Category Archives: toddlers

Teaching Children Emotional Regulation: Can Happiest Toddler on the Block Help Kids AND Adults?

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Many child psychologists and psychotherapists are focusing on attachment theory and the problems of poor emotional regulation in children.  The rise of self-harm behaviors in teens and aggression in children as young as 3 can be related to difficulties handling emotions and experiences that increase arousal levels but never get resolved.

Not every child who throws their book down in frustration or slams their bedroom door needs to see a therapist.  But I do wonder how many of those teens that cut themselves, starve themselves or get suspended for putting their hands on a teacher or fellow student, actually needed Dr. Karp’s techniques when they were 3 or 4.  Maybe, just maybe, if they had been helped with Patience Stretching when they wanted that toy, or if someone had used the Fast Food Rule with them when they had a tantrum Use The Fast Food Rule For Better Attunement With Your Child, maybe they would be in better shape at 13.

Why?

Because these techniques don’t just work on the child.  They work on the adult using them as well.  And adults who can self-regulate raise kids who learn to do it too.

When I use Patience Stretching Stretch Your Toddler’s Patience, Starting Today!with a toddler that wants one toy while I want them to work a bit longer on a therapy task, I am actually receiving the benefits of the technique as well.  I am both teaching and experiencing the reduction in frustration and the decrease in agitation as this strategy calms down the whole situation.  Oxytocin gets released when we calm down with a child, and adults need that hit as much as children do.  If we “go there” with an agitated child, we feel worse, even if we think we won because we have the power to deny or punish.  It doesn’t feel good to do either, but it also doesn’t feel good to give into a screaming child.  Not really.  Even the most permissive adult will say no to something dangerous, and then the child who is unfamiliar with hearing “no” will really explode.

The good news is that you don’t have to get an advanced degree to use Dr. Karp’s strategies.  You have to practice them so that your delivery is flexible and confident, but anyone can do it, not just therapists.  In fact, if these techniques don’t work well once you improve your delivery, that could be one way to decide that you need to consult a child specialist.

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Are You a Trauma Survivor AND the Parent of a Special Needs Child?

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First, let me say that trauma survivors can be among the most loving and active parents I work with as a pediatric occupational therapist.  How do I know they are survivors?  Some parents share their histories openly, and some aren’t aware of what their actions and words reveal.  Therapists that have worked in psychiatry are particularly attuned to patterns of behavior that suggest a history of trauma.  And after therapy has gone on for a while and the therapeutic relationship blossoms, some parents wish to share more of their personal story with me.

Trauma survivors that had complicated pregnancies Can The Parents of Pediatric Clients Have PTSD? , have children with genetic disorders, or deliver children who develop developmental delays, come in all ages and social/support situations.  Some currently have a therapist for support, and some have done a tremendous amount of therapy in the past.  Others may not even recognize that what they experienced in the past was traumatic, or that there is specialized help for trauma-related issues.

What they all have in common is the (mostly) sudden stressor of having a child with special needs, the seemingly endless daily demands of care, and the constant seeking/managing of medical, educational and therapy services.  Survivors of trauma may not realize that they aren’t alone with their feelings of distress, or that their child’s therapists can help them cope.

I wrote a post on how therapists can help a child’s siblings, How an Occupational Therapist Can Help The Siblings of Special Needs Children , but parents can ask for and receive support from therapists for themselves as well:

The simplest way therapists can help you is to validate the real demands of care and give you some perspective on what other family’s lives are really like.  We are aware that we are asking parents to do home programs and obtain equipment and toys that facilitate development.  We also know that life is messy, and it is OK if you admit that you find it hard just getting through the day.  You can ask us if other parents go through the same things that you do, and you will find out that you might be doing more than we expect.

If you are having a rough period, ask us to give you just the ONE thing that would be the easiest to incorporate into your day that would help your child this week.  We won’t be offended.  You might be surprised to find that we know what those days/weeks/months feel like too.

