Thursday, June 9, 2016

Twin toddlers OT and speech IEP

Well we've been headed down this road for a while. The Help Me Grow program ends at age 3 and the IEP program takes over. IEP means "Individualized Education Program" which is basically a formal process for the school to evaluate and treat kids with any kind of special needs. This can range from very severe to very minor issues.

We took Brooklyn and Bailey in for an evaluation in May. My concern was that Bailey would qualify and Brooklyn would not. Obviously, I would prefer neither kid is on an IEP, but if only Bailey was, I was really nervous about Brooklyn being left behind at daycare and Bailey attending preschool for two hours by herself. The preschool program has "typical peers" (aka kids without any issues) and then kids with special needs, but the typical peers are chosen in December for the following year and we did not even think to have the kids entered into that. My plan was to just keep them in daycare till kindergarten and skip preschool altogether. Things change though!

Anyway so the evaluation. I thought there was no way the girls would split up from Darren and I as they are very shy and really don't like strangers. But the preschool teacher won them over instantly with promises of toys and the girls followed him into the room without a second glance back. We sat outside the classroom on tiny preschool chairs and filled out endless paperwork. Times two.

After the evaluation, we met briefly with the school psychologist and school speech and language pathologist (SLP). They said they had some concerns and would like to set up the formal meeting to go over the ETR (evaluation team report) and discuss if an IEP is needed.

Fast forward two weeks.

So both kids quality for an IEP for both speech and OT for fine motor skills. Did we know or have any concerns about their fine motor skills? Nope, that totally flew under the radar for me. Now that it's been brought up though, I can see their point.

For Bailey, they have concerns about her motor skills to produce sounds and that she is basically unintelligible. She'll be getting one on one speech for a half hour each week. Her fine motor skills were slightly delayed she she'll be getting extra help in a group setting each week. As the school's SLP was discussing her speech delays, I asked him if he thought she had apraxia of speech. This has been a concern of mine for a while. Here is the clinical definition:

Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words. - http://www.asha.org/public/speech/disorders/ChildhoodApraxia/

The SLP said he's not ready to diagnose her with this, but it is something he's considering. I discussed it with the speech therapist Bailey sees at the Cleveland Clinic but she seemed to brush it off. Will bring it up again. I go back and forth with it. I think it fits with Bailey's issues pretty well but some of the symptoms - being clumsy and having trouble eating/not like things in your mouth like a tooth brush - don't fit at all. On the flipside, it also calls out issues with fine motor development and she (apparently) does have this. Time will tell. I feel like she is making so much progress but I am noticing people besides Darren, me and our daycare provider have difficulty understanding her. She is the HAPPIEST kid in the world and it breaks my heart that she has such a hard time communicating.

As for Brooklyn, on paper she doesn't have a speech problem. We took her into Cleveland Clinic and she passed. They did not think she needed speech therapy. It's been hard for me to explain the issue with Brooklyn because she CAN talk, she just doesn't. So it was a huge relief when on her IEP that they were able to understand the issue. In their words - she isn't using her speech very functionally. Yes, that is the phrase I needed to explain it! During the one on one evaluation she was able to use words and sentences, etc but in a group setting she clammed up and wouldn't speak, or would barely utter a whisper. She wouldn't ask for things and wouldn't answer anyone. So her treatment will be in a group setting and have more of a social focus. She also scored extremely poor on the fine motor skills (again, I had no idea) so she'll be getting one on one help with this.

The team also had a lot of social concerns about the girls. This did not surprise us. They play so well with each other and us but really don't like people. If another kid comes on the playground they will often freeze. So that's another thing the school will work on with them both.

The other bomb that got dropped during the meeting was the plan to put the girls in separate classes. My mama bear instincts were going full force like absolutely not! They countered with the they are their own person argument. (Trust me, I am well aware of this.) Totally on board with separating them for Kindergarten and beyond. My concerns are that at age 3 that seems soooo young when they are already so shy and don't seem to like other people. They IEP team, however, said that twins with social/speech issues really do so much better being separated so I agreed to it. This makes me a little nervous, but I am hoping each girl will do great and progress quicker. Plus it's only two hours a day.

What's slightly awkward is that the preschool is two hours a day. The kids with special needs are eligible for busing but only within our city. Our daycare is in the neighboring city by seven blocks. No exceptions though. We are lucky that Darren works from home and while not an ideal plan, he can drive them back to daycare after the bus drops them off. I think it's important enough for them to get help.

