New School Year - Time For a New Routine

As the beginning of the school year draws near, so end the lazy, unstructured days of summer. Relaxed bed times and spontaneous outings are soon to be replaced with early morning alarms, carpool, and homework. The transition from summer to school is never an easy one and putting the reins on a child so used to the freedom of summer can be a daunting task, but every year, like clockwork, it must happen.

Ironically, the one thing we have avoided all summer can be the most helpful during this challenging time: a routine.

As much as it would appear otherwise, children thrive on routine and predictability. When they know what to expect in their daily life, they can relax (at least subconsciously). They don’t have to be at the ready, waiting to handle the next surprise or questioning you incessantly to find out what's happening next. The predictability of a consistent daily routine provides them with comfort and stability. When they don’t have to be on constant alert and can relax, they often exhibit more balanced behaviors and less melting down or acting out. A typical trait of most children is a difficulty to handle change initially. Not having a routine provides ample opportunity for children to come up with their own game plan only to become upset (insert undesirable behavioral outburst) when it’s not what they are allowed to do. To avoid this mismatch of expectations between parent and child, provide your child with a clear guideline ahead of time and then be consistent.

Additional benefits of a routine:

Sleep: A regular bedtime provides children with sufficient sleep to help them perform well in school and it can improve how children are able to control their emotions and behaviors. A consistent, calming bedtime routine can help “down shift” energy levels and get kids into bed on time.

Mornings: A morning routine for getting dressed, breakfast, packing bags, chores, etc. is helpful for the whole family. When the expectations are clear and consistent, kids know what to do and there is less rushing (and shouting). Practice this routine before the school year starts to get everyone acclimated; the longer you stay consistent with it, the more automatic it becomes.

Homework: Having a daily homework routine sets up the work and reward expectations, especially when they are kept consistent, which potentially decreases melt down behaviors. Providing children with 30-45 minutes of down time after school (i.e. snack and non-tech free playing) gives them a chance to relax and clear their heads before working. Setting a timer can help with the transition from play to homework. Providing a nutritious snack can give them the energy boost they need to stay alert for homework. Designating a homework area in the house, free from distractions (the TV should be off) but in proximity to a parent, can assist with attention and focus which in turn can increase success with homework and time spent working. TV, computer, or video games should be reserved as a reward when homework is complete and correct (check correctness to prevent rushing through the work). If kids go straight to “plugging in” as soon as they get home, the transition back into homework can be a struggle for parents and the quality of the work then produced by kids can be less if they have already “zoned out.” Limiting TV, personal computer time, and video games to 1-2 hours a day combined can have a positive effect on increasing behavior and attention. 

Extracurricular Activities: After school activities can play such a positive role in the development of children. Attending after school sports or clubs can provide more structure and also teach children important time management skills, as they have less time in the afternoon and evening to get homework done than their peers who go home after school. Be careful not to over-do it though; too many activities within a week can become overwhelming and stressful for a child. In this case, less is more. 

As an occupational therapist, I often work with children who require more than a standard routine to help them function well in their daily life. If you recognize that your child is more disorganized than his peers or has a lot of difficulty with transitions, despite putting routines in place, there may be some underlying issues preventing your child from reaching his/her potential. An occupational therapist can be helpful in determining what the underlying issues are and assisting parents and teachers with organizational strategies for the child. If you would like more information, you can contact my occupational therapy practice for assistance: www.pdc-atlanta.com. 

Great Expectations - Part I: Does Your Child Measure Up?

I'm starting a new series of posts that focus on the expectations that we, as parents and teachers, have for our children.  Our expectations of our children determine whether or not we view them as being successful in any given situation.  It is important to have expectations that are age, skill, and situation appropriate so that we do not judge their behaviors and actions unfairly.  Expectations that are too high leave us feeling disappointed, frustrated and our kids feel like failures when they don't live up to them.  Having expectations that are too low often leads to children behaving inappropriately  for their age (which can cause problems at school and with peers) and learned behavior patterns of dependency.

Consider the following scenarios of two girls who are both four years old and essentially equal in development, each with parents who have different expectations in the same situation of a morning routine:
Child A: To get her daughter ready in the morning, a mother gives her child a choice between two outfits, then gives her child instructions to take her pajamas off and put on the clothes that she picked out by herself before coming out to the kitchen for breakfast. Mom already knows she may need to come back in to give a reminder and possibly a countdown to get her daughter motivated if she gets off track (she is only 4, after all).  After a few minutes Mom checks back in to find that her daughter managed to get her clothes off, but got distracted by toys before getting her new clothes on. She praises her daughter for getting her pajamas off and then kindly, but firmly, reminds her of the task she is supposed to be doing and gives her a countdown, "10, 9, 8...." as her daughter recognizes what this signal means (based on consistency in the past) she starts getting her clothes on and mom goes back to the kitchen.  The little girl soon follows all dressed and ready for breakfast.  Mom and daughter are both happy.


Child B: To get her daughter ready in the morning, a mother comes into her daughters room and tells her to get dressed because breakfast is almost ready.  She leaves to go finish cooking.  After a few minutes she yells from the kitchen, "come on, hurry up and get dressed; breakfast is ready!"  When there is no response, she goes to her daughter's bedroom to find her daughter, still in pajamas, playing with toys.  Exasperated, the mother says, "I told you to get dressed. Why do I always have to ask more than once?!"  She then chooses an outfit and quickly puts it on her child who is pouting and resisting.  As they both go down to the kitchen the mother is frustrated and wondering why her daughter can't dress herself. The daughter is sulking because she feels her mother's disappointment.


Neither one of these mothers is a bad mom, but they both approached the same situation differently; one more successfully than the other.  The first mother understood that in order for her 4 year old to dress herself, she had to set her up for success, be patient, and give reminders until she was successful.  Because the task of getting dressed was completed within her expectations, it was successful for both mom and child.  The second mother wanted her daughter to dress herself as well (which is age appropriate for a 4 year old), but the expectation for it to be done independently from start to finish with only 1 request and no assistance was not realistic.  When her daughter didn't meet her expectations she was frustrated and the little girl didn't feel successful.

Why did both of these moms have different expectations of their child in the same situation?  Those expectations have to come from somewhere....

