Sensory issues - problems with textures

It seems that quite a few ex-prems develop sensory processing and integration disorders - some need a lot of sensation to keep them happy (sensory-seeking) and some find sensory input overwhelming (sensory-sensitive or sensory-avoiding). I’m sure it’s not just a premmie issue, but it does help make sense of what can otherwise seem like odd behaviour in a toddler. You can read more about sensory issues here.

Recently I responded to a request on a prem forum for suggestions about how to help a child who struggled to deal with certain textures, with the following:

We had an OT visit us for 6 weeks in late 2008 (when Talia was nearly 18 months corrected) as part of the Play and Learning programme, and she did some work with textures. Some things Talia coped with, other things she would not go near, she was sensory-sensitive or sensory-avoiding. Here are a few of the things the OT did which you could try:

1. Put a mix of different dry pasta shapes in a big bowl or plastic tub, and then put in some of your child’s favourite small toys (semi-hidden), so that they have to fish through the pasta to get the toys out. Also works with popcorn, bits of packing foam etc.

2. Invest in or borrow a water table (or sand & water table), and spend some time putting things in and out of water, pouring, splashing etc. This was a huge hit with Talia, and lead to her picking up “wet” things like cut fruit which she had previously refused to touch. The OT also brought shaving cream to put in the water table, we found Talia disliked that almost as much as she liked the water but it may have also been the smell of it. We subsequently bought our own water table and it has been one of her favourite play activities since, even in the middle of winter she wants to play with it!

3. Vibration. We had a cat’s toy which the cat never liked, a little fake mouse with a string you pull to make it vibrate across the floor for the cat to chase. We would pull the string then give it to Talia to hold while it vibrated, to get her used to a different sort of stimulation. The OT had a different toy which had the same effect but it wasn’t as cute as our mouse!

Good luck and I hope you see some improvement over time as your child gets used to different textures and sensory experiences.

Protection versus overprotection?

All children are precious, but when they arrive early and give you a real scare, I think you cling to them even more tightly. Sometimes your need to protect them is very real - if, for example, they are prone to lung infections following chronic lung disease, or have other medical issues which require them to avoid anyone likely to be infectious. KEMH recommended that I avoid taking Talia into shopping centres and other crowed places for the first few months, and that she not attend childcare for her first two years, as she had struggled to breath for so long and came home after 11 weeks of CPAP with O2 and another week just with oxygen via PBF. Fortunately for us, she has had no lung or chest problems since discharge, but I know other prems who are in and out of hospital every winter and come down with bronchiolitis as easily as some kids come down with a cold. So precautions are important, and despite what your family has to say on the subject, if you want your child kept away from Granny because she has a cold then your decision should be respected!

However, as the years pass and our little ones grow and amaze us that anyone so tiny could come so far, sometimes I wonder if we maintain that sense of vigilence for longer than we need to. A while ago, a friend told me of a colleague, a psychologist, who had done some research involving premature children. Her unofficial summary of his findings was “The kids were normal but the parents were not.” From what I remember her saying, he had not found evidence that premature birth lead to increased psychological problems - but he did feel that the parents of those ex-prems were much more anxious than parents of full term kids, and worried about their kids much more than parents of other kids he had studied. When I mentioned it to some other prem mums, they admitted they had noticed it themselves - for example, if their child had flu-like symptoms they would tend to panic and go directly to A&E rather than waiting to see a GP.

After that conversation, I decided I really needed to consciously try not to overprotect my prem. I am relaxed about the common cold and “normal” germs - and thankful for a child with a great immune system despite her unpromising start. After a year and a half, I started using childcare. But some things are harder. I read an article in a parenting magazine last year entitled “cottonwool kidlets”.

The level of protection your child needs will change as they grow older. Obviously very young children have no ability to determine danger so they rely on their parents to keep them safe, however the problem emerges when parents are unable to let go of their growing child and allow them to explore their own independence. Parents have to be careful about over-protecion because a child can pick up on separation anxiety and can also become anxious. And we know anxiety in early life can lead to anxiety and even depression in adulthood. Anxious children can become timid, shy and develop social phobias like a fear of meeting new people. This can be tough on them when they start school. Parents need to give children safe but effective opportunities to play and explore, and to learn to cope and self-soothe.

It all makes sense… but it’s not always easy from a parent’s perspective. My child is already much more timid than her peers and takes a long time to adjust to situations where there are crowds or she is separated from me. It might be just her personality and nothing to do with her prematurity, but either way I hope I can help her to grow more resilient, and to keep myself from becoming an over-anxious parent.

Sensory Processing

The healing process

Ever since Talia was born, I’ve been ambivalent at best to fullterm newborns. They seemed so different, almost alien. I felt quite negative about seeing them; even though my head told me everything was OK, clearly in my subconscious I still harboured either some sadness or anger or jealousy or maybe just a yearning for other people to understand what I had to endure. I wasn’t proud of these feelings, but they welled up within me of their own accord.

Then this week, a friend with a premmie son the same age as Talia had a daughter, Elizabeth, born at 38 weeks and for the first time in two years I looked at a photograph of a full term newborn baby and felt only happiness and relief.  Yesterday an old school friend had her first child, a full term baby, and again I felt only joy and excitement.

It has been a slow process but I think I really am now healing emotionally.

Two year eye check

Talia and I were at PMH this week for a check with the opthalmologist.

Our last visit was a year ago, and I was a bit concerned about how she would react this time as a year ago she was a lot more placid! Fortunately it all went pretty smoothly.

Firstly a doctor held up some cards for her to look at, checking that she looked in the direction of the picture on each card (some with picture at the top, some at the bottom), using both eyes equally. The pictures were line drawings on a grey background, and at first they were thick lines and easy to see, but at the end they were very fine lines that were difficult to distinguish from the background. There was also a very groovy plastic card with 3-D pictures on a speckly grey background that you can only see using both eyes (I tried it myself, the pictures completely vanish if you cover one eye).

Next she had eyedrops put in - and you would be impressed with the strength of Talia’s eyelid muscles! She really tried very hard to keep her eyes shut. So that was a bit traumatic but I had been expecting it.

Last, after her eyes dilated, the opthalmologist did the checks using a little torch and looking through lenses held just in front of her eyes. I was expecting this part to be a total nightmare, but the doctor was a man with lots of toddler experience - he turned it into a game of peek-a-boo. So after a few initial squawks, she decided the whole thing was great fun and happily co-operated.

So… after all that, the verdict is: her eyes are currently exhibiting normal vision. This sounds great, but actually at Talia’s age they expect children to be slightly long-sighted, as she was at her one year check. So it looks like she has already started her journey to short-sightedness. (I knew it would happen, both my husband and I and all our parents are short-sighted, but I had kind of hoped it might take a little longer to become evident.)

Talia’s next eye appointment will be in 9 months time.