Tag Archives: sensory processing

How To Remember to Do A Sensory Diet With Your Child

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A “sensory diet” is the cornerstone of managing a child’s sensory processing issues.  Every therapist knows that without a good home program that only addressing a child’s needs in a session, we aren’t going to see much progress.  Treatment sessions are spent half playing catch-up:  trying to increase postural activation, calming them down, or waking them up to participate .  When a child’s nervous system has the right input, their performance and how great they feel inside…it can blossom.  You can see what their potential really is, and their life gets better.

COVID-19 has halted many children from attending treatment in clinics.  Parents are now trying to do activities through telehealth, and their success is determined by many factors.  As therapists, we know that if we cannot see your child live, the sensory diet becomes even more important.

Sensory diet activities don’t always run smoothly.  Kids are busy, parents are stressed, caregivers aren’t around as much or as often.  Parents are asking “How do I remember to do these activities when I have so much else to do during the day?”

The answer is to build a routine that makes sense and that your child will use without a fight.  

  • Find the right time of day, when your child needs this imput.  Using the same things at the same times each day make them more familiar.  More familiar can mean less of a fight.
  • Find the right place, where you aren’t fighting their desire to see the TV or see kids outside playing.  Use a space that supports, not competes, with your goals.  Some kids don’t do well in bright lights, big spaces, or with competing sensory input.
  • Find the right sequence, in which a challenging activity is preceded by one that helps your child focus and get in a positive state of mind.  Ask your OT if there is a way to put activities in an order than makes sense for modulation.
  • Find the right toy, book, person, or food that makes a sensory diet activity a chance to play with something or someone special.  This may mean enlisting the other parent, a sibling or someone else in your pandemic pod.  It takes a village.

The perfect sensory diet is the one that you will do and your child will use.  Your therapist might suggest an amazing activity, but if you cannot do it, your child resists it, or you don’t have the time for it….it isn’t an amazing activity.  It is a burden, and a chance for you to feel like a failure and your child to act up.

Don’t let that happen.

If you cannot manage the current sensory diet with enough ease, ask for advice.  Ask for new activities, new toy recommendations.  Ask for more of a demonstration, even if you think you risk seeming less than perfect.  We like parents who show interest, and we don’t mind repeating our instructions.

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Gifted Child? Try “How Does Your Engine Run” For Sensory Processing

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I love working with gifted children.  OTs get referrals to work with gifted kids whether or not they have been tested by a psychologist.  Some have motor delays amplified by the asynchronous development, but many are sloppy at handwriting because their motor skill cannot keep up with their language skill.  Some are sensory avoiders or sensory seekers.  Or both.  They aren’t always in distress.  They are almost always out of synch with their families, peers, and teachers.  Without understanding how to manage sensory processing issues, these kids are driven by the need to handle motor demands and sensory input, often driving their teachers and parents a little bit nuts.

Some gifted kids really do need motor skill training and sensory processing treatment.  They are struggling with tolerating their world, and can’t achieve their potential in school, with peers, and at home.  While many kids are “twice exceptional”  and have a learning disability or other disorder in addition to being gifted, simply being gifted creates permanent processing challenges.  The gifted brain will always be driven, and it will always prefer intensity and complexity to an extent that exceeds people with typical skills.   Almost all younger gifted kids need help to understand that their brains will always respond this way, and they will constantly bump up against the typical world in ways that can create problems.  Knowing how to manage this conflict in daily life is our wheelhouse.  Occupational therapy is focused on function.  Always.  We don’t stop with a neurological explanation of giftedness.  We have solutions.

One of the most useful strategies to address a child’s aversions or sensory seeking behaviors is to create a “sensory diet”.  This can be very simple or very complex.  A sensory diet provides activities and equipment that help people tolerate sensory experiences that overwhelm them, but it also “feeds” the desire for sensory experiences that can derail them from interaction and participation.

Avoidant kids learn that more proprioception will help them tolerate noise without wearing headphones and blocking out all interaction.  Sensory seekers learn that they don’t have to kick another kid’s chair to get input; they can do wall push-ups or wall sitting quickly in the hall between classes.  Therapy that includes a sensory diet helps the child who has such pressure to speak that they interrupt everyone, and it helps the child that learned to escape bright lights and scratchy clothes through daydreaming.

Developing a sensory diet that a child can use independently is the goal of Mary Sue Williams and Sherry Shellenberger’s book “How Does Your Engine Run?  Children learn about sensory modulation by thinking about their ability to perform sensory processing as an engine.  Running too fast or too slow doesn’t allow for great performance.  Running “just right” feels good internally and allows a child to learn, respond appropriately and achieve mastery.  Finding the right activities and environments that allow for “just right” processing is based on what therapists know about neuropsychology, but this program asks the client to assess what works for them, and asks them to use these strategies effectively.

This book isn’t new, and it isn’t perfect.  But it is a good place to start.  It explains behaviors using neurological strategies that work, and provides a framework for inexperienced therapists to move from prescribing to guiding.  A gifted child can begin the process of using a self-directed sensory diet far earlier than their typical peers. I have seen 4 year-olds start to master their own drives once it is explained to them.  They feel terrific when their abilities are recognized, and adults are seen as supporters instead of controllers.

The biggest problem I encounter is unlearning the behaviors that children have developed before their parents and teachers understood that giftedness is more than a big vocabulary.  Children may have learned to push a parent to exhaustion to get what they wanted.  They may have bullied adults or intentionally alienated adults to be allowed to do what they want.  They may have become extremely bossy and gotten away with it.  They may have decided that any skill that takes time to develop isn’t worth it.  They will lead with the things that they find effortless.  This will trip them up over time, but without understanding the life of the gifted child, these behaviors sprout like weeds.

Gifted children are still children, and they need guidance and support to grow into their gifts!  Occupational therapists can help them and their families do just that.

Looking for more information on helping your gifted child?  

I am writing an e-book on this topic, but you can also call me for a consult as well.  Visit my website Tranquil Babies  and use my contact information to set things up today!

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Sensory Processing and Colds: Nothing to Sneeze At!

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Here in the US, it is cold and flu season.  Most of my day is spend with kids recovering from some upper respiratory virus.  A few seem to have a continuous runny nose and cough.  They also have an increase in their sensory processing issues.  Is this connected, and if so, what can be done?

  1. Anything that affects health will make sensory processing harder.  Anyone, at any age, will struggle more when they don’t feel well.  If a child is super-sensitive, feeling ill will make them edgier and more avoidant.  If a child is a sensory seeker, that funny feeling in their head that changes when they flip upside down will probably make them do it more.  If a child is a poor modulator, and goes from 0-60 mph easily, they will have more difficulty staying in their seat and staying calm.
  2. Colds often create fluid in the ears.  This is a problem for hearing.  This is often a problem for speech and mealtimes.  It is also a problem for vestibular processing.  Fluid in the ear means that children are hearing you as if they are underwater.  Their speech may be directly affected.  They probably realize that biting and chewing open the eustacian tubes from the mouth to the ear, so they may want to chew more.  On everything.  They may also be unable to handle car rides without throwing up.  They may refuse to do any vestibular activities in therapy.
  3. Children sleep poorly when ill.  Anyone with sensory processing issues will struggle more when they are tired.  Young children cannot get the sleep they need and don’t understand why they feel the way they do.  Enough said.
  4. Spatial processing problems will get worse.  Being unable to use hearing to orient to the space and the people and objects in the room, children will roam around more, touch things more, startle more, stand still and look disoriented, and may refuse to go into spaces that are hard to process, like gyms or big box stores.  Uh-oh.

So what can you do as a parent or a therapist?

