The Pelvic Floor – Everyone Has One!

Yesterday I went to a course about fucntional rehabilitation of the pelvic floor.   For a long time, pelvic floor was associated solely with “female issues” and while urinary and fecal incontinence are the number one and number two reasons for admittance of the eldery to nursing homes, many people didn’t seem to be willing to look into options for treating the challenges.

I am happy to see that times are changing.  Physical therapists (and hopefully doctors) are screening the genitourinary (so urinary, colo-rectal, reproductive systems)  system just the way physical therapists screen all systems of the body.  (For the record, this includes the integumentary(sking), neurological, musculoskeletal, cardiovascular, and respiratory systems for therapists plus gastrointestinal and genitourinary systems along with general constitution, eyes, ear/nose/throat, hematological, immune, endocrine, and pyschiatric systems).

The pelvic floor is a region with over 20 muscles in 3 distrinct layers, and yes, men have a pelvic floor as well.  The pelvic floor provides support for the pelvic organs.  Genitourinary and reproductive function includes excretion, urination, urinary sensations, sexual functions, menstruation, procreation, genital sensations.  Many doctors seem to forget that men have a pelvic floor as well.   The pelvic floor also provides sphincteric control for the bladder and bowels, supports sexual function, supports stabilty of the back as part of the core muscles of the body, and supports the lymph system.

Some of the main issues pelvic floor physical therapists work with include elimination disorders of the bowel (constipation, incomplete emptying, incontinence), pelvic organ prolapse (when the pelvic organs are no longer in the right place due to loss of muscle, fascia, or ligament support), pelvic pain,  nerve pain.  Incontinence also rises with diseases such as insulin-dependent diabetes, chronic pulmonary disease, and more.  Low back pain is also associated with pelvic floor problems, and EVERY low back pain patient should be screened for pelvic floor problems.  You would hate to have a back surgery when the real problem is something in your pelvic floor that a back surgery will not fix! Pre-existing incontinence, gastrointestinal problems, and breathing disorders are also associated with developing low back pain.

Incontinence is a big deal because it is a huge independent predictor for falls and injuries, depression, and nursing home placement.  But you don’t need to be over 65 to have incontinence.  There have been studies on  elite athletes and incontinence.  17 percent of elite female athletes are noticing incontinence for the first time in JUNIOR HIGH and 40 percent of elite athletes are noticing incontinence in HIGH SCHOOL.   You are actually 1.37 times to have urinary incontinence in middle age if your strenuous activity exceeded 7.5 hours per week during the teen years.  Leakage of urine is failure of the tissue to handle the repeated load put upon it – if you keep straining the pelvic floor muscles repeatedly, the incontinence will just grow!

There are many ways to rehabilitate the muscles of the pelvic floor, and Kegel exercises (which most people do INCORRECTLY) are not the only way.  Anyone having pelvic pain or leakage incontinence or suspiciion of prolapse should be evaluated by a therapist instead of just throwing a Kegel exercises at it. You will need more than one exercise to fix any of these situations, and “exercising” for pelvic pain might just make the pain worse.  Pelvic physical therapists will work on posture (of the body and the posture/positioning of the pelvic organs), strength and endurance and coordination of the pelvic floor muscles in order to help challenges.

It was an interesting course, and nice to see physical therapy moving in the right direction in recognizing the pelvic floor as an integral part of core stability and as a body systems and a neuromuscular region that responds the way to rehabilitation as any other region of the body.  There is hope!

Blessings,

Carrie

 

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Toolbox of Tips For Communicating With 9-12 Year Olds

This is second in a three-part series of discipline, communication, and development for 9-12 year olds so we can all be more effective parents!  The first part to this series can be found here and got a warm reception from readers as it tackled discipline, responsibility, protection, sports, emotional intelligence, and more.

One thing I love about this age is that I think we have a chance to make a big impact on how we resolve conflict and communicate with one another.  The home is really the first and most major place in which children learn this!