The Origin of Expectations
Where do our expectations of our children stem from? As a pediatric occupational therapist, my knowledge and understanding come from literature and experience with a lot of kids besides my own; but most parents don't have a professional background on child development, so where do they get the information that they base their expectations on?
- parenting books (and there are some really great ones out there too), but in my experience, this area of information is vastly underutilized by parents, for whatever reason
- the internet, where you can get a quick answer and there is some good info, but no quality control
- pediatricians offer a source wisdom, although doctor visits are often infrequent and rushed so doctors don't always have time to get the full story before they make comments on behavior issues
- past experience seems to be one of the two most common sources of expectations for behavior.  We think back to when we were kids and base our expectations of our kids from that.  This can be good and bad:  good, if you had a solid upbringing and your expectations are age appropriate; bad, if expectations of you as a child were unreasonable and age inappropriate.  For parents of multiple children, using past experience with earlier children is often helpful in creating expectations of subsequent children, but every child is different and sometimes expectations need to be adjusted for each individual child to be successful.
- word of mouth is the other most popular means of gaining information to form expectations; this is most commonly through friends and family members.  Again, this can be good and bad, depending on who you are taking advice from.  If the person you are getting your info from has a good understanding of child development and what is and isn't age appropriate, then chances are you are getting good advice.  When comparing our children to others, we sometimes can get a picture of what other typically developing kids of the same age should be able to do, but we can also get into trouble and develop skewed expectations that may not be appropriate for our own children if the comparison isn't equal.

The Breakdown - Unrealistic Expectations
Despite having multiple sources of information to pull from, I find that when it comes to having expectations of children, parents most often tend to have expectations based on how they want their children to behave in a given situation based on what's easiest for the parent and not what is most realistic for the child.  For example, expecting a two year old to sit through a 90 minute dinner without becoming restless is convenient for a parent and unrealistic for a two year old.  Or, expecting a four year old to pick up all of their toys on the first request.  The problem with this is, having expectations that do not meet the abilities of a child set everyone up for failure and frustration.  In turn, punishing (age appropriate) behavior that didn't live up to unrealistically high expectations leads to increased negative behaviors and low self esteem in children.  This problematic situation is further complicated when parents do not maintain consistent expectations of their children.  If the same type of behavior is ignored in one circumstance and then punished in another similar circumstance, how is a child supposed to know which one is correct.

Technology and Society Negatively Affecting Expectations
As our society runs full speed ahead with newer, faster technology to make our lives easier we are becoming lazier as people and parents.  I know that sounds like a harsh statement, but I see and feel the effects both personally and professionally.  Through the use of high speed technology adults, and children, have become conditioned to require little effort, control, immediate responses, and instant gratification in our lives.  We no longer have the patience to wait, work hard, work together with others, or problem solve.  And in our own virtual realities, where we can always find someone else to back up our opinions, we are always right.  What we, as parents, don't always recognize is how all of this is impacting our expectations of our children's behavior.  We no longer have the patience to tell to our children to do something more than once, to wait for them try repeatedly until successful, to teach them new things, to model good behavior and correct their behaviors appropriately.....  Our expectations of them to behave perfectly and perform perfectly without any effort on our part to teach them how to behave is completely unrealistic.  The most important part of being a parent, besides loving your children unconditionally, is TEACHING THEM!  (More on you as your child's most important teacher in a future post).
The other negative influence of technology is on the actual behavior of children.  Even if you are the model parent when it comes to having appropriate expectations of your children, overuse of technology (computer, video games, TV, iphone) will undoubtedly cause unwanted behaviors whenever they are forced to turn off their source of entertainment, and frustration, impatience, and decreased attention once their little brains are conditioned to expect instant gratification in all aspects of life.  You can avoid this by limiting their daily exposure to entertainment technology to age appropriate limits and use it as a reward to be earned for good behavior instead of an automatic right.

The Bottom Line
When our expectations of our children are higher than what they are capable of no one wins.  Instead of ignoring the problem or assuming the behaviors are due to some sort of diagnosis, it is important to take a step back and evaluate the situation.  Are your expectations of your child appropriate and realistic or would they be more appropriate for a child years older?  Clear, consistent, age appropriate expectations are crucial for success.  And children also need parents to model and encourage appropriate behaviors first.  Help your child be successful!

This first post in a series is food for thought.  After reading this, think about your own expectations of your children.  How often do they meet those expectations or are you constantly scolding or getting frustrated with their behavior?
Stay tuned for Part 2 when I discuss how to manage expectations of children to make them realistic.

Reading Early Part 2: Book Selection for Infants & Toddlers

Writing a children’s book is no easy task. In the publishing world, children’s literature is considered the hardest in which to succeed. Your audience, while small and sweet, can be a harsh critic. When they do not like a book, they don’t hesitate to slide off your lap and go play elsewhere or emphatically toss the book aside with a definite “no!” So for those of us without an education background or lots of experience around small children, how do you choose a good book?

Which Books?

Books come in countless forms these days. Even the same title will be offered in various presentations, including:

-board (small or mini-sized, sturdy cardboard)

-oversized board (great for reading aloud to more than one child; great gifts for a preschool or child care class)

-cloth

-softback

-traditional hardback

-”collections”

-books on tape/CD

-books on DVD

-electronic form such as “Leapster”

-bath

I intentionally have listed “bath” books last to emphasize my recommendation against these books. Bath books are generally constructed with PVC/vinyl, with foam inside the pages to allow for buoyancy. PVC/vinyl has been found to contain phalates and other chemicals that are harmful to children. Young children will quickly put these books in his or her mouth, and even older children can be exposed from simply touching them or soaking in the bath with them. Best to avoid these books altogether until a safe form of plastic book is created for this purpose. Alternatively, reading during bathtime can be very enjoyable, so grab a favorite book and read aloud tubside.

Now that we have an idea about the different types of books that are out there, we can discuss which books are best for children of different ages and stages.

Baby’s First Library

So you want to start your baby’s library! I would recommend hands down board books to be the bulk of your baby’s books until your child approaches her second birthday. Board books are sturdy and well-constructed, ready to be chewed, dropped in the bathtub (by accident of course!), sprinkled with crushed cheerios in the back of the car, and read over and over again. By the time my second boy came along, the only board books that needed to be replaced were those with flaps or pop-ups.

