Tall Kneeling

In January this year, I emailed Matthew's physical therapist (PT) at school to ask how he was doing during his PT sessions. One of the things she said was that in the group he had difficulty staying in a tall kneeling (on knees, not sitting on buttocks) and half kneeling ( one knee up the other down on floor and balancing in this position).

When googling for information on tall kneeling, I came across Adaptivemall.com. We didn't need the equipment but it was very interesting to see that adaptive equipment to help with tall kneeling actually existed. Also to quote from the site:

Tall kneeling is achieved when someone is kneeling and the buttocks are not resting back on the feet. Tall kneeling can assist with the development of balance and leg strength. Note: This position can be difficult for people who have limited ankle bend (plantar flexion) or who wear ankle foot orthotics (AFO).

Matthew doesn't wear orthotics but he does have insole wedges in his shoes for ankle support since he has pronated ankles(but I don't think that matters). The gluteal/buttock muscles are needed to maintain the tall kneeling position. I imagine his gluteal muscles didn't inherently have the tone to easily get into a tall kneel and maintain it. He always preferred to sit on the backs of his feet to stabilize himself.

And of course, I wanted him to develop better balance and leg strength because that will make more physical play activities easier for him. So what do we do? We work on it at home!

How to Position?
His PT and NACD evaluator gave me a few suggestions:
- try kneeling at support surface.
- work on him imitating you go from sitting on heels to tall kneeling position, or in front of a mirror.
- (if he were still in diapers) try bridges, like when his diaper was being changed, ask him to raise his bottom up with knees bent and feet flat on the floor. Hold the position for 5-10 seconds....move a train, ball under his hips to keep hips up.
- have him get on hands and knees and cross creep (crawl on hands and knees). Then while facing him, model getting up into a tall kneel and ask him to do it. From there play something or sing something while maintaining that position.
- practice kneewalking around the room to get things off of the sofa or low tables.

Which strategy worked for him? Asking him to cross creep and then get into a tall kneel to kneewalk and then pause in the tall kneel position helped him understand the concept of tall kneeling. So we played around with kneewalking a lot. He liked jumping and running on giant bubble wrap so I used that as our kneewalking activity motivator.



Within days, his kneewalking improved. More importantly, he was developing the balance and strength to maintain the tall kneeling position for longer periods of time. He'd still sometimes take 3-second breaks to sit on the backs of his feet but he could now easily return to the tall kneeling position without falling over.

Just yesterday, Matthew, Elizabeth, and I had lots of fun playing a fast-paced game of rolling the beach ball back and forth to each other in the tall kneeling position.

At age 2, Elizabeth had no trouble with tall kneeling at all. Seeing her easily play in tall kneeling was one of the many reminders of how much more work Matthew had to put in just to achieve what Elizabeth could do so naturally and effortlessly (relatively). It's at moments like that when one simply appreciates each child's development as it is and admires and learns from Matthew's determination and can-do attitude.

Stickers Activity for Fine Motor Skills

I love great ideas, especially if it's a fun, productive, educational activity for the kids. I recently picked up two great resources for promoting fine motor skills from the facebook group "Educational Strategies for Children with Down Syndrome".

hands on: As We Grow - 30 Kids Activities & Materials for Promoting Fine Motor Skills
PreKinders: Resources for preK teachers - Fine Motor Skills

We tried the sticker activity from "hands on". It was a success! We used small stickers and $1 Shape Tracing activity books from Target. Since I haven't been working on handwriting with either of them, I thought this was a good opportunity to use the tracing books.

Elizabeth was determined to put stickers on the dotted lines to complete her square.

Matthew stayed focused putting stickers on the dotted lines for his oval.

They both did a great job!

Wipe Your Chin Please

Teaching Matthew independence starts with the little things - like wiping his own chin.

Matthew is generally neat and likes to be clean. But when eating, he doesn't usually sense if some food has strayed to his chin or cheek or nose. And when he does, it's not easy for him to pinpoint it's exact location. So we use a small acrylic mirror (won't shatter if dropped) to show him where he needs to wipe. It works flawlessly for my visual learner.

And it's quicker than just telling him verbally.

And it's a baby "I-do-it-myself" step.

Using Chopsticks

Incorporating some fine motor work into our meals, we use training chopsticks from amazon.com (Fred Party People Chopsticks, set of 6) for some food at the table. There are other kinds of training chopsticks available but this colorful set looked like the simplest to use and easiest to clean.

We started with green beans.

Matthew picked up and transferred green beans from the serving plate to his using the training chopsticks. Then he ate them with his fork. Not wanting to be left out, Elizabeth got her own pair of chopsticks too. She used chopsticks, fingers and a fork.

We've been using ice tongs for Matthew to serve himself salad from the salad bowl. He really enjoys being able to do it himself.

Related post:
Toy Review Tuesday: Tongs

TalkTools Straw #4

"Use your lips, not your tongue." That was what I'd say when we started with Straw #4 in the beginning of June. I doubt many parents have to give their children specific (and odd) instruction on how to drink with a straw.

Straw #4 is relatively a shorter straw and has a smaller diameter than straw #3. The smaller diameter makes straw #4 a challenge. In the beginning, I used a lip block (as shown in the photo) to control how much straw tip goes into Matthew's mouth.

The lip block, which was positioned 1/4-inch from the tip of the drinking tip, was essential as a tactile prompt to seal his lips around the straw. Without the lip block, he sometimes shifted to suckling or wrapping his tongue under the straw as his natural urge is to let a longer straw tip into his mouth. A longer length of straw in his mouth (more than 1/4-inch) makes it easier to suckle.