So, the first thing to be aware of is what is your communication style?  I find many adults have a really hard time helping 9-12 year olds with conflict and communication within the family because they themselves were never taught communication skills or conflict resolution?   So, I think we need to think of things such as:

  • How do we deal with things and other people when things are not flowing smoothly? How do we react? What do we say?
  • Do we accommodate conflict by being a people pleaser and backing down on our boundary?  Do we avoid conflict and run away?  Do we become competitive and try to win over why we are right?
  • How good are we a collaborating during times of conflict?
  • Are we direct?  Can we say and use “I ” statements directly when we communicate – “I am frustrated!”  “I am angry!”  But……
  •  What do we do with those feelings then, though?  Take it out on everyone around us?  Yell, scream, shut people out, cry?
  • Do we put people down when we are frustrated or irritated at the situation?  What do we perceive as “disrespect”, why, and what do we do about it?
  • Do we use steps in resolving conflicts?  Only then can we really model.

For younger children, we often think of things such as using our bodies to walk over to the child, connecting with the child and getting the child’s attention, using a calm voice with a simple request, helping the child follow-through in the request.  If conflict ensues, it often is just a matter of hungry/tired/exhausted/needing connection, helping the child calm down, following through or making restitution.  Attacking, lecturing in a long tirade, blaming doesn’t do anything to teach a child how to communicate or solve conflict.

For older children, things become infinitively more complex however.  There is often less of a “working together” model in place developmentally, which is normal, but it can also impact communication and openness.  Here are some suggestions to lay a good baseline:

What are the ESSENTIAL family rules (boundaries)?  Not like pick your socks up off the floor, but the really essential things. What specifically triggers the adults in the family, and the 9-12 year olds and makes the house less peaceful?  What is so essential it can’t be avoided, but what is not essential and could be discarded?  Pick and choose the ESSENTIAL.

In our family, this does include respect and good manners for one another.  Manners are how we show we care about one another, and we should have respect for the fact that we are all different people with different temperaments, personalities, and interests living in the same house together.

If there are things like doing homework or completing chores causing conflict in the family how could you break it down into an action plan that garners cooperation?

Make the family a place of POSITIVENESS and SUPPORT.  One of my favorite phrases to use with my children is, “I am here to help you.  Tell me what you would like to see happen.”  That opening often sets up a much better conversation.

Make the family a place of TEAMWORK.  This is often set in ages birth-9, but it is never too late to start!

EMPOWER.  Children ages 9-12 are not going to do things the way you do them as an adult, but the more empowerment you can give them within the rules of the house and what needs to happen. What will happen if responsibilities are not done?  If poor words are chosen?  If the child becomes completely angry?  Figure these things out in a time of quiet and calm, and have it ready to go and draw upon.

START TEACHING. Responding to what other people say in a defensive way is not an effective way to communicate, and just like learning to walk or throw a baseball, learning how to communicate takes PRACTICE.  A few hints:

Everyone must be calm. This step often takes much, much longer than everyone would like.  Take the time to calm down. Come back later.  There are few things that have to be solved in a split second.

No defensiveness. No yelling. No name calling.  No accusations.  No physicality. If any of these things happen on the part of your 9 to 12 year old to you, stay calm.  Tell your child you would like to help them.  Most 9-12 year olds can still get really overwhelmed by emotions, and need space and time. Defensiveness, yelling, name calling, accusations only ramps up the whole thing and instead of problem solving it is just emotions spilling everywhere.

We can all disagree, but the reality is if we all live together, we have to come up with solutions that work for the family, and we have to agree upon boundaries and rules in order to  live together.  Nine to twelve year olds are often not really logical, so it is important to help guide the discussions.

Listen carefully, and talk about how things happened and what you would each like to see happen.  Come up with a plan.   Make restitution.

I would love to hear your experiences in communicating with your 9-12 year olds!  Let’s exchange ideas!

Blessings and love,
Carrie

 

 

 

Toolbox of Tips For Dealing With 9-12 Year Olds

(This is Part One of a three-part series)  There is absolutely so much written about how to discipline, communicate, and recognize the stages of human development in smaller children, especially those under the age of 7.  And then…

Things just sort of drop off.  Community and friend support diminishes.  Family support may be there, but it can also be difficult if you are raising your children differently than your parents did.   It can feel invasive to talk about what is going on with a twelve-year-old to friends.  Parents end up feeling alone.  