If you have not been around children’s books in a long time, you will probably have sticker shock when you start looking to begin or add to your baby’s collection. Board books are small and compact, but they are expensive. Their average price is around $6, ranging in price from about $4 to as much as $12! (Eric Carle books are wonderful, but notoriously pricey) Needless to say the bill can run up quickly when you are picking out these cute little books. A good reason to have a book registry (local bookstore or Amazon)! When my husband and I were expecting our first, we agreed to pick out 1 or 2 titles each time we were at the bookstore.

The number of titles that are now available in board book format has grown tremendously in recent years. Titles now include the “classics” such as Goodnight Moon (Brown) and The Carrot Seed (Krauss) allowing you to share books that were most likely a part of your own childhood. Books that I would call “modern classics” comprise a large number of the titles that you will see at Barnes and Noble, such as Jamberry (Degas), Hippos Go Beserk (Boynton), and Freight Train (Crews). These books have been reprinted in board book format, and you will be hard-pressed not to find most popular titles from the last 20 years as a board book. More recently, new titles that are only printed as board books have emerged. The popular “My First Board Book” series (DK publishers) and the “Little” finger puppet books series (Chronicle Books) are two noteworthy examples. (*Note: Just because a book is a “board book” does not mean it is the right match for an infant or young toddler. There are many preschool level books that have been published in board book format that are not really appropriate for infants or toddlers. If the book has a large amount of text on each page (in story format) it is probably too advanced and will bore your child. Examples include Owl Babies (Waddell) and The Runaway Bunny (Brown). Best to purchase these worthy titles in softback for an older toddler and beyond.)

So which titles to get?

Reading to your child is the most important thing. It is wonderful if you are able to create a diverse and plentiful library--but not necessary if this is not feasible. Babies under a year old will delight in just a few titles that can be read again and again. Remember that these books will no doubt make it to your child’s mouth, so be prepared for a little drool while you read aloud.

Babies less than 6 months of age are still developing their eyesight. Babies 4 months and younger have yet to develop full color vision and are still near-sighted. So at least a few of your early selections should include books that are printed in high contrast black and white with larger images. More specifically, books that include patterns and faces will be of particular interest to your baby. It is also important to pick a book that you enjoy reading. Whether it be the illustrations that draw you in, or the easy to read rhyming pattern, if you are enthusiastic and enjoy reading, than your child will enjoy listening to you. Generally speaking, the books that you select for a young baby (under age 1) should have only 1 line per page, or perhaps no words at all. Don’t expect to always be able to finish a book with a young child. Talking about what you see during your shared experience is all you need sometimes. Once he or she is able to help turn the pages, you will be lucky to read 2 pages in their entirety! Learning to turn pages is an important step in book knowledge and reading schema. A few choices might include: The Begin Smart books (Stages 1&2), Peek-a-Who? (Laden), The “Little” Finger Puppet books, Peekaboo! books (DK), and My Animals (Deneux).

Toddlers will become increasingly sophisticated in their interest and attention span for books soon after they start walking. This is no coincidence. Walking is such a huge developmental milestone for a child physically, it is hard for him to focus on much of anything else until he has reached his goal of mobility. Once reached, the brain is “freed up” to begin some cognitive leaps that you can sometimes see on a daily basis. A toddler is not just a passive listener to your reading sessions. She is becoming an active participant, excited to be making connections between the illustrations she sees and the words she hears with the rest of her world that is growing everyday. Look for books that have objects, settings, and routines that are a part of your child’s world. Labeled books are fun for your child as he begins to talk. You can make your reading time together interactive by asking your child to point things out in the book or in the room, rereading a special book two or more times, emphasizing the patterns and rhymes that are in the book, singing along to a book that follows a song, taking a themed book along on a family field trip, and making books part of a bedtime ritual. Titles to look for include Jamberry (Degas), School Bus (Crews), Touch and Feel books (DK), Big Red Barn (Brown), Sheep in a Jeep (Shaw), Dog/Cat (Van Fleet), Tip Tip, Dig Dig (Garcia), Dear Zoo (Campbell) and Time for Bed (Fox).

As your child reaches the age of two, he will have developed an attention span sufficient to allow him to sit through longer board book stories (Dig Dig Digging by Mayo or The Very Hungry Caterpillar by Carle). You can “test” this growth by trying longer softback/hardback books, such as a Curious George or Llama, Llama, Red Pajama (Dewdney). Don’t be surprised or concerned if your child loses interest after a few pages. The longer format, smaller words, and more complex story may appear overwhelming at first. Try again a few days later. Before you know it, she will be ready and excited to explore these “big kid” books.

Upcoming Part 3: A Well-Rounded Book Diet!

The Picky Eater vs The Problem Eater: Understanding your child's eating habits

I have often been told that my children are great eaters, but one scenario always sticks out in my mind.  When my kids were around 3 years and 18 months we were eating at a local mexican restaurant and the mother of a family sitting nearby remarked at how well my children ate.  Both of my kids were eating chicken tacos, diced tomatoes, beans and rice.  To us, this was normal and definitely not some of the more interesting foods that they eat, but here was this woman's 6 year old son eating nothing but Teddy Grahams for dinner.  She laughed it off in comparison to my 1 year old, but I could still sense how frustrating it was for her to have a child who wouldn't eat normal food. 

