My last post discussed a little about the feelings parents may have if they or someone they know is concerned about a child’s development, and their feelings about Early Intervention. Today, I want to talk about what happens once you are referred to EI, and your child is eligible for services.

Once there is a referral to EI, parents are contacted to get information and then schedule an intake and evaluation. The intake is an interview with parents to get background information about the child. This involves one person coming to your home, and a lot of paperwork. The evaluation team consists of 2-3 professionals, all with different roles (often there will be an educator, a physical therapist and a speech therapist). The evaluation tool is the same for every child. The team will bring a bag of toys, specific to the test being given. Tasks will be presented, and there are “rules” about how things are presented, and what can and cannot be said or done. The team will continue to present items until it is clear that they can determine at what age-level the child is performing.

Sometimes the intake and evaluation are done at the same time. Personally, I prefer two separate visits so that parents are able to be there to watch the evaluation without being busy with the interview and paperwork.

Once the evaluation is done, the team will give you feedback immediately, and will then be able to tell you if your child is eligible for services. If eligible, the next visit will be to write a plan with goals for the next six months. Parents are involved in this plan and establish goals that are realistic and applicable to their family and child. This plan will also identify who will visit (what type of profession), and how often and where visits will occur. EI focuses on services occurring in the child’s natural environments; so at home, daycare, grandparents home, playgrounds or stores. Each case is specific and different. Some families are only in need of services monthly by one provider, while others need visits from several providers several times a week. It depends on the needs of the family and the child. Some children also need other specialized services for Autism Spectrum Disorders, or visual and hearing issues. These services are contacted by EI and coordinated by the EI Agency.

Typically, when your service providers visit, they will bring toys and activities to target the needs of your child. Sometimes they will go to a park or playground, again to target the needs and goals of your child. Parents are informed and included in visits, and given a note at the end of the visit, the whole visit lasting about an hour.

Every six months, there will be another evaluation to look for progress and to reevaluate the goals and plan.

As a nurse, please remember that if you or your child is sick, it would be best to cancel a visit. EI staff is in contact with lots of families, and try very hard to stay healthy so as not to spread illnesses. On this same note, EI staff wash their toys after all visits to be sure that little ones don’t share their germs!

In my future posts about development and EI, I will talk about speech concerns, sensory difficulties, feeding issues and why skipping over, or missing, some areas of development is sometimes of concern (why it is not always so advanced to go straight to walking without first crawling).

Every year, Save the Children releases a report on the state of the world’s mothers. Since Mother’s Day was just on Sunday, I wanted to share some findings from their most recent report, which ranks 165 countries for the best and worst places to be a mother based on health, education and economic conditions. This year’s report focuses on nutrition during a child’s first 1,000 days of life. While the United States jumped from #31 to #25 in 2012 among the world’s best countries to be a mother—and  we arguably have a very high quality of life here compared to many other nations—I found some very disappointing statistics on the state of American motherhood.

• Among 36 industrialized countries, the United States ranked last, having “the least favorable environment” for breastfeeding mothers. Save the Children looked at maternity leave policies, laws regarding nursing breaks at work, among other indicators. I find this depressing, but not entirely surprising given that breastfeeding rates are so low. Furthermore, I think that media coverage, like Time’s recent cover photo showing an atypical nursing scenario, doesn’t really help to increase awareness or support for breastfeeding (no judgment here, if this works for them). In 2011, about 24 percent of mothers breastfed for an entire year, which I’ve written about before. Therefore, those making it to 3 years, as shown on this photo, comprise a small percentage of mothers. On its website, Time has also published what I consider a more important story and representative photo of a nursing mother, but apparently it’s not provocative enough for the cover.

• The United States is the only developed country that doesn’t have any laws requiring some form of paid maternity leave. This report indicates that among developed nations, paid maternity leave can range from 12 to 46 weeks, and mothers during their leave receive pay ranging between 55 to 100 percent of their regular salary. Without federal policies for paid maternity leave in the United States, even if an employer allows new mothers to take a long unpaid leave, mothers may not be able to afford it. This lack of paid maternity leave also creates inequitable access among mothers who want to stay home and care for their new baby. Mothers who can afford unpaid leave have the opportunity to stay home. Mothers who can’t afford unpaid leave must return to work sooner and potentially before they’re ready.

