Worried Mamma needs your help - LONG (sorry)

[Mamma2004]

I will try to be brief, as I know how busy everyone is. I would really appreciate hearing your thoughts and suggestions!

DS is now 20 months old and was born two months prematurely. He spent 50 days in the NICU before coming home in July 2004. We have been involved with Early Intervention since his release from the hospital and they have followed his development (mostly gross and fine motor skills). While he may still be a bit behind his peers, someone unfamiliar with our situation may not even notice at this point.

I should preface the remainder of this post by saying that I, as his mother, think DS is the sweetest and most precious child ever to have walked the earth. That goes without saying, right? Well, DS is also very gentle in public so friends, family and complete strangers comment on his sweet disposition, how easy-going and good-natured he is, etc. I don't disagree with them; I just see another side, too, that truly has me worried.

At 20 months (18 adjusted), I realize DS is at the early stages of the terrible twos and that certain undesirable behaviors - while they may make me crazy - are to be expected. I also understand that since I stay home with him and he sees me more than anyone else, I am likely his "safe place" so he knows he can act out without fear.

My concern regards DS's emotional development. His separation anxiety still results in hysterical screams if DH or I should leave the room (even while talking or singing to him) or if I turn my back or even use the restroom...with him standing right there! Okay, that seems typical enough. Next comes the car. DS is now front-facing (out of our desperation) and has countless sources of potential distraction (DVDs, books, photos, Elmo, maracas, etc.) but he screams uncontrollably once we get moving. I try everything I can think of to calm him, in part because I fear I'll be so distracted and upset by his blood curdling screams that I'll cause an accident. I just don't know what more to do.

These are very minor concerns, I realize. The greater issue is that like many toddlers, he explodes with frustration and has begun to hit both me and himself. It stopped for a period and now it's worse than ever. I have tried soothing and distracting him, ignoring him when he hits just himself, giving him a time out (he just screams for the 60-90 seconds), etc. but the behavior continues. If he is not hitting, he is having meltdown after hysterical meltdown over EVERYTHING and he now spends a large portion of the day screaming. I started to think that he might be feeling really sick but then he started to giggle so sweetly as I was trying to feel whether he might have a fever. Yes, our days are sprinkled with laughter, special time reading books, etc.

DS is the love of our lives and if his nearly constant tantrums are just a symptom of his age, please let me know. Had he not been born prematurely DH and I would likely just accept his deviations as normal behavior at this challenging stage of development. We fear, though, that there may be some underlying problem that requires more serious attention. I know that toddlers get frustrated very easily but at what point is it problematic? Hitting is unfortunately a normal way of testing boundaries but now that he has hit me in front of people, I am more worried.

Then this morning he touched the oven door and said "HOT!". Touching the oven is one of the only absolute NOs in our house so I calmly but firmly said, "Please do not touch the oven". DS walked the 2-3 feet over to me and slapped my leg really hard. Maybe I just don't want to think that my little angel has such a horrible disposition, particularly with me. I chose to be a SAHM but I am starting to question that decision. DS is not sheltered, though - we have weekly music and gym classes, play dates and other outings that give him ample opportunity to socialize and see how other children behave.

Sorry for my rambling - I would be so grateful for any advice you all might have to offer. Thank you to anyone who has read this long post.

Stephanie

[bunnisa]

Your child sounds EXACTLY like our friends' DS (who is now 3). He was recently diagnosed with mild autism. He is very sociable though, which is uncommon.

I don't want to worry you - just a thought. Your child might be fine and just need firmer boundaries?

Bethany
mom to one and one on the way!
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"And children are always a good thing, devoutly to be wished for and fiercely to be fought for."
-J. Torres

[SeekerMage]

It does sounds like it could be the terrible twos....but a more aggressive version. We do not allow hitting in our house by any means. I would talk to your ped about his agression. Is he having problems communicating? Is there some way you can work on the separation issues etc. You mentioned he does lots of activities, but it sounds to me like they are ones you are there with them. Perhaps some separation time might help...you leving him somewhere alone without you or DH. Also for the ride in the car, do you have him in the middle or off to the side? I would if he is in the middle maybe he gets car sick, putting him in the windowo seat might help this. I would definitely talk to your ped or someone else, especially since you are concerned. We have minor separation anxiety issues but ours are at night, nothing like if I leave the room etc. I dont think its related to his prematurity...perhaps just behavioral that you should address sooner then later...but thats just my $.02 :)

[ribbit1019]

