Category Archives: kindergarten

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.
  • 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.

In my 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 Your Special Needs Child?

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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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Deluxe Water Wow Pads Offer More Challenge And More Fun To Preschoolers and Kindergarteners

 

91Wl4b-x3nL._SX425_.jpgMy clients and colleagues know how much I love the original Water Wow books.  They are reusable and mess-free fun for kids at home, at the doctor’s office, the restaurant and the plane ride.  These bigger books are going to be even more fun for preschool kids and kindergarteners!

Here are some great reasons why I love these books:

  • They have more pages, and more pages means they keep kids busy (and happy) longer.
  • They offer more detail and more challenge.  The graphics inspire critical thought (Is this a silly thing to find in the supermarket or not?) and the red lens that looks like a magnifying glass makes kids feel like Sherlock Holmes as they search for secret items.
  • There are mazes, hidden items and pages where kids can compare two almost-identical pictures and find the anomalies.  It is more than just wiping water on a picture.
  • Like the originals, the pages dry quickly and can be used over and over.  It seems like kids would get bored after the first run-through, but children can enjoy the “reveal” and the sensory play of water on a page for a long time after they have solved all the puzzles.  If you are at 30K feet and your kid is getting restless, this could buy you a bit of time without having to resort to screens that they will insist on for the rest of the (expensive) trip.  Genius.
  • Oh, and the pen is easy to grasp, and it develops a mature pencil grasp with repeated use.  Yeah!

I think these would be terrific holiday gifts.  If you are looking for more gift ideas, read Automoblox: For the Discriminating Preschool Gearhead and Melissa And Doug Tape Activity Book Is Reusable Fun for some other good toys that build skills while having fun!