  • Understand that this is happening.  It is real.  It may not be a personality issue, a deterioration in their ABA program, or a problem with therapy.
  • Ask your pediatrician for more help.  There are nasal sprays and inhaled medications that can help, and some, like steroids, that can create more behavioral issues.  If your child needs steroids, you need to understand what effects they can have.  Saline sprays, cold mist humidifiers, soups and honey for coughs, if your pediatrician approves, are low-tech ways to help a child suffer less.
  • Alter your daily routine if needed.  Making less appointments, fewer challenges, and more rest could help.  Kids can be over-scheduled and under-rested.  Therapy sessions may have to be adjusted to both be less stressful and more helpful.
  • Your child may benefit from vestibular movement if they do not have an untreated ear infection.  Your OT can help you craft a sensory diet that moves fluid, but not if there is an infection.

Read more about sensory processing here: Does Your Child Hate Big Spaces? There is a Sensory-Based Explanation and Spatial Awareness and Sound: “Hearing” The Space Around You

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Young Children, Sensory Modulation, and the Automatic “NO!”

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Kids as young as 18 months can express their sensory processing issues with one word: “NO!!”  What appears to be a budding attitude issue or even oppositional defiant disorder can be a sensory modulation issue instead.

How could you possibly tell?

Well, if your child has already been diagnosed with sensory sensitivity or sensory modulation problems, you know that these issues won’t just make it harder to wear clothes with seams or touch Play-Doh.  These issues affect all aspects of daily living and create emotional regulation and biological over-activation issues as well.  Young children are learning how to express their opinions and separate physically and emotionally from their caregivers.  Saying “NO!” isn’t unusual for young kids (and a lot of older ones too!).  But refusals that make no sense can have a different origin.

So what is the giveaway?

When a child has an almost immediate “NO”, perhaps even before you have finished your sentence, and the reaction is to something you know they have liked or almost certainly would like, you have to suspect that sensory modulation is at play.  You usually sense when your child is trying to get your attention or get you activated.  This should feel different.

What do I do next?

You also need to respond in a specific way to test your theory that sensory issues are the root of the ‘tude.  Your response should be as vocally neutral and emotionally curious as you can manage.   “Oh, really….you said no…” is a good template.  Whether it is “no” to their fave food, show, toy or an activity.  You remove all criticism and encouragement from your voice.  You don’t want to fuel the refusal fire; you want to shut it off and see what is left in the embers of “NO”.

Now you need to wait for them to neurologically calm down.  Little brains are like old computers.  They take a while to reboot.  Look at the floor, wipe your hands, etc and wait a minimum of 15 seconds, probably 30, then ask again if they want a cookie, want to go out, want to play, to eat, or whatever.  The child who needed the primitive defensive part of their brain to go offline to allow them to use their budding frontal lobes may sweetly ask for what they just refused, or respond to your exactly identical request with a cheery “YES”.

Please try to have compassion for them.

It can seem maddening to do this all day long, and in truth, if you are, you need to learn how to work with an occupational therapist in order to learn powerful sensory treatment strategies that can get your child out of this pattern.  But your child isn’t jerking your chain when their behavior fits this pattern.  They are more likely a captive of their brain wiring.   Don’t let yourself react as if they are intentionally being difficult.  That day will come…..13 is just around the corner!

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Should the PARENTS of Kids With Sensory Issues Use Quickshifts?

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My clients and my blog readers know that I started using a therapeutic sound treatment called Quckshifts earlier this year Quickshifts: A Simple, Successful, and Easy to Use Treatment For Regulation, Attention, and Postural Activation.  I haven’t lost my enthusiasm for this treatment.  It has made easy sessions more effective, and difficult sessions workable.  Kids that are struggling get a boost, and kids that needed a lot of preparatory sensory activity to regulate and engage rapidly find their footing.

Could this be useful for parents too?

There is no age limit on the use of Quickshifts, and the creators at Vital Links write and speak about treating adults using this program in their training materials.  But thus far I haven’t heard them talk about the use of Quickshifts with the parents of their clients.  I wonder why.

If you have a child with sensory issues, even one who attends mainstreamed programs and is doing fairly well in social activities, your days have a certain level of stress in them.  Sensory diets work, but they also take work to use and monitor.  Children aren’t crockpots, so you are actively administering or at least setting up the activities the comprise a sensory diet.  Kids reach bumps in the road, and kids with sensory issues can have bigger meltdowns over smaller bumps.  Parents have to help them manage things that other kids shrug off.  And parents always are thinking ahead, wondering what effect a new summer camp or new school with have on their child.  Even when things are going well, parents can feel some stress about all of these things.

It is well known that if you are a therapist treating children with sensory processing issues, at least one parent could say to you “Wow; I used to have the same problems, and everyone told me I was just being difficult/stubborn/picky, etc.”  Treatment options picked up in the early 90s, so we do hear this less and less.  But not in every community  or school system.  And if a parent’s parents refused to “believe” in sensory treatment, then these kids got nothing.  Or perhaps they were sent to a psychologist.  When I describe their child’s experiences using sensory processing terms, some parents recognize that their responses are very similar.  They have been told, or they have assumed, that they are reacting psychologically to events or stimuli.  They now are thinking differently about themselves as well as their children.

Finally, in this era of #MeToo, there is growing awareness that many of the parents of the children we work with bring their own trauma with them into parenting  Are You a Trauma Survivor AND the Parent of a Special Needs Child?.  I just did a presentation in FL (Feb2020) on using sensory processing treatment to help adults with traumatic dissociation.  The dysregulation that accompanies trauma doesn’t disappear after delivering a child.  At times, having a child can bring past traumas up to the surface and create problems that seems to have been handled or forgotten.  These parents need our support and assistance.

Which brings us to the question:  Should the parents of kids with sensory processing issues, especially the parents that have problems with self-regulation, use Quickshifts as well?

My strong opinion is that since there isn’t a downside, they should give the Regulation albums a try, and see how they navigate a typical day after listening.  The changes in adults are more subtle because their lives are more complex.  Parents need to know what changes to look for: usually the ability to remain calm with transitions, to focus on a task or to think a process through more easily.

Parents with more anxious tendencies might use Gentle Focus successfully, and parents that need to up-regulate would love Synching Up or Rockin’ Surf.  The decision to use Quickshifts and how to select albums really is easier when you consult an OT.  Wasting money and time buying and using the wrong album is unnecessary!  I love working with adults that have regulation issues or sensory sensitivities.  The relief in their faces tells me that they are getting the help they need to be their best.

 

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The JointSmart Child Series: Parents of Young Hypermobile Children Can Feel More Empowered and Confident Today!

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My first e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, was a wonderful experience to write and share.  The number of daily hits on one of my most popular blog posts  Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children helped me figure out what my next e-book topic should be: hypermobility.

Hypermobility is a symptom that affects almost every aspect of a family’s life.  Unlike autism or cerebral palsy, online resources for parents are so limited and so generic that it was obvious that what was needed was solid practical information using everyday language.  Being empowered starts with knowledge and confidence.

The result?  My new e-book:  The JointSmart Child:  Living and Thriving With Hypermobility.  Volume One:  The Early Years.

What makes this book unique?

  • This manual explains how and why joint instability creates challenges in the simplest tasks of everyday life.
  • The sensory and behavioral consequences of hypermobility aren’t ignored; they are fully examined, and strategies to manage them are discussed in detail.
  • Busy parents can quickly spot the chapter that answers their questions by reading the short summaries at the beginning and end of each chapter.
  • This book emphasizes practical solutions over theories and medical jargon.
  • Parents learn how to create greater safety at home and in the community.
  • The appendices are forms that parents can use to improve communication with babysitters, family, teachers and doctors.

Who should read this book?

  1. Parents of hypermobile children ages 0-6, or children functioning in this developmental range.
  2. Therapists looking for new ideas for treatment or home programs.
  3. New therapists, or therapists who are entering pediatrics from another area of practice.
  4. Special educators, and educators that have hypermobile children mainstreamed into their classroom.