  Plus, all this has a connection to breastfeeding. It’s easier to nurse your baby longer, if you’re home on a longer maternity leave. If longer maternity leaves encourage higher breastfeeding rates, and if mothers take longer maternity leaves when countries have paid maternity leave policies, then the solution seems obvious if we want to increase these rates (and there’s some data out there to back this up)

• In terms of maternal mortality rates and mortality rates of children under 5 years of age, the United States also has disappointing results. Among developed countries, the United States has the highest maternal mortality rates—mothers face a 1 in 2,100 risk of death due to a pregnancy-related cause. For children under the age of 5, the mortality rate in the United States is worse than 40 other developed countries—8 per 1,000 births. Why isn’t THIS on the cover of Time?

Mothers and children in the United States have opportunities and access to education and health care far greater than mothers in those countries falling at the bottom of Save the Children’s list of rankings—Niger, Yemen and Afghanistan. While I’m encouraged to see the United States raising its position among the rankings, we still have a lot more to do, as shown by the disappointing findings highlighted above. Let’s all think of how we can help in our own neighborhoods, the Merrimack Valley and beyond to support mothers and children. Whether it’s writing your elected officials, donating time and money to a charity, or just giving a nursing mom a glass of water, there’s something you can do. We’ve got it good here, but it could be so much better.

We  usually don’t talk about family business, especially if we are in a fragile state. Sometimes I think it’s because we have a lot of pride. Other times I think it makes us vulnerable. In any case, not talking about things just kept us at a stand still. And that was okay for a while. We needed time to be still and recover, not only from a family crisis but also from financial disaster.

Years ago my husband and I were looking at houses and found one way out in the country. It was slightly higher than we could afford, but boy was it beautiful. Set on two acres of land bordering N.H., a pond full of ducks and more firewood than dear hubby could ever burn in a lifetime. It had a shop (perfect for my sewing studio), a long driveway and an old picket fence. The farmer’s porch had two wooden swings and it was simply charming.

We moved in, filled our house with brand new furniture from the savings we had and hosted many cookouts that fall!

Two months later we learned our little boy had Neurofibromatosis. A progressive disorder that causes tumors to grow anywhere, at anytime.

From that very moment, nothing seemed to matter anymore. We had three teenage daughters that were devastated and scared. It was a frightening time for everyone. The next three years went by in a whirlwind.

And when things seemed stable, our mortgage went up nearly $500.00.

It was an adjustable rate mortgage that couldn’t have adjusted at a worse time. We decided to put the house up for sale and move back home. We packed up the house and took whatever would fit in our new two bedroom apartment and left everything else behind. My daughter went away for her first year of college and it was our new beginning.

Even though we lost our house, we were peaceful. We were in a much more affordable situation and it was a good place to be. We have been back here three years, and just recently we’ve started to talk about everything and are moving forward.

We learned so many IMPORTANT things:

Never get into a situation that is not comfortably affordable (not even if you’re certain things will change for the better).

Always keep a savings or reserve account if possible for unexpected expenses (we’re still working on that one).

Get involved in community service.

We are just learning that there are so many programs that can help families rebuild and rebound. You just have to be willing to put a lot of time and effort into it! We are attending financial counseling and hope to buy a house again someday. This one will not already have the porch swings and pond, but with enough sweat equity it will be just perfect!

Remember that you are not alone. Well, at least you do not have to be.

My grandmother had a print hanging in her room that read, “People are only lonely because they built walls instead of bridges.”

We were blessed to have the love and support of family and friends to help us through. I could not imagine being alone. For those who are struggling and don’t know where to begin, start building bridges.  Make friends, join a church, club or group. Find resources. Search community listings and ads. Get Help. Do what you need to access these resources. Be organized and diligent. Give back! A lot of these programs are not state funded and need volunteers regularly.

For our family, the most useful help we received was becoming educated. In the long run the information we’ve obtained will be priceless. Be creative, be resourceful, and most of all, be patient! Little steps in the right direction can take you a long way.

Cheers to new opportunities that allow us to continue to be independent!

Me and my mom

As Mother’s Day is fast approaching, I thought I would take a moment to salute all of the moms out there. There is no way to fully describe to someone who has not had the experience of being a mother what being a mother is. From the moment you find out that you are going to be a mother till you take your final breath you never stop being a mother, no matter where your children are. There are no words strong enough or descriptive enough to explain this state of being.

As a mother you learn what it really means to have a part of your heart and soul leave you and grow to be something entirely independent of you, but still a part of you. How do you describe the joys and sorrows of trying to raise a child and help them to become something wonderful? There are words that come close but I don’t know that they completely do the job.

