Tag Archives: discipline and toddlers

The Subtle Ways Chronic Medical Care Affects Infant and Toddler Development

 

hannah-tasker-333889-unsplashThe good news:  more and more extremely premature and medically complex babies are surviving.  The bad news: there is a cost to the extended and complex treatment that saves their lives and helps them to thrive.  This post is an effort to put out in the open what pediatric therapists know only too well goes on after the medical crisis (or crises) are over.   Only when you know what you are seeing can you change it.

This is not an exhaustive list; it is a list of the major complications of a complex medical course of treatment on behavior:

  1. Your child is likely aware that their coughing, crying, or other reactions will stop parents and even some medical professionals in their tracks.  I have had kids who didn’t get what they wanted learn to hold their breath until they turned blue.  If you have worked in medicine, you should know that if a child does this and faints, they will immediately begin breathing again.  It doesn’t scare me.  But it can terrify family members, teachers, and other caregivers.  They will stop whatever they were doing and may give in to any demand right away.  Many kids learn who will take the bait impressively fast.  It is very damaging to a child’s relationships and destroys their ability to handle frustration.
  2. Invasive treatments have been done while distracting your child and often without involving your child in any way.  This has taught your child not to attend to an adult’s actions or words in the same way a typically developing child will do naturally.  Since learning language and fine motor skills are highly dependent on observation, these skills are directly impacted by this consequence.  This pattern can be reversed, but it is highly resistant and has to be addressed directly.  Don’t think it will simply go away as your child recovers medically.  It doesn’t.  As soon as your child can be involved in self-care any way (holding a diaper, etc) you need to engage your chid and demonstrate the expectation that they respond and interact to the degree that they can manage.  All the time.
  3. Typical toddler attitudes are ignored because “He has been through so much already”  If your child is kicking you while you change his diaper ( a real question to me by a private duty nurse) then you react the same way you would if your child didn’t have a G-tube or a tracheostomy.  The answer is “NO; we don’t kick in this house”.  You don’t get into why, or what is bothering them right away.  The immediate answer is “no kicking”.  Not now, not ever.  Aggression isn’t unusual or abnormal, but it has to be addressed.  With understanding and as little anger as you can manage as your beloved child is aiming for your face with his foot.
  4. Children who are unable to speak to engage you or able to move around their home will come up with other methods to gain and hold your attention.  Some children throw things they don’t want and HOPE that you make it into a big deal.  Or they throw to gain attention when they should be using eye contact, vocalization or signing.  They wanted your attention, and they got it.  Without speaking, signing or any other appropriate method of communication.  This is not play, this is not healthy interaction.  This is atypical past 10-12 months, and should be dealt with by ignoring or removing the items, and teaching “all done” or “no” in whatever method the child can use.  And then teaching the correct methods of gaining attention and rewarding it immediately.  The biggest roadblock is that if one caregiver takes the “throwing” bait, the child will dig in and keep using that method.  Adults have to act as team managers, and if they fail, the behavior keeps on going.
  5. Children can request being carried when they don’t need the assistance, but they want the attention.  This can delay their advancement of mobility skills.  One of my clients has learned which adults will hold his hand even though he can walk unaided.  He likes the attention.  The clinic PT doesn’t know this is happening, even though the family brings him to therapy.  Like a game of telephone, each caregiver assumes that the child needs the help he is requesting.  He is not developing confidence in his own home, which should be the first place to feel safe and independent.  He depends on adults to feel safe.  Oops.

 

In many ways, my job as an OTR is to alter some of these behaviors to allow normal development to take place.  Long after those medical crises are terrible memories, the consequences of those days, weeks, months and sometimes years can have significant effects on learning and independence.

Looking for more ideas to help children grow and develop?  Read Need to Support A Child’s Independence? Offer to Help Them! and The Not-So-Secret Solution for Your Child With Motor And Sensory Issues: Dycem.  Do you have issues with your child’s siblings?  Read Are Your Other Children Resentful of Your Special Needs Child?

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Does Your Special Needs Child Have a “Two-tude”? Its Not Just the Age; its the Circumstances

 

patrick-fore-557736I spend a lot of my work week with toddlers, and they can be a challenge.  One minute sunny, the next screaming because their cookie broke.  Special needs toddlers can have a “tude as well, but many professionals sweep it under the rug.  They tell parents that this is normal, and that they should be grateful that their child is going through a completely normal stage of development.

Except that many parents who have already raised typically-developing kids KNOW that there is a difference with this child.  It could be the intensity of the ‘tude, or the frequency of the meltdowns, or the types of events that trigger the tantrums.  OR ALL OF THEM!  Parents know that this doesn’t feel the same, but they often shut up when they are told that it is so normal.  Perhaps their eyes and ears and memory isn’t correct.

