Category Archives: parenting

Should You Install a Child-Sized Potty for Your Special Needs Child?

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Affordable accessibility and no institutional appearance!

I know that some of you don’t even realize that such a thing exists:  a toilet sized for preschoolers and kindergarteners!  Well, you won’t find it in Lowe’s or Home Depot on the showroom floor, but you can buy them online, and it is an option to consider.  Here are the reasons you might put one in your child’s main bathroom:

  1. You have the space already.  Some homes are large enough to allow each bedroom to have its own bathroom.   If you have the option, it might be worth it during renovations.  It shouldn’t add considerably to the overall cost, and it should not be that difficult to swap out when your child grows.  If you have a bathroom near the playroom, that might be another good location for this potty.  Most older kids and adults can make it to another half-bath on that floor, but it might be perfect for your younger child and his friends!
  2. Your child is terrified of the standard-height potty.  Some kids are unstable, some are afraid of heights, and some have such poor proprioception and/or visual skills that they really, really need their feet on the ground, not on a footstool.
  3. Your child was a preemie, and their growth pattern indicates that they will fit on this toilet comfortably for a while.  Some preemies catch up, and some stay on the petite size.  Those children will be able to use a preschool-right potty into early elementary school.  Even if your preemie is average in size, they may have issues such as vision or sensory sensitivity that will make this potty a great idea for a shorter time.

I am just beginning to build my materials to do in-home consultations as a CAPS, but I think that an underserved population are parents of special needs kids that would benefit from universal design and adaptive design.  This toilet would come under the category of adaptive design, and it is an easily affordable solution for some children.  Having more comfort on the toilet speeds up training for many kids.  It also decreases the aggravation of training and monitoring safety for parents.  I am very committed to helping the entire family have an easier time of things like toilet training.

Think about what your family’s needs and capabilities are, and if you are planning to remodel or build a new home, consider finding a CAPS professional in your area to help you make your home as welcoming for your special needs child as possible!

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How Being Toilet Trained Changes Your Child’s Life

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Think your child doesn’t care that he is wearing pull-ups in pre-K?  Well, he might not…yet.  After all, he doesn’t know another life.  He has been using a diaper (because we know that pull-ups aren’t anything other than a diaper, right?) for elimination since his first day of life.  Wait until he is trained, and you may see the difference that being trained will make for him.

Children who have accomplished toilet training have made a significant step forward in independence.  They are the masters of their domain, to borrow from Seinfeld.  Not needing help for something so personal, they have a different attitude about body ownership and privacy.  This is important and personally meaningful.  We want children to have pride in their bodies and a sense that they own them.  Even though you would never harm your child, when you are involved in their “business”, you are taking some of that pure ownership away.  The sooner they have a sense that they can manage alone, or with only a bit of help for the hard bits, they build their sense of self.

When kids master a major life skill, they often are more willing to take on other skills such as writing and dressing.  They are interested in holding their spoon and fork the “grown-up” way.  They have entered the world of the older child, in their minds.  And adults aren’t immune.  We see potty trained kids differently too.  When they are able to take care of themselves in the bathroom, we start raising our expectations for them as well, and treat them as older children, not babies.  And they react to our change in perception as well.  Toilet training can lift everyone up!

The practical realities of life mean that being trained allows them to go to activities and even schools that they wouldn’t be able to attend.  Pools and camps have rules, and being fully engaged with their community means being out there and participating as much as possible.

A mom told me yesterday that her 5 year-old told her “I am so happy that I can use the potty!”  It took him a long time to get all the skills together to be fully trained, and he is off on a family cruise next week.  This will be the first time he can attend cruise camp with his older brother.  He has arrived!

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The Not-So-Secret Solution for Your Child With Motor And Sensory Issues: Dycem

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In adult rehab, occupational therapists are regularly providing patients who have incoordination, muscle weakness or joint instability with both skill-building activities and adaptive equipment such as Dycem.  In pediatrics, you see a predominance of skills training.  Adaptive equipment shows up primarily for the most globally and pervasively disabled children.  I think that should change. Why?  Because frustration is an impediment to learning, and adaptive equipment can be like training wheels; you can take them off as skills develop.  When kids aren’t constantly frustrated, they are excited to try harder and feel supported by adults, not aggravated.