I am not going to discount your feelings that something underlying might be going on. In fact I would encourage you to talk to your DS's care providers (ped, early intervention therapists, etc.) about your concerns.
*However* All of what you mentioned consumes most of our days spent together now (DD is 19 1/2 months) I work full time so the only time I really get to spend with her is the weekends, car travel (I sit in the back to/from MIL's so I can visit with her) and about an hour after work (dinner, bath, books, bed). Biting, hitting, screaming in anger and frustration, throwing herself on the floor meltdown style when one or both of us leave the room, are all things I attribute to normal behavior at this age. The only thing you mention that is different is time spent in the car, DD is rear facing and can usually be consoled with her favorite music CD's. We have always spent a lot of time in the car and she really loves music. Other than to and from MIL's during the work week I sit in the front seat so it isn't as though that makes much of a difference (just a difference to me since I miss her terribly during the day).
I hope this maybe makes you feel a little better. But again I think you should continue looking into this if you feel something is wrong.
Hugs, this stage is very hard.

Christy
Maddy born 6/09/04
http://lilypie.com/baby2/040609/3/4/0/-5/.png

Little Man due 3/02/06
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Co-Owner Ribbit Baby

Frogs are lucky, they eat what bugs them.

[lilycat88]

I have no "professional" advice to give and no real personal advice either. But, I do want to let you know that this post could have come from a friend of mine. Her DS (not born early) hit a stage at about 18 months that is eerily similar to what you are describing. His separation anxiety is EXTREME and his mom had to literally be touching him all day. He had to be standing with her while she was on the toilet, cooking, reading, eating, etc. She is a PT SAHM and he does ok with his sitter. He had explosive meltdowns over the smallest things. Also, he would get frustrated and bite....but only mom or dad (or the sofa :-)). She would talk about how sweet and giggly and funny he was and then be ready to stick him on the neighbors doorstep the next minute.

To me, as a first time parent who doesn't know a whole lot!, most of what you mention seems totally inside the realm of normal toddler behavior.

That being said, the one thing that did strike me was your comment about his reaction to being in the car. Hopefully, one of the moms of kids with sensory integration issues or one of the PTs will pipe in here. Do you think the *motion* of the car is bothering him somehow? Perhaps his mind isn't processing that feeling/movement very well. Our DD was in physical therapy for 6 months through the EI program here and we also had her evaluated for sensory integration and feeding issues by an occupational therapist. She qualified for OT but we didn't feel it was necessary to start services. We still think she has some very mild sensory issues that we work with her on at home...hers are touch/texture issues. Have you had your EI program evaluate him for any sensory issues? He might be having problems with feeling overwhelmed by the mass of signals his brain is receiving and get frustrated.

Good luck!

Jamelin
DD Susanna 6/29/04

Edited - Duh, I really should read more closely before hitting the little button.

[npace19147]

I completely understand your anxiety b/c DD was born at 29 weeks, spent 9 weeks in the NICU. She's 19months now (16 adjusted, although we don't really think about it like that so much anymore) and so far we have been very lucky, but I too worry about any potential consequences. At this point, though, I think it would be very difficult to know what is a consequence of prematurity and what might have happened anyway, IYKWIM.

Your child's behavior seems pretty standard to me (though I'm no expert, certainly). Children at this age love to test boundaries, especially the big no-no's. They know they're not supposed to do it but love to try it again and see your reaction.

I wouldn't say that hitting you in front of other people is a cause for concern - I don't think children make that in public/in private connection the way that we do. I've seen lots of DD's buddies hit, kick, bite, etc. their moms in public (and DD has done it too!) - people just let the mom deal with it b/c different people have different discipline styles. But everyone has it at one time or another, I think it's how your child is the majority of the time that matters. I know I'm not always in a good mood!

But of course I can talk (or type :) ) as much as I want, the issue is whether *you* feel concerned. If you do, then talk to your peds or the EI folks about it. Most likely it's not an issue, but if there is an issue better to catch it early. And don't let anyone dismiss you if you feel it's important! As a pp said, you know your child best.

It's so hard being responsible for someone else, isn't it? Good luck!

[brittone2]

That statement jumped out to me as well. I am also thinking you might want to talk to EI and see if there is any chance there may be some sensory stuff going on. Sometimes that can manifest itself in ways you are describing. Jamelin gave you a good description. Some children really just can't filter out the constant barrage of sensory input they get in their lives...so things like a scratchy tag on their shirt may be unknowingly causing them to be on edge and tantrumy all day long.

How is he with textures? Does he have a strong preference for say crunchy foods? Can he tolerate chunks? Will he touch a variety of textures? Does he seem way more dare-devil like than most kids his age or way more cautious? Does he have any problems with clothing (seams on socks, tags on shirts, etc)? Is his behavior worse if he's in a busy or overwhelming environment? Do loud sounds bother him? How is he with motion in general? Does he like rough and tumble play waaay more than most kids or way less than most kids? All of those things can be normal but they can also indicate sensory issues. An OT would be the best person to discuss checking him out for sensory things.

