Thursday, April 26, 2012

Speech Therapy

My three-year-old, SB, didn't start really speaking until he was about 17 months old, old enough for a little concern from most people. However, NJ, the oldest, also didn't start really talking until that age, and he went from a few signs and pointing to complex sentences in the space of about six months, maybe less; I figured SB would follow a similar pattern, so I didn't worry. At his 18-month well checkup, the doctor asked if he spoke at least 10 words. I had counted seven the day before, which is quite low for a bright 18-month-old, but I explained about NJ having been the same way and that I wasn't worried. I didn't get him evaluated by an audiologist or speech pathologist. I didn't take my doctor's referral to Regional Center. By 19 months, these were his words:

1) Moo ("What does a cow say?")
2) Moooor (More)
3) Moooooo (Moon)
4) Baa ("What does a sheep say?")
5) Mo-mo (Remote)
6) Bapa (iPod)
7) Mama
8) Derrrr (Truck, switch (as in, switch sides when nursing), train, among other things)

(Yes, one of his early words was iPod. He still loves that thing, too.)

In fact, I was right. Just a couple months after this appointment, SB suddenly started really talking, putting together two- and three-word phrases. By the time he was two years old, he was building complex sentences. There was one problem, though. His words were terribly unclear. NJ almost from the start spoke remarkably clearly. Complete strangers could have a conversation with him before he was three. There were very few words he said in a funny "learning to talk" way. (We remember a fond few, such as "battached" for "attached," but really, he spoke incredibly well.) SB not so much. I assumed it was just him still trying to figure out how to make the sounds, and surely by the time he was two or 2-1/2, he'd be speaking more clearly.

Alas, not. Some words gradually improved, or he'd suddenly begin saying something more clearly than he used to, but, for the most part, if you didn't live with him, you couldn't understand him, and even if you did live with him, you had to work pretty hard to understand him. I and NJ are the best at deciphering his speech, and other people will randomly catch words and sentences that I don't, but the faster he goes, the less clearly he speaks. I didn't know how to fix that, or if I should worry, or when I should worry, or what I should do.

At his three-year checkup, with a kid who spoke in totally unintelligible paragraphs, I expressed my concerns to his pediatrician, who referred us to an audiologist and speech pathologist. His hearing tested fine, so we went to the speech pathologist where she confirmed that his grammar, vocabulary, and syntax were quite advanced, but his enunciation problem was "severe." The good news was, it appeared he could make the various sounds, he just didn't always use them properly. Most consonants were "m", "n", or "d", and even some of his vowels were distorted. "Big" and "bridge" sounded like "buuuuh," for example. The speech therapist said we'd see her once or twice a month and she'd send us home with exercises to try to form new speech habits.

We have quite the task ahead of us. The goal is to create new habits and break the old ones. We need to get him to say the ending consonants: "ha-T," not "ha';" "Po-P" not "Po'." And so on. Then we have to fix initial "s" and initial "f" (he uses "d" for both). Then we have to work on other strident sounds, and reduce the lisp, and fix some other initial "s", and so on.

Fortunately, SB is very bright and realizes that it's hard for people to understand him. He will repeat himself over and over again in the hopes that this time you'll get it, but he doesn't know how to fix it himself. But he's getting there. A few things, he's already fixed on his own, and others he corrects when he remembers to. I can see that eventually, he'll be speaking more clearly. I just feel so bad for him, because he has so much to say and so many questions to ask and so much bubbling in his head that he wants to get out there, and he trips over his own tongue trying to express all the wonders of the world that an almost 3-1/2-year-old has discovered. And after a long descriptive paragraph, our response, more often than not, is, "I'm sorry, but I have no idea what you said."

I think it's hard to be willing to seek help when you think your child might have a problem. No one wants to think their child isn't "normal." But realizing that we could help SB to be better understood, which would improve all of our quality of life, made getting him evaluated and starting treatment totally worthwhile. I think there's a lot less stigma to various kinds of therapy than there used to be, and, in the end, when you see the change in your child when he's getting the help he needs, you know you've done the right thing.

Monday, April 16, 2012

Let's Talk About Potty Training!

Though I mostly talk about birth and breastfeeding here, I figure other parenting topics certainly have their place, so today's discussion is about potty training or potty learning! I'm lucky enough to be in the midst of potty training my middle son, SB. He turned three in December, and though I had every intention of having him out of diapers before the baby was born, or at least before he turned three, we're only just now starting to have some success in that department.

