Category Archives: toddlers

The Three Stages of Color Recognition in Toddlers and Preschoolers

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Although this is not officially an OT issue, I field questions about when and how to teach color recognition to young children.  Like many of my other posts, I am writing this one so that I have something I can send parents; they can read about the concepts we discuss.  There is so much going on in a session that it is hard for the average parent to retain everything I “throw” out in a 30-45 minute session!

Color recognition doesn’t usually emerge before 14-16 months, and typical children can be struggling to match primary colors for months after that age.  But the progression, delayed or on-time, follows a fairly standard pattern.   Expecting stage 3 responses when your child is still at stage 1 is simply asking for frustration from your child, and creates unnecessary concern for parents.  These stages aren’t seamless, meaning that one day a child will consistently be at stage 2, and the next, they are functioning at stage 1.  This is also normal, because a young child that is ill, tired, distracted, upset or even hungry cannot perform skills consistently.

Color identification generally happens with primary colors first, and progresses to secondary and tertiary colors.  This  means that a child often can distinguish red and blue  before they know purple and gray.  There are children over three that are totally confused about brown, gray and beige…..that is completely normal.

Stage 1:  Your child is able to match colors shown to them without being able to respond to a request for a specific color or to name the color.  You hold up a blue block, and ask your child to give you another block that is the same color.  You may even find one and say “HERE it is!  The same! I found another block!”  Your child clearly looks at a few blocks, and hands you the blue one.

Stage 2:  Your child is able to respond to a request to find a block of a specific color.  You say to your child “Please give me a BLUE block”, and without showing them which block is blue, they find one and give it to you.  This requires receptive language, as a child interprets your words and assigns labels to the objects they are seeing.

Stage 3:  Your child is able to correctly answer the question “What color is this block?”  This level of skill means that they know the names of colors and can state them on demand.  This requires expressive language, and anyone who has learned another language will know the internal Rolodex as you search for the right name for the color you are viewing.

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Is It Sensory Treatment…Or Sensory Stimulation? How To Know The Difference

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I have spent the first part of my career in pediatrics convincing parents, teachers, and other therapists that sensory processing is important for development, and that sensory processing disorders are a real “thing”.  I am spending the latter part of my career trying to explain to the same groups that using a sensory-based activity does not constitute sensory treatment.

Why?

Results.  You will not get good results to any treatment if the underlying principles aren’t understood and used correctly.  This requires more than a therapy ball and a brush.  A local school district uses general sensory activities for the whole class, rather than sensory-based treatment for kids with sensory processing disorders.  I get a lot of private practice referrals from this neighborhood.  The district’s refusal to address children’s needs in the classroom, while telling parents that they are “sensory-aware”, is frustrating to everyone, including the therapists in the district.  They don’t seem to stick around…..

Therapy for sensory processing disorders requires an evaluation.  Assessing the problem and identifying a rationale for the related behaviors or functional deficits is essential.  Tossing out a sensory-based activity because it is fun, easy, or has worked for another child is the hallmark of a well-meaning provider that wants to help a child but doesn’t have the training of a licensed therapist.

A good example would be to offer teething toys to a child that chews their shirt.  Sounds like a solid plan:  oral seeking equals oral stimulation.  But wait! What if the child is using oral seeking to address severe sound sensitivity?  Isn’t it better to deal with the cause of the problem rather than the end-point behavior?  You would need an evaluation to know that their greater problem is poor modulation and sensitivity.

Treatment techniques follow a pattern that is based on the brain’s neurological response to sensory input.  I didn’t take courses in neuroscience because I liked looking at brain sections.  I took those courses so that I could understand the structure and function of the brain!

The right intervention (movement, pressure, etc.) uses intensity, duration, specificity of sensory input, location of contact/input, frequency, and timing to achieve results.  This sounds like a lot to consider, and….it is!  The way OTs create a sensory diet isn’t by looking at what worked for another child.  We look at what we observe, what we assess, and what the child’s performance demands are.  Only then can we identify what should be used, how and when it should be used, and how to determine our next steps in treatment. 

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A great treatment that isn’t used at the correct level of frequency or used when it is most needed is going to fail.  So will the right frequency of treatment used vigorously rather than with skilled observation.  Non-therapists can be taught a treatment intervention, but it takes training and experience to create a treatment program.  This is no different from any other type of therapy.  Psychotherapists aren’t just talking to you. Speech therapists aren’t simply teaching you how to pronounce the “r” sound.  If it was that easy, we wouldn’t need licensure or even a degree.   

It would be a lot more fun.  We make it look easy, and that is the art of OT.

 I have just explained (some of) the science.

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How to Help Toddlers Prepare to Write

Ian, Lila, and Tom aren’t writing. They are drawing!

Contrary to the ideas of some preschool teachers, most three year olds don’t write their names.  In truth, most young fours don’t either.  I refuse to count the kids who “draw” their names like the photo above.  That isn’t writing.  That is drawing, the same as if I copied my name in Mandarin.  I would be drawing the characters, not writing.  Writing requires that I know the correct start and sequence of strokes.

So…What can you do to help late twos and the threes prepare to write?

The mom of a toddler brother of a private client asked me, and I know this child uses his fist to hold a crayon.  Improving his grasping skills should be one big goal, and there are a bunch of fun toys that can support this.  Read Water Wow: Summer Pre-writing Fun on the Road  and read LEGO Duplo My First Car Creations: Putting Together Cars, Building Hand Coordination for two great toys that kids in this age group will love.

 Another way to prepare a young child for handwriting is to build a child’s skilled use of spoons and forks for self-feeding.  I wrote a post on this  How Using Utensils To Eat Prepares Your Child To Write  , and I don’t think parents always fully understand that offering finger foods isn’t going to build hand skills after age 2, unless your child is very physically delayed.  Once they can pop a chicken nugget into their mouth, finger feeding isn’t building hand control.  It certainly isn’t enhancing grasp!  Getting a child the right utensils seems to be an issue in many homes.  Pre-pandemic, I did live EI sessions, and regularly asked parents to throw out those infant feeding spoons (they have a tiny bowl and a super-long handle) because they DO NOT HELP YOUR CHILD SELF-FEED.  THEY MAKE IT HARDER.  Read Which Spoon Is Best To Teach Grown-Up Grasp?  and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child   to find good utensils that support hand control.

The use of a vertical easel, the kind found in any preschool classroom, can build hand control and prevent the development of an awkward crayon grasp.  Stabilize the paper with clips or tape, because young children will not hold loose paper while coloring.  Using a screen stylus builds finger strength and makes drag-and-drop screen time into a hand exercise.  

