Tag Archives: occupational therapy

OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues

shopping-2.jpeg

shopping-1.jpegshopping.jpeg

Does your child knock over her milk on a daily basis?  Do utensils seem to fly out of your son’s hands?  I treat kids with hypermobility, coordination and praxis issues, sensory discrimination limitations, etc.; they can all benefit from this terrific line of cups, dinnerware and utensils.

Yes, OXO, the same people that sell you measuring cups and mixing bowls: they have a line of children’s products.  Their baby and toddler items are great, but no 9 year-old wants to eat out of a “baby plate”.

OXO’s items for older kids don’t look or feel infantile.   The simple lines hide the great features that make them so useful to children with challenges:

  1. The plates and bowls have non-slip bases.  Those little nudges that have other dinnerware flipping over aren’t going to tip these items over so easily.
  2. The cups have a colorful grippy band that helps little hands hold on, and the strong visual cue helps kids place their hands in the right spot for maximal control.
  3. The utensils have a larger handle to provide more tactile, proprioceptive and kinesthetic input while eating.  Don’t know what that is?  Don’t worry!  It means that your child gets more multi-sensory information about what is in her hand so that it stays in her hand.
  4. The dinnerware and the cups can handle being dropped, but they have a bit more weight (thus more sensory feedback) than a paper plate/cup or thin plastic novelty items.
  5. There is nothing about this line that screams “adaptive equipment”.  Older kids are often very sensitive to being labeled as different, but they may need the benefits of good universal design.  Here it is!
  6. All of them are dishwasher-safe.  If you have a child with special needs, you really don’t want to be hand-washing dinnerware if you don’t have to.

For more information about mealtime strategies, please take a look at Which Spoon Is Best To Teach Grown-Up Grasp? and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child.

thanh-tran-369711.jpg

Advertisements

Can You Use The Wilbarger Protocol With Kids That Have Ehlers-Danlos Syndrome?

guillaume-de-germain-329206

My posts on proprioception and hypermobility have been popular lately, leading me to think that parents (and therapists) want more information on the sensory basis for their children’s struggles, and that often their treatments don’t include addressing their sensory processing issues. The Ehles-Danlos Syndromes (yes, there are more variants than just vascular and hypermobile!) are somewhat rare connective tissue disorders that can create generalized joint hypermobility.   Kids with EDS are often diagnosed as having a coordination disorder before they get the EDS diagnosis, and their families describe them as “clumsy” or even “lazy”.  I see them as having sensory processing issues as well as neuromuscular and orthopedic issues.   Take a look at Hypermobility and ADHD? Take Stability, Proprioception, Pain and Fatigue Into Account Before Labeling Behavior and Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children for more on this subject.

There are some caveats in using techniques from sensory integration protocols with this population.  This doesn’t mean “no”; it means think about it first.  The use of the Wilbarger Protocol is one that requires some thought before initiating with EDS kids.

The Wilbarger Protocol:

For those of you who are unfamiliar with the Wilbarger Protocol, it is a common treatment approach for children with sensory sensitivity, sensory discrimination issues and poor sensory modulation.  Created by Patricia Wilbarger, a terrifically talented OTR  who directly trained me as a young therapist, it is a neurologically-informed treatment that can be used quickly for both immediate improvement in sensory processing and it can make long-term alterations in the brain’s ability to use sensory input for movement and state control.  The Wilbarger Protocol involves skin brushing and joint compression in a carefully administered method that uses the “gate theory” of sensory processing to assist the nervous system in regulating awareness and arousal.

There have been other protocols for regulation developed over the years, and adaptations to the Wilbarger Protocol have occurred since it’s creation.  But daily and repeated use of brushing the skin and use of joint compression to deliver deep pressure input (to inhibit light touch registration and enhance proprioceptive discrimination) are the cornerstones of treatment delivery.

