Category Archives: self-care skills

A Great Toilet Training Book for Neurotypical Kids: Oh Crap Potty Training!

sean-wells-471209My readers know that I wrote an e-book on potty training kids with low tone ( The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! ) but I have to admit, I learn a lot from other authors.  Jamie Glowacki  has written a terrific book that speaks clearly and directly to parents who aren’t sure they are up to the challenge of toilet training.  Oh Crap Potty Training is a funny title, but it is filled with useful ideas that help parents understand their toddler better and understand training needs so they can tackle this major life skill with humor and love.  I have to admit, I am really happy that she suggests parents of kids with developmental issues ask their OT for advice.  So few parents actually do!

Here are a few of her concepts that illustrate why I like her book so much:

  1. She gets the situation toddlers find themselves in:  using the potty is a total change in a comforting daily routine.  Jamie points out that since birth, your child has only known elimination into a diaper.  The older they are when you start training, the longer they have been using diapers.  WE are excited to move them on, but they can be afraid to sit, afraid to fail, and afraid of the certainty of the diaper always being there.  You can’t NOT get it in the diaper!  She also gets the power struggle that can be more enticing to an emerging personality after about 30 months of age.  Just saying, she gets it.
  2. Potty training success opens meaningful doors for kids, diapers keep them back.  Some great activities and some wonderful schools demand continence to attend.  By the time your child is around 3, they can feel inferior if they aren’t trained, but not be able to tell you.  They express it with anxiety or anger.  If you interpret it as not being ready, you aren’t helping them.
  3. Some kids will NEVER be ready on their own.  I know I am going to get some pushback on this one, and she already says she gets hate mail for saying it.  But there is a small subset of kids who will need your firm and loving direction to get started.   Waiting for readiness isn’t who they are.  If you are the parent of one of these kids, you know she’s right.  Your kid hasn’t been ready for any transition or change.  You have had to help them and then they were fine.  But this is who they are, and instead of waiting until the school makes you train her or your in-laws say something critical to your child, it might be OK to make things happen rather than waiting.
  4. You must believe that you are doing the right thing by training your child.  They can smell your uncertainty, and it will sink your ship.  She really sold me on her book with this one.  As a pediatric therapist, I know that my confidence is key when instructing parents in treatment techniques for a home program.  If I don’t know that I am recommending the right strategy, I know my doubt will show and nothing will go right.

If you are looking for some ideas on training kids of all stripes and needs, check out my posts  For Kids Who Don’t Know They Need to “Go”? Tell Them to Stand Up and Toilet Training For Preschool And Stuck in Neutral? Here’s Why…...  Of course, if your child has low muscle tone or hypermobility, my e-book will help you understand why things seem so much harder, and what you can do to make potty training a success!

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For Kids Who Don’t Know They Need to “Go”? Tell Them to Stand Up

 

photo-1453342664588-b702c83fc822For children with either low muscle tone or spasticity, toilet training can be a real challenge.  If it isn’t clothing management or making it to the potty on time, they can have a hard time perceiving that NOW is the time to start heading to the toilet.

Why?  Often, their interoception isn’t terrific.  What is interoception?  Think of it like proprioception, but internal.  It’s the ability to identify and interpret sensory information coming from organs and internal tissues.  Among them, the pressure of a full bladder or a full colon.  If you can’t feel and interpret sensation correctly, your only clue that you need the potty is when your pants are soiled.  Uh-oh.  A child with muscle tone issues is almost certainly going to have sensory issues.  Tone will affect the amount and quality of sensory feedback from their body.

What can you do to help kids?  The simplest, and the fastest solution I have found, is to tell them to stand up and see if they have changed their mind.  Why?  Because in a sitting position, the force of a full bladder or colon on the abdominal wall and the pelvic floor isn’t as intense.  Gravity and intra-abdominal pressure increase those sensations in standing.  More sensation can lead to more awareness.

