Update: Twelve Weeks Adjusted
CURRENT WEIGHT: 8 LBS, 12.5 OUNCES
CURRENT LENGTH: 20.8 INCHES
ADJUSTED AGE: 12 WEEKS
FEEDING CLINIC SESSION:
On Friday, Truman met with a speech therapist to assess feeding issues. Up until the last couple of weeks, Truman had struggled with many of his bottle feedings, causing concern for his doctor and stress for us. The therapist felt like Truman had bad case of reflux and that he was at risk for failure to thrive. However, the more we thought about the assessment, the more we realized it wasn't really accurate for Truman. First, many of Truman's eating issues have improved in recent weeks as we have re-adjusted his nursing and bottle schedule to make sure he always nurses during his colicky evening hours. We also switched to a faster-flow nipple and have been able to have 90% of his bottles come from Ben rather than me. When he was initially referred more than a month ago to the therapist, none of these changes had been made. Also, despite our protests that Truman only likes to bottle feed while lying on his side (like breastfeeding), the therapist insisted on feeding him upright. Anyway, we did implement her recommendation to keep him upright for 15 to 20 minutes after each feeding and that seems to have cut down on the spit-ups a lot. We discussed the rest with Truman's pediatrician and nutritionist at his regular appointment today and decided that since he has improved so much over the last couple of weeks, we don't need to seek any help with his feeding at this point.
PEDI APPOINTMENT TODAY:
GROWTH AND DIET: Truman has slowed down his growth over the last three weeks back to half an ounce a day (a typical full-term baby would be gaining about an ounce a day at this age). Because of that and because he is getting close to cutting out a feeding by sleeping longer, the pediatrician, nutritionist, and we made the decision to increase the additive in his milk to bump it to 30 calories. As a result, we will have to keep an eye on him over the next week or so to see how his digestive system reacts.
FLAT SPOT: The doctor feels like the flat spot is just about gone. He suggested a gel pillow if Truman starts favoring one side again, but since he does not, no treatment or particular placement or exercises are called for at this point. At one point, Truman had a very pronounced flat spot on the right side of his head and would only turn that direction. The OTs caught it early, back in the hospital, and the NICU began being vigilant about making sure he slept on the opposite side and doing neck exercises. We have continued to make similar efforts. Everything seems to have done the trick.
IVH FOLLOW-UP: When Truman underwent an MRI just before discharge, it showed that there was still blood in his brain, but that damage had not occurred to the brain matter itself. It was suggested that he get a follow-up MRI at three months. Dr. Suterwala said today that he is so pleased with Truman's developmental progress that he doesn't want to do one. It would require sedating him in order to do the procedure and no developmental problems are indicated at this time. At one year of age, an MRI and complete developmental work-up will be as a prognostication tool.
Truman has come so far since we last posted. He coos much more and has added the occasional higher-pitched sound to her repertoire. He still mostly coos while playing, particularly in response to toys dangling from anything -- a mobile, playmat, bouncy seat, etc. However, he now coos some at me even when not playing as well, particularly when I kiss him. In the last week or so, about 75% of the time, he has begun lighting up with a very big smile when I kiss him on the face or the palms of his hands.
Over the last several weeks, he has developed a very good aim when swinging at the objects on his playmat and hits them most of the time. In the last couple of days, he has started grabbing the objects, and today, he grabbed one and pulled it to his mouth. In just the last week or so, he has finally started sucking on his hands regularly, which means he is finally learning to soothe himself some. The last two mornings, I was awakened by the sound of his sucking on his hands to indicate hunger rather than cries. It was a welcome change.
Although he initially began rolling from his stomach to his back when he was two weeks adjusted, we had not seen him do it in a while and were concerned that he had forgotten how. However, last week at his feeding assessment, he was also evaluated by an occupational therapist and rolled over repeatedly for her. (Maybe he has learned that if he cries, we will rescue him from the dreaded tummy time, and he doesn't have to do the hard work of rescuing himself). Based on his history, she is going to start meeting with him once a month to monitor his progress and make sure he stays on track. In addition to rolling from his tummy to his back, he has begun rolling onto his side and even made it all the way over from his back to his tummy once, although it was clearly unintentional. We've been scolded again to make sure he gets more tummy time despite his protests.
In general, he is tolerating and starting to request more frequent and longer play sessions on the floor or in his cradle. It's so fun to participate and watch. Based on his reaction to other family members, medical personnel, and the occasional visitor, it also seems that in the last couple of weeks that he has become more attached to the two of us and more aware of us as a special role apart from others. It finally seems that we have unique powers to soothe him, which feels so nice.