Grandma with her first grandchild

For me, looking into my boys eyes, I see a physical manifestation of so many of my hopes and dreams. I see the hand of God working in my life and a gift that is so precious that it sometimes scares me that I might not be worthy of it. Yet somehow I know that I am.  That motherhood is something that I was meant to do and that these children that I have been given were meant only for me. They are my legacy, my light and my joy.

Me and my boys

Being a mother grounds you and gives you wings, it takes sacrifice and brings joy. As mothers we are teachers, mentors, cheerleaders, disciplinarians, peacekeepers and mediators. It is a job that I always knew I wanted, but could never understand until I was given it. I hope that every day is a Mother’s Day to you and your experience as a mom brings you as much joy and happiness as I have been blessed to feel in the short time that I have been a mother.

I would love to hear your own thoughts about how to best describe being a mom.  What does it mean to you?

Last summer we went on our first official family vacation to Sesame Place in Langhorne, PA.  I’ve had a couple of friends ask me for advice as they’re planning their own vacations there, so I thought I’d share our experience and advice with you.

We drove down to Pennsylvania, and while it was a substantial drive, Sara was able to nap a little and watch a movie on the iPad while we drove.  We stayed midway between Langhorne and Philadelphia because we wanted convenient access to both places.  We stayed at TownePlace Suites in Horsham, PA, and were very happy with the accommodations.  We were able to get a 2-bedroom suite so that Sara could go to bed early and we weren’t stuck with lights out at 8pm. It worked great! Plus, we had our own kitchen (sink/dishwasher/stove/fridge).  They have an outdoor pool, which Sara had a blast in.

For Sesame Place, we bought the 2-day Elmo passes.  With these, the 2nd day is free, so it’s really worth it to get this one – you’re not paying anymore, and if you want a 2nd day, you’ve got it.

We went to both character breakfasts – Elmo & friends, and Cookie & Abby’s. Those were both really great. The characters come visit each table, and are available for photo ops (with Elmo & friends, you have to pay extra for a professional photo with Elmo, and at Cookie & Abby’s, you pay extra for a professional photo with Cookie Monster).  Sara was OVER THE MOON about meeting all her Sesame friends.  Bert and Ernie being her favorite, when each came over and sat down at our table, she couldn’t contain herself.

We opted for the Abby’s Magical Queue passes which let us jump the lines on most of the rides and the live shows (there are a few exceptions). It saved a lot of time. We also rented a locker so that we had somewhere to store stuff we wanted with us but didn’t need with us all day. They also offer a deal where you pay $20, and you get one free play at a bunch of their carnival games (ring toss, etc), and you’re guaranteed at least four wins (we won all but one on our own, so Sara got a LOT of prizes). That was really neat, and you can buy it there in the games area.

All of these things are extra money, but we found them invaluable. The rides are fun, and the waterpark is awesome! Sara was just about to turn two, and was able to do most of the stuff she wanted to.  The food is nothing to write home about (expensive and not the greatest quality), and you’re not allowed to bring your own food into the park. You can, however, go out into the parking lot to your car, picnic there, and then come back in. Parking is $15 a day so if you leave, you have to pay to get back in. If you just go to the parking lot and don’t leave the parking lot, you’re fine. We saw a lot of families doing this. If you can get a spot near the grass, it’s perfect.  Sara really did have a blast, and honestly, so did Brian and I. We got to go on all the rides with her and into the waterpark.

Philadelphia and the surrounding area have other tourist attractions that might interest your kids, too.  We went to the Philadelphia Zoo, the Adventure Aquarium in Camden, NJ and the Ride the Ducks Philadelphia duckboat tour.  We even took advantage of a drive through beautiful Amish country while Sara napped in the backseat.

It was a great vacation and we were blessed with great weather at the end of July!  Definitely a trip to consider for your family this summer!

Do you have an original product idea or a startup business?  Are you thinking about making the jump from mom to mompreneur?  Well then sharpen your (digital) pencils because applications are now being accepted for the Huggies MomInspired Grant Program.  You have until the deadline of July 31, 2012 to apply for one of the $15,000 awards.

Once a child begins to walk, talk and think on their own, discipline becomes much more varied and interesting. Most children reach this next phase at around second grade. Some reach it sooner (my daughter), and others later (my son). When they reach this level, there are other factors that heavily influence reaching this stage, such as the child’s basic personality. If I were to draw a parallel between my daughter and my niece, I would say that my daughter needed very clear boundaries and discipline, whereas my niece (who is actually almost two years older), did not need nearly as much intervention at that point.

Simply put, they were completely different children. My niece tended to be quiet, shy and she would avoid conflict if possible. My daughter, however, thrived on conflict and managed to do things that never would occur to my niece to do.