The good news is that information is out actually out there, and this series of  posts is the round-up of helpful hints and ideas!  Take what works for you and your family and leave the rest behind.

Discipline:

Rhythm is STILL your friend.  Hold on to it!  This is the step that makes life and your nine to twelve-year-olds less crazy and easier to deal with! Don’t move too fast into the realms of letting 9-12 olds deciding everything that is going on for them.  Nine-to-twelve year olds still need bedtimes, help in not taking on too much at school, and yes, even helps in  taking breaks to eat and drink.  I personally recommend that if you are not working later at night and are home that your nine year old still goes to bed between 7:30 and 8:00 and that your 12 year old is in bed by 8:30. In order to do this, your children need to (and will be up) in the morning and will need to expend a good amount of physical energy  outside each day. The energy of  many boys in particular, seem to go up around age eight or eight and a half  and continue through about age fourteen, so they need hours of physical work and exercise.

That being said, RESPONSIBILITY is important, even as you carry the bigger pieces of the daily and weekly rhythm.  Nine to twelve year olds are very capable.  They should be doing chores and helping around the house, yard, or farm.  The way I work with chores is to make a list of daily chores for morning and evening, and assign teams. I only do morning and night because that tends to be when I have time to be available and check and rally the troops of this age.  I also try to catch children of this age doing fantastic things to help or be kind without being prompted.  Having a culture of taking responsibility and contribution is so important, and these ages are a great time to build that! I consider this step the first real step towards self-discipline.

WONDER is still important. This is NOT the time for a computer or cell phone yet.  It just crushes wonder and limits in-person communication – and in these days, most cell phones that parents give children also open up the Internet.  You can see more about smartphones here . Boys and gaming is also an issue, and I would encourage you to wait.  You can see practical advice about gaming here..  

I recommend clocking (in your head at least) the number of hours you are spending outside in nature – hiking, biking, walking as a family, camping. If you have difficulty with this and you are in the United States, there are several organizations you could look into that would help your children get outside, including Boy Scouts, Girl Scouts, Fire Side, Earth Scouts, Boys and Girls Clubs of America, Fresh Air Fund.  This is a step toward learning self-regulation.

PROTECTION – Yes, the world is opening up but some level of protection is still important. The best way to start is, of course, modeling and exposure to different people and culture in real life in whatever way that looks for your family and talking about things that you come across.

Talking about bodily changes needs to happen for most children who will have bodily changes between ages 10-14 (and some as early as 8 or 9). Most parents do not do an adequate job preparing their girls for menarche or talking to their boys about bodily changes.  The first part of sexual education is seeing the body in a healthy light, and yes, in seeing healthy relationships that include facets besides just sexual activity.  

EMOTIONAL INTELLIGENCEIn a society  where our number two killer of our teenagers is suicide, we have got to do a better job as parents talking to our children about growth mindset, resilience, emotional attitudes, positive attitudes, what to do with feelings, how to cope with stress, and providing techniques for breathing, yoga, body scanning.  

It is our job to model dealing with stress effectively and to model humor and to keep the lines of communication open.  This age benefits greatly from some one-on-one time with a parent if you have a lovable tribe of kids.

Also, don’t underestimate the sibling pack as the first way of promoting how we act in relationships, respect, love, loyalty, and yes, how we make restitution when we cross the line as siblings are wont to do!

SPORTS– I think in the United States if parents hold off till nine to start organized sports, especially in this day and age due to the lack of neighborhood play and less space in general to run for many children, you are doing well. Holding off until middle school would be even  better.  If you must start something, please see the back posts on sports (here is one to start). I recommend i9 sports for a variety of reasons, but mostly because this organization seems to understand the importance of rotating sports, of practicing and playing a game in one session for recreational sports, and the fact is that whilst some children are crazy about one sport and play for years on end, the majority of children involved in sports QUIT by the teenaged years if they are pushed too hard.  Also, from my standpoint as a pediatric physical therapist, many coaches are simply not educated enough about the developing pre-teen body, the importance of things like pitch counts, etc whilst they are in the midst of pushing intensive year round practices, weight training , and more.

