Tag Archives: low tone

Low Tone and Toilet Training: What You Can Learn From Elimination Communication Theory

Yes, those folks who hold a 6 month-old over the toilet and let her defecate directly into the potty, not into a Pamper.  Elimination Communication (EC) has committed fans, as well as people who think it is both useless and even punishing to kids.  I am not taking sides here, but there is one thing that should get even the skeptics thinking:  a large portion of the developing world deals with babies and elimination this way.  It is very hard to buy a disposable diaper in Nepal, and it is a problem finding water to wash cloth diapers in the Sahara.  I know there are a bunch of parents who roll their eyes whenever EC comes up, but some aspects of the process could help you train your child to use the toilet.  Why not consider what you could learn from EC that will help your child?

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First, parents who practice EC become very very good at anticipating when their kids are going to need the toilet.  Signs such as grunting, flexing the trunk forward, even facial expressions are quickly noted.  If you spend a lot of time watching your child then you probably know some of the signs.  This makes it easier to tell them to sit on the potty when their attempts will actually be successful.  You can also help them connect the physical feelings they are reacting to with language.  Telling them that when they get that feeling in their belly, they need to go use the toilet sounds so obvious to us.  But if you are little, you need help connecting the dots.  If you are little and have learning issues, you need to hear it more often and stated clearly.

Secondly, EC counts on knowing that reflexive intestinal movement happens about 30 minutes after food enters the stomach, and kidneys dump urine into the bladder about 30-45 minutes after a big drink.  Unless your child has digestive issues, this is a good start to create your initial potty schedule plan.  Kids with constipation or slow stomach emptying may take longer, but you already know that you have to work on those issues as well to be successful in toilet training.  Remember, if your child is roaming the house with a sippy cup, it is going to be a lot harder to time a pee break so that they have a full bladder (remember the issue with poor proprioception of pressure in low tone?).  If not, check out  Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!)  Toilet training is a good time to limit drinking to larger amounts at meals and snacks.  This will work for preschool preparation as well.  Most programs would not allow your child to wander with a cup for hygiene reasons, and you are helping them get off the “sippy cup syndrome”, in which children trade bottle chewing for sippy cup slurping.

Think that embracing EC fully will fast-track your kid?  Not necessarily.  In fact, some EC kids struggle to become more separated from a parent as they are not cradled any longer while “making”.  Taking responsibility for their own hygiene and awareness can be harder for some very attached children than if they were using diapers and used them independently.  But EC concepts are something to think about carefully when you are making your plan to help your child with low muscle tone.

 

 

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Low Tone and Toilet Training: Parents And Children Need To Work Together

This one is simple to explain, but not so easy to achieve with some kids.  Children whose interactional pattern is defiance or whining are going to be much harder to train, regardless of whether or not they have significant issues with low muscle tone.  In fact,  I would rather coach a very physically unstable but cooperative child than a toddler with mildly low tone but a firm commitment to resist any adult request.   If both parties aren’t able to work together, things may not go well.  At all.

Toddlers and preschoolers are known for their tendency to love the word “no”.  Did you know that, developmentally, the high-water mark for hysteria and the reflexive “no” is between 18 and 24 months?  Yup, that’s when language skills haven’t emerged to support expressing feelings and comprehending adult reasons. It is when emotional fuses are neurologically short, as in that forebrain is still sooo immature.   They really can’t handle their emotions at all on a brain level.  They have just left that sweet-baby phase where they want to please you more than anything, and they can’t be quite as easily distracted from bad behavior now.  This is a generalization, and there are some parents reading this that are thinking “We never got that lovely baby phase.  He went from crabby infant to bossy toddler!”  Well, I sympathize,  and I still invite you to read on.  All is not lost.  As language, emotional and reasoning skills slowly grow, a child who still falls apart easily and rages constantly isn’t always at the mercy of neurology as much as not having some basic coping skills.  It’s time to work on them before you jump into potty training.

Toddlerhood is long, all the way up to 5 years-old, and I won’t minimize the tantrums and agitation that can emerge.  This extended path to greater maturity is why I bought, devoured and constantly use The Happiest Toddler on the Block, Dr. Harvey Karp’s great book on building toddler coping skills. Half of the benefit is learning to both listen to and talk to toddlers in a way that calms things down.  I could not do my work as a pediatric occupational therapist with as much joy and enthusiasm as I have without these strategies.  Thanks, Dr. Karp!