 

What Dycem Can Do For Your Child

Dycem isn’t a new product, but you hardly ever see it suggested to kids with mild to moderate motor incoordination, low tone, hypermobility and dyspraxia.  We let these kids struggle as their cereal bowl spills and their crayons roll away from them.  Dycem matting is a great tool for these kids.  It is grippy on both sides, but it is easy to clean.  Place a terrific bowl or plate on it OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues, and it won’t tip over with gentle pressure, and even if the surface has a slight incline.  It lasts a long time, and can be cut into any shape needed for a booster seat tray or under the base of a toy like a dollhouse or a toy garage.  The bright color contrasts with most objects, supporting kids with visual deficits and poor visual perceptual skills.  It catches their eye and their attention.

How To Use Dycem To Build Motor Skills

Will it prevent all spills or falls?  No.  But it will decrease the constant failures that cause children to give up and request your help, or cause them to refuse to continue trying.  Children are creating their self-image earlier than you realize, so helping them see themselves as competent is essential.  Will it teach kids not to use their non-dominant hand to stabilize objects?  Not if an adult uses it correctly.  Introducing Dycem at the appropriate stage in motor development and varying when and where it is used is the key.  Children need lots of different types of situations in order to develop bilateral control, and as long as they are given a wide variety of opportunities, offering them adaptive equipment during key activities isn’t going to slow them down.  It will show them that we are supporting them on their journey.

The Cheap Hack:  Silicone Mats

I will often recommend the use of silicone baking mats instead of dycem.  These inexpensive mats often do the job at a lower cost, and can be easily replaced if lost at daycare or school.  Dycem is a specialty item that can be purchased online but not in most stores.  Silicone mats aren’t as grippy, but they are easily washed and dried.  Some families are averse to anything that looks like adaptive equipment, so I may introduce these mats first to build a parent’s confidence in my recommendations.

How An Aging-In-Place Specialist Can Help You Design an Accessible Home for Your Child

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I finally did it; I got my CAPS certification!  I know, you are asking yourself “What does a pediatric occupational therapist want with an Aging-In-Place certificate?”  Well, as it turns out, many of the barriers and home access problems that require redesign or better design for older adults are also issues with children dealing with developmental issues.  And they deserve the most functional home they can possibly have!

I treat children in their homes, so I see a wide variety of situations.  Here are a few of the most common problems I encounter:

  1. Entries and stairs that don’t have railings at a helpful height for children with motor control issues.  If your child is likely to struggle with stairs for a while, adding a lower railing on both sides of the stairs is very, very helpful.  They can be removed later on, but since you cannot alter the risers (the height of the steps) without major construction, do what you can to give your child a secure handhold.
  2. Slippery floors.  Tile can be treated to make it just a bit tackier, but not feel like gravel.  Online sellers will offer this, and you can apply it yourself if you are skilled, or hire a tile company to coat your tile for you.
  3. Right-height work areas.  Young children with motor issues often need the play table to be the correct height for them.  Their reach and grasp, as well as their balance, improves when they are sitting well.  But they grow.  What can you do?  I suggest buying an inexpensive wooden table and cutting the legs until they are the right height.  When your child outgrows it, buy a new table and trim the legs as needed.   You can add brackets on the leg joints to add stability to an inexpensive table.

If you are in the market for a new home, a CAPS professional can help you think about accessibility as a factor when shopping for real estate.  Although the easiest way to achieve universal access is to build a new home, there are homes that are easier to adapt, and home that are nearly impossible.  Being able to see what a house offers is more than location, location, location.

Know what the implications of your child’s diagnosis means for accessibility and function.  Children with cystic fibrosis, cerebral palsy, or muscular dystrophy will likely do better in a ranch house or a house with an elevator.  Don’t think you have the room for an elevator?  You might, you might not, or you might install a lift instead.  Your CAPS consultant can help you look at all the options.  Improving bathing, grooming and safe play spaces is on the list of things that a CAPS professional can address.

I will be exploring all of my options for consulting as a CAPS, but my training as an OTR and my background in adult and pediatric home care means that I will be as excited to help young families as to help older people.  Who knows: I may decide to offer a multi-generational package of services!  Stay tuned for more information and suggestions for accessibility!

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Could Your Pediatric Therapy Patient Have a Heritable Disorder of Connective Tissue?

 

vincent-van-zalinge-752646-unsplashTherapists see lots of hypermobile kids in clinics and schools.  I see hypermobile children  every week in their homes for private sessions, consultations and ongoing treatment through Early Intervention.  My estimate is that at least 25% of kids over 5 and almost 50% of the younger kids I have treated have some degree of hypermobility.  But young children are naturally more flexible than older kids, and there are other diagnoses that include hypermobility.  What would cause  a therapist to suspect a rare CTD when so many children have this one symptom?

