Ohhhh - TEEEEEE!

Liza had her occupational therapy (OT) assessment today. Yes, I know that sounds like we're trying to figure out whether she'll be a good bus driver or secretary or biochemist, but in reality OT is just a way of saying "teaching people how to do what they need to do in order to live their lives." OT can help children with developmental delays learn the everyday skills that other kids figure out on their own ... silly things like, oh, say, SITTING UP. Here's a link to the national OT association's description of pediatric OT: http://www.aota.org/featured/area6/docs/Child0-3fact.pdf

Our appointment today was at a local gymnastics center that is only about two miles from our house. The therapist does a lot of the pediatric appointments there because they already have a lot of the mats and toys and stuff that she needs, and it is a little less clinical than the OT/PT office where she works. I was pleased to see that the therapist had already disinfected the mat we'd be using, and she was ready to go as soon as we got there. This same gym does an "open mat" time on Wednesdays that I've been told is a lot of fun for the kids once they get older and can run around and play on the trampolines and stuff. Personally, I had fun walking on the springy floor and bouncing on the little trampoline with Liza ... maybe we'll go to the open time just so I can play around :)

Denise, the OT therapist, seemed really nice, and she was really good with Liza. She did a pretty detailed (if free-form) evaluation of what Liza can and can't do. She had her sit and try to reach for toys, lay on her stomach and roll over, etc. She spent quite a lot of the visit trying to see if Liza would sit up from a prone position if Denise sort of molded her body into the right position. Liza did pretty well, considering she was in a strange place with a strange person and it was almost naptime ... there weren't many meltdowns that weren't cured by the application of some goldfish crackers. Here are some of the observations that Denise shared with me (my comments in italics):

1. "Wow, she really knows what she wants and gets mad quick if she doesn't get it, doesn't she?" Uh, yeah. Like continuously for the first seven months of her life. She's a little grumpy now because it's naptime, but overall this is the improved version.
2. Liza has good range of motion when she's sitting - she can turn and reach for objects off to the side and even sort of behind her. That's my girl!
3. Liza's hips seem a little stiff when Denise tries to get her to sit up from a prone position. That is, Liza tends to stiffen up and not want to bend her legs the way that Denise wants her to, and Liza doesn't cooperate as much as Denise would like her to. Same with turning over - she seems to resist turning to one side, but has no problem turning to the other side. Hey, at least now she's turning over again. There for a few months she had given up "turning over" for Lent or something.
4. Liza doesn't seem comfortable in a prone position. Denise said this is common among kids who seem to prefer sitting up when they're young - parents see they prefer sitting, and they automatically put them in a sitting position to play. This means that the kids don't get the time to explore in the prone position the way they need to in order to figure out how to get themselves out of it. Guilty as charged - since Liza hated tummy time so much and her head was getting flat from laying on her back all the time, as soon as we could prop her up into a sitting position, that was what we did. Ooops - we messed up our daughter!
5. "Liza really likes to bounce, doesn't she?" Bouncing was the only thing that would calm her down when she was screaming, and even now it's the best way to jolly her out of a tantrum or a sleepy crying jag. "We'll have to keep an eye on that, because a lot of times kids that like to bounce all the time end up walking on their tippy toes so they get that sensation, and we want to head that off as soon as we can. We don't want to get her to sit up, only to have her running around on her tippy toes, flapping her arms." Um, yeah, I'll get right on that right after we get her to SIT UP.
6. Liza seems to be stuck on a few sensations, repeating them rather than trying to see what else things can do. For example, when Liza picked up a whiffle ball Denise handed her, she didn't sniff it or lick it or turn it around or try to roll it or bounce it ... she started smacking it with her free hand. When Liza picked up another ball, she smacked the two of them together, then dropped one and picked up a third and smacked them together. Yeah, she does this a lot with all of her small toys. Once she figures out one way to play with them, she'll do it over and over. I didn't think it was unusual, but I guess it is a little weird. For example, we have some small baskets of toys she plays with when I'm in the shower or fixing dinner. She'll happily sit there for 10 minutes, pulling everything out of the basket, banging things together, banging them on the floor, and then throwing them over her shoulder. But in order to get her to do anything new with the items, I have to show her over and over again, sometimes moving her hands to do it with me. It looks like there's going to be a lot less self-entertaining and a lot more Mama-directed play in our future if we're going to get her to change how she plays.
7. Liza has good manual dexterity - she was picking up the goldfish in a pincer grip, and she managed to extricate her finger from the hole in the whiffle ball when she got it stuck. But she doesn't use those skills in new ways - such as by turning a ball over in her hands to look at the whole thing (see #6 above). But just a few weeks ago she learned how to pry the puzzle pieces out of the puzzle ... so she could pick them up and bang them together and throw them over her shoulder. But still - the 'pulling them out of the puzzle' part was new!

