One Thousand Words

Niko had his 3 year check up today, where we discussed:

His asthma (pretty much unchanged)
His mental acuity (recognition of colors, shapes, numbers, letters, etc)
How much we LOOOOOOVE poking him with sharp objects.

Poor dude had another blood draw to check for lead and anemia this time around. Unlike last time, he noticed the needle. Perhaps if I’d surprised him with another All! New! Experience!– perhaps a kitten?– it would have gone as well as last year’s blood draw. But alas, a shiny sticker and a sucker were not enough to distract him from someone jabbing him with a needle and stealing his precious life essence. I explained to him what was going to happen, then what WAS happening, and I think that helped. When the nurse put the rubber tie around his arm he said “Oh, this gives me an owie owie” and made a sad face, then bit into his lollypop. When she stuck the needle in, he said “Oh!” and tried to slap her away, but stayed pretty calm and still as we talked to him and held him. He got a Sesame Street bandage, which helped.

He doesn’t need any more vaccines until he is 5 years old, and our doctor decided to forgo the TB test until it’s required for kindergarten because he’s low risk for TB. He also FREAKED OUT when she tried to look in his mouth because he “didn’t want her to get it dirty” and cried when we laid him down so she could palpate his stomach/check his genitals. His lament? “I don’t want you to see me CRRRRYYYYYYY.” So we hid his face and he calmed down some.

The problem with making doctor appointments is that Nesko doesn’t get vacation days, which means if he takes a day off he doesn’t get paid for it, so we try to schedule appointments for when he goes in late to work, and that tends to coincide almost exactly with the danger zone of lunch time and nap time. So Niko is often a super cranky pants by the time it’s belly-checkin’ time. But he’s in general a laid back dude so frankly, it’s not THAT bad, and the staff are all super great at being patient and managing the situation, working with him, etc.

He is, if I remember correctly, 36 pounds and also he is 38 1/2 inches, which means that in two more feet he’ll be taller than I am. He’s about in the 85th percentile for weight, if I remembered his weight correctly, and 65th percentile for height.

I think I was going to write more about this, but Niko woke up from his nap halfway through the very first sentence, so whatever I had intended to write vanished into the ether. Ah well.

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I just thought I’d toss out a little inhaler update.

Niko has asthma. We use an inhaler 2-3 times a day, 2 puffs, with a spacer, and a dose of claritin in the morning because he also has allergies.

We had serious, severe problems getting Niko to calm down and cooperate with the inhaler/spacer at first. We mitigated these problems in part by giving him M&Ms after each dose and praising him for specific behavior: sitting still; being calm; cooperating; breathing in and out; etc. His initial spacer had a small sized mask, and when we got a refill of the medication we also got a new spacer and mask. The new one’s medium sized and fits him better, and we let him play with the old one with the small mask. He carries it around and “doses” his toys… his trains, his baby doll, his cars.

We give him the first dose almost immediately after waking up. Actually, our routine is like this:

• I eventually drag myself out of bed, and go to the bathroom and brush my teeth.
• Niko starts clamoring for his vitamins, which are gummi vitamins. I give them to him. He does a little dance.
• I dose him with claritin while he’s sitting on his changing pad, still in his pyjamas. If he spills, it’s on his jammies which are going in the hamper.
• I change his diaper and get him dressed.
• We go into the living room and sit on the couch together. He sits on my lap, I give him one puff and count slowly to 30 while encouraging him to breathe in, then give him praise and M&Ms.
• He runs off and plays a bit, or sometimes brings me a book to read, and then I call him back and we repeat the dosing.
• We read a book together, and then I sort out the breakfast situation.

I don’t like to give treatments closer than 4 hours apart, so his next treatment is either right before his nap or right after he wakes up, and then if he gets another one it’s before bed. If he gets too much albuterol he gets hand tremors and is a little bit hyperactive and his heart races a bit. The same thing happens to me when I have too much albuterol; it’s a collection of known side effects. His inhaler doesn’t have a little thing that counts down how many doses are left, and it became VERY clear that we’d run out of doses prior to our refill, when his first treatment with the new inhaler left him tremulous. But he soon adjusted.

