Appointments, Part 5: Early Intervention

A couple of weeks after we got home from China, I took Jack to see the pediatrician at the International Adoption Clinic at the nearby university hospital.  As part of the work-up, an OT came in and did an assessment of Jack. 

At the time, she and I talked about how Jack's walking had largely improved since I met him, but how he ran with his arms extended for balance.  And how he had recently learned to put rings on the yellow cone, and go up and down stairs holding an adult's hand, but he still lacked a pincer grasp, and he couldn't lean down and pick things up without falling over.  At the time, she indicated that if evaluated for Early Intervention that day, he would qualify for both physical and occupational therapy.  We discussed how I fully expected him to continue to improve quickly over the coming weeks, but if he didn't continue then I should push for OT services with someone who is also skilled in gross motor development.  She gave me some exercises to do, and off we went.

In the meantime, I had been trying to get Jack enrolled in Early Intervention.  At first, they qualified him based on his severe hearing loss.  Except, after we saw the audiologist we realized that he didn't actually have severe hearing loss, and therefore no longer qualified based on that.  And so we had to start over with a thorough evaluation of several different developmental areas.  When I filled out the questionnaire, he failed every single area. 

Two weeks ago, Ms. Teresa came out to do the evaluation.  This was 10 days after the questionnaire.  Two weeks after we saw the OT.  And he did totally awesome.  His walking - while still not developmentally at 21 months - had improved even further, and we have no reason to think it won't continue.  His grasp has gone from a full hand grasp to a fingertip grasp.  Still no two finger pincer, but it will come. 

He did things that I had tried to teach him only days before, but at the time he hadn't figured out.  He could put long pegs into the tiny holes on the first try.  He could put wooden shapes into the puzzle.  He could drive the Little People car.  He could sit on a riding toy and push with his legs. 

In other words, he is learning even faster than I thought. 

But of course, there is one area in which he did qualify for Early Intervention - speech.  But that is a post for another day:)

Posts (so far) about Jack's cleft/developmental/IA issues:

• Let the Appointments Begin!
• Appointments, Part 2: Audiology
• Appointments, Part 3: Plastic Surgeons
• Appointments, Part 4: The Dentist 

Posts (yet to come) about Jack's cleft/developmental/IA issues:

• ENT (and probably more audiology)
• Speech (even though this is part of EI, it will get it's own post)

Appointments, Part 4: The Dentist

We went and saw Dr. Wendy on Monday.

(We saw the dentist at the Commission, but he is retiring at the age of 85, and - I kid you not - he miscounted Jack's teeth.  The sum total of his advice is always, "Brush your teeth!"  Then he hands me a Princess Tiana toothbrush and sends us on our way.)

My kids adore Dr. Wendy - and she is a Commission provider, even though she doesn't come to clinic.  She is competent, has excellent bedside manner, and Will always liked how pretty she was.  When Jack got into the chair, he wasn't particularly happy, but once I signed to him (have I mentioned we are signing again?  Yay!) that we were going to brush his teeth, he lay really still waiting. He let them clean his teeth and even take x-rays.  He did so well that the hygienist said she wanted him to teach the 10 year olds to be still in the chair.


We have been concerned with Jack's lack of teeth - he has four on the top (the middle two, and the first two molars) and six on the bottom (the middle four, and the first two molars).  Dr. T (the IA doc) was concerned that the top ones might be missing on both sides.  But we got good news at the dentist.

Dr. Wendy says that all of his baby teeth are present, but she isn't completely sure of the position of the baby tooth nearest to the cleft.  It was a frontal x-ray, and she said it is possible the tooth is far back in the palate, and the plastic surgeon may need to remove it during the palate repair.  Or maybe it is where is is supposed to be and will be nothing at all.  She could also see the permanent teeth buds growing, in all of their crooked glory.  The only one not visible was the one nearest the cleft, which probably isn't there at all.  Kate is completely missing this same tooth.

So, all in all, good news - no cavities, teeth that haven't erupted yet are coming soon, and a happy dental patient.  Go, Jack!

