Heart Murmurs

Although not normal, it is very common for newborns to be born with a heart murmur–a small hole or tear in the tissue of the heart.  It sounds scary but usually it is nothing to worry about.  A doctor will pick it up on the first day or two, and then they will send you home as long as the baby passes an echocardiogram (ECG) and doesn’t show any other symptoms (i.e. especially breathing difficulty).  They then tell you to make an appointment with your pediatrician (like you do for all newborns) and see if he/she still hears it.  This gives the baby’s heart a couple days to heal on its own, which sometimes it does.

If the pediatrician still hears the murmur, he/she will probably refer you to a children’s cardiologist and the cardiologist will do another ECG and listen to the murmur.  A cardiologist’s ear is so fine-tuned for diagnosing murmurs from a simple stethoscope that it is amazing.  He or she will usually be able to tell you how big the murmur is and in what part of the heart, just by listening for a couple seconds.

Apparently the region of the heart is important because there is a greater percentage of the murmur healing depending on which chamber it is in.  I can’t remember the facts anymore, but the chamber that my baby’s murmur was in had a 75% chance of healing all by itself in a couple months.  I believe there is only one chamber where it normally doesn’t heal on its own.  Usually the cardiologist will send you away to return in another two months, just for a listen and another ECG.  The vast majority of murmurs heal on their own by that time because the baby is growing so much during that first two-month period.

If for some reason your baby’s heart murmur doesn’t go away by then, it can still go away any time during the first five years of its life.  The pediatrician will keep an eye (ear) on it as they grow.  But if for some reason it still doesn’t go away, usually the consequences are minor.  The child has to go on antibiotics for dental procedures, and other medical or surgical procedures might be more complicated because there is a risk of infection that can travel to the heart.  But there is usually not any other trouble, including in the area of exertion.  Things should be normal.

It is important to know that while a heart murmur is considered “a heart condition,” you don’t need to panic.  The only time that panic is warranted is if the baby starts having trouble breathing… chest heaving, sucking in at the breastbone, bluish face, clammy or non-circulating extremities.  This is because the heart circulation directly affects the respiratory system.  You’d probably notice very soon if this were to happen post-partum.  Take the baby to the ER immediately.

Video Series for Kids

I am probably the pickiest person you will come across, when it comes to kids’ videos. Maybe because I am a psychology person, or maybe just because I’m sensitive. I have spent a lot of time watching my children and trying to understand how they learn, how they see things. When I then see most shows or videos, I am sensitive to what I call the Adult-Child Gap. That is when adults think they’re teaching children one thing, but because of how children learn, they actually teach something else.

I believe this phenomenon is responsible for a lot of the bad attitudes/behaviors kids pick up from TV… in fact, I suspect it is number one after the actual choice and frequency of the media is considered. I have found that as I add or eliminate shows from their diet, that my kids’ hearts immediately change. It truly impacts them a lot, perhaps because video is one of the most powerful forms of media available.

That said, I have some comments on popular series my kids have seen. Remember, they are only 4, 3, 2, and 7 months… these are comments from a young preschooler perspective.

Barney

I hate to say it, but as much as adults cringe to hear the sound of Barney, it is a pretty good series for little kids–I’d say two-year olds especially. There is something about that purple dinosaur that kids really learn from, and there are educational topics like nursery rhymes, manners, farm animals, letters, or hygiene. The kids are fake but nice to each other, and they talk respectfully, which is a rarity these days. They also talk through their feelings and issues, which I think is especially educational for little guys. The other characters are less educational, however, and Baby Bop in particular, shows some bad examples whenever I’ve caught it. Best for youngest ages, 1-3.

And, of course, you have to leave the room once you turn it on, if you want to stay sane =)

Boz the Bear

Definitely the best kids’ series out there. Since it’s made by evangelical Christians, there is very little that is objectionable on the videos I have seen. Non-Christian kids could watch it too, as it teaches good character traits without hitting them over the head with anything that would be offensive. My kids loved pretending they were “Drew” and “Gracie” afterwards, and singing all the silly songs on there. Good for all ages, one to five.

