How do you know?

We were at the play place at the mall last night. The children were having an amazing time. Michael loved it when a 15 month old baby followed him around trying to give him hugs. Ava was inside a tent like structure with three other girls about her age and appeared to be having a great time. It was idyllic.

Then Ava exited the tent and was running towards us. I think she just wanted to tell us something. First she tripped over one structure. I saw it. She got right back up and continued towards us looking back over her shoulder at the offending structure. So, of course, she stumbled right across the next thing in her path.

She fell with her right arm twisted beneath her. I knew right away that I needed to go to her. This wasn't a wait and see if she shakes it off kind of situation. I was concerned about the arm and shoulder. She was crying and I scooped her up and cradled her in my lap. Often, if the injury is minor, she'll be off again after a short cuddle, but not this time.

She was crying that her hand hurt. In that moment it looked like the area on the top of her hand around the middle two knuckles was swelling up and red. Her fingers weren't moving and quivered a little. I can admit it. I panicked a little. I scooped her up and rushed her over to my husband. Meeting his eyes and giving him a significant look, I told him I thought her hand was -hurt-.

Now when we looked together, I could no longer detect anything that looked like redness or swelling. She was able to tolerate having her fingers wiggled and bent a little. When we asked her to get her shoes, she held one in each hand. I was starting to feel better and a little silly about overreacting.

But then, she didn't go back to playing. And she was favoring the hand. She wouldn't use it to play "high five." She was visibly scared when I tried to hold that hand instead of the other when leaving the mall. She was extremely careful when I unbuckled her from her carseat to take that arm out from the straps of the 5-point harness without bumping the hand at all.

I just wasn't sure what to think. Even with all that it didn't seem like an ER on a Friday night kind of situation. Give some ibuprofen, wait, and observe seemed to be the most prudent choice. I hate the uncertainty though. How do you know how serious something is?

The Weekly Review: Week 45

Ava this Week

Ava had a hidden talent that has recently become quite prominent. She is a born manipulator. She is impressively good. She has started having trouble falling asleep at night. She'll leave her room over and over and over. Sometimes this will go on for 90 minutes and the number of excursions will reach 8-10.

Now, I have a plan. The plan is to not interact with her at all. The plan is to simply pick her up, return her to her bed, tuck her in, and leave the room without even making eye contact.

Well, that sounds great in theory, but Ava knows how to derail that plan. For example, this is how the other night went...

Round 1: First she needed help going to the bathroom. And she actually produces when she's there. It doesn't seem right to just tell her to pee in her pullup.

Round 2: Then she wanted some treasured item she needs to sleep that has been forgotten somewhere in the house. She has about 8 things she cuddles in her bed so inevitably something has been forgotten. She knows how to play it too. Her eyes are wide, her voice trembles, she asks so nicely. I feel like such a grinch not responding to her when all it takes to be responsive it to walk three feet into the next room, pick up the requested item, and hand it to her.

Round 3: Then she'll hear a scary noise. And this time there are some tears and an actual quiver in the voice.

Round 4: Her tag reader pen (which she carries everywhere listening to stories) runs out of batteries.

Round 5 Her tummy hurts. She acts pitiful when delivering this line. Somehow, "I don't care, go to sleep sweetheart" doesn't seem like the appropriate parental response.

and so on...

I am so hoping that this is a brief stage in her development.

The Weekly Michael

The issues with Michael are already becoming more complex. How am I supposed to respond to the following:

"What does stupid mean mama?" (Where did he even hear that word? I certainly don't use it. Must be school.)

"Boys don't like pretty things mama." (I was speechless. I stammered something about Daddy and Grandpa certainly liking pretty things.)

I'm sure this is just a tip of the "big kid issues" iceberg and I don't much like it.

Weekly Home Therapy Focus

We are still working on /s/, /sh/, /f/, /l/, and /k/. /k/ continues to be remarkably stubborn. In fact, it has been worse this week than it was a few weeks ago. /sh/ and /s/ are moderate. /f/ and /l/ are coming along nicely. We're doing those sounds in sets of three (light, light, light) and in pairs where I put out two cards and the same time and she'll say each word with an and in between (light and lamb). We also are practicing those sounds in short 2-3 syllable phrases.

Weekly Song

Sung to the tune of Oh Where, Oh Where Has My Little Dog Gone.

Oh where, oh where did the pm nap go?
Oh where, oh where could it be?
I took care of it and I loved it so,
How could it abandon me?

(It isn't completely gone, but it is going. I'm wondering if Ava's night-time sleep issues might actually be because she doesn't need her nap any more.)

Our Last IFSP Meeting

Our last IFSP meeting was held yesterday morning. To be honest, it was mostly a formality. It was due by January 29th and therefore we had to have a meeting even though Ava will age out of the program in five weeks.

I filled out a few forms about the progress Ava's made and the concerns I still have ahead of time. Our case manager emailed them to me so that we could have a head start at the meeting. We went over the forms and she took our new insurance information (some insurance will reimburse Missouri First Steps for part of their expenses). We agreed to leave Ava's services the same for the next 5 weeks.

I worried and worried and planned and planned before the first IFSP meeting to ultimately feel relieved that it seemed so easy. Then I repeated that experience before the second IFSP meeting. This one just felt a little token.

My focus is moving forward to the transition from early intervention services to school age services. We've qualified and our first IEP has been written. Now we just wait for Ava's birthday to switch. We'll appreciate the last few sessions of OT in our home and our last few sessions of speech with our wonderful early intervention therapists. Then we'll start all over again.