There seems to be a common misconception about what normal eating habits are for babies, toddlers, and school aged kids.  In the US, chicken fingers, french fries, hot dogs, and plain pasta have become labeled as "typical" kid food with many kids not expanding their food choices far beyond that. Restaurants and schools subscribe to this "kid food" myth too; they all serve the same four kids meals: chicken fingers, hamburger, mac n cheese, and grilled cheese, all with a side of fries.  But where's the nutrition in those meals? I wonder what happened to fresh apples, berries, tomatoes, broccoli, grilled chicken, lasagna - why aren't these considered typical kid food? Somehow common knowledge about childhood eating habits has become skewed.  The normal assumptions seem to be:
- if a baby doesn't like a certain food on the first try then they never will
- toddlers snack throughout the day instead of eating meals
- toddlers are naturally picky eaters
- there is 'kid food' and then there is 'adult food'
- kids of all ages need to be entertained by the TV to eat a meal
    In actuality, many babies and even toddlers need to have a new food introduced up to 10 times before they may eat it.  And by 10 times, I don't mean once a month for 10 months; instead, you should offer it every day or every couple of days and eventually they will try it and begin to like it.  Age 6 months - 18 months is the best time to introduce your child to as wide a variety of foods as possible because they are more open to trying at this age than later on.  I even served my children food that I hated, like beets, olives, and mushrooms.  Aside from mushrooms, they both like a greater variety of food than I do as an adult.  You may also notice that toddlers begin to get more selective in their foods than they were as babies and this is developmentally normal as they are just practicing their independence.  Continue to offer the same variety of foods and eventually they will start eating them again.

   Toddlers do tend to eat smaller portions and snack more because their busy brains and bodies have a hard time focusing on eating, but it doesn't mean that you should deviate from a normal eating schedule of: breakfast, snack, lunch, snack, dinner.  If you give too many snacks they won't be hungry for a meal. To improve mealtime success, give smaller portions; your child will ask for more if they are hungry and by adjusting your expectation of your child everyone will be happier when they meet your new, more appropriate expectations.  Toddlers may need to move during their meal (this is normal); we allow our toddler son to get down from the table and move around, but we do not feed him on the run or allow him to walk around with food.  If we don't try to impose food on him, he will get back in his chair on his own and finish his meal.  Again, adjusting the expectation that children of all ages should sit still until their meal is finished to a more age appropriate expectation can make the experience more successful for everyone.  Just avoid trying to force feed your toddler child.  It's also good to keep in mind that toddlers fluctuate in the amount of food they eat, tending to go in cycles.  Some people notice that their toddlers eat more at certain meals and less at others; some people notice that their toddlers go through phases of eating more for a few days and then less for a few days.  Either way, it's pretty typical and your child will not starve, so do not force feed.  However, if there is an underlying medical issue or disorder or your child is losing weight, then seek professional advice.

    Other than pureed food for babies who cannot yet chew, there is no difference between what adults eat and what children should eat.  When we categorize food like this we automatically limit our children.  What you feed your children from an early age is what they are going to want to eat when they are older.  So, if it's pizza, chicken fingers, fries, gogurts, and pudding now without fresh fruits and veggies and other types of food, then they are not going to miraculously start eating these new foods when they hit a certain age.  A good rule of thumb is, whatever you're eating for dinner, your kids can eat too.  If you're making barbecued chicken, corn on the cob, and baked beans then serve that to your children; you don't have to play short order cook and make them a separate meal too.  If you're making salmon, green beans, and rice for dinner, give that to your kids!  If you can start this habit between 9 and 12 months (when your baby starts eating table food), then you'll be way ahead of the game.

    Babies, toddlers, and children do NOT need to be entertained by TV or a movie to eat.  This is another bad habit to get in to!  Appropriate mealtime behavior starts with a good model of behavior (that's you, parents) and conversation is a great form of entertainment that actually makes your kids smarter (TV will do the opposite).  And if a child is watching TV while they are eating they are not paying attention to the food or the meal experience: they won't develop a love of food, they won't taste what they are eating, they won't know how to pace themselves, and they will actually eat more than they need.  The family meal is a powerful thing and has positive impacts on your relationships with your kids, communication with your kids, your children's grades, etc. (I will get more into this in a future post on the importance of family meal time).  So, if it is your expectation that your children should behave appropriately at the dinner table whether you're at home or in a restaurant, remember that you have to teach it to them first and modeling a behavior is the best form of teaching it.  Playing a DVD while they eat is keeping them quiet (only while it's on), but it is not teaching them anything and it will be harder to teach them correct behaviors once you have already started the DVD/TV habit.

The truth is that most children are born with the ability to eat and like a wide variety of foods, like: tomatoes, beets, broccoli, strawberries, blueberries, beans, grilled chicken, fish, hummus, avocado, etc.  It's all about understanding how to introduce food, reading your child correctly, having appropriate expectations and using some strategies to make eating more successful.

   When it comes to why children are picky eaters, it seems to be a bit of a chicken or the egg scenario.  It's hard to tell if any given child came hard wired to reject most food or if his parents set him up for it by automatically introducing the "typical" kid diet because that's what they thought was the norm, thus never giving their child the opportunity to develop a liking of a good variety of tastes and textures.  Children who have a medical or congenital condition that affects their ability to eat or tolerate certain foods, such as a cleft palate, low oral muscle tone, severe reflux, sensory processing disorder, or autism legitimately have atypical eating habits and we classify these eaters as "problem eaters."  Other children without an underlying cause of their restrictive diets can be classified as "picky eaters."  There are several reasons why children become picky eaters, but this post is focused more on explaining the difference between picky and problem eaters.  At the bottom, there are also strategies to use with picky eaters and helpful hints for avoiding picky eating habits.

The Picky Eater

·         The picky eater will refuse certain foods and may show a preference for certain types of food, but over time with repeated exposure will eventually add new foods and textures to their diet

·         The picky eater typically does not have any major underlying problems that require intervention; but can benefit from a few helpful hints to use at home to make mealtime and eating more successful

·         It is typical for children to be picky eaters up through the toddler years; if they have an extremely limited diet, exhibit problem behaviors associated with eating, or the pickiness extends beyond the toddler years it may be indicative of some underlying issues and the child could benefit from a feeding evaluation

Common Traits of the Picky Eater:

-          Spits out new food, but after up to 10 attempts at introducing the same food will eventually begin to eat it

-          Avoids foods with a certain taste or texture, but with repeated exposure eventually begins to add new foods to diet

-          Will take more risks eating new foods when with peers or relatives, but are more controlling in their eating preferences with parents

-          Changes preferences for food over time; i.e. begins to refuse foods that previously enjoyed but also begins to eat foods that previous wouldn’t eat

-          More likely to try new foods or eat if using new colorful dishes, utensils, games, or music during mealtime

-          May tend to graze as opposed to eating scheduled meals and snacks

The Problem Eater

·         The problem eater has a very limited diet and exhibits behaviors associated with food and feeding time; this is most often due to an underlying sensory and/or motor problem

·         The problem eater typically requires a feeding evaluation done by an occupational therapist or speech therapist with a background in oral sensory and motor development to determine the underlying problems; this child will greatly benefit from therapy to address these issues

·         The traits and behaviors of a problem eater listed below are indicative of a problem more serious than just picky eating; they can be observed as early as 6 months and persist throughout the lifespan if not corrected

Common Traits of the Problem Eater:

-          Spits out food or refuses food repeatedly, even after more than 10 attempts at introducing it

-          Has developed behaviors associated with certain foods or mealtime in general: head turning, pushing food away, crying, screaming, throwing food, gagging, throwing up, etc.