It was a lot of information crammed into a two hour session. I am really glad the girls will be getting services but also feeling like shitty mom because they are so behind in speech and fine motor. All those guilty mom thoughts rise up like if I wasn't working and was home with them all day or if we read more books or I should have had more fine motor activities and toys for them. And then I think about how ridiculous this all is. It's not like my mom or grandma had 18 fine motor activities from Pinterest laid out each morning. Also, Morgan is doing awesome. She already says: kitty, cheese, down, mom, dad, no, uh oh, oh dear, hi, bye, i love you, and a few more keep coming every couple days. And she's 13 months. Which is crazy early. She has said some sentences too like "hi dad" and "bye dear." So perhaps it's not "shitty mom" and B&B really just have some issues. I'm sure being preemie has contributed some to this, which also packs on the mom guilt. If only I could have stayed pregnant for a couple more weeks, would they have these issues? I don't know. It's not helpful to think that way, but sometimes it can't be helped.

In other news, Bailey is also getting her tonsils and adenoids out so perhaps that will help some with the speech (they were very, very enlarged. She snores like a grown man and has sleep apnea).



Friday, May 20, 2016

Rock stuck in lip...

So this happened.

We were on walk in the valley and Brooklyn tripped, and face planted. She was crying and had a bloody lip. I took her into the bathroom ad cleaned her up. There was a weird mark on her lip but I couldn't really tell what it was - blood blister? scab? cut? Darren took one look at her and says, "That's a rock." I was a little skeptical. We couldn't wipe it away, and it did feel a little hard, but what was it? (See top left pic)

Anyway, we took the kids for ice cream and she perked up and seemed okay. Put her to bed. She woke up at 10 pm just crying soooo hard and her lip was super swollen. (see top right pic). I was FaceTime calling my parents and my sister to try and figure out if there was something in there. Finally just took her to the ER.

The ER doctor had to give her some baby valium to sedate her some. Then two doctors and a nurse came in to hold her down (mama was crying too) and the one doctor used tweezers and pulled a little pebble out of her lip! It got wedged under the skin.

As soon as it came out (bottom left pic) the swelling went down and she was much happier. Took her home (not stitches!) and put her to bed. She was a little high from the hospital drugs and spent about thirty minutes talking nonsense in her bed which was hysterical. Anyway, she was fine the next day (bottom right). 

First haircuts, first dentist appointment


Finally took B&B in for their first haircut. They were beginning to look like feral urchins but I hated the idea of cutting their hair. Bailey loved her haircut and smiled the entire time. Brooklyn cried the entire time. We had the first dentist appointment a week later and the results were the same ha. One cried and one smiled. 


Morgan is one year old!!!


Morgie celebrated her first birthday last month. That came up fast!
She was officially walking for her party, albeit unsteadily. Bailey and Brooklyn like to imitate her and take shaky, unstable steps and fall dramatically into my arms. Hilarious.
Morgan did pretty good with her smash cake. The kid likes sugar, of course. 
About a week after the party she was walking pretty regularly, and now walks with no problems. She is also climbing on top of everything (you turn away for one second and she's on top of the picnic table about to leap to her death, laughing hysterically at your panic).  
At her one year appointment, she weight in at 23 lbs and height was just shy of 30 inches. Giant baby! (B&B were both 20 lbs 7 oz at one year and about 29 inches). 
















Thursday, March 31, 2016

Morgan is 11 months

Late again on posting this! Here's Morgan at 11 months. This little cuddle bug is almost a year.

Twin speech delays in toddlers

Both Brooklyn and Bailey were pretty delayed with speech. Only saying "uh oh" at 18/19 months. I know it's fairly common for both twins and preemies to have speech delays, but generally they catch up around age 2. This did not happen. Now the girls are getting close to 3 and I'm starting to be a little more concerned.

Brooklyn seems to have finally caught up with speech but Bailey is still lagging behind. We've been doing the early intervention with the state (Help Me Grow) since they were 18 months. It's nice because it's free and they come to your house. But wanted to get a second opinion and a little extra help so we took them in to get evaluated at the Cleveland Clinic children's rehab center.

Brooklyn passed and didn't need any extra services. This didn't surprise as she's really exploded with words the last month or two. She is putting together sentences just fine and will repeat just about anything. No concerns anymore. She seems to still be a bit behind typical peers, but I know there is a range of normal and she is just on the lower end.

