Girl's menstruation/puberty

SPECIAL NEEDS GIRL
As a parent of a AS girl, I realised there are many things I would like to find out eg puberty but it is quite impossible because nowadays I don't take my girl to school.  Thus, I don't get to meet parents of older special needs girls.  During Club Rainbow outings, I didn't get to chit-chat either because by chance, those that I met, although few years older than my girl but were 'blessed' with no menstruation .... not yet.  I wish my girl has no menstruation forever,  I was frighten of that big day.  What if my house is stained with blood every month?  What if my girl end up with severe pain like a 12 years old normal girl that I met in KK Hospital, year 2014 ....worries and fear.

KKH doesn't recommend that I remove my girl's ovary.  They felt I am cruel. Gynae commonly prescribed pills (contraception pill).  What about the inconveniences and 'horror' .... nobody cares how I felt and the long-term stress, the ordeal with blood! Do take note, my maid is taking care of my girl when I am working full-time.  Nowadays, maids want an easy job.  She may leave and the next person may also be frightened off.

I chat on Facebook with some AS parents in the overseas, they recommended giving pill with some wipe cream for easier swallowing.  By eating pills, the menses will not come every month.  Tried to get into the puberty Facebook page that they recommended but was rejected because I refused to use my real name.  The page owner felt I wasn't sincere or afraid I am a pervert (fake AS parent) trying to learn their secrets/invade their privacy.  Can't blame them.  I have my privacy to protect so I am not using my real name or real pictures in this blog.

I decided that her milestones, our experience may benefit other Spore parents with a special needs girl.  Till date, I am still learning.  Each special child is unique, they may not develop the same 'symptoms' or learning hurdles but parenting them is the same .... lonely and may not be fully understood, supported by other family members and friends.

One of my friend's girl (same age) had her first menses one month later than my girl.  From a girl who is 8 years seizure free, the start of menses triggered seizure.  Another friend warned me to be careful.  Said she knew a child who died due to the 'kick-off' of puberty.


FIRST MENSTRUATION
20 Nov 2015, my girl had her first menstruation. Probably the obvious sign she displayed was scratching her private part - vulva.  Few days ago, a quick glance, I thought her vulva has wrinkles.  Day 2 of her menses, when I was washing her bottom before wearing a new diaper, I realised it was newly grown hair.  My girl's breast started to develop a few months after her 12th birthday.  I was getting cold feet, fear and worries .... finally her big day arrived.   Once thing good about not being toilet trained is that she's still wearing diaper.  Thus, maid was able to detect blood on her diaper.  Phew .... Don' be too happy, who knows my mischievous and highly curious girl decides to pull off her diaper to examine or play .... faint!

Day 1 - her 'lady' transition was not that frightening.  Didn't see her show any obvious sign.  Touch wood, no pain detected.  Sleep wasn't disturbed.
Day 2 - morning, her soiled adult diaper contained more urine than menses.  Night time, due to prolonged diaper wearing, bottom starting to see redness and itchy.
Ended on Day 5.  The whole cycle was manageable.  Maybe as my girl grows older, I'll face more challenges then I'll have to make some drastic changes, eg removal of womb.  Not something I look forward because she'll be in pain and I need to ensure she doesn't touch the wound... could be harder then changing diapers.

2nd and 3rd MENSTRUATION
Dec - just a bit of stain.

12 Jan 2016 - menses that is not heavy, lasted for about 24 hours only.

**Update**
11 months later... Menstruations were manageable.  My teen is now wearing adult S size diaper.

*.*.*.*.*.*.*.*.*.*.*.*.*.*.*.*.*.*
When will menstruation start?
No one can say exactly when your child gets her first menstrual period but she will get it sometime during puberty.

First period usually happens about 2 years after the breasts start to develop.  Some girls may get their period in less than 2 years. For other girls, it may take longer. Every girl is different, and there is a wide range of normal development during puberty.  A period usually lasts from 2 to 7 days. About 2 weeks after the last period, a new egg is released as the cycle repeats itself.

Puberty
Some girls start puberty at age 8 and others may start as late as 13 or 14. Each girl goes at her own pace. So don't think you're weird if you start puberty a little earlier or a little later than your friends.

