Category Archives: toddlers

Is is Sensory Or Is It Behavior? Before 3, The Answer Is Usually “Yes!”

If I had a dollar for every parent that asked me if head banging when frustrated means their child has a sensory processing disorder...well, I would be writing this post from a suite in Tahiti.  Modulation of arousal is the most common sensory processing concern for the parents that I see as a pediatric occupational therapist.  Their children struggle to transition, don’t handle change well, and can’t shift gears easily.  But hold on.  A lot of this behavior in children  under 3 is developmental in nature.  Not all, but a lot.  Parsing it out and addressing it takes a paradigm shift.  Not every annoying or difficult behavior is atypical for age and temperament.

Everyone knows that you can’t expect your infant to self-regulate.  Nobody tells their baby “Just wait a little; why can’t you be like your brother and sit quietly for a minute?”  But why do adults assume that once a child can speak and walk a bit that they can handle frustration, wait patiently, and calm down quickly?

I know parents WANT that to be the case.  Toddlers are a handful on a good day.  Adorable silliness can melt your heart, but getting smacked by an angry child that was just given a consequence for trying to put your cell phone in the toilet to see if it would float?  Nah, that isn’t going to put a smile on your face.  Parents tell me “If they could only understand that when I say “wait”, I mean that you will get what you want, just not immediately.”  But no.  The toddler brain grows very slowly, and even the super-bright children who read at 3 cannot make their emotional brain grow any faster.  Sorry.  Really.   This brain thing means years of developing communication and regulation skills.

Here is the good news:  Even young children with clear sensory-based behaviors do better when your responses to their behaviors help them self-calm.  The recipe is simple to describe.  You give limits based on age, use familiar routines, teach emotional language and responses by modeling, and communicate effectively.  The Happiest Toddler strategies have transformed my work because children feel listened to but I don’t give in to toddler terrorists.  Everybody wins.

Here is the bad news:  You have to change your behavior in order to help them.  And you have to do it consistently and with loving acceptance of their limitations.  “Behavior” isn’t just their problem.  It is both of yours.  Take a look at my posts on Happiest Toddler techniques that really work for the little ones, and see if your suspicions of a sensory processing disorder wane or even evaporate as you and your child learn some valuable communication and self-calming skills.  The posts that can alter things today might be Nip Toddler Biting in the BudToddlers Too Young For Time Out Can Get Simple Consequences and Kind Ignoring, and How To Get Your Toddler To Wait For Anything (Hint: They hear “Wait” as “No”)

Good luck, and let me know what works for you!

 

Taping The Paper To The Table For Your Child? Stop!

Many young children between 2 and 5, especially children with low muscle tone or postural instability, will struggle with bilateral control.  In preschool, one way to notice this is to see the paper sliding around the table while a child colors.  The common response of teachers (and parents) is to tape the paper down.  Oops!  This  eliminates any demand for both hands to work together.  Bilateral control only develops if it is needed and practiced.

The better approach, the one that makes the brain work and builds a child’s skills, is to make it even more slippery while making the activity more fun.

Why?  This child,’s brain, as described, needs more information about what is going wrong with the activity.  You can use heavier paper, stickers in a book that need accurate placement, or fun glittery markers.  Really, anything that makes a child care more about placing marks accurately.   I select the smoothest table surface available.  Glass coffee tables are a fave at home.  The alternate choice is a bumpy surface, something that will be slightly uneven and make the paper move more with each stroke.

I have some older kids that really struggle but can use a visual cue.  I make a mark on their paper and tell them to put their “helper hand” – the one not coloring- on this mark.  This is sometimes helpful, but it is limiting the extent that this hand is providing optimal postural support.

Yup, support.  The hand that holds the paper is also performing another function.  It is stabilizing the child’s body so that the dominant hand can execute a skilled movement.

So….no more tape on that paper, OK?

