Fistula Repair and P-Flap 6-Month Post-Op

Matteo had his six-month post-op visit to check up his recovery from his fistula repair and p-flap surgery back in February. Despite how well his mouth has recovered, he did develop a fistula, or in layman's terms, he developed a hole. The hole appears small, but the surgeon can't tell how deep it goes. The good news is that the surgery appears to have been a success given that the fistula is not impacting Matteo's speech and his p-flap closes off properly to prevent air from going through his nose, which gives him the ability to pronounce a broader range of sounds. At this time, we don't think he'll need another surgery to do a revision to the p-flap, which means his next surgery won't be until he's somewhere between seven and 11 years old when he'll have a bone graft.

The bad news is that despite Matteo's incredible work ethic during speech therapy, his repaired and lengthened palate, his age (he's turning four soon) and being home for a year and a half now, his speech is still nearly impossible to understand. And when I say impossible, I mean that I as his mom have extreme difficulty in figuring out what he's saying. It's heart-breaking to hear him repeat a word over and over again with such persistence and helplessly can't understand him.  

The doctors told me what I already know, that he has a severe articulation disorder. Of the 44 phonemes (the smallest units of sound that distinguish one word from another) in American English, Matteo can only pronounce nine according to his speech therapist's evaluation. His speech includes multiple phonological errors, such as phoneme omissions ("poon" for "spoon"), syllable reduction ("jamas" instead of "pajamas") and difficulty sequencing phonemes in single words. Just like Kiera, Matteo doesn't readily initiate verbally and communicates in one- to three-word phrases at most. 

Aside from identifying that Matteo has a "severe articulation disorder", they can't do further testing on his expressive language skills due to how unintelligible his speech is. So we must plug away at speech therapy and wait until he develops more intelligible speech to be able to identify a more exact speech disorder. 

Matteo is so smart and inquisitive and like his sister, I'm curious what he's thinking and wish he were able to tell me.

Fading Memories

Soren was barely three and a half years old when we came home with Kiera and Matteo. He knows he stayed at his Grandma and Grandpa's house while we were "at China" as he worded it, but when we pressed him for his memories of that time, he thought intently before finally answering that he thought he made a fort while we were gone. Really, that's all he could give us. He insists though that he remembers coming to the airport and that Kiera was carrying an orange backpack and wearing a purple shirt and that his dad was the first person he hugged.  Okay, he got that correct. However, most other details are far fuzzier or incorrect.

Oliver remembers a little more, yet surprisingly not as much as I would have thought since he was five and a half at the time.  He remembers minor details, like that the bitter winter winds rattled the windows at Grandm and Grandpa's house and more monumental ones, like Skyping with us and even some of the reactions Matteo had during what was probably his first ever Skype session. Oliver rattled off many more details of the night we arrived home and said that what surprised him the most about Kiera and Matteo was that they were really little.  He had thought they would be Soren's size. (Although, they quickly caught up.) 

What surprised me the most about their memories is that neither remembers a time when Matteo and Kiera were not their brother and sister. This was especially surprising of Oliver, who has clear memories of meeting them for the first time and had a reasonably good understanding of the adoption process.  Yet when we had Oliver and Soren recall special memories that occurred before Kiera and Matteo came home, like being at the cabin with Grandma and Grandpa, neither could explain where their other two siblings were.

Oliver and Soren know that Kiera and Matteo came into our family differently than they did, but for them, those are just minor facts.  What matters most is that they are all siblings and they can't imagine it any other way. 

One-Year Post-Adoption Visit

Anniversaries of bringing a new child home is not only marked by photos popping up from prior years on your Facebook wall, but by visits from your social worker.  Ours came to our house last week for our one-year post-adoption visit. I spent much of the hour listing out all the procedures, surgeries and evaluations Kiera and Matteo have had in the six months since our last post-adoption visit as Ava, our social worker, tried to keep up jotting everything down in her notes. I talked about the challenges we've had and the unknowns we're still trying to sort out.  Since we had last seen Ava six months ago and before that, shortly after we came home, she was able to remind me of how far we have come.  Yes, we still have a longs ways to go, but look at what has changed in the last year.  I received a huge compliment when Ava said she listened to me describe a challenge, but before she could offer some suggestions, I described how we were handling it and it was exactly as she would have advised. 

I've enjoyed our post-adoption visits and was sad to learn that we won't be seeing Ava again.  Due to a change by China in post-adoption reporting, the one-year post-adoption report is the last one that must be written by our social worker and we will be allowed to write the two-year-, three-year and five-year post-adoption reports ourselves. 

Since our work with our home study agency is coming to a close, I would like to give International Adoption Services, and particularly, Ava, our social worker, a shout-out. If you live in the Twin Cities and need a home study, they're the ones to call.

Speech Consultation at the Mayo

When Chris heard I was bringing Kiera to the Mayo Clinic for a speech consultation, he joked with me that I was "bringing out the big guns."  I sure was.  I was tired of hearing people tell me that Kiera just needs time to adjust and that she's still learning English. She's been home for a year and turns four in March.  She starts kindergarten in a year and a half and can't communicate with more than one word, if she initiates speech at all.  I'm too impatient for a "wait and see" approach and have grown increasingly frustrated with her lack of progress despite the intensive speech therapy she's undertaken since July. 

Our consult at the Mayo Clinic was with Dr. Ruth Stoeckel, an expert in speech and language disorders.  This is the speech language pathologist recommended by my Facebook group for parents of children adopted from China who have speech and language delays. When I had no idea what to do next, this group offered their support and ideas. 

As expected, it took Kiera some time to warm up, so she wouldn't make a peep as Dr. Stoeckel tried to engage her.  She wouldn't even tell the doctor her name. As we know, Kiera responds to movement and once Dr. Stoeckel got her interested in a Nerf gun and was suddenly incredibly LOUD as she chased after the Nerf pellets. 

Dr. Stoeckel tested Kiera's receptive language first.  For conversational receptive language (tested using questions about the child, like asking how she's doing, what her name is, how many brothers and sisters she has, etc.) Kiera tested in the three-to-four-year-old range.  For academic receptive language, (tested by having her answer questions about a picture, such as asking where certain objects are located in a picture or what she sees) she tested on the level of a three-year-old.  Academic receptive language is considered harder and it's not surprising when kids score lower.  Overall, Dr. Stoeckel has no receptive language concerns and this is in line with what the school district found when they tested her in the early fall.

Dr. Stoeckel's speech evaluation revealed that Kiera can say a lot of words, but with a lot of errors. With the multiple speech issues the doctor pointed out, it now makes sense that Kiera's speech is so unintelligible. 

• Final consonant omissions - We're all familiar with how Kiera does not say the final letter in a word. "Hat" is "Haaa."
• Vowel distortions - She might pronounce the word "book bag" like "bay bye". We have a lot of vowel sounds in the English language (16?) and Kiera distorts a fair number of these.
• Fronting - She replaces certain sounds with other sounds, such as saying "tar" instead of "car."
• Cluster reduction - This is where she reduces consonants in a longer word or drops letters to make a word shorter or easier to say, such as saying "boon" instead of "spoon." I was told this is not unusual for this age and stage of English acquisition. 
• Glottal stop - not sure how to explain this one...

