Sunday, June 26, 2022

Are Babies Underestimated?

How much is impossible for young children, as opposed to just believed to be?

My baby, who is currently 6 weeks old, has on several occasions made hand movements that vaguely resemble signs. Several times she's made a movement that could be FOOD/EAT or HUNGRY. (More likely hungry, because I've signed that more in her presence.) And just today, she made a motion that could've been the sign MILK, also a sign I use frequently when communicating with her*.

In each case, when I responded as if the gesture was communicative, she reacted in the manner that would be expected if she was making a request. In other words, she seemed like she was signing to request milk, I gave her milk, she drank it and seemed happy.

But she's 6 weeks old! The earliest estimate I've seen for when a baby exposed to sign-supplemented speech might start to sign is 6 months, not 6 weeks. She should be still at least five months away from her first signs, right? And most likely more.

And of course there are alternate explanations. Maybe she's just randomly flailing. The gesture that could've been HUNGRY or FOOD/EAT is very similar to a common instinctive response to hunger in newborns - trying to suck on their hands. This is a behaviour my baby has also shown.

It's also possible that she's started hand babbling in imitation of my signing, but with no real communicative intent. She does like to imitate us, within her ability to do so. She'd be early for hand babbling - the VCSL says about 25% of 4 month olds can do it - but that's less remarkable than actual first signs.

Or perhaps she's been operantly conditioned, unintentionally, to associate hand movements with getting fed, even though she doesn't yet understand that specific hand movements have specific meanings. Certainly, I haven't noticed her appearing to sign in any other context than requesting food. Then again, there's nothing she's as urgently motivated to communicate about as that, and it's also the context I've ended up most consistently signing to her in, so it wouldn't be surprising for that to be her first signed communication function anyway.

And all this has me wondering - how do we know that it's impossible for a one month old to use linguistic communication? We just know it, right? And that means that if a one month old shows behaviour that, in an older child, would be taken as linguistic communication, it's interpreted differently because of the child's age.

But a lot of people "just know" that children don't even begin to develop bowel and bladder control until 18 months, and yet, in many cultures the average age at completing toilet training is younger than that. I've had my share of incredulity at telling people that I started potty training my child at 3 weeks, because so many people see potty training as a process that requires a mobile, verbal child who meets a set of "readiness criteria". 

Incidentally, I know fully continent disabled adults who don't meet the standard toilet training readiness criteria. Especially the ones related to walking and self-dressing. I even knew someone who had poorer motor skills as an adult than my baby does at one month, and yet was fully continent. Obviously, she needed help with the process of going to the bathroom, but she didn't need diapers.

I sought out Mary Ainsworth's book Infancy in Uganda because of her later advancements in the field of attachment theory, which built on her experience in Uganda. But in reading the book, I was struck not by the attachment behaviour (which was basically the same as how babies I've known in Canada acted at the same ages) but by the children's motor development.

You see, Ugandan babies, at least at the time of her study, regularly reached certain motor milestones far younger than the norms in Westernized countries full of European-descended people. This phenomenon has also been observed in Kenyan infants.

Another example is reading. I'm not trying to teach my baby to read, currently, but I have been considering it. The argument I've seen for it argues that sight word recognition is just as possible for young children as recognizing spoken words, provided that they are regularly exposed to text that is actually large enough for them to read with their immature eyes, and presented in real-life communicative contexts. I don't know if that's true. But I do know that, like toilet training, reading is often stated to require prerequisite skills that many people I know apparently didn't actually need.

Of course, disabled people are different from small children. Disabled people often have skill scatter, with some skills way ahead of others, so what they can do doesn't necessarily reflect on the abilities of nondisabled children who are similar in some of their abilities. However, they are informative about what really is or isn't a prerequisite, and that raises questions about nondisabled children who lack the same prerequisites.

And in general, I think people underestimate both how much variation there is in children's abilities, and how much the cultural context can alter early development - even when it doesn't have similar effects on later development (after all, there doesn't seem to be any lasting difference between children potty trained at different ages once they've all completed the process).

There's also a lot of people who clutch at theorized negative impacts of various forms of precocious development. I think this is mostly because they're defensive about their own children being slower than someone else's child, especially if that might be related to parenting choices. Even if the parents of the precocious child aren't in any way trying to claim superiority, some people will automatically react as if they are.

