Focus on sign language: Sleep

This sign language post is devoted to the sign for "sleep/tired/bed." This can be a good sign to teach your preemie so that he/she can tell you when he/she is ready for bed or tired. Once they understand the sign, it is also a useful tool to help your preemie transition to bedtime.Go here for an explanation and pictures on how to do the sign.

For beginning tips on introducing sign language to your preemie, click here.

How to incorporate the sign:

• Start introducing the sleep sign before naps and bedtime. You can say “time to go to sleep” and then use the sign. Make sure that once you make the sign, you put your preemie into bed. If you use a different name for sleep or bed than use that word in order to help your preemie understand.
• When you see your preemie looking tired, ask him/her “do you want to go to sleep?” and then make the sign.
• If you see your preemie making the sign for sleep, honor his/her request and put your preemie to bed. If it’s during a non-nap or bedtime that is okay. Sometimes your little one may want to experiment with signs and the power it gives him/her to communicate. Even if he/she only goes down for a minute, the important lesson is that he/she learns what the sign means.

General signing tip: Create a chart of the signs that you have taught your preemie so that you (and everyone else) can easily tell what signs your preemie knows and/or is working on.

Clothes matter

Don't worry. This isn't a post about the best in children's fashion or a lecture about how to dress your kid more like Suri Cruise. Considering the fact that last week I took my daughter out in pants with fruit snack stains on them (mortified doesn't begin to describe it)- I don't think I'm qualified for that kind of post. Instead this post is about paying attention to clothes as it relates to helping your preemie with their fine/gross motor skills.

1) Shoes - as soon as your preemie starts to work on standing, cruising, etc. they should be in some sort of shoe. Preferably one with a tennis shoe like bottom for the best possible grip. These days you can find shoes with a good sole in almost any style. Socks are far too slippery - imagine trying to learn how to stand or walk on ice. Bare feet are good too because your preemie can use his/her toes to better grip the floor.

2) Pants length - No matter how cute those baby jeans may look on your little one, if they are too long than they will interfere with your preemies movement. I constantly roll up the bottom of my daughter's pants to ensure that she won't trip or slide on the bottom of her pants. Just remember to unroll them when you are going out.

3) Sleeve length - The same rules apply to shirts. If your preemie can't see his/her hands than he/she won't be using them correctly. Make sure your preemie's shirts don't have sleeves that are too long or loose. Also, when working on self feeding or any other messy activity - remember to roll up the sleeves. It will be easier on them and you will feel less stressed about possibly cleaning yet another shirt (and less stress makes for happier mealtimes).

Favorite Product #30

Today's favorite product is a wooden Pop Up Toy.

I absolutely love this toy for its simplicity. There are four cylinders that have hidden springs on the bottom so your preemie can push each one down and then watch it pop back up again. I was amazed at how much time my son spent playing with this toy. Beyond the concept of cause and effect, it is also a great toy for teaching colors.

Ways to encourage development with this toy:

1) Cause and Effect - show your preemie how to push the cylinder down and then have him/her watch as it pops back up again. Help your preemie the first few times and then let him/her do it on his/her own once the concept is understood.

2) Fine motor skills - Once your preemie has figured out how to push the cylinder down, encourage him/her to use just one finger to push the cylinder. This will help him/her learn how to point and to isolate one finger to do something.

3) Colors - As your preemie gets older and starts to notice colors, this can be a great first toy for teaching different colors. Point out and talk about each color. Say a color and then push down the matching cylinder. As your preemie starts to get the concept you can ask him/her to do the same.

Developmental Post #24

This week's developmental post is focused on the developmental milestones of preemies who are 12-15 months old. Previously I have done posts for 9-11 months, 6-8 months old, 3-5 months old and 0-2 months old.

Large/Gross Motor:

• Can walk alone
• Creeps up stairs
• Squats when playing and then resumes standing

Small/Fine Motor:

• Turns pages of a board book
• Stacks things
• Takes the lid off a container (box, tub)

Social/Play Skills

• Combines related objects in play (spoon in cup, man on truck, doll on bed)
• Initiates ball play or other social game
• Imitates adult in simple task (wipes table, dusts, sweeps, etc.)

Communication

• Child's babbling sounds like a sentence of real words intonation
• Uses two single words meaningfully
• Follows a simple direction
• Points to a body part or familiar toy on request

Ways to encourage development:

• When reading a book - encourage your preemie to turn the page
• Put items inside a clear container with a lid and encourage your preemie to take the lid off to get the toy
• Encourage pretend play with items that go together - when "feeding the doll" stir the food in the cup and then feed the baby, put a driver in the truck before it drives away, etc.
• Let your preemie "help" with household tasks like dusting, cleaning tables/cabinets, putting things away, etc.

