An early childhood educator's response to stress.

In my forum here today, I take a break from telling the stories of my own life, and address in a more general way various issues that have to do with early childhood. This is something I wrote for a class I took on building self-esteem in young children. It is written from the perspective of an early childhood educator, and is a discussion of the warning signs of stress in children and what teachers or caregivers can do to respond to a child's stress.

Many things cause stress in life. As adults, work, relationships, money, and the time crunches we all experience can cause stress. In my own life, some of the things that help relieve stress are getting out in nature, walking or biking, playing with my kids (unless they are the ones causing my stress!), getting involved in a hobby (mine’s scrapbooking), reading a good book, or calling a friend.

Many kinds of things, large and small, can cause stress in a child’s life. Stress can be caused by death or serious illness in the family, divorce or custody changes, moving (across town or around the world), getting a new sibling, family money troubles, parents arguing a lot, being bullied, learning a new language, having a learning disability or developmental delay, being abused (mentally, physically, sexually), witnessing abuse of another, not having the “right” clothes, being excluded, feeling shy, not knowing new routines, a parent leaving for a business trip, toilet training, a friend moving away, or many other reasons. A child experiencing stress may become withdrawn, act aggressive, seem depressed, have toilet accidents (when previously able to stay dry), regress to babyish behavior, be unusually clingy or whiny, cry more easily than usual, act overly silly, be quick to anger or take offense, be unable to sit still, or want to hide. It seems to me that any uncharacteristic behavior may be a sign of stress (a quiet child who suddenly gets loud, or a loud child who suddenly acts very quiet, for example).

Appropriate ways of helping a child experiencing stress would depend on the nature and severity of the stress, and on the personality of the child. Showing caring and empathy would be a beginning. Listening to the child and really letting the child feel heard and cared about is important. Books can help introduce uncomfortable subjects, and let a child know that s/he is not the only one to experience a particular situation. Dramatic play can be a “safe” way to explore feelings—playing a character, or having a puppet speak, may allow children to say things they are uncomfortable expressing as themselves. In some cases, a child may be experiencing a level of stress that warrants professional help, and in those cases, the family may need to be referred to the appropriate agency or professional (using the utmost confidentiality and tact, of course). In some cases art may help express difficult feelings, and other children may need active outdoor play to “blow off steam” when they are feeling stress. Some children may need extra hugs and nurturing, or to be given a classroom job to feel important and needed. Structure and routine may be very comforting to a child experiencing upheaval in their home life. In short, the response must be tailored to the child. We may not always even know what is causing the stress, but we can provide a safe haven in the classroom where they can experience a brief respite.

And still more of Beanie's history...

So, Beanie started with physical therapy and early intervention services. As he got older and began talking, it became clear that he had difficulty with speech and language, so we added speech therapy (and there is a shortage of qualified speech therapists, at least in our area, so it took while to get him set up with a speech therapist). After an occupational therapy evaluation, it was recommended that we add some OT, as well.

Some people wonder what on earth they do in speech therapy and occupational therapy for toddlers. The answer is...play! In fact, that's what they do in all therapy for toddlers, because they have no motivation to do any of the exercises if it doesn't seem like play. OT basically works on fine motor skills and sensory development (PT covers most of the gross motor skills). Speech therapy works on oral-motor skills through blowing bubbles, making kissing noises, exercising the tongue by licking the sides of the mouth, top lip, and sticking out the tongue, and all kinds of silly activities like that. Beanie thought it was great fun!

More of Beanie's story

Okay, so here another installment of Beanie's past history...I'll get up to current events soon, I promise. Anyhow, Beanie had a scan (MRI) of his brain to see it there were any structural problems causing his poor weight gain and low muscle tone in his neck and torso. The MRI came back inconclusive. So, back to Dr. Doom we went, to hear what she had to say, which was...not much. She suggested we have him evaluated by the local Regional Center (http://www.dds.ca.gov/RC/RCSvs.cfm) for possible early intervention services. [from the Regional Centers' Early Start Program page: "Families whose infants or toddlers have or are at risk for developmental delay or disability can receive an "Early Start" in the State of California. Teams of service coordinators, healthcare providers, early intervention specialists, therapists, and parent resource specialists can evaluate and assess an infant or toddler and provide appropriate early intervention services to children eligible for California's Early Intervention system of services."]