So, is my one month old actually signing? Maybe. I think there's reason to doubt it beyond just the widespread belief that language is impossible for such a young child. But I do think that we should evaluate her behaviour for itself, instead of presupposing what she's doing based on what children her age are widely believed to be capable of. And I certainly don't see any way that responding to hand gestures that might be requesting milk by giving her milk and talking about it could possibly harm her. Even if she's not actually signing yet, that response would help her learn to do so eventually.

* A typical commentary from me would be the following, spoken with the capitalized words signed as well: "Are you HUNGRY? Do you want MILK?" (Sometimes I'll also sign WANT.) Soon afterwards, I generally put the bottle to her mouth and see if she'll drink from it.

Sunday, June 05, 2022

Newborn Curriculum Goals - 3 week update

 So, my child is born now. In fact, she’s* three weeks old as of June 3rd.


In the past three weeks, I haven’t really been active online because I’ve been very focused on adjusting to the challenge of being a parent in a more direct, hands-on way than when she was in utero. However, I have been regularly noting down curriculum goals she’s met, as well as reorganizing some goals.


Life Skills

Eating

When I first discussed my newborn educational goals during pregnancy, the Life Skills category consisted only of four goals related to Elimination Communication. That’s been a bit complicated, but first, let me talk about two new goals I came up with myself, both related to Eating instead of Toileting.


  • Drinks from cup held to lips

  • Getting a decent latch and sucking persistently until no longer hungry


I added these two for two very different reasons. Drinking from a cup was something she was having unexpected success with, and latching onto breast was causing unexpected difficulty.


This and a couple items I'll discuss later also led me to create a new field in my curriculum database for noting concerns related to a curriculum goal. That way, I can more easily track the items she's having unexpected difficulty with or that might be linked to potential underlying issues that make them harder for her.


When she was first born, my child immediately latched onto my breast and nursed quite well, but after that initial success, she proved to be extremely difficult to breastfeed. Although I had plenty of lactation assistance in the hospital and was repeatedly assured that I was doing everything right, she wouldn’t, or perhaps couldn’t, cooperate. She’d start to latch and then turn her head away, she’d recoil from the nipple, she’d act like she’d latched but instead close her mouth and suck on her lip or tongue, she’d try to suck on her fingers and get her hands in the way, she’d latch with her tongue above the nipple blocking her efforts to suck… It seems like there’s a myriad of ways that it’s possible for this baby to get nursing wrong.


After a scare with low blood sugar (due to my gestational diabetes), when a nurse offered me a bottle of formula just to make sure she was fed, I accepted. It was simultaneously a big disappointment and a huge relief, watching her eagerly suck down that bottle of formula. I may not be able to nurse my baby, but at least I can feed her.


Since then, I haven’t given up on nursing, though I haven’t been trying to latch her as much as I probably should. It’s really discouraging to try and fail, so I usually go for a bottle first, but I’ve been trying to do at least one latch attempt each day. I’ve also been exploring resources online for possible theories about why she’s struggling to latch (my current theory is oral motor issues), and I’m looking into hiring a professional lactation consultant to try to help with breastfeeding.


In the meantime, we’ve fed her a mix of formula and expressed milk (though now that I’ve gotten an electric breast pump and built up my supply it’s looking like we’re not going to need to use formula anymore), using either a syringe (though unfortunately our syringe is broken now), one of two different bottle designs that we have, or, bringing us to the other goal, I’ve occasionally fed her directly from a cup.


She can’t drink more than a small amount from a cup at a time - if I pour too much, she’ll choke and spit it out. However, she can finish off the last bit that got caught on the rim of the nipple if I remove the nipple and carefully offer her the bottle as an open cup. I also use this method sometimes to give her vitamin D supplements, since she’s supposed to get a drop of vitamin D supplement every day. I honestly wasn’t expecting to be able to cup-feed a newborn, but I tried it once and it worked, so I’ve kept doing it.


Toileting

As I’ve mentioned above, prior to my child’s birth, I planned on doing elimination communication - a toileting method where you provide children with opportunities to eliminate in a “toilet” (using the term loosely - could be an actual toilet, a potty, a sink, or anything like that) instead of their diaper, long before the age they’re considered ready for conventional potty-training.


However, initially, the whole process of parenting was so overwhelming, and I realized that I basically had no idea how to make EC actually work in practice, so I tabled the idea - even going so far as to reclassify the four EC goals as starting at 3 months instead of birth.


