Early Intervention Support

Building Positive Habits

Breastfeeding

Why Should You Breastfeed Your Baby?

Pediatricians recommend breast milk for baby’s health

A mother’s milk has just the right amount of fat, sugar, water, and protein that is needed for a baby’s growth and development. Most babies find it easier to digest breast milk than they do formula. The antibodies in breast milk have been proven to help protect infants from bacteria and viruses. This helps babies fight off infection and disease. In addition, there’s no need to worry about the quality of the water used to make the milk; human milk straight from the breast is always sterile.

Breastfeeding is good for mom’s health, too!

Breastfeeding saves times and money. You do not have to purchase, measure, and mix formula, and there are no bottles to warm in the middle of the night. Breastfeeding also helps a mother bond with her baby. Physical contact is important to newborns and can help them feel more secure, warm, and comforted. Nursing uses up extra calories, making it easier to lose the pounds gained from pregnancy. It also helps the uterus get back to its original size more quickly and lessens any bleeding a woman may have after giving birth. Breastfeeding also may lower the risk of breast and ovarian cancers.

The U.S. Surgeon General recommends breastfeeding

The U.S. Surgeon General recommends that babies be fed with breast milk only – no formula – for the first 6 months of life. It is better to breastfeed for 6 months and best to breastfeed for 12 months, or for as long as you and your baby wish. Solid foods can be introduced when the baby is 6 months old, while you continue to breastfeed.

Breastfeeding a Baby With Special Needs

Learning to breastfeed can be difficult for any new mother, but if your baby is born prematurely, or with a congenital condition, such as Down Syndrome or, a cleft lip or palate, breastfeeding becomes even more challenging – and important. Breastfeeding can be a calming respite from the emotional ups and downs of raising a special-needs baby, and your child will reap the nutritional and immunological benefits of breast milk.

“A baby with a cleft lip or palate, for example, is often more prone to developing upper respiratory problems, such as colds, allergies, and ear infections,” says Aimee Creelman, a breastfeeding consultant at St. Luke’s Hospital in San Francisco. “Many studies show that these babies do much better when they get their mother’s milk.”

Breast milk helps babies with heart problems or cystic fibrosis gain needed weight. It can also help prevent the respiratory infections and bowel problems that are common with Down Syndrome.

“Breast milk can help protect your baby from infections in surgery and help them heal afterward,” says Jan Barger, a lactation consultant in Wheaton, Illinois. “Sometimes a mom feels helpless while the doctors are busily trying to help her child, but breastfeeding is something that only Mom can do for her baby.”

What challenges you may face

A baby with a cleft lip or palate, the fourth most common birth defect, may have difficulty latching on to your areola. The cleft palate, an opening in the roof of the mouth that goes up to the inner chambers of the nose, makes it hard for a baby to create an airtight seal on the breast. Your baby’s sucking ability will depend on the size of the cleft, as well as on the size of your breast and the compressibility of your nipple. “A compressible, soft nipple works best for a baby with a cleft palate, because if the breast is soft enough, it can press into the palate and suction can be created,” Creelman says.

A Down Syndrome baby may have muscles that are either poorly developed or too stiff (“hypertonic”); either condition can make it difficult to position her at your breast. She may also have problems in her mouth, such as a too-large tongue or a flat palate, which can affect the depth of latch and make your breasts sore.

The small jaw and receding chin that are symptomatic of Pierre Robin Syndrome, a rare condition, can also make it very difficult to breastfeed.

But just because your baby has been diagnosed with one of these conditions doesn’t necessarily mean you won’t be able to nurse. “The amount that a disability affects breastfeeding depends on the degree and type of the condition,” Barger says. “The only condition that I know of where you absolutely can’t breastfeed is galactosemia, when the baby can’t metabolize lactose.”

How do you solve these problems?

Although the challenges are different for different conditions, many of the solutions are similar. The first step is to establish your milk supply. If your baby doesn’t take to your breast immediately, you should start pumping as soon as possible after the birth and pump every two or three hours, as often as a baby would nurse. It’s equally important to make sure you stay well nourished and well rested. “There’s a lot of stress and anxiety for a mom whose kid is in intensive care and that can affect milk supply,” Creelman says. “Our emotions play a big role in our milk’s ability to let down.”

It’s easy to become overwhelmed by concern for your baby and your desire to establish a bond with her, but these emotions can become detrimental to breastfeeding. “I always encourage moms to try and approach the first feeding without too much expectation,” Creelman says. “The first feeding attempts are times to snuggle and let the baby be close to your breasts. Just let it be a good, close bonding experience.”

Sometimes this connection can lead naturally to breastfeeding. Creelman recommends what she calls “kangaroo care,” or cuddling skin-to-skin with blankets over you and your baby. “This helps the mother build her milk supply and can often segue into breastfeeding,” she says. “Sometimes the baby will just start licking and rooting and moving its head toward the breast. It’s just one of those magic moments.”

Once you have established your milk supply and created a bond with your baby, it might be necessary to try special feeding positions or equipment. A Down Syndrome or premature baby with poorly developed muscles needs a lot of physical body support on the head and upper back. Creelman recommends the “football position,” in which you hold your baby under your arm, because you can support the baby’s chin and jaw with the same hand that’s supporting your breast. Positioning is critical for a baby with Pierre Robin Syndrome; unless he is positioned virtually on his stomach, with Mom lying beneath, he will not be able to breathe.

Sometimes, despite your best efforts, a baby with special needs may be slow to take to the breast. Before his sucking reflexes are developed, you can provide breast milk through other means, such as Medela’s Supplemental Nursing System (SNS). Just fill the small bottle, equipped with a tube, with breast milk and then tape the tube to your breast or finger. An SNS is also useful for a baby who can latch on but needs supplementation. “It decreases the length of time feedings take, and you don’t run the risk of creating a nipple preference for the bottle,” Barger says.

It’s generally best to avoid bottles and pacifiers, because a baby may get used to the feel of the rubber nipples and refuse to go back to the breast, a state known as “nipple confusion.” But in some cases, a bottle can help. Creelman recommends the Haberman Feeder, a bottle made by Medela, for babies with a cleft palate. “It has a soft silicone nipple that’s a bit elongated and a chamber so the person who is doing the feeding controls the flow, based on how well the baby’s doing,” Creelman says.

