The Texture Of Things

Notes on Therapy, Week #2

January 19th, 2011

In-home therapy is complicated in some ways. Like, you have to open yourself up, not just the emotions you are working on, but, um, your whole house. Yes, that includes all the dirty dishes you left on the table. And by “you”, I mean “me”, and by “dirty dishes on the table”, I mean “the mess throughout the entire house”.

Let’s just say that one good thing about starting up with S again is that she is familiar, a good friend, so I’m less worried about my house than I would be if our therapist were a stranger. And, frankly, I’m more concerned with getting to the bottom of things that if it so happens that S sees a pattern in our home that reveals a clue, then all the faster we go toward our goal. (Though, I feel kind of cring-y and twitchy thinking about how painful some of the work we are going to have to do will be. Stuff like refocusing meal times or rules or that sort of thing. Oy.)

Anyway, S came right after the tot got of the bus. The tot CHOWED a snack. She must have been starving. But, you know, as I think about it, the issue of familiarity comes up again. If it weren’t S, I wonder if she’d have eaten like that. I think not, because when there are people here, she generally doesn’t eat well. I wonder if she’s comfortable eating with S in a way that she isn’t with other, non-family people. I will mention this to S when I email her later.

During snack and after play, S and I chatted. More background stuff, details, and strategizing about how to put together the necessary releases for her to go observe the tot’s classroom someday. Then they went into the tot’s room to play with the baby dolls. The most salient thing that came out of the play was the tot’s reaction to S making one of the babies be scared of something. The tot called off the game temporarily and said, “All of my dolls are BRAVE.” So, she’s not ready to let down her guard and be scared with S, but it’s early, and that will come with time.

On the topic of procuring OT, let’s just say that I’ve called the two best contenders, and the wait lists are loooooooong. The place we went to before told me that because it’s been so long since we were patients there (2 years), we would be treated like new patients, and that means going to the end of a very long waiting line for after-school time slots — after all the current patients who are waiting for those times. The receptionist was not very warm, welcoming, or open to the idea of, say, putting me on that list. In our conversation, she created no openings for me to say, “Put me on the list.” I was brokenhearted to discover that the wait could be so long, but I called the other place, just in case.

The receptionist at The Other Place was warm and inviting from the get-go. She did admit that there can be quite a wait for those time slots (and their Saturday times), but she practically jostled me into giving her the info necessary for an OT to call me back with answers to my questions about approach, training, etc. The OT called me yesterday, and after hearing our story and talking through things like background, current therapy with S, and the tot’s school situation (lots of stress there!), she had the receptionist call back to schedule an in-person eval for this coming Saturday.

THIS SATURDAY!! OMG, WTF, BBQ!!!

Provided I can get all the necessary fuzzy little ducks in their fuzzy little row, naturally, and that includes a prescription from the pediatrician.

No problem! Except — problem…. The nurse at the ped’s office called back with a hundred questions and a solid undertone of cynicism. I guess the first time we got a script for OT two years ago, the ped didn’t put anything in the chart, and last summer at the tot’s physical (when we happened to see a different doc, purely due to schedule availability) nothing was put in her chart then either. Now, we didn’t talk at length at that last physical about it because things were generally fine, but I DID ask about caloric intake because I was worried about the tot getting enough to eat. The doc gave her a little speech about eating lots of vegetables so she’ll be “big and strong”. You know the one? The speech that all grown ups give all kids at some point to drive home the message of “healthy food might not be your thing, but you still have to suck it up and eat it”? That one. But there’s nothing in the chart, so the nurse has to talk to both docs before she can write the script for a doc to sign. She says she’ll get back to me on Friday about whether they will write the script.

W-T-F-Ever.

Bonus: Because of the rules with our new health insurance, I have to renew this prescription every 30 days. Let me tell you, I CAN HARDLY WAIT FOR THAT. Oy. Shoot me now.

Things to do/prepare for this week’s in-home therapy:
*work on OT paperwork
*get scary creature toys, like dinosaurs, sharks, etc.
*tidy the tot’s room

The Problem with OT

January 9th, 2011

The tot received play therapy through a local organization from just after she turned two until she aged out of the program at four. At that time, we transitioned to Occupational Therapy at a privately owned clinic.

I was sad to be leaving our in-home therapy (and S!), but I had hope that the change would trigger a leap forward, as we had been stalled a bit. When we had begun, the tot had so much anxiety that trying to work on food desensitization could only happen at home. Outside the home, she would simply shut down. But as the tot got older, she progressed and, I think, was actually held back by being at home. So, the clinic.

