Tuesday, 29 November 2011

Hip Dysplasia and the Wheaton Pavlik harness

R at One Egg Please has just learned that her daughter will have to go into a harness for hip dysplasia, and that's prompted me to look back at my own experience with my daughter's hip dysplasia earlier this year.  As with all such posts, please note that this is very much an individual account.  It's anecdotal evidence and cannot be considered generally representative.

Hip dysplasia ended up being the last (I hope!) in a long list of minor complications and false alarms starting from when my daughter was an embryo.  She was diagnosed more or less at birth since the 'click' was so obvious, but for the first three days of life we were struggling to keep her blood sugars up, so I had time to get used to the idea of hip dysplasia without ever actually worrying about it.  I was just relieved there were no more needles in her future.

Our paediatrician said that she had never come across a bigger 'clunk' than the one our daughter's right hip made, so we were referred straight to an orthopaedic specialist.  At exactly two weeks old, she had her first appointment with them.  They set up an ultrasound for her, but they didn't need to wait for that to set her up in a Wheaton Pavlik harness.  She clearly needed it.

Our first sight of the harness was dazing.  I'd vaguely expected something around her waist, not the huge tangle of straps that the doctor fitted to her from shoulder to foot.  It was gratifying to discover that there were no rigid parts (save for a few plastic loops) and everything against her skin had a fleecy pad.  The point of the harness (in my layman's comprehension) was to hold her legs frogged, so that the ball of her hip joint was pressed firmly into the socket.  Hip dysplasia arises when the socket isn't big enough, and having the ball press into it stimulates growth.

Frog-girl - about three weeks into wearing the harness

Learning how to get it on and off ourselves was intimidating, but not a problem once I got a feel for how it all fit together.  The doctor had used a sharpie to mark where the velcro should go (the adjustments for size largely depending on fastening the velcro higher or lower), and that helped hugely.  We were assured that we could do everything we already did with the harness still on, and by and large that was true, although it was a bit of a learning curve.  One leg or the other seemed constantly in the way, yet after a few days, we'd adapted.

The only thing I never managed successfully after the harness was swaddling.  Of course, after I was done with the harness, I came across Swaddle Straps which look like a perfect solution, but as swaddling was a long gone thing of the past by that point, I can't personally vouch for them.  I can go on record saying that my daughter's sleep was pretty bad for a few nights – she has always been a light sleeper anyway, so suddenly having her legs in a new position while her arms could flail freely spelled disaster.  In the end, we switched to sleep sacks and got used to those.

Because she was spitting up all the time, we ended up putting her clothes over the harness to give it some protection.  Clothes could be washed more easily than the harness.  I tried washing it exactly once, to get rid of the sour milk gunk.  Cleaning it was fine; drying it was next to impossible, thanks to all the fleecy padding that soaked up apparently gallons of water.

I spent about half an hour running a hair dryer over the wretched thing, frantic that my daughter had been out of it for so long as if her hips were going to regress or something.  We ended up having to put it back on the baby when it was still wet, which generally made me feel like a failure.  After the trauma of that experience, we never washed it again.  I lived in fear of getting poop or urine on it which would necessitate a wash, but thankfully we escaped that.

Basically, I have zero advice when it comes to maintaining harness hygiene.

Still, with clothes going over the harness, we only had to take it off when we were washing her, so that meant she was in it all the time, stimulating that hip socket.  She used to love her bath, kicking her legs for sheer joy at the novelty of it, but she was never fussed about going back into the harness.

Finding clothes to go over the harness was a huge pain.  I had always scorned dresses for baby girls, because they seemed so impractical, so it was ironic that they became the near exclusive fixture of my daughter's wardrobe.  I'd put her in a onesie under the harness very now and then, just for a change, but mostly she wore these little short dresses over the top, with nothing but a nappy underneath (and her legs splayed out to show that off in most unladylike fashion).

