Saturday, December 13, 2014

The iPad and all it's Wonders

Technology and Development

Whether you have, like, or use technology such as an iPad or smartphone, there's no denying that our kids are going to be whizzes with ALL of it so we might as well get on board! There is no single tool/toy that has helped Wes progress more than the iPad/smartphone, hands down! We are so blessed to have an iPad that we are able to dedicate almost solely to Wesley's apps and we use it DAILY for everything from movie watching to high chair games to practicing any number of developmental moves!

First recommendation, child proof iPad case.  I mentioned this in a previous post, my brother all but made me buy a Fisher Price iPad case when Wes was about 18 months old and thank goodness he did! Once I felt safe letting Wes play with the iPad (drop it, throw it, etc), dozens of opportunities suddenly opened up for its usage! 

One of the biggest ways we've used the iPad was to get Wes to move! Simple moves we take for granted are huge feats for Wes such as rolling over, holding a crawl position, pulling to stand, walking, etc. Wes is what I like to called determined, but not necessarily motivated. If something is too hard to get, too far away, or he's weighed the amount of energy it would take to play with the toy versus the fun he would have and they don't add up,  he just moves right along to something else. The iPad, however, is a motivator for him... and we take full advantage of that! So, we find some apps he likes, place that bad boy just out of his reach, and motivate him to get to it by working on whatever skill we need to work on. This tool has helped tremendously with crawling and holding the crawl position... I put it out of his reach to make him crawl to it, then lay it flat on the floor so he can watch/play while holding the crawl position. I also love propping up the iPad on a low table and sitting with Wes a few feet away so he can see it. Then we practice standing from a sit or from the ground, walking, and pulling up on the table to get to the iPad. Works like a charm and he is always determined to get to that game no matter how many times it takes him!

The iPad has also been a lifesaver at therapy. Just like at home, he weighs the benefit to himself as to whether he wants to do what his therapists ask, so if it's not worth his time then we can forget getting anything done! Que the smartphone. Once I bring that phone out and he hears the music of one of his favorite apps, he'll walk the whole hall or crawl through every tunnel they have to get to it. I can't count how many times my phone has prevented meltdowns with the PT, Speech, and OT! 

We also like to use the iPad in the high chair. I'm not a big fan of letting kids watch TV or play games while eating, however in Wesley's case anything to keep him distracted while trying to eat by mouth prevents him from throwing a bigger fit than he already does. We have to pick our battles. In the high chair, though, we're able to work on OT and comprehension skills such as pointing, cause and effect, matching, identification, dragging, and more! He stays focused in the high chair and can really concentrate on the apps, so we're careful to target certain apps that align with skills he needs to work on. We also work on his weak hand in the high chair. We have a restraint cast that we put on his left arm to block the use of his hand, forcing him to use his weaker right hand/arm. We put apps on the iPad that only require him to tap the screen or have simple buttons to activate, that way he gets practice using his right arm to hit the screen without frustrating him. Honestly it has tremendously helped Wesley's aim and coordination with his right hand! 

No matter how you use it, the iPad can be a wonderful tool for development! What are the best apps to get though? I subscribe to Smart Apps for Kids and they send me daily emails with free recommended apps for kids and kids with special needs! These are very helpful for ideas along with recommendations from family and friends. But, like any toy, kids can be finicky so it's always a battle trying to find apps they like. Wes is a stickler for the familiar, so it's a bit of a struggle when introducing new apps to him because they're unfamiliar and make him uncomfortable.... even though he gets completely tired and bored with the old ones. I have to slowly introduce new apps by turning them on every couple of days and playing with them with him... eventually they become more and more familiar and he actually likes playing them instead of whining when I put them on. It's a process! I especially love, when picking out apps, the free (of course) and "lite" versions because you can try them out before paying for them.

So, here are the apps that have worked wonders with Wesley:

Fisher Price  
Basically ANY Fisher Price app, especially the baby ones, are home runs in our house! These are great for cause/effect, pointer skills, learning shapes, colors, numbers, etc. Here are the titles of our favorites, and they're ALL free!!!

