How Old is Hallie?

Lilypie Fifth Birthday tickers

How Old is Lea?

Lilypie Second Birthday tickers

Saturday, June 11, 2011

Friends on Steps

Last night we ate dinner with our friends Uri, Shira, and Eran.  Eran goes to school with Hallie and Lea and is approximately halfway between our two girls, age wise (he's about 3.5).  Eran made a very strong first impression on the kids:  from the moment he started school at the YCCA this fall, we've been hearing about him.  Hence we felt very happy/lucky to have begun to make good friends with him and his family this past winter. 

Anyway, we were over at their house last night for a very fine dinner composed mostly of their yummy and fresh CSA (farm share) produce. 

The kids had a great time wrestling around like bear cubs (Hallie insisted that we bring her pink pop up princess castle and it was a real hit with Eran, as she predicted).  They tore the place apart as only they can do (Uri and Shira insisted that most of the mess was Eran's and predated our visit but I've met our kids before and have seen their amazing handiwork, particularly in relatively new environments replete with unfamiliar toys that must.all.be.explored.at.ONCE!). 

We also inaugurated Hallie's birthday season, which began at school with mini cups of Haagen-Dazs ice cream and party hats for the Rainbows (Hallie's group at school).  All of the kids were still wearing them and talking about the ice cream when I got there at pick up time.  Sadly, no one took pictures of this, but Hallie declaimed it, and the ice cream, to be the favorite part of her day yesterday. 

Then, after a nice healthy dinner, we got out a small ice cream cake (half chocolate for Hallie and half vanilla for Eran, who despises chocolate) and sang and blew out candles again.  Hallie was very pleased, to say the least.  And she can now blow out five candles quite quickly, completely unassisted (this is a major change for her).  Being the really dreadful parents that we are, we have no pictures of this, either.

I might put some candles in Hallie's toast this morning.  Perhaps I can get pictures of that!

Memorial Day Weekend

We spent Memorial Day weekend hanging out with our friends Sheila, Brett, and Alex.

First, we took in the school carnival.  Hallie and Alex were thrilled to go on some pretty grown up rides without adult companionship.  Here they are getting ready to be swung wildly:

Brett did have to accompany them on their spin on the tornado:


And, likewise, Brett was there for the ride on the "Scrambler."  This only makes sense since, as you will note, we cannot even see Hallie's face over the bar (though you might be able to make out the hair on the top of her head if you look real closely):

Lea, meanwhile, could only ride on one ride by herself:


Sharon and I took turns taking Lea on the two rides that she could go on while accompanied by an adult (a pretty innocuous dinosaur ride and one other the identity of which now escapes me) but she was far from satisfied by these experiences.  She wanted to do it all, and particularly the fast, scary rides.  Both kids love roller coasters, speed, and height.  I am 100% certain that they do not get this from me (astute observers will note that it was Brett taking them on these rides, whilst I was manning the iPhone camera).

I did manage to sort of deflect Lea's ire at not being able to operate her own bumper car by taking her over to some of the game booths where we could win prizes.  Strategically, we decided to play a game which everyone won.  There's really nothing quite like shelling out six dollars for a dollar store ball to placate a two year old's tantrum. 

Amazingly, I did win Hallie a prize on my first shot a wack-a-mole.  This was not something that I could replicate so yes, of course, we ended up shelling out lots of money for another prize for Lea.

Suffice it to say that the kids had a great time (even with Lea's confinement to solid ground for much of the time) and we have just what we need out of the experience:  more balls and more stuffed creatures to which we must tend.

Anyway, here's a cute shot of all the kids on Alex's front porch: 

And here's one of Lea standing in the green grass.  Doesn't her hair look really red?  During the winter she seemed to be turning into a brunette, but now that she's out in the sun a lot, her red hair has returned.
Anyway, the girls really love spending time with their friend Alex and hope to do it again very soon!

Friday, June 10, 2011

Two Gorgeous Girls

I really enjoy having one-on-one time with each of the kids. This is something that really is only possible when I am done teaching for the semester since our childcare tends to coincide with my teaching schedule; right now the kids go to preschool three days a week and our nanny takes care of them on the fourth day (which is also a therapy-heavy day for Hallie). But having Laura watch the kids on Tuesdays has enabled me to schedule appointments and such of various sorts for one or another kid on Tuesdays and not have to schlep both of them all over the place. So, while the idea of having alone time with each of the kids overlap with appointments might sound a tad bit pathetic (and certainly less obviously fun than alone time spent at a music class or playground or what have you), our kids are used to attending lots of appointments for all of the obvious reasons and hence are quite good at refashioning the mundane into something fun.  You can see this very clearly from these pictures:

Here's Hallie on a pizza 'date' with mama after an evaluation at Penn:


And here's Lea hanging out waiting for her new hair-do:



Thursday, June 2, 2011

Making Magic

Lea loves to do "magic" tricks.  Take a look for yourself; isn't she cute?

Thursday, May 26, 2011

Vocal Cord Surgery: The Picture

This was the picture that Hallie's ENT gave us after the surgery yesterday.  What you are looking at is a magnified image of her vocal folds (taken via the camera attached to the scope).  You will note that there is a bubbly area that is white---that's some of the material that Dr. Z injected to 'bulk' Hallie's paralyzed fold (which is on the left--it's the one that looks a bit irritated).




In case you are interested in learning more about normal and abnormal laryngeal function and vocal folds, you can check out this website.

Hallie's voice today is still hoarse but definitely louder than it had been prior to surgery.  It's nice to hear her more easily.  I'll try to capture a video/audio of Hallie reading or something and will post that soon.

Wednesday, May 25, 2011

Surgery Complete!

