Saturday, July 16, 2016

Potty Training 101 for children with Down syndrome



Image result for a potty for me   

I am not an expert, but I hope this information will give you some ideas and help you with the endeavors of potty training. 

We initially began putting Presley on the potty around age 3 just before bath time.  We just made it part of our routine with no stress about it, sometimes she went, sometimes she did not.  Then when she was four, "I decided" she was ready and went for it.  It went horribly wrong, she became very constipated and refused to make "brown".  After ten days, I called it off and had to work on correcting that issue.  So for starters, encourage regular predictable bowel movements.  If this is an issue, read more here for ideas to help with constipation.  Observe for those subtle clues and predicable patterns, such as going off to another room by themselves, after a certain meal, pulling at shorts, squirming, etc...

Next, establish what you will call going to the bathroom.  For us, we called it "yellow" and "brown" to identify with what color she obviously saw.  Everyone in the family or who works with your child should be aware of your choice of words so there is consistency and your child is not confused by others.   These are also words that Presley could easily say.  If your child is non verbal, then consider using the sign for potty or maybe have a picture they can point to when they need to go.

Our second attempt only a few months later went great and 12 days later, Presley was potty trained.  Below is a list of what worked and what did not work for us. 

*  Buy at least two small children's potties that play music when they sense wetness.  One for the bathroom and one for your vehicle.  Here is an example on amazon.  It gives them a reward to hear and also lets you know when to cheer.

Product Details


*  When you begin placing your child on the potty, try putting their feet in warm water to help them understand what it is that you are wanting them to do.  Give praise as soon as the potty plays music and announce the word you have chosen to use.  We would say "Yay for yellow".   This is also a great trick when you want them to leave the house with an empty bladder and they can't go yet.  Presley would even say "warm water please" when she couldn't go.   I used one of our small plastic step stools and just turned it over to hold water.

*  Plan some time on the calendar to stay home as much as possible.  I am retired, so other than their dance class, piano, groceries, and church, we stayed close to the house.  This is when the children's potty in the vehicle comes in handy. When we have to leave, I have the potty in the third row of the vehicle ready with paper towels, plastic bags, wipes, and homemade sanitizer.   We called it "truck yellow".   We would also use the restroom before we left, when we got to our location, possibly before we left, and again when we got home.  She didn't always go, but we offered often.     I truly believe staying home, watching for cues, watching the timers, being consistent, and keeping it low stress was the biggest key for us.

*  I kept Presley in a t-shirt or just underwear when at home.  Presley is a typical size 4 year old, so disposable diapers were getting tight.  So, I spent money on fancy cloth diapers since I thought we would be using them for awhile.  However, they didn't fit well  either and left a rash on her bottom when used overnight.  Next, I tried Good nites trainers which look like underwear that you place an absorbent pad in.  Again, a little snug around the legs.  Then I bought the lining and water resistant material for a cloth diaper at a local fabric store and sewed it into the bottom portion of some of her panties.  This was ok, but failed at night.  Finally, I ended up purchasing a lot of panties her size with characters she picked out herself.  She knew immediately when she was wet and so did I.  For those  "brown" accidents, well some of those just got thrown away.   I wish I had just gone straight to panties in the beginning.

*  A bidet/diaper sprayer such as these were very helpful to rinse out panties and eventually little bottoms.  It also helps rinse out the children's potty.  A worthy investment and very easy to hook up.

SmarterFresh Cloth Diaper Sprayer, Premium Stainless Steel Diaper Sprayer for Toilet - Diaper Washer Hand Held Bidet Sprayer for Cloth Diapers


Squatty potty - this places your child in an position that encourages full bowel movements and doesn't let them "hold it in" when using the regular toilet. I used a small step stool on the floor to elevate her legs when she was using the children's potty on the floor.  



                                            




*  A reward or potty chart.  I made this one, because she loves Minnie Mouse.  I made a word document, added pictures and names, then laminated.   I cut out smaller pictures and put Velcro on them instead of stickers.   I made one for my other daughter (age 6), so Presley could see her using the chart and encourage her to use hers.   I tried offering chips or a special snack when she used the potty, but that has never been a great motivator for Presley.  Some have recommended using a bag of small toys and letting them pick a new one each time they get it right.



Timer or potty watch - I used a small timer and set it for every 15 minutes initially then increased the time.  A few times I tried staying in the bathroom for an extended period until she used the bathroom.  We played on Ipad, watched videos, etc.. but that did not work well for us as I found it difficult to stay still in one room with so many things needing to get done and a 6 year old needing my attention too.  Instead, we ended up going into the bathroom every 15 minutes.  If she couldn't go, I would either use the warm water or just wait for another 15 minutes. I took away all the distractions (ipad, toys..) and we focused on the task at hand.   A friend used the potty watch.  She put it on her daughter and while she went to mother's day out, therapy, or at home, whoever was around her when it went off knew to take her to the bathroom.  I could also see it beneficial for the mom to wear a watch to remind her in case the child is playing in another room when it goes off.