This is more or less what all of our pictures from 1-3 months look like

I tended not to worry about trousers and the booties made socks unnecessary, but every now and then, on cold days, I'd put a size-too-large all in one sleeper on her, leaving the crotch unsnapped. Sometimes the sleep sack would function as a coat too.  Otherwise, I'd just pile blankets over her legs – since she was so young, she spent most of her time lying in one position anyway, so blankets were a viable replacement for clothes.

In retrospect, it was weird how accustomed we got to it.  When we were out and about in public, I'd be sitting with her on my lap for five or ten minutes, when it would suddenly strike me that the people around me must wonder why the harness was there (nobody ever asked nor stared that I noticed).  I used to tell people if I was making conversation with them, but otherwise I didn't worry about it.  That part wasn't something that bothered me.

Hip dysplasia runs in families, and it turned out that my husband had it (unusual – it's more commonly female babies that have the problem).  His mother had never mentioned it to anybody, hadn't even thought about it for a long time, so we would never have found out if it hadn't been for our daughter.  Back in the days of her father's infancy, the treatment was to wear one nappy over another.  I can't help but think that this sounds an easier (though probably less effective) solution.

For all of that, it is uncommon enough that when she went in for her two month well-baby appointment, I was asked if the visiting student doctor could come in and get a first-hand look at the harness.  It's always been my policy to permit the observations of student doctors anyway, and I certainly had no wish to deny them the joy of looking at my stupendously cute daughter (and her gross, milk-stained harness).

For eight weeks she wore her harness, and then, at ten weeks old precisely, we had another appointment with the orthopaedic doctor, to find out the results of a second ultrasound: normal!  The harness came off, and we were told we could do what we liked with it.

I wanted to incinerate it, but we kept it, tucked away in a keepsake box.  When my daughter is much older, we'll get it out to show her.

Having her out of harness was crazy and wonderful.  She felt so skinny and seemed ridiculously long when she stretched her legs out.  We had to learn how to hold her all over again, as suddenly she had these long legs flopping all over the place, and when we picked her up, we felt her body not her straps.  She had to learn how to sleep with her legs free too... another round of broken nights!  Best of all, we could see her toes again!

The day her harness came off: we still haven't bought her any pants, she still hasn't got used to stretching out her legs, and none of us have realised that she doesn't need to be photographed with her legs apart anymore.

By serendipity, the day her harness came off was the anniversary of her (in vitro) conception.  What better way to celebrate?  In the above picture, she has her petri dish resting on her tummy, since I was repeating the photo-set-up I'd done with her brother, one year after his conception.

Still, we soon adapted back into normal babyhood, and an X-ray at five months was also normal.  We have to go back again once she's walking, but we're optimistic that everything will be fine now.  My suspicion is that we were helped a lot by getting such a prompt diagnosis.  It seems logical to me that if you stimulate the hip socket to grow at the time when the baby's growing the fastest, you're going to get a better result.  From what I can tell, talking to others, our eight-week session with the harness is on the short side.

Now, at nine and a half months, my daughter is crawling all over, pulls herself up, cruises a little and gets a kick out of pushing a walker.  I think I can safely say that it hasn't inhibited her development one whit.

Thursday, 24 November 2011

A Thanksgiving for Brits

I always look forward to Thanksgiving, even if I technically don't celebrate it, being British.  But I love an excuse for a good roast dinner, and I like the simplicity of the holiday's message: be thankful.  Not so keen on the commercialism of Black Friday, but Thanksgiving itself is very nice.

Some years we get invited to share in somebody else's Thanksgiving meal.  Other years, we don't actually do anything but enjoy the day off.  We've tended to view it as a holiday we can opt into or out of as we see fit.

But while we are wholly British, the children are half-American.  They have dual citizenship until they reach eighteen, at which point they will choose whether to be British or American.  We hope they'll want to be British, in the vague expectation that, as a family, we'll be settled back in our homeland at that point.  But we don't really know what lies between now and then.

