Toddler Thursday: When Your Toddlers Aren’t Toddling Together

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Categories Difference, Prematurity, Toddler ThursdayTags , , , , , , 1 Comment

We’ve all heard the common question, “How do you do it?” That is how we got our name. Another common phrase I have heard over the years, as many parents of prematurely born twins do is, “They’ll catch up on their own time.” I hate to say it, but sometimes this phrase is like a Band-Aid trying to cover up a bigger “owie” than it can. Sometimes it’s the only thing people can think to say to try to make the mother feel better, when she is wondering if there is a bigger problem to be addressed.

Take my little guys, for example. Growing and progressing a little more slowly than the average baby, but also born much earlier than the average baby. We always take their early arrivals into account. We don’t want to overshoot and stress them out during their development, yet, as a mother I don’t want to undershoot their capabilities by overprotecting or making excuses for them. I believe mothers of premature children may be a little more likely to overprotect their children at times, and that’s okay. Everyone has been through a lot! I also believe there is a balance and it can take a bit of time and self-reflection to understand your parenting style.

My twins are about to turn 4 and when I think back to two years ago, I remember twin b was not yet toddling. Meanwhile his twin had started motoring around on his own. Twin b was able to walk everywhere on his knees, but not his feet. Alarm bells were going off in my head, but I tried to ignore them and give my son more time to figure it out. We shouldn’t compare our twins, as they are individuals and they often do learn things at different times. I kept watching him closely and mentioned it to a few people now and then. I often heard, “he’ll figure it out on his own time.” Hmmm…Are we sure about that?

After lots of watching him in silence, assessing and reassessing; working with him one-to-one to try to get him to walk, I finally trusted my instinct. Something was NOT right. As he approached 24 months corrected/27 months actual we looked at his feet closely. I knew he was able to walk if he had the right support for his feet. I had inspected his feet closely, compared them to his brothers (sometimes comparing twins IS helpful,) watched what he was doing when he tried to toddle and cruise along the couch. I put 2 and 2 together when I realized he could cruise without a worry, but as soon as he tried to stand in the middle of the floor or walk, he’d collapse. His teeny tiny feet just couldn’t keep him standing upright because his feet were very flat and one was practically turning over. We weren’t seeing it because we were trying to promote his walking by keeping him in supportive shoes most of the day, which was supported by his physiotherapist. Once I realized his feet were likely the problem, I contacted our PT and she said my instincts could be correct and he was seen later that week. She yanked off his little shoes, assessed his feet and confirmed that his feet would benefit from the use of orthotics. He was fitted with a custom pair of ankle-foot orthotics (AFOs).

The day we picked up his custom AFOs, the physiotherapist helped him put them on as the orthotist watched. First we had to dig through a box of extra shoes at the centre to fit the larger sized AFOs. Once the AFOs and shoes were on, twin b was set in the middle of the floor…and…HE STOOD…and then…HE WALKED! ALONE. It was amazing to see unfold. One moment he’s a non-walker, the next he’s toddling around the assessment room on his own! I could not hold back my happy tears! They were also likely tears of relief, but I didn’t realize it at the time.

The moral of this story? Trust your instincts and if you feel something isn’t making sense or you’ve said and heard, “he’ll catch up on his own time,” maybe a few too many times, it’s okay to put your foot down (pardon the pun) and ask LOTS of questions to get the answers you need.

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They’re Still Twins

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Categories Balance, Community, Difference, Friendships with Other Multiples, Parenting, Relationships, Special NeedsTags , , , 6 Comments

During pregnancy, my husband and I had many conversations about all the things we would do for our twins to let them know they were loved and valued as separate individuals, not just half of a set. That they cohabited in utero was only a very small part of who they would become, and we wanted them to always know that.

I dealt with all the comments during pregnancy—the “better you than me”, the “double trouble”, the “my cousin’s neighbor has twins”, the “I always wanted twins” (or, bizarrely to me once: “I almost had twins”…a story which did not result in the loss of a twin, but rather a woman who, prior to ultrasound technology, knew all along she was having twins, but never heard two distinct heartbeats and only delivered one baby). I joined twin groups, mentally prepared myself for the barrage of twin-comments we’d receive everywhere we went.

I never imagined how much it would sting to lose that.

I am luckier than many in the twin world: both my twins are alive and thriving.

But.

They do not reach developmental milestones within days of each other. Not even within months. They do not wear the same size of clothing, and haven’t since D outgrew the preemie size (while A was still a 3-pounder, outfits hanging on him like Doby’s pillowcase). They will probably not be in the same class at school (except perhaps preschool). Strangers do not ask me if they’re identical or fraternal, or even “Are they twins?” They ask me, “How far apart are they?”