The hour-long sessions occurred on a weekly basis, and were broken down roughly as follows:
*about fifteen minutes doing gross motor play and motor planning
*about fifteen minutes doing pretend play
*a transition from the big gross motor play room to the small room, plus getting situated
*about 10 minutes doing oral motor play (whistles, bubbles, etc)
*whatever time was left rushing through the food items we had brought to focus on

This was problematic, and my criticism of it is tangled. On one hand, I understand that the tot has a motor planning delay. Yes, she needed to work on that, but that was a secondary concern for me. Additionally, I understand that the tot scores on the border of Sensory Processing Dysfunction (or whatever they’re calling it this month), so yes, she needed the gross motor play to help her regulate her sensory integration, but the amount of time we spent on it could have been shorter because, with coaching, I could have done it prior to the session.

My priority was food, from day one, but it was not K’s priority. So, each week, we spent too much time doing things that were useful, yet they used up the time I wanted to be spending on eating issues. This was complicated by the fact that K was impossible to communicate with. We routinely ran over time, so there was no time to talk about how to improve the session during the session, and only after a couple of months did she reluctantly give me her email so I could send some questions to her. Even then, I don’t think she checked her email every day because it would take many days before I’d get a reply, and when I did, it never fully addressed my concerns.

So, I bailed. I am not proud of this, but my aversion to confrontation got the better of me. I used the birth of Tater to try to reschedule as a way of getting to meet another therapist, but it didn’t work. My schedule didn’t line up, plus they were booked solid and acted like they preferred to simply put me with K on another day.

I completely felt like I was done. At home, HG was making progress with the tot eating, and it didn’t cost a 20% copay each week. On top of that, it was during this time that we discovered the tot’s tongue tie, and when I asked K to take a look and tell me what she thought of our choice to pursue surgery (eventually), she dismissed it. She said it was definitely tied, but the tot didn’t need surgery because she didn’t have a speech impediment. (Bonus: the ENT had *just* told us that some large percentage of kids with tongue ties do not actually have speech problems. I don’t recall the percentage, but I recall being STUNNED!)

Ugh. So, we went for a few more weeks, and then HG caught wind of some downsizing happening at his company, and I decided to temporarily cancel therapy and sock the money away as a way of battening down the financial hatches at home. I figured, at the time, that I could try to go back in a while and request another therapist, but following the tot’s surgery, we had so much success at home that it hardly seemed worth it.

We’ve had our ups and downs, but it wasn’t until this most recent big down that returning to therapy even crossed my mind. Now it seems pretty critical.

Please have a look at this

February 25th, 2009

I want you to see the thing that has kept me from blogging. No, it is not a picture of Tater. I’m not allowed to post those here. (Email me if you’d like to take issue with that.)

It is, however, a side effect of Tater. You see, Tater is always ALWAYS eating, thereby rendering me incapable of typing on my keyboard, so I’m left using this:

osk

It’s called the on-screen keyboard. This entire post was created with it. I “typed” it with no interruptions, and it took 15 minutes. No, I don’t have carpal tunnel yet. Yet.

Therapy in Small Doses

September 24th, 2008

Recently, I took a peek at the search phrases that have led people to this blog, and one stood out to me. It regarded a small child’s aversion to the texture of sand. When I read it, I remembered a picture I have on my phone of the tot, playing happily in the sand pit at our local park for the first time. I recall the surge of happiness – sheer glee – I had that she was sitting in the sand and was happy. It was the month she turned two, and I had all but given up hope that she’d ever tolerate this activity that – it seemed – every other child in the world enjoyed and every other parent in the world took for granted. Ah, the relaxing moments sitting on a bench in the shade while the children scoop and dump and shape and smear and dig in the cool sand at the park. Would I ever get to be that parent? I wondered.

Seeing the search phrase popped me back to that time and I realized that I’m not sure I’ve fully appreciated the 30 minutes I can now sit while the tot plays in her sand cart this summer. How did we get here?

Whereas many parents can simply plunk their kid down in the sand pit and watch as the child seeks more information about this new tactile sensation, we did not enjoy such instantaneous success. Sand was just not appealing to her. Too gritty, perhaps? Too wobbly under her feet? Too unpredictable? I mean, this stuff gets everywhere! When I’d take her to the park’s sand pit, until that day in late June, she did not want to walk on it, touch it, play in it, explore it. No no no, no no no bad.