* Laugh & Learn Shapes & Colors Music Show for Babies
* Laugh & Learn Where's Puppy's Nose for Baby
* Storybook Rhymes Volumes 1, 2, and 3
* Laugh & Learn Learning Letters Monkey
* Create & Learn - Animals
* Laugh & Learn Smart Stages Around the Farm
* Create & Learn
* Stamp & Learn Shapes!
* Laugh & Learn Let's Count Animals for Baby
* Laugh & Learn Animal Sounds for Baby
* Fisher Price Giggle Gang App for Baby

Kids Games Club by Tab Tale 
This group has tons and tons of kids apps, but Wes really likes the music based ones! These apps come with an animated nursery rhyme song, then several related games. They are great for cause/effect, identification, pointer skills, and more... and the great thing about these apps is they have a lite version, so you can try them out first... then if you like them, they're only $2-3 for the full version. WELL worth it...

* The Wheels on the Bus - All in One Educational App (FAVORITE!)
* 5 Little Monkeys - All in One Educational App
* Itsy Bitsy Spider - All in One Educational App
* ABC Song - All in One Educational App
* Kids Song Collection - Interactive Playful Nursery
* Farm Friends: First Numbers and Animals (another FAVORITE)

There are dozens of different nursery rhyme apps with this group so check them out and grab the ones they like!

Baby First
Baby First apps are super cute... they have two different main characters Wes loves, a little blue Peekaboo baby and VocabuLarry. These apps are great for pointer skills and identification... they have lite versions, then full versions for a couple of dollars.

* Peekaboo, I see you! (FAVORITE)
* Play with VocabuLarry
* VocabuLarry's Things That Go book
* VocabuLarry's Things That Go Game

These are fabulous apps for teaching identification, pointing and dragging skills, matching, and more! These are free to start, then if you like them you can get full versions for a couple of dollars...

* Match it up 1, 2, and 3
* Families 1

Lucky Ducky Studio
These are super cute for teaching pointing skills, characters and storylines, identification, and more! I think these were a couple of dollars but again they have a lite version so you can check them out first!

* Toddler's Playroom - Fun & Learning All in One
* Kids Policeman
* Kids Fireman

Here are some random apps we've found that are hits with Wes...

* Knock Knock Family - Toddler's First App
* The Alphabet Train for Kids
* Dusty the Digger
* ABC Ninja - The Alphabet Letters and Phonics Slicing
* Sago Mini Ocean Swimmer
* Animal Band - 3D Interactive Music Toy
* ABC Wow! - Kids' Alphabet Flash Cards
* Talking Paul
* WATCH Disney Junior

These are just a few of the apps we've used over the past year that have been favorites! If we discover any new hits we'll be sure to share!

Monday, December 1, 2014

G-Tube Positivity

The G-tube

No parent wants their kid to come home with a G-tube (or any assistive device), but rarely do we have a choice. Wesley has a G-tube, which he received in the NICU, so we're going on 2+ years now. Unfortunately, like most babies who get a G-tube, Wes had really bad reflux and aspirated when we tried to feed him. It sucked, but after 100+ days in the hospital we would do anything to get him home. The doctors will try to tell you they’ll only have the tube for a few months, at most a year. I'm sorry, that's a lie. Once you eliminate the culture and function of eating from a baby’s life, the process of teaching that to them is HUGE. Not only do the muscles in their mouth weaken tremendously, but the flavors and textures associated with food that we take for granted become major sensory issues.

For anyone who doesn't know, a G-tube is a tube surgically inserted into the stomach. All food goes directly through the tube instead of through the mouth. Initially they get a long tube with a port at the end where a small machine (similar to an IV pump) pumps milk into the stomach. There's a pump and a pole that follow them around whenever they're eating. You can also get a little backpack that holds the pump so they can be mobile while eating. After a few weeks you can swap out the long tube for what's called a Mic-Key button, or a smaller port, that's much easier to maintain. Is all of this ideal? NO... we hate worrying about it pulling out all the time (first CON) and Wes having this little white tube popping out of his stomach (second CON). BUT, at the end of the day it's not as bad or intimidating as a lot of people think. In all honesty, it has been a blessing.... 









G-tube Feeding Progression

Wesley's G-tube feedings have gone through a major progression. When we first came home he was on 24 hour feeds.... NOT fun. We couldn't go anywhere without the pump. It’s hard to work on anything developmental (another CON), especially tummy time, when you're connected at the belly and going out is that much more complicated. Slowly, we were able to wean him to three hours on, one off. Then two hours on, two off. Then finally one hour on, three off. This took months of transition and he ate all breast-milk (highly, highly recommend! I pumped for seven months, until I was completely dried up, and froze it all for later). Finally at about a year old we were able to bring him down to 30 minute feeds every three hours. We also started introducing rice cereal into his milk to see if we could bring more solids into his diet. Warning.... do not put rice cereal through the pump! The pump ends up miscalculating the volume/time and they don't get the full meal. That realization led to the biggest transition for Wesley's G-tube feedings.... the 10cc syringe. 

