If we were meant to pop out of bed , we would all sleep in toasters- A lesson in sleep for CI toddlers

sleeping baby

sleeping baby

In the last few months so much has taken place that I have wanted to write to you about but I haven’t found the time.

Back in the day, Harry had a decent afternoon nap which meant if I could possibly stop myself from loading the washing machine or sorting the clean laundry I could sit at my computer and churn out a Blog entry. But alas, no more. He actually hasn’t had an afternoon sleep really since we went to London this time last year. He still sleeps at Kinder but I have had to restrict it to one sleep cycle of 45 mins. only as otherwise it massively impacts on when he goes to bed.

This leads me to the first part of my story- SLEEP

At the beginning of the school year we decided Harry was too large for his cot. The base was bowing under his massive 16 kg weight and when he didn’t want to go to sleep he was now able to scale the bars and fling himself out, usually requiring a Chiropractic adjustment on landing. 
So a small purchase of an Ikea toddler bed was thought to be the best transition to freedom. At least he could manage to safely get himself in and out of it without my fear of falls everyday. His delayed vestibular development effects how Harry understands where his body sits in space, so getting him to maneuver himself up and down from a normal single bed seemed to me to be adding an extra layer of processing he may be better off without at this point.

 

In hindsight, this new freedom was probably the cause of the fast path to no sleep. The first 4 weeks in the bed went perfectly and I was congratulating myself on how he was able to adjust to change. As an aside, the reason for this thought was that often when various Doctors or Specialists are assessing you, they could start to direct their assessments to a place that is in “ The Spectrum”. Seeing whether a deaf child is one that also has social issues or behavioral issues, is a common discussion and one for another Blog post… Remind me about it later.

 

It started to go pear-shaped when daylight savings was approaching and Harry realized that in the time he was in bed and before he fell asleep it became progressively darker outside. He would lie staring at the window and wouldn’t let me put the blinds down. Then he wanted the main light on to read with, which as you can imagine sent me crazy as there is no way you can fall asleep with the ceiling lights on. What we thought was a little fear of it getting dark escalated into him refusing to go to sleep – AT ALL.

 

The compliant boy, who used to read until he dropped off, now clambered out of the bed and started pulling everything in the room out of its position and onto the floor to play with. He was over stimulating himself and using whatever was in the room to aid him. The only logical step was to remove these things from his room, which I did one by one until there was only his bed and the change table left. He also used to bang his feet against the wall, which I guessed was to feel the vibration and allow him to work out where he was. Then he started to climb into the shelf of the change table with a doona and pillow and try and sleep there, as it was the only thing left besides the bed… Obviously sending me a message he would sleep anywhere except the bed.

I was really unsure what was going on at this point and was it was now taking us until 11pm to get him to settle.  The level of noise he was generating so late at night was impossible to tone down as he was used to having no CI’s on at night. Often the only way to get him to sleep was to put him in the car and drive until he fell asleep to the motion. I also threw in some of the Super Nanny tactics I had seen on TV which were meant to ensure he stayed-put on the bed. The reality was a major workout for me, lifting a 17kilo boy back onto the bed hundreds of times a night. If you picture the scenario: an overtired, worked up, small child who was unable to communicate to us his needs and we were unable to communicate verbally what he was required to do. My challenge in communicating with a 2.5 year old who refused to sign, refused to look you in the eyes and was without his connection to sound resulted in hours of getting physical.

 

Through his stubbornness to succumb to sleep, he progressively became more and more overtired and with that he became over – sensitive or technically, hyper- defensive to touch. This meant I couldn’t hug him or stroke him or use any sensitive physical means to make him feel secure in the environment he was becoming stressed in. He started to display many of the signs shown by a child with Sensory Processing Disorder (http://www.sensory-processing-disorder.com/tactile-defensiveness.html) and in my own sleep deprivation I started Googling…. Never a good thing.

His behavior in the day was a direct result of the stress of getting to sleep at night.   Dan and I had not eaten a hot dinner together, the girls hadn’t been able to get to sleep in their room next to his before 10 pm due to his noise and we couldn’t have anything resembling a social life for more than 6 weeks- it was time to call in the BIG GUNS.

In floods of tears at the GP’s clinic we were given Melatonin and a sedative 6 times stronger than Phenergan to put him to sleep. The idea was to allow him to fall asleep aided in his bed in his room rather than the car and eventually he would forget the scary associations he had developed with his room and night time and only remember the current calming sedative induced sleep from the antihistamines.