Another helpful accessory is a nipple shield, which gives more definition and firmness to the nipple. “This can help a baby who is having difficulty latching on,” Barger says. “But in general, you want to use as few interventions as possible and make things as natural as you can.”

Where can I go for more help?

Even more than other children, special-needs babies must have routine checkups with a pediatrician to ensure that they are developing normally and healthily. You’ll also need emotional support from your doctor, partner, and family, since learning to breastfeed your baby will require a lot of patience and flexibility.

“One of the best things to do is talk to other mothers who have been there,” says Barger. Your hospital should be able to refer you to a support group. If not, try some of these resources:

• Smiles, an organization for families of children with clefts, hosts an online discussion forum.
• The Nursing Mothers Council provides breastfeeding information and support on their 24-hour referral hotlines. Call their National Referral Line at (650) 599-3669.
• La Leche League International provides support for breastfeeding mothers. To find a group or trained leader in your area, call (800) 525-3843 or visit the La Leche League’s Website. Accredited La Leche League leaders will also answer breastfeeding questions via e-mail.
• The La Leche League catalog offers a variety of publications for parents of challenged babies, such as Breastfeeding a Baby With Down Syndrome, (LLL Publication #23a), Nursing a Baby With a Cleft Lip or Palate (LLL Publication #122), Special Children, Challenged Parents (LLL Publication #3791), and Give Us a Little Time: How Babies With a Cleft Lip or Cleft Palate Can Be Breastfed (LLL Publication # 3331).
• The Cleft Palate Foundation publishes a free 20-page pamphlet called Feeding an Infant With a Cleft. To order, call (800) 242-5338.

Additional Resources

• Wide Smiles, a resource for parents about cleft lips and palates, provides step-by-step basics pertaining to clefts and feeding.
• Nobody Smiles Like I Do is a first-person account of learning to breastfeed a baby with Down Syndrome and a heart condition.
• Visit the Pierre Robin Network and meet other families of children with Pierre Robin Syndrome and learn how they’ve dealt with the breathing and feeding problems that can arise.

Helping Your Child With Transitions

Take a moment and remember the last time you were absorbed in a really good book. Or the last time you were right in the middle of trying a new recipe or craft project. Then think about what it feels like when someone or something else demands your attention in the middle of that activity. What are some of the emotions that come up? Maybe some of them are frustration, anger, exasperation, exhaustion. Children feel these same kinds of emotions, yet don’t always have the coping skills to address them in acceptable ways.

Now put yourself back in the middle of that book or recipe or craft project. This time, imagine that you know ahead of time that you have to stop on page 75, or take a quick break when the noodles are boiling. Imagine that you know that after three pages of scrapbooking you’ll need to put your materials away and clean up. Makes it a little more manageable, right?

Verbal cues are an absolute necessity when encouraging your child to transition from one activity to the next. Cueing should take place before, during and after the transition. For example: Before, “After this tower, we’ll put the blocks away so we can have lunch.” During, “Time to put the blocks away so we can have lunch.” After, “Nice job putting the blocks away! Now it’s time for lunch.” Of course, this doesn’t usually happen this smoothly, and that’s okay. Kids aren’t always going to like the fact that they have to stop something that they’re enjoying. Here are some steps to take to move towards smoother transitions:

• ALWAYS use verbal cues before, during and after a transition.
• Use verbal cues that your child can understand. Young children don’t understand abstract time frames like 5 or 10 minutes. Use concrete references like, “Three more times down the slide.” Then, help your child count reminding them how many times are left after each turn. Or “After Mr. Rogers, we’ll turn the television off.” Then remind your child several more times before the end of the show.
• For children who have a hard time following verbal directions, picture schedules and cards can be helpful. Pointing to the picture of the next activity, or handing your child the picture and letting them carry it to the next activity can be helpful in transitioning. Frequently, these kids simply don’t understand or can’t process the verbal direction alone. This technique can be particularly helpful in classroom settings.
• Establish and maintain regular schedules and routines in your household. When children know what to expect and can anticipate upcoming transitions, they can maintain a sense of organization and order leading to smoother transitions.
• Allow for adequate time for children to engage in their preferred activities without interruption.

Transitions will always be difficult for your young child. Developmentally, they’re simply not equipped to always be able to leave an activity that they’re enjoying and move to a frequently less desirable one. Keep in mind that this, like any other step in your day, will be exacerbated by lack of sleep, hunger or illness. Remember, even though they may put up a fight, the parent is the one setting the rules and limits. If it’s time to leave the playground, it’s time to leave the playground. And luckily, at least for a little while, we’re bigger than they are and can scoop them up under our arms when all else fails!

Eliminating Distractions

In today’s age of electronic everytthing, it’s rare to have a truly quiet moment. A child’s “down time” is frequently spent with the television on or playing video games. Even many of the toys we give our youngest children involve lights and music. All of this stimulation leaves little room for self reflection, critical thinking, imagination or problem solving.

Certainly, too many distractions prevent children from attending to one task at a time and sticking with it until completion. Yet, these are the skills that are highly valued in classroom settings. Promotion of these ways of thinking needs to start early on and requires turning off the television or computer and allowing your child to simply be with his or her thoughts and imagination.

Here are some ways to reduce the constant distractions in your child’s environment:

• Limit your child’s television watching to about an hour a day, if at all. The American Academy of Pediatrics recommends NO television for children under two.
• Offer toys that don’t require batteries and encourage imagination, creativity, problem solving and space awareness such as wooden blocks, simple dolls, stacking/nesting cups, inset puzzles, etc.
• Turn the television OFF when nobody is actively watching. Train yourself to get used to not having it on in the background. Instead, if you must, keep gentle music playing quietly in the background.
• Balance out media based games with simple turn taking or solitary games. If your child plays 15 minutes of a computer game, then spend at least 15 minutes engaging in non-media activities.
• Create a “quiet spot” in your home where your child can go to look at books, color, rest or just think. For school age children, it’s important to have a spot that is free of too many visual or auditory distractions where they can complete school work, read and do craft projects.
• Model “quiet time” behavior. Let your children see you sitting quietly reading a book, listening to music or just thinking.

