The last thing I said to my husband before getting on a train to London, before my flight to Canada was, "keep my baby safe while I'm away!" Two days later, the message that we needed to "FaceTime" revealed a very upset husband who had just returned from A&E with Adam...in a plaster cast to his knee. A morning at one of our local soft play areas and an awkward fall resulted in a broken foot and an expectation of six weeks in plaster. It was of course just one of those accidents that happen in childhood, but there was an unforeseen complication because of Adam's autism and that, more than the injury itself, has been a real test for us all.
We soon realised that Adam makes absolutely no cognitive connection between injury / pain and the need to sit down or even limit his activities. Now of course, it's hard to explain injury to any young child - that's a given - but Adam's brain works differently to that of many other children; he has very limited one word communication which is restricted to concrete things like "eat" "drink" and "nappy". We have absolutely no way of explaining abstract concepts like "ow" "pain" or anything remotely like bones and casts.
What's more, Adam genuinely doesn't understand why pain in his foot should stop him from walking / running and even jumping. Over the two weeks since the injury, we have found him attempting to jump up and down on the settee (and jump off it onto the floor), stomping his feet along with one of his favourite characters on TV, and trying to run. It's not that he doesn't feel the pain, because some of these things have occurred with tears streaming down his face, it's that he doesn't understand the pain, what it means or what he should do (or not do) as a result.
This morning, we had a follow-up appointment with the Consultant at the hospital and new X-rays gave us a shock - originally we had been told that Adam had broken two bones in his foot, but today the Consultant said it looks more like FOUR bones. So out of his five available metatarsals, he's broken four of them. Thankfully, none of the bones are displaced and are healing well so we now have a goal of removing the cast earlier than expected. But four broken bones should be incredibly painful, despite the medication he's on, it should make him willing to self-limit his activities - that after all is what pain is for, a signal from the body to the brain to stop or slow down.
But whether this is about body-awareness, cognitive ability or communication skills, we genuinely don't know - maybe a combination of all three. In the meantime, in an effort to protect his healing, Adam is spending a lot of time in his pram as it has a harness to keep him seated, we're carrying him whenever possible (and struggling with back pain as a result - he's too big for carrying!) and trying to give him lots of time with the iPad as he sits more frequently when watching TV on it....but certain programs have been banned like "Five Little Monkeys" (jumping on the bed...) for perhaps obvious reasons.
It's a whole new...and challenging...world.