Category Archives: self-care skills

Improving Daily Life Tasks for Kids With Special Needs

 

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Therapro, the terrific source for a lot of handy therapy equipment and especially for items that help kids with sensory processing issues, has posted another piece from me on ADLs.  Take a look: What Helps Special Needs Kids Tolerate Grooming and Hygiene?

“Activities of Daily Living” don’t have the cache’ of kineseotaping or therapeutic listening, but helping families improve the little things in life is something I haven’t ignored.  The basics of life are still the basics, and when they are a struggle, life gets harder.  Every single day.

Sometimes using SI techniques like the Wilbarger Protocol Can You Use The Wilbarger Protocol With Kids That Have Ehlers-Danlos Syndrome? makes self-care activities better, but sometimes you need a targeted approach.  This post describes some of my best strategies to make face-washing, tooth-brushing, dressing and bathing easier for kids to tolerate and they also help them to become independent at these important skills.  After all, one of the best techniques to reduce defensiveness/aversion is to have a child do the task independently.  They can control the pace, the amount of force and the timing.  And they are empowered.  So many kids with special needs develop the impression that they don’t have the ability to do things for themselves.

So check out my post on Therapro, and then go shopping for some of their terrific materials for your child or for your therapy practice!

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The view north from West Point.  Welcome spring!

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OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues

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Does your child knock over her milk on a daily basis?  Do utensils seem to fly out of your son’s hands?  I treat kids with hypermobility, coordination and praxis issues, sensory discrimination limitations, etc.; they can all benefit from this terrific line of cups, dinnerware and utensils.

Yes, OXO, the same people that sell you measuring cups and mixing bowls: they have a line of children’s products.  Their baby and toddler items are great, but no 9 year-old wants to eat out of a “baby plate”.

OXO’s items for older kids don’t look or feel infantile.   The simple lines hide the great features that make them so useful to children with challenges:

  1. The plates and bowls have non-slip bases.  Those little nudges that have other dinnerware flipping over aren’t going to tip these items over so easily.
  2. The cups have a colorful grippy band that helps little hands hold on, and the strong visual cue helps kids place their hands in the right spot for maximal control.
  3. The utensils have a larger handle to provide more tactile, proprioceptive and kinesthetic input while eating.  Don’t know what that is?  Don’t worry!  It means that your child gets more multi-sensory information about what is in her hand so that it stays in her hand.
  4. The dinnerware and the cups can handle being dropped, but they have a bit more weight (thus more sensory feedback) than a paper plate/cup or thin plastic novelty items.
  5. There is nothing about this line that screams “adaptive equipment”.  Older kids are often very sensitive to being labeled as different, but they may need the benefits of good universal design.  Here it is!
  6. All of them are dishwasher-safe.  If you have a child with special needs, you really don’t want to be hand-washing dinnerware if you don’t have to.

For more information about mealtime strategies, please take a look at Which Spoon Is Best To Teach Grown-Up Grasp? and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child.

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What Helps Sensitive Kids Handle Haircuts?

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Depending on your child’s age and issues, getting a haircut can be anything from a chore to a dreaded event that you put off, and then put it off a bit more.  So many kids fear them:  kids with ASD, kids with sensory issues, children that have had multiple hospitalizations or procedures, children with anxiety disorders.   I have been asked by parents of children well into grade school to help them with the problem of getting their child to the barber or hairdresser without a major fight.  My strategies are informed by my training as a pediatric OTR and as a Happiest Baby on the Block educator.

My approach to improving a child’s tolerance for a haircut is based on three goals: reduce the novelty of the experience, reduce the sensory impact of the haircut, and build their overall coping strategies based on their developmental level.