Hallie was a model patient and cooperated throughout even though she was pretty scared.  The worst part was recovery and getting her IV taken out (can't say that I blame her, really).  But Sharon was there with her as Hallie woke up and that helped a bit.

Hallie's voice sounds a lot louder but is still quite hoarse (think:  loud frog with a touch of laryngitis) but it should even out in tone a bit as the irritation from the intubation and having the scope down her throat. 

We got a very cool picture of the injection site and I'll post that later as soon as we can scan it.

Vocal Cord Surgery Day

Hallie and Sharon were off to CHOP bright and early this morning so that Hallie could be prepped and sedated for her latest round of vocal cord bulking.  At least this time they did not need to be there at 6:00am and instead had a comparatively late arrival time of 7:00.

Even though Hallie would like her big voice back (since whatever benefits of the temporary bulking have long been reversed and it's nearly impossible again to hear the kid), she was quite nervous and scared about the impending surgery.  Over the past few days, we've been discussing it with her in preparation for this morning.  She remembers the last round and we find it much better not to try to spring difficult things upon the kid; introducing things to her via social stories is far preferable. Hallie generally is a model patient and letting her know in advance what is expected of her usually works quite well.

Anyway, we do hope that the surgery proceeds as quickly and smoothly as it did last time.  The worst part is the anesthesia (coming out of it more than the process of sedation).  But the surgery itself is very quick (it took five minutes last time; however, it's quite high tech and involves robot-guided needles attached to cameras that inject the paralyzed vocal cord with an expensive bulking agent.  Dr. K. will guide the robot by watching the action on a computer screen.  It's all pretty amazing stuff and we are lucky to live so close to CHOP, which is one of the few places where this sort of surgery is done.  I think the last surgery, which was just a test using saline, cost something like $15,000.  This one is probably going to be even more expensive.  Thank goodness we have insurance coverage and our insurance isn't giving us a hard time about paying for this surgery).

Anyway, to give you an idea of what Hallie's voice will sound like, I am uploading a couple of videos I took at her last ENT testing.  This was about two and a half months after the last surgery was done and half of the benefits of that surgery had already worn off, but  this should give you some sense of Hallie's vocal quality.  We are hoping that what we are able to hear from her after today's surgery is better than this but bear in mind that the voice you will hear when you listen to these videos is MUCH stronger than her voice was pre-operatively:





I will update later on today to let everyone who reads this know how things went!




Saturday, May 21, 2011

Kids on Couches

The kids spend a lot of time on our couch.  They jump on the couch; they fall asleep on the couch (this used to be a prime napping zone and it's still where Lea falls asleep every night); they stand on the couch looking out the window; they climb onto, tumble over, and hang out behind the couch (where their millions of stuffed plush creatures reside).  While I will not miss the couch (and its mate, the chair) once we so trash them that we really do put them outside to be picked up and/or turned into firewood, I imagine that the kids (and the cat who has ripped up the couch and chair) will lament their absence.

Anyway, here are a few random pictures of the kids on the couch that I took (and never posted) this winter.

Our heat was out in this one.  We have a pesky boiler that we installed new when we bought the house but that has a piece that blows out constantly.  The piece, called a thermal coupler, costs about $3.00.  The heating repair folks charge $300.00 to replace it.  Sharon has learned how to do it herself and has saved us about $2990.00 over the past ten years.  But sometimes it takes a day or two to track down the right part when we run out of the stash we maintain, so the kids were huddled up in blankets on the couch while Sharon hunted down the correct piece.  They looked awfully cute when doing so.

In this picture, Lea is pretending to be a dragon.  She makes an awfully cute dragon, but I am not sure why the blanket's makers decided that dragons are orange.


And here Lea has fallen over, fast asleep after a session of jumping on the couch. 

Discharged!

This week, Hallie was discharged for the very first time by one of the specialists whom she sees at CHOP.

When we got home from the NICU 4.5 years ago, we immediately set up appointments with pulmonology, gastroenterology, otolaryngology, and ophthalmology.  Over the years, we've added orthopedics and developmental pediatrics.  And we've always considered ourselves lucky because we have never needed to see a cardiologist, neurologist, nephrologist, and a bunch of other folks whom I am sure are very knowledgeable, personable, and at the top of their fields but whom I prefer not to get to know up close and personal.

Anyway, we see most of the aforementioned specialists twice a year, which is about an average schedule for a former micropreemie, though there were times that we had to go in to GI or Pulmonology three or four times a year when Hallie was going through particularly rough spots.

This past year, we ended up needing to see Ophthalmology an extra time because one of Hallie's OTs (there's been a lot of turnover at both the private practice and school-based agencies that see her) thought that Hallie wasn't tracking properly.  We had also begun to note a pronounced squint and facial tic developing and were pretty concerned.  Hallie had developed advanced Retinopathy of Prematurity (ROP)  (she was at Stage 3, Zone 3, with Plus Disease, which means that the blood vessels behind her retina were severely abnormal and she was getting close to the point where her retina could have detached).  Things were so bad that the mobile CHOP Ophthalmological team had scheduled her for bedside laser surgery.  They checked her out the night before surgery (they'd come into the NICU with their crazy headgear, dilate the babies' eyes, and check them out.  This all would have been super cool were my kid's eyesight not at stake).  And lo and behold, the ROP began to resolve.  They continued to check on her every few days, and then every week, for the next eight or ten weeks (we had weekly appointments at CHOP to see the eye specialists after discharge).  But things were looking good.

Still, Hallie's eye doctor warned us that it was extremely likely that Hallie would require glasses by the time she reached school age.   Pretty much all kids who have the laser surgery do, but most kids who develop such severe ROP require them as well.  We could live with this (I am extraordinarily  near-sighted and while I would prefer to see well, or even better, and while this has affected my peripheral and night vision even more than my daytime vision, between glasses and contact lenses and possible corrective surgery, there are fairly easy measures that one can take to rectify poor eyesight).


