Category Archives: Uncategorized

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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Is Compulsive Gaming A Disorder…Or A Symptom?

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The WHO has recently classified compulsive gaming a mental illness.  I am not so sure.  What I do believe is that doing anything compulsively is a big problem for developing brains.  Is your child heading in the direction of using gaming or web surfing to deal with issues such as social anxiety or poor executive function skills?  Here is what you should be thinking about when you see your young child screaming because you have unplugged them from their tablet (or your phone, or your tablet):

  1. Have you (unintentionally) modeled this behavior for them?  I  don’t know any adult that isn’t tethered to their phone.  Whether for business or to keep track of where their spouse or children are/what they are doing, most of us have a phone that we look at repeatedly all day long.  When you are with your family, think carefully about how important it is to model the opposite and put it down as quickly as possible.  In effect, you are saying “You are more important to me than this device”.
  2. Be clear about what you are doing when you put down the phone in their presence and why.  In the spirit of The Happiest Toddler on the Block, which my readers know I adore, young children need to hear and see you explaining why you are doing what you do.  They don’t assume things the way we do.  Really.  The older they get, the more it appears that they are ignoring you, but don’t you believe it.  Parents are and always will be the most powerful models in a child’s life.  Forever.  Your teen may roll her eyes, but they are still open, and she is watching you.  So tell your child that you want to focus on them, and your phone is a distraction and you can always look at it later.  You want to be with them and pay attention to them.  I know this sounds a bit weird, even awkward and preach-y.  It isn’t if you do it with warmth and confidence.  Find your own wording, but the message is the same: I care more about you than I do about data.
  3. Look around.  Are your child’s activities, toys and games unsatisfying?  Don’t count the toys, look at them and what they offer your unique child.  An artsy child may need new paints, clay, yarn, etc.  A reader may need to go to the library or get a new book series.  Not a digital copy.  A young scientist might need a kit or a microscope.  A social kid may need more playdates or a creative class like cooking.  Their interests and needs may have changed since the last birthday or holiday.  If you want them to play instead of look at a screen, they need things that excite and inspire them, or the digital world will fill in the blanks.
  4. Does your child need help in building skills?  Shy kids, kids with ASD, or kids that don’t make friends easily can find the less-demanding digital world much easier to navigate.  Siblings sit quietly side-by-side, not fighting but also not learning how to solve interpersonal issues.  This isn’t preparing them to go out there and succeed.  The earlier you realize that your child is struggling, the faster you can stop bad habits and prevent rigid behaviors.
  5. I read a challenging piece this week on the origins of addiction to porn that might change your mind on dealing with gaming and digital devices.  The author’s suggestion was that early experiences have impressive power to wire the brain, to the diminishment of alternative methods of engagement and interaction.  I know, not exactly what you would expect me to discuss on my site.  But the problems of finding easy satisfaction through a non-challenging (and solitary) source of excitement fits this post.  Once a behavior is hard-wired into the brain’s system, it is going to be really difficult to change.   Not impossible, but really, really difficult.
  6. Should you ban all media?  You could, but you would be denying the reality that the world they live in is heavily digital.  I tell parents of the kids I treat that I use my tablet in sessions to teach kids that this is just one activity or toy, in the same way that I will eat cookies but not to the exclusion of everything else.  Putting the phone or the tablet away isn’t the end of the world, and using it is not a fabulous reward.

Looking for more on using technology with intent?  Read Want A Stronger Pencil Grasp? Use a Tablet Stylus .  To help kids engage and learn social and emotional skills, read Stop The Whining With The Fast Food Rule.  Yes, it really works!

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Is Automaticity The Key To Handwriting Success?

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I know that this is a bold statement.  Handwriting is a complex skill, with visual-motor coordination, perceptual, cognitive and postural components.  But when I evaluate a child’s writing, and I watch them having to think about where to start and sequence movements to form a letter and place it on a line, and then decide how far apart the letters and words should be, it makes me think that the lack of automaticity is often a child’s biggest hurdle.  Even if their motor control isn’t terrific, they can still have legible and functional writing if they make fewer errors and write fast enough to complete their work in a reasonable amount of time.  Slow and labored writing isn’t functional, even if it is beautiful.

Think about how important it is for any visual-motor skill to become automatic in order to be efficient.   You cannot hit that ball if you have to think about it.  You just can’t.  It has to be a smooth and automatic response that comes from practice and refined feedback loops developed by experience.  While practicing, professional athletes drill down on minute aspects of the swing, but during the game, they choke if they “overthink”.  Ask anyone who has done a ton of free-throws in basketball (you get an unimpeded chance to drop that orange ball into the hoop) for practice but cannot make it when the game is on the line.

In this current culture, teachers have so many skills to impart.  Handwriting is still a skill children need.  Paper workbooks and worksheets are still used extensively until 3rd or 4th grade.  You cannot wait it out until kids get old enough to keyboard.  And a struggling writer in second grade is already feeling bad about their abilities. Sometimes so bad that they don’t want to do the language arts work that develops spelling, vocabulary and creative expression.   So waiting until they can type isn’t the answer.  You want excitement and enthusiasm for reading and writing early on.  Nothing develops excitement like success.  Nothing kills enthusiasm like boredom and failure.

If automaticity is the key to handwriting success, how do you develop it in children?  I think the folks at Handwriting Without Tears have figured it out.  I no longer use any other handwriting materials.  Their workbooks and pre-K multi-sensory learning tools are just too good.

  1. If you look at the pre-K and early primary workbooks carefully, you will see that the left-to-right, top-to-bottom orientation is embedded in everything.  Even the cute animals for little kids to color are all facing left-to-right!
  2. The two lines (baseline and midline) are simple to use.  No wondering where to place letters.   The pre-K letters are at the bottom of the page, creating an emerging automatic sense of baseline.
  3. The developmental progression (versus the alphabetical progression) builds slowly from vertical and horizontal lines to curves and diagonal lines.  Letters are grouped by the way they are formed, making automatic movements emerge early and consistently.
  4. Workbook pages aren’t overwhelming with activities, but the skills are repeated to intentionally develop writing automaticity.

For example, instead of writing 12 letter”B”s and 12 letter “b”s,  uppercase letters, with their larger and simpler hand movements are taught together and earlier.  Letters “b” and “d” aren’t taught together since they can easily be reversed.  Letters “b” and “h” are taught together since the formation is very similar.  Fewer reversals, more success without having to go back and re-teach letter formation.

Take a look at the best “pre-K into K” book I have ever seen, HWT’s KickStart Kindergarten.  It is the perfect summer bridge activity for your preschooler or your older special needs child.

Happy summer writing!

 

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