Sometimes two, or even three, of these speech issues are present in one word, which is why it's difficult to understand Kiera.  When she says "tating" instead of "skating," she's exhibiting cluster reduction by dropping the "s" and fronting by using a "t" sound instead of a "k".  "Stop" becomes "ta". Again, there's cluster reduction with the dropping of the "s", but also final consonant omission by not pronouncing the "p".

Dr. Stoeckel diagnosed Kiera with having a "speech sound disorder" and "delayed expressive language skills secondary to the speech sound disorder."  She didn't identify any obvious language disorder at this time, but said that could change as she gets older and she talks more and they can better diagnose her. 

Kiera has motor planning problems, which means it's harder for her to sequence longer words or phrases. This might explain why Kiera really doesn't talk with more than one word at a time and that her few two-word phrases are not more than two or three syllables in total.  (For example, she yells, "Do it!" if she wants to do something for herself, like get herself dressed instead of letting me help her.)  Or when you ask her to say a word with three or more syllables, she gets lost before she finishes saying the word. If you've noticed, typical of a kid Kiera's age, she "asks" a lot of questions.  For Kiera, that means every movement you make prompts her to ask, "Doing?"  Saying an entire sentence of "What are you doing?" is too much to sequence.  Plus, she's probably figured out that we know what she's asking simply by using the one word. 

Motor planning might also explain why she has trouble answering questions, like what she wants for lunch or even her own name. Kiera most likely knows what she wants, but something as easy as saying, "I would like a peanut butter and jelly sandwich" or  even, "peanut butter and jelly" is a lot for her brain to sequence and communicate with her mouth to say. While we may never know what other factors play into her inability to answer questions or initiate speech, she could be aware of the errors she makes and be self-conscious, or she could have adapted to her speech limitations and makes do with pointing or not getting what she wants. 

I had originally thought could possibly have Childhood Apraxia of Speech (Apraxia), and even the neurologist at the Mayo who reviewed the videos I had taken of Kiera speaking, thought that could be the case, but Dr. Stoeckel, an expert in Apraxia, says she doesn't have it.  However, the "motor planing with vowel movement" that Kiera presents is present in all kids with Apraxia. A small number of kids have motor planing issues, but not Apraxia, and Kiera fits in this category. The main clue that Kiera does not have Apraxia is that there is often consistency with her errors and when she has someone guide her through the word, she can often say it correctly by the third try.  (That is, if she's in the mood!) Kids with Apraxia will say the same word three different ways and not get it right.  There's no pattern to their errors.

Here are two resources that talk more about motor planning. They are specific to Apraxia, but the information is still relevant to Kiera. 

• http://www.apraxia-kids.org/library/what-is-the-difference-between-speech-motor-planning-programming-and-execution/
• http://www.tayloredmktg.com/dyspraxia/das.shtml
  

I was relieved to learn more about Kiera's speech needs, but I was also desperate to learn what the next steps should be in speech therapy. Most traditional speech therapy (sometimes called articulation or phonological) therapy doesn't focus on vowels and this is the area Dr. Stoeckel is most concerned about because they're the hardest to fix. She recommends motor planning therapy because it will improve communication efficiency.  This type of therapy is sometimes referred to as a "core vocabulary" approach.  Core vocabulary therapy focuses on teaching kids usable phrases instead of trying to learn how to pronounce individual sounds. She recommended a program called P.R.O.M.P.T.

Dr. Stoeckel recommended some speech pathologists at Children's Hospital of Minnesota, but unfortunately, we couldn't get Kiera on any of their schedules.  Since we haven't been happy with her progress at Gillette's, we'll still give Children's a try with a different speech pathologist.  Our first appointment is in mid-March.

Both Kiera and Matteo have been receiving speech services through the school district twice a week.  The wonderful part is that these services are free and the speech pathologist comes to our home. Their speech pathologist is familiar with Core Language Therapy and did some extra research to come up with a new game plan for Kiera.  Our goal now is to work with Kiera on familiar words that she needs to communicate.  We'll work on up to 10 each week. The task is to twice a day have Kiera practice pronouncing each word five times.  The idea isn't to quiz Kiera on what the picture is, because she most likely knows that, but to provide an example of how to say the word and then get her to repeat it. Because of her motor planning issues, Kiera might not be able to produce the word correctly on her own without watching and hearing someone say the word, which is why much of our "quizzing" her on names of objects has been mostly fruitless and frustrating for both us and Kiera.  The hope is that practice will increase brain "muscle memory" so that words her brain has struggled to communicate to her mouth to speak, or speak correctly, will become second-nature.

Because there's an emotional/psychological component to Kiera not being able to/wanting to speak, the speech pathologist also suggested we create a sticker chart and make a big deal out of Kiera using words to communicate her wants or needs, similar to what we did with Oliver and Soren during toilet-training.


I'm looking forward to a new chapter in Kiera's speech therapy, but I'm also overwhelmed because even under the best of circumstances with a proper diagnosis and skilled speech pathologists providing the correct kind of therapy, we still have a long road ahead of us and a lot work to do. 

Fistula Repair and P-Flap Post-Op

Matteo's recovery from his fistula repair and P-flap surgery has gone so much better than last year and his surgeon confirmed that when we went in for his post-op appointment. His mouth is still healing, but that's to be expected, and why the poor guy has another week and a half of a liquid and then soft foods diet.  But so far the fistula repair is still intact, which is really a miracle, because his surgeon said nearly all children with a bilateral cleft palate (especially to the degree Matteo's was) end up with at least a small fistula. There's still a possibility for that, but with each passing day, I feel more and more confident that we won't see the repair completely fail. The doctor isn't worried about a hole the size of a pencil eraser or smaller, especially if his speech isn't affected and food doesn't come out his nose.

After the doctor's visual inspection of Matteo's mouth and my report that he's snoring loudly, his surgeon thinks the P-flap is healing and doing what it's supposed to do.  Unfortunately, snoring is a side affect of the surgery because when the lengthened the palate, his throat can now be blocked off, which will help him make sounds that would be otherwise inhibited if air could escape.  The snoring will lessen in the coming weeks and months, but sadly for his future partner, won't completely disappear.  His surgeon, who's getting close to retirement and has been married many, many years, gave Matteo a fist bump and assured him that he's done just fine and his wife hasn't kicked him out yet.  Matteo of course had no idea what the joke was about, but flashed the surgeon his beautiful smile for good measure.

We won't know how much the P-flap surgery will impact Matteo's speech until he's completed another six months of speech therapy.  We'll be back in August for the six-month post-op visit and will also meet with his speech therapist at that time.  About 15% of children who've had a P-flap surgery need a revision.  Thankfully, that's an out-patient procedure with minimal pain and "only" five days of a liquid diet.  So a walk in the park for a brave little boy like Matteo.

