”.  The resulting failure and frustration, even with high overall test scores, builds their resentment and avoidance.

What can you do to transform a gifted troublemaker into your family’s champion or star?

  • The first step is to recognize where the ‘trouble” is coming from.  Your child’s early developmental skills and rapid acquisition of new information could be fueling their behavior.  Seen through this lens, many of the frustrating reactions and interactions with gifted children become understandable.
  • Explore ways to create a more enriched environment for your child.  It doesn’t have to be classes and microscope sets.  It could be more trips to the library or more craft materials to allow all that creativity to be expressed.  Children that are fulfilled are less crabby, less demanding and less resistant.
  • Be willing to take the time to answer questions and discuss the origins of rules.  A rule that is in place for safety can be accepted if it is explained.  A rule about social behavior, such as allowing everyone to have a turn in order, is an important lesson in navigating a world in which the kids with the fastest brains aren’t always the ones who get the first turn.
  • Consider the possibility that your gifted troublemaker is “twice exceptional”.  There may be issues like dyslexia or sensory processing disorder that need to be addressed.  Other issues don’t have to be cognitive.  Your child may be struggling with anxiety or coordination.  Giftedness doesn’t discriminate or remove all challenges to learning.  But remember that these do not minimize their profound gifts in other areas.  They complicate them.
  • Share your awareness of their gifts with them.  Kids who know that their frustrations and responses have a source other than being a difficult person have higher self esteem.  A gifted kid who thinks badly about themselves?  Yes, it does happen.  Feeling different from their friends, knowing that their ideas aren’t always welcomed, being told to be quiet and go along with the flow.  All of these can make a gifted child question themselves.  When you explain that their brain works differently, and that you will help them navigate situations successfully, your support can make a tremendous difference!

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Picking The Best Trikes, Scooters, Etc. For Kids With Low Tone and Hypermobility

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Welcome to the world of faster (and faster) movement!  After mastering walking and possibly even running, older toddlers and preschoolers are often eager to jump on a ride-on toy and get moving.  If a child has had motor delays and has had to wait to develop the strength and balance needed to use a trike or another ride-on toy, they may be a bit afraid or they may throw caution to the wind and try it all as soon as possible!

Selecting the best equipment for kids that have low tone or hypermobility doesn’t end with picking a color or a branded character ( Thanks, Frozen, for bringing up my Disney stock almost single-handedly!).  In order to find the right choice for your child, here are some simple guidelines that could make things both easier and safer:

  1. Fit matters. A lot.  Hypermobile children are by definition more flexible than their peers.  They stretch.  This doesn’t mean that they should be encouraged to use pedals so far away from their bodies that their legs are fully extended, or use handlebars that reach their chins.  In general, muscles have their greatest strength and joints have their greatest stability and control in mid-range.  Fit the device to the child, not the other way ’round. Choose equipment that fits them well now,  while they are learning, and ideally it can be adjusted as they grow.
  2. Seats, pedals and handlebars that have some texture and even some padding give your child more sensory information for control and safety.  These features provide more tactile and proprioceptive information about grip, body positions and body movements.  You may be able to find equipment with these features, or you can go the aftermarket route and do it yourself.  A quick hack would be using electrical tape for some extra texture and to secure padding.  Some equipment can handle mix-and-match additions as well.  Explore your local shops for expert advice (and shop local to support your local merchants in town!)
  3. Maintain your child’s equipment, and replace it when it no longer fits them or works well.  Although it is more affordable to receive second-hand items or pass things down through the family, hypermobile kids often find that when ball bearings or wheels wear down, the extra effort required to use a device makes it harder to have fun.  The additional effort can create fatigue, disinterest in using the equipment, or awkward/asymmetrical patterns of movement that aren’t ergonomically sound.  Repair or replace either than force your child to work harder or move poorly.

Looking for more information about low tone and hypermobility?  Read The Hypermobile Hand: More Than A Strength Problem and How Hypermobility Affects Self-Image, Behavior and Activity Levels in Children.  My new e-book on living and thriving with hypermobility is coming soon on Amazon.com!

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Is Compulsive Gaming A Disorder…Or A Symptom?

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The WHO has recently classified compulsive gaming a mental illness.  I am not so sure.  What I do believe is that doing anything compulsively is a big problem for developing brains.  Is your child heading in the direction of using gaming or web surfing to deal with issues such as social anxiety or poor executive function skills?  Here is what you should be thinking about when you see your young child screaming because you have unplugged them from their tablet (or your phone, or your tablet):