The whole point of today's visit was to determine whether Liza is sufficiently delayed to require assistance. Denise believes she is, and is going to write up the report and send it back to our pediatrician for his sign-off so we can get started with the actual therapy. She said that usually takes about a week, so hopefully we'll be able to get started on the therapy appointments later this month.

Denise said that there were a few things she'd like to work on with Liza. They include:

• Getting her more comfortable with the prone position. Denise said that if Liza gets used to laying down, at some point she'll work out on her own the mechanics of how to sit up. But until she's more comfortable exploring from a horizontal position, she's not going to make much progress doing more advanced things.
• Getting her to expand her sensations. Denise wants to teach her that you can do more with toys than just bang them together and throw them over your shoulder.
• Trying to convince her to not get frustrated so quickly that she doesn't give new experiences a shot. Denise said that while there would be some physical work associated with the sitting up, a lot of what we'd be working on would be mental ... trying to get through to Liza that sitting up is fun and important, for example, and that if you can't reach a toy you shouldn't throw a fit, you should just go get it.
• Contrary to what the First Steps lady said, Denise doesn't think there should be that much crying involved in the OT work we'll be doing at home once the therapy starts. I sort of had visions of having to show her how to sit up a few times, then putting the appropriate motivation (i.e. chocolate) nearby and listening to her scream while she refused to try to reach it on her own. But Denise thinks that if we can get through to her to overcome the mental block she's got about being prone, she'll be a lot more patient and willing to try to get to things on her own. It's not all going to be happy smiling baby, but it shouldn't be a 40-minute scream-fest like I had dreaded.

I'm still trying to process the whole experience, so I'm sorry if this post is a little disjointed. On the one hand, it's nice to know that I'm not just being a paranoid mother, there is something a little strange with Liza's development. On the other hand, nobody wants to be told that there's something wrong with their child, no matter how correctable it might be.

Unlike some mothers, I have never worked under the illusion that my child was perfect ... Liza screamed too much for that to be true. But I was happy to believe that some of her quirks were signs of genius, rather than signs that she was developmentally stuck in one gear. It's much more reassuring to say, "Look how she explores the sounds those blocks make when she bangs them together!" than it is to say, "Yes, but she should have moved on from block-banging months ago and be doing more complex things with the blocks by now."

Every mother desperately hopes there child will be brilliant, and with my genes and Jason's genes Liza will be hard-pressed to not turn out at least above-average. But hearing that some of her behaviors are delayed was harder than I expected it to be. It's not like I'm going to collapse in a soggy heap in a corner or anything, but it was more of a blow than I thought. I don't tend to be romantic or sentimental or overly dramatic about most things - I've been very matter-of-fact about this whole process of seeking help for Liza. I guess part of me was expecting that the therapist would say something along the lines of, "Not that much wrong with her - a couple of sessions of sitting-up practice and you'll be chasing her around the house by the Fourth of July." When that's what you're expecting, it's not hard to be matter-of-fact ... you just plod through the system, secure in the knowledge that your child is brilliant except for this one minor delay that you'll have fixed in no time.

See, now I'm starting to sound melodramatic, because what Denise told me today isn't that different from what I was expecting, and I can't say I disagree with any of her observations. I guess the part about not exploring things in different ways caught me off-guard. I was prepared to talk about not sitting up, not about how it's a little weird that she's still banging things together, and that's got me a little verklempt. It's not like we went in and Denise said, "Oh, by the way, did you know your child has such-and-such a horrible developmental condition that she'll be fighting for the rest of her life?" Chances are very good that a few months of OT will set Liza on the right track, and she'll turn out to be the internationally-acclaimed astronaut-turned-President that I plan for her to be.