Posts (so far) about Jack's cleft issues:

• Let the Appointments Begin!
• Appointments, Part 2: Audiology
• Appointments, Part 3: Plastic Surgeons

Posts (yet to come) about Jack's cleft issues:

• ENT (and probably more audiology)
• Early Intervention (this one might be a doozy)
• Speech (even though this is part of EI, it might get it's own post)

The Honeymoon Period is Over

Sometimes when a child is adopted, everything goes really well.  Everyone puts their best foot forward in an effort to please.  The parents have an unlimited patience with the child, and the child is agreeable, loveable, and basically angelic.  Sometimes this is called the honeymoon period in adoption circles.  But as all parents know - whether your kids are adopted or not - this is an unnatural state.  At some point, the honeymoon will come to an end.

Reality has set in at our house in the last couple of days.

When we brought Jack home, he was super easy-going.  He rarely cried.  He freely gave out hugs and kisses to us.  He happily went to bed, smiling at us as he fell asleep.  He came to us when he needed something.  And because all of this was going so well (and because Tim and I have been flat-out exhausted) we got lazy with our attachment parenting.  We have let him wander off and grab other people's hands or ask to be picked up.  We have let various relatives and close friends give him food while we dealt with other children.  And while I cringed a little inside, I was too tired to be firm.  And I thought, He is doing so well!  Why should we worry when nothing is wrong?

And all the adoptive parents out there are shaking their heads at my naivete.  (I'm shaking my head too, for good measure.)

Sunday I decided to take Ben and Will to a movie.  Just the three of us. It turned out to be good, quality time, which we sorely needed.  But Jack noticed that I was gone.  For four hours. I had never done that before.

When I returned I offered to give Jack his bottle while Tim got the others ready for bed.  Now, Jack and I have always had a little control battle going on around food.  He wants to dictate when, where, what, and how much, but I know that this is a sign of distrust and of potential food issues.  And so I have danced around it, offering lots of healthy options whenever he is hungry, and sometimes when he is not hungry.  For example, when he sees anyone eating, he demands food right that moment, even if he ate five minutes ago.

So. Jack and his bottle.

I immediately noticed that not only would he not let me hold the bottle for him, he wouldn't even let me touch it. He cries when I do.  He refuses to look at me during this interaction and is constantly trying to turn his body so his back is to me.  In bed, he clutches the bottle like I am trying to steal it.  He hits, pushes, and turns his back on me.

And the whole time I am thinking that this is a full-blown Kate NaNa attachment fit.  Some of you haven't been around long enough to know this, but Kate NaNa used to despise me.  During the day she liked me fine, but at night she wanted me to leave her completely alone.  She oozed distrust and anger. And so I started crawling in bed with her every night.  When she hit me, I would kiss her hand.  When she screamed at me I would tell her I loved her and would never leave her.  When she would push me away I would pick her up and dance with her.

And now it is time to do this with Jack.  He, of course, doesn't know what to do with this.  He has never had a permanent caregiver.  He doesn't understand that no matter what, he is staying in this family.

He hits me, and I kiss his fist.  He screams at me, and I say, "I love you."  He pushes me, and I refuse to move.  Over and over I have to show him that I am not going anywhere.  No matter what he throws at me, I will always love him.  No matter how much he tries to push me away, I will always be his Mama.  I am not going anywhere.  I will not leave him.  I am here to stay. 

On a final note, please forgive me when I ask you not to feed my son, or pick him up, or take his hand.  I am teaching him that I am his Mama.  That he can trust me to feed him, to comfort him, to keep him safe.  And to never, ever leave him.  Because I am not going anywhere. 

(And a special thanks for some attachment posts I have read recently - RQ, Stephanie and Nancy at NHBO.  I just didn't know I would need them so soon!)

Happy Mother's Day

Yes, I know this is a day late.  I had a beautiful post in my head on Saturday night - a tribute to all of the mothers in my life and all that they have done for me.  I have especially been missing my Ma-Ma and my Bunk, and wanted to write about them. 

But that didn't happen.

(And you know that when I write a single sentence fragment as a whole paragraph, that I am getting ready to launch into a rant, right?)

Where did we get the idea that Mother's Day is this glorious time where everyone celebrates mom and caters to her every desire?  Because that has never happened at my house.  Not even a little bit.  Never.  At my house, my husband (whom I love, but for the purpose of this story is not the hero) gets up and leaves for work on Mother's Day before I have even considered getting out of bed.  Because it is Sunday and that is what pastors do on a Sunday.  Except, oh yeah, I did get out of bed several times in the wee hours of the morning to help one kid vomit into the toilet after eating too much junk food at a baseball game last night.  Oh yeah, and to get another crying child out of his bed and into mine before he woke up three other children.  (Although in the husband's defense, he did take the crying child from me so that I could go back to sleep for a little while before I had to get up.  Maybe he is the hero of the story.  Or at least one of them. Huh.)