Looking for a preview?  Here is a sample from Chapter Three:  Positioning and Seating:

Some Basic Principles of Positioning:

Therapists learn the basics of positioning in school, and take advanced certification courses to be able to evaluate and prescribe equipment for their clients.  Parents can learn the basics too, and I feel strongly that it is essential to impart at least some of this information to every caregiver I meet.  A child’s therapists can help parents learn to use the equipment they have and help them select new equipment for their home.  The following principle are the easiest and most important principles of positioning for parents to learn:

  • The simplest rule I teach is “If it looks bad, it probably IS bad.”  Even without knowing the principles of positioning, or knowing what to do to fix things, parents can see that their child looks awkward or unsteady.  Once they recognize that their child isn’t in a stable or aligned position, they can try to improve the situation.  If they don’t know what to do, they can ask their child’s therapist for their professional advice.
  • The visual target is to achieve symmetrical alignment: a position in which a straight line is drawn through the center of a child”s face, down thorough the center of their chest and through the center of their pelvis.  Another visual target is to see that the natural curves of the spine (based on age) are supported.  Children will move out of alignment of course, but they should start form this symmetrical position.  Good movements occurs around this centered position.
  • Good positioning allows a child a balance of support and mobility.  Adults need to provide enough support, but also want to allow as much independent movement as possible.
  • The beginning of positioning is to achieve a stable pelvis.  Without a stable pelvis, stability at the feet, shoulders and head will be more difficult to achieve.  This can be accomplished by a combination of a waist or seatbelt, a cushion, and placing a child’s feet flat on a stable surface.
  • Anticipate the effects of activity and fatigue on positioning.  A child’s posture will shift as they move around in a chair, and this will make it harder for them to maintain a stable position.
  • Once a child is positioned as well as possible, monitor and adjust their position as needed.  Children aren’t crockpots; it isn’t possible to “set it and forget it.”  A child that is leaning too far to the side or too far forward, or whose hips have slid forward toward the front of the seat, isn’t necessarily tired.  They may simple need repositioning.
  • Equipment needs can change over time, even if a child is in a therapeutic seating system.  Children row physically and develop new skills that create new positioning needs.  If a child is unable to achieve a reasonable level of postural stability, they may need adjustments or new equipment.  This isn’t a failure; positioning hypermobile children is a fluid experience.

The JointSmart Child:  Living and Thriving With Hypermobility  Volume One:  The Early Years is now available as a read-only download on Amazon.com

It is available as a click-through and printable download  on Your Therapy Source!  

NEW:  Your Therapy Source is selling my new book along with The Practical Guide to Toilet Training Your Child With Low Muscle Tone as a bundle, saving you money and giving you a complete resource for the early years!

Already bought the book?  Please share your comments and suggestions for the next two books!  Volume Two is coming out in spring 2020, and will address the challenges of raising the school-aged child, and Volume Three focuses on the tween, teen, and young adult with hypermobility!

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Quickshifts: A Simple, Successful, and Easy to Use Treatment For Regulation, Attention, and Postural Activation

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Every child loves music, but not every music is therapy!

What if you could add a sensory-based treatment that targets specific sensory, motor, and behavioral goals, doesn’t require expensive equipment or a large therapy space, and you could see the effects within a very short time?

Since adding Quickshifts to my therapy sessions, I have been able to successfully address some of the more difficult behaviors and sensory processing issues I encounter.  Very young children are often afraid of being on therapy balls and swings, and they don’t always tolerate the Wilbarger or Astronaut protocols Why Is The Wilbarger Protocol So Hard To Get Right?.  But everyone can listen to music.  Enter Quickshifts.

I am primarily using them over speakers, since even older kids are struggling with wearing headphones.  I find that this isn’t preventing progress, and I periodically try to reintroduce headphones with children over 2.  They change so quickly that I never know when “NO” will turn into “maybe”.

Every Quickshift album uses brainwave entrainment.  The use of binaural beat technology (BBT) for entrainment of an alpha brainwave state has made a difference with the kids who display predominantly anxious or dysregulated states, but it is also very helpful to entrain better attention and postural activation.  Read more about BBT in Binaural Beats and Regulation; More Than Music Therapy.  It is great for parents too Stress Relief in the Time of Coronavirus: Enter Quickshifts.

Why Modulated Music Wasn’t Working For Me

I stopped using Modulated music a long time ago.  Not because I didn’t think it was an effective treatment.  Because I couldn’t get any compliance at home, and I saw very little progress with use only in my therapy sessions.  There was often a learning phase, in which I had to adjust the amount of listening time to prevent overwhelming young or very challenged children.  Using them only in treatment sessions seemed to make little meaningful difference in my little customers.  Families were resistant; even the families that really wanted to use this music.  The way Modulated music needed to be scheduled and used (two daily 30-minute sessions, 2-3 hour wait before sleep times and between listening times) made it almost impossible to use with very young children at home, regardless of how willing parents seemed to be.  And very few parents were that willing.  Maybe they would be able to do insulin injections on a schedule, but not therapeutic music.  I hated begging, so I had to find something easier that worked well.

Quickshifts:  More Flexible, More Easily Tolerated, More Effective in EI

Quickshifts have been much more flexible, but just as successful.  Maybe more!  They can be used often throughout the day, any time of the day.  I haven’t seen one small child react in a way that indicated that they were overwhelmed.  The ability to target specific types of sensory-based goals means I can deliver results the parents can see.  the emphasis on alpha brainwave states seems to deliver an extra layer of calmness.

Gearshifters are similar to Qucikshifts, but they do not have the targeted immediacy that I find so helpful.  When are Gearshifters better to use?  When I need a longer-lasting modulation effect and I don’t have concerns about spatial awareness or need to reduce agitation.  Some kids need a Quickshift album followed by a Gearshifter to have a few hours of really good sensory modulation time.

Parents are happy to be able to download the albums onto their phones and use them to improve transitions, sleep, attention and more. The use of technology to entrain an alpha brainwave state means that if the album isn’t a perfect fit, I don’t get an overwhelmed child; there is always some degree of improvement in regulation and arousal.  But when I have seen kids generate more postural activation, calm down and even laugh, or tune into their environments in ways they never have before Quickshifts, I wonder why I waited so long to get this treatment on board.  It isn’t just for sensory sensitivity or modulation problems; read more about how it can help kids with motor control issues here: Therapeutic Listening Can Enhance Motor Skills….Really!

Wondering if adults can use Quickshifts too?  Read  Should the PARENTS of Kids With Sensory Issues Use Quickshifts? for more about how this music can help everybody in the family.

If you are tempted to go out and buy these albums without the guidance of an OTR that is trained in sound therapy, please reconsider.  The reason that I have had such success with Quickshifts is not just because this treatment works.  It works because I use it as part of a whole sensory-based protocol, in which I can select and prescribe the right music to be used at the right time.  There really is a reason to have an OTR help you.  You will get better results, avoid problems, save time and money, and have someone trained in treatment guiding you.  Not Dr. Google.  I do phone consultations to help people decide on a sensory processing treatment plan that saves them time and money.  Visit my website tranquil babies to book a session!

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Sensory Stimulation is not Sensory Treatment

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I thought that I might never hear it again, but there it was.  Another parent telling me that a member of her child’s treatment team had placed her hands in a rice-and-bean bin.  “Why?” I asked.  “She said it was sensory.” was the response.  This particular child has no aversions to touch, and no sensory-seeking behaviors either.  Her aversion to movement out of a vertical head position keeps her in my sessions, and her postural instability and hypermobility will keep her in PT for a while. But unless she is swishing around in that box while on a balance board or while she is sitting on a therapy ball (BTW…not) it isn’t therapy.   I struggle to see the therapeutic benefit for her specifically.  It is sensory play, but it isn’t therapy.