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*  Leave the light on in the bathroom, this encourages Presley to go in there on her own when she needs to go.  We typically turn the light on when we use the restroom, so this invites them into the room even if there is adequate light from a window already.

*  Place your hand on their lower abdomen.  This worked for teaching how to put "brown" in the potty.  I sat on a stool in front of her and put my hands on her lower portion of her belly and said "push that brown out".  She would instinctively push back against my hand and therefore learned exactly how to use her muscles to push it out at her command.

*  Potty videos and books - we read and watched many of these.  Signing times has a cute video here that has catchy songs you can sing together while waiting. We also had a lot of fun making our own videos using her older sister and their doll Minnie. Presley likes to read so we used flashcards to establish a certain routine in the video, but you could use pictures too.   The flashcards were like this:
        - Do you need to go to the potty?
        - Yes
        - Go to the potty.
        - Panties down.
        - Go pee pee or yellow.
        - Wipe.
        - Pants up.
        - Wash hands with soap and water.
        - Dry hands

Here is one of our videos:



Make it fun.  Each time we headed to the bathroom, I would sing a silly song or phrase to try to make her laugh so she would have a positive association with going to the bathroom.  I still sing (imagine Beach boys surfing song)  "Let's go potty now, everybody potty now, come on and go potty with me.   How about "1 little, 2 little, 3 little browns....."  I won't bore you with the others, but sometimes Presley now says "Mom stop".   I also told Presley we were having a "brown party" and she needed to make brown so she could add it to the potty party.  She thought she was a big girl doing this.  Let them flush also since this isn't something they ordinarily get to do.

Auditory processing - a minimal 3 or 4 was recommended by our neurodevelopmentalist at NACD.  This ensures they truly comprehend the task you are asking of them.  See here for more information about auditory processing.

Reflex integration - we initially did rhythmic movements and learned about reflex integration from Play Move ThriveIt seemed to wake up her body and let her feel all the sensations easier.  Some moms are having success using the QRI laser to integrate reflexes and produce results much quicker in many different areas.   Before using the laser, Presley would make yellow in the shower as soon as the warm water touched her, but after a week of using the laser, she stood up and asked to get out and go to the potty instead.  We were not using the laser when she was potty trained though. 

Accidents - I carried extra underwear, pants, and a baggie everywhere we went.  We had lots of accidents in those 12 days, but she caught on that we weren't turning back and we stayed consistent.  One time at a 30 minute piano lesson for big sister, we changed outfits three times.  When she had an accident at home, I would walk her over to get the paper towels and cleaner and she had to help clean up the mess.  She then had to take her underwear off and put them into the washer by herself.  She did not think this was very fun.  I tired my best to be unemotional when there were accidents, but hey, I am human.

*  Some parents have had good results using this 3 day potty training method.  I have best success when I incorporate a variety.  http://www.3daypottytraining.com/ and the Bridget Murphy 4 day method seen here.

*  As with everything, keep diet and environment consistent without changes as possible when starting potty training.  Don't add any other stressors to them or yourself.    Always a good, clean diet with adequate sleep.   Good luck!


Many blessings,
Robin







 

Sunday, June 5, 2016

Language Pyramid from Gemiini



In 2014 Laura Kasbar's speech and language program that she created became available to all of us.  Gemiini, which offters educational videos for people on the autism spectrum, brain injuries, Down syndrome and other types of learning disabilities.

After Emma started showing signs of echolalia we thought it would be a great addition to our daily routine.  Gemiini has certainly proven that video modeling intervention is one of the most effective way to promote speech.  Studies have proven that video modeling is a viable intervention.

Video modeling and word identification in adolescents with Autism Spectrum Disorder


To best describe what Gemiini is and why is was created please check out this video.




Recently Gemiini created a series of videos called The Language Pyramid-Growing a Confident Communicator, which illustrates the language development process.  Please take the time to watch these short videos for better understanding.

Video 1:  The Language Pyramid-Growing a Confident Communicator






Video 2:  Sparking Imitation







Video 3:  Animal Noises







Video 4:  Basic Word Labels






Video 5:  First Action Words







Video 6:  Putting Sentences Together







Video 7:  More Action Words-Tenses and Pronouns







Video 8:  Modifiers







Video 9:  Chunking with Phrases






Video 10:  Conversation Builders










Friday, March 4, 2016

What's for breakfast? Smoothies, applesauce, eggs. vitamins....