Sensory integration issues can affect just one sense (for example tactile/touch) but not the others. It can also involve multiple sensory systems. It can manifest as "sensory seeking" behaviors (needing a LOT of stimulation and literally craving it, therefore doing things like grinding teeth a lot if they seek oral stim, or jumping from huge heights/crashing into things a lot if they seek tactile stim). Conversely it can manifest as sensory avoiding behaviors (not wanting to eat different textures or touch them if the child is avoiding tactile things). As a PT I have some background in this, but OTs tend to be more of the experts in this area. For someone with sensory issues, the sound of a plane flying overhead can actually be *painful* to their ears for example. Bright lights can literally be *painful* to their eyes and cause them to have behavioral issues. It is a big continuum and can be very subtle though, which is why talking with an OT would be a great idea.

I have a somewhat clingy and very intense almost 2 year old (23 months) and I think there's a huuuuge range of "normal." He's not particularly tantrum-y but doesn't like me to be out of his line of sight. So...it may all be well within normal, but I think you need to honor those mama instincts and maybe talk with someone who is very knowledgable about sensory issues. It is really the big picture, and they may be able to get a better idea after talking with you about specifics and/or observing your DS.

If it is sensory-related, there are tons of fun sensory activities OTs can help kids work on to meet their needs. It can involve things like a "sensory diet" where appropriate sensory activities are provided on a schedule throughout the day, or skin brushing which can help organize sensory input coming into the brain.

HTH. I just wanted to chime in and say that sensory stuff definitely popped into my mind as well.

ETA: another random thought is food allergies/sensitivities triggering some of the behavior. This is a less conventional approach mindset I'm coming from, but I know a lot of parents who have had great success in improving similar situations by eliminating dairy/casein (but you have to cut out all dairy, including hidden sources), gluten/wheat (again, all of it including hidden sources), and things like dyes in food (I've worked with kids that had serious behavioral issues triggered by dyes). The Feingold diet encompasses this stuff. Not easy, but depending on how desperate you are with this, it could be worth a consideration.
http://www.sensoryint.com/faq.html
http://www.incrediblehorizons.com/sensory-integration.htm

[Mamma2004]

My heartfelt thanks to all those of you who have responded. I know there are no easy answers and that DS may be entirely typical or have a genuine issue/problem that needs addressing. I just want so much for him to be a happy, thriving little boy. I am trying to be clear about boundaries the consequences for serious transgressions. At the same time, I don't want to be saying "no" all day long so I really pick my battles.

I will look at the sites that you suggested, Beth, and I will also place a call to our EI team in the morning.

I neglected to mention a couple of other concerns in my OP. I realize that some babies drool more than others, particularly when teething, but DS has a pretty good set of teeth (including four molars) but the drool literally pours from his mouth. It seemed to subside during the summer so I thought it was surely tied to teething. Now we are back to going through 8-10 bibs per day (I am not exaggerating!) and I wonder whether that, too, could be an issue. Am I just looking for problems? Maybe I am just letting my Type A personality get the better of me.

DS uses both words and signs for the big, potentially frustrating issues so don't know how else to get beyond the meltdowns.

We seem to have two extremes: clinging, whining and commanding Mamma's attention OR completely losing it. I have left DS with a babysitter, well, maybe a dozen times. It used to be ugly but the last few times went very well. He loves his music class and usually enjoys his gym class (maybe yesterday was a bad day). Any thoughts as to what else could help with his social behavior?

Thanks again for listening...

Stephanie

[chiqanita]

Hi Stephanie
I agree w/PPs. I only want to add that I have 17 m.o. twins and I could've written a lot of what you did about them. We don't have that big a problem in the car but the tantrums, hitting, and testing their limits is similar. I was just thinking about how DSa used to bite DSb...teething, I'm sure. Recently, DSb has been hitting, scratching and taking toys from DSa. DSa lets it roll off his back, usually. They both have major meltdowns when they are frustrated or when I don't satisfy their desires (want out of play area, want into the drawers, or just want me in thier play area). I chalk it up to Terrible Twos and I'm going to find a good book on the topic this weekend. They both have hit me or grabbed my face out of anger when I have to change diapers. I don't hit them so how do they know how to hit?

I am going to talk to my ped at their 18 month well baby check up to be sure. Oh, BTW, my twins were born at 36 weeks which is long enough for twins but still early. They were 5 pounds each, again good for twins but still little peanuts. Thank goodness they didn't have to spend any time in the NICU.

