Ellen had called on Thursday to set up an appointment. She asked if we could call Henry's doctor to send over his weight, length, and head circumference information. We set up an appointment for yesterday afternoon. I had called Dr. Bianchi's office about the growth information and left a message. I had suspected that it wouldn't get to Ellen in time, so I sent her information from our records (I record just about everything). When she visited yesterday, she had plotted Henry's growth information on a growth chart made specifically for very low birth weight (VLBW) boys, which means baby boys who were born under 1500 grams (approximately 3 lbs 4.8 ozs) and born at 37 weeks or less gestation. We have at times plotted Henry on the preemie charts, but the preemie charts include all preemies not restricted to VLBW babies. Ellen weighed Henry on her scale at 14 lbs 5 ozs. His length was 60 cms (23.6 inches). His head circumference was 41.5 cm (16.3 inches).
On the VLBW boy preemie charts, Henry is doing very, very well. His weight is in the 75th percentile, his length is in the 50th percentile, and his head circumference is in the 50th percentile. In short, he is growing well. Not only has he placed well, but more importantly, his growth trajectories are following a nice pattern. His length pattern has actually gotten a little steeper since leaving the NICU, suggesting that he is making progress on his length. One of the things that we have read and heard is that in some ways, the growth trajectories of a child are more important than where they actually place on a given scale. She plotted his weight and length on a "Weight-for-Length" scale. He is actually in the 90th percentile for that...suggesting that he's actually a little chubby for a preemie. We think that things will sort themselves out, now that he's sleeping more and getting longer.
The primary reason why I wanted a consult with a nutritionist is that I have been concerned about how my diet has impacted Henry (and me). We were told at the Wilmot Developmental Clinic that I needed to being eating 80 grams of protein a day. Mind you, the average non-pregnant adult needs approximately 40 grams. When Henry was diagnosed with the dairy and soy protein allergies, this made it very hard on my diet. Hitting 80 grams of protein is difficult; hitting it when you don't eat dairy or soy and are a vegetarian is even harder. I have eaten a lot of nuts and seeds, beans, rice, corn, and vegan brown rice powder supplements to make it to the target of 80 grams per day. And, I do eat chicken on occasion for Henry. Now that Henry has fewer problems with dairy and soy, I have incorporated some dairy and soy back into my diet. But to reach 80 grams of protein essentially means that I have to eat A LOT more than my body needs in terms of calories and fat. Seeds and nuts are fatty. No way around that. Consequently, I'm getting fat. Now, I'm not a vain person, so I really don't care how it has impacted my physical appearance. And, I'll do just about anything for my son. I gained a lot of weight during pregnancy. Lost about 20 lbs of it. But ever since I started trying to eat 80 grams per day, I have been gaining weight. And, I don't know how I will be able to keep up with an active Henry with the extra padding weighing me down. It is so much work trying to eat 80 grams of protein per day...I really hate eating this much. When I have not made the 80 grams/day benchmark, I feel so terribly guilty.
According to Ellen, I actually don't need to be eating that much. Two possible approaches. The first approach says that a lactating woman needs to eat 0.8 grams of protein per 1 kg per day. Under this calculation, 80 grams per day is appropriate for a woman weighing 220 lbs!!! OK. I admit I need to lose weight, but I am no where near weighing 220 lbs!!! No wonder I've been gaining weight. I'm eating like a Chicago Bear (move over Refrigerator Perry). The second approach says that a lactating woman needs to eat 62 grams if her child is 6 months or older. I don't think this approach takes into account a woman who has been pumping for over 7.5 months because her baby was born early, although this was the number that Ellen said I could go by. I peaked at her table, and it looked like the suggested grams was 65 grams for a lactating woman who has a child who is under 6 months. I'm assuming that Henry's dietary needs match what is appropriate for his adjusted age. Regardless of the approach, the bottom line is that I don't need to eat nearly much as I have been!!! I can reduce my dietary intake by about 20%, and I am ecstatic about this!!! I'm going with approach two, because it is the conservative thing to do (eating more protein than I would if I used approach one). I am also overjoyed, because it means that even when I wasn't hitting the 80 gram mark, Henry was getting the protein he needed.