So the next time your child tells you they don’t have to “go”, ask them to stand up and reconsider their opinion.  Now, if they are trying to watch a show or play a game, you aren’t going to get very far.  So make sure that they don’t have any competition for their attention!

Looking for more information on toilet training?  Well, I wrote the (e) book!  The Practical Guide To Toilet Training Your Child With Low Muscle Tone gives you readiness checklists and ways to make readiness actually happen.  It has strategies you can use today to start making progress, regardless of your child’s level of communication and mobility.  Learn what occupational therapists know about how to teach this essential skill!  It is available on my website tranquil babies, on Amazon and on a terrific site for therapists and parents Your Therapy Source.  Read more about my unique book:The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

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Universal Design For Parents of Special Needs Kids: It’s Important for You Too!

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Stunning, but how many potential safety problems can YOU spot?

I just finished the coursework for my CAPS certification (certified aging-in-place specialist)!  Amazing instructor and loads of valuable information about construction and renovation that only the National Association of Home Builders could impart.   And not just for aging-in-place; the concepts of accessibility make homes more visitable for family and friends, and more livable and adaptable for the future.   Now I have to decide how to add this knowledge to my practice to help families make their lives easier and better….might as well start blogging about it now!

Universal design is more visible in public places.  Hotels are installing features that make showers more accessible and banks are providing variable-height counters to fill out deposit slips.   But most of us don’t think that we need universal or accessible design in our own homes as non-disabled adults.  Wrong.

Universal design allows your great-grandmother more ease when she wants to meet your baby in your own home.  It helps your neighbor with multiple sclerosis come over and water your plants when you take the kids to Disney.  And it allows you to carry a kid, carry a bag and pull the dog into the house without dropping one of them.  Universal design also allows your husband, who tore his achilles tendon during a pickup basketball game, to get into the shower by himself while he decides if he can admit he’s not 25 anymore.

 But for parents of kids with special needs, the need is two-fold: universal design helps them do a demanding physical job, but it also allows their children more independence earlier. These parents are lifting and carrying heavier children than they might otherwise.  In and out of the car, the crib, the stroller and more.  There is a big difference between lifting a 20-pound toddler and a 47-pound preschool child wearing heavy AFOs.  Parents are hauling around equipment like therapeutic strollers, standers and medical equipment every day.  I have written a bit about positioning your child How To Get Your Special Needs Child To Sit Safely In The Tub and Kids With Low Muscle Tone: The Hidden Problems With Strollers , but now I will be addressing design beyond equipment.

Universal design’s principles of low physical effort and adequate size/space for approach and use will give enough room at a landing for the stroller, and the parent, and the dog.  It will make it possible for your child to open the door for himself and to reach the sink without being held up to the water.   Universal design’s principles of equitable and flexible use will allow children more access with less assistance as they build skills.  The principles of simple and intuitive use, tolerance for error and perceptible information reduces confusion and safety risk to children.  A good example would be faucets with both temperature control valves to prevent scalding and handles marked with red/blue codes instead of H/C.  No reading interpretation is required once your child knows “red is hot” or “red is stop”.  That happens easier and earlier than reading skills.

I don’t hear a lot of parents complain about the wear-and-tear on their bodies as they care for their children, but I see it.  Parents: don’t think that because you don’t say anything that your occupational therapist isn’t aware that your back is giving out.  That is a shame, because OTs could be helpful to parents in this situation.  Not in telling them to hire help, but in teaching them how to move with more ease and how to select and use equipment based on universal design principles to make life better for everyone.

Maybe after this post, I will be hearing from all those parents who go to bed tired and wondering how they will be able to keep up with the physical demands of special needs parenting over the years to come.

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Tub Safety For Special Needs Children

Bathtime is usually a fun experience for young children.  Toys, splashing, bubbles.  But it’s not always fun for parents.  If your child has issues with sensory sensitivity, sensory seeking or hypermobility, you can feel like a one-armed paperhanger; juggling toys, washcloth and child!