It seems that OTs got so good at being known for sensory-based interventions and fun activities, that it appears that engaging in sensory play is therapy.

Let me be clear:  if your child is demonstrating sensory processing issues, random sensory input will not help them any more than random vitamin use will address scurvy or random exercises will tone your belly.

Sensory processing treatment is based on assessment.  Real assessment.  A treatment plan is developed using an understanding of the way individual sensory modalities and combinations of modalities are neurologically and psychologically interpreted (remember, mind-body connection!)  It is delivered in a specific intensity, duration, location and/or position, and in a particular sequence.  I know it LOOKS like I am playing, and the child is playing, but this is therapy.  In the same way that a PT creates an exercise program or a psychotherapist guides a patient through recalling and processing trauma, I have a plan, know my tools, and I adjust activities on the fly to help a child build skills.

I never want to make other professionals look bad in front of a parent.  That’s not right.  I ended up making a suggestion that the therapist could use that would be actually therapeutic.  Some day I hope to finish my next e-book, the one on hypermobility, and hope that the information will expand the understanding of what OT is and is not.  It is absolutely not playing in sensory bins….

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Kids With Low Muscle Tone: The Hidden Problems With Strollers

jeremy-paige-146338-unsplashWhether you live in the city or the ‘burbs, you almost certainly use a stroller for your infant or toddler.  Even parents who use slings or carriers for “baby wearing”  find themselves needing a stroller at some point.  Why are strollers a problem for children with low muscle tone?  The answer is simple:  sling seats and ineffective safety straps.

The Challenges of a Sling Seat:

Strollers, especially the umbrella strollers that fold up into slim spaces, have a sling seat, not a flat and firm seat.  Like a hammock or a folding lawn chair, these seats won’t give a child a solid surface that activates their trunk.  When a child sits in a sling seat, they have to work harder to hold their body in a centered and stable position.

Why is that important when you are transporting your child in a stroller?

Because without a stable and active core, your child will have to work harder to speak and look around.  A child with low muscle tone or hypermobility that is in a sling seat may be inclined to be less active and involved, even fatigued from all that work to stay stable.  It could appear that they are shy or uninterested, but they might be at a physical disadvantage instead.  A collapsed posture also encourages compensations like tilting the head and rounding the back.  Will it cause torticollis or scoliosis?  Probably not, but it is certainly going to encourage a child to fall into those asymmetrical patterns.  Kids with low tone don’t need any help to learn bad habits of movement and positioning.

Safety strap location and strapping use in many strollers is less than optimal.  

There are usually hip and chest straps on a stroller.  Some parents opt to keep them loose or not use them at all, thinking that kids are being unnecessarily restrained.  I think this is a mistake for kids with low tone.

Good support at the hips is essential when a child with low tone sits in a sling seat.  It is their best chance to be given some support.  Chest straps are often not adjusted as the child grows.  I see two patterns:  Straps too low for an older child, and straps too high for a younger one.  The latter issue usually occurs when parents never adjusted the straps after purchase.  They left them in the position they were in from the factory.  Make sure that the straps are tight enough to give support but not so tight that a child is unable to move at all.  A child that is used to sliding forward may complain about having their hips secured so that they can’t slouch, but they will get used to it.

You may have to reposition a child with low tone from time to time as you go about your errands or adventures.  They often don’t have the strength or body awareness to do so themselves.  They could be in a very awkward position and not complain at all.  Check their sitting position as you stroll along.  Good positioning isn’t “one and done” with these kids, but doing it right will benefit them while they are in the stroller, and also when they get out!

Think about your high chair as well.  Read How To Pick A High Chair For Your Special Needs Child and A Simple Strategy To Improve Your Child’s Posture In A Stokke Tripp Trapp or Special Tomato Chair.

Looking for more information that could make things easier for your child and for yourself?

I wrote an e-book just for you!

The JointSmart Child: Living and Thriving With Hypermobility Volume One:  The Early Years is finally available!

Filled with more information on seating and positioning, how to select the right high chair, and how to help your child learn to get dressed and use a spoon or fork, it is the manual that parents have been looking for!  There are even chapters on how to improve connection and communication with family, your child’s siblings, teachers, and doctors.  Parents who know what to do and what questions to ask feel confident and empowered.

This unique book is available as a printable and click-able download at Your Therapy Source and as a read-only digital download on Amazon.com

Is your back killing you every time you lift your child out of their stroller or crib?

Parents of children with special needs often neglect their own bodies in service of their children.  This is a shame because there are things you can do to protect your body and make your life easier while caring for your child.  Read How An Aging-In-Place Specialist Can Help You Design an Accessible Home for Your Child and Universal Design For Parents of Special Needs Kids: It’s Important for You Too!.

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Hypermobility and ADHD? Take Stability, Proprioception, Pain and Fatigue Into Account Before Labeling Behavior

 

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There is nothing worse than using a scientific study that correlates two variables and assuming causation. Translation:  If behaviors typical of disorder “A” are seen in a lot of people with problem “B”, we cannot assume that “A” is the cause of their behavior.   But we do it all the time.  People who love coffee adore studies that say coffee drinkers seem to live longer.  People who hate to exercise are validated by reports that find the number of heart attacks after exercise “is increasing”.

When it comes to labeling children’s behavior, we should take a couple of big steps back with our erroneous reasoning.  And when the label is ADHD, take three more.  Not because ADHD isn’t a big issue for families.  The struggles of kids, parents and educators shouldn’t be minimized.  But we should be cautious with labels when two situations occur:  children at very young ages and trying to make a diagnosis when it is  determined largely by clinical observation, not scientific testing.  Seeing ADHD in a child with hypermobility is one of those situations.

Hypermobility without functional movement problems is very common in young children.  Super-bendy kids that walk, run, hit a ball and write well aren’t struggling.  But if you have a child that cannot meet developmental milestones or has pain and poor endurance, that is a problem with real-life consequences.  Many of them are behavioral consequences.  For more on this subject, take look at How Hypermobility Affects Self-Image, Behavior and Regulation in Children.

Yes, I said it.  Hypermobility is a motor problem that has a behavioral component.  I don’t know why so little has been written on this subject, but here it is:  hypermobile kids are more likely to fidget while sitting, more likely to get up out of their chairs, but also more likely to stay slumped on a couch.  They are more likely to jump from activity to activity, and more likely to refuse to engage in activities than their peers.  They drape themselves on furniture and people at times.  And they don’t feel as much discomfort as you’d think when they are in unusual positions Is Your Hypermobile Child Frequently In An Awkward Position? No, She Really DOESN’T Feel Any Pain From Sitting That Way

Why?  Hypermobility reduces a child’s ability to perceive body position and degree of movement, AKA proprioception and kinesthesia.  It also causes muscles to work harder to stabilize joints around a muscle, including postural muscles.  These muscles are working even when kids are asleep, so don’t think that a good rest restores these kids the same way another child gets a charge from a sit-down.

Hypermobility impacts all the things that kids like to do.

Final Thought:  If your child has been diagnosed with hypermobile Ehlers-Danlos syndrome, dysautonmia is a fairly common co-occurence.  It is not diagnosed as easily as it should be, and the “spacing out”, the moodiness, the fatigue, and the forgetfulness that are all common in dysautonomia are often misinterpreted as behavioral, even psychiatric, problems.  This continues even when a child has an hEDS diagnosis, because it is so poorly understood.  There are medical treatments for this problem, and when a child who has been told to behave better is treated successfully, the only problem is the regret for all the wasted time and money spent on worthless treatments.

