Category Archives: self-care skills

Parents of Kids With Sensory Sensitivity Can Feel Like The (Food) War is Still Going On

What do parents of children who have had successful treatment for oral sensory sensitivity have in common with Vietnam veterans? Parts of them do not know that the war is over.

Raising a child that can become unglued over the texture or taste of a new food is like walking through a minefield. As a pediatric OT, I have seen many children make amazing progress. The toddler who once grimaced while watching his mom eat a piece of chicken now grabs it from her hand and stuffs it into his mouth. The baby who screamed when cereal fell onto her hands is now happily swishing it around the high chair tray.

It’s the parent that is still frozen in fear. PTSD is something that people assume only happens to victims of crimes or war. Wrong. The daily emotional rollercoaster of dealing with sensory issues in young children (and older ones too, to be honest) can leave parents with all the signs of PTSD. Anticipating problems, recalling the worst mealtime blowups even when things are going well now, feeling anxious even as your child munches down a snack happily. And reacting to any minor and non-sensory complains with an internal “Oh, here we go again, I knew it would come back!”

It makes sense to me. The stress seemed to never end because the meals kept on coming. You never know if it will be a horror or an easy meal. The level of reaction your child exhibits is not always the same, so you wonder what will happen. All the time. And you feel as if no one could possibly understand how this feels. You feel alone and on edge. The next meal could be the worst, so you have to be prepared for it.

If this description fits you, please don’t think that you are alone. You are not. Good therapy can help your child learn to manage their reactions to food and mealtime. It really can. But you may need some support too. Seek it out, and reject any professional that tells you to just relax. You would have relaxed if you could have. You have been through a lot, and sometimes getting some support helps.

“Toilet Training Season” Is Coming. Do You Have a Plan?

 

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Here in the northeast, the buds on the trees are reminding parents that it will be time to sign up for summer camps and preschool.  And therefore toilet training season is upon us.  Most schools for typically-developing kids over 3 don’t accept children that aren’t trained.  If they do, they may demand a surcharge, have only a few classrooms for older kids in diapers, or limit activities such as the use of swimming pools.

If you are thinking that now is the time to train, you are probably wondering if you are going to use the “Boot Camp” approach, or the “Gradual Training” approach.  Going all in is the “Boot Camp” method.  Your child’s life, and yours, is focused on learning the mechanics of using the toilet and perceiving when to run to the potty.  “Gradual Training” is slowly developing awareness and skills in young children.  You might start from a very early age, describing your actions during a diaper change and demonstrating what potties are for, and that it is both something grown-ups do and not anything to be afraid of.

Either way can be totally successful, and your choice rests on their temperament and yours, your timeline, and your available support.  If your child doesn’t handle failure well, or would find it difficult to spend a whole weekend in or near the potty, then you might consider Gradual Training.  If your child learns best by frequent repetition and rewards, then Boot Camp has appeal.  If you have no one else to watch other kids or you know your patience will be strained by a day of (your child) drinking and peeing, then you may want to go Gradual.   I want to emphasize that choosing the approach you take by looking at your own abilities and limitations is important.  So often, parents discount their feelings and end up displaying their frustration or boredom to their child.  Here is the bad news:  children think that negative parental moods are THEIR FAULT!  Choose wisely, and both of you feel good about yourselves and the experience.  Choose poorly, and you both get more aggravation than you expected.

So now that the season for training is upon us, choose your plan and get ready to give your child all the support and encouragement that you can!

Want more help?  My new e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is available on my website, tranquil babies .  Just look for the ribbon at the top and click on “e-book”.  I go into all the details on whether your child is really ready for training, provide you with checklists for readiness, and give you an in-depth explanation of the Boot Camp and Gradual Training methods.  Halfway there and experiencing some resistance?  The chapter “Bumps In The Road” is for you!  

To get a sense of how I view true readiness, check out my post Low Tone and Toilet Training: The 4 Types of Training Readiness.  While not as complete as the chapter in the book, this will start you thinking about readiness in a different way.

Low Tone and Toilet Training: Learning to Hold It In Long Enough to Make It to The Potty

 

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If your child can’t stay dry at night after 5, or can’t make it to the potty on time, there are a number of things that could be going wrong.  I won’t list them all, but your pediatrician may send you to a pediatric urologist to evaluate whether there are any functional (kidney issues, thyroid issues, adrenal issues etc.) or structural issues ( nerve, tissue malformations).  If testing results are negative, some parents actually feel worse rather than better.

