Advanced Pediatric Therapies

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Self Regulation 101

 Here is an article I wrote for kidsmoveandtalk.com about self regulation:

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Self regulation is the current buzz term in parent and developmental literature.  We’ve all heard of the famous “marshmallow study” where a marshmallow was placed in front of a child by an adult who also told them not to eat it, then left the room.  In the study, the kids who were able to control their impulses (and thereby earn a second treat) were followed up years later and found to have generally done well in life (think: good SAT scores and a lower body mass index).  The marshmallow study, originally done in the early 1960’s by Walter Mischel, has been called into question for it’s methodology, but it is still often quoted and referenced.  Mischel even recently wrote a follow up book about the study.  But the basic principle holds true through years of research: A child who is able to monitor and control their own behavior builds lifelong skills such as persistence in the face of challenge, ability to deal with anxiety and problem solve in an increasingly complicated world.

In a behavioral context,  self regulation refers to the ability to act in a long term context consistent with your deepest values (Psychology Today).  What does this mean for a child who is still developing a moral compass?  Primarily that they value the power of adults and morally want to please them.  It may also mean that they deeply value candy!  In either case, the child shows a resolute decision to forego the immediate pleasure to attain a greater reward.  In an emotional context, self regulation refers to the ability to calm yourself when upset or even keep yourself from getting upset in a the first place when some sort of trigger arises.  Kids do not have the full cognitive ability to self regulate at all times, their brains simply are not developed enough to do so.  Hence, tantrums occur.  Learning self regulation is a lengthy process that occurs throughout development and can still be learned into adulthood.

Developmentally, even newborns turn their heads away from things they perceive as noxious such as, loud noises or bright lights.  By about age 12 to 18 months, children are able to change their behaviors upon request, if not all the time.  They respond to social and verbal cues from their parents such as “blow kisses”. By about age two, if a known caregiver is not present, they are able to transfer these skills with people they don’t know as well.  From age 3 to 11, these skills continue to grow.  Kids are beginning to learn that they need to wait until mom is off the phone until they can receive that snack they want.  Of course, they are still not able to completely resist impulses at this age, as any parent of a young child will attest!

Older kids and adolescents, while better at self regulating than younger children, may still have problems curbing impulses.  As their brains develop, though,  they are better able to know what works for them and what doesn’t (parents also are learning these things about their own children).  For example, a child may decide to go outside and play when they are angry with a sibling simply because they internally know it will distract them from the upsetting incident.  Similarly, an adolescent may use that same intuition to reach out to a friend to help them calm their nerves before a tough test at school.

What might keep a child from being able to comply with requests or calm themselves down?  Many factors as it turns out.  A child who doesn’t want to play with a certain toy is more likely to help put it away.  Other factors such as fatigue or hunger can affect all of us in being able to keep our emotions in check.  Whatever the situation, kids who buy into the request have an easier time complying than those who don’t agree.  For this reason, it’s recommended to give the request a positive spin rather than a negative.  For example, instead of saying, “You can’t have candy for breakfast!’, say, “How about some delicious eggs for breakfast?” It’s always a good idea to help your child see, in as few words as possible, the positive aspects of a given choice.

The following are also great ways to help your child self regulate as they grow from infants to adolescence: (Gillespie, 2006)

  • Observe:  A baby will tell you she’s hungry by fussing or crying.  But an older child is harder to read.  They may come home from school out of sorts.  You may need to help them to regulate themselves by offering a snack or sitting down to talk with them.  You can also help identify their personal triggers such as crowded spaces or noisy areas.
  • Respond:  Be aware of your child’s particular needs.  Do they need some time and space?  Or do they need tighter routines and order? In the above example, a child may need to move their body to help them reorganize themselves after a busy day or a fight with a friend.
  • Provide structure and predictability:  Let your child know if things may change.  Give them an idea of what’s happening that day or week.  Keep a family calendar.
  • Keep it developmentally appropriate:  You can’t expect a toddler to sit quietly in a waiting room for half an hour.  Bring toys or games to keep them occupied.  For older kids, ask them if they need some space.  Let them know you are there when they need you.
  • Set age appropriate limits:  For younger kids, for example, they need to stay in line so the teacher knows where they are. Explain why teachers have the expectations that they do.  For older kids, develop contracts or agreements to let them know you respect their safety and their space.
  • Show empathy and caring:  For all kids, no matter their age, it’s vitally important that we as parents respect their needs and treat them as people of value.  In the long run, this is what helps them handle strong emotions.
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Parenting the Highly Sensitive Child