Niko knows roughly when it’s time for his treatments, and he will remind me that it’s time for one. He thinks the spacer looks a bit like a train, so he’ll say “tootoot! *heavy breathing noise* myom myom” and point to where we keep it. He doesn’t always want M&Ms now; sometimes he takes a dose and then wanders off to play, not super interested in the reward. He does put up a fuss sometimes, but calms down pretty quickly once the mask is on his face and we’re counting to 30 again.

My ultimate hope is that his lungs improve and we’re able to get him to a point where he doesn’t need daily medication. Statistically, with treatment, 50% of childhood asthma cases resolve; so my hopes are pretty realistic here. I also realize how lucky we are that his asthma is relatively minor. In retrospect, I probably had asthma from a pretty young age, but it’s cough-variant asthma and not the more common wheezing asthma that everyone recognizes. It’s caught much more often now, people know more about it, but untreated asthma really messes up lungs. I absolutely don’t want Niko to have to live with that.

I’m going to call our pediatrician at the end of the month and see if she wants to discuss his treatment. He’s doing better than he was, but seems to have plateaued. He gets a little grunty sometimes, and has a cough when he over exerts himself (or it’s really cold, or he’s been screaming/crying). I’m optimistic, though!

Mirrored from Now Showing!.

We’ve been having “issues” using Niko’s inhaler and spacer (with mask). He hasn’t been afraid of the spacer per se– he enjoyed carrying it around, calling it a train whistle, and pressing the mask briefly– briefly!– to his face. But he hated HATED hated us using it on him. I’m talking sobbing, flailing, clawing, back-arching, terror tantrums.

Last night, I asked Nesko to buy a package of M&Ms.

This morning, we used bribery.

Look. If you thought I was the kind of parent who was above bribery than I think you haven’t been reading this blog for very long. I will use any trick at all to make my life easier, including candy.

Sweet, delicious candy.

So we gave Niko his first dose early in the morning. Nesko sat with Niko in his lap and held him, I explained my way through the spacer/inhaler use, and then… 2 M&Ms! There was a struggle with the first use, but less of a struggle the second time. We dosed him again right before leaving the house to drop him off at Baba’s. He was reluctant at first, but the second dose? He was calm as anything. Patient. Compliant. The proud possessor of 2 M&Ms afterwards (although not for long, he quickly ate them).

My in-laws dropped him off (complete with a haircut/trim by my FIL, a man with 30 years’ experience cutting his sons’ and now his grandson’s hair), and we had some cuddle time and then I pulled out the spacer. He objected, not too strenuously, at first but when he saw the bag of M&Ms? Oh my yes. He cuddled in my lap and I put the mask on him and counted and demonstrated big inhales and he did everything I wanted him to do, as calm and patient as anything. I gave him much praise and 2 M&Ms after, and we read a short book, and then did the second dose. It went even easier than the first dose. Thank God.

I really hope that his ability to be bribed to use his spacer means we can also quickly and easily (and successfully!) incorporate bribery into potty training.

Anyway, after all that we read another book, then went to bed, where we read our traditional 2 books in bed… or tried to. He is having a love affair with a Richard Scarry book that has cars in it over a two-page spread, which means he ASKS for someone to read him the book but REALLY he just wants to keep turning the pages to that spread so he can look at the cars. Well. He is not allowed to do that all night. So I gave him fair warning I was going to turn the lights out on the count of three, did so, and didn’t force him to give up the book. He “read” the book with the lights out, then fell asleep with it on his face.

This is not the first time he’s fallen asleep with a book. Previously he feel asleep curled up with one.

Adorable? Yes. Nerdy? Oh hell yes. My child? Oh, definitely.