One of the things that has me a little upset is the nasty suspicion that I contributed to some of Liza's delays. Before you jump in and post comments about how that's not fair to me, think about the following:

• Denise said that part of the not-sitting-up problem is the fact that we put her into a sitting position so often, rather than leaving her prone and letting her work it out on her own. I kind of thought this myself when the problem first surfaced, but by then Liza was at the "I will scream incessantly until you sit me up again" stage and I couldn't deal with it.
• I can't deal with Liza screaming, especially if I know how to fix it. We spent so many hours being unable to get her to stop crying no matter what we tried, that to know how to soothe her and not do it seems barbaric. Baby's crying because she can't reach the toy? It's much easier to nudge the toy a little closer than it is to listen to her crying, crying which makes me not like her and not want to be around her, even with the Zoloft. So for the sake of not having to commit myself to a mental institution I've made things easier for Liza than I probably should have, and now she's accustomed to getting things the easy way. Why bother to sit up when it uses all those silly muscles, and if you cry long enough Mama will pull you up anyway?
• Part of the reason Liza doesn't play with toys in multiple ways may have something to do with the fact that she plays so well by herself. I tend to let her play alone more than I probably should ... it's so nice to be able to sit her down with a basket of toys and jump in the shower and know that she'll be happy for 10 minutes or so. I've been making use of this as much as I can recently, since I know that once Liza starts walking, my days of showering while she's awake are pretty much over. It would be one thing if it was just a 10-minute shower, but I'll admit I let her entertain herself a lot more than that every day. Maybe if I spent more time actively playing with her - rather than letting her play near me while I do something else and make approving comments every once in a while - she would have caught on to some of this stuff sooner. I have no defense for my actions, other than a) babies are boring until they're old enough to sit up, b) I've got too many hobbies and things I want to do around the house, and c) it was less stressful than actually trying to play with her. Besides, at least I know she's not totally dependent on me to provide entertainment for her ... I think I need to find more of a happy medium, where sometimes I let her play alone, and sometimes I sit there and play with her purposefully. I'm sure we'll have to do some of the purposeful playing once the therapy starts, as I'm sure there will be homework involved in that.

I've purposely sort of cleared out my schedule (such as it is) of things that usually distract me from Liza, so that I won't be tempted to go do something else instead of hanging out with her. Quilt projects are wrapping up, most of the household repairs are at a stage where they can sit for a while and be worked on during evenings and weekends when Jason can do the childcare, and I've decided not to apply for a couple of part-time writing positions that would involve me needing to spend a couple hours a day in front of the computer. Blogging is going to have to take a backseat for a while, too, as I've decided I'm no longer allowed to write while she's awake and in my care. She's still taking two naps a day and going to bed at 8, so it's not like I've got no time at all, but it will cut into my famous ability to get ridiculous amounts of stuff done.

I love my daughter to pieces, and I know she's among the prettiest and smartest children on the planet. Up until now I have been very lackadaisical (hah! I spelled that right the first time!) about my parenting, and that's going to change. I want Liza to have plenty of other children to model her behavior on, and I want to spend more time working with her on some of the skills she's missing. The babytime group starts meeting at the library in early June, and I'm going to see if I can adjust Liza's naptime to accommodate it. There's a toddler music class at the local arts center that I'm probably going to sign Liza up for - since she seems to respond so well to banging things together, I might as well learn some new songs and meet some other mothers. I've been getting together with a group of other moms of toddlers once a week, and I'm going to keep that up. The signup for the baby swim lessons at the university is later this month, and I think I'm going to try that. I don't want to turn into one of those over-achieving uber-moms who push their children to do EVERY activity and sign them up for EVERY enrichment course. But a few of these things, which expose her to new people and new experiences, can't do anything but help the situation.

I'll be sure to keep you posted on our progress - Liza with her sitting, me with my momming - in blog entries that will undoubtedly be much shorter than this one. : )