I'm still in disbelief by how well Matteo's recovery has gone.  I really had prepared for the worst.  However, in the hospital, the surgeon told me that for some kids, this type of surgery ends up not being a big deal.  I can't believe Matteo ended up in the "1 in 10."  We have the advantage that he didn't end up with a double ear infection and stitches that ripped apart, both of which only added to his misery. 

Family Day Anniversary

Thank you for taking a trip down memory lane with me these past two weeks. With "Gotcha Day" and adoption finalization for two children, (four days total right there) the much-awaited consulate appointment and the day we arrived home, there have been a lot of first anniversaries in this short time. Today marks the final anniversary in this string of anniversaries, as February 12 is the day we arrived home from China with Kiera and Matteo. For us, this day is Family Day. When we walked through those doors into baggage claim at Minneapolis-St. Paul International Airport holding Kiera's and Matteo's hands, Oliver and Soren literally threw themselves into our arms, and we were united for the first time as a family of six. 

Anniversaries are an opportunity to reflect, and I've done a lot of that recently. Adopting Kiera and Matteo is an experience I often have trouble putting into words.  So I watch the videos, look at pictures and read old blog posts and let the memories come back to me. Some bring a smile to my face and others make me want to cry happy tears. Amid the gratitude that I get to call these two my children, these anniversaries have also stirred up feelings of anxiety and being overwhelmed, as they're a reminder of not only how far we've come as a family in one year, but how much work is still ahead of us.     

A look back...
Our Journey to Kiera and Matteo
Welcome Home Kiera and Matteo

Post-Surgery Recovery

Matteo's post-surgery recovery is going a lot better than this point last year.  Of course having this extra year together has helped, both in attachment and Matteo being a year older and able to understand that much more.  But I give a lot of credit to Matteo himself.  This kid is such a trooper!

Matteo was seemingly back to his usual self when I arrived back at the hospital the morning after his surgery.  He was sitting in bed watching a movie and although Chris hadn't been able to get him to eat more than a few small bites of ice cream, he had been drinking plenty and his pain seemed under control.  Chris went to work and Matteo and I hung out the rest of the morning and into the afternoon.  We received visits from various health care providers, played a matching game, put stickers in the sticker book Grandma had brought him and then cruised through the hospital in a wagon.  It was a lazy and quiet day at the hospital for us.

The only time Matteo appeared in pain is when I cajoled him into eating a few bites of his lunch.  Granted, he was eating pureed chicken mixed with gravy, so that there might have been the root of his discomfort, but I knew the nurses weren't going to discharge him if he didn't get some "solid" food into his stomach.  I otherwise wasn't concerned by what he was or wasn't eating because he had practically chugged two bottles of PediaSure and Carnation Instant Breakfast in one sitting and was willingly drinking plenty of water. He had already defied the surgeon's prediction that he was going to barely drink anything for five days following the surgery due to his throat, so I considered Matteo to be ahead of the game.

Into his second full day of recovery, Matteo continued to only want to drink Carnation Instant Breakfast, but I made it with whole milk and added some of the protein powder Marcel had left behind in an attempt to get as many calories and as much protein into his body to fill his tummy and heal his mouth. I got him to eat a fruit puree pouch and then a bowl of chocolate ice cream for dinner, but if he otherwise just wants to drink Carnation Instant Breakfast for the next two weeks, I'm fine with that if it means we get him through the liquid diet.

Overall, I can't believe how much better this surgery has been compared with last year's surgery and compared with what I had prepared myself for.  I brought Matteo into work this afternoon to visit my co-workers, some of his biggest fans, and no one could believe what a good mood he was in.  He was hamming it up for everyone, playing peekaboo from behind the cubicle partitions and basically acting like a typical three-year-old kid who had NOT just had surgery 48 hours prior.

As thankful as I am for his easy recovery, we're definitely not out of the woods.  I'm still very nervous that his palate could suddenly fall apart.  A small opening the size of a pencil eraser or smaller wouldn't be concerning and "shouldn't" affect his speech, but anything bigger than that is something they want to keep trying to repair.  My question was how.  They could do another fistula repair, which would be possibly an out-patient procedure, but would require the same liquid diet during recovery, or they could do a procedure where they take skin from the inside of his cheek and "fill in" the hole.  I know I shouldn't be focused on the options for another repair since it hasn't come to that yet, but it does make me feel a little better knowing that there are options.

Thankfully the p-flap procedure, which extended his palate and will do the most to improve his speech, has a high success rate and the doctor isn't worried about that coming apart.  There is the possibility that the surgeon will need to "tweak" the p-flap at some point in the next year if the desired speech results aren't achieved, but that's at least an out-patient procedure and less painful of a recovery.

In addition to Matteo's physical recovery, a lot of speech therapy stands ahead of him as he learns to retrain his muscles to make all the sounds that have been impossible for him until now.  Even though Matteo had not made much progress in speech therapy prior to his most recent surgery, I took comfort in hearing his speech therapist tell me that all the hours of therapy was time well spent because he was learning proper placement of sounds, even if he couldn't actually master those sounds. He has the practice in place so that once the surgery is completed, he has the potential to make more rapid progress than if he had done no speech therapy prior to his surgery. 


While hearing all this from Matteo's speech therapist was promising, a lot of unknowns still remain about how much progress he will actually make and in what time period.  My biggest concern is that Matteo's speech may be affected by more than just his cleft palate.  My gut has been telling me lately that there's maybe more going on and Matteo's speech therapist admitted the same hunch to me.  She had never mentioned anything until now because a speech disorder is too difficult to properly diagnose in a child who doesn't have much discernible speech. It's an observation she had tucked away and will wait to look into more a few months post-surgery. 

Chris does not believe anything beyond a cleft palate is affecting Matteo's speech and predicts that by his fourth birthday we'll have trouble keeping him quiet.  Let's hope he's right about that!

Fistula Repair and P-Flap Surgery

Matteo had his second cleft palate surgery today. It was a "twofer" surgery with fistula repair (to repair the hole in the roof of his mouth that was created when his palate repair dehissed) and a pharyngoplasty, (also called a "P-flap" surgery) which will lengthen his soft palate and, fingers crossed, improve his speech.

Matteo has heard us talk about the surgery a lot, but we'd never actually sat him down and explained what was going to happen and I realized I owed it to him, even if he's barely three and a half years old, to do that.  Given his lack of a sense of time, I chose last night, the night before surgery.  I explained that when he woke up he wouldn't be allowed to eat or drink anything and that right after getting dressed, we would be going to the hospital for a surgery to fix his mouth.  He seemed sad and when I asked him if that made him scared, he shook his head yes.   

His mood changed at the hospital and he was suddenly excited to push the buttons on the elevator and show me where to go.  He goes to the hospital for speech and other appointments, and it's clear he's become quite familiar with the place.

