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Child with iPad

Tips To Improve Transitions

“The only constant in life is change” – Heraclitus

Does your child struggle with ending activities, trying new things, or engaging in non-preferred tasks/demands? Transitions can be difficult especially when a child is not expecting the change. Advanced preparation, knowledge of perceived consequences, and balanced thinking can all aid in smoother transitions and overall compliance with directives.

Plan Ahead

Whether your child is anticipating a new ballet class or only has 20 minutes for the iPad, providing your child with clear expectations will help them transition. Having a conversation with your child a couple weeks in advance to identify any worries or fears regarding the new class, as well as identifying the positives, can help the child feel more in control and ready for something that doesn’t seem so “new.” Visiting the space, meeting the staff, and purchasing cute leotards can all challenge negative thinking and help the child view this new task as positive and familiar. In the event of transitioning from one activity to another, using a visual clock or kitchen timer as well as periodic reminders can assist your child in preparation to leave the iPad when it’s time.

Easier said than done…

Help your child create more balanced thinking by incorporating cognitive flexibility skills so they don’t feel like the world is over when you take away their preferred item.

Problem solving: help your child to come up other alternative solutions to the problem.

Ex: “When the iPad is over we can identify another time either later today or tomorrow you can use it” or identify another fun thing you can do if the iPad is not a choice (i.e. reading, TV, coloring).

Identify the positives in what will come next.

Ex: “I’m hungry for dinner, glad that’s now”, “going to the dentist so my teeth can be clean and healthy.”

Identify the size and severity of problem.

Ex:  “Getting off iPad is a small problem compared to getting sick and missing my birthday party or a highly anticipated concert or baseball game.”

Have your child evaluate the potential consequences of their actions.

Ex:  “If you don’t get off when I ask, what will happen…”

“I will lose dessert, I won’t be able to go on iPad the rest of the week. I might miss sleepover this weekend.”

Encouraging your child to evaluate the consequence of their choice prior to action and to engage in cognitive flexibility skills can aid your child in a smoother transition.






 

 

 

Child scared of the dark

How To Deal With Nighttime Anxiety

Try these steps to reduce nighttime anxiety and improve compliance with evening time routine.

At the end of a long and exhausting day, how do you effectively transition your kids from the stimulation of the day to the peace and quiet of the night? Now, combine that tall order with nighttime anxiety. It would appear as though this would be more difficult, but there are simple strategies to integrate into the nighttime routine to reduce anxiety and increase overall compliance with this tricky transition.

1. During non-triggering times, talk with your child about what causes them to feel nervous or anxious with regards to bedtime. Are they afraid of the dark? A monster under their bed? A zombie in the closet? Identify with them what they are afraid of and then problem-solve with them ways to reduce their fear. If they are afraid of the dark, offer to keep their door open with a hall light on in addition to a nightlight. If they are spooked out about creatures living in their room, add an additional step before lights out to go through their room with them and search for these alleged monsters. When they see they are non-existent prior to bedtime and with support of their parent, they can feel more at ease going to sleep. Set up a plan with your child to eradicate irrational thoughts to facilitate more restful nights.

2. Begin the transition to bed earlier. If it takes a long time for your child to “unplug” and transition to bed, starting earlier can be helpful – even if it is just a conversation about starting the routine soon. If a child has anxiety about nighttime, the more advanced preparation and warning they have, the better. They can begin their thought-process and, in turn, anxiety-reduction process sooner to aid in a smoother transition. Create positive, self-coping talk that you can model for your child about bedtime such as “Sleep is important because it recharges us for the day,” or, “Bedtime is a chance for us to reflect on our high points from the day and set positive goals for the next day,” and, “Everybody sleeps.”

3. Integrate the use of a “worry doll” or “worry journal” that the child can externalize their fears and worries prior to bed to reduce rumination of irrational thoughts or fears. The worry doll can be a doll or figure that can hold the child’s worries while they are asleep. The child can tell the doll what it is worried about and clear their mind before bed. This can also present an opportunity for the parent to listen and hear what is concerning the child. If it is not appropriate for the child to have a doll (i.e. older child or male), encourage the use of a worry journal to either draw or write out concerns prior to bed. The journal will house the worries so the child can clear their mind and focus on positive, coping self-talk prior to bed.





How To Handle Tragedy With Your Children

What happens when tragedy occurs?

When the unthinkable happens, both adults and children access their darkest fears and concerns about national, community and personal safety.  Trauma is an emotional response to a terrible event and can be expressed in a variety of ways. Most kids are resilient and with validation of their feelings, opportunities for them to talk and be listened to, and reassurance that many people are working hard to ensure their safety (i.e. policemen, teachers, doctors, volunteers, parents and teachers) can resume previous levels of functioning. Other kids may display acute signs of anxiety such as excessive worry, school refusal, sleeplessness, nightmares, headaches, stomachaches, loss of interest in previous enjoyed activities, changes in relationships with peers and changes in school performance. It is also important to note that children may appear unhinged by trauma initially, but may demonstrate more delayed symptoms of anxiety after the exposure to the tragedy.