-          The young child may only eat pureed foods; the older child may develop a preference for a certain taste or texture and will only eat foods in that category

-          Will only eat what they are familiar with, including only specific brands of food

-          Refuses to touch or pick up some or most food; also delayed in self-feeding

-          Mealtimes are extremely stressful for the child and parent

-          May show delays in speech development

-          Difficulty moving food around in the mouth with the tongue

-          May have avoided putting objects in mouth as an infant or may have mouthed objects excessively

-          Avoids/dislikes tooth brushing

-          May have a strong gag reflex; or may overstuff mouth with food and then choke or spit food out

-          May continue with thumb sucking, pacifiers, bottles, or sippy cups longer than typical

-          Child tends to be very controlling, at mealtimes and in general

-          May also avoid certain clothing, textures, and playing with messy or gooey substances

Helpful hints to avoid picky eating:

-          Introduce new foods to babies 6 months to 12 months as directed by pediatrician, increasing the complexity of taste as they get older; children are most receptive to new foods before the age of 1 year

-          Introduce new and thicker textures to babies 6 months to 12 months as they show mastery over simpler textures; babies who have mastered thick textures should be introduced to table food around 9 months and eating only table food at 12 months

o    A baby is ready to be introduced to new, thicker textures when they no longer gag, tongue thrust, or spit out the stage food they are currently eating

o    A baby is ready to start on small, simple table food when they have mastered thick textures and can chew easily broken down food, such as cheerios or Gerber Puffs; look for the ability to move food side to side in the mouth

-          Children are products of their environment and will respond to food and eating based on the parents’ approach:

o    Exposing babies to a wide variety of foods before the age of 1 year will help them eat a larger variety of foods as an older child

o    Self feeding promotes independence; start encouraging self feeding with hands around 7 or 8 months and with utensils before 12 months

o    Make eating an enjoyable and social experience by always eating with or sitting with your child while they eat

-          Keep open communication with daycare about what your child is eating; if necessary, send in the food you would like your child to eat

Helpful hints to use at home with the picky eater:

-          Make mealtime fun: use brightly colored utensils and dishes (especially with pictures at the bottom); play games and/or music; eat with your child

-          A new food may need to be introduced up to 10 consecutive times before a child will try even it

-          Introduce new foods one at a time and wait until child becomes comfortable  with it before adding another new food

-          Start with what the child is familiar with, even if this is pureed foods, and gradually add small amounts of texture (such as cooked oatmeal, mushy fruits/vegetables, cooked couscous or rice, alphabet pasta, tiny pieces of cooked carrots, peas, or other soft vegetable starting with an amount 1/8” in size and moving to 1/4” in size)

-          At mealtime, introduce a new food before offering foods the child prefers

-          Go slowly! Allow the child to touch, smell, lick, or bite new foods, spitting out if necessary (continue to introduce the food several times like this); place the new food 18 inches from the child and gradually move it closer to the plate as he/she becomes more comfortable and praise all efforts at interacting with or trying the new food

-          Once the child has become familiar with the new food then present a very small amount of food that he/she is expected to eat; as the child’s comfort with the food increases, gradually increase the serving size offered and begin to add the food in with the regular meal

-          If the child won’t eat mixed textures, separate out the foods using a divided plate

-          Finger foods may be more enjoyable if the child has trouble using utensils; but offer low-stress opportunities to practice with utensils

-          Allow the child to “dip” food into ketchup, sauces, syrup, apple sauce, jam, yogurt, or salad dressing

-          Get creative with food presentation by using cookie cutters, food coloring, referring to food by fun names

-          Avoid serving food in the container that it comes in, as children will start to notice and only eat specific brands

-           Involve your child in meal preparation

-          Change the location of the meal if necessary; use a booster seat at the table if the child doesn’t like the highchair, eat at a children’s table, etc.

-          Try to avoid power struggles over food and eating; make eating enjoyable and stress free by having a playful attitude; if a child gags, throws up, or exhibits any other behaviors in response to eating, calmly end the meal, clean up, and let child know that you’ll “try again later”  

-          Keep open communication with daycare providers or teachers about food and eating so all experiences are successful

-          If eating problems persist your child may benefit from a feeding evaluation done by an occupational therapist or a speech therapist with a background in oral sensory and motor development

The take home message here is that you do not have to just accept that your child is a picky eater. You can take steps to try and improve the range of foods your child will eat and their eating habits because it is important that all children get the necessary nutrients from food for their brain and physical development. A processed carb-heavy diet does not have the same benefits as a balanced diet with fresh fruits and vegetables, dairy, unprocessed whole grains and protein.

     If you are concerned with your child's diet and eating habits you can seek help from a pediatric occupational therapist who will determine if there is an underlying cause.  If present, the underlying issue needs to be worked on first before the eating can be expected to improve.  In any case, an occupational therapist can work with you and your child to come up with strategies to improve their eating.

Beach Activities That Work on Developmental Skills

It's beach season!!!  And seeing as I am currently at the beach with my kids, I thought that this was an appropriate time to write a post on beach activities.  The beach is a great place to play and work on dvelopmental skills at the same time, as well as a wonderful sensory experience.  Children really have the opportunity to run wild, explore, be creative, and have fun at the beach because, other than obvious safety restrictions, there really are few limits to what their little bodies and minds can do there.  Another great thing about the beach - kids are so entertained by all the sights, sounds, and opportunities to play and explore that they forget about the TV and computer for a while. 
So here's a list of beach activities to get your kids moving and having fun, with a quick explanation of some of the developmental skills that they work on.  Most of these activities can be done by kids of all ages, toddlers to tweens, just adapt the activity to make it age/skill appropriate for your child/children.  I'll bet that you already do many of these activities with your kids without even realizing the developmental benefits!  Also, at the bottom there are some other activities that are more appropriate for older kids only.  