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We have lots of kids who come through our doors that parents describe as “sensitive.”  What does this mean?  The book The Highly Sensitive Child written by Elaine Aron, defines a sensitive child as… (from website)

A highly sensitive child is one of the fifteen to twenty percent of children born with a nervous system that is highly aware and quick to react to everything. This makes them quick to grasp subtle changes, prefer to reflect deeply before acting, and generally behave conscientiously. They are also easily overwhelmed by high levels of stimulation, sudden changes, and the emotional distress of others. Because children are a blend of a number of temperament traits, some HSCs are fairly difficult–active, emotionally intense, demanding, and persistent–while others are calm, turned inward, and almost too easy to raise except when they are expected to join a group of children they do not know. But outspoken and fussy or reserved and obedient, all HSCs are sensitive to their emotional and physical environment.

Sensitive kids require extra attention and modification from their families.  The best route to effective intervention is to accept them where they are and not try to change them.  You can try to change your approach to your child in some different ways, though, to keep things calmer at home and provide some much needed predictability.  Sensitive kids tend to get “triggered” more easily.  They are more emotional and struggle to not become overwhelmed.

For parents needing some peer support, this series of articles on the blog Scary Mommy is really helpful.  Raising a Sensitive Child and My Imperfect Child give perspective on what it’s like to raise a sensitive kid.  Some additional reading is a book that has been recommended by parents is by Ted Zeff called The Highly Sensitive Boy.

In any event, parents often confront a difficult issue with these sensitive (or “emotional” or “difficult” as frequently labeled) is how exactly to discipline them so as not to break their fragile spirits.  From the book and this article in Creative Child magazine, we have some ideas.

Firstly, there are discipline techniques that should definitely be avoided.  Shaming, by way of name calling and “why can’t you get this?” type of correcting are perceived very negatively by your sensitive child and be potentially very detrimental.  Teasing a sensitive child is bound to provoke their intense emotions and likely will not be felt in the playful nature that was intended.  Best to be direct.  Physical discipline is also devastating to sensitive kids and most childhood developmental specialists warn against using it with any kids.  Time outs likely will be perceived as being sent away by sensitive kids and can take an additional emotional toll.  Finally, being too permissive in an attempt to avoid tears or meltdowns is to be avoided as well.  Loving correction is best.

Discipline Techniques That Work Well:

  • Be careful of your tone.  Loud does not mean you will be listened to any better, and to a sensitive child can be even more harmful.
  • Connect first.  Remind your child you love them and gently tell them what your concerns are.  You don’t want to be perceived as threatening.
  • No time outs.  Instead, take your child someplace that will help them to calm down and peacefully explain what went wrong and what should happen next time.
  • Consequences should be mild.  Most sensitive kids will adjust their behavior based on their ability to see it displeases you and is not acceptable within the family.  Consequences that make them stand out are shaming and to be avoided.
  • Follow up.  Have play time, and use positive language after the discipline has occurred.  This restores connection.

Hope these are useful to you and your family.

Ask any of our OT’s if you have questions or ask about our lending library for resources on sensitive kids.

 

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Vision and Your Growing Child

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The Amazing Vestibular System

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Hello from the APT book club!

apt photoWe recently met at Tamar’s lovely home to discuss “The Whole Brain Child” by Dan Siegel and Tina Payne Bryson.