Crayola’s PipSqueak markers and their My First Crayons are great choices for pre-writing.  ColorWonder paper and markers will not make a mess.  They will save your MIL’s couch at the same time!

Enhancing bilateral assembly skills will prepare a child for the visual-perceptual and midline awareness needed for handwriting.  I love MagnaTiles and DUPLO blocks, but there are other ways to build.  A great variety of building materials will support a typically-developing child.  Sitting passively in front of a screen will not.  Safety scissors should be offered.  The kind that really work: Lakeshore Scissors for Toddlers That Only Cut the Paper, Not the Toddler

Finally, young children need to see adults and older siblings drawing and writing.  If your older kids are addicted to screens, you will have to be the one coloring and drawing.  During stressful times, this might help you relax as well.

A Fun Way to Help Kids With Low Tone Stand Up Straight: Stomp-Stomp!

sven-brandsma-gn-I07tTixw-unsplashKids with hypermobility or low tone are often found standing in the most dysfunctional of positions.  Toes pointing in, feet rolled in or out, feet on top of each other: take your pick, because these kids will alternate between these wobbly choices and more!  Read How To Improve Posture In Children With Low Muscle Tone… Without a Fight! and How To Correctly Reposition Your Child’s Legs When They “W-Sit” for some other ideas.  But if you want a quick idea that works to help a child stand up with better control and stability, read on.

Telling a child to “fix your feet” often makes no sense to them, or gets ignored.  Passively repositioning their feet doesn’t teach them anything, and can annoy children who feel that they are being manhandled.

What Can You Do?

Tell Them To “Stomp-Stomp”!

Have the child stomp their feet. Repeat if necessary (or because they want to).   It is simple, you can demonstrate it easily, and most kids grin happily and eagerly copy you.  It is fun to stomp your feet.  It also give kids a chance to move in place, which they often need when socially distancing in a classroom.

 

Why Does It Work?

Because in order to stomp their feet, they have to bring their attention to their feet, shift their weight from one foot to the other in order to lift them up, and their feet almost always end up placed in a more aligned position after stomping.

Many of the goal boxes their PT and your OT have on their list are checked.  Kids don’t feel controlled or criticized.  They are having fun.  Sensory input happens in a fun way, not as an exercise.

Want more help with your child, or help improving treatment plans as a therapist?

I wrote three e-books for you!

The Practical Guide to Toilet Training Your Child With Low Muscle Tone, and the JointSmart Child series on hypermobility are all valuable resources for parents and therapists.  I wrote them because there is simply nothing out there that provides an explanation for why these symptoms make life so difficult for kids (and parents, and teachers, and even therapists!) and what can be done to make everyday life better.

Learn why low tone and hypermobility both create sensory processing issues, and what kinds of social and emotional issues are understood to accompany hypotonia and hypermobility.  When parents see these issues as complex rather than only about strength and stability, they start to feel more empowered and more positive.

Read more about these books, available for purchase on Amazon and Your Therapy Source,  in A Practical Guide to Helping the Hypermobile School-Age Child Succeed, and The JointSmart Child Series: Parents of Young Hypermobile Children Can Feel More Empowered and Confident Today! as well as The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

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Got a Whining Child Under 5? Here Is Why They Whine, And What To Do About It

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A lot of my youngest clients have started to whine.  That cute toddler has turned into a whiny young preschooler.  The pandemic isn’t helping them avoid it, or help their stressed parents handle it.

But I can help both parties.  I cannot make these kids grow up any faster, but understanding many of the reasons why kids under 5  whine and having strategies to manage it (notice I didn’t say “eliminate it”) can help.  Here is why they whine (most of the time) and what parents can do to get this behavior under control:

The Whys:

  1. They got smarter.  Not exactly more manipulative, but smarter about what gets your attention and what sustains it.  They can wear you down, and they can see that they are wearing you down.  Infants can wear you out, but they are oblivious to the effects of their screaming.  Not these guys.  They are taking notes, and taking names.  They know who is the best target for a whine, and who is impervious.
  2. They have more endurance.  You can’t divert their attention as easily as you once could.  No “look at the doggie!” and certainly no “It’s OK sweetie” will work any longer.  They know what they want, realistic or not, and they are gonna hold out for it.  Or make you pay.
  3. They have bigger ideas.  They can imagine more, and see that their productions don’t measure up to yours or their big brother’s results.  That scribble isn’t looking like the firetruck they wanted to draw.  Not nearly.  And they don’t know how to ask for targeted help or even any help sometimes.  This is a source of constant frustration for the most perfectionistic child, and even the most even-tempered.
  4. They still don’t understand physics.  Buildings that collapse, paper that tears, crayons that break.  They haven’t reached the cognitive level where they can anticipate these things, so they have “disasters” all the time.  I imagine if all your laundry turned pink, all your cooking burned, and all your pens broke.  You’s be annoyed too.
  5. They care deeply about what they are making, but their baby sibling doesn’t.  But they can’t anticipate and ensure the safety of their production line.  Babies are always up in their grills, ruining things.  Not because they are trying to; they are exploring, and destruction is a way to explore.  Let the frustration and the whining begin….

What can you do to decrease the whining so you don’t lose your ever-loving mind?

  • Telling them “I don’t understand you when you whine” isn’t likely to work.  You could tell them what you DO want them to do, which is to speak to you calmly.  It could be called an “inside” voice, or a “kind voice”, or any other name for it that your kid understands.  Telling someone what you want them to do works better than telling them you have become deaf.
  • Be amazingly consistent.  Don’t let circumstances rule.  Bake space into your events, so that you can wait out a whiner, and the essential things that need to get done happen with or without their participation.  You can leave the store without buying anything if you have something in the freezer you can serve for dinner, diapers for the baby, and “emergency milk” in the fridge.  Once a child sees that you mean business, they remember it.
  • Come up with something more fun for them to do than whine.  Since they now have bigger ideas but are unable to anticipate every disaster, you can give them methods to stop their LEGO from falling apart, or at least explain why it fell.  Be the solution to their problem in a way that makes problems normal and not a reason to fall apart.
  • Praise them for anything they do that is helpful, kind, or cooperative.  Yes, they should be cleaning up anyway.  But they will still be happy to hear that you liked their efforts.  Praise them to your partner or another sibling when they can hear you but aren’t in front of you.  This is Dr. Karp’s “gossiping” strategy, and it works!
  • Don’t let the baby destroy things, and then tell them they should be more tolerant of it.  Tell the baby not to touch, and tell your older child that they have to move their toy to avoid the baby breaking it, or they have to play with it when the baby naps.  Explain that babies just cannot understand what they are doing is a problem.  They aren’t trying to break things but they do. Make it clear that their toys are a priority for you, and that hitting and whining won’t work, but planning will.  This is my secret weapon.  When a child sees that I am on their side, they are my best buddy.  I won’t put up with aggression, but I will limit the rights of anyone else to attack their precious toy.

