Sadie's List of Accomplishments for October, 2010:
- Learning how to "share" objects (by hurling them at high velocity at people's heads)
- Climbing up steps
- Trying -- and liking -- baked pumpkin, green beans, bean and corn salad
- Climbing over objects
- Pulling up on furniture
- Cruising
- Sitting -- sort of, and only if she doesn't think too much about it
- Learning the power of withholding physical affection and how it makes everyone go "aw" and make a sad face -- crafty chick
- Making fish faces
Thursday, October 21, 2010
Friday, October 15, 2010
Regional Center
So, yay! We finally got contacted by the North Valley Regional Center for a developmental assessment.
The Regional Center is a fantastic thing -- it's a not-for-profit business that provides free help for children with developmental delays. Many of the children they work with are far worse off than Sadie -- kids with autism, retardation or neurological problems. For these kids, the Regional Center is a lifeline: they refer parents to in-home physical therapy teams, behaviorists, even childcare, all for free or the cost of an insurance deductible.
Everyone from our pediatrician to our nanny has recommended the Regional Center, with the caveat that they don't approve all applicants, and are often very backed up so it can take weeks or even months to be evaluated and approved for help. With that in mind, we sent in an application about a month ago, but went ahead and found Joy on our own without waiting for approval that we might never get.
Nevertheless, when they assigned a case worker to Sadie two weeks later, it was positive news. And last night I got a call from an assessor, asking if she could come by today and evaluate Sadie.
What we learned was really interesting. It was great, for one thing, to see Sadie finally be evaluated by someone who has familiarity with low muscle tone babies, and to see her put through a series of tests to get a solid idea of just how behind she is. The format they use is called the Gazelle test, and it divides skills by month as a way for the assessor to determine where a baby is compared with other children of the same age.
The assessor, a very sweet woman named Rita, tested Sadie's fine motor skills as part of the full work-up. All of those tests she passed with flying colors. She can bang blocks together, fit a peg into a hole, pull on a string to pull a toy towards her, and find a block hiding under a plastic cup. She even did some things that surprised me, like stacking one block on top of another without prompting. In nearly all of her fine motor skills she's on par with 12 and 13 month-olds.
The telling part came when we moved on to gross motor skills. I showed Rita the range of Sadie's abilities, which extend to crawling, pulling up on me, taking a few tentative steps while hanging on to furniture. Rita observed that in this area Sadie's on par with 8 and 9 month old babies.
Rita then surprised me by saying that in her estimation Sadie's hypotonia is quite moderate, not mild as we thought at first. She points out how Sadie sits: with her legs and butt making a "W" shape for maximum stability. She pointed out how her hips wobble back and forth when she stands, and how she tends to lean forward over her ankles instead of standing straight. This occurs because of the looseness in her joints, giving her an above-average range of flexibility and making her, in Rita's words, "loosey-goosey."
To demonstrate this, Rita basically sat Sadie down on her lap, grabbed her legs, and waved them around in a giant circle, shoving them into her mouth and pointing them in wild directions. Dude. Kid is CRAZY flexible. She may never be a bullfighter, but she might just become the world's tallest gymnast.
Kids like Sadie generally reach their first milestones later than other kids do -- she probably won't walk for another couple of months, and she'll most likely be late to run, climb or jump (not a surprise considering how risk-averse she is). Eventually she'll catch up and the delays will become more subtle and less immediately noticeable -- for example, Rita noted that kids like her are often late to learn how to ride a bike. As we've been told before, getting her into sports and helping to strengthen her muscles through exercise will help minimize this gap.
I explained the issues we've been having with her tantrums -- how she now refuses to cooperate during PT and is prone to throwing massive hissyfits at the drop of a hat, at which point she'll throw herself dramatically onto the floor, lie there and wail until the session is over. Rita stressed that for kids like her, in-home PT tends to be much, much more successful than off-site. Kids are familiar and relaxed in their own surroundings, willing to try new things and to cope with frustration. (And sure enough, she was an angel through the entire eval, which took place on our living room floor.)
She also scoffed at the idea of taking Sadie to see a developmental pediatrician or a child psychiatrist, saying, "I REALLY am not getting that she needs that." Bless her heart.
