Sam turned twenty months old this week, and as you can see from the title he has yet to start speaking. I wrote about his apparent language delay in the past post Waiting to Hear “Mama”. At that time we were preparing for Sam to be evaluated. On Evaluation Morning I felt nauseous as I anxiously wandered around our apartment once again to reassure myself that it was clean and orderly. The evaluators were coming after naptime. Hopefully Sam would be well-rested and ready to “play.” While he napped I showered and dressed, but couldn’t bring myself to eat lunch.
All my worries about the evaluation being stressful were, happily, unfounded. The key evaluator was a relaxed and pleasant older “grandma” type. “Grandma” brought with her a big bin full of toys and wonders for Sam to explore. Sam had fun while the nice lady played with him and took notes. He especially loved the mirror. We play and dance in front of the big bathroom mirrors all the time, but this was a mirror he could hold himself so that was great fun. She also had a wind-up caterpillar that enthralled him. He cried when she was leaving. I’m pretty sure that he wasn’t crying because of some instant magical bonding between him and the evaluator. More likely he was thinking “Who brings me a bin full of presents and then takes them away when they leave??? What kind of person does that? Bring back those toys!”
So thankfully the evaluation was fun for Sam, and I was relieved to have it over, but I felt ambivalent about the results. There are four areas: cognitive, communication, social-emotional, and motor and self-help skills. Sam scored below average in three areas and slightly delayed in communication. They said it wasn’t enough to qualify for therapy at that time. Contact them again in three months if we didn’t see positive progress in Sam’s language skills. On one hand, I was relieved to discover that, while I thought he might be very delayed, in truth it wasn’t that severe. On the other hand, if three months were to pass and he still wasn’t speaking, then he would be even more delayed due to the wasted three months without therapy. To pile on more worries, I was surprised that he scored below average in social skills. I think his social development has been great because he has a strong connection with us, and he loves to give me hugs and kisses. It’s all tied in together though; a lot of the social skills tested also require communication. Ultimately though I decided I was glad about the results. He didn’t need therapy. Sam would probably start talking in no time.
Two months passed. Sam still doesn’t say any words. He does recognize some more words such as “socks.” And if I ask “Where’s froggy?” he searches the room and then brings me his stuffed frog that he got for Christmas. (We also got him a mirror to play with for Christmas since he had so much fun with the evaluator’s.) But still no “Mama.” Still no words at all. And I haven’t had much luck with signing, although I admit I really didn’t know what I was doing, I couldn’t even get him to do the simple sign for “more.” I’ll have to call the evaluation agency back in a few weeks, and I feel disheartened by that. I thought for sure that he would be picking up language and speaking by now.
To add on to my worries over Sam’s language delays there’s my frustration with the tantrums. It’s a safe bet to say that we are now in the stage of toddler tantrums. From the horror stories I’ve heard, his tantrums aren’t even that bad. However, they are super frustrating for me because of the lack of language. I don’t even know why he’s tantrumming! He’s screaming and crying but not asking me for anything! I can’t help but think that maybe if I just knew what he wanted, I could eagerly give it to him and we’d all be happy. For instance, this morning beginning at breakfast time he was screaming and crying and screaming and crying. Perhaps he was just saying, “Gee, Mama, this oatmeal is too warm, too cold, needs a bit more cream, I’d rather have some of that lovely spinach soufflé instead, etc.” All valid requests I would have been happy to fulfill. But I have no idea what he wanted. It makes me sad, really sad. It probably makes him sad, too, and frustrated, too – thus the tantrum. He was crying like that on and off all morning. I still don’t know what he wanted.
For once, I stayed calm and didn’t allow myself to get frustrated and raise my voice over his. I used to think that the best course of action to take with a tantrumming child was to walk away and ignore them. I know that is the common advice from most experienced moms and experts. Now, I’m not so sure. And like I’ve said at the beginning of writing this blog, I’m tending to lean towards the crunchy munchy side of things, off center from the mainstream way of thinking.