For parents of children with language, communication or cognitive issues that result in developmental delays, your child may be 4 years-old but their other skills that are closer to 18 months old.  You can still toilet train.  Has your child been diagnosed on the autistic spectrum?  You can still train them.  Really.  The process may take longer and you may have to be both very creative and very consistent, but it can be done.  Job #1 is still the same: building a cooperative and warm relationship.

If your days are defined by defiance and whining, you need to learn all of the Happiest Toddler techniques that reduce frustration, including Patience Stretching and the Fast Food Rule.  Stretch Your Toddler’s Patience, Starting Today! You need to use “time-ins” for shared fun and warmth without a goal in mind.  You could try some of the more language-based techniques such as Give It In Fantasy and Gossiping.  And of course, you need to look at your approach to setting limits. All that love is great, but if your child knows that there are no consequences to breaking family rules or aggression,  your plan is in trouble.  Dr. Karp’s techniques aren’t intended to be a toilet training plan, but they set the stage for learning and independence.  Those are the ultimate goals of toilet training!

If you would like a more detailed or more personal level of support, visit my website tranquil babies  and purchase a consultation (in the NY metro area) or a phone/video consult!

 

Low Tone and Toilet Training: Kids Need To See How It’s Done

Low muscle tone creates more challenges for toilet training, but that means parents need to focus on getting all the parts of teaching and practicing down right.  If your child is unfocused or inattentive when you speak about potty training, you can try books and videos. Sometimes the use of media will spark interest and generate excitement.   If you don’t see an immediate boost in interest and cooperation, then your child might need a front row seat for a live demo.  By you (or your partner).

I know, most of us want privacy for this activity, even between couples.  Most women I know aren’t enthusiastic about the idea of demonstrations.  But many kids, and almost all kids whose communication and attention skills are delayed, really need to see what’s going on when you use the toilet.  Kids that have issues like ASD may have been present for your bathroom routine but they were paying attention to something else.  It is time to make a point of having them watch this very personal but important skill.

Sometimes you pick the moment, and sometimes it picks you.  If your child happens to be around and nature calls, bring them along.  If they wander in while you are using the bathroom, don’t send them out.   You may also have to make this “appointment viewing”.  Plan for it, so that you aren’t tearing them away from an activity they have chosen.  Being dragged away from fun to stand there watching isn’t going to work.

Be descriptive, use nouns and verbs.  Saying what you are doing provides them with more language about these activities.  They need to know how to describe to you what they are feeling before and during.  If your child signs, it is time to learn the relevant signs and teach them.  Here is the place where the signs make sense, in the bathroom.

If your son thinks that peeing into the shrubs/snow outside with daddy is the best thing in the world, take the show outside, neighbors permitting. Not everyone is so open to this idea.   I know a family that said that this game was so much fun that her son begged for more juice so that he would have more urine available for the game!!

 

 

Great news!  My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is done and available!  Visit my website tranquil babies and click “e-book” on the top ribbon.  I will proudly say that there is nothing out there that explains exactly why low tone makes training so much harder, then gives you readiness checklists and real-life strategies that work!

 

Is My Child Ambidextrous?

I answer this question from parents about once a month, on average.  Here is the better question: Is my child developing age-appropriate grasp?

The statistics are against your child being ambidextrous:  only about 1% of people are truly ambidextrous.  Being able to hit a ball equally well with either arm is valued on a team, but when they sit down for supper, switch hitters probably don’t use both hands equally to twirl their spaghetti.  But….children who have poor core stability often do not reach across the center of their body and switch hands to reach what they need.  Children who have motor planning or strength/stability issues will switch hands if the become fatigued or frustrated. None of these children are truly ambidextrous. They are compensating for delays and deficits.

Studies I have read on the development of normal hand dominance suggests that some children are seen as having emerging hand dominance (consistent and skilled use of one hand rather than the other) as early as 12 months.  You know those kids; they pick up cereal bits with their thumb and index finger at 9 months and pop them into their mouths individually as if they were sitting at a bar with a bowl of peanuts and a beer!  They delicately hand you the bit of string they found while crawling, and are already trying to unzip your purse.  Those kids.  It is more common to see emerging hand dominance in the 18-24 month range.  Developmental issues often delay this progression, and issues such as cerebral palsy can result in a child whose neurology would be expressed as right-dominant requiring more left-dominance due to hemiplegia.  That’s right:  hand dominance is biological, not learned, and very likely inherited to some degree.