So, looking back, I have some observations about what worked to get her past that early aversion to sand.

First, she had had some positive experiences with sand the summer before. (Before this, her only exposure to sand was at the park.) We were driving to a friend’s cabin in another state, and along the way we stopped at a state park beach. The tot walked in the sand with her daddy and eventually sat in the sand and pawed through it to examine the occasional tiny shell. What was different about that sand? Several things come to mind:

* the beach sand had a much smoother feel to it (i.e., it was less gritty), due probably to smaller overall size of the grains
* the beach sand had a fairly even consistency, in that it was sand and a few small shells, unlike the sand at the park, which has lots of rocks, twigs, leaves, etc., in it
* the temperature of the beach sand was warm, but not hot, unlike the sand at the park, which is cool (and the tot did not like cold)
* we all felt relief to be out of the car – it was a looonng drive – so we were craving different sensory input
* the beach population was less dense than the park is, so we could easily have our own space and ignore other patrons and focus solely on our own experience (and the tot did/does sometimes get overwhelmed by throngs of people)

What I take away from this is that to have success introducing a texture-averse kid to sand is to back up and see the whole scene. What else could be raising the child’s anxiety about the situation? If you can control or change that variable, will the child be more open to the texture?

Second, the day the tot sat in the sand pit and had fun, I had lowered my expectations. I didn’t expect her to play in the sand for more than a few seconds, so I let her keep her socks and shoes on, in spite of the general dread I had about getting the sand off of her when it came time to leave. How much sand could it really be if she was going to hit the sand and immediately bail? Not much, right?

Ha ha ha – WRONG. (Given the success, that’s all right.)

I’m sure it was more than just one thing that led to success, but I can’t discount the possibility that having her feet and some of her legs covered made a difference. Instead of having to manage the sensory input from hands, arms, legs and feet, she only needed to focus on tactile input from the skin on her hands and arms. (And as I think about it, judging from the picture, I’ll bet it was not breezy that day, so that was one less tactile input she needed to cope with.)

What I take away from this is a question I should ask myself more often: what coping mechanisms can we offer to help the child manage on her/his own? If the child becomes overwhelmed by too much of a tactile experience, how can we block some of it in order to prevent the child from shutting down completely? In this case, the solution was – in part – to cover more of the body. Fine. If the tot wants to keep her shoes on in the sand box, I can live with that if the outcome is she plays happily and has a healthy experience. And what I’ve discovered in the last two years is that if I grant her the choice to keep shoes on or take them off in the sand, she will take them off once she’s had a chance to relax and get into what she’s doing. The shoes help her cope at the beginning, and when she no longer needs the shield, she will set it aside. Nowadays, it doesn’t take very long to get to this point.

At occupational therapy, the OT uses a similar coping strategy to get the tot to eat frozen g0gurts. The tot does want to lick it and play with it, but she does not want to hold something that cold. The strategy: wrap a napkin around it. Same thing goes for foods like string cheese. When the OT first offered her string cheese, the tot wanted to join the OT in playing with it, but she didn’t want to hold it. Fine. The OT wrapped a napkin around it, and the tot was no longer troubled by the feel of the cheese. Since then, she will pick the cheese right up without the napkin. (Tasting it is an entirely other matter, however.)

One key thing to remember about exposing a child to a challenging thing in small doses might be that we cannot always control the physical size of the dose; rather, it might be making the dose seem more manageable, or smaller. Time is one such constraint we can (often) control in this way. As in, “Hey, here’s a sand pit. Check it out. Oooh, sand. Okay, you’re done? Fine, we’ll move on to the slides and visit the sand later.” I find if I allow the tot this much control, she will return to it in time, more open to the sensory experience. On the other hand, although the exposure doesn’t last long, the overall desensitization takes a while because the exposures must take place across time.

So, even though the beach was not a small place, by any stretch of the imagination, the dose (challenge) was smaller there for the tot than at the local sand pit because certain variables like texture consistency, temperature, and spatial pressure did not push the tot’s tolerance as far as the park experiences had.

In case a parent of a sand-averse child happens to find this, there are two other points not related to dose size that I want to mention here. The first is the importance of lowered expectations and the second is the importance of role models.

I can’t say for certain that the day I let go of my desire for the tot to like playing in sand played any part in her moving through her issues, but it certainly made it easier for me. And a more relaxed mommy makes for a happier family. At least, in this house I think that’s true. But to let go of that desire I had to accept – truly, deep down, accept – that it’s okay for her to not like a sandbox. In fact, I often have to remind myself that not everyone likes everything. Some stuff she’s just not going to enjoy. Okay. That’s fine. I admit that many of my expectations for her are based solely on cultural expectations – like, all kids like pizza, or all kids fingerpaint. You know what? When it comes to kids, there is no “all.”