You observe the systemic signs and symptoms that could indicate an HDCT, and you ask their parent(s) for details about their health and activities.  You will need far more information than you can get from your intake evaluation to explore the possibility of a heritable disorder of connective tissue.

Here are a few of the more common current or past indicators of a HDCT:

  • Multiple joint involvement.  Not just lax hands, but laxity at many joints, both small and large at times.
  • Skin that is either very smooth, very thin, or bruises easily, and bruises in places that are not common sites for active children.  For example, shins and dorsal forearms are commonly bruised in play.  The medial aspect of the thigh and the volar forearm, not so much.  It is not uncommon for ER staff to incorrectly suspect abuse when they see this pattern, so be aware that as a mandated reporter, you have to ask more questions before you make that call.
  • Sensory processing issues that are primarily poor proprioception, sensory seeking and perhaps poor vestibular functioning.  Children with a HDCT may have no sensory sensitivity and no modulation issues, and good multi-sensory processing.  Why good?  The more information they receive, the less the impact of poor proprioceptive input makes on performance.  With good positioning and support, their sensory issues seem to significantly disappear or are eliminated Hypermobility and ADHD? Take Stability, Proprioception, Pain and Fatigue Into Account Before Labeling Behavior.
  • Lower GI issues or incontinence issues.  These kids may have more toilet training problems and more issues with digestion than your micro-preemies at ages 4 or 5.  Girls may have a history of UTIs, and both genders can take a long time to be continent all night Teach Kids With EDS Or Low Tone: Don’t Hold It In! You may hear about slow GI motility or a lot of sensitivity to foods that are not common allergens in children.
  • Dental issues such as bleeding gums or weak enamel.  Remember, if it is a CTD, then there will be problems with many kinds of tissue, not just skin or tendons.  Read Hypermobile Child? Simple Dental Moves That Make a Real Difference in Your Child’s Health for more practical ideas.
  • Strabismus or amblyopia are more commonly seen in HDCT.
  • Really slow progress in therapy, even with great carryover and a solid team.
  • Recurrent injuries from low-impact activities that were well-tolerated the day before.   Micro-trauma can take a day to develop into pain, swelling or stiffness.  You  could see overuse trauma that doesn’t make sense at first, because the overuse is just regular levels of activity but for a CTD, this IS overuse.

Should you say something to a parent?  I don’t have a license to diagnose children, but I may contact their referring physician if I see many indications that a child needs more evaluation.  More directly, I can help parents manage the issues that fall within my practice area, and educate families about good joint protection, equipment choices, and body mechanics.

 If a child does have a HDCT diagnosis,  the current and future risks of certain sports and careers should be discussed with families.  As therapists, we know that early damage can contribute to significant impairment in decades to follow.  Just because a child isn’t experiencing severe pain now isn’t an indication of the safety of an activity.  Understanding the many ways to adapt and adjust to ensure maximal function and maximal preservation of function is embedded in every OT.  Adapt your treatment protocols to respect the nature of a CTD, such as in  Can You K-Tape Kids With Ehlers-Danlos and Other Connective Tissue Disorders?

We can make a difference for these kids and their families, but only if we know what we are really looking at.

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Raising a Gifted Child? Read “A Parent’s Guide to Gifted Children” For Successful Strategies

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Raising a gifted child isn’t all rainbows and first place ribbons.  Especially in the early years, the intensity, drive and complexity that gifted children bring to the table can come out looking like bossiness, perfectionism and extreme sensitivity  How To Spot A Gifted Child In Your Preschool Class (Or Your Living Room!).  Many books try to explain why gifted individuals are challenging, but this book is unique. It is offering parents clear strategies to help their child thrive and help them navigate school and social activities with confidence.

A Parent’s Guide to Gifted Children is written by four leaders in gifted education and research.  James Webb, PhD, was a strong supported of the gifted community and gifted children in particular.  The other authors; Janet Gore M.Ed., Edward Amend Psy.D and Arlene DeVries M.S.E., are all specialists in this area.  They offer useful information about both the benefits of giftedness and the challenges in every chapter.

This book is unique in many ways.  It offers solid parenting advice, not theories and research studies.  Gifted children are still children who require support, limits, education and love.   The authors are eager to give parents tools to make life at home and school easier.  Gifted kids can be misunderstood, teased or excluded. Dealing with this is not easy for any parent.  They even acknowledge that parents themselves may be criticized or mocked for advocating for their child’s needs.  The chapter on what to do if your child is twice-exceptional (for example, having a learning disability in addition to giftedness) address getting help for both skills and areas of challenge.  It also helps parents consider whether their child’s diagnosis is accurate.  Many characteristics of giftedness can be seen incorrectly as ADHD, bipolar illness or ASD.  Getting the right diagnosis is essential to maximizing your child’s abilities and happiness.