Without the lip block, verbal prompts or reminders "use your lips, not your tongue" and my fingers positioned 1/4-inch from the drinking tip were necessary to get a similar effect as having the lip block in place. Then I re-read the instructions and learned that I was supposed to cut the straw close enough to the first loop so that the loop served as a lip block. So I cut the straw and did away with the yellow rubber lip block.

After 4 months of using straw #4, I have noticed better and stronger lip closure. Along with this physical progress, I have noticed clearer articulation of single speech sounds. Stringing sounds together is still a work in progress though.

I don't doubt that the straws have been helping Matthew develop a stronger oral foundation for speech but his progress in speech is really a combination of the right amounts of speech therapy, reading sight words, oral stimulation techniques (including use of the TalkTools straw kit), and articulation practice. Other oral stimulation techniques include using a z-vibe and offering food that require a lot of chewing or brings more awareness to the mouth such as pickles, grilled chicken, grilled steak, fresh cut apples, lemon sorbet, and so on.

Since the end of September, he easily and successfully (no leaking) drank 4 ounces of milk or juice with straw #4 in one uninterrupted sitting and with less prompting. He has moved on to straw #5!

Distract Her With Kisses

It was time for a morning snack. In her little toddler voice, Elizabeth said "no! no!" to yogurt and happily nodded "yes!" to eggs. Matthew was at school. She had me all to herself.

I got out the pan and started to take a few steps to the refrigerator to get the eggs. Elizabeth started whining and clinging to one of my legs. She wanted me to sit and play with her - immediately!

I scanned the area quickly, looking for a toy. There were none nearby. Aha! The old valentine chocolate sitting on our kitchen counter finally had a purpose.

I showed her how to sort by color, count, and pour. She discovered peeling the foil off all on her own.

Cooking the eggs turned out to be a peaceful, non-screaming few minutes. The Hershey kisses had her undivided attention. Even the cat thought it was entertaining.

If only it were this easy to distract her all the time... Maybe I should keep Hershey kisses as a handy distraction when I need to buy myself a little time. But that would be expensive and too much chocolate for me to eat. Real kisses are better - zero calories and priceless!

Armpits: Our Newest Potty Training Motivator

Forget M&M's or any food as a "reward" for using the toilet. That never worked for Matthew anyway.

Unless his bladder has reached or exceeded maximum capacity, Matthew will sit on the toilet and hold... hold...hold... and nonchalantly act like he doesn't need to go. BUT show him your armpit and say you'll let him tickle your armpit after he pees. And just like turning on a faucet, he wills himself to pee. Several times while he's going, as crazy as it seems, he'll stop peeing midstream and want to tickle your armpit. Saying he can AFTER he's done, he restarts the flow instantly.

As soon as he's done, he gets his "armpit reward" and many chuckles out of him and us. I'm not sure which he finds more hilarious - the fact that he gets to tickle our armpits or that he's secretly got us under his "potty control".

Does He Initiate?
Usually not. But there are a few times he has. He'll either come find me and say "I need to go potty" and lead me to the bathroom with him hand-in-hand. Sometimes, his pants and underwear are still dry. Other times, he had already leaked into them. He knows very well when his pants are wet or dry. And there were a few times in the past 3 days when he went to the bathroom himself and just needed my help getting dry pants and underwear from the closet.

Bigger bladder? Better Control?
I'm not sure. He may have a bigger bladder. After all, he has grown some.

Seeing how he can stop the flow midstream, I would think he had better control. But why the leaks/ accidents? Some days he can hold it for an hour. Some days he has held it and stayed totally dry for 2 hours.

Other Motivators
We have had some success using include clapping, lots of praise and cheers, bringing a small toy to the bathroom, allowing him to read a book while on the toilet, and playing on my iPhone while on the toilet. Some worked better than others, depending on his mood. And some were effective only for a couple weeks.

The most effective strategy we've tried is using a kitchen timer as an audible cue that it was time to go. It worked like a charm for a whole month and a half. No resistance whatsoever from him. Then it got to be less effective. I must have jinxed it by blogging about it. He actually still responds to the timer going off and knows it's "potty time!" but he needs more convincing these days. So we still use the timer despite the muted effectiveness.

Another effective strategy that we still use is giving him a short sequence of activities he can expect after going potty. For example, "go potty, get dressed, wash hands, listen to music." Or "go potty, wash hands, blow bubbles." The key is to know what HE wants to do in order to truly motivate him to get through the pottying process without spacing out, without a tantrum, and with as little help as possible.

By the way, this is our 10th month into potty training.

Toy Review Tuesday: Watering Can

Pouring a drink from a shallow pitcher is one of the fine motor skills that I plan on teaching Matthew this year. A watering can is one of the many ways that provides fun learning and practice time for moving his wrist a certain way and how much to tilt it so that a steady stream comes out. It takes some wrist strength and stability and a certain level of control to pour. And when pouring from one container to another, that sense of control and ability to gauge just the right amount of wrist movement becomes more important in order to avoid spills or overpouring. Watering plants doesn't require such precision but it may be a good way to start developing that precision.

Both kids love playing with water so they each have little plastic watering cans, which have been fun additions to our Water Table play and kiddie pool.

They also love to imitate what Bill and I do. We planted tomato plants in pots on our back deck this year and both kids eagerly want to participate in watering all our plants. So yes, we let them "help". They enjoy it so much that they ask to water the plants.