As for role models, I cannot ignore the positive influence our next-door neighbor children have had on the tot, particularly in the area of sand play. They have a sandbox in their yard, and the kids in that family are not at all bothered by messes, sand in every crevice, or things mixed in with the sand. They have acted as ambassadors, in a way, demonstrating how kids deal with and enjoy sand, even what to do when playing in the sand just isn’t fun anymore.

Would role models alone have made the difference for the tot? No, I don’t think so, just as I find certain advice for parents of picky eaters incomplete. Hey – you might be able to put a new food in front of your children ten or twelve times and find your children will try it and, if the heavens are smiling on you, decide they like it, but that is not my kid. And when I tell you I do it and it’s not enough for my kid – she just needs more exposures and sometimes that doesn’t even matter – don’t smile, nod, and tell me it’ll happen because a kid won’t starve herself, because that is statistically untrue. There are some kids – about 4% – who will starve themselves, however inadvertently. [scroll down past bullet list.]

In the meantime, I’ll keep doing what I’m doing. Expose, expose, expose. When something is so hard that she shuts down, contain the challenge and help the tot manage and cope, then let her do it herself and on her own terms. And measure the successes we have with a smile.

Wheels

May 6th, 2008

This week, the tot has gone from not pedaling her trike to pedaling her trike everywhere. She has had this trike for over a year – what the hell happened this week that triggered the change?

In the beginning I thought she didn’t pedal because she didn’t get how it worked and/or her legs were too short to reach. In some ways that was true, but she grew and still she didn’t pedal.

A couple of weeks ago, HG chased us outside, put the tot on her trike (complete with parent handle bar), and we went for a walk around the neighborhood. The tot was clearly excited, so I blew off the fact that she cannot steer. She just does not get it, which surprised me since she knows left from right. Watching her that day, I thought the missing piece of that puzzle seemed to be hand-eye coordination.

The next week, I took her with me to a local camping and hiking store so that I could buy into the hysteria. We were just barely through the door when the tot saw the bicycles and insisted on riding one. I took her to a miniature bike (12″ wheel, with training wheels), and she climbed on. She desparately wanted to ride this bike, but she could barely get the pedals to turn. She simply didn’t have enough mass or strength to make it move, so I pushed her around the aisle, much to her delight. In that moment, I thought maybe the missing piece was not hand-eye, but power, and perhaps the struggle for forward motion interfered with her ability to steer.

BTW, she had her first in-store, public crying tantrum fit when I told her (for the fiftieth time, as we were leaving) that no, we were not taking the bike home with us, but maybe she’ll get one for her birthday. She really wanted that bike. She still reminds me of it any time we talk about bikes.

So then yesterday, actually, the day before yesterday, I took her for a short walk and on the way up the driveway, she started pedaling – really pedaling. What she figured out that day escapes me. Was it the coordination or simply the knowledge that she can do it – she can make her body do it?

Whatever it was, yesterday something clicked in both her head and body. We were at the Occupational Therapy Center for an evaluation (more on that in another post), and at the start of the session, she was encouraged to play in the indoor playground. One of the things they offer there is a path and a huge choice of wheeled things to ride on. The tot hopped on and tooled through the place like she’s been doing it for a year. First a strange two-footed pedaling device, then a trike, then a two-wheeler with training wheels. What’s more is she steered. Accurately. Without crashing.

WTF? Where is my daughter and what have you done with the pod?

We got home, and she started up on her trike like she’s preparing for a cross-county ride. The transformation is amazing and awesome, but weird.

I foresee a lot of outdoor time this summer, don’t you?

At the very least, this experience is a good reminder that whenever I get frustrated with the tot being stuck at a level of competence in something, or when I completely give up and say something like “So she’ll go to college in pull ups – I’m fine with that”, she bursts through it. Her pace is not my pace, and I need to remember that. She’ll get it, by and by.

Bursts of Progress

March 7th, 2008

Over the time we’ve been working with S., our Food Friend, we’ve worked gently toward several goals. The list has evolved, and some of the early goals fell off the list and some have stayed. For instance, one early goal that we retired was noodles because – sweet jeebus – what child doesn’t like pasta? Mine, it turns out. It’s too wet, too wobbly. It was too far-fetched a goal, so we put it on a back, back burner and turned toward some goals we thought were more achievable, like finger painting, self-feeding with utensils, and (target food) breads.

