Picking through Dinner

Last week I posted on how to make change incrementally. After I wrote this, I got thinking about a concrete way to demonstrate these principles. An example we can all relate to and even start practicing in our own lives. I had to think no further than dinnertime. Every. Evening.

My 3-year-old adorable son has a way of eating at a pace that is uniquely his (and not the rest of his family's). God bless him for marching to the beat of his own drum, but sometimes, child, I just wish he could take an ounce of our Type A and get the eating done on Harrison time.

Needless to say, it can be a struggle to get him to eat a decent amount. Setting a goal of "finishing your plate" has rarely, if ever, ended well. Then, predictably, right before bed we hear the plaintiff plea, "I'm hungry." Here are the steps our household is taking to deal with it: 

• Control portion size. We dish out much less than we want him to eat. It makes the goal of finishing more attainable, and we can praise the heck out of him for it like he's just "walked on the water."  We reinforce asking for healthy food if he wants more dinner.
   
• Adjust expectations. We're all done eating, and he still has half of his mini-portion left. Instead of telling him to eat or threatening to remove a reward, we'll pull out 2 bites that I really want him to eat, usually a meat or veggie piece. I clear the rest of his plate. Once he finishes those two bites, he is finished at the table (sans treat if we had to negotiate).
   
• Offer a reward & make it contingent. If he finishes his plate, he gets something he wants to eat right then and there. One he can pick for himself. We have a perpetual candy bowl in the house that started with Halloween and will transfer like miscellaneous sugar tumbleweeds into an Easter basket soon enough. All of the candy is individual bite-sized servings so they're not inhaling a ton of it. ALSO: He only gets to pick out a piece of candy after he has eaten his meal to our general satisfaction; there is no foraging later or earlier in the day for candy until he has eaten the meal we reasonably provided.
   
• Offer alternatives. But only if it's already an option (side dish) associated with the dinner you prepared. This is hard for my Better Half. She seriously thinks he will starve to death if he doesn't eat one meal. If he cries at the sight of chili and short-cons us into offering chicken fingers, we're effectively reinforcing crying to get the food you want. I fully recognize that this example is not that simple in a lot of situations, but I do think there's a lot of value in making sure whatever options you intend to offer are already available.

One way to re-route this process is to have your "what they ingest" priorities straight out of the gate and have your "check-downs" at the ready before you engage them. If the meal is chili with crackers and cheese, have it all laid out on the table and lead with a small portion of chili, reminder of eating this portion, then incrementally dole out the crackers with cheese once you have some positive momentum on the chili side of the dinner. Then, only the candy bowl after the small-sized serving of chili and the crackers and cheese are finished. Yes, I really do put this much thought into this, but I only do it because, more often than not, it works well for us.

Here's a simple dinner contingency map for those visual learners out there.

New Year, New Health Insurance Plans

It seems like none of us are immune to the ever-changing landscape of healthcare insurance. Like many others, my family and I are going through new plans, rules, and deductibles effective with the New Year. I think these insurance changes can be confusing and overwhelming.

I wanted to use this transition to the New Year as an opportunity to highlight the healthcare coverage options available to my clients.

• I accept health insurance, health savings account (HSA), and fee for service clients.
• I am an approved provider with:
  • Excellus Blue Cross Blue Shield
  • Aetna
  • Other insurance companies (as an out of network provider)

If your insurance provider is not listed, you may be able to pay for fee for service with a pre-tax healthcare savings vehicle, such as a Flexible Spending Account or HSA. Consult with your employer or health insurance company to learn more. 

Last year, I worked with several clients to maintain their level of care while effectively navigating the health insurance landscape. This included seeking out pre-authorizations or offering more tailored, focused sessions prior to families having met their annual deductibles.

My mission has and will remain the same as stated on the homepage of this website: 

“I will work with you to improve your quality of life”

Being on both sides of the health insurance system as a provider and a patient, I understand how challenging it can be to read the tea-leaves of ever-evolving health insurance coverage.

At the beginning of a New Year, I don't want client progress hindered or halted because of insurance changes. So let's work together in 2017 to focus on quality of life through behavioral change rather than getting bogged down in details while perseverating on the fine print.

Baby Wearing

Staying at home with kids when they're little is a crash course on multi-tasking. It took me a while to get the hang of it, but baby wearing is totally where it's at when they're so little.

1. Sling - This one is my personal favorite because it was so simple to use even I figured it out. Some of my favorite baby memories and pictures involved wearing the sling while our little one was passed out in the nook of it. I also liked that this sling din't take up much space and fit in almost any diaper bag we brought.

2. Baby Bjorn - I liked this for longer walks once the kids gained more neck and trunk strength. Facing them outward was fun for outings and festivals, facing them inwards was great when I really needed them to chill and/or fall asleep. Using this took a bit more style and finesse than the sling.

3. Moby Wrap - My Better Half bought one of these, and I never figured out how to use it. It required more hand-eye coordination than I will ever acquire, but she always made it look easy.

Product Review: Teach Me Time Clock

Last week I posted about Bedtime Routines. I wanted to share an accompanying product review of something I have and use daily in my home, along with some ideas on how I use it to improve my kid's sleep. 

Sleep can be challenging at different stages of development for a variety of reasons. Sleep can also be a sensitive subject for caregivers and healthcare providers alike when it comes to improving the onset (how long does it take to fall asleep) and increasing the duration (how long do they stay in bed asleep). At the end of the day, we all need sleep to function, so I’ve talked about it often with my friends and with families I have worked with over the years.

So...my cherubic first born child learned to sleep through the night at a young age. This is something we took relatively for granted until our second child arrived 22 months later. Just about the time our 2.5 year old transitioned to her big girl bed, she started developing the fabulous habits of A) getting in and out of her bed repeatedly and B) waking up too early. By my math, she was losing anywhere from 60 to 120 minutes of sleep on the front and back ends.