Then Mom has to get the children who are neither crying nor vomiting ready for church and there on time (or at least within 30 minutes of said time for church).  When the children and husband arrive back home from church, the four smallest of the crew want to sit on Mom's lap at the same time.  Which is lovely in sentiment and theory, but is distressing to a mother who wants to avoid two of said children from cold cocking each other.

At which point Mom goes into the kitchen to get some water.  And realizes that no one has bothered to clean up one single dish from the lunch that she cooked.  On Mother's Day.  And so she clears the table, loads the dishwasher, washes the dishes that don't go into the dishwasher, wipes down counters and table, sweeps the floor, and at some point realizes that she needs an escape hatch.

At which point Mom grabs the Kindle, the car keys, and her wallet and leaves.

After cooling off for an hour or so, Mom decides she misses the little boogers and goes back to get the two bigs for a movie date.  Mom and her big boys really do enjoy themselves, and this is the one point in the story where true appreciation is shown to Mom.  Because she did something she never ever ever does.  She let them watch a PG-13 movie.  And so naturally the bigs are very appreciative and kind.  And Mom can't believe she stooped so low just to get a thank you out of her children.


Upon returning to the nest, the smallest bird has decided that he Does. Not. Like. It. when Mom thinks that she can just up and leave and then she returns and expects everything to be normal.  Oh, no.  No, he decides he is not happy with Mama for that one.  And he spends the next few hours refusing to let her give him a bottle, look her in the eye, or let her put him to bed. 


I wish I could say that Mother's Day is typically a really great day for us, but honestly, this story is typical of my Mother's Days.  Except we don't usually throw attachment issues in there.  That one was a new bonus for Mother's Day. 


And now you know why, when Tim asks me what I want for Mother's Day, I tell him I want to crawl in bed. 

Appointments, Part 3: Plastic Surgeons

Ok, back to our visit last week at the Commission's cleft clinic. We have done this more times than we can count with Kate, but for Jack it was a new experience.  (Warning: detailed information for those who care about cleft issues and/or who are local people who have asked about these doctors lately.)

(Skip to the end if you want the short version.)

There are these three brothers in our area who are plastic surgeons, and they all three work with the Commission.  Or, at least they used to.  Dr. Woody did Kate's repair, but unfortunately he is in semi-retirement because of health issues.  Last time she was there she saw Dr. Andy instead.  We noticed several differences in their approaches.  First, Dr. Andy has a better bedside manner overall.  It is hard to describe if you haven't met either of them in person, but he looks you in the eye and is easy to talk with.  However, we adore Dr. Woody.  Not only is he a fabulous surgeon, but we like several of his methods better.  For example, Dr. Andy recommends no-nos for the arms and syringe feeding after surgery to prevent the child from messing up their stitches.  While I know these things are common practice, Woody felt like it was more bother than help for a two-year old.  He never made us use them.

Also, Dr. Woody believed that if the initial lip repair was good that the child should be a teen before deciding if they wanted cosmetic surgery to "clean up" the area (nose, lip, etc.).  He always told Kate that her lip looked good.  Last time Kate was at the Commission, Andy told Kate he wanted to fix it now.  That was the first time anyone had ever told her that her lip needed to be fixed at all, and now it is an issue.  So what we had before was a child who knew her lip was different but didn't care, and what we have now is a child who worries about her lip being different.  Needless to say, Mama Bear is a bit miffed about that.  I plan to have a chat with Dr. Andy in the near future about little girls, self-esteem, and body image.

Ahem.  Back to Jack's appointment.

One the first things we noticed about Jack's cleft was that the gum line is somewhat intact. We were fully expecting it to be a complete cleft since the lip, nose, and palate are involved, but when we snuck a peek we got a surprise.  The plastic surgeon (Dr. Andy) thinks that because Jack's gum line is partially intact, he probably won't need a bone graft when he is older.  This is fabulous news, as this can be a very painful procedure.  (Kate will probably have hers in the next couple of years, and we are not looking forward to it.)

Dr. Andy hopes to do the palate repair sometime this summer.  Ideally we will coordinate the palate repair, get the ENT to put in tubes, and have a sedated ABR (hearing test) done, all at the same time.  It will likely be a one night stay in the hospital, and he will be allowed to go home when he is eating/drinking/urinating.  It won't be fun, but we will all survive.