Some parents who are trauma survivors are less likely to ask for a review or clarification of a technique or treatment when therapists give them instructions.  This can come from fearing criticism, having been taught not to question authorities, feeling judged by therapists they perceive as punitive authorities, and even being dissociative during their child’s therapy session.  “Spacing out”, forgetting, being confused, etc. are all possible dissociative responses.  Parents who are reliving a NICU nightmare or who are triggered and recall their own medical trauma or physical abuse may have a lot of difficulty learning to do treatments on their child that involve any level of restraint or distress.  This can be managed, but only if it is addressed.  Your child’s therapists have many different ways of holding and positioning a child, and different ways of administering a treatment technique.  You can express your discomfort in general terms or you can tell us that this is a trigger for you, and you can ask us to make things easier for you without having to tell your own story.  Asking for a few reviews of home programs is seen by most therapists as indicating interest in what we do.  We aren’t offended; we are flattered.

Some survivors need to be out of the treatment room, and that is also OK.  We like to share your child’s progress, and we welcome you into the session, but we understand if you need to have some distance.  Scheduling treatment at your child’s school or in a therapy center, rather than at home, may be easier for you.  Your child will still receive excellent treatment.

Trauma survivors can be extremely distressed when their child cries in therapy, or even while witnessing their child struggle to learn new skills.  This can bring up distressing childhood memories for them, some of which they may not fully recall or even connect with their responses to their child’s therapy session.

Therapists can be healing models for actively managing a child’s distress and expressing how they handle their own feelings when children struggle.  A parent that grew up in a punitive home may not have seen adults model healthy reactions to a child’s distress.

Therapists can teach you their techniques for grading challenge and providing support that reduces your child’s level of agitation.  My favorite book to learn how to respond to young children warmly but with limits is The Happiest Toddler on the Block by Dr. Harvey Karp.  His techniques support healthy attachment and children respond much more quickly than parents expect.  Everyone feels better, not just the kids!  Read Teaching Children Emotional Regulation: Can Happiest Toddler on the Block Help Kids AND Adults? for more on this amazing program and how it can help both of you.  Today.

 

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Secrets For Getting Young Children to Share

 

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It is the rare toddler that eagerly gives up a desired toy or snack to share with another child.  Yup; your child isn’t any different from the great majority of kids out there.

You may even have witnessed the “grab-and-go” move, where they take a toy from another child and then quickly escape to a corner of the room.  I know it doesn’t feel great when the thief is your child, but it also doesn’t mean they are destined to be selfish or live a life of crime.  It is normal for young children to behave selfishly; they haven’t fully developed the cognitive abilities that provide them with awareness of another’s perspective, nor do they fully appreciate social norms.

So, what can you do to teach your child to share?

Well, here are a few things that don’t work:

  1. Shaming.  Telling your child that they are selfish and bad because they don’t want to share isn’t going to build empathy.  It may have the exact opposite effect.   And they may try to hide or deny their behavior from you.
  2. Bribing.  Paying off for good behavior has been scientifically proven to backfire.  Paying kids for good grades, paying employees to exercise or lose weight, etc.  It won’t create a more empathetic child, but it could create a scheming child who parlays their desire for something else into a little show for you.
  3. Begging.  Pleading with your child makes you look powerless and puts your child in an awkward-but-intoxicating position.  It won’t make you more credible when you deny them something or try to teach another civic lesson.
  4. Playing the “Your behavior makes Mommy sad” card.  Children desire love and will do almost anything for it, but making it appear that they have crushed your heart because they followed theirs?  This is a slippery slope, and shouldn’t be taken unless you think long and hard about what you are teaching.

So what ELSE could you do or say that might elicit sharing?

  • You can demonstrate sharing YOUR items, and be very clear about how you made the decision and how you feel.  Make sure that you admit that sometimes you want all of your snack for yourself, but then you remember how good it makes you feel when you share and see how happy the other person is.
  • You can also have another person say how they feel when you share with them.  Children really don’t always pick up on the subtle feelings of others, and they need to hear it out loud.
  • When your child does share, be crystal clear about how good it makes you feel when they do.  This is different from telling them how bad you feel when they don’t, and different from bribing them to share.
  • Read some age-appropriate books on sharing, and try to discuss how the characters felt in the story.  Some kids prefer to talk about characters and not about their own feelings.

Your child may still shrug and refuse to share, or they may want to try sharing, now that they know so much more about it!

How To Stop Your Toddler From Hitting You and Use The Fast Food Rule For Better Attunement With Your Child are two of my popular posts that also help you help your child manage their feelings without crushing their spirit!