Boys and girls both begin to grow hair under their arms and their pubic areas (on and around the genitals). It starts out looking light and thin. Then, as kids go through puberty, it becomes longer, thicker, heavier, curlier, and darker.

Girls' bodies usually become curvier. Their hips get wider and their breasts develop, starting with just a little swelling under the nipples. Sometimes one breast grows more quickly than the other, but most of the time they even out. Girls may start wearing bras around this time, especially if they are involved in sports or exercise classes.



Update on 25 Aug 2016
The only + I have for wearing diaper ...a the age of 13+ is that it captures menstruation, fully wrapped and my life didn't turn out scary and gloomy.

It was really hard to find an adult diaper that is slightly bigger than Drypers Wee Wee XXL (a cheap and biggest XXL diaper in the market), that is about 22" waist.  Most hypermarts, supermarkets, etc sell diapers from M size onwards.  Parents like me are stuck with a diaper too small or a gigantic diaper with waist 32" onwards.... you simply can't wrap well.  It is too big so urine will flow out.  Big doesn't mean good coverage and great protection.... useless, waste of money!  I have purchased adult diaper of waist 28"... that's the smallest online... not cheap, no good, too big.

Just want to share I found Dr P 包大人 adult diaper S size, 18 pieces at Giant IMM S$10.80.  It is big (for my girl) but not that huge compared to M size.  When I posted this post, I have visited Giant IMM a few times but the pink packing small size diaper wasn't available for sale.  The only thing no good about this Dr P is that it is in non breathable plastic.   Also the tape can't be resealed if you're toilet training.
Was told this size can be found in Fairprice Joo Koon warehouse/mega store.  You need membership to buy.... would anybody be keen to waste money on membership and don't forget, you can't teleport the diapers home.  You either drive to stock up or take a taxi back.... it is a chore and heavy!


2019
It's really not easy to buy Small size adult diaper from the rack (supermarkets) so after doing lots of homework, last year, I found Dr P diapers online.  Buy 6 cartons with discount from the website, each pack cost around $9.50, WITH DELIVERY.  This is a good deal for parents like me who don't own a car.  Now small size is just nice for my teen, I think I need to look for medium size soon ... well, on the bright side, medium size can be purchased much more easier than small size adult diapers.

Behavioural issues

It Changed My Life: Man with the brainy moves, Straits Times, 26 Jun 2016
The "roller coaster years" usually allude to adolescence, but in Mr James Tang's case, is an apt descriptor of his life until three years ago.  His academic journey - from primary school to university - is a series of peaks and troughs: he flunked and aced exams in equal measure.  His career, too, had many ups and downs, traversing both the public and private sectors, chasing at times after money, and at others, after meaning.

His personal life lurched between confidence and insecurity, anxiety and nonchalance. Even his weight vacillated: now a trim 84kg, the 1.8m-tall man once tipped the scales at 105kg.  The turbulence, he believes, is driven in large part by his ADHD (Attention Deficit Hyperactivity Disorder). The 42-year-old has never been formally diagnosed with the neurodevelopmental disorder - marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity - but is convinced he has it after reading tomes on the subject.

It probably explains, the former teacher adds, why he has a soft spot for students with behaviourial issues or special needs.  A passionate pursuit ensued when Mr Tang - who has a post-graduate diploma in education and sports science - chanced upon research which shows there is a relationship between exercise and cognitive abilities.

Today, he is the founder of Brainy Moves, which provides personalised training to improve fitness as well as psychomotor and cognitive skills.  About 70 per cent of his clients are children with conditions ranging from autism to ADHD to dyslexia. He also conducts programmes for schools and institutions, including the Calvary Baptist Kindergarten, East Spring Secondary School and Institution of Mental Health.

The elder of two children of a couple who ran a handicrafts business, he was a handful as a child. In primary school, he was extremely talkative and hyperactive and got up to all manner of mischief like slashing the arms of classmates with metal rulers and leaving mounds of staples on the chairs of his teachers.

"To cope, my parents sometimes caned and scolded me," he says with no hint of resentment, adding that the thought of testing him for ADHD probably never crossed their minds. "They just thought I was lazy, talkative and not focused on what I was doing," he says.