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terrific safe scissors for little hands!

In my professional career, the greatest predictor of age-appropriate grasping skills has been not core stability or even muscle tone, but exposure and interest.  I work with a child that is legally blind since birth, and his grasping skills are very delayed.  His exposure is biologically limited.  He cannot see what his fingertips are doing, and since he has some vision, he is not doing what totally blind children usually do. They increase their tactile exploration of objects because they don’t have any visual information, and in doing so, end up with generally good refined grasp and control.  This child has slowly developed his skills with carefully chosen and strongly emphasized activities in therapy.

Low muscle tone makes it difficult for infants to develop effective opposition, the rotation and bending of the tip of the thumb opposite to the tip of the index finger.  It is common to see opposition to the tip of the middle finger.  The stability offered by that finger’s placement between two fingers at knuckle-level, plus less rotation needed, explain that quite clearly.  Sadly, the middle finger doesn’t have the refined movement of the index finger, so control is lacking.  They tend to use a fist for gripping toys, and often end up dropping or breaking their goldfish crackers.  These kids often actively dislike using their hands in a skilled manner.  “Read me a book or let me run around” rather than “Give me tiny snacks and beads to string”.  If it is true pattern of avoidance and frustration, it isn’t simply a preference.  It’s an issue.

Wok and Roll!

Playing Wok ‘n Roll with Edison Chopsticks!

How can parents support the development of hand skills at all ages?

  • Infants under 12 months:  Provide safe and desirable things to pick up.  Bits of food that aren’t choking hazards.  Toys with tags firmly sewn on.  Toys with parts that spin and have textures to explore.  Show your interest and delight in this exploration.
  • Toddlers:  Even more opportunities and enthusiasm.  Let them scribble on magnetic boards, use food as fingerpaint, and introduce utensils as early as safe.  Us lots of containers that need to be opened, closed and held for filling and emptying.  Check out Easy Ways To Build Bilateral Hand Coordination for Writing for more ideas.
  • Preschoolers:  Don’t tape down that paper!  Teach the  use of the “helper hand” Better Posture and More Legible Writing With A “Helper Hand” if it isn’t being used, and double-down on toys that require both hands.

What are your best methods for refining grasp and dominance?  All you teachers, therapists and parents out there, please comment and add your ideas!

 

Low Tone and Toilet Training: The 4 Types of Training Readiness

When clients ask me if I think their child is ready to potty train, my answer is usually “Maybe”.  There are numerous factors to consider when assessing toilet training readiness if a child has low muscle tone.

Physical Readiness

After about 18 months, most children can keep a diaper dry for an hour or more.  Their sphincter control increases, and their bladder size does too.  Kids with low tone can take a little longer, but without additional neurological issues, by 24 months many of them will be able to achieve this goal to accomplish daytime urinary continence.  Bowel control is usually later, and nighttime control is later still.  Achievement of the OTHER physical readiness skills are less predictable.  These skills include:

You will notice that children need enough skill, not amazing or even good skills.  They just need enough ability to get the job done.

I need to mention that issues such as constipation can derail the best plans.  Kids with low tone are more likely to have this problem than not.   Read my post Constipation and Toilet Training  for some ideas on how to manage this issue and who can help you.  The best time to manage constipation is before you start training.

Cognitive/Communication/Social Readiness

The trifecta for toilet training readiness in typical children is a child who is at the 16-20 month cognitive/communication/social level.  This child has the ability to follow simple routines and directions, can understand and communicate the need to use the toilet and their basic concerns, and is interested in learning a skill that adults are guiding and praising.

What about children with global developmental delays?  They absolutely can be toilet trained.  I have worked with children who have no verbal skills and perform tasks like dressing and self-feeding only by being prompted, but they can use the toilet.  Do they always know when to “go”, or do they simply follow a schedule?  Well, to be honest, sometimes they toilet on a schedule for quite a while before they connect the physical impulse with the action by themselves.  But they are dry all day.  The essential abilities are these:  they know what they need to do when they sit on the potty, and they know that they are being praised or rewarded in some other way for that action.  That’s it.  Have faith; children with developmental delays can do this!!

