Bronchiolosis

Erin started having a cough on the evening after her MRI. Since she'd been cleared that morning by the anesthesiologist with just a normal stuffy nose, we initially thought it was due to the tube for or the effects of the anesthesia.

On Saturday, we thought she was getting better, so we got our Christmas photos taken and even took her to an early Christmas party. On Sunday, Kurt headed out of town to Louisiana for a few days. Unfortunately, that evening her coughing returned and by Monday evening, Erin was running a temperature of 101 F. So, the next day I took her back in to see Dr. Grier.

After five hours, a chest x-ray and lots of waiting in doctor's offices and running errands, I finally made it home with Erin and her diagnosis of bronchiolosis (most likely RSV), with a secondary ear infection. Dr. Grier said Erin probably got a "double whammy" by being at the tail end of her head cold when she was exposed to a child with RSV in her day care on Friday.

RSV, is a type of respiratory virus. It's like the flu in that there are so many different strains that you never develop an immunity. In adults, it apparently mimics a really bad head cold, however in babies, the symptoms include nasal congestion and coughing and last about 3 weeks. It is very serious in babies under two months, and in older babies if they become "air starved". So, I had to give Erin breathing treatments (albuterol through a nebulizer) twice daily. Luckily, after the first one or two, she didn't seem to mind them too much, unless she was hungry, and would nap during most of them.

Needless to say, Kurt's trip was cut short and I didn't do as much for Erin's first Christmas as I would've liked to. However, the most important thing was taking care of Erin; and she's on her way to feeling like herself again.

Update 1/19/09: Erin has been over her ear infection and bronchiolosis for several weeks now and had no unexpected complications or lasting effects.

MRI update

Erin's MRI results are back and they show no underlying cause for her torticollis. According to the nurse, her brain and spinal vertebra are normal. So, that is wonderful news.

However, there were two incidental findings on the MRI. Apparently Erin has 3% extra fluid around her brain/skull. (I'm assuming it's added protection for her big brain!) They assure us that it's normal, is in no way related to wearing the DOC band, and should resolve on it's own by the time she is two years old. In addition, Erin has an "insignificant" syrinx cyst from the base of her cervical spine to the top of her lumbar spine, that 99.9% of the time does not turn into anything. However, it's the standard procedure for the neurologist to make a referral any time there is an abnormal finding on MRI. So, Erin will be going to see a neurosurgeon in mid-January.

Supposedly, all of these tests and doctors' visits are to make us "feel better". Funny, but we felt just fine before, and still think our daughter is perfect just the way she is. :-)

UPDATE 1/15/09: We saw the neurosurgeon. He said that there is NOT a syrinx cyst on the MRI. He also said that Erin's brain is normal. Her skull basically had a growth spurt and grew faster than her brain could fill it. So her body made extra fluid to cushion her brain, but it should all level off by the time she is three. The doctor said some kids just have bigger heads, and Erin probably gets hers from her Daddy. He said "go home and enjoy your daughter." So, we never have to go back because, like we already knew, Erin is just fine. :-)

MRI

This morning at 8 a.m. Erin had MRIs of her brain and cervical spine to rule out a structural cause (such as a brain cyst or scoliosis) for her torticolis. In order to do the MRIs, Erin had to be placed under general anesthesia to make sure she would not move for the hour and forty-five minutes it took to complete the procedures. It was a little rough to wait knowing that something could go wrong while she was under. However, she apparently did very well, although waking up was pretty tough on her little system. She cried inconsolably for awhile, and I was glad Kurt didn't see her until she was out of PANDA and in the recovery room. When she finally woke up and saw him, she gave the biggest grin. She enjoyed listening to Christmas carols on our way out of the building, and then proceeded to fall asleep for the next five hours. Can't say I blame her as it was an early and rough morning for her. We probably won't get the results back until Monday, but we're just glad she made it through and is back to her happy, hungry self.

First Sleet

Erin got her first taste of winter weather Tuesday evening when we went out to a local Mexican restaurant and it started to sleet. No, it's not snow or ice, and it had melted by morning, but around here, that may be the closest it gets for several months.