That he was intelligent, however, there was no doubt. When he applied himself, he often excelled in his studies. Restlessness and playfulness, however, often tripped up the former St Andrew's student. He flunked quite a few exams but always pulled through when it mattered.

"Fundamentally, people with ADHD are not dumb, we just have issues," he says with a laugh.  Until his teens, he led a fairly cushy life. The family lived in a three-storey corner terrace house in Bartley and could afford holidays.  But when he was 18, his mother told him she had to cash out the insurance policies she had bought for him and his brother to save their troubled business. The family also downgraded to a four-room HDB flat in Lakeview.

"I had to find my own means to go to university," says Mr Tang, who took a five-figure loan to study mechanical engineering at Nanyang Technological University (NTU) in 1995.  A six-month attachment with an ammunition design firm in his final year convinced him that he wanted to work with people, not machines.  He ended up selling insurance but quit after eight months to become an untrained teacher at Hua Yi Secondary. It was not his first teaching stint. While waiting for his A-level results, he did relief teaching at Teck Whye Secondary and enjoyed it immensely.  "I was then teaching Maths to Sec 5 students. I was 18, they were 17," says Mr Tang, whose students included many who came from dysfunctional families.

Teaching at Hua Yi Secondary offered fulfilment, he says, but something gnawed at him. "I felt that I was not equipped with work experience and I was not adding value to my students," he says.  Although he was about to enter the National Institute of Education (NIE) to get his post-grad diploma in education, he quit and became a management trainee with Borneo Motors in 2002. "But I left with the intention to come back to teaching," he says.  The car distributor gave him the corporate experience he craved. Over four years, he worked in various departments, including workshop, marketing and sales.  

His four years in Borneo Motors were prosperous, in more ways than one. He drew an ample salary which helped him to clear his student loan and get married to a marcoms executive; he also piled on the kilos because of the drinking and entertaining.

Despite the good life, he nursed a deep desire to help children. He went on several humanitarian trips to Cambodia, organising summer camps and distributing food and other essential items to poor communities.  His next gig was a regional one - as country manager in Indonesia - with a German equipment company. "I learnt a lot; I also saw a lot of the dark side of the corporate sector," he says.  That and health reasons - his weight had ballooned to 105kg - prompted him to call it a day.

"A colleague just collapsed and died. I developed hypertension and couldn't even finish running 1km even though I was a track and field athlete in school. It was time to leave," he says.  True to his word, he returned to teaching even though it meant a substantial pay cut. "I felt I had experienced enough to share with students. I don't know why but I have a lot of heart for kids who need help."

He got himself admitted to NIE in 2008 to get his post-grad diploma in education and sports science. But before that, he overhauled his diet and started exercising to lose 25kg in three months.  After graduation, he was posted to Ang Mo Kio Secondary to teach PE and Maths. He told his department head he wanted the most challenging class.  "He laughed and said, 'You don't have a choice. PE teachers are always sent to the most challenging classes'," he says, adding that some of his charges wrestled with conditions such as dyslexia and ADHD.

The turning point came when, over time, Mr Tang noticed changes in his class of 20 students which had their PE lesson just before Maths. "I saw changes in their motivation, in the way that they engaged with me in class. I was curious and started to read up more."

Through a trainee teacher, he met a Korean professor researching the relationship between exercise and the brain. The latter introduced him to the works of Dr John Ratey, an associate clinical professor of psychiatry at Harvard Medical School who has published several books on ADHD as well as the relationship between exercise and the brain. They include Spark, Driven To Distraction and A User's Guide To The Brain.

"The books gave me a lot of insights into my work as a PE teacher," he says, adding that he also ploughed through scientific papers on neurological conditions. "When I read about ADHD, I realised how many symptoms I had."

He began to incorporate what he had learnt into his class. Except for one student who did not sit the Maths examination, all his students passed their N-level Maths paper.  Three years later, in 2013, with encouragement from his wife, he decided to strike out on his own.