The Whole Brain Child provides 12 strategies to “nurture” the child’s mind as they grow and mature.  It’s an extremely user-friendly book that makes the neurology easy to understand and the strategies easy to implement.  We have been using some in the clinic (and with our own kids!) since reading the book, many of us for the 2nd time.  We have been using the Wheel of Awareness, “What would you do?” questions, engage don’t enrage and S.I.F.T. most specifically.  Feel free to ask about the book or borrow one of our copies.  We’re here for you!

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Sensory Processing 101: What does it mean?

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Clothing for Sensory Kids!

A parent shared the link for this clothing line called “Independence Day” for her son with autism.  Getting dressed with all the belts, snaps etc. was causing her to set her alarm for an hour earlier just to help him get ready for school.  In addition, the fasteners were irritating to him.  She discovered this line of clothes for young adults which are fashionable, comfortable and you can even purchase a GPS tracker for kids who are at risk for wandering.  The line includes t-shirts, dresses, tunics, leggings and cargo pants.

If you are looking for other sensory friendly clothing for other ages, check out this blog post on Friendship Circle.  These include soft clothes, swimwear, shoes and easy to put on socks.  Check it out!  Please speak to your occupational therapist before ordering any specialized clothing.  We can help you figure out if pressure garments or compression vests are right for your child.

 

from the Independence Day website

from the Independence Day website

 

 

 

 

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Do You Have a “Picky Eater”?

Recently, the New York Times blog Motherlode did a series on picky eaters.  The term “picky eaters” is somewhat tricky; you don’t want to pigeon hole your child into a role by calling them something in front of them.  And by the way, most kids are picky eaters.  However, on the website, they tried some new and inventive ways to get kids to eat new things.  They set family goals (meeting together to come up with them, not just parents) and they set family-friendly, non-blaming rules.  For the full article, go here.  Below is a brief synopsis of what they did specifically that worked to help families eat a better variety of foods and make it so there was only one meal being prepared.  (Keep in mind some of our kids have genuine food sensitivities, allergies and triggers that this plan will not address.  Please work with your OT if this applies to you).

photo from WebMD "Quick Tips to Feed a Picky Eater."photo from WebMD “Quick Tips to Feed a Picky Eater.”

Create a mission statement together. What do you hope to achieve together by the end of the six weeks?

Make a few “mealtime rules” for everyone. See below.

Cook one meal together this week. Based on your family’s preferences.

Plant a small herb garden Put a few plants in the windowsill or backyard to harvest from later.

Try one new food Taste something that you’ve never had before and write a quick sentence of what you thought of it to share next week.

If you have a picky eater in the family, know that it can’t change unless you try, and better yet, try together. Create your own “picky eater project” and let us know what works!

Here are the “rules”that the Motherlode readers made:

10 Rules of Picky-free Parenting:

1. As parents, we will be good role models. We will only ask the kids to eat foods that we are willing to eat ourselves.

2. As parents, we will decide what foods are offered, when, and where. As kids, we will decide of the food that is offered, what we will eat and how much.

3. We will value the process of learning to be more adventurous eaters. We will be willing to try new foods, even if it is just a tiny bite.

4. We do not have to clean our plates. We will listen to our bodies and let hunger be our guide.

5. We will not offer food rewards. In other words, we do not have to ‘eat our vegetables’ in order to get dessert. We will not reward good behavior with sweets and ‘treats’.

6. Mealtimes are a family affair. As often as we can, we will shop, cook, and eat together.

7. We are one family, and we will eat one meal. We will not make separate meals. But we will be sure to include at least one thing each family member likes at each meal.

8. We will learn together about food, nutrition, farming, and cooking.

9. We will have fun, play, and experiment with new foods.

10. We will be consistent in following these rules, but not rigid.

For more in the series, including “Nudge Don’t Push,” “Peer Pressure Helps Picky Eaters Try New Foods,” “12 Ideas to Take Back the Dinner Table,”  and “This Kind of Picky Eater is made, not born,” go to the website here.  All the articles are under “The Picky Eater Project.”

Please see a follow up post on ideas for what to pack for lunch now that the kids are back in school!