On June 3rd, however, because my child has a diaper rash, I’ve decided to try to make a tentative start on elimination communication (and also started using cloth diapers, which I'd purchased but not tried using until today). And as such, I’ve moved these four goals, drawn from the Standards Based Life Skills Curriculum, back to the 0-3 age bracket:

  • Cooperates with being placed on toilet

  • Toilets on a scheduled time with prompt

  • Urinates in toilet

  • Voids bowels in toilet


Of those, the last one, voiding bowels, is the only one she’s made any progress on so far. She has a tendency to give very clear signals when she's pooping, and also tends to poop a bit, wait, and then poop some more. This habit has sometimes resulted in either soiling a diaper immediately after being changed or pooping on the changing mat mid-change, but it occurred to me that it's also an excellent opportunity for EC.


So, today, when she pooped her diaper and then started acting like she was working on more poop, I took her to one of the many spare sinks in our office (my mom runs a family business we all work in, and the office building used to be a medical clinic so there's a lot of sinks). I've changed her diaper in the sink a few times - this time, I just waited with her undiapered in the sink until she did her next bit of pooping.


It's not the first time she's pooped without a diaper on, but it's the first time she did so when I actually wanted her to, so it's progress. Of course, it wasn't intentional on her part, but that doesn't matter in the early stages of EC.


She was not cooperative, either - in fact, she was crying and struggling, as she usually does with most diaper changes. But I have some ideas on how to make the experience more pleasant for her next time. Specifically, I'm going to run warm water in the sink before I put her in it, so she's not sitting on cold porcelain. I think that was her biggest objection to the process. So hopefully we'll have some progress on the cooperation goal soon, too.


Motor Development

Equilibrium

These items were drawn from the Montessori Scope and Sequence:

  • Lifts head while being held (MD.E.1)
  • Raises head while lying on stomach (MD.E.2)
  • Masters control of the head (MD.E.3)
  • Supports upper body with arms while lying on stomach (MD.E.4)
  • Stretches out and kicks legs (MD.E.5)
  • Pushes down with legs when held above a hard surface (MD.E.6)


She was kicking and stretching her legs a lot in utero, much to my discomfort in the third trimester! She's continued to be very active with her legs since birth, especially during tummy time. She also loves to push her feet against things, and shows a definite stepping response.


Head control seems to be a strength for her. While she certainly does still need help holding her head steady, especially when she's being moved around, I first saw her lift her head deliberately during the first skin-to-skin contact after her birth, and both during cuddling and during tummy time, she regularly lifts her head briefly to reposition it when she wants to look in a different direction or get more comfortable. I'm sure it won't be long until she has a steady head.


She's not pushing up with her arms yet. Currently, in tummy time, her arms are pretty much the only body part she doesn't tend to move. I am not particularly concerned about this, I think this is one of the more advanced goals in this group.


Hand Control

Hand Control goals:

Opens and closes hands (MD.HC.1)

Brings hand to mouth, explores hand with mouth (MD.HC.2)

Instinctive prehension evident in grasping adult finger or object offered (MD.HC.3)

Begins to observe own hands (MD.HC.4)

Swipes at objects (MD.HC.5)


Both of the two goals that were possible to observe on ultrasound were things she'd definitely started doing before birth. Since birth, she's mostly only brought her hand to her mouth when hungry, and often this leads to sucking on her fingers. The nurses at the hospital figured she probably sucked on her fingers prenatally, too, so it's likely that the times I saw her bring her hand to her mouth on ultrasound were related to finger-sucking.


She grasps adult fingers consistently, and also grabs grandma's hair. During feedings, she's also started to grab the bottle, and sometimes is able to help hold it steady. She also swipes at her high-contrast tactile books, which are crinkly black and white books I bought that have so far been her favorite toys. I discuss them more later on in terms of visual response.


Communication

Hearing & Understanding

Still with the Montessori goals, here's the ones related to Hearing and Understanding:

  • Responds to loud sounds in environment (L.H&U.1)

  • Calms or smiles in response to human voice (L.H&U.2)

  • Recognizes voice of parent or primary care-giver (L.H&U.3)

  • Moves eyes towards direction of a sound (L.H&U.4)

  • Notices objects that make a sound (L.H&U.6)

  • Responds (pays attention) to music (L.H&U.7)

  • Turns head towards direction of a sound (L.H&U.10)


And let's throw in the Visual/Auditory: Auditory item, since it seems more relevant here:

  • Reacts to different sounds (VA.A.1)


As I mentioned before, in utero, I noticed strong and clear responses to sounds from outside. My child kicked in response to loud noises, cat purring, and music, and also in response to her grandmother's voice but no one else's.


