New things

We've had a lot of changes this week: Gabriel finally had his first official Birth to Three therapist visits, I went back to work, and he had his first day without either one of us taking care of him.

B-3 sent both a speech therapist and a physical therapist to visit with Gabriel, and now we have homework. They'll visit about once a week for now and hopefully we'll make some progress. The feeding therapy visit was the most interesting. It seems that Gabriel is "self limiting", meaning he has the ability to take more food from the bottle, but he's choosing not to for some reason. So, we are changing our goals. Previously, we were focusing on volume, now we're focusing on attitude. "Feeding time is fun time" is our new motto, and so if Gabriel is showing us stress cues such as falling asleep or rejecting the bottle, he gets a little break and then we try again. We aren't pushing as hard, so if we feel he's done for the session, even if it's only been 5-10 minutes, then we're done. During his feeding tube time, we are making sure he's getting in a lot of pacifier time and also dipping the pacifier in breastmilk repeatedly so he can make the association of yummy milk = full stomach, not syringe = full stomach. Falling asleep may sound like a weird stress cue, but his behavior is certainly consistent with using the tactic to avoid working. He'll fall asleep almost as soon as you start with the bottle, but if you put him down, he wakes back up and wants to be social. He is also almost always very social during feeding tube time, so he's not acutally tired or cranky, he just doesn't want to work on the bottle.

On Wednesday, Gabriel had his very first babysitter. She's still speaking to us and is coming back next week, so I guess he didn't give her too much trouble. I definitely needed the time away, and going back to work was great. I came home, and I was tired, but I felt so much better for having been able to get out of the house for awhile and do something else I enjoyed. Playing with tiger cubs will do that for you. :) We promised ourselves that we wouldn't be helicopter parents and call to check in on Gabriel every few hours. We were good. Neither of us called -- we knew our babysitter would call us if anything happened.

After having two days away, spending the whole day as stay-at-home mommy was hard to get back into. Feeding Gabriel takes a lot of energy. Each session is about an hour long by the time we get through everything, and then I still have to use the breast pump which is another 30 minutes. As a result, several things fall off the wagon. Unfortunately, breastfeeding is one of them. Getting the timing right -- having him hungry and having had enough time pass since my last pumping session is difficult. Plus, he doesn't take much in a session, it's just kind of for mommy-son time at this point, so it adds to the already marathon feeding session. He's never going to be an exclusively breastfeeding baby. I'm looking forward to January when we may be able to start introducing solids and hopefully he'll like that enough to take in his required calories all by himself. The other things that fall by the wayside are the extra baby playtime things. He doesn't get as much tummy time as he should, since I need him to be awake and not having just had a full meal. It's timing again. And there are many other things we should be working on to reach those developmental milestones, but it feels that there just aren't enough hours in the day to do everything. We want to give him the best chance we can to catch up developmentally, but being the all-around super parent just isn't possible. Since feeding is his most pressing issue, we spend most of our time and energy overcoming that hurdle.

However, we do have happy points: Gabriel makes quite the range of sounds and we are able to identify little baby laugh. He smiles quite a bit and loves to look at your face. His abdominal muscles are improving. If you put him on his back, he will raised both legs all the way up over and over without arching his back. It looks like quite the workout. I don't think I could do that half so easily as he seems to. He is also getting quite active with his hands; holding onto toys and looking at them intently and he has even managed to start sucking his thumb.

First Thanksgiving and 7 month birthday

We had much to be thankful for this past Thursday -- it was Gabriel's first Thanksgiving. Except for a minor cold, he is a healthy happy little boy. You would never know he spent his first 5 months in the hospital. He met all his Moser cousins and family via Skype and the next night he spent with his Ruthford family. Greatgrandma Edna held him for a large chunk of the evening and his aunt and two uncles were able to spend time with him, too. Grandma Jane and Grandpa Charles were very happy to see him and Grandma Jane took LOTS of pictures.

