The Lilting House Archive

Speech Therapy Games

As I've mentioned before, mommyspeechtherapy.com is a good source of tips for how to work on specific speech sounds with your children.

As I work (and play) with Wonderboy, I've come up with a few games of my own that are helping him practice the new sounds he is learning to produce. One particularly sweet one is how we practice the p sound, which is still relatively new for him. I thought it might help if he could feel it, feel how the air explodes from one's lips during the puh sound. I touch my lips to his cheek, like a kiss, and say words like piano, pizza, apple, emphasizing the p. He has begun to reciprocate, pressing his little face to my cheek and puhracticing his puhlosives. It's so cute, I want to eat him up, like pizza or an apple.

We also use the Visual Phonics signs to help make consonant sounds pop for him. Since sign is Wonderboy's other language, having signs connected with sounds makes a lot of sense to him. If I make the visual phonics sign for the first sound in a word, and then follow with the whole word, both in English and ASL, he gets that the sound itself is something that can be broken out of the word and made on its own. So: buh, buh, baby. The "buh" is the Visual Phonics sign for the sound made by the letter b: you hold the ASL sign for b up to your mouth, and as you say "buh," you move the b sign rapidly away. That's the phoneme sign.

We do this over and over, all through the day. Guh guh go, kuh kuh car, puh puh pizza. (Yes, more pizza. If you spend much time at my house, you know that we are all about the pizza here. I don't cook for people. I invite them over for pizza. Can't make it? Eh, we'll order that pizza anyway.)

We're working on developing his listening differentiation skills with a game we play with Rilla. Wonderboy thinks he is teaching things to Rilla (and he is), and this makes it loads of fun for him. He doesn't realize he's making big leaps himself.

We have a stack of pictures of objects with sounds we're working on. Right now it's the f sound, so we have fish, frog, fire, phone, etc. I lay out two or three of the cards and give Wonderboy or Rilla a block to hold. Then I'll say the name of one of the items on the cards, and the child whose turn it is puts the block on the right card. It's a very simple game and both the little ones eat it up.

For Wonderboy, what the game is doing is helping him hear the subtle differences between similar-sounding English words. With his hearing aids, he can hear a good deal of speech, but not everything—not some of the soft, unvoiced consonant sounds. So I lay out pictures of phone and bone, or fish and dish, and the game—which is great fun, especially because of the antics of little miss Rilla—hones his listening skills.

I think he is doing a lot of lip-reading. He's a crackerjack at the game when he can see my mouth, and has more difficulty if I hide my lips behind a hand. When he sits beside me and chatters away, as is happening almost constantly these days, he cups my chin with one determined little hand, turning my face toward his. This is indescribably sweet, I have to say. At a birthday party a couple of weeks ago, a friend's mother was watching Wonderboy talk to me, and she said, "That is so dear! The way he studies your face! He can't take his eyes off you."

It is dear. It's a good idea, though, to help hone his listening skills without visual clues when we can. So we play another game, also with Rilla, in which each child hold a little ball up to his or her ear, and I cover my mouth and make a sound. The game is simple: when the child hears the sound, he or she drops the ball into a container. We use an empty tennis ball canister. The main purpose of this game is to get Wonderboy into the groove of what happens in a hearing test when we go to the audiologist. In order to accurately test his hearing (and therefore ensure that his hearing aids are calibrated correctly, in the way that will give him the best possible amplification), we need him to respond to each sound he hears. The ball-in-canister game is one we can easily duplicate in the sound booth.

It's also great fun. Rilla thinks it's a hoot! Her excitement is infectious, and Wonderboy and I are usually in giggles the whole time. They hold the balls up to their ears just to reinforce that they are going to listen. Wonderboy thinks Rilla jumps the gun a lot; he doesn't realize that she is hearing sounds that don't exist for him. He doesn't seem to hear S or SH at all.