The melatonin was to try and get his body clock back on track and bring his circadian rhythms in line so he was going to sleep when he was tired.  (http://www.sleephealthfoundation.org.au/files/pdfs/Melatonin-and-Children.pdf) There is not much research in to the long-term effects of using melatonin on kids but short term there is no harm. It seems Pediatricians have used it for kids that have autism, ADHD and other special needs for the last 20 years. I can also tell you that in this time when I did not know what to do, I reached out to the Facebook page I belong to “Parents of CI kids”. The most common response to my call out for help was to try melatonin. It transpired that I was not alone in this sleep-deprived world of a nearly 3-year-old deaf child with CI’s. It appeared to be a common occurrence at this age, there were other parents around the world who had also experienced similar sleep disruptions from their CI kids. I love this site and if you are a parent of a CI kid and don’t belong I highly urge you to join up.

It took a good further 2 months to get him back on track. I also sought the advice of a “Sleep Consultant” on the referral from our Pediatrician. It was at the Epworth-Monash Sleep Clinic in Melbourne (Dr. Margo Davey) http:/www.epworthsleepcentre.com.au/index.php/doctor-margot-davey  ,  a Doctor with enough experience to see through the smoke and mirrors of the situation and who gave me the biggest telling off I had in many years. Interestingly she told me that I needed to forget Harry’s deafness and focus in on his behavior, which was that of a standard 2 1/2 year old boy ruling the roost. Yes, he may have some issues relating to not hearing at night but essentially when she striped back our routine, she felt he was running the schedule, not us. I can laugh about it now, as that short consultation allowed me to remember that I had been a mum twice before and probably not perfected sleep routines either time. But the rules of engagement I applied to very articulate 3-year-old girls to get them through this period just didn’t make the grade with Harry. He needed routine and no deviation and me to be firmly in the driving seat.

We are still not back to where we were at the beginning of the year but we are in a place we can manage and it works for us all. I am in the room till he falls asleep and we are still using the melatonin but in such small doses it is negligible . He still has the blue light on all night and some nights will ask to fall asleep with the bedside light too. He is sleeping all through the night for 11 to 12 hours so I actually don’t think I can ask more than that of him at this age.. He will now also let a babysitter or even his big sister put him to bed and read to him until he can no longer fight the heavy eyelids.

There is no doubt that on this journey you can get so embroiled in the struggle for normality that when something fairly normal takes place you are unable to see it for what it is. I have said before that we are on a rollercoaster with Harry and it goes at quite a speed. We don’t have the luxury of time to reflect and ponder the best move in our chess game; we have to be instinctive and practical. This episode really taught me that it is easy to lose my natural instinct amongst the labels and the instructions for Harry. But it is still there if I dig deep enough and get enough sleep!

Next BLOG I will discuss Clinical Assessments

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Happy birthday Harry

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Today begins celebrations in honour of our Harry turning 3 on Tuesday.
It has been an emotional road as you know but it is incredible what he has
achieved in that time . I created a video/ trailer as the invitation so check out the link

https://www.youtube.com/watch?v=8B0wnFp98Q0

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Harry 33 mths: gymnastics for balance

Gymnastics classes on a Friday morning are a great way to get Harry to work on his vestibular system as recommended by our OT. Last week it was themed for the Australian Grand Prix annually held here in Melbourne.
He had such a ball and practiced this racing track circuit most of the session until he could manage it without toppling over- what perseverance my son has…..

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Summer rap up

xmas 2013

xmas 2013

It has been 3 months since I last wrote on the Blog, which is remiss of me.

To make me feel better I will share with you that I have noticed a trend within the Blogs of Parents of Children with Cochlear Implants. And that trend is that once things start to click into place with their child’s speech the outlet of the Blog takes a back seat.

Is it that we no longer need to voice our frustrations and challenges?  Maybe, but they certainly don’t completely disappear with time it is just that we have more tools in our tool box to cope with them , I think .
After a period as a family of a CI kid we enter a world of relative calm and dare I say it “normality” which doesn’t feed the necessity to pour out our heart and soul to the world. Of course I am going to continue to write this Blog as you never know what is around the corner and I am still digging up interesting  experiences as we plod along .