All in all, she's going to take her findings back to the case worker and recommend that Sadie be approved for a series of in-home therapy sessions. Whether or not they'll accept her is borderline. Typically to be approved a child must exhibit a developmental delay at 50% or less of their expected capability -- that is to say, in order for a one year old to qualify, they should be evaluated as having the capabilities of a 6 month old. Sadie, as I said, is at 8-9 months.
Even if she doesn't get approved, though, I think we'll still consider switching to in-home therapy. As nice and as patient as Joy is, it's a waste of her time and of ours to bring Sadie in and see her fuss and scream for an hour every week. She isn't learning any new skills because she's so bound and determined not to cooperate.
And we must keep baby happy.
The Regional Center is a fantastic thing -- it's a not-for-profit business that provides free help for children with developmental delays. Many of the children they work with are far worse off than Sadie -- kids with autism, retardation or neurological problems. For these kids, the Regional Center is a lifeline: they refer parents to in-home physical therapy teams, behaviorists, even childcare, all for free or the cost of an insurance deductible.
Everyone from our pediatrician to our nanny has recommended the Regional Center, with the caveat that they don't approve all applicants, and are often very backed up so it can take weeks or even months to be evaluated and approved for help. With that in mind, we sent in an application about a month ago, but went ahead and found Joy on our own without waiting for approval that we might never get.
Nevertheless, when they assigned a case worker to Sadie two weeks later, it was positive news. And last night I got a call from an assessor, asking if she could come by today and evaluate Sadie.
What we learned was really interesting. It was great, for one thing, to see Sadie finally be evaluated by someone who has familiarity with low muscle tone babies, and to see her put through a series of tests to get a solid idea of just how behind she is. The format they use is called the Gazelle test, and it divides skills by month as a way for the assessor to determine where a baby is compared with other children of the same age.
The assessor, a very sweet woman named Rita, tested Sadie's fine motor skills as part of the full work-up. All of those tests she passed with flying colors. She can bang blocks together, fit a peg into a hole, pull on a string to pull a toy towards her, and find a block hiding under a plastic cup. She even did some things that surprised me, like stacking one block on top of another without prompting. In nearly all of her fine motor skills she's on par with 12 and 13 month-olds.
The telling part came when we moved on to gross motor skills. I showed Rita the range of Sadie's abilities, which extend to crawling, pulling up on me, taking a few tentative steps while hanging on to furniture. Rita observed that in this area Sadie's on par with 8 and 9 month old babies.
Rita then surprised me by saying that in her estimation Sadie's hypotonia is quite moderate, not mild as we thought at first. She points out how Sadie sits: with her legs and butt making a "W" shape for maximum stability. She pointed out how her hips wobble back and forth when she stands, and how she tends to lean forward over her ankles instead of standing straight. This occurs because of the looseness in her joints, giving her an above-average range of flexibility and making her, in Rita's words, "loosey-goosey."
To demonstrate this, Rita basically sat Sadie down on her lap, grabbed her legs, and waved them around in a giant circle, shoving them into her mouth and pointing them in wild directions. Dude. Kid is CRAZY flexible. She may never be a bullfighter, but she might just become the world's tallest gymnast.
Kids like Sadie generally reach their first milestones later than other kids do -- she probably won't walk for another couple of months, and she'll most likely be late to run, climb or jump (not a surprise considering how risk-averse she is). Eventually she'll catch up and the delays will become more subtle and less immediately noticeable -- for example, Rita noted that kids like her are often late to learn how to ride a bike. As we've been told before, getting her into sports and helping to strengthen her muscles through exercise will help minimize this gap.
I explained the issues we've been having with her tantrums -- how she now refuses to cooperate during PT and is prone to throwing massive hissyfits at the drop of a hat, at which point she'll throw herself dramatically onto the floor, lie there and wail until the session is over. Rita stressed that for kids like her, in-home PT tends to be much, much more successful than off-site. Kids are familiar and relaxed in their own surroundings, willing to try new things and to cope with frustration. (And sure enough, she was an angel through the entire eval, which took place on our living room floor.)
She also scoffed at the idea of taking Sadie to see a developmental pediatrician or a child psychiatrist, saying, "I REALLY am not getting that she needs that." Bless her heart.