That his mom is late for everything actually ended up working in his favor.  Last year Matteo had an afternoon surgery, which started late, and it was tortuous trying to keep a hungry, thirsty and cranky two-year-old distracted.  He had what I thought was a 9:00 a.m. surgery, which meant we were supposed to be there at 7:30 a.m.  Well, the surgery was at 8:30 a.m., so we should have been there at 7:00 a.m., but well, I was shooting for 7:30 a.m., and of course we were late.  When we showed up at 7:45 a.m., the staff was waiting for us, checked us in quickly and whisked us back to a pre-op room.  One after another, nurses, the surgeon, the pharmacist, a nurse anesthetist and the anesthesiologist stopped by the room to check in. At exactly 8:30 a.m. a trio of nurses wheeled him back to the OR, he calmly let them put his mask on, he quickly fell asleep, I gave him one last kiss, and the surgery I'd grown so anxious about in the preceding weeks was finally underway.   

The surgery took about an hour and Matteo ended up spending longer in recovery than he did in surgery thanks to needing an extra-large dose of Morphine, which caused him to take an extra-long nap. His surgeon met with me while we waited for Matteo to wake up and he reported that both procedures had been completed without complications. Despite the uncomplicated surgery, he reiterated how painful the next 5-7 days could be for Matteo since a p-flap surgery involves taking skin from the back of the throat to use to lengthen the palate.  He also reminded me how fragile his palate is and why a strict liquid diet is going to be crucial to his recovery.  The failure rate is still relatively high, which makes me nervous.

We spent the afternoon settled in Matteo's hospital room, where he went in and out of sleep.  When he was awake, we tried to get him to drink and eat something, but that was a tough sell because swallowing clearly caused him a lot of pain.  My mother-in-law had come to keep me company, so we hung out and did our best to help Matteo stay comfortable.

I know the therapy dogs are there for the kids, but with Matteo sleeping off the anesthesia, I got to spend some time with Freddie, a six-year-old Golden Retriever. 

Chris and Celina came over after dinner with the kids, who seemed to have forgotten why Matteo was in the hospital and fixated on what they thought was a sweet set-up - all the juice, pudding, ice cream and DVD's Matteo could ever want.  Not even Matteo throwing up dried blood (and what looked like a lot of it!) scared them away.

Chris volunteered to do the night shift, which I'm so thankful for since I find sleeping overnight in hospitals so incredibly lonely.  I'll be back in the morning to relieve him.  Hopefully Matteo's stomach has settled by then and he is finally able to eat something.  He won't be discharged until he's eating and the nurses feel like his pain management is under control. 

One Year Ago Today We Met Kiera

One year ago, it was finally time to meet Kiera. In a crowded and humid civil affairs office in Guangzhou, the provincial capital of Guangdong, Kiera surprised us by being one of the first to arrive. Before I realized what was happening, a quiet, curious little girl stood in front of me as her nanny urged her to go to Mama. This brave girl indeed came to me and never looked back. Our hearts were finally complete.

Read about our first day with Kiera.

February 2, 2015 in Guangzhou, Guangdong

 One year later home in Minnesota

One Year Ago Today We Met Matteo

One year ago, Chris and I were anxiously waiting to meet Matteo for the first time. What should have been a three-hour car ride from his hometown of Fuyang to Hefei, the provincial capital of Anhui, was slowed down by a very rare snowfall. Just when we were wondering how much longer we were going to need to wait, one of the bravest little boys we've ever met walked through that door and into our lives. Our hearts haven't been the same since.

Read about our first day with Matteo.

January 26, 2015 in Hefei, Anhui

One year later home in Minnesota

Please Don't Say All Kids Do That

Please don't say "all kids do that" to adoptive and foster families...
By Shannon Dingle

Children cry. Children have meltdowns. Children sometimes push or shove or hit. Kids act out from time to time. Some kids shut down when disciplined or even simply when an adult talks directly to them at all.

I could go on, but you get the picture. Many behaviors or responses are common for kids.

But behavior is always a form of communication. Who we are, where we’ve been, and what we want others to know all direct our responses. While all children act out or shut down or lose tempers or cry from time to time, what each one is communicating with that behavior might be different.

While all children display certain behaviors, not all children have lost their parents to death or abandonment or addiction or disease. Not all children have been uprooted from the home or country or familiar voices in the womb to live out the rest of their days in a different home and maybe a different country and with a different mother. Not all children have witnessed or experienced abuse or neglect or malnutrition. Not all kids have permanent structural changes to their brains due to early childhood trauma. Not all kids have learned that adults aren’t always trustworthy, home isn’t always safe, and family isn’t always forever.

Some of my kids have, though. And some other kids who have been adopted or are in foster care have too.

I have two daughters turning 8 soon and two sons who’ll be 6 in March. For each pairing, one arrived via birth from my womb and one joined our family by adoption after years of life experience before us (almost 7 years for our daughter and 4.5 years for our son). Sometimes our kids act out in similar ways, but I know their behavioral responses aren’t coming from the same place.

For example, my friends recently adopted a preschooler. They already had another son less than a year older than their new addition, so they’ve parented a two year old boy before. They’re familiar with those things that all kids do. But like any good parents, they know their kids. They know that when one son is clingy at Sunday school drop-off, it’s just age-appropriate separation anxiety that will resolve not long after they’re out of sight. Likewise, they know that when their other son does the same, he’s acting from a genuine fear based on a history in which other caregivers left and never came back. It looks the same, but it’s not the same.

I get the temptation to say “all kids do that.” Truly, I do. But when foster or adoptive parents like me hear that, it feels dismissive to the real grief, pain, and trauma our kids have experienced and how that history still influences their actions today. Usually when someone tells another parent “all kids do that,” the words are meant to be helpful, to soothe our nerves or encourage us in the midst of a hard parenting moment. But that’s not what your words do. Instead those words invalidate what we know to be true and minimize the extra layer of thinking that parenting kids from hard places requires.

Finally, every adoptive and foster parent has different ground rules about how much we can or will share about the children in our homes. You might not know our children’s trauma or circumstances, because you don’t need to. You don’t need to know the details of their personal pain to understand that when our kids cry or yell or fight or melt down, they might be acting out of deep losses and hurts.

So, please, don’t say “all kids do that” because even if behaviors look the same, that doesn’t mean they are the same for our kids from hard places.

Link to original article source

I can think of so many examples of how I see and react differently to the behaviors of Kiera and Matteo than from Oliver or Soren.  Oliver was a shy and anxious baby and toddler and now is a chatty kid who easily talks to any adult.  I never wondered if grief or trauma was causing my little boy to be so clingy and I never worry about attachment when he chats it up with a random parent at the playground. But when Kiera didn't cry when I dropped her off for her first day of preschool, my internal attachment alarm bells went off, as they still do whenever she shows any interest in an adult outside our immediate circle of friends and family, 

I was guilt-stricken when I learned that I'd slept through Matteo's middle-of-the-night crying and our au pair had instead heard him and gotten up to comfort him.  I'm confident in his attachment to his dad and me, yet I feared that underneath the sunny disposition he displayed the next morning was a new seed of loss or distrust. 