Let’s face it, distractions are a part of modern life and there’s no way to completely eliminate all of them. Unless you plan to move to a deserted island, your kids will be exposed to an almost constant stream of sounds, sights, smells, textures and tastes. You can, however, find simple ways every day to encourage your child to spend time with only his or her thoughts and ideas...after all, it’s the thoughts and ideas – not the games they play or television shows that they watch – that truly make up the “who” of our children. Let’s let them figure out that “who” without so many distractions!

Positive Ways to Change Behavior

Here is a compiled list of proven strategies to use to help your child learn how to behave:

What doesn’t work

• Yelling
• Scolding
• Lecturing
• Threatening
• Bribing
• Spanking
• Name calling
• Criticizing
• Sending your child to bed

What does work

• Ignore
  If your child is having a temper tantrum, calmly leave the room and ignore him/her. (You can ignore interrupting, nagging, silly questions, siblings bickering, whining, stuttering, “I hate you” statements. Never ignore if your child is hurting someone else or themselves or breaking something on purpose.)
• Change the situation
  If your children are fighting, have them stop playing together until they can calm down and play nicely.
• Change the environment
  Your toddler keeps playing with your cell phone, so do not leave it out where he/she can reach it.
• Say what you want
  Tell your child want you want him/her to do instead of what you do not want him/her to do. Say, “Remember, we must walk inside.” instead of saying, “Do not run!”
• Distract
  There is only one red ball. Your child and his cousin both want the red ball. Pick up your child and have him help you feed the fish.
• Take away a privilege
  Your older child teases your younger child. Tell the older he cannot stay up and watch his favorite TV show.
• Positive feedback
  Your child cleans up his/her toys before you ask. Remember to give him/her a hug and a thank you.
• “If-then”
  “If you clean up your room, then we can go to the park.”
• Prevent
  If your child always wants to walk around in the restaurant, tell him/her before you enter that he/she must sit in his/her seat. Reward your child for his/her good behavior.
• Accept – Tolerate
  It’s a warm day in July and your child puts on his winter boots. You think it looks crazy, but you let him/her wear them.
• Catch them being good
  Your child repeatedly leaves his/her books on the floor. He/she puts them back on the bookcase without you asking him. Tell him/her, “You put away your books all by yourself. That’s great!” Look for other times you can catch your child behaving the way you want him/her to and then praise him/her.
• Active listening
  Your child tells you, “Josh isn’t my friend anymore. I hate him!” You respond, “It sounds like Josh made you mad. Why do you feel this way?”
• Charts and stars
  Give your child a visual reminder of every time he/she did something right. For example, focus on one problem. Let’s say your daughter never cleans up her toys. Give her a star for every day she cleans up. After three stars on her chart, she would get a reward.

Dealing with Temper Tantrums

When a toddler sees something he/she wants and cannot have it immediately, the natural response is to scream. Tantrums usually start around 15 months because that’s the age a young child starts to voice his/her own desires. Your child simply doesn’t know any other way to communicate the anger and frustration he/she is feeling. Being hungry, tired, sick or are too excited can trigger a tantrum.

Temper tantrums are completely normal and an important developmental milestone.

Ways to cope with temper tantrums

1. Ignore it. If possible, go to another room and do not talk to your child until he/she has calmed down.
2. If this doesn’t work, try to distract your child so he/she forgets why he/she was upset.
3. If your child is extremely upset and is hitting and kicking, try using a brief time-out by either holding him/her firmly, or putting him/her into a playpen or other safe area.
4. When the tantrum ends, don’t refer to it. Give your child a big hug and start a new activity. Forgetting about the tantrum is better than discussing it.
5. Help a young child learn the words he/she needs to express the emotions he/she feels. For example, “I know you are mad, but we do not kick the television when we are mad.”

Using the time-out tactic

A time-out is an effective strategy to use with children aged two and older. Time-outs are best used for behaviors that can hurt the child or others, such as hitting, kicking, biting, etc. Here’s how to use a time-out:

1. Explain the rules. Tell your child that he/she cannot get out of the chair until the timer rings. He/she cannot talk, watch T.V., play with toys, kick the wall, or scream.
2. Put a chair in a boring location. The bottom of the steps can be used if you don’t have a child’s chair.
3. Tell the reason. Your child might not remember what he/she did wrong. Tell your child, “You hit Maria so you are in time-out.”
4. Act immediately. If too much time passes, the time-out will not be effective.
5. Do not talk. If your child tries to talk you out of the time-out, ignore him/her.

Establishing Good Nutritional Habits

Babies and toddlers – adults, too – are their healthiest if they eat a variety of wholesome foods. Since the early years of your child’s life are such an important period of growth, make sure the baby’s diet includes foods rich in vitamins, proteins, carbohydrates, fats, and fiber.

Recommended foods for a l-year-old
Food	Serving
Milk and cheese	4 servings per day
(1.5 oz. cheese/ 1 c. milk), 1/2 c.
Meat group (protein foods)	3 or more servings per day
(1 egg, 2 T lean meat, fish, poultry)
Fruits and vegetables	At least 4, including...
Vitamin C source (citrus fruits, berries, tomato, cabbage, cantaloupe), 1/3 c. citrus	1 or more, twice as much tomato as citrus
Vitamin A source (green or yellow fruits and vegetables), 2 T	1 or more
Other vegetables (potato and legumes), 2 T or other fruits (apple, banana, etc.), 1/4 c.	2
Cereals (whole-grain or enriched)	at least 4
Bread, 1/2 slice Ready-to-eat cereals, 1/2 oz. Cooked cereal (including macaroni, spaghetti, rice, etc.), 1/4 c.
Fats and carbohydrates	to meet caloric needs
Butter, margarine, mayonnaise, oils (1 T = 100 calories)
Desserts and sweets	1 portion
Pudding or ice cream, 1/3 c. 2 - 3" cookies Cake, 1 oz. Pie, 1-1/3 oz. Jelly, jam, honey or sugar, 2 T