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From “A Sensory Life”: Homework Success

You are probably already starting to have some homework battles at home.  It’s a great idea to spend some time planning for homework success for your child.  This means:  Where are they going to do it? When?  What equipment do they need?  What strategies work best for my child?  This article is from the “A Sensory Life” blog that has lots of great ideas.  We are happy to help you figure out a way to set up your child for success when they are doing their homework.  Just ask!

SETTING YOUR KIDDO UP FOR HOMEWORK SUCCESS!   
SENSORY STYLE!

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The sensory strategies below apply to ALL children, and are of utmost important for those with sensory differences.  After a long challenging day at school,  the last thing a child needs is homework…but since I can’t do anything about that part, I will do what I can do, which is provide sensory solutions!  Two things to keep in mind: 1. The brain and nervous system are still sorting out and processing all of the multi-sensory input from the school day, so insisting on homework to be complete the minute a child gets home is probably the worst thing you can do for the brain.   2. It is critical to give the brain time to sort out and decompress, THEN re-boot the brain by sensory activities to maximize attention to task, executive functioning and cognition, and to make the homework process efficient and a success!

TOP 16 SENSORY STRATEGIES FOR HOMEWORK! 

  • Give the child a break!  At least 30 minutes of free sensory play when they arrive home from school, and this does not count screen time (That can perhaps be the reward after homework)
  • During the 30 minute break, offer various sensory activities, primarily vestibular and proprioceptive 
  • Also suggest resistive sucking and blowing games prior to homework such as a bubble mountain
  • Offer a crunchy or chewy snack during homework or drinking something resistive through a straw, such as a smoothie or even yogurt or pudding
  • Offer chewing gum during homework or another oral sensory tool
  • Be sure homework is complete in a quiet area, not in the kitchen or living room..unless you can be sure it will be quiet and distraction free
  • Allow the school work to be done on a clipboard while sitting in a squish box or in another sensory retreat with adequate lighting
  • Offer earplugs or noise cancelling headphones during homework (even when in a quiet place) as the sound of the fan or noises outside can be enough to disrupt sensory processing for those who have difficulty filtering out auditory input
  • Try using a vertical surface for any written homework, such as an easel or even taping the work to a flat surface on the wall.  You can also encourage using a chalkboard or dry erase board for working out math problems and such.
  • Use an indoor or outdoor swing or trampoline for working on memory type homework such as studying for a test or for studying a spelling list
  • Use a ball chair instead of a standard chair
  • Place Theraband or other resistance bands around the base of the chair for pushing and pulling with the legs, or wrap over shoulders for deep pressure and resistive work with the arms. The resistance bands can also be wrapped around the arm of the chair.
  • Another alternative is laying prone on elbows for working on homework, especially when reading
  • Never allow homework to be done with the TV on in the background
  • Offer tools such as a weighted lap pad or vibrating pillow to be used during homework
  • And how could I forget, a fidget toy of course!
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Making a Balanced Lunch for your Child

This post was written by Caroline Kaufman, MS, RDN on “Kitchen Explorers”; part of the PBS Kids website.  You can find the article here

We often field questions from parents who are worried that their kids are not eating a balanced diet.  It’s important to try and keep calm.  We can help you when sensory and/or oral motor issues are interfering with your child’s diet.  But these are some common sense suggestions to help make a lunch your child will eat.  Remember that if your child isn’t getting the proper nutrition during the day (either at breakfast or lunch), you may have a meltdown on your hands when they get home from school.  Also, one of the most regulating things your child can do during their school day is sip water from a water bottle.  In any event, get your child involved!  

Does making school lunch stress you out? Of course it does! You have to pack a balanced, edible meal five days a week for a child who hates sweet potatoes one week, and adores them the next. But just because it can be stressful doesn’t mean it has to be. With these five simple strategies that range from planning in advance to cutting yourself some (much needed) slack, you’ll be able to banish school lunch burnout.

