Tag Archives: SPD

Child Writing Too Lightly on Paper? It Might Not Be Hand Strength Holding Him Back

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If your child barely makes a mark when he scribbles or writes, most adults assume that grasp is an issue. Today’s post suggests that something else could be the real reason for those faint lines.

Limitations in postural and bilateral control contribute far more to lack of pressure when writing  than most parents and teachers realize.  For every child in occupational therapy that is struggling to achieve good grasp, I see three whose poor sitting posture and inability to get a stable midline orientation are the real issues.

Think about it for a minute:  if you sat with your non-dominant (not the writing hand) hand off to the side and you shifted your body weight backward in your chair, how would you be able to use sufficient force on a pencil or a crayon?  Try this right now.  Really.  You would have to focus on pressing harder while you write and hope your paper doesn’t slip around.  That would require your awareness and some assessment of your performance.  Children don’t do “awareness and assessment” very well.  That ability comes from frontal lobe functions that aren’t fully developed in young children.  But they can learn where to place their “helper hand”, and that sitting straight and shifting forward is the correct way to sit when you scribble or write.

If a child has sensory processing or neuromuscular issues such as cerebral palsy, Ehlers-Danlos Syndrome or Down Syndrome, achieving adequate postural stability may take some effort on the part of the therapists and the teacher.  Well worth it, in my experience.  There are easy hacks that help kids; good equipment and good seating that won’t cost a fortune or inconvenience the class.  Every child can learn that posture is important for writing.  But the adults have to learn it first.  Kids take their cues from what adults appear to value, and if they figure out that they are allowed to slump or lean, they almost always will.

I am doing a lecture on pre-writing next week, and I intend to make this point, even though the emphasis of my lecture is on the use of fun drawing activities to prepare children to write and read.  Why?  Because it may be the only time these preschool teachers hear from a pediatric occupational therapist this year, and I want to make a difference.  Understanding the importance of postural control in pre-writing and handwriting could help struggling kids, and make decent writers into stars!

 

For more information, take a look at For Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance and Better Posture and More Legible Writing With A “Helper Hand”.

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Low Tone and Constipation: Why This Issue Delays Toilet Training Progress

Kids with low tone and sensory processing disorders are not the only children who struggle with constipation, but it is more common for them.  The reasons are many:  low abdominal and oral tone, less use of available musculature because they use compensatory sitting and standing (the schlump, the lean, the swayback) patterns, and even food choices that have less fiber.  If you struggle to chew and swallow, you probably aren’t drinking enough and eating those fruits and veggies that have fiber.  Sucking applesauce packets may get you Vitamin C, but it has pulverized all that fiber.  Now add discomfort with the sensory experience: the smells, feelings, sounds of bathrooms and using the potty.  It can all be too much!

Without fluids, fiber and intra-abdominal pressure to support peristalsis (the automatic contraction of the intestines), children with low tone are at a huge risk for constipation.  And constipation makes pooping harder and even painful.  Sensory overload makes kids agitated, distracted, and sometimes even aggressive.  Not good for learning or letting it go into the toilet.  Hence, resistance and even fear of pooping, and therefore more stress and withholding of stool.  A really big problem, one that you may have to get your pediatrician’s assistance to solve.

It can change.  Here is your secret weapon: your child’s occupational therapist.  If you haven’t been involved in your child’s therapy before, this might be the time.  Research has shown that sensory-based issues can contribute to toileting problems, and OTs are capable of evaluating all the sensory and motor-based contributors.  While  your pediatrician gives you recommendations on diet, laxatives and more, your OT can help your child stay in the alert-but-calm zone where digestion is relaxed, get better core stability to help push that poop along, and adapt the toileting experience for minimal sensory aversion and maximal sensory perception.  Take a look at Low Tone and Toilet Training: How Your Child’s Therapists Can Help You and Low Tone and Toilet Training: The Importance of Dry Runs (Pun Totally Intended).

Update:  Many of my clients have been successful with a creative combo approach:  they use stool softeners, they limit refined carbs (sorry, Goldfish crackers are cheese plus refined carbs!), ensure lots of fluids and then add some tasty fiber.  Prunes covered with chocolate have been popular, but beware the results of too much of a good thing!  They use abdominal massage and make sure that their physical and occupational therapists are working those core stabilizers.

