Tag Archives: preschoolers

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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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!

 

Summer Fun Pre-Writing Activities

Here in the U.S., summer is fully underway.   Pools, camps, and vacations!  Handwriting isn’t really on anyone’s radar.  Except mine.  Without practice, kids with learning differences, motor control issues, and visual-perceptual concerns can lose a lot of the skills that they worked so hard on all year long in therapy.

Here is a fun activity, not a boring worksheet, to keep or build pre-writing skills for preschoolers and kindergarteners.  Remember, into each summer some rain will fall, and there will be overcast days, or times when kids have to wait for a meal in a restaurant  while on vacation.  This activity can be a fun way to pass the time!

Ice Cream Cones

I picked this theme because ice cream is a food that most kids love, and the strokes/shapes needed have pre-writing value.  Your child will have no idea that she is building the visual-perceptual and finger control needed for handwriting instruction!

For the youngest pre-writers:  Draw an ice cream cone as below, at least 4-5 inches tall, and have your child aim for the “scoop” to wiggle their crayon, making sprinkles. I lightly colored in the scoop and drew lines on the waffle cone.  Younger children don’t always recognize a figure in a line drawing as easily as a completed one.  Their scribbles will be large, but demonstrate that our scribbles stay inside the scoop and are reversing vertical or horizontal lines, or a circular scribble.  The important thing is that they are attempting to stay inside the scoop and they are reversing the direction of their stroke.

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For children that are beginning to trace letters:

  1. Write the letter “V” in gray, about 3-4 inches tall.  Why gray?  So that your child can use a bolder color to trace over your lines.
  2. Have them trace your letter in a brighter color, then use your gray crayon to make a line across the “V” from left-to-right (for righties.  lefties will be more comfortable tracing right-to-left).
  3. Let them trace that line as well.
  4. Draw an arch, starting at the beginning of your “V”, curving upward and ending at the end of the “V”.
  5. Let them trace that line.
  6. Demonstrate how to keep your crayon tip barely moving as you “wiggle” to create a tiny sprinkle.  Ask your child to copy you.

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For kids that are writing their own letters with demonstration:

  1. Write the letter “V”on your paper, placed directly above theirs.  Ask them to copy you.
  2. Make a line across the “V” from left-to-right( for righties; lefties cross from right-to-left).  Ask them to copy you.
  3.  Make an arch to form the scoop, starting from the beginning of the “V”, curving upward and ending at the end of the “V”.  Ask them to copy you.
  4. Demonstrate how to wiggle your crayon tip slightly to create sprinkles, and even add little lines for drips of ice cream falling off the scoop.

 

BONUS ROUNDS:  Use sturdy paper and have your child cut out his ice cream scoops.  Have him ask everyone what kind of ice cream flavor and how many scoops they would like him to make for them.  Grab the toy cash register, and use the cones to play ” ice cream shop”. 

Color Wonder Paper Will Boost Creativity and Save Your Walls

 

 

Nothing ruins the fun of scribbling like the frustration of discovering that clothes, skin and walls are also covered with “creativity”.  It is important to teach children that we color only on specific surfaces, but messes will happen on the path to full comprehension and compliance.  Crayola has just about solved this problem for parents of kids 12 months and up with their Color Wonder line!

There are paper pads, fingerpaint, markers, and coloring books in the Color Wonder line. The markers and fingerprint will only work on their specially-treated paper, but I have a suggestion for those of you who are as frugal as I am:  use regular markers on the back of this thick paper, and then use it for scissor practice!  The fingerpaint is really only safe for children that do not put their fingers in their mouths.  I imagine that the chemicals that allow the paper to react with the paint are not to be swallowed.  The coloring books are widely branded.  If you have a fan of “Frozen” (who isn’t?) or “Cars”, you are in luck.  My strong preference for kids under 3 is the blank pad and markers.  Why?

Perceptual skills are very immature before 3, so the black-and-white line drawings in the coloring books appear to them as just a mass of curved and angled lines.  The little ones get so much more creativity out of plain paper or coloring on your drawings.  If they need a simple graphic, you can draw them a face that they can scribble on, or an ice cream cone like mine above, on which they can add colorful sprinkles.

