Tag Archives: toddlers

Boost Pincer Grasp With Tiny Containers

These days I am getting pretty…lazy.  My go-to items are designed so that children automatically  improve their grasp or their posture without my intervention.  I am  always searching for easy carryover strategies to share with parents too.  As with most things in life, easy is almost always better than complicated.

My recent fave piece of equipment to develop pincer grasp in toddlers and preschoolers is something you can pick up in your grocery store, but you are gonna use it quite differently from the manufacturer’s marketing plan….

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Remember these?

Enter the tiny party cup, AKA the disposable shot glass!  Yes, the one you used when you played “quarters” in school.  The very same.  These little cups work really well to teach toddlers to drink from an open cup, but they are also terrific containers to promote pincer grasp in young children.  Drop a few small snacks into these little cups and discourage them from dumping their snack onto the table instead of reaching inside with their fingers.

No matter how small your child’s fingers are, they will automatically attempt a tripod or pincer grasp to retrieve their treat.  You should’t have to say much of anything, but it never hurts to demonstrate how easy it is.  Make sure you eat your snack once you take it out of your cup.  After all, grownups deserve snacks too!

These little containers are much sturdier than paper cups.  This means that they can survive the grasp of a toddler who cannot grade their force well.  The cylindrical shape, with a slightly smaller base than top, naturally demands a refined grasp.  The cups have a bit of texture around the middle of the cup (at least mine do)  which gives some helpful tactile input to assist the non-dominant hand to maintain control during use.  They are top-shelf dishwasher safe and hand-washable, in case you feel strongly that disposables aren’t part of your scene.

Has your child mastered pincer grasp?  These little cups are fun to use in water and sand tables as well.  Mastery of pouring and scooping develops strong wrist and forearm control for utensil use and pre-writing with crayons.

For more ideas on developing grasp, take a look at Want Pincer Grasp Before Her First Birthday? Bet You’ll Be Surprised At What Moves (Hint) Build Hand Control! and Develop Pincer Grasp With Ziploc Bags.

 

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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.

 

 

Is My Child Ambidextrous?

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

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

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

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terrific safe scissors for little hands!

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

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

Wok and Roll!

Playing Wok ‘n Roll with Edison Chopsticks!

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

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

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

 

How Early Can You Use The Happiest Toddler Approach?

Something happens to babies between 12 and 18 months.  The adorable little child that could be easily distracted from grabbing your earrings, ate anything you offered, and smiled when you praised him is replaced by someone whose favorite word is “NO!!”, delivered at astonishing volume for a person who weighs in at only 23 pounds.

Welcome to toddlerhood.  Get ready, it is going to be a bumpy ride!

Dr Harvey Karp’s Happiest Toddler techniques are usually discovered by frustrated parents of two year-olds who are tearing around the house, taking hostages.  But these effective behavior management methods can be cherry-picked to be used with younger toddlers.  In fact, starting early with patience stretching and the Fast Food Rule Taming Toddler Tantrums Using Sympathetic Reframing is a smart way to grow a toddler.  These techniques really do teach patience with kids Stretch Your Toddler’s Patience, Starting Today! and teach them that their complaints will be heard without always getting their way.  Dealing with bad habits later takes longer than instilling good ones any day.

You just have to be aware of which methods work for tiny minds and start planting the seeds before things get out of hand.  Some methods, like Giving It In Fantasy, will not work.  Young toddlers do not have the capacity to distinguish reality from fantasy.  Too many words, as well.  Same with Gossiping About Good Behavior.  They think that you are talking to them and don’t get the full effect of “overhearing” a compliment.

Not sure you want to “time-out” a 14 month-old?  Use Kind Ignoring, in which you momentarily turn away from the whining or defiance of a very young child.  Ignore the behavior briefly, even move 10-15 feet away without saying anything or making gestures or even a negative facial expression.  In fact, doing nothing at all but removing your self from the banging or throwing of toys sometimes works better than a statement or a look.  Your action coveys that this is not going to get your attention, it is going to remove you from their presence.  So much of the time, the littlest toddlers are doing these things to engage you when they don’t have the words to do so.  Don’t take that bait, and you have avoided what the Baby Whisperer would call “accidental parenting”.

She is a big believer in “start as you mean to go on”, and so am I.  Consistency gives all children a bedrock at home and at school.  They know what to expect, how to gain attention and how to successfully communicate even at an age where they have less than 20 words.  If you want more peace, don’t think that you have to wait until you can have a conversation about behavior with your child.  The door to communication is open way before that point!