They aren’t wrong.  Their perception that something is a bit different can be totally correct.  And the reason(s) are quite obvious to me.

Special needs kids come in an almost endless combination of needs.  Some are physical, some are communication needs, and some are cognitive or social skill needs.  Some are all of these.  Having challenges in moving, speaking, comprehending language and/or concepts or struggling to interact will create more frustration for every single day of a child’s life.  That’s the reality of disability.

The image of the placid and sweet special needs child, patiently waiting to be assisted and supported is just that: an image.  Most kids bump into frustrating barriers every day.  The toddler that has just learned to walk but can’t run, the toddler that is talking or signing but still isn’t understood by their older brother, the toddler that cannot handle a change in routines…it goes on and on.

Typical toddlers spend less time frustrated that they are unable to accomplish simple skills.  The typical 14 month-old that can’t tell you what he wants becomes the 18-month old that can say “cakker, pease” for “cracker please”.  A special needs child could be 4 years old and still struggling to explain that he wants another cracker.  That is a long time to be frustrated.  The typical 26 month-old that can’t run after their brother in the backyard becomes a runner at 30 months.  A special needs child may not run for years.  That is a long time to be left in the dust when everyone is running.  Is there any wonder that parents see more frustration, more tears, more stubbornness?

My saddest story of failed inclusion is when a family placed their special needs child in a toddler development group with mobile kids.  Even though this child had a personal aide, he still watched as his peers got up from the snack table and ran outside.  They left him with the aide, who then carried him outside so he could WATCH his peers climb and run.  He became distraught at home when he was left alone in a room.  A puddle of tears.  It was so sad to see.  No one had thought of the emotional cost of inclusion to this toddler, only the social and academic benefits.

What can be done?

I teach families the Happiest Toddler on the Block strategies as soon as they are appropriate.  Dr. Karp’s techniques build a child’s skills while enhancing interpersonal connections.  Yes, sometimes you have to provide consequences for aggression, but mostly it is about building frustration tolerance and emotional intelligence.  For everyone.  I use these techniques all day long.  I could never handle so many toddlers for so many years without them!

Looking for more information on special needs toddlers?  Read Need to Support A Child’s Independence? Offer to Help Them! and Safety Awareness With Your Hypermobile Child? Its Not a Big Thing, Its the Biggest Thing.

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How To Stop Your Toddler From Hitting You

 

patrick-fore-557736When your sweet little baby turns into a toddler that smacks you, you may be so shocked that you don’t know how to react.  The second time you get hit, or pinched, or even bitten in anger, you might feel a level of rage come up that is both surprising and horrifying.  Well, I am not going to shame you for any of that.  I want to help you get this under control and help your child handle what is (probably) a normal level of aggression.

Yes, this is likely a normal response for toddlers.  They have really limited language, hardly any understanding of their own feelings, and they live in the moment.  You probably have one of the 85% of kids who are not placidly calm most of the time.  If you have a very young child with a strongly spirited temperament (15-20% of the population) then you probably see this behavior at least a few times a week, if not daily.  It’s still normal. And you have to deal with it or you will have a bigger, stronger, and more aggressive child next year.

Here are my suggestions to deal with aggression:

  1. You are going to have to use Dr. Karp’s Fast Food Rule.  The first simple step is to state what you think your child is thinking, such as ” You say “No go inside”, in as short and simple a phrase as you can, based on age and level of emotion.  The younger and more angry your child is, the simpler the message.  Match your expression and gestures to the emotion you are stating.
  2. Wait for a shift in body language or level of screaming.  Repeat the phrase if needed, may be more than once.  Then state “No (biting, hitting, throwing)” and you say  “I don’t like it” or a “We don’t hit” if your child isn’t totally out of control.  If they are out of control, you have to wait until they can hear you.
  3. You must make it clear that YOU don’t like this behavior, not simply that it isn’t “nice”.  Why?  Because a personal message is more powerful to a toddler than stating that they broke the rules.  I even throw in “That scared me and I don’t like it” to slightly older toddlers, to come down to their level.  They might be a little surprised, but they know all about being scared.  You aren’t admitting weakness, you are telling them how they crossed a line.  As long as you are using body language that tells them you are still the adult in control, this helps them understand the seriousness of what they did.  But the 12-18 month olds don’t get that, so wait until they are older to add that one in.
  4. If you were holding your child when this happened, put him down. Nothing says confuse me like saying these phrases while cuddling.  If you were sitting next to them, move away a bit.  The message is that they have crossed a line, because they have.  They may cry about this, but that is OK.  For now.  Once they shift out of aggression, you can be more welcoming.  Get it?  Good behavior we welcome, aggression we do not.  Simple.
  5. If you see the clouds building and you can anticipate your child will hit, bit, kick or throw, you are allowed to intervene.  Pull your arm away, put them down, reach for the toy you think she will throw, or move away.  You could say “I don’t want you to kick” and then offer a solution.  This solution could be what you think your child needs, like a nap or a snack, or it could be something amusing, like looking in your purse for your keys.  Young toddlers can switch things easily.  Older toddlers sometimes commit to aggression and they won’t take the bait.  But sometimes they will.
  6. Don’t be afraid to issue consequences.  I don’t believe in physical punishment, but I have no problem with removing toys that got thrown or issuing kind time-outs.  Losing the opportunity to go do something fun because you tossed your boots at my head is just fine for me.  I never reward bad behavior.  Ever.  I have too much to lose if a child thinks that aggression will work to avoid something or receive something.  Kids can hurt themselves in the process of being aggressive, and that is always going to be my fault.  Not a chance.
  7. I always give children a chance to come back into the fold.  Maybe not to get the same thing they were being aggressive about, but a new fun thing.  You have to wait until they are calm to do this.  This isn’t coddling.  This is teaching them how I want them to behave, and that there is always a chance to do things better.

Stop The Whining With The Fast Food Rule

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Whining is a “fingernails on a chalkboard” experience for most adults.  We often give in to a whining child, just to avoid hearing that noise.  Or we explode and scare them (and ourselves) with the anger that whining can trigger.  What can you do?

What would you say if I told you that I use a technique that works more than 50% of the time, and it can work in mere seconds to halt a child in mid-whine? Well, read on and let me tell you the secrets that I learned from Dr. Harvey Karp and his Happiest Toddler on the Block book!

I spend more than 75% of my treatment day as an occupational therapist with children under the age of 6.  That can add up to a lot of whining!  Why?  Not because I am inexperienced, or because I am a pushover.  Anyone that knows me knows that neither statement is true.  It’s because young children may be able to talk, but they aren’t very good communicators.  Being able to express their feelings effectively and negotiate their desires is just beyond their pay grade at this age.  Their default is whining.

Dr. Karp’s Fast Food Rule has made my job so much easier. It makes young children see me as a friend, not just another adult telling them what to do.  This one simple strategy lets kids know that I care about how they feel, but doesn’t suggest that they will get their way with me every time.  In fact, they often find themselves following my directions without fully knowing why they have stopped crying, begging, or pleading with me.

Here is what the FFR entails:

Part 1:  Repeating what you believe is your child’s complaint or desire, using simple words, short phrases and more emotional tone and gestures/facial expression than usual.  You may not know for sure what a very young child wants, but take your best guess.  If you are wrong, you can always give it another try.  The more upset or younger the child, the simpler the wording and the more expressive the tone and gestures.  Why?  Because emotional people don’t hear you well, but they will pick up on your non-verbal cues effectively.  You are trying to convey a simple message:  I understand you.

Part 2:  Only after you see that your child has calmed a bit with the knowledge that they are understood can you then begin to comfort, negotiate, or solve their problem.  Not before. We jump in very early in the interaction to tell them “It’s OK, honey” or “I can’t hear you when you speak to me like that”.  It’s only when they know you have heard THEM that they can listen to YOU.

The importance of being understood by another when you are upset cannot be overstated.  Children need this from us more than we know.  Even young toddlers are aware that they won’t always get what they want, but they need to know that we understand their point of view.  If you do not convey this message, a child will whine, wail or scream to make it clearer to you that they are upset.  That is why telling them that things are fine seems to throw oil on the fire.  They think you don’t get it.

So, help them pull it together by stating their situation (as you perceive it) out loud and using some non-verbal messaging:  I got it.  You want more cookies.  You don’t want to leave the park.  You want Logan’s truck.  Whatever it is, tell them that you understand before you offer a solution, an alternative, or explain why they aren’t getting what they want.  I promise you, it will work more often than it does not, and sometimes it will work so well that you almost cannot believe how simple it was to calm things down.

There is a secret benefit from using the FFR:  your child will gradually become less likely to break out in a whine even when things have gone badly.  After repeated experiences of being understood and treated with respect and firmness, a child will expect that you are the source of solutions instead of a dumping ground for agitation and anger.

 

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How Early Can You Use The Happiest Toddler Approach?