I am comparing two girls because sometimes there is a stereotype between “boy” types (rambunctious) and “girl” types (quiet, civilized). In my experience, personality is a much more important differentiation than sex.

It is important first to decide what you will discipline and what you will not. What are the rules? Each family is different. A child must know, repeatedly and concretely, what rules apply to your family and what don’t. A child should know what is okay to do in your house and what is a no-no. What is true for your house may not be true for a friend’s home, but your own rules for your child should be very clear and should not vary much. If eating food in the family room is not okay on Monday, it shouldn’t be okay on Tuesday, and so on.

Establishing firm rules makes a child feel secure because he will know what to expect if he is following the rules and if he isn’t. In addition, if Mommy says no food in the family room, it should be the same if Daddy is there and Mommy isn’t. Trust me, conflicts will arise if there is more than one parent, but you must be as consistent as possible.

I can guarantee that you will disagree with each other about what’s okay and what’s not when the kids are small, and more so when they get older. Just try very hard to work it out together, away from the child if possible, so that you can parent with a united front. Sometimes you will have to bend to his rules and sometimes he will have to concede his. You will argue about this, but do the best you can. Remember, you both grew up in different households and you played by different rules in each one.

It’s a little bit like combining a soccer game and basketball game.

School-age kids, up until around grade six, are generally the easiest to discipline. This is because they can usually understand cause and effect, consequence and action. They are still small enough to be smaller than most adults and still hold the belief that adults are a separate species from themselves. They are not babies anymore, so they can be denied a favorite toy as a form of discipline, denied television, understand that behavior is related to privilege (i.e., if you don’t stop making so much noise, we won’t go to the movies because that is not acceptable behavior).

The balance of power between child and parent is very lopsided right now, in favor of the parent. Physically, we are bigger and stronger. Mentally, we have education and experience to draw on that heavily favors us. Economically, we have control over what they receive or don’t receive.

In fact, almost everything that a child this age has is a direct result of you (This does not include, excuse or endorse abuse in any way.   Abuse is a separate issue and shouldn’t happen.).

This may be overstating the obvious, but I can’t begin to explain how many parents of children this age allow a child to have the upper hand. One example that stands out for me: When I was watching a group of children and a mother came in with her six-year-old and he didn’t want to stay with the group and turned to his mother, demanding (yes) that she would have to buy him X candy and go to Y in order to have him stay with the group. She promised him and gave me a tortured look.

“I’m so sorry, he just gets like this sometimes.”

I was astounded by this, and after mom left he began to work on me. He wanted some candy from the candy machine that was outside the room. Since his mom had asked me not to give him any sweets, I told him “no” and he proceeded to get very upset and said he was going out there himself to get it and tried to grab my purse to get money for it. This was very simple for me. I first put the purse out of his reach (he was only about three and a half feet tall and weighed 30 pounds). Next, I closed the door and stood in front of it. Since he couldn’t reach the money, and since he couldn’t move me, he finally understood who was in charge; and that he wasn’t going anywhere he wasn’t supposed to. Once he understood this, he stopped hollering about it and played with the other kids.

I firmly believe that what he really wanted was for some adult to take a stand and say no to him.

There is a reason why kids are born to adults and the balance of power is this way. We have to establish this authority at this age so that the child understands that the adults in his life are there to protect him from the outside world and to protect them from themselves. The world is a big, scary, hurtful place and they need to know that there is a buffer between them and the big bad world. You are it.

I cannot emphasize how important the establishment of this authority is at this age. Psychologically, the child must be convinced of your authority. Why?

Well, that’s going to be the next part of this article. The balance of power changes. It’s coming, and it is unavoidable. Get ready. Your treasure, your heart, your baby, is going to be a teenager!

Last week at work, my coworkers and I were talking about our kids (a common occurrence!), and realized that most of us had children who were or are enrolled in Early Intervention (EI) services.  I used to work for one of the local EI programs, and the twins were enrolled there.  One of my coworkers, a nurse, was just beginning the referral and evaluation process.  She had been quite stressed, but felt relieved when she realized that she was not alone.

Many of the concerns she has about her son are ones that others have also had about their own children.  This got me thinking that I would like to write a series of blogs about developmental concerns, starting with the initial referral process and information about early intervention; and then continuing with topics about particular areas of development, the transition to preschool, kindergarten and beyond.

I hope that other bloggers (especially my homeschooling friend, Sue) will pipe in with ideas and experiences, too.