6 months old

Erin had her six month visit with Dr. Grier. She is almost 29 inches long, weighs 19 pounds 1 ounce, and her head is 45 cm. She is now in the 95th percentile for everything and growing! She is getting her two front teeth (which is all she really wanted for Christmas!) She is now able to have solids other than cereal. So, we've been having a lot of fun in the high chair lately. We are starting her with vegetables and she really seems to like squash. She is however NOT a fan of shots!

Update 1/19/09: At six months, Erin also started to outgrow her reflux, which is on the early side of what we were told to expect. We were able to wean her off the Prevacid without any problems. She still has occasional wet hiccups, but no projectile vomiting, and she is able to lie flat on her back. She graduated to sleeping in her own crib in her own room on New Year's Eve (almost seven months). We sill have her sleep on a slight incline, but that's more for sinus drainage (she had RSV in mid-December) due to the rapid climate/temperature changes here in Austin.

Thanksgiving

Erin celebrated an early Thanksgiving with my parents the Saturday before, so that we could visit Kurt's family in Hammond for the actual holiday. We had a very nice time with my parents, who seemed to appreciate our first attempts at turkey, mashed potatoes, and sweet potatoes.

For Thanksgiving, we stayed with Kurt's older brother, Carl Jr., and his wife, Merri. They had over 40 relatives for dinner! I enjoyed meeting so many members of Merri's family, and Erin enjoyed being held by so many new people. It took her several hours to fall asleep after all the excitement.

Erin was glad she finally got to meet her great aunt Fay, and really enjoyed the time she got to spend with all of her relatives. She spent much of her time mesmerized by their glasses, jewelery, dogs, and cameras. She even had the chance to go to her second Renaissance Festival - this time with her cousin Christina, Aunt Merri, and Christina's friends, Sarah and Joey.

I'm glad Erin's first Thanksgiving was spent surrounded with lots of family, friends, and love. We truly are thankful for our daughter and for those people who have loved and supported her and us.

New developments

In the last two weeks, I've made some significant advances in my development including:

1) Able to purposefully grasp an object and transfer it between hands
2) Able to put my toes/feet in my mouth (baby yoga)
3) Almost able to sit up unassisted in tripod
4) Able to roll from my back to my side (working on going all the way to my stomach and back again)
5) Able to lie flat in my playpen at night
6) Starting to scoot in attempt to crawl
7) Able to put my spoon in my mouth (without food) by the third attempt
8) Starting to eat oatmeal
9) Able to look for a person when they are out of sight
10) Able to pull to standing from sitting, engaging my abs, by holding onto Daddy's fingers
11) Starting to turn in a circle in my exersaucer
12) Getting my first tooth.

Watch out, here I come!

My physical therapist, Elva

Here are some pictures of me with Elva, the senior physical therapist at Dell Children's Medical Center who I work with twice a week. Since I was born with really tight, shortened muscles on the right side of my neck, for awhile I didn't even know I had a left side. Elva has been working with me not only on stretching, range of motion, and balance, but also on things that people might not realize - such as sensory integration, vision, learning what it means to be straight, and making sure I don't fall behind in developmental milestones. I must be getting better because I'm learning how to roll, sit up, and try to scoot in a circle (a precursor to crawling).

Today she started me on a TOT collar. It's a training orthosis for torticollis. Basically, it's an annoying plastic tube thing that I have to wear for ten minutes a day (gradually working up to an hour). Every time I try to tilt my head to the right it rubs my cheek and "provides me with a noxious stimuli" to remind me to hold my head up straight. Obviously, I'm not a big fan of it, but at least it's not as heavy as the DOC band was.

Recent trips

I have done a lot of traveling in the last two months. At the end of September, I went to Dallas for the annual Greek festival with Granny and Grampa. It was nice to learn about Granny's culture (as she grew up Greek/Romanian Orthodox). I really enjoyed the music and all the bright colors.

