Category Archives: toddlers

Can You K-Tape Kids With Connective Tissue Disorders?

enis-yavuz-387710-unsplashThe short answer:  some of these kids, some of the time.  The long answer:  To use K-tape effectively, you need to understand the mechanics of tape on the skin and underlying tissues, how connective tissue disorders disrupt skin healing, how to minimize skin shear and inflammation, and that only using one type of tape may not be enough.

I love to use taping for kids with hypermobility, but kids with connective tissue disorders such as Ehlers-Danlos syndrome aren’t always able to tolerate taping without some significant adaptations.  Children that were preemies often have the same issues that make taping more challenging.  Fragile skin, immune system reactions, etc. will require adaptations and alterations to standard taping procedures and protocols.  But it doesn’t mean an automatic “no”!

Here are my clinical suggestions to make K-taping more successful for kids with connective tissue distorders:

  1. Very few children with connective tissue disorders are able to communicate discomfort clearly. Their hypermobility creates limitations in proprioceptive and kinesthetic awareness.  Children of all ages with poor proprioceptive discrimination have a sensory deficit that directly reduces their feedback for taping.   Therapists have to be very skilled at observation and clinical judgement.  A good therapist will carefully listen to a parent’s descriptions of movement, skin conditions and complaints to hear clues that should guide your taping.
  2. Assume significant skin sensitivity and fragility.  If a child sails through your test tape period, don’t assume that you can use regular taping procedures and protocols.  Always use a test tape, and consider doing multiple test tapes in different locations and with different levels of tension.  Paper-off tension is highly recommended in treatment, and so is caution with taping protocols that add significant skin shear.  Those include placing the tissue on stretch as you apply the tape, and protocols in which rotary force is exerted (such as spiral patterns around limbs).  Because skin recovery may be impaired, skin tolerance can deteriorate after repeated taping.  Use the most conservative treatment plan, even if you are getting good results.  Slow and steady is better for everyone.
  3. Expect to take taping breaks and shorten the amount of time tape stays on the skin. These kids should receive longer periods without tape.  This allows any micro-damage to be repaired.  Once the tape has lost the majority of it’s elastic properties, it is less beneficial and becomes more of a risk for skin integrity.  Instruct parents to trim the tape or remove it completely when the edges start to catch on clothing.  The effect is constant shear on the skin next to the loose edge.  This is irritating for all kids, but it can create significant inflammation for kids with CTD’s.  Try taping another location and returning to taping after a substantial break.  Children with connective tissue disorders usually have more than one area of instability that could benefit from taping.
  4. Use pediatric tape and pediatric protocols well into childhood and perhaps beyond.  I use the Milk of Magnesia barrier technique with all children under 3, and with all children with diagnosed or suspected connective tissue disorders.  I am also a big fan of PerformTex’ pediatric tape.  Their adhesive seems to be to be less intense than ROC Rx tape, and significantly less adhesive than regular tape.  The cure monkeys and flowers don’t hurt!  Once I started using pediatric tape, I haven’t looked back.  No parent wants to see their child’s skin inflamed, and no therapist wants to strain their client’s trust by appearing to be unconcerned about skin integrity and pain.
  5. Expect that some children truly cannot tolerate taping, and move on.  Good therapists have many different ways to make a difference in a child’s life, and taping may be tolerated better as a child grows up.  We can never predict the clinical course of a connective tissue disorder with certainty, so don’t give up, but don’t become rigid in your treatment planning either.

Looking for more information on treating hypermobility and hypermobility syndromes? Check out How Hypermobility Affects Self-Image, Behavior and Activity Levels in Children and Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children.  I am working on an e-book series for parents and therapists of kids with hypermobility.  Check back here soon to see when and where it is available!