Recommended food for a 2 - 3-year-old
Food	Serving
Milk and cheese	4 servings per day
(1.5 oz. cheese/ 1 c. milk), 1/2 - 3/4 c.
Meat group (protein foods)	3 or more servings per day
(1 egg, 2 T lean meat, fish, poultry) Peanut butter, 1 T
Fruits and vegetables	At least 4, including...
Vitamin C source (citrus fruits, berries, tomato, cabbage, cantaloupe), 1/2 c. citrus	1 or more, twice as much tomato as citrus
Vitamin A source (green or yellow fruits and vegetables), 3 T	1 or more
Other vegetables (potato and legumes), 3 T or other fruits (apple, banana, etc.), 1/3 c.	2
Cereals (whole-grain or enriched)	at least 4
Bread, 1 slice Ready-to-eat cereals, 3/4 oz. Cooked cereal (including macaroni, spaghetti, rice, etc.), 1/3 c.
Fats and carbohydrates	to meet caloric needs
Butter, margarine, mayonnaise, oils (1T = 100 calories)
Desserts and sweets	1-1/2 portions
Pudding or ice cream, 1/3 c. 2 - 3" cookies Cake, 1 oz. Pie, 1-1/3 oz. Jelly, jam, honey or sugar, 2 T

Recommended food for a 4 - 5-year-old
Food	Serving
Milk and cheese	4 servings per day
(1.5 oz. cheese/ 1 c. milk), 1/2 - 3/4 c.
Meat group (protein foods)	3 or more servings per day
(1 egg, 2 T lean meat, fish, poultry) Peanut butter, 2 T
Fruits and vegetables	At least 4, including...
Vitamin C source (citrus fruits, berries, tomato, cabbage, cantaloupe), 1/2 c. citrus	1 or more, twice as much tomato as citrus
Vitamin A source (green or yellow fruits and vegetables), 4 T (1/4 c.)	1 or more
Other vegetables (potato and legumes), 4 T (1/4 c.) or other fruits (apple, banana, etc.), 1/2 c.	2
Cereals (whole-grain or enriched)	at least 4
Bread, 1-1/2 slices Ready-to-eat cereals, 1 oz. Cooked cereal (including macaroni, spaghetti, rice, etc.), 1/2 c.
Fats and carbohydrates	to meet caloric needs
Butter, margarine, mayonnaise, oils (1T = 100 calories)
Desserts and sweets	1-1/2 portions
Pudding or ice cream, 1/3 c. 2 - 3" cookies Cake, 1 oz. Pie, 1-1/3 oz. Jelly, jam, honey or sugar, 2 T

Recommended food for a 6 - 9-year-olds
Food	Serving
Milk and cheese	4 servings per day
(1.5 oz. cheese/ 1 c. milk), 1/2 - 1 c.
Meat group (protein foods)	3 or more servings per day
(1 egg, 2 - 3 oz. lean meat, fish, poultry) Peanut butter, 2 - 3 T
Fruits and vegetables	At least 4, including...
Vitamin C source (citrus fruits, berries, tomato, cabbage, cantaloupe), 1 med. orange	1 or more, twice as much tomato as citrus
Vitamin A source (green or yellow fruits and vegetables), 4 T (1/4 c.)	1 or more
Other vegetables (potato and legumes), 1/3 c. or other fruits (apple, banana, etc.), 1 medium	2
Cereals (whole-grain or enriched)	at least 4
Bread, 1 - 2 slices Ready-to-eat cereals, 1 oz. Cooked cereal (including macaroni, spaghetti, rice, etc.), 1/2 c.
Fats and carbohydrates	to meet caloric needs
Butter, margarine, mayonnaise, oils, 2 T (1T = 100 calories)
Desserts and sweets	3 portions
Pudding or ice cream, 1/3 c. 2 - 3" cookies Cake, 1 oz. Pie, 1-1/3 oz. Jelly, jam, honey or sugar, 2 T

Recommended food for a 10 - 12-year-olds
Food	Serving
Milk and cheese	4 servings per day
(1.5 oz. cheese/ 1 c. milk), 1/2 - 1 c.
Meat group (protein foods)	3 or more servings per day
(1 egg, 3 - 4 oz. lean meat, fish, poultry) Peanut butter, 3 T
Fruits and vegetables	At least 4, including...
Vitamin C source (citrus fruits, berries, tomato, cabbage, cantaloupe), 1 med. orange	1 or more, twice as much tomato as citrus
Vitamin A source (green or yellow fruits and vegetables), 1/3 c.	1 or more
Other vegetables (potato and legumes), 1/2 c. or other fruits (apple, banana, etc.), 1 medium	2
Cereals (whole-grain or enriched)	at least 4
Bread, 2 slices Ready-to-eat cereals, 1 oz. Cooked cereal (including macaroni, spaghetti, rice, etc.), 3/4 c.
Fats and carbohydrates	to meet caloric needs
Butter, margarine, mayonnaise, oils, 2 T (1T = 100 calories)
Desserts and sweets	3 portions
Pudding or ice cream, 1/3 c. 2 - 3" cookies Cake, 1 oz. Pie, 1-1/3 oz. Jelly, jam, honey or sugar, 2 T

Recommended food for a 13 - 15-year-olds
Food	Serving
Milk and cheese	4 servings per day
(1.5 oz. cheese/ 1 c. milk), 1/2 - 1 c.
Meat group (protein foods)	3 or more servings per day
(1 or more egg, 4 oz. or more lean meat, fish, poultry) Peanut butter, 3 T
Fruits and vegetables	At least 4, including...
Vitamin C source (citrus fruits, berries, tomato, cabbage, cantaloupe), 1 med. orange	1 or more, twice as much tomato as citrus
Vitamin A source (green or yellow fruits and vegetables), 1/2 c.	1 or more
Other vegetables (potato and legumes), 3/4 c. or other fruits (apple, banana, etc.), 1 medium	2
Cereals (whole-grain or enriched)	at least 4
Bread, 2 slices Ready-to-eat cereals, 1 oz. Cooked cereal (including macaroni, spaghetti, rice, etc.), 1 c. or more
Fats and carbohydrates	to meet caloric needs
Butter, margarine, mayonnaise, oils, 2 - 4 T (1T = 100 calories)
Desserts and sweets	3 - 6 portions
Pudding or ice cream, 1/3 c. 2 - 3" cookies Cake, 1 oz. Pie, 1-1/3 oz. Jelly, jam, honey or sugar, 2 T

