4.28.2010

bittersweet news

well, many of you know that we had our EI (early intervention) evaluation yesterday... here's a bit of history on that in case you're unfamiliar with the EI program.

wren passed, er... failed...er... didn't qualify. which is great news! it gives me hope that she's actually "going to be ok". of course, we're still early to see exactly what possible effects her prematurity could have (some we wouldn't notice until she's learning long division).. but even something so small as being "normal" for her adjusted age is really encouraging.

the bad part is that EI is the main source of support for kids here in
oklahoma. according to the pediatric clinic at reynolds army medical center, they don't give referrals outside of the early intervention program. i guess we'll see how all that pans out. i've got her an appointment to check her weight (yes, she has to actually see a doctor to check her weight. hubs said that it's probably at command discretion, but we've never experienced such an idiotic medical environment since joining. there's actually a posted notice that you're not allowed to take kids to appointments- unless it's for them. i mean, come on, like we all have babysitters on call! ugh. those are just some of the crazy things going on there... i could list a thousand inefficiencies we've encountered so far.. but i digress.) and at that appointment i'm going to push the referral issue again.

the weird thing is that at the eval they didn't check her reflexes (she still had some primitive reflexes a month or so ago.).. they didn't check her asymmetry (she's right side dominant)... they didn't check her muscle tone... all those things are risk indicators that should warrant intervention. it seems that the idea is "when they're behind, we'll help them catch up". rather than "let's keep kids from getting behind".  they did all of their testing based on her adjusted age... 7-8mo.

i took many pictures of the eval... the different tasks they checked etc. but i've lost the camera cord, so i can't get them off the camera.. so i'll just talk about them for now, and add pictures in later.

motor
gross motor & fine motor

 pincer grasp
 raking grasp
  • they had small toys that they wanted her to pick up, one at a time, they wanted her to shift from hand to hand, to hold one in each hand, to hold one object with both hands, and to bang the two objects together. 
  • in addition they wanted her to push up, at least to an elbow while on her belly. she doesn't do this. she'll roll belly to back immediately after being put on her belly. (to the left predominantly) she has started reaching for things like she would roll from back to belly, but seems to realize that she doesn't want to end up on her belly! for now, nothing can even entice her to roll back to belly, or to stay on her belly and scoot toward something. she will sometimes push up, but only insomuch as it helps her to get off her belly. belly time development is something she is on the lower end on.
  • they wanted her to pick up small things. for her age, a raking grasp is normal... she used a pincer grasp on her right hand- she succeeded at impressing them with her puff pickup. :) the left side is still mainly a fist grab, and she has to shove the whole thing in her mouth to get the puff in there... so, i hold her right arm frequently to make her use and develop that left side more. 
  • she is sitting unassisted, and falling over less and less. in fact, if there's nothing out of reach that she goes for, she doesn't really fall over any more. this is pretty good for her adjusted age.
  • she should be using her hands for support while sitting. this also plays into some of her problems that they didn't address... because she doesn't really open her hands flat enough to push up from her belly, or to support herself while sitting.
  • she explores things she's holding, or that adults are holding.
  • overall, her fine motor (holding her own bottle, etc.) is way ahead of her gross motor (scooting around).
cognitive
attention & perception and concepts
  • they checked to see if she would be interested in things sitting around her... she is super curious, so she passed this part with flying colors.
  • she also was aware that something was there, even when it was hidden. (ie. she watched as a toy was put under a cup and she would tip the cup over to get the toy.)
  • she explores with her mouth... everything is hand to mouth.
adaptive
self care
  • they asked about how she responded when fed- did she close her lips around the spoon? what types of foods was she eating? how did she do with small foods- like puffs? did she reach for the spoon? was she eating any babyfood with chunks? yes, level 2 and 3, some home made and some store bought, does well with puffs, reaches for the spoon every time, and yes, just started with the chunks. she is an eater extraordinaire. she was almost ahead in this category.
personal & social
adult interaction & self concept
  • she interacts well with adults, smiling and reacting to talking or activities.
  • she is showing stranger anxiety. (which just emerged a few weeks ago. i thought we'd ruined her by never letting people hold her... but apparently it's actually a good thing that she's naturally developed an understanding of who the regular people in her life are.)
  • she is interested in what other people are doing. ie. wanting to eat what we're eating, drink out of our cups, hold what we're holding, and looks where we're looking. (ever try to fill out paperwork while holding a curious baby? tried to do that today. first and last time- if i can help it.)
  • she's developed separation anxiety. which also is apparently a normal developmental process. when i leave the room she cries. when she can't see me sometimes she cries just to get me to come back in the room etc. 
communication
receptive & expressive