  1. You can borrow techniques from “exposure therapy” to make the experience of getting a haircut more familiar.  The very first step could be making combing or brushing their hair a non-event.  Explore what tool is the most comfortable for your child, and gradually introduce combs and even hair clippers.  Let them turn the clippers on and off ( establish safety rules first) and let them hear the clippers both far away and close to their ears.  Let them comb their hair first, then allow you to do so.  Washing their hair in the bath is another experience that you can use for pretending that you are giving them a haircut.  You can also get a bit wet and allow  them to pretend to cut your hair.  I have safety scissors that don’t cut anything but paper  Lakeshore Scissors for Toddlers That Only Cut the Paper, Not the Toddler  that work very well for this experience.  Expand grooming so that it can happen at different times of the day and in different locations in your home.  It needs to become as much of a non-issue as possible at home before a child is truly comfortable in the hair salon.
  2.  Remember that the entire experience of receiving a haircut has strong sensory components:  the salon and the sight, sound and smell of it’s other staff and customers, the tools used to cut hair, the feel of the chair and the drapes on your child.  They can all be contributors to agitation and aversion.  How can these be minimized?  Early appointments might be less crowded, there may be ways to apply water or lotions to reduce the experience of being sprayed, or children can be actively involved in saying that they are ready rather than feel attacked when they don’t expect touch.  Some kids just to be told before the event that their hair will be sprayed, or they need to feel in control of the timing.  Your child may seem too old to sit on your lap, but it could help them stay calm.  Ask if this is something they would like.  Your hairdresser is interested in doing a good job without a lot of drama.  Most of them will work with you.
  3. Many of the kids I see that struggle with haircuts also struggle handling frustration and anticipatory anxiety in general.  They are used to big dramatic exchanges when asked to do the things that are expected of them that they CAN tolerate.  These kids have often spent years developing a dance of refusal and opposition that they are now stuck in with their parents.  In my sessions, they quickly learn that I don’t engage this way; I am a no-drama girl.  I set limits and consequences, and I provide options so they feel they are working with me, not against me.  I use Dr. Harvey Karp’s Fast Food Rule and use all of his “Feed The Meter” strategies Turn Around Toddler Defiance Using “Feed the Meter” Strategies to build a sense of compassion and communication.  Both of these Happiest Toddler strategies work well with older children because anyone that is upset is thinking and behaving at a lower developmental level.  My best strategy is simple:  I stop a challenging task before a child has the chance to bail.  I may introduce another task that is similar and still offers challenge.  Stopping isn’t always ending the overall challenge.   The child’s experience is that they don’t have to fight to get a break, as for support or have adjustments made.  I am now their partner in learning to handle haircuts, dressing or nail cutting, not an authority making demands.
  4. Try not to minimize their distress, even if you can’t see why they feel that way.  In Why Telling Your Toddler “It’s OK” Doesn’t Work (And What To Do Instead)  , I wrote about how important it is to actively validate a child’s perspective.  with children that have sensory issues, this is huge, absolutely huge.

It is my belief that if you can help a child handle the daily challenges of their life with compassion, respect and skill development, that child will trust that you can help them with the other events in life that make them frightened or overwhelmed.  They have a new sense of how to manage their behavior, and believe that adults are resources for learning and partners in growth.

Looking for ideas on nail trimming or dressing as well? Read Why Cutting Nails Is Such a Challenge for Autistic and Sensory Kids and Dressing Without Tears: Sensory-Sensitive Strategies That Work

And don’t forget that my e-book on toilet training is out there to help you with this challenging skill:  The Practical Guide To Toilet Training Your Child With Low Muscle Tone isn’t just for kids with low tone; kids with ASD and sensory processing issues can use these strategies to build skills that help them make real progress quickly! You can buy my e-book on my website Tranquil Babies, at Your Therapy Source (a terrific site for OT workbooks and other products), and on Amazon.

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Teach Utensil Grasp and Control…Without the Food!

Therapro has just published my latest guest post! There are some situations that almost require occupational therapists to separate mealtime from utensil manipulation, at least at the earliest stages.  Check out my post Teaching Utensil Use Outside of the Mealtime Experience to find out if your child or client would benefit from this approach!

If you haven’t already read this very popular post I wrote earlier, make learning to use utensils an opportunity to bond emotionally,  take the pressure of self-feeding off the table and help an avoidant child engage in food play with Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child.

Therapro has been one of my go-to sources for quality therapy equipment for years.  Take the time to review their catalog online and explore their unique bowls, plates and utensils that can help children with developmental delays achieve independence in self-feeding.