Something happens to babies between 12 and 18 months.  The adorable little child that could be easily distracted from grabbing your earrings, ate anything you offered, and smiled when you praised him is replaced by someone whose favorite word is “NO!!”, delivered at astonishing volume for a person who weighs in at only 23 pounds.

Welcome to toddlerhood.  Get ready, it is going to be a bumpy ride!

Dr Harvey Karp’s Happiest Toddler techniques are usually discovered by frustrated parents of two year-olds who are tearing around the house, taking hostages.  But these effective behavior management methods can be cherry-picked to be used with younger toddlers.  In fact, starting early with patience stretching and the Fast Food Rule Taming Toddler Tantrums Using Sympathetic Reframing is a smart way to grow a toddler.  These techniques really do teach patience with kids Stretch Your Toddler’s Patience, Starting Today! and teach them that their complaints will be heard without always getting their way.  Dealing with bad habits later takes longer than instilling good ones any day.

You just have to be aware of which methods work for tiny minds and start planting the seeds before things get out of hand.  Some methods, like Giving It In Fantasy, will not work.  Young toddlers do not have the capacity to distinguish reality from fantasy.  Too many words, as well.  Same with Gossiping About Good Behavior.  They think that you are talking to them and don’t get the full effect of “overhearing” a compliment.

Not sure you want to “time-out” a 14 month-old?  Use Kind Ignoring, in which you momentarily turn away from the whining or defiance of a very young child.  Ignore the behavior briefly, even move 10-15 feet away without saying anything or making gestures or even a negative facial expression.  In fact, doing nothing at all but removing your self from the banging or throwing of toys sometimes works better than a statement or a look.  Your action coveys that this is not going to get your attention, it is going to remove you from their presence.  So much of the time, the littlest toddlers are doing these things to engage you when they don’t have the words to do so.  Don’t take that bait, and you have avoided what the Baby Whisperer would call “accidental parenting”.

She is a big believer in “start as you mean to go on”, and so am I.  Consistency gives all children a bedrock at home and at school.  They know what to expect, how to gain attention and how to successfully communicate even at an age where they have less than 20 words.  If you want more peace, don’t think that you have to wait until you can have a conversation about behavior with your child.  The door to communication is open way before that point!

 

Stretch Your Toddler’s Patience, Starting Today!

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I spent some time yesterday with the mother of a spirited toddler who pointed out that even though she saw that The Happiest Toddler on the Block technique of patience stretching works, she found it hard to be cheerful and upbeat after hours of her son’s whining and hanging on her legs.  At the end of the day, her toddler and her preschooler had worn her down.  She needed to fine-tune her approach and hear that her efforts would bear fruit sooner rather than later.

Good news!  Patience Stretching isn’t just a technique that works for the moment. It builds a child’s ability to wait.  A toddler that is used to waiting may not even start whining, he may just ask/gesture for what he wants.  You get a calmer house.  Done consistently for even a few days, combined with the Fast Food Rule ( Taming Toddler Tantrums Using Sympathetic Reframing ), and she should be able to stretch that calm waiting time at the dinner table up from 7 seconds (his current best time) to over a minute.  He showed me his potential; after a brief “top-off” reminder that his yogurt was indeed coming,  he waited another 7  seconds until she placed it on the table.  He needed a combo of patience stretching with fast food rule restatements so that he knew that I got what he was thinking: he wanted to know why there was a bowl of yogurt on the table but it wasn’t in front of him.  It was his brother’s bowl, and his brother was washing his hands. Tantrum averted, and this spirited toddler waited 14 seconds more than he did before we tried patience stretching.

Why even try it when you are totally exhausted?  Think about how all that whining is slowly draining the life energy out of you.  Some toddlers don’t just whine, they start to get a little aggressive to get your attention.  Think about the energy it takes to sweep up the cereal they throw on the floor in protest, and reconsider the benefits of patience stretching.  You will be expending your energy with toddlers one way or the other.  Might as well be building skills instead of sweeping up a mess made in protest.

Your delivery is key to a little person who hears how you say it more clearly than what it was that you said.  This mom admitted that she delivered her patience stretching lines without a lot of warmth; she was truly tired of all the whining.  It was time to bring on her academy award-winning performance skills.  Hint: toddlers can’t tell that you are faking it.  No one is cheerful all the time, but toddlers are very literal. They are reading your tone and gestures more than your words, so pleasant words delivered in a frustrated tone don’t work.

If you say something good (“Let me go look for your cookies”) with a note of sarcasm or annoyance, guess what they hear?  “I am not happy with you”.  If you want a smile back from a toddler with a spirited temperament( the child that can go full-ninja on you in seconds) you want to tell them that their cookie is coming with a big grin on your face and a lilt in your voice.  They will be smiling back at you without knowing what hit them!