They make a Boz preschool workbook that is very good, too, if you’re into that sort of thing.

Bob the Builder

Also a pretty good series. It’s on PBS and Nickelodeon, and it is not as educational as Barney, but it still teaches a lot… about tools, teamwork, completing a job, fixing problems, personalities, etc. I haven’t seen all the shows, but we have five or six videos, and I’m surprised at how good they are for a secular show. There are occasionally bad attitudes (i.e complaining, jealousy) or events of disobedience (especially from Pilchard and the pets), but generally it is respectful. Definitely watchable too, in comparison to Barney! Best for threes and fours.

Kipper

I have since taken these videos out of my collection because I didn’t like my kids impersonating the grouchy and envious character in the shows (Tiger), but I have to say they were very instrumental in my oldest child’s ability to retain and understand a story. Probably because the character sketches and plots are very simple. It is sort of like Winnie-the-Pooh lite, and made by British people too. If you have a high-functioning autistic child, or one who has trouble with listening/comprehension, or even social skills (i.e. Asperger’s), you might consider this series. Minus the unrespectful parts, it is extremely well done and slow pace, witty and not flashy. Best for twos and threes.

Blue’s Clues

Definitely a step-up from Sesame Street. In fact, I think it should replace Sesame Street, which has turned loud, obnoxious, and socialist. Blue’s Clues is best for preschool academic skills, although they have recently made some shows on concepts (like frustration, listening, thinking) which are fantastic. They really drill one thing at a time. My kids learned a ton from these shows, and, in combination with healthy play and interactive times with us, cemented almost all the prekindergarten knowledge they needed. Probably will outgrow by age 4 or 5.

Spot

Spot is a beloved chidren’s classic in the book department, but there is also one video that is excellent. In combination with Kipper, this video helped my oldest son with auditory processing disorder, learn a lot of language. For awhile, he talked with pieces of the Spot script, which I recognized and was able to “build bridges” from, to other things I wanted him to know. The video has lots of short stories on it and is interspersed with clips of real children doing pretend games or extrapolating on the short story just told (i.e. they ride hobby horses around, after the story about Spot’s hobby horse). Very thoughtful idea. There is some humanism and dysfunctional elements to Spot’s morals (i.e. his parents basically laugh off anything he does wrong or says disrespectfully), but this occurs more in the books than in the video. Best for twos.

Thomas the Tank Engine

Normally a Christian staple, but I have to confess we just got rid of Thomas in our house. My son was (perhaps abnormally) drawn to the negative models they gave. I think perhaps the newer Thomas videos are not as carefully constructed as the old classic ones. But even some of the older ones we have try to teach character lessons by examining a problem (i.e. wanting revenge; wanting to be the first, fastest, or best) and dwell too much on the problem rather than the resolution. I think for younger kids that this is a bad method of teaching. Older children can learn a moral story if their beloved character has a sinful attitude and then gets punished for it somehow; they see how they should adopt a better attitude. But I don’t think younger children can abstract this lesson very well. They simply see the bad stuff and get a better understanding of that. I could see my sons acting out stuff they had seen in Thomas, or using the language about it to one another (i.e. “You took this before me. Now I need to get revenge.”) And I really didn’t like that. They were sort of able to reason through the plot when we talked about it with them, but they definitely weren’t able to purge the bad language they’d learned. Alais, it had to go.
I also didn’t like the more pagan aspects of some stories, like Ghost trains.

Caillou

I personally don’t like Caillou because it articulates negative emotions better than positive ones. And his parents are basically useless. He talks about jealousy, getting what he wants, taking things, not wanting to go to bed, and all other kinds of “normal” bad behavior for toddlers or preschoolers. But it gives too many bad ideas to kids instead of modeling good ideas or ways to communication/resolve problems. Especially in the area of sibling rivalry, I think it is not helpful to put in a kid’s “diet.” I have never seen the “Arthur” series, but a Christian friend of mine has the same complaint about it. This is an especially sensitive area to guard your child’s heart in. I would suggest working with your older child just one-on-one about his feelings if they are bad, rather than giving him TV to watch about it.