Because I Adore, Cherish, and Appreciate Redundancy

I will repeat what I just wrote in an email to a fellow ClubMom blogger whose toddler son, the delicious Noah (over whom I have drooled in person), is going through the same Early Intervention evaluation process Wonderboy went through a couple of years ago. Noah has been diagnosed with speech delay, and I feel a bizarre and probably obnoxious urge to welcome Amy to the club. She mentioned on her blog that although they think hearing loss is not likely in his case, Noah will be undergoing a diagnostic hearing screen soon, to be safe.

And that prompted me to spout forth a great deal of unsolicited advice about how to get most out of a toddler hearing screen. Then it occurred to me that that's what ClubMom is paying me for, to spout forth unsolicited advice on this here blog. So spout I shall.

When Wonderboy was an infant, his hearing tests were the auditory brainstem kind I wrote about here. But once he was a year old and had his hearing aids, his periodic testing shifted to a sound booth. Kids with aids need testing on a regular basis, to make sure the settings are right. As the child gets older and more responsive in the booth, the audiologist can better fine-tune the settings.

For a child under four, the big challenge of the sound booth hearing test is understanding what the audiologist wants him to do. Typically, the child will be in the booth with a parent or the audiologist's assistant. The audi is behind a window, pushing buttons on her fancy machine. The child (or his helper) holds a toy or block up to his ear, and he's wearing little earplugs that pipe in sound, and when he hears a sound he's supposed to put the block in a basket or something. Then a little monkey* in the corner bangs a toy drum and FREAKS HIM OUT. At least that's how it goes with Wonderboy. The drum-banging is supposed to be the payoff for responding to the sound but Wonderboy suspects the monkey wants to eat him.

*(Sometimes the monkey is a rabbit.)

I don't know why they never tell you in advance, but you can help this test go much better by doing some prep work. You can play the hold-the-block-to-your-ear-and-slam-dunk-it-when- I-go-beep game at home to get him used to how the whole thing works. It's good to hold a card or something in front of your mouth so he has to listen for the beep instead of watching you open your mouth. Also try it with shhhh and ssss sounds, and clicks, and whispering of all sorts.

The first time we did this kind of hearing screen, it was a big waste of time because Wonderboy didn't know what to do. The audiologist told me no worries, the first time is mainly to train the child to do the test and we should come back next week. I wanted to scream because Scott had lost half a day of work to take care of the other kids so I could go to this appointment, and now we were going to have to repeat the whole process. I would have had Wonderboy practice, had I but known. (Had I but known Google Reader.)

Say! I don't think I ever showed you my snazzy blue ear molds. And after my nutty mother made you look at all those How Ear Molds Are Made pictures and everything!

Speech Therapy at Home

You know how enthusiastically I recommend the Signing Time DVDs as a resource for developing expressive and receptive language skills in young children, even those whose hearing is normal.

I've written, too, about how useful I am finding the Visual Phonics program as an aide to helping Wonderboy (3 1/2 years old, moderate hearing loss) expand the range of consonant sounds he can make.

I'm always on the lookout for useful resources, and this website looks promising: Mommy Speech Therapy. Posts range from practical advice for helping a child work on specific sounds to informative discussions about working with speech professionals, getting a diagnosis, and when to be concerned about things like lisps, pacifiers, and thumb-sucking.

Newborn Hearing Screen: A Piece of Advice

OK, so I'm 15 months late making this little PSA. I've been meaning to share this advice since the day Rilla was born—the day she failed her newborn hearing test.

Yup, that's right, she failed. Just like her brother had failed, three years earlier.

Hearing loss can run in families, you know. When the hearing-screen tech gave me the news, it came as a bit of a blow. To be perfectly honest, the first thing that passed through my mind was: Oh dear God, where are we going to come up with another five grand for hearing aids?

(Did you know that most insurance companies do not cover hearing aids, even for children? Don't get me started.)