Why?  Because they may be facing a situation that is harder to evaluate and treat:  low tone reducing sensory awareness and pelvic floor control.

Yes, the same problem that causes a child to fall off their chair without notice can give them potty problems.  When their bladder ( which is another muscle, after all) isn’t well toned, it isn’t sending sensory information back to the brain.  The sensors that respond to stretch aren’t firing and thus do not give a child accurate and timely feedback.  It may not let them know it is stretched until it is ready to overflow.  If the pelvic floor muscles are also lax, similar problems.  Older women who have been pregnant know all about what happens when you have a weak pelvic floor.  They feel like they have to “go”  but can’t hold it long enough to get to the bathroom!   Your mom and your daughter could be having the same problems!!

What can you do to help your child?  Some people simply have their kids pee every few hours, and this could work with some kids in some situations.  Not every kid is willing to wear a potty watch (they do make them) and the younger ones may not even be willing to go.  The older ones may be so self-conscious that they restrict fluids all day, but that is not a great idea.  Dehydration can create medical issues that they can’t fathom.  Things like fainting and kidney stones.

Believe it or not, many pediatric urologists don’t want kids to empty their bladder before bedtime.  They want kids to gradually expand the bladder’s ability to hold urine for a full 8-10 hours.  I think this is easier to do during the day, with a fully awake kid and a potty close at hand.  Too many accidents make children and adults discouraged.  Feeling like a failure isn’t good for anyone, and children with low tone already have had frustrating and embarrassing experiences.  They don’t need more of them.

There are a few ideas that can work, but they do take effort and skill on the part of parents:

First, practice letting that bladder fill up just enough for some awareness to arise.  You need to know how much a child is drinking to figure out what the right amount is, and your child has to be able to communicate what they feel.  This is going to be more successful with children with at least a 5-6 year-old cognitive/speech level.  Once they notice what they are feeling down there right before they pee, you impress on them that when they feel this way that they can avoid an accident by voiding as soon as they can.  Try to get them to create their own words to describe the sensation they are noticing.  That fullness/pressure/distention may feel ticklish, it may be felt more in their belly than lower down; all that matters is that you have helped your child identify it and name it.

You have to start with an empty bladder, and measure out what they are drinking so you know approximately how much fluid it takes them to perceive some bladder stretching.    It helps if you can measure it in a way that has meaning for them.  For me, it would be how many mugs of coffee.  For a child it might be how many mini water bottles or small sport bottles until they feel the need to “go”.  You also need to know how long it takes their kidneys to produce that amount of urine.  A potty watch that is set to go off before they feel any sensation isn’t teaching them anything.

The second strategy I like involves building the pelvic floor with Kegels and other moves.  Yup, the same moves that you do to recover after you deliver a baby.  The pelvic floor muscles are mostly the muscles that you contract to stop your urine stream.  Some kids aren’t mentally ready to concentrate on a  stop/start exercise, and some are so shy that they can’t do it with you watching.  But it is the easiest way to build that pelvic floor.  There are other core muscle exercises that can help, like transverse abdominal exercises and pelvic tilt exercises.  Boring for us, and more boring for kids.  But they really do work to build lower abdominal strength.  If you have to create a reward system for them to practice, do it.  If you have to exercise  with them, all the better.  A strong core and a strong pelvic floor is good for all of us!

Finally, don’t forget that the same things that make adult bladders edgy will affect kids.  Caffeine in sodas, for example.  Spicy foods.  Some medications for other issues irritate bladders or increase urine production.  Don’t forget constipation.  A full colon can press on a full bladder and create accidents.

Interested in learning more about toilet training?  My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone is available on my website, tranquil babies.  Just click ‘e-book” on the ribbon at the top of the home page, and learn about my readiness checklists, and how to deal with everything from pre-training all the way up to using the potty in public!

 

 

 

 

Hypermobility in Young Children: When Flexibility Isn’t Functional

Your grandma would have called it being ” double jointed”.   Your mom might mention that she was the most flexible person in every yoga class she attended.  But when extra joint motion reduces your child’s performance or creates pain, parents get concerned.  Sometimes pediatricians and orthopedists do not.

Why would that happen?  A measure of flexibility is considered medically within the norm for children and teens.  Doctors often have no experience with rehab professionals, so they can’t share other resources with parents.  This can mask some significant issues with mild to moderate hypermobility in children.  Parents leave the doctor’s office without a diagnosis or advice, even in the face of their child’s discomfort or their struggles with handwriting or recurrent sports injuries.  Who takes hypermobility seriously?  Your child’s OT and PT.