The magic of Color Wonder is that the markers will not leave a mark on anything but the paper.  Not skin, not clothes (maybe silk, but who wears silk in the presence of toddlers?), not sealed wood furniture, and not walls.  The fine print on the products says that there will be a mark on unfinished wood and some fabrics, but in my experience it has been unable to leave a mark on most everything a toddler can reach.  If you are willing to allow a toddler near a 10K designer sofa, then maybe you can afford to buy another one next year.  I can’t.

This no-marking feature makes it safe to bring to public places and relatives that do not appreciate their home being attacked by young artists.   Not everyone decorates in “toddler chic”.  You probably know that style, where nothing is white and nothing exists that cannot be scrubbed clean? The grandparents have redecorated since you left home, and they will not thrilled to see their home drawn on.  Make them happy and make your toddler happy too, with these Color Wonder products.

Once a toddler realizes that they cannot draw on themselves or you with Color Wonder, they usually give up decorating themselves and your home.  They color on the paper without an argument.  But not always.  One of my families with an almost-2 year-old did get the plain paper pad and mini-markers on my advice, and the mom reported that her son didn’t scribble with her as much as he does with me in our sessions. The reason?  We figured out that he really enjoys getting a negative reaction out of her when he tries to color on the walls or the floors.  Deprived of her strong response, he wandered away, searching for another way to get her attention.  I guess I should link her over to Turn Around Toddler Defiance Using “Feed the Meter” Strategies for some methods to engage him in more positive ways.

I very much prefer the mini-markers, with the caps removed (not clicked onto the ends) while coloring to the standard size markers.   The short shaft promotes a more mature writing grip, while the longer shafts encourage children to use a fisted grasp. There are pastel and bold color sets.  One feature of these markers is that they take a few seconds to react with the special paper.  Young toddlers may think that they don’t work.  Demonstrate that they do indeed work, and even count it off:”One, two, three….magic!!”

My trick for impulsive or impatient kids?  I keep my markers top-off in a small, well-sealed, zip-top plastic bag.  They don’t dry out and I can quickly grab a few markers to offer to a child before she races off to find something else to do.  Clean-up is faster too.  Since the markers don’t stain fingers, I can just scoop and dump them in.

Try these products and see how easy it is to color this summer when you don’t have to clean your walls, skin, and clothes!

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!

 

When Sensory Seeking Becomes Attention Seeking

As an occupational therapist, I see sensory-seeking kids every week who crash, jump, wiggle and hug their way through their days.  If a couch is available, it is either a launching pad or a landing pad.  Adults are for hanging on, landing on, or giving full-body hugs.  Seeking unsafe or inappropriate movement and touch for sensory seeking can be worked on in therapy and with a sensory diet, but there is another aspect of these behaviors that often needs to be addressed.

Once a child recognizes that adults will give him more attention but not meaningful consequences for sensory-based behavior, it can be his choice to use these behaviors to engage with them socially, to divert an adult’s attention from a sibling or a phone call, or to avoid participation in something less desirable, like cleaning up the mess he made earlier that day.

Don’t get me wrong:  many sensory-actions-that-are-really-attention-seeking behaviors start out as a child’s way to calm down and get more proprioceptive, vestibular and tactile input.  Kids can also do the same actions for either reason all in the same day.  Crashing in the morning to calm down, crashing at night because an older sibling is getting all the attention.

All kids like to experiment with how far, how loud and how hard they can move their bodies.  Sensory seekers have greater frequency, variety and endurance of these behaviors, and can look more unstable, unfocused and uncoordinated without some movement input Good Posture: Is it Vestibular or Proprioceptive?.  An example that adults can connect with would be the guy in the meeting who taps his pen on his teeth as he thinks about a solution to a problem.  He isn’t doing it to annoy you (probably); he is getting some sensory input to rev up his system and focus harder.  Really.  Once you can look at his actions through a sensory lens, it’s still annoying behavior, but you know it isn’t a plot to irritate you at work.