Some children with low tone have no delays in any of these areas, but many have delays in one or more.  The most difficult situation with cognitive/communication or social readiness?  A child who has developed a pattern of defiance or avoidance, and is more committed to resisting parental directions than working together.  Toddlers are notoriously defiant at times, but some will spend all their energy defying any directive, must have everything their way or else, and can even enjoy being dependent.

If this is your child, job #1 is to turn this ship around.  Toilet training will never succeed if it is a battle of wills.  And no adult wants it that way.  Repair this relationship before you train, and both of you will be happier.  Read my posts on the Happiest Toddler on the Block methods for ideas on how to use “Gossiping” Let Your Toddler Hear You Gossiping (About Him!)and  Turn Around Toddler Defiance Using “Feed the Meter” Strategies to build a more cooperative relationship with your child.

Family Readiness

Research suggests to me that the number one indicator for training is when the parents are ready.  Sounds off, right?  But if the family isn’t really ready, it isn’t likely to work.  I worked with a family that had their first 3 children in rural Russia.  Boiling dirty diapers on a wood stove makes you ready ASAP!  Families need the time to train, time to observe voiding/elimination patterns and to identify rewards that work for their child.  They need to be prepared to be calm, not angry, when accidents happen and to avoid harsh punishments when a child’s intentional avoidance creates an accident.  They have to be ready to respond to fears and defiance, and then handle the new independence that could bring a child freedom from diapers but more insistence on control in other areas.  Many of my clients have nannies, and most parents have partners. Every adult that is part of the training process has to be in agreement about how to train.  Even if they are more cheerleader than “chief potty coach”, it is either a team effort or it is going to be a confusing and slower process.  Check out Toilet Training Has It’s (Seen and Unseen) Costs for more information about how the process of training has  demands on you that are not always obvious.

Equipment Readiness

Do you have a stable and comfortable potty seat or toilet insert?  How will your child get on and off safely?  Do you need a bench or a stair-like device?  Grab bars?  Do you have wipes or thick TP? Enough clothing that is easy to manage?  Underwear or pull-ups that also do the job?  One of my clients just texted me that having a mirror in front of her daughter seemed to help her manage her clothing more independently.   A few weeks ago we placed the potty seat against a wall and in the corner of the room so that if she sat down too fast or hit the edge of the seat with her legs while backing up or standing, it wouldn’t tip and scare her.  No rugs or mats around, so she won’t have to deal with uneven or changing surfaces as she gets to the potty.

Really think out the whole experience for safety, simplicity, and focus. You might want to install a child-sized potty in your child’s main bathroom Should You Install a Child-Sized Potty for Your Special Needs Child?.   If you want to learn what your occupational and physical therapists know about these things, ask them Low Tone and Toilet Training: How Can Your Child’s Therapists Help You ?

You can see why parents rarely get a simple answer when they ask me if their child is ready to train.  I will say that since they are asking the question, they may be ready, and that is one of the four types of readiness!

Do you want more details on toilet training readiness?  

The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is available as an e-book on my website, tranquil babies, on Amazon.com,  or at Your Therapy Source ( a terrific site for parents and therapists!).  If you want more guidance to evaluate your child’s toilet training readiness and learn how to prepare them well, this is your book!  It includes readiness checklists and very specific strategies to build readiness.  Think you are ready to jump in and start training?  My book will guide you to choose between the gradual and the “boot camp” approach, and it addresses the most common stumbling blocks children experience on the road to independence.

Read my post The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived! , to learn more about this unique book and see what it can do for you today!

Low Tone And Toilet Training: Pull-Ups or Cloth Training Pants?

My post on clothing choice when toilet training a child with low muscle tone  Low Tone and Toilet Training: Teaching Toddlers to Wipe covered a lot, but it did not include a very important garment:  underwear.  I am putting pull-ups and their generic equivalents in the underwear category.  Many would not, as they are as absorbent as a diaper, disposable, and most children themselves do not think of pull-ups as step toward being a big boy or girl.  Apparently they do not watch or believe the ads.

