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Let’s face it—children can be MOODY! They want what they want, when they want it. Or maybe your child is the one who has a hard time getting going. It can be exhausting trying to motivate a child who can’t tune in or get with the program. And if you’re anything like me, you can probably remember a time (or two!) when you didn’t respond in the best way. Or maybe it’s hard to recall a time you actually felt like you got through to your child. Parenting is not for the faint of heart, and it can often feel like you’re stuck or unsure of what to do when your child isn’t cooperating or becomes overwhelmed by simple requests, like “eat your macaroni and cheese!”

While all children have periods of what we’ll call “moodiness,” some children have more significant difficulties regulating their emotions than others. These children may show more intense and frequent displays of anger, avoidance, refusal, or even combativeness. All children—especially toddlers and preschoolers—can have moments when they overreact to small events or requests. But if these overreactions happen several times a week and last longer than five to ten minutes, it might be time to explore why they’re occurring.

Even if your child is having frequent meltdowns, there are strategies that can help you support them and shift their behavior. One effective method is called counterbalancing—responding in a way that contrasts with your child’s current mood to help balance their emotions. As a parent and a pediatric occupational therapist, I use counterbalancing strategies all day long, and I can assure you they work. However, they do take some practice, so give yourself some grace as you get the hang of it.

What is Counterbalancing?

Picture an old-fashioned scale with two sides balancing weight. On one side, you have your child’s big emotions—frustration, anger, refusal—tipping the scale. 

Let’s take the example of a toddler who’s refusing to put on their shoes to leave the house for daycare. They’re throwing themselves on the floor, screaming—can you picture it?

Now, as the parent, you have a choice. You can add more weight to your child’s side by reacting similarly: raising your voice, picking them up abruptly, threatening consequences, or over-explaining the situation. Or, you can choose to counterbalance their emotions. This involves:

• Getting on their level physically,
• Lowering the volume of your voice,
• Using fewer words,
• Validating their feelings, and
• Offering choices to help them feel more in control.

For example, you could calmly say, “You didn’t want to put on your shoes, huh? I can help with that.” Or you could shift the emotional tone by using humor: “Those shoes must not want to be on those stinky toes! P-U!” Adding a bit of humor can be an excellent way to lighten the mood. Giving your child two simple options—“You can put your shoes on here, or in the car”—allows them to feel like they have some control, which can also calm them down.

Counterbalancing Strategies for Heightened Emotions

When your child is experiencing strong emotions like anger, fear, or frustration, here are some tools to help balance their mood:

• Stay calm: Your calm demeanor can help regulate their emotions.
• Use a quiet, monotone voice: This reduces stimulation and tension.
• Get on their level physically: Sit or kneel next to them.
• Validate their feelings: Acknowledge their emotions by saying, “You are mad about that.”
• Give simple choices: Allow them to have a say in how an activity can be completed.
• Redirect with humor or another calming activity: Try using humor, offering a favorite book, or engaging in a calming task.

Counterbalancing for Zoned-Out or Less Responsive Children

Counterbalancing isn’t just for intense emotions. You can also use it with children who seem zoned-out or low-energy. In these cases, you want to energize them with more stimulating activities. Here are some strategies:

• Use sing-songy speech: A playful tone can grab their attention.
• Incorporate big movements: Dancing, jumping, or even exaggerated gestures can wake them up.
• Use enthusiastic language: Fun, animated speech and songs can help lift their energy.

 

Practice Makes Progress

Counterbalancing takes practice, but keeping these ideas in mind can help you stay focused and calm when your child gets into a mood. The more you practice, the more natural it will become.

If your child continues to have multiple outbursts or struggles to engage despite using counterbalancing techniques, it may be time to seek professional support. A pediatric occupational therapist can evaluate your child’s emotional regulation and develop strategies that are specific to their needs.

For more information, visit www.pediatricTLC.com or check out the Profectum Parent Toolbox.

If you are a parent or caregiver of a child over the age of one, you have likely experienced a meltdown! The meltdown—when your child is no longer calm, no longer in a state to be reasoned with, and seems to have one goal: to make sure that everyone within a two-mile radius knows they are upset and unwilling to comply. Meltdowns can leave a parent or caregiver feeling helpless and out of control. In that moment, there are typically a dozen thoughts racing through your mind, most revolving around, “How can I make this stop?”