Toilet Training

Signs of readiness

Most children are not ready for toilet training until at least 2 years old. The physical development that allows for bowel and bladder control, occurs around 18 months. However, it may be several months or another year before your child recognizes the need to go, or be aware he/she has control to do something about it. For successful potty training:

• A child must feel urge to go
• Understand what urge means
• Be able to hold off going
• Get to the toilet
• Remove lower body clothing independently
• Sit on the toilet
• Relax enough to control

Your child needs to be able to communicate the need to go as well. Expressing wants and needs plays a key role when determining toileting readiness. Finally, consider timing when introducing toilet training. Postpone training if there may be a significant change in your toddler’s life such as a new baby, a move, transition to daycare or babysitter, etc.

Helping your child to use the Potty

Before actual training begins, purchase a potty chair that sits on the floor rather than one that fits onto the toilet seat. There are many styles of chairs; it is best to keep it simple. Toilets are not toys. Be consistent with a potty training word for urination e.g. “pee-pee”, and bowel movements e.g. “poo”, to help your child link urge with action. Pick out underpants together. Make this fun and a big deal. The disposable pants are fine when going out, but at home, pull-ups can be confusing since there is little difference in how they feel while worn and discarded just like a diaper. Keep outer clothing simple to remove e.g. sweat pants, elastic waist and no fasteners.

Potty Time

Begin a daily routine, especially if your child is having regular bowel movements by removing diaper and placing on potty around time he/she usually goes. Never force to sit too long (no longer than 5-10 minutes). If your child does not go after sitting for a few minutes, don’t punish or push. Simply say, “I guess you don’t have to go.” Begin routine of washing hands after potty each and every time. When your child does pee or poo, praise him/her! Successful toilet training is based around positive reinforcement, praise and approval. Throughout the entire day ask, “Do you need to pee-pee?” Keep potty close by, but not in front of the television. Once your child gets the hang of it, place the potty permanently in bathroom. Stay calm! Accidents are inevitable. Don’t scold or punish. Instead, take your child to the potty to make sure he/she is finished. Reassure your child, he/she will learn to make it to the potty on time. Be prepared for accidents when out of your home. Before you go out, take your child to the potty. Expose your child to potty use in different situations; don’t stay house bound. Instead, plan short trips to the park or visit a friend. Bring the portable potty chair with you. Be consistent with your routines. If you’re out of town with your toddler, continue with toilet training. Do not return to diapers out of convenience. This will confuse him/her. Use protective sheets or pads until your child stays dry at night. Your toddler will have accidents, but stay calm and be consistent.

When your child is ready to transition from a potty chair to the toilet, plan to use a step stool and fitted seat over bathroom toilet. Wiping bottom effectively, may not occur until 4 or 5 years old. Encourage your child to wipe self using wet wipes. You can check if done efficiently.

Try again

If your child never makes it to the potty on time or appears confused after several days of trying, he/she may not be ready. Return to diapers. Try training routines again in a few weeks or months when your child is showing more signs of readiness listed previously.

Advice on Toilet Training a Child with Special Needs

If your child is diagnosed with autism, Down Syndrome, mental retardation, cerebral palsy, etc. it may be more difficult to train him/her to use a toilet. While most children between the ages of 18 months and 3 years are ready to learn to use a toilet, a child with special needs may not be developmentally ready until he/she is older.

Here are the signs that your child has the intellectual and/or physical readiness to be potty trained:

• Able to follow simple instruction and be cooperative
• Is uncomfortable with dirty diapers and wants them changed
• Recognizes when he/she has a full bladder or needs to have a bowel movement
• Is able to tell you when he/she needs to urinate or have a bowel movement
• Asks to use the potty chair or asks to wear regular underwear

Here are signs that your child is physically ready to be potty trained:

• You can tell your child is about to urinate or have a bowel movement by his/her facial expressions, posture or by what he/she says
• Your child can stay dry for at least 2 hours at a time
• Your child has regular bowel movements

Being able to at least partially dress and undress him/herself is helpful during potty training. If your child has a condition that makes it difficult for him/her to physically get on the potty or get undressed, know that special potty chairs exist. You can ask your child’s doctor for other recommendations based on your child’s condition.

It doesn’t matter if your child does or does not have special needs, you’ll be more successful at potty training if you:

• Do not start potty training right before moving, bringing a new baby into the home, or any other stressful event
• Do not push your child too fast
• Do not punish your child for the inevitable mistakes
• Always provide encouragement and praise when your child is successful

In addition, it’s important that your child can sense when he/she is wet. Sometimes diapers can actually hinder the process since they can keep a child too dry. In that case, changing to underwear or training pants during the day might help your child become more successful at using a toilet more quickly.

Routines for Successful Bedtimes

Children need to be taught routines and then assisted in maintaining them in order to fall asleep and stay asleep successfully. Without bedtime routines, young children can feel disorganized and uncomfortable. Here are some ways to help your child feel confident and secure during bedtimes:

• Start quieting down after dinner. Play quiet games, read books, turn off the television. This sets the tone for a peaceful evening.
• Keep bath time calm. Rowdy water play is best saved for the backyard pool.
• Try some infant/toddler massage techniques after the bath. You don’t need to know any specific techniques – just do what comes naturally and what you would imagine would feel good to you.
• Find a cozy spot to snuggle in and read a few books. Stick with the same preset number of books each evening. Three books then lights out!
• Choose a favorite lullaby, nursery rhyme or prayer and say it each evening before putting your child in bed.
• Give a hug and a kiss, say goodnight and leave the room.