Hypermobile Kids, Sleep, And The Hidden Problem With Blankets

 

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Everyone knows that sleep is important.  Research in sleep science (yes, that is a thing) tells us that our brains are working to digest the day’s learning, the immune system is active during sleep, and our bodies are repairing and renewing tissues and organs while we slumber.  As much as we need sleep, kids need it more.  They are building the brains and bodies they will carry into their future.  Children need good quality sleep as much as they need healthy food.

Helping children to sleep well is usually a combination of creating good and consistent bedtime routines, giving them a full day of physical action and warm social interaction, and developing a healthy sleep environment.  This means providing a sleep-positive environment and removing any barriers to sleeping well.  But giving kids the chance to get a good night’s sleep can be harder when a child has hypermobility.

Some of the challenges to sleep for hypermobile kids are sensory-based, some are related to activity during the day, and some are orthopedic.  Here is a list of things that make sleep more challenging for these kids:

  • Children with limited proprioception and kinesthesia due to low tone or excessive joint mobility can have difficulty shifting down into a quiet state for sleep.  They spend their day seeking sensory input;  not moving reduces the sensory information that makes them feel calm and organized.  Being still is a bit similar to being in a sensory deprivation tank, and it’s not always calming.  To understand more about the sensory concerns of hypermobility, take a look at Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children.
  • Some hypermobile kids have joint or muscle pain that keeps them up or wakes them up in the middle of the night.  Pain also makes kids more restless sleepers.  Restless sleepers thrash around a bit under the covers, becoming trapped in multiple layers of bed linens, or they can fall asleep in awkward positions that result in pain.
  • Children that are sedentary during the day for any reason (preference for tablet or video play, fatigue, pain, etc) may not be physically tired enough at night.  They may also be staying up too late at night.  Good sleep hygiene includes enough daytime activity combined with a conscious wind-down hours before bedtime occurs.
  • Some children with generalized low tone or joint hypermobility (especially with a connective tissue disorder) have issues with the partial collapse of their airway during sleep.  They snore or gasp in their sleep, and appear exhausted even after a full night’s sleep.  This is a serious issue.  Sleep apnea should be evaluated and addressed by a professional.
  • Hypermobile kids can get arms and legs caught in their bedclothes or between crib slats and mattresses.  Any layer can be a potential problem, from the sheet to the decorative afghan that Granny sent for his birthday.
  • Limbs can slide off the mattress during deep sleep and create strain on ligaments and tendons.   You and I depend on our brain to perceive an awkward position and take corrective action by waking us slightly.  The same child who “w” sits and slides off a chair without noticing is not going to wake up when her arm is hanging off the bed during sleep, even though the tissues are stretching beyond their typical range of motion.

Here are some simple strategies that may improve your child’s sleep:

  • Try a duvet or a flannel sheet set to minimize the number of layers of bedclothes.
  • Use a rashguard suit instead of pajamas.  I am particularly fond of the zip-front style so that less force is needed to get arms in and out while dressing.  You can peel it off more easily.  The lycra creates sensory feedback that can support body awareness while keeping them cozy.  An all-in-one suit also gives a bit of support so that limbs don’t easily overstretch.  A little bit of proprioceptive input in a breathable fabric that can also generate a bit of neutral warmth (from body heat) to keep tissues from getting too stiff.
  • Avoid footie sleepers that are too short.  Too-small footie sleepers create compressive forces on joints and could even encourage spinal torque.  Hypermobile kids will be the last ones to complain since they often don’t feel discomfort right away.  My preference is not to use these sleepers at all with hypermobile kids or kids with low tone.  See the next suggestion for another reason why I feel this way.
  • Make them take off those footie sleepers when they wake up and walk around.  As fabric twists and children stand/walk on the fabric, not the soles, it creates a safety risk underfoot.  Less sensory feedback and slippery soles!!  Get them dressed once they wake up.
  • Address sleep apnea, lack of daytime activity, and toilet training/scheduling rather than waiting for things to improve.  Not all young children achieve night time dryness on pace with other children, but ignoring the impact isn’t going to help things.
  • Carefully consider the issues before you try a weighted blanket.  Originally sold for kids on the autistic spectrum and for kids with sensory processing disorders without muscular or orthopedic issues, these blankets have become popular with other groups.  The biggest concern for hypermobile kids is that placing weight (meaning force) on an unstable joint over time without conscious awareness or adult monitoring is a safety issue.  It is possible to create ligament injury or even subluxation of a joint with weights, depending on limb position, length of time weight is applied, and the amount of force placed on a joint.  Talk the idea of a weighted blanket over with your OTR or PT before you order one of these blankets.
  • Consider aromatherapy, gentle massage, white noise machines, and other gentler sleep strategies to help your child sleep well.  For kids who sleep well but wake up stiff, learn how to use gentle massage and possibly heat to help them get going.  do not ignore pain at bedtime, or complaints of pain on awakening.  These are important clues that you need to address.   Ask your occupational therapist or your pediatrician for ideas to adapt your bedtime routine (OT)  or your pain plan (MD) to handle nighttime pain.
  • Try K-Taping or Hip Helpers for stability.  Kineseotape stays on for days and gives joint support and sensory input while your child sleeps.  Hip Helpers are snug lycra bike shorts that limit extreme hip abduction for the littlest kids (legs rotate out to the sides excessively).  They gently help your child align hip joints correctly.  As with weighted blankets, I strongly recommend consulting with your therapists to learn about how to use both of these strategies.  When used incorrectly, both can create more problems for your child.