Got a child who whines?  You  may have a child with a huge issue with frustration and asynchronous development.  What is that? A kid whose skills in some areas lag behind his otherwise normal developmental path.  Read  Got a Whining Child Under 5? Here Is Why They Whine, And What To Do About It  to know what to do to turn this ship around.

Read Hypermobility and Music Lessons: How to Reduce the Pain of Playing and How Hypermobility Affects Self-Image, Behavior and Activity Levels in Children and Should Your Hypermobile Child Play Sports? to learn how to help hypermobile kids get more out of life with less behavioral problems.

Looking for more practical information about raising your hypermobile child?

I wrote 2 books for you; One for young children, and one about supporting school-age kids!

The JointSmart Child:  Living and Thriving With Hypermobility Volume One: The Early Years is your guide to making life easier for your baby, toddler and preschooler.

Read The JointSmart Child Series: Parents of Young Hypermobile Children Can Feel More Empowered and Confident Today!  to learn how my new e-book will build your confidence and give you strategies that make your child safer and more independent…today!  The above link includes a brief preview on positioning principles every parent of a child with hyper mobility should know.  You can find a read-only download on Amazon and a printable and click-through version on Your Therapy Source.

The JointSmart Child:  Living and Thriving With Hypermobility Volume Two:  The School Years is an even larger and more comprehensive book for children ages 6-12.  Filled with information on how to pick the right chair, desk, bike and even clothes that make kids safer and more independent; this book is for parents and therapists that want to make a real difference in a child’s life and feel empowered, not confused.  It is available on Your Therapy Source as a printable download and on  Amazon  as an e-book, and don’t worry: you can download it from Amazon on your iPad as well as your Kindle.  Amazon makes it easy!

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When a hypermobile child starts to move, the brain receives more sensory input from the body, including joints, skin and muscles.  This charges up a sensory system that was virtually starving for information.  Movement from fidgeting and movement by running around the house are solutions to a child’s sense that they need something to boost their system.  But fatigue can set in very quickly, taking a moving child right back to the couch more quickly than her peers.  It looks to adults like she couldn’t possibly be tired so soon.  If you had to contract more muscles harder and longer to achieve movement, you’d be tired too!  Kids  develop a sense of self and rigid habits just like adults, so these “solutions” get woven into their sense of who they are.  And this happens at earlier ages than you might think.  Take a look at Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children to understand a bit more about this experience for hypermobile kids.

Then there is pain.  Some hypermobile kids experience pain from small and large injuries.  They are more likely to be bruised,  more likely to fall and bump into things, and more likely to report what pediatricians may call “growing pains”.  Sometimes the pain is the pull on weak ligaments and tight muscles as bones grow, but sometimes it isn’t.  Soreness and pain lead some kids right to the couch.  After a while, a child may not even complain, especially if the discomfort doesn’t end.  Imagine having a lingering headache for days.  You just go on with life.  These kids are often called lazy, when in truth they are sore and exhausted after activities that don’t even register as tiring for other children their age.

How can you tell the difference between behaviors from ADHD and those related to hypermobiilty?  I think I may have an idea.

After a hypermobile child is given effective and consistent postural support, sensory processing treatment, is allowed to rest before becoming exhausted (even if they say they are fine), and any pain issues are fully addressed, only then can you assess for attentional or emotional problems.  Some days I feel like I am living in a version of “The Elephant and the Six Blind Men”, in which psychiatrists, psychologists and pediatricians are all saying that they see issues with sensory tolerance, movement, attention, pain and social development, but none of them see the whole picture.

Occupational therapists with both physical medicine and sensory processing training are skilled at developing programs for postural control and energy conservation, as well as adapting activities for improved functioning.  They are capable of discussing pain symptoms with pediatricians and other health professionals.

I think that many children are being criticized for being lazy or unmotivated, and diagnosed as lacking attentional skills when the real cause of their behaviors is right under our noses.  It is time to give these kids a chance to escape a label they may not have.

 

Share Could Your Pediatric Therapy Patient Have a Heritable Disorder of Connective Tissue? with your therapist and see what reactions you receive.  The truth is that many kids don’t get a diagnosis as early as possible.  Rare syndromes aren’t the first thing your pediatrician is thinking of, but you can raise the issue if you have more information and feedback.

Looking for more posts on hypermobility?  Check out Should Hypermobile Kids Sit On Therapy Balls For Schoolwork? , Hypermobile Kids, Sleep, And The Hidden Problem With Blankets  and Should Your Hypermobile Child Play Sports? for useful strategies to manage  hypermobility and support both physical health and functional skills.

How To Teach Your Child To Wipe “Back There”

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Potty training is a process.  For most kids, the final frontier is managing bowel movements.  Compared to learning to pee into the toilet, little kids are often more stressed by bowel movements and have less opportunities to practice.  Most children don’t have more than one BM per day, but they urinate many times per day.  For an overview on wiping, even if your child doesn’t have low tone, read Low Tone and Toilet Training: Teaching Toddlers to Wipe

Constipation or just the discomfort of normal bowel elimination can make them wary, sometimes enough to convince some children that this is a process better done in a diaper.  In comparison, urination isn’t an uncomfortable experience for healthy children.  Bowel movements sometimes only happen only a few times a week, instead of the multiple times a child needs to urinate per day.  Less practice and fewer opportunities for rewards (even if your reward is warm praise) make bowel training harder.

So when they finally make the leap and manage to do #2 in the toilet, a lot of parents decide to delay teaching their child how to wipe themselves.  After all, wiping can be messy and it has to be done well enough for good hygiene.

Here are my top suggestions to make “making” a complete success:

  1. Teaching should still be part of your narrative while you are the one doing the wiping.  In my book, The Practical Guide To Toilet Training Your Child With Low Tone, I teach parents how to transform daily diapering into pre-teaching.  While you are wiping, and even while you are waiting for them to finish on the toilet, your positive narrative about learning this skill doesn’t end.  You are telling your child how it’s done, in detail, as you are doing it. You convey with your words, your tone and your body language that this is a learn-able skill.
  2. Don’t forget the power of the “dry run”.  Practice with your child when he is in the bathroom, whether it is before bath time, before dressing, or during a special trip to the bathroom to practice.  Dry runs take away the mess but teach your child’s brain the motor planning needed to lean back, reach back and move that hand in the correct pattern.  The people that invented the Kandoo line of wipes have an amusing way to practice posted on their site:  spread peanut or sunflower butter on a smooth plate, and give your child some wipes or TP.  Tell him to clean the plate completely.  This is a visual and motor experience that teaches how much work it is to clean his tush well.  After this practice, your child will make a real effort, not just wave the paper around.  Brilliant!
  3. Will you have to reward your child for practicing? Possibly.  It doesn’t have to be food or toys.  It could be the ability to choose tonight’s dessert for the family, or reading an extra two books at bedtime.  You decide on the reward based on your values and your child’s desires.
  4. Use good tools.  The adult-sized wet wipe is your friend.  The extra sensory information of a wet wipe versus a wad of dry paper is helpful when vision isn’t an option.  They are less likely to be dropped accidentally when clean, but having a good hold is especially important after it has been used. “Yucky”stuff  makes kids not want to hold on!  Wet wipes are more likely to wipe that little tush cleanly.  Don’t cut corners.  Allow your child to use more than one.
  5. Take turns.  Who wipes first and who bats “clean-up” (couldn’t resist that one!) is your decision.  Some children want you to make sure they are clean before they try, and some are insistent that they go first with anything.  This can change depending on mood and even time of day.  Be flexible, but don’t stand there like a foreman, ordering work but not willing to help out.  One of my favorite strategies is to always offer help, but be rather slow and inefficient.  This gives children the chance to rise to the occasion but still feel like you are always willing to support them.
  6. Teach them how to know when they are done wiping.  It’s kinda simple;  you wipe until the toilet paper is clean when you wipe.  This usually means little kids have to do at least two separate wipes, but they get the idea quicker.  Little hands are not that skilled, but dirty versus clean is something they can grasp.