All in all, she's going to take her findings back to the case worker and recommend that Sadie be approved for a series of in-home therapy sessions. Whether or not they'll accept her is borderline. Typically to be approved a child must exhibit a developmental delay at 50% or less of their expected capability -- that is to say, in order for a one year old to qualify, they should be evaluated as having the capabilities of a 6 month old. Sadie, as I said, is at 8-9 months.
Even if she doesn't get approved, though, I think we'll still consider switching to in-home therapy. As nice and as patient as Joy is, it's a waste of her time and of ours to bring Sadie in and see her fuss and scream for an hour every week. She isn't learning any new skills because she's so bound and determined not to cooperate.
And we must keep baby happy.
Tuesday, October 12, 2010
Let It Be
I'm done with all of it.
The over-analyzing, the worry, the second-guessing, the consulting of experts. Yesterday I got a call back from Dr. Colgrove, the developmental pediatrician recommended to us by Sadie's regular pediatrician. He was really super-nice and willing to listen, and as I tried to explain the problems we've had with Sadie in the past, it sounded ridiculous to my own ears.
I mean, really: "My baby cries when she's with strangers. She's often fussy when expected to do things she doesn't want to do. She's clingy and doesn't want to be with anyone other than me."
"How old is she?" asked Dr. Colgrove, sympathetically.
"Well...she just turned one."
"Oh, she's just a little thing!" he exclaimed, and I felt even sillier. THIS IS HOW ONE YEAR OLDS ARE. WHAT DID WE EXPECT?
Dr. Colgrove explained that he doesn't work with kids under three, and he gave me the name of a child psychologist whose office is close by. He said it would probably be useful to take her there -- not for her, but for me, so I can learn how to introduce her to unfamiliar situations in a way that will be more comforting and less scary to her, which will make day care -- and eventually, preschool -- a less stressful experience. And I listened and took down the number and thanked him, but after I hung up, none of it seemed very necessary and important and more than anything I just kept thinking over and over, "Enough already."
She's a good baby. She's content 90% of the time. When she isn't content, it's typically because she's tired or hungry or has recently bumped her head -- or because she's at the office of that mean lady who has a bunch of cool toys but has the maddening tendency to always set them just out of reach. So she hates day care. What's wrong with that? The routine we've settled into now, with the nanny coming every morning and playdates in the afternoon, isn't an ideal one, but it's working.
It feels nice to let it go.
The over-analyzing, the worry, the second-guessing, the consulting of experts. Yesterday I got a call back from Dr. Colgrove, the developmental pediatrician recommended to us by Sadie's regular pediatrician. He was really super-nice and willing to listen, and as I tried to explain the problems we've had with Sadie in the past, it sounded ridiculous to my own ears.
I mean, really: "My baby cries when she's with strangers. She's often fussy when expected to do things she doesn't want to do. She's clingy and doesn't want to be with anyone other than me."
"How old is she?" asked Dr. Colgrove, sympathetically.
"Well...she just turned one."
"Oh, she's just a little thing!" he exclaimed, and I felt even sillier. THIS IS HOW ONE YEAR OLDS ARE. WHAT DID WE EXPECT?
Dr. Colgrove explained that he doesn't work with kids under three, and he gave me the name of a child psychologist whose office is close by. He said it would probably be useful to take her there -- not for her, but for me, so I can learn how to introduce her to unfamiliar situations in a way that will be more comforting and less scary to her, which will make day care -- and eventually, preschool -- a less stressful experience. And I listened and took down the number and thanked him, but after I hung up, none of it seemed very necessary and important and more than anything I just kept thinking over and over, "Enough already."
She's a good baby. She's content 90% of the time. When she isn't content, it's typically because she's tired or hungry or has recently bumped her head -- or because she's at the office of that mean lady who has a bunch of cool toys but has the maddening tendency to always set them just out of reach. So she hates day care. What's wrong with that? The routine we've settled into now, with the nanny coming every morning and playdates in the afternoon, isn't an ideal one, but it's working.
It feels nice to let it go.
