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!

Wait Out Your Whiner (or Whinger) And Everybody Wins!

Whining/whinging can drive a calm parent to the edge. Like nails on a chalkboard, the effect of a small person squealing their demand may unhinge you. Add refusal to comply with a reasonable request, and you have a recipe for disaster. OK, maybe not disaster, but how your react can inflict damage on the warm and happy relationship that you really want with your child.

So what do you do with a small child who whines/whinges? You could come down on them, all threats and authority. Good luck. Your child already knows that you have the power to deny them. They are choosing whining as an alternative to outright defiance, probably as a way to avoid a showdown. Insist on taking it there, and you may get immediate compliance but risk later explosions, or risk teaching your child that threats are the way to get what he wants. Oops.

Giving in to whining/whinging isn’t much better. You may have stopped the noise for now, but you have taught them a powerful lesson: this works! If you think that your child won’t try it again, or won’t try even harder the next time he wants something, you are experiencing wishful thinking.

This is how giving in will doom your plan. Every psychologist knows that the way to get a behavior solidly stuck in a child’s mind is to reward it intermittently. If it works some of the time, it will be tried again and again. Don’t believe me? Visit your local casino to see intermittent reward theory in it’s adult form. Every time that slot machine pays out, the customer is “taught” that it could do so again, if only they will keep playing. And playing. Folks, adults know the house always wins. Your child does not. They will keep trying their strategy on you.

Looking for advice from teachers or other “experts”? You will come away with some plausible strategies that often ultimately fail to bring the whine/whinge to and end. They sound so supportive, so understandable. “I can’t understand you when you speak to Mommy that way” is a common recommendation. An alternate strategy is “Use your big-boy/girl voice please.” I am going to tell you that neither of these strategies work very well with the chronic and committed whiner, especially if the perpetrator is under 5.

Why? Because you are using words to negotiate with children that respond better to actions. I am not referring to very young children or special needs kids with language skills under 18 months of age. But wait: those children generally do not whine/whinge. They don’t have the social and language skills to do so. They can be dealt with differently. This is why peak whine/whinge time is 2-5 years old. At this age, children can create strategies and observe their success or failure. But they are still little. They don’t infer from discussion, and they watch your reactions and the tone of your voice to support their limited language and social skills. Ask Dr. Harvey Karp. Happiest Toddler on the Block transformed my understanding of toddlers, and gave me happier days as well.

If your child clearly understands your request and your response to their request, and you consistently react in the same manner, you can wait out a whiner and teach them how to approach you. If you sometimes give them cookies right before dinner so that you can concentrate, or if you inconsistently administer natural consequences (taking toys that are thrown away from them, for example), then again, waiting them out isn’t going to work. But if you are reasonably consistent, this is the one strategy that will save your sanity and improve your child’s behavior in a lasting way.

By wait-it-out, I mean ignore the whine. Don’t react. You have ALREADY given them a response. Whether you are using Patience Stretching, my favorite move from Happiest Toddler on the Block, or simply a statement that if they want a snack, they need to sit on their chair, your response was already understood and rejected. Now you do nothing. You do not even make eye contact. Busy yourself, if possible, with some task in the room. This could be putting dishes away, folding clothes, etc. You want to be observed by your child to be non-reactive. You need to be able to observe them so that if they improve their behavior, you can respond right away.

The best way to respond to a formerly whining/whinging child who has come around is with warmth and humor. Nothing, absolutely nothing, sends home the message of success to them like an adult that welcomes them warmly. Don’t spend your time reviewing what went right. “You listened to Mommy so well. Nice sitting on your bottom in the chair” only works well with the youngest of the whiners. Most of them already understand that your warm response is in reaction to their compliance. Save the sing-song review for your infant; give your toddler or preschooler a hug, a kiss or some physical response instead.

Good luck, and see if waiting works for you!

Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children

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When most parents think of sensory processing issues, they think of the children who hate clothing tags and gag on textured foods.   Joint hypermobility, regardless of the reason (prematurity, Ehlers-Danlos syndrome, head injury, etc) can result in kids who stumble when they move and wobble when they rest.  They are seen by orthopedists and physical therapists, and told to build up those weak muscles.  Well, those kids have sensory processing issues too!   And they deserve more effective treatment than they typically receive.