Anyway, we were all geared up for this to be the year that Hallie would need glasses.  Instead, Dr. D. cheerfully discharged Hallie:  as it turns out, Hallie sees 20/30 in her left eye and 20/40 in her right.  She is at no more risk than anyone else for needing glasses and while we are welcome to come back any time (which we will if we think she does need glasses; why go to Pearle Vision when you have the fabulous CHOP docs right in your 'hood?), we need not make a follow up appointment for Hallie ever again.  At all.


That does not mean, however, that we will not be seeing the lovely Dr. D. in six months.  As it turns out, she would like to follow up with us for Lea.  At Lea's two year well-baby check up (the same one that turned into a check-up for a raging double ear infection), our ped. noted that light was reflecting off of her cornea unevenly.  This could be a sign of strabismus, where eyes do not look at an object at the same time.  So he wanted us to check this out, and as it turns out, Dr. D. is an expert in both ROP and strabismus.  She does not feel that Lea has it (instead, she thinks she's got a condition appropriately called pseudostrabismus).  But, since strabismus is a fairly serious condition that can lead to permanent vision loss and requires treatment, she wants to see Lea in six months to be sure that her diagnosis is correct.  So we'll be back at CHOP Ophthalmology in the fall.


Meanwhile, just a note about how good the kids were at the eye doctor:  We got into the exam room and Hallie immediately sat down in the examination chair (she's sort of an expert patient, which makes things really easy for us, but is a bit sad when you think about why this is the case).  When the assistant (maybe a fellow?) came in to do a basic examination before Dr. D. saw Hallie and Lea, Hallie said to her: "Hi Dr. D.!"  The assistant told her that her name was Samantha, so Hallie said, "Hi Samantha!  Do you want to see my books?  This one (pointing to a Dora book) is my favorite, and this one over here (pointing to Danny and the Dinosaur) was mommy's favorite when she was little!"  This is a major indicator of how far Hallie's social skills have come this year.  A year ago (two months ago, even), she'd never have been so personable, and would certainly not have initiated conversation in this manner.


Hallie happily read the eye chart for Samantha.  Then she greeted Dr. D. warmly and chatted with her.

When it was time for Lea to read the eye chart, Hallie asked if Lea could sit on her lap.  We put Lea on Hallie's lap and had her attempt to decode the shapes on the screen.  Since Hallie was reading the eye chart with letters at 18 months, Dr. D. wanted to try Lea with the letter chart, but that was a no go.  Everything except for the letter "O" was a "K" and this was not helpful.  So we resorted to a shape chart, but even this was hard for Lea, who predictably identified circles correctly but mixed up squares and triangles.  So we gave Hallie a card with the various shapes on them to hold and asked Lea to point to the correct analogy to what she saw on the screen. 

In the old days, Hallie would have just shouted out the answers (she is a bit of a know it all who in the past has demonstrated limited self-restraint).  But Hallie listened to our directions to allow Lea to do the work, controlled herself admirably, and held up the chart so that Lea could point to things on her own.  I was so proud of her.


Anyway, even with the tiny meltdown that the eyedrops induced (telling kids that they are "magic drops" does not, in fact, make them any more acceptable or less uncomfortable), the kids were fabulous and the appointment could not have gone smoother.


Next up:  vocal cord surgery for Hallie on Wednesday.  We are sort of excited about this because her voice has gotten pretty weak again and I know that she wants her big voice back.  So wish us luck.  We are pretty old hat at the anesthesia-and-surgery-thing but still it kind of stinks that we have to keep doing this.

Friday, May 20, 2011

The One Where We Forgot to Blog about the Second Child's Second Birthday





The good news is that Lea is a few weeks away from being 2.5 years old.  The bad news is that her moms, in their constant state of being harried parents who are finding it increasingly challenging to juggle parenting, two full time jobs, the great search for an appropriate kindergarten, and general household duties like folding laundry, taking out trash, and changing yet another failing garbage disposal, have somehow neglected to blog about their second kid's second birthday.  It's a pathetic truism that there are fewer pictures of the second child than the first, but this seems less motivated by intentional neglect than the exponential speeding up of time that ensues when one is chasing two kids in two different directions and still attempting to remain centered.  Whatever that might mean.

So in the spirit of attempting to rectify this situation, I present you with a brief (and I mean brief) pictorial timeline of the week long celebration of Lea that occurred at the end of January.

Behold the Cookie Monster cupcakes:


These were very much a collaborative endeavor.  Lea was really into a cookie monster phase (which we find interesting and a bit odd considering that the kid does not watch Sesame Street at all.  Instead, she favors her sister's 'shows' -- this is what Hallie calls them.  So Lea's viewing tastes run in the direction of Ni Hao, Kai Lan! and Dora the Explorer, which Hallie is only beginning to sort of outgrow).  Anyway, Lea loved/loves Cookie and we decided to make her these cupcakes.

A few observations about cupcake making:

1.  Do yourself a favor.  If you are going to make 36 or 63 or 122 cupcakes to bring in to preschool, buy a mix.  Duncan Hines has some great ones.  This runs counter to everything in which I firmly believe (apparently, my mom's lessons about baking from scratch sunk in completely despite the fact that she rarely let me actually help in the kitchen and tried to pass off doing the dishes--which she abhorred--as a glamorous component of baking).  But cupcakes are a major pain in the butt; kids like things sweet, and no one eats them anyway.  So just buy a few boxes.