We had an awesome summer. I think the best holiday we have had as a family of five and that would make sense as it was wasn’t the one when we were waiting for Harry to be implanted on our return and it wasn’t the one following his hideous infection last year. It was just normal really- how I remembered Summer holidays when we just had the 2 girls. Dan and I laughed a few times at the long list of “requirements” we had jotted up on the trip this year that will become our bible for booking a family holiday. NO stairs, gates that lock to the street. Door handles high enough for him not to be able to reach and open, shade by the pool for when he can’t go in. And most importantly lots of room to spread out  toy cars and trains.   We also  had grass and playgrounds close by so Harry had options for playing that also met his Occupational Therapy needs. And for Dan there was always a big, well equipped kitchen so he was happy too.

Having Harry walking was a huge advantage on the trip. It meant he was able to be independent inside the houses we stayed in and that meant I could relax ( to an extent) . But as with most 2.5 yr old boys this independence extended to constantly needing to be on the move. When we weren’t enjoying the luxury of the house we had swapped or rented , we were running after him in a High Street nearby where we were attempting to have lunch or dinner or just getting an ice-cream. That boy does not stop moving, it is almost like he is trying to make up for the delay he had in getting onto his feet properly. Thank goodness for those huge stretches of wet sand on the Northern NSW beaches. Endless walking and navigating rock pools was the perfect environment to test Harry’s balance.20140226-181404.jpg

We had nearly 4 weeks off together and when we returned and everyone was back in full swing and routine , I took a moment to reflect on how far Harry had come in the last 12 months.

We are nearing the 2nd anniversary of his implant switch on and I have a son who not only hears what we say but is also observant enough to recognise and name many sounds in the environment .

I have stopped counting his words and have replaced that with a record of the number of words in each “sentence”. The constant and detailed review might be obsessive but as parents we are the best advocates for our kids and the more you know the more you can help them.

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Swimming for kids with cochlear implants

using the aqua accessory

using the aqua accessory

IMG_0160I am sure many of you wonder whether swimming can be on the agenda for Harry at this stage.
Not only does he wear electrical equipment ON his head but he also has grommets inside his inner ear. Neither of these make it impossible for him to swim but they are certainly huge deterrents .

 

 

http://bit.ly/1evLPJLnucleus5 new aqua accessory to launch

http://www.cochlear.com/wps/wcm/connect/au/home/support/cochlear-implant-systems/nucleus-aqua-plus

 

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Words are just noise

xray

The life of a CI kid’s family appears to me to still be a roller coaster of emotions. It has now been 20 months that Harry has been hearing and we have survived a winter without incident. 
The latest appointment with our ENT was no more than 4 mins long and we left with a huge smile, as internally everything appeared to be perfect. We made a comment to our surgeon that Harry was starting to get fussy about putting his ears on in the morning but once on he was fine. Our ENT remarked that we should just do what we needed to get them on and not to be concerned that we had resorted to bribery through use of TV or I Pad to assist us.

It was almost as if the last 4-5 months of normality was cursed by throwing in a Specialist appointment, as that following week Harry got progressively more annoyed with his ears to the point where at school it was taking them over half an hour and three teachers to get them back on after his afternoon rest.

I put in a call to the Cochlear Implant Clinic and they scheduled some immediate Mapping for Harry (checking the sound levels and electrode functions by computer). It is a hard call to know whether the issue is a sudden shift in behaviour or a technical glitch. Sometimes a mother’s instinct just doesn’t kick in and I was at a loss as to why this was happening.  Harry was not a kid that got annoyed by his ears. He had always been extremely compliant.  Checking the Mapping would allow me to rule out a fault in the sound levels and focus on his behaviour if that was the issue.

It turned out that Harry had developed sensitivity to some high frequency sounds on his left side. He was getting agitated by the high volume he was accessing these sounds just on that side. The session at the CIC aimed at reducing the sound levels right down on the left to a place he was comfortable with at this point. Before we arrived at this conclusion we went through the stress of taking Harry for an X-ray to make sure none of his recent falls had dislodged the electrodes internally. Dan and I had become somewhat complacent about Harry falling on his head. His “balance challenges” mean he falls a hell of a lot and his threshold to pain seems to be extremely high. We just pick him up and brush him off these days and move on with the next activity. But in actual fact some of those falls could result in damage to the internal components and our lesson here was to perhaps pay more attention to changes after each falling incident that results in his head colliding with the ground! 
It was extremely fortunate in this instance the X-ray proved to be clear and there was no issue with the internal pieces. Thank goodness, as the outcome would have been more surgery. So the Clinic set about changing his levels to make it more tolerable for him.