Adapting the Protocol for Ehlers-Danlos Syndrome

Since the Wilbarger Protocol was not created to treat EDS, I am recommending that therapists and parents consider adapting it to protect the joints and skin of children with EDS while still gaining benefit from this technique:

  • Reconsider using the brush.  Although the dual-treatment of brushing and joint compression makes this technique a powerful approach, kids with EDS often have skin that is more fragile than average.  It can bruise and tear more easily, especially with the vascular or classic EDS subtypes.  Small children will be brushed repeatedly over the same skin area, increasing the risk of shear, abrasion and bruising.  Children (and adults) with EDS will have skin reactions far in excess of the amount of pressure applied.  This is related to the assumption that the connective tissue that makes up skin and blood vessels is either weaker or thinner than typical children.  My advice: go with the joint compression component alone, and see if you get a clinically valid result without the risk of skin damage.
  • Make sure that you are well-trained in the positioning and administration of joint compression.  I have taken joint mobilization training courses, as well as having dual licenses in massage therapy and occupational therapy.  Being able to feel correct joint position and alignment is absolutely key when children have loose joints, so use this technique with care.  Avoid painful joints and limit repetition to the shortest amount needed to see a clinically meaningful response.
  •  Train parents extremely well before recommending home use.  Most parents can learn this technique with the right explanation and some practice.   If a parent seems unable to perform joint compression correctly, reconsider the use of a home program.  This has only happened once in my career.  A mom was truly unable to perceive the amount of force she was using.  She admitted that this had been an issue for her since childhood, and I suspected that she had her own sensory processing issues.  We moved on to other treatment choices.  There is never a reason to stick with a treatment that causes a risk to a child or makes a parent feel like they are a failure.  Ever.

The true skill of a therapist is the ability to offer the just-right challenge to each child, based on a therapist’s observations, assessment and knowledge base.  I believe that there are many kids with EDS that could benefit from the Wilbarger Protocol when it is effectively adapted to their needs.

Looking for more than blog posts?  Visit my website tranquil babies and purchase a phone/video session to discuss your concerns and learn about what occupational therapy has to offer your child!

chris-lawton-484907

Gifted Or Disordered? The Unrecognized Behavioral Traits of Young Gifted Children

 

marc-zimmer-421611

Here is a short list of many common behavioral characteristics of gifted children:

  1. Spontaneous. 
  2. Boundless enthusiasm.
  3. Intense focus on passions.  
  4. Highly energetic.  This is the child who doesn’t seem to need as much sleep or downtime as peers.
  5. Constantly asking questions.  Constantly.
  6. Insatiably curious.  Everything is interesting, all the time.
  7. Impulsive, eager and spirited.  Novelty is a total turn-on, not to be feared.
  8. Persistent and goal-directed in areas that are important to them.
  9. Very easily frustrated, especially when they are unable to meet their own standards.
  10. Volatile temper when perceiving that they have failed.
  11. Chatty; absolutely a non-stop talker.

So…now are you excited to parent a gifted child, or to have one in your class or in your therapy clinic?  Or are you thinking “This sounds more like a child with learning problems, not gifts, and it sounds even be more like a child with autism”.    Or even “Children like these could be really annoying”.  Well, you aren’t alone.  Many of these characteristics exhaust adults, and create difficulties when gifted children try to navigate the world of typical kids and adults.  They may be 5-10% of the population, but they can be the source of 80% of the excitement in your home, class or clinic.  And they are often misdiagnosed as troubled rather than talented, just based on their behavior.

Welcome to the world of the gifted and those who interact with them.  It isn’t all sparkling conversation and shining rows of chess/debate medals.  Gifted children that have many or most of these characteristics may also be amazingly sensitive to others, the world around them, and to their own inner experiences.  That combination of behavior and sensitivity makes for some intense and often exhausting interactions that others find irritating or worse.   It really is the gift that keeps on giving.  And we aren’t even talking about the twice exceptional children. These children have diagnosable difficulties with learning, behavior, movement and sensory processing in addition to their gifted qualities.  They often wait years before clinicians parse out which is which.

So how could you know if the child in front of you is actually gifted, other than a psychologist’s tests?  And even if you know you have a certified smartypants, how can you determine whether their behavior is typical for gifted people or a sign of a disorder?  The answer could be to assess the quality of their behavior while looking at the level of cognition, the complexity of the conversation and the emotional depth and intensity of the interaction when compared to their age.