So I spent the better part of the morning holding him. (It’s similar to an idea I read on another blogger’s site. She’s a mom in New Zealand with interesting insights and ideas about children and parenting, and she wrote about Boring Cuddles.) From what I’ve understood about small children not yet mastering their emotions and self-soothing skills, it seems counter-productive to just let him tire himself out screaming. Counter-productive, and cruel. When it comes right down to it, my compassion for his frustration and my crazy love for the little guy make me want to hug him. So I hold him, firmly so he feels secure, and I sway back and forth. Sometimes it’s difficult to hold him when he’s thrashing about, but I do my best. And sometimes it takes longer than other times (this morning took a while) but eventually he’ll calm down. Some people might disapprovingly accuse me of coddling during a tantrum, and perhaps when he’s older and throwing a tantrum in the middle of the store because he wants candy I won’t stop to hug him. But, for now, he’s only twenty months old, he can’t even say “Mama” yet, and I think he needs hugs and cuddles. Come to think of it, I could use a hug and a cuddle today, too.
(After he calmed down, I took him outside for a long walk. He got some exercise and to release some energy, and the fresh air was good for both of us. After our walk, he fell right to sleep for his nap.)
Red lights when you’re running late. Picking the slow check-out lane at the grocery store. Insomnia. Seeing red splatters decorate the wall after the spaghetti sauce somehow flies out of your grasp. Dealing with in-laws that are staying for three weeks. Listening to the new upstairs neighbors stomp back and forth across your ceiling.
As frustrating as those events may be, none of them reach the level of frustration involved with trying to understand a pre-verbal toddler.
Sam’s wailing cry is implausibly both guttural and piercing. It means that he is unhappy or uncomfortable. Or he is hungry or thirsty. Or he wants to play. OK, I admit I really have no idea what it means. Oh wait, I do have some idea; it means that my head is going to start hurting. Not that that helps.
Sam is 16 months old, and doesn’t say one recognizable word. If only I knew what his little crying heart desired, I would most gladly offer it to him, silver platter and all. Our saving grace is that Sam is overall a very content little boy. But when he lets loose with a demanding howl I wish so much that he could tell me what he wanted. As frustrating as this is for me, I can only imagine it is even more so for my Sam.
It’s not as simple as teaching Sam a few signs. See, not only does Sam not speak yet, but he also shows no (or very little) sign of comprehending anything I say. Some kids are late talkers, and that’s usually A-OK, because you can see that they understand everything that is said to them. Babies begin to build their receptive language vocabulary first. After developing their receptive language comprehension, they’ll eventually start speaking. My son, however, never responded to simple directions such as “Give me the ball.” And he wouldn’t turn towards me or Jack when we would ask “Where’s Mommy?” or “Where’s Daddy?” Sam seems to have gotten stuck somewhere on the path to language comprehension.
It has been, at times, so frustrating to decipher his grunts and yells and to feel that sense of emptiness where there should be comprehension. But even worse is the creeping fear that something is wrong.
So I’ve grown more and more anxious about his lack of language. I almost never mention it to anyone. I spoke about it to my sister once. She quickly replied with assurances that Sam was fine, all kids are different, Sam is so smart, don’t worry. I’ve always found that uninformed knee-jerk assurances are utterly useless and insulting to my intelligence. Worse, it’s like a quick dismissal of my feelings and concerns. I haven’t spoken to her about it since. I was anxious and worried, and I didn’t have anyone to talk to.
My husband believed, or wanted to believe, that Sam was understanding everything we were saying. I knew better. Jack argued that Sam would respond with happiness when my husband would propose their various fun activities, like running or swimming. I pointed out that Sam always responded with happiness whenever Jack would speak with a happy tone. That wasn’t clear evidence of comprehension.
Then we had Sam’s 15-month check-up with his pediatrician. He agreed that it sounded like Sam may have a language delay. And no, I didn’t really want to be right, but finally, I felt like my concerns were acknowledged and validated. Our next step is to set up an appointment to have a speech evaluation done.
The creeping fear didn’t have a concrete shape, but the scary A-word was almost certainly driving it. Autism is a huge terrifying monster for most new parents. It definitely was weighing on my mind as I waited to hear “Mama.” I don’t pretend to know a lot about autism. I know that language problems are one aspect, so understandably this was a root source of my anxiety. But as our pediatrician explained to us, social problems are far more indicative of autism than are language delays. My sweet Sam, I am happy to tell you, has great social skills.