But then I managed to collect my wits, or at least enough of them to ask some questions. Had she done the test in the newborn nursery? Yes, she had. Aha.

I had learned from our experience with Wonderboy that many newborns don't pass the initial screen in the nursery, especially in a NICU (as with Wonderboy, but not with Rilla) where there is so much ambient noise. Wonderboy was tested three separate times on his discharge day before they gave up trying and sent us home with instructions to have him re-tested as soon as possible, but not to worry, it was highly unlikely he really did have hearing loss, it was just all the background noise in the NICU mucking up the test results.

"Ask for the newborn hearing test to be administered in the quiet of the mother's room."

OK, in his case, it turned out NOT to be the ambient noise skewing the results; the kid really does have hearing loss. But still, that didn't mean Rilla's test had necessarily been accurate, and I wanted confirmation before leaping to conclusions.

I asked the tech if she could re-do the test, right there in my hospital room, where it was nice and quiet. I didn't even have a roommate.

The tech was kind and sympathetic, but doubtful. "Honey," she said gently—they always call me honey, these hospital personnel about to deliver potentially upsetting news—at least, the female ones above age forty always seem to—"I'm willing to give it a try, but this is a brand new machine, state of the art, and it's especially designed to NOT be affected by ambient noise. And with hearing loss in the family..."

"I know," I said. "But I think it's worth our time to try."

"Well, what you need to do is have her re-tested in one month."

I sighed and explained that my HMO would make me go all the way to Richmond, 80 miles away, for further testing (this I knew from prior experience), and it would be a big pain in the neck, and if there was any chance today's test wasn't 100% accurate, it would be a huge help to me to give it another try.

Now it was her turn to sigh, and you could see her thinking thoughts about how you have to humor these post-partum mothers, and she shrugged and said, "All right. We'll try. I'll go get the machine."

She wheeled in the contraption and attached the little sensors to Rilla's head, and stuck the thingamajig in her right ear. Then, while the test started running, the tech popped back into the nursery for a chart she'd left behind. When she returned five minutes later, she took one look at her State of the Art Machine and gasped.

"It's finished already! It took me 20 minutes to get a finish before!"

Me: "Finished, good?"

But already I knew it HAD to be good, because the way this test works is the machine sounds little clicks into the baby's ear, and the sensors record how many times a nerve twitches or something like that, in response to the clicks. You need a certain number of clicks within a certain window of time to get a "hearing is normal" result. If the twitches aren't happening, the machine will keep on sounding clicks until a biggish chunk of time has passed, and then you get a "hearing is not normal" report like the one Rilla had already been given.

A finish in five minutes meant the machine had already counted enough nerve-twitches to know that Rilla's right ear was working just fine.

The tech was openly flabbergasted. This is where this becomes a really satisfying story, because it is one of those rare times that an expert admits frankly, and with pleasure, that she was mistaken.

"I'm stunned," she said. "It's not supposed to be affected by ambient noise, but obviously it is."

I could have kissed her.

She tested the other ear, and that side too yielded A-OK results in under five minutes. Rilla's hearing was pronounced normal, and the stern document instructing us to take steps X, Y, and Z toward further testing was removed from her chart, ripped in half, and pitched into the wastebasket.

Of course, it's possible for a child who passes a newborn hearing screen to show signs of hearing loss later in life, and sometimes it is years before a parent realizes there is a problem. If Rilla had been diagnosed with hearing loss at birth, or six months later like her brother was, or at any point in the future, we would deal with it, and it would be fine. The point of my pushing the tech to re-test, and the point of this story, has simply to do with a tip that can save parents time and unnecessary anxiety. When the hospital wants to administer a hearing test to your newborn, request that it be done in the relative quiet of the mother's room or some other isolated place, not in the nursery.

The tech seemed somewhat dazed, but she was awfully sporting about it. She told me, "This is really going to change things for me. It usually takes me up to an hour to test each baby. I think you've just saved me a ton of time."