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Technorati Tags: albuterol, asthma, child, make monday, nebulizer, parent, parenting, spacer, toddler, toddler asthma

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Yesterday we had Niko’s 24 month check up, and we’re actually (somehow!) on schedule for this as his birthday is the 16th. His original appointment was scheduled for the end of March, then they called to reschedule and we rescheduled for the 12th, and then they called again and left a message saying we need to reschedule (what the yo) and I was totally unable to reach anyone at the practice because my calls kept getting routed to a hospital. I don’t even. We finally got a real appointment, which was a relief because in addition to needing to get shot full of OMG TOXINS!!!! right INTO HIS BLOODSTREAM!!!! (because that is totally how vaccines work, right?) Niko’s had a cough for like… uhm. A month and a half? I mean, he had a terrible cold with a cough (how terrible was the cold? So terrible that I wound up dressing him in a long sleeve shirt, pants, socks, slippers, and sweater and then he sat quietly on the couch, glassy eyed, cuddled under two blankets. I could tell when the fever broke because he shoved off all the blankets and plucked at the sweater in a frustrated way, finally insisted I exchange it for a lighter sweater.) and then… never really got rid of the cough. And he’d occasionally randomly run a low (99*) fever. But mostly no fever, just lots of coughing at night (enough to wake himself up!) and random coughing during the day. Not just a cough, either, but a “stop what he’s doing and grind out a gaspy asthmatic sounding cough, unable to breathe in, sometimes coughing till he gagged” type thing. And then he’d go back to whatever it was he was doing which, in retrospect, mostly involved him running around and yelling.

You know. As toddlers do.

I have asthma, and my dad has asthma, and my mom has chronic bronchitis, and I am worried about Niko developing asthma. So I tried to frame my description of his cough and my worries in a way that made it clear to his pediatrician that 1) it’s a problem and 2) it might be this BUT I might be over-worrying. She asked some good, pertinent questions, listened to us, and then spent a lot of time listening to his chest/lungs.

Niko has an albuterol inhaler and a spacer/mask, and we’re to use it on him 4 times a day (two puffs a time) and see if he improves. If he improves a little bit or doesn’t improve, we’re to call his pediatrician and figure out what to do next. If he does improve, we’re to wait until he has several good days (and nights) in a row, then stop using it unless he needs it again. If you have experience with toddler asthma and/or using an inhaler/spacer please tell me about your experiences.

Other than that, he’s fine. In good health. Got his Hep A jab and that brings him up to date. He isn’t in day care, so no TB screen.

Niko is 35 inches tall and 30 lbs 8 oz. His head circumference is 48.5cm, which is still a tiny head. TINY HEAD.

Here, have some Milestones:
Mastered Skills (most kids can do)

• Names at least six body parts. Well. He doesn’t name them. But he can point to his head, eyes, ears, nose, mouth, chest, arm, elbow, butt, hand, fingers, knees, legs, feet, and toes when told to in English or in Serbian. He can also point to them on other people, in drawings/diagrams, and on many animals.
• Half of speech is understandable. Yes-ish. He’s being raised more or less bilingual, and the non-English language is one I barely speak. So stuff I don’t always catch frequently turns out to be Serbian. Which is cool, but I can’t really judge how much of what he says is “understandable.” It’s not understood by me, but that’s because I’m, you know, ignorant.
• Makes two- to three-word sentences. Yes. He narrates things, and likes to talk about stuff that happened previously. Especially if involved trains, cars, or falling down.

Emerging Skills (half of kids can do):

• Talks about self. Yes. He refers to himself as “baby.”
• Arranges things in categories. Yes. He groups like things in rows– blocks, cars, trains, etc. He also orders things by size sometimes. He does not group things by color, however.
• Can walk down stairs. Yes, although he does best when holding onto a banister or someone’s hand. Which I’d assume is normal, considering he has short legs and steps are pretty high up.

Advanced Skills (a few kids can do):

• Begins to understand abstract concepts (e.g., sooner and later). Yes. In fact, we can use this to bargain: “we’ll read Mike Mulligan AFTER we cut your nails. But FIRST we’re going to cut your nails.” That sort of thing.
• Becomes attuned to gender differences. I’m not sure. He calls adult-female-appearing people “mama” and adult-male-appearing people “tata” and older-female-appearing people “baba.” But all children and babies are simply “baby.”
• Learns to jump. You have no idea how much this kid likes to jump. Up and down. Around. In circles. While singing. Across the entire apartment. He also stomps and marches. He is On! The! Move!

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Technorati Tags: advice, parenting, potty training, toddler, toilet training

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