2.  Don't be afraid of taking this task on.  After all, someone else can do the actual decorating.  Preferably someone else like Sharon, who is, after all, an architect who is meticulous and detail oriented.  So, really, all you have to do is buy the materials.  A couple of trips to Wegmans, finding a nice recipe for frosting on the internet, and a couple of emergency trips in medias re to the grocery store to procure yet some more confectioners' sugar and you are set.

3.  Be tolerant of sweets.  The whole house smelled like powdered sugar for a several days running.  Cooking dinners that involved the consumption of lots of garlic helped restore the olfactory pH of the place by the end of the week.

4.  Buy an awesome cupcake carrier.  Buy this one. Ours is an oh-so-fashionable lemongrass and really works.  But don't plan on balancing it on top of your double stroller.  This is impossible to do once it is filled with 36 cupcakes and is still not advised when empty.  

5.  Plan on showing up at school for the event, even if you need to be at work.  Attempts to get teachers to both take and send you pictures often prove futile. 

Anyway, this explains why we have no pictures of Lea blowing out her candles at school, but we are assured everyone had a great time.  No one seems to have suffered in a long lasting way from sugar shock, either.

Of course, we were not satisfied by the notion of just having a school party (especially since neither of us were able to attend).  It's kind of hard to figure out what to do to celebrate a two year old's second birthday when said birthday takes place at midwinter.  Fortunately, we are blessed with kids who love to see shows and who are excellent audience members.  We are also extraordinarily lucky to be living in the middle of a city that has a lot of cultural offerings for kids, many of which are quite reasonably priced.  So after some major research, we decided to take Lea and a few of her/our friends to see a matinee of Harry the Dirty Dog:  The Play,  which was being produced at the oldest theater in the United States, the Walnut Street Theater.

Given that we needed a whole bunch of tickets and got a comparatively late start on things, we ended up with nose-bleed seats.   No one's nose actually bled (though there was some running here and there) and we all had a good time despite this.

The kids got all dolled up for the production:









After the theater, we came back to our place for some snacks, followed by cake.

The theme of the day was dog (though we did not serve hot dogs.  At that point Lea did not eat hot dogs, so that would have been a poor choice).

Instead, we went with Snoopy and a Peanuts theme:



This time we outsourced the decorating to Wegman's.  We drew a mock up of the cake and purchased all sorts of plastic/PVC figures to place on the cake ourselves (since apparently Snoopy/Peanuts designs have fallen out of favor and have been supplanted by the likes of Dora, Diego, Elmo, Disney Princesses, etc.  We are finding that the same is true of Puff the Magic Dragon, who is the guest of honor of Hallie's upcoming 5th birthday celebration).

Anyway, Lea thought her cake was grand (and so did everyone else.  Wegman's does mighty tasty cakes for a mere $26.00 for a half sheet.  We highly recommend them). 

 


Here's a picture of Gina, Jake's mom, with Lea:

The girls loved the Mickey Mouse ears that they got from Aunt Laura, Uncle Bryan, and the kids (not a birthday present, but a souvenir from the cousins' Christmas/New Years trip to Disneyworld).  And everyone really enjoyed (and still enjoys) the awesome keyboard that Jake and Gina gave Lea for her birthday:


As the day wound down, Hallie was able to have some quality time with her sister (which she devoted to giving Lea some raspberries--still a favorite activity of our belly-button obsessed two year old).


And, since we have the benefit of some hindsight here, suffice it to say that being two has proven to be a grand thing for Lea:  she is much more self-sufficient (don't even try to help her get dressed in the morning!), capable (she can count to twenty, sings the lyrics of numerous official songs and makes up many of her song lyrics and melodies), and dramatic (despite her incredibly advanced language skills, she knows how to use the well placed whine and shriek in her favor, sadly enough).  She is also a great younger sister and has a wonderful relationship with Hallie and a great pet mom who is always looking out for her cat Zen (and making impassioned pleas for why we need to get a dog sooner rather than later).

We are thrilled to have Lea in our lives and happy to celebrate everything about her and with her, even when we do neglect to blog about it for a good four months!  So happy belated second, not so little one!

Sunday, May 8, 2011

Mothers' Day 2011

Pink flowers (2 kinds, no less)?  Check
Pink paper?  Check.
Pink princess?  Check.
Mommy returning home from three-days away on West Coast?  Check.

Happy Mothers' Day, 2011!  Check, Check!

Tuesday, April 26, 2011

Baby!


Lea loves her baby dolls, and one in particular, whom she has (appropriately, if unimaginatively) named "Baby."  Baby accompanies Lea on most of her journeys, including ones to school.  Keeping track of Baby is something that we do a lot of around here.  Naturally, we have applied one of our many Mabel's Labels to Baby's tush tag so that she doesn't blend in with the crowd of other naked baby dolls who reside at the YCCA.  (Apparently it is a lot easier for the kids to identify Baby than it is for us adults; Hallie and Lea frequently correct us when we hand Lea her second-favorite naked doll, who is named CoCo, when she's requested Baby). But sometimes we forget whether Lea has brought Baby with her to school and this can lead to all sorts of problems.  In one harrowing incident,  our nanny only discovered that Baby had gone missing once she had gotten the kids home from school.  Fortunately, she figured this out before the school had closed for the night and walked back the eight or nine blocks with Hallie and Lea to retrieve Baby.


Otherwise, Lea's face might have looked a lot like this (apparently this melt down had nothing to do with Baby's absence and probably instead was related to one of us telling Lea, "NO!," which is not one of her favorite words.


Lea is a fabulous mama to her babies, as you can see from this very cute but admittedly somewhat long YouTube video:





But I digress from the subject at hand:

On Sunday, Hallie, Lea, and I went out for a stroll in the stroller. Naturally, Baby came along with us. Lea, who fought naps all week during her Spring Break, really needed a rest and was asleep, clutching Baby, within seconds of hitting the stroller. Several people oohed and ahed over how cute she looked, with her arms wrapped around Baby.