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How To Stop All The Diapering Drama

 

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does this look familiar? read on!

I regularly field questions about this problem from the parents of children I treat.   If your 8 to 24-month old is fussy during diaper changes and you know it isn’t from diaper rash, keep reading.  I have some information and ideas for you.

Parents of kids with sensory processing issues or developmental delays often assume that this is the source of their child’s diaper drama.  Parents who lack confidence or parents who spend a lot of time online with “Dr. Google” think that it could be sign of autism or of poor attachment.

Nope.

At least, not usually.

If your young child is suddenly giving you the business, even though they really need a diaper change, there are a few things to think about before you run to a developmental pediatrician (or any pediatrician):

  1. Your child may have been busy exploring, and they are unhappy that they were interrupted with a task they find boring.  Getting a fresh diaper isn’t much fun after those first few months of face-gazing and smiles.  Once a child can really play, they have better things to do.   Parents can be surprised that their gurgling infant that loved diaper changes is now resisting, or even fighting, to get off the changing table.
  2. If your child is one of the 15-20% of kids that Dr. Harvey Karp identifies as having a “spirited” temperament, then you are going to get a strong reaction to  almost any action they didn’t initiate.  Bedtimes, leaving to go to the park, leaving the park to go home, etc.  Spirited kids are going to give you oversized reactions in both directions; super happy, super sad, super angry.
  3. Kids with limited receptive language aren’t sure exactly what is going on when you pick them up.  Receptive language means understanding the words another person is using.  Your child doesn’t have to be delayed; they could simply not have enough language skills to understand what you are saying.
  4. Your child has decided to use diapering as their “line in the sand” to express their independence and test your limits.  Testing limits is normal, and I believe that nature intended this to start early.   By the time parents are experiencing limit testing with a teen, they have been practicing for a while.  Young children that feel that they are being controlled will test more and with more energy.  This doesn’t mean that their parents are actually more controlling.  Perception is reality, and if a child feels micro-managed, then they react whether or not they are indeed highly controlled.  This could happen when they spend a lot of time with babysitters instead of parents, or if they have had many recent changes in caregivers, new sibling, new home, etc.

What works to reduce diaper drama?

  • Use routines to improve language comprehension and manage expectations.  Kids that get a regular diaper check/change know what you are doing and where they are going.
  • Shorten your phrases and use the same words for the same events.  See above.
  • Try not to over-react to an overreaction.  Spirited kids don’t need more fuel for the fire, and neither do tired, sick, or hungry children.
  • Give your child more chances to control other situations in their life.  Manufacture the situations if you have to.  This means that they get to decide of the doll goes in the cradle or the car, or if the blue car goes down the ramp first, or if it is the red car that leads.  Dr. Karp’s “give it in fantasy” strategies  Give (Some of) Your Power Away To Your Defiant Toddler And Create Calmness and all of his positive “time-ins” are excellent ideas to build a child’s sense of fairness and autonomy.
  • Offer the 8-24 month old child something interesting to hold and look at during the diaper change.  It could be a new soft toy, but it might be better to give them a tiny collapsible colander to examine.  The novelty factor should buy you enough time to do the deed.  Remember to change it up regularly.  They need to learn to expect that this could be more fun than drama.
  • Older kids with the language skills to understand the negotiation could be asked “Do you want your diaper change NOW or in one minute?”  It doesn’t have to be 60 seconds later.  The idea is that you have given them a choice.  You have to stick to the agreement.  If they still balk after the minute is up, don’t use this again right away.  You will be teaching them that their protests work to avoid following your directions.  Oops.

The truth is that most children know that you are going to change their diaper regardless of their protests, and they can handle it if you help them a little bit.

 

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The JointSmart Child Series: Parents of Young Hypermobile Children Can Feel More Empowered and Confident Today!

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My first e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, was a wonderful experience to write and share.  The number of daily hits on one of my most popular blog posts  Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children helped me figure out what my next e-book topic should be.

Hypermobility is a symptom that affects almost every aspect of a family’s life.  Unlike autism or cerebral palsy, online resources for parents are so limited and generic that it was obvious that what was needed was solid practical information using everyday language.  Being empowered starts with knowledge and confidence.