Just yesterday, he officially turned 7 months old. His adjusted age (the age he would be if he hadn't been premature) is now 3 months old. We've definitely seen some new things develop over the past month, not the least of which is that he is now wearing 6-month clothing. It's a little big, but the 3-month sizes were getting on toward the small side of "just right", so we made the switch. He is 12 lbs. 10 oz. and 23.5".

We are seeing quite a few smiles, he is VERY social, and we're starting to identify his little laugh as well. He still struggles with eating, and we haven't really seen significant progress. We have had to switch back to the Dr. Brown's bottle he was using the hospital since he seems to be thoroughly rejecting the easy bottle he has been using since leaving Swedish. And yes, he likes his milk nice and warm. Tomorrow he starts with his new feeding therapist and a new physical therapist. By January, I'm hoping that his pediatrician/dietician will approve starting solids to see if he can get his calories that way.

Another new change is that I am coming off maternity leave and starting work again tomorrow. This means he now gets a "Daddy day" on Tuesdays and a babysitter for the first three Wednesdays until my schedule switches to Saturdays. It will be nice to have a break in the week and be able to take care of all my zoo animals again.

Gabriel did develop his first cold this week -- we're on day six if it right now. We saw the doctor yesterday since it's his first respiratory illness since being home. It's uncomfortable for him, but the doctor said he should get over just fine on his own. For the most part, he doesn't act too sick, but definitely has the congested cough. It's nice to know his lungs are as healthy as they seem to be, even as he's sitting here crying at me because he just started coughing. He has the air to cry... But we will be starting his winter sit-in and stop taking him to church on Sundays. At least we can still do outside walks.

Here's hoping (and praying) that tomorrow he will start improving and get over this first of many colds to come.

Tweaks

For the past two days, Gabriel has been really fighting the bottle feeding. It's been very frustrating for all of us. So, today we gave him an "ad-lib" day meaning that we feed him either when he cries or 3 hours pass -- whichever comes first, and he only gets what he takes from the bottle. He gets nothing through the tube. The thought is that if we make him hungry enough, he'll drink from the bottle. Normally, we do get a little bit of a good response to this tactic......but not today. It was going worse than usual. So, we started playing with things. We have three separate bottle options we can use for him, so we tried them all. Then we started playing with milk temperature. The combination of a Dr. Brown's bottle with preemie nipple and warmer than average milk got the best result. Of course, this was also the last thing we tried so it may be that by the end of the day he was hungry enough to put up with us. We don't know. But it's worth trying tomorrow. I'm really hoping Birth to Three gets back to us soon (we're just working our way through the red tape necessary to get him scheduled with a therapist) so we can get some fresh eyes and more experience working on the problem again. When I worked up all the totals, he has been doing worse this whole past week, and we didn't lose ground today, but we didn't gain any either.

Helping hands and DuckTales

Gabriel's new trick is to be more involved in his bottle time. He has started to take his free hand (we feed him on his side, so one hand is usually under him) and push/grab/paw at the bottle. The feeding therapist told us this is a good thing since it is the precursor to the behavior of eventually holding the bottle himself. Therefore, we let him do it. But just like your two-year-old wanting to "help" with the dishes....it isn't that helpful. But it is good to see him developing new, corrected age appropriate behaviors.

His other trick is to push off with his feet when he's being held. This led to Thomas naming the behavior "playing launchpad" and now all I can think of is Launchpad McQuack. So, I guess he earned himself a new nickname. He is quite strong and can get himself into some pretty awkward positions for both him and us doing this. Hence the appropriateness of the nickname. Launchpad wasn't exactly known for his precision flying...