Toddlers who experience many interactions throughout their day in which they feel listened to, felt that they were respected and occasionally got what they wanted (eventually) are more likely to be able to hear a firm “no” as well.  They have this bank of positive interactions with you, and a sense that you are not a pushover but that you are on their side.  Again, their perception of you is as important as what you actually feel about them.  An adult that loves them dearly but comes down hard with frustrating tones and annoyance is not going to be perceived warmly by a toddler.

Strangely enough, if you rush lovingly to provide things for a toddler most of the time, they can still whine.  Why?  Because there will be about 10% of requests that you cannot or will not grant due to safety or lack of resources.  They must get in the car seat since you have to go pick up their sister.  You don’t have any more goldfish crackers, etc.  At that point, their expectation that you grant every single wish has been shattered, and they do not know what to do.  They get very angry at you!  By giving them what they want most of the time except in very rare circumstances, their anger when you cannot deliver is much worse than if they had been turned down a few more times in the past.  Let that one sink in…your past generosity is not appreciated, it is hugely resented when you absolutely must buckle them in to the carseat, or when you really have to leave right now.

The wish-granter that requires them to wait using the patience stretching model is more likely to get a pass when the crackers run out or time at the playground is over.  The child who has experienced calm waiting will be more capable of hearing alternatives and accepting them.

Want more support?  Visit my website tranquilbabies.com and purchase a video/phone session.  If you are in the NY metro area, you can contact me for a direct consultation session.

Teach Toddlers Not to Hit Without Saying A Word

Toddlers hit.  Some toddlers hit out of anger, some out of frustration, and some to get your attention. I never allow an out-of-control toddler to intentionally try to injure me and not say something.  But some toddlers hit me and I don’t say a word…but I immediately DO something. Adults can make it very clear that hitting is not acceptable without saying a word.  Really.

  • Step 1 in preventing a child from hitting is never to hit a child in anger or in any other situation.  Children who have been hit learn very quickly that hitting is allowed if you are bigger and stronger.  Make sure before you spank or tap them on the arm that this is the lesson you intend to teach them.
  • Step 2 is to have clear limits on aggressive behavior every day.  Young children do not have full control of their impulses, and will work on that skill for years to come.  This is not an excuse not to impose consequences, but it might mitigate the intensity of your response.  And it means that the limits have to be MORE consistent for toddlers to help them remember what will happen if they are unable to control their behavior.  If your child knows that you will always impose the same consequence for pushing a sibling, for example, then when they do shove their sister, they should not be surprised that they will experience the consequence.  It might be a time-out, loss of a privilege, or whatever your family has decided is the consistent consequence.  If your child hits, then they will gradually expect the consequence to that act.  Feel free to state house rules, such as “We don’t hit in this house”.  It sends the additional message that the child is an integral part of something important: a family.
  • Step 3; now to the part about not saying a word.  You can use Kind Ignoring from the Happiest Toddler (see earlier post on my blog) or just a quizzical look that says “Really?  You think that is going to be successful in getting what you want?” Look at them with aggression and you will get more of what they just dished out.   If you have clear limits and the child knows them, they know what you are thinking. If their intent was to get a rise out of you, Kind Ignoring makes it clear that you are not going to be a party to this behavior.  Dangerous aggression is no time for Kind Ignoring, but then, the minor aggressions that benefit from Kind Ignoring happen so much more often in daily life than dangerous aggression for almost all children.
  • Step 4 is to teach toddlers how to manage aggressive impulses.  It comes as a shock to many first-time parents that their adorable baby has turned into a toddler with aggressive impulses.  This is the human condition, and some children seem to have a harder time managing their impulses.  Aggression is normal.  It really is.  Learning what to do instead of lashing out is so important, and not easy for any toddler.  This is where it gets tricky.  My favorite strategy is to use the Fast Food Rule from Happiest Toddler on the Block (see previous blog posts) to make it clear that I understand their message of anger, frustration or desire, and then explain what is going to happen, or how the child can achieve the goal.  If they wanted a turn with a toy, giving them the words for a request or commiserating that it is sad that the other child is not willing to share is more instructive.  Older children can absorb empathetic statements like “You don’t like it when your brother hits you, do you?” but younger toddlers really do not have the ability to fully empathize, and certainly not when upset.  Make it all about them and their needs, and you will get further.  When they reach the cognitive stage to experience full empathy, they will be so much more able to wrap their heads around that concept.

It is so much easier to set up limits and teach appropriate behavior rather than constantly correcting a child and having to use things like time-outs.  Life with toddlers is always a roller coaster but it doesn’t have to be a fight.