For me, when a child is having a meltdown, it triggers a certain level of panic. I have worked for years to quell that panic, but even with my own children, staying calm has always felt harder than when I’m working with clients who are experiencing a meltdown. If my mom or mother-in-law was around during one of these meltdowns… well, the panic rose exponentially! In those moments, it was easy to respond out of frustration, embarrassment, and overwhelm. But when I reacted with shouting or punishment, it almost never stopped the meltdown. Why was that?

Before diving into how to handle these situations, I think the best place to start is by defining a meltdown and understanding the differences between intentional behaviors and meltdown behaviors.

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What is a Meltdown?

Meltdowns are often due to an overload in the nervous system. This overload can stem from sensory issues, emotional stress, or a child’s difficulty in self-regulating. The nervous system goes into distress, and we see behaviors like crying, refusal to participate, abandoning activities, or aggression toward others or themselves.

You may have noticed that these behaviors are often associated with the “Terrible Twos,” and there’s a reason for that. The toddler and preschool years are a time of rapid cognitive development, which can overwhelm children, leading to meltdowns.

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Meltdowns vs. Intentional Behavior

So, if meltdown behaviors result from nervous system overload, how can we differentiate them from intentional behaviors?

Intentional behaviors typically occur in response to a specific circumstance or event. These behaviors can often be altered or influenced by rewards or consequences. Examples include when a child is seeking attention or defying a rule or instruction. In these moments, the child is usually aware of what they are doing—they might make eye contact, check to see if you’re watching, or appear calm despite pretending not to hear you.

These behaviors differ from those of a child who cannot process what you’re saying because they’re too distressed, crying, or distracted by their environment. During a meltdown, it may feel like your child has become someone completely different!

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Checklist: Meltdown or Intentional Behavior?

Here’s a little checklist to help you decide if your child is having a meltdown or demonstrating intentional behaviors:

Intentional Behaviors:

• You understand the reason your child is objecting; it typically responds to a direct task, instruction, or environment.
• Your child can make eye contact.
• Your child is purposefully refusing to comply, either by saying “no” or ignoring directions when you know they heard you.
• Your child can negotiate or try to bargain.
• Your child may use emotional manipulation.
• Your child may engage in attention-seeking behaviors (e.g., throwing items in your direction, slamming doors).

Meltdown Behaviors:

• Intense, prolonged crying or screaming that’s difficult to stop or redirect with words.
• Physical aggression, such as hitting others or themselves.
• Signs of panic, such as sweating, increased heart rate, rapid breathing, or attempting to run away.
• The child’s response seems disproportionate to the event or circumstance.
• The child’s communication decreases, and they struggle to express themselves or understand others.

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How to Respond to Intentional Behaviors

• Stay calm, as hard as it may be!
• Offer clear examples of expected behavior. Instead of saying, “No, stop throwing that,” say, “You can put your toys in the bucket.”
• Let your child know what behavior needs to be completed before their desired activity: “First clean up the toys, then we can play outside.”
• Ignore attention-seeking behaviors (e.g., stomping, screaming) if they’re not hurting anyone or damaging property.
• Offer choices, such as “Do you want to clean up the books first or the cars first?”
• Praise their effort: “Good job putting one book on the shelf. I can tell you’re ready to clean up,” or “I like how you’re using your inside voice.”

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How to Respond to Meltdowns

• Stay calm and get down on the child’s level.
• Minimize how much you talk to them—avoid giving too much information.
• Give them space, but keep them safe. Try not to hover or chase after them.
• If they’re ready, hold them on your lap and gently rock them.
• Model deep breathing.
• Validate their feelings: “This is hard. It’s okay to be upset.”
• Slowly redirect their attention to something calming, such as blowing bubbles, looking at a book, or doing a simple puzzle.
• Once they’re calm, revisit the meltdown later, away from the situation.

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Parenting certainly has its challenges, but helping your child learn to self-regulate is a skill that will benefit them for the rest of their lives! For more information on handling your child’s meltdowns, visit our website or email us.

If you have ever been around a baby or young toddler learning to eat solids and feeding himself, then you KNOW that it is a messy situation.  There is food everywhere…on the floor, all over the high chair, all over the baby, on the walls, and even on the dog! It leaves you wondering how in the world you are ever going to clean up everything before it is time for the next mess.  And where do you start? The high chair, the baby, … the dog?! The clean up process can be quite an undertaking. Yikes!