A three-year old that can eagerly exchange ideas regarding how tornados differ from hurricanes in their potential for damage and their source of power for 10 minutes is exhibiting a level of comprehension, intensity, curiosity, persistence and enthusiasm that you don’t typically see in this age group.   His ability to string together concepts, retain and analyze information,  respond to your own perspective and tune into your emotional tone during the discussion gives you clues that this is a gifted child, not a child with attention issues or autism.

A five year-old that paints and re-paints a picture until the colors and shapes express exactly how happy she was at the zoo may also be showing you some of these characteristics.   Her frustrated insistence on a complete representation of form and emotion, as well as her unique use of media are telling you a lot about her talents.  If you are amazed that all this focus doesn’t tire her out but energizes her more; there’s another clue.  The depth of her joy she has while creating or when opening a box of new pastels, like Christmas has come again, is another hint that she may be gifted.

When a child’s asynchronous development gets in the way, a gifted child can struggle.  Most gifted children aren’t gifted in every area of development, so a gifted artist may not be able to physically draw what she sees in her mind, a gifted writer may not be able to write his book legibly at 6, and a gifted athlete may not be able to handle her team losing.  That is where wise adults can provide strong support and education in managing their talents and explaining their struggles to gifted children.

I am frequently asked as an OT for ideas on how to manage gifted toddlers in class and at home, and I wrote a short post earlier this year in response Gifted at Preschool: How to Support The Young Gifted Child In Class.  For suggestions on how to make life easier at home, my suggestions focus more on building sensory and emotional tolerance for kids, and teaching self-awareness and self-calming skills.

If your child receives OT for any reason, this may be a place to start.  Check out this post for more information:  How Occupational Therapy Can Help Gifted Children (And Their Exhausted Parents!)  Occupational therapists that can see the difference between gifted traits and symptoms of an attentional or learning disorder can help parents on this amazing journey of discovery with their gifted child. Read Gifted and Struggling? Meet the Twice Exceptional Student and How OT Can Help for some strategies to help your gifted child who also has dyslexia, ADHD, or motor control issues.

Should Hypermobile Kids Use Backpacks?

 

brevite-434273

Yo! A photo shout-out to my old life in Brooklyn! I loved coming to work to see this iconic view!

It is back-to-school season here in the US.  One of the items on shopping lists is a new backpack.  But for kids with low muscle tone or hypermobility, backpacks can be more than a way to carry books and water bottles.  They can be a source of pain, headaches, even numbness in hands and fingers.  The important question isn’t how to lighten the load of a heavy backpack.  It is whether these kids should be using them at all.

The standard recommendations from occupational therapists and orthopedists regarding backpacks are simple:  lighten the load, use both straps (select one with wide straps), and make sure the heaviest items are placed close to the body.  All good suggestions.  But if a child already has pain or weakness around their spine and/or shoulder joints, reduced stability and endurance, and limited ability to judge posture and force, then the picture changes.  Using a backpack may be a significant physical risk, no matter how well designed or used.  And still many kids will insist that it isn’t possible to go without one.

Here are some suggestions that further minimize the risk of injury but can be acceptable to kids who may be sensitive to being perceived as different if they don’t have a backpack:

  • Request a set of the heaviest books for home use.  This can be part of an IEP or a 504 plan, or the school may be willing to do so without anything formal on paper.
  • Select the smallest size backpack possible.  Stores like Land’s End and L.L. Bean  are great sources for a variety of backpack sizes.  Bigger backpacks encourage kids to load more stuff inside.
  •  Have your child carry lighter and fewer items.  Pick the smallest water bottles and travel sizes of anything they really need.  Think “weekend in Paris on a shoestring” not “trekking the Himalayas”.  At least they have a backpack like the other kids.
  • Teach your child to carry their pack in their arms, close to their chest, instead of wearing it.  I know that sounds a little weird.  But if the pack is small to medium in size, this is the best way to carry it to reduce strain on the back and neck.  And they still have a backpack like the other kids.  It might be a long shot to get a kid to change how they carry a pack.  Some kids can respond to reminders of how awful it is to be in pain, and how not being able to sleep or play sports is much worse than carrying that pack in their arms.
  • Considering a rolling case?  Not so fast.  The twisting of the spine and the use of one arm to drag a rolling case may be worse than using a backpack.  Then there is the lifting and lugging of a case up non-ADA stairs.  Out of the frying pan……

Looking for more information about hypermobility, low tone and back-to-school planning?  Check out Does An Atypical Pencil Grasp Damage Joints or Support Function In Kids With Hypermobility? and Great Mechanical Pencils Can Improve Your Child’s Handwriting Skills.  Before you wonder if all that fidgeting and leaning over the desk is a behavior problem, read Hypermobility and ADHD? Take Stability, Proprioception, Pain and Fatigue Into Account Before Labeling Behavior.  There are pencil grips that can really help kids with a weak grasp, so check out The Pencil Grip That Strengthens Your Child’s Fingers As They Write.