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How To Respond to Your Child’s Aggressive or Defiant Acts To Get Results

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Throwing toys.  Screaming “NO!!!!!”  Dumping a plate of food on the floor while they look right at you in defiance. Kids can go from cute to aggressive in the blink of an eye.

Is it annoying?  Sure.  Is it dangerous?  Not all the time.  Should you completely ignore it?  Not unless you’d like to see what real defiance looks like at 10.

But what should you do when your child is really testing your limits and the limits of your rules?

  1. You are allowed (and encouraged) to use a firm “no”.  Not the weak kind, and not a hair-raising screech either.  Lower your voice and look directly at your child.  “No”  clearly tells them they have crossed a line.  Avoid too many words, or weakening the message with explanations of why pulling the cat’s tail is a “no”, or why throwing their car at the flat screen TV is a “no”.  Young kids really have no idea about warranties or parsing cause-and-effect.  “No” is simply “no”.
  2. If they continue the behavior, you don’t have to do that whole “count to three” stuff.  The author of “1-2-3 Magic” states clearly in the book that this technique is intended for children over 2 that can comprehend it.  Under 2, and definitely if they have any language delays, you are making a fool of yourself if you think they can follow the idea.  Set limits and use consequences they can appreciate.
  3. Should you ignore some things?  Absolutely.  If there is no risk of danger, and if you are going to have them scoop their mac and cheese from the floor back onto a plate and into the trash in a few minutes, you can ignore it and try to turn things around.  You never want to teach anyone that bad behavior is the best way to get your attention.
  4. Never ignore physical aggression.  Unless people in your home routinely are allowed to hit each other, why would you accept that from your child?  You don’t hit them back, but you certainly don’t hug them warmly after they have smacked you in the face.  Think I am making this up?  I watch this now on telehealth in therapy sessions, but I used to witness it in person!  With parents that should know better.  After your child has smacked you while holding them, put your child down on the floor and tell them “No hitting” and walk a few feet away for a moment.  That is enough to message to a younger child that violence never is OK.  With an older one, that is an immediate time-out without any discussion.  They know they crossed an immovable line.
  5. Always praise good or good-enough behavior when you see it.  I tell parents that praising breathing out and then in again is OK.  So is sitting for three seconds without screaming, and so it giving me your plate instead of tossing it to the floor.  Very young children don’t see that as overkill.  They are little.  They see any praise as simply praise.  And you have to be positive if you are going to be firm about the defiance.
  6. Offer a better game than defiance.  You may have to buy some new toys.  You may have to be more fun with them than you were before.  You may have to be silly, and sit and play with them for a while.  But you were spending a lot of time with them anyway, dealing with defiance.  So this is a better deal.  When it is more fun to be “good”, most children, most of the time, will choose that.

If you find spending time with young children boring, if you expect them to never be defiant, if you aren’t willing to set limits, if you don’t want to deal with their anger when you stop their actions….you need to think carefully about your own issues.  

Kids aren’t houseplants.  Raising them is work, hard work, and it never ends.  But in the end, teaching them to manage their aggressive impulses without crushing their spirit helps them be the decent humans you want them to be.

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Teach Kids How to Cut With Scissors…The Easy Way

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terrific safe scissors for little hands!

As a pediatric occupational therapist, scissor use is something I assess but also something I teach.  And I teach it early.  I also teach safety early, and teach it with a focus on early success.

What makes it easier to teach children to cut with scissors?

  1. Good timing.  Typically-developing children have the visual-motor skills to start snipping with scissors at 24 months.  YUP; that early.  What they don’t have is safety awareness and the ability to select what they should be using.  To teach scissor skills this early, you have to know about fine motor development, child behavior, learning skills, and have access to the right tools.  If a child is unable to attend to your demonstration, unwilling to tolerate assistance of any kind, or unable to use both hands at midline, then 24 months of age is too soon.
  2. Good tools.  My long-time readers know that I use only one type of scissor until a child is 4 or 5:  Lakeshore Scissors for Toddlers That Only Cut the Paper, Not the Toddler  Nothing derails training like needing a bandage!  In addition to the right scissors, beginning to cut is helped when the paper is a bit stiff.  The cheap printer paper most teachers and even therapists use to make copies of cutting sheets is difficult to cut.  We don’t experience it as difficult, because adults have better graded grasp.  We can control the scissor more easily as well.  Young children do much better with card stock or at least high-quality printer paper.  Try getting the administration to pay for it, though.  But if you want success, use the right tools.  My private clients learn using the Kumon “LET’s Cut Paper” series of books, or “Paper Playtime”.  Read more about these excellent books here: Kumon Learn to Cut Books: Paper Truly Worth Snipping Up   . 
  3. Good demonstration.  Some children watch every move you make.  Others are completely oblivious.  Most are somewhere in the middle.  But learning to cut isn’t intuitive.  Not any more intuitive than changing the air filter in your car is.  Could you learn to do it?  Sure, but it would really help if you could watch someone before you tried it.  I make sure that a child is able to observe me, and being that close to a scissor is another reason to use Lakeshore’s brand of safety scissor.  If a child grabs my hand or my scissor, I might not be happy about it, but the will not be injured.  If they ONLY watch me the first or second time I use a scissor in front of a child, that is just fine.  Some kids are risk-averse, and pushing them to try isn’t smart.  The next time I bring the scissors out, they may be more eager to try to use them, and they will have some information stored away about how they work.
  4. Good experiences.  Learning should be fun.  Play should be fun.  Learning to use scissors should be play, not work.  Make it fun.  I will demonstrate cutting on a page that results in something fun to play with.  The “Let’s Cut Paper” books make some cut things.  Another thing that is fun is cutting pieces of paper that fall to the table.  I am doing telehealth during the pandemic, so I am teaching parents to cut 1/2-inch strips of paper and have kids cut across the paper.  They joy in a child’s face when they snip across the strip is wonderful.  It isn’t the same as snipping on the side of the page.  You need to make it fun, or it isn’t going to work.