When managing your child’s reaction to tragedy it is imperative for the parent to understand their own thoughts and feelings regarding the event. Getting any parental concerns and anxieties under wraps will be essential prior to managing any child anxieties and concerns. Children, by nature, are dependent and vulnerable and rely on their parents to exude a sense of control, protection and care. If a parent is highly reactive to their own anxieties, children can pick up on this and in turn will mirror their parent’s anxieties. If a parent is calm and objective the child can then have a solid sense that their parent is in control of the situation and give the child permission to feel safe and cared for.

Validate and acknowledge your children’s fears and insecurities regarding the tragedy

This provides outlets and opportunities for your child to express their feelings and insecurities. Brushing over their feelings of sadness, anger, fear, and anxiety with “don’t feel this way” and  “don’t worry, it won’t ever happen to you”  can prove invalidating and deny the child the opportunity to effectively process their responses. Acknowledging your child’s fears and concerns will help them process the event and encourage them to self-express.

Limiting screen time to avoid continued media coverage regarding the event will help to reduce anxiety and re-traumatization. The most important part of dealing with trauma and tragedy is to process both you and your child’s interpretation of the event, not the actual facts and details (i.e. how many people died, who killed them, the severity of this national tragedy, how it compares to other national tragedies, etc.). Exploring with your child how they interpret the event and what they think has happened is more therapeutic than rehashing the gory details. Also, instead of initiating a conversation about what has happened to your child, ask your child what they think has gone on and work from there. Providing too much information that does not fit within their scope of understanding can prove to further confuse them and elicit anxiety.

Uncontrollable tragedies occur and have the power to threaten our perceptions about our safety and understanding of our world around us. Providing a safe space to process the feelings that our children have is the best way to acknowledge the legitimacy of their concerns and regain a sense of normalcy.



Strategies to Help Your Teen Make Good Decisions

The teenage years are marked with new experiences.  Teenagers want to be independent and are drawn to exciting, new opportunities.  During this time period, chemical changes in the brain also motivate teens to seek out risky behavior.  What can parents do, then, to help their teens learn to exercise good judgment despite the internal and external motivators they have to make poor choices?

Strategies parents can use to help teenagers make good decisions:

  1. Help your teen to take positive risks.  For example, encourage your teen to try out for a new sport, visit a new place, or make new friends.  This will help instill confidence and self control in your teen.  It will also satisfy your teen’s quest for new or exciting things. Read more

Explaining the Boston Bombing to Children

There is no doubt that as the world watches the tragedy that hit Boston yesterday, many parents are unsure of how to approach the mr rogerssubject with their children. As the story evolves, more pictures, videos and personal narratives are showing up depicting innocent runners and bystanders affected. Sadly, the death toll number continues to climb, and the Boston marathon bombings brings fear and confusion to families.

Here are some tips when discussing the evolving story with your children:

  1. Tell your children that they are safe.
  2. Tell your children that affected people are getting better with the help of doctors and nurses.
  3. Offer your children to write or color a card to scan and post on FB or send to Boston.
  4. Make a family project to collect for charity or do a good deed this week in honor of the 8 year old victim and others affected.
  5. Talk age appropriately and keep the news channels off around children.

It can be difficult to take away any positive from such baseless acts of terror. And yet, in the midst all this horror, the good people sprung into action to help. Try to focus on the kindness of people when talking about the tragedy. Point out how many bystanders, runners, and strangers ran to help those that were hurt. Mr. Rogers put it perfectly when he said: “When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.”

Please read this blog by two LCSW’s on ways to handle tragedy with children

Help Instill Balanced Thinking in Your Child

Our goal is to help train your child’s brain when they make assessments about specific situations.  We need to make them aware that it girl thinkingis not the event or person that makes them feel a certain way; it is their thinking behind it. The more we are able to help children challenge their thoughts in an empathic manner,  the more often they will challenge their own thoughts automatically.

STEP ONE:   Gently challenge extreme or dramatic language:

  • If your child says something like, “Everyone at school hates me.  Respond with, “Hmmm.  That doesn’t sound realistic.  How can we make that a more realistic (balanced) statement?”
  • Help them replace extreme words with balanced words and refer to the specifics. Instead, they could say, “Sometimes I feel like kids like me at school  when we work on group projects, but they don’t talk to me on the playground.”
  • Help your child focus on actions they can take in order to remedy the situation and avoid feeling like a helpless victim:  “And I bet if we practice joining kids in talking to them about what they like, you’ll get better at making new friends.”
  • Provide opportunities to empower your child through practice: “How about you try introducing yourself to kids at the park?  If they are mean and reject you, we won’t take it personally and just try again until you get it.”