She explained that, if they approved him for services like physical therapy, it would be at no charge to me, and since it certainly would not do him any harm, and might be very beneficial to him, why not take it? That seemed reasonable and non-invasive, so I set up an interview.

He was assessed by a developmental specialist, and initially approved for home-based Early Intervention and Physical Therapy services. Shortly thereafter, we set up appointments with an early intervention specialist and a physical therapist, both of whom would come to our home once a week (separately) and work with Beanie.

The PT would do things like have him lie on his tummy on an inflatable ball and work with a toy set about head-high on a box, so that he had to lift up his head and shoulders to play (thus strengthening his neck and upper back). The EI person (the delightful Karla, who would be with us for well over a year and become a family friend) worked with him on a variety of tasks exploring sensory, fine-motor, gross-motor and cognitive skills, such as having him reach into a bag to feel different textures, or pulling on a ribbon to get a toy, or trying to grab a toy held out to him, all the while narrating her actions to develop language skills. Both the therapists would offer suggestions for things to do with him in between visits, to aid in developing his weak areas. It felt good to finally be working on treating his deficits, even though we still had no specific diagnosis. So on our journey went...

News of the day

Taking a break this time from telling Beanie's past history to write about some current events.... As I said in my introduction, I have two boys, Beanie and his older brother, who is 7 and in 2nd grade. Big bro's nickname as a baby was "Pickle" but somehow that seems too baby-ish for him now. I think now I will call him Monkeyboy, for his love of climbing anything, anywhere.

Anyway, last week Monkeyboy had an animal report to complete, along with a model of the animal's habitat, for the school science fair. He chose to write about eagles. He was very intimidated by the size of the project (8 pages!) and didn't want to do it, but with some coaching by me, he was able to break it down into small steps and tackle it. He ended up saying it was really fun and interesting, and he did a good job. Now, Mamallama (that's me) used to build props and even do museum exhibits, so it took all my willpower not to simply take over the habitat building part and do it for him (must resist urge ...but I LOVE building models...no, must resist...must resist...). In the end, he did it himself, with only minimal technical assistance from me (e.g. he wanted the eagle--a plastic toy figure--to look like it was flying, so I used fishing line to suspend it from the top of the box and anchor it to the bottom, but since I was only implementing his idea, it seemed okay for me to do it). I also helped to make the tree trunk he sculpted out of brown Playdoh sturdier by adding some support and bracing. But I always wrestle a little with how much assistance to give, and how much to let him struggle to find a way to do it himself. I have definitely seen school projects where you could tell there was heavy parental involvement.

Tonight we will go to school to see all the projects from all the grades at the Science Fair.

In addition, he was required to give his report orally to another class. This was a MAJOR source of stress for him. He was so scared to stand up in front of a class of children he didn't know well. But yesterday he gave his report to a classroom of 3rd graders, and the teacher told him it was good enough to have been done by a 3rd grader! He was so proud he could hardly contain himself. So I am one proud Mamallama today!

More tomorrow...stay tuned!

The Beanie story goes on...

The nurses told me to return in about an hour, so I went off to the hospital cafeteria (making sure the had my cell number so they could call me if they needed me) and had a bagel and coffee. I tried to read the newspaper, with moderate success. Eventually I headed back to the MRI suite. After a bit, they brought Beanie out. If you've ever seen the cribs they put babies in in the hospital (ones who are too big for a bassinet), they look like large metal cages on wheels. He was wrapped up in a white blanket, amid the white sheets with only his face showing...at first I couldn't even see he was in there. He was groggy from the anesthesia, but fine overall. When he woke up enough to nurse, I fed him.

After the docs had checked him over and were satisfied that he hadn't suffered any ill effects from the sedation and the procedure, we were discharged and our long ordeal was over. Two weeks later we got the results..."inconclusive". Arrgh! We went through all that for "inconclusive"?? They said there were no obvious brain abnormalities, which was good, but there were some atypical patterns of myelination...which might indicate a problem, or might not. I was frustrated, to say the least, that is was not a more definitive clean bill of health, after all we had put him through. As with all his other tests, we didn't learn much.