For most kids, time is an all-important ingredient in working through sensory issues, and this is true for the tot. Maybe it’s because the passage of time also brings with it a maturation of her body and brain. Maybe it’s because during this time, HG and I have altered our approaches to food and feeding the tot, as well as our reactions to her reactions. Maybe it’s because these past almost-two years have seen her exposed to so many textures and tactile sensory experiences that she is becoming desensitized – which is what we wanted. Probably it’s a combination of all of these things, and that’s fine, except when people ask me what’s working. (My stock answer, BTW, is “Hell if I know.”)

So here we are. Time has passed. Progress has happened. What I am constantly re-learning is that the tot’s predominant pattern is burst-lull, lull-lull-lull-burst-lull. It’s not just in therapy areas – she did this when she was learning to walk, too. She started to walk. She walked for a few days. Then she wasn’t interested in it anymore. Then a week later, I go in to her bedroom to see just exactly what all this supposed-to-be-naptime ruckus was, and it was the tot. She was staggering back and forth, the length of her crib, with the wildest grin ever. She was practicing in a controlled space.

Of course, you know the words that went through my mind after days of plying her to walk and meeting only resistance: “Why you little shit.” On the outside, I was all wild grins too.

So let’s talk about some bursts.

I’m not sure when it happened (I can say it happened slowly), but the tot is now kind of digging finger painting. She asks to paint almost every day now. I don’t let her, that’s me being Mean Mommy, but the point is that she wants to. And even when I provide brushes and sponges, she always asks to get paint on her hands to make hand prints. This is huge.

The therapeutic point of working on finger painting is for the tactile sensation and the desensitization to mess (for me and her, people) with the hopes that she would tolerate messier foods on her hands as well as art products. On the whole, it is working, particularly in the area of anxiety management. When she reaches tolerance capacity with either paint or wet something on her hand or fingers, she no longer immediately flips out. She uses words to ask me to wipe it off. I, by request of S., dilly dally and talk about gosh, what could we use to wipe it up? Oh, a napkin? Great idea! Now, where can we find one of those? And by this time, she is no longer worried about the paint/food/liquid. She still wants it gone, but she is coping by focusing on solving the problem rather than being overwhelmed by it.

I can’t say that there is any therapeutic reason for working on self-feeding with utensils. That seems to me to be pretty straightforward, so I’ll just share some of my thoughts, bullet-style.

*Honestly, I don’t care how she gets food to her mouth. Certainly she needs to know how to use a fork without putting an eye out (what on earth would you tell the ER doc? “Yes, Doctor, my 15-year-old is just learning to use a fork. What? That’s wrong?”), but when we’re home, I couldn’t care less. If she wants to scoop food up in her fingers and then smack her lips while she licks the mess off her fingers, well dammit, more power to her.
*She doesn’t really like to use utensils, but she almost always wants her own set. I think that is funny. Except when we’re at a restaurant and they only gave us two sets.
*It seems like she should be better at using them because her fine motor skill is pretty good, but really she’s pretty awful still. And the spilling of food off a fork or spoon pisses her off. More practice necessary, I guess.

Lastly, breads. Ah, breads. S. wanted to work toward breads since they presented a medium challenge. The bread group includes bread, toast, waffles, cake-type products, pancakes, breadsticks, etc. Bread is a challenge because it is soft and sometimes chewy. The challenge, S. and I agreed, was not so so great because bread is not (barring the application of another food product) wet, overly sloppy, or squishy (like noodles). Bread is an important target food because it is everywhere. I mean, what does a kid eat for lunch if they won’t touch sandwiches or pizza? And don’t say mac and cheese.

We tried a lot of things, again and again. We tried involving her in prep by playing with bread dough, making shapes, and baking it together. Even once she started touching the bread dough, it was still not enough investment for her to do more than pick up the baked bread and set it down without putting it to her mouth.

One thing that did get her manipulating pancakes, though, has been to make letters for her to play with. She’s into the alphabet and reading right now, and I’ve been using that to at least get her handling the soft pancakes. I don’t think she’s done more than put one to her lips, just to touch, but that is progress too, so we’ll count it.

Then, three or four weeks ago, on a single weekend, she dove headlong into the bread category. Boom. Burst.

