First snow

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Maggie first snow 2014

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Four months home

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Maggie has been home for four months now. Sixteen weeks. During that time she has learned many new things and experienced many “firsts”. She has endured surgery and recovery. Most importantly, she has enjoyed the unconditional love of her new family. She prefers mommy above all others, and she also loves daddy’s tickles and funny games. She almost jumps out of her skin with excitement whenever she sees one of her brothers and she adores holding hands and smiling at her big sis.

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When we got her at 13 months of age she was still working on some of her 3-6 month skills. I am sooooo tempted to purchase a video upgrade for this blog just so I can post some of her first videos. She struggled to bring her head along when I pulled her to sit up, and she couldn’t bear any weight on her legs. After a few days she learned to hold a puff in her hand but it took many more days before she could manage to transfer it to her mouth without losing it.

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photo courtesy of Chloe Virginia photography

Now, at almost 18 months of age, she is slowly but surely checking off her 9 to 12 month skills and hopefully soon we will be able to start working on her 12 to 18 month goals. We are in the process of setting up speech, physical, and occupational therapy evaluations for her with the hope of pushing her a little more so she will progress more quickly. She is improving steadily and learns quickly when we work with her on specific skills, but if she is left to her own devices she is content to repeat previously mastered skills rather than pushing the boundary to try new things.

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We realized that, given her personality, we need to be more intentional and more proactive with her. I recently printed out a checklist of all the skills she needs to work on, divided up into different categories, and posted the list in a few different spots where she plays. I taught each of the older kids how to work with her on each skill and instructed them that whenever they are tasked with watching her they need to choose something from the list and work on it. When she gets tired of one thing they can choose something from a different category.

The boys are happy to know now exactly what games to play and what skills to teach her and we are seeing great results from this. Before, I was the only one intentionally working with her, and everyone else just followed her lead. Now we are all working together to help her master new concepts and she is gaining ground more quickly. The boys have been thrilled to teach her how to put shapes in her shape sorter, how to stack blocks, and how to pull up to stand. They feel almost as much pride and satisfaction teaching her as she does when she learns something!

Learning new skills and getting stronger

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Maggie went to UAB in Birmingham for her post-op check up on January 2nd. While we  were there we squeezed in a visit with the occupational therapist from the adoption clinic. We realized at that visit that she would benefit from being challenged more intentionally. She lost some ground after her surgery as she took about two weeks off from her exercises. No one was sleeping much during her post op period and I didn’t feel comfortable having her work on physical skills while she was wearing her “no nos” and her arms were immobilized, and her lip was so fragile.

Now that she is fully healed and back to normal we are making a renewed push to work with her very intentionally on a large variety of skills. I put together the following list, instructed my army of boys about how to teach each skill, and posted it in the places where she plays. Everyone has enjoyed knowing exactly what to do when they play with her, and she is gaining ground more quickly now that everyone is being more intentional during play time.

Here are the skills we have been working on since January 3rd, with italicized updates as to how she is doing:

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COGNITIVE

Simple games and songs like Pat-a-cake, Peek-a-boo, Itsy Bitsy Spider, Wheels on the Bus, etc. (she loves peek a boo, and if we cover our eyes she will pull our hand away)

demonstrate/teach how to point or poke at a named object with index finger

identifies 3 to 6 parts of her own body

simple pretending (stirring a spoon in a cup, pretending to give a drink, feeding a doll, brush a baby’s hair, etc.) Use sound effects and/or words while helping her learn to pretend (she is doing well with her pretending and with learning how different items are used. She often tries to give us drinks from her cup, bites from her spoon, and combs her hair and our hair with her brush. She still has a ways to go–sometimes she tries to give me a drink from her pan instead of stirring in it with a spoon, for example).