Veggie Tales

Esther and Jonah are really great, but some of the others are hard to follow.  Sometimes they can be too silly or loud and my kids ask to turn it off.  I think it is because they can’t follow the plot as easily as other kids’ series.  And while they are really funny for an adult because of the wit and humor, I am not sure the kids would get it until they were teenagers! Basically innocuous series, though, and good is always rewarded while “the bad guys” get it.  Best for 4s and 5s.

Fertility

Fertility/infertility is a private and deep topic.  Most people don’t go around just talking about it, and those who do are probably a little strange.  Like miscarriages, usually the subject doesn’t come up at all until you confide in someone that you are having trouble and then they suddenly share with you that they had the same problem.

Infertility can be caused by a variety of problems.  Some of the most common are:

• low sperm count
• testicular trauma, infection (including having the Mumps, for the man)
• lack of ovulation (anovulation)
• lack of cervical mucus
• endometriosis, fibroids, tumors, or polycystic ovarian syndrome
• blocked fallopian tubes
• chemical or immune reactions between partners’ chemistry that prevents conception
• latent effects of birth control (namely, the Pill)
• diabetes, infections, or chemotherapy, either present or past
• thyroid or pituitary problems (female)
• STDs, or effects of STD medications

And obviously impotence, removal/severance of reproductive organs, and pre-menopause are no-go’s.  But many couples experiencing fertility problems don’t have any of these factors.  They are simply timing their intercourse patterns wrong.  Any fertile couple will have between a 1 and 4 chance and a 1 in 10 chance of conceiving in any given month.  If more than a year goes by with effort but no results, doctors may suggest going to an infertility clinic for treatment… usually in vitro fertilization (IVF).

So while I don’t pretend to be an expert on fertility/infertility, if you want to get pregnant and you’re having trouble, there is a really good book called “Taking Charge of Your Fertility” by Toni Weschler.  I would try this or something like it before taking the next invasive step of seeking medical assistance.  The cost and psychological impact of doctoral help for infertility is often underestimated.  When I worked at the Duke University Infertility Clinic for awhile, I have to confess that it was one of the most depressed environments I have ever been in.  The atmosphere was thick with depression, hesitancy, and exhaustion.  Obviously not everyone experienced these emotions, but I am just warning you that it is not an easy process.  The husband is often put out too, and there can be stress in the marriage once doctors get involved with your intimate life.

Toni Weschler’s book talks about four helpful factors when it comes to fertility.

1. Charting your cycle on the calendar
2. Basal body temperature
3. Cervical fluid
4. Cervical position

While the amount of information can be a little overwhelming for someone not so acquainted with their body, it is very very good.  A couple of my friends who were having trouble getting pregnant for several years finally found out that they had some patterns which pretty much ensured that they were missing their fertility window almost every time!  As soon as they got some information, they were pregnant with no problem.  One of the most startling facts I learned in her book is that a woman is only fertile, technically, for about 24 hours.  While it is possible for intercourse to lead to pregnancy up to several days beforehand, I finally understood why the timing was so delicate.  Nowadays they have these ovulation tests—I haven’t heard how well they work.  But I would imagine combining them with the knowledge in the book would be a very powerful strategy.

Does Being Pregnant with Boys feel different than Girls?

It depends on who you ask.  For every mom who swears they knew what gender their baby was because it felt totally different than her other pregnancy, you will get a mom who says her different gender pregnancies felt exactly the same.  The same is true with how you carry… For every mom who says they carried their boys big and round out front (the “I just swallowed a basketball” look), you will find a mom who says that’s what she looked like when she had her girls.

So maybe everybody has their own truth.

I had three boys and one girl, and I was definitely one of those people who saw a huge difference between the genders.  I mean huge—hardly anything was the same.  I craved different, felt sick different, slept different, had different moods and skin issues, different pains, different weight gain, etc.  In appearance I definitely had the skinny but basketball carrying look with my boys and the all over rounded-out look with my girl.  But that’s just me.  A hundred people are like me and a hundred people are different.