* Carrying buckets sand and water - it's hilarious how interesting this is to kids; they will fill buckets and carry them to different places, dumping and filling over and over just for fun.  This builds strength and endurance, works on balance and even coordination.

       * Shoveling sand, turning over and dumping buckets works on grading movement as kids figure out how much force they have to use and how fast to move in order to dump out the right amount.

* Building a sand castle is fun for everyone and parents usually like to get involved with this one too.  All the parts of creating a sand castle work on important skills, like planning how the castle will look before beginning, sequencing the steps to build it, shoveling and carrying buckets of sand to build it, and creativity when it comes time to decorate it.

* Finding shells is fun and exciting for kids as they locate new shells they've never seen before or find whole shells instead of just pieces.  Looking for shells works on visual scanning and several visual perceptual skills that are important for other things, like reading.  It's also a great opportunity to teach your kids about shapes, colors, textures, and even correct names of shells for the older kids.
      * Sorting shells - for an extended activity, have your kids sort shapes into groups by different characteristics, like color, size, shape, texture, name, etc
       * Shell sequence - line up 4 or more shells in a specific sequence, let your child see it for 5 to 10 seconds, then cover it up, mix up the shells, and have your child repeat the sequence of shells correctly.  Try different sequences and add shells to increase the challenge.  This works on sequential memory skills.

* Grab Bag: Fill a bucket or small bag with items found on the beach (shells, rocks, coral, small stick, feather, etc.) and have your child try to correctly identify the items in the bag without looking.  Sometimes showing the items and letting your child hold them first, before putting them in the bag, helps to improve their success at picking them out of the bag correctly.  Another variation of this game is to have matching pairs of items, like 2 rocks, 2 clam shells, 2 pieces of coral, 2 welch shells, etc, placing 1 set in the bag and leaving 1 set where your child can see them as he/she searches in the bag for the matching pairs.  This activity works on visual perceptual skills, memory, and tactile perception.

* Buried in the sand - burying kids in the sand (but not too far) is a fun sensory experience, you may even notice them trying to bury their own legs and feet.  By burying their legs or even torsos (when lying on their back) and arms as well (and only if they want to of course) they work on strength when they move to get out from under the sand. Kids also love to bury their parents!  Come on, just let them; it's fun!  And they have to do a lot of shoveling, digging, and carrying which works to strengthen their muscles and tires them out.  Just as a safety note - do not bury kids in holes and do not put too much sand on top of their bellies; they still need to breathe!

* Drawing/writing sand or playing tic-tac-toe: Grab a rake, a stick, or a shell and get creative in the sand.  The resistance of writing or drawing in the sand is good for building strength in the hands and upper body.  Drawing gets the creative juices flowing and writing or playing tic-tact-toe works on cognitive skills.  If your kids are working on spelling their name or writing in cursive, this is a fun sensory-filled way to practice.  The more senses involved in a learning experience, the more areas of the brain get involved and you can get a lot more retention of information and carry-over.

* Maze in sand:  Draw a maze in the sand for your children to follow; a kid's shovel or a rake works well to draw it.  This sounds silly, but they love it!  You can even have them repeat it doing it in different ways: crab walking, bunny hopping, frog jumping, twirling, running, etc.  For older kids, do timed races.  The great thing about this activity is that it works on visual-perceptual skills, motor skills, coordination and motor planning, and attention and focus.  To increase the challenge and to work on balance, draw a course with only 1 line that your kids have to follow and keep their feet on.  You can also have your kids walk through the maze or on the line balancing a ball or big shell on a sand shovel or something else.

* Relay Races: Kids love to run and at the beach where there are wide open spaces it's that much more fun!  Take this energy and enthusiasm for running and set up some relay races; and it really gets hilarious when the adults get involved too.  You can do relay races made up of just one activity, or you can combine several activities within one race.  Here are some examples: filling buckets with water or sand, carrying buckets of water or sand, running, hopping, cartwheeling, wheelbarrow walking (wheelbarrowing walking and pushing a ball along with your hand), balancing a ball/shell/water on a sand shovel, etc.  Relay races work on skills like strength, endurance, motor skills, motor planning and coordination, and social skills.
      * Sponge and water relay:  This is another fun relay that you may have played before.  You place a bucket filled with water at one end and an empty bucket at the other.  Starting at the empty bucket end, you run with a sponge to fill it from the water bucket, run back to the empty bucket to ring it out, then pass the sponge to a teammate who then does the same thing.  This process gets repeated until the empty bucket has been filled to a marked line.  The first team to hit the line wins.

* Obstacle Courses: If your kids are getting bored of playing in the water and in the sand, then create an obstacle course (or better yet, have them create one), using beach chairs, towels, buckets, sand piles, balls, etc.  Do timed trials for older kids.  Even young kids can do an obstacle course that is created on their level.  This fun activity works on strength, endurance, motor skills, motor planning, and coordination.

* Jumping waves: To get your kids working on movement, balance, and coordination, try jumping the waves.  For the youngest kids, or kids who are unsure of the waves at first, start by jumping at the edge of the water.  Pre-walkers can get involved with this activity if you hold them and jump them over the waves; you may even need to hold the hands of toddlers in order for them to be successful at jumping.  Travel into a few inches of water to jump with kids who are capable of it; the resistance of the water and the greater height they have to jump will be a bigger challenge for them.  For older kids who can swim, going farther out into the water and jumping the bigger waves is really fun!  Safety note: watch your kids carefully when they are playing in the water; go in with them, but never allow anyone to go in if there is an undertow.