Completely by accident I forgot Wesley's pump and bolus venting tube while out one day and needed to feed him a bottle. I rummaged through the diaper bag and found the 6cc syringe you get with the Mic-Key button set, the one that fits directly into the G-tube. I used that to suck up the milk and feed him….. it worked beautifully! It then dawned on me that I should start feeding him every meal this way, especially since the rice cereal wasn't working in the pump. So, I found a 10cc version of the same syringe and started direct feeds that way and we've never gone back. Now, instead of connecting the pump to feed him his meals, we've transitioned completely to syringes only. Here's where the G-tube PROS begin....

Healthy Benefits of a G-tube

We didn't want Wesley to be on milk forever (my breast-milk ran out around a year) and the Complete and Pediasure milk they typically recommend for G-tube kiddos was way too rich for his sensitive stomach, so what to do? We asked ourselves, what is the first thing you introduce to a baby by mouth (besides rice cereal)? Baby food right? Sweet potatoes maybe.... or applesauce.... something bland with little texture. Well if a typical one year old could eat sweet potato baby food, why not Wes? So, one day we tried it. We bought a jar of sweet potato baby food, sucked it up in the syringe, and went for it. Worked like a charm. I asked my friend who also had a one year old how much food she feeds him for each meal. We made a chart for each meal and started cooking (we make ALL of Wesley's food.... will post separately about that!) and blending. Currently Wesley gets two four ounce bottles of almond milk (morning and night) and ten ounces each of blended fruits, veggies, grains, and proteins for breakfast, lunch, snack, and dinner per day with lots of water sprinkled in throughout the day... all via 10cc syringe fed directly into the G-tube (usually while Wes is in the high chair). PRO number one! As an added bonus, meals this way are virtually spotless. No messy faces, messy hands, messy high chairs, messy floors! Just saying…
Understandably, this feeding method may not work for everyone, but we cannot stress how much this process has positively affected Wesley’s growth and development and what a blessing it has been. He eats nothing but healthy and nutritious food! One of the most memorable things our surgeon told us before we left the hospital was that in order for Wesley to develop and function with his brain bleed, he needed to GROW! Wesley's brain needs constant nutrition and nourishment to allow the healthy parts of his brain to take over for the damaged parts. We took that completely to heart! We bought a scale and weighed him almost every day (NICU habit), kept a chart, and NEVER missed a meal (well almost).

Some Pros and Cons

One major PRO of a G-tube is complete control over the amount of food Wes eats. We know exactly how much food and calories he is eating every single day. This is extremely important for a number of reasons.... weight gain being number one. We've never had to fight with Wes to eat a meal, panicked if he didn't like it or wouldn't eat something, or worried whether he ate enough on any given day. This can also work against you, however (insert CON here)… having complete control means your child has no self-regulation or control of their own. It’s hard to always know how hungry they are, if and when they’re thirsty, or if they need more or less food. This can be a major source of stress, to me at least!

On the flip side, when Wesley’s sick this can again come in very handy (back to a PRO). We asked the pediatrician the first time Wes got sick if we should still feed him regular meals since kids typically don’t like eating when they’re sick. YES! As much as seemed reasonable and that he could tolerate, especially the fluids. She explained that he needs those calories to help him fight the illness and to keep up his energy. Makes sense… and very true, Wes somehow seems to have an abundance of energy even when he’s sick (maybe not such a good thing). In a related sense, the G-tube is also handy with medicine (Wes is on a seizure med that tastes horrible), which can go directly through the tube so he never has to choke or gag on them (another major PRO).  

Meals while sleeping are also an amazing PRO. We are able to feed Wes even when he's sleeping, throughout the night or during naps. This is extremely convenient and important for those of us with weight gain problems because you never have to stress about them sleeping too long and missing a meal (particularly when they’re really little), they can still get the calories in! It’s also nice because a baby with a full belly sleeps really well. When Wes first came home he would get his first meal of the day around 6am... we could plug his pump in without him even knowing and he would sleep right through the whole meal until 8 or 9am. I'm not saying we weren't still exhausted getting up every 2-3 hours to reset the pump throughout the night (putting this on the CON list).... warming the milk, setting up the pump, flushing it, priming it, venting him (letting out any air), plugging it in, etc. PURE EXHAUSTION! All parents go through this with new babies of course. The difference with G-tube babies is this phase lasts a LOT longer… months and months longer depending on how many meals you have to get in per day.