One solution is to use a bath seat.  A word of common sense first:  never leave a child unattended in any type of bath seat.  Just because these devices improve stability, they don’t remove all the risks of bathing in a tub.  Young children need to be supervised at all times.  But a tub seat does help a special needs child remain sitting and stable, and that can really help parents during bathing.  Here are the positive effects of using a bath seat or tub insert:

Kids with sensory seeking or sensory sensitivity can find the expanse of the standard tub overstimulating, and in response, they may become agitated or fearful.  The youngest kids can’t tell you how this feels.  They just act up.  Using a bath seat or a tub insert can allow these children to stay in the tub long enough to be washed, and help them stay calm and relaxed.  Since bath time is usually before bedtime, that is a big plus!

For kids with instability, the bath seat or insert can prevent them from injuring themselves if they tip or lean too much.  They could even build their ability to sit up if the seat is well-chosen for their needs.  These kids need to acquire a sense of independence, and if they are given the right support, they can start to sit without an adult holding them.  They may be able to use both hands more freely, developing coordination for learning to wash themselves and confidence in their independence.

Selecting the correct equipment can be easy or challenging.  After determining what level of assistance your child needs, figure out if your child fits well in the seat you are looking at.  Some seats are made for very small children.  If your child is older or larger, keep looking until you find equipment for them.  Therapy catalogs and sites have equipment for children with significant difficulties in holding their head up or maintaining a sitting position.  These are more expensive than mass-market items, but they are often adaptable and you can remove parts as your child builds their sitting skills and safety.

For more information about self-care and the special needs child, check out Kids With Low Muscle Tone Can Sit For Dinner: A Multi-Course StrategyImproving Daily Life Skills for Kids With Special Needs, and OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues.

Are you toilet training your special needs child?  Do you worry that it may never happen?  I wrote the e-book for you!  The Practical Guide To Toilet Training Your Child With Low Muscle Tone is filled with readiness tips, techniques to find the best potty seat, and techniques to make learning faster and easier for both of you!  It is available on my website tranquil babies, and on Amazon and Your Therapy Source )a terrific site for parents and therapists).  Read more about this unique guide here: The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

 

Not Making It To the Potty In Time? Three Reasons Why Special Needs Kids Have Accidents

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If your special needs child isn’t experiencing a medical reason for incontinence (infection, blockage, neurological impairment) then you might be facing one of these three common roadblocks to total training success:

  1. Your child has limited or incomplete interoceptive awareness.  What is interoception?  It is the ability to sense and interpret internal cues.  The distention of the bladder, the fullness of the colon, etc are all internal cues that should send them to the potty.  Unfortunately, just as poor proprioception can hinder a child’s ability to move smoothly, poor interception can result in potty accidents, among other things.  Working with them to become more aware of those feelings can include monitoring their intake and elimination routines.  You will know when they should have more sensory input, and can educate them about what that means.  Listen to how they describe internal feelings.  Kids don’t always know the right words, so use their words or give them a new vocabulary to help them communicate.
  2. Your child’s clothing is difficult to manage, or their dressing skills aren’t up to the task.  They run out of time before nature calls.  Tops that are hard to roll up, pants that have tricky fasteners, even fabrics that are hard to grasp and manipulate.  All of these can make it a few seconds too long once they get into the bathroom.  If you are not in there with them, you may have to ask them to do a “dry run” so you can see what is going on and what you can change to make undressing faster.  In my e-book, The Practical Guide To Toilet Training Your Child With Low Muscle Tone, I teach parents the best ways to teach dressing skills and the easiest clothing choices for training and beyond.  If you have ever had to “go” while in a formal gown or a holiday costume, you know how clothing choices can make it a huge challenge to using the toilet!
  3. Your child is too far from the bathroom when they get the “urge”.  Children  with mobility problems or planning problems may not think that they are in trouble right away.  They might be able to get to the bathroom in time in their own home.  When they are out in public or at school, the distance they have to cover can be significant, and barriers such as stairs or elevators can be an issue.  Even kids playing outside in their own yards might not be able to come inside in time.  If you can’t alter where they are, teach them to use the potty before they go outside or when they are near the bathroom, instead of waiting.  Taking the time to empty a half-full bladder is better than an accident.