I can't tell you how much I appreciated those words!

But I appreciated being spared the drive to Richmond, and the stress of putting baby Rilla through further testing (stress on her, I mean), and the month or more of back-of-the-mind worry we'd have had to deal with while waiting for the next test, even more. I was able to take her home without any questions gnawing at me, and when I think back to that peaceful, happy babymoon,

I'm terribly grateful the tech was willing to honor my request.

Something Else to Buy Instead of Curriculum: Signing Time

It's been a while since I wrote about Signing Time, but it occurred to me that I ought to mention it for new readers.

The Signing Time DVDs are a wonderful series of half-hour shows designed to teach American Sign Language (ASL) to children. Adults who happen to be in the room will find they can't help but learn as well. The shows are delightful, with catchy songs, cute kids, and practical ASL vocabulary.

Here's an excerpt of what I wrote about Signing Time two years ago:

It's hard for me to imagine our lives without Signing Time. Rachel Coleman, the creator, and her daughter Leah, who is deaf, and Leah's cousin Alex, who is hearing, are practically part of our family. "Rachel says" and "Leah says" are regular utterances around here. When Wonderboy watches the videos, he looks back and forth from me to Rachel, or from his sisters to the children, in awed delight. His hands soar through the air, mimicking his beloved Rachel. He understands the spoken words "Signing Time" even without his hearing aids in. (This is significant. He probably hears something like "eye-ee-eye," but he sure knows what it means.)

Rachel's songs have become my personal highway belt-it-out favorites (along with Marie Bellet and Bruce Springsteen), because she *gets it* so completely. Leah was a year old when her parents learned she was deaf. Rachel's family's love and occupation is music, and my hat is off to Rachel Coleman for finding a way to so beautifully combine her old life with her new one. Next to the joy she has brought my children, my favorite thing about Rachel Coleman is her honesty in lyrics. Her song, "The Good," expresses my understanding of motherhood better than anything I've ever written: "Maybe we won't find easy, but baby we've found the good."

Lately, Wonderboy has been re-immersed in these DVDs, asking for them daily. They are the ONLY television show he has ever shown any interest in watching, ever. When his sisters watch other shows, even cartoons, Wonderboy pays no attention. But for Signing Time, he is always all eyes and ears.

He has learned a ton of vocabulary from them, including (just lately) words like "remember," "learn," and "smart." I wrote a post for Bonny Glen last night about what a big deal it is that he is now beginning to grasp abstract concepts (such as remember, learn, and smart!). I really think ST has a great deal to do with that.

Rilla (she is 15 months now) is also enchanted by ST and enchants the rest of us with her perfectly scrumptious signing...when she signs "More," her daddy is putty in her plump little hands.

I also think the DVDs spurred Beanie along the path to reading when she was four and five years old. The English words for each sign appear on the screen before the signs are demonstrated, and those were some of the first words she learned how to read.

The shows are now being aired on PBS, so you can check your listings to see if it's playing in your area. But the DVDs are a worthy investment (and they make great gifts). (And no, I don't get a commission on these materials! I just love them.)

The first three volumes are simpler, younger, than later editions. Volumes 4-6 are my family's favorites, except for Wonderboy, who prefers, ironically, the "Welcome to School" disk.

I see on the website there are two new "Practice Time" DVDs—I haven't seen those yet.

We seem to have lost Volume 11, "My Neighborhood," somewhere along the trail during our cross-country trip. I'm thinking about re-ordering it, because I know Wonderboy would be very into the whole police- officer-firefighter theme right now.

There is also a Signing Time blog and forum.    

Speech Therapy and Visual Phonics

Monday morning, early. Wonderboy and I are off to speech therapy in a few minutes. His sessions have been going wonderfully well, and he is now regularly saying B and P sounds. This is huge progress; two months ago his only consonants were M, hard G, K, N, and an occasional H (as in "Huh moni!"—that's "Good morning" to you conventionally annunciating types).