* Dad's little acrobats: I know it is every mother's instinct to freak out when she see her husband tossing their toddler in the air, but relax mom's, it really is ok.  Dad's are actually providing their small children with some important movement that is very good for the development of the sense of movement. Most kids love being tossed in the air, turned upside down, or flipped over, although they may be hesitant initially.  Obviously Dad's should use smaller movement for babies than toddlers and preschoolers.  Side Note on Movement: Some kids are over-sensitive to movement and will be scared being tossed off the ground.  If you notice this in your child, instead of avoiding the movement, get them used to it by holding them close to your body and jumping up and down, tipping side to side, and spinning in circles.  Gradually (as in over time, not just in one day), hold your child farther away from your body to do these movements.  Then introduce small tosses or dips and bring your child back to your chest for a strong hug before doing it again.  This will help a baby or toddler with movement sensitivity become more comfortable with this type of movement so that they can benefit from it developmentally.  On the other hand, there are kids with under-sensitvities to movement and these kids will be begging to be tossed over and over or higher and higher.  Their bodies need the extra movement for it to make an impact on their brain and sensory system.  These type of kids can also benefit from lots of gross motor activity every day, and this will have a positive impact on behavior and attention.

* Pulling on towels and swinging in towel: Another fun movement activity is to give your kids rides on a beach towel.  Have your child sit or lay on the end of a towel as you quickly pull them across the sand.  Two adults hold on to each end of a towel can also swing a child in the towel back and forth.  These activities are fun for kids and also works on developing their sense of movement.

  * Walk/run: Take a walk or a run on the beach with your kids.  Walk or run a distance that is appropriate for your child and it will work on endurance and strength. Walking through the water will provide resistance and work on strength and balance too.

* Play catch: Playing with balls, tossing and catching, kicking, football, frisbee, etc are all fun activities that work on motor skills, coordination, strength and endurance.

* Crab Soccer: Playing soccer the traditional way is fun at the beach, but so is playing like crabs!  Get in the crab position, that's on hands and feet with bottom lifted just about the ground, then make your way across the sand trying to dribble, kick, and score with your feet without falling over.  This works on motor skills, motor planning and coordination, and helps to improve strength and endurance.

* Little Helper: Have your kids help you carry stuff to the beach, like a towel, a bucket, or even a backpack.  Even if it is something small and light, like their own water bottle, it still teaches them responsibility, cooperation, works on strength and endurance, and helps you out a little.

* Scavenger hunt:  Give your kids a bucket along with a picture list or a written list of things to search for and collect on the beach.  You can also do an alphabetical scavenger hunt by searching for things that begin with each letter of the alphabet.  If collecting items proves to be too much, take a walk and have your child point out items on the list without actually picking them up.  This activity is good for visual perceptual skills, visual scanning, sequencing, following directions, attention and focus, and other cognitive skills.

Older Kids
Older kids can do a lot of the activities listed above if you adapt them to meet the skill level of your older child.  But these activities below are specifically for older kids above the age of 10.

* Boogie boarding, surfing, body surfing: Your child may need you, or an expert, to teach them these activities, but once they've got the skills to do one or all of them, they work on strength, endurance, motor skills and motor planning.


* Riding bike on beach: Lots of beaches or beach destinations rent bikes and even weird, fun beach contraptions to ride on the sand and in the water.  But going for a bike ride is a fun family experience that works on strength, endurance, balance, motor skills, motor planning and coordination.

* Fly a kite: A fun activity, that I don't see people do all that often anymore, is flying a kite.  This is a great beach activity because there's often a breeze at the beach.  Flying a kite works on coordination, motor skills and motor planning, as well as visual perceptual skills.

* Picking up trash: If you're looking for your adolescent or teen to gain some civic responsibility, then go on a family walk to pick up trash on the beach.

* Beach boot camp:  If you have an adolescent or teen that is interested in sports (or a technology addict that needs to get out and get moving) then coordinate an early morning family boot camp session on the beach (or look for a resort sponsored one).  Even if just for 30 minutes, a 1 mile run, some push-ups, sit-ups, squats, and other exercises will be enough to benefit your child's strength, endurance, coordination, and focus/attention.

Best Toys for Babies 9 months - 2 years

First time parents often wonder just what toys they should buy for their baby once they get to the stage where they are mobile and can really interact with toys.  This should be a helpful guideline to get you started, or help weed out some toys you don't need if you already have too many.  Remember that in the case of toys for babies, less is more, you don't want to overwhelm or overstimulate them; you want to focus on increasing their attention span with one toy as opposed to decreasing their attention span with many toys.  If you have a lot of toys, they don't all need to be out at the same time or in the same place.  Choose quality over quantity.  And most importantly, choose age appropriate toys that support developmental skills.  To help with this, for each toy or category of toy that I list I will also add a quick highlight of some of the areas of development that are addressed by that toy.

A note before we get started:  I have focused on an age range of 9 months to 2 years, which actually covers a broad range of skills, but during this time a baby can play with the same toy in different ways, always working on some type of skill (as long as it is a developmentally appropriate toy). A 9 month old baby needs more assistance and supervision with toys than a 2 year old, but that doesn't mean that they can't play with many of the same toys.  Although, when choosing a toy use your own discretion based on your child's skills and safety level.  Remember that children put things in their mouth and this is age appropriate, so please never give a young child an object that could be a choking hazard!
 
TOYS
 
Blocks - big blocks (3"-4"), little blocks (1"-2"), blocks of different shapes, colors, textures. Blocks are great for working on grasp, fine motor control and coordination, motor planning to stack blocks, etc.
 
Stacking and nesting toys - cups, cubes, cones, rings, nesting dolls (just remove the small choking hazard size pieces).  Stack and nesting works on fine motor control and planning, as well as visual perceptual skills, and early cognitive concepts and problem solving.  Examples: Rainbow Stacker, Cone Sorting, Nesting Dolls, Nesting Blocks, Nesting Cups
 
Shape sorter - Shape sorting buckets and blocks help toddlers with shapes, colors, matching and other cognitive concepts as well as problem solving.  These are toys that children typically need a lot of assistance with and modeling for a while before they become independent with it, but they are great toys that bring up a lot of teaching opportunities! Melissa and Doug Shape Sorter, Bucket Sorter, Barn Sorter, Animal Sorter

Musical instruments - Musical instruments offer opportunities for learning cause and effect, to practice and improve motor skills, and sensory experiences. Instruments that involve blowing to make noise, like harmonicas, kazoos, or whistles, work on oral motor skills. Plus, babies love things they can shake and bang on! Examples: Beginner Band Set, Bells, Instrument Set, Drum, Piano, Tambourine, etc.   
 