In the first few months, the father of three children - aged between four and 10 - earned just $800 doing fitness coaching with a few clients.  One of his first clients, referred to him by his wife, was Dr Jia Jia, the Singapore youngster best known for his series of YouTube videos on Singlish.  Then eight years old, Dr Jia Jia - whose real name is Chua Jin Sen - is dyslexic and has ADHD. His parents wanted him to be more focused.

Mr Tang got the boy to take a psychometric test before putting him on his programme. "After eight weeks, I administered the test again. There was a huge jump in the score. It gave me the confidence to know that my programme works," he says, before launching into an animated discourse on how different exercises can stimulate different parts of the brain to help it become more malleable and supple.

After seeing the improvements his son made, one client got Mr Tang to write a business proposal to formally set up Brainy Moves. He became Mr Tang's business partner and Brainy Moves was officially incorporated in November 2013 with a paid-up capital of $160,000.

The centre in Joo Chiat opened in March 2014 and Mr Tang beavered away, calling on schools and speaking at roadshows and educational fairs to promote his programme. He recruited more than 20 students in its first month of operations; today, the number averages 170.

In November 2014, his wife urged him to write to Dr Ratey to come to Singapore to train him and to give a talk. The public workshop that the Harvard clinical psychiatry professor gave at the SportsHub in November that year was well attended not just by the public but also folks from NIE and the Ministry of Education.

Dr Ratey was so impressed by what Mr Tang had done with Brainy Moves that he agreed to become an ongoing consultant for free.  Word of mouth spread. Last year, Dr Zachary Walker, an associate professor in early childhood and special needs education at NIE, invited Mr Tang to give a couple of guest lectures to his students.

Dr Walker says Mr Tang does three things really well.  "He follows the research which has always shown that movement is critical to learning. He relates very well to children and adults so he establishes a connection with them quickly. And he is always willing to learn more and modify his own practice for the children he works with in his centre," he tells The Sunday Times.

Mr Tang - who has secured a couple of licensees for his programme - says he takes great pride in what he does.  "I interview every single candidate and I tell the parents I will not give them a schedule unless I meet their children and understand their competency and personality," says the entrepreneur, who now has three trainers on his payroll.

Although 70 per cent of his clients have a condition, he has no objections from parents of children who are neurotypical.  "Parents know I have a mix of kids in my class. But I think it's a good thing to let children know from a young age that there are different people out there. They need to learn to accept differences; they should accept differences," says Mr Tang who intends to get his master's and doctorate in special needs education.


He believes more needs to be done to raise awareness of children with special needs who are often misunderstood.  "I really hope that our education system will become more inclusive. The number of people with special needs is huge and many fall through the cracks. I hope the Government will allocate more funding for early intervention."

***********************
SPITTING
Ever since the school speech therapist taught my girl to blow whistle, she learnt how to spite saliva.  The therapist left and position was vacant for a few months.  As usual, Yishun Park school said unable to slot her in when a new therapist was recruited.  So spitting saliva became a bad habit since my girl was 9.5 years old, a way to express her excitement or draw attention.  My girl is an attention seeker.

The school physiologist said I should distract her, teach her the proper way to express her happiness, anger and sadness.

I can imagine a stranger, family or friends who were 'mouth washed' by my girl.  If you scold her, she gets your attention and will be encouraged to do more.  Slapping her mouth or apply chilli sauce on her tougue aren't usual but how many of you understand?  To you, I didn't discipline her.  You felt I failed my duty as a mother to correct her.  You get irritated and angry.  There are some kind strangers (rare) who assured me "No problem, don't worry" or say "it must be hard to take care of such a child" .... thanks for being so understanding.  You have made me less guilty.


REFUSAL TO TOILET TRAINING
Have reminded my current maid to get my girl to press on her toy phone to indicate she wants to pee or poo.  Haven't achieved results as my maid wasn't that keen to 'educate her'.  As she gets older, it has become really tough to train her.  Now a teen, she is stronger.  She can resist and there's no way I or the maid can get her to get up to walk to the toilet.  Previously, school advised to get my girl to get a certain item, eg toilet roll to indicate she wants to go to the toilet.  As a non-verbal child and maid not constantly eyeing her, it is hard to catch her holding the toilet roll or picture card.