We managed to go to the store and return home (with Hallie walking alongside the stroller most of the way, so we were going none too quickly) and Lea remained fast asleep. I did not monitor Baby's whereabouts.

After she awoke, Lea was refreshed and played raucously. We had a grand old time tossing balls; playing baseball with a drum stick and superball; dancing; bouncing on the chair and sofa; and all sorts of other fun stuff like that. Until bedtime. When Lea requested Baby.

I had no idea where Baby was. I had no idea what Baby's brand was, either. All I know is that I, and then Sharon and I, tossed the house upside down to locate baby. We were having a Knufflebunny moment.  There is a reason why Mo Willems has subtitled the book, "A Cautionary Tale."  We were clearly not nearly cautious enough.

Fortunately, Baby turned up in the heap of stuffed creatures that reside behind our couch.  And fortunately I pinned down her origin and identity.  I have a substitute 2006 Fisher Price Little Mommy, complete with snaggle toothed smile, on its way from Ebay.  I am dubious whether Lea would fall for the old switcheroo, but at least we're trying to avoid major childhood trauma.  And in the meantime, I'm investigating whether we can install a microchip into a plastic-and-soft-bodied Baby.

Saturday, April 23, 2011

Playtime Progress and Kindergarten Angst

There are several major picture posts that chronicle the past five months (!!!) of our kids' lives in preparation (as in:  I finally managed to download pics and videos to my computer and will at some point soon organize them).  But in the meantime, you will just have to put up with my random thoughts about current events/developments and our upcoming educational endeavors/stressors.

Hallie has made truly amazing progress over the past year, and especially over the past three months.  Here are a few of the great things that are happening for her developmentally:

1.  Pretend Play:  A year ago, Hallie's pretend play skills were at best rudimentary.   At most, she acted out scripted routines that were familiar (so she did things like re-enact fairy tales like the "Three Little Pigs" or "Goldilocks and the Three Bears").  While Hallie still enjoys a good fairy tale or classic story (in addition to the aforementioned, "Jack and the Beanstalk," "Peter Pan" and lots of lots of stories related to princesses are a big draw for her), Hallie has developed the skills she needs to develop her own stories, put on plays, etc.
And since dressing up is so much fun, the entire family has decided to get in on it.  Here's a picture from a Purim party that we attended at the home of Eran, who is one of the girls' school buddies and regular playdaters, and another cute one of "Peter Pan" smiling (since Lea was looking away or frowning in all of the group shots we took).



Back to Hallie:  She's not just doing pretend play with her body and a bunch of costumes but also with small figures (people, animals, etc).  In the old days, Hallie used to line up her toys or perhaps arrange them in some activity (so they might all be lining up to get on the school bus, or surrounding the TV watching a show, or something of that nature).

The configurations and arrangements were extremely precise and she was none too pleased if you disturbed them. 


These days, Hallie's play skills have moved so far beyond this stage.  She's now having the little figures talk, walk, interact with one another, and act out realistic scenarios.  From my eavesdropping in on her play, it's clear that she's playing out the scenarios that matter to her and her life in the process.  Her little figures are having trouble sharing their toys, but when one does decide to share with another, a third will chime in with praise.  If they don't share, the characters might have angry words with one another and they sometimes end up in time out (she has threatened her doll house baby, who may be named "Bunny" and the little girl who inhabits the same structure with banishment to the High Chair (the unfortunate location of her own time outs now that she no longer eats in one) for misbehaving or having accidents.   Her little people go to school, play in playgrounds, go swimming and have a nicely well rounded existence.  Just like Hallie's.

Hallie initiates a lot of this play and doesn't just follow along with others when they are playing in this way.  The other night, Hallie got out the pretend food, took orders from us, and she and Lea served up slices of cake ("gumdrops or strawberries?"), pizza (She had a few slices of plain but was happy to accommodate our request for pepperoni, mushroom, or spicy--which is how she thought of the pepper rings).  She was also very happy to make us triple-decker sandwiches if we were not in the mood for pizza.

Interestingly (and not at all surprising, really), our play space (which still remains cluttered despite repeated attempts at culling and organizing toys) is not nearly as much of a disaster zone anymore.  Less stuff comes out and that which is on the ground experiences more intense, robust play.  And both kids seem much more able and willing to help clean up when they are done.

What's nice is that Hallie is testing out all sorts of emotions in this play.  It used to be that there were no badly behaved or angry characters; the big bad wolf would quickly be recuperated into a positive figure by Little Red Riding Hood or the Three Pigs or whoever because any other alternative seemed too dangerous to Hallie to be tenable.   Now Hallie explores the dark side; there are fire-breathing dragons and scary monsters along with all the helpful snakes and friendly dinosaurs.   Characters can have trouble sharing or get into conflicts and Hallie can devise strategies to resolve problems.  All of this suggests that Hallie is filling in of some of the pieces that had been developmentally missing (or misplaced).  We credit Floortime/DIR with a lot of this progress.  Hallie and her therapist (and Sharon, who takes Hallie to Floortime) have been working with Hallie on exploring and figuring out how to handle uncomfortable, scary, and difficult emotions.  Hallie's progress has gotten even quicker now that she's been attending structured play dates with peers (her psychologist hosts these three times a month) in addition to her regular weekly Floortime session, we've seen amazing things happen vis-a-vis Hallie's play skills.

Hallie isn't just doing all of this stuff at home; she is also initiating play with her peers much more consistently at school.  Her conversations with peers are still more rudimentary than typical 4.5 year old kids but she has branched significantly beyond the social greeting stage.  And she's no longer just playing intensely physical games (lots of running, chasing, duck-duck-goosing sorts of things) with them; now there's more sophisticated, quieter, and smaller-scale play going on.