He loves Miss Tammie, the speech therapist, and our fun half-hours in her room, playing games, singing (okay, listening to Miss Tammie sing), putting the buh buh baby and the puh puh popcorn on the buh buh bus, and the puh puh puppy goes in the buh buh box.

His astonishing and rapid progress is due in large part, I believe, to Tammie's use of something called "Visual Phonics." This language development program is actually new to Tammie, and we are more or less learning it together. The concept is truly brilliant. In Visual Phonics, a hand sign is assigned to every single sound. It's like taking the sign language alphabet (with which Wonderboy is already quite familiar, though he does not sign it himself yet—when he was two, his favorite way to fall asleep was to watch my hand while I signed and sang the ABCs) one step further.

For example, there a sign for the B sound (buh). You use the ASL sign for B, a flat hand, fingers together and pointing up, thumb folded over the palm, and you hold that handshape up by your mouth, moving the B away from your lips as you say "Buh."

Not all the Visual Phonics signs are based on the ASL alphabet; the P has your fingers sort of exploding away from your lips. Really, it hardly matters WHAT the signs are; the brilliant innovation was in attaching signs to these small units of sound. There are signs for every speech sound, including consonant blends and all the vowel sounds, including diphthongs.

Wonderboy GETS sign language; he knows how to connect a sign to a spoken word to a thing or idea. He clicked with the concept of buh and puh immediately, just as soon as we turned the sounds into Real Things for him by giving them signs.

I missed a chance to go to a Visual Phonics training session last month, but I'll share more about the program as I learn about it. It is primarily intended to help kids struggling with reading, but Gallaudet and other institutions have recognized its immense value in both reading and speech instruction for deaf/hard-of-hearing kids. I imagine Visual Phonics is going to be a big part of our lives these next few years, first in helping my boy learn to speak English, and later in helping him learn to read.

Buh buh brilliant. Also, buh buh bye—I've got to run or we'll be late!

Fun With Audiology: Making Ear Molds

Did you know that ears are one of the few body parts that never stop growing? I think noses might be the other. Besides hair and fingernails, obviously.

When you wear behind-the-ear hearing aids, the hearing aids last for years, but the ear molds—the little custom-made silicone or acrylic doohickeys that fits into your ear—need replacing every so often. As your ear grows, the ear mold ceases to fit, and first you get a feedback problem, and then eventually the mold just won't stay in the ear at all.

So you go to the audiologist's office, and she makes new impressions of your ears with a quick-hardening goo. You ship the impressions off to a lab, and in a couple of weeks you'll have your brand new ear molds.

If you are three years old, you may find this process somewhat entertaining, if mildly uncomfortable. If you are six years old and the uncomfortable part is happening to your brother, not to you, you will consider it a ripping good time. Beanie pronounced it "huge fun."

I get a large number of hits every day from hearing-aid-related searches, including variations of "toddler ear molds," so I thought it might be helpful if I posted a walk-through of the process. Besides, pictures are always fun.

First the audiologist checks your ears, making sure there isn't too much wax in there—that might mess up the shape of the impression. Then she carefully inserts a little foam stopper to make sure none of the impression goo goes too far up the ear canal.

Then she pops the two kinds of goo out of their little bubble wrappers, and she mixes them together into a pliable substance that can be squeezed out of a syringe but will harden within a few minutes. Beanie, supervising, thought this mixing process looked pretty nifty and is now wondering how to work "become an audiologist" into her plan to be a scuba-diver with ten children.

The audiologist scoops the goo into the syringe and carefully squeezes it into the ear, sort of like making an icing rose on a birthday cake. Now you have to sit and wait. You can't poke at the goo, much as you might wish to. Nor can you pull on the string that is connected to the little foam stopper inside your ear canal. Patience, grasshopper.

Meanwhile, the audiologist squirts the leftover goo out of the syringe. This, I am told, is THE BEST PART.