Of course I tried to find out why this had happened. Is it not possible we can go through a year without hiccups and incidents? Does there always have to be a drama? I am sure for many parents when their child decides not to put the CI’s on for a day they just resign themselves to it and try again the next day. For some reason his defiance makes my blood boil and I see red. Thinking of everything we go through as a family to give him sounds I can’t bear to be defeated. So when the headband is hanging on a door handle and is not on his head it creates a drama in my mind! Given my reaction to his world of silence, I was determined to get the audiologist to give me a scientific reason for this need to change his sound levels. But, they couldn’t.

There are so many unknowns with the toddlers. Thinking about how much physical change goes on with them to grow and become people, is it any wonder that occasionally there is a need to adjust their volumes? Of course it doesn’t affect all of them, but for some reason unknown to us all, Harry now is only able to tolerate 40% less volume on his left side for the high frequency sounds.  The left side is coincidentally the site of the infection from last year- and no-one can say if that is linked or coincidence. Mastoiditis (the infection he had) is rarer than being profoundly deaf.  One needs to be pragmatic and focus on the fact that this change in sound levels shouldn’t really matter. 7 or 8 years ago newly implanted kids were only ever given one implant and managed to learn to speak and listen perfectly well. He’ll be right Mate.

pitch in the cochlea

Overall I can pick up that in the last few weeks of this lower sound level there has been a decrease in the accuracy of Harry’s speech. Some of his regular words are starting to sound the same. I can’t tell the difference between “Bubbles” and “thank you” but his listening is still on track and I can tell he understands everything fine.  It also hasn’t stopped him repeating new words, which is the huge stepping-stone to language he is accessing right now. He has started to use words to get what he needs. Utilising verbs such as “Help” and “fix” in his play routines means he can verbalise what he would like to achieve. Spontaneously saying “Thank you” when he is given something makes me go all warm and fuzzy inside. His latest leap has been when you ask him to choose between two activities without any visual clues he is clearly repeating the activity he wants to undertake.

Given all this progress my primary question to the Audiologists had to be whether it would go back to the same level it was at in July.

Their response to my question was simply that Harry would slowly start to build a tolerance to the high-pitched sounds and therefore allow an increase in volume over time. If not, the brain will learn to interpret speech at that volume.

I guess either way he will get there in the end.

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Harry’s Headband H.ears

Harry’s Headband H.ears.

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“Size matters not. Look at me. Judge me by my size, do you?”

Empire Strikes Back

For the last year and a half I have been often heard quoting “never tell me the odds” as Harry seemed to always be the kid that didn’t do anything by the book.
This phrase reminded me of a movie and sure enough it is a quote from one of the best Bloke movies of all time. To give you a clue, I feel like the Force has been with us in recent months; there have been no major illnesses, Harry’s balance is showing signs of strengthening close to normality and his speech has jumped into Hyperspace.

“Sir, the possibility of successfully navigating an asteroid field is approximately 3,720 to 1.”
“Never tell me the odds.”

Forgive me for using the Star Wars analogy but as I have spent the last few months convincing myself his slower progress with speech and his desire to only mimic words related to food, cars or trains is directly linked to his gender, I am going to run with it as appropriate.

In the last 2 weeks Harry has managed to surpass my stereotyping and is able to parrot a huge percentage of what we are saying to him. This is a skill you will notice in most 18 month- 2 year olds. You say a word and they repeat it back to you several times and then it forms part of their vocabulary. Given Harry’s hearing age is 19 months ( 17 if you take out the 2 months he was sick this time last year) this is spot on. In the near future we can wish he surpasses his hearing age to have  birth-age appropriate speech and language skills , but for now I am thrilled.

In his speech lesson this week, Beth and I spoke of his huge increase in vocab and given his desire to take in the language we are now moving to weekly sessions. This will give us the time to start working on expanding his vocabulary to include verbs or action words to add to the nouns and names he has learnt. With the addition of verbs he will be more able to start putting small sentences together. At the moment he is able to say 2-3 words together but they are phrases such as “see you later” rather than combining individual words.

I have dug into a great resource which Cochlear provides on their website. It is called the “Listen, Learn and Talk Auditory Habilitation Theory”. So for us laymen it is a chart showing age appropriate stages of listening and speech for babies and toddlers. Checkout http://www.cochlear.com/wps/wcm/connect/au/home/support/rehabilitation-resources/early-intervention/listen-learn-and-talk/listen-learn-and-talk

Harry has mastered all the 16-18 month old skills. In listening he discriminates between phrases and is now imitating words heard.The section of  Expressive Language covers the following for a 16-19 month old.
o Jargon disappears
o Increases vocabulary, 10 or more meaningful words
o Decreases use of gesture – relies on talking to communicate
o Imitates words heard
o Asks for more Receptive Language
o Understands more simple questions
o Begins to understand longer phrases with key word in middle of sentence
o Identifies more body parts
o Finds familiar object not in sight
o Understands 50 or more words and for speech in this age group

For Speech in this age group  toddlers increase single word approximations , most vowels  are present  but they still mainly producing front consonants  [p, b, d, m, n, h, w].