 

My e-book on potty training, The Practical Guide To Toilet Training Your Child With Low Muscle Tone, is a great reference for therapists and a helpful resource for families.  Many of our hypermobile preschoolers are still in pull-ups because no one knows how to make it easier.  My book has readiness checklists and equipment assessment guides that can help kids move forward with training immediately!  Visit my website to purchase my book at tranquil babies, or go to Amazon , or visit Your Therapy Source, a wonderful site for therapy materials.

aziz-acharki-281209

 

Advertisements

Use The Fast Food Rule For Better Attunement With Your Child

adrien-taylor-412724-unsplash

What’s attunement?  The physical and emotional connection that a healthy parent makes with their upset child that brings them both back into a calm and balanced state.  Why is it important?  Because without attunement you don’t have healthy attachment, and attachment is the foundation for a healthy emotional and interpersonal life.  Attunement and attachment are some of the biggest issues in psychology today.  Everyone is talking about it, but once those early years are over, it takes a lot of therapy to repair rifts in this foundation.  So reinforce your emotional connection with your toddler, and know that the effort you make today will help them recognize healthy relationships for the rest of their life.

How does The Fast Food Rule help parents develop attunement?  By reflecting back the child’s perceived complaint with enough gesture, facial expression and vocal intensity to register in the mind of a child, your child will feel that you “get” them, just as they are, regardless of whether you agree that a broken cookie is the end of the world.  Knowing that a parent understand where you are coming from is essential.  For more details, read Stop The Whining With The Fast Food Rule.

Again, later in life, realizing that a partner isn’t “getting them” is important when deciding whether to develop or stay in a relationship.  From there, your child will be able to consciously decide to communicate more effectively, invest more time and effort in the relationship, or move on to another person who can connect more successfully with them.

Does this mean that you give in to every howl from a young child?  Of course not.  Even toddlers know that they won’t get everything they demand.  They may be unhappy to hear that they can’t have cookies for dinner, but they don’t actually think they will be having them for dinner.  What matters is that they know that you understand them, understand their feelings, and aren’t rushing to squash their anger, sadness or frustration.

Once you see those little shoulders drop, hear the scream become a wail or a whine, and get more eye contact, you will have been given the green light to offer a solution.  Wait for it.  And look for that moment when the two of you are calm and moving forward together.  That, my friends, it attunement at work.

conner-baker-480775

Improving Daily Life Tasks for Kids With Special Needs

 

long-lin-475905

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

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

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

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

IMG_0857

The view north from West Point.  Welcome spring!

How Hypermobility Affects Self-Image, Behavior and Activity Levels in Children

carolyn-v-546929

Loose joints affect emotions and behavior too!

As rehab therapists, OTs and PTs are focused on skill building and reaching functional goals with our clients.  In this post, I would like to address the many ways that hypermobility can create social and emotional issues for children.  Without awareness of these experiences, we cannot be the best therapists for these kids, or help parents be the best advocates for their children.

Because hypermobility varies so widely in it’s severity, it’s presentation (generalized, primarily proximal, or primarily distal) and it’s progression (decreasing with age or increasing with repeated injuries and overstretching of tissues), the psychological impact on a child will also vary tremendously.  The child who has had significant and global hypermobility from birth will have a very different presentation than the young teen who is only recently experiencing functional issues with instability or pain after years of sports-related injuries.

Here are some major points to consider:

  1. Hypermobility and it’s accompanying effect of stability and proprioceptive processing contribute to both sensory seeking and sedentary behavior, sometimes in the same child.  Add in pain and fatigue, and perhaps even POTS or dysautonomia, and you have a kid that is both active and inactive, both attentive and unfocused on tasks at different times of the day.  Self-regulation appears to be very unstable.  If a child’s entire physical condition isn’t taken into assessment, a referral for an ADHD diagnosis could result.
  2. Difficulties with mobility and stability make active play and engagement in sports more difficult.  This has social as well as physical effects on children at all ages.  For some kids, they can play but get injured at a more frequent rate.  Other children aren’t able to keep up with their peers on the playground and seek more sedentary or independent activities.  And for some other kids, they experience the pain of being the last kid picked for group play or being bullied for the awkward way they move.  The child that was more mobile and athletic when younger, and is now experiencing a loss of skill or an increase in pain, is also at risk for feelings of depression and fear of movement.  That fear is a real problem, with a name: kineseophobia.   This isn’t the same as gravitational insecurity, but it may look like it without the therapist’s awareness of a child’s history or current problems.
  3. Kids with hypermobility can have problems with falling and staying asleep, which affect daytime alertness and energy.  It is well-documented that a lack of good-quality sleep results in childhood behavioral changes.  Pain, lack of daytime activity levels high enough to trigger sleep, bladder control leading to nighttime awakening or bedwetting…the list of sleep issues for kids with hypermobility can be long.  Evaluating a child’s behavior without knowing about these issues is going to lead to incorrect assumptions about the source of reactions and interactions.
  4. Hypermobile kids can have issues with feeding that contribute to patterns of behavior that extend beyond the dinner table.  Difficulty with eating, chewing, and even constipation can result in behavioral changes.  Especially with younger kids, learning social interaction skills at the table can be lost in a parent’s need to alter food choice or their concerns over nutrition.  Hypermobile kids don’t always have issues that restrict them from eating; some kids don’t get enough exercise or find eating to be a pleasurable activity that doesn’t take too much energy or skill.  Used along with media use or gaming, snacking is something that they enjoy.
  5.  Children develop social and emotional skills in engagement with others.  The child who attends therapy instead of playdates, the tween that doesn’t have the stamina to go on a ski trip, the child who can’t sit still during a long play or movie.  All of these kids are having difficulties that reduce their social interactions to some degree.  Encourage the families of the children you treat to be mindful of a child’s whole life experiences and weave interventions into life, not life into interventions.

As therapists, we owe it to our clients to ask questions that help us understand the daily challenges of life and create treatment plans that support a child’s social and emotional development.  Waiting for mental health professionals to ask those questions isn’t enough.  And remember, if there is a counselor or therapist involved, share what you know about the impact of hypermobility on behavior.  Without awareness of the physiological and sensory basis of behavior, professionals may make an incomplete assessment that will not result in progress!

 

Looking for more information on treating kids with hypermobility?  Take a look at Can You Use The Wilbarger Protocol With Kids That Have Ehlers-Danlos Syndrome? and Hypermobile Kids, Sleep, And The Hidden Problem With Blankets .

olivier-fahrni-337130

 

 

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

shopping-2.jpeg

shopping-1.jpegshopping.jpeg

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

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

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

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

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

thanh-tran-369711.jpg

Parenting Experts: Check Your Privilege

colin-maynard-231363

Another day, another piece about how important it is to chat with your young child.  Zero-To-Three just ran this summary on their Facebook page MIT language study and I felt so sad.  For everyone.  For the umpteenth time in the past few years, I am in the awkward position of agreeing with “experts” that kids learn language skills best with face-to-face interaction that expands language, but I also appreciate why some cultures don’t interact with children like MIT researchers want them to.  My concern is that the  researchers can’t seem to see beyond their (boojie) bubble.

Because I have the good fortune to treat children in their homes, and have family and friends that span every economic group from barely-getting-by to (almost) Richie Rich, I have seen a lot of parenting styles.  A lot.  Here is what I see:

Parents teach children to behave so that they will succeed in the culture their parents exist in and the world they hope their children will access.  How parents interact with their children is also affected by how stressed they are.  No parent thinks about this consciously.  But there are huge differences, right from the start.

What I think the MIT folks haven’t realized is what goes on for those parents who come home after working two jobs, who worry about which bills to pay now and if they will have a job this time next month. These good, hardworking folks don’t have the extra bandwidth to chat with their children in the same way that a less stressed parent does.  Maybe the researchers haven’t thought to ask, maybe they assume that what they see in an interview tells the whole story.  But they haven’t seen these family’s homes and their lives.

When that proud, super-stressed, working-class parent thinks about their child’s future, they want to see a job with benefits, a job that can’t be outsourced, a job that has automatic raises.  Many of the jobs they dream about for their children are government or union jobs.  These jobs require obedience to rules and to supervisors.  In these positions, telling your boss that he or she is wrong could cost you your job.  Staying out of controversy and following the rules gets you to the next rung on the ladder.