Looking for more information about managing hypermobility in children?  Take a look at Should Your Hypermobile Child Play Sports? and Hypermobility and ADHD? Take Stability, Proprioception, Pain and Fatigue Into Account Before Labeling Behavior.

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Potty Training Boys: Do You Teach Standing Up Or Sitting Down?

 

darran-shen-477150.jpgTraining children for bladder control before bowel control is often easier for quite a few reasons:  More frequent bathroom trips = more opportunities for success, digestion and diet issues don’t stall success,  and urination is usually a painless, phobia-free, and quick experience.  In general, families that hire me as a consultant are encouraged to consider bladder training to be the first mountain to conquer.

But should little boys sit or stand to do the deal?  After a child has been sitting on the potty, understands it’s use, and has consistent success, I will encourage parents to have their sons stand to urinate.  But it isn’t as simple as that.  There are pros and cons.

First, the pros of standing to urinate:

  • little boys have probably seen their brothers, cousins and dad use the toilet, and most children want to copy their same-gender parent.  This is often more motivation to become independent in the bathroom.
  • young children may be a little more mindful of why they are standing in front of the toilet.  Children that are sitting have a harder time seeing what is happening and can get distracted. I know, I know, even the “big boys” can have terrible aim.  But children need all the help they can get to stay focused.
  • improving aim is motivation to use the toilet.  I wrote a blog post on using targets to teach boys to improve their accuracy and build interest in toileting.Piddlers Make Potty Training Fun!  These really work!

And now the cons:

  • See the item about distractibility under “pros”.  Some boys are so distracted that sitting on an toilet seat insert with a splash guard is the only way to prevent spraying the bathroom and any supervising adult.
  • Some children will start out urinating and begin to have a bowel movement concurrently.  Oops!  These children often have issues with low tone or digestive problems, and cannot “hold it” long enough to finish urinating and then sit on the toilet to have a bowel movement.  If they have an accident, it could be very upsetting to them and make them less eager to be fully trained.
  • Children with low muscle tone or postural stability issues may need to sit to achieve a safe and stable position.  No one can eliminate when they are unsteady or fearful.

Some children are vocal and clearly tell you what they want to do and why.  Some cannot or will not communicate, but you can figure out what they are thinking.  Some need to be encouraged to give standing a try.  If your son was initially interested and now has lost some of his enthusiasm and is still sitting to urinate, try telling him that it is time to stand like the big guys and see if you can regain some of your momentum in toilet training!

For more information on toilet training children with low muscle tone, check out my other posts such as   Low Tone and Toilet Training: The 4 Types of Training Readiness   as well as my useful e-book.  Here is a post that explains why this unique book will help you move forward with training right away! The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

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Make Wiping Your Child’s Nose Easier With Boogie Wipes

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

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

I was wrong.  These really work.

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

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

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

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

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

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

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