They next age group is 19-24months and there are certainly skills here he is yet to master but by no means does he need to master them all.

For listening (audition)  at this age they need to master the following list:

Auditory memory of 2 items,Discriminates songs ( yes mastered), Comprehends a variety of phrases ( yes mastered), Discriminates descriptive phrases ( not sure about that one!), Follows a two step direction, e.g. Get your ball and throw it. ( yes with very familiar routine such as shoes and socks)

Then there is Expressive language

Expressive Language

Uses new words regularly

o Increases expressive vocabulary to 30 words or more ( mastered)

o Attempts “stories” –longer utterances in jargon to get message across ( certainly not here yet)

o Begins to use own name when talking about self ( this will come )

o Uses possessive pronouns – mine ( certainly not here yet)

o May ask where questions Where car?

o By 24 months may use2 – 3 word phrases with nouns, some verbs and some adjectives ( this is what we are targeting in Speech classes)

The Receptive language and Speech sections for this age bracket are what we are working towards. I can list them here so you get an understanding of our benchmark and they are only a guide as each child is unique ( of course)

Receptive Language

o Completes two requests with one object

o Chooses two familiar objects

o Comprehends action phrases

o Points to a range of body parts, e.g. elbow, cheek

o Begins to understand personal pronouns –my, mine, you

o Recognizes new words daily

o Increases comprehension – decodes simple syntax

o By 24 months understands 250 – 300 words

Speech

o Approximates words

o Substitutes /w/ for /r/

o Uses suprasegmental features

o Most vowels and diphthongs present

o Consonants [k, g, t, ng] emerging

o Consonants[p, b, m, h, n, d] established – used in initial position in words

o Consonants often omitted in medial and final position

Let me end on this note. There is not an ounce of delay on Harry’s Cognitive skills . He has developed ahead of the game in this area and has really great fine motor skills ( probably to balance out the slightly delayed gross motor skills)

The list the provide for this age in this category goes as follows ands I can tick them all!

Cognition

o Imitates symbolic play, e.g. household activities

o Uses one object as symbol for another

o Places triangle, circle, square in shape board

o Imitates vertical strokes

o Threads three beads

o Begins to tear paper

o Imitates ordering of nesting cups

o Begins to categorize objects in play

o Uses two toys together

o Stacks blocks/builds tower

o Completes simple pull out puzzle

o Activates mechanical toy

Please watch the videos below to see Harry’s progress.

I know I’ve said it before  but it is “AWESOME”

 

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Loud Shirt Day 2013 supporting First Voice Centres in Australia

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To support Loud Shirt Day in 2013 both our local primary school and Harry’s ELC will be running a Loud Shirt Day event to raise funds for Taralye, our Firstvoice centre. This is our opportunity to give a little back to the service that got us through our first year of Harry’s hearing loss and continues to give us amazing assistance to find Harry’s true potential to hear and speak.
If you would like to donate please click on this link
https://loudshirtday2013vic.everydayhero.com/au/EPS

My Story
Harry is the brother of two EPS students Tess and Alice Feller. He was born profoundly deaf ( we don’t know why- it is just one of those things) and couldn’t even hear a 747 jumbo jet take off next to him. When he was 10 months old he was given the gift of sound by the amazing Bionic Ear also known as the Cochlear Implant. This technology allows the user to hear the sounds around them and speech , but it takes a lot of intervention and help by Specialists to teach Harry how to listen. Supporting Loud Shirt Day supports the centres that teach Harry and other kids like him how to hear and speak, the younger this starts the better the outcome.
All being well, by the time Harry is ready to start school he will be just like all the rest of the kids in Prep- listening and speaking beautifully and clearly to his friends and teachers.
Thank you for your support to give Harry and other deaf children the best possible start in life.
You can follow Harry’s journey from the beginning at http://www.harrysears.com

17 mnths 11.2012

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A Balancing Act.. the true story of Harry learning to walk

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I had some fun tonight playing around with the iMovie program on my Mac.

The most footage I had was of Harry trying to walk over the course of this year .

I think I did an OK job…next project Learning to Talk!

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September 13, 2013 · 10:40 pm