I guess I would say that if you are experiencing a pregnancy that is radically different from the previous one, that there is probably a greater chance that you are carrying the opposite gender.  But if you are experiencing the same type of pregnancy, there’s probably really no way to tell.  So much goes into a pregnancy other than the hormonal differences you are supporting in utero, so it’s best to rely on ultrasounds rather than old wives’ tales… or the experience of your best friend =)

Weaning

Weaning a baby can be difficult. Especially if you’re nursing. They get so attached to their food! And that’s fine, totally normal. It can even be hard for mom, who all of a sudden realizes that they are losing their “baby.” You probably have these reminders throughout the baby year as your little one crawls, gets the first teeth, and so forth. But definitely walking and weaning are the two big landmarks that denote the baby year being over.

There is nothing magical that happens at 12 month, but many moms decide to wean their baby from breast or bottle around that time. Biology dictates that the first year, more or less, is when the baby gets the most benefit from the special constitution of breastmilk or formula. Lots of moms wean before or after this time, and you should do what’s right for you and your family. I’m not going to go into the philosophy of when you should wean because people feel so differently about it. But to put it in perspective, weaning shouldn’t be the most passionate thing in your life. At some point, you just have to do it. Here are some things I learned:

If you are weaning a baby from the bottle, the easiest thing is to move their formula to a sippy cup first. Once they are ok with the sippy cup, and they are at least a year old, then start diluting the formula with milk. The pediatrician recommends whole milk, but you can use rice, soy, almond, oat, or whatever- milk. Introducing other liquids into their diet at this time (if you haven’t already) can also help… water, diluted juice, etc. This will help lessen the attachment to the formula.

When I weaned my first baby, he was on formula and I started with doing half milk, half full-strength formula in a sippy cup. You can always start with a different dilution if you want. Then when he was happy with half and half, I started diluting the amount of formula I mixed in. I think I had two scoops in a regular size sippy cup with half milk, and I then moved to just one. When he was happy with that concentration, I lowered it again until he was on just plain milk. I think I started this process at eleven months, and it took maybe until thirteen or fourteen months to get him down to normal milk. It wasn’t too difficult because he’d been on the sippy cup for several months already and I gave him formula only at mealtimes (4 times a day) so he was kind of full and happy with the taste of his food (not focused on his drink). I gave him other liquids in between meals if he needed a drink.

Another thing that helped was not falling into the “bottle before bedtime” routine. I think he would have been more sensitive to his weaning process if he’d still been getting a bottle the last thing before bed. I would suggest doing something else to pacify. I used to give some water and a “cookie” so he felt privileged instead of deprived. I did notice that in the beginning, he seemed mildly addicted to the formula so I tried to go slowly on him until his system didn’t need it anymore.

If you are weaning from the breast, you can’t dilute breastmilk (unless you are expressing it and putting it in the sippy cup), so the easiest thing to do is start cutting back the number of feedings. Save the first and last feedings of the day, for last and work on cutting down the number of feedings during the day. Some people do the sippy cup thing and if that works for you, then that’s great. I’d follow the same routine as the bottle weaning above until the toddler was on milk alone. But for most people, that is too much work and what the baby really clings to is the sensation of nursing, not just the breastmilk itself.

I weaned two of my breastfeeding babies around nine months, so the process of weaning them entailed not just getting them off the breast but onto formula. That was very tricky and I don’t recommend it. Babies know their stuff, and most of them want nothing to do with formula when the breastmilk is available. I had to slowly wean them onto formula by doing the reverse process as I described above–by giving them sippy cups of rice milk and slowly adding formula into it until they were drinking formula alone. They were just too young to take off breastmilk and put on regular milk—they needed the benefits of formula until they were a year old. (Incidentally, I weaned them because I got pregnant again and my milk supply dropped drastically, not because I didn’t want to keep nursing them.)