Among our social circle in the UK, it is not considered terribly cool to have American children.  However, I see no point in pretending that they aren't American nor in being ashamed of that.  Moving to the US has brought our family a lot of luck--it certainly wouldn't exist in this current format if we hadn't!  My husband's job isn't American, he's just at the American base, but we've certainly benefited from the resources available to the American middle class.  In the spirit of the holiday, I appreciate that.

It would be petty to shield the children from American heritage and culture, and that means we should celebrate the American holidays with them (it's a running joke that they're going to be very conflicted on the 4th of July).  Besides, my son is at an age (almost three) where he can see that there is something different about today--plus he attends school, so there's no escaping it there!

I talked briefly to him about being thankful this morning, and we had my brother and his wife around for a roast dinner (we opted for beef and yorkshire pudding instead of turkey).  I'm not sure, in the end, how much he took on board, since he spent most of the day singing "Happy Birthday" to himself.  He knows full well he's got a birthday party coming up, and I think that's what he's really waiting for.

Still, he refused dinner and then threw up all over himself, so he entered into the family holiday spirit, after all.  His sister was fussy because I was cooking and making other people hold her.  Wails, stress, vomit and good company.  I think we can consider ourselves fully indoctrinated.

Happy Thanksgiving to all!  May we all have much to be grateful for.

Tuesday, 22 November 2011

Reason #268 that I am a bad mother...

I had a doctor's appointment today, and I was obliged to take my daughter with me.  As I checked in, it became clear that she had soiled her nappy, so I asked where I could change her.  They didn't have actual changing facilities, but they (with no reluctance!) offered me a spare examination room.  I cleaned her up and put a fresh nappy on, in spite of her wriggles as she tried to get a better look at her surroundings, then took the dirty nappy to the bathroom for disposal.

The job done, I returned to the waiting room, and popped her on the floor next to a big wooden activity cube.  She gazed up at me and started making the instantly recognisable grunts of a bowel movement. 

Now, did I have the courage to go back up to the desk and apologetically ask if I could use the exam room again, less than five minutes after leaving it?  No, no I did not.  Instead, I was frozen by the dilemma of balancing a convenient space of time between requests against changing my daughter before she got a rash – not forgetting to factor in the possibility that she might have a third bowel movement in another few minutes.

To my immense relief, I was called through two minutes later, so I was able to change her discreetly in the examination room allotted to me before the doctor came in, and she managed to refrain from pooping again before we got home.

One day, she will be potty trained.  Until we reach that point, she's just going to have to cope with a mother who's too self-conscious for her own good.

Monday, 21 November 2011

The appeal of Montessori

Although the term Montessori is floated a lot in parenting circles on the internet, your average parent doesn't have a real idea of what it is unless their child has attended a decent Montessori school. The 'decent' qualification there is because the term Montessori is not copywrited and any learning centre can use the phrase regardless of what their methods are.

If you want to find out precisely what Montessori is, I advise you to start with the wikipedia entry and Google.  The nutshell background is that it was a teaching method developed by an Italian woman, Maria Montessori, for children with learning difficulties that she went on to apply to 'normal' children with great success.

This entry is for those of you want to know why Montessori?  Is it just another way for unrealistic parents to jumpstart their offspring on the path to Oxbridge or the Ivy League?  Is it simply the latest fad in child-raising?  Is there really any benefit to these crazy educational theories?  Bear in mind that you could get a million different answers to this question, but here's my personal view.

I discovered Montessori in 2007, when I knocked on the door of the local Montessori school looking for a job.  When I first observed the children, I was blown away by how much they could do practically.  Carrying trays, pouring water, cleaning and polishing workany number of things that I simply would never have expected of a child under six. 

I was a ridiculously impractical child, and I can't say I'm much better as an adult.  The thing that really struck me was watching children of two and three neatly roll up rugs, since I clearly remember being incapable of doing that at the age of five.

For that alone, I would have been a convert to Montessori.  It's too early to be sure if my children have inherited my lack of physical coordination, but my son has mastered rolling up a rug before his third birthday.  (My daughter's only nine months... I should really give her a bit more time before introducing the skill.)