Sam is my Snuggle Monster. He is very affectionate with both me and Jack. He makes eye contact and smiles and laughs easily when we’re being silly. He plays peekaboo. He also has his own version of peekaboo that he made up. While in his highchair, he covers his eyes with his hands. I say “Where’s Sammy?” until he peeks out from behind his tiny fingers with a twinkle in his eye. Of course I call out “There’s Sammy!” and he giggles and hides behind his hands again. It’s adorable.
While we were sitting in the doctor’s room, the pediatrician observed Sam giving Jack hugs and kisses, unprompted by us. A good sign, he said. Also, Sam carefully watched the doctor throughout the appointment, which the doctor said was very much expected behavior for his age. He said that an autistic child would more likely be gazing towards the corners and not paying attention to the stranger in the room. That half hour with the pediatrician did a lot to allay my fears.
In the past two weeks since then, I’ve had the joy of seeing some progress. It would look insignificant to the casual observer, but it feels momentous to me. Being careful not to look in the direction of the ball, I said to Sam “Get the BALL! Can you get the BALL? Where’s the BALL? Get the BALL Sam!” Where’s the B-B-B-ALL?” Four out of six times, Sam has turned, crawled straight to the ball, and grabbed it and looked at me with a big smile! You know I was whooping and clapping with joy! Such a seemingly little gesture, but I was overwhelmed with happiness and relief. I call that clear evidence that Sam understood exactly what I said! In the past, when I have asked him to get the ball, he would sit and give me a blank expression. He wouldn’t even glance in the direction of the ball. Now 4 out of 6 times, he made a beeline for his ball. And as for the two times in which he did not move towards the ball… well, he’s one. One-year-olds don’t always listen. They get distracted by other toys. That’s what I’m telling myself.
I still need to call to set up the speech evaluation. Hopefully we can get some advice on how to help Sam build his language skills. Until then, I’m still waiting to hear my sweet boy call me “Mama.” I can’t wait!
When the generalization becomes an expectation, there lives a stereotype.
Men are generally taller than women. There’s the generalization.
Men are tall or at least the real men are supposed to be tall. And there’s your stereotype.
Sam is a little guy. Even for a toddler, he’s small. Sure, he could go through a growth spurt at 14, sprouting gangly limbs and lurching around awkwardly, and end up a 6 foot tall giant. I don’t think it’s likely though. Did you pick up on the fact that I think 6 feet tall is a giant? That just might hint to you at how tall, or to change the perspective – how short, I am. I’m 5’3”. Jack is 5’5”. It seems likely then that our son Sam will follow the family trend.
When Jack was 18 months old he stopped growing for a while. For six months his growth had completely ceased, and then it began again, perhaps more slowly than normal. He was poked and pricked and tested for the next several years while he fell to the bottom of the growth chart. By fifth grade his buddies, the bullies, and the rest of his classmates towered over him by several inches or much more.
From x-rays of his hand and wrist, Jack was diagnosed with constitutional growth delay. It’s a condition whereby one’s physical age is younger than one’s chronological age. What? Yeah, I don’t really grasp a medical understanding of it either. But I do understand that it causes the kid to be behind his peers, growth-wise. Interestingly though, it does not cause any physical health problems; the individual should eventually reach full height and maturity albeit much later than everyone else.
In Jack’s case, six months of no growth was combined with short family genes and a case of ordinary late bloomerism. (The family trait of late bloomerism was evident in his brothers, too, who were also the shortest kids in their grades until their growth spurts naturally kicked in during junior high. However, while there’s no doubt that the brothers were short kids, the gap between Jack and his classmates was greater. As adults his brothers are 5’9” and 5’10”; there are a few tallish genes floating around the family tree. I think shortness reigns though. Jack, at his adult height of 5’5”, is still taller than both of his parents.)
You can imagine that, for many, the years of adolescence is rife with insecurity and general misery as a kid navigates the sometimes hellish social ecosystem that is middle school and high school. (It could be unpleasant for us nerdy types anyway.) In a population that, like most of society, values height, physical strength, and athleticism in males, how much more difficult do you think adolescence might be for a small boy? The problem with constitutional growth delay then isn’t one of poor physical health; it is a social problem. Additionally, constitutional growth delay does not only affect height; puberty is also delayed. It’s hard enough to ask a girl for a date. It must be even harder when you have the body of a younger boy.