BOOK TIME:

Looks at pictures in a book, and pats pictures or helps to turn pages (she learned to turn pages as of 1/3)

points to pictures in a book upon request

Practice finding pictures on the page (Where is the puppy?) Help her learn to point at picture with one finger

Ask questions, “What’s this? What is he doing?” even though she can’t answer–you answer for her

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FINE MOTOR:

placing shapes in a shape sorter or coins in piggy bank (she tries to put her coins in the piggy bank but can’t quite get there. They fall to the side every time but at least she has the idea. She can push them down if you put them in the slot. She can put three shapes in a shape sorter, though she has most success with the round shape. We have to hand her the shape right side up and cover the “wrong” holes so she only has one option–with these accommodations she can put the shape in the hole though rarely does it go in on the very first try, it takes her a few tries usually). We also help her using the “hand over hand” technique a lot while we are teaching her new skills.

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stacks one block on top of another to make a tower of two blocks (Knox was able to teach her to build a tower of three blocks last week)

places 3 shapes correctly in a puzzle–words to use include “turn, turn, turn”, “no, no fit”, “Yes, in”, “where does it go?” (she cannot place the shapes in her puzzle alone, but she understands the concept and tries. We help her “hand over hand” to fit the pieces in her large 3-piece toddler puzzle).

SPEECH:

imitate animal sounds

sign language–work to teach and reinforce signs (she can sign “more” and “all done”, and occasionally she will sign “bye bye”, though not often. We are working on “thirsty” and “thank you” right now, and learning/teaching more signs is a top goal since she won’t be able to start learning to make speech sounds until after her palate repair in May.)

Block play (practice “my turn” and “your turn”, “up” when you stack and or “down” when they fall

Shape sorter play: say “in”, “out”, “all done”

sing or recite nursery rhymes

Show a photo album and point to/name our family members

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photo courtesy of Chloe Virginia photography

GROSS MOTOR:

bounce on her yoga ball, lean from side to side

practice standing up and sitting down (she is doing well with this, though she can’t stand up from flat on the floor–I sit cross legged and she sits in the crook where my ankles meet and pulls up to stand from that position, using the slats of her crib or a low table or chair. She is getting strong enough to almost stand up from that position without holding on to anything–she steadies herself only ever so slightly. Next skill to master is being able to stand up and sit down from the floor, without being slightly raised).

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Lay her on her tummy on the yoga ball and roll back and forth (since she has not learned to crawl, preferring to “scoot” on her behind, she needs to work on “catching” herself with her hands. We roll her forward on the ball and she puts out her hands to brace herself on the floor, then we roll her backwards and she supports herself to stand against the ball when her feet touch the floor. This is a favorite game for her, and so good for her to practice).

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Crawling (she may not learn to crawl until after she learns to walk at this point. She can get all over the house by scooting, and has no desire to learn to crawl. But crawling is an important skill for many reasons, so we still practice putting her up on all fours and helping her rock back and forth. I have to hold her legs in that position, because she immediately sits up as soon as I let go. She will not stay on her knees without someone holding her there. But she doesn’t mind it anymore–she used to cry whenever she had to bear any weight on her knees at all.)

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She still wears her “hip helpers” which I wrote about in another post. Our goal is for her to wear them for four hours a day (two in the morning and two at night) while she is playing. I am not sure how much they are helping, as she can still spread her legs with them on, but it does cut down on her “W” sitting some…the idea is that they will force her to strengthen her core muscles and rely less on her bad habits for sitting and supporting her weight without using her stomach muscles.

photo courtesy of Chloe Virginia photography

photo courtesy of Chloe Virginia photography

Additional:

There are a few things that I am doing with her, additionally, which the boys do not participate in. Maggie was probably not exposed to anything “soft” in the orphanage–no carpet, no plush toys, no dolls. All her toys were plastic and all surfaces were “easy clean”. Even the beds were not plush or soft. She seems to have a sensitivity to soft things, and refuses to play with dolls or stuffed animals. She immediately pushes them away or drops them every. single. time.