  1. Have you (unintentionally) modeled this behavior for them?  I  don’t know any adult that isn’t tethered to their phone.  Whether for business or to keep track of where their spouse or children are/what they are doing, most of us have a phone that we look at repeatedly all day long.  When you are with your family, think carefully about how important it is to model the opposite and put it down as quickly as possible.  In effect, you are saying “You are more important to me than this device”.
  2. Be clear about what you are doing when you put down the phone in their presence and why.  In the spirit of The Happiest Toddler on the Block, which my readers know I adore, young children need to hear and see you explaining why you are doing what you do.  They don’t assume things the way we do.  Really.  The older they get, the more it appears that they are ignoring you, but don’t you believe it.  Parents are and always will be the most powerful models in a child’s life.  Forever.  Your teen may roll her eyes, but they are still open, and she is watching you.  So tell your child that you want to focus on them, and your phone is a distraction and you can always look at it later.  You want to be with them and pay attention to them.  I know this sounds a bit weird, even awkward and preach-y.  It isn’t if you do it with warmth and confidence.  Find your own wording, but the message is the same: I care more about you than I do about data.
  3. Look around.  Are your child’s activities, toys and games unsatisfying?  Don’t count the toys, look at them and what they offer your unique child.  An artsy child may need new paints, clay, yarn, etc.  A reader may need to go to the library or get a new book series.  Not a digital copy.  A young scientist might need a kit or a microscope.  A social kid may need more playdates or a creative class like cooking.  Their interests and needs may have changed since the last birthday or holiday.  If you want them to play instead of look at a screen, they need things that excite and inspire them, or the digital world will fill in the blanks.
  4. Does your child need help in building skills?  Shy kids, kids with ASD, or kids that don’t make friends easily can find the less-demanding digital world much easier to navigate.  Siblings sit quietly side-by-side, not fighting but also not learning how to solve interpersonal issues.  This isn’t preparing them to go out there and succeed.  The earlier you realize that your child is struggling, the faster you can stop bad habits and prevent rigid behaviors.
  5. I read a challenging piece this week on the origins of addiction to porn that might change your mind on dealing with gaming and digital devices.  The author’s suggestion was that early experiences have impressive power to wire the brain, to the diminishment of alternative methods of engagement and interaction.  I know, not exactly what you would expect me to discuss on my site.  But the problems of finding easy satisfaction through a non-challenging (and solitary) source of excitement fits this post.  Once a behavior is hard-wired into the brain’s system, it is going to be really difficult to change.   Not impossible, but really, really difficult.
  6. Should you ban all media?  You could, but you would be denying the reality that the world they live in is heavily digital.  I tell parents of the kids I treat that I use my tablet in sessions to teach kids that this is just one activity or toy, in the same way that I will eat cookies but not to the exclusion of everything else.  Putting the phone or the tablet away isn’t the end of the world, and using it is not a fabulous reward.

Looking for more on using technology with intent?  Read Want A Stronger Pencil Grasp? Use a Tablet Stylus .  To help kids engage and learn social and emotional skills, read Stop The Whining With The Fast Food Rule.  Yes, it really works!

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The Hypermobile Hand: More Than A Strength Problem

 

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

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

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

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

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

Don’t forget that hypermobility creates poor sensory processing feedback loops.  Reduced proprioception and kinesthesia will result in issues when children try to grade force and control movement without compensations such as visual attention and decreased speed. This can result in kids being labeled clumsy or careless.

Looking for ideas to address the difficulties children face when they have hypermobility in their hands? Take a look at For Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance and Does An Atypical Pencil Grasp Damage Joints or Support Function In Kids With Hypermobility?.  Depending on the age and skill level of the child, adaptations and education can be just as important as therapeutic exercise.  Your pediatric occupational therapist can help with more than pencil grasp; we are able to help with so many real-life issues!

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

Would you like more ideas about managing your child’s hypermobility?  Visit my website,  tranquil babies , and purchase a consultation session.  You can ask questions, get equipment sources and find out about treatment techniques that you can pursue with your team at home.  This is your chance to learn more about what low tone is, how it may be affecting your child’s progress, and have someone help you problem-solve for your child (or yourself)!

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

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

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

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

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

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

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

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

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

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

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

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Help Your Child Develop Self-Regulation With Happiest Toddler On The Block

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Children start learning self-regulation early.  Most kids eventually become reasonably skilled at it, given some help from loving adults.  The problem is they don’t learn it quickly.  Self-regulation takes a long time to become established in the slowly-developing brain of a young child.  While you are scooping up the puddle of Jell-O that used to be your toddler before she dropped her ice cream cone, think about how you can use this moment to build her ability to come back to a calm state:

  1.   Reflect her emotions without denying them or taking them on.  After all, you know that it isn’t the end of the world.  But at that moment, she can’t see it.  She is sad and maybe even angry.  Use the Fast Food Rule Use The Fast Food Rule For Better Attunement With Your Child to state what happened and how you think she feels.  Remember to use lots of gestures and alter your vocal tone to convey empathy.  Don’t be placid; after all, she needs to know that you get how unhappy this has made her.  Kids tune into your expressions much more than your words at this age.  You may think you should be soothingly quiet, but she is thinking ” You don’t see my pain!!”
  2. Make sure she knows that you care about what happened, and use this moment to identify what she is feeling.  Even if you intend to get her another cone, allowed her to be upset for a very brief period, and let her know that we call that feeling “sad”.  Kids depend on us to explain what happened to the dinosaurs, how to eat with a fork, and also how to identify and manage emotions.  Take that moment to explain that there is a name for what she is feeling, and that it is normal and understandable, even if you intend to fix it with another ice cream.
  3. Ask her if she wants another ice cream cone, but not too soon.  Sometimes children aren’t ready for our solutions, even if they do want them, and presenting one too early gives a message that we never intended:  I can’t handle your pain, you can’t either, and I need to fix it right away.  Look for that shift in body language, eye contact or verbal connection that tells you she is starting to pull herself together before you jump in with a solution.

 

If you find yourself more upset than your child, their pain ripping through you, take a moment to look inside and see what experiences in your past are contributing to this feeling.  You may have been taught the same lesson early in your own childhood.  If you received the message that pain is unbearable and should be avoided at all costs, you are not alone.  Well, I am going to tell you that an important part of your life, and a part of your child’s life is all about learning to feel feelings without fear and come back to a good place after a difficult experience.

Bad things happen to us all, and the most important lesson you can teach your child at this moment is that she can handle this feeling and come through it.  With your support, and with the support of other people who love her, she will get through the loss of her ice cream and other losses in life as well.

And it can start with how to handle the loss of an ice cream cone….!

 

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