So hopefully you don’t have to do that. If you can wean your baby from the breast onto regular milk, you might have more luck because various milks taste more like breastmilk than formula. Sometimes babies will drink lowfat milk before they drink whole milk because the consistency and smell is more similar. Other times they take to soy or non-lactose milk, especially if it is vanilla flavored or something appealing. (You can wean out the vanilla later, pretty easily.) I started with cutting out the mid-morning feeding first because that was the easiest. I just gave food and a little soy or rice milk instead. By the afternoon, the babies really wanted to nurse again, so I kept that feeding in for quite awhile. I tried to drop the late afternoon feeding next because that was always the hardest feeding for me to do, with dinnertime approaching. I think I tried to give the baby a graham cracker and put them down for a quick nap instead. So you can see that a lot of the weaning process depends on how many times you are feeding already… I think I was generally weaning from five or six feedings a day. I dropped the first quickly, the second sort of quickly, and tried to get to three feedings (morning, noon, night) as soon as I could. It took maybe a month, and a lot of effort (substitution).

By the time I was on three feedings a day (and pregnant), my milk supply was low enough that dropping the midday feeding wasn’t too difficult. If I fed the baby solid food first and put them to the breast afterwards, there wasn’t enough milk to sustain them for more than a couple minutes anyway. They’d suck a bit and then jump off. Then I’d supplement with some more rice milk. I kept the wake-up and bedtime feedings going for at least another month just to keep peace; the baby really wanted to nurse those times and I couldn’t deal with getting off on the wrong foot in the mornings or having a huge bedtime battle in the evenings. At some point, I just started shortening the amount of time they were at the breast at those times, and I basically got it down to two minutes or something like that (followed by a real breakfast or graham cracker at night). Then the last little bit to get off completely just happened on its own. They were successfully weaned by eleven months.

My third nursing baby is still nursing, at nine months, and I am not pregnant, so I plan to keep nursing her until the year mark and wean her somewhat like the process above except without the introduction of formula. If I end up doing something different, I’ll let you know =)

You can always pray that your baby will wean itself too! I have known some moms with that situation, and they were either rejoicing or horrified =)

Prickly Heat Rash

I do not intend to put a lot of medical stuff in this blog because I want it to stay authentic and reliable, not off-the-cuff and faddish.  But every now and then when some health issue comes up between my friends and I (we all have little children), I might post it here.

 A couple people have asked me about rashes.  I don’t pretend to be a doctor.  If your child has a rash, and you don’t know what it is, take him or her to the pediatrician ASAP.  They will “quarantine” you in a private room (sometimes in the way back!) until a doctor identifies what it is.  Rashes sometimes indicate a highly contagious disease (i.e. chicken pox, measles).  If you’re panicked, there are some good websites that have pictures of various rashes and what they mean.  For non-urgent things like eczema or hives, these are great.  Sometimes rashes that indicate diseases have very distinctive marks and these help too.

I am writing this post about “Prickly Heat” or heat rash because it is so common, scares the life out of you, and means nothing.  All my babies have had it, and usually I forget what it is and get scared, take my child to the doctor, and remember.  The fourth time around, I only cancelled a playdate before I remembered… so I’m learning.

Prickly Heat is basically a term for a totally benign rash that goes away on its own.  It can be a sign of tight clothes, clothes that are too hot, clothes that are mildly dirty, diaper irritant, or any other kind of heat or mild irritant next to the skin for too long.  It looks like small pink pricks close together and all over the skin, usually starting around the waist area and extending up the trunk or down the thighs.  Sometimes it can be on the arms and chest.  It usually does not appear on hands, feet, private parts, or face.  It does not itch, burn, or hurt.  But it can spread a little.  You might think it looks like measles, except there is no fever or malaise usually associated with an infectious disease like that.  If your child is bouncing around happy as a lark, but you go to change the diaper and find all these pink goose-pimply marks on their stomach and legs, it is probably Prickly Heat. 

I’m not saying to forget checking it out with your doctor, I’m just warning you!  Change your child’s clothes or take them off for awhile, and run a warm wet rag with mild soap over the areas to clean them.  (Don’t scrub).  You’ll see more bumps and they’ll look a little redder after you do this, but they will vanish on their own probably by the next mealtime. 

Medications while you’re pregnant

In general, try not to take them.