When Kiera melts down if we redirect her behavior, she looks like the many other children who can't handle even the gentlest criticism. However, her lack of eye contact and silent treatment that can last hours are subtle clues to us that there's more going on.  We don't know if it's grief or loss or fear of re-abandonment.

Lots of kids are afraid of dogs, including Soren and Matteo. But in Matteo's case, we don't know what his history with dogs is. 

Speech Therapy Progress Update

A question commonly asked is how learning English is coming along for Kiera and Matteo.  As far as we're concerned, they understand English really well.  Even in the early days and weeks home when there were occasions they couldn't have understood what everyone was saying to them, they never seemed upset or frustrated due to lack of comprehension.  Because of their young ages, they learned English quickly and we never needed to rely on translators. 

Speaking English has not happened at the explosive pace that their language comprehension has occurred.  And it's not because they haven't learned English, it's because they both have speech delays, and very significant ones.  Of all their medical needs and catch-up care we've tended to the last 11 months, speech therapy has dominated most of our time.  

Matteo
We knew Matteo would need years of speech therapy because he was born with cleft lip and palate. The idea of speech therapy seemed so straight-forward initially. The therapists would teach him how to talk and we would watch him progress with leaps and bounds.  The difficulty of understanding his speech would be similar to a child with a lisp or mild speech impediment.  Of course this has not been our experience. 

I had little understanding of what kind of time commitment, patience and emotional fortitude Matteo's speech therapy needs would require. I wasn't prepared for a child with no intelligible speech who eventually didn't even try to say anything, perhaps because he had learned no one understood him. I was relieved to finally get him started on intensive speech therapy where he had up to four sessions a week - two at our local children's hospital with speech therapists who work specifically with kids with cranial facial differences and two through our school district's Early Childhood Special Education department.  I thought all we needed to do was put in the time. Given how hard Matteo worked, we should have seen  more progress, but we didn't. I don't think I'm exaggerating when I say that I can understand maybe 10% of what he says. There are so many sounds he simply cannot make. 

I was not surprised when Matteo's speech therapist and surgeon advised that he needs another surgery.  His bilateral cleft lip had been repaired at five months of age in China and he had surgery a month after coming home to repair his bilateral cleft palate. Closing his palate prevented food from coming out his nose when he ate, but we had to give speech therapy a couple of months before we would know if the procedure had done enough to help his speech.  It was clear to me very early on that the palate repair alone was not going to be enough for Matteo. His surgery next month will involve two procedures - a fistula repair (to repair the hole in the roof of his mouth that was created when his palate repair dehissed) and a pharyngoplasty, (also called a "P-flap" surgery) which will lengthen his soft palate and, fingers crossed, improve his speech.

The P-flap surgery won't be a magic procedure, unfortunately.  Matteo's speech therapy will continue for years as he works to master each and every sound in the English language.  However, I'm hopeful that the surgery in February will allow him to make sounds he is currently not able to make and will make more of his speech intelligible, even if not perfect.  

Kiera
The root of Kiera's speech and language delays is still a big mystery that we've spent the last 11 months trying to figure out.  Although she had not been diagnosed with any speech delays while in China, we knew based on the updates we had received prior to traveling to meet her that she had significant delays. When Kiera was two years and nine months old, I had asked the orphanage how many words she had or if she had too many words to count, and the response was simply, "She can say, Mama, Papa and sister."  She didn't have any two-word phrases.   

The little girl we met in China was happy, but quiet.  Just like we had been told in an update, she got her needs met through a lot of pointing and smiling, and by our observation, just looking plain cute. While many kids have a handful of English words before they even arrive in the United States, Kiera wasn't saying words in any language, or even vocalizing much. We attributed this to her shy, cautious and quiet demeanor. Her nannies and foster family had reported that even as a baby she was quiet and didn't cry a lot.

Home in the U.S., the ENT discovered that Kiera had a significant amount of ear wax impacted on her ear drum and I thought for sure the mild conductive hearing loss that caused was the reason she wasn't talking.  She just couldn't hear!  With the ear wax removed and some more time exposed to English, I eagerly waited for the language explosion to finally occur.  Still nothing.

At follow-ups at the ENT, her right ear kept failing the OAE and they sent her for additional testing under general anesthesia right before Thanksgiving. Even though the doctor assured me that even if she was completely deaf in her right ear, it would not affect her ability to learn to talk, I couldn't help but "hope" deafness would explain Kiera's lack of words and what we were noticing to be an inability to follow multi-step directions or answer open-ended questions. 

The audiologist met me in the waiting room following the testing and announced that Kiera's hearing was perfect.  Those failed hearing tests in the ENT's office was due to what the audiologist had discovered was a "weirdly-shaped" ear canal.  No one could figure that out before we put our daughter under general anesthesia.      

As I continued to be concerned, it felt like everyone around me was telling me to relax because she was going to talk when she was ready or that I couldn't "get" her to talk if she didn't want to. No one had ever met a child adopted from another country and it seemed as if everyone was simply amazed that this cute and endearing little girl was doing as well as she was doing and easily overlooked that she wasn't talking. 

At five months home, I finally got Kiera into speech therapy, but not without a lot of advocating and a bit of a fight. One of the speech therapists at our local children's hospital commented with a hint of frustration in her voice, like I was wasting her time, that their role wasn't to teach Kiera English.  No one seemed concerned that at nearly three years old, Kiera had maybe five words in her native language.  In their opinion, Kiera just needed to learn English.

Language delays are not uncommon from children raised in even the best of orphanage environments, because nothing replaces the positive impact a loving and stable family has on a child's development. Yet Kiera had what my admittedly non-professional opinion felt like were pretty significant language and speech delays that couldn't be completely explained away by an orphanage upbringing.  Kiera came from an orphanage where the kids were well taken care of and she had spent the last year before we met her in a foster family where she was doted on and well-loved.  She attended preschool more days a week than Oliver and Soren did back here in Minnesota.  No, she was not living in a permanent family where her parents read to her every day and made sure she was meeting all her milestones, but she was not in a horrible orphanage setting where she sat in a crib most of her day and no one talked or played with her.       

That we were successful in getting speech services for Kiera was not because anyone listened to my concerns about her lack of language in Chinese or English or her questionable receptive language ability, but because an evaluation of Kiera's speech identified that she drops the last consonant sounds when she mimics words. My disagreements with the speech therapists aside, she was at least in speech therapy and I was hopeful that we would finally start to hear her voice more often. 

Kiera worked very hard at speech therapy for what consisted of up to four sessions a week. She enjoyed going and was persistent, but six months in and she had gained little progress.  Her vocabulary had increased, but she still speaks mostly with single words - when she initiates speech at all - and has only about three two-word phrases she uses.

The only noticeable change in her speech is that for a kid who can't talk, she can be quite loud!  She was super quiet the first couple of months home and while she's still quiet overall, when she's playing, she can make a lot of noise.  While she will patiently and persistently mimic words and even answer questions asked of her during a speech therapy session, all the vocalizing she does while playing isn't discernible speech.  It doesn't even sound like she's trying to make real words. (Except for the word, "Mine!" She quite good at that one.)