 

Looking for more information on toilet training?  Take a look at my e-book, The Practical Guide To Toilet Training Your child With Low Muscle Tone to get a clear understanding of how to prepare for and execute your plan without tears on both sides.  Will it help you even if your child doesn’t have low muscle tone?  Of course!  Most of my techniques simply speed up the learning process for typically-developing children.  And who doesn’t want to make potty independence happen faster?

This e-book is available on my website tranquil babies, at Your Therapy Source (a great site for parents and therapists), and on Amazon.  Read more about my book with Amazon’s “look inside” section, or by reading The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

Low Tone and Toilet Training: Learning to Hold It In Long Enough to Make It to The Potty

 

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If your child can’t stay dry at night after 5, or can’t make it to the potty on time, there are a number of things that could be going wrong.  I won’t list them all, but your pediatrician may send you to a pediatric urologist to evaluate whether there are any functional (kidney issues, thyroid issues, adrenal issues etc.) or structural issues ( nerve, tissue malformations).  If testing results are negative, some parents actually feel worse rather than better.

Why?  Because they may be facing a situation that is harder to evaluate and treat:  low tone reducing sensory awareness and pelvic floor control.

Yes, the same problem that causes a child to fall off their chair without notice can give them potty problems.  When their bladder ( which is another muscle, after all) isn’t well toned, it isn’t sending sensory information back to the brain.  The sensors that respond to stretch aren’t firing and thus do not give a child accurate and timely feedback.  It may not let them know it is stretched until it is ready to overflow.  If the pelvic floor muscles are also lax, similar problems.  Older women who have been pregnant know all about what happens when you have a weak pelvic floor.  They feel like they have to “go”  but can’t hold it long enough to get to the bathroom!   Your mom and your daughter could be having the same problems!!

What can you do to help your child?  Some people simply have their kids pee every few hours, and this could work with some kids in some situations.  Not every kid is willing to wear a potty watch (they do make them) and the younger ones may not even be willing to go.  The older ones may be so self-conscious that they restrict fluids all day, but that is not a great idea.  Dehydration can create medical issues that they can’t fathom.  Things like fainting and kidney stones.

Believe it or not, many pediatric urologists don’t want kids to empty their bladder before bedtime.  They want kids to gradually expand the bladder’s ability to hold urine for a full 8-10 hours.  I think this is easier to do during the day, with a fully awake kid and a potty close at hand.  Too many accidents make children and adults discouraged.  Feeling like a failure isn’t good for anyone, and children with low tone already have had frustrating and embarrassing experiences.  They don’t need more of them.

There are a few ideas that can work, but they do take effort and skill on the part of parents:

First, practice letting that bladder fill up just enough for some awareness to arise.  You need to know how much a child is drinking to figure out what the right amount is, and your child has to be able to communicate what they feel.  This is going to be more successful with children with at least a 5-6 year-old cognitive/speech level.  Once they notice what they are feeling down there right before they pee, you impress on them that when they feel this way that they can avoid an accident by voiding as soon as they can.  Try to get them to create their own words to describe the sensation they are noticing.  That fullness/pressure/distention may feel ticklish, it may be felt more in their belly than lower down; all that matters is that you have helped your child identify it and name it.

You have to start with an empty bladder, and measure out what they are drinking so you know approximately how much fluid it takes them to perceive some bladder stretching.    It helps if you can measure it in a way that has meaning for them.  For me, it would be how many mugs of coffee.  For a child it might be how many mini water bottles or small sport bottles until they feel the need to “go”.  You also need to know how long it takes their kidneys to produce that amount of urine.  A potty watch that is set to go off before they feel any sensation isn’t teaching them anything.

The second strategy I like involves building the pelvic floor with Kegels and other moves.  Yup, the same moves that you do to recover after you deliver a baby.  The pelvic floor muscles are mostly the muscles that you contract to stop your urine stream.  Some kids aren’t mentally ready to concentrate on a  stop/start exercise, and some are so shy that they can’t do it with you watching.  But it is the easiest way to build that pelvic floor.  There are other core muscle exercises that can help, like transverse abdominal exercises and pelvic tilt exercises.  Boring for us, and more boring for kids.  But they really do work to build lower abdominal strength.  If you have to create a reward system for them to practice, do it.  If you have to exercise  with them, all the better.  A strong core and a strong pelvic floor is good for all of us!

Tell your child to stand up and check again to see if he “has to go”.  Why? Because the extra force of gravity on that full bladder will add sensory information.  Many children with low muscle tone sit or lie down while playing.  The force of a full bladder isn’t felt as intensely, and young children aren’t always able to parse the small cues.  Stand up, and there should be more force on the internal sphincter and more of a sense that it’s time to use the toilet.

Finally, don’t forget that the same things that make adult bladders edgy will affect kids.  Caffeine in sodas, for example.  Spicy foods.  Some medications for other issues irritate bladders or increase urine production.  Don’t forget constipation.  A full colon can press on a full bladder and create accidents.

Interested in learning more about toilet training?  My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone is available on my website, tranquil babies.  Just click ‘e-book” on the ribbon at the top of the home page, and learn about my readiness checklists, and how to deal with everything from pre-training all the way up to using the potty in public!

 

 

 

 

How Occupational Therapy Can Help Gifted Children (And Their Exhausted Parents!)

rockybeachGifted children have abilities that make them more sensitive to their bodies, their world and the people in it.  They notice sensations, emotional states and the interplay between the physical and the non-physical world in ways that non-gifted people do not.  Exquisite sensitivity often comes at a price for gifted children and their parents.  Most parents of gifted toddlers and preschoolers don’t know the their child is gifted, but they know how they feel: worn out!

Occupational therapists are highly skilled in addressing sensitivity that impacts functional performance.  And it doesn’t have to be sensitivity to shirt tags!  We are trained to look at emotional modulation and attention skills as well, and to help children and adults use sensory-based treatment approaches to improve their performance in these areas.  Need better executive functioning?  it doesn’t happen in a vacuum.  You need a solid sensory processing system to rise to that level of cognitive ability.

A parent’s pride in her child’s amazing abilities can be overshadowed at times by the fatigue and frustration in dealing with tantrums, rigidity, sensitivity, and their child’s seemingly inexhaustible energy.  If you take your child to a psychologist that doesn’t recognize the behaviors as aspects of giftedness, you may leave with a prescription for play therapy or pills.  There is another option.  Occupational therapy can help manage the current of giftedness running through your child’s mind, and “keep the lights on” without those power surges that can destroy their functioning  in the mainstream world.

Bright, but Being Overwhelmed by Input

Particularly in the early years, gifted children can become easily overwhelmed when their emotions, their impulses and their perceptions exceed their ability to process everything they experience.  They may feel clothing or food as intensely strong sensations.  They may want to swing for an hour, then cry when it is time to leave the playground. They might be aware of a parent’s sadness or another child’s frustration more acutely, but have no idea what is happening or what to do.  They really “get” the plight of the polar bears on the disappearing ice sheets.  After all, they can read the New York Times at 5!    They just don’t know what to do with all these feelings, thoughts, desires and sensations.  You could take them to a psychologist, but in my experience, most of them don’t see toddlers or don’t get what the problems really are What Psychologists Just Don’t Get About Raising Gifted Toddlers.

Some abilities in gifted children are advanced by years, such as reading or math.  The ability to share with a sibling?  Not advanced at all!  This “asynchronous development” can cause internal conflict and may result in more frequent and more intense outbursts, refusal to participate in school or playdates, sleep issues and more.