  • she does respond to sounds and voices around her... she will turn her head to look and see what's going on. she also startles to loud noises. (she passed her audiogram today as well- so we know she can hear. :)
  • she doesn't respond to her name specifically. i can call her booger face or wren or be talking to the cat and she'll look no matter what. 
  • she doesn't babble. at all. she shrieks, and will express dislike or joy... but she doesn't have any repetitive sounds. not that she should know what they mean at this age, but she should have at least some repetition, if not short words. (ie. bababa, mamama, dada etc.) 
  • at this age she should also be responding to "no". or at least realizing a negative reaction. she just laughs. i've tried no with a point, no with a firm voice, no with a furrowed brow, no with a swat to the offending hand, (undoubtedly trying to tip a glass or baby food bowl), no while removing the offending hand and putting it back in her lap, i've tried just about everything i can think of and she just thinks i'm kidding and tries again. so, we'll hope she gets this soon. it's a pretty important developmental step. (and will help keep mommy and daddy sane!)
  • she also doesn't play "sound games" with us. this is how babies learn to make noises. we should be able to say ba-ba-ba... and have her babble back with something similar. we're going to keep this up and hope she picks it up soon.
  • in addition to the sound games, we read at least 2-3 books to her a day, and we've started your baby can read. she loves to look at the pictures and is patient to listen when we read. if it's a board book we let her hold it and turn the pages. when she watches ybcr she is absolutely GIDDY! she just laughs and laughs and seems to be picking up on some of the words' meanings. (ie. arms up. i thought she was going to do it yesterday! i was just sure of it. she's close!)
  • communication was her lowest scoring area... at almost a "mid-delay" (25% delay. she would have needed 2 areas at 25% delay to qualify anyway...)
some other topics that we covered

sippy cups
  • it's best to skip the sippy cup stage if at all possible. i remember thinking, back before i had kids, when i knew everything about kids, that using a sippy cup seemed counter intuitive. why train them that things can't spill and to use a weird top when they're just going to have to be retrained to use an open cup- with lots of spills- later on? well, then i became the parent i was a few days ago, and i decided it made sense to "transition" from a nipple to something else that they suck but less, then on to the open cup. after talking to these ladies i've decided i was right the first time. so, after buying 3 different sippy cups, i'm going to actually pick up a slit topped cup and go from there. the only one i've been able to find so far is this one from europe. the speech pathologist said that they are hard to find, but are the best option for "transition". if a sippy cup is necessary, the straw kind are best. the type of sucking is different than the little spout tops, especially the soft tops, and the straw sucking motion is helpful in the formation of sounds/words as they get older.
binkies

  • they should be off the binkies about the same time they come off the bottle. the point of the binky is to soothe a baby with the sucking motion that would comfort them if nursing. as they get older, and stop nippling feeds, the need for a sucking motion to comfort them becomes a habit rather than a natural response. (if i'm making any sense here.) so, off the binky by 1. any longer than one can affect the way they form sounds (again, that sucking motion that trains the tongue to behave a particular way) as they're developing speech. not that they wouldn't be able to talk, just that they might need speech therapy to properly form sounds at the age of 7 or something. (of course, i'm sure lots of kids are functioning just fine with misformed sounds! haha... but, that's just what the lady told me. :) personally, i guess this is what we'll shoot for. she still absolutely has to have it to sleep... but that's pretty much the only time we use it. or, if she's super fussy. (usually because she's sleepy!) 
tips for crawling strength
  • play on her knees. it's important that her knees are up under her hips and not "frogged out"... but if her knees are properly in place, knee play can mimic crawling in many ways and help boost strength if she's lacking in belly time. we've tried it a few times now and she's really receptive to it! i was actually shocked. we have a small step down into our den and we just propped her there, with some toys in front of her. she was holding herself up and everything! the bumbo was the right height for her to be almost upright playing with toys on the tray- but it needed to be held the whole time because it slides around. (being lightweight and round.) we're really excited to keep trying this and hope it offers a successful alternative to belly time! (or at least in addition to belly time!)

here are some interesting child development resources:

cognitive development (this was super interesting, and will filter into my parenting choices in the future.)
ages & stages

UPDATE: [here] are the pictures i promised to add. they're of some various tests they did during the evaluation.