Thursday, October 7, 2010
Counter-Argument
Sometimes I look at our drama through the eyes of someone else and it just seems so ridiculous and over-dramatic. Which I think is a good thing -- a little perspective never hurt.
My sister is six years younger than me, but when it comes to kids, she's the expert. She doesn't have her own (yet), but she's been babysitting, caring for, and adoring kids her whole life, whereas I've always tended to view them as cute, bald, alarmingly fragile aliens. The letter she sent me today helped calm me down a lot, so with her permission I'm reprinting it here.
My sister is six years younger than me, but when it comes to kids, she's the expert. She doesn't have her own (yet), but she's been babysitting, caring for, and adoring kids her whole life, whereas I've always tended to view them as cute, bald, alarmingly fragile aliens. The letter she sent me today helped calm me down a lot, so with her permission I'm reprinting it here.
I know that, prior to Sadie, you haven't really spent a whole lot of time around babies... and therefore, you're really forced to listen to doctors/therapists (physical or otherwise), other mothers, daycare providers, nannies, nosy strangers, etc. about what is "normal" and "not normal" in a baby.Thanks for the common sense bitch-slap, sis.
There is always something different about every child. Some are totally ballsy, others are big wimps. Some are total bullies, some get bullied. I baby-sat the son of my 6th grade teacher a few times after class... that kid had some serious aggression. He used to punch and kick the crap out of his little brother until his little bro was SCREAMING his lungs out, and then he'd laugh and laugh. I'm sure that there are 100 doctors out there who would have diagnosed him with some psychotic aggression disorder... maybe even relating it back to some phantom "physical abuse" he must have experienced as an infant... but in reality, he was just a butt. And he grew out of it.There is ALWAYS the shy kid at any day care or school. There's always the one kid who doesn't want to play with the others, or get into the middle of things... the one who hangs back and watches things happen around him/her. The one who isn't nuts about strangers and only calms down when Mommy or Daddy are nearby. Have you had any parents bring their kids over recently so Sadie is in her comfort zone, but still able to interact with other children? She was absolutely perfect when Mom and I watched her... clingy, yes, but after the quick bout of crying after you left, she was fine. And I've yet to baby-sit a kid who DIDN'T start blubbering when Mommy walked out the door, especially right around this age.Don't worry that you've missed (or are in danger of missing) an opportunity to make sure that Sadie is a happy, healthy, well-adjusted, developmentally normal child. I don't think she needs a specialist, or a psychiatrist, or anything like that. Just my opinion... and I know you know her better than I do, but I know kids in general pretty well, and you have yet to say anything to me that makes me think "Oh wow, that IS weird." In case that matters at all. :)
Touchy Touchy
Today I took Sadie in for her regular PT session, and it didn't go well. At home she's been so great -- crawling everywhere, being cool with me moving around the house. This week she began cruising, although she's still very tentative about it and will only do it if I'm standing nearby. She also pulled up successfully a few times on the couch and coffee table.
At PT, though, she's a mess. She immediately wigs out if I try to move away from her, or if she gets frustrated by not being able to do something, and goes into complete shut-down mode, screaming. She stiffens up all of her muscles, grabs whatever toys are in reach, and hurls them across the room. Usually she can be distracted out of her crying, but today it just got worse and worse. Eventually she went into full meltdown, crying hysterically. It was so hard to watch her physically shut down, so that even though she was standing up playing with toys, she wouldn't sit down so she could crawl over to me. Joy had to move her into a sitting position by hand, after which she crawled over to me, wailing dramatically, buried her head in my lap, and refused to move.
Joy and I had a talk afterwards. I explained that while she's cool at home, social situations often cause her to freeze up. Even if she's more curious than fearful -- like, for instance, if we're at a baby gym or at someone's house on a playdate -- she still would much rather sit in one spot and watch the action around her than explore, experiment or join in.
I know that I'm making it sound like I'm expecting too much of her, and maybe I am. On the other hand, this is all tied together to her behavior at day care, where she would get upset and, rather than try to find a solution on her own, go into immediately hysterics and stay in that hysterical state until someone picked her up and soothed her, gave her a paci, let her hold her special blanket.