One aspect of giftedness that is rarely addressed in this much detail but is solidly reviewed here is the emotional sensitivity often seen at an early age.  This book spends considerable space on helping parents teach their gifted children how to handle frustration, perfectionism, and even existential depression.  What is that?  A child that can comprehend the level of danger and inequality in the world at a young age may not have the emotional ability to come to terms with this knowledge.  The authors do a terrific job of explaining the sources of  a gifted child’s pain and offer concrete advice to parents.

There is so much to say about the joys and the pitfalls of parenting gifted children of any age.  This book does an excellent job of helping families (and educators) see the road ahead and handle it well.

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How To Stop Your Toddler From Hitting You

 

patrick-fore-557736When your sweet little baby turns into a toddler that smacks you, you may be so shocked that you don’t know how to react.  The second time you get hit, or pinched, or even bitten in anger, you might feel a level of rage come up that is both surprising and horrifying.  Well, I am not going to shame you for any of that.  I want to help you get this under control and help your child handle what is (probably) a normal level of aggression.

Yes, this is likely a normal response for toddlers.  They have really limited language, hardly any understanding of their own feelings, and they live in the moment.  You probably have one of the 85% of kids who are not placidly calm most of the time.  If you have a very young child with a strongly spirited temperament (15-20% of the population) then you probably see this behavior at least a few times a week, if not daily.  It’s still normal. And you have to deal with it or you will have a bigger, stronger, and more aggressive child next year.

Here are my suggestions to deal with aggression:

  1. You are going to have to use Dr. Karp’s Fast Food Rule.  The first simple step is to state what you think your child is thinking, such as ” You say “No go inside”, in as short and simple a phrase as you can, based on age and level of emotion.  The younger and more angry your child is, the simpler the message.  Match your expression and gestures to the emotion you are stating.
  2. Wait for a shift in body language or level of screaming.  Repeat the phrase if needed, may be more than once.  Then state “No (biting, hitting, throwing)” and you say  “I don’t like it” or a “We don’t hit” if your child isn’t totally out of control.  If they are out of control, you have to wait until they can hear you.
  3. You must make it clear that YOU don’t like this behavior, not simply that it isn’t “nice”.  Why?  Because a personal message is more powerful to a toddler than stating that they broke the rules.  I even throw in “That scared me and I don’t like it” to slightly older toddlers, to come down to their level.  They might be a little surprised, but they know all about being scared.  You aren’t admitting weakness, you are telling them how they crossed a line.  As long as you are using body language that tells them you are still the adult in control, this helps them understand the seriousness of what they did.  But the 12-18 month olds don’t get that, so wait until they are older to add that one in.
  4. If you were holding your child when this happened, put him down. Nothing says confuse me like saying these phrases while cuddling.  If you were sitting next to them, move away a bit.  The message is that they have crossed a line, because they have.  They may cry about this, but that is OK.  For now.  Once they shift out of aggression, you can be more welcoming.  Get it?  Good behavior we welcome, aggression we do not.  Simple.
  5. If you see the clouds building and you can anticipate your child will hit, bit, kick or throw, you are allowed to intervene.  Pull your arm away, put them down, reach for the toy you think she will throw, or move away.  You could say “I don’t want you to kick” and then offer a solution.  This solution could be what you think your child needs, like a nap or a snack, or it could be something amusing, like looking in your purse for your keys.  Young toddlers can switch things easily.  Older toddlers sometimes commit to aggression and they won’t take the bait.  But sometimes they will.
  6. Don’t be afraid to issue consequences.  I don’t believe in physical punishment, but I have no problem with removing toys that got thrown or issuing kind time-outs.  Losing the opportunity to go do something fun because you tossed your boots at my head is just fine for me.  I never reward bad behavior.  Ever.  I have too much to lose if a child thinks that aggression will work to avoid something or receive something.  Kids can hurt themselves in the process of being aggressive, and that is always going to be my fault.  Not a chance.
  7. I always give children a chance to come back into the fold.  Maybe not to get the same thing they were being aggressive about, but a new fun thing.  You have to wait until they are calm to do this.  This isn’t coddling.  This is teaching them how I want them to behave, and that there is always a chance to do things better.