We saw all of this come together at a play date at our house the other week.  One of the other little girls whom Hallie plays with a lot at school came over for a few hours on Wednesday (my day at home with both kids).  I did little to no hovering or structuring of play.  Rather, Hallie and B. ran upstairs, did some dress up stuff, came down and made puppets and put on a puppet show, and ate lunch (Hallie actually ate more, and more willingly than her friend did, amazingly enough).  At one point Hallie wanted to continue to horse around and chase B., but B. told Hallie that she wanted to do something else.  Instead of letting B. go off and play on her own or act out in some other way, Hallie turned to B. and said, "That's a GREAT idea!  Let's do "x"!" (whatever it was that B. chose to do).   I have to say that I was completely impressed with Hallie and was thrilled that it went so well.  I think that over time the sort of shock (good kind of shock, obviously) that I feel when things go so well will dissipate, but meanwhile, it's nice to have such pleasant surprises.  They also serve as good reminders to never underestimate Hallie.

2.  Social Skills. These overlap with and go hand-in-hand with Hallie's new found play skills.  Indeed, I am now a firm believer in why play is such important work for kids:  it's where they get to develop and act out the "stuff" that they need to interact with the human world around them.  Hallie is much more conscious of other people and other peoples' feelings and very quick to help if something is wrong, someone gets hurt, etc.  She also exchanges more language that is directed at 'social niceties' (she's long been a polite kid whose speech is peppered with 'pleases' and 'thank yous' but she has elaborated on this a lot and can hold basic social exchanges (things like--"How are you?" "I feel fine!" type of stuff that is the cement of daily life exchanges).  She also does more 'small talk' with peers and is initiating a lot of it.

Hallie still has some major issues with eye contact and responding when asked a question (even if she hears you, it looks like she is ignoring you).  Since people like to be acknowledged and it can be quite off-putting if the person whom they are addressing doesn't look up at them, says nothing in response to a question (let alone a statement) and sometimes just walks away when being spoken to, I am trying to work with Hallie on just looking up and acknowledging the person who is addressing her.  This is very much a work in progress but I am hoping that I manage to train her to do this by the time kindergarten rolls around.

3.  Academic skills.  These are Hallie's strong point.  I'm not an early childhood specialist by any stretch of the imagination, but it seems to me that Hallie's math skills are pretty age appropriate for a 4.5 year old:  she has long been able to count objects but is beginning to get the notion of addition when provided with a visual aid, knows what halves and wholes are and the like.  She's great at pattern recognition (remember, she was a champion sorter-by-color-and-shape before she was age 2).  I don't think she's a math whiz; she's just keeping up with her peers quite nicely.  And that's perfectly fine with me.

Where Hallie really blows us away is in terms of her ability to read.  We knew a year ago that she had a lot of sight words and could spell them as well as recognize them.  About six months ago we sensed that the words she recognized included many atypical ones (multi-syllabic, long words that are not hugely common).  What has become clear over the past two months is that she is reading fluidly at what I imagine is somewhere around the end of the first grade level.  When she encounters long words, she sounds them out phonically.  She makes educated guesses by filling in syllables in longer words quickly but in cases where she misreads the word, will happily stop and sound out the word and get it right the second time  (so, for example, the other day she encountered the word "character."  She initially read it as "creature" (which made sense from the context of the sentence); I stopped her and told her that this was a good guess but not the correct word.  She looked at the word, sounded it out (understanding intuitively the 'ch' blend) and read it correctly the second time.    Reading in this manner, Hallie has gotten through entire books at one sitting and is equally happy reading the unfamiliar as she is the familiar.

It's clear to us that Hallie understands what she's reading, too.  She does a good job of narrative retelling (even with her pragmatic language delay), happily answers questions about the content of her books (several years of speech therapy will really hone those skills!) and asks us for clarification when something isn't familiar.  She also responds emotionally to books (getting scared when something bad happens, happy when something good happens, etc).

We love it that Hallie will often come home, pick up a recent favorite book, and just start reading.  And apparently she is having a positive influence on Lea, too, who now does the same thing (including narrative retelling of the story based on the pictures she sees; to our knowledge Lea does not yet recognize letters and/or words).

Reading opens up the world and this is a great thing.  Apropos of this, here's a recent funny Hallie story:  For whatever reason, Hallie has always been fond of China.  We suspect a lot of this has to do with Hallie's love of panda bears, on the one hand, and her Nick, Jr. shows on the other (and most specifically Ni Hao, Kai Lan!, courtesy of which she has learned a couple dozen Chinese words as well as a smattering of cultural practices like dumpling eating on Chinese New Year; given that I will buy Hallie any kind of food she requests, she actually had me out purchasing New Years dumplings this year--which she refused to eat, of course.  So her "Chinese" food consumption is sadly still limited to fortune cookies.  Anyway, I digress.)

At school, a couple of months ago the kids were doing a unit on the world and on travel.  One of Hallie's teachers asked the members of the pre-K class where they had been.  Hallie said that she had been to China.  Hallie's teacher and aide checked with us, and we replied that she had not, in fact, been to China.  (Sadly, Hallie is not well traveled; she has been to New York, New Jersey, Ohio, Maryland and Washington, D.C.).


Apparently this was not just a random comment.  Hallie really wants to travel to China.  She is convinced that this is the only place that she can see panda bears (I hate to break it to her but my suggestion of the zoo will probably yield more in the way of panda bear watching than hanging out in Beijing will).  So Hallie was very very thrilled to read the bottom of one of her rubber ducks (we own a vast collection of these) the other day:  Hallie excitedly pointed to the raised letters and said, "Mama!  I got this in CHINA!"  I wasn't quite sure how to break it to her that most of the stuff we own at this point is likely made in China, but I thought that her comment was awfully cute.