First, I hear that boys are more difficult to potty train than girls, and that girls typically learn at a younger average age than boys. I have no idea if this is actually true, although from casual observation of friends, it seems to be the case. I think maybe girls are just more likely to be bothered by a wet and/or dirty diaper and are more interested in emulating mommy? I have no idea. All's I know is that neither NJ nor SB cared one bit about getting out of diapers until we forced the issue, and that both would happily walk around in a dirty diaper for hours, even lying about whether they needed a change, from about 2-1/2 until they were potty trained.

Before I had kids, I couldn't believe that parents would let their kids stay in diapers until they were three. I was aghast when I saw that they made diapers big enough for a three-year-old. Once NJ became a toddler, I realized quickly that it's not always up to the parent, and you can't force a kid to use the potty. Indeed, toileting is one of the few things a small child truly has control over. He has to decide that he wants to use the potty, that wearing underwear and being dry is way better than wearing a diaper. Whether that's through a reward system, simple maturity, or some combination of both, if the child doesn't want to use the potty, you'll be cleaning up a lot of "accidents." I'm amazed when a parent tells me their child was potty trained at two, or earlier, but I am certainly no longer enraged by parents who "let" their three-year-olds stay in diapers! Goodness me, I'm one of them!

So, let's start with NJ, my strong-minded, strong-willed child. By 2-1/2, he was very verbal and would willingly sit on the toilet at daycare. We thought, great, let's potty train! SB was a few months old, and we were already tired of having two in diapers. Plus, NJ was so big that he was in the largest size diapers there were, and we didn't know what we would do if he got much bigger and still wasn't using the toilet. For a week, we tried to help him learn to use the toilet, but he didn't seem to have the awareness of when he needed to go. Every other day, we sent him to daycare in underwear and he'd come back with three or four dirty pairs of underwear and no toilet success. The in-between days, he'd express that he just wanted to wear a diaper. It seemed to be very stressful for him. One day, he didn't pee all day and in the evening was complaining of pain. We thought he might have a UTI from holding his pee all day and took him to the ER. That was a traumatic experience all on its own, and we decided then and there to put off potty training.

It took a full year before we finally got fed up enough with his wearing diapers to give it another try. We wanted him to move up to the preschool room (and out of the toddler room) at school, which he couldn't do until he was potty trained. His teacher said he was totally ready, just needed a little push. Push we did. We had to force him to decide to try using the toilet, but once he did, it was about three days until he was in underwear all day, accident-free. The first day, a Thursday, was very hard, but by Monday he was using the toilet. And he was big enough to stand to pee at a regular toilet and to sit on a regular toilet without a potty seat or a stool, which made everything easier when he had to go to the bathroom when we were out and about. There are definite advantages to waiting until they're older!

At this point, SB was 16 months old, and we knew we wouldn't push him. We thought he might be ready sooner just because he had his older brother to emulate, but we didn't want a repeat of that tough, unsuccessful week. Plus, we quickly learned that diapers are way easier than the early months of toilet-using. For months, NJ would announce, in the middle of dinner at a restaurant, or at the far end of Walmart or Costco, that he had to go potty, and one of us would have to interrupt what we were doing to take him there. It can be annoying. At home, it wasn't so bad, because he became independent in the bathroom pretty quickly, so we could just send him off to use the bathroom on his own. But, obviously, we couldn't do this in public! Another reason not to rush SB, in our opinion.

Flash forward to 2011. Not long after GI was born, SB suddenly started showing interest in the potty. He wasn't yet three, so I was very excited that he'd be potty trained earlier than NJ had been. He did well for about a week or two, but we didn't push him at all, not wanting to scare him off from it. I have one memorable picture of coming downstairs to find SB sitting on his frog potty in the middle of the living room, playing with my iPod. It was hilarious. I promised him a big present when he was in underwear all day, cheered him on whenever he was successful on the potty, but after a week or two, he just as suddenly decided he wanted to go back to diapers. Since I had a newborn and didn't have the energy to argue the point, we allowed him to go back to using diapers. Every so often, we'd try to entice him back to the potty with promises of presents and new underwear and pointing out how babies wear diapers and wouldn't he rather be a big boy like NJ?

When he turned three, we tried again, briefly, by putting him in Pull-Ups instead of underwear (because I so didn't feel like cleaning up accidents), promising him rewards, etc. He had no interest whatsoever and was actually very defiant about it, refusing to try, insisting he didn't have to, then going in his Pull-Up five minutes later.