 

Up in Part Two;  Communication!  This is what parents are really talking about  when they talk about “talking back” or “tween attitude”. I think it is actually less about discipline and more about teaching our children how to communicate not only with us, but with their friends.  More on that to come!

Blessings,
Carrie

 

The Authentic Heartbeat of Parenting

I was thinking this morning about running and metronomes; that rhythmic quality of running on the pavement or around the track is like a metronome set to a certain tempo; steady and going at the same pace, reassuring in its steadiness and how we can speed up or slow down to match the metronome. Unceaseless and rhythmical and the source of strength and rest.

This, to me, is so much like parenting.  We need find that authentic heartbeat, that authentic pace, and be able to hold it steady when the times of development and changing and growing in our children is not so steady.

When older children and teens are ready to spiral out of control, we are there with our authentic selves, and holding that authentic pace so if they are trying to speed so far ahead or so far behind, we can reach down and gently whisper, “Stay with me for a little while.”

When do we lose our pace?

When we become overwhelmed by our own baggage and our own triggers and our own emotions and our own lack of self-care.   I admit it has happened to me so much over the course of parenting!  I used to feel ashamed.  Why is this triggering me?  Why am I so frustrated with this particular piece?   But I don’t feel ashamed of it anymore; the longer I parent I can separate myself out of it all, the longer I just hold that it will all work out, the more I know my children have their own journey and their own work to complete that is not my work.

And then it came to me…

I am the metronome, but what am I set to?

Inner work and the work of grace.

I am married, so hopefully I am set in time with my spouse.

Can I keep the pace myself and not forge ahead with a clash of emotions?  Can I keep it less about me and more about just the gentle pace of growing up, the pace of our values as a family, and less about the tiny situation at hand?  The big picture is calling and the tiny details of today’s scrabble must not get in the way.

Parenting older children is tricky business. No one can really tell you how to do it as every family is unique and every child develops at a different time and pace, even if following along in a general way the developmental and archtypal patterns we have come to recognize that are common to children everywhere.

Development matters.  We are having an amazing discussion over on The Parenting Passageway Facebook page about parenting the 9-12 year old, and so much of it has to do with when the developmental changes (and on what scale) these changes hit.

The  reality is that all children eventually grow up, so changes will come, even if not at the standard times. And every family is different, so it may look different.  All we can do is be the steady pace, the gentle guide, the wonderful whisper of ease for those children who are finding no ease in the moment.

Stay strong,

Carrie

How to Talk To Your Teen About Teen Mental Health and Suicide

This past weekend, I was at the Secular Eclectic Academic Homeschool Conference.  One of the most important sessions I attended was about teens and mental health, and I wanted to pass along some of the wonderful work the American Foundation for Suicide Prevention is doing for teen mental health and suicide prevention.

One of the big take-aways from this session is that we should be having layered conversations not only about mental health with our children and teens, especially by age 13 and onward, but also specifically we should be talking about suicide.  The suicide rate for American teens (2016 statistics) was 6,159 reported deaths by suicide for youth ages 10-24.

It is the SECOND leading cause of death for teens!

If the second leading cause of death was due to lack of seat belt use or eating tomatoes or whatever, we would be talking about it.

But because it is suicide, we don’t talk about it.

There is a very steep incline in terms of suicide death between the ages of 10 to ages 14-16 (meaning it is very rare to have a death from suicide at age 10, but then the curve of number of deaths by suicide by age goes up very sharply).  Suicide cuts across all ethnic groups.  No one is immune.  Every person in my session had been touched by suicide in some way.

Girls attempt suicide more than boys, but boys are more successful in succeeding and killing themselves, and for every death by suicide 100-200 teens make an attempt.  Up to 17 percent of teens have reported attempting suicide in the last year and 8.6 percent attempted suicide more than once.  It is not “attention seeking,” as some onlookers ask – it is often a feeling of wanting to disappear and not be a burden.  It is complete hopelessness.

