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Monday, August 31, 2015

Failure to Thrive ~ Part 3

Recap on our situation with Evie. 

6mo appt - she was 11.6lbs and the doctor expressed concern, wanted to see her back in a month. 

7 months 14 days appt - We traveled to Texas for 4 weeks so it took us a little longer to get her back to the doctor and she had not gained any weight, in fact she had lost .1 ounce so this put the doctor into panic mode where we were told to get her weight up in one week or she'd be hospitalized.

7 months 21 days appt - She went up to 11.8lbs so the doctor eased off the hospital threat and we agreed to make an appointment with a gastroenterologist and I continued to fed her every 2-3 hours and throughout the night.  We also took her to church and got her anointed and prayed for because that's what we do as Christians, ask God for help to fix our baby.  We also started feeding her a cookie at every meal and she seems to enjoy this new routine.  We buy the Gerber Arrowroot cookies and organic shortbread cookies that are 150 calories for two.  She refuses to take any bottles or sippy cups and nothing from a spoon. 

8 months 2 days - She went up to 12.2lbs.  The doctor was satisfied and said she didn't need to come back for a month.  This was a huge answer to prayer both in weight gain and in doctor backing off on making us come in every week.  We're also thankful we didn't need to subject her to tons of testing. 

This is her chart:

In my experience babies hit a super active period around 8 months old and then they get really hungry.  With Violette, we had a similar situation where she 11.9lbs at 6 months, then 12.1 at 7 months with a big spike to 14.5 at 9 months.  In that two month period she was down on the floor playing, building muscle mass and she got really hungry.  We expect the same to happen with Evie.  Next update will be after her 9 month appointment on the 30th of September.

Saturday, August 22, 2015

"Failure to Thrive" Diagnoses at 7 months - Part 2

Now that our little one has been diagnosed with failure to thrive and we know she will not take bottles or solids, we need to make the best of our nursing relationship to get her to grow.

Here are the specific changes I'm making to help increase her weight:

Babies Eating Schedule and Supplementation: 
Prior to the diagnosis of last week, I had been feeding her every three hours and only at night if she woke up.  Since returning from our Texas trip she had been sleeping through the night for at least a week before the diagnosis.  She was getting 5-6 breast fed meals per day.

After the diagnosis we tried offering bottles and she surprised us by taking 5 two ounce bottles after every meal.  The next day she was constipated and took maybe 2 bottles and by the 3rd days she was so cranky she wouldn't touch a bottle.  She finally had a big poo and didn't take another bottle for the remainder of the week.  By Tuesday I was worried that I wasn't making enough impact so I spoke with a lactation consultant from the hospital who suggested that Evie was not staying on the breast for long enough and to work really hard with her to keep her on longer.  I realized that she was so distracted during the day that maybe she'd take longer feedings at night so I started waking her up every three hours to eat - even though she was sleeping through the night!  This got her to 7 breast fed meals per day.  By Wednesday she had gained 3 ounces which is normal weight gain for her age. 

We're not out of the woods yet.  She's supposed to be taking in 150% of a normal calorie intake so the doctor still wants us to do whatever we can to increase her calorie intake.   I've started feeding her more frequently than 3 hours.  If she sees me and howls at 2 hours I'll feed her.  If it's 2.5 hours I'll feed her.  I do work full time from home but have the flexibility most of the time to feed her regardless of what I'm doing and I've even fed her during conference calls because she really can't wait and her refusal to take a bottle just means she will cry and potentially lose weight from the stress of crying hard. 

We're supposed to give her solids and anything that she'll take but she really has no interest so far in solid foods.  We have given her a high chair and a place at the table to sit so she can get accustomed to our eating habits and we know that over time it will become more interesting for her.

My theory is this - between 7-9 months babies get really super active. They are on the floor learning to crawl and getting super jazzed about life.  All that movement burns calories and makes them really hungry so I think she will pick up an appetite just from having a more active life.  This is exactly what has happened with my other two ultra slim girls. 

My other girls took bottles early on because I went back to work at an office.  With this baby I've had the joy of working from home but it's also made it to where baby has never really had to take a bottle - with the exception of business trips and that's a story for a different post! 

This is really my first attempt at breast feeding a baby full time.  It requires an extensive amount of care for my own self which leads me to the next part.

Mama Eating Schedule:
I've researched what a breast feeding mom needs to eat and the general consensus seems to be eat about 300 to 500 calories more than normal, eat fish twice weekly and eat a well balanced diet.  I was concerned that I should be eating with every meal that baby takes throughout the night but I've found no evidence that this is necessary.  Therefore to keep up with the babies needs I'm eating a large breakfast when I wake up that is around 500 calories, lunch at noon with 500 calories, snack around 3pm that has around 300 calories and dinner usually has around 500 calories.  I drink a 20oz glass of water per day, one 15oz cup of coffee in the morning and an iced latte in the afternoon.  I considered reducing my coffee but this amount falls into LaLeche's standards of 4-5 cups per day so I think I'm okay.  I'm also drinking several cups of Mother's Milk tea per day with honey and decaf iced tea with lunch and dinner. 