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Toilet Training? Your Child Needs the Right Shorts!

 

In my first e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, I wrote almost a full chapter just on clothing management.  If your child needs you to pull clothing on and off, they are NOT fully trained.  And if they have clothes that make it impossible for them to manage, you are holding them back from feeling like a real success.

Target has your back!

Yes, the same place you go for their swimsuits, toilet paper, and hand soap.  Target sells a cheap pair of shorts that children can easily pull down and back up again.  Their Cat and Jack line is pretty inexpensive, which is helpful when you know that you will be going through a few pair of shorts per day due to accidents.  They are soft to the touch for kids with sensory sensitivities, and they do have a drawstring waist if you have one of those kids whose shorts slide off their tush.  But remember that if you knot it, your kid won’t be able to slide their shorts off easily.  Better to buy a smaller size.

I would pair these with a T-shirt that ends close to their natural waist.  A longer top will get in the way during bathroom use.  You want to give your child every chance to have a positive experience, and peeing on your clothing by accident isn’t a positive!

Here is a link to a post on dressing skills: Low Muscle Tone and Dressing: Easy Solutions to Teach Independence

Want more help with your child?  

The Practical Guide….. is available on my website Tranquil Babies as a printable download, and on Amazon as a read-only download.  It is also available on Your Therapy Source individually and bundled with either my book on hypermobility in very young children The JointSmart Child Series: Parents of Young Hypermobile Children Can Feel More Empowered and Confident Today! or as a discounted super-bundle with my book on hypermobility in school-age children included A Practical Guide to Helping the Hypermobile School-Age Child Succeed

Should You Use Pre-Mixed Dough to Bake With Your Toddler?

food-photographer-jennifer-pallian-OfdDiqx8Cz8-unsplashOK; this is a trick question.

Using prepared dough is one of the easiest ways to introduce very young children (or special needs kids of any age that are functioning at the 18-36 month level) to food preparation.  With the right mindset, it is the beginning of a wonderful way to share practical skills, build sensory and motor skills, and enjoy the company of very young cooks.

The greatest objections to using prepared dough, whether pre-cut or just pre-mixed, are that these are high-carb/low nutrition foods, and that they include preservatives.  Both of these statements are true.  They are also true of most of the food I see served to young children and consumed by parents.  I can count on one hand the number of families I have worked with in 25 years that do not consume any foods containing either preservatives or sugar.

Most families limit their consumption of both, and that makes a lot of sense.  Nobody is going to make cookies of any kind every day of the week, and maybe not even every month.  These are treats.  The dough can be purchased, already made with very wholesome ingredients, in specialty stores.  Adults can also make their dough from scratch well before including the child, as you would do with “refrigerator cookies” and pre-slice it, so that a child only has to place circles of dough on a cookie sheet to bake them off.

The greatest benefit of using pre-made dough is the ability to have only a few steps in the entire process of baking, so that a child is introduced to the experience of making food in an easy and positive manner.  Beginning with many ingredients and many steps that only the adult can perform is a sure-fire way to create a huge mess and create a negative experience for both the child AND the adult.  Young children have no sense that food is prepared.  They aren’t often witness to any preparation or cleaning.  This is a wonderful way to introduce them to the process.  Of course, no child can be involved with the use of an oven or touching hot pans.  That is OK; we want children to build their patience and attention!

Most kids are quickly ready to progress to using pre-mixed dry ingredients and blending them with wet ingredients, and then helping to measure and mix all ingredients.  The use of pre-made dough is simply a first step in a long process of involving kids in the kitchen!

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Want Better Self-Regulation in Young Children? Help Them Manage Aggression

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You might think as a pediatric OTR, I would be writing a post about sensory-based treatment for self-regulation.  And I have in the past.  Not today.

But I have been an OTR for decades, and what I know about today’s children is that agitated and dysregulated kids often need help managing aggressive impulses and negative emotions first, in order for me to assess whether or not their behaviors have a sensory basis.

That’s right:  a young agitated child cannot be assumed to have sensory processing difficulties if they haven’t learned any self-management tools.  It is too easy to assign them a label, and I refuse to do that.  But I can and will use effective techniques to manage aggression before I jump in with all the bells and whistles from my sensory processing treatment bag.

What works for me?

I get a lot of mileage out of Dr. Harvey Karp’s Happiest Toddler on the Block strategies.  Once I learned these simple techniques, I applied them to every situation in which a young child was oppositional, aggressive, defiant, or threatening/delivering a tantrum.   That could be every session!  Toddlers aren’t known for their easy-going ways.

His Patience Stretching, Fast Food Rule, and Time-Ins are my three-legged stool that supports my therapy sessions.  Read Use The Fast Food Rule For Better Attunement With Your Child and Stretch Your Toddler’s Patience, Starting Today!  Kids aren’t born with the ability to handle frustration and manage impulses.  Adults teach them how to deal with their feelings.  When they aren’t taught what to do when they are disappointed, when they want attention, or when they are angry, things can get pretty unpleasant.  The good news is that learning can begin around their first birthday.

Job number one should never be unclear to anyone, but as time has gone on, fewer and fewer parents seem to communicate it clearly:  physical violence from anyone isn’t acceptable at any time.

Are parents committing violence against their child?  No.  It is the child that is biting, hitting, or damaging items.   “We don’t hurt people or animals in this house” isn’t always communicated clearly to a child.  I never hear a parent say that they like being smacked across the face by their child, but they also seem to struggle to clearly communicate that this behavior is unacceptable.  Resorting to responding with violence is not helpful.  Teaching how to manage aggression can be done without spanking a child or even raising their voice.  Changing their tone of voice and rapidly putting the child out of arm’s reach will make it clear to their child that they have crossed a line.  But so many parents seem hesitant to set limits, and some seem to worry that being firm will harm their child or hurt their feelings.  This is coming from,  remember, the same child that just smacked them in the face or bit them.  By not reacting clearly, parents are in fact communicating that aggression toward others isn’t a problem.

I try hard to teach parents that it is kind and loving to teach children that they can have their feelings but they cannot express them with aggression.  There are limits in the wider world, and if they act this way with people that don’t love them, the consequences aren’t going to be good.  Learning to hear “no” from someone that loves you is a lot easier.

Young children need to learn the vocabulary of negative emotions like anger, disappointment, frustration and sadness.  They need to practice waiting and need to be spoken to in a way that makes it clear that they are understood but may not get their way all the time.  Negotiation and appreciation go hand in hand.  Dr. Karp’s techniques really work for me, and they aren’t difficult to learn or use.  I wish every parent would try even one and see how easy they can be incorporated into daily life with young children!

