infant development

Let's Talk About Pee.

Mannekin Pis, bronze statue in Brussels, Belgium. Pixabay.

Mannekin Pis, bronze statue in Brussels, Belgium. Pixabay.

After sleep, and perhaps after discipline, potty training is next in line as one of the likely questions you’ve had (or will have!) about raising your wee ones. Aside from it being a rite of passage for our kiddos, moving beyond diapers is also a big leap for us as parents. When our children stop using diapers and start regularly using the toilet:

  1. We cut down on purchases and on garbage (extra garbage tags, anyone?);

  2. We spend less time dressing and undressing, wiping, and washing the kids.

  3. We have more freedom on outings, even if initially we are simply trading diapers for a portable potty seat.

  4. And we can relish in a significant milestone that shows us our little ones, regardless of how many other ways they need our support, are developing and growing up.

Getting to that point of diaper free, however, is not like stepping through a single doorway. Just like with infant sleep, it is a developmental skill that is complex and cannot be rushed without consequences. Below are strategies for approaching toilet learning with kiddos. And, as with all things parenting, we can begin setting the path right from birth.

  1. “R.E.S.P.E.C.T.”. Awareness of and respect for one’s own body (and all its bodily functions!) starts with how others treat us. Telling your little one what you are doing as you do a diaper change is a simple and yet helpful way of reminding us (and teaching our children) that we respect them.

  2. Pay attention to patterns. Whether you approach peeing and pooing from the perspective of Elimination Communication, or whether you have a toddler with longer periods of time between wet diapers, or an approaching enrolment date for kindergarten, being aware of body language, timing, and triggers (how many pee-infused baths have your kiddos had?!) is helpful.

  3. Each in their own time. Although there are general trends on when children are able to use the toilet regularly for peeing, the age at which children are ready varies so widely that these age ranges are usually not helpful. With the exception of identifying medical, neurodevelopmental, and emotional barriers to toilet learning, the age when most kids are toilet trained may not be helpful in appreciating when your child is ready. Paying attention to signs of readiness, instead of age, can be helpful for taking the pressure off and for respecting your own child’s development.

  4. Model the outcome you want. Kids who see how the toilet is used are more likely to imitate its use, even at the age of one. Consider pointing out why you are using the toilet, and perhaps even invite your toddler to flush! But be prepared that modeling your behaviour might transfer over to putting other things in the toilet —a plumber once told me that in one troubled toilet he found an entire mini collection of playskool people. Pens are surprisingly effective at causing all sorts of back ups (this from personal experience —oh what chaos one little pen can cause). And no one wants their toothbrush to make its way into the bowl. Take it in stride. And keep a plunger nearby!

  5. Offer it and they will pee. Eventually. Having available a potty or an accessible toilet seat (including this one that is built right into the adult seat) along with an appropriate step stool can encourage children to spontaneously try toileting. Getting a potty long before your child is ready results in it being as natural a part of the bathroom as the toilet itself. For kids who don’t like dramatic change, this may be helpful.

  6. Pomp and Circumstance. For kiddos who love to have their milestones celebrated in style, novelty toilets with their favourite characters on it may help. But more importantly, the positive and genuinely pleased approach you take towards their learning may make a longer term impact (and transfers over into all sorts of achievements and milestones without the need to surround yourself with Paw Patrol paraphernalia). Being interested and excited—without been too interested and excited—may take some trial and error. Knowing your child’s temperament, and what works for them in terms of your reaction to other achievements, can help guide you.

  7. Go with the Flow. Whether your child goes diaper-free or bottomless for three intense days in the winter, or for two months in the summer, there will likely be wet clothes and pee on the floor at some point. Cleaning it up without chastising, and (if you can muster it without it seeming like you are punishing them) recruiting their help in a calm way is important for avoiding shame and embarrassment about a tricky developmental skill that will inevitably have its ups and downs.

  8. Know when to hold’em… know when to walk away. If things are not going so smoothly, it is often a sign that they are not ready. Put the goal of potty training aside for a while, and return to it when there are other cues. If, however, you feel like there is more going on, pursue it with your doctor. Urinary tract infections can sometimes be symptom free and yet will cause all sorts of upsets to the progression of potty training.