Raising kids, it seems like there is always a mess to clean up somewhere. Trying to avoid mess in the first place becomes a parent’s daily mission.  So of course, if you can get your child fed without the mess, it seems like a no-brainer, right?! Do the math, and that’s about six potential messes in the high chair that could be avoided!  As a mom, I am screaming “Heck yeah, let’s avoid that messy face, bib, outfit, highchair, hair, ears…(you get the picture)!”, but as a feeding therapist, I have to tell you that the mess is necessary.  I know, I know…I am apologizing in advance for the many wipes, towels, outfits, and bibs you will go through, but if you want a child who eats a well balanced diet, the mess is a must.  

A vital part of eating is experiencing the food with all of the senses. When we see a child in therapy who has aversions to touch and avoids interacting with wet substances or objects, this can interfere with the development of feeding. A pilot study recently was conducted and published in OT Practice that incorporated increased sensory play with food and discussions about the sensory properties of food with children that had problematic feeding issues, and while the study sample was low, the study discovered an increase in the number of foods the children ate. So what does this mean for parents? It means we have to accept the mess, and even more than that, we have to encourage the mess. 

Encouraging the mess is opposite to the commercial trends right now. Food pouches are marketed to parents on the go as an easy way to get fruits and vegetables into their child, and it has even extended to grains and proteins. The mom in me is screaming “Thank goodness for something easy and neat!!!”, but the trend I am seeing as a therapist is that babies love these pouches too, so much so, that they don’t want to stop eating them! 

I am a pretty practical mom, so I am not saying get rid of all pouches, but what I am saying is there needs to be multiple opportunities a day for a new eater to explore his food with all the senses, not just taste or get a little feeling in the mouth. Pick a time that you know you can get that baby in the bathtub after he is done eating and playing, and maybe when your spouse or partner is home to help out with the clean up. Let the food be the entertainment, and turn off the TV or other distractions.  Offer dry foods, wet foods, sticky foods. Put a mat under the child’s chair that can be easily shaken off outside or thrown in the washing machine. Strip down the baby to only his diaper to make him easy to wipe down. And hey, if you have a dog, let the dog help with the clean up on the floor!  Find ways to make cleaning up the mess easy on you, but still allowing your child to explore and learn about foods in the messiest way possible. 

Source: Gettier, M. “Children with problematic feeding, selective restrictive eating: A pilot program.” June 2022. OT Practice. 

“Wait…you are an occupational therapist…who works with children? Aren’t there child labor laws prohibiting that kind of thing?”

This was a real question. I had been an occupational therapist for only a couple of years at the time, but I remember thinking that the guy asking me was not that smart or not that worldly. Either way, I had to figure out how to answer him to hopefully enlighten him, because SURELY he should know better! (Haha)

Over the many years I have now practiced as an occupational therapist, I have come to expect questions like this one. Some people introduce me as a speech therapist (“you do work with kids with special needs, right?!”); some people introduce me as a physical therapist (“well you are kind of like a physical therapist because you work with muscles and help people get stronger.”). To be honest, some days I feel like a speech therapist, and some days, I feel like a physical therapist, but I am neither of these. I am an occupational therapist. I also work with children. So what does that mean, and what the heck do I do?

Occupational therapists work in many different areas, and that is because the “occupation” part of our title was given to us many years ago, when an occupation was better understood as any activity that a person spent time doing. Occupation certainly could be a job, but it could also be past times, hobbies, or any meaningful activity that a person participated in. Now that occupation is synonymous with a profession or work, the profession of occupational therapy gets a little misunderstood. Hopefully, I can help shed some light on that!

Occupational therapists work with individuals of all ages, of all abilities. One of our superpowers is to analyze a task or activity to figure out why a person might be having difficulty with it. You can find occupational therapists in hospital settings, outpatient settings, schools, nursing homes, and also in the home health setting after an illness or injury. You may even find occupational therapists in some non-traditional places, like in dance studios working with dance teachers to assist children of all abilities; or corporations working on the ergonomics of the work environment. We occupational therapists can show up in a variety of settings, helping identify the difficulties in tasks and modifying those tasks to allow individuals to work smarter and become more successful and efficient. So that is why we work with children…to identify what their strengths are and what areas are contributing to their challenges.

Working with children, occupational therapists assess a variety of areas. Typically, the parent or caregiver will identify some concerns and/or tasks that his child is having difficulty with, and the occupational therapist will assess many factors that contribute to the child being successful with the task. Those could include, posture, strength, attention, sensory processing, visual perceptual skills, fine motor skills, gross motor skills, sequencing tasks, and much, much more. Once the underlying challenges are identified, the therapists will work directly with the child and family to help strengthen the problem areas, make modifications until the child is able to effectively complete the task independently, and help educate the child, parent, and other caregivers, such as teachers, to ensure that the child is successful in the occupations he wants or needs to participate in his daily life.