My naughty girl likes to pee in my bed so if I'm not around her, I'll close my bedroom door. She also has the bad habit to poo in her bed, with diaper .... almost everyday. Noticed that many times, her poo wasn't that smelly so maid failed to detect.  The weirdness part is, my girl can sleep well with poo in her diaper, doesn't cry.  She has a toy phone hanging on her bed but she refused to cooperate and do something good.

While diaper-free during the day, she pee or poo in her pants even though not long ago, she was asked to go to the toilet.


HITTING
My girl will hit her own head, mine, surrounding eg chair or table when she's angry or didn't get her way.  She seems like not in pain when she hits something hard.... didn't cry.  My girl has short attention span (doesn't sit and watch a show throughout) and good memory on shows/songs/MTV that she has watched on Youtube so if I don't play some new or interesting ones, she'll start hitting.  I have tried holding her arms tightly but she is really strong, during the struggle she could hit something and end up with bruises. Sometimes, in her resistance, her head could accidentally hit my jaw and I end up with painful ulcers.

Child's Oral Care

Dental clinic caters to special needs, Straits Times, 22 Jun 2016
A dental clinic set up for seniors and people with special needs was officially opened at the National Dental Centre Singapore (NDCS) yesterday.  The Geriatric Special Care Dentistry Clinic, located at the Singapore General Hospital's Outram campus, sees patients with complex oral health conditions and who typically also have behavioural issues.

For instance, patients with Parkinson's disease may have trouble brushing their teeth, while many of those with autism get easily agitated by dental care.  The new clinic, which started operations last September, is the first of its kind in Singapore. It has seen more than 4,000 patient visits to date. Patients are generally referred from polyclinics or hospitals.

The clinic is designed to make dentist visits as fuss-free as possible for its special clientele.  "For example, for the less mobile and frail patients who have difficulty being transferred to a dental chair, the wheelchair tilting system allows the dental team to treat the patients in their wheelchairs," said Health Minister Gan Kim Yong, who spoke at the opening.

Every room is equipped with a dental X-ray machine so that patients do not need to travel to another part of the building.  In addition, general dental radiography and surgical procedures that require only local anaesthesia can be done within the clinic.

Madam Theresa Khoo, whose husband had a stroke more than 10 years ago and now uses a wheelchair, started visiting the centre last year. She finds the wheelchair- friendly dental chair a great help.  "If he falls when I transfer him to the dentist chair, he might also crack the equipment," she said.  "(The chair) is a lot of help, both for him and for me."

Geriatric and special care dentistry is an emerging speciality, but one in which there are many unique needs, said Associate Professor Poon Choy Yoke, who is the director of NDCS.  "It's not just the dental treatment delivery, which all of us have," she explained. "These special patients need a lot more explanation and patience, and sometimes maybe multiple visits because you need to win their trust a little bit at a time."

Mr Kiran Raj, 21, has developmental delay due to epilepsy. Before he started monthly visits at the clinic in January, he had never seen a dentist. His mother, Madam Jothi Marimuthu, had heard "nightmare stories" from other parents of special needs children. Even at home, she struggled to help him brush his teeth.  "He would refuse to open his mouth and make all kinds of noises, and he used to be so agitated," recalled the 46-year-old.

His dentist at the new clinic took the time to calm him down, and even played his favourite music to help him relax. Madam Jothi is confident that her son is in good hands.  "He can't express pain or tell you where the pain is," she said. "But now I know that if there's anything wrong with his teeth, the dentist will let us know."


00000000000000000000000000000000000000
AS: My girl has been receiving yearly dental care from Rainbow Centre Margaret Drive.  All the while her tooth was ok .... in the care of my ex-filipino maid.  Lately, her tooth got from bad to worse care.  My current maid only brushed the front and ignored the teeth behind.  Yes, I was surprised why every time teeth brushing time is so fast, suspected something fishy so gently reminded her.  Also reminded her to brush my girl's teeth twice a day, in case during the struggle with my girl, she failed to do a clean brush after lunch, the second brush in the night could fix things.  She kept telling me she brushed in the school, morning.  I had to tell her after the Nov dental visit that brushing her front teeth is wrong, I need her to brush well.