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Is Your Child With Low Tone “Too Busy” to Make it to the Potty?

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Since writing my first e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, I have fielded a ton of questions about the later stages of potty training.  One stumbling block for most children appears to be “potty fatigue”.  They lose the early excitement of mastery, and they get wrapped up in whatever they are doing.  What happens when you combine the effects of low tone with the inability of a  young child to judge the consequences of delaying a bathroom run?  This can lead to delaying a visit to the bathroom until it is too late.  Oops.

Kids with low tone often have poor interoceptive processing.  What is that?  Well, interoception is how you perceive internal sensory information.  When it comes to toileting, you feel fullness in your bladder that presses on your abdominal wall, in the same way you feel a full stomach.  This is how any of us know that we have to “go”.  If you wait too long, pressure turns to a bit of pain.  Low muscle tone creates a situation in which the stretch receptors in the abdominal muscles and in the bladder wall itself don’t get triggered until there is a stronger stimulus.  There may be some difficulty in locating the source of pressure as coming from the bladder instead of bowel, or even feeling like it could be coming from their back or stomach.  This leads to bathroom accidents if the toilet is too far away,  if they can’t walk fast enough, or if they cannot pull down their pants fast enough.  You have to work on all those skills!

Add in a child’s unwillingness to recognize the importance of the weak sensory signals that he or she is receiving because they are having too much fun or are waiting for a turn in a game or on a swing.  Uh-oh.  Not being able to connect the dots is common in young children.  That is why we don’t let them cross a busy street alone until they are well over 3 or 4.  They are terrible at judging risk.  Again, this means there are skills to develop to avoid accidents.

What should parents do to help their children limit accidents arising from being “too busy to pee?”

  1. Involve kids in the process of planning and deciding.  A child that is brought to the potty without any explanations such as “I can see you wiggling and crossing your legs.  That tells me that you are ready to pee” isn’t being taught how to recognize more of their own signs of needing the potty.
  2. Allow kids to experience the consequences of poor choices.  If they refused to use the potty and had an accident, they can end up in the tub to wash up, put their wet clothes in the washer, and if they were watching a show, it is now over.  They don’t get to keep watching TV while an adult wipes them, changes them, and cleans up the mess!
  3. Create good routines.  Early.  Just as your mom insisted that you use the bathroom before leaving the house, kids with low tone need to understand that for them, there is a cost to overstretching their bladder by “holding it”  Read  Teach Kids With Ehlers-Danlos Syndrome Or Low Tone: Don’t Hold It In! to learn more about this.  The best strategy is to encourage a child to urinate before their bladder is too full, make potty routines a habit very early in life, and to develop the skills of patience stretching Stretch Your Toddler’s Patience, Starting Today!  from an early age.  Creating more patience in young children allows them to think clearly and plan better, within their expected cognitive level.

Looking for more information on managing daily life with your special needs child?

I wrote three e-books for you!

My e-book on toilet training, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, and my e-books on managing pediatric hypermobility, are available on Amazon as read-only downloads, and on Your Therapy Source as printable downloads.  The JointSmart Child:  Living and Thriving With Hypermobility  Volume   One:  The Early Years and Volume Two:  The School Years are filled with strategies that parents and therapists can use immediately to improve a child’s independence and safety.

Your Therapy Source has bundled my books together for a great value.  On their site, you can buy both the toilet training and the Early Years books together, or buy both hypermobility books together at a significant discount!

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The Preschool Water Arcade Game You Need This Summer If Camp is Cancelled (and maybe even if it isn’t)

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I cannot BELIEVE how much fun this Step 2 Waterpark Arcade toy could be!  You hook it up to your outdoor garden hose and play.  As an occupational therapist, I want all of my older toddler and all my preschool clients to get one of these arcade games to work on visual-motor coordination and hand strength.

What kid isn’t right for this toy?

  • This isn’t a toy for a child that cannot resist the impulse to spray others, as the water flow could be pretty strong.   Almost every child is going to have some experimentation with controlling the hose.  That isn’t the same as intentionally nailing their baby brother in the face.
  • Nor is it a good choice for a child that is really unsteady on their feet.  It won’t be easy to handle a hose while sitting down, and too much failure is really hard on kids that are already stressed because of missing camp.
  • They have to have enough hand strength, even with two hands together, as shown, to squeeze the trigger while aiming.  Older kids can stand farther back from the toy and use one hand.
  • Kids with significant problems with strabismus may not be able to aim from a distance.  Strabismus will force them to use one eye to avoid “seeing double” at a distance.  Again, failure isn’t fun.  Weakening one eye isn’t a great idea either.  If this motivates a child to wear their special glasses or eye patch, on the other hand, it could help you get some compliance.

Can You Incorporate This Toy Into Fine Motor or Handwriting Practice?  SURE!!!!

  1. Parents can come up with a score sheet on the sidewalk with chalk, on a white board with a marker, or use a bucket with pebbles.  Every time a child hits the mark, they get a point.
  2. They can write a hash mark or erase the previous score and write the new one, which is great for preschoolers and kindergarteners to practice writing numbers over the summer.
  3. Of course, they have to write their names and their opponent’s name as well.
  4. Counting the pebbles without writing them could be great practice for younger kids.

Looking for more outdoor fun this summer?  Read Doing Preschool Camp at Home This Summer? This is the Water Table You Want!  Worried about rainy day fun?  Read Doing OT Telehealth? Start Cooking (And Baking)!

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Doing Preschool Camp at Home This Summer? This is the Water Table You Want!

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I just found this online after a parent asked me for recommendations for equipment.  She isn’t sending her two kids under 5 to camp this year, and needs some ideas to turn her backyard into a fun place to spend the summer.  This is the Little Tikes Magic Flower water table.

Why do I love this one?

Watch their video on Amazon and you will understand!  But before you do, here are my reasons, as an occupational therapist, for recommending this water table:

  • Multiple levels mean that children of different ages can both have fun.
  • Multiple ways to explore helps kids take turns without having to choose between “the fun thing” and the “barely OK things” on the water table.
  • The animal theme works for lots of kids.  Not everyone likes pirates.  Or even understands pirates.
  • It is big enough to have at least 2 kids playing at the same time, maybe 3.
  • They include 2 duckies (who doesn’t love duckies?), 2 frogs, 3 turtles, a fish, and three pouring choices.  I hate tables where you STILL have to go out and buy stuff to make it fun.  This table is “one-and-done”.
  •  All of my clients with low tone and hypermobility that can stand will be motivated to do so; there isn’t really any way to lean on this water table.  They can stabilize by holding an edge, but they cannot drape themselves over it.  They will be bending and reaching.  A lot.  That is a good thing.  But be mindful of the heat Helping Children With Low Muscle Tone Manage Summertime Heat
  • Kids that use a wheelchair or need to sit while playing due to mobility issues will still be able to have fun with their friends and siblings that can stand and bend.  This water table is inclusive.