Let's do the other ear while we're waiting. It's okay to drool.

Finished! Time to pull out the impression. No need to be suspicious; it won't bite.

The impressions go into a box and are dispatched to the Lab, that mysterious place where ear molds are born.

Now comes the fun part! (The other fun part, says Beanie.) What color ear molds do you want? The sky's the limit. No, Bean, your brother isn't getting the sparkles.

What color did he get? You'll have to wait two weeks to find out.

Nobody Warned Me...

...that the thing about having another baby when you have a hard-of-hearing toddler is that at least once a month you will catch yourself trying to put the toddler's hearing aids into the baby's ear.

Whoops.

(Amy, consider yourself warned!)

Homeschoolers and Special Education

Today my ClubMom topics, homeschooling and special-needs kids, come together. I'm taking Wonderboy to our local public school—yes! I said public school!—for a meeting and evaluation with the special education office, a speech therapist, and the district audiologist. Even though we plan to home-educate this child like all our others, we can and will avail ourselves of the special services made available to all children according to federal law.

From birth to age three, qualifying children can receive services such as speech therapy, physical therapy, and occupational therapy through Early Intervention programs. Wonderboy received all of the above, in our home, beginning at about four months of age. (For PT & OT, that is. When his hearing loss was diagnosed months later, we added speech & hearing therapies.) The first step in the Early Intervention process is an evaluation that leads to the writing of a big ole document called an IFSP—an Individualized Family Service Plan.

At age three, children age out of Early Intervention and from that point on, the special services they qualify for come through the local public school district. The IFSP gives way to a new document, the IEP, or Individualized Education Plan. The IEP spells out what services the child requires and how the district is to go about answering the need. The whole IEP process can be tricky to navigate, or so I've picked up from several friends (public-schoolers, not homeschoolers) whose older children were diagnosed with learning disabilities or autism spectrum disorders. Those parents had to be sharp-witted advocates for their children to make sure that all their classroom needs were being met.

For us, it's a bit simpler. Wonderboy "graduated" from PT before we left Virginia (amazing, amazing! miracle boy!), but he will almost certainly continue to need some speech therapy during the next several years. His verbal language skills are growing by leaps and bounds—really, it's so exciting; he's using long sentences now, like when I hollered "Ladies! Dinner's ready in five minutes!" and he BOOKED down the hall shouting, "GIRLS! Time to eat! Dinner!" Excellent progress. But of course since he still lacks most consonants, it sounded more like "GUH! I oo ee! Ginnah!"

I want to make sure he has every advantage. I know his verbal skills will continue to improve naturally as he gets older. But he may need extra help to master certain sounds. And so after we got settled in here, I called the district spec ed office to see what kind of speech program they have. After a lot of faxing (his IFSP and audiology reports) and phone calls—just the normal process!—we set up an evaluation with the aforementioned folks.

Today we'll be meeting to determine what goes into his IEP. I'm going to blog the process, because I haven't found too much else out there about homeschoolers and IEPs. I might hold off on attending the speech therapy sessions until next fall, depending on how today's eval goes. At Wonderboy's age (he'll be three this week!), speech therapy takes place in small parent-child sessions at the school up the road. That sounds great—but I can already see that timing will be tricky. I don't know that I want to chop up a morning once a week with a jaunt to speech therapy. That'll monkey with my older kids' schedule.

But we can figure out the logistics later. Right now, step one: the speech evaluation.

My Other Part-Time Job

If I earned a wage for all the hours I've clocked on my kids' medical issues, well...I'd be a case manager, not a mother. But I'd also be rich.

I spent this first month in California shoving to the back of my mind a looming dread  over the necessity of Finding New Doctors. Oh, how this pains me. We had the most fabulous family practice back in Virginia. Excellent and attentive doctors, compassionate and capable office staff, kind nurses. I loved everyone there, really loved them! Even the lab tech who took my blood. I miss her. I miss the whole gang. Thanks to Wonderboy, we spent so much time in their offices we might as well have kept extra toothbrushes there.