There are medications that improve gastric motility, but they aren’t always tolerated or even prescribed for small children.  Pediatricians are very hesitant to be aggressive with a small child that could dehydrate in a few hours of diarrhea.  Find a doctor that listens to you and is creative.  My suggestion?  Think outside the box and consider an osteopath.  They are “real” doctors, but they have more training in alternative and manual treatment approaches.

Think constipation is only going to affect pooping?  Wrong!  Read Is Your Constipated Toddler Also Having Bladder Accidents? Here Are Three Possible Reasons Why to understand more about how this problem can contribute to other toilet training struggles.

Good news!

My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is done and available at  Your Therapy Source ( a terrific site for parents and therapists!), on Amazon as well as on my website, tranquil babies !!  Just click on the “e-book” section, and start making progress with your child today!

I include detailed readiness checklists and a full explanation of how to train your child in all aspects of toilet training.  You will know how to get the right equipment, what clothes to use so that dressing doesn’t derail your child’s best efforts, and how to deal with defiance and distress.  And yes, constipation is addressed in more detail than in this blog post.  It may turn out to be only one of the issues that you have to confront.  Don’t worry, help has arrived!

If you want a hard copy, contact me through my site and request a mailing address for your payment.

            As I say in my book:  be prepared, be consistent, expect to practice, and be positive that you and your child can do this!

 

 

 

 

Is Low Muscle Tone A Sensory Processing Issue?

Only if you think that sensing your body’s position and being able to perceive the degree/quality of your movement is sensory-based.  I’m being silly; of course low tone creates sensory processing issues.

It isn’t the same sensory profile as the child who can’t pay attention when long sleeves brush his skin, nor the child who cannot tolerate the bright lights and noise at his brother’s basketball games.  Having difficulty perceiving your foot position on a step, or not knowing how much force you are using on a pencil can make life a challenge.  Sensory processing issues mean that the brain isn’t interpreting the sensory information it receives, or that the information it receives is inadequate.

That is the situation with low muscle tone.  Low tone reduces the amount of joint and muscle receptor firing because these receptors need either pressure or stretch to activate.  If it is not in a sufficient quantity, the receptors will not fire in time or in large enough numbers to alert the brain that a change has occurred. Therefore, the brain cannot create an appropriate response to the situation.   What does this look like?  Your child slowly sliding off the side of a chair but not noticing it, or your child grinding her crayon into the paper until it rips, then crying because she has ruined another Rapunzel picture.

Muscle tone is a tricky thing to change, since it is mediated by the lower parts of the brain.  That means it is not under conscious control.  You cannot meditate your way to normal tone, and you can’t strengthen your way there either.  Strength and tone are entirely different.  Getting and keeping strength around joints is a very important goal for anyone with low tone, and protecting ligaments from injury is too.  Stronger muscles will provide more active contraction and therefore pressure, but when at rest, they are not going to respond any differently.

Therapists have some strategies to improve tone for functional activities, but they have not been proven to alter the essential cause of low muscle tone.  Even vestibular activities, the big guns of the sensory gym, can only alter the level of tone for a short period during and after their use.   The concept of a sensory diet is an appropriate image, as it feeds the brain with some of the information that doesn’t get transmitted from joints and muscles.    Sensory diets require some effort and thought, just like food diets.  Just bouncing on a therapy ball and jumping up and down probably will not do very much for any specific child.  Think of a sensory diet like a diabetic diet. It doesn’t make the pancreas start producing insulin, but it helps the system regulate blood glucose more effectively.

Managing low muscle tone for better movement, safety and function is complicated.  Step one is to understand that it is more than a child’s rounded back when sitting, or a preschooler that chews his shirtsleeve.  Step two is to make a multifocal plan to improve daily life.

For more information on life hacks for toilet training, dressing and play with children that have low muscle tone, please look in the archives section of my blog for targeted ideas! My post and are new posts that go into more details regarding life with kids that have sensory processing issues.

For personalized recommendations on equipment and methods to improve a child’s functional skills, visit my website and buy a 30-minute consult.  We can chat, do FaceTime, and you get the personal connection you need to make your decisions for your family!