Risk factors include:

  • Health factors:  undiagnosed or underdiagnosed mental health disease
  • Pyschological risk factor such as perfectionism/very black and white thinking (which is normal but should move past black and white thinking in upper adolescence)/perfectionism
  • Past history of abuse/brain injury/Suicide in family.
  •  Life events can be a trigger but not the only thing.

Warning signs include changes in behavior for your teen, withdrawing, isolating, agitation or being easily angered, increased anxiety, changes in sleep or appetite, expression of suicidal thoughts, giving possessions away. Usually the person feels hopeless with no reason to live, feels as if they are a burden to others, feels trapped and in unbearable pain.  Hopelessness is a major feature.  Humiliation can be another risk factor/warning sign for suicide in teens, when teens often feel as if everything they do is in a fishbowl of everyone looking at them.

Protective factors against death by suicide include feeling connected, regular health care and mental health care, learning and using coping strategies, and being willing to seek help.

You can acknowledge your teen’s changed behavior, and you can say you have noticed that they seem to be dealing with a lot and that sometimes people who are dealing with a lot may think about killing themselves.  It does NOT increase suicide if you talk about it, or directly ask about it. It may provide some relief to the teenager, and you can also then know the teen’s ideas or possible intentions and reassure them that they are not alone and that help is available and GET THEM  HELP.

At this point, not only is immediate mental health contact needed along with the immediate reduction of what is stressing the teen, but also TAKE the step to secure any item that could be used lethally – unload and dissassemble firearms that might be in the home and LOCK them away, take any old prescription medicine hanging around and get rid of it, etc.  You can call 1-800-273-TALK or text TALK to 741-741  in the United States for help.  Do NOT leave your child alone!

Here are some of the free resources mentioned in this session so  you can keep having these conversations  with your teens.  There is an Ad Council campaign and series of You Tube videos called #seizetheawkward.  It was done by a number of actors/You Tube stars and while the  ad campaign may seem edgy to you,  in group testing these were the only ads that got the teens’ attention to watch.  It is aimed for 16-24 year olds.  Here is one of the Ad Council videos to get you started, but there are number of them you can watch with your teens and get those conversations rolling. #seizetheawkward

Resources:

1-800-273-TALK or text TALK to 741 741

The American Foundation For Suicide Prevention  (there are chapters in all 50 states in the United States)

More Than Sad is the program developed by the American Foundation for Suicide Prevention

Just like talking about healthy relationships, about sex, about drugs and drinking, let’s keep talking to our teens about mental health, suicide risk, and coping strategies.

Blessings,

Carrie

 

 

 

 

Three Steps in Dealing With Challenging Behavior

There probably have been complaints about children and teen’s behavior as far back in time as one can imagine!   In light of behavior that is less than desirable and is repeating, I think there are three main steps to take as a parent in dealing with this behavior head-on:

  1.  Ask yourself if this is normal behavior for this age?   Many parents have expectations that are far beyond their child’s age and need to be reassured this is part of childhood maturation.  We are losing perspective on this in American society rapidly.
  2. If it is normal behavior for the age, but it is still making the family full of tension, ask yourself how you will guide it with boundaries so your family can live in harmony? 

a.  For a young children under the age of 7, guide with the principles of rhythm carrying things (lack of sleep, hunger, thirst, etc doesn’t help any behavioral situation!), songs and pictorial speech to move things along, and the child making reasonable restitution for what isn’t going well.  If you determine things aren’t going well due to a lot of stress and hurriedness in the family, try to decrease the amount of stress. Look carefully and listen to what the child in front of you  is telling you, but do balance that with the needs of the family.

b.  For the child ages 9-13, guide with the ideas of rhythm and restitution in mind, and rules of your family and of life in general – how do we treat each other in kindness; how do we treat ourselves and others.  Listen carefully to what your child is saying, but also state the expectations and boundaries firmly and kindly.   Go in with the idea that these things will need to be worked on 500 times or more to stick.  If things in the family are super stressful for varying reasons, consider simplifying and also adding in techniques for dealing with stress for the whole family.

c.  If the child is 14-18, guide with the ideas of family rules in mind, and consequences and restitution.  A teen can vacillate widely from seeming very mature to seeming very young and immature, and it is important to remember that the teenaged brain is not yet fully developed.  You must still be there to guide, and you are not at the “friend” stage of parenting.   Teenagers still want boundaries, limits, and a guide.