Later, in mid-October, Daddy and Mommy took me to Balmorhea State park with Uncle Larry, Aunt Heidi, Lauren, and our friends, the Loutons. There is a natural spring there, where you can go scuba diving. I'm too little to know how to swim, but Daddy and Mommy had the chance to do some diving. We also went to the McDonald Observatory to see the stars. I had a great view from my stroller, but fell asleep before the "show" was over. We also did a little hiking in the Davis mountains. I tried out my Baby Bjorn carrier for the first time. That was cool. I liked being higher up looking out at the world.

At the beginning of November, I went to Dallas again. This time, we were there to support Aunt Heidi in the 3 Day Breast Cancer walk. Last year, I walked inside Mommy's tummy, but this year I just helped cheer for Aunt Heidi and play with cousin Lauren. I was so proud of Aunt Heidi. She walked without the rest of our team and raised over $3,000. :-) While Aunt Heidi was out walking, I also got to go with most of my cousins to the zoo on the DART train. It was the first time I'd ever been on the train or to the zoo. Like cousin Erica said I'm lucky because I got to go before any of them ever did - when I was only zero! I had fun watching my crazy cousins play and seeing all the animals. I liked the otters and gorillas the best. That night, after the zoo, I got to go somewhere else new. It's called Chuck E. Cheese and it's full of kids, bright lights, and interesting sounds. Mommy says I'll like it even more when I'm older. I know my cousins did. It was a nice place to celebrate my cousin Sara and cousin Lauren's birthdays.

In a few weeks, I'm going on another trip - back to Louisiana to see some of Daddy's family for Thanksgiving. I'll tell you all about it when I get back.

Love,

Erin

Happy Halloween from Sweet Pea

Halloween is Kurt's favorite time of year. So, of course we had to take Erin out trick or treating. She was dressed as a sweat pea, because that's what we call her.

Her cousin Lauren went with her, and was very good about sharing and asking for candy for "Baby Erin". Perhaps I shouldn't have tried to teach Lauren to say "trick or treat smell my feet", since she kept saying "bye smelly feet".

Uncle visits

Erin got to finally meet her Uncle Hans when he came to visit from Colorado on September 30th (our second anniversary). They had a great time talking together. :-) Hans was great help - making her do her physical therapy, helping us decorate her room, and building shelves. We were sad to see him go and hope he will come visit often.

Uncle Carl came out to visit at the end of October while here for work. It was the first time he got to see our house. We all had a lovely visit. Erin and Kurt enjoyed taking him to Fry's (the computer store). Next time, we hope he'll bring Merri and Christina too. :-)

4 month doctor visit

Erin had her four month check up on October 7th. Did I mention that was my 35th birthday? I thought it'd be fun to take the day off and spend it with her - since she did so well after her 2 month appointment (sleeping most of the way to Louisiana to visit her grandparents). However, Erin had a rougher time with the shots and was uncomfortable for much of the day. She seemed to finally start feeling better in time to enjoy a birthday dinner at the Cheesecake Factory with Kurt, Heidi, and Lauren.

As for the visit, in addition to getting four vaccines, Erin got a glowing report! She is now in the 90-95th percentile for height, weight, and head circumference. No wonder she is in the 6 month clothes already. She's 15 pounds 8 ounces and 26 inches long. She's more than happy to show you how tall she is too - she can stand up with very little support for over a minute! We think she may walk before she crawls.

Her beloved pediatrician, Dr. Mark Grier, said that she can definitely start rice cereal. We are worried about how this will affect her reflux, but are cautiously optimistic. We have heard that it can have a positive impact by "thickening" the foods in her stomach so they don't move around as much. We have also heard that it can have a negative effect, by giving her something more solid to throw up. So, we will start slowly adding a little bit to her bottle and eventually work to spoon feedings of thicker consistency and see how it goes. Why do I have the feeling that Shadow is going to be really fond of Erin very soon?