Hallie is also doing a much better job in terms of writing and drawing than she used to.  She still has exceedingly weak fingers and this makes grasping a writing implement with a proper tripod grasp very hard work for her.  When she gets tired she'll revert back to bad grasps.  But her tripod is firmer than it used to be and she is drawing letters pretty appropriately (both in terms of how she produces them and in terms of drawing ones that are smaller and more uniform in size).  She loves to write words and has pretty good spelling for a not-quite-five-year-old.  I suspect she'd be writing even more if it weren't such hard work though.

Hallie does have some difficulty copying out images, though.  We need to keep an eye on this.  This first came up at her last Developmental Pediatrics appointment where she was administered the Beery-Buktenica Developmental Test of Visual/Motor Integration. Hallie was able to copy lines and crosses and circles pretty accurately but had much more difficulty copying more complicated shapes and configurations of lines.  She would often get the number of lines correct but not their spatial placement.  This is curious given how strong of a visual learner she is and how acute her visual memory seems to be.   The big question that Sharon and I had was whether this was related to a VMI deficit or her fine motor skill delay.  But it's definitely something we should monitor and address therapeutically if it turns out to be a real issue.

The other concern that we still have in terms of academics is Hallie's issues with attention.  We raised these at our last Developmental Pediatrics visit (which was about a month ago) and right now we are in a wait-and-see mode.  Given how much progress we've seen this year in terms of Hallie's behavior and learning and gap-closing, it seems to make sense to give her time to mature a bit more.  Great social maturity might even out some of the problems we are seeing with attention.  If not, we can take the next step.  Our first recourse would not be medication; not only would this exacerbate her eating issues but it also might make her focus too much on some of the stuff that detracts from her social skills/communication.  There are plenty of strategies for enhancing her attention that we can try before we get to meds (things like providing her with her own copy of a book when teachers are reading out loud to seating her close to the teacher to minimizing classroom distractions etc).

The attention issue is a big one since it really ties into some of our concerns about school.  In the best of all worlds, we would be able to place Hallie in a school that has small class sizes (12-14 would be ideal), a rigorous academic curriculum, and the potential for supports should she need them.  The only problem is that the first two characteristics are ones that you can more or less find at good quality private schools and the last is one that you can find in the public school system (because of the IDEA, which is the law that covers disabled students).  So there's an obvious disconnect here that will be difficult to bridge.

A year ago (or even six months ago), we probably would never have even considered the private school option for Hallie.  Her support needs seemed so great (we were thinking that she'd need intensive speech, OT, possibly PT, definitely a one-on-one aide).  So the only real option seemed to be moving out to one of the better suburbs on the Mainline that has a school system that supports higher functioning kids on the spectrum (or at least support them right now, since these things change and not always for the better).  Both of us are a bit uncomfortable with the notion of leaving the city; there are plenty of negative things about raising kids in an urban environment (no big back yards for swing sets and lack of space more generally, which is probably evident in every picture we take, is the obvious drawback), but there are lots of really good things about raising kids in a big city:  they become more savvy, world-wise, and edgy (in lots of positive ways), are more open to diversity and appreciating difference.  The cultural opportunities in a city are vast (not just formal stuff, like being able to easily and quickly get to the Franklin Institute or Philadelphia Museum of Art, but also informal ones that allow me to 'teach on the street' and use the neighborhood as a classroom).  And even though the suburb we would choose were we to choose a suburb is close to the city (about twenty minutes by commuter train or car from Center City), the honest truth is that we would probably rarely make it in to Philly. 

Anyway, we are not taking a move to the suburbs off the table, but we are beginning to explore other options.  The director of Hallie's kindergarten (who knows Hallie very well and has observed how much she has changed over the two years she has been at the YCCA) thinks that Hallie would be a very good fit for one of the private Quaker schools in Philly and so we will be exploring that option quite seriously.  Other than the staggering cost (we would need financial aid were we to go this route, unless we chose the one Friends school where tuition is accessible to the middle and lower classes), both Sharon and I very much like this idea.  The class sizes are small, the academics are rigorous and highly structured, and Hallie will probably be among other kids whose parents value education and where hopefully she will blend in with other academically advanced but socially awkward kids.  As a professor, I am more than slightly concerned with the ridiculously standardized testing-oriented environment that now prevails in public schools and would like to avoid this if at all humanly possible (not to go too far off on a tangent, but this form of education seems to train children to be seek 'right' answers rather than real problem-solving skills; teaches the creativity and curiosity out of them and replaces it with an emphasis on rote responses; devalues critical reading, thinking and writing; and is a big part of what is wrong with our education system.  Since so much rests on the results of these tests, teachers are no longer able to teach and instead train students to take tests.  See this interesting article for more about what is wrong about the Pennsylvania system).  Private school students are not subject to the same volume of standardized tests as their public school (or charter school) peers and this is a good thing.

So we will check out the private school option for kindergarten.  Since Hallie already reads fluently and is doing age-appropriate math, even if it turns out that she cannot handle a small environment with few supports, we'll learn this early on and at a point where the experiment will not pose a major impediment to her future academic goals.

We will also explore the public school and charter school options in the area.  I have interviews and open house dates set up at several and intend to set up one-on-one meetings with the principals at the schools that seem like good fits for Hallie.  Should we decide that the Friends schools are not for her, or should she not get into one of them, or should we not be able to afford the tuition, we obviously need alternatives.  And it would be nice for her to be able to go to school with some of her friends from preschool (most of the kids with whom she goes to school now live in our neighborhood and will be attending one of the public or charter schools in Center City or Queen Village/Bella Vista.  Alas, we will not send her to the school for which we are zoned for all sorts of reasons so we will have to get an out-of-catchment transfer, which is not an easy thing to do, or win the lottery for a much-coveted slot in a charter school, which is even harder to do).