Lack of joint integrity, especially decreased joint stability, results in a decrease in proprioception and kinesthesia.  These two under-appreciated senses tell a child about her body’s positions and movements without the use of vision. The literature out there is sparse. If you are hoping that a lot of research on this topic exists, and doctors understand why your child curls his fingers around a pencil but can squeeze the @@#$% out of clay, good luck. Most of the hard science has been done by PTs on proprioception in the leg, and there isn’t a lot of it. But OTs know a lot about the connections between sensory processing and motor performance.

Consider the process for touch-typing to better understand these senses.  Your awareness of your hand’s position while at rest on the home row is proprioception.  You know where your movement starting and end points are via proprioception.  Your awareness of the degree of movement in a joint while typing is kinesthesia.  Kinesthesia tells you that you just typed a “w” instead of an “e” without having to look at the screen or at your fingers.Your brain “knows”, through learned feedback loops, that your finger movement was too far to the left to type the letter “e”, but far enough to have been a “w”.

You are able to grade the amount of force on each key because your skin, joint and muscle sensors transmit information about the resistance you meet while pressing down each key.   Your brain compares it previous typing success and the results on the screen, and makes adjustments in fractions of a second. This is sensory processing at work.

Why do children with hypermobility have proprioceptive and kinesthetic processing problems?  Because information from your body is transmitted is through receptors embedded in the tissue within and surrounding the joints.   These receptors respond to muscle and tendon stretch, muscle contraction, and pressure within the joint.   Joint hypermobility creates less stimulation (and less accurate information) to these sensory receptors.  The information coming into the brain is insufficient or delayed, and therefore the output of postural stability or dynamic movement is correspondingly poor.  This shows up as a collapsed posture, difficulty quickly changing positions to catch a ball or leap over an obstacle, a heavy-footed gait, and a whole lot of other difficulties.

Can children with hypermobility improve their sensory processing and thereby improve the quality of their movements in daily life?  Absolutely.  Because sensory processing is a complex skill, addressing each component of functional performance will give the hypermobile child more skills.  Building muscular strength within a safe range of joint movement is only one aspect of treatment.  Positioning a child to give them more sensory feedback while in action is essential.  Increasing overall sensory processing by using other sensory input modalities is often ignored but very helpful.

I believe that vestibular input is one of the most powerful but rarely used modalities that can improve the sensory-motor performance of hypermobile children.  They don’t have to demonstrate vestibular processing deficits to benefit from a vestibular program.  This program can be done without stressing fragile joints, which is a limitation for the programs that focus too much on muscular strengthening and stabilization activities.

My favorite sensory processing strategy for hypermobile kids?  The use of rhythmic music during movement.  Programs that use the powerful effects of sound on the brain are effective treatments for hypermobile children.  It is difficult to explain to insurers and sometimes even neurologists ( don’t get me started on how hard it is for orthopedists to follow this) but if you understand the complex processes that support sensory processing, you will be changing the background music in your clinic or your home in order to capitalize on this effect!

Children with hypermobility can benefit from occupational therapy sessions that provide more than a pencil grip and a seat cushion.  All it takes is an appreciation for the sensory effects of hypermobility on function.

Teach Your Child To Fail Today. You Can Thank Me Later

Yes, I said it: fail.  We all will fail at something sometime.  Even, and most especially, the gifted kids who experiment and explore constantly, will fail at something.  Knowing what to do with your feelings when you fail is essential for a happy life.  And that is why you will thank me later.

Angel Duckworth is one of my heroes.  Her focus on building grit is so important in this new world we live in.  In the old days, say 50 years ago, families and religious institutions provided a roadmap for children to handle challenges in life.  Maybe it didn’t always provide the widest highway for people with differences, but opportunities to learn perseverance and receive support after a failure were more available.  I don’t believe we can turn back the clock, so it is time to move forward and create new structures.  And this time, everyone will fit under the tent and get more support.

When we fail, we have the choice to feel bad or feel inspired.  The child who believes that his intelligence and his abilities are fixed will feel worse, perhaps even ashamed.  That child will be less likely to want to feel those emotions again, and will look for situations that ensure success.  At any cost.  Even cheating.  The rise in anxiety disorders and suicide in the college-age population has me worried about how these kids see failure.  It doesn’t have to be a crisis, it can be a learning experience in the truest sense.  Why you failed and what to do differently (if possible) are things you can learn, but only if you aren’t crushed or horrified that you failed.