Looking for more information on toilet training?  Read How To Teach Your Child To Wipe “Back There” and Low Tone and Toilet Training: Learning to Hold It In Long Enough to Make It to The Potty.  and of course, my e-book is available for more extensive assistance The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

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Toilet Training For Preschool And Stuck in Neutral? Here’s Why…..

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Many of my clients are in a rush to get their kid trained in the next few weeks for school. They have been making some headway over the summer, but things can stall out half-way through.  Here are some common reasons (but probably not all of them) why kids hit a plateau:

  1. They lose that initial boost of excitement in achieving a “big kid” milestone.  Using the potty isn’t an accomplishment now, it is just a chore.
  2. Parents and caregivers aren’t able to keep up the emotional rewards they need.  It is hard to be as excited about the 10th poop in the potty as the first time.
  3. The rewards used aren’t rewarding anymore.  A sticker or a candy might not be enough to pull someone away from Paw Patrol.
  4. An episode of constipation or any other negative physical experience has them worried.  Even a little bit of difficulty can discourage a toddler.
  5. Too many accidents or not enough of a result when they are really trying can also discourage a child.
  6. Using the potty is now a power play.  Some kids need to feel in control, and foiling a parent’s goal of toileting gives them the feeling that they are the ones running the show.  “I won’t” feels so much better than “I did it” for these kids.
  7. Their clothes are a barrier.  When some families start training, it is in the buff or with just underwear.  Easy to make it to the potty in time.  With clothes on, especially with button-top pants or long shirts, it can be a race to get undressed before things “happen”.
  8. They haven’t been taught the whole process.  “Making” is so much more than eliminating.  Check out How To Teach Your Child To Wipe “Back There” and The Ten Most Common Mistakes Parents Make During Toilet Training for some ideas on how to teach the whole enchilada.  And if you need a great book for kids without developmental or motor delays, look at my review A Great Toilet Training Book for Neurotypical Kids: Oh Crap Potty Training!.

Should you pause training? The answer is not always to take a break.  I know it sounds appealing to both adults and kids, but saying that this isn’t important any longer has a serious downside.  If your child has had some success, you can keep going but change some of your approaches so that they don’t get discouraged or disinterested.  If your child really wasn’t physically or cognitively ready, those are good reasons to regroup.  But most typically-developing kids over 2 are neurologically OK for training.  They may need to develop some other skills to deal with the bumps in the road that come along for just about every child.

Sometimes addressing each one of these issues will move training to the next level quickly!  Take a look at this list and see if you can pick out a few that look like the biggest barriers, and hack away at them today!

For kids with low muscle tone, including kids with ASD and SPD, take a look at my e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone.  Read Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!) to understand why I wrote this book just for you!   

I give parents clear readiness guidelines and tips on everything from the best equipment, the best way to handle fading rewards, to using the potty outside of your home.  It also includes an entire chapter on overcoming these bumps in the road! To learn more about what my e-book can do for you, read The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

For Kids With Hypermobility, “Listen To Your Body” Doesn’t Teach Them To Pace Themselves. Here’s What Really Helps.

 

chen-hu-664399-unsplashI ran across a comment piece online that recommended parents teach their hypermobile  children to “listen to your body” to pace activities in an effort to avoid fatigue, pain or injury.  My reaction was fairly strong and immediate.  The sensory-based effects of hypermobility (HM) reduce interoception (internal body awareness)  and proprioception/kinesthesia (position and movement sense, respectively).  These are the  main methods of “listening” we use to know how we are feeling and moving.  For children with HM, telling them to listen to their body’s messages is like telling them to put on their heavy boots and then go outside to see how cold the snow is! 