As everybody knows, you’re not supposed to take any medication while you’re pregnant, or drugs/substances of any kind. Even over-the-counter medications like Tylenol have the standard advisory warning to ask your doctor about the medicine if you’re nursing or pregnant.  This is because most (if not all) chemicals pass directly into a baby’s system from the mom, and we’re not sure how much they impact their sensitive development.  A lot depends on the type of chemical, the amount, strength, or frequency, and any individual sensitivities involved.  The medical establishment, fortunately, just does not conduct potentially dangerous studies on pregnant women and nursing babies.  So we learn mostly from accidents, case studies, animal experiments, or good old logic.

Because the developing baby is the most precious time of that child’s life, healthwise, it makes sense to be extraordinarily careful with any chemicals you are around or ingesting.  If you can avoid taking something, you should.  That said, sometimes there are extenuating circumstances that drive moms to the drugstore for relief, or situations they cannot avoid taking medicine for (if they are diabetic, for example).  Fortunately, history has shown that the majority of babies can be born “ok” under these types of medical circumstances.  Only a handful of medicines have caused such devastation as the Thalidomide tragedy, and other chemical tragedies are associated with recreational drugs, substance abuse, or chronically unsafe working conditions.  So rest easy if you took some Nyquil before you knew you were pregnant!

In general, you have a lot less risk with over-the-counter medications.  That doesn’t mean you should just pop an Advil every time you get a headache.  But a certain number of OTC medications like Tylenol, Pepto Bismol,  Sudafed, and Robitussin have been generally approved for occasional use during pregnancy without alarm.  I took some generic decongestants, including Dayquil and Tylenol Flu, a couple times while I was pregnant because I was hit hard with influenza for about seven days whenever I had a winter baby.  Also I had a rotavirus once and needed to take Immodium for  several days for safety’s sake.  These types of occasional uses, in warranted conditions, can actually help your baby because they are helping you.  Obviously the body calls for rest and fluids to self-medicate, but there are times when self-medication is difficult, too long, or too impractical to wait for on its own (especially when you have other small children at home to watch).   Use your judgment and call your practitioner if you have questions when the sickness comes up.

For prescription drugs, I can’t say much.  My midwife recommended Reglan to me when I was hyper-nauseous with my fourth child, past the first trimester.  I had three other toddlers at home and was barely sleeping at night because my stomach ached so badly.  After thirteen weeks of trying to withstand the pain, I caved and got the prescription.  It worked immediately, so I used it for several months.  The only side effect was that it made me sleepy, so I switched to double-strength Zantac in my seventh month, then to Pepto Bismol for my eighth.  By my ninth, it was pretty much gone.  I did what I had to do!  (And the baby was born fine, with no health problems so far).

So do what your situation warrants, but always err on the side of caution.  Try not to get pregnant if you’re on questionable drugs like Zoloft or Paxil, or have been on them within the past year.  They can take awhile to exit the system and can effect the baby’s as well as your own body.  Try not to get new vaccines, try new medications, or experiment with new regimens while you’re pregnant.  Play it safe.  The reality is that whatever you put into your body will affect your prenatal baby somehow, and probably even your nursing one.  The question is to what extent and whether the benefits outweigh the costs.  Many women side with the epidural, for example, or need the spinal for Caesarean sections, and they get them because the effects on the baby are limited in time and intensity.  But babies can be born drunk, high, or otherwise intoxicated with whatever chemicals you took.  And obviously there are risks of defects when the substance is dangerous.

But this post is for the normal moms out there afraid to take their Tums because they’ve got heartburn.  Or who had their daily cup of caffeine for two months before they found out they were pregnant.  Rest assured that it’s probably ok.   I even drank Diet Coke throughout one pregnancy, against my conscience (but because I was so tired in the mornings from dealing with my firstborn, who was only six months old when I got pregnant).  And my second born child is probably the most peaceful, laid-back, non-caffeinated baby you could ask for.  He even slept through the night at six weeks old.  So don’t freak out.  Be smart but cool.  Health is not your religion, but it is your responsibility.  Especially when you’re pregnant.  So do the wise, reasonable thing, and you’ll both turn out fine!