That Sunday evening, I wrote an email to S.
“Here is what she ate this weekend:
puppy chow* – chowed the remaining with help of daddy
wheat toast (with butter) (at a restaurant)- three bites
blueberry muffin (gigantic) (at the same restaurant) – many many bites, with a fork
Lego eggo waffle – at least two bites the first time; one or two again last night
Mickey Mouse cheese shape – put teeth marks in the first time; took one small bite, chewed it, swallowed it last night
banana nut muffins (mini muffins from grocery bakery) – she’s had three now: the first she shied away from, the second she picked at, the third (today) she ate the top off of
chocolate no-bake cookies (from grocery bakery) – she really wanted them and managed to push through the texture factor to eat them
oatmeal raisin cookies (soft, from grocery bakery) – she took 1/2 of [HG’s] and wouldn’t give it back
burger king nuggets and fries (slightly more bendy than McD’s) – she’s working on these right now”

(Normally, I don’t send a record of what she eats to S., but holy cow – what a burst! I had to share.)

Since then, well, she’s picked at some toast, eating a bite or two at most. She has picked at a muffin again, but she’s also pushed many away. No more cheese, and we haven’t had the cookies or the puppy chow in the house again since.

It’s hard to know where to go from here. Well, that’s not true. I know that I need to keep presenting her with these foods so that they become familiar, and she’ll start eating them again. But. We’re in the lull phase now, and that is so frustrating. I think that I am like most parents in that I hate to waste food, and that is exactly what happens in the lull phase. The food goes in the trash. But there’s no guaranteed timetable for when the next burst comes, and I sure don’t want to miss it.

*Puppy Chow – we had made it a couple of days before for the first time. She didn’t want it at first, but then… and she’s asked for it twice since then.
Here is the version we made:
1 stick butter
12 oz. jar peanut butter
12 oz. pkg. butterscotch chips
melt these three things together in microwave

stir in large box rice chex
mix well
put in a large paper grocery bag with 1 lb. of powdered sugar and shake well
eat, eat, eat.

Victory! Is! Mine!

January 29th, 2008

We’re still sick, but well enough to head to the grocery store for some much needed provisions (read: Reese’s Peanut Butter Hearts), so we did just that.

We came home, had dinner, and then it was time for The Bath. (The tot LOVES baths, and I have come to dread them because she’d stay in there all day and night if I let her.) As she was getting undressed, I pulled out a Heart and began unwrapping it.

“Can I have that?”

“This?”

“That. Can I have that?”

“Ooookaaay. It’s chocolate on the outside and peanut butter on the inside. Here – touch it.” I held it out, expecting a one or two finger touch.

She grabbed it, turned it all around, and scratched the back.

“Oooh! It’s scratchy!” (Adjectives, so problematically all the time.)

She handed it back and I took a small bite. I held it up for her to look at the peanut butter.

“See? Peanut butter.” We’ve been having a lot of peanut butter lately, hoping to – I don’t know – get her to eat it eventually. :sigh:

She nabbed it from my hand and took a bite. Part fell out of her mouth and she handed the candy back to me.

“You got some! Did you get a bite in your mouth?” Glee or incredulity, I’m not sure which I felt more of. Of which I felt more? Whatever. Happy Happy Joy Joy.

She swallowed. (Miracle of miracles, this alone.) “Uh huh!”

I held the point of the heart up. “You could bite this part now, if you want.”

Again she grabbed it and ate the heart point.

I could tell from the look on her face both times that the mooshy texture in her mouth was not exactly great, but man oh man, she held it together and ate it.

This is so awesome. Now, if we could just get her to eat bread.

Advances in Texture: Air

December 5th, 2007

Before I had a kid, I thought all children liked to be naked, possibly all the time naked. The tot surprised me in this regard. Shocker, I know.

First off, she has always been a child who does not like to be cold. Ever. So I always kept her clothed except at changing times and bath times and I bundled her throughout her first fall and winter. When the weather started to break the following spring, I put her in one of the seven hundred and three cute outfits that she finally fit into and took her outside. She hated it.

Hated. It.

sitting2.JPG

what i remember of this day is that it was my first mother’s day.* i set her in the grass and she was mildly distressed. she kept lifting her legs simultaneously in order to get the bare parts out of the grass. she looked like she was trying to levitate. lifting her legs messed with her balance, which made her put her hands down, which distressed her. i distracted her with the stick. i was not actually poking her with it.

sitting.JPG

What I didn’t know at the time is that someone who is tactile defensive has to get accustomed to every sensation, including that of air on bare skin. Imagine, if you will, the feeling of the first time you wear shorts outside after a long spell of pants or of staying inside. Clothing is protective because it dulls the feeling of everything against your skin and it’s a very predicable sensation, particularly if the clothing item is familiar.