So I have been very surprised that her hearing has actually been an area where concerns have been raised after birth. During her newborn hearing screening, she failed in her left ear, and she's due for a follow up hearing test later this month. I've also found that she tends not to react as strongly to ambient noise as she did in utero - she sleeps through pretty much any noise, and she's shown no interest in music.


She has, however, startled a few times at loud, sudden noises, and she still seems very interested in her grandmother's voice. She also sometimes orients to sources of sounds, though this is still inconsistent.


Notably, despite her hearing results, she has shown response to left-sided sounds. For example, once when I was overwhelmed because she'd been crying a lot while I was home alone with her, I called up my mother on the phone, and she started talking to the baby soothingly. Even though her right ear was pressed firmly against my arm and the phone was to her left, my child quieted and looked at the phone as her grandmother was talking to her. (Indeed, both times I've recorded her calming in response to human voice, it's been her grandmother. I don't know what it is about her voice, but my baby definitely responds more to her speech than anyone else's.)


She hasn't yet moved her head to look at sources of sounds (despite moving her head to look at interesting sights, as I discuss below). And she hasn't shown any clear responses to music since she was born, only prenatally. But otherwise, she's shown progress on all the hearing items, despite the concern raised by her newborn hearing screening. I have no doubt that she can hear - the question is, can she hear well enough to be considered fully hearing as opposed to hard-of-hearing? We'll know more soon.


In the meantime, this just cements my conviction that I want her multilingual language environment to include ASL as well as spoken languages. If she is hard-of-hearing, ASL could be a very important language for her to know, even if her hearing is good enough to use speech fluently as well.


I researched one-sided deafness when she first failed her hearing screening, and it seems that the biggest concerns tend to be noisy environments and people trying to talk to them from the wrong side, and I could see ASL code-switching being a useful strategy to deal with those situations. It could also be really helpful if she has hearing fatigue, as many hard-of-hearing people do, where situations that require listening carefully are exhausting and lead them to need rest afterwards. Of course, to make effective use of ASL in those situations, I'll need to improve my own ASL fluency as well, which is an ongoing goal I've been working on. (She's not the only one here with educational goals!)


And if it turns out it was just some amniotic gunk in her ear that's since cleared up and she's fully hearing, well, there's a lot of benefits to learning ASL regardless of hearing status, too.


Speaking & Listening: Speaking

Here's my goals for this age period in the area of Speaking:

  • Communicates pleasure through cooing sounds (L.S.2)

  • Indicates different needs through different cries (L.S.3)

  • Smiles when seeing a familiar person (L.S.4)

  • Uses body language to communicate needs (L.S.13)


She's been making pretty good progress on these goals. She has different cries and nonverbal cues for hunger as opposed to pain/discomfort (usually related to the need to burp or poop). Interestingly, I was able to distinguish her cries subconsciously before I could do so consciously - before I could tell hunger cries from discomfort cries consciously, I noticed that hunger cries induced letdown of milk and discomfort cries didn't, and used my breasts' response to her cries to help me figure out how to calm her. As for nonvocal cues, hunger is associated with rooting and mouthing/sucking on things, and abdominal discomfort is associated with arching her back, grimacing, and writhing side to side.


Pleasure is less consistently signalled so far. She has made cooing or burbling sounds sometimes when she's calm and contented, and she smiles occasionally while drinking milk, but hasn't shown any social smiles yet.


Next, this area also includes goals I've drawn from The Pragmatics Checklist, an assessment of social communication skills in Deaf children that I came across. As I mentioned previously, although this checklist was used with 2-7 year old children, several of the easier items had been mastered by all of the hearing comparison group even at the youngest ages, so I figured out appropriate ages for them based on my research on child development. The following items ended up in this age band:

  • Makes requests nonverbally (1-1)

  • Requests help nonverbally (5-1)

  • Complains nonverbally (13-1)


All of these she's definitely been doing. She cries and roots around when hungry, and also cries and writhes when she's physically uncomfortable. It's unclear how much communicative intent she has - in other words, it's hard to tell if she's crying just because being uncomfortable or hungry makes her want to cry or if she's actually trying to tell us how she's feeling by crying. But she does briefly calm and make eye contact sometimes when I touch her or pick her up when she's crying, which makes me think she might be expecting me to fix whatever is bothering her.