Manners

What kinds of manners are appropriate for 2,3,4 year olds to learn? What things can reasonably be expected at these young ages?

These are things we work on with at least moderate success. Of course they need reminders all the time, but the point is not memorization as much as it is a general awareness of other people/their property. This type of orientation is more important than success with any one rule.

Saying please and thank-you

Shaking someone’s hand when they greet you

Saying excuse me when you pass

Saying excuse me when you burp (or worse!)

Covering your mouth when you sneeze/cough

Giving younger children a toy, letting them go first

Waiting for their turn, giving someone else a turn

Sitting at least semi-correctly and acting at least semi-politely at the table

Saying I’m Sorry when you do something wrong

Giving a crying child a hug or kiss, getting them help

Sharing a treat, gift

Saying no, thank you when offered something they don’t want

Giving up “watch me” (“look at me”) or “watch this”

Not yelling across the house (or playground, restaurant, mall) for parent

Giving up “me first”

Taking shoes off in someone else’s house

Asking to use the bathroom or have some food in someone else’s house

Keeping feet off the furniture

Keeping legs down/closed

Not standing in the way of the TV

Not standing in the way of two adults speaking

Interrupting politely, at appropriate times

Not bossing around; asking permission of someone else to help, enter, etc.

Cleaning up toys they got out (especially in a doctor’s office, friend’s house, etc)

Not yelling in a restaurant, library

No whining; using an adult voice to ask permission

knocking before entering (waiting for an answer is harder, but at least you can get a warning signal!)

Turning off lights when leaving a room

Not stepping on toys or other people

Giving others “space”

Giving others “a spot” when they are watching, playing, etc.

Being careful around a baby or someone laying on the floor

Not touching, waving things in people’s faces

Not pulling hair or touching people’s bodies inappropriately; keeping hands to themselves

Not answering questions intended for others

Saying something nice when someone gives you a present (even if you don’t like it)

Saying “bless you” when someone sneezes

No fake coughing or making weird noises

What is Early Intervention?

Early Intervention is a state-sponsored program that allows children 0-36months to receive special services should they qualify for them in the areas of language, motor, or social skills.

What usually happens is, someone like you or your pediatrician may suspect that your child has developmental delays in one or more areas (i.e. they are not meeting some age-appropriate criteria on a developmental checklist).  If you as the parent want a free evaluation from Early Intervention, you need to get a referral from your pediatrician–they will almost always support you unless you have a peculiarly unreasonable doctor–and then you just call your local Early Intervention place and set up a time.  (You can get the number online or from the pediatrician or local elementary school.)  A small group of evaluators will come to your house and give your child a thorough exam–they look at various language, motor, and behavioral abilities.  It is very non-threatening, and you get to be present the whole time.  (Get a babysitter for any other children, though!)  The evaluators will ask you lots of questions about developmental milestones, prenatal history, what your child is or is not doing, and why you are concerned.  The evaluations are largely fun for kids, and the testers do not force your child to do something if they are unwilling or insecure about it.  At the end of the evaluation, the Early Intervention team will score your child’s results and talk to you about them.  They will “grade” your child’s abilities within several sub-categories (i.e. gross motor, fine motor, expressive language, receptive language…) and tell you what developmental level they are currently operating at (i.e. 20-month level, 30-months).  You can then see if your child is behind in some area (or more than one) in comparison to his/her age, and to what extent.

After the evaluation, you don’t have to commit to anything right away.  There will be quite a bit of paperwork, but they want you to talk things over with your spouse, etc.  They will even come back out or talk to you on the phone afterwards if you need more input.  If your child is significantly enough behind developmentally, they will recommend a course of action where one of their team members will come over to your house (usually once a week, for an hour) to have a special playtime with your child.  She will tailor the playtime to your child’s needs and personality, and it is normally very fun.  You are encouraged to watch and participate, as they will show you different ways to work with your child’s weak areas.  You can decide not to participate, but this is not a babysitting time so you should at least be within eye/earshot.