The result?  My new e-book:  The JointSmart Child:  Living and Thriving With Hypermobility.  Volume One:  The Early Years.

What makes this book unique?

  • This manual explains how and why joint instability creates challenges in the simplest tasks of everyday life.
  • The sensory and behavioral consequences of hypermobility aren’t ignored; they are fully examined, and strategies to manage them are discussed in detail.
  • Busy parents can quickly spot the chapter that answers their questions by reading the short summaries at the beginning and end of each chapter.
  • This book emphasizes practical solutions over theories and medical jargon.
  • Parents learn how to create greater safety at home and in the community.
  • The appendices are forms that parents can use to improve communication with babysitters, family, teachers and doctors.

Who should read this book?

  1. Parents of hypermobile children ages 0-6, or children functioning in this developmental range.
  2. Therapists looking for new ideas for treatment or home programs.
  3. New therapists, or therapists who are entering pediatrics from another area of practice.
  4. Special educators, and educators that have hypermobile children mainstreamed into their classroom.

Looking for a preview?  Here is a sample from Chapter Three:  Positioning and Seating:

Some Basic Principles of Positioning:

Therapists learn the basics of positioning in school, and take advanced certification courses to be able to evaluate and prescribe equipment for their clients.  Parents can learn the basics too, and I feel strongly that it is essential to impart at least some of this information to every caregiver I meet.  A child’s therapists can help parents learn to use the equipment they have and help them select new equipment for their home.  The following principle are the easiest and most important principles of positioning for parents to learn:

  • The simplest rule I teach is “If it looks bad, it probably IS bad.”  Even without knowing the principles of positioning, or knowing what to do to fix things, parents can see that their child looks awkward or unsteady.  Once they recognize that their child isn’t in a stable or aligned position, they can try to improve the situation.  If they don’t know what to do, they can ask their child’s therapist for their professional advice.
  • The visual target is to achieve symmetrical alignment: a position in which a straight line is drawn through the center of a child”s face, down thorough the center of their chest and through the center of their pelvis.  Another visual target is to see that the natural curves of the spine (based on age) are supported.  Children will move out of alignment of course, but they should start form this symmetrical position.  Good movements occurs around this centered position.
  • Good positioning allows a child a balance of support and mobility.  Adults need to provide enough support, but also want to allow as much independent movement as possible.
  • The beginning of positioning is to achieve a stable pelvis.  Without a stable pelvis, stability at the feet, shoulders and head will be more difficult to achieve.  This can be accomplished by a combination of a waist or seatbelt, a cushion, and placing a child’s feet flat on a stable surface.
  • Anticipate the effects of activity and fatigue on positioning.  A child’s posture will shift as they move around in a chair, and this will make it harder for them to maintain a stable position.
  • Once a child is positioned as well as possible, monitor and adjust their position as needed.  Children aren’t crockpots; it isn’t possible to “set it and forget it.”  A child that is leaning too far to the side or too far forward, or whose hips have slid forward toward the front of the seat, isn’t necessarily tired.  They may simple need repositioning.
  • Equipment needs can change over time, even if a child is in a therapeutic seating system.  Children row physically and develop new skills that create new positioning needs.  If a child is unable to achieve a reasonable level of postural stability, they may need adjustments or new equipment.  This isn’t a failure; positioning hypermobile children is a fluid experience.

The JointSmart Child:  Living and Thriving With Hypermobility  Volume One:  The Early Years is now available on Amazon.com

And now a click-through and printable download is available on Your Therapy Source!  

For the week of 10/26/19, it is on sale, and when bought as a bundle with The Practical Guide to Toilet Training Your Child With Low Muscle Tone, it is a great deal and a complete resource for the early years!

Already bought the book?  Please share your comments and suggestions for the next two books!  Volume Two will address the challenges of raising the school-aged child, and Volume Three focuses on the tween, teen, and young adult with hypermobility!

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Why Injuries to Hypermobile Joints Hurt Twice

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My new e-book, The JointSmart Child: Living and Thriving With Hypermobility, Volume I, is just about ready to launch.  One of the book’s major themes is that safety awareness is something that parents need to actively teach hypermobile young children.  Of course, physical and occupational therapists need to educate their parents first.  And they shouldn’t wait until things go off the rails to do so.

