Category Archives: toddlers

Three Ways To Reduce W-Sitting (And Why It Matters)

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Children who sit on the floor with their thighs rolled inward and their calves rotated out to the sides are told that they are “W-sitting”.  Parents are told to reposition their kids immediately.  There are even garments like Hip Helpers that make it nearly impossible to sit in this manner.  Some therapists get practically apoplectic when they see kids sitting this way.  I get asked about W-sitting no less than 3x/week, so I though I would post some information about w-sitting, and some simple ways to address this without aggravating your child or yourself:

  1. This is not an abnormal sitting pattern.  Using it all the time, and being unable to sit with stability and comfort in other positions…that’s the real problem.  Typically-developing kids actually sit like this from time to time.  When children use this position constantly, they are telling therapists something very important about how they use their bodies.  But abnormal?  Nah.
  2. Persistent W-sitting isn’t without consequence just because it isn’t painful to your child.  As a child sits in this position day after day, some muscles and ligaments are becoming overstretched.  This creates points of weakness and instability, on top of any hypermobility that they may already display.  Other muscles and ligaments are becoming shorter and tighter.  This makes it harder for them to have a wide variety of movements and move smoothly from position to position.  Their options for rest and activity just decreased.  Oops.
  3. Sitting this way locks a child into a too-static, too-stable sitting position.  This appeals to the wobbly child, the weak child, and the fearful child, but it makes it harder for them to shift and change position.  Especially in early childhood, developing coordination is all about being able to move easily, quickly and with control.  There are better choices.
  4. A child who persistently W-sits is likely to get up and walk with an awkward gait pattern.   All that over-stretching and over-tightening isn’t going to go away once they are on their feet.  You will see the effects as they walk and run.  It is the (bad) gift that keeps on giving.

What can you do?

Well, good physical and occupational therapy can make a huge difference, but for today, start by reducing the amount of time they spend on the floor.  There are other positions that allow them to play and build motor control:

  • Encourage them to stand to play.  They can stand at a table, they can stand at the couch, they can stand on a balance disc.  Standing, even standing while gently leaning on a surface, could be helping them more than W-sitting.
  • Give them a good chair or bench to sit on.  I am a big fan of footstools for toddlers and preschoolers.  They are stable and often have non-skid surfaces that help them stay sitting.  They key is making sure their feet can be placed flat on the floor with their thighs at or close to level with the floor.  This should help them activate their trunk and hip musculature effectively.
  • Try prone.  AKA “tummy time”, it’s not just for babies.  This position stretches out tight hip flexors and helps kids build some trunk control.  To date, I haven’t met one child over 3 who wouldn’t play a short tablet game with me in this position.  And them we turn off the device and play with something else!

For more strategies for hypermobile kids, take a look at Picking The Best Trikes, Scooters, Etc. For Kids With Low Tone and Hypermobility and How Hypermobility Affects Self-Image, Behavior and Activity Levels in Children.

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Is Your Gifted Child A “Troublemaker”?

 

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When you hear hoofbeats, maybe you SHOULD think zebras and not horses!

Gifted and talented children are frequently leaders in their schools and communities.  They often have advanced language skills and display an early and intense sense of humor. Gifted children can be the funny, outgoing, energetic kids who have deep empathy and abundant warmth.

But being gifted isn’t all rainbows and first place ribbons.  Some aspects of being gifted contribute to styles of interaction with authorities and peers that are not a cause for celebration. Gifted kids can be perceived as causing trouble, creating conflict and disrupting things wherever they go.  Super-bright children might end up with this label for the following common behaviors and characteristics:

  • They resist many rules as limiting and irrelevant.  “Because that’s the way it’s done” is not accepted when a gifted child sees the rule as useless or worse: illogical.
  • Boredom with class material they have already mastered gets expressed as anger or  criticism.
  • Their unique interests mean that they may reject their peer’s play schemes and try to convince their friends to play games their way or else.
  • They talk.  A lot.  At times, they may take over a discussion or attempt to alter a teacher’s presentation to address related issues or get more in-depth about a topic.  They may not be able to let a topic go until they have asked every question and made every point that they find important.
  • The frequent sensitivity of gifted children might make a normal level of noise, light or interaction too stimulating, and younger children especially will react in frustration or even tantrums.
  • Your gifted child may be having difficulty with an area of development that has been masked by their talents.  Gifted and Struggling? Meet the Twice Exceptional Student and How OT Can Help A common example would be the gifted child who is struggling with dyslexia, but has been able to use powerful memory and logic to fill in the blanks in a story.  They may not have read the book, but they are able to recall enough of the teacher’s description or the cover’s blurb to “fake it”.  The resulting failure and frustration, even with high overall test scores, builds their resentment and avoidance.