Therapists are the specialists who analyze functional performance and create effective strategies to improve stability and independence.  I will give a shout-out to orthotists, physiatrists and osteopaths for solutions such as splints and prolotherapy.  Their role is essential but limited, especially with younger children. Nobody is going to issue a hand splint or inject the ligaments of a child under 5 unless a child’s condition is becoming very poor very quickly.  Adaptations, movement education and physical treatments are better tolerated and result in more functional gains for most middle and moderately involved hypermobile children.  Take a look at Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children to understand more about what an OT can do to help your child.

Low tech doesn’t mean low quality or low results.  I have done short consults with children that involve only adaptations to sitting and pencil choice for handwriting, with a little ergonomic advice and education of healthy pacing of tasks thrown in.  All together, we manage to extend the amount of time a child can write without pain.  Going full-tilt paperless is possible when pain is extreme, but it involves getting the teachers and the district involved.  Not only is that time-consuming and difficult to coordinate, it is overkill for those mildly involved kids who don’t want to stand out.  Almost nothing is worse in middle school than appearing “different”.  A good OT and a good PT can help a child prevent future problems, make current ones evaporate, or minimize a child’s dependence and pain.

Hypermobile kids are often bright and resourceful, and once they learn basic principles of ergonomics and joint protection, the older children can solve some of their own problems.  For every child that is determined to force their body to comply with their will to compete without adaptation, I meet many kids that understand that well-planned movements are smarter and give them less pain with more capability.  But they have to have the knowledge in order to use it.  Therapists give them that power.

Parents:  please feel free to comment and share all your great solutions for your child with hypermobility, so that we all can learn from YOU!

Is your hypermobile child also struggling with toilet training or incontinence?  Check out Low Tone and Toilet Training: Learning to Hold It In Long Enough to Make It to The Potty  to gain an understanding of how motor and sensory issues contribute to this problem, and how you can help your child today!

Why is Staying Dry at Night So Challenging For Some Children?

I have received a few questions on this subject since publishing my e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone.  Parents are wondering how to expand daytime success through the night.  Here is what I know about getting through the night high and dry:  it is as much a physical milestone as a behavioral accomplishment.  The pituitary gland is involved in hormonal secretions to diminish urine production, and the nerves for sphincter control may not be fully developed in younger children.  The bladder has to expand to hold a quantity of urine at night, so tiny children really cannot accomplish this feat, regardless of motivation.

Typical children who are dry all day can need another 2-4 years (yes, years!) to stay dry at night and/or wake themselves and use the potty independently.  The child who is a “potty master”, getting there on time and managing all the skills at school, may still need a pull-up style training pant as an insurance policy.

What can you do to improve the odds of dryness at night?

  • Limit drinks right before bed.  As you know from my book, children will generate enough urine to “go” about 45 minutes after a big drink.  The kidneys are also responding to hormone and salt levels in the blood, so some urine will be generated at night, even if nothing has been taken in by mouth for 2 hours before bed.  Deny that late night sippy cup or that last swig of juice, and come up with a better bedtime routine in it’s place.
  • Insist on the bathroom being a last stop before bedtime.  Empty that bladder, even if your child insists that they don’t feel that they need to “go”.
  • Make sure your child is well hydrated during the day.  A thirsty child is going to beg for that drink, and then fail to stay dry.  The bladder gets it’s exercise during the day, as it fills and empties.  Constantly running to the bathroom, or never making it to the bathroom can both contribute to late preschool bedwetting.  Be encouraging but firm with children that tend to dry out during the day.  They don’t realize the part their refusal plays in bedwetting, they just feel like a failure, and maybe worry that they are a failure in your eyes as well.
  • Recognize the role of constipation can play in bedwetting.  The pressure of stool on a bladder can be enough to create problems.  My book has many ideas to address constipation, and this is another reason to address this problem instead of hoping it will go away.
  • Accept that brain maturation is a key driver of night dryness.  A child with brain differences, from ASD to ADHD to SPD, may need more time to achieve this milestone.  Criticism and harshness isn’t going to make that brain develop any faster.
  • Ask your pediatrician’s advice if your typical child isn’t dry at night by 7, or if you suspect that there is another issue.  Never ignore your gut feelings about your child.  You know more than you think!

Take a look at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! to learn more about my e-book and how it can help you toilet train your child!  Visit my website tranquil babies to purchase the book and buy a phone consultation to get your specific questions answered personally!