Other research:
I found this article today "Healthy and Petite" that seems reflect many of the issues I've had with our little one.  I certainly don't want to rule out that there might be something wrong that's causing our baby to not gain weight but then again there does not appear to be any indicators that there is something wrong except for the fact that she doesn't fit into the doctor's growth chart.  I think it might be time to start looking for a more supportive doctor who knows more about FTT and it's relation to breastfeeding.  According to this page breast fed babies do grow slower then formula fed babies so its important to keep this in mind.

Finally I'd like to share this website, KellyMom, who has many articles on this issue and significant support for breastfeeding moms and there is always the awesome LaLeche website for advice on everything related to breastfeeding.

Friday, August 21, 2015

"Failure to Thrive" Diagnoses at 7 months - Part 1

My darling Evie  has been given the same diagnoses as Violette - at the exact same age - "Failure to Thrive", Vi's post is here.  We also had weight gain issues with my 1st daughter Charlotte from 6 - 12 months. 

Charlotte would have probably received the same diagnosis had we not been on bottles from day one because she was born five weeks early and lived in NICU her first five days thus thwarting my ability to breast feed her exclusively.  With bottles there are many tricks to increase calorie content such as adding more formula and rice cereal.  We did both heavily with Charlotte so while she was always a light weight  and did cause concern for only gaining 5 ounces from four to six months, she was always above the 5% percentile mark which didn't put her into the "Failure to Thrive" category. 

For Charlotte our pediatrician highly encouraged getting as many calories as possible into her by way of adding heavy cream, canola oil and corn syrup to her bottles.  The shock I've received from parents when I recount this is pretty common because oil just sounds gross but now that we've lived through "failure to thrive" twice, I can see how she was just trying to keep us from falling into this category.

Violette's weight went from 11.9 at six months to 14.5 at nine months and we were able to do this by supplementing with bottles and using more formula and rice cereal as we did with Charlotte. 

Evie will not take bottles and breast feeds exclusively so the general hypothesis is that I'm not producing enough milk.  I'll touch more on breast feeding in part two.  First, let review what FTT means. 

To be diagnosed with "Failure to Thrive" one must fall below the 5th (depending on what report you read) or 3rd percentile mark for weight (I've seen both 5th and 3rd mentioned).  Here is an excerpt from John Hopkins website on this subject matter:
"Children are diagnosed with failure to thrive when their weight or rate of weight gain is significantly below that of other children of similar age and gender. Infants or children that fail to thrive seem to be dramatically smaller or shorter than other children the same age. Teenagers may have short stature or appear to lack the usual changes that occur at puberty. However, there is a wide variation in what is considered normal growth and development. 
In general, the rate of change in weight and height may be more important than the actual measurements.  
Infants or children who fail to thrive have a height, weight, and head circumference that do not match standard growth charts. The person's weight falls lower than 3rd percentile (as outlined in standard growth charts) or 20% below the ideal weight for their height. Growing may have slowed or stopped after a previously established growth curve. 
The following are delayed or slow to develop:
  • Physical skills such as rolling over, sitting, standing and walking
  • Mental and social skills
  • Secondary sexual characteristics (delayed in adolescents) 
I've seen no delay in Evie's physical abilities - she rolled at three months, she's been standing with support since five months, she's scooting around the floor at seven months, she plays with toys, laughs all day and reaches for her siblings and everything in sight.  She has normal sleep patterns and loves to breast feed.  She never vomits and shows no signs of discomfort when breast feeding. 

Evie's height is in the 25th percentile and her head size is 17" which falls in the center of expectations so when I read the highlighted yellow part I can say she's only falling short on the weight factor.

At Evie's six month appointment she had only gained seven ounces in 2 months which was slightly better than Charlotte who gained five and definitely better than Violette who had only gained four ounces.  I was not worried nor surprised when the doctor asked us to bring her back in one month because we'd been down this road before.  We spent the next month in Texas, traveling and baby wanted fed every 3 hours and once every night.  I was sure she had put on weight so when she went back for the 7mo appointment we were shocked to see she had actually lost one ounce.  This is what put the doctor into panic mode because babies are not supposed to LOSE weight.  The doctor gave us a mandate to increase her weight in one week or she would be hospitalized.

I'll be honest, I was so upset I could barely breath or eat.  I called my mom and asked for prayer.  I couldn't even bring myself to attend church that evening because I was so upset.  I can say that at one week later we had an answer to prayer because at her weight check she had put on three ounces so that seemed to put off the threat of hospitalization.  We will continue to have weekly weight checks until the doctor is satisfied. 