Nutrition is so important for children, but having the extra chromosome can cause difficulties with the immune system.  We encourage a diet low in sugar and grains and without MSG, GMO's, artificial colors, processed foods, or gluten.  We do this as a family, because it improves all of our health and sets up Payton (neurotypical) and Presley (our 4 year old with DS) for healthy choices throughout their lives.

Now, for our morning routine.  Shortly after Presley awakens, she is given her Naturethroid crushed with a small amount of applesauce.  This is more effective when given alone, so we wait a minimum of 30-45 minutes before giving anything else.   This is the time I spend preparing everything.

We began introducing smoothies to Presley as soon as she stopped breastfeeding.  It helped naturally thicken the liquids, so she has never had to use a thickener. This made it easier to get vitamins in without a fuss.

Presley's smoothie:


Ingredients: 

Coconut or almond milk
banana 1
avocado -  1/2 - this makes it very creamy, rich, and thick
carrot - 1 sm - med, sometimes I use the small baby carrots if store was out
cilantro, spinach, or kale - keeping it a variety
blueberries
mixed berries - strawberries, blackberries, raspberries
bee pollen 1/4 tsp - contains 22 amino acids
aloe vera - 1 tsp - for constipation
coconut oil - 1 Tbsp - healthy fat
local, raw honey - 1 Tbsp
flax oil - 1/4 - 1/2 tsp
black cumin oil - splash  - adult dose is 1 tsp
almond butter - 1 Tbsp
elderberry syrup - 1 Tbsp, immune modulator, homemade
royal jelly - 1/2 tsp
cinnamon - dash

I also put her vitamins in: probiotics, vitamin C, vitamin D, acetyl L carnitine, PC, vitamin E, ECGC,  leucovorin, circumin w/resveratrol, fish oil, and magnesium.  I personally use the Seeking Health brand for supplements.

When I have these on hand, I like to add goji berries and thermos cereal.

 
Everything gets mixed together in the Nutribullet.  I have used this one for 3 years many times a day and it still works great.
 

 
It took awhile to convert from plastic cups, but we now use glass jars with stainless steel tops and straws.  This obviously fills Presley up for awhile, so I also prepare Payton a snack until breakfast is officially made.
 
 
 
Payton's morning snack:
 



Frozen blueberries
Elderberry syrup
Organic, dark chocolate (80% cacao) - 1-2 pieces (it isn't a reward or treat, it is just part of her morning routine)
Fresh fruit: apple, orange, grapes, kiwi, banana, or strawberries
Applesauce with:
          probiotics
          fish oil
          royal jelly
          local, raw honey
          vitamin C powder
          cinnamon
          chia seeds - 2 tsp - let sit in refrig and it will thicken it

Payton will drink one of these: kefir, milk, herbal tea, or komboucha

An hour or so after this, the girls are given two eggs (from local farm) fried using coconut oil in a stainless steel pan and sprinkled with powdered garlic.  Afterwards, I use a homemade spice consisting of turmeric, Himalayan salt, paprika, garlic, onion, and pepper that is similar to Lawry's seasoning salt.

In the meanwhile, I also enjoy a coconut milk smoothie with almond butter, berries, carrots, cilantro, kale, spinach, coconut oil, chia seeds, avocado, pure greens powder, and collagen powder. aloe vera, and flax oil.  If we only took care of ourselves as well as we do our children.......

Yes, I am a stay at home (retired military) mom and have the privilege of being able to do this each morning.  Tricia will be posting soon from a working mom's perspective of how they get nutrients into during their morning routine.

Please let me what ideas you have to help keep your kids healthy.

Many blessings,
Robin Tolliver
         

Thursday, February 11, 2016

Exercise & DS. How to get moving!

According to the U.S. Centers for Disease Control and Prevention, about 20 percent of all American adolescents and teenagers are obese. Poor dietary choices and a low level of physical activity are major contributing factors to the childhood obesity epidemic in the United States.   Children with Down syndrome have been reported to participate in less physical activity than other children, including children with developmental delays and intellectual disabilities without Down syndrome. This lack of physical activity likely contributes to the higher numbers of overweight and obese children and adults with Down syndrome.  (source)

We all know the benefits of exercise, but these benefits can mean even more for our children with Down syndrome as it encourages muscle strength, better balance, increases endurance, and establishes a foundation for a healthy, active lifestyle. 

As with anyone beginning an exercise program, please discuss with your child's pediatrician before beginning. You should also consider your child's health, interest, limitations, abilities, strengths, weaknesses, balance, and time.  You could also gather input from your child's therapists, such as the physical therapist.   If your child has low energy levels, evaluate their thyroid status, nutritional status, and diet with a professional.