Best of all, oh so marvelous, was Dr. H., whose name I'd like to shout all over the internet but if I did her phone would never stop ringing because SHE MADE HOUSE CALLS. She was the doctor I'd been looking for my whole life, or at least since Jane got sick in 97. Scott and I used to sit in the hospital lamenting the fact that no one in our families had married a doctor, because we could have really really used one in the family, someone to call up and say "Listen, there's This New Weird Thing going on—do I haaave to haul the kid into the office? Or can this just be a wait and see?"

And then Dr. H. walked into our lives—through our front door!—and I swear I was like a sixth-grader all over again. Hi, you're so awesome, will you be my best friend?

You want to know how awesome? When I told her I was going to be driving all five kids to California by myself, SHE OFFERED TO FLY WITH ME INSTEAD.

I almost took her up on it, but I was afraid I might accidentally lock her up in a secret room in our house and never never let her go. And she has kids of her own who need her. Humph. So when the time came, I hugged her goodbye and bawled like a baby all over her stethoscope.

And here I am, poring over our new provider directory, cowering at the thought of starting all over with some stranger. It's like dating again after a bad breakup.

There really ought to be an eHarmony for finding doctors.

One pediatric practice here was highly recommended by several of our new friends. I took a deep breath and made the call, which felt like going on a blind date. Nice voice on the phone says that yes, they are taking new patients but the first available well-child appointments are in January.

I'm fine with that, as long as they'll see us before then if someone gets sick. I've been burned this way before—some docs won't see you for sick visits unless you're already a patient. But these folks say, nope, not a problem, if someone gets sick we'll get you in right away.

So, okay, it's a start.

BUT. My next question was about finding an audiologist for Wonderboy. He needs new ear molds for his hearing aids about every six months. The current pair was made in late June. Already they're getting a little loose; he'll need a new pair in Jan or Feb for sure. And I know how these things work. We'll have to have the new-patient visit to the audiologist too, with hearing tests, and then they'll probably have us come back a second time to get the ear molds made. And then it'll take a few weeks for the new molds to come in. Time, time, it all takes time. I'm an experienced case manager now and I know you have to anticipate the patient's needs.

So the new pediatrician's office recommended an audiologist. But THAT office says there's a two-month wait for new-patient appointments there, too. And also? They can't make an appointment for Wonderboy without a prescription from his pediatrician.

Me: "A prescription? Do you mean a referral? We have a PPO now; we don't need specialist referrals as long as they're in the network. Which you are."

Audiology office: "No, a prescription. For a hearing test."

Ohhhhkay. Right. Because, you know, there's such a black market for hearing tests. Hearing test abuse, it's a real problem in urban centers. Especially among three-year-olds. Their mothers are always trying to sneak in preschoolers with perfect hearing just to get a quick buzz off those intoxicating beeps and clicks.

I called the pediatrician's office back. I told Scott it was a test: how they respond to this situation will give me a good idea of what has the upper hand in their practice: human need or red tape.

The first person I spoke with scored well. When I explained that I can't wait until January (when our new-patient appointment is scheduled) to get the prescription because then it will be MARCH before the audiologist can see us, and probably APRIL at the earliest before we get new ear molds, and even though Wonderboy doesn't need new molds now, he will certainly need them before April—when I (gasp, pant) explained all this, the Unnamed Office Person on the phone totally understood the problem. She took all our info and said she'll have a nurse call back.

So now I'm waiting for round two. Meanwhile, I keep finding myself staring at the phone, with Dr. H's number on the tips of my fingers. Chill out, I tell myself. They have good doctors in California too. I might call her anyway, because now that she's officially not our doctor anymore, I am totally latching onto her claiming her as a friend. And if she ever does fly out here for a visit I promise not to make her give us all checkups.