You have time to think about whether or not you agree with the evaluation and course of action, but Early Intervention only provides services until the child is 36months old.  After that, they must attend the public preschool and get another evaluation done there to see if they qualify for services (and what kind).  If they do qualify (meaning, they still have issues), the preschool will recommend placement there, and the administrators will need to draw up a special education plan (called an IEP–individualized education plan) for your child.  This IEP is a legal document (meaning, the school pledges their commitment to provide services for your child), and it will have a list of specific, testable goals that they want your child to reach in one year.  You normally have a meeting about it, sign it, and meet again the following year (with progress reports given to you a couple times in between).

The benefit to Early Intervention is it’s not so involved as the preschool step.  It is free (or cheap), non-threatening, and non-legal.  It can be a little intimidating to have people test your child, but it is a non-binding step that, if done when signs of a problem are emerging, can really help the child overcome and get back on the developmental track.  My one friend who is a speech pathologist with Early Intervention says that sometimes they even work with newborn babies who they know will have problems because of Down’s Syndrome, cleft palate, or some other detectable problem at birth, and they are able to make remarkable progress.  By the time your child gets to preschool age, at 3yrs, some things are already harder to change.  And at 4 yrs, even more.  So act soon and get an evaluation if you are at all concerned.

Physical or Occupational Therapy?

So yesterday I took my 3 yr old (who has Sensory Processing Disorder) to a physical therapist because he was having trouble pushing and pulling, among other things. Turns out he needed a combination of both physical therapy for his overall strength and coordination, and occupational therapy for strengthening his hands.

It is funny how his sensory processing problem has caused issues with his gross motor development as well. He has trouble in the following areas:

* pushing and pulling
* opening drawers
* putting on shirts, shorts, socks, shoes (taking them off is slightly easier)
* opening jars or bottles
* balancing–falls often when running, can’t stand on one foot
* can’t jump
* goes down stairs backwards if there is not a good rail
* hates merry-go-rounds, large bouncy balls, bouncy castles, etc
* hates water
* stepping down from a ladder (even just one step)
* jumping down from a chair (even just a couple inches too high)
* climbing
* tearing paper (i.e. toilet paper, wrapping paper)
* kneading playdoh, squeezing, rolling it, pounding it
* hammer toys–can’t bang with any strength
* throwing a ball

On the other hand, his fine motor seems fine. He can string beads, do zippers, draw lines and circles, stack blocks, do mosaics, pick up tiny things one at a time, do tinkertoys and legos, push buttons, and roll or aim a ball to the correct spot.

It is almost like he is afraid of force… of any kind. I try to think of how I parented him that would make him afraid of forcefulness, and I can’t recall. I do remember that he was a very gentle and passive baby. He would fall asleep easily, even if he needed something, and for that reason he was a failure to thrive baby. He was so skinny at 6 and 9 months that I had to stop breastfeeding him and put him on formula and regular meals. Then he got really fat but his activity level never moved up. He was slow to sit alone (9months), crawl (10 months), and walk (16months). He didn’t run well until two and a half, and he still doesn’t jump or climb. He can’t maneuver his body when he needs to get in somewhere (the carseat, tub, or a piece of furniture), and sometimes when he falls, he just lies there whimpering instead of trying to get up.

I can’t figure out what makes him so passive. Did I not respond well enough when he was a baby, to his needs? Maybe I didn’t, although I certainly never ignored or neglected him. He was my second baby so I wasn’t a first-time mom, and I thought I recognized his hunger, diaper, and boredom cries quite well. I took him everywhere because he was an easy baby, and I do remember him loving the jolly jumper, where I kpt him when I was cooking or cleaning–I watched him jump and laugh at me for hours as an older baby.

But, passive he is. He still doesn’t initiate or ask for help very well, at least not with people other than Mom. He defends his own turf and will yell “NOOOO” or something if someone invades his space, so I am not worried that he will go off with strangers or get taken advantage of. But he does get dominated and controlled easily because most kids know what they want and have an active approach to life. This little guy lets go too easily and settles for crying about it in his own private space. He clearly isn’t happy that someone got there first, faster, better than him; but he doesn’t feel able to confront the situation and make some effort. How do I encourage this?