However, the thing that's really held my interest is how Montessori fosters independence.  Previously, I'd assumed that any such idea meant that the child was allowed to do whatever it wanted to detrimental effect.  Actually, Montessori sets very clear boundaries for appropriate behaviour.  Here, independence is about taking responsibility for one's own actions.

For example, children use breakable tableware instead of plastic.   If they do not use their plates and glasses properly, they get broken.  I remember that my son threw a plate in a temper once and was clearly taken aback when it smashed to pieces.  He's never done it again.  Compare that to a child who throws a plastic plate.  You can shout at them or enforce some other punishment but there's nothing that's going to have the same impact of illustrating why it's wrong.

Disclaimers: There probably are children out there who wouldn't care if their plates broke; I personally haven't come across one.  Thrift stores / charity shops are your friend when it comes to supplying your child's tableware!  Finally, I don't exclude plastic on principle; if I see an item that I like in plastic, I'll buy it.

The first time I put Montessori to use in a real life (i.e. outside the classroom) situation was when some friends visited with their three year old son, and their little boy knocked a drink over.  Immediately, he threw himself down on the floor, hid his face and started crying in embarrassment, while his equally mortified parents scolded him.

I spoke to the boy directly, telling him to calm down and we would get him a paper towel to clean up his mess.  Now that he had some positive action to take, he duly pulled himself together and mopped up the spill as well as a three year old could.  I'm sure the embarrassment still lingered, but because we had given him the ability to fix his own error, there was no need to dwell on it.

This is hands down the biggest thing that I've taken from Montessori and applied to my own children.  When they get themselves into a situation, what skills do they need to learn to get themselves out of it?  With my daughter, that might just be giving her a chance to right herself when she topples over.  With my son, it ranges from cleaning up his literal messes to saying 'sorry' for figurative ones (at which point I am supposed to stop being angry with him... that's the painfully difficult part on my end).

While I have become something of a rampant advocate for Montessori, I don't believe that it's an approach that will work for every child and certainly not for every family.  What I really want is to get parents thinking about their approach to childcare and what their rationale is.  Maria Montessori was a big believer that you learned best by figuring things out for yourself.  By extension, we'll parent best by working out our own methods.  All we need are the resources for learning.

Saturday, 19 November 2011

A Mission Statement

I have been tempted to join the blogosphere for a long time.  I've been reading blogs of people I don't know for four years, starting with infertility blogs and gradually moving towards parenting ones.  Through them, I found a network of virtual support, even if I had no direct contact with the writer.  Listening to the stories of other people at different points along the same emotional journey was more helpful than I can express in words.

Is it worth adding my voice to the multitudes that are already out there?  There's an often-quoted saying: 'It takes a village to raise a child.'  Of course, these days, it's an old-fashioned sentiment, since few people live in such a community.  Instead we have e-villages, as mothers exchange advice, beliefs and anecdotes on web-forums, social networking sites and blogs.

It's important to bear in mind that misinformation is often disseminated in this way, as we create the modern day version of 'old wives tales'.  Our personal accounts are based on our own experience which is too limited to compare to any scientific study; I cannot in all conscience tell anybody what they 'should' do.  My child-raising experience is limited to two children.  Even if you add in my experience working at a preschool, it's far too small a selection and too short a time frame for me to conclusively state anything as a fact.

However, I think this is a very feminine social phenomenon: women more often feel a need to articulate their problems and learn how others feel about it.  While anecdotal evidence cannot be considered proof of anything, it does provide a look at what it's like to experience the issue at hand.  The more anecdotes available, the clearer a picture can be drawn from them.

So here are my voice, my thoughts and my stories.  I intend for this blog to primarily be about parenting issues, but I am approaching it from a background of infertility, of raising children in a country not your own and of Montessori.  My own experience is diverse enough that I think it is worth blogging anyway, but as I said, I've drawn support from such blogs for four years so perhaps it's time to pay it forward.