I really hate sand tables.  You would think that as an OTR, I would love them.

Nope.  Sand gets everywhere.  In clothes, in body folds, everywhere.  Kids get sand in their mouth and in their eyes.  It tracks into the house unless you shower your kid outside, and maybe it will be found inside even then.  Sand is a pain in the neck.

As long as you empty your water table and hit it regularly with some soap or a diluted bleach solution to keep it clean, it is much easier on everyone to have a water table rather than a sand table.  This one is going to be a lot of fun!

Need more ideas for fun this summer?  Read The Preschool Water Arcade Game You Need This Summer If Camp is Cancelled (and maybe even if it isn’t) and Doing OT Telehealth? Start Cooking (And Baking)!

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Doing OT Telehealth? Start Cooking (And Baking)!

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Parents are looking for ways to survive the lockdown without daycare and preschool.  Even the easiest child is starting to chafe under the oppression of the COVID quarantine.  As an OT, it is my job to help parents support growth and development, but I don’t have to make it feel like work.

Enter cooking and baking as OT activities!

The simplest recipe I know has two ingredients and cannot be ruined unless you step on it:  Chocolate rolls.

You need:

  • Baking sheet, preferably non-stick or lined with parchment paper.  This dough is sticky, and the melted chips are a pain to clean off a surface.
  • Work surface: possibly another baking sheet, non-stick foil, or parchment paper.  
  • One container of crescent rolls (8 to a package, usually) Keep it cold until you are going to use it.  When it gets warm it gets very goey.  Kids either love it and mash it about, or won’t touch it.
  • 1 to 1 1/2 cups chocolate chips, separated into two small bowls.  You will need only about 1 cup, but have extra since kids will taste a few.  Or a lot.  A mom only had a chocolate bar, and she broke it up into small pieces.  I think she needed to smash something that day!   COVID has made us adaptable….

DIRECTIONS:

Preheat the oven to 350 degrees F.

Unroll two triangles of dough, one for the adult, and one for the child.

Demonstrate how to gently push the chips into the dough, then roll up, starting at the wider end.  Assist your child to imitate you. Don’t over-fill with chips.   If it becomes a squishy mess when they roll it up, don’t panic.  This will bake off just fine.  I promise.

Repeat with all dough triangles.

Place both rolls on the baking sheet, and once filled, place the baking sheet on the center rack of the oven.

Bake for about 8-12 minutes or just until the bottom of the rolls turns light golden brown.  You will have to check them after 8 minutes, as they bake quickly.  They keep baking a bit after you take them out of the oven, and if you overbake, you will have 8 chocolate hockey pucks.

Cool and enjoy!

NOTES:

I ALWAYS make a recipe by myself first before baking with kids.  Why?  Two reasons:

  1. I need to know what can go wrong and how my oven responds.  Every minute counts in baking.  Kids take failure personally, so I want to make mistakes and fix them before I ask a child to try a recipe out.
  2. You have a finished product to show them.  Young children cannot look at dough and chips and imagine what it will be like when it is done.  Showing them the actual, real, tasty end product makes it understandable to them.

Is your child likely to snack on the supplies?  Use an “eating bowl”.  I often tell parents to assemble a small amount of chocolate chips in a separate bowl and designate this as an “eating bowl”.  Rather than criticize a child’s desire to sample, they can eat from this bowl without altering the amount needed for the recipe.  Even Julia Child liked to snack on her supplies!!

If you want to get fancy, you can place a few raspberries at the wide end of the dough.   Toddlers and preschoolers aren’t gourmets, and they can reject things that aren’t simple, so don’t insist that they copy you.  But this is a way to expand a child’s awareness of food variety as well as make your chocolate roll tastier.

 

 

 

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How To Pick A High Chair For Your Special Needs Child

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My first Early Intervention home visit always involves seeing the child sitting in their high chair.  I learn a few things.  I learn how the child is handled by the parent or caregiver, including whether they use the available strapping to secure them.  Many don’t, and don’t realize that it is part of the problem.  I learn how well the child fits into the chair, and how well the child can balance and reach in this chair.  And I hear about what problems the parent or caregiver is having with using this seating system.

This post is intended to share some of what therapists know about seating, and how to pick a better chair for kids that have challenges.

Every parent reading this post should know that their child’s therapists are their best source for getting the right high chair.  Never consult Dr. Google when you have licensed professionals available.  There is a reason for that license!  The folks you meet online cannot evaluate your child and provide safe recommendations for you.  This includes me; my comments are meant to educate, not prescribe.  That would be unethical and unsafe.

Typical children need a high chair when they can maintain their head balanced in the center and can start reaching and holding a bottle or finger food.  Before that, they use a feeding seat.  Feeding seats are slightly-to-moderately reclined and do the job of a parent cradling a child while feeding.  A child in a feeding seat usually isn’t expected to independently steady their head or hold a bottle. There are usually straps that stabilize a child’s chest and shoulders as well as a strap that stabilizes their pelvis.

Again, not every adult uses these straps correctly to give a young child the best support.  I will always do some education on methods to correctly position and adjust strapping.  The adult’ reaction (relief, curiosity, resistance, disinterest) tells me a great deal about what is coming down the pike.  Some special needs kids will use a feeding chair well past 12 months of age.  The commercially-made feeding chairs aren’t large, so some kids won’t fit  into one much past 18 months.  After that happens, we have to think about either a commercial high chair or adaptive seating.

Commercially-made high chairs in the US are gigantic.  They could hold a 4 year-old! This is always a problem for special needs kids.  Too much room to move in the wrong way isn’t helpful.   These chairs may or may not have chest/shoulder straps, and they may not have an abductor strap (the one between a child’s legs, that prevents them from sliding under the waist belt).  The best chairs have the waist belt low enough that it sits across a child’s lower hips like a car’s seat belt.  This is always preferable to sitting at the bellybutton level.  It provides more stability.