Letting Matthew use the big watering has added benefits for him. A half-full big watering can is heavy enough to improve his muscle tone. He learns to gauge how much "power" he will need to apply to lift the watering can. He learns how to hold it upright to minimize spills as he walks from the faucet to the plants. He learns to hold it different way to water the plants.

It is considered a "heavy work activity". Many books on sensory processing talk about heavy work activities as a way to provide proprioceptive input to the body. According to a site called Sensory Processing Disorder,

Proprioceptive input is the performance of tasks that involves heavy resistance and input to the muscles and joints, and is essential in helping our bodies assimilate and process both movement (vestibular) and touch (tactile) information.

Intense proprioceptive input has been beneficial for Matthew. He doesn't have an "excessive need to crash and bump into objects, walls, and people" like the Sensory Processing Disorder website describes wherein the input is calming. On the contrary, I believe the right intensity of input helps awaken and stimulate his muscles and nervous system thereby helping him attend better to an activity and allowing him to get more out of the experience cognitively.

Since Elizabeth can't manage the big watering can yet, she's content using the little plastic one.

She's also more than willing to tell Matthew where to water. "There!" she says, as she points. She's proving to be quite a natural at directing.

A Step Stool for School

The kiddie toilets at Matthew's preschool are about 2 inches shorter than the ones we have at home. But Matthew is still too short to back up and sit on the toilet. He is one of the smaller kids at school.

At home, we use a product called The Potty Stool, which is also available on amazon.com for $129. It is serving its purpose very well at home, allowing Matthew to get on and off the toilet independently with ease and stability.

In order to replicate his toileting experience at home, and in collaboration with his occupational therapist at school, we decided he would need a step stool for the kiddie toilet at school.

A store-bought plastic step stool like the Baby Bjorn Safe Step was not wide enough for him to get on and turn around on safely as it measured only 13.5" wide x 9.25" deep x 6" high. The Little Looster Booster Step Stool was too high for the shorter kiddie toilet, measuring approximately 26" wide x 19" deep x 8" high.

We needed a step stool similar in width and depth to The Potty Stool at home. It needed to be 18" wide x 11" deep x 6" high. So we (I) decided to make one.

Why not just have the school order one to be made or buy one themselves? Why wait when I can make one easily? Who knows how long it will take to get one made or bought? It will be exactly what I would want Matthew to use until he grows tall enough that he won't need it anymore.

We used:
- (2) 1" x 6" x 10.5" wooden boards
- (1) 1" x 6" x 15.5" wooden board
- (1) 1" x 12" x 18" wooden board
- (6) 1-1/2" long wood screws

The hardware store cut the wooden boards to size. I sanded the splinters and rough edges then penciled in locations for the wood screws. Bill drilled. Elizabeth, our foreman, handed us each piece making sure we had them all. And together we assembled the pieces. It was actually quite simple. And the materials and cutting charge only cost around $25, with enough extra material to make a second step stool.

Matthew, our quality manager, gave us his seal of approval after a test run where he was able to step up on it and slowly turn around without assistance.

I hope it works out at school.

Was Matthew Ever A Runner?

I was asked this question last week.

Matthew is an escape artist. He doesn't take off running 100% of the time but the times he did were enough to make me think of ways to help him stay where he's supposed to or at the very least, slow him down.

When Matthew was just over 3 years old, I took him for an echocardiogram to check on the murmur (trivial amount of tricuspid regurgitation) as a baby. It was also required pre-op procedure for his tonsillectomy, adenoidectomy, and bilateral myringotomy (ear tubes) back in October 2010. The waiting area was just off of a maze-like hospital hallway. Matthew decided to explore so I trailed him. He started out walking a few steps and then ran. I called out, "Matthew! Turn around and come back this way." He stopped for a second, looked at me over his shoulder, gave me the "catch-me-if-you-can" smile, and then took off running and laughing down the hallway and turning a corner or two.

Another time, we were at the pediatrician's office. The waiting area was not enclosed and it felt more like being in an open mall. Elizabeth was seated and buckled into the sit 'n stand stroller. Matthew was seated, facing me, on the little seat in the "stand" part of the stroller. There was no way to buckle him. I turned away from the stroller to hand Matthew's insurance card to the receptionist. Then I looked back at the stroller. Matthew was gone! I had only taken my eyes off of him for a few seconds. My heart skipped a few beats as I was frozen in place as I scanned the area. He was already more than 25 feet away from me, climbing on a chair in the waiting area of another doctor's office.

A much scarier instance of him taking off happened just a month ago. I was carrying Elizabeth, the diaper bag and had to push a heavy door open, so I had to let go of his hand momentarily. The door opened into a sidewalk but it didn't take much time for Matthew to dash into the street, which is usually busy. That took a few years off my life. Luckily, there weren't any cars at that time.

He also thinks it's hilarious to run on our driveway and head toward the street. I've learned to anticipate it and head him off before he builds any momentum. Otherwise, I just avoid being in that situation unless I had a good way to contain Elizabeth so she can be safe while I run after her big bro.