How OT Can Help You and Your Child

OT’s with a strong sensory processing background can help gifted children and their families navigate the complex sensory-motor, cognitive and emotional/social overload that happens when brainpower exceeds management capacity.  What unique skills does an OT bring to the table?  The ability to assess and implement a whole-person approach.    Talking about behavior, making a rewards chart, and cognitively understanding where all that energy comes from is simply not enough to make the days and the weeks easier for a gifted child.  The occupational therapist’s toolbox is deeper and wider, and includes physical interventions that look like play, social/emotional mastery experiences (not just talk), and sensory-based activities that support self-regulation as a child grows into their amazing abilities.  Take a look at Gifted and Struggling? Meet the Twice Exceptional Student and How OT Can Help if your child is gifted but dealing with issues such as sensory processing, ADD, learning issues or ASD.

Occupational therapists do use cognitive strategies such as the “How Does Your Engine Run?” program by Williams and  Shellenbarger.  A cognitively gifted 4 year-old may be fully capable of engaging in this useful program.  A sensory diet, one of the core concepts of most sensory processing treatment programs, can help children discharge and manage sensitivity and excitement throughout the day.  The use of therapeutic listening programs is often easy to do at home with your OTR’s guidance.  I like Quickshifts because they are targeted and work well with the busy schedules most kids have Quickshifts: A Simple, Successful, and Easy to Use Treatment For Processing, Attention and Postural Activation.

Check out Gifted Or Disordered? The Unrecognized Behavioral Traits of Young Gifted Children  for more thoughts on how the behavior of gifted kids can be misdiagnosed as a disability.  I wrote a helpful post on how to use The Happiest Toddler strategies, informed by what we know about the gifted mind, to improve your communication with your child  How To Talk So Your Gifted Child Will Listen.  Is your child misunderstood or mislabeled at school?  Gifted kids can be labeled as troublemakers instead of talented.  Read Is Your Gifted Child A “Troublemaker”?  and  How To Spot A Gifted Child In Your Preschool Class (Or Your Living Room!) for some ways to think differently about those strong opinions and the resistance to rules.

Parents that know how to help their child regulate their arousal feel empowered, not defeated, when their child becomes overwhelmed.  Children learn that their parents “get” them, and that they can turn to them for support instead of criticism.  Feeling understood and feeling capable is the bedrock of self-confidence and self-esteem.  Gifted individuals need to know that they are more than their stratospheric IQ, and this is where it begins. Take a look at Raising a Gifted Child? Read “A Parent’s Guide to Gifted Children” For Successful Strategies To Navigate the Waters  to learn more about how to communicate with your child about his or her gifts.

Dr. Harvey Karp’s Happiest Toddler on the Block program is amazingly effective at teaching children how to handle the strong emotions of early childhood, and teaching parents how to support their children without crushing their spirit.  I use his incredible techniques with every gifted client I see.  Children with ASD respond, children with SPD respond, and gifted children respond.  Dr. Karp’s strategies allow children to learn how to express their feelings without judgement, and teach parents to set limits and place consequences on behavior without crushing a child’s spirit.  Isn’t that what we all want for our children?  Check out Stretch Your Toddler’s Patience, Starting Today! even if your child is not a toddler.  It turns out that Dr. Karp’s easy technique for handling demands works on impatient people at almost any age.  You just alter your presentation to fit their emotional state and communication level!

Should you consult a psychologist?  If you are expecting to get concrete strategies to manage your toddler’s or preschooler’s highs and lows, probably not.  My professional experiences and my search online for resources from psychologists has lead me to believe that they don’t start being really interested in or helpful until your child is in primary school.  If your toddler is being a problem in daycare or preschool because she doesn’t want to do the “stupid” macaroni pictures and instead wants to read their chapter book at age 3, psychologists don’t seem to know what to say.  Here is something more helpful: Why Gifted Children Aren’t Their Teacher’s Favorite Students….

Research suggests that the way a gifted brain functions is always going to be different than the typical child.  This is the difference between being atypical and abnormal.  Most psychologists don’t see things that way, but the few working with gifted children will know what I am talking about.  I believe that therapy for gifted children effects change in a very similar manner to therapy for the autistic child; therapy can make daily life easier, and it can help a child learn to handle their thoughts and experiences with greater comfort and ease.  Brain function changes as it learns to adapt and make better connections, but the structure of the gifted brain will remain unique.  Occupational therapists support gifted children and their families in exactly the same way we support people in the special needs community:  without judgement or dismissing problems that arise in living.

If you are the parent of a very young gifted child, and you would like more support, take a look at some of my previous posts:Supporting The Gifted Toddler at Preschool   and Your Bossy Baby or Toddler May Be Gifted. Really. Here Are The Signs You Are Missing! You can use these strategies today to help your gifted child!

Want more personalized support to manage your gifted child’s behavior at home and school?  Are you a new OT and have questions about how to treat gifted kids in your practice?  Visit my website tranquil babies and purchase a phone consultation.  You will have a chance to ask questions and get answers that can make a difference!

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Should Your Child Use A Pencil Grip?

I will be asked about pencil grips every time I teach a workshop or lecture on handwriting.  My popular post, The Pencil Grip That Strengthens Your Child’s Fingers As They Write. , partially explains when and why I would recommend the use of this excellent pencil grip with older kids.  I have a message for preschool teachers that see awkward or clumsy pencil grasp in their 4 -year-olds:  don’t use a grip until you have worked on grasp!  The reason?  The other grips will not develop better grasp, and pencil grips are too frequently lost or used improperly with young children.

Pencil grips can be a huge help for older children or children with specific muscular or neurological issues.  Kids with low muscle tone or too much joint mobility in their fingers can really benefit from their use.  Children with mild cerebral palsy and muscular dystrophy can also benefit from the use of a good grip and the correctly-sized writing tool.

For typical kids who aren’t using a tripod or quadruped grasp but are writing letters, the better choice is to get creative with crayon and marker dimensions.  Short crayon pieces, Flip crayons from Handwriting Without Tears (HWT), and writing with a tablet stylus from iCreate can strengthen muscles and increase tactile and proprioceptive awareness.  Finally, teach grasp actively.  HWT does a fabulous job in their teacher guides.  These books, especially  the pre-K book, are underutilized.  They are fantastic resources for any preschool teacher and pediatric occupational therapist.

Pencil grips can help some children, but don’t jump into a grip until you have addressed the reasons you were thinking of using a grip in the first place!

Teach Your Kindergartener How To Erase Like a Big Kid

Does it matter how a child erases their mistake?  You are probably thinking that I ran out of topics for my blog this week.  Not exactly.

I was thinking about what makes my handwriting posts different than other bloggers that publish posts on early writing skills.  I like to look at all the details when I work with struggling writers.  I search for every way I can build a child’s skills and confidence.   Knowing how to control an eraser is a simple but important skill for children in kindergarten to master, and can save a homework assignment from the trash bin.

Controlled erasing prevents removal of well-written characters.  This means more work and more time to complete an assignment.  It prevents paper destruction.  If your child struggles to write, imagine how he would feel if he accidentally tore the paper and had to start over.

Why would children struggle to control an eraser?  Kids with limited hand strength and stability often press too softly or use too much force.  Children with sensory discrimination difficulties do the same.  Kids who have difficulty focusing, are impulsive or are defiant can make the same erasing mistakes.  Finally, kids with motor or orthopedic issues can have the same difficulty controlling the eraser that they experience with their pencil.

What can you do to help?

