I saw Nina last year when she was two years and four months old. Consultation was being sought because she was delayed in all aspects of development. She was as yet unable to walk well although she had started to cruise, was not talking but apparently understood spoken language because she would follow commands and could communicate with gestures, and she weighed just less than 20 pounds. I ordered thyroid studies and sent her to a developmental pediatrician after I gave advice on feeding and mental as well as motor stimulation. I did not see her again for a whole year but she came back with her mother a month ago. I was told that her tests were normal, the developmentalist could find no reason for the delay, and the mother decided not to go to the neurologist because the child had started walking.
This time, she was brought for a persistent 'cold'. I prescribed a decongestant and commented on her serious demeanor and on the apparent improvement in her motor skills. The mother was happy with her activity level; however, she had one concern. She felt that Nina generally ignored her, did not look for her, and preferred the company of her maternal grandmother rather than her own family. She even slept with her grandma and had not been heard to call her mother by any name. The mother was upset because she intentionally did not get a job so she could take care of Nina, but Nina did not seem to notice despite her efforts to win the child's affection with toys and things that ordinarily interest little girls.
I was sure that there was more to this story but since there was a highstrung mother waiting after them, I opted to ask the mother to talk to Nina when she slept. The script included statements of love at the beginning and end of the session and a statement of the problem as well as a portion that included mother's apology for whatever may have caused the child to reject her. Luckily, this young woman did not find it strange that her pediatrician was asking her to do this -- she was that desperate -- and promised to update me.
Nina, her mom and maternal grandmother came back two weeks later -- the nasal drip had not abated, so they hoped i would give something else. I had by this time concluded that allergy was the culprit, but what really got my attention was that Nina sat comfortably on her mother's lap and kept looking at me. Then her mom told me that Nina had been sleeping at home, had called her "Mama" and would cry whenever she had to leave the house. The grandmother attested to this. That's when I found out that the mother had been ill soon after her baby was born, so the paternal grandmother had to take care of the child for a while. Because of her recurrent nausea and vomiting, the mother was so uncomfortable she felt inadequate at child care. Then, when she was better and had to take business trips to Manila, she would leave the child for days at a time with her mother-in-law, so there were many short periods of separation during Nina's infancy.
There were about three 'sessions' of the 'sleep-talking' before a difference in behavior was noticed. Nina's mother felt a great sense or relief when the little girl started to snuggle up to her and even kiss her without being asked to. I could only say -- "That's great!" "Wow!".
Perhaps this is another mother who had been forgiven.
Today, I saw a little girl who will turn a year in two weeks' time. She is slightly smaller than we expect, but she turns to smile at her mother when I ask her where mama is, so I am not worried about her development.. She is almost walking and 'talks' to me. Her mother is worried that she may have some physical problems because since two months ago, she has been sobbing in her sleep for almost an hour several nights a week.
There have been no major physical nor emotional trauma although her father occasionally teases her and her mother has hit her gently on the butt a few times for not paying attention to her "No!"s. Considering that she usually wears a diaper, that could not have been really painful. Besides, this little girl would smile broadly at mom when that happened, indicating she knew exactly what she was doing.
It seems too early for night terrors -- the child would actually sob in a heart-breaking way, not cry in the night terror style complete with screams and sweating. Sometimes she would moan as if in pain or discomfort but the parents could only imagine what was happening in what seemed to be dreams. They felt that her sobbing was akin to that of someone mourning a great loss. They wanted some relief for the baby; they also felt helpless when that was going on because even efforts to wake her up did not work, and the baby's heart would be racing each time. She would stop after about 45 minutes and normally wake up after an hour to feed again.
Could these be seizures?, they asked They didn't seem to be, I said, but I asked about activity, diet, medications, then requested that they keep a record of these episodes so we could have more information. In the meantime, I thought I'd have them do some sleep-talking. That's when the mother told me that I had told her to do that six months before............
I vaguely remember that visit. What happened was that the mother had just found out she was pregnant and she wanted to stop breast-feeding because she would feel uterine contractions each time and was afraid she would lose the second baby. She was concerned about her six-month old and realized how difficult it might be for her. She envisioned the little girl protesting the change and herself feeling guilty about it.
When she asked me how she could stop breastfeeding, I told her to consult her obstetrician about continuing breastfeeding if it was safe. If that was not possible, she could do what some mothers in the area do -- just refuse to give the breast and have someone else give the baby the bottle, after talking to the baby about this new feeding method. . I also said that some desperate mothers rubbed either pepper or ginger or bittermelon on their nipples to discourage the baby from sucking, but some of the babies grew to love that taste instead. ( I knew one mother who put blue material on her breast because nothing helped). She felt that those solutions were too drastic, and she didn't want her baby to suffer. I agreed, and said that maybe something else can be done.
I then told her to try explaining the situation while the baby was asleep -- that mom loved her very much, that she was sorry she had to stop breastfeeding, that she really planned to do it much longer, but that she was afraid she'd lose the new baby. The mother also asked that she understand, not be angry and just give up the breast voluntarily, As it turns out, she only had to do one session.
The next day, she opened her blouse to breastfeed, fully expecting the six-month old to go for the nipple right away as she usually did. The little girl opened her mouth as if to suck but did not. She playfully made a go for the nipple again but did not feed. Then she patted her mother's breast and kissed the nipple. That was the last breastfeeding attempt -- the child did not ask again and did not protest when the bottle was offered! Her grandmother could not believe the ease at which weaning was done -- she had been through several herself and expected the household to be disturbed for at least a few days.
I can hardly wait for our next checkup to find out what happens to the sobbing episodes!
March 10, 2003
Nina and her mom went to the clinic again for the follow-up concerning her nasal drip, which stopped for three days but recurred as soon as her medication was discontinued. Her maternal grandmother was not with her as her mother needed no help with her -- she was very well-behaved.
I asked her a few question to which she replied with head shaking or a soft "uh". She had been to the developmental pediatrician that morning and was thought to be doing so well she was not supposed to go back.
Her mother told me that she would lie down to sleep when told (it used to be a big fight to have her go to bed), and she had not asked to sleep in her grandma's house since. The father, who works outside the city, was amazed when told about this.improved behavior when he called home. When he learned about the technique his wife used, he asked her to put him in the script also, to say that he loved his little girl very much and that he was sorry if sometimes he raised his voice when he talked to her!
When Nina was ready to go, she clearly said "Goodbye" and "Thank You" in a much louder voice that showed her confidence in herself and her acceptance of me as a friend..............
(Update as of June 5, 2003 -- Mary's mother told me that Mary stopped sobbing in her sleep after her mother told the people in the house to stop teasing the child during her waking hours. The mother realized that the adults in the house often did that, and many times Mary would be upset and frustrated. Which tells us -- we should always investigate when a child exhibits changes in behavior, whether awake or asleep!.)