Finally, two weeks ago, I'd had it. His Pull-Ups weren't holding his poos, so I was cleaning him up from poop-overflow every day. Plus, we've decided to try to send him for a couple of weeks to summer camp at my mom's preschool this summer, and for that he needs to be potty trained. So I said, that's it, we're doing it. I'm forcing the issue. I put him in underwear and kept reminding him to use the potty. I bought jelly beans, and after peeing in the potty, he'd get one jelly bean, and if he pooped in the potty, he'd get three. If he pooped in his underwear, I'd throw away the underwear, hoping that would upset him enough that he would try to go in the potty instead. He's basically good with pee at this point - even went at Walmart today! - but poop is still iffy. I've thrown away quite a few pairs of underwear and even a pair of pants that were not worth trying to salvage. Ew. I'm not sure if the poop issue is that he "can't" go or that he doesn't want to. I've seen him do it, so I know he can. He's so funny, though. He knows what he gets as a reward, so whenever he successfully uses the potty, even totally on his own, he'll go and take just one jelly bean (or last week, during Passover, it was macaroons - the kids loves macaroons. Heck, I'd go potty for macaroons, too). Honest kid. So cute.

My husband bought him a really big (literally) present to give him when he's accident-free for a day or two. If he doesn't poop at all during the day, he's pretty much accident-free. But if he poops, it's more likely to be in his pants than in the toilet, which is very, very frustrating. I'm hoping something clicks soon. I figure that by the time July rolls around, he'll be good to go (literally, ha!). Hey, he's only 3 years and 4 months. NJ was a full 3-1/2.

Of course, now we're back in the territory of reminding him to go to the bathroom constantly (but not too often - don't want to annoy him and risk regression), of being interrupted in the middle of shopping or dinner to help him in the bathroom, of bringing extra clothes and/or Pull-Ups wherever we go in case of accidents. And SB is considerably smaller than NJ was at this age, so he's not comfortable sitting on a "big toilet" on his own, without a potty seat. He can use a urinal, though, and the beauty of having an older boy too is that NJ takes SB to the bathroom! He showed him how to use the urinal. Love that. I'm not comfortable saying that SB is completely potty trained at this point, but we're surely going through fewer Pull-Ups, and he's been clean all day today (so far - it's 5:45pm as I write this). We still put him in a Pull-Up at night, as we did with NJ, although he's usually dry in the morning anyway. NJ started wearing underwear at night around when he started kindergarten, and that was totally fine with us. He rarely wets the bed, and even rarely wet when he was wearing a Pull-Up, but we let him wear it for his own peace of mind.

It will be interesting to see how GI does, with two big brothers to follow after. I wonder if using cloth diapers more with him will help him learn the sensations faster, if I'm still using cloth with him when the time comes. (I sure plan to - I bought some more!)

My basic feeling about potty training is thus: You do what works for your kid. For SB, he needs the cookie or the jelly bean as motivation. NJ didn't. He just needed a push, and then he pottied for potty's sake. SB needs that carrot of a BIG present. NJ got a big present, but we didn't have to have it sitting in Daddy's closet for him to see and wish for. SB needs to be reminded fairly often. NJ didn't. And it's interesting that I have NJ to help me potty train SB and to give him some tips of the trade. And he wants NJ to help him, which is pretty cool, too. (A lot of this has to do with their overall close relationship, and the fact that NJ just likes to help "parent" SB and GI anyway.)

So when my friends ask me for potty training advice, well, as with sleep, I can only say what worked for me. As far as I know, every person has a slightly different potty training experience, even with each kid. And then there are the lucky ones whose kids potty train themselves. I don't know what magic causes that, but it's pretty amazing when it happens.

I have to say, though, that the first time you see your little one's adorable tush in underwear instead of a diaper, it feels like a huge milestone. Suddenly, he's a big boy.

Thursday, April 5, 2012

Starting Solids!

I promised a post about introducing solid foods, and here it is!

GI turned six months on March 5. I had been anxiously awaiting that day for several weeks, planning how we would introduce solids, what he should eat first, how we would balance nursing and eating. I should have known after three kids that things come together fairly naturally if you let them. I did know, after three kids, that there were many different ways to introduce solids, and many different theories about what is best. The only things I can see that anyone seems to agree on these days is that you should wait until the baby is six months old.