As I understand it, our skin processes 4 kinds of information: warm, cold, pressure, pain. Our touch nerve endings don’t actually register hot as an individual input. The sensation “hot” is made up of warm and cold triggering together, which is why something really cold can almost feel like it’s burning you and something extremely hot has the same piercing feeling of ice cold. Add to that the fact that light touch runs along the same pathways as pain and what you get in the person hypersensitive to touch is someone for whom air-rustling-through-leg/arm-hair is processed as a painful sensation.**

I live with a pretty good example of light-touch = pain sensory experience. Say I have a small itch, like a wonky tag in my shirt. I have to be careful to either scratch it very lightly with my fingernails (so lightly as to almost tickle) or to rub it with a medium deep pressure touch; when I do not – when I scratch it like I see other people scratch a random itch – the relief of having scratched is followed immediately by the pain of a charley horse.

I have lived with this my whole life. I have, for the most part, quit sharing this experience with others because everyone has always reacted to this like I am probably a leper. I’m not. But, it’s not something that anyone is ever going to cure in pill form and I do not expect I will ever “outgrow it,” so I learn to cope by listening to and respecting my body’s feedback. Scratching lightly or rubbing with pressure can be considered a Compensatory Strategy – a strategy one develops in order to cope with an immediate problem. Another Compensatory Strategy could be removing the tag. The long term solution is Desensitization. That’s it. There is nothing else one can do to address tactile hypersensitivity but those two approaches.

The qualities of sensation the tot feels are beyond her ability to articulate and beyond my ability to detect. The pattern I see, however, is made up of: a preference for long sleeves and pants for the first few weeks (or more) of the warm seasons, even when it’s really too warm for that much clothing; a need for clothing to be “just so” (e.g., any coat or sweater must always be fastened all the way to the top) (this is pretty mild for the tot – some kids can’t tolerate a single wrinkle or twist in fabric); a brief panic when clothing is going over her head; whiny, whiny, whiny whining when the car windows are down or the breeze picks up while we’re outside; a dislike of being barefoot, mostly just when outside these days; and so on. I’m sure I’m forgetting some as I write this.

So, a year ago it was a big damned deal that one afternoon she took to running through a small pile of leaves I raked up. When the wind picked up and started blowing leaves around, we had to go in. Leaves okay, breeze maybe, breeze plus unpredictable leaves intolerable.

This past summer it was a big damned deal that I could put the windows down while we were driving, moreover that her curiosity about her own body has finally caught up and starting some time in late summer, she now wants to be naked, like, daily. I let her as much as possible, and as the cold has sidled in to Michigan (read: pounded us with brutal winds and unseasonably cold temps), she’s transitioned from naked to pantsless (pronounced: “pants-a-less”). This means she’ll deign to wear a shirt. For a while. Until she’s freezing cold, at which point she’ll need a turtleneck, a sweatshirt, pants, socks, a blanket, and snuggling.

There have been so many changes lately and in the last six months that I begin to wonder what the big deal ever was, before I started this blog. Maybe I’ve just replaced my expectations of what is normal with how things are. That’s fine. It’s going to be a long time until she eats like a typical kid, if she ever does, and I realize now that what will be a more lasting contribution to her life than a line in baby book that she ate broccoli at age ___*** is a healthy self-esteem and confidence that she is loved no matter what, that there will be things she’ll be good at, that there are always struggles to surmount, but those are the accomplishments that make life worth living.

This epiphany subject to clear by nightfall.

.

*For the baby-book record, in this picture she was eleven months old, cut her first tooth that day, was anemic but improving with treatment, was not crawling (never did), would not walk for about 6 more weeks. she weighed probably around 15 pounds and the outfit she is wearing is size 3-6 months. What a total peanut.

**Tickle runs on the same pathways as pain, which explains (for me, anyway) why a ticklish person recoils from a tickle as if it were pain.

***Sha. In our dreams. If that number ends up being a single digit, I will pass out in shock right where I stand.

A Letter to S., Our Food Friend

December 2nd, 2007

Dear S.,

Last week’s cupcake experiment went about as well as I could have hoped. The ice cream cone seemed to do the trick. It provided a dry, smooth handle for the tot to grasp, making the prospect of bringing something potentially messy to her face easier to tolerate.