Water table and sand box - I have to say that I'm more of a fan of sand boxes than tables because in the box kids sit, kneel, and get on their hands and knees to play, which works on more foundations of developmental skills (strength and postural control) than when standing to play.  Water play can be done in a water table, in the bathtub or sink, or in a baby pool. Step 2 Water table, Sand Box, Sand Table  I like sand boxes over sand tables because it gets kids sitting in the sand which is a really great sensory experience!

Puzzles - Basic puzzles for babies have large knobs and only 3-4 chunky puzzle pieces and then progress in challenge and skill level to small knobs on puzzle pieces with matching pictures on the pieces and on the board, to puzzles with interlocking pieces; then increasing the challenge to puzzles without matching pictures, increased number of pieces, and then jigsaw style from 12 pieces and up.  Other types of puzzles involve sound, magnetic poles to pick up puzzle pieces, magnetic sticks to move pieces within the puzzle, dressing puzzles, locks and latches, and parquetry puzzles (I like the magnetic versions the best to hold the designs in place).  Check out Melissa and Doug for a wide selection of quality puzzles.

Cause and Effect toys - Cause and effect toys teach children just that: when I do an action, I get a result and different actions have different results. It's an important concept to work on because it is so essential for a lot of other cognitive, social, and communication skills. Some basic cause and effect toys are:
Pop up toys (see a list on amazon)
Banging/pounding toys like the Plan Toys Drop and Punch and a Melissa and Doug version
For 18 month to 2 year olds, look for toys that involve sounds and movement when a button is pressed or something else is done.  For example, check out the iplay fun tractor.

Push toys - Heavy push toys, like the Radio Flyer push wagon ensures that a baby on the verge of walking won't go over backwards when they put all their weight on this, and thus allows them to work on balance, stability, and strengthening the core muscles and leg muscles needed to walk in an upright position.  For walkers who are more stable, lighter weight push toys such as Little Tikes Lawn mower, shopping carts, Melissa and Doug push toy, and others like these, are more fun and easier to use.

Books, books, and more books - Providing a child with a literature rich environment from infancy and making reading time together a daily occurrence has far reaching effects on brain development as well as a life long love of reading.  For more information read the post on Early Literacy.  Babies enjoy board books that are durable enough for them to turn pages and even chew on; they like simple, repetitive, and rhyming phrases as well as interesting and uncomplicated pictures.  As babies get older their attention span for books increases and their understanding of story lines increases so that they can enjoy longer books.  Sticking with books that are age appropriate and paying attention to your child's interests and attention span can make reading from an early age a fun experience.

Pretend play toys - Baby dolls, stuffed animals, dinosaurs, trucks, play food, dress up outfits, etc are all ways that toddlers can begin to practice being older.  They mimic their parents, stories, and other scenarios in their life through these toys as well as begin to come up with their own imaginative play using these toys too.  Giving your child real objects of yours, like cooking utensils, a baseball hat, an old purse, an old key chain, etc are also ways to encourage pretend play.  A baby sitting on the floor of the kitchen banging on pots and pans with a wooden spoon is the first example of this.

Active play toys - Tunnels, tents, tent/tunnel combo, short slide/climber combos (I like the Little Tikes models), basketball hoop, T-ball, ball pit, trampoline, swings, etc.  Active play toys get babies and toddlers moving, which in turn furthers the development of motor skills, balance, coordination, and strength.  Developing these skills appropriately and on a normal timeline set the foundations for developing more advanced skills later on, such as running, skipping, playing sports, handwriting, supporting good desk posture for writing tasks in school.......

Balls - A very simple toy, balls are a great (and inexpensive) developmentally appropriate toy for all ages.  A baby who can sit and crawl can begin to work on rolling a ball back and forth to a parent or push the ball through a tunnel, a walking baby can carry a ball and work on balance in a new way, a toddler can work on tossing and catching and putting a ball in a toddler-sized basketball hoop, a toddler can also kick a ball.  Sensory balls with different textures, lights, or noises can offer a fun sensory experience.

Objects Around the House - Babies and toddlers are active explorers and quite curious by nature.  They also like to mimic mom and day by doing things like, trying on dad's work shoes or mom's high heels, pretending to shave, playing with cooking utensils, etc.  Observe the types of objects around the house that interest your child and set aside a cupboard or basket filled with old home items that are safe and appropriate for your child to play with.  And when you see your child trying to experiment with objects or furniture around the house, if you feel it is safe, use that object or piece of furniture to play with your curious child in a way that you feel is appropriate.  Maybe it's a cardboard box turned boat, maybe it's pots and pans turned into a drum set, or maybe it's old plastic flower pots turned into a stacking or bowling game.  There is all kinds of fun to be had when you play along with your young child's curiosities.  And by modeling and teaching them proactively how to play with home objects safely, you decrease the risk of them playing with them unsafely when you're not looking.

Bottom Line: Babies and toddlers don't need toys that entertain them and they definitely do not need TV (at all)!  Babies and toddlers have an innate drive to explore their environment - this is what builds all those connections in the brain to make them smart.  So, the more they explore and play, the more they learn, and the greater their potential to be an intelligent individual.  When they watch TV or interact with toys that do all the entertaining for them their brains are not working to make those important connections and in fact all of that rapid visual and auditory stimulation can be detrimental to brain development.
- Keep it simple when buying toys for your baby and toddler and only bring out a couple of toys at a time so as not to overwhelm your young child; this also improves focus and attention when they are not distracted by too many other toys
- Choose toys that work on developmental skills, like the ones listed above
- Look for durable toys made out of quality materials
- Play with your child!!!!!  And then give them the opportunity to play independently (see my previous post on  independent play for more info on this)
- It's ok for babies and toddlers to play with the same toy or do the same active play activity over and over - they are practicing until they are successful, which is part of the learning process (learn more about why children do this)
- Have fun!