1. Get Preppy
If you do little bits of prep throughout the week, you’ll be ready to assemble lunch in no time. For example, when you buy a bag of baby carrots, have your kids divide them into individual portions, so they’re ready to pack when you need them, advises Angie Hasemann, MS, RDN, CSP, Weight Management Dietitian, Pediatric Endocrinology at University of Virginia Children’s Hospital. Yes – the kids. Hasemann says she sees “way too many teenagers who still have their parents pack their lunch. From a very young age, kids should be involved in this chore and taught this skill. It will pay off later.” (You can use your knife skills to cube the cheddar cheese, rinse and halve the grapes, and slice those cucumbers.)

2. Don’t Overthink It
To pack a balanced lunch, just pick something from each of the five food groups. “Adults often forget that kids don’t require their food to ‘go together’ like adults do. They’re more likely to be fine with (and enjoy) random ensembles,” says Hasemann.

Here are some sample foods you can mix and match from the different groups:

  • Grains (1-2 servings): wheat tortillas, whole grain noodles, wheat bread, whole grain pretzels, and popcorn
  • Vegetables (1 serving): baby carrots, edamame, avocado, cucumbers, pickle spears, and roasted sweet potato
  • Fruit (1 serving): apples, grapes, strawberries, clementines, watermelon, kiwi, and applesauce
  • Dairy (1 serving): milk, part-skim cheese stick, yogurt, cottage cheese, and cream cheese
  • Protein (1 serving): turkey, grilled chicken, nut or seed butter, eggs, hummus, and veggie burgers

3. Give Leftovers a Second Chance
There’s nothing easier or more cost effective than re-using something you’ve already made. Meghan Girard, mother of three (ages 4, 2 ½ and 1), makes a double batch of macaroni and cheese for dinner, reheats leftovers the next morning with egg whites for added protein, spinach, and a little extra cheese, and packs it in an insulated thermos for her four year old.

Sara Haas, RDN, LDN, chef, and spokesperson for the Academy of Nutrition and Dietetics offers these creative ways to reinvent leftovers:

  • Stuff stir-fry into lettuce wraps and pack low-sodium soy sauce for dipping
  • Fold BBQ pork into burritos with low-fat cheese and pre-cut veggies
  • Turn grilled chicken into grilled chicken fingers by cutting it into thin strips and sending along BBQ sauce or honey mustard for dipping

4. Find the Fun
Try to find something you like about packing school lunches. For Girard, it’s all about the pumpkin bread. She loves to bake treats and quick breads with her kids, and when she includes a slice in her son’s lunch, he gets so excited he starts bouncing around the classroom, telling everyone his mom made it.

Maybe the fun is watching your kids pack their own lunches…nothing wrong with that. Set up bins in your refrigerator and pantry, recommends Hasemann, one for each food group. “Think a dairy bin with yogurt, cheese sticks, and individually packaged soy milk; a veggie bin; a fruit bin; a protein bin of small packages of nuts, individually portioned hummus, and lunch meat; and a grain bin of bread and pretzels. The kids can grab one food from each bin and pack their own lunch that way.”

5. Go Easy on Yourself
You don’t need to pack a perfect lunch – ever. Instead, do the best you can. Some days will be better than others. If you skipped a food group, you can serve it for breakfast or dinner, or just call it a day and try again tomorrow. In the bigger picture, your stress level has a greater impact on your child’s well being than a serving of dairy on Tuesday afternoon.

Here are easy lunch ideas to inspire you:

5 Simple Techniques to Get Started with Bento Lunches on Kitchen Explorers
Bento Lunches by Wendolonia.comPin It

Submarine Sandwich by Lisa Storms
Submarine Sandwich by Lisa StormsPin It

Customizable Pizza Kabobs by Mom to Mom Nutrition
Pin It

Caroline Kaufman, MS, RDN, is a freelance writer, blogger, and nutrition counselor with a holistic approach to healthy living. She has an A.B. from Harvard University and an M.S. in Nutrition Communication from Tufts University.

What ideas do YOU have for easy, nutritious lunches?  

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