It's the lack of initiative to speak and the inability to answer questions that concerns me more than Kiera's articulation issues.  Other than sometimes saying "Potty," when she has to go, she does not use words to express her needs or wants.  She can't answer open-ended questions like asking her what she wants for a snack and will only answer if you give her choices to choose from.  We often don't trust her answers, even in this case, because it seems like she knows we expect an answer, so she just chooses one of them.  She will usually talk if we ask a direct question like pointing to an object in a picture book and asking what it is.  

I'm working on getting Kiera re-evaluated, because my gut says something isn't right, but I don't know what the answer is.  I don't know if it's an auditory processing disorder, apraxia of speech, anxiety or a combination of things.  It is possible she truly is a late bloomer.  I've learned that speech disorders are difficult to properly diagnose, especially in young children, but that early intervention yeilds the best outcomes.  There are also different approaches to therapy depending upon the disorder, which is why proper diagnosis is so important.  

I've been accused of worrying too much and told to just let it be, but my job as Kiera's mom is to be her advocate. She didn't have that for the first three years of her life. 

Attachment Reminders

I'm 100% confident Matteo is firmly attached to me, but given how hard he rejected me in China and in the weeks after we got home, I don't take any displays of his attachment for granted.  They still catch me by surprise and fill my heart with love. Yesterday he gave me another sweet reminder of how far we've come as mother and son.

Kiera, Matteo and I met a friend and her kids at the park this weekend.  I was thrilled to see my friend's baby and scooped him out of his car seat and cradled him in my arms.  I knelt down so Kiera and Matteo could get a good look at him and Kiera's eyes lit up and a rare smile spread across her face.  She adores babies and points out everyone she sees, whether in real life or in a picture.  I then turned to Matteo and asked him what he thought of the baby.  He looked at me really sadly and repeatedly shook his head no.  I thought his reaction was an anomaly or perhaps he misunderstood me.  But he continued to look sad as I held my friend's baby.

Matteo is not an aggressive or mean-spirited child.  He expresses his disapproval subtly with the gentle tug of my hand or the quiver of his lip as he looks longingly at the child nestled in my arms.  Any attempts to get him to interact with my friend's son was met with more shaking of his head no. 

That night when I tucked him into bed, I knelt down, looked him in the eye and told him that no matter how many babies I hold, I'll always love him and I'll always be his mom. I wasn't sure whether my words mattered to him or whether he even understood what I was saying, yet he looked intently in my eyes and shook his head yes. 

Grandma Nan, Our Honorary Speech Therapist

Even though no one ever mentioned speech delays in the referral paperwork or updates we received for Kiera and Matteo, let alone officially diagnosed them, they have significant delays. Thankfully we knew of these delays because we thought to ask questions about their speech when we requested updates during our long wait to travel.  However, for children with special needs adopted from abroad, you won't fully understand the extent of their diagnoses until you meet them and then have them evaluated by a doctor back home. 

We arrived home with a two-and-a-half-year-old and a three-year-old who each couldn't say more than five words in any language.  I pushed as hard as I could to have them evaluated as soon as possible because I didn't want to lose any more precious time, but also because my maternity leave was about to end.  We quickly scheduled surgeries, (ears for both, cleft palate for Matteo) but they did not magically spur my children to suddenly speak in clear and complete sentences like I had hoped.  So we moved onto speech therapy.  That is where Grandma Nan stepped in. 

I was so excited to get Kiera and Matteo started, but the speech therapist laughed as she reminded me that they're not miracles workers.  Speech therapy requires long-term commitment,(for us, that will mean years) persistence and practice.  I want to give my children all the resources available to reach their full potential, but what Chris and I are both lacking right now is time.  We can't take that kind of time off work to make sure the kids get to the six appointments weekly between the two of them. 

Grandma Nan is the reason we can sign them up for the intensive speech therapy they need.  We were able to start them right away because Nan had the flexibility to accommodate whatever openings the therapist had her tight schedule.  I type the appointments into our shared calendar app and Nan takes care of the rest.  She brings the kids to their appointments and then sends Chris and me page-long, detailed reports of what Kiera or Matteo worked on that day.  We read about what words or signs they practiced, activities or techniques the therapist used to help them develop certain sounds, and what the kids need to practice at home. 

The benefits of Nan's participation in the kids' speech therapy extends beyond being able to attend the appointments.  When you're one of four children, one-on-one time with someone special like a grandmother is precious.  The kids love the individual attention and I think Grandma enjoys the opportunity to bond with her new grandchildren.  Ever the patient teacher she is, she works in additional speech practice and reinforcement of what they learned in the sessions as she goes about her one-one-one time with Kiera or Matteo. 

When Your Heart is Still in China

A fellow adoptive mama recently posted in one of my adoption Facebook groups about how she thinks all the time about going back to China.  The desire to go back sticks with her even during the lowest of lows of parenting a child whose background includes trauma, even though she and her husband are not getting any younger, even while they struggle to regain their footing financially, even with their hands full being the best parents they can be to the children they have and even though she knows that for all of these reasons, they probably won't go back.

My heart is broken along with hers.  Every last word of her confession could have been written by me.  Chris and I went to China knowing that we would be completing our family.  Yet it's so hard seeing how many children still need families and I came home questioning whether we were truly done.  So I dream about going back even though we absolutely cannot adopt again anytime soon, if ever.  I can't stop looking at the advocacy boards on Facebook and imagining the children staring back at me in the pictures blending into our family, even though in reality we have no room left in our house.  We're still catching up financially and adjusting to the expenses that come with having four children. We're two parents being pulled at times in too many directions trying to meet all our children's needs. 

I understand the reality for our family, but I may still never stop dreaming of China. And that's okay even if it hurts a little.  Adoptive families will tell you, "China changes you."  I guess it was inevitable that coming home from China did not mark the end of our family's story. 

Six-Month Post-Adoption Report

What a difference a couple of months makes.  Back in February when our social worker visited us to complete our one-month post-adoption report, we were still adjusting to our new normal, just embarking on a never-ending series of doctors appointments and not sleeping much thanks to a someone who preferred sharing our bed over sleeping on his own.  And yet we were doing so well that I assumed that things couldn't get any better. 

Fast forward a couple of months and so much has changed.  I've gone back to work, Kiera started preschool, Matteo had his palate repair and got cool new glasses, both kids stopped napping, everyone goes to bed in their own beds, and things are going even better.  Our normal doesn't feel new anymore, it just feels, well, normal.

Our social worker asked if we had any questions for her, but we really didn't.  It's not that everything is perfect - I don't feel like we're 100% there with attachment, both kids need speech therapy and we won't know for another couple of months whether Matteo needs a follow-up surgery on his palate.  But we feel like we have a plan in place and are managing these issues just fine.