Gifted at Preschool: How to Support The Young Gifted Child In Class

Gifted children often cannot wait to go to preschool.  They may follow an older sibling into their classroom and cry when they have to leave.  After all, look at all those books, art supplies, and science stations to explore!   Things can go right off the rails, however, if the teacher and the classroom aren’t prepared for everything a gifted child brings with them.  And I don’t mean the lunchbox or the fidget spinner!

Gifted children are more intense, use more complex thinking, and more driven than other children.  Even at the preschool level.  This is a child who may teach himself to read, tells wonderful stories, creates wonderful multi-media art, and practices kicking a soccer ball into a goal until it is too dark to see the ball.  At 3.  It can also make a child argue about school routines,  insist on changing the rules of every game, and constantly discuss and examine every item in the room.  Imagine the average teacher’s reaction when a gifted toddler wants to grab the story book from the teacher at circle time to determine exactly which type of dinosaur is displayed.  Is that a T-Rex, a brontosaurus, or a brachiosaurus?  She can pronounce their names and knows the difference at 2, and she wants to figure this out, while her classmates are making growling sounds or picking their noses!

Here are some suggestions for teachers to understand and manage the behavior of their gifted students without crushing their spirits or allowing them to run the classroom:

  • Learn about the child’s gifts.  Knowing who you have, who you really have in your classroom: it will help you make a plan.  What they like, what they love, and what frustrates them.  This doesn’t mean that you focus the class on them, but you know that a module on space will elicit a lot of interest, and a module on the color red will not.  Unless you talk about the red planet, Jupiter.
  • Learn about the multiple sensitivities of gifted individuals.  They are not limited to intellectual gifts.  They can include physical sensitivity, emotional sensitivity, and even spiritual sensitivity.  Some will be easier to deal with than others.  But you want to teach the whole child, right?  That way, you see a three year-old’s intense need for movement throughout the day or wanting to have a formal ceremony for the recently deceased goldfish as normal, not perverse.
  • Explain the rules, negotiate the deal when possible, and acknowledge the frustration of things that seem unfair or arbitrary.  Helping gifted individuals fit into a society that says it loves giftedness but really supports conformity, without crushing their spirit, is tricky.  You can help.  Bring their awareness to the fact that controlling the game and telling people what to do and how to do it makes other children less likely to want to play.  This is real teaching.  Even if their new rules for Candyland are truly innovative.
  • Offer real enrichment, not busywork or babysitting.  I have heard stories from parents of teachers who tell gifted children to read to their classmates, or tell them to “teach” their friends about shapes.  This alters the relationships between classmates and is not a good idea.  These kids are going to be singled out soon enough as different.  Build friendships, not mentorships.  More worksheets that they can race through isn’t better.  Find worksheets that challenge them, even if you have to look at kindergarten or first grade materials.  Better yet, make your own, following their interests.  You will be rewarded by a child that loves school and knows they are truly seen as an individual!

 

Joint Protection for Hypermobile Toddlers: It’s What Not To Do That Matters Most

 

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Do you pick up your toddler and feel that shoulder or those wrist bones moving a lot under your touch?  Does your child do a “downward dog” and her elbows look like they are bending backward?  Does it seem that his ankles are rolling over toward the floor when he stands up?  That is hypermobility, or excessive joint movement.

Barring direct injury to a joint, ligament laxity and/or low muscle tone are the usual culprits that create hypermobility.  This can be noticed in one joint, a few, or in many joints throughout the body.  While some excessive flexibility is quite normal for kids, other children are very, very flexible.  This isn’t usually painful for the youngest children, and may never create pain for your child at any point in their lifetime.  That doesn’t mean that you should ignore it.  Hypermobility rarely goes away, even though it often decreases a bit with age in some children.  It can be managed effectively with good OT and PT treatment.   And what you avoid doing at this early stage can prevent accidental joint injury and teach good habits that last a lifetime.