We needed to shore this issue up in a hurry since it was ratcheting up the household stress.

Like most things in my life, my Better Half deserves a lot of the credit. She read about this product, we purchased it, and had it all set to go atop the dresser in our daughter’s bedroom:

Teach Me Time Clock can be purchased on Amazon. This is the nightlight ("stay in bed") mode.

Here’s what the Teach Me Time Clock can do:

• Tell time
• Work as a traditional alarm
• Provide touch-button voice-over to speak actual time
• Serve as a nightlight
• Change colors at different times (this is the key ingredient).
• Here are our current settings:
  • 7:30pm - soft yellow light comes on (serving as a nightlight)
  • 8:00pm - soft yellow light continues on (time for bed)
  • 6:45am - soft green light comes on (indicating time to get up)
  • 8:00am - soft green light turns off (nobody is asleep at this time...)

So our daughter used to wake up around 6:30am, but was now waking up at 5:30am. She used to go to bed around 8pm with little fuss, but now was getting up and down until close to 9pm.

This is what we needed to do:

• Talk about the clock to her, the colors, and what she could earn for following the rules
• Identify a strong motivator soon after the light changes (morning tv show)
• Tell her what she would get for staying in bed until the light turned green (tv show)

The careful reader will likely notice that I have said nothing about getting her to stay in bed in the evening without getting up and down a bunch. I believe the the venerable Sun Tzu put it best when he said, in different words, “never fight a war on two fronts.” Sage advice here.

It would’ve been amazing if this took only one evening to do the trick. Of course, it did not.

What we needed to do was set the clock to 5:45am (close to her new 5:30am awake routine) and then gradually move the time toward our 6:30am goal in 10-15 minute increments over a few weeks. In addition, she would often wake at 5:30am, come get one of us, and then want to go watch her tv show. I would take her back to her room, lay her back in bed, and then lay with her until it turned green. I praised her to holy heck, got her dressed, and took her to tv time.

Then we worked on having her lay by herself until the light turned green. Then once this new behavior of laying in bed on her own until the light turn green appeared firmly established, we moved the time forward. This would often reset the level of support back to her needing to be taken back to bed, me laying beside her, then fading my physical presence, and her staying in her bed on her own. Then we’d move the clock forward another increment toward our goal.

Green light means time to get out of bed. "I slept until the light turned green" - parenting win!

What happened if she refused to stay in bed until the light turned green? This is where we would "ride the lightning."

She just didn’t get tv time that morning. And yep, it was not fun for either party.

But she got the hint relatively quickly because we also were not doing tv time in the evening, so this increased the reinforcement value of tv time.

This is one of those parenting battles where I feel like we fought the good fight and won. It wasn’t a one week or even a one month slam dunk, silver bullet sort of deal for us or her. But I do think this alarm clock provided a nice level of cuing and support that we still use with her.

Now we are preparing to transition our son to a big boy bed and will be ordering a second Teach Me Time Clock soon.

Bedtime Routines

I believe our souls call out for consistency in the form of predictable, daily routines. I am sure that life would be boring for most of us if everything was predictable and routine, but when learning something new and potentially challenging (like how to eat or sleep or drive a car), a consistent order and flow gives a comfort that enables new things to come more readily to us.

Bedtime is a ritual that rewards parent and child alike.

For the child, having a bedtime routine signals what to expect as they transition away from the wakeful part of their day where they acquire new skills and encounter new situations at a ferocious pace.  The order in which the routine unfolds matters a great deal, but can vary depending on what you know about your child. For example, certain children become animated during bath time (or don't even like getting their hair wet), while others begin to quiet down and doze. If your child becomes more animated or upset during the bath time routine, starting bath time sooner or only bathing every other night might be an easy place to modify things.

For the parent, having a bedtime routine gives you a chance to gently guide your child toward a restful state that readies them for falling asleep. It also provides an opportunity to lay the foundation for the next day (picking out clothes after looking at the weather on your phone). 

For the parent and child, the bedtime routine provides an opportunity for bonding and more attentively observing the subtle ways in which your child responds to their world and others.

Recommendations to consider with the bedtime routine:

Provide your child with a clear indication of when the bedtime routine will begin. For example, you could say, “In ten more minutes” or “at 7:30, we will get ready for bed." For some children, setting an alarm (fun song) on your smartphone could be a creative support.

Pay attention to how you announce the bedtime routine. For some children, saying, “Time for bed” is the equivalent of saying, “the fun thing you are doing right now (e.g., playing with toys) will have to end soon because I said so.” Instead, try changing the way you state this by using a preferred activity or item as part of the announcement. For example, you could say, “Time for bubble bath!” or “silly story time is soon!” This reminds children of the fun parts of bedtime.

Start the bath early enough that you don’t have to rush your child through it. If your child likes to play in the tub, build in extra time by starting earlier so that they can have more time to play in the bathtub.

A lot of kids have a hard time transitioning from the bathtub to getting dressed and brushing their teeth. In these situations, I'd recommended leading with a clear contingency that gives them something to work for and look forward to. Something like, "Once you hop out of the tub and have your pajamas on, you can pick an extra book!" Help them get dressed and praise them for using nice hands. With tooth brushing, I think having your child pick out a favorite toothbrush from the store and/or a preferred tooth paste container can help make this part of the routine fun.

I really like background sounds or some for of white noise when I sleep, and both of my little ones have a white noise machine in their room. It's also served as a discriminative stimulus for my kids -- sleep machine turned on signals little butts into bed in order to have story time.

Since starting my private practice, I have had the opportunity to work with more than one family to improve their bedtime and sleep routines. I really enjoy this type of work, besides who doesn't enjoy a good night's sleep?