What can you do to transform a gifted troublemaker into your family’s champion or star?

  • The first step is to recognize where the ‘trouble” is coming from.  Your child’s early developmental skills and rapid acquisition of new information could be fueling their behavior.  Seen through this lens, many of the frustrating reactions and interactions with gifted children become understandable.
  • Explore ways to create a more enriched environment for your child.  It doesn’t have to be classes and microscope sets.  It could be more trips to the library or more craft materials to allow all that creativity to be expressed.  Children that are fulfilled are less crabby, less demanding and less resistant.
  • Be willing to take the time to answer questions and discuss the origins of rules.  A rule that is in place for safety can be accepted if it is explained.  A rule about social behavior, such as allowing everyone to have a turn in order, is an important lesson in navigating a world in which the kids with the fastest brains aren’t always the ones who get the first turn.
  • Consider the possibility that your gifted troublemaker is “twice exceptional”.  There may be issues like dyslexia or sensory processing disorder that need to be addressed.  Other issues don’t have to be cognitive.  Your child may be struggling with anxiety or coordination.  Giftedness doesn’t discriminate or remove all challenges to learning.  But remember that these do not minimize their profound gifts in other areas.  They complicate them.
  • Share your awareness of their gifts with them.  Kids who know that their frustrations and responses have a source other than being a difficult person have higher self esteem.  A gifted kid who thinks badly about themselves?  Yes, it does happen.  Feeling different from their friends, knowing that their ideas aren’t always welcomed, being told to be quiet and go along with the flow.  All of these can make a gifted child question themselves.  When you explain that their brain works differently, and that you will help them navigate situations successfully, your support can make a tremendous difference!

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Kids With Low Muscle Tone: The Hidden Problems With Strollers

jeremy-paige-146338-unsplashWhether you live in the city or the ‘burbs, you almost certainly use a stroller for your infant or toddler.  Even parents who use slings or carriers for “baby wearing”  find themselves needing a stroller at some point.  Why are strollers a problem for children with low muscle tone?  The answer is simple:  sling seats and ineffective safety straps.

Strollers, especially the umbrella strollers that fold up into slim spaces, have a sling seat, not a flat and firm seat.  Like a hammock or a folding lawn chair, these seats won’t give a child a solid surface that activates their trunk.  When a child sits in a sling seat, they have to work harder to hold their body in a centered and stable position.

Why is that important when you are transporting your child in a stroller?  Because without a stable and active core, your child will have to work harder to speak and look around.  A child with low muscle tone or hypermobility that is in a sling seat may be inclined to be less active and involved, even fatigued from all that work to stay stable.  It could appear that they are shy or uninterested, but they might be at a physical disadvantage instead.  A collapsed posture also encourages compensations like tilting the head and rounding the back.  Will it cause torticollis or scoliosis?  Probably not, but it is certainly going to encourage a child to fall into those asymmetrical patterns.  Kids with low tone don’t need any help to learn bad habits of movement and positioning.

Safety strap location and use in many strollers is less than optimal.  There are usually hip and chest straps on a stroller.  Some parents opt to keep them loose or not use them at all, thinking that kids are being unnecessarily restrained.  I think this is a mistake for kids with low tone.

Good support at the hips is essential when a child with low tone sits in a sling seat.  It is their best chance to be given some support.  Chest straps are often not adjusted as the child grows.  I see two patterns:  Straps too low for an older child, and straps too high for a younger one.  The latter issue usually occurs when parents never adjusted the straps after purchase.  They left them in the position they were in from the factory.  Make sure that the straps are tight enough to give support but not so tight that a child is unable to move at all.  A child that is used to sliding forward may complain about having their hips secured so that they can’t slouch, but they will get used to it.

You may have to reposition a child with low tone from time to time you go about your errands or adventures.  They often don’t have the strength or body awareness to do so themselves.  They could be in a very awkward position and not complain at all.  Check their sitting position as you stroll along.  Good positioning isn’t “one and done” with these kids, but doing it right will benefit them while they are in the stroller, and also when they get out!

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Parents With Disabilities Need The Happiest Toddler on the Block Techniques

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I usually write about children with disabilities, but today’s post is about parents with challenges.  As an occupational therapist that sees children in their homes through the Early Intervention program, I meet all kinds of parents.  This includes parents with disabilities of their own.  Some parents have vision or hearing issues, some have orthopedic issues (try lifting a toddler all day with a bad back!}), and some have emotional or cognitive issues.  I have worked with parents with addictions and parents that were intellectually challenged.  I may have seen it all, with the exception of parents in wheelchairs and parents that are deaf.  But my career isn’t over yet; there is still time.