  1. Avoid over-stretching joints, and I mean all of them.  This means that you pick a child up with your hands on their ribcage and under their hips, not by their arms or wrists.  Instruct your babysitter and your daycare providers, demonstrating clearly to illustrate the moves you’d prefer them to use. Don’t just tell them over the phone or in a text.  Your child’s perception of pain is not always accurate when joint sensory aren’t stimulated (how many times have they smacked into something hard and not cried at all?) so you will always want to use a lift that produces the least amount of force on the most vulnerable joints.  Yes, ribs can be dislocated too, but not nearly as easily as shoulders, elbows or wrists.  For all but the most vulnerable children, simply changing to this lift instead of pulling on a limb is a safe bet.
  2. Actively discourage sitting, lying or leaning on joints that bend backward.  This includes “W” sitting.   I have lost count of the number of toddlers I see who lean on the BACK  of their hands in sitting or lying on their stomach.  This is too much stretch for those ligaments.  Don’t sit idly by.  Teach them how to position their joints.  If they ask why, explaining that it will cause a “booboo” inside their wrist or arm should be enough.  If they persist, think of another position all together.  Sitting on a little bench instead of the floor, perhaps?
  3. Monitor and respect fatigue.  Once the muscles surrounding a loose joint have fatigued and don’t support it, that joint is more vulnerable to injury.  Ask your child to change her position or her activity before she is completely exhausted.  This doesn’t necessarily mean stopping the fun, just altering it.  But sometimes it does mean a full-on break.  If she balks, sweeten the deal and offer something desirable while you explain that her knees or her wrists need to take a rest.  They are tired.  They may not want to rest either, but it is their rest time.  Toddlers can relate.

Although we as therapists will be big players in your child’s development, parents are and always will be the single greatest force in shaping a child’s behavior and outlook.  It is possible to raise a hypermobile child that is active, happy, and aware of their body in a nonjudgmental way.    It starts with parents understanding these simple concepts and acting on them in daily activities.

Good luck, and please share your best strategies in the comments section so other parents and therapists learn from you!

Wondering about your child’s speech and feeding development?  Take a look at Can Hypermobility Cause Speech Problems? to learn more about the effects of hypermobility on communication and oral motor skills.

Looking for information on toilet training your child with Ehlers Danlos, generalized ligament laxity, or low muscle tone?  My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, gives you detailed strategies for success, not philosophy or blanket statements.  I include readiness checklists, discuss issues that derail training such as constipation, and explain the sensory, motor, and social/emotional components of training children that struggle to gain the awareness and stability needed to get the job done.

My book is available on my website tranquil babies, at Amazon, and at yourtherapysource.com.

Sensitivity and Gifted Children: The Mind That Floods With Feeling

Gifted children are often the most emotional and empathic toddlers in the room.  They are the kids who cry when the ASPCA runs those tearjerker commercials.   They are the teens who want to develop an NGO to provide clean water in developing countries.  Gifted children don’t do this to get a boost on a college application, but because it physically hurts them to think of another’s suffering.  Your gifted child’s mind cannot help but to feel strongly and care deeply.  

How can you help your child navigate these feelings without crushing their altruism and energy? The first step in helping these children to handle their sensitive social and emotional nature starts with adults understanding that this isn’t a personality quirk; it’s a neurological bias that accompanies an impressively active and intense brain that doesn’t “turn off”.

Sensory Sensitivity, Autism, and Gifted Sensitivity
When OTs usually refer to sensitivity, we usually speak about the physical sensitivity that our clients may experience.  We know that sensory sensitivity can lead to avoidance of sensory input and poor modulation of arousal.  The poor modulator is the child who has a hard time staying in an optimal state of calm, struggling to focus attention on accomplishing their daily activities.  This can be true with gifted children, but is not always a feature of giftedness.

We also know that children with ASD find it difficult to connect with another’s emotional experience due to their neurological wiring.  It is not that they choose to misinterpret other’s emotions.  They may long to know what others are thinking and what to do and say in interpersonal relationships.  Temple Grandin and John Elder Robison have written about their difficulties and discomfort in understanding how friends and family feel.