What I've Learned To Do
Redirect when possible. Last week, we were leaving one of his therapy sessions. On the way to the front door, there was a dance room lined with mirrors. The door was open. He decided that running full speed in the dance room while watching himself was more fun than going to the car to go home. I couldn't chase him down because I had the diaper bag on my back, Elizabeth with her baby doll in my one arm and a small lunch box in my other hand. Elizabeth was refusing to be set down and I did not have a stroller with me. After a few laps, I finally got a hold of him and quickly redirected him toward the door, telling him to wave and say "bye everyone" even when there was no one directly in sight. Having him do something else that he perceived as fun (ie saying "bye" and waving" helped stop the running. It (thankfully!) worked all the way to the front door and to the car.

When at the car, I tell him to touch our car or tap on it or knock on the door, especially if I'm carrying Elizabeth in my other arm. It keeps him preoccupied long enough for me to unlock the doors - I have to stick the key into the lock to unlock it. Then I have him climb in first. Once he's in, I walk around to the other side to put Elizabeth in her car seat and buckle her in. Then I walk back to Matthew's side to buckle him in.

Holding hands has been the most effective way to keep him near me, especially in the parking lot, stores, etc. It took a lot of practice for him and persistence on my part. Of course, it's harder when I have to carry Elizabeth with my other arm. Whenever possible, I find something that would contain either one or both kids. I have both of them in a shopping cart at a store. Or Elizabeth is in an umbrella stroller with Matthew helping me push so then, he is between me and the umbrella stroller or at least right next to me. He loves helping me with the umbrella stroller.

I have not resorted to using a safety strap or harness like this one (photo from amazon.com). Maybe I will someday. Maybe I should get one just as a back-up tool.

Another thing I'm trying to teach Matthew is to ask permission to go somewhere and not just take off. It's a work in progress though and I don't feel like I've gotten through on the "how to ask permission" lesson with him yet. That might sink in when he's older.

More Ideas & Suggestions?
I'm sure many moms with kids who elope have their own tried and tested strategies. If you have ideas or suggestions, we would love to hear them. Please consider commenting. Thanks!

Potty Trained in 4 Days

Not Matthew. We took the scenic route.

But Bridget Murphy's son, now 19 years old and in college, was completely potty trained in 4 days when he was 5-1/2 years old. Bridget Murphy is currently the Board President of the Down Syndrome Guild of Greater Kansas City. She created a 4-day potty training plan. It requires consistency, a lot of toilet training-devoted time, patience, and firm resolve.

I attended Bridget Murphy's potty training seminar last week. Her 4-day method was night-and-day different from the ABA (Applied Behavioral Anaylysis) toilet training method that I had just read a few days before her seminar.

Except during the first day when toileting is being introduced, the 4-day method was all about making the child solely responsible for toileting, no reward system, and absolutely no prompting (visual or verbal) to use the toilet. Her method is based on the assumption that a child can and will learn to self-regulate when the child has to deal with the natural consequences of not using the toilet when needed.

The ABA-based method involved adult assistance and prompting but eventually fading the prompts over a period of time.

Where We Are
We are currently somewhere in between or maybe on a super extended version of Day 1 of Bridget Murphy's method. We prompt. We ask Matthew if he is wet or dry and ask him to check his pants. If he says he is dry, we say, "Good, your pants are dry." If he says he is wet, we say, "You're wet. Let's go potty."

Sometimes he complies. More often though, he is resistant especially if he is doing a preferred activity and does not want to be interrupted. He'll flop and drop to the floor saying, "Nooooo!"

We don't have a set reward system in place for when he uses the toilet. We go with whatever he is interested in at that time. It usually helps us to avoid the flop and drop if we say, "Go potty and then blow bubbles (or whatever preferred activity he wants at that time)." So we don't necessarily "reward" as much as we just tell him what he will be doing next after he uses the toilet. We praised him for using the toilet but we've been fading that. The only "reward", if we call it that, is he gets to flush the toilet. He's happy with that.

Not For Everybody
Bridget Murphy's 4-day method worked with her son and several people that had tried it. And I've heard that ABA was very effective for several people as well. Different strategies work for different people depending on the many variables involved such as family circumstances.

And as much as I'd like to cut our potty training period short, the 4-day method won't work for Matthew unfortunately. Not right now anyway.

Her method requires the child to be able to dress and undress without assistance. Matthew still needs help and some prompting to take his pants on and he has trouble putting his pants back on. There was one time yesterday when he put on his underwear by himself without prompting from us. But he hasn't done it yet again since. Maybe if we waited a few more months until his fine motor is stronger and he can dress and undress unassisted, we can launch into the 4-day method. But until then, we'll do what we've been doing.

I will, however, tweak our strategy and adapt a few good ideas from the seminar.

1. Instead of wearing a pull-up over his underwear for car rides, we will eliminate the pull-up and put a puppy pad on his carseat.
2. Give him more opportunities to practice dressing and undressing.
3. Lessen prompting during the toileting process.

If Bridget Murphy has a seminar near your area, I would recommend going. Or perhaps your local DS Association would invite her as a speaker.

Potty Tracking System and Rewards

In addition to using the ListMaster iPhone app, I now also use the I Go Potty app by Huggies. It's a simple app that I use for potty reminders. I can set the time til the next potty and set regular potty interval reminders, like every 30 minutes for example. And I can also set reminders to be sent between specific hours during the day so I don't get a potty wake-up call in the middle of the night. Best of all, the app is FREE!

To address the timing issue we've been having, I'm using a Toilet Training Data collection sheet for the next 2 weeks to try to get a better idea of when we should take him to the potty depending on patterns he might have. The data collection sheet has 5 columns:
- Time
- Pants Check (W/D/BM)
- In Potty (N/P/BM)
- Self-Initiated (Y/N)
- Notes.