Let me explain a little bit about what Early Intervention is, for those who are not familiar with it.  EI is an agency that works with families of children ages birth to three, who have or have the potential for a developmental delay.  Children are evaluated in their own home to determine eligibility for the program.  If eligible for services, and the family agrees, staff visits the family in their own home or daycare.

In order to be eligible, the child has to meet certain requirements: certain medical diagnoses, developmental delay (calculated as a percentage of delay) at certain ages, or at risk criteria.  If you continue to need services when your child turns three, your service coordinator will guide you through the process of transitioning to the school system.  Services are covered by most health insurances, although there is a fee, as well.  I have not worked there for a while, so don’t want to quote more than this, as things have most likely changed. Children can be referred to EI by anyone involved with the child or family, including parents themselves.

Way back when I started working in Early Intervention, I had a mom tell me that the evaluations (which occur initially at referral, and then every six months) were incredibly stressful.  It made sense to me that the first evaluation would be stressful.   I was surprised to think that follow-up evaluations would be stressful because I looked at them as a way to document progress.  I always looked forward to them.  I guess I am a glass half full kinda girl!  I was also not yet a mom myself.  This mom explained that she feared that she would see things that her daughter was not able to do, or was not yet doing that would make her feel badly about her daughter’s progress.  Good point.

Once I became a mom, and the twins were in Early Intervention, I could understand what she meant so much better.  I had the advantage of being familiar with EI and the staff, but I could see the other perspective and feel the stress now.  MY kids were not ‘average’ or not ‘exceptional’ or were having difficulty with something.  I watched them struggle with some of the tasks and felt badly about it.  I had referred them to Early Intervention myself, but sometimes parents are approached by a family member, teacher, daycare provider or doctor with concerns about their child.  This has also happened to me.  That doesn’t always feel good or sit right.  Sometimes, you, as the parent, may not agree that there is a problem.

Sometimes, you, as the parent, may not be able to see or have the knowledge to know that there is a problem.  Sometimes, what one sees as a problem, another sees as a strength or a unique quality.  Whatever the opinions are, there is someone who is concerned about YOUR child.

The staff in Early Intervention consists of wonderful and knowledgeable professionals.  They are educators, speech and language pathologists, physical and occupational therapists, nurses, social workers and music therapists.  They possess an incredible amount of knowledge and experience working with children.

Their experience is vast, varied and valuable (yeah, I was going for the cute triple v here!).

Of course, I am biased because I did this for a living, but feel that Early Intervention is an incredibly valuable resource for families.  If you need it, you will learn this once you are enrolled.  And, when you they are done with services for you and your child, you will miss them.

Late last year, I watched First Lady Michelle Obama tell Barbara Walters that she places herself at the top of her priority list. Investing in herself and ensuring she meets her own needs helps make her happier and a better mother and role model for her children. Her examples of how she prioritizes herself included making time for exercise and getting together with her girlfriends.

During a typical week, I find it really hard to put myself first. However, I know my schedule is not unique. We all have busy lives balancing our work and family commitments (MV Moms Blogger Amy Dienta also recently wrote about this issue). Maybe you have a similar routine that starts at the crack of dawn (or before) and ends with you feeling completely exhausted? Caring for young children can be physically and emotionally draining, even though I love my little guys so much!

While I want to embrace the “putting yourself first” concept, I may need a few more years before I can really do it. For the time being, I’ll keep trying to squeeze in a run during my lunch hour or meet up with my friends when I can coerce my husband into watching the kids. Part of this is also trying not to feel so guilty about making time for myself; mothers (and fathers) need to focus on their own needs and interests from time to time. I hope you’ll try to do whatever makes you feel happy too—even if just once in a while.

My youngest, Teddy, had his braces put on the beginning of this month. It was probably one of Ted’s most exciting days ever. He had been looking forward to the event for weeks (possibly years) and even shot a documentary of his trip to the orthodontist on the morning of the big event. Because Ted is the youngest in the family, I think in his mind, having braces placed him in the same league as his older brothers and sisters. He was finally one of the big kids.

Ted did not complain once about the braces. His older brother, Charlie, had warned him ahead of time that his mouth would feel like it had “gnomes climbing up his cheeks with ice picks,” but Ted didn’t seem to mind. He was oblivious to the pain. He had ice cream and pudding the first day, brushed his teeth numerous times with his new toothbrush, and was happy as a clam.

This was a big milestone in Teddy’s life. I don’t remember it being as much so in his siblings. It was a big milestone in my life also. Ted is the last of six kids who needed braces. I am done paying for orthodontic treatments. I will now look into finding myself a new (newer) car!