The first time I got that question, the boys were 9 months. Now, D quickly outgrew the “adjusted” charts and was over 50% in height quite early, and has been slower but always on-the-charts in weight. Even so, he looked at most 11 months old. With A, who yes, (yes, believe it or not, I know), is small. But at 9 months, he looked perhaps 4 months, but probably closer to 5. Just what gestational length did these questioners have in mind, anyway??

But now, at 16 months, D could easily pass for 2. And A could be a tall-but-skinny (95th and below-zero) 9-month-old. Which is probably about where he is developmentally as well. The question is no longer absurd.

And it hurts. Selfishly, it hurts, as it is not what I imagined. It is not what “twins” entails in popular culture, mythology, anyone’s mind. But it also hurts for them. They are and always will be brothers, but I feel like they each are missing that twin-thing: the sharing of clothes, sharing of friends, sharing school books, mastering new skills together.

I rarely comment in my twin group. I feel like so much of it just does not apply.

A lot of it does, though. A lot of it applies, and then some. Feeding twins is so hard! Feeding twins when one of them has a feeding tube? Even harder. Getting any sleep with twins is hard! Getting any sleep with twins when one of them has several alarms hooked up to him, which give both real and (thankfully) not-real alerts? Harder. Dealing with extended family who plays favorites? Whoooo, boy, let me tell you. Finding time to {x}? You get the picture.

A and D will never know a different life. As brilliant as they are, I highly doubt either of them pondered the concepts of twinhood while womb-mates, probably not even recognizing that other kicky-squirmy creature with a heartbeat from my own intestines. They are twins, and this is what twinhood will mean to them, even when they understand that it may not hold true for the greater world. In some ways, they are wiser than I am.

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Our Speech Therapy Journey(s)

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Categories Development, Feeding, Medical, Preschoolers, Solid Foods, Speech Therapy, ToddlersTags , , , , , 4 Comments

M has successfully completed two programs with a speech therapist, and we’re considering having her evaluated again. Twin sister J joined her for the second of those programs, and also benefitted greatly. Watching both my daughters work their way through speech therapy has taught me a few new things, and convinced me all the more of others.

  • There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.
  • Follow your gut.
  • It never hurts to get a second opinion.
  • Some lessons are more likely to stick if they come from someone other than a child’s parent.
  • Things are often more complicated than they appear.
  • There is such a thing as knowing too much about something.

The first time we visited a speech therapist was at the recommendation of the family pediatrician. When M was nearly 3 years old, I became concerned about how slowly she ate. I once timed her spending 17 minutes chewing a single piece of meat, and finally had her spit it out. The pediatrician suggested that she had dysphagia, or trouble swallowing. I had imagined that a couple of degrees in linguistics gave me a basic understanding of what speech therapists do, but I was wrong. Speech therapists deal with all sorts of oral motor issues, including problems with chewing or swallowing.

It turned out that M had never quite figured out how to use her tongue to effectively move food around in her mouth as she chewed. Because of that, foods that required chewing would cause her to choke. After six sessions of feeding therapy with an amazing speech therapist and a lot of reinforcement at home and daycare, she could eat successfully. Meals became enjoyable again. It’s been over 2 years, and we haven’t seen any backsliding. In fact, M enjoys food so much now that she plans to open a restaurant when she grows up. Bonus: military medical insurance covered 100% of speech therapy session costs.

It was during feeding therapy that the therapist raised a concern that M might have articulation delays. It had never occurred to me that there was anything off in her speech, since the child talked incessantly and no one who knew her—I, her teachers, or our neighbours—had any trouble understanding her. I thought her pronunciation of yellow as “lellow” was darling, rather than worrisome. The linguist in me had always ignored the nagging doubts, knowing full well that there was variation in the timing of pronunciation mastery, but there should be no cause for alarm as long as the order of acquisition were being followed.

When my husband returned from Iraq and needed me or J to translate for him so that he could understand M, it was clearly time to revisit the speech therapist. My MA in theoretical linguistics hadn’t taught me as much about the practicalities of language development as I’d thought. The practice we’d been to for feeding therapy no longer took our insurance, so we had to find a new therapist. We had both girls, now 3 months shy of turning 4, evaluated at the new practice. They ended up being evaluated by different therapists, and we learned how incredibly subjective these evaluations can be.