Another mom shared it with me (Thanks Jennifer!). I wish I had done this when we first started but better late than never, right?

Contact me if you would like a copy of this document. I can email it to you.

It probably seems like overkill to have 3 things to track his potty progress but it's what I feel needs to be done right now.

Rewards
The I Go Potty app has a star reward system that unlocks games after 9 stars (9 successful potty visits). But Matthew isn't interested in a cumulative reward system. An immediate reward makes more sense to him. So I really just use that app's 30 minute alarm and I'll show him the game once it is unlocked.

So what do I reward him with after using the potty? More drinks! I got the idea from one of the comments on my previous post "Potty Training." He likes juice so I give him a small cup of watered down apple juice if he's in the mood for it.

Food rarely works as a motivator or reward for Matthew unless it's juice, pears or oranges. But he has to be in the mood for food even with accepted, ultra-limited selection of favorite food. So we use toys or games as a reward too. His current favorite toys are Alphie the Robot, vReader, and preschool apps on our iPhones. We go with whatever works.

And most importantly, he loves the praise we give him for sitting on the potty for 2 to 5 minutes and for successfully peeing in the potty. We haven't tackled #2 in the potty just yet.


Related Posts:
Toy Review: Alphie the Learning Robot
Go Potty
Potty Progress: Saying "Wet"
Potty Training

Potty Progress: Saying "Wet"

By 2pm on a Saturday, Matthew had already sat on his potty chair 15 times. He'll be going more times after his 2-ish to 4-ish pm nap. I think we're making progress! I may be celebrating too soon and end up eating my words but a baby step is still progress and reason to celebrate in our home.

Of the 15 times that he was on the potty, he peed in it 4 times.

Of the 4 times that he peed in the potty, he had been dry and only went in the potty, not in his pants.

Here's the big deal: Of the 4 successful potty visits, at least 2 (if not 3) of the visits were self-initiated. He comes running to me and says "wet!" At times, he's already gone and saying "wet" have just been his reaction to being wet. Other times, he's dry or is only slightly wet and goes more as soon as we get him to the potty.

Tweaking Our Strategy
First of all, thank you for all the suggestions via facebook and comments on my previous post Potty Training. They made me think about how we could tweak our current strategy and gave me other ideas to try. A blogger friend, Ellen, also shares some important tips in her blog post When You Begin Potty Training Your Child with Down Syndrome.

So as far as potty time intervals, we were taking him to the potty every hour during Christmas break, which is when we shifted to high gear with potty training. Then in January, we tried taking him every 30 minutes with an alarm helping us keep track of the time.

First we had him in pull-ups only during the day and a diaper at naptime and bedtime. Then we tried underwear under his pull-ups to give him the sensation of being wet. That was 50% effective with him. Whenever we went to the potty with wet underwear, I'd let him touch the wet underwear and dry underwear to reinforce his understanding of wet and dry. In the 2 weeks that we tried the underwear under pull-ups, I think he knew he was wet when he went but didn't care and continued to play. He only communicated that he was wet two times in that 2 week period.

Then we got braver. Yesterday, I put him in underwear and shorts ONLY. No pull-ups. He soon found himself standing in the kitchen with wet shorts and pee running down his legs. He had an "uh-oh" look on his face when he looked me. We went to the potty, cleaned up, and put on dry underwear and pants. After that incident, he seemed to understand "being wet" better.

Today, he is in underwear and pants only. And in addition to taking him to the potty at our scheduled intervals, we also rush him to the potty as soon as he says "wet!"

At this point, it seems "wet" either means he already went and his pants are wet or he is on the verge of going. We don't think he necessarily understands the urge to go just yet. He'll get there eventually.


UPDATE:
# of times Matthew sat on the potty today = 22
# of times Matthew peed in the potty = 9
# of times Matthew said "wet" and came to get me and then went in the potty = 7

Related post:
Go Potty
Potty Training

Potty Training

Sitting on his potty chair for the 10th time today, Matthew was successful with a pee potty. Unfortunately, he wasn't sitting quite right so pee shot out over the front guard of the potty chair and soaked my pants since I was sitting in front of him. But I praised him for going. I applauded his effort. That was more important than my wet pants.

He understands that going in the potty is expected and loves the praise he gets for successfully using the potty. He even clapped for himself as he was peeing. Yes, it's a proud moment for us all.

Readiness signs
We started introducing Matthew to the potty in August last year. He was showing an interest in the toilet, imitating Bill or I in the bathroom. He was willing to sit on his potty chair at bathtime and bedtime.

He knows the sign for potty. He can also verbalize "potty." However, without recognizing the urge to go yet, he doesn't communicate that he wants to or needs to use the potty.

Generally, sensory awareness is low in individuals with Down syndrome. This seems to be true for Matthew as he doesn't seem to sense the urge. He is also indifferent to being wet or having a poopy diaper. So in this regard, perhaps he isn't completely ready but we wanted to start the process anyway because of his interest.

Potty Strategies & Ideas
During the Christmas break, we ramped up our potty training efforts, taking him to the potty (roughly) every hour. He now wears pull-ups during the day, even to school. So he uses the potty at school too even if it wasn't originally in our IEP (Individualized Education Plan). He wears a diaper at naptime and bedtime.

