Sunday, August 31, 2008

How Does Your Child Grow?

For many, the term "failure to thrive" brings to mind images of neglected children in Eastern European orphanages and other institutional settings.

In simple, straightforward terms, "failure to thrive" is an impairment in growth.

Every young child's height and weight should be monitored and plotted at regular intervals by their treating physician. It is the clearest way to see if a child's growth has plateaued or regressed. It is the easiest way to assess for the possibility of impaired growth, which can then be addressed through medical intervention. If a child's growth is dropping off the growth curve, questions such as whether the cause is biological or environmental can be looked at and appropriate referrals made.

A great resource in the Los Angeles County area is the Failure to Thrive Clinic headed by pediatrician, Carole Berkowitz, M.D. at Harbor-UCLA hospital. The clinic has been around for over 25 years and they have a great deal of expertise in helping children who are experiencing problems related to growth.

Harbor-UCLA Medical Center
1000 W. Carson Street, Box 437
Torrance, CA 90509

An Ounce of Prevention

Something that continues to surprise me, perhaps because it is not talked about enough, is that so many women I know or am acquainted with, continue to believe that it is okay to drink during pregnancy.

Let me be clear and say this: It is absolutely NOT.

I could link you to a number of articles stating the reasons why, but I'll simply describe some of the children I work with. These include a pair of siblings ages three and four whose mother drank throughout her pregnancy. These boys cannot self-soothe and are hypersensitive to stimulation such as touch and sound (even the sound of grandma singing a lullaby is intolerable). Unable to manage moving through the world, they scream, tantrum, throw toys, and bite. One of them is microcephalic, a red flag for possible brain damage.

Another child whose mother drank intermittently and moderately during pregnancy, is almost three years old now. He struggles to communicate and engage with his mother. He goes from toy to toy and wants to run out of the room. When provided a lot of support and positive feedback, he is able to respond well, but it takes a lot of energy and his mom becomes quickly exhausted from her interactions with him.

We are fortunate to have a Fetal Alcohol Spectrums Disorder (FASD) center linked to our clinic. Many of the children they screen come to us for treatment of severe behavioral and regulatory problems. I particularly feel for these children because I know that many of their challenges could have been prevented. I look at them and see the healthy children they could have been.

The consequences of consuming alcohol during pregnancy can be serious and detectable in newborns and infants. However, in other cases the symptoms are not easily noticed at first. Rather, they manifest themselves in learning and behavioral problems as the child gets older. Is it really worth the risk?

American Academy of Pediatrics: "Because there is no known safe amount of alcohol consumption during pregnancy, the Academy recommends abstinence from alcohol for women who are pregnant or who are planning a pregnancy."

Wednesday, August 20, 2008

Saying Goodbye

Hello, and welcome to my blog.

I am a child therapist working in Los Angeles and I want to share through this blog what it is like to provide psychotherapeutic services to children. In an effort to protect confidentiality to the utmost, names in this blog will be changed, no direct quotations will be used, and information may be slightly altered. I will also focus on my own experience of providing clinical services so you can get a feel of my own process as well as the overall therapeutic process when working with children. If this sounds good to you so far, then read on!

I am starting this blog by writing about saying goodbye. That is, in therapy, when we go through a process called “termination” with our patients.

Why is it that no matter how well things are ending, it is always difficult to say goodbye? This morning while I was meditating, I began thinking about a 10-year-old boy I had a final termination session with yesterday. I call him “The Big-Headed Boy” because he when I first met him, he was so thin and small, his head appeared almost too large for his body (I’m glad to report that he has grown into his head over the time that I have seen him. But that’s another story!).

We had been working together approximately 14 months. Like many of the children I see, he was initially brought in because he was physically abused by his father. The boy and I had been able to work through much of the trauma in that time. We had developed a good relationship. Through therapy, he had learned ways to feel less anxious and generally safer in the world. He had learned to be more assertive and to stand up for himself, including most recently by speaking up and telling his mom that it was embarrassing for him when she said certain things about him in front of other people. He was still a shy and anxious, sensitive boy but he’d also grown tremendously. It was wonderful to see this transformation and it was time to say goodbye.

We sat and made goodbye cards for one another with colored construction paper, markers, pencils, and sea life and puppy stickers. He worked slowly, thoughtfully, and as I could see on his face, sadly. When it was time to exchange the cards, he said he did not want to read what I had written for him. He was saving it for reading at home. There really was no reason to explore this with him. No “What makes you want to take it home to read on your own?” business. I knew. It’s just too sad. So, I also agreed that I would read his message privately after he left. Then, I verbally shared with him what I had written in the card I’d made for him (without telling him that I had written such things in the card).

Having to end therapy with my patients has taught me a lot about goodbyes. I’ve learned that I really hate goodbyes (as I have hated them since I was a child – goodbyes were loaded for me, but again, that’s another story we’ll possibly get to later), and will probably continue to always find them to be difficult. No matter what. However, as we all know, goodbyes are also necessary and provide the child with the healing experience of a positive ending where they can say what they feel and have the other person know and honor those feelings.

For me, it’s important to tell the kids I work with that they have given me a gift. I tell them how lucky I have been to know them, to have watched them change, grow, get better, have more courage, become less scared. Then, when they leave the therapy room and move into the next phase of their lives, even if they are only 10 years old, it is my hope that they can do so with greater sureness and a well-filled heart.