If a special needs child collapses their posture while sitting in a high chair, when I stabilize their hips in a way that doesn’t allow them to collapse, they might complain.  They were allowed to slouch so much that this new position, with appropriate core activation, feels wrong to them.  It can take a while for a child to learn that eating and playing in a chair requires them to use their core.  I allow them to gradually build up their abilities with short periods of eating and playing.  Not every parent is comfortable finding out that they were contributing to core weakness by allowing a collapsed posture.  I don’t add to that feeling; you know more, you do better.  Simple as that. No guilt.

Some providers insist that every child, at every age and stage, have a place to put their feet.  The strongest proponents of this idea are usually not therapists but educators or speech therapists who attended a positioning lecture or inservice.  Occupational therapists know that a child that doesn’t have the hip control and emerging knee and foot control to place weight into their feet will not be able to use their feet to steady their trunk.  They will, however, figure out how to use a footplate incorrectly.  Unless a child is older than 2 and requires lower leg stabilization to avoid tightening their hamstrings (which will derail their positioning) and sliding forward, or to prevent sensory-seeking or ataxic movements, I don’t strap a child’s feet onto a footplate, or even worry about providing a footplate.  A child that is in a feeding chair, or just beginning to use a high chair, isn’t going to use a footplate correctly, and is more likely to use one to ruin previously decent positioning.  A child that is able to bench-sit or is starting to take weight into their feet?  That child can use a footplate to build sitting control.  Here is a post to help you use one well: A Simple Strategy To Improve Your Child’s Posture In A Stokke Tripp Trapp or Special Tomato Chair

Special needs kids that have very limited head and trunk control will often need an adaptive seat that gives them more support.  It can transform them!  More support can allow more freedom, not less.  These chairs are able to be customized, are obtained through DME vendors and can be paid for by insurance or EI.  They are expensive, and considered medical equipment, not chairs.  Parents need instruction in their use to avoid harming a child by too intensive strapping and incorrect adjustments.  But when done right, they can transform a child’s abilities in ways that no commercially-available chair can accomplish.  Giving a child a seating system that frees them to reach and look and eat and communicate is a wonderful feeling.  Those of us that are trained in seating evaluation know that the right chair can build skills, not substitute for them!

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Want Your Child to Show Hand Preference (Righty/Lefty?) Where You Place Their Spoon Matters

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I get a lot of questions about this issue, based on my experience as a pediatric OTR.  Starting at 12 months, some children show a strong hand preference and never look back.  Other kids are switching hand use long after 4.  Without the existence of disorders that directly affect hand dominance such as orthopedic disorders, cerebral palsy, or untreated torticollis, hand dominance is hard-wired and emerges naturally.  But there are situations in which it is delayed or incomplete long after the typical window of skill development.

Here is what can be happening, and here is what you can do as a parent or a therapist:

Hand dominance only emerges with the development of refined hand control and the child’s awareness that they need more skilled control for an activity.  I tell parents that I can pick up my coffee cup with either hand to drink, but that doesn’t make me a lefty.  If you paid me $100, I probably couldn’t thread a needle with my left hand.

Children that aren’t practicing refined skills like feeding or assembling blocks, or even intent on picking up every darn piece of lint on the carpet…they don’t need refined grasp, and they probably will not demonstrate hand dominance on time.  Kids that are scribbling wildly but haven’t tried to draw a circle with closure ( a 36-month skill, BTW) also have no need to develop dominance.  The self-starter, the baby and toddler that watches you intently and decides to learn all these skills?  They won’t need much help.  But the child who avoids challenge or gets help because it is easier and faster for an adult to feed them or help them build a tower?  They may lag behind in hand development.

Some kids are very tuned into adult actions, and copy the hand that a parent or teacher uses.  These are the children that are great mimics.  They can see that you are using your right hand, and even if they naturally grab with their left hand, they transfer objects into the same hand you are using.  Adults are naturally inclined to assume dominance as well.  I cannot count the number of times I absent-mindedly handed a pen to a left-handed parent into their right hand.  If you do that to a child under 5 , they assume that you want them to use that hand, and will struggle on.  This is where spoon placement matters.  I encourage parents to place the utensil in the center of the placement or tray, and watch which hand (both of the child’s hands must be free) their child chooses over many trials.

If a child is inconsistent but clearly uses their left hand more often, placing their spoon on that side of the tray should boost use, and with skilled use comes more skill and awareness.  I never pull objects out of a child’s hand.  I don’t need to.  They will drop their crayon or spoon frequently enough for me to have another chance to offer it back to them.

What if I (or a parent) picked wrong?

Dominance isn’t that easy to alter.  Ask your grandmother what the nuns in Catholic school did to alter dominance in lefties (it was considered “the devil’s hand”, and what they did wasn’t pretty).  Children will eventually simply transfer their spoon over to the other hand.

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How To Help Your Toddler Hold a Spoon

hal-gatewood-e3Y23rtVk8k-unsplash.jpgHolding a spoon or fork isn’t an intuitive skill for children.  Neither is assisting another person, of any age, to self-feed.  Parents really have struggled with this issue, and there must be many more out there who are struggling still.  This post is intended to help both parties be more successful.

Young children use a “gross” or fisted grasp to hold a utensil; see the photo above.  This continues until 3-4 years of age, when they have the hand strength and dexterity to use a mature grasp that incorporates the fingertips and thumb:

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Trying to force a toddler to use a mature grasp is almost impossible, and allowing a toddler to use an atypical grasp is also unacceptable.  It is inefficient and frustrating.  The amount of spillage almost always makes parents decide to feed a child that should be learning to feed themselves.

Parents need to teach utensil grasp, and support it with the right tools and assistance until self-feeding becomes easy and natural to a child.  Here is how to make that happen:

  1. Have the right tools.  Once a child is old enough to try to self-feed, they need toddler utensils.  Adult utensils have thinner, longer shafts.  This makes it much more difficult to hold.  Not impossible, just harder.  Make life easier on both of you and invest in toddler spoons and forks.  Infant feeding spoons have a tiny bowl and a very long shaft.  That is because they help scoop food from a jar and reach a baby’s mouth:  adults are the intended users!  Do not give them to your toddler.  They are harder for toddlers to use.  Shallow plastic bowls with a non-skid base are very helpful.  OXO sells the best bowls for this purpose, and since they are well-designed, you don’t have to get rid of them as kids get older.  They will be attractive and useful for years to come.
  2. Provide the right assistance.  In the very beginning, I encourage parents to load a fork with a safe food such as a cooked piece of carrot.  Food on a fork doesn’t fall off as easily.  They place the fork in the child’s hand and assist them in bringing it to their mouth.  Adults need to “steer” the utensil until a child develops the motor control sequence to successfully get food on the utensil.  Parents should be holding the end of the handle so that the child can place their hand in the center of the handle shaft.  Children will grasp the end of the spoon if the parent uses any other hand placement.  Young children will not automatically hold a utensil correctly.  It is the parent’s job to know how to present the utensil for grasp.
  3. Make it fun.  Feeding shouldn’t be difficult or unpleasant.  I wrote a popular post on the best way to make learning to use utensils enjoyable Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child .   This works even with children with ASD and SPD.  In fact, it might be the best way to get kids with these diagnoses to learn to use utensils.  There is an opportunity to develop social skills and turn a daily living skill into a fun game!

