Ped Appointment. Help me thinking through this?

[Katico]

I could use some thoughts and/or btdt.  Here's the deal.  

DD2 is 16 mo old. When she was born she was very similar to DD1 for about 4 months...bright, alert, seemed much older than she was, hit milestones early....kind of an intense child (she would get really ramped up about silly fun, for example) but happy, funny baby.   Until she was about 4 mo old and then, holy hell, a different child moved into our house.

Screaming night and day.  Intense separation anxiety.  Never, ever, ever happy.  Ever.  Hated everyone who wasn't me.  Wasn't happy even when she HAD me.  Scowled through fun.  Screamed so loud and for so long I often worried the neighbours might call the police.  She started climbing things at 6 mo and was into everything.  Walking at 8mo, into even more.   She started throwing real, intense tantrums at about 8 or 9 months. Angry, angry tantrums. For awhile, recently, she was waking up in the middle of the night to throw a tantrum.  Every night.  She resists napping and sleep. 

She has had a few minor physical issues, she had RSV and was hospitalized around 3.5 mo and since then everything viral goes to her chest, she has slight eczema, she pees a lot and hates to be wet, just little things that I don't think could possibly make her as miserable as she has been.  I have had her to our doctor so many times, just to be sure there isn't anything physically wrong. 

It's been pretty hellish, honestly.    We have finally managed to get her in a better sleep cycle and it has made a big difference.  She is much happier, and has returned to that funny kid, playing independently, curious, enjoying things, letting people interact with her.  But she is still exhaustingly intense most days. Still a lot of swings between super happy and super angry.  Still a low tolerance for frustration.  Still very needy for me.  

Awhile back, when she was waking and tantruming in the night and her head was black and blue from banging it on things when she tantrumed, our family doctor referred us to a ped.  The thought was that we could test for food allergies, explore things like migraines etc.  

Shortly after, I was talking to  friends  about the night tantrums and my friend told me it sounded like my child might be bipolar!   And.....I was so gobsmacked....and right then, that seemed so serious and crazy to me, suddenly for the first time I was struck with the idea that maybe  the fact that we presume DD1 is gifted is something I should remember and consider when trying to figure out DD2.

Suddenly it seemed kind of obvious to me that when you have ONE kid who sits at the lunch table hounding you with questions about atoms before they turn 4yo...you should consider the idea that your second child may be facing some sort of related difficulty or frustration.  I knew DD2 was smart and quick and bright like her sister had been but all we had seen for months was misery and screaming. Since her sleep has improved she is quickly following many of DD1's little quirks, i.e. she is obsessing over the alphabet and is not interested in the story in a book, just wants us to tell her what all the letters in the text are.

So here is my issue.  I have never really discussed DD1 with our doctor, there has been no need, she has been very well adjusted thus far.  My doctor knows she has always been advanced, she has always loved to talk to dd1with her precocious vocabulary and manners and knowledge, knows her milestones have always been early.....but she doesn't know the depth of it.  DD1 presents as a very smart and mature but social and happy kid in public, whereas at home she is much more intense and serious. 

So, I had never had any sort of discussion about giftedness with our doctor with regards to DD2 because we'd never discussed it at all and it wasn't on my radar AT ALL as potentially being a cause or related to the hellish behaviour. So now I have this appointment with a pediatrician......I'm still interested in the food allergy testing etcetera....but.....

1) Do I bring this up?  I feel like I shouldn't bother because I will get "yeah, sure" and there isn't really anything she would/could do anyway?  But then what if she is worrying about the possibility of some mental disorder like my friend did? Has anyone had this conversation?

2) What do I even say?

3) Am I even correct in thinking some of this could be related?

4) Or *should* I be worried about something i.e. bipolar?

Thank you.  I have worried more about this girl, in the past year, than I have about anything in my life, I think!! I could sure use some perspective and wisdom from you fine ladies. 

[Babayaga]

It certainly sounds like a difficult situation and my heart goes out to you. I would want to check for allergies, etc as well. I can't speak too much to gifted over-excitabilities in this case because she does sound fairly extreme, so maybe that's a factor but it's hard to say. But I would be very, very reluctant to even entertain the possibility of bipolar in a child so young. Bipolar can be debilitating and the medication used to treat it is powerful. I would want to have explored every other possible avenue before I considered in a young child.