However, with the hourly schedule, we seemed to be missing the window 90% of the time. We were either 3 minutes too late or 3 minutes too early. So last week, we decided to take him to the potty every 30 minutes when he's home and offering water or juice as often as possible. Yes, it's a tedious process but we've learned to incorporate it into our day by keeping an eye on the clock or setting a "potty alarm." It certainly isn't easy when I have 8-month old Elizabeth to tend to as well. But the more practice he gets, the more chances for more successes. Each success is a little baby step to being potty trained.

An idea from another mom is to put Matthew in underwear under the pull-up so he'll feel that he's wet since pull-ups tend to wick moisture away from the skin. I'll try it for the sake of trying it but I don't have high hopes that it will work for someone who doesn't seem to mind playing in wet pants.

I also thought of purchasing the "Peter Potty" which is a standing toddler urinal made just for boys. My sister-in-law recommended it as it worked for slowly transitioning her son out of diapers. The Peter Potty purchase has not been made. Amazon.com is out of stock and we haven't decided if we wanted to try this. We'll continue to use the Baby Bjorn Potty Chair for now.

Another thing I tried was putting Matthew on the toilet. But he was not comfortable on it and seemed very unsteady even with me holding him since his feet couldn't reach the floor.

Standing to pee in the toilet isn't an option for him yet either since he is short. Standing on a stool and using toilet targets is another idea I've quietly entertained but haven't tried. He'll need more stability getting up on a stool and standing on it without holding on to anything and I'm afraid it might turn into a messy game, which would involve me mopping the bathroom floor multiple times a day.

A Learning Process
Matthew is learning the routine: use the potty, wash hands and dry hands. He is learning to pull his pants down and pants up, which requires finger and hand strength and coordination. He still needs help with this. He usually falls forward when pulling his pants up. He is learning that he needs to keep his balance when pulling his pants up.

It's the baby steps that matter to us. Some days we take a few steps forward. Some days we take a few steps back.

Potty Tracking
I've been tracking the number of successes and number of times he sits on the potty using my newest iPhone app "ListMaster." More searching led me to more iPhone apps specifically for potty training utilizing reward systems. However, Matthew doesn't yet understand cumulative reward systems so accumulating several stars to earn a treat or a toy will not work for us right now. So I'll stick to the chart I created on ListMaster for now. As you can see, our batting average for success is currently pretty low.

No Deadline
We're taking it a day at a time. Having him potty trained by the time he goes to Kindergarten would be ideal. Age 5 is the earliest that kids start Kindergarten here. Because his birthday is in October, which is past the beginning of the schoolyear (August), he will be going to Kindergarten a few months before he turns 6. So we have time. But if that does not happen, then we'll just have to rethink things.

Asking other moms in the DS community, it seems kids with Down syndrome potty trained at age 5 - 7 on average, with a few trained as early as 3 and a few as late as 8 to 11. Some did it in a week. Some took a few years.

Every child is different though. Maybe Matthew will be potty trained by his 4th birthday. Or maybe Matthew won't be completely potty trained until he's 5 or older. But right now, with his interest, cooperation and willingness (very important!), we feel it is certainly worth the effort to try. It's another little step toward independence.

Stopping and trying again later is also certainly an option.

Your Experiences, Ideas and Strategies
Please share potty training ideas and what worked for you by leaving a comment. I would love to hear them and many parents who read this blog would find it helpful too. Thanks!



Related posts:
Go Potty
Potty Training

The Dentist and the Alligator

I've never taken Matthew to the dentist. That task has been delegated to Bill since it would be easier for him to hold Matthew in the dental chair than it would be for me. His first appointment was 6 months ago.



The 2nd visit to the dentist for a routine check went fairly well. He was calm when in the waiting area. But Bill needed to sit in the dental chair with him and hold him still. The dentist looked in Matthew's mouth while he screamed in protest. The screaming stopped shortly after the dentist was done checking his teeth. And I think he forgave the dentist when she gave him a giant toothbrush and toothy alligator to play with. He enjoyed using the giant brush so much that he even tried to brush Bill's teeth with it.





The good news is he has zero cavities! I'm hoping Matthew inherited Bill's genes for good teeth and not mine. I had lots of cavities while growing up while Bill is 30+ and he has not had a single cavity in his life. Bill drinks soda everyday, a few times a day. Unbelievable but true (and so not fair)!

As Matthew gets older and his language skills increase, I foresee us not needing to hold him down at the dentist anymore. But that will probably be several years from now when he can understand why it is important to see the dentist.

Until then, I'm thinking of ways to help him cope. I've put together some pictures from his recent dental appointment to show Matthew using an iPhone app called "Stories2Learn" which allows me to create short stories using my own pictures and words and record my own voice. Since he's a visual learner, maybe this will help him cope better at his next visit to the dentist. Showing him pictures of himself at school to help him adjust to preschool seemed to work so maybe it will work for the dentist too. Or maybe it won't make a difference. But it doesn't hurt to try and is certainly worth the effort.

Toy Review Tuesday: Mailbox (Little Tikes)

Matthew's interest in checking our mailbox for mail daily was my cue to find him a mailbox toy. I scored a used Little Tikes Mailbox at our local consignment store for $9.99. This simple mailbox only produced one sound - a bee buzzing around it unlike the Fisher Price mailbox which has a song mode, learning mode and play mode with various mailbox sound effects.