It is not new news that children on the autism spectrum typically have difficulty with communicating and socializing. This, in fact, is criteria for obtaining an autism diagnosis. Many times parents notice these differences as first signs that their child may not be developing along the typical developmental sequence. Parents may notice difficulty connecting with their child or that their child seems to enjoy playing with objects more than playing with them.

Parents notice difficulties in relationships first because having a relationship with your child is such a desired aspect of having a child! As a parent, you love your child so much, and you are always striving for him to know just how much you love him, so of course when that love seems to go unnoticed, it leaves a parent concerned and desiring to find a way to have her child be able to reciprocate.

The relationship is what drives the DIR philosophy. The R in DIR stands for RELATIONSHIP! Helping a child to stay regulated and engaged in order to interact and communicate is the foundation of the DIR approach, and it is a beautiful thing to watch a child grow and expand his interest in the people in his life. To only redirect behaviors or ensure compliance is not typically what people look forward to in the role of parent, and while it is necessary, building safe relationships with your child is what allows the child to feel safe and secure to go into the world and build relationships with other people.

So how do you work on relationships with children? One of the most important aspects of building relationships is to find common ground and shared interests. Oftentimes children who are having challenges in relationships have limited or different interests, so instead of having the child join YOU, you have to join the CHILD. Finding shared joy in an object or game that the child loves helps the child to work within a familiar, comfortable activity on skills that may be more challenging for him, such as shifting attention between his favorite object and a person or connecting facial expressions to the emotions that underlie them. If the child loves roaring like a bear, then we have to love roaring like a bear, petting the bear, feeding the bear, and all the other things that the child likes to pretend to do as a bear. If the child loves stacking books, then we can love to stack our own books, color code them, and center them on top of each other.

It can be difficult to understand why a child enjoys an activity as much as he does, especially when it is repetitive and simple, and quite honestly, boring! For whatever reason, whether we see it or not, it is the child’s love, and it is the entrance into shared joy that allows for a deeper relationship with the child. Children tend to feel safe when participating in these favored activities, and when we not only allow them to continue them, but join them, the feeling of safety is even further enhanced. So, even when it is hard to do, get down on the floor with your child and see the world through his eyes.

For more information on DIR/Floortime, visit www.profectum.org.

As early as 4 months of age, Pediatricians are encouraging parents to expose children to baby foods. This milestone is pivotal in staging the rest of the child’s feeding experience. The main goal of this exposure is not for ingestion, as calories are still predominantly from breastmilk or formula, but for exploration.

Encourage your child to get messy! Show them how to smash their food, touch it with both hands, and smear it on their highchair tray. Is in in their hair? No problem! What you are encouraging is learning about the foods! Is it soft or hard? Can it break? Is it warm or cool? Does it have a big flavor or a small one? How can the child manipulate the food? Provide opportunities for children to use their fingers, a tool (such as an infant spoon), or a celery rod. The opportunity to be creative are endless!

Suggestions for messy play at home:

• Mix baby cereal with preferred breastmilk/formula
  • Can be mixed with more or less milk to alter the consistency
  • Can mix with water as an alternative
  • Can be warmed in the microwave
  • Can be cold from fridge milk
  • Can put in freezer for a few minutes before serving
• Stage 1 purees (can mix different flavors once introduced one at a time and checked for allergic reaction- consult your Pediatrician before mixing textures)
• Smashed banana
• Smashed avocado
• Smashed sweet potato
• Celery rod (at least 6 inches long)
• Carrot rod (at least 6 inches long)
• Cooked then pureed squash (Acorn squash, Butternut Squash)

What are Hard Munchables?

Hard Munchables are rod shaped food items that a child can hold independently and when inserted into the child’s mouth, it does not break apart and is long enough that a portion of the food remains outside of the mouth. The goal of hard munchables is NOT to eat, but for the child to explore the inner surfaces of their mouth and learn about this food texture. Exploring hard munchables is extra important for teaching the tongue to put foods to the back of a child’s mouth, thus enabling the child to eat more complex foods in the future, such as steak and baby carrots. Hard munchables are also useful in moving the gag reflex towards the back of the mouth as well as teaching the mouth how to accommodate for different size food objects.