Joy has recommended that we take her to a developmental pediatrician. Apparently there's a woman who works out of the Pasadena Children's Center who is supposed to be very good. I talked with Scott about it and his immediate reaction was, "If they want to put her on drugs, we're saying no." I agree with him, of course, and I feel torn about the whole thing.
We know that Sadie has no physical conditions that will prevent her from learning and growing. We know that with Selena, her nanny, or with me or Scott, she's curious, content and happy to learn and play. So maybe she's not the most adventurous baby -- is that really such a bad thing? Should I just let her grow up the way she pleases and just accept that she's emotionally...rollercoaster-y?
On the other hand, I see her get furiously upset over nothing. I see her react to Joy with utter rage, the way she used to react to the women at Happy Star when they wanted her to play by herself independently or sit calmly in her high chair like all the other babies. I see this behavior, and I want to know how to fix it -- or at the very least, find out what's behind it. I'm not the kind of person who accepts that some things just are -- I always want to know why, and it's killing me that I don't know.
Today Joy became the second person to posit the theory that maybe something happened to Sadie when she was younger that traumatized or frightened her (Rose was the first), which might explain why she gets so panicked when I'm not around. I know it's nothing that ever happened at home -- she's been a lucky baby in that she's never even sported so much as a lasting bruise. Could something have happened to her at day care, something they never told me about or never even knew happened to begin with? If that's true, then how could a problem like that ever possibly be fixed?
Well...regardless, I guess the next step is to call the developmental pediatrician and take her in for yet another evaluation. At what point do we just acknowledge that she is who she is, for better or worse?
At PT, though, she's a mess. She immediately wigs out if I try to move away from her, or if she gets frustrated by not being able to do something, and goes into complete shut-down mode, screaming. She stiffens up all of her muscles, grabs whatever toys are in reach, and hurls them across the room. Usually she can be distracted out of her crying, but today it just got worse and worse. Eventually she went into full meltdown, crying hysterically. It was so hard to watch her physically shut down, so that even though she was standing up playing with toys, she wouldn't sit down so she could crawl over to me. Joy had to move her into a sitting position by hand, after which she crawled over to me, wailing dramatically, buried her head in my lap, and refused to move.
Joy and I had a talk afterwards. I explained that while she's cool at home, social situations often cause her to freeze up. Even if she's more curious than fearful -- like, for instance, if we're at a baby gym or at someone's house on a playdate -- she still would much rather sit in one spot and watch the action around her than explore, experiment or join in.
I know that I'm making it sound like I'm expecting too much of her, and maybe I am. On the other hand, this is all tied together to her behavior at day care, where she would get upset and, rather than try to find a solution on her own, go into immediately hysterics and stay in that hysterical state until someone picked her up and soothed her, gave her a paci, let her hold her special blanket.
Joy has recommended that we take her to a developmental pediatrician. Apparently there's a woman who works out of the Pasadena Children's Center who is supposed to be very good. I talked with Scott about it and his immediate reaction was, "If they want to put her on drugs, we're saying no." I agree with him, of course, and I feel torn about the whole thing.
We know that Sadie has no physical conditions that will prevent her from learning and growing. We know that with Selena, her nanny, or with me or Scott, she's curious, content and happy to learn and play. So maybe she's not the most adventurous baby -- is that really such a bad thing? Should I just let her grow up the way she pleases and just accept that she's emotionally...rollercoaster-y?
On the other hand, I see her get furiously upset over nothing. I see her react to Joy with utter rage, the way she used to react to the women at Happy Star when they wanted her to play by herself independently or sit calmly in her high chair like all the other babies. I see this behavior, and I want to know how to fix it -- or at the very least, find out what's behind it. I'm not the kind of person who accepts that some things just are -- I always want to know why, and it's killing me that I don't know.
Today Joy became the second person to posit the theory that maybe something happened to Sadie when she was younger that traumatized or frightened her (Rose was the first), which might explain why she gets so panicked when I'm not around. I know it's nothing that ever happened at home -- she's been a lucky baby in that she's never even sported so much as a lasting bruise. Could something have happened to her at day care, something they never told me about or never even knew happened to begin with? If that's true, then how could a problem like that ever possibly be fixed?