[Myelination explained here: http://www.urmc.rochester.edu/smd/Rad/neuroanatomy/nl_myelination.htm & http://en.wikipedia.org/wiki/Myelination]

He showed no long term effects from it, but I still felt bad about it. When Dr. C suggested we repeat the test at age 2 to compare, I was skeptical. In fact, she saw him every six months until we moved away from LA and never brought up MRI testing again, so we skipped it (at this writing he is nearly 3, and doing very well, so we have not, thankfully, had another MRI for him).

Beanie's story, continued... So we went off to the pediatric neurologist to try to figure out what was keeping baby Beanie for gaining enough weight. He was about 3 months old. Dr. C checked him over, ordered a few tests, and reviewed his chart. She noted that his head circumference was normal at birth, but had failed to keep growing as expected. His weight was in the 2nd percentile for his age (meaning 98 % of boys his age weighted more than he did), and so was his head circ. His height was around 40th percentile, which was okay. The head circumference might mean he just had a naturally small head, which is not a problem, or it could be that his brain had simply stopped growing, she explained matter-of-factly. Okay, not what mommy wants to hear about her precious boy. If he had simply stopped developing, there would be nothing we could do except make him comfortable and wait (for him to die, was the clear unspoken end of that sentence). She explained this in the same tones you might use to tell someone their child had a slight overbite, but would probably grow out of it...as if is were nothing terribly worrisome, just an interesting case.


I went out to my car with Beanie and held him on my lap and just wept. I cried until I had no more tears. Then a song came into my head..."I don't know much, but I know I love you, and that may be all I need to know." And I sang these words softly to him as he nursed there in the car, and told him I loved him, and hoped he would be okay.


A mom friend of mine who is also a doctor once remarked, "the LAST thing you want your child to be to a doctor is an 'interesting case'!" She had also had taken her child to Dr. C, because her daughter had her head pulled to one side as an infant. Dr. C told her that, among other possibilities, it could be that her daughter's brain was atrophying on one side. "Oh, Dr. C?" she told me, "we call her 'Dr. Doom'!!" Her daughter turned out to be fine, suffering from nothing more serious than tight neck muscles, and that made me feel better.


Anyway, nothing conclusive was revealed in any of the tests Dr. C ran, so she suggested an MRI of his brain, to look for any abnormalities. So we scheduled one at UCLA hospital. It took multiple phone calls to get it approved by my insurance and then scheduled. Now, UCLA has two hospital campuses. The main one is on the UCLA campus in Westwood, and the other is UCLA-Santa Monica, which is a smaller hospital in Santa Monica that UCLA took over a few years ago. When Beanie was hospitalized at 2 weeks old for breathing problems, is was at UCLA-Santa Monica. So I got myself scheduled for the test at UCLA-SM, or so I thought.



The instructions for preparing for the test included no food for 12 hours before--this is NOT fun for a 4-month-old (which was his age by the time of the test), who normally eats every few hours during the day. Since one has to be perfectly still for the test to work, babies have to be sedated ("asleep" under anesthesia) during the test, and fasting is the normal protocol for this.



Beanie was breastfed, but I was also supplementing him with formula to try to put on weight. He had never had anything else at this point, but the nurses said he could have clear juice up until 4 hours before the test, so I got some white grape juice to give him, just so the poor baby could have a little sustenance during the night. His test was scheduled for 8 in the morning, so we stopped all food except juice after 8 pm the night before. After a not too restful night with a cranky, hungry baby (not even juice past 4 am), we set off for the hospital in Santa Monica. After some confusion (the first information desk clerk sent us to the wrong floor), we finally found the MRI center...only to find they had no record of our appointment. Beanie was screaming (he was hungry, poor little guy), and no one seemed to know what to do with us. A supervisor was consulted, and she thought perhaps we were at the wrong hospital. She explained that most pediatric sedation MRI's were done at the main UCLA hospital campus in Westwood. Through all of the scheduling, I had always thought we were talking about UCLA-SM, since that's where I had been referred by my insurance, that's what my authorization paperwork said, and that's what I had asked for when i fist made the appointment. BUT somehow, I had, in fact been scheduled for UCLA-Westwood, as we determined after a few crazy phone calls (a screaming baby made it hard to hear, too). So now I was in Santa Monica, while my scheduled appointment time came and went in Westwood. Westwood told me to come over as soon as possible and they would work me in.