This exact routine might not work for your situation. Create whatever type of routine that will work for you and keep that structure. Bedtime routines that are established early and followed consistently keep children and parents happy!

Techniques to Encourage Waiting

Before you get upset with your toddler’s impatience, you need to remember that your child isn’t emotionally or socially ready to understand the concept of waiting. Use the following tips to prevent your two-year-old child from screaming every time he/she has to wait:

• “First/Then” language can help prepare your child that he/she might not get what he/she wants immediately. “First we will wash our hands, then we will have a cookie.”
• Stay calm, even if your toddler isn’t.
• Ask your child to look in your eyes or gently touch her shoulder. You need to make sure he/she is paying attention to you.
• If you know you will be waiting a long time, be prepared to get your child interested in various tasks.
• Let your child know you understand his/her frustration and put what he/she is feeling into words. “I know you want to go outside right now, but we must wait for the rain to stop. It’s hard to wait, isn’t it? Let’s read a book while we wait.”
• When your child gets closer to three, try a visual timer. Looking at an egg timer gives your child a concrete reminder of a set amount of time.

Of course, these strategies will not work every time. If your toddler starts whining and screaming, take a moment to ask yourself if he/she is hungry or tired. In those desperate moments when you are tempted to give in, don’t! Teaching your child how to delay gratification now will payoff in the future.

Techniques for Engaging in Play

Sometimes, despite the back flips and cartwheels we attempt, kids just don’t seem terribly interested in our attempts at engaging them in play. Before stepping up your efforts to even more outrageous antics, make sure that all of your child’s basic needs are met. As adults, we know that if we are hungry or tired, we are not usually in the mood to play either. If they seem to be well rested, well fed and have a clean diaper, here are some strategies to attempt:

• Change the type of play. If you’d been trying to engage in rough and tumble play, switch to quiet activities like books, puzzles or blocks. If quiet activities aren’t doing the trick, try motor games like airplane flying, climbing on sofa cushions or jumping jacks.
• Engage in play that requires reciprocal interaction, like rolling a ball back and forth or building a tower of blocks for your child to then knock over.
• Deliberately establish eye contact and wait for reciprocation before initiating interactions.
• Model the appropriate way to play with a particular toy while commenting on your actions. (“I put the circle in the hole. In. Your turn!”)
• Use hand-over-hand assistance to help your child use a toy appropriately.
• Follow your child’s lead and then build on what he/she shows interest in. For example, if your child is only interested in lining his/her cars up, line them up with him/her and then model pushing a car along a “road”.
• Eliminate distractions from the environment. Some children become over-stimulated very easily. If there is a lot of noise or overly stimulating activity happening in the environment, your child may not be able to focus on what you’re presenting.
• Start with just one or two simple items, and as your child is able to tolerate those, gradually add more.

Your child’s temperament plays a large role in how he or she responds to play initiations. Some kids will always prefer to sit back and watch rather than be in the middle of the excitement. If you feel that your child is excessively passive in his/her interactions or doesn’t seem to be motivated to interact with you or presented toys, talk to your pediatrician about your concerns.

Play Ideas

Want an idea for the week?

Set a theme for your week. For example, “Vehicles”. Go to the library and check out books on vehicles. Identify pictures of vehicles in magazines. Draw pictures of vehicles. Sort the play vehicles your child has at home. Go for a walk with your child and search for red vehicles, etc.

Parenting is a busy job. Although every parent wants time to sit on the floor and play with their child, this is not always possible (nor always necessary). Part of growing up is learning to do many of the “chores” of life together. Taking a task that needs to be completed, and allowing your child to participate, may take a few extra minutes but in the long run, your child will not only develop important skills, but also feel helpful and successful. It also works wonders for the adult soul, to add a new perspective to your daily routines. A few everyday activities to do with your child:

• Grocery shopping: Ask you child to point to or pick out the “blue cans” or the “milk with the pink label”. Have your child help you put things onto the conveyor belt by passing the items to them from the cart. You are working on colors, shapes and upper body strengthening.
• Unpacking groceries: Depending upon the age of your child, place him/her on the floor with the grocery bags around him/her. Ask your child to hand you the cans, or place them on the counter. Can your child sort them by color or size? For older children, include him/her in the process of putting them away, teaching him/her where a few items go. You are helping your child to follow directions, learn colors, matching, lifting, reaching, holding, strengthening and visual scanning, to name a few.
• Sorting socks: Have your child try to match the socks and hand them to you. Once bundled, toss them to your child to practice catching skills. You can take this one step further to have your child toss them into a basket to carry and put away.

Calming Techniques

Infants

Take a look in the Parenting section at any major bookstore and you’ll find a wide selection of books promising to make your baby the happiest in the neighborhood or so quiet and calm that others will think that you have some sort of magic touch. What these books don’t tell you is that everything you need to know to calm your baby, you already have right at your fingertips. There’s no magic technique and certainly no formula that can be applied to EVERY baby EVERY time he or she is upset. Take some time to get to know your baby and yourself, and you may find that you know just what to do to bring about that calm, cuddly, sweet and cooing baby you always imagined yourself with.

Many of the calming techniques that are suggested in these books are things that you may find yourself doing naturally and that your mother, grandmother and great-grandmother have done for years before you. They are things that you’ll see veteran mothers doing absent-mindedly any time they’re in the same room with a crying baby...whether they’re holding that crying baby or not. They are things that you may find yourself doing without even realizing that they’re “techniques.” Some of these “techniques” are:

• Feeding, changing the diaper, putting the baby to sleep – before trying anything else, make sure that these basic needs have been met.
• Changing the environment – overstimulation or boredom can create cranky kids. If the environment is too overwhelming to the senses, turn off the lights, change the music, stop demanding eye contact and interaction, and allow your baby to “chill out.” If your baby is lacking stimulation, provide something to interact with...keep in mind that your face is the most preferred play item!
• Swaddling – wrapping your baby firmly provides a similar sensation to the tightness he or she felt when snuggled in your womb. Swaddling can help provide proprioceptive input that can regulate and organize behavior. For some babies, swaddling even beyond three or so months is warranted.
• Bouncing, swaying, rocking, patting – these movements are soothing and again, can mimic the movements your baby experienced while he or she was on the inside. This is why babies will frequently fall asleep in the car or in the stroller (both of which can be good calming strategies).
• Shushing, singing – a gentle and constant chant in your baby’s ear can distract your baby and allow him or her to attend to something other than what’s causing the fussing.
• Massaging – you don’t need to have taken any special class to know how to touch your baby and firmly yet gently massage his or her muscles. This kind of deep, yet gentle touch can be calming and, again, can help regulate and organize behavior.