Bailey however needs some extra help. We counted and she can maybe say about 60 or 70 words but it's hard to really accurately count this since so much of what she says is inaudible. Bailey talks a lot, she just drops so many consonants it's difficult to make out a word without context clues. So, when we hold up the "car" flashcard, she can't really say "c" or "r" so she basically just uses the "a." And you know she is trying to say car when holding up the flashcard but if she were to say it without that clue, you wouldn't know what she was saying. It can be frustrating for her, and for us, that she can't communicate what she wants or needs. Even asking for more milk is difficult and usually results in her tugging at the fridge going "uh uh uh" rather than saying "more milk." So the inability to communicate does sometimes result in some tears for Bailey, though this could also just be toddler tears. Bailey CAN say milk, but it comes out sounding the same as mom, moo, and pretty much any m word since she drops the end consonants. Again, without context clues (her standing next to the refrigerator is a safe bet she's asking for milk) you don't really know what she's saying.

What makes it so difficult for Bailey is that her receptive language scores extremely high. She understand everything, she just can't communicate it.

So we are working on getting her to use two word phrases and expand her vocabulary. My Google adventures have pointed me to a lot of theories:
1. She is totally fine and all kids develop at their own pace.
2. As a twin and preemie, it's not super unusual to be behind. She tends to let Brooklyn (who speaks clearer) talk for her.
3. She is a smart kid and picks up that people have trouble understanding her. This makes her try less and use gestures instead to indicate what she wants.
4. Allergies. Bailey had a lot of ear infections last year and has always been a mouth breather. She seems constantly stuffed up. Could allergies be impacting her speech? Could she have fluid trapped in her ears? (We had her hearing tested about six months ago and she did pass that). Based on my Googling, yes, this could be possible. Will discuss this with the doctor and possibly follow up with a pediatric ENT.
5. She just has a speech delay and will catch up with early intervention.

The Help Me Grow program ends at age 3. Both Brooklyn and Bailey have an appointment with our school distract for evaluation to see if they qualify for the preschool program (this would include speech services). My initial thought is that Bailey will qualify and Brooklyn will not. While they do have peer models in the program, it's fairly competitive and I think we missed the timeline on Brooklyn getting in. So that leaves me with the possibility of splitting them up. I don't love this idea. I know a lot of research says it's better to split twins. But that looks at elementary aged children, not a three year old. I think it would not be good for either of them. We'll cross that bridge when and if we get there though. I would hate to deny Bailey a spot in the preschool when it would probably help her tremendously. Things to think about later.

Toddler activities

With spring weather still coming and going, I'e been on the hunt for more activities to do with the older girls when we are trapped inside after work or on the weekends. Got a few ideas from Pinterest and hit up the dollar store to get supplies. Here's a few things we've been doing lately!

1.Matching colored popsicle sticks with colored paper. This kept the girls entertained for a long time. They would sort all the popsicle sticks onto the correct color, and do it again.


2. Gluing random shapes onto paper. Glue sticks have pretty minimal mess too. Added bonus: kept everything contained within this plastic container to make clean up easier.















3. Pipe cleaners. Sticking pipe cleaners into strainers is fun, if you are a toddler. Again, kept them entertained for a long time.




4. Colored puff balls. This was both a sorting and pouring activity. Also the baby loved trying to eat them.




























5. More fun with pipe cleaners. And also painting.
















6. This was a Pinterest idea. Looks simple right? Put the paint into a baggie and tape it over a white piece of paper. The writer claimed it would be days of messy-free fun (DAYS she claimed!) We made it about 15 minutes before they ripped the bags open and wanted real painting. Looked cool though, right?





















7. The rice table. We used to do this all the time at the daycare where I worked in college at the sensory table. It obviously gets messy but it's a cheap and easy activity that really does keep them interested for a long time. We left this out for a week or so and they kept coming back to it and really having fun. Side note: the baby tried really hard to shove fistfuls of uncooked rice into her mouth.

Wednesday, March 2, 2016

Morgan is 10 months! Takes a step

Morgan is now ten months old. She has take a couple one step journeys and is walking pretty well with the walker. She's also made it up the stairs on her own (with only a few slips while we follow behind).

Tuesday, March 1, 2016

Three kids under three with the stomach bug...

This pretty much sums it up:
So all three kids were throwing up and running temps (fairly high, Bailey hit 103.5). I missed three days of work. The baby literally puked IN MY MOUTH. If they weren't sleeping and puking in their sheets, they were puking on me. You know how sick little kids just want to be held? It was such a violent illness that when they did throw up they didn't even have time to react and it just went all over the both of us. But everyone survived and we are all healthy now. Not surprisingly, I got it over the weekend too. Overall, compared to last year at least, we had a lot less sickness this winter. Spring, go ahead and bring your better weather and relatively healthy atmosphere please.

I have no strategies or survival tips. Stomach flu will win every time.

Thursday, February 4, 2016

39 weeks in, 39 weeks out

In and out pics below!
Still have some to go...
Baby weight seems to come off faster with your first delivery