After Ellen left, Henry's DDD developmental specialist Tara came by for her weekly visit. Henry did some push-ups for her. He was getting pretty far up using his arms. She was very impressed. She said that she knows that he may have some special needs in the future (given Henry's rough start), but right now, if she hadn't read his file, she'd think he was a "normal" 4 month old. At one point, Henry was on his back, and one of his hands was grabbing the fingers on the other. He was fascinated by them. I think that he was figuring out some cause and effect from the interaction of one hand with the other. Toward the end of our visit, Tara said to me and Jeff, "So do you two work with Henry when I'm not here? Because he is doing great." I was taken aback by the question. I said, "Do you mean to tell me that you see a lot of kids whose parents don't work with them, except when you visit?" She said "Yes. Out of the 12 kids I see each week, there are three children, including Henry, who have parents that work with them. There is one family who asked me when I'll get their child to talk. I asked them if they had done the exercises that I have shown them when I am not around. They said no." Astonishing.
Henry gets a lot of attention from us and his grandparents. The projected outcomes for micropreemies are scary. It varies depending on the study, but it amounts to about 1/3 who have mental retardation, cerebral palsy, blindness, and/or deafness, about 1/3 who have some sort of "minor" learning disability, and about 1/3 who are "normal." Micropreemies are "at-risk" in part, because they enter the world when their brains haven't fully formed, and they are bombarded with stimuli to which they shouldn't have been exposed. Consequently, they are "wired" differently. Micropreemies, on average, have less gray and white matter in their brains than full-term babies. That said, it is also the case that much brain development occurs during the first three years post-birth. At birth (or what should have been a baby's due date), the brain has over a trillion neural pathways. During the first years of life, the brain figures out which neural pathways to keep and which ones to "prune," which is why talking and interacting with babies and toddlers is so important. Parents (and friends and family) help shape what is kept and what is pruned (see http://www.teachthemind.com/brainlearning.html for more information). So, of course, we work with Henry every day. To think that there are families who do otherwise is rather depressing and sad. But I guess that's the reality. We see Tara next Thursday when the massage therapist is also coming for a consultation.
We took Henry for a walk last night. At some point, he crashed on the couch during an episode of "Holmes on Homes" (which may be Jeff's new favorite show; I've gotten sucked into it too). As we took him to bed around midnight, he began to stir, so Jeff fed him a bottle. He began to stir around 5:30AM, but didn't fully get up until 6:30AM. Jeff took care of him, which was good, because I woke up around 3AM feeling sick (scratchy throat, like Jeff had before he got his full-blown cold). I basically slept on and off until 11AM. I had to get up a few times to pump.
It was 29 degrees this morning, so Henry missed out on his morning walk. He had a good day, though, inside with his dad. Jeff weighed him at 14 lbs 4.5 ozs. I tried to stay away, but I'm afraid that the reality is that Henry has been exposed to whatever cold Jeff and I have. We think that we made a mistake going to Coco's for breakfast on Sunday morning when my parents were taking care of Henry. Given crowd for breakfast, we probably should have realized at the time that it wasn't a good idea. Of course, there are other places that we could have picked up germs (for me, school). We are try to eliminate unnecessary crowd exposure when possible. So, no more breakfasts at Coco's until RSV season is over (March or April).
Henry almost rolled over today when doing some tummy time with Jeff. He had his legs going in the right direction, but he hasn't quite figured out the right arm placement yet. But he was very, very close. Jeff also had him doing some modified tummy time on this lap. He was rolling side to side on Jeff's lap. It was very cute. Henry got overzealous a few times and apparently plopped over on his face. I said to Jeff, "You let Henry fall on his face." Jeff replied, "It's how he learns." I rolled my eyes. We have slightly different parenting styles at times.
We are currently at my parents' house. My mom hadn't seen Henry since Tuesday. So this is a good chance for her to get some "Henry time" in. Last night, my sister Carolyn returned from her first stellar semester at vet school, so she will hopefully get to spend some time with the Doodle Bug tomorrow.
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