Again, there’s no magic formula to plug in that will make every baby stop being fussy and you should be leery of literature that suggests this. Fussiness is a form of communication and frequently, the most powerful and effective way for your baby to get your attention. Teaching your baby early on that his or her needs will be met swiftly and effectively will reduce the necessity for fussing. And on those days that nothing from your bag of tricks seems to work, rule out ear infection and any other physical ailment and then call your local veteran mother to come to the rescue!

Toddlers/Preschoolers

Teaching self-soothing can be more challenging with some kids. These kids just don’t seem to come equipped with that internal calming mechanism and may continue to need some external help well into school age. An Occupational Therapist trained in Sensory Integration can be helpful in these situations and an evaluation could be warranted. In the meantime, here are some strategies to try:

• Keep routines and structures simple and clear. For some kids, too much time without structure can lead to disorganized behavior. Find ways to create structured activities and assign tasks to everyday routines.
• Use frequent physical touching and guiding. Sometimes kids need more than just verbal input to process a request.
• Establish a “Calm-Down” spot in your home or classroom. This spot should be free of many visual and auditory distractions but should allow for some movements like jumping, pounding, swinging, rocking, etc.
• Continue to use techniques that provide deep pressure, such as swaddling (with a much bigger blanket than you used with your infant!), massage, squishing between sofa cushions, etc.
• Provide “fidget toys” during highly structured activities like circle time or any other setting that requires your child to sit and attend. These items should be small and quiet toys that do not distract other children but that provide some sort of calming stimulation for your child. This can be a Koosh ball, a water tube, a vibrating teether, etc.

If your child seems to have extreme difficulty calming, talk to your doctor about your concerns and perhaps follow up with an OT evaluation.

Techniques to Encourage Turn Taking

Opening the front door, pulling the plug in the bathtub, washing hands for dinner, turning the television off, having the blue cup, getting to cuddle with Daddy...these are only a few of the daily turn taking events that require intense intervention and cajoling in just my household alone. Once certain suggestions are made and the idea that one might get something more or better, or could possibly attain a higher level of independence and clout within the family, my children become incredibly eager and willing. Other suggestions are made, such as tidying up the living room, and I’m lucky to even hear a peep let alone a cheerful, “I do, I do!” I’ve learned to not make suggestions but rather, to assign tasks doing my best to remember which one it was that got to flip the light switch last or to choose the bedtime book last night. My sanity is sacrificed if I remember incorrectly!

Turn taking is a challenging, yet critical skill to teach our children. I’m reminded of a poster that used to hang in my dentist’s office which listed everything that the author learned in Kindergarten and how those skills transfer into adult life and our daily interactions. Turn taking is among those skills. This is a skill that one carries from the sand box to the boardroom and certainly, into our personal adult relationships as well. I believe that the ability to take turns gracefully yet while effectively sticking up for your own needs, requires extensive prompting and coaching early on. Done properly, you can help prevent some of the hurt that will undoubtedly take place...both in the sandbox and in the boardroom.

Simple turn taking games should be part of daily play. This begins as early as Peek-a-Boo: Mommy’s turn to hide, baby’s turn to giggle, Mommy’s turn to hide, baby’s turn to giggle. Even before Candy Land and Chutes and Ladders, there are simple and fun games that even very young children can play. My children love Crocodile Dentist and Kerplunk. These are both suggestions of games that require very little explanation of rules yet are hugely effective in encouraging waiting for and taking one’s turn.

Turn taking can require some verbal and physical reminding. Remind your child that it’s “Ava’s turn to go down the slide” or “Finn’s turn to spin the wheel.” Make the language of turn taking familiar and usable for your child. Even when stacking blocks, use simple language to describe turn taking: “My turn, your turn.” Frequently, pairing the verbal reminder along with a gentle physical reminder is necessary. Placing your hand on top of your child’s shoulder to stop them from grabbing or reaching is perfectly fine and effective.

Try not to get into lengthy explanations of why it’s not your child’s turn or how long they’ll have to wait for their turn with a particular item or activity. Remember that they aren’t capable of understanding how long two minutes is and when they really want something, explaining that it’s “not fair to snatch the truck out of Ben’s hand” or asking them “how would you feel if Lillie took the doll stroller from you?” aren’t effective ways of intervening. Clear and concise language that they’re used to hearing is what’s effective: “Lillie’s turn. Your turn is next.” If you do choose to assign a time frame, be sure to use a visual or auditory timer to give a concrete cue of time.

Keep in mind that turn taking is a skill that you unknowingly model for your child from the very beginning. This happens when they observe you having a conversation with another adult, waiting in line at the grocery store, and waiting at a red light. Call attention to the fact that you take turns too. And don’t be afraid to admit that even you sometimes have a hard time waiting your turn...just like the poster says!

My Child is a Biter...What Should I Do?

“He’s a biter.” I’ve overheard daycare workers utter this phrase with disdain and judgment over and over. Biting remains one of the most socially taboo topics in daycare and playgroup circles. Its effects have both physical and emotional implications and frequently result in heightened and prolonged emotions for all parties involved...the biter, the bitten, and both sets of parents. The sword cuts both ways: the parent of a biter frequently feels embarrassed and shamed that their child engages in such behavior, while the parent of the bitten feels personally attacked and outraged. I’ve known children to be expelled from daycare (what a mark on that child’s academic record!) for excessive and unresolved biting. I’ve also known parents to pull their child out of a daycare or to stop attending playgroups to avoid their precious child from being bitten by the same repeat offender. Clearly, the simple act of biting has major implications and is a pervasive event that leads to strong emotions.