  • Select the right eraser.  Although pencils usually come with erasers, some children do much better with a larger eraser or one that is shaped for easier grasp.  A larger eraser can also have more textured edges and even more weight, giving children more sensory input with use.  My favorite eraser is the Pentel Hi-Polymer latex-free eraser.  Super at cleanly erasing, and easy to grasp.  Beats every pencil eraser I have ever used.  Here it is:Problems With Handwriting? You Need The Best Eraser.
  • Demonstrate how to hold the eraser for control.  If a child uses a fisted grasp, they are erasing with elbow or shoulder movements.  These large movements are likely to be harder and less controlled.  Demonstrate that using a mature tripod pencil grasp will result in more control and faster erasing.
  • Make eraser practice fun.  Write awful letters, your worst products, in between good examples on a page.  Have your child erase your mistakes.  Draw mean faces and have them get rid of the “bad guys”.  Draw “coins” and see who has the most money left.  Bonus round:  have them write in the amount on the coins.  Larger number, more money!!

 

Low Tone and Toilet Training: How Your Child’s Therapists Can Help You

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Over the years as an occupational therapist, I have been giving parents hints here and there.  Writing my e-book  this fall, and preparing an e-course (coming soon) to support families makes me realize that some clients did not ask me very many questions while they were toilet training their child.

So….Are there aspects of therapy that can help you with toilet training?  Yes indeed!  Does getting more therapy mean that your child will automatically be trained earlier and more easily?  Unfortunately, not really.

When it comes to potty training, you can bring a child to the potty, but you can’t make him “make”.  Toilet training is a complex skill, and even the best therapy will still only prepare all of you and develop important skills needed for this skill.  Bringing it all together is still the job of the parent or the full-time caregiver that creates and executes the plan. Waiting for readiness?  Read Waiting for Toilet Training Readiness? Create It Instead!  to understand what you can do today to inspire interest and build skills. Thinking that it’s too soon?   How Early Can You Start Toilet Training?  will shad some light on what is really important when you are wondering if your child is old enough.  If you are wondering if your child’s diagnosis is part of the issue, take a look at Why Do Some Kids With ASD and SPD Refuse Toilet Training?  And finally, if you are eager to move into night-time training, read Why is Staying Dry at Night So Challenging For Some Children? for support at the finish line of toilet training.

Here is a list of what therapy can do to support you and your child for toilet training.  If you haven’t heard your therapists discussing these treatment goals/approaches, you might want to share this post with them.  They may be more focused on other very important skills right now, but always keep your discussions open and inform them that you are planning on training.  Most therapists are very eager to support families whenever they can with whatever goals the family has.

  1. Core stability for balance, abdominal strength and safety on the toilet.  Most kids with low tone do not have great core stability, and this is where the rubber meets the road.  A weak core will put a child at greater risk of falling or feeling like he will fall.  It is harder to relax and pee/poop if you are afraid you will land on the floor.
  2. Clothing management and hand washing.  No child is really independent in using the toilet if someone else has to pull clothing up and down.  Washing hands is a hygiene essential.  Time to learn.
  3.   Good abdominal tone.  See #1.  Helps with intestinal motility as well.  That is the contraction of smooth muscle that moves the poop through the colon and on out.  My favorite hack is the use of kineseotape in the classic abdominal facilitation pattern.  All but one of my clients have had a nice big bowel movement the next day after taping; no pain, no fuss.  Regular taping along with strengthening can improve proprioceptive awareness internally (interoception, for those of you who need a new word for the week!)
  4. Transfers and equipment assessment/recommendations.  Therapists can teach your child how to get on/off, up and down safely from a toilet or potty seat.  They can teach you what to say and do to practice transfers and how to guard them while they practice.  They can also take a look at what you already own and what you might need to obtain.  Children with significant motor issues may need an adaptive toileting seat, but most mildly to moderately low-toned kids do not need that level of support.  What they do need is safe and correctly-sized equipment.
  5. Proprioceptive awareness for balance and stability.  Some therapists use balance discs or boards, some use other equipment.  Swings, climbing, jumping, etc.  More body awareness= more independence.
  6. Sensory tolerance for the feeling of clothing, using wipes/TP, the smells and the small enclosure of a bathroom.  If your child has sensory sensitivity issues in daily life, you have to know that they are going to be issues with toilet training.
  7. Effective vestibular processing.  Children that have to turn around, bend and look down then behind their bodies to get TP or pull up their pants need efficient vestibular systems.  Vestibular processing isn’t just for walking and sitting at a table for school.
  8. Practicing working as a team and following directions.  Your child needs to be responsive to either your praise, your rewards or both.  Therapists that support independence (all of us!) and develop in your child the sense that the she is a part of the therapy plan will make it easier for your child to work with you on toileting!

Want more information on potty training?  Read my first book or call me for a consult!

 My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone is now available at Amazon.com as well as Your Therapy Source ( a terrific site for parents and therapists)  and on my website,  tranquil babies .  Families are telling me that they have made progress in potty training right away after reading my book!

Read The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived!  to learn how my book will help you and your child move forward today!

Want 30 minutes of my time to problem-solve things?  Visit my website  Tranquil Babies and buy a Happiest Toddler on the Block session.  We don’t have to do HTOTB; we talk about whatever you need!  I can’t do OT with you, but I can give you potty training advice an behavior strategies that really work!

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.

 

 

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!

 

 

 

Great Mechanical Pencils Can Improve Your Child’s Handwriting Skills

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Great mechanical pencils for kids !

These pencils help students with the following handwriting issues:

  1. They use too much force while writing, and the pencil tips break frequently.
  2. They need more tactile information to achieve and keep a mature pencil grasp.
  3. They rarely notice that they need to sharpen their pencil to improve legibility.
  4. Getting up to sharpen a pencil distracts or disorganizes them so much that it extends the time to complete assignments.

I usually do not recommend mechanical pencils for the earliest writers, but that changes after the first half of second grade.  Once a child is facing the volume and speed demands of later second grade or above, it is time to be creative and think outside the box.

Working on the physical skills and the sensory processing skills that cause a child to struggle with grading force, perceiving tactile input, and monitoring their performance is still important.  They would probably take away my OTR license if I didn’t say that!

The problem is that sometimes life hacks are essential to keep a child functioning and feeling like a success.  Having the right equipment is an important and easy life hack for the child that already (at 7!) thinks of himself as a bad writer.  Using this pencil can be one of those “low-hanging-fruit” situations where performance improves while skills are developing.

PaperMate hasn’t targeted the kids with low tone, sensory processing, ASD, ADHD, or any other issues, and that is actually a nice thing.  Older kids don’t want a “special” anything in the classroom or even at home.  They might reject seat cushions and pencil grips that help them because they don’t want to look different or feel different.  Well, these are easy to get at office supply stores.  There is nothing “special” about them at all, except that they really help kids write neatly.

  • The pencils have #2 leads, a good eraser, and come with both extra lead and erasers.  We all know that running out of erasers will communicate “I don’t really need to erase that mistake” to a child.
  •  The colors are appealing to kids, but not infantile.
  • Adults know that their handwriting will immediately look better with a fine point writing utensil, but kids do not.   Children that have visual-perceptual or executive functioning issues often struggle to accurately assess what is causing their handwriting to look illegible, and then take the appropriate action.  They just shrug it off and say that they are simply “bad at writing”.
  • The pencil shaft is smooth, but the thick triangular shape adds much more tactile input than a regular pencil.  Feeling an edge, rather than a cylinder, is often just enough tactile feedback to remind kids to reposition their fingers without an adult saying “Fix your grip”.  Kids get so tired of adults telling them what to do.
  • The triangular shape limits how often the pencil rolls away or rolls off the table.  For kids with ADHD, that can be enough to derail homework without any drama!
  • Finally, mechanical pencils seem more grown-up to children than standard pencils, and you can spin it as such.  What a nice opportunity to be positive about handwriting!

What happens when your child makes a mistake and needs to try again?  They need the best eraser!  Check out Problems With Handwriting? You Need The Best Eraser , because the erasers on these PaperMate pencils are good but not great.  Having the best equipment positions your child for success!