Here is why it is worth thinking about your choice of undergarment:

  1. Kids with low tone often aren’t as aware of touch input as other children, and aren’t bothered by the very mild warmth and wetness of an absorbent undergarment.  Sometimes they don’t even notice it at all.  That will make it harder to recognize when they have had an accident, or when they need to get to the toilet right now.  This sensory-based issue is one of the two big issues with teaching low-toned kids Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!).  Being able to dash to the potty and successfully avoid an accident is a big deal for them.  This is an accomplishment, and wearing a garment that prevents them from experiencing success reduces training progress.
  2. I understand that having an accident is not fun for either the child or the parent, but it is memorable.  No one learns unless the lessons are memorable.  Understanding what those body signals mean and respecting them is the cornerstone of training, and for kids that need to listen to their bodies, it is essential that they not ignore them.  The Baby Whisperer even encourages parents with children that refuse to sit on the potty and intentionally make in their pants (not exactly an accident, but a mess nevertheless) to take off their clothes themselves and jump in the tub, then wash themselves off.  They get some help, but this isn’t playtime.  There is no quick wipe-off as they stand in front of the TV, watching the show they refused to leave to go potty.  Her thinking is that it is not done as a punishment at all, it is a natural consequence of intentionally not answering the call of nature.  No harsh words, no threats, but no continued watching of that show either.
  3. These children are often unsteady when they are calmly standing still, so being in a rush to pull their underpants down to use the potty is not likely to make them more stable and coordinated. Picking a garment that they can pull up and down easily under pressure is the only kind way to go.   You may have to try both to see what your unique child can manage, and do dry runs Low Tone and Toilet Training: The Importance of Dry Runs (Pun Totally Intended).  I explained it to a stylish mom this way:  if you have to use the toilet really badly and you have spanx and stockings on, think about how embarrassed you would be not to make it in time.  That is what many kids feel every time they need to go.  Dads, if you do not know what spanx are, ask!  Imagine wearing bike shorts under your khakis. Then add thin long underwear over the bike shorts.  Got it?
  4. Some kids are mature enough to care about the graphics on their clothing, and it’s enough to motivate them to commit to toilet training in the first place.  If you can only find the specific superhero that your son adores on a pull-up, you may have to use it, at least at first, to get him excited about learning.
  5. The companies that manufacture pull-ups would like you to believe that they are the only way to get out of diapers.  They are not. You can use cloth training pants, which have a thick crotch area to absorb small accidents.  Some parents have their kids wear 2 pair at a time for extra protection.  They aren’t that bulky.  You can also buy breathable waterproof covers for these pants.  The quality and comfort of these covers has improved over time.  But they do not have a princess on them…
  6. If you go for the cotton pant/waterproof liner combo, you will have to be more vigilant and have kids change out of them more often.  Some kids have more sensitive skin, so make sure you are giving them a little diaper cream as a barrier if you know that your child has had some diaper rash as an infant. As your child stays dry for longer periods, you can even take off the cover for more breathability.
  7. Pull-ups are one-and-done, no way to decrease the level of absorbency and safety.  There is one strategy that “kinda” works for the younger kids:  a pair of underwear and then the pull-up.  They get wet/soiled and kids have a modified experience of an accident without as much mess.  But even this solution limits the real-life experience of really, really having to get to the toilet on time.  This is one reason why children do not want to give up the pull-up.  The older toddlers understand all too well that it is a huge leap from diapers or pull-ups to a thin pair of underwear.  That seems to me to put a lot of pressure on a small child.  I think that this is one reason that toilet training all children has moved later and later.  It has nothing to do with less pressure on them to train or more freedom of children to choose.  They are afraid to fail at something that their parents clearly value.  They want to please us and succeed for themselves.   We should do absolutely everything we can to help them feel good about themselves while learning this important life skill.  Having an accident can be an opportunity to learn and not be judged.

Low Tone and Toilet Training: Transition to Using The Adult Toilet

Once the potty seat has been mastered, the question soon becomes: How is she going to use a regular toilet?  Most younger children use a step stool and an insert to sit securely on an adult toilet.  Kids with low tone often need a little more assistance to get up there and stay stable.