 child will be wrapped, arms strapped at the dentist chair

Last year, my girl's tooth showed decay.  Last June, her bottom molar received a filling.  2 weeks ago, my girl had another filling at her upper molar. Dentist asked "did you brush her teeth?" I am aware it is hard to brush my girl's teeth, reminded maid to be slow but she simply wants to get things done fast so that she can spend more time on her tablet.  Recently, I have to catch 'brushing time', watch her and ensure she did a better job. Maids these days don't listen instructions, they have their own minds and want job satisfaction at Employers' expense.  If you scold them or be bit strict, they may ill-treat, vent her anger or accusing you of not treating her like a family member.

When my girl is in pain, she can't express, point or tell me.  Taking good care of her teeth is important but my maid simply doesn't want to spare a thought for her.  Last 2 visits cost me S$45 each.  Maid probably think spending money is no big deal.  What I am worried is having a toothache.... the unknown pain, the pain my girl has to endure.  Visiting a normal dentist is not feasible because they can't handle special needs child, don't know how to manage her and get rid of her pain effectively.  Also it will be tough pacifying my girl because she can't point out where's her pain.  Last time when school dentist didn't have the weighted blanket, there must be at least 4 persons - 1 to hold her legs, 1 for her arms/body, 1 for her head, another to assist in opening her mouth for the dentist to treat/see well.

To get a dental appointment in govt clinic eg National Dental Centre, the normal waiting time can be months to half a year, how to wait that long?  Private dentists are easily available.  Although costly but has shorter queue time, sometimes immediate appointment.  Biggest problem,  normal clinic doesn't have the right support, lack of understanding and dentist can be very impatient.


Oral Care 'Need Not Be Nightmare' for Special Needs Kids, December 2014
Brushing Muhd Syamil Abdur Rahman's teeth and getting him to trust dentists used to be a struggle, but the eight-year-old, who has autism, now willingly gets into the dentist's chair.

Muhd Syamil Abdur Rahman, eight, has autism, and brushing his teeth used to be a daily struggle. One family member had to hold him still as his mother cleaned as many of his teeth as possible. Said Madam Norlizan Mohidu, 40, of her son: "He just refused to open his mouth because he didn't like foreign objects in it." Syamil's case is typical of parents who have children with special needs and who often fear taking them to the dentist because of how unruly they can get.

Last month, the National Dental Centre Singapore (NDCS) hosted a public forum for around 70 parents of special needs children for the first time. A survey of the group showed that four in 10 had never taken their child to the dentist, while the vast majority feared that their child would not cooperate while there. About half said that no dentist would see their child, or that they did not know where to look for one who would.

Paediatric dentist Terry Teo of The Dental Studio - a Singapore Medical Group Clinic - said most children visit him for the first time between ages three and five, but those with special needs do so, on average, four years later.  "Very often, they have been turned away by (other) dentists," he said. He added that others may bring their children in only when they complain of pain, which may not be detected at the outset in children with special needs, because they might be unable to express themselves.

"It is only when these children get older and have possibly tolerated such pain for a long time do the parents become aware that this is affecting them." But NDCS hopes to drive home the message that dentist visits do not have to be a nightmare if you start them young.  "When you go to a stressful environment that is new, children do not know how to cope," said Dr Tan Wee Kiat, a senior consultant at the centre's paediatric dentistry unit.

"You have to teach them coping strategies to get them used to the environment. With each visit, the child gets better at coping with stress and, therefore, behaves better." Ideally, she said, all children - with or without special needs - should start seeing a dentist by age one. In Syamil's case, his mum, a housewife, sought help at NDCS in 2012, after noticing her son's cavities getting worse. There, he underwent an operation to extract eight baby teeth. But getting him to trust the dentist was not easy. She related how the dentist would perform check-ups by making Syamil laugh, then sneaking a peek at his open mouth.

"She was so patient," Madam Norlizan recalled. "She would play games with him, and introduce him to all the equipment." This year, they had a breakthrough when Syamil willingly got into the dentist's chair for the first time. New adult teeth are slowly emerging - and he brushes these on his own.