In other news, we got the results from his therapy evaluation last week. Most of his behaviors are appropriate for a 2-month old which is right around his corrected age. This means he's on track developmentally, he is just overall weak in the muscular developmental area which was expected. He will have both physical and feeding/speech therapy, and if we can strengthen his muscles, that should improve his feeding behavior as well. The one area where he is tracking closer to his chronological age of 6-months is social skills. Those the cute baby smiles are right on target. :)

Sleepy Buddy

Yesterday was a super sleepy day. Gabriel slept from about 10am until 6pm, and he still slept through this past night as well. I'm guessing those shots on Tuesday really got to him since he was awake all day Wednesday and then sleepy all day yesterday. Unfortunately, this meant that his feeding ability pretty  much tanked. We were back down to 20cc and 26cc for two of his four feeds (we offer 110cc each time). Although, the middle of the day feed was a little interesting. He was pretty much out, but he still latched on to his bottle absolutely perfectly and took down 50cc in the 20 min. I gave him to eat. I could tell that it was a super-coordinated session, and had he been awake, he probably would have done something in the 80-90cc range. So, there's hope, I guess. He's awake and playing this morning, and hopefully he'll be ready to eat in a half hour when I have all his stuff together...

Ouchie!

Today, Gabriel had his 6 month vaccinations. He had his first two sets at the hospital, so we were never around for the actual event. For those of you who may not know he cries now...let me tell you, he has quite a set of lungs on him if given the proper motivation! Even the Iron Man bandaids didn't make it all better. I suppose he's probably too young to care about such things yet. I thought for sure he wouldn't do any bottle feeding for me after that, but the magic feeding fairy apparently visited for his lunchtime and he took down 69cc in about 10 minutes. She proves to be elusive, though, as the next two feeds were quite mediocre, but at least he had one good one today. Maybe it was the tylenol, who knows?

First month at home

Gabriel came home from the hospital a day before his 5 month birthday. You can read about his hospital days on his CaringBridge journal.

Gabriel has been home from the hospital for a little over a month now. He just had his 6 month birthday, but in developmental time, he is only two months old. We have seen a lot of changes in him in just this past month. He has started smiling quite a bit; we noticed the "real" smiles right around his Chrismation in October. He is also very active and social in the mornings. He enjoys kicking in his bouncy chair and waving his arms around, which is much more activity than he was doing in his hospital crib. He has grown from over 10 lbs. to over 12 lbs. and has gained an inch or two in length as well. That's a long way from his birth weight of 1 lb. 6.9 oz. and 12.5"! He currently trends just below the 50th percentile on the WHO growth curves, and we're watching him closely.

His current challenge is still his eating ability. He came home with a gastrostomy button so that we can get food directly into his stomach if he is unable to take it all by mouth, and we do this at every feeding still. He is using a super-easy bottle called the Habermann that lets him get milk just by compressing the nipple. Of course, if he sucks, he gets a lot more! His volumes have slowly gone up. At the hospital, we would see days where he would take nothing at several feedings in a row or only take 20mL or less. Now, he does eat at every attempt (we feed him on a schedule four times during the day) and his minimums are around 30mL, so he is improving, but slowly. He gets his nighttime milk via a feeding pump plugged into the gastrostomy button, so he sleeps through the night. We didn't want to fight with trying to wake him up at feeding times overnight, since that didn't work so well in the hospital. Let him (and us) sleep! Every once in awhile he goes into what we call "vacuum pump" mode where he can take down over half his bottle in less than 10 minutes. We see this behavior once or twice a week, but it seems to maybe be happening a little more often than before. It's still a very slow process though. He has been seeing his hospital occupational therapist since discharge, but tomorrow, he will be evaluated by the local Birth to Three program who will hopefully keep working with him on bottle feeding as well as muscle development.

We are very happy to have him home. It's so nice to not worry about getting through downtown Seattle traffic every day and having to make it to the hospital for his care times. We set the schedule. I'm slowly adjusting to being a stay-at-home mom for now. It's quite exhausting, especially emotionally, but I'm planning on returning to my two-day-a-week job at the zoo in about a month so I can have some away time in a job I enjoy. Every mommy needs some mommy-time, right?

We will be posting some short Gabriel updates, some long ones, but at the very least a monthly update for those that want to keep following his progress.