 

Parents With Disabilities Deserve Real Support, Not Pity or Praise

 

 

dawid-sobolewski-285650Parenting is hard.  Everyone that has children or works with them knows that this is true.  Parenting when you have a disability is harder by far.  Like parenting… squared.  But instead of real support, many disabled people who become parents or are thinking of becoming parents face a lot of reactions from the non-disabled.  It usually arrives in one of two packages.  First, the more positive but less helpful responses.

People see disabled parents diapering a child with one hand or with both feet, or navigating the playground with a cane and remark on how amazing it all is.  They are either pitied for their struggle or praised for their bravery.  If you have a disability, what you could really use is to be seen as an equal.  And maybe the chance to share how to get your child to wait for more than a nanosecond for juice.  Real support and real camaraderie, the kind that other parents give and get on the playground.

Of course, there is another packaged form. These are those difficult responses that can and do happen.  Parents with disabilities may be treated like criminals (how dare you subject a child to your problems?) or idiots (“You will never be able to handle the challenges”).  I suppose pity and random praise could be better than these responses, but how about another reaction?  Support.

Sadly, one of the groups that should be actively supporting disabled parents often drops the ball.  Parenting issues aren’t always on the radar of doctors and therapists.  In fact, the act that gets you into the business of parenting may not even be fully acknowledged by professionals.  Yes, that one.  Accepting that disabled people are sexual and often (or mostly) capable of having children is so rarely mentioned in training and treatment protocols that it is a true crime.  When people with disabilities do have children, receiving equitable medical care and respectful treatment as parents isn’t a given.  Don’t believe me?  Think about how many accessible GYN tables you have ever seen, or how people with disabilities might struggle to attend the soccer game to cheer their child on.  Simple things that most of us take for granted.

I think that occupational therapists have much to offer parents with disabilities.  We are known for being the MacGyvers of rehab.  We love to solve real-life problems and use our wide range of skills to help clients achieve their goals.  Supporting people with disabilities to be the best parents they can be could be as simple as teaching a parent an easier way to hold or carry their child.  OTs are rarely consulted for this, but helping clients identify the positions, adaptations and adjustments needed to make that baby in the first place is actually in the OT skill set.  All discussed with respect and sensitivity, not pity.

OT support could be as complicated as redesigning a kitchen for safe and easy meal preparation.  Feeding your child is a wonderful way to participate as a parent.  Or as subtle as identifying how visual and auditory stimuli in the home set off sensory-based anxiety and agitation in a parent.  Being as calm as you can be is important when you are raising children.  A few sessions with a good occupational therapist can result in less stress, less pain, more skill and more confidence for all involved.

Occupational therapy isn’t always thought of as an essential service for adults with disabilities after the initial injury (think spinal cord injury rehab) or for people with more common issues such as fibromyalgia or back pain.  Perhaps that could change.  Parenting is hard.  It is harder when you don’t get the support you need.

 

Hypermobile Child? Simple Dental Moves That Make a Real Difference in Your Child’s Health

As the OT on a treatment team, I am the ADL (Activities of Daily Living) go-to person.   Why then, do so few parents ask me what ideas I have about ADLs, especially dental care?  Probably because OT as a profession has developed this reputation as either focused on handwriting or sensory processing.  Maximizing overall health and building skills by improving ADLs is often pushed to the side.  Not today.

People with connective tissue disorders have a greater chance of cavities and more serious dental problems.   Knowing what to do for your child and why it is important helps parents make changes in behavior with confidence and clarity.