We Don't Force It

With all this said, of course we hope Wesley will eat by mouth sooner than later. But one thing my husband and I agreed on from the start was NEVER forcing Wesley to eat by mouth. His growth and development are our number one priorities always.... at no point will we starve or withhold food from him to force him to eat. We know people who have done this, and yes their kids eat, but many times the kids have sensory issues and weight gain problems. These are two things we are committed to avoiding, along with any trauma this would cause for him (he’s been through enough!). We know Wes can do it, he’s passed his swallow studies and has no medical reason not to eat now. We get frustrated, though, when we hear people tell us we should let him get hungry and that will make him eat. Not true. First of all, Wes shows virtually no signs of being hungry (another potential CON). Secondly, just because he’s hungry doesn’t mean the muscles in his mouth magically know how to process the food or handle the textures and flavors. By not sucking, chewing, or swallowing those muscles become very weak and uncoordinated and the senses become very sensitive… they need practice to be able to properly function to eat full meals (add major CON here). No amount of speech therapy can fix this overnight… all you can do introduce the food, practice, stimulate the muscles as much as you can, and show extreme patience! We’ve learned the more we force Wes to eat by mouth, the more aversive he becomes.

I saw a post on Facebook once that supported avoiding the use of the G-tube to make a child eat. It read something to the effect of "no one wants a kid with a G-tube. You want your kid to be normal." I cannot describe how ANGRY that statement made me. The G-tube has saved Wesley's life. It helps him grow, it keeps him healthy, and it eliminates a stress from his brain that allows him to focus on other developmental areas. Can you imagine hearing someone say “who wants a kid with glasses?” Isn’t that the same concept? Glasses help you see…. G-tubes help you eat. Again is it ideal? No, but I would certainly take a kid with a G-tube over no kid at all! Wes will eat by mouth someday… when he’s ready! So next time you hear a parent concerned about having or getting a G-tube for their child, remember they are many pros to counter all the cons and try to look at some of the benefits you will gain from what the G-tube provides!

Sunday, November 23, 2014

Pointer Skills

Pointer Skills...

One area we've been working really hard with Wesley on are his pointer skills. One of the first questions the neurologist and all our development evaluations always ask is does he point to things that he wants. No, actually, he doesn't. He never has. The next question then is, well how does he tell you what he wants? Well, honestly he's not a very demanding kid and he's extremely easy going, so a lot of the time he just moves on. If he wants something or can't get what he wants he whines (no talking yet) until I figure it out for him, or if I'm close enough he'll grab my hand and move it to what he wants or needs. That's obviously not an answer they want to hear and twice now I've been told that could mean he's on the Autism Spectrum. This was extremely upsetting to me, not so much because I care about the actual diagnosis, just add it to the list... but because I feel like he's being labeled based on a behavior that can be explained by a dozen other characteristics he has or deals with (easy going personality, delayed motor skills, no talking, etc).

I think it makes doctors and specialists feel better when they can throw a label on the kid to define their behavior... what I can't understand is how they can possibly think that a simple checklist with yes/no questions can tell them whether a kid has Autism for example. Wesley had a severe brain injury at birth, how can anyone possibly say that his behaviors are the result of Autism and not the consequence of his injured brain? Even more frustrating is that they ask these questions without explaining what behavior they're looking for or what that means. When they ask me whether Wesley points to things he wants, I think about it for a second and say "no, not really." What I don't get an opportunity to explain are the ways he does tell me what he wants/needs. It's only afterward, when I'm home replaying the conversation/appointment in my head, that I get upset for not saying what he is able to do instead of pointing.

Regardless of what it does/doesn't mean, pointing is still a skill Wes needs to learn and we're working working working on it. He can use his pointer finger to do things like hit buttons, light switches, iPad activities, and he's just now starting to use it to point to what he wants when I present him with options. What he can't do is point to something across the room or when he throws something under the couch, for example, he can't point at it to tell me that's what he wants. So, this skill is still a work in progress...