  9. Natural Opportunities and Oops’s: At one point in the gradual transition to full toileting with my first born, I found myself at a park ten minutes from home when he had to go pee —and we had not brought a diaper with us. This was the first time in the toilet-learning process that he’d been away from home for toileting and he wasn’t so gung ho about the idea of peeing in the public washroom. I offered a choice: he could either pee in the public toilet or we go home right away for him to pee there and remain at home. Although not initially happy with this choice (it was a beautiful day at the park, but boy oh boy the toilet at home was familiar) he weighed his options and chose to give the public toilet a try. It worked! We got to stay another hour, and he overcame the milestone of using a washroom other than our own. The next week, however, at the same park, we ended up with a surprise wet pair of pants. Sometimes natural opportunities (or genuine forced choices) help us make progress. But it’s not always linear.

  10. Dry Nights. If dry diapers at night seem like a distant dream, and you feel like it ought to have happened already, consider constipation. If children are backed up (even if they are pooping every day), it can cause night wetting. If you feel this may be a factor, an x-ray can confirm it, and strategies can be put in place to get things flowing better. Once the bowels are emptying easily and fully, there is less pressure on the bladder and ureter, and more ‘room’ for developmentally-appropriate night dryness. Resolving constipation will also set the stage for smooth transition to toileting for bowel movements too.

When Hurdles Get In the Way

There are a number of situations that delay toileting or that prevent independent toileting. Mobility issues, neurodevelopmental and social-emotional challenges, frequent UTIs, and cognitive delays can impact a child’s ability to progress towards independent toileting. Whether these hurdles are resolved over time (e.g. cognitive development or resolving UTIs) or whether these hurdles remain, respecting a child’s developmental, emotional, and physical abilities is crucial. By appreciating what the challenge is, we as parents may work towards remaining calm about the goal, the timeline, and the barriers.

This patience and acceptance includes when the child is ready and willing emotionally and yet is unable to achieve this milestone, and vice versa —when the child appears physically able but is not emotionally ready.

Signs Your Child May Be Ready for More Progress to Toileting:

  1. Their diaper remains dry for a greater length of time;

  2. They pause activity and take a pee posture (or expresses to you verbally that they are peeing in their diaper) that lets you know they are peeing willfully;

  3. They show an interest in the toilet, especially if it involves imitating you. (However, imitating can happen long before a child is ready physically.) Encourage this imitation, even if it doesn’t ‘yield results’. Toilet habits are a nice thing to develop, if led by your child, even before toilet use is consistent.

Should I Use Rewards to Encourage Toileting?

I generally take an “Alfie Kohn” approach to rewards (see his book Unconditional Parenting for his perspective on rewards and punishment): rewards usually coerce compliance rather than support the development of a skill. Although a well-timed encouraging gesture can tip “almost ready kids” solidly into the “totally potty-trained” category, rewards tend to assume that all the pieces are in place for success, and that all the child needs is a sticker or toy or chocolate to achieve the milestone. This is not usually the case. Kids are built to want to develop new skills. If they are resistant to developing a new skill then perhaps (a) they are not ready yet and a reward will frustrate, rather than motivate, or (b) they are relying a lot on this skill being your priority rather than a priority that comes from within. Occasionally, a reward to sweeten the deal can be helpful in cases where there is a lot of fear —the extra motivation to overcome that fear might help. But in my view, we ought to use rewards sparingly.

All in Good Time

Generally, as with most developmental skills, if we as parents provide the environment (nurturing, supportive, with opportunities for development, and access to the right tools -e.g. a potty!) children will develop new skills when they are developmentally ready, including toileting. If the timing is right, this happens smoothly, albeit gradually and with set backs along the way. And although there may be pressure to speed things up and rush the process, we can remind ourselves that, just as with learning to walk, most kids will get where they need to go when they are ready.

Resources

Alfie Kohn, Unconditional Parenting

Built-In Potty Seat, amazon.ca

Mannekin Pis, bronze statue in Brussels, Belgium. Credit: Pixabay.

Mannekin Pis, bronze statue in Brussels, Belgium. Credit: Pixabay.

Reflections on Parenting

I recently took some time to reflect on what my priorities are in supporting parents with infants and young children. I wanted to hone in on what message I am really trying to share with families, regardless of whether we connect about infant sleep, development, or parenting. Whether family life is going along tickity-boo, or whether things feel like they are falling apart at the seams, these thoughts are ones I turn to to help me have perspective, and to have trust in the process.