The gifted client is swimming at the other end of this pool:  they have profound emotional connections to people (and sometimes feelings for objects as well!),  even strong connections with the imagined emotional experiences of strangers!  Again, this is not just their temperament or their personality; the emotional flood is coming from their brain wiring that generates deep connections between profound concepts and expansive comprehension of situations. Gifted kids see very clearly how the human race is all one, how affecting a part results in affecting the whole, etc. It can be overwhelming for them to know this at 4. Or 14. Gifted children are not little adults, even when testing indicates amazingly advanced mental abilities. Their asynchronous development means that they may understand concepts but still cry when they lose a game. They are still children.

There is some science behind the idea that gifted children are emotionally advanced as well as academically advanced.  Researchers on giftedness are eager to display their fMRI views of the gifted brain as it thinks, showing it humming along at warp speed, lighting up like a Christmas tree in areas that are mostly quiet for other people.  I would guess that those mirror neurons (proposed to support empathy and interpersonal skills) that seem inactive in ASD are probably switched on 24/7 in gifted individuals.  

Parents get their first taste of this quality when they see how attuned their baby is to their speech and their movements.  “She would just watch our faces all day long!” is a familiar report when asked about early development.  Toddlers begin to be aware of their own emotions and the emotions of others, and the gifted toddler can be quite a handful as she sorts this out. The gifted child may want to volunteer, may become upset when reading news stories, and may insist that the family participate in activities for social causes. On the other hand, a gifted child may become sad and overwhelmed by situations that other children are unable to comprehend. It can lead to feelings of powerlessness and anger when the adults in their world don’t respond in kind or disregard their concerns.

My message to parents and teachers of gifted children, and those who work with children showing strong emotions and advanced skills without a gifted label is to consider that the strong reactions that you see may be a brain effect, not a personality defect. Your next step: supporting a child to handle the flood of emotion, and help them channel their feelings into productive actions and interactions that build social skills, not isolation and a negative self-image.
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Parents of Formerly Picky Eaters Can Feel Like The (Food) War is Still Going On

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

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

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

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

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

Want A Stronger Pencil Grasp? Use a Tablet Stylus

The trick? They need to use a short stylus and play apps that require primarily drag-and-drop play. Stop them from only tapping that screen today, because tapping alone will not make much of a difference in strength and grading of force.

Why will drag-and-drop play work? The resistance of the stylus tip on the screen builds strength and control at the same time. They gain control as they get the immediate feedback from game play. Too much force? They get stuck and can’t move the styluses the target. Too little force? Again, the target doesn’t move. Could they revert to a fisted grasp and accomplish this? Sure, but that is exhausting, and you are within view of them anyway….right?

For this to work, young children need supervision, but not helicopter supervision. And they need to know that how they hold any utensil matters to you. My best approach to build grasp awareness is to appeal to their desire to be older. Tell your child that you have been watching them, and you believe they are ready to hold a stylus like an older kid. Oh, and you can explain to them how to hold the stylus the easy way. They just have to watch your example and play some games for practice. Yup, you ASK them to play on a tablet!

Best drag-and-drop games for young children? I like the apps from Duck Duck Moose, especially the Trucks and Park Math. Every app has some tapping, but you can select and “sell” the games that require drag-and-drop. There are apps that little girls can play to dress up princesses, mermaids, etc. Pick the ones where they have to drag the items over to the characters. Same with wheels on trucks, shapes into a box, etc. The Tiny Hands series of educational apps have a lot of drag-and-drop play.

Finally, mazes are wonderful, and so are dot-to-dots that require drag-and-drop play.

Have a really young child, or a child who struggles to keep their fingers in a mature grasp pattern without any force? Then apps that require just a tap are fine. I set the angle of my tablet at various heights (my case allows this) to prompt more wrist extension (where the back of the hand is angled a bit toward the shoulder, not down to the floor). When a child’s wrist is slightly extended, the mechanics of the hand encourage a fingertip grasp without an adult prompting them.

Try drag-and drop play with a stylus on your tablet today, and see if your child’s grasp strength starts improving right away!