Well...regardless, I guess the next step is to call the developmental pediatrician and take her in for yet another evaluation. At what point do we just acknowledge that she is who she is, for better or worse?
Monday, October 4, 2010
A Quick Update
So we interviewed a ton of nannies. Good nannies, not-so-great nannies, and one nanny who didn't even show up for her interview. We ended up hiring her -- I like an air of mystery about my support staff. Just kidding! What I really meant to say is that we found a really nice woman named Selena who now comes in the mornings to take care of Sadie while I hide out at a coffeeshop and attempt to return to some semblance of a normal work schedule.
Sadie has been progressing in leaps and bounds, which I attribute partly to her not being in day care anymore, partly to twice-weekly physical therapy, and partly to my working with her a LOT. Scott gets partial credit, too, but he's been out of town a lot so by default, I get to claim most of the credit for all of the cool things she's finally started doing.
It's so great to watch her learn -- she's quite literally packing months' worth of learning into a few short weeks. Just in the last week she's doubled her crawling speed, almost figured out how to pull up on furniture, started to take the first tentative steps towards cruising (walking along on furniture), and in general become fearless around the house.
Outside is a different matter; she still sobs her way through PT and is very shy and prone to bursting into tears when in an unfamiliar environment. Joy, the therapist, refers to her dryly as being on a "constant emotional rollercoaster," which is a nice way to saying that she's kind of a shit head.
This morning Joy told me something great, which is that in her estimation, there's nothing about Sadie's physical makeup that is keeping her from learning typical skills. Despite being long and skinny, she's strong enough to move around as well as any other kid -- and she proved that by learning how to crawl in the span of about five days, something that kids with hypotonia "just don't do," in Joy's words.
What really holds Sadie back, in Joy's opinion, is her natural tendency towards cautiousness that manifests as wussy-ness. Rather than wanting something and impulsively throwing herself towards it, as a typical baby might do, Sadie stops, considers, and weighs risk versus benefit. If the motion requires too much effort, or is unfamiliar and potentially scary, she doesn't want to do it. Hence she can stand while balancing against a chair until the cows come home, but the thought of sitting down by herself makes her shriek in terror.
The way to combat this is to help her through the motions, over and over again, until they become rote instead of something she needs to think about. Stand up, sit down, pull up, walk over, sit down again. Eventually she'll have the confidence to do it every day.
Although I don't think that a career as a bullfighter is in the cards for her.
Sadie has been progressing in leaps and bounds, which I attribute partly to her not being in day care anymore, partly to twice-weekly physical therapy, and partly to my working with her a LOT. Scott gets partial credit, too, but he's been out of town a lot so by default, I get to claim most of the credit for all of the cool things she's finally started doing.
It's so great to watch her learn -- she's quite literally packing months' worth of learning into a few short weeks. Just in the last week she's doubled her crawling speed, almost figured out how to pull up on furniture, started to take the first tentative steps towards cruising (walking along on furniture), and in general become fearless around the house.
Outside is a different matter; she still sobs her way through PT and is very shy and prone to bursting into tears when in an unfamiliar environment. Joy, the therapist, refers to her dryly as being on a "constant emotional rollercoaster," which is a nice way to saying that she's kind of a shit head.
This morning Joy told me something great, which is that in her estimation, there's nothing about Sadie's physical makeup that is keeping her from learning typical skills. Despite being long and skinny, she's strong enough to move around as well as any other kid -- and she proved that by learning how to crawl in the span of about five days, something that kids with hypotonia "just don't do," in Joy's words.
What really holds Sadie back, in Joy's opinion, is her natural tendency towards cautiousness that manifests as wussy-ness. Rather than wanting something and impulsively throwing herself towards it, as a typical baby might do, Sadie stops, considers, and weighs risk versus benefit. If the motion requires too much effort, or is unfamiliar and potentially scary, she doesn't want to do it. Hence she can stand while balancing against a chair until the cows come home, but the thought of sitting down by herself makes her shriek in terror.
The way to combat this is to help her through the motions, over and over again, until they become rote instead of something she needs to think about. Stand up, sit down, pull up, walk over, sit down again. Eventually she'll have the confidence to do it every day.
Although I don't think that a career as a bullfighter is in the cards for her.
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