[pbjmama]

1) your friend is out of line suggesting that your child has a mental illness unless this friend happens to be a professional in that field. If your doctor has this concern independently or at your prompting you will get a referral to someone who help you determine if mental illness is a possibility. 16 months would be extremely young for a diagnosis.

2) If you wish to address it with your ped I would list out on paper your concerns.

Not sure how to address 3 and 4

My recommendation would be to go ahead with the testing you are thinking as well as get an evaluation with an OT, a few things you mentioned seem like they are sensory issues. I have a child that has some sensory seeking and avoiding behavior and was generally a miserable baby/toddler and 6 months of OT changed our lives and greatly increased our sleep. You could also ask for a referral to a developmental ped and consider seeing a chiropractor.

[nenegoose]

Originally Posted by Katico 

It's been pretty hellish, honestly. We have finally managed to get her in a better sleep cycle and it has made a big difference.  She is much happier, and has returned to that funny kid, playing independently, curious, enjoying things, letting people interact with her.  But she is still exhaustingly intense most days. Still a lot of swings between super happy and super angry.  Still a low tolerance for frustration.  Still very needy for me.  

Is she still throwing tantrums that are intense enough to leave bruises or has that stopped?

If getting more sleep has resolved most of her problems, I'm not sure if I'd be overly concerned. 

ETA: At 16 months, my DD was (still is) exhaustingly intense and very needy. I wouldn't say she was super angry or frustrated easily but she wasn't exactly a mellow child either. We ended up in the ER one night around that age because she wouldn't stop screaming and we had never heard her scream as she did that night. We thought she was in intense pain but as soon as the pediatrician entered the room, she stopped crying and started smiling. We were so embarrassed. Our pediatrician's take was that she had her first night terror.  

Edited by nenegoose - 3/21/13 at 12:55am

[Katico]

The worst tantrums (and the nighttime tantrums) where she was injuring herself have thankfully stopped for now, with the increase in/better quality of sleep. Our days are hard and intense but thankfully manageable now.  Knock Wood.  Please Universe, let this continue 

I thought about posting this in the special needs forum because I am mostly wondering about sensory overexcitability....

She would INSTANTLY freak out the second she dribbled a little pee in her diaper...we had to switch to disposables from our cloth because she handled it a tiny bit better.  She has gotten a little more tolerant of this.  

One time she started screaming above and beyond anything she had done before...to the point I took her right to the doctor, who looked at her and the only thing she could find was a slightly sore looking throat...like she was intensely bothered by it.  

But, I do also wonder about possible frustration etc....like when DD1 complained yesterday that her head was busy, only in infant form.

I'm going to ask the ped about sensory issues and if she doesn't know, I will ask for a referral

[Geofizz]

Given your description, I'd look into food allergies or sensitivities first.

[KCMichigan]

Originally Posted by Katico 

The worst tantrums (and the nighttime tantrums) where she was injuring herself have thankfully stopped for now, with the increase in/better quality of sleep. Our days are hard and intense but thankfully manageable now.  Knock Wood.  Please Universe, let this continue 

I thought about posting this in the special needs forum because I am mostly wondering about sensory overexcitability....

She would INSTANTLY freak out the second she dribbled a little pee in her diaper...we had to switch to disposables from our cloth because she handled it a tiny bit better.  She has gotten a little more tolerant of this.  

One time she started screaming above and beyond anything she had done before...to the point I took her right to the doctor, who looked at her and the only thing she could find was a slightly sore looking throat...like she was intensely bothered by it.  

But, I do also wonder about possible frustration etc....like when DD1 complained yesterday that her head was busy, only in infant form.

I'm going to ask the ped about sensory issues and if she doesn't know, I will ask for a referral

I would look into a few things:

1. Could she have reflux and/or stomach pains from food allergens/intolerances? I know that both caused one of my DD to scream/wail/thrash around/be incredibly uncomfortable. She did not vomit, but upon further testing they found it to be 'silent' reflux. It was refluxing into her esophogus and causing great pain. They checked it fairly quickly because she was a preemie and it is common in preemies, but full-term babes get it as well. Medication helped a lot! We also had to do dietary changes.