3.  If the behavior is not normal for the age...

a.  Is it quirky  behavior and being exacerbated by stress and hurriedness? Simplify things and see if things improve.

b. Is it truly not appropriate behavior and not responding to anything you do?  Then you may need professional help  through family therapy or other behavioral intervention.

c. If you are a homeschooling family, do not assume that going to school will make things better.  I think kids who are having problems at home often will have problems at school unless the family is so chaotic they will function better in a more structured environment. But if the child themselves is really  having problems stemming from themselves, they will have problems across environments.

Just a few thoughts,
Carrie

 

Friendships: Part Three: Ages 14-15

This is the last part of our series on friendships from ages ten to fifteen.  Today, we are jumping into looking at the fourteen-year-old ( which is often a much better time than being thirteen and hiding in one’s room) and the fifteen-year old.

It can be really important to some fourteen-year-olds to really belong to a group, but some may need help untangling and being untangled from a group.  This is the age where the girls especially really want to fit in to some elusive and sometimes exclusive group.  She may pick friends or even a best friend that she has no shared interests with, and not a lot of connection even,  but just feels that person is  for whatever reason now her good friend.  She may try to join into a group or clique just to be a part of it without really having a great connection to those people.  Criticism or discussion of different friends begins in earnest this year, noticing the differences or social problems of varying friends or people at school. However, fourteen-year-olds are generally better about talking about things that have gone badly between them and a friend and trying to restore the friendship rather than the thirteen-year-old who just lets the friendship drift away.

Boys often have a bit of any easier time. They still may hang around in a gang; they may or may not have a “best” friend and they may or may not care at all about that.  They do choose friends that they like rather than shared activities.  Often they still hang out with neighborhood friends, whereas girls may be done with that around this age.   Some fourteen-year-old boys still don’t have many friends, or only one friend they really like, and that is certainly okay as well.

What  you can do to help: Girls in particular often want to feel “accepted”  and hence start looking to their own place to belong away from their family.  I think based on the family as the first and most important unit of socialization, it could be important to let teenagers know that  siblings can be close friends, and that the family is such an important thing outside of friendship.

Talk about cliques and groups.  Talk about conflict mediation and conflict resolution.  Talk about how being an individual, and about diversifying friends and encouraging friendships outside of the clique with a different group.  Talk about bullying and social exclusion if you think that is going on, and how and why to be an includer if your child has a temperament that lends itself to that.  This article talks about dealing with cliques   and this article has 8 tips for dealing wtih cliques.

Fifteen-year-olds often have less emphasis on cliques, although many are still influenced by their friends in regards to clothing choice, music, etc.  Some fifteen-year-olds (and this is where your boundaries as parents are important!) may be pairing off into romantic relationships that are occupying more of their time than their friends.  A deeper capacity for caring and sharing may exist than before. Mature friends can accept differences between one another and can maintain closeness despite separation or time. They also can juggle several close friends and no one feels threated by that. I feel this often comes AFTER the fifteen/sixteen change.   Right before this change, I think there can often be a big shake-up in friends – teachers have noticed that for years the fifteen year old year (what is typically sophomore year in American high schools), often sees their students have a big change in friends.    This can also be a time of feeling restless and lonely and depressed, which may also change after the fifteen/sixteen year change is complete.

Your fifteen-year-old may be more likely to seek out advice from friends than from you, the parent.  Therefore, part of dealing with these friendships and even romanatic relationships outside of the family is putting a priority on the family.  Family days, family traditions, are all still very, very important.  It is a source of stability that many teens can’t even really put into words, but do still value.

What you can do:   Hopefully you have many talks with your children by this point as to how to be a friend, how to mediate conflict, how to apologize, how to recognize bullying or aggression and how to cope with stresses.   You are really preparing them for what comes after this fifteen/sixteen year change and as they become more and more independent and perhaps bring less to you regarding interpersonal conflicts.   Junior and senior years of high school are really the young adult phase where you are letting go, being there,  giving that right amount of space where guidance exists.

Blessings,
Carrie