Before addressing the “What to do about Biting,” it’s important to understand the “Why” of biting. Biting, like most other behaviors, is an effort at communicating a need. Whether that need is met or not will determine the effectiveness of the communication effort. If the need is for a toy that another child has and the biter is given that toy, he will be taught that biting is a good way to get what he wants. If that need is for attention or to continue a previously playful and affectionate interaction and that attention is given, the child will learn that biting is an effective way of gaining the attention that she craves. It is important to redirect the behavior into a more appropriate and effective way of communicating.

The most commonly given advice about biting is to “Bite them back.” This is hugely misguided and ineffective advice. Please don’t bite your child back! Young children are simply not capable of putting themselves in others’ shoes and can’t transfer events that happen to them into what it must feel like for someone else. In addition, social behavior is mostly learned by what you model. If you bite them back, you’re teaching them that despite the possible consequences, biting is something that is okay.

Your goal should be to clearly and immediately communicate that biting is not acceptable. Quickly remove your child from the situation or from your lap and state firmly, “No biting.” The next step is the hardest one: WALK AWAY! Show no further emotion about the biting and discontinue your interaction...immediately. This is tough to do because as previously mentioned, biting elicits strong feelings. Continuing to berate your child and explain why biting is bad, not only is ineffective but could inadvertently be giving them the attention that could allow the behavior to continue. Instead, give the attention to the child who was bitten.

Once the situation has defused a bit, calmly return to your child and explain that your child must find other ways to tell you what he or she needs. If your child can understand language, tell her that she can point to what she wants or use her words to tell you. Remind her that biting is not okay but stay away from lengthy and complicated explanations of why.

Biting rarely continues beyond the toddler years so know that your child WILL grow out of this. These strategies will hopefully help your child grow out of biting faster...heaven forbid you have to start looking for a new daycare or group of friends!

Yoga and Families

Yoga is everywhere. You might pass a billboard with an upside-down can of Coca-Cola on it with the word “yoga” underneath, or see an advertisement for pretzels claiming that it is the only snack that does yoga, or you might see people walking down the street in your neighborhood with brightly colored sticky mats. You know where they are going and sometimes you say to yourself, “Maybe I should try yoga someday.” But, it’s something new and you don’t know where to go or how to start. Maybe you did yoga during a pregnancy or took a class in college, but things have changed since you had children and you don’t know how to find the time or if your new mommy or daddy body is up for the challenge.

The good news is that yoga is for everybody and you can find a class that works with your lifestyle, schedule and all levels of fitness. Many studios and community centers also offer Pre- and Post-Natal Yoga, Baby and Me, Family Yoga, and classes that you can bring your children to so that the challenges and expense of finding childcare are not an obstacle to your practice. Some teachers specialize in yoga for children and many schools from pre-school through high school are adding yoga to their physical fitness curriculum.

Just as every person is unique, so is each person’s experience of yoga. While a personal practice can improve physical fitness and flexibility, relieve tension and stress, lower blood pressure, support weight loss, stabilize mood and decrease back pain, practicing with your children or as a family comes with additional benefits. For many adults, sharing yoga with their children reveals that yoga doesn’t have to be so serious! Classes shared with children include stories, songs, imagination, laughter and moving together in a celebration of the body and life. If you have a personal practice as a parent, family classes are a beautiful way of sharing this part of your life with your children in a way that they can experience and understand. Family yoga practices provide a shared experience of physical joy while allowing each participant the room to be themselves. Sometimes your toddler might stay right by your side and practice with you and sometimes they may walk off and sit by themselves or engage in play with another child in the room. Finally, Family Yoga and shared Baby and Me classes are a gathering place for like-minded parents and it is a wonderful way to create community networks.

Children love yoga because the poses and breathing are natural to them. It is not always easy being little and yoga provides some tools that children can use to center themselves in the sea of physical changes, developmental transitions and social adaptation that young people experience on a daily basis. As the mother of a moody and incredibly energetic 2-year-old, I was in nothing short of awe the first time we participated together in a yoga class for toddlers. As soon as the class started, my son transformed from a body of unbridled energy to an efficient and careful participant following all the directions and enjoying the playful, yet predictable atmosphere of the class. At the end of the class, the instructor had us all lie with our legs up the wall and with my son cradled next to me, our feet touching, he sighed and I could feel him allow his body to sink into the floor and the support of my arm. For just a few moments, we breathed together there on the floor and shared peace. It was just a minute, but it was magic!

There are many wonderful resources for exploring yoga and meditation that you can share with your infants, toddlers and young children. Here are a few of my personal favorites:

• Baby Buddhas: A Guide for Teaching Meditation to Children by Lisa Desmond
  This is a beautiful book including specific ideas for introducing meditation to young children from 18-months through 3-years of age. The instructions and activities are easy to follow and Desmonds’ methods are time tested techniques.
• Helen Garabedian has published two books illuminating her “Itsy Bitsy Yoga” program. The first book on Itsy Bitsy Yoga is for infants to toddlers and the second book, is specifically for toddlers and preschoolers. She claims that the benefits of yoga for toddlers includes fewer tantrums, better sleep, improved digestion, increased listening skills, better self-expression among other things. Her books provide suggestions on complete sets of yoga poses and breathing exercises, songs and massage. The books are clear, but the suggested exercises are playful and practical.
• Jyothi Larson’s Yoga Mom, Buddha Baby: The Yoga Workout for New Moms and Laura Staton and Sarah Perron’s Baby Om: Yoga For Mothers and Babies are both excellent resources for yoga exercises for mothers to share with infants up to one-year of age. Baby Om provides workout sets organized by post-partum weeks and provides excellent guidance for using yoga to heal from surgical birth.

The only value of yoga is in the sharing of it. Creating a shared memory of movement, song and laughter is a beautiful gift you can give your family. Giving your children the gift of peace in their bodies, minds and hearts is a treasure that they can carry with them well into adulthood. Remember, if you can’t smile while you are doing it, it’s not yoga. Enjoy!

Yoga information provided and written by Sharon Rudyk of Yoga Matrika.