This work is important to me. And I’m honoured to get to come along with you on your parenting journey as your OT when you reach out to me for support.

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Holiday Gift Giving: Re-thinking, Re-prioritizing, and Re-gifting

gift with ribbon.jpeg

Holiday Gift Giving : Re-thinking, Re-prioritizing, and Re-gifting
 

When we think of Christmas time we think of an abundance of joy, toys, wrapping paper scattered happily everywhere, and excited squeals of delight.

The reality may be quite different: overcharged credit cards, disappointed gift receivers who didn't get the latest toy, an overwhelming and cluttered play space, and toys that go untouched after the initial excitement is over.


It may be worthwhile, before preparations for the holidays go into full swing, to reflect on your priorities and your vision of what gift giving could be like in your family.  It is an especially good time to give this some thought if you are expecting a birth in the coming months, or if your children are very young.  Setting your family's intentions around gifts and toys early is easier, and can set the stage for many years to come.

If the idea of abundance and meaningful toys without the clutter is appealing, enjoy the links below this article about how to make the shift to more meaningful and minimalist gift giving in your home.  And if you would like exploring this idea more, send me an email ....I’d be pleased to organize a workshop to explore ideas around gift-giving in the new year (when you have lots of time to think about things for next year!). Simplicity is a central value of mine and one that can shift our thinking from how to buy the ‘right’ toy to:

  • How to choose developmentally appropriate toys that last;

  • How to enjoy the abundance of gift-giving while moving towards minimalism; 

  • The love language of gift giving and why it can be a wonderful thing and a challenge;

  • Gift giving traditions based on simplicity.

Heather

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Resources for Giving in Meaningful Ways:

https://www.happysimplemom.com/minimalist-gifts-for-kids/

Parentshttps://www.parents.com/fun/toys/baby-toys/your-guide-to-age-appropriate-toys/

https://www.friendshipcircle.org/blog/2014/04/30/the-five-types-of-toys-for-children-with-special-needs/


https://www.simplicityparenting.com/gift-giving-and-receiving-with-simplicity-and-relationships-in-mind/

Infant Mental Health

Infant Mental Health: A primary goal of attachment-based parenting

Early in my career as an occupational therapist, I had the privilege of participating in York University's inaugural Infant Mental Health certificate program.  The focus was on understanding the environmental and biological basis for infant mental health. 

Since that time I have studied the science of attachment theory and ecology, and learned the impact of our parenting approaches on infant mental health. What has struck me most across all of this learning was appreciating the impact that our environment can have on the developmental well-being of infants and young children. Our children’s environments are largely created but us in the early years, and we have a significant influence on how nurturing their environments are.

Nurturing, stable, safe, and loving environments can have a positive influence on children, including those with a history of trauma. Although we cannot change the past, what we do today to shift towards more nurturing environments can support infant mental health.


The passion I have for connected parenting in the early years and beyond is reflected heavily in my approach to supporting infant sleep.  Sleep deprivation can make even the most patient parent short-tempered and less compassionate.  Sleep-deficient infants are more easily upset, more 'wired', and often more difficult to get to sleep.  And yet, at the heart of it, infants need proximity to a loving adult who has the capacity to parent in a nurturing way. It is helpful to listen to our instincts about how to support their biological and emotional needs, and to seek support (from family, from friends, from skilled mental health care professionals) to do that.

My approach to infant sleep is to inform, to guide decisions, and to change the environment and expectations in order to progress towards sleep practices that support everyone's sleep needs.  For families who have additional challenges, including mental health issues, and trauma history, I connect families with local health care professionals who can continue to support families in ways that respect the family's needs and goals.

Understanding the huge impact that we, as parents, have on our children’s well being is not intended to add a burden. Rather, it can help make decisions easier: we can choose to meet the need. We can choose to connect. We can choose to be present with our children. And we can choose to take care of ourselves and to get support when we feel overwhelmed.

Key Messages:

  1. Attachment based parenting improves infant mental health.

  2. Our environment impacts our health.

  3. Decisions are easier when we know why attachment is important.

  4. Self-care is critical: fill your own cup so you can fill theirs too.

I am not a mental health professional. But there are talented and compassionate people in our community who are. If you are concerned about mental health and about your capacity to support a nurturing relationship with your child, reach out and seek support.