The only question I had was whether the agency ever hears back from the CCCWA regarding the post-adoption reports the social workers submit.  Even though our social worker dutifully schedules the post-adoption visits, writes thorough reports and submits them on time, she never hears anything once she submits the reports.  I like to think of the required post-adoption reports as a way of relaying information on the well-being of our children to all the people who cared for them before we met them, but I know the reality is that most likely no one but CCCWA officials has access to the reports.  For all I know, they're never even read and collect dust on a shelf.  Nonetheless I hope someone is reading all these reports and is comforted knowing that for China's children scattered across the world, they are so loved and well-cared by their new families. 

Starting Speech Therapy

This week starts speech therapy for both Kiera and Matteo.  I'm relieved they have finally been evaluated and recommended for therapy because I know they need the extra support.  Too many people have made excuses for them because "they're still learning the language." I think everyone who has interacted with my kids has really low expectations because they can't wrap their minds around these children moving around the world to a new family, language and culture.  And then they see two happy, well-adjusted kids and probably think, what more could I want from them?  

We underestimate being able to communicate, especially in young children who've gotten by so far with a lot of pointing and smiles.  Whether you're deaf and communicate with sign language or are hearing and communicate with spoken language, having the ability to communicate with other human beings impacts our happiness, our friendships and our learning.

While I never lost hope that Kiera and Matteo would experience an English-language explosion, my gut told me ignoring the problem wasn't going to help.  I know that if my children were speaking Chinese, they'd have the ability to learn English, and that they should be able to pick up words in a new language quickly, even if it takes up to two years to catch up to native-speakers.  The reality is that my children spoke no more than five words in Chinese when an almost-three-year-old like Kiera should have been jabbering away.  Some children leave China already speaking a couple words in English, whereas as at five months home, my children don't use more than five words in English to communicate.  We have recently heard them imitate words or randomly say a word, but not in context to communicate a need or want.  

For awhile I tried to stay patient.  Matteo needed surgery on his palate and wasn't physically able to say most sounds without a repaired palate.  Both children were diagnosed with conductive hearing loss, which we addressed through surgery and they passed their repeat audiology test one month later.  It was in the weeks following their surgeries that I really had hope that just any day now their language would come together, but it never did.  

I contacted Help Me Grow, a state-funded program that provides free therapy services for children from birth to age five.  Matteo easily qualified, and starts his first session this week, but since Kiera is over age three, it's harder to qualify for services and we'll need to wait until the fall to have her reevaluated. 

I also asked a fellow China adoptive mom in my area where her boys with cleft lip and palate go for speech therapy, and in addition to working with Help Me Grow, she recommended doubling up on therapy by also working with Gillette Children's Hospital, where Matteo had his palate surgery.  Kiera started her first session this week and we're in the process of scheduling Matteo with a therapist who works specifically with kids with cleft lip and palate.  

Therapists with both programs cautioned me that they're not miracle workers and that speech therapy takes commitment and time.  This is especially true for Matteo since kids with cleft lip and palate typically need years of speech therapy.  But we're now doing something proactive to support their speech development and that makes me feel better than if we were doing nothing at all. 

And that my children are able to attend their recommended appointments I owe all to my mother-in-law, Nan.  Each child will have one to two appointments through Help Me Grow and Gillette's each week, which means there could be some weeks in the fall when we have a total of eight therapy appointments scheduled.  Without Nan's offer to take them, the reality for our two-working-parent household is that we would not be able to pull off that level of therapy.  And that's even though I work ten minutes from home and five minutes from the hospital and have an incredibly flexible workplace.  

In addition to bringing Kiera and Matteo to their appointments, my mother-in-law takes incredible notes.  The evening of Kiera's first appointment, Nan e-mailed Chris, me and our au pair a summary of the session, the ten words in sign language we need to learn and practice with Kiera and links to a website to learn the signs.  (Sign language foster language development by giving non-verbal children a way to communicate.)  Chris and I may not have been able to make the appointment, but Nan made sure we didn't miss a thing.  

Now let's see if we can teach Kiera one more sign before her next appointment. 

Retaining Adopted Kids' Native Language

Today marks our fourth month home from China.  Although I assumed that Matteo had lost virtually all his comprehension of Mandarin, today's speech evaluation confirmed he hadn't.  We've been working on getting Matteo qualified for speech services through the school district.  They had evaluated him in English last week and while it was clear he's delayed in speaking, he did a really good job following most of their directions through the hour-long session.  For today's evaluation, they insisted on bringing a Mandarin interpreter even though I told them I didn't think it would do any good. However, the Mandarin interpreter led him through similar tests today and he did just as well following directions in Chinese as he had in English the week before. 

Hearing Chinese again and watching my son follow the interpreter's playful directions was bittersweet for me.  I was happy Matteo still holds onto a vital piece of his culture, but also sad, because I know his retention of his native language won't last much longer.  When I had assumed Mandarin had slipped away permanently from him, I got a surprise glimpse into his still-bilingual mind.  But the next time someone addresses him in Mandarin could be the time he stares back at the speaker as blankly as his American-born family, unable to understand beyond a simple greeting.

Anyone who has struggled to learn another language later in life would give anything to know a second language early in life.  It would be wonderful if Matteo (and Kiera) could grow up bilingual in Chinese and English.  Sadly, maintaining their native language is not realistic given our family's resources.

Since kids' brains are like "sponges" and they pick up languages "quickly," it's easy to overestimate their ability to either acquire another language or retain one. Language acquisition or retention require routine practice and another human being to speak with. I know a family who is hosting the college-age child of family friends from China.  What an incredible resource for helping their newly adopted seven-year-old son keep up his Chinese.  Another family has hosted Chinese au pairs since their daughter's adoption three years ago.

Since Chris and I both work full-time, hiring a caregiver who also speaks Chinese would probably be the only feasible way to get regular language exposure.  With four children, hosting an au pair is really our only affordable childcare option. We looked au pairs from, and Germany and Brazil and Mexico and from everywhere else in the world because it's very difficult I discovered to find an au pair willing to come to Minnesota and take care of four children, so we had to cast our search wide.  That said, we weren't going to chose the first person who agreed to this and spoke the desired language we want our children exposed to.  In the end, the most qualified person happened to be a German-speaker.

To be honest, I might never have been able to bring myself to pick a Mandarin-speaker for our first au pair after adopting.  If we had lived in China and my bio children had learned the language and I wanted them to retain it after returning to the states, it would have been a no-brainer to pick a Mandarin-speaking au pair.  But I'm also not worried about my bio children's attachment to me as their new parent.  Given the challenges with attachment we have faced with both of our children, I can't imagine it would have helped our attachment if we had a third adult in the house speaking to them in their native language.  Of course there would have been other benefits like making our children feel comfortable and maintaining their native language.  But I was stressed enough with how the presence of our non-Mandarin-speaking male au pair was going to play in the bonding process. 

Since our au pair doesn't speak Mandarin, our only other option with children as young as ours (two and a half and three years old) would have to hire a Mandarin-speaking babysitter or a tutor.  But that would have put us back in a position of struggling with how to best support Matteo's and Kiera's attachment to us.  We also don't have a lot of extra money or time to hire someone extra.