Need help getting started?  Here are some suggestions that work for us.  We usually begin our day with yoga.  If you live in an area with limited internet, you can download the videos from youtube to your computer for free and have access to them anytime.  When you find a video on youtube you enjoy, put "ss" in front of the word youtube in the webpage address box.  If it says "www.youtube.com/star" then you simply change it to "www.ssyoutube.com/star " and hit the download button.  Too easy!


Here are Payton and Presley teaching yoga to their dolls.
They even made their own yoga video.  

Some ideas to get your family moving:

          *Cosmic Kids - super fun yoga for all ages.  She dresses up and takes kids on a storybook like adventure each session.  All videos are free on youtube.

          *Yoga Kids - "YogaKids empowers children and teaches them the skills to better care for their bodies, access and interpret feelings, manage stress, solve problems, and connect to others".  Videos for different ages and learning, such as Silly to Calm, ABC's, etc...  I found their videos much cheaper here on Amazon though.


          * Dance X - fun dance moves, but maybe a little fast the little ones.  Here is a clip showing several of the dances.


          *  Debbie Doo and Bounce Patrol - my daughter's favorites to watch.  They encourage lots of movements to fun children's songs.   Favorites Star Jump and Hokey Pokey on youtube.


          * Happy dance by The Learning Station - fun to dance too. Short video with lots of movement to music.


          * Fit cards - the girls get to pull out a card to choose an exercise to do. This could travel easy also.  Costs $7.95.
                         
          * Magic Moves Microphone - the kids push a button and it tells them what move to do, such as "gallop like a horse" or "stomp like a dinosaur".  This encourages good listening too. 

                                          
        * Skip A Long - the rope is around one ankle while the other foot jumps over it.  It does require balance and coordination of timing, so better for older kids.
                                
                                   

          * Small indoor trampoline - encourage them to jump (if no contraindications for health, such as neck instability, and be cautious with children who stim as this may encourage peripheral vision play).  It is fun to do auditory processing (see previous post)  before each jumping episode.

          * Obstacle course - inside or outside.  We set it up inside using these fun soft play blocks. Here is an example of a fun outdoor one.   We do "follow the leader" and my 4 year old follows my 6 year wherever she goes.  You could also make a small circuit training and have a sign for each even and use a timer to change stations every 30 seconds.  Here is a short clip of ours in our home:
(See previous post here how insurance paid for this equipment)

          * Jump rope

          * Hopscotch - draw it in the dirt or on a sidewalk using chalk

          * Walking - hiking - we call this our "Nature therapy" when we go walking through trails, by the river, or around the farm.  We talk about everything we see.  Sometimes I give them a list of items for a scavenger hunt to make them memorize things.  We stop and write words or math problems in the dirt as we go.

 

          * Biking - see this article how 30 minutes 3 times a week improved speech, dexterity, and IQ using "assisted cycle therapy".  So strap them into their Smart Trike and get those legs moving as you push the little ones.



          * Monkey bars or trapeze bar - inside or outside.  We also use a swing platform indoors.

          * Basketball - we use a heavier cushioned ball indoors to build upper body strength.

         * Balance beams - place a 2x4 piece of wood on the ground or use one like this.

         * Dance class - see Presley 4 year old (DS) doing her routine here. It is always a fun work out for her and socializes her too.  At home, put bubble wrap on the floor and have a loud dance party.

         * Using tape on the floor for kids to follow: (thanks Pinterest)

                  What to Do with Just Some Lines of Tape - 2 very simple tape activities can do quickly - pinned by @PediaStaff – Please Visit  ht.ly/63sNt for all our pediatric therapy pins:      Indoor Gross Motor Sensory Play for Sensory Processing:

               * A fun exercise wheel.

                                        Turn a lazy susan into a fun spinning wheel the kids will love! Label the dry-erase segments with activities, exercises, chores, treats, rew...:


          * ABC exercise cards - click here and print
                                     ABC Exercise Cards - Use at circle time and pick one at rancom to do with students:

         * Make fun exercise dice by clicking here.

                                             Get the Kids Moving Game from Paperelli for iheartnaptime.com:

        *  Cute idea called "exercise eggs" that uses eggs with notes inside there were hidden around the room.
                                             This would make a GREAT brain break idea. What a fun way to use plastic Easter eggs.:

                                                  
         * Others  bowling, soccer or kicking a ball back and forth, climbing, croquet,  hula hoops, Frisbee, tag, swimming, go to a park, skipping, gardening,


I hope this post encourages you and your family to get moving and have fun together.

Blessings,
Robin Tolliver