Now, if you know LA westside traffic, you know that getting from Santa Monica to the UCLA campus, though not far in miles, is a long way in traffic, but off we went. Beanie was NOT amused by being loaded back into the car seat, with still no food. I drove to UCLA, navigated the parking labyrinth, picked up the baby in the carrier seat, and hiked off to the MRI suite (a long walk from the parking lot, I can tell you that much).

Since we were about an hour late for our appointment time, they had taken another patient ahead of us, and we had to wait. So I paced the small waiting room with my screaming child, now nearly apoplectic with anger and hunger. I'm sure he could not figure out why his beloved breastmilk was not being offered. He must have felt frustrated beyond belief..."I am telling you people the only way I know how that I AM HUNGRY; why won't you feed me already???" All told we waited almost an hour for him to be called in, as I tried every non-food form of comfort I could think of (hugs, singing, bouncing, rocking). Other adult patients waiting felt so sorry for him--THEY wouldn't like having to fast for 12 hours, and they couldn't imagine what it was like for a baby. By now it was going on 14 hours with out any food for my poor little guy.

Finally they called his name, and we followed a nurse back to the ante-room outside the MRI chamber. There they inserted and IV line into his leg to administer the sedation, which did nothing to improve his mood, believe me.
Then they make you sign a waiver stating that you understand the risk of anesthesia (which include, "death", of course). I signed, but it didn't sit easily with me. Unfortunately, they had to take him into the room and get him in place before sedating him, and I was not allowed to come along, so now, on top of my (to his point of view) betrayal by suddenly deciding not to feed him, I was handing him over to strangers who had already caused him pain (the IV line), and who would take him into a cold, sterile room with a big, scary machine, and away from Mommy. I felt heartless.

[To be continued...]

Special needs frustration

Hi, again. As I posted before, my toddler has some special needs. Those of you who have been down this path know how complex it is just to figure out what is wrong, and then what to do about it. My toddler was nicknamed Jellybean (hence the name of this blog) while in utero, which evolved into Beanie, Beanie Baby, Beanie Boy, and other variations on this theme. So, for the purposes of this blog (and guarding my family's privacy), I will call him Beanie here.

Anyway...so when Beanie was born, he was apparently fine, but at two weeks old he had an episode of difficulty breathing, slow heart-rate and low body temp. He was hospitalized while they tested him for everything they could think of. All the tests came back negative, normal or inconclusive. He got better, and they sent him home with an apnea monitor (a device that sense breathing stoppages and sounds a shrieking alarm). These are reassuring in one sense--since they won't stop breathing without you knowing about it. But they are also prone to numerous false alarms at all hours of the day and night, causing terror at first, and then annoyance once you get used to it. I had kind of a love/hate relationship with the monitor (only without much of the love).

Following this episode, he had no further breathing problems, but did have real trouble gaining enough weight. The guidelines for healthy weight gain in infants is one half ounce to one ounce per day. (Imagine is adults gained a pound every 16 days!) Some weeks Beanie would gain only an ounce in a week. I fed him and fed him, but he was not interested in eating much, and also was very sleepy and would nod off before finishing a meal. I was frantic to get some weight on him (nurses used phrases like "failure to thrive" that made me feel like a horrible mother, and made me afraid for him).

Initially, his pediatrician was not concerned, even though I was very worried, and my lactation consultant was, as well. At his well-baby visits, the doc would brush off my concerns about his weight. Eventually, though, the doc became very worried, and suddenly it was treated as an emergency (with the implication of why hadn't I brought this to his attention sooner?). We were referred to a pediatric neurologist (which surprised me--I would have thought maybe a gastro-enterologist or something), whom we eventually referred to as "Dr. Doom".

Tomorrow--the saga continues--what did Dr. Doom say?

Jellybe-ginnings

So this is my new blog, called Jellybean Journal, which is my place to write about parenting issues and other stuff. I am: a married mom of two boys, 40-something, college-degreed in Drama (emphasis in set design and theater technology), certified in Early Childhood Education, living in southern California. My boys are 2-almost-3 and 7.

My little guy has some developmental issues, like delays in speech and fine motor skills. So, my goals for this spring are to work with him more on his exercises (gross motor and oral/language development) and to be more fit and healthy. That last one involves the whole family, as I am on a quest to introduce more veggies, lean protein and whole grains into family meals.

Here I will share thoughts on my life and child development and parenting.