And, finally, we will be touring the schools in the close-in suburb that I referenced above and interviewing their principals.

Nothing is off the table.  And the one thing that is always on the table around here is the concept of 'paying it forward.'  Sharon and I are quite nervous about the idea (and reality) of private school tuition (and what it will mean in real terms not only for the household budget but also for college savings).  But if there is one thing we've learned in raising Hallie is that it is essential to pay it forward.  The fact that we've been doing an enormous amount of work with her now -- all of the therapies, all of the over-scheduling, etc -- has really paid off.   Floortime emphasizes a developmental approach; the whole principle behind it is that one must build a strong foundation before moving on to higher intellectual and academic skills.  (Here is a very eloquent formulation of the Floortime/DIR philosophy).

I think these ideas could be generalized quite nicely to the K-12 setting; building a solid academic foundation (paying it forward in school) will enable Hallie to learn anywhere (well, almost anywhere).  It will instill in our kids a life-long love of learning, foster their intellectual curiosity, and give them the critical skills that will enable them to take charge of their education (something that is sadly missing among many of the college students whom I encounter; this is very disturbing to me.  When I started teaching 15 years ago, many more of my students possessed much more in the way of intellectual curiosity than my current students.  And it's not that my students today are worse, in objective terms--whatever those may be--than the ones I had back in the day.  If anything, their test scores are often higher than those of their predecessors.  It's just that they don't appear to be learning as much in high school as they used to.)

Anyway, even if we have an idea of what we want, whether we will find it for Hallie (and Lea, down the road) remains a huge question mark.  And this keeps me up at night a lot right now.  And if this is how I feel about kindergarten, how bad is it going to be when our kids are ready to apply to college?  I can't even think about that right now!

Friday, April 1, 2011

Let's Play Ball!


Sharon and I are headed out to Citizen's Bank Park on this wet and snowy (yes, we did have some flakes earlier) April Fools day for Opening Day of the 2011 season (tickets to this game and five others were my Valentine's Day gift from Sharon this year.  Thanks, Sweetie!).

The kids are all decked out in their Phillies gear (their preschool was awash in shades of red and pinstripe) and very excited about it, too.  So in honor of the Phillies, I thought I'd break my blog silence and post this picture (alas they are not both looking at the camera, but I think we may have a decent Flip Video to upload later).

Let's go Phillies, and may the rain, rain go away and pretty much not bother coming back for a while!

Saturday, February 5, 2011

Insight into Hallie's Mind

Having found her voice (or having been given a new, temporary one by the wonderful ENTs at CHOP), Hallie has turned into a chatterbox lately.  We love it.  She still has conversational skills that are well behind those of her peers, but she's making progress and we are so grateful for this and I think that Sharon and I know that there is no going back--we need to make sure that Hallie keeps her voice.

Anyway, since Hallie is talking more, she is also providing us with greater insight into how she thinks about the world.  She had the following conversation with Sharon last night which is interesting on a couple of different levels:

Setting:  Sharon came home late from work last night after running a couple of errands related to our little family party for Lea today. So there had been no time for dinner (and I suspect that Sharon did not have much time for lunch, either, since she was catching up on work having spent the prior two days dealing with doctors visits, sick kids, lost car keys that led to a major crisis that was ultimately resolved when we discovered that Lea had hidden the car keys in our nanny's mitten, and a bunch of other fun stuff like that).  So Sharon was starving and her stomach began to growl a lot as she was reading Hallie her stories before bed.

Hallie looked over at Sharon sympathetically and said:  "Mommy, you have a tummy ache!  Don't worry mommy, I will get you some water and you will feel all better!"

Hallie proceeded to get out of bed, run over to the bathroom, climb up and get down a dixie cup and fill it with water, bring it over to Sharon and ask her to drink it.  Sharon, of course, complied.

Hallie, satisfied, declaimed:  "There you go mommy!  You will feel all better.  You won't have a tummy ache anymore."

This was such an interesting conversation.  First, it shows how empathetic Hallie is.  She notices when others are in need and she really tries to help them.  She is constantly getting things for Lea (and Lea, having learned at the feet of the master, reciprocates by getting stuff for Hallie all the time.  This of course does not prevent them from having knock down, drag out fights over stuff just like any other healthy sibling dyad).  And she uses her own experience to try to figure out how to help others, which makes perfect sense (though down the road I suspect that we will need to work with her on that ever important theory of mind issue to help her figure out that others might want something different from what she desires).

But this was really interesting on another level:  it is clear that, when Hallie says that her stomach hurts, she means (or at least sometimes means) that she feels hungry.  But she has no idea that this is what is going on with her body.   It may also be clear now why it is that she constantly requests water.  She drinks tons of water, all day long.  This is a great thing for her body in general, but not a great way to satiate hunger.

One interesting thing that lately has struck me about autism, or at least Hallie's version of it, is that the communication deficit that is so central to this condition is not just related to communication with the outside world.  Rather, Hallie has trouble communicating with herself.  And if you cannot interpret the signals that your own body is sending you, of course you are going to have problems communicating with others and interpreting their body language, right?  This may be why professionals have noticed that sensory integration problems are prevalent in autism.

Anyway, while all of this is extremely interesting from an intellectual standpoint, what I want to know is how to help Hallie make those connections so that she can feed her hunger appropriately.   Conventional feeding therapy doesn't really do the trick (and it's certainly not going to teach her how to interpret hunger.  It  kind of does the opposite).  If anyone has any ideas about how to do this, please let me know!