Here is what your child needs to be able to do in order for her to climb up and use a regular toilet with an insert:

  1. Have enough sphincter control to “hold it” while getting clothing and positioning right.
  2. Be able to manage easy clothing independently and have awareness of their needs for clothing management.  This means that if you have to tell them what to do or how to fix their clothes, they are not that independent yet.  Will you still help them?  Maybe, but if your child is able to know when her panties are down low enough, and a boy knows that he picked up his shirt before he pees, then your child can be a responsive participant if they find themselves unstable and need to think on their feet ( pun intended).
  3. Be stable while momentarily standing, either to manage clothing, while turning around, or for boys, to pee standing up.  Some little boys will pee in sitting for a long time, others (usually the ones with big brothers) demand the right to stand.  Aim is a lot harder if you are not standing in a stable position.  The handles on the following item give young children something to hold onto.  Just like seniors, grabbing a towel bar or the paper holder is a risk.  Every time they reach too far, their balance is altered.  That can be a huge help, compared to just a step stool.

41lLLbRbbkL._AC_US160_The best support with a step that I could find anywhere is the Mommy’s Helper Cushie Step Up Potty Seat.  There are a few available models with this basic design, but this one gets the best reviews for stability and ease of use.  If a set-up is wobbly with a typically-developing child, a child that has issues with safety and control in other situations is going to be in trouble as they climb up to use the toilet.  It doesn’t do as well with an elongated seat as a rounder one.  The contoured seat grips that tushie a bit more, and the texture and softness of the seat prevents accidental sliding as well.  This is not permission not to supervise for a while.  Kids are unpredictable, so a wobbly child might need your eyes just to see what will throw them off their focus and put them at risk of falling.

52733343312610pThe Baby Bjorn footstool is an amazingly stable choice.  The legs have rubber grips all the way around, and the top is super-grippy.  Even when wet!  It is hard to tip, and it is so sturdy that adults can stand on it without any problems at all.  Easy to clean too!  If your child can use a step stool instead of a ladder, this is the one.  Little boys that pee standing up will stand on this and hold the top of the tank or the back of the adult seat to steady themselves to aim.  The biggest problem for some kids is that sometimes it isn’t wide enough for the kids that normally stand with their feet very far apart (your OT or PT will call that a wide base of support in their progress note).  Their feet might go to the edges, seeking that same wide stance.  Not safe.  Practice having them standing on it without using the toilet, so that there are no surprises about how to climb and turn in a small space.

Remember, they have to get up there first, then pull down underwear and clothes.  Trying to climb stairs with pants around your ankles is asking for trouble.  Just try it yourself some day!  That means that clothing choice still matters.  Nothing with belts, long tunics or long skirts, tight leggings or skinny jeans.  Unless you want to do all the work and slow down their learning curve.

Hint:  Having kids develop independent dressing skills when they are off the potty, i.e. getting ready for bed, dressing to go to daycare, etc. is essential.  I started writing “important”, but that is not accurate.  It is essential.

These kids need chances to build smooth and fast movements under pressure.  The only way to get there is practice and learning from repeated opportunities.  Good teaching is nice, experience is better.  The more automatic and controlled a skill is, the less difficult it will be to execute it when rushing to make it to the potty.  Being able to manage clothing without even trying to toilet train is important.  If your low-toned child is miles away from getting on the big toilet, and you are reading this for future reference, then today’s goal might be for her to to help more with getting dressed.

If your child is still struggling, you may want to install a child-height potty temporarily.  they are available online through big box stores and easy to swap out when your child grows.  Read more about how using the right height potty can help your child in Should You Install a Child-Sized Potty for Your Special Needs Child?.

Looking for more information on low tone and daily life skills?  Check out Low Tone and Toilet Training: Teaching Toddlers to Wipe and Low Muscle Tone and Dressing: Easy Solutions to Teach Independence.

My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is finally done!  You can buy it at Your Therapy Source (a great site for parents and therapists), Amazon.com or on my website, tranquil babies.  I cover all the prep you need to do for success, help you address issues like constipation and language delays, and even deal with the inevitable setbacks that arise along the path to independence.  Read more about this unique book at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

Wish you had someone to ask about toilet training a child with low muscle tone?  You do now!  Visit my website,  tranquil babies , and purchase a phone consultation to get personalized attention, and a chance to ask all your questions!