The used Little Tikes mailbox came with only 1 plastic piece of mail instead of 3 but the missing pieces did not take away from this toy's play value. I improvised. Using small envelopes, I labeled them "Daddy", "Mommy", "Elizabeth", "Matthew", and "cat". Since Matthew can sight read, he hand delivers each piece of mail to the intended recipients without any help. It's very cute and puts a smile on my face whenever he does this. He looks so proud of himself too whenever he delivers the mail. It's hilarious to watch him try to give Yuri, our cat, his mail. Matthew follows Yuri around until Yuri finally settles down somewhere. Then Matthew will lay the "cat" mail in front of Yuri.

For several minutes of entertainment and Matthew's enjoyment in pretending to be a mailman, we like having this mailbox. It's great for pretend play. And to me, any toy that encourages pretend play encourages language development as well.

Toy Review Tuesday: Easy-Grip Pegs & Pegboard

Matthew played with the Easy-Grip Pegs & Pegboard for the first time when his developmental therapist in the Early Intervention program brought this to our house. He was 2 years old. It was initially used for developing hand-eye coordination and improving his finger and hand grasps on small objects. As Matthew has a relatively great attention span, getting him to sit for this activity was not a problem.

But he initially was not drawn to the pegs. It was love at first bite with the foam pegboard. He just loved to mouth it and bite it. We redirected his chewing to putting a few pegs into the holes, hand over hand and always ending on a good successful note - one guided peg in was a success. Keeping the activity short, simple, frustration-free and seemed to be the keys to holding his interest, especially for the next time she brought this toy.

Over time, he was liking this toy so much that I included it in his Christmas wishlist in 2009, afterwhich he got his very own set from Beyond Play. He also eventually outgrew the desire to bite the pegboard.



To date, Matthew has used this for:
- putting pegs in holes
- stacking as high as Matthew can stack
- learning colors
- counting
- sorting colors, playing same and different

Sequencing is another activity for these pegs but we haven't tried that yet. He is now 38 months old.

Tackling Fine Motor and Gross Motor Simultaneously
Lately, with Elizabeth getting more mobile and more interested in Matthew's toys, I've been using this to help her practice get from sitting to kneeling and reaching for pegs to pull out of the board. I taped the pegboard to the back of a whiteboard, just slightly out of her reach.

She just turned 8 months old today and requires only a tiny bit of support while kneeling since she does not have low muscle tone (hypotonia) like Matthew. At 8 months of age, Matthew was nowhere near crawling and he could sit with boppy pillow support. Needless to say, Matthew would not have been able to do this at 8 months, maybe at 13 months.

When developmentally ready and if we had this toy when Matthew was younger, this would've been a good one to use for leg and hip strength by moving from sitting on heels to a full kneeling position instead of the full range of motion (full sit to full kneel). And with good support to make sure he was not using any compensatory movements during the activity. I did something similar when encouraging him to pull up to stand with a vertical surface using the Leapfrog Fridge DJ as his motivator.



Wrist Movement
I actually learned the tip to stick the pegboard on a vertical surface from Matthew's preschool teacher. I saw it in his classroom and his teacher said it helps with wrist movement leading up to writing. I tried it and the wrist is certainly angled differently when working with a vertical surface compared to a horizontal surface.


Overall, a great educational and developmental toy with no bells and whistles. I'm glad we have it.


Related post:
Toy Review Tuesday: Leapfrog Fridge DJ

Locked Out By 3-Year Old

Add me to the list of moms who answer "YES!" to the question: Has your child ever locked you out of the house?

I told Matthew I'd be right back and went to get the mail, not closing the door all the way. It took less than a minute, especially in 30°F weather when I ran to the mailbox and ran back to the house. As I reached the front door, I heard the door close all the way, then I heard a *CLICK*!!



I tried the doorknob. I could turn it. Matthew had locked the deadbolt! He had never done this before. I never taught him that but I'm sure he's seen me lock the front door hundreds of times. I couldn't believe it! Obviously this boy has great fine motor skills.

There I was in the cold (luckily I had a jacket and scarf on), wide-eyed, heart pounding, looking in through the glass on the side of the front door. I didn't have the cordless house phone on me or my cellphone or a house key. I wanted to break down the door.

My sweet 3-year old was smiling at me through the glass and twisting the doorknob. He thought this was a game. Of course, he didn't know how to unlock the deadbolt. I could see Elizabeth was still happy in her jumperoo. I rang the doorbell and knocked on the door. That kept Matthew at the door where I could see him. The house was kid-proofed but it just made me feel better if I could see him.

Then I made a quick dash across the snow-patched lawn to our neighbor's. Thank goodness they were home! I used their phone to call my sister-in-law, who had a spare key and I knew she was out and about in our area at this time. No answer on her cellphone. Panic! I called Bill at work. He was 40 minutes away but he could make some calls for me.

I ran back to the house. Matthew was still at the door smiling at me when I knocked and rang the doorbell. Elizabeth was starting to pout in her jumperoo. Uh-oh! Maybe I can just break a window to get in??

One more call, I thought, and ran to the neighbor's and got a hold of my sister-in-law this time. She was 5 minutes away and on her way. Whew! In the meantime, I had asked our neighbor if they could try picking the garage door lock and perhaps I could get in that way. Our neighbor tried and tried but the lock wouldn't give.

Then my sister-in-law arrived. And she had a key to our house!! Whew! Quickly thanking the neighbor, I rushed to the front door with my rescuer. With one turn of the key in the lock, we were in!!! Thank you, thank you, thank you, Kris!!

I hugged Matthew tight. Elizabeth had just started crying so I got her out of her jumperoo and hugged her tight too.