 

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

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

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

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

 

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

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

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

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

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

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

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

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

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!

 

 

 

Give (Some of) Your Power Away To Your Defiant Toddler And Create Calmness

One of my favorite strategies to develop a warm but equitable relationship with toddlers is to share the power.  Yes, I said it.  Adults have power in the relationship and toddlers know it.  In order for you to succeed in using this strategy with your toddler, you have to accept the fact that children long to be the powerful ones in a relationship. but they know the reality:  we make most of the decisions.

This is true even if you are a committed push-over.  Even if you subscribe to free-parenting and allowing the child to lead, you are still the one deciding when the last book is read at bedtime and when to leave the park in time for grade-school pick -up.  In fact, I will guess that children who have the power to turn the kitchen into a diner that cooks to order have the larger tantrum when they hit a situation they cannot control.  Say…there are no more goldfish crackers in the house right now.  It is raining and the pool at the club is closed.  Kids that cannot believe that this time they will not get what they want are often inconsolate.  They have no regular experience of it.  Remember, they cannot be expected to understand that there are circumstances beyond our control.  They think magically.  That is normal for toddlers, and if you think that they can comprehend the difference, you are in for some major meltdowns when events take their course.

The other extreme will also get you some award-winning tantrums.   Expecting immediate and full compliance with all your instructions will put you at odds with the natural limit-pressing that children must do, all the way into the teen years.  If toddlers do not feel that they have any power ever, they are more likely to demand it by taking hostages in the check-out line at the grocery store or in the lobby at daycare.  If you have ever been that parent with a wigged-out toddler in the grocery store, looking right at you as he twirls and kicks, you know what I mean.

I work with a child privately whose mom really argued this point with me.  She was doing a good job convincing me that her kids had equal power until she told them at the end of my session that they had to get their coats on NOW, and they would be leaving for haircuts shortly.  Who decided on haircuts today?  At that exact time?  Did they have a choice whether to go or where to go to get their hair cut?  Of course not!  Her kids knew that they were going to get haircuts then, even if they didn’t want to, and not complying would be met with consequences.  So much for “equal power”.

Adults are the managers of kid’s lives,  and most kids really want and need adults to give them confidence that the “big people” know what to do and can take care of them.  Adults being powerful doesn’t automatically crush their spirit or destroy their confidence.  Kids just want to be considered and respected.  I think ceding some power over minor situations  can show them that respect, and give them a chance to feel powerful without using whining or aggression to get there.

You may think of yourself as a very democratic parent, always offering your child freedom and choice.  I cannot argue with that, but it might not even matter that you are right.  Dr. Karp (of the Happiest Toddler on the Block) taught me that all that matters to toddlers is how they see a situation.  I am suggesting that by inserting many, many daily opportunities for tiny power moves, you create the sense in a toddler that they are respected and have enough power.  It creates easier transitions when adults have to step in and take charge, and it gives toddlers opportunities to experience what happens when they make the choices.

The low-hanging fruit of this strategy are the decisions children make for themselves that do not affect any significant outcomes.  These are the ones that all the parenting articles mention.  Give your child two choices on which shirt to wear.  Let him choose the blue or green bowl for cereal.  Well, that does works a little bit, and works better with the youngest or most compliant toddlers.  No 2.5 year old is empowered by a choice that he knows has no teeth.  You could use those magazine’s techniques all day long and still not make a dent in your defiant toddler’s demands.  Your more impact-ful power sharing technique with a controlling or older toddler?  controlling YOU!  

Which puzzle do you want US to do now?  Do you want me to sit here or there?  Can I color on your ninja picture or do you want me to stay on my own picture?  Can I go first or do you want to?  Now we are talking!  Telling you “no”,  or at least having the opportunity to do so, and then seeing you comply, this is real power!  

I weave no less than 5 little opportunities to tell me “no” into a 45-minute therapy session with a defiant toddler.  At first, they are all about shutting me down.  They love it.  This can go on for a while if a child really has perceived themselves as less powerful than siblings or has had a major life changes such as a new school or sibling.  Gradually, and sometimes it happens over many sessions, they get it:  I will give them power and respect them.  Then the magic happens.  Easier transitions, fewer defiant moments.  Life has become better.