Advocate Series: Doctors

When it comes to being an advocate for your preemie one of the best (and often frustrating) resources you will have is doctors. You will often have various specialists involved in your preemies care. Every doctor has an opinion or a way of doing things. The key is to find out how to work with all of them in order to get the best care possible for your preemie. So this part of the advocate series is devoted to doctors. There will be three parts including general tips, practical advice and specific ways to get the most out of your team of doctors.

General:

Ask Questions. It is your right and your responsibility to ask your doctor questions about any procedure, medicine, test that they want (or don’t want) to do on your preemie. Make sure to ask the “who, what, why, where and how” questions. This will give you a better idea of what they want to do so that you can make a more informed decision.

Do research but use it appropriately. The internet and message boards can be a great tool for giving you as much information as possible when it comes to various issues your preemie may face. If can be helpful to better understand what your doctor is talking about or to find new options. But a word of caution – spending 5 hours on Google does not take the place of an medical degree. Use your research wisely. It can help you suggest something new or understand why they want to do something. If you read something that indicates your doctor isn’t doing what other doctors have done for other preemies than ask.

Ask for time. If you are being faced with making a decision about a procedure, surgery, medicine, etc and you aren’t sure about it, ask for time to discuss it and decide. There may be times when this isn’t possible however a doctor can usually give you some time to really be comfortable with a decision before moving forward.

Follow up/follow through. I’m sure you have heard the old adage “the squeaky wheel gets the grease.” This can be very true with doctors – especially in the NICU. If you have more questions or if you feel like something isn’t being done than ask. And ask again. On the flip side – do it appropriately. We were told that line in the NICU for our son so we would ask to see the doctor every time we came in but we quickly realized that the doctors didn’t really have an important update and we were more annoying than anything else. Also, if it is something small that you are worried about than bring it up but then give them time to fix the issue. Don’t expect an instant response to everything.

The Ultimate Goal. For preemies there are often many specific goals they need to attain such as eating orally, weight gain, getting off oxygen, going home, etc. Sometimes it can appear like nothing is being done to accomplish those goals or the amount of time/steps it would take to get there is too much. So find out what the ultimate goals are for your preemie and more importantly, have your doctor outline the steps that it will take to get there. Sometimes when you know “the plan,” it is easier to see when and why things are being done. For example, some preemies that go home on oxygen end up getting the rate increased at first rather than decreased. This can be frustrating for parents because it seems like an unnecessary step backwards. Often times it is actually paving the way towards weaning off oxygen. For weight gain – find out exactly how much weight they want your preemie to gain and what they are doing to get your preemie there. Or what you should do to get your preemie there.

Focus on sign language: All Done

This sign language post is devoted to the sign for "all done." This is a great sign to teach preemies because being able to indicate that you are done eating/playing/doing something is very important. It gives your preemie a sense of control over the situation which can help ease potential meltdowns.

Go here for an explanation and pictures on how to do the sign.

For beginning tips on introducing sign language to your preemie, click here.

How to incorporate the sign:

• Start by using the sign in specific situations where you know that your preemie is "all done" such as at the end of a bath, at the end of a meal/feeding time or when you are done with an activity that has a specific end to it (time at the park, playing a game, reading a book, etc). Tell your preemie "bath all done" and make the sign for all done as you say "all done." Repeat this over numerous occasions. The key is to let your preemie be all done when you do the sign. He/she needs to know exactly what all done (and the sign) means.
• Use meal time or playtime to ask your preemie if he/she is all done. Are you "all done?" and then point to whatever it is you are doing. Encourage your preemie to do the sign. Honor any small motion that indicates the all done sign.
• When your preemie makes the "all done" sign, encourage him/her to tell you what he/she is all done with. For example, if you are reading a book and your preemie makes the all done sign, ask him/her - Are you all done with the book and touch the book. This will encourage your preemie to start telling you (by touch or later verbally) what he/she is all done with. This is an important part of extending the communication process and understanding for your preemie.
• Word to the wise - your preemie may start using the all done sign during times when you don't want him/her to be all done. My daughter will say she is all done before we are done with a specific therapy activity or meal. Acknowledge that he/she has said all done but let him/her know that the activity isn't done quite yet. This may take some time to work out but as long as you honor him/her being all done as much as you can it should be just fine.
  

General signing tip: Make sure that you teach your spouse, other children and other caretakers the signs that you are teaching your preemie. This will help your preemie use the signs more often and they will be able to understand what your preemie is saying. It can also be a helpful part of the learning process - when your spouse or other children make the sign be sure to offer lots of praise just like you would if your preemie did the sign.