The child who knows that failure is common to all of us eventually, and is not a sign of weakness or lower ability, will give things another try.  In fact, that child will not want to engage in a “sure thing”, whether it is a class, a sport, or an interaction in which there is no challenge.  The child who isn’t afraid of failure will welcome novelty and risk. They have, as Dr. Duckworth would call it, a growth mindset.   Failure is their clue that some variable in the experiment should change; useful information for their next attempt.

Just imagine what your child could do if she wasn’t afraid to fail!  Solve the many health and environmental challenges we have, broker peace between groups and countries, raise a family that believes in the power of failure….anything!

If you have a fixed mindset about failure, if you were raised to take the sure thing, the easy road to success, use the emergency instructions you get from the airlines.  Change your mindset before helping your child to change theirs.  You can thank me later.

Your Bossy Baby or Toddler May Be Gifted. Really. Here Are The Signs You Are Missing!

Toddlers are known to be a challenge at times.  Tantrums over broken cookies, insistence on hearing “Goodnight Moon” for the 11th time in one night, etc.  They can be adorably cute and amazingly difficult in the same 15 minute period!   But lurking inside chaotic toddler behavior may be signs of genius.  Really.  Here are two important signs of giftedness that emerge before 12 months of age:

  • Makes eye contact early and frequently.  The gifted baby seems incredibly alert and appears to be constantly aware of what is going on around her.
  • Resists being left alone without anything to do; wants interaction with you and with the world.

Yes, the gifted baby is taking notes and making plans.  Once she can move, she is into everything.  The things that fascinate her might be objects you never suspected an infant would even notice.  She may have abandoned those rattles very early in life.  She might not be interested in chewy toys or tags on toys. In fact, one of the signs of a gifted baby can be a distinct disinterest in chewing on books and toys.  They realize that these objects have another (higher) purpose!

Here are some signs of gifted behavior in toddlers:

  • Obvious and strong interest in shapes, shape sorters, containers, letters and numbers in all forms.  This is way beyond being taught to sing the “Alphabet Song” in a cute way.  The gifted toddler is likely watching, listening and teaching herself what those symbols mean!  She may even gather three sorter toys and proceed to group all the circles, triangles, etc in a pile before 12 months old.
  • Completing puzzles and shape sorters beyond age expectations for the toy.  For example:  I expect a child to place a circle in a shape sorter by 12-14 months.  If I see a 9 month-old that can manage it easily, I assess that as significantly early motor and perceptual development.
  • Is eager to please, and feelings can get hurt easily.  Yes, this is one of those gifted characteristics that parents don’t brag about.  Sensitivity, in all it’s versions, (emotions, physical sensitivities, allergies, etc.) is very commonly seen in gifted people of all ages.
  • A long attention span, with insistence on finishing things and completing tasks independently.  This can lead to tears and frustration as a child imagines actions and creations he cannot execute to his satisfaction.  His physical development isn’t at the same level as his mental capacity. The frustration this asynchrony causes is a pervasive issue for gifted children well past early childhood.
  • Other adults describe your child as bossy, stubborn and possibly spoiled.  Yup, the gifted toddler isn’t always everyone’s fave grandchild.  They can be insistent on doing things their way, and only their way.

How can you tell the difference between typical toddler behaviors and signs of giftedness?  It isn’t always that easy.  The behavioral issues of developmental asynchrony and sensitivities can mask the underlying issue of giftedness.  I look for improvement in their behavior when they are given appealing but highly complex problems to solve. I might invite a toddler to join me in a play activity that is complex and intense, but has been selected to modulate arousal states.  The gifted toddler who is given a chance to shine in this environment is a wonderful thing to observe.  A typical child with behavioral issues often becomes more irritable and bossy when given the same situation.

When I am working with a child that is reported to have sensory processing difficulties and I ask the right questions, I start wondering if I am also seeing signs of early giftedness when I hear the following comments come out of a frustrated parent’s mouth:

  1. “From the minute we brought him home, he seemed to watch everything we did”
  2. She isn’t happy unless she has something new to play with, and then she always surprises us with how fast she figures it out”
  3. “He never stops exploring, from the minute he wakes up”
  4. “She put together her brother’s puzzles and then said “Store” so we would go get her more puzzles!”
  5. “He watched his sister drawing, and before we knew it, he drew a face, right down to the eyebrows and ears!”