With NJ, we followed our pediatrician's advice and started solid foods at four months. We did rice cereal mixed with formula for a week or so to get him used to the spoon and see how he did. We then started on pureed vegetables and fruits, like sweet potato, squash, peas, banana, pears, and apples. We did one simple food at a time, starting a new food every three to four days, and slowly built up to the "stage 2" foods and mixtures by the time he was six months. From then on, he had at least one or two meals of solid foods per day in addition to his bottles. We went ever-so-slowly and carefully, and I was afraid to give him finger foods because I was sure he would choke. I did eventually start giving him finger foods, like Gerber's fantastic Puffs, Cheerios, pasta, and bits of bread. It was a long time before he was just eating regular food with the rest of us.

With SB, we were more experienced and less nervous about the whole thing. And a good thing we were, because SB wanted nothing to do with purees. We started at six months, attempting to give him rice cereal mixed with breastmilk. He didn't like it. I found it was way more trouble to prepare food for him and to figure out what to give him than it was to just nurse him when he was hungry. It's likely that if we had pushed it more, he would have gotten the idea and eaten more solids sooner. I'm not saying we should have, just that I was too lazy. He nursed a lot well into the second half of his first year. It wasn't until after he was a year old that he was actually replacing breastfeedings with solid foods. He would eat bits and pieces of solid foods, crackers, pasta, peas, Puffs, cereal, melon, and so on, but he wouldn't be satisfied until he'd nursed.

So with GI, I thought it might be nice to do a combination. Maybe he could have purees sometimes and finger foods other times, so that we'd have options. I wanted the freedom of being away from him for more than two hours without worrying if he was getting hungry, so I thought if my husband or a babysitter could give him a meal of a puree, that would help. So we started with rice cereal mixed with breastmilk, which he found yucky, of course. I then tried mixing rice cereal with purees instead, which he actually sort of took to. He was very interested in the spoon. I tried to make it a point to give him some puree at least once a day, but he didn't eat much of it. He kept trying to steal food off my plate. So I finally just started giving him bits and pieces of whatever we were eating - bread, a pea, cereal, etc. I stay away from anything too acidic - citrus, tomatoes - or things babies really shouldn't have, like honey, and I don't want him to have dairy yet, but almost anything else, I'll let him try. He had a bit of avocado today, and a few peas. Some days, he gets some tortilla or bread. My friend's son had a big birthday party the other day, and there were roasted vegetables, so GI got some scraped-out bits of squash and zucchini and a little carrot and a banana. Whatever seems soft and small enough for the toothless little guy to manage, I'll let him try. He seems to enjoy it, but he only takes a few bites before he starts refusing.

There is research to suggest that babies who are allowed to go at their own pace with finger foods are less picky and healthier eaters as they grow up. It seems that being fed purees means that the baby doesn't have control over what he eats, how much he eats, and he doesn't learn to differentiate foods by texture, shape, and color, since it's all just liquified. I'm not sure how much I agree with this, but it's interesting to think about. That's why I figured a combination of finger foods and purees might be the way to go this time. I'm not going to force-feed anything, and if he doesn't want something, he doesn't want it. He's still going to mostly nurse for a while. He's seven months old today, and I'm hoping to continue to slowly increase his solids intake.

I did try leaving him with a babysitter last week. I gave her about half a jar of squash puree mixed with a some rice cereal for texture, and he ate almost all of it for her. He'll eat solids for other people more than for me, which makes sense, since when he's with me, he just wants to nurse. I did find that he still practically leaped into my arms when I got home. It seemed like even though he wasn't necessarily terribly hungry, he didn't feel satisfied until he could nurse. It's kind of nice to be pounced upon like that. Makes you feel needed.

The process of introducing solid foods can be referred to as weaning, in the sense that you are slowly replacing breastfeedings (or bottle feedings) with other foods. By one year, babies can be taking in at least half of their caloric needs from solid foods, maybe more. It depends on your kid, of course. Some babies just aren't that interested in solids at 12 months, and that's okay too. Obviously, at some point, they're going to have to subsist solely on solids, but it doesn't have to be at one year, or even at two. Your breastmilk is still supplying vitamins, minerals, fats, proteins, and sugars, along with anti-inflammatory agents, antibacterial and antifungal substances, stem cells, and all the other things that make breastmilk so great.

And the realization will come, at some point after starting solids, that if you plan to replace nursing with solids, you'll actually have to prepare food for your baby instead of just sitting down and nursing! I'm realizing that I'll now have to cook for three kids, not just two. Why rush that?