Graduation day

On September 24th, Erin officially graduated from DOC band therapy, when she outgrew her helmet in under five weeks! Luckily, all of her right to left cranial asymmetry had been corrected by the week before, and her last fitting had just been for added volume and roundness (something Erin will eventually achieve on her own during development). As we were expecting her to be in the helmet at least 3 more weeks, and possibly need a second one, you can imagine our sup rise when they told us she was done. We never even got around to decorating it! But, apparently Erin is already setting records by being the fastest user in the history of the company! We think a lot of it has to do with her getting the DOC band at such a young age and with her rapid growth. Erin started treatment at under three months and most babies are at least four months, but closer to nine (why my insurance is refusing to cover it). In addition she has blossomed from 50th percentile to 90-95th percentile for everything.
In addition, after she graduated from using the DOC band, her head was so much stronger that she was able to pose for the 3D exit photos instead of having to undergo plaster casting again.

Could Be Colic

Colic - A condition in which an otherwise healthy baby screams and cries for extended periods with no discernible reason.

From the top - what the heck kind of diagnosis is this? By definition, there will never be a known cause of colic, because then it will be a discernible reason, which means it can't be colic. This kind of logic makes my brain hurt. Is colic some kind of "holding area" where we put crying babies until a cause is found, at which point colic will be a thing of the past?

Regardless, we're pretty sure that our little angel either has colic, or she was stolen in the night by gypsies, and replaced with her evil twin. (Come to think of it, Christine's family is part Romanian...) We will start putting her to bed around 10:00 or so, and are usually unsuccessful until well after midnight. Last night, Christine took it upon herself to put our little angel to sleep, and I drifted off around 1:00 AM. I woke at 2:30 AM to Erin's cries, and Christine trying the classic "five S's": Swaddling, Side (or stomach), Swinging, Shushing, and giving her something to Suck on. We even added a few S's of our own, such as Simethicone (a/k/a Mylicon, for gas), Swearing, and beSeeching the powers that be for help.

Update: But it turns out that it's reflux. I wrote this a number of weeks ago, and haven't touched it since Erin was diagnosed, in case it wasn't reflux. In one sense, this isn't important; it's not affecting Erin.

But seriously... what the hell kind of medical logic is this?

Accessories, Accoutrements, and Apparatuses

Like most essentials of modern life, babies are delivered with few of the necessary additional accessories, mainly a placenta that ceases to be useful once it's delivered. So, just like a car, a house, or a husband, a baby must be properly accessorized to be fully functional.

Judging from the amount of time we spent on its selection, the single most important thing a baby needs is a car seat. Luckily, a car seat doubles as a bed, sling, prison, handbag, weapon, and catcher of bodily fluids. Properly utilized, a car seat can transform a newborn into a high-maintenance and occasionally noisy piece of luggage. At least that's the rumor; we have yet to see it borne out in practice.

Most manufacturers will try to talk you into buying a "travel system", which is a combined car seat and stroller package. At first blush, this sounds great - a two for one deal. We found that most of them make some serious compromises along the line, such as hauling around a 30 lb. stroller to carry your 12 lb. car seat that holds your 8 lb. baby. With many manufacturers, you end up with two sub-par pieces of equipment, such as a car seat that only handles a 20 lb. baby. (Little known fact: Your infant should be in a rear-facing car seat until they are both 20 lbs. and one year of age. Are you absolutely positive that your kid will hit one year before he or she hits 20 lbs?)

We decided on a Graco Safe-Seat car seat (good for up to 30 lbs.), and a "Snap n' Go" stroller frame to carry it. With 20-20 hindsight, this was an excellent decision. We ended up with the exact car seat we wanted, and a truly lightweight stroller frame that fits in the back seat footwell (as opposed to the trunk). And all for less total money than the travel systems. You don't have to go Graco, either; there are generic car seat carriers made for almost any car seat out there.

Car seat advice: Is the fabric part easily removable and washable? Can you get it in and out of the base while balancing yourself on one knee on your car seat, and holding the baby bag over one shoulder? Does it release the base easily? Does the buckle release easily (but not too easily)?