Self-Determination

As with The Pragmatics Checklist and the Standards Based Life Skills Curriculum, the Self Determination Goals and Checklists also was designed for older children with disabilities, and I've adapted the ages based on developmental research. Only two items ended up being relevant for this age range, and one of them, "Have a way to communicate that they need help?" is redundant with The Pragmatics Checklist item 5-1 above. That leaves only one item:

  • Have a way to communicate they need a break?


The first time I noticed my child showing signs of needing a break was during the 20 week anatomy ultrasound, which, for those of you who aren't well versed on the usual pregnancy ultrasound schedule, is a standard screening test performed roughly around 20 weeks gestation where the ultrasound tech attempts to get a detailed look at basically all of the baby's major organs.


It's a very long ultrasound, and ultrasounds are believed to cause vibration that the baby inside can detect. My child seemed to find it stressful, since towards the end, she'd decided to turn away from the front and curl up with her arms crossed in front of her chest, resulting in the ultrasound tech not getting a good look at her heart and one of her arms.


After birth, she's also told me when she needs to stop tummy time or other physically effortful positioning by whining and struggling.


Sensory Development

Visual/Auditory: Visual

Here's the Visual items from the Montessori Scope and Sequence for this age:

  • Displays interest in black and white mobiles. [or other visual targets] (VA.V.1)

  • Follows moving objects with eyes (VA.V.2)

  • Recognizes familiar objects and people (VA.V.3)


She is very interested in black and white things. I don't have a black and white mobile for her, but I do have some black and white tactile books, made of some sort of crinkly cloth with interesting textures and some bells inside some of the pages. But she's not that interested in the auditory and tactile elements of the books yet - what she cares about is the simple black and white pictures on each page. She loves to look at them and reach for them, and I've used them to keep her calm during diaper changes (even with a diaper rash!) as well as to motivate head movements in tummy time. I've also Googled high contrast pictures to distract her when she's upset, and gotten her to play with handmade crocheted colored balls and cups by putting the black ball in the white cup and vice versa.


Visual Communication

I found a scale for assessing sign language development known as the Visual Communication and Sign Language Checklist. Two items are relevant at this age, one of which, item #15, is redundant with the Montessori Speaking item L.S.4 above, so that leaves this one:

  • Looks at the visual environment with alertness (item #14)


She's been getting more and more interested in looking at things in the three weeks since she's been born. During tummy time, she looks around a lot, especially at her high contrast books. She's also shown interest in watching the screen while me and my brother are playing video games together as one of us is cuddling her, stared out the window during car rides, and watched my hands and face with interest as I practiced ASL while playing with a children's educational app (Khan Academy Kids) in her presence.


Advanced Skills

There's also two items I've been expecting to be working on later, but which she's shown some notable progress on already. Both of these are from the Montessori Scope and Sequence:

  • Begins to roll both ways (MD.E.8)

  • Scoots along floor using arms and legs to propel body forwards (MD.E.10, 3-6 months)

  • Begins to show preferences in the tastes of food (GOT.G.2, 6-9 months)


No, she's not rolling or crawling yet, and probably won't be for awhile, but she's definitely trying. In tummy time, I've noticed her making movements with her legs that look like a crawling pattern, but without the strength and coordination yet to actually gain traction. And when she's on her back, she often tries to roll to her front, getting stopped only by the fencing reflex. This kid wants to move, that's for sure! I suppose that tracks with how vigorously and frequently she moved in-utero.


As for the food preferences item, I was expecting this to only be relevant once she started getting solid food. After all, if things had gone according to my plans, she'd have only had breastmilk before 6 months old. But she's had formula, too. And as a result, she's had the opportunity to compare two different-tasting foods - breastmilk vs Similac. And my mother has noticed that her facial expressions are less enthusiastic when she's being fed Similac vs my pumped milk. (I agree with her preferences, btw. Similac is gross-tasting, whereas breastmilk is sweet and tastes like almond milk. Meanwhile colostrum is like a cross between sweat and honey.)


* My child is AFAB, and since most AFAB individuals prefer she/her pronouns, I’ll use those until/unless my child indicates a different preference. I considered sticking to they/them pronouns, as I’d been using before I knew her sex, but it’d be challenging within my community context and there’s only a small probability that the choice would make an important difference to my child’s wellbeing. I’d rather know this is a fight that will matter to my child before I pick it. However, although I chose not to use they/them pronouns for my child, I heartily encourage others to do so, because each person who makes that choice normalizes their use a little more.


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