That, actually, was not that great a hurdle to cross. We have known of her desire to eat cupcakes for the last, what? 8 or 9 months now? We know that she in fact licked frosting off of them on two occasions at day care, but we were never able to repeat that success. Until last Tuesday. Perhaps the combined threat of cone-as-handle plus keeping the cupcake low in the cup, with the frosting just cresting the top of the cone the key to our success.

So I am writing this today because I want to tell you about the birthday party the tot and I went to on Friday night. It was, in a word, chaos. It was, in more words, not a recipe for success. The tot had fallen asleep on the way home from my work, and she slept through getting out and back into the car again to go to the party. And I don’t need to tell you how slow she is to warm up when she’s just woken up. Add to that the facts that the kids at the party are W.I.L.D., that the only food there was pizza (ha! – thank goodness I packed a Pedi@sure), and that although she’s met these kids before she has never liked to play with most of them, nor had she been to their house.

As you can imagine, I was floored when she happily picked at the piece of birthday cake she was served. It was an inside piece, with dark, dark chocolate crumbs dragged through the cut edges of the white frosting. Yet she never wavered. It was sitting in a puddle of cookies and cream ice cream, wet and foreign, yet she never wavered. She reached into the frosting and picked up the tiny shards of purple and pink sugar sprinkles, eating them and the smudges of frosting they came up with. She licked her fingers and stuck them in for more. She held up a fingerfull of frosting and crumbs at one point, as if to say to me, “What’s up with this?” I said, “Yum! That’s the good part. Gotta lick it off.” And she did.

The tot is turning 3.5 this week, and I have new hope for next summer’s birthday party. Yes, I admit it might be a bit foolish to have my hopes up already, but it’s kind of fun to daydream that this next birthday might be the one when my daughter – my only child – eats some of her own birthday cake for the first time. What fun it will be! I hope she loves it like a kid should.

So thanks, S. We are getting somewhere, and it is fantastic.

And Then She Was Three

July 17th, 2007

On Monday, our Food Friend came for our weekly visit and we had homemade apple juice popsicles. Tot had never seen nor touched nor tasted a popsicle before, and I was dubious because she is not real keen on the extreme temperatures. In fact, she has been known to freak out when presented with an ice cube to play with.

But, apparently Three is the first age of shocking one’s mother (followed in time by every other age, I suppose) because she licked the popsicle for some time, worrying over drips and melting-ness, but recovering nicely from those worries and licking said popsicle some more.

A popsicle. I cannot even believe it.

Then we did some finger painting, at the tot’s request (Wah?!), and then we had a second snack: sugar cones. We did not put anything in them – we treated the ice cream cones as a food. And it’s a lovely, crunchy food, too. Usually when I get an ice cream cone, I’m wrapped up in the ice cream experience, and I neglect the cone experience. Eating the cone on its own was a lot like eating a conical (surprise) fortune cookie, and that’s enough to make me happy.

It turned out to make the tot happy, too, after some hesitation, some play (bite the bottom and make a telescope), some more hesitation, and finally crushing it to bits.

Food Friend S. said, “Maybe her three-year-old appetite will be an improvement over her two-year-old appetite.” I think maybe it will.

So now it seems we have in place the two components to eating an ice cream cone.

Why is eating an ice cream a goal? Fine question, if you’re crazy. Why wouldn’t it be a goal?

Oh, wait. There I go getting defensive again. Let me approach this from another standpoint, the “What it Means to be a Kid” perspective.

I realize the tot doesn’t have expectations about what experiences are necessary to her childhood, but there are some that I would like her to have. One of them is eating birthday cake. Another is playing in the snow. Another is running through a sprinkler, or sleeping over at a friend’s house, or eating ice cream on a hot, hot day. I want her to go to preschool some day and make a mess with the paint because she’s so engrossed in finding the perfect shade of blue for her picture that the mess becomes inconsequential.

I want her to feel more carefree about these things or to at least be able to shrug off the worries long enough to simply be a kid. To fit in, to be average, if only for a few moments.

On the therapy side of things, ice cream will be a great bridge to other things. It could lead us to melty foods, like cheese or dips. It could lead us to self-spoon-feeding of liquidy foods (which could lead to her eating breakfast cereal with milk, rather than dry with a cup of milk on the side – this is important to the sleepover experience), which could include yogurt (oh holy protein, we long for your presence in our diet). It could lead us to – is it too much to hope? – the mixed textures of ice cream and cone.

But she’s three, so it’s probably all a tease.

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