11 comments:

Kathy said...

it sounds like overall she is doing well! FWIW Andrew didn't start babbling until 11 1/2 months adjusted...now he's 13 months adjusted and he still can only say "babababa". I think the delay is due to his reflux and other digestive issues causing general discomfort around his mouth area. Anyways, she'll get there!

Sara said...

Jacob didn't qualify based on his "skill level", but automatically qualified in MA because he was born before 28 weeks so they continued to see him once a month even though he was on track for his adjusted age. It wasn't until he was between 12-15 months old when he truly qualified based on his skills (or lack thereof).

Here's hoping she didn't qualify because she is going to be an over achiever!

Sara B said...

I just wanted to share a cup idea...we tried this with Marino with some success but now he wants to walk around swigging a cup, so we need a sippy. But we used a Doidy cup at first and loved it.
http://www.amazon.com/Doidy-Cup-Red-color/dp/B001298VTU/ref=sr_1_120?ie=UTF8&s=baby-products&qid=1272506820&sr=1-120

wrensmommy said...

thanks for the tips! :)

those doidy cups look interesting- i think we'll give them a try.

Michelle said...

Yep. Liam qualified both because of his delays and because in TN he automatically qualifies being born more than 10 weeks premature. It does sound like she is doing very well... but I know that I want Liam to get all the help he can get so that would be a bit frustrating!

SupersammyG said...

I could have written this post about E's EI eval with the exception of the crawling part (as she is army crawling) and the belly part (when on her back she flips to her belly which makes diaper changing and getting dressed "interesting").
E is still not babbling but my mom reported to me that I didn't either. So we will have to see. DW thinks E is going to develop a studder since I am constantly trying to get her to copy me babble. I must sound so silly going mama mama baba baba nana nana over and over again. Oh well if it gets her to talk then I guess it is worth it.
Oh and when was Wren's due date? It seems like they are almost the same age adjusted.

sweet tea in a pink glass said...

My daughter is 3 months adjusted age, she is Left side dominent, at first they thought she had tordacolois, sent us to PT, they thought it was her eyes, went to eye doctor he said no, we are going to see a neurologist in May do see what he says. After 2 weeks of PT, we've seen much improvement, but haven't gotton any answers on favoring one side. Have they given you a reason, I know every child is different.

Jennifer said...

Our SLP told us to use the rubbermaid "Litterless" straw cups. I bought a bunch of them at the container store online. They are the ones with the blue lids. They work pretty well, but the twins still prefer the bottles....oh well, we'll keep working on it. Thanks for posting about those cups--that makes sense to me!

Southern Loves said...

Congrats on the "sweet" news!! :-D

wrensmommy said...

@supersammyg- i was thinking that maybe i'm delaying her speech by not actually talking to her- i squeal and coo and babble all the time trying to get her to mimic me... but that's what they recommended too! haha.. and if "they" say something it's got to be right! :)
her due date was aug. 30

@sweat tea- no reason... it is an indicator for CP though... which has us a little worried. it also can just be a random thing that they have for a bit and outgrow. (the funny thing is initially she was left side dominant and we worked and worked and basicallly switched her or something! :) the dev ped said the best thing we can do is just constantly work with her. good job getting all those helps for her! that's the greatest thing for you guys to do. the dev ped said many, many things can be overcome with diligence and patience in working with them physically and/or mentally. good news-eh?

@jennifer- i'll check it out. thanks for the tip. :)

criticalcrass said...

i'm sorry that wren struggles with her development. i imagine it must take a toll on you, the worry over it. but much of what i read seems to be good news, and i will pray that as she gets older, her progress is greater and your worry is lessened.