How can you tell whether a child is seeking movement input more for communication/behavioral reasons than for sensory satisfaction?  This one is more of an art than a science, but here are some questions to ask yourself:

  • Can he ask for attention effectively when you are otherwise occupied?  If your child is great at interrupting you on the phone politely, and expects a consequence for rudeness, but he still demands a full-body hug, then he may really want that deep pressure and not see another source of calming input.  Have you given him clear instruction about how to request deep pressure?  It might be time to clarify it.  Even kids around 2 can say “Big hug please” or sign it to you.
  • Does your child get a reasonable amount of physical play every day?  Small children need to stretch it out and move.  A lot.  Any child that doesn’t get enough movement will seek it out.  It isn’t sensory or behavior; it is satisfaction of a natural physical need.
  • Have you created clear expectations about tasks like cleaning up, and developed methods for going from one activity/location to another?  Self-Regulation in Autism and Sensory Processing Disorder: Boost Skills By Creating Routines and Limits  Kids that either don’t want to end a game, don’t want to put toys away, get dressed, or go on to the next event can stall by using fun crashing and jumping instead.  If you have no problem getting them to clean up in order to go out for pizza, then you might have a stalling child, not a sensory seeking one, right now.
  • Is your child more interested in your reaction to his jumping or crashing?  Could you give him deep pressure while talking to someone else, and he is totally fine with that?  Does he ask for deep pressure when he already has your undivided attention, or just when you are on the phone or speaking with his dad?  Sensory seekers primarily want that physical input, and having an audience is secondary.  If a child is more interested in you seeing him launch off the couch and won’t switch to the available outdoor trampoline that he usually craves, it may be because he will be losing your attention once he goes outside.  And that was what he was really seeking.

Teach ASD and Sensory Kids How to Manage Aggression

Little boys as young as 2 use play fighting, crashing, and even pretend killing in their play, without anger or intentional destruction or injury. Is this a very bad thing?   I was challenged this week three separate times to explain why I would initiate physical play that can look aggressive (think crashing cars or our ninja pictures fighting each other) with younger boys that struggle with behavior issues in daily life.  These little boys aren’t good at managing aggressive impulses, at using words to express thoughts, or handling all the excitement that physical play brings out in them.  Their teachers often have to stop all aggressive play at school if the administration has a zero-tolerance policy.  But someone has to help all the little guys figure out how to express their desire to get physical without getting into trouble or injuring someone.

I told the parents of the boys I treat that I want to provide a safe space for them to learn how to express their aggressive tendencies, and to witness an adult modeling how to be physical, have fun, and do it all with respect and affection.  To learn all that, they needed an adult who was not automatically forbidding aggressive physical play.

If I forbid all pushing, grabbing, growling, shouting in fun, then those aggressive behaviors are almost certainly going to come out as defiance and even destructive behaviors that will require a loss of a privilege or even a time out.  Feelings and impulses don’t evaporate.  They go somewhere, and they can go to places that are much less constructive than crashing cars together on a warm spring day.

For little boys who have issues like sensory processing disorder or autism, it is absolutely essential to teach them how to manage aggressive play in order for them to succeed in the wider world.  That is everyone’s goal, to be able to play happily in a mainstreamed environment and without adults controlling the events.  These kids often don’t manage any of their emotions well, becoming overwhelmed very quickly.    They can have difficulty following what other kids are doing once the wilder play gets going.  They can’t stop their actions when another child says “stop” or change to another game.  And they don’t read subtle cues that the game is changing or that their behavior is not appropriate for the current game.

Teaching specific strategies and practicing them with trusted adults can go a long way to building success on the playground.  Pediatric occupational therapists who trained with the amazing occupational therapist Patricia Wilbarger and her crew of therapists that pioneered sensory diets know about “play wrestling” for deep pressure input.  That is the kind of physical activity that calms kids down and helps them gain positional awareness.  Modeling specific safe ways to engage someone else physically, what to say when you have had enough, what to do when the other guy is saying “STOP”, and demonstrating how to be silly without being physically intrusive are all important.  Simply instructing a child without modeling the behaviors and playing with them isn’t as effective.  Adults have to get in there and communicate using kid’s play, speak about emotions and interests, and have fun!