Strollers are a close second to the car seat in terms of the amount of time we spent standing in Babies R Us, comparing one against the other. Choosing a stroller frame meant that we'd have to choose a real stroller one once Erin gains enough neck control to move to a front-facing model. A couple of considerations: The stroller should be small enough to maneuver the stores in a shopping mall. It should have a pretty big cargo area that is easily accessible. It should be able to carry a bottle (and/or water bottle for the parents).

Strollers come in sizes from expedition-sized monstrosities to "umbrella strollers" that have the structural integrity of a toothpick, and which will fall over if anything is on the handles when you take baby out of it. We split the difference with a lightweight and cheap stroller for everyday tasks, and a big-assed three-wheeled Jeep stroller (complete with pneumatic tires) for outdoor excursions.

Next, you need furniture. You probably spent most of your life using hand-me-downs and whatever was on Craigslist, but everyone knows that a newborn's sense of style demands nothing less than an entire suite of classically designed, hand-made furniture that should last for generations. Resist this temptation, because new safety standards will make your baby's furniture obsolete before it's paid off. Or simply go to Ikea and get everything you need for less than $20.

A couple of notes on furniture: All the experts tell you not to use bumper pads, but if you pick a solid back or sides for your baby's crib, you can't use them anyway. Pick a finish that cleans easily with nothing more than a wet rag. Don't use 'heirloom' furniture; early generations were tough enough to survive finger-eating swing sets and the Charles Darwin line of "survival of the fittest" furniture, but it's apparently not considered safe for today's fragile and clumsy children.

Don't waste your money on bassinets or other baby ephemera. A simple Pack and Play (a/k/a play yard, baby jail, etc) is fine for the first few weeks, months, or years when Baby is living at the foot of your bed. That said, a "kidapult" or wire-frame bouncy chair is invaluable, if only as a place to but Baby while you're laundering (again) the padding to his or her car seat.

Whatever you put Baby in to sleep, make sure that you have plenty of sheets for it. We've gone through three sheets in one night before we found that Erin's diapers weren't exactly performing as advertised. (Write this down: Pampers for girls; Huggies for boys.) With her reflux, Erin now sleeps in the car seat, so we now have a massive Pack and Play sitting in our bedroom as nothing more than a hugely oversized changing table. Don't even ask about her fully-stocked bedroom upstairs...

Ahem. What else? We found these remarkable disposable multi-use pads that resemble a large, heavy-duty paper towel backed with a very thin waterproof plastic sheet. Wherever you're putting Baby, put one of these down first. Trust me on this (he says, having washed two sets of king-sized bedsheets in one night). If you're not into the disposable thing (and you have no problem with baby poo and pee in your washing machine), they make the same thing in a reusable form.

Bottles. Wow, where to begin? I liked the design of the Dr. Brown's bottles, but they used BPA in their plastic (at the time), and our tile floors aren't quite compatible with glass. We went with some cheap Evenflo bottles at first, as we were positive that we were going to breastfeed the vast majority of the time. But one of the wonders of parenthood is that the parents finally learn that expectation has no actual bearing on reality. So we went with Born Free bottles, mainly because anyone willing to name a product after a 1970s feel-good movie must know what the hell they're doing.

Burp cloths, towels, receiving blankets, washcloths: These are all fancy names for "rag", and a simple cloth diaper will suffice for almost all of them. (Except for the swaddling part of a receiving blanket, but a big dish towel should do a fine job there.)

Speaking of swaddling - the blankets the hospital uses are perfect for the first month or so. Steal as many as your conscience allows. While you're at it, snag a few of their pacifiers and aspirators (snot suckers) as well. These are excellent, and hard to find outside the hospital.

If your expertise with Origami extends about as far as "wadded-up paper", look for the easy-to-use swaddles, complete with velcro closures. We strongly recommend them. For those of you with the ability to securely wrap a struggling three dimensional object with a two-dimensional cloth, look for muslin swaddling cloths; the ones we found were huge, and the muslin breathes yet sticks to itself quite well.

We haven't used them recently, because Erin is now sleeping in her car seat during the day, but Christine and I both bought baby slings. When Erin's reflux was really bothering her, and she needed to be held just about every waking hour, these were life-savers. I could put her in the sling, and actually get some stuff done around the house without my arm cramping up or going numb.