They all have had one thing in common:  parenting small children is even harder when you have a disability.  Not impossible, and no reason to think that they cannot do a good or even a great job.  But it is definitely harder to raise children when you have a disability.  Small children are demanding, in a 24/7, self-centered manner.  That is normal, that is the natural state of a young child.  It doesn’t make it any easier.  There are no coffee breaks, there is no weekend off.  Not unless you have willing relatives or friends that will come over or take care of them in their own homes.

The Happiest Toddler on the Block techniques are methods to teach children self-regulating skills and strategies to help children learn to communicate their needs and feelings without aggression or defiance.  They don’t require an advanced degree, and they could save you from going to a therapist yourself, just to complete a sentence that doesn’t start with “For goodness sake,….!”

Parents with disabilities often think that what they need most are the skills or the capacity that they lack.  And I am not going to tell you that being able to see well, hear well, move easily or have boundless energy wouldn’t be a good thing.  But if a child is able to calm down, wait for a snack or a toy, follow directions and even assist the parent in accomplishing something, life gets so, so much better.  Just the removal of stress from tantrums and whining makes everyone’s life better.  You are able to focus and work out how to get things done and feel good about yourself as a parent.  Children that can self-regulate are better able to handle the frustrations of life, and better able to empathize with others.

If you are a parent with a disability, or you know such a parent, please share this post with them.  Tell them to read Why Telling Your Child “It’s OK” Doesn’t Calm Him Down (And What To Do Instead) , Stretch Your Toddler’s Patience, Starting Today! and Use The Fast Food Rule For Better Attunement With Your Child for some useful strategies that start turning things around right away.

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Picking The Best Trikes, Scooters, Etc. For Kids With Low Tone and Hypermobility

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Welcome to the world of faster (and faster) movement!  After mastering walking and possibly even running, older toddlers and preschoolers are often eager to jump on a ride-on toy and get moving.  If a child has had motor delays and has had to wait to develop the strength and balance needed to use a trike or another ride-on toy, they may be a bit afraid or they may throw caution to the wind and try it all as soon as possible!

Selecting the best equipment for kids that have low tone or hypermobility doesn’t end with picking a color or a branded character ( Thanks, Frozen, for bringing up my Disney stock almost single-handedly!).  In order to find the right choice for your child, here are some simple guidelines that could make things both easier and safer:

  1. Fit matters. A lot.  Hypermobile children are by definition more flexible than their peers.  They stretch.  This doesn’t mean that they should be encouraged to use pedals so far away from their bodies that their legs are fully extended, or use handlebars that reach their chins.  In general, muscles have their greatest strength and joints have their greatest stability and control in mid-range.  Fit the device to the child, not the other way ’round. Choose equipment that fits them well now,  while they are learning, and ideally it can be adjusted as they grow.
  2. Seats, pedals and handlebars that have some texture and even some padding give your child more sensory information for control and safety.  These features provide more tactile and proprioceptive information about grip, body positions and body movements.  You may be able to find equipment with these features, or you can go the aftermarket route and do it yourself.  A quick hack would be using electrical tape for some extra texture and to secure padding.  Some equipment can handle mix-and-match additions as well.  Explore your local shops for expert advice (and shop local to support your local merchants in town!)
  3. Maintain your child’s equipment, and replace it when it no longer fits them or works well.  Although it is more affordable to receive second-hand items or pass things down through the family, hypermobile kids often find that when ball bearings or wheels wear down, the extra effort required to use a device makes it harder to have fun.  The additional effort can create fatigue, disinterest in using the equipment, or awkward/asymmetrical patterns of movement that aren’t ergonomically sound.  Repair or replace either than force your child to work harder or move poorly.

Looking for more information about low tone and hypermobility?  Read The Hypermobile Hand: More Than A Strength Problem and How Hypermobility Affects Self-Image, Behavior and Activity Levels in Children.  My new e-book on living and thriving with hypermobility is coming soon on Amazon.com!

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Boost Pincer Grasp With Tiny Containers

These days I am getting pretty…lazy.  My go-to items are designed so that children automatically  improve their grasp or their posture without my intervention.  I am  always searching for easy carryover strategies to share with parents too.  As with most things in life, easy is almost always better than complicated.

My recent fave piece of equipment to develop pincer grasp in toddlers and preschoolers is something you can pick up in your grocery store, but you are gonna use it quite differently from the manufacturer’s marketing plan….

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Remember these?

Enter the tiny party cup, AKA the disposable shot glass!  Yes, the one you used when you played “quarters” in school.  The very same.  These little cups work really well to teach toddlers to drink from an open cup, but they are also terrific containers to promote pincer grasp in young children.  Drop a few small snacks into these little cups and discourage them from dumping their snack onto the table instead of reaching inside with their fingers.