I found this website to be very informative on FTT:  http://www.aafp.org/afp/2003/0901/p879.html
One area of interest to me was the paragraph explaining the severity of our case:
A complete physical examination is essential, with four main goals: (1) identification of dysmorphic features suggestive of a genetic disorder impeding growth; (2) detection of underlying disease that may impair growth; (3) assessment for signs of possible child abuse; and (4) assessment of the severity and possible effects of malnutrition.12,13 The severity of a child's undernutrition can be determined most easily by using the Gomez criteria. By comparing the child's current weight for age with the expected weight (50th percentile) at that age, the degree of malnutrition can be assessed. If the weight is less than 60 percent of expected, the FTT is considered severe, 61 to 75 percent denotes moderate FTT, and 76 to 90 percent is mild.14
Our case is moderate.  A seven month old at the 50 percentile mark is 17 pounds.  Evie is 11.8 pounds so she's at 70% mark.   Considering the doctor was recommending hospitalization a week ago I find her reaction to be on the extreme panic side because she was only reacting to the one number that she didn't put weight on for a month.  She also failed to consider that scales can be off as much as 3 ounces, something I learned as I did research on buying a home scale to monitor Evie's weight.  Was the baby weighed on more than one scale?  No.  Ironically this also means her recent weigh in might be off but I'm still going to take it as a positive sign as it helped us remain in control of Evie's health and eating needs.

An important factor to consider in your child's pediatrician is someone who can calmly assess your situation and advise solutions.  We were given a medicine for potential reflux issues and one week to improve her weight with the threat of putting her in the hospital if we didn't comply.  This disturbs me on many levels.  While I welcome opportunities to take Evie to a specialist such as the gastroenterologist or lactation consultants since she's so determined to avoid bottles, I do not welcome an option that will deprive me of the ability to breast feed my child and hospitalization would certainly create complications.  There is also the issue that if we don't comply the doctor could call CPS to investigate our family and after hearing horror stories of how families in Maryland have been treated I find this to be a further threat.  I need solutions and specialists, not threats. 

This will be an ongoing issue until we can get Evie's weight to an acceptable number.  We are exploring feeding options in many ways which I'll go into in my next post.  This post was more to introduce the issue and potentially provide some guidance to any parent dealing with this issue.  My advise would be to read up on the issue as we have done and go to your doctor informed about the situation.  Take a chart of your babies eating schedule for the past three days.  If you breast feed exclusively, consult your local lactation consultant.  We found ours through the local hospital where Evie was born. 

Finally I do believe prayer to be a factor in any babies growth because we are all God's children and if he made us then he's the one who knows how to fix what's not working.  Therefore I must reiterate that we are grateful for the prayers from our local congregation and family and we are thankful to God for intervening and helping Evie put on 3 ounces in one week.

Tuesday, August 18, 2015

How to Entertain Kids on a Road Trip

Trip to Pittsburgh - 3 hours
We got all the kids headphones to reduce the noise level in the van but it hasn’t helped.

·         7 year old sings along, off-tune, to everything she’s watching while wearing head-phones

·         5 year old broke his head-phones in 4 weeks.  He hung them on hooks in the van and did God knows what with them.

·         3 year old can’t keep them on her head correctly and gripes so much we just keep them in a bag so she watches movies on the Kindle right behind us.

Someday they will all be as good as 7 year old in wearing them so I’m dreaming of our next van upgrade which must have the following:

·         DVD player in the front of the van where parents can control the movies and each kid has a plug in for headphones. 

·         Cup holders for every child

·         At least 2 plugs for re-charging electronics

I’m sure I’ll still hear “na na nan a Na NA NA nan a na nana aaaaaaaa” but at least they will be on one shared movie system. 

Our current entertainment options include:

·         MobiGo2 – two with one cartridge that is shared (with a timer that mom sets)

·         Old iPhones with Bugs & Buttons and Angry Birds – two

·         Kindle – with movies and games

These get passed around until they die.  I bring extra batteries for the MobiGo’s but I’m not equipped to keep everyone’s electronics plugged in at the moment.  So sorry for the inconvenience kids, we will do our best to get you guys fully charged at all times on the entire road trip, even if it kills us J 

Thursday, August 13, 2015

The Welcome Committee

I've worked from home for two years now and occasionally I get the urge to go out and have lunch by myself, outside on a sunny day.

Today I slipped out unnoticed but when I returned there was a welcome committee assembled at the door!

Sam is outside the frame running to my truck to ask where I went.  Baby is in the window and she's happy to see me because she's hungry!

Can't say I ever got a welcome like this at the office!!