To schlep all this crap around, you'll need luggage. There are many factors to consider when choosing a diaper bag: color, style, fashion, designer name, number of pockets, etc. Forget all that, what you need is volume. You'll be hauling around a half-dozen diapers, a full brick of baby wipes, three or four outfits, a few burp cloths, a swaddle, a blanket or two, extra pacifiers, some formula or breastmilk, a couple of bottles, hand sanitizer, a changing pad, Boudreaux's Butt Paste (don't laugh, it's the best stuff ever for diaper rash), an aspirator, toys, etc... I have never wished I had a smaller diaper bag, but I've often wished I had a larger one.

If Mom ends up pumping, spend the money and get the Medela Freestyle pump. It's battery-operated and about the size of a Walkman (for those of you who remember such things). Yes, it has a belt clip. The flanges can be strapped to a nursing bra, so Mom can set 'em up and do something other than just sit there, strapped to a small suitcase.

Finally, if you're in the Austin area, go to Special Additions before you deliver. It's across Lamar from the Central Market at 38th, and is a great maternity store. They rent hospital-quality breast pumps, and have a great lactation consultant on-site.

Getting Plastered

Rubber Glove... Vaseline... This does not look fun.

Erin has a three-part condition: reflux, torticollis, and plagiocephaly. None of these are serious, but they all have their little quirks. Apparently it works something like this: A child with gastric reflux will arch their back and throw their head back and to the right. (Back and to the right... back and to the right... Maybe JFK had terminal reflux?) Eventually, the position of "back and to the right" becomes the new normal, and the muscles in and around the neck adjust to it (torticollis). Also, the bones of the skull aren't quite solid, and lying "out of whack" causes them to develop "out of round" as it were (plagiocephaly). It wasn't obvious to a casual glance, but Erin's skull was out of round to over 12 mm (measured diagonally, outer corner of eye to over the ear).

Is this solid science? Probably not, but I understand that the three conditions are commonly seen together, and are somehow related to each other. If you're a medical professional, please excuse my simplistic explanation.

So Erin gets to take Prevacid (noted elsewhere) for her reflux. She goes twice a week to pediatric physical therapy. And she wears a DOC Band. Which is where she got plastered for the first time...

A DOC Band is like a helmet that doesn't cover the entire head. It exerts low levels of pressure on certain parts of the skull, slowly encouraging it to grow properly. They're the product of Cranial Technologies, nationwide company.

To create a DOC Band, the company needs an accurate model of the skull. For most children (and hopefully all adults), they have a really neat 5-camera system that creates a 3-D model of the subject's head. A sheer stocking cap somehow helps with the imaging (see picture), so Erin got to wear one for a few minutes. I don't know how it helps with the camera work, but it definitely makes for interesting conversation. (What's the line from Raising Arizona? "Boy, you got a panty on your head.") It also makes for quite a distraction, as Erin felt something against her lips, but no matter how much she licked it, she couldn't get it to produce milk.

However, this approach doesn't work terribly well on 2-month old babies, who have difficulty holding their head up for more than a few seconds. Since it only takes a few seconds to get the pictures, we tried nearly a dozen times to get Erin to hold still at just the right time, but no luck.

So we used plaster. It's not nearly as high-tech as 3-D imaging, but it made for some memorable pictures. They put a heavier knit stocking over Erin's head, cut a hole for her nose and mouth, and mark the location of her eyebrows and ears with a marker. I've gotta say, the eyebrow marks remind me a lot of the 'eyebrows' on the old Batman...


Thick layers of cast material are then laid over the stocking, and allowed to firm up. The entire sequence of pictures is on Erin's Photobucket site. Erin wasn't happy about the whole ordeal, but we produced a bottle, and she chilled out with a nice milk buzz, at least until they started removing the plaster.

The DOC Band was delivered a day early, which was fortunate as it was Christine's day off. Erin wasn't terribly happy with it; she had just managed to learn how to keep her head still for a few seconds, and here we were adding more mass to