Niagara Resources:

In Niagara, local supports for infant and family mental health include:

  • Pathstone Mental Health Services, pathstonementalhealth.ca

  • Emily Pollak, Social Worker, individual and family counselling, St. Catharines, emilypollak.ca

  • Niagara Infant Mental Health website (Early Childhood Community Development Centre), http://www.eccdc.org/infant-mental-health/

Within and beyond Niagara, supports include:

  • 911 for medical emergencies

  • 411 for information about local mental health services in some jurisdictions

  • Your family physician

  • Local initiatives to support infant and child mental health

What is Normal? Six Month Sleep


Photo credit: Studio 7042, Pexel.

Photo credit: Studio 7042, Pexel.


When it comes to understanding the normal development of independent sleep, knowing the facts can make a profound difference in our perspective on the “problem”. Understanding normal sleep patterns in childhood can be incredibly reassuring. And, frequently, this involves realizing there is no problem at all!

Knowing what is typical can help us figure out if the expectations we have (or our family has, or strangers have!) match with what is developmentally reasonable. To know that frequent night waking doesn’t indicate that we have “done something wrong” to cause our babies to have frequent night waking, but rather that it is biologically normal, can take away a lot of pressure! Putting energy into coping with the phase rather than fighting our child’s nature can be a refreshing shift from trying to fit our babies into the expectations,. This way we can model our expectations on our babies’ abilities.

In my September 12, 2018 facebook interview with Built to Birth’s Melanie Farrell, we spent an hour online chatting about what is normal, how to shift perspectives on the problem, and how to manage the challenges that come with supporting infants and young children to gradually develop the holy grail of parenting: independent sleep. One of the papers I mentioned was Sadler’s 1994 paper called (most encouragingly!) Sleep: what is normal at six months?

Here is a bit more of the detail of that paper, and why it is relevant to parents of young babies.

  • Of 640 parents who completed a survey about the sleep of their infant, only 16% reported that their 6 month old “slept through the night”.

  • 16% of the infants were reported to not have a regular sleeping pattern at 6 months of age (meaning a sleep pattern maturing from within the child, rather than a lack of ‘routine’ from the parents). This suggests that the internal regulation required for a regular sleeping pattern takes several months or more to develop. This fits with our understanding of infant development and neuro-maturation.

  • 61% were sleeping in their own room by 6 months, but many ultimately shared a bed with the parents upon waking: a whopping 43% were always, almost always, or routinely (34%) brought into mom and dad’s room upon waking.

The author suggests that knowing that these sleep patterns (frequent waking, proximity to parents during sleep) are normal can be reassuring.

What may help in re-framing the perspective of night waking in your 6 month old:

  • It is normal for babies (even at the ripe age of 6 months) to wake often and prefer proximity to mom.

  • “Sleeping through the night” is typically defined as 5 consecutive hours, not the 8-hours-a-night we come to expect as adults.

  • The pressure to have young babies “sleeping through the night” does not coincide with biologically normal sleep.

  • Trusting your instincts regarding sleep problems can be helpful, especially if baby is not sleeping as well as they ought to be because of colic, reflux, food allergies, sleep apnea, or poor air quality.

  • A return to more frequent night waking at 9 months, after a period of relatively good sleep, is normal. This tends to improve after 12 months of age.

  • The route to independent sleep is not a linear one.

  • Sometimes the best strategy is to anticipate the wave, hang on tight, recruit help, and ride it out. When mother nature is the one dictating the rules, changing course may be futile! Nature has a way, and we’d do well to consider that although our environment has changed a great deal, the nature of sleep has not.

So, what is a parent to do if they are struggling with their young child’s sleep but think it might be developmentally normal? Get support! Support can go a long way in reassuring you, in tweaking some strategies for sleep, and in emphasizing (giving you permission!) to focus on your own self-care. Parents who have sought my help and needed, primarily, reassurance, are among the most rewarding consults I’ve done because it puts the power back in parents’ hearts that what they are doing feels right, is supported by evidence, and, in the end, works to create healthy, and even joyful, bedtimes and a happy and confident independent sleeper. It may not take much to bring this power back to parent decision-making, but it can make a world of difference to how you feel about your child’s sleep.

References:

Sadler (1994). Sleep: what is normal at six months?. Prof Care Mother Child. 4 (6): 166-7.