Also, I got the physical copy of Jack's hearing test today.  Not only is his hearing loss in the mild/moderate category, but according to that latest test he can hear at 20 decibels.  The original report from China had him hearing at 45-100.  (I am sure that all of the audiologists, doctors, and SLPs out there are shaking their heads at my lack of ability to use hearing test terminology appropriately, but that is the best I can do at the moment.) That is huge, and we are very happy.

Posts (so far) about Jack's cleft issues:

• Let the Appointments Begin!
• Appointments, Part 2: Audiology

Posts (yet to come) about Jack's cleft issues:

• ENT (and probably more audiology)
• Early Intervention (this one might be a doozy)
• Speech (even though this is part of EI, it might get it's own post)
• Dentist (ie, How many teeth does Jack have, and will that be all?)

So, to recap: Good news - Probably no bone graft needed.  Repair in the summer (July?).  Probably will get tubes.  Hearing is much better than expected.

Jack: 4 Weeks With Us

There will be more medical/developmental reports when I have time to write them up, but for now, a general "settling in" post. 

Jack is still feeling kind of yucky, between his cold and his ear infection.  His symptoms were fewer today, but he just seemed kind of "off".  He wanted to be held a lot and didn't want me out of his sight.  These aren't bad things to occur in an adopted child.  It is a good thing that he is seeking me out for comfort.  It is a wonderful thing.

Today during his naptime and tonight at bedtime, I laid down with him.  He would first lie down next to me, and then he would sit up and rearrange himself on top of me.  Then, he would raise his head up, give me a big open-mouthed kiss, and then lay his head back on my chest.  Over and over he did this.  I think part of it is him learning to imitate me.  Not that I give him open-mouthed kisses, mind:) But I do lean down and give him kisses when I am changing his clothes or putting him down for a nap, so I think he was trying to be like me.  I also think his comfort level with us is increasing.  He has always been a cuddle-bug, but the hugs and kisses are getting more frequent. 

And last, a picture of Jack and my Emery, who I used to babysit.  I know they look cute, but this was just before they both decided to start screaming and talking loudly in the middle of church.  They didn't stay there much longer before their mamas had to drag them out crying.  It also looks like they might be friends here right?  Well, Emery is trying really hard to make friends, but Jack isn't sure what to make of this guy yet.  I'm sure Emery will keep trying:) 

Appointments, Part 2: Audiology

This post started out as a full description of all the the specialists we have seen so far, but I quickly realized that it would take a couple of hours to read it all, so I better break it up a little:)

We spent yesterday morning at the Commission's cleft clinic.  We have done this more times than we can count with Kate, but for Jack it was a new experience.  Thankfully it went very well.  And so there is good news, and there is bad news. 

First, the good news.

We saw Kate' regular audiologist (who is now Jack's audiologist), and she did an evaluation, even though Jack's ears are full of fluid and infected.  She told us that she feels like with tubes, Jack has a great chance at completely normal hearing.  We are absolutely thrilled with this news.  She said his loss is probably mild/moderate and told us to come back when his ears are infection-free for a more accurate test.  She also requested a sedated ABR to be done during the palate repair. 

And now for the bad news. 

Jack's enrollment in early intervention was based on his hearing loss being severe in his left ear.  A diagnosis of mild/moderate hearing loss means that he no longer qualifies for services based on his hearing loss.  When Kate was enrolled, cleft palate was considered a significant enough issue to get her in the program, but it no longer does.  (I would love to know how many cleft kids don't need speech services, for Pete's sake.)  And so now I have to start from scratch and get him qualified another way.  Basically it has to be proven that he has significant development delays to get the speech therapy that he will obviously need, even though he is very young and the delays aren't that serious yet.  Should be fun. I am eagerly awaiting the paperwork to get the ball rolling on that. Hopefully his expressive/receptive speech delays will be considered significant enough, because I don't think his motor delays alone will be.

The OT we saw on Wednesday had warned me about this.  Unfortunately, budget cuts mean that they have to find ways to cut services for kids who need them.  She said that I will have to fight for services that they automatically would've offered to Kate.  That's ok.  I am pretty good at that.  Y'all remember how much I love arguing with navigating insurance companies, state-run red tape services, and healthcare providers? Actually I take a sick pleasure in conquering it, but that is probably a post for another day.