When their child questions a request, they aren’t going to have a heart-to-heart about why they don’t want to unload the dishwasher.  A parent wants it done because they need to do three loads of laundry immediately and won’t be done with it until 2 am tonight.  Everyone in their family has to help to make tomorrow a possibility.  And they want their child to know that refusal to follow a supervisor’s order could mean that they could be out of a job and maybe out of a home.

Someday there will be someone at MIT that learns more about these families, is brave enough to say what they think, and maybe even publish a study.  That will be something that I can’t wait to post on my blog!

Why Telling Your Child “It’s OK” Doesn’t Work (And What To Do Instead)

 

adrien-taylor-412724-unsplash.jpg

In a few months I will be doing another lecture on managing difficult toddler behaviors, and I can’t wait.  I love teaching parents, therapists and caregivers how to help young children manage their most difficult behaviors.   The responses that most therapists dread (crying, whining, tantrums, etc.) are the ones I hope will happen in a session with a parent.  Why?  So I can demonstrate and explain how to handle these tricky moments.  How you respond to your child can do more than help you get them into the car and back home.  It can teach them how to deal with their feelings and how to communicate them to other people.

When faced with a crying child, telling them “It’s O.K.” right away seems to be the most natural response in the world.  For one thing, it is usually the truth; you can clean up the broken cookie and get another, their bump is a minor scratch, and they have another blue crayon to replace the one that rolled under the couch.  And we want to help them feel better; comforting an upset child is what we do as caring adults.

But for many kids, telling them “It’s OK”  elicits more crying, if not some wailing and even physical responses like throwing things or hitting.  You go over to console them, and they might even push you away.  The baby that used to melt into your arms is now a toddler, rejecting your best efforts at comfort!

Why?  Very likely because your response did not show them that you understand the gravity of the situation and the pain they are experiencing.  I know, pain from a broken cookie? Really? Well, when you are 18 months old, you can’t always comprehend that there could be more cookies in the cupboard.  The horror of seeing your favorite treat destroyed in front of you is just too great.  And the feelings inside of you really do hurt.  Young children need two things to recover:  someone to say that they know what your problem is and for that person to say that they are aware that you feel this way.

Note that I did not say that the other person has to agree that it is the end of your toddler world.  The adult is only agreeing that something has happened and that you feel badly about it.  As adults, we don’t always remember a toddler’s perspective, and we invalidate it more than we think we do.  This is why telling your child “It’s OK” is heard as “Your complain is without merit, sir, and you have no right to feel angry or sad about it”.

You would never intend to say that to your child, and yet that is the message many children get when you rush in too soon with this response.  

What could you say instead?  I first use Dr. Harvey Karp’s Fast Food Rule combined with his Toddler-Use communication style to respond to an upset child.  It is fairly simple:  State what you believe your child is thinking in simple phrases that match their comprehension level when upset (which is always less than when they are calm) and matches their emotional tone by 1/3.  So if your child is screaming  “COOKIE, COOKIE, COOKIE!!!” and you know that her cookie fell on the sidewalk into the mud, your response has to be similarly short and heartfelt.  Something like “COOKIE BROKEN!  You want cookie!” tells the sad story of what has happened to her snack.

This can be enough validation to calm her down a bit, as seen by a decrease in the volume of her screaming, more eye contact with you, and even a sad nod.  NOW it is time for consolation, and perhaps the offer of an alternate snack.  You have shown that you know her problem and her pain.  She has felt understood and her feelings accepted, and may now be ready for a resolution to this crisis.  If she continues to scream, repeat your statement once or twice while further shortening your words and slightly increasing the emotion in your voice/the emphasis of your gestures.  Sometimes it takes the toddler brain a moment to process.  Give her that time.

Good luck trying out this approach with the next upset toddler or preschooler you encounter.  I promise you, communicating your empathy and modeling acceptance of feelings delivers more than a calmer child.  It teaches important emotional skills and deepens the connection between you.

And it all started with a broken cookie….

carolyn-v-546929.jpg