The occupational therapist gave me a small brush and instructed me in how to use “brushing techniques” to help desensitize her. I don’t know if it is working or not, but in the absence of other ideas I am trying it.

Also, she is a very quiet child. She rarely verbalizes, preferring to use sign language and gestures to get what she wants. When she wants more food she touches my hand, or signs “more”, or bangs her feet against her high chair. She doesn’t call out, and although she can laugh, cry, and whine, she rarely “babbles”.

The speech therapist at the adoption clinic gave me several speech tools to use with her, and I am working on helping her learn to put things in her mouth. Her favorite is a little vibrating wand which she will sometimes kiss or hold in her mouth for a few seconds. She rarely puts anything except food in her mouth, and we hardly even have to worry about child proofing–of course we do, but it is just “best practice”, not because she gives us need to. She just doesn’t seem to explore things orally as most babies do, and that is something that we will need to address in regular speech therapy (which we are trying to set up right now). She also doesn’t know how to take bites–at almost 18 months of age she has no clue, and I haven’t been able to figure out how to teach her that skill.

Yesterday she started babbling “mamamama” for the first time, and she did it again today! I’m not sure if she knows it refers to me, but it warms this mama’s heart nonetheless!

 

Surgery and post-op

Arriving for surgery at UAB

Arriving for surgery at UAB

Maggie had surgery on December 9th to repair her cleft lip and her nose, to put tubes in her ears, and to check her hearing while under anesthesia. I posted regular updates that day on Facebook but haven’t been able to post here yet, due to a busy and exhausting post-op period followed by Christmas. Scheduling surgery 2 weeks before Christmas was insane and I wouldn’t recommend it!

The day before surgery I posted the following prayer requests on Facebook. It is encouraging now to see how every single one was answered. What a blessing!

Praying friends: Maggie has her surgery at 7:30 a.m. on Monday to repair her lip and nose. The surgeon says it will be a “challenging repair” because of how wide her cleft is. Please pray with us for the following:
1) That she stays healthy enough to have surgery on Monday–she is developing a slight cough and runny nose.
2) That the surgery will go well and she will not need further plastic surgery later for her lip and nose.
3) She is also getting tubes and her hearing nerve will be tested while she is under anesthesia since she failed her first hearing screen–please pray she has no permanent hearing loss.
4) Please pray for her recovery–she will be kept overnight at least one night, and released once she is drinking on her own and managing her pain. 
5) From what I understand, it can be common for internationally adopted children to develop night terrors after surgery–please pray that Maggie will weather the separation from me, anesthesia, narcotic pain medications, doctors, needles, and everything else with her customary resilience and that she will not experience any night terrors.
6) Please pray for her attachment, that as she experiences pain and need she will allow me to comfort her and that our bond will be strengthened.
THANK YOU, praying friends!

As soon as they took Maggie away we gathered our things and went out to the family waiting area. We were instructed to wait about 30 minutes or so until the nurse called to let us know that Maggie was under anesthesia and the surgery had begun. Once we got that call we were able to go get some breakfast. By that time we were starved, as we had been up since 4:15.

After breakfast we went back to the waiting area. Maggie had so many people helping with her surgery and several of them checked in with us during our wait.

About 11:00 a.m. I posted the following on Facebook:

I just spoke to one of the doctors. The ENT cleaned a ton of very thick, infected fluid out of her ears. She still needs to have the hearing test but they feel hopeful at this time that her hearing loss was due to fluid and won’t be permanent. Also the lip and nose surgery is going great. The ENT said it will take the surgeon about another hour. He reports that although it was a very wide cleft and a difficult repair she is looking really good and that he would use this particular surgeon for his own child.

This report was such a comfort and an encouragement to us!

Just before 11:45 a.m. I posted the following on Facebook:

Just spoke to the surgeon. Sounds like everything went as hoped. He said she looks great and that she is very cute! Praise God for a very positive report! They are testing her hearing nerves now while she is still anesthetized and we hope to see her in an hour or so. 