Here are my suggestions to support a child that has been diagnosed or is suspected of having Ehlers-Danlos hypermobility or any connective tissue disorder:

  1. Teach good dental hygiene habits early.  Why?  Habits, especially early habits, seem to be harder to dislodge as we age.  Good self-care habits can and should last a lifetime.  Automatically brushing and flossing gently twice a day is cheap and easy.  Make it routine, not optional.  I know how this can become a fight for young children.  This is one of those things that is worth standing your ground on and making it fun (or at least easy) for children to do.  Brush together, use brushes and pastes with their favorite characters, pair it with something good like music or right before bedtime stories, but don’t think that dental care isn’t important.
  2. Research on people with typical connective tissue suggests dental care reduces whole-body inflammation.  Inflammation seems to be a huge issue for people with connective tissue problems, and no one needs increased inflammation to add to the challenges they have already.  Enough said.
  3. Tools matter.  Use the softest toothbrushes you can find, and the least abrasive toothpaste that does the job.  Tooth enamel is also made from the same stuff and skin and bone, and so are gums.  Treat them well.  Water-powered picks and battery-operated brushes may be too rough, so if you want to try them, observe the results and be prepared to back off it becomes clear that your child’s tissues can’t handle the stress.  Toothpaste that is appealing will be welcomed.  Taste and even the graphics/characters on the tube could make the difference.  My favorite strategy is to give your child a choice of two.  Not a choice to brush or not.
  4. Think carefully about acidic foods.  Lemonades, orange juice, energy drinks, and those citrus-flavored gummies all deposit acids on teeth that are also mixed with natural or added sugars.  Those sugars become sticky on teeth, giving them more time to irritate gums and soften enamel.  Easy hack?  Drink citrus/acidic drinks with a straw.  Goes to the back of the mouth and down the hatch.  At the very least, drink water after eating or drinking acidic foods to rinse things out.
  5. Baby teeth count.   Because your young child hasn’t lost even one baby tooth, you may think this doesn’t apply to you.  Those permanent teeth are in there, in bud form.  Children can develop cavities in baby teeth as well as permanent teeth.  Gum irritation is no different for young children, and they are less likely to be able to tell you what they are feeling.  Sometimes the only sign of a cavity in a young child is a change in eating habits.  This can be interpreted as pickiness instead of a dental problem.
  6. Consider sealants and fluoride   I know…some people are nervous about the composition of sealants and even fluoride, which has been in the public water system here in the US for a long time.  I would never criticize a parent who opted out of either.  It is a personal decision.  But be aware that they don’t increase tissue irritation, and they protect tender enamel, tooth roots and the surrounding gums.  At least have an open discussion with your pediatric dentist about the pros and cons.  I am mentioning sealants here specifically because some parents aren’t aware that this treatment option can reduce cavity formation and gum deterioration.

Looking for more information about ADLs and hypermobility?  Take a look at Easy Ways to Prevent Skin Injuries and Irritations for Kids With Connective Tissue Disorders and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child and Low Muscle Tone and Dressing: Easy Solutions to Teach Independence.

Taping The Paper To The Table For Your Child? Stop!

Many young children between 2 and 5, especially children with low muscle tone or postural instability, will struggle with bilateral control.  In preschool, one way to notice this is to see the paper sliding around the table while a child colors.  The common response of teachers (and parents) is to tape the paper down.  Oops!  This  eliminates any demand for both hands to work together.  Bilateral control only develops if it is needed and practiced.

The better approach, the one that makes the brain work and builds a child’s skills, is to make it even more slippery while making the activity more fun.

Why?  This child,’s brain, as described, needs more information about what is going wrong with the activity.  You can use heavier paper, stickers in a book that need accurate placement, or fun glittery markers.  Really, anything that makes a child care more about placing marks accurately.   I select the smoothest table surface available.  Glass coffee tables are a fave at home.  The alternate choice is a bumpy surface, something that will be slightly uneven and make the paper move more with each stroke.

I have some older kids that really struggle but can use a visual cue.  I make a mark on their paper and tell them to put their “helper hand” – the one not coloring- on this mark.  This is sometimes helpful, but it is limiting the extent that this hand is providing optimal postural support.

Yup, support.  The hand that holds the paper is also performing another function.  It is stabilizing the child’s body so that the dominant hand can execute a skilled movement.

So….no more tape on that paper, OK?