How To Improve Posture In Children With Low Muscle Tone… Without a Fight!

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With pediatric occupational therapy going on at home using parents as surrogate therapists, it isn’t helpful to ask a parent to do too much repositioning of children with low tone.  First of all, kids don’t like it.  Second, kids really don’t like it.

I have never met a child that enjoys therapeutic handling, no matter how skilled I am, and I don’t think I ever will.  They don’t know why we are placing their hands or legs somewhere, and they tend not to like to be told what to do and how to do it.  The best you can hope for at times is that they tolerate it and learn that therapists are going to be helping them do what they want to do For Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance.

Leaving a child in an awkward and unstable position isn’t the right choice either.  They are going to struggle more and fail more when out of alignment and unsteady.  If you know this is going to happen, you can’t let them stay that way because you also know that this will blow back in your face in the form of frustration, short attention span, and children developing a sense that whatever they are doing or whomever they are doing it with is a drag.  A real drag.

So how can you improve the posture of a child with low tone without forcing them physically into a better position?

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Potty Training in the COVID-19 Age

 

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Parents are staying home with their toddlers and preschoolers now.  All day.  While this can be a challenge, it can also be the right time to do potty training.

Here’s how to make it work when you want to teach your toddler how to “make” in the potty:

  1. You don’t have to wait for readiness.  What you might get instead is a child that has lost the excitement of being praised by adults, and fears failure more than seeks praise or rewards.  If that sounds like your child,  quickly read Waiting for Toilet Training Readiness? Create It Instead!
  2. Have good equipment.  If you don’t have a potty seat that fits your child or a toilet insert and a footstool that is stable and safe, now is the time to go online shopping for one.  Without good equipment, you are already in trouble.  Children should be able to get on and off easily and not be fearful of falling off the toilet.  If you are training a preschooler and not a toddler, you really need good equipment.  They are bigger and move faster.  Safety and confidence go hand in hand.
  3. Have a plan for praise and rewards.  Not every child will want a tiny candy, but nobody should expect a new toy for every time they pee in the potty.  Know your kid and know what gets them to try a new skill.  Some children don’t do well with effusive praise Sensitive Child? Be Careful How You Deliver Praise , so don’t go over the top if this is your kid.
  4. Know how to set things up for success.  If your child is typically-developing, get Oh Crap Potty Training by Jamie Glowacki, because she is the best person to tell you how to help you be successful.  She even has a chapter just on poop!  If your child has hypotonia or hypermobility, consider my e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone.  It is inexpensive, available on Amazon and Your Therapy Source, and gives you checklists and explanations for why you need to think out-of-the-box to potty train these kids.  You don’t leave for vacation without a map.  Don’t wing this.  Just don’t.
  5. Build your ability to calm yourself first.  Exactly like on an airplane, (remember them?  We will get back on them eventually) you need to calm yourself down in the face of refusals, accidents and tantrums.  You are no good to anyone if you are upset.  Read Stress Relief in the Time of Coronavirus: Enter Quickshifts and Should the PARENTS of Kids With Sensory Issues Use Quickshifts? for some ideas.

Looking for more information on potty training?  I wrote an e-book for you!

The Practical Guide to Toilet Training Your Child With Low Muscle Tone was my first e-book.  It is still my best seller.  There is a reason:  it helps parents and kids succeed.  This unique book explains why learning this skill is so tricky, and it gives parents and therapists detailed strategies to set kids (and parents) up for success!  Understanding that the sensory and social-emotional impacts of low muscle tone are contributing to potty training deals is crucial to making this skill easier to learn.  I include a readiness guide, strategies to pick the best equipment and clothes (yes, you can dress them so that they struggle more!), and how to move from the potty seat onto the adult toilet.

It is available on Amazon and on Your Therapy Source, a great site for materials for therapists as well as parents looking for homeschooling ideas.

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Is Your Toddler Home From School Because of COVID-19? Save Your Sanity With Fun Routines

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Many families have toddlers that are not attending daycare or preschool now.  They are at home.  All day.  They are off their schedules, and sometimes seem off their rockers!  Here are some ideas to help their parents retain their sanity:

  1. Create a routine for them.  This means that they get snacks at a certain time, outdoor play at a certain time, look at books, take a nap, listen to music, etc.  all in a predictable sequence.  Paint rocks, tear up scrap paper and glue it onto a bigger piece of paper, etc.  Crafts are fun and they can be cheap.  You don’t have to reproduce the school routine, you just have to be consistent about your home routine.  They will learn to anticipate what comes next, with all the calmness that consistency provides.
  2. Have some emergency items/activities.  Bake off some pre-made cookie dough, open up some new toy you saved for a special time.  It is special now!  Root through the back of the gift closet or the toy box and find something that is new or seems new.
  3. Turn on music and calm everyone down.  Music is powerful, and these days we need it.  Sing out and be silly.  You probably could blow off some steam too.  Consider using Quickshifts  Binaural Beats and Regulation: More Than Music Therapy if your child has sensory processing or low muscle tone.
  4. Make sure they get to move.  Every day.  Even if all you do is dance around the room, make it active.  Jump on pillows, log roll around safely, etc.  I treated kids in tiny NYC apartments, so I know it can be done.  It isn’t about having a lot of space.
  5. Reconsider the use of screens as rewards.  I know it works, but there is a price to pay after that initial quiet time.  Think carefully about what will happen when time is up, or when meals of bedtime come.  It could get ugly.  I have used screen activities in treatment, but NEVER EVER a reward, or even a consistent activity every session.  It is another fun thing we do that isn’t always available, and certainly not received by howling for it.  For apps that teach instead of entertain, read Screen Time for Preschoolers? If You Choose to Offer Screen Time, Make it Count With These Apps

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