No matter how small your child’s fingers are, they will automatically attempt a tripod or pincer grasp to retrieve their treat.  You should’t have to say much of anything, but it never hurts to demonstrate how easy it is.  Make sure you eat your snack once you take it out of your cup.  After all, grownups deserve snacks too!

These little containers are much sturdier than paper cups.  This means that they can survive the grasp of a toddler who cannot grade their force well.  The cylindrical shape, with a slightly smaller base than top, naturally demands a refined grasp.  The cups have a bit of texture around the middle of the cup (at least mine do)  which gives some helpful tactile input to assist the non-dominant hand to maintain control during use.  They are top-shelf dishwasher safe and hand-washable, in case you feel strongly that disposables aren’t part of your scene.

Has your child mastered pincer grasp?  These little cups are fun to use in water and sand tables as well.  Mastery of pouring and scooping develops strong wrist and forearm control for utensil use and pre-writing with crayons.

For more ideas on developing grasp, take a look at Want Pincer Grasp Before Her First Birthday? Bet You’ll Be Surprised At What Moves (Hint) Build Hand Control! and Develop Pincer Grasp With Ziploc Bags.

 

The Cube Chair: Your Special Needs Toddler’s New Favorite Seat!

 

 

Finding a good chair for your special needs toddler isn’t easy.  Those cute table-and-chair sets from IKEA and Pottery Barn are made for older kids.  Sometimes much older, like the size of kids in kindergarten.  Even a larger child with motor or sensory issues will often fall right off those standard chairs!

Should you use a low bench?  I am a big fan of the Baby Bjorn footstool for bench sitting in therapy, but without a back, many toddlers don’t last very long without an adult to sit with them.  Independent sitting and playing is important to develop motor and cognitive skills.   The cute little toddler armchairs that you can get with their name embroidered on the backrest look great, but kids with sensory or motor issues end up in all sorts of awkward positions in them.  Those chairs aren’t a good choice for any hypermobile child or children with spasticity.

Enter the cube chair.  It has so many great features, I thought I would list them for you:

  • Made of plastic, it is relatively lightweight and easy to clean.  While not non-slip, there is a slight texture on the surface that helps objects grip a little.  Add some dycem or another non-slip surface, and you are all set.
  • Cube chairs can be a safe choice for “clumsy” kids. Kids fall. It happens to all of them.  The design makes it very stable, so it is harder to tip over. The rounded edges are safer than the sharp wooden corners on standard activity tables.
  • It isn’t very expensive.  Easily found on special needs sites, it is affordable and durable.
  • A cube chair is also a TABLE! That’s right; turn it over, and it is a square table that doesn’t tip over easily when your toddler leans on it.
  • Get two:  now you have a chair and table set!  Or use them as a larger table or a surface for your child to cruise around to practice walking.  That texture will help them maintain their grip.  The chairs can stack for storage, but you really will be using them all the time.
  • It has two seat heights.  When your child is younger, use the lower seat with a higher back and sides for support and safety.   When your child gets taller, use the other side for a slightly higher seat with less back support.
  • The cube chair is quite stable for kids that need to hold onto armrests to get in and out of a chair.  The truly therapeutic chairs, such as the Rifton line, are the ultimate in stability, but they are very expensive, very heavy, and made of solid wood.

Who doesn’t do well with these chairs?  Children who use cube chairs have to be able to sit without assistance and actively use their hip and thigh muscles to stabilize their feet on the floor.  Kids with such significant trunk instability that they need a pelvic “seatbelt” and/or lateral supports won’t do well with this chair.  A cube chair isn’t going to give them enough postural support. If you aren’t sure if your child has these skills, ask your occupational or physical therapist.  They could save you money and time by giving you more specific seating recommendations for your child.

Your child may be too small or too large for a cube chair.  Kids who were born prematurely often remain smaller and shorter for the first years, and a child needs to be at least 28-30 inches tall (71-76 cm) to sit well in a cube chair without padding.

You may add a firm foam wedge to activate trunk muscles if they can use one and still maintain their posture in this chair, or use the Stokke-style chair A Simple Strategy To Improve Your Child’s Posture In A Stokke Tripp Trapp or Special Tomato Chair or the Rifton chair until your child has developed enough control to take advantage of a cube chair.

Looking for more information on positioning and play?  Check out Kids With Low Muscle Tone: The Hidden Problems With Strollers,  Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children and How To Pick The Best Potty Seat For Toilet Training A Child With Low Tone.  I am in the process of writing a series of practical guides for parents of children with hypermobility, so keep checking back on my site for the launch this summer!!