STEP TWO: Use and teach coping statements to your kids, such as:

  • This is hard, and that’s OK.
  • I have done what I can; now it is out of my hands.
  • One day at a time.
  • It’s a pain in the neck but it’s not a disaster.
  • Could be worse.
  • It’s not life-threatening; it’s not important.
  • If it’s beyond my control, let it go.
  • I’m not going to let this unhappy person spoil my day.
  • I only need to compare myself with myself.
  • S/he is not perfect and neither am I.
  • It takes two to tango; there must have been something I did to encourage this situation. What can I change?
  • People aren’t born evil; what is going on that makes this person treat me this way?
  • Justice is in the eye of the beholder.
  • I can learn life lessons (good or bad) from this situation.
  • In 5 years, will this even matter?

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Childhood Depression: The Difference Between “The Blues” and Mood Issues

How can you tell the difference between a rough day or week versus a more serious mood issue in your child? We all have the depressed teenoccasional bad day, but when a child’s mood or behavior changes so dramatically that it begins to interfere with their overall quality of life, depression may be present.

In addition to persistent feelings of sadness, key indicators of childhood depression are:

  • Anger and irritability
  • Changes in sleep patterns (e.g., sleeping more or less than usual)
  • Fluctuations in weight
  • Difficulty focusing or concentrating
  • Social withdrawal or isolation
  • Guilty or worthless feelings
  • Feelings of hopelessness, helplessness
  • Loss of interest in previously enjoyed hobbies or activities
  • Low energy and fatigue
  • Heightened fear of being rejected
  • Crying and other vocal outbursts
  • Physical symptoms (e.g., stomach aches or headaches that are not responsive to other modes of treatment)
  • Thoughts of death or suicide

For example, if your child has always enjoyed school and valued completing homework, but now has become resistant towards going to school and failing to complete assigned tasks, this could be a red flag that there is something deeper going on with your child. Your child does not need to meet every criteria listed above in order to meet depression diagnostic standards. If depressive symptoms are present for at least 2 weeks, it is important to contact your medical and/or mental health care provider. Factors that may contribute to depression include family history of depression, interpersonal conflicts or life event changes. The good news is that depression responds to mental health treatment. Cognitive-Behavioral Therapy alters the way in which a child views the world. Children and their therapists are able to address underlying messages and assumptions that the child has about him/herself and the world. Addressing these underlying messages and assumptions will help the child re-create a more positive and realistic framework from which to function within. Depression involves more than sadness; it is a low-mood state that affects all aspects of daily life and functioning.

Download our Childhood Depression Checklist here

Watch a 2 minute webisode detailing the 3 Signs of Childhood Depression

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What is a Feeding Team?

A feeding difficulty is a complex medical condition. Feeding issues can result in poor growth, nutrient deficiencies as well as developmental delays. Due to the fact that the process of feeding involves numerous systems throughout the body, addressing the issue is multi-faceted. Feeding difficulties can stem from various issues, such as dysphagia, reflux, history of intubation and/or feeding tubes (such as in a NICU stay), food allergies or anxiety.

Feeding difficulties are very challenging for a large majority of families. Parents may become frustrated, overwhelmed and stressed. At North Shore Pediatric Therapy, we have a unique, multi-disciplinary approach to treating feeding difficulties that provides a more effective treatment result.

The feeding team is comprised of four members that represent the following disciplines:

[table id=10 /]

The following are common reasons for referral to a feeding team for evaluation (1):

  • Limited variety of accepted food/selectivity. See my previous blog on “Problem Feeders”.
  • Limited volume of accepted foods. The child takes very small bites of certain food and then pushes it away.
  • Food refusal, including from the bottle or breast during infancy.
  • Gagging, coughing and/or choking with meals.
  • Difficulty progressing with table food.
  • Aversion to certain food textures.
  • Vomiting with meals.
  • Poor feeding skills or inability to chew and swallow well.
  • Fear or anxiety when eating certain foods or new foods.

If you or your child’s doctor is concerned with feeding issues, please contact a Family Child Advocate at North Shore Pediatric Therapy to schedule a feeding team evaluation for your child. Based on the evaluation, the team will recommend a plan for treatment in which disciplines may need to be involved. Although not all cases will require all disciplines to be involved for treatment, a thorough assessment from a strong multi-disciplinary team will ensure that your child will experience the best possible outcome.

1. Cerezo CS, Lobato DJ, PInkos B, LeLeiko NS. Diagnosis and treatment of pediatric feeding and swallowing disorders: the team approach. Infant, Child, & Adolescent Nutrition. 2011;3(8):321-323.

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