Toilet Training Older Kids: Equipment Matters as Much as Approach

Is potty training after the toddler years different?  Yes, and no.  Here is what you need to consider when you are looking at the equipment for an older child that is still in a diaper or a pull-up.  Whether they have language or not, whether they have rigid or stereotyped behaviors or not, your set-up when training the older child is very important.

  1. Your child probably won’t fit correctly on a toddler potty seat.  Unless your child is significantly shorter and thinner than her peers, she won’t fit.  Children that are nonverbal or very compliant may not complain about sitting so low or so tightly.  They just won’t do well.  They may only sit for a short time, get agitated, or withhold.   They may cling to you when transferring on and off because they are sitting so low.  It can look like they either don’t understand what to do, or won’t comply.  Both can be wrong.  The defiant ones will cry and refuse to use a seat that doesn’t fit them.  Some crafty parents have adapted the smaller seats for their slim little ones, but not everybody can do that.  Look at my post on the adult toilet Low Tone and Toilet Training: Transition to Using The Adult Toilet for help to reconfigure your set-up ,giving your child a better chance at success and comfort.
  2. The right environment for toileting is not in front of the TV.  After all these years of using diapers or pull-ups (which is developmentally really a diaper that you wear, not absorbent underwear), using the toilet can seem as silly to them as going into a restaurant and cooking our own dinner would be to us!  If you have the room, use the bathroom for training.  Bring them into the fold by requiring them to assist you with all aspects of diapering, turn off the TV so you have their attention, and when you do watch potty videos, make sure you are there reminding/encouraging them.  Your demonstrated interest has more power than you think!
  3. You are gonna need a bigger boat (wipe).  Nod to one of my favorite movies, Jaws.  But seriously, using those tiny little toddler wipes from the cute dispenser might not do the job on a 5 year-old heine.  Not enough wiping with a tiny one, and if they aren’t clean down there, it is not only messy, it is a hygeine issue.  Use the grown-up wipes and put Paw Patrol stickers on it if you have to sell them as appealing.

Good news!  My e-book, The Practical Guide to Toilet Training Your child With Low Muscle Tone, is up on my website, tranquil babies .  For a sense of what it includes, take a look at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!  I took all the requests from my consultation clients, and my years of experience as a pediatric OTR, and wrapped it into a book that gives you real help, not just charts or encouragement that it takes time.  If you want a hard copy, go to my website and send me an e-mail to find out how to get one!

Piddlers Make Potty Training Fun!

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Your son will eagerly run for potty time!

I laughed out loud the first time I saw a toddler pee onto one of these circles.  Then he asked for more juice so that he could come back later and try again!

Piddlers aren’t a new concept.  Parents have been tossing cereal circles into a potty for “aiming practice” for a long time.  These commercially-made circles are just easier to aim for, dissolve more, and clean up easily.  Cereal has a funny way of bouncing around in the toilet, making it more frustrating, not as successful and not as much fun.

Getting children motivated to use the toilet can be a big headache.  For every totally cooperative toddler, there are 5 more that are defiant or simply uninterested.  They just won’t “go”.  Piddlers may not be a total answer, but they can get your son over these barriers to skill development.  Once a child is successful and has a routine, things are so much better!

Little boys have to control their aim if they are going to urinate standing up.  This is a totally new concept for them, and a skill.  Yes, a skill.  Since they have been using a diaper for elimination from the day they came home from the hospital, toilet training is a completely foreign concept, from beginning to end.  It’s a little bit funny: mostly the mommies are in control of toilet training, but only brothers, cousins and daddies can demo this particular skill.   Read Low Tone and Toilet Training: Kids Need To See How It’s Done to understand why a live performance can jump-start your child’s comprehension of toilet use.

Piddlers are made of starch and food coloring, and won’t turn anything blue or orange.  You may not even need the whole package!  Once a child has success and has developed a routine, explain that you need to go to the store later to buy more (not really), but he can use the potty right now anyway without one or two Piddlers in the potty.  Eventually you won’t need Piddlers any more, but you will have a little boy that is paying attention to what he is doing in the bathroom!

Great News!  My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is now available as an e-book on my website, tranquil babies .  Just click the “e-book” section on the top ribbon to get your copy.  

Don’t think your child is ready for toilet training?  You need this book more than the parents of kids that are struggling with training!  Knowing how to prepare your child and yourself before you start training can make all the difference.  My book will explain in detail what you need to know and how you can start developing potty skills…today!