2. Continue with the sleep. I know EVERYONE (adults and kids) have a hard time handling things when they are tired. If she continues to have sleep issues, ask for a sleep study and see if she is having night terrors/apnea/etc that would cause sleep disturbances.

3. For the sensory stuff : Maybe look into OT eval. My (other DD) did 2 years of OT and it made a huge difference in her ability to tolerance clothing, textures, visual overstimulation, etc.

 

Originally Posted by nenegoose 

Is she still throwing tantrums that are intense enough to leave bruises or has that stopped?

If getting more sleep has resolved most of her problems, I'm not sure if I'd be overly concerned. 

ETA: At 16 months, my DD was (still is) exhaustingly intense and very needy. I wouldn't say she was super angry or frustrated easily but she wasn't exactly a mellow child either. We ended up in the ER one night around that age because she wouldn't stop screaming and we had never heard her scream as she did that night. We thought she was in intense pain but as soon as the pediatrician entered the room, she stopped crying and started smiling. We were so embarrassed. Our pediatrician's take was that she had her first night terror.  

Agree here- one of my DDs is 'high needs' personality. She also had complicating medical factors. The combination can make for a lot of unknowns (not knowing why she was upset or knowing if she was in pain or not) when she was a baby. She is now in 2nd grade and is an intense cute little person. She does tend to be dramatic and needy as well. Her ability to cope has improved, but it is still just part of her own unique self.

As far as worried about a mental health issue : 16 months is way too early to be honest for any professional to determine bipolar/ADHD/etc. I would try to find a Dr you trust and go from there. He/She can give you referrals , if needed, when age appropriate evaluations can be conducted.

[Tjej]

If she hates peeing in her diaper, she is plenty old enough to use the toilet or potty.

It sounds like you got a very intense kid for #2.  My #3 is intense and is extremely sensitive and moody when tired.  

I think that if you want to talk about your child being precocious with your pediatrician, that is fine.  I would personally just give examples of her interests and intensity, and they can figure it out from that.

A bi-polar baby?  Really?  Your friend ought to work on holding their tongue.  Bi-polar is a real mental issue that is has profound impact on peoples' lives - but it is not something you could even come close to diagnosing in a baby.

[Katico]

Originally Posted by Tjej 

If she hates peeing in her diaper, she is plenty old enough to use the toilet or potty.

...

A bi-polar baby?  Really?  Your friend ought to work on holding their tongue.  Bi-polar is a real mental issue that is has profound impact on peoples' lives - but it is not something you could even come close to diagnosing in a baby.

Oh trust me....if there had been any way to EC with this child I would have...but she just wouldn't have it/was too busy rolling on the floor screaming most of the time.  Now that she is finally happier and calmer it is definitely on my radar of things to try....we have just been decompressing and trying to pull ourselves back together in the relative calm, before we add anything new.  I hope it helps her.  

...

I know.  She was trying to be helpful....and wasn't.  She knows someone who apparently had their child diagnosed super young, ugh, anyway......it isn't really truly on my list of things to worry about, but I did start to wonder if I was being a bit naive, not considering something more serious than "intense" or "difficult".


I really appreciate everyone's thoughts.  Even just explaining the issue here has helped me sort out my thoughts and questions
Edited by Katico - 3/22/13 at 6:20am

[nenegoose]

If the pediatrician cannot find any medical reasons to your DD2's unhappiness, as PP suggested, you might want to seek a referral to a developmental pediatrician. I hope you find the underlying cause to her oversensitivity and disproportionate reactions to stressors in her life. My DD hated her wet diapers too so she's been potty trained since she was18 months old. I was so happy that my stinky diaper washing days were over. There are upsides to having a child who is intense and determined. :)

I have been using Dr. Greene's Explosive Child approach ever since DD turned one and for us, it has made a big difference. Whenever she starts whining or flipping out these days, I tell her that she is being illogical and explain why her reaction makes no sense. That stops her dead in the tracks and she starts negotiating for what she wants. I swear my child is half human and half vulcan. 

It does get better. You might look back and wonder how you survived it but you will get through it. 

[oaksie68]

Originally Posted by Geofizz 

Given your description, I'd look into food allergies or sensitivities first.

This.