Relying primarily on felt senses when you have difficulty receiving adequate sensory feedback doesn’t make…..sense.  What often happens is that kids find themselves quickly out of energy, suddenly sore or tripping/falling due to fatigue, and they had very little indication of this approaching until they “hit a wall”.  They might not even see it as a problem.  Some kids are draped over the computer or stumbling around but tell you that they feel just fine.  And they aren’t lying. This is the nature of the beast.

I am all for therapy that helps kids develop greater sensory processing (as an OTR, I would have to be!), but expecting HM kids to intuitively develop finely tuned body awareness? That is simply unfair. Kids blame themselves all too easily when they struggle.  What begins as a well-meaning suggestion from a person with typical sensory processing can turn into just another frustrating experience for a child with HM.

What could really help kids learn to pace themselves to prevent extreme fatigue, an increase in pain and even injury due to overdoing things?

  1. Age-appropriate education regarding the effects of HM.  Very young children need to follow an adult’s instructions (“time to rest, darling!”), but giving older kids and teens a medical explanation of how HM contributes to fatigue, pain, injuries, etc. teaches them to think.   Understanding the common causes of their issues makes things less scary and empowers them.  If you aren’t sure how to explain why your child could have difficulty perceiving how hard they are working or whether they are sitting in an ergonomic position, read Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children for some useful information.  You could ask your child’s OT or PT for help.  They should be able to give you specific examples of how your child responds to challenges and even a simple script to use in a discussion.  Explaining the “why” will help children understand how to anticipate and prepare for the effects of HM.
  2. Consider finding a pediatric occupational therapist to teach your child postural, movement and interoceptive awareness, adapt your child’s learning and living environments for maximal ease and endurance, and teach your child joint protection techniques.  Occupational therapists are often thought of as the people that hand out finger splints and pencil grips.  We are so much more useful to your child than that narrow view!  For example, I have adapted desks for optimal postural endurance and decreased muscle tension.  This has immediate effects on a child’s use of compensations like leaning their chin on their hand to look at a screen.  OT isn’t just for babies or handwriting!
  3. Pacing starts with identifying priorities.  If you don’t have boundless energy, attention, strength and endurance, then you have to choose where to spend your physical “currency”.  Help your child identify what is most important to them in their day, their week, and so on.  Think about what gives them satisfaction and what they both love to do and need to do.  This type of analysis is not easy for most kids.  Even college students struggle to prioritize and plan their days and weeks.  Take it slow, but make it clear that their goals are your goals.  For many children with HM, being able to set goals and identify priorities means that they will need to bank some of their energy in a day or a week so that they are in better shape for important events.  They may divide up tasks into short components, adapt activities for ease, or toss out low-level goals in favor of really meaningful experiences.  Can this be difficult or even disappointing?  Almost certainly!  The alternative is to be stuck at an event in pain, become exhausted before a job is completed, or end up doing something that places them at higher risk for injury.
  4. Help your child identify and practice using their best strategies for generating energy, building stamina and achieving pain-free movement.  Some kids with HM need to get more rest than their peers.  Others need to be mindful of diet, use relaxation techniques, wear orthotics regularly, adapt their home or school environment, or engage in a home exercise program.  Learning stress-reduction techniques can be very empowering and helps kids think through situations calmly.    Sports can be an issue or they can be a wonderful way to build endurance and body awareness.  Read  Should Your Hypermobile Child Play Sports? for some ideas on managing pain, endurance and coordination.  Creating a plan together and discussing the wins and failures models behaviors like optimism and resourcefulness.  Children depend on adults to show them that self-pacing is a process, not an endpoint.

Looking for more information to help your child with hypermobility?  Take look at The Hypermobile Hand: More Than A Strength Problem and How Hypermobility Affects Self-Image, Behavior and Activity Levels in Children.  My e-books on pediatric hypermobility are coming out soon!  Check back here at BabyBytes for updates.

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