Learning the Basics

Obviously, Wes can only use his good hand to point to things since he has no real control over his fingers with his weak side. One of the first toys/tools we used to get him to use that pointer finger were toys with buttons of course. Toy phones, piano toys, anything with music buttons, etc. He started with the whole hand and slowly got better and better with narrowing down the pointer finger. One toy in particular that has helped with this is his Rainforest Music box that we keep in his crib. As I've said before, Wes is a major music lover and this toy is a major source of comfort for him while sleeping. Once he figured out that he could control the music and lights by hitting the bird button, his pointer finger skills got real good real quick! I highly recommend something like this in the crib if possible since Wes, for example, spends a lot of time in bed either going to sleep or waking up and ends up playing with the box the whole time!!

Another game we play that helps with Wesley's pointer skills is identifying body parts, particularly on the face. He learned the nose and eyes first just with repeated asking and modeling with hand over hand pointing, then he picked up ears, hair, and mouth. We make different buzzing sounds every time he touches his or our nose, which he thinks is a game, so he points back and forth between our noses to get the buzz effect. Unfortunately he's gotten a little bored with this game lately but it was good while it lasted and taught him not only to point, but what each part of the face is... win win.

Our next challenge was getting Wes to point to objects when presented with options (instead of just grabbing what he wants)... not going to lie, this was not an easy task. I had to present him options, then when he went to grab what he wanted I intercepted his hand and modeled the pointer finger to the object before I let him have it. This took a LOT of practice over and over and he was very frustrated when he didn't get his chosen toy immediately... but practice makes perfect and after weeks of modeling, he finally started pointing to his choice once each time we practiced (I think he didn't want to give me the satisfaction of doing it), then twice, then finally he went all in and pointed every time. WHEW!

We've also been working on Wesley pointing to objects in a book to identify things. He's still a little hit and miss, but with certain books (ones we've specifically worked on) he is able to point out the animals on each page. Eric Carle's Brown Bear and Polar Bear books are ones we always read and we've taught Wes that he can't turn the page until he points to the animal first. We also have a lot of those baby's first words, baby's first animals, baby's first sounds, etc books and we use those to practice pointing to different objects that Wes knows or needs to learn. He's temperamental when it comes to participating, it all depends on his mood that day, but we always try!

iPad and Pointing Skills

The real difference maker in the pointer skill department, though, has been the iPad. I never used to let Wes do anything with the iPad except watch a story book when he was younger, but my brother talked me into (demanded really) buying an iPad case so Wes could actually touch and play with it. Let me tell you... BEST PURCHASE EVER! It was $35, (for a CASE, ugh), but worth every penny! Here's the one we got and it's been a life-changer:   Once I put the iPad in that case it became indestructible, LITERALLY!

There are 100 reasons why the iPad has been an amazing tool for Wesley's development, but I'll stick to the pointer skills for now. When he first started playing with the iPad, it was really him watching the screen, not a lot of interaction. So, we had to show him that there was a cause/effect relationship. When you touch the iPad, something happens. Fisher Price Storybook apps are the BEST for this. Actually ALL Fisher Price toddler apps are amazing and free, I recommend downloading every one you can find (I've scour the app store looking for all things Fisher Price). The great thing about the Storybook apps is they sing/read a nursery rhyme one page at a time. So on one of the app's settings, all Wes has to do is hit the screen anywhere and the page turns. PERFECT for cause/effect and teaching him that touching the screen causes something to happen.

Once Wes figured that out, he started to realize that if he touched in certain places, different things would happen. Again with the Storybook apps, they have another setting that allows you to play with the pictures on the screen and you can't turn the page unless you hit the arrow button. All of the Fisher Price apps have similar settings with arrows, characters, and buttons that you can play with and these features have literally taught Wes that he has to use a pointer finger (not the whole hand method) if he wants to do more things with the app. Now, that's not to say he doesn't slap the iPad with his whole hand still... he's a boy and he always tries the easiest method first :) SO, I have to constantly remind him to "use your finger" and many times I still guide his hand and help him point his finger to target certain buttons/areas.

Now what we're trying to teach him is to drag an object with his finger across the screen to complete a task. This has taken a LOT longer for him to understand and he still doesn't quite get it, but I can see him starting to make that connection with some of the apps so we're getting there. I'll dedicate another post solely to the iPad apps that have been fantastic for Wes since there are so, so many and they're all great for development!

At the end of the day, one of the lessons I've learned about pointer finger and other fine motor skills with Wesley is practice practice practice. Even if he doesn't seem to be getting it, learning, trying, or even paying attention, as long as we try even just once a day, over time it will become a routine and he WILL learn it. Patience always pays off!