Hang in there and keep a journal...you can show it to your little angel when he's all grown up and has toddlers of his own. ;)

[brittone2]

The drooling definitely sounds like there could be some low muscle tone or a sensory component as well. I would definitely mention that to EI. The OT could probably check out some oral-motor stuff in conjunction with the other sensory things. That kind of drooling would definitely make me think oral-motor issues need close consideration.

If it *is* a sensory problem underlying the behavior, it would be important to address that in order to really help him socially IMO. If he's overstimulated for example, his behavior is probably going to lead him to do things like hit/bite/etc. He may need smaller groups for social interaction (one on one vs. a larger group). Also kids with sensory problems often have issues w/ personal space. Either they feel like people are really really intruding on theirs, which can lead them to kick/hit/bite to defend themselve (even if the other child isn't that close, they perceive that the child is close to them) or conversely they may intrude on the physical space of others and that may cause other kids to lash out against them.

OTs can do things to work on this like having a child crawl through tunnels so they better learn where their body is in space (one of many examples), and they may have small group sessions w/ other kids where they can practice staying within their hula hoop or on their carpet square on the floor while the teacher reads a story to them. Just rambling here but if it *is* sensory, you really need to treat the root of the sensory issues to see behavior/social interaction improve IMO. Part of it is understanding the triggers that set him off, anticipating them, and setting him up for success. If it is sensory, an OT can help you with this. For example, if a lot of stimulation causes him to act out behaviorally, it might be necessary to minimize those exposures or working on leaving before he gets to that point. In time, it could just mean learning to anticipate if he needs a break from the action (temporary) before things get out of control. They could help you with that if it is indeed sensory. If he's sensitive to bright light, he might feel better with sunglasses on, even inside. They can help with things like that.

LMK how things go and I'd definitely mention the drooling if you call tomorrow. I'll be thinking of you and hope that you can get some help with this. It all seems scary to think about but OT can truly make a huuuuuuge difference in this type of thing if it is indeed sensory.

[starrynight]

He sounds a lot like my dd who has sensory integration. She often hits others, I'm not sure if it's the personal space thing Beth mentioned or her "seeking" behavior. (she wants touch/wants to be touched and is going about it the wrong way, I notice it happens more when I'm lax about her sensory play or she is overstimulated) She also has extreme meltdowns and separation anxiety. She can go from happy to flipping out if one of us walks out of the room!

She is also very calm and sweet natured when she isn't in the middle of one of her fits. And when she is there is no calming her like you mentioned, dvds, favorite songs etc. nothing works with the exception of her lovey. She chews on and fiddles with a blankie, it helps her calm down.

The only other thing I can think of is pain or sickness and he is acting out because of it. Dd got better after we figured out she has reflux, she wasn't puking, it was silent and the acid was just going up to her throat and coming back down. She was in pain so obviously miserable. She still has her fits and screams at times but it's not as bad.

[Mamma2004]

Jackie, might I ask what her "sensory play" is?

I know our EI team will not be able to come for at least a week so I am eager to experiment with any techniques possible.

I still maintain that DS is exhibiting typical - if sometimes extreme - toddler behavior. I just don't want to ignore what might be the signs of a greater problem.

Thank you again!

Stephanie

[starrynight]

>Jackie, might I ask what her "sensory play" is?

Just anything that desensitizes her, each kid is different but what works for her is:
playing with dry rice or beans, I put some in a bucket with small trinkets(alphabet magnets, small figures) and she has to "dig" them out with her hands.
Or dumping them from one cup to another, the touch and sound gets her used to both. Sand is good too but where I live all the sand is treated to keep out parasites and the chemical they use makes her skin break out.
Playing with water, deep massage and pressure touch, we have a special brush from her OT it's called the willbarger (I know I'm spelling it wrong!) protocal.
But note some kids hate it, my ds has mild autism and sensory issues related to that and when we used the brush on him he flipped out and was off the walls and talking to himself for 2 hours. Eliza on the other hand loves it and it calms her right down.

E also has an "oral" fixation so I bought those baby teether sticks that are meant for helping teeth break through, they are like a toothbrush with rubber nubs on them instead of bristles and she would chew on those when she was cranky or overstimulated. She also chews on a blankey most of the day. (I switch them out and wash them daily!)

Some other ideas, look into the book "The Out of Sync Child" and/or "The Out of Sync Child has fun", we got sensory play ideas from the second book from our OT. There are various things to do to help with what behavior you want to stop (the hitting for example) and to help the child find another outlet for the sensory stuff they are looking for.

She was so bad no one could touch her but us, she would get upset at even the anticipation someone would touch her (the docs office for example) and after a lot of ot work and sensory play we got her to the point she walked up to her ped for a hug!!! It was great :).

Good luck!