The Story so Far

In 2005, my husband and I made the decision to accept a job he'd been offered in the States.  At the time, we were newly-weds living in the UK.  Obviously this was going to have a major impact on our lives, although we didn't realize quite how much.  Six years later, I look back at what that acceptance has meant to me personally and find it hard to believe that my first instinct was to say "No."

There are three very specific ways in which it changed our lives.  The first one was that my husband's salary would be enough for us to live on (which was kind of a necessity if we were going to uproot ourselves for the sake of one income).  Being free of any dependence on my salary meant that we could start a family and that I could be a stay at home mother.  That last was something I always believed in very strongly until I became familiar with the actual logistics of parenting!

Accordingly, once we'd settled down into our new home and my husband had had his contract confirmed, we went off birth control and started not-preventing a baby.  And as the months went by, we started trying, and then trying harder...

Secondly, I had to leave my own job as a secretary.  I had never been particularly career-motivated, and because we were planning for a baby, I did not take finding a new job in the States entirely seriously, although I did want to be doing something other than twiddling my thumbs and counting the days between periods.  More or less on a whim, I knocked on the door of the local Montessori School asking about secretarial work.  The next thing I knew, I'd been talked into co-teaching the toddler class with another lady.

I hadn't had any dealings with small children for a good ten years--in fact, part of the reason I accepted was that I figured it would be good experience before I became a Mum myself.  I had never heard of Montessori before.  Yet while I was predictably nervous and incompetent at first, I realised early on that I loved it, and after a few months had gone by, I realised I was good at it.  All my life, I'd had no idea what I wanted to do when I grew up.  A few months before my thirtieth birthday (in 2007), I finally figured it out.

However, we were no closer to starting a family more than a year after we'd started trying.  I knew that if twelve months of regular unprotected sex doesn't get you pregnant, you're considered infertile.  I also knew that my periods had always been irregular, although I'd been burying my head in the sand against that fact.  My cycles were getting longer and longer, and some online research was doing nothing to help me 'monitor' my fertility.

So I went to my doctor, suggesting that I might have Polycystic Ovarian Syndrome (thank-you, Dr Google).  She was dubious since I was thin and not overly hairy.  She told me I should probably just relax (I managed not to throttle her) but had my blood tested anyway.  The results came back indicating PCOS, and after discussing our options, she referred us to a fertility clinic.

This is where the third impact of my husband's job came into play.  Our insurance covered fertility treatments.  We didn't realise it at the time, but that is practically unheard of.  So it was that when a few months of pills didn't work, we were able to progress to IVF without having to worry about our finances.  And of course, because we had the option of doing multiple tries, we got pregnant first time and had our son in 2008.

I was sorry to leave my school, but I was given the option of working part-time and bringing my son with me.  Honestly, I wasn't much more than a glorified cleaning lady at that point, but being able to carry on with something I loved without sacrificing my time with my son?  That's definitely having my cake and eating it too.

I especially loved the fact that from six weeks old, my son was exposed to a Montessori environment.  When he started school 'officially' in 2011, he settled in easily, and I had the advantage of knowing his teachers and routine intimately.

I had always wanted two children, so in 2010, we went back to the IVF drugs.  One stimulation and one frozen cycle later, I was pregnant again.  Our daughter was born in 2011, by which point I had left working at the school altogether, barring occasional helping out.

So here I am.  A stay at home Mum of two children, a healthy boy and girl (plus cats and a husband!).  I know exactly where my career track is going but I have the luxury of choosing when to start it up again.  To all intents and purposes, my wishes have come true... Do I now find out the meaning behind the phrase "Be careful what you wish for"?

Not really.  It's not all as rosy as I pictured it, and I complain far more than I have any right to.  But usually I feel like it's all been too easy, and I'm deeply grateful for the twists of fate that brought me to this point.  There's a superstitious side of me that's waiting for my luck to run out, but for now, I'm focused on this parenting thing with a twist of Montessori.