Others have suggested language classes, language instruction videos, music and television show and moves online.  Those are all wonderful resources for language exposure or supporting fluency, but they alone cannot make or keep someone fluent in a language.  You need a human to interact in the language with, most likely multiple times a week, at least with the young ages of our children.

Adoption adds unique considerations to how we help our children preserve their first language.  It's hugely important to many adoptees to maintain a connection to their culture, including language, but as adoptive parents, we have so many needs we're trying to balance on behalf of our children.  The first few months home (or longer) are just about survival.  We're still getting to know our new children and adapting to changed family dynamics.  The last thing on my mind was adding something to my plate that didn't absolutely have to happen, like taking care of my children's medical needs.  We've been home for four months and while our adjustment has gone better than I could have hoped for, I know we still have a ways to go until we fully settle into our new normal. 

We'll continue to support Kiera and Matteo's connection to their Chinese culture and first language, but I do mourn the loss of their fluency in their native language and the fact that there's only so much I could do to prevent that.  

The End of Leave

Tomorrow I return to work exactly 12 weeks from the day we left for China, 11 weeks, four days since we met Matteo and 10 weeks, four days since we met Kiera.  I utilized every last hour of FMLA available, but when I can count in weeks how long I've known my children, parental leave in this country simply isn't long enough.  In many ways Kiera and Matteo are doing so well.  I'm honestly amazed they could come this far in such a short time.  Yet returning to work at this point in their transition still isn't ideal.  Neither child has learned to speak any English in these 10 or 11 weeks and their "minor special needs" still require multiple doctors visits over the next couple of weeks.  When I tried to kiss Kiera goodnight this evening, she refused to look me in the eye, a stark reminder of how far we still have to go with attachment.

Despite my feelings on the length of FMLA, I'm remarkably calm about returning to work.  I'm neither excited for my first day back, nor dreading it.  Maybe because I'm at kids number three and four, I've accepted the return to work as part of the natural evolution of a working mom, even when I'm returning sooner than I would like.  My calmness is also in stark contrast with the days leading up to my departure where my nerves were so shot that I could hardly sit still.  I will take my feeling of indifference to returning to work over my emotional state 12 weeks ago.

I do know that I'm returning to work a changed person.  I am definitely not the person I was three months ago when I could still only imagine what it would be like to travel around the world to meet my children.  

Two Months Home

Only two months home and I go back to work this week.  It's really a shame how little time I get at home with Kiera and Matteo.  Given how little time off from work I have, I'm lucky and so thankful that they're adjusting well.  I'd have some hard decisions to make if they weren't.  Instead I'm focusing on how far we've all come as a family in these two months.  Honestly, we've hit a really good place in our lives and it's hard to believe that it only took two months to get here.

I've heard so many adoptive parents say that it's like their adoptive children have always been with them, no matter what age they joined the family.  I'm definitely feeling that now, to the point that when I look at pictures taken before Kiera and Matteo were home, I have to remind myself that they weren't in the pictures because we hadn't met them yet. 

Sleep 
Let's start with sleep, because whether it's going well or not will determine how you feel about everything else.  And the verdict is...sleep is going well.  (I'm inclined to whisper that for fear that I'll jinxed myself.)  And by well, I mean that Matteo is out of our bedroom and bunking with Kiera in their own bedroom.  We felt so confident that this was a permanent change that we packed up the spare crib mattress we've had beside our bed for the past couple of weeks. 

How did we get there?  The adoption world is going to gasp in horror, but honestly, it was transitioning him to his room combined with cry-it-out.  We started by getting him to nap in his room and that involved some tears, but he quickly became comfortable with that idea and there were even some days where he joyfully jumped into bed at nap time and waved to us as we left his room.  He  was napping in his room for a few weeks before we tried getting him to sleep in his room at night.  It really only took one night of hard crying for 20 minutes and after that, it's been pretty smooth sailing.  We've had a stable bedtime routine since coming home and he gets plenty of activity during the day to tire him out, along with a nap to keep him on an even keel so he's not over-tired at bedtime and I think that all helped in the transition to sleeping in his own bed.  In in a first-ever occurrence, Matteo was fussing one night as I was getting ready for bed.  Chris was already asleep, so I went in there and he let me comfort him. 

Kiera and Matteo now go to bed at the same time their brothers do at 7:00 p.m. and are usually out of bed between 6:30 a.m. and 7:00 a.m.

Attachment
I think our children's attachment to us has been developing very well. Matteo openly gives us kisses and Kiera reaches for Chris and me to pick her up and doesn't show the indiscriminate friendliness as much as she used to.  We're not 100% there yet, but I know we're on the right path.  There may always be doubts in my mind though that we'll ever get "there" even though I'm not sure what "there" is supposed to look or feel like.  It doesn't seem reasonable that kids who've had so many caregivers in their short lives would trust us that we're going to be here for them forever.  Just like our kids have in fact trusted Chris and me, I'm trying to trust that we will get to the point where Kiera and Matteo hug someone outside our immediate family and I don't feel panic or sadness.  

Food
We're so incredibly fortunate that we have good eaters (among many things we're fortunate for).  Back when I was so naive about what it was going to be like to raise children, I had this notion in my head that I would serve my children a variety of healthy and adventurous foods and they'd joyfully eat and mealtimes would be this time of familial bliss.  My dream was shattered with the first hurling of lovingly-prepared potatoes by my first-born.   

And then along came Kiera and Matteo, who happily come to the table when it's time to eat and more or less eat anything you put in front of them.  Even without language, they could express their discontent with the food through whining or some other non-verbal expression, but they don't.  You put food in front of them and they start eating, or if they don't like it or aren't hungry, they simply don't eat it.  It's kind of amazing. 

They do have their preferences.  Kiera loves milk and eggs and Matteo eats Cheerios like he's a teenager, not a two-year-old. And they both prefer to pick the contents out of their sandwiches and leave the bread. 

There's plenty of time for their good eating habits to regress since we're still in the honeymoon stage of their adoptions.  I'm seeing signs of over-eating/food insecurity with Matteo, but I'm attributing that to the effects of being on a liquid diet for two weeks and the hunger he experienced during that time.  Still, I'll try not to be surprised if one of their first English words is "yuck" or "gross". 

Potty-Training
We regressed in potty-training with Matteo after his surgery, but we made some progress with Kiera, so still a win, right?  Matteo is finally day-time trained again and will even "tell" us he has to go by becoming distressed or pointing upstairs, where the bathroom is.  Kiera may well still have us trained, as after we got through a messy couple of days of constant accidents, we finally got in a routine of sending her to the toilet on a regular basis.  Both kids are in pull-ups at night since they're not in the same room as us and still don't know how to yell at the top of their lungs that they have to use the potty like Soren does.   

Sibling Relationship
All four kids generally get along well, which means that we're probably still in the honeymoon phases in this area as well.  Spats usually revolve around toys or who gets to choose what color plate or cup among our classy Ikea plastic dinnerware.  We need to keep reminding Oliver and Soren that Kiera and Matteo are still learning our family rules or they don't necessarily understand what they're trying to tell them to do.  We've been practicing patience, but also how to work together and help each other out.