J was determined to be 2 standard deviations above the norm for her age when it came to grammar, vocabulary and comprehension, but 2 standard deviations below the norm for articulation, the production of mature speech sounds. She sounded more like a child just turned 3 than one soon to be 4. M, on the other hand, was evaluated only for articulation, and declared to be just dandy. These results didn’t ring true for us. M was, to our ears, far less clear in her speech than J. My husband insisted that M be reevaluated, this time by the therapist who had seen J. When the office staff let us know that they were concerned that insurance might not pay for a second evaluation, we offered to pay out of pocket. Insurance did end up covering it, though. The second set of results was more in line with our expectations. Although J’s need for speech therapy was a judgment call, M definitely needed it. Where the first evaluation had her placed her in the 43rd percentile, the reevaluation placed her in the 2nd percentile for articulation.

Since their delays were along the same continuum, the therapist offered to work both twins together in weekly sessions. The sessions were great fun for the girls. The therapist pulled out board games, and let them each take a turn after they completed a pronunciation exercise. She focused on making them aware of how the sounds coming out of their mouths were different than hers. Soon enough, they could say ‘sh’ and ‘v’ easily. It was extraordinary to see how those two sounds alone helped with others’ comprehension of their endless chatter.

After 3 months, both the girls graduated from speech therapy. All J had left to master were ‘l’ and ‘r’, and the speech therapist didn’t think those needed to be rushed. M had a lisp to work on too, but we were comfortable with the exercises she needed to do at home to help with that. We should keep an eye on the girls, she told us, and consider revisiting a speech therapist if they didn’t appear to be making any headway after a while.

My husband and I think that we’ve given it long enough, and both girls’ ‘r’s are still very baby-like. At this point, speech evaluations are often conducted through the school district, so we need to ask both their classroom teachers what they think of their speech before we go hunting for yet another speech therapist.

If you’re curious about what precisely goes on in a speech therapist’s office, feel free to peruse the detailed tales of feeding therapy and speech therapy sessions on my personal blog.

Sadia and her 5-year-old girls, M and J, do their talking, lisps and all, in El Paso, TX, much to the exhaustion of her soldier husband. They try not to talk while eating, but it’s tough when there’s so much to say. They are happy to report that chewing challenges are no longer to blame for the length of conversations around the dinner table.

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But they're the same age, so they should be doing the same things

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Categories Development, Identical, Parenting Twins, ToddlersTags , , , 12 Comments

When you have two (or more) babies who are the same age, it can be hard not to compare them.  For the first 9 months of their lives our girls were very similar in temperament.  There were a few differences, but generally the behaved very much alike.  And, just when we thought we had a way to tell them apart like one was more active than the other or one slept more than the other, they would switch.

Around 9 months, one of our girls figured out how to move.  Slowly at first, then faster and more deliberately.  It took almost two months before her sister started moving; she was content to stay in one place.  I didn’t really consider this difference in their desire to move – I don’t think it had to do with ability as much as motivation – as a problem.

At their one year check up, the pediatrician mentioned that both girls seemed to be on the slower end of the developmental spectrum for gross motor skills (standing, walking, etc).  He said he wasn’t concerned because all children develop at their own speed, but he wanted to see them again in 3 months to follow up. Again, I wasn’t too concerned.  Their big brother didn’t start walking until 16 months.

Since that appointment about 6 weeks ago, one of the girls (the first to move) has become much more active. She can roll over, get from lying down to sitting, pulls herself up to standing, sits down from standing and walks holding on to furniture or a hand.  She’s clearly getting more active, and I’m sure she’ll be where the pediatrician expects her to be by the next appointment.

Her sister is learning things more slowly. Just this week, she figured out how to go from lying down to sitting.  She’ll stand leaning on the furniture, if you can get her in position. When she’s had enough, she’ll fuss until you sit her back down.  I’m not as confident she’ll have achieved the milestones as soon.

It is hard to look at both girls and not compare them.  It takes patience to help them both at their own pace, to celebrate their achievements as they come. But I try to remember that a year from now being a few weeks apart in learning to stand up won’t really matter.  One isn’t ahead and one isn’t behind; they are both learning as they are ready. This is a lesson we’ll all have to keep learning. And the sooner I learn it, the more I can help them and support them as they grow. I’m sure they will face people who expect them to have the same abilities and interests, and that’s when they’ll need to count on their family to affirm they are each unique and valuable as individuals so they can help other realize it too.

How do you encourage your multiples when they are learning at different speeds?  Do you have any ways to remind yourself not to compare them?

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