This scary experience probably took 5 years off my life in the 15 minutes that I was locked out of the house.

Moral of the story:
Always be prepared and have a back-up plan that does not involve relying on other people or breaking down the door or breaking a window.

What if Kris wasn't nearby? What if my next-door neighbors weren't home? What if...

The plan of action:
- Have a house key on me at all times, especially when stepping outside for just a minute to grab the mail. I'm going to get a wrist or arm wallet so I can wear my house key all day.
- Hide a house key somewhere outside.
- Take along a cellphone or the cordless house phone.

Never again!

Toy Review Tuesday: Doctor Kit

"Bup bup bup bup bup bup," says Matthew as he puts the stethoscope on Elizabeth. He also likes to listen to my heart and his teddy bear's heart. This photo was taken when Matthew was 34 months old.



The doctor play kit serves two main purposes:
1. To encourage language through fun pretend play.
2. To encourage better cooperation from him at doctor visits.

He's usually trying to grab the stethoscope or fighting us when the doctor wants to look in his mouth or ears.

I have to admit, getting him to cooperate still largely depends on how he's feeling that day. He refused to sit still for anything and cried about everything when I took him to his pediatrician to check on his sore, swollen throat and tonsils. This was before his tonsils were removed.

On better days though, he has become more cooperative. So far, he doesn't try to grab the stethoscope. He sits still and says "bup bup bup bup bup" while the doctor listens to his heart and lungs. Looking into his ears and mouth has been less of a struggle so far too.

But maybe the doctor kit has nothing to do with him cooperating more. Maybe it's just because he understands more and it's easier to talk him through things like asking him to count to 10 while the doctor looks in his ears. Either way, the doctor kit is a fun addition to his toy bin.

Make Your Own Doctor Kit
Another idea is to create your own doctor kit as described in detail in this article "Pretend and Learn Doctor's Office". I like the idea of getting a real but cheap stethoscope so I am currently searching for one. I wonder what Matthew will think about being able to actually listen to his sister's heart. But he might be disappointed when trying to listen to his teddy bear's heart.

Schedule An Appointment Today!
Dr. Matthew is taking new patients. To schedule an appointment, please leave a comment. :-)

On Tongue Protrusion

Matthew and I went to the zoo last month. We were looking at the elephant when I heard a young boy ask his mother, "Why does he keep his mouth open?" I looked over and he was looking at Matthew. It was an innocent question. Matthew's mouth was open. The boy was probably around 8 years old. I didn't hear his mother answer his question and saw her trying to redirect his attention to the elephant. I just smiled at them but didn't say anything else.

I've heard stories of encounters where strangers would actually rudely tell a toddler (or even a baby) to keep his/ her tongue in, as if the child was doing it on purpose. Our encounter wasn't like that. Otherwise, my blood would've been boiling and I would have definitely said something.



Looking back, maybe I should have casually said, "Oh, he doesn't keep his mouth open all the time" or "He's just so amazed by the elephant." It might have been better than saying nothing. But at that time I didn't think there was anything I could say that wouldn't lead into explaining low muscle tone, jaw stability, large tonsils and Down syndrome to strangers at the zoo.

It has been commonly thought that tongue protrusion was due to an enlarged tongue. There are many articles online that still cite that. An online article titled "Tongue Protrusion" by Karen Henderson, who is a Senior Speech & Language Therapist at Cheeverston House, Tempelogue, Dublin, has an extensive list of factors that may contribute to tongue protrusion. It also acknowledges that every individual with Down syndrome is affected by a different combination of these factors. No one is the same. She also suggests several simple activities to increase tone and awareness around the mouth.



Encouraging Tongue Retraction
Several people, including Matthew's Early Intervention therapists, have observed and commented that Matthew is able to keep his tongue in and mouth closed most of the time. Yet in my mind, having his mouth open for perhaps 30% to 40% of the time each day is still an indicator that he needs to increase his overall tone, jaw stability and awareness.

I personally do not believe that Matthew has enlarged tongue. I think his large tonsils are also a contributing factor to his tongue protrusion. I don't know this for a fact but this is what I speculate.


I did (and do) many things to encourage tongue retraction including:
- breastfeeding when Matthew was a baby as much as I could. I nursed him (but not exclusively) for about 8 or 9 months until my body decided it couldn't keep up anymore. He also drank milk from a Dr. Brown's bottle.
- facial massages to stimulate the nerves in the face.
- tapping my finger on his tongue when it was out to make him aware of it. He was less than a year old. It didn't work all the time though.
- asking him "Where's your tongue?" to encourage him to point to it and in effect, pull it back in his mouth. This was when he knew what "tongue" was.
- using a z-vibe and Jiggler to stimulate the mouth muscles.
- using straw cups whenever possible to encourage lip closure, which helps with oral-motor tone.
- prompting him to say "mmmm" when we were working on the m sound in speech therapy.
- increasing his overall tone with various fine motor and gross motor activities.
- getting him to smile or laugh a lot. He almost always smiles with his tongue in plus it's just nice to see him smile or hear him laugh.

There are so many suggested activities to encourage tongue retraction. An occupational therapist and speech therapist will have lots of ideas. There are even programs like the "Horn Hierarchy" and "Straw Hierarchy" available at Talktools if one is willing to spend the money.

It's an ongoing effort. I imagine it will get easier as he gets older and more aware of whether his mouth is open or not and if his tongue is in or out.

Related post:
TalkTools Horn Kit
TalkTools Straw Hierarchy Kit