The gifted infant and young toddler is almost always more work for parents than a typically developing child.  That constantly curious mind likes complexity, it is driven to explore the world and the world of ideas, and their non-stop intensity seems to begin at birth.  Some parents are also gifted individuals, and they recognize the situation right away.  They may be worried about being up to the challenge of parenting a gifted child, or they are overwhelmed by their job, their other family roles, and now the responsibility of supporting a gifted child.

Some parents aren’t gifted, even if they are professionally successful and personally content.  The perspective from their gifted child is hard for them to embrace.  They don’t see the world through the same mindset as their gifted son or daughter.  I believe that is because the mind of a gifted person is as different to a non-gifted individual as the mind of a developmentally challenged person appears to them.  Different processes, different problems.  Every parent can come to understand their child, regardless of brain differences.  Knowing what those differences are is the very first, but very important, step.

Do I rush to tell the parents my suspicions?  No.  I am not a neuropsychologist.  My license doesn’t give me the right to diagnose.  I watch, work, support, and trust that the truth about a child’s abilities and issues will come out in time.  And I go right on doing what I have been asked to do.  Addressing the sensory processing issues that some gifted children face is more than enough of a challenge for an OT, and I am happy to support these kids to have happier, calmer and more enjoyable lives because of my input!

 

 

 

 

 

 

 

 

 

Infants With Sensory Sensitivity: When Your Fussy Baby Takes Over Your Life

Parents are often the first to suspect that their infant’s constant and intense complaints are more than just fussiness.  Sometimes pediatricians pick up on a pattern of edginess that cannot be explained by all the usual suspects:  teething, food sensitivity, temperament.  Having a baby who complains bitterly about the most common events, such as diaper changes and nursing, can take over a parent’s life and make them question their sanity.

Judging by the research literature, you would think that sensory sensitivity only happens to toddlers or preschoolers!  Those 4 year-olds who refuse to wear shirts with long sleeves and cannot handle a car ride without vomiting often started out as super-fussy babies.  Their parents may have tried the lactation consultant, the pediatrician, maybe even the neurologist, in a frantic search for help.  They could have used an OT.

I have treated babies as young as 6 months-old that displayed clear signs of sensory sensitivity after prolonged periods of peri-natal NICU stays or procedures.  Why would a few months in the NICU make a baby sensory-averse to diaper changes and being held?  Well, look at it from the perspective of an immature nervous system.  They got more stimulation than they could handle, and their brains responded by interpreting everything as a potentially invasive experience.  Turns out, a good percentage of children who require intensive and ongoing medical procedures to save their lives don’t recall the experience, but their body does. Ask psychiatrists doing fMRIs, or functional MRI’s, what they see in adult trauma victims.  Parts of the brain that encode emotion and memory will light up like Christmas trees when faced with innocuous stimuli.  Oops.

Progressive NICU’s are making changes, but those nurses have no choice to perform multiple and invasive procedures and do them in a very stimulating environment.  They are working hard at a very difficult task; saving the lives of really tiny, really sick babies.

Is a NICU stay the only way to become a sensory-averse infant?  Not at all.  It seems some infants are just wired to be more sensitive, and some babies need only a little bit of extra excitement to become sensitive.  I treated an infant under 6 months of age that struggled to nurse.  She had the oral motor skills to suck, the swallowing skills to avoid choking, but she disliked the feel of her mother’s skin touching her face.  She nursed until she wasn’t starving, then refused any more.  Her mother felt rejected and not in love with her little girl any more.  The baby wasn’t growing and was constantly agitated.  We worked hard in therapy to help this baby, but until we realized what the problem was, every time her mom tried to get her to nurse more, she was repeating the cycle of aversion and agitation.

My approach for my youngest sensory-averse clients combines everything I know from Happiest Baby on the Block and all my training in sensory processing theory and practice as a pediatric occupational therapist.  The first step is convincing parents that they didn’t cause this behavior, and then convincing them that there is treatment that works.  Combining calming sensory input, environmental adaptations, and skill building in these little babies can make a huge difference in their lives and their family’s experience.  If your baby is incredible fussy and no one can find a good reason, pursue pediatric occupational therapy with an experienced therapist.  It could calm things down more quickly than you think!

Help Your Newborn Adjust to Daycare By Using Happiest Baby on the Block Strategies

ID-100108085.jpgReturning to work soon after delivery can mean putting your 3-month old in daycare.  As challenging as this can be emotionally, it can also be a struggle for your baby, especially if her only self-calming strategy has been nursing.  Should you (or could you) quit your job or just tough it out?  There is another alternative:  teach your little one to respond to  a wider variety of self-calming cues.