Hypermobile kids end up falling, tripping, and dropping things so often that most therapists have the “safety talk” with their parents on a regular basis.  What they don’t speak about as often are the long-term physical, emotional and social impacts of those injuries.

Yes, injuries have more than immediate physical effects on hypermobile kids.  Here is how this plays out:

  • The loss of mobility or function after an injury creates more dependency in a little person who is either striving for freedom or unsure that they want to be independent.  Needing to be carried, dressed or assisted with toileting when they were previously independent can alter a child’s motivation to the point where they may lose their enthusiasm for autonomy.  A child can decide that they would rather use the stroller than walk around the zoo or the mall.  They may avoid activities where they were injured, or fear going to therapy sessions.
  • A parent’s fear of a repeated injury can be perceived by a child as a message that the world is not a safe place, or that they aren’t capable in the world.  Instilling anxiety in a young child accidentally is all too easy.  A fearful look or a gasp may be all it takes.  Children look to adults to tell them about the world, and they don’t always parse our responses.  There is a name for fear of movement, whether it is fear of falling, pain or injury: kineseophobia.  This is rarely discussed, but the real-life impact can be significant.
  • Repeated injuries produce cumulative damage.  Even without a genetic connective tissue disorder such as Ehlers-Danlos syndrome, the ligaments, tendons, skin and joint capsules of hypermobile children don’t bounce back perfectly from repeated damage.  In fact, a cascade of problems can result.  Greaster instability in one area can create spasm and more force on another region.  Increased use of one limb can produce an overuse injury in the originally non-injured limb.  The choice to move less or restrict a child’s activity level can produce unwanted sedentary behavior such as a demand for more screen time or overeating.
  • Being seen as “clumsy” or “careless” rather than hypermobile can affect a child’s self-image long after childhood is over.  Hypermobile kids grow up, but they don’t easily forget the names they were called or how they were described by others.  With or without a diagnosis, children are aware of how other people view them.  The exasperated look on a parent’s face when a child lands on the pavement isn’t ignored even if nothing is said.

In my new book, I provide parents with a roadmap for daily life that supports healthy movement and ADL independence while weaving in safety awareness.  Hypermobility has wide-reaching affects on young children, but it doesn’t have to be one major problem after another.  Practical strategies, combined with more understanding of the condition, regardless of the diagnosis, can make life joyful and full for every child!

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Targeted Toilet Training Strategies to Help The Child With A Receptive Language Delay

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After writing my first e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! ,I continue to think of additional issues that can complicate (but not derail)  training.  One of these issues is a receptive language delay.  This is when a child’s ability to comprehend language is not age appropriate.  It may be accompanied by a delay in expressive language as well.  I don’t think it is a hard stop to training, but there are some strategies that improve the experience.  Not all of them are obvious.

When a child is unable to easily and quickly understand what you are saying during toilet training, you will need to do a few things differently:

  1. Expect to need established routines to support your verbal instruction.  This can include very regular trips to the potty rather than happening randomly.  Routines are essential for all children, but these kids really need them to shore up the language you are using.  Think about buying something in another language.  The routine or presenting the item, finding out the fee, offering payment and leaving with your item helps you get over the fact that you have forgotten most of your high school level French.  When they always sit on the potty right before a specific show, they know why and what you are saying more easily because they know the context.
  2. Use clear and consistent gestures and facial expressions as additional messaging while teaching and encouraging performance.  Gestures and facial expressions clarify your words and help kids respond quickly.  If they have too many accidents because they were confused, they could decide to stop cooperating.
  3. Monitor your language complexity, and consider simplifying it for ease of comprehension under stress.  As in the Fast Food Rule’s use of Toddler-ese, shorten phrases and emphasize important words.  This is not the time to lengthen your statements.  Repeat if necessary, but don’t elaborate.  Read Taming Toddler Tantrums Using Sympathetic Reframing for more details on TFFR.
  4. Assume that you will need to be more enthusiastic, more positive, and spend more time on training in general.  Your child is probably already someone with a short fuse.  Struggling to understand what people are saying makes that easy.  Now you are trying to teach a new skill, possibly one that they aren’t 100% excited to learn.  That doesn’t mean never teach it.  It means have a good plan, with lots of optimism and patience on your part.

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