The surgeon also told us at this time–and again later–that many people had stopped him to say how adorable Maggie is and how amazing she looked.

About 12:00 noon I posted:

More great news! Her hearing is normal, praise God! And the audiologist said she looks phenomenal, and that this surgeon is amazing and that we will be stunned and thrilled and will probably cry when we see her. I can’t wait!

It was such a joy to finally be reunited with our girl and to see her beautiful face. She was in and out, of course, still coming off the anesthesia and with heavy duty pain killers on board, including morphine. We got settled in her room and talked to the nurse about how to manage her pain and what to expect.

Finally, about 4:30 I posted:

Maggie looks amazing and we praise God for leading us to such a skilled surgeon. She is somewhat restless and trying to get out of her arm restraints so she can suck her fingers. We are trying to keep her calm with some narcotic pain medicine and letting her sleep in mommy’s arms, the only place she really feels relaxed. If she can’t leave her restraints alone–and she has already gotten out of them a couple times–they want to tie her arms down. We will do everything possible to avoid that traumatic scenario. Please pray with us that it won’t become necessary. If she picks at her stitches she can undo all the doctor’s excellent work and we can’t let that happen either.

Thankfully we were able to keep her from getting too restless. I was surprised that the nurses wanted me to decide how to manage her pain, and it was stressful to me knowing that many people choose non-narcotic options. I wasn’t sure what to do. The nurse and surgeon both felt the narcotics would help her that first day–morphine and Tylenol with codeine, in addition to Ibuprofen. She was in a lot of pain and trying to fight her restraints whenever she was awake. With the nurse threatening to tie her arms to the bed if she didn’t stop fighting the restraints I felt it was best if she could spend much of that day sleeping, so I took their suggestion and used all of the medications they recommended, including the narcotics.

For her, it all worked out. This was a good regimen for managing her pain and enabled her to sleep a lot that first day, so that she never needed to be tied down or restrained beyond wearing her “no no’s”, the arm bands that kept her from bending her elbows and touching her mouth. She spent a lot of time sleeping in my arms that day, too, as that was the most comfortable place for her. I was glad to hold her as much as she wanted.

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The only major challenge in her care that day was the night time. We woke her up at 2 a.m. for her Ibuprofen and she decided she had slept long enough. It was time to get up and play. I was exhausted, of course, having slept barely a few hours the night before. We played until 5:30 when I finally got her to go back to sleep. She was hesitant about taking her bottle that first day, but I managed to get her to take about 16 ounces over the course of the day, which was a very good start for her first post-op hours.

Several hours following surgery Maggie was already trying to smile and wanting to play.

Several hours following surgery Maggie was already trying to smile and wanting to play.

The day following surgery she felt a lot better and was ready to get out of bed and DO something. It was hard to entertain her any longer in the room. She was ready to eat something but refused to touch the hospital food, which was disgusting. They pureed everything and then somehow formed it back into its original “shape”.

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She was able to come off her IV since we stopped the morphine and she no longer needed IV fluids. That gave us the freedom to try out the wagons at UAB. Maggie loved sitting in the wagon, and she spent much of the morning ride peacefully here and there through the halls. As long as the wagon was moving she was happy. If the wagon stopped for any reason, she banged on the sides as if to say, “Let’s go!”

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24 hours post op

There were lots of lovely Christmas decorations to look at.

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At the end of our wing there was a large open place where she could crawl around and play. I quickly learned on Day 1 that the only way to keep her arm restraints on was to layer them between two sets of clothing–a shirt underneath so they wouldn’t slip down and a jacket on top so she couldn’t pull them off.

One day post-op

One day post-op

We were told about 11 a.m. that she was doing well enough to be released, so I called my mom and she made the 3 hour drive to Birmingham to pick us up. Maggie did great and slept most of the way home. I was exhausted, too, and so thankful to be headed home.