Self-calming at 3 months?  Well, yes and no.  Babies at this age are learning to respond to messages that we send.  This is the very beginning of self-regulation.  Actions and sensory inputs that tell their nervous system ” You are safe”, “It’s time to sleep” and “I get it; you need a little more help to calm down and I know what to do”.  They aren’t able to devise  their own solutions yet, but they can begin to self-calm if we read their behavior correctly and understand what they need developmentally and neurologically.  This is where Dr. Harvey Karp’s Happiest Baby on the Block strategies, and his other great sleep solutions, can save your sanity and your child’s sleep.  Many of the 5 S’s that worked so well in the first 12 weeks of life can be adjusted to support this transition into daycare.

The weeks between 3 months and 6 months are almost the 5th trimester (Dr. Karp refers to the first 3 months of life as the “4th trimester”).   I think it is a bridge period in which babies need more help to calm down than many realize.  At this age, they suck their fingers to self-soothe while awake.   But… they aren’t strong enough to keep their hands or their thumbs in their mouth when they are lying down and falling asleep.  Gravity pulls those heavy hands down to the crib mattress. They don’t babble their way to sleep the way a 6 month-old does, and they are barely ready to listen to lullabies. So what can you do?  Be creative and use the 5 S’s as a launching point for your new routines.

Swaddling may not be as effective, or even safe, at this stage.  Babies who are rolling could be strong enough to roll onto their bellies.  With their arms swaddled, they are at risk for suffocation.  Once your baby is in that “I’m gonna practice this rolling thing all day” stage, swaddling becomes more of a risk than a solution.

There are swaddle garments that convert to safer solutions for this stage.  The garments that still give firm pressure over the chest but leave legs and arms free are specifically designed to keep that nice calm feeling going.  They allow your child to roll freely.  Dr. Karp also suggests that swaddling in an infant swing is another safe choice for those babies that are experimenting with rolling but still need swaddling to pull it all together.  REMEMBER:  your baby needs to be put into the swing calm, and securely strapped in.  If she is too big for the swing, then don’t use it.  Just because it is calming for her is not a reason to use a too-small swaddling blanket or a tiny infant swing.

Pacifiers are recommended by both Dr. Karp and the American Academy of Pediatrics, but some babies don’t love them, and some parents are afraid of creating a paci addict.  For those nervous parents, I wrote a special post: Prevent Pacifier Addiction With A Focus on Building Self-Calming Without Plastic.  The truth is that sucking is a normal developmentally-appropriate self-calming behavior, and addiction really doesn’t become an issue until your child has nothing else that works at all.

Between 3-6 months, your little one is still benefitting from sucking, and she can learn to use a paci in daycare.  She isn’t at risk of nipple confusion, unlike a 2 week-old, and she won’t reject your breast because of paci use.  Nursing is the total package of love, warmth and nutrition.  If she says “no more” to nursing, it is likely that she would have done so without the paci.  Some babies are just ready to be done early.  Use Dr. Karp’s paci learning technique to teach a baby how to handle a paci and keep it in her mouth.  By 3 months, she has strong oral muscles, so it is a matter of practice and helping her to realize how handy pacis can be to calm a bit for sleep.  If she spits it out while asleep….well, mission accomplished!

White noise is the one HBOTB strategy that never needs to end.  But for these little guys, the new noises of daycare are so different from home that this may be the secret weapon.  Dr. Karp sells his carefully designed white noise CD.  It can be loaded onto a phone as well from iTunes. Select the track that matches your child’s state (crying, drowsy  and calm, etc.) and watch the magic begin.  Encourage your daycare to use this totally safe method of soothing.

Rocking a baby in your arms can replace the infant swing, and some older newborns still calm down when held on their sides or stomach.  Again, this is never a sleep position, just a calming position.  But if it works for your baby, feel free to use it when you hold her.

Once you have created an updated HBOTB routine that works, share it with the daycare staff.  You may find that they have rules and regulations, and some staff aren’t open to new ideas.  My suggestion is to emphasize how easily you can get her calm.  Even the most rigid care provider’s ears perk up when she thinks that there is a way to make her job easier.  These people work long hours and work hard.  Think of this as helping her and your little one have a better day!