Advanced Pediatric Therapies


Toothbrushing: Making it easier

To you, it's a simple toothbrush.  To your child, it may be a feared object.

To you, it’s a simple toothbrush. To your child, it may be a feared object.

For our kids, toothbrushing can be extremely stressful.  It’s an invasive process that a child can perceive as highly unpleasant or even painful.  Figuring out what is causing the distress is key to providing the best environment, equipment  and techniques to make toothbrushing more pleasant for the whole family.

Firstly, is your child a sensory seeker or do they have sensory defensiveness in his or her mouth?  If you don’t know the answer to this question, ask for guidance from your occupational therapist.  Generally, however, sensory seekers tend to seek movement, are constantly on the go and can be difficult to calm down.  A sensory seeking child is more likely to mouth non-food objects and grind their teeth (aka “bruxism”).  Also, a sensory seeking child may have a hard time standing still to just brush their teeth at all.  These kids do best with vibrating toothbrushes, a wide toothbrush or a toothbrush that sings songs (yes,some do).  You can also sing a song (one that is long enough for an average toothbrushing or at least a minute).  Allowing your child to move around while brushing is also helpful.  A timer is a good way to get them to know when they are finished.

For a child with sensory defensiveness, brushing teeth can range from pretty unpleasant to almost unbearable.  Often these kids don’t move food around in their mouths well, can have low tone in their mouths and tend to have a very limited repertoire when it comes to textures.  Try these ideas to help your child become more comfortable with having a toothbrush in their mouth:

1.  Stand behind your child and give firm pressure to the back of their head using both your hands.  It should be calming touch and hold for a count of five.  Repeat X3 and try to do as often as possible.  This is done to provide counter calming touch to the back of the child’s head that feels good.

2.  Once your child tolerates that touch, begin providing the same firm and calming pressure to other areas, such as forehead and face, below the ear and lower cheeks.  Then, using calm strokes and consistent pressure, make deep sweeping motions from the ears to the chin.  Finally, add deep pressure to the lower lip, upper lip and cheek bones.

3.   When you get to the lips, repeat the previous steps using a warm wash cloth.

4.  Once your child can tolerate the warm wash cloth on their lips, try having them accept it into their mouth.  You can make it a game by having your child pretend to be a pet who licks then chews on or bites the wash cloth.

5.  Once your child can accept you touching the front and side teeth with a washcloth, then introduce the toothbrush.  Go slowly.  This process may need to be done over and over.  Do your best to make it fun.  Don’t use toothpaste yet.

6.  There are a huge variety of pieces of equipment which are helpful.  Ask your occupational therapist, speech therapist and your dentist for guidance.  These are preliminary ideas to help get a toothbrush into your child’s mouth without force.  There are many other approaches and techniques which can be useful.  Go into it with a deep breath and an open mind, despite the stress you may be feeling about your child’s dental health.

Thanks to and Delta Dental for some of the tips.


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Jar of Calm: Ideas for Coping

Give your kids some ideas for dealing with discomfort.

Give your kids a jar filled with ideas for dealing with discomfort.


In the last post, we talked about self control and how to help kids gain it on the way to independence.  Sometimes, however, kids need some help.  In the heat of the moment, when your kid is on their way to a meltdown, their brains may be too foggy with anxiety, fear or anger to know how to help themselves.  We can give them some ways to chill out when they aren’t able to come up with anything on their own.  If your child is just about to tip into a full blown meltdown, it may not be the best time to try these ideas.  They really are more if you notice your child:

*becoming irritable

*seeming withdrawn and crabby

*not wanting to “talk about it”


These could be for a variety of reasons they may not even be able to articulate like:

*someone bumped into them at school

*the noise at school is too loud

*the feeling of their clothes

*feeling left out

*having a hard time paying attention at school

Here are some ideas for when your child seems to be bubbling over:

1.  talk to a trusted adult or friend

2.  sit in a ball in a corner/on a beanbag/ on the floor in their closet

3.  take a bath or shower

4.  blow out candles/blow up balloons/blow bubbles

5.  write it down, crumple it up and throw it away

6.  play with some Legos

7.  scream in a pillow

8.  read

9.  nap

10.  listen to nature sounds

11.  look out the window

12.  drink some water through a straw

13.  cuddle with a pet

14.  take some deep breaths, at least 6 seconds in and 6 seconds out.

15.  hug a pillow or teddy bear

16.  make up a story about a photo or picture

17.  make a collage with magazine clippings

18.  throw some ice cubes somewhere where it can do no damage

19.  do some guided imagery

20.  meditate

21.  help someone

22.  read the comics or jokes

23.   make silly faces in the mirror

24.  dance

25.  have a chewy snack

26.  change into sweats/comfy clothes

The ideas are as limitless as your imagination!  Most important is to have something ready for when you have to come up with something-quickly-when your child is feeling like things are out of their control.

Some ideas from:

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Self Control/Self Regulation: What does it all mean?

In the clinic, we often refer to self regulation or self control as an important skill for kids to develop.  Why?  In our media-saturated culture, our kids often have trouble switching gears.  They focused on that little noise when the heat kicks on or so entranced in a game that they can’t even hear you calling them.  We want our kids to be independent, but in order to do that, they have to be able to put distractors aside so that they can focus on something more important, like playing with a sibling or doing their homework.  Not so easy.  But there are some ways kids can practice self control.  Try some of these ideas in your home and see what works for your child.


1. )  Follow a recipe or start a new game.  Each requires step by step instruction.  It has to be a game your child really wants to play or something they really want to eat.

2.)  They must learn to wait for you.  Don’t drop whatever you’re doing because your child is jumping up and down to get your attention.  The world won’t stop for them so they need some practice waiting.  This may be harder for you than it is for them, but worthwhile.

3.)  Use a timer!  We use one all the time in the clinic.  A visual timer (red denotes the time until the activity is finished) is useful for kids who can’t read numbers.  They know how much time is left and can see it pass.

4.)  Remind them you can help if they need it.  Try not to ask, just inform that you are there if needed.  Questions are often stressful when a child is trying to do something difficult.  Take turns.  Or start and let them finish.

5.)  Start a project that will take an extended amount of time to complete.  Plant a garden.  Work on a Lego Challenge.  Sign up for a race together and train for it.  This teaches patience, and that steady effort and consistency is required.

6.)  Look in the mirror.  You are your child’s greatest teacher.  If you fly off the handle easily or are quick to give up when challenged, consider how your behavior looks to your child.

7.)  Give them some ideas if they are all out.  Tell them you can give them some ideas if they are open to it.  (Post coming up on “coping strategies”)  Suggest getting a drink of water or going out to climb their favorite tree.

8.)  Don’t expect more than their age can deliver.  If a tired toddler is dragged into a supermarket, you really only have yourself to blame!  Set reasonable expectations and your child will be more likely to meet them.

9.)  Give them some down time.  This can’t be overstated.  Research suggests that children who are over-scheduled are more likely to have meltdowns than those who are given more free time during the day.

10.)  Know when to do nothing.  When your child is demonstrating some self control, let them.  The only thing you need to do is give them positive reinforcement for doing so.

Thanks to for ideas for this post.


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