When to introduce hard munchables?

– Child is mouthing toys without prompting.

– Child has neck and head control to sit independently.

– Number of teeth are not a prerequisite….. it is preferred to introduce hard munchables BEFORE children have teeth!

What are examples of hard munchables?

– Raw carrot rod

– Raw celery rod

– Raw jicama rod

– Beef jerky stick

– Hardened pizza crust/bread stick

– Hardened Twizzler stick

– Rib without meat on it

– Frozen French toast sticks

As always, only expose your child to foods under direct and constant supervision. Feeding skills vary and change frequently, so be mindful that one day a celery stick does not break apart and a few weeks later, the child is shredding pieces off!

Once your child’s molars protrude and jaw strength increases, the hard munchables are no longer used for exploration and become a food for ingestion purposes.

Happy Exploring!

“You are a speech therapist.  How can you help a child who does not speak?” When speech therapy is recommended for a non-verbal child, many people who are not familiar with the role of the speech-language pathologist (SLP), aka “speech therapist,” wonder why this recommendation was made.

In order to answer this question, it is important to understand that SLPs are communication specialists and that communication is not just verbal.  Imagine the messages you send with just a look to your loved ones.  Think about how you know what other people might be thinking or feeling, even if they don’t say anything.  How often do you point or gesture throughout the day to communicate?  Now imagine what it would feel like if you had none of these ways of communicating.  Not only is your voice silenced and your mouth motionless, but you also can’t use your hands or your facial expressions to convey meaning to others.  Try it.  You might get a sense of the frustration that some of our non-verbal or low-verbal children experience.

As SLPs, specifically those trained in DIR/Floortime, we start with the most basic form of communication, which is back and forth emotional signaling with a trusted partner. This could be in the form of eye contact and smiling—a basic human connection.  We then use techniques to  help the child explore his sound system, as well as use his body and face to gesture.  We help the child and his/her family communicate in continuous circles, even if not a word is spoken.   When children achieve this level of communication and they still can’t talk, we can introduce alternative communication devices that will give them a voice while theirs continues to develop.

“Speech therapy” is crucial to the overall communication development of a non-verbal child.  If any professional tells you that speech therapy can’t help, they are misinformed.  If an SLP tells you that he/she can’t help your non-verbal child, thank them for their honesty and find one who can.

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Games are wonderful developmental learning tools for children.  They challenge many developmental areas simultaneously, requiring communication among different areas of the brain. So which skills need to come together to effectively play a game? Here are at least 6 of the things we observe/ work on when helping children learn how to play games:

1.  Understanding game etiquette.   This means you have to know when to take your turn and when to wait,  accept losing, maintain your “cool” when things don’t go your way, be gracious when your friend gets lucky and joke/have fun in a non-offensive manner.
2. Following multiple steps.    Setting up a game usually requires at least 3 steps, and even the simplest games require at least 2-3 steps to play, all at different levels of difficulty.  Some games might require picking a card and putting your token on the matching color square (i.e., Candy Land). Others might require spinning a wheel, determining the rule that is associated with that spin, then acting out that step (such as in Hi-Ho Cherrio!).
3. Working with contingencies and being flexible.    Even simple games like Chutes and Ladders or Candy Land require players to deviate from the standard of counting and moving, if certain things happen.  More complex games like The Game of Life and Monopoly require decision-making and a variety of money transactions, in addition to spinning, counting, and moving.
4. Sustaining attention and remaining in one spot.  Two-(or more)-player games are only fun for all parties if each person is invested in the game and can sustain attention.  An inability to sustain attention to the game could be related to the difficulty level of the game, the child’s impulse control, their need to move around, or a host of other reasons.
5. Making precisely graded movements.  Games often have small pieces that need to be put in precise locations in order to maintain order in the game. When kids have difficulty grading the amount of pressure they put on something or lack precision in their movements, they may inadvertently mess up the whole game board, upsetting themselves and others.
6. Exercising Cognitive and Language Skills.  Some of these skills include one-to-one correspondence, quantity concepts, counting, matching, reading for meaning, following directions, communicating with play partners, remembering, and many, many more!

Games are a wonderful way to support your child’s development, but can be frustrating if your child struggles with any of the skills above.  Modifications can be easy and fun and can support your child in their challenge areas.  In future blogs, we will discuss modifications for a variety of games. Meanwhile, take a look at some of our favorite games by clicking here, and scrolling about half-way down the page.