DD was very intense (but not as intense as your DD). Very stubborn to get her way, at ANY cost. Many times when she was a toddler/preschooler, I could pull her back from the edge of epic tantrums, but when I couldn't, she would cry and cry and cry....then 30-45 minutes later, would throw up!

For years I had suspected food sensitivities, but it wasn't until she started manifesting more obvious physical symptoms (snoring, tummy aches, night terror/thrashing in her sleep, etc.) did I finally do something about it(at about 10 years old). She tested sensitive to gluten, dairy and eggs (which surprisingly to me, might be the worst, behavior-wise). Oh, and she had GERD as an infant, resolved with medicine by age 1.

[joensally]

Check out the Seng site re pediatricians:

http://www.sengifted.org/archives/articles/where-does-a-pediatric-doctor-fit-in-the-care-of-gifted-children

http://www.sengifted.org/Gifted-ADHD-Diagnosis-News-Release.html

http://www.sengifted.org/archives/articles/health-care-providers-know-little-about-gifted-children

My experience with doctors/professionals is they come in three basic types: those that don't know/care about gifted, those that have a healthy, reasonable approach to the issues, and those that will ascribe everything to giftedness, which can certainly be to a child's detriment when they're gifted and something else.

It's ridiculous to be talking bipolar.  Not diagnosable at this age, and arguably diagnosable in a young child. 

Sounds sensory to me. Even if it's not sensory, sensory-based strategies may help.  Out of Sync Child is a great book.  The companion book has great practical ideas:

http://books.google.ca/books?id=JrSiX9ZWxAkC&printsec=frontcover&dq=child+has+fun&hl=en&sa=X&ei=vtZLUffwMueXigLpqYGwDQ&redir_esc=y

You may also like Webb's Guide to Gifted Children and The Mislabeled Child - this book is a goldmine of info about different processing systems.

My teenager is very sensitive generally, but was definitely red dye sensitive (think head spinning, thrashing meltdowns) as a young child. 

---

[Katico]

I feel like my original post was kind of unclear, when she mentioned bipolar it seemed really ridiculous and extreme and suddenly I realized that given dd2's highly gifted father and (all signs point to) gifted sister, if there is something going on in her brain it is MUCH more likely to be related to giftedness, sensory issues, over excitability etc, than it is to be a mental disorder. So, I do know that bipolar is a pretty far fetched notion.

[Katico]

Thank you SO much for all these replies and suggestions and links.

[Katico]

Update

I have been doing lots and lots of reading in preparation of today's appointment.  I read the Out of Sync Child and just...did not see C in it!  I see her symptoms when I look at the Infant/Toddler SPD checklist, but when you look at the nuts and bolts and details of SPD, I don't see it.  

I find it interesting how different the discussions of sensory issues are when you read about gifted overexcitabilities vs SPD.  

Anyhow, her appointment was today.  I had decided to play it by ear to see if I was going to mention giftedness etc.  I shouldn't really have worried,  Both girls sat and played with alphabet blocks and a puzzle and it wasn't long before the conversation turned to yes, she was fascinated by the alphabet, yes, she was very advanced physically, yes she was very focused and curious and great with that puzzle and yes, actually her sister xyz....  So, the doctor clued in on her own.  And then I told her about DD1 and about how I worry that maybe this is at least partly because C's brain is busy and she is frustrated.  We also discussed sleep at length and I also mentioned I worried about food sensitivities.  

So, the Ped's feeling is that C is a very intense and intelligent child who is frustrated by her inability to do and say what she is thinking.  She isn't "behind" in language but she does not talk much or have many words yet.  DD1 was almost silent until she was 2 so this is "normal" to us.  Her suggestion was to do everything we can to encourage verbal development.  Getting rid of her soother to start  ...this makes me want to cry....I know it has to happen but she is SO attached to the darn thing and screeeeeeaaaaaaaams without it.  

She was happy that in all other ways C is perfectly healthy physically, no signs of any mental or developmental issues.

She didn't think there was any sign of a food sensitivity or allergy.....honestly, I'm not surprised.....but the fact that she discounted it doesn't rule it out for me though as I find doctors rarely entertain it as a real possibility.  I will probably get her tested just to see. 

So....relieved that there were no red flags at least.  Next steps....language, maybe a few signs, potty training, losing the soother, trying to enable her to do more for herself? And some allergy testing.   I guess I'm feeling better about things...