Jack’s parents made the decision to start Jack on doses of testosterone by sixth grade. He’s glad they did. It gave his growth a much-needed jumpstart. Specifically, he was able to enter the not-so-magically-wonderful world of puberty. He gained all those delightful additions of hair in funny places and other awkward changes, and his voice transformed into the voice I know and love. He was still short but started making greater progress towards reaching his full mature height.
Fast forward thirty odd years, and here we have our sweet Sam.
Having gained a mere 4 oz since his six month check-up, at Sam’s nine month appointment he weighed 15 lbs and 9 oz. And he grew one inch. Our wonderful pediatrician Dr. Morton noted that although Sam was at the bottom of the growth chart, he looked healthy and happy. And he does; Sam has good muscle tone, healthy color, not scrawny looking at all. He looks like a completely healthy baby, but a bit miniature sized. Dr. Morton at this point is more concerned about Sam not gaining any weight than about his length. He said it was time to work another meal into Sam’s diet. Jack and I followed his advice, and it’s been three meals a day now. Lately Sam has been my little piggy; by which I happily mean that he has had a healthy appetite. At first we were only giving Sam about a ¼ cup of food for a meal, and he seemed satisfied with that (not even finishing that all the time.) But in addition to increasing the frequency of meals we’ve also increased the amount. Sometimes it’s ⅓ cup, ½ cup or even more depending on his appetite and mood. We make our own baby food: a mix of fruits, veggies, yogurt, chicken, and some cheese. I’m no farmer; when I say “make” I mean that I buy fresh organic produce and dairy and cook/mash/puree it. I still breastfeed Sam five or six times a day. Jack gives him an 8oz bottle of formula at bedtime—a remnant from the very early days when we had to supplement my breast milk. Now it gives me a much-needed, much-appreciated break in the evenings!
Tomorrow we go back to the pediatrician to check on Sam’s growth. It’s been six weeks. With all this yummy and nutritious food in his diet, I’m hopeful that we’ll see some significant weight gain. In fact I’d be very surprised if we don’t because, as Jack joyfully pointed out to me last week, Sam’s thighs have put on some extra chubbiness. When he’s being changed, Sam lies on the changing table and points his feet straight up in the air. Now I grab his legs and jiggle his thighs and gleefully sing “Chuuubbyyy thiiiighs!!!” and he laughs and laughs and laughs.
I can see the chubby thighs, but I don’t see any evidence that he’s grown in length at all, but who knows? Chubby thighs certainly indicate a positive weight gain, but there may still be some trials ahead. What would we do if Sam had constitutional growth delay? Would we give him testosterone? Some parents in that situation might even opt for the more extreme growth hormone treatment. Thank God that Jack’s parents didn’t do that. The children who took the newly available growth hormone in the 1970s didn’t fare so well as they got older. I don’t know about growth hormone for Sam. That feels extreme, and definitely doesn’t seem very crunchymunchy to me. Lastly, I get to what I see as the crux of the situation. Sam’s emotional well-being.
How do Jack and I teach Sam that height doesn’t matter nearly as much as society may lead you to think it does? How do we instill confidence in Sam, or help and support him in having confidence in himself? Jack had a friend in high school who was also shorter than most of the guys. Ted, however, was brimming with confidence, and nobody messed with him. What was Ted’s secret? And how do we raise Sam to not feel as though his height is a plague upon him? Jack believes that all children have a moment where they realize that they are different from other children in an undesirable way. For Jack, it was his height. The undesirability of the trait may be all in the child’s own head (for example maybe it’s glasses or red hair that marks them as different) but that doesn’t make the feelings and self-consciousness any less real. If height proved to be an insurmountable obstacle to Sam surviving the teenage and college years happily and perhaps an obstacle to romance as well, but there was some way we could improve the situation, wouldn’t we want to do it? If we decided to use testosterone treatment to advance growth, how would we do that while simultaneously preaching that Sam was perfect and beautiful exactly the way that he was? Perhaps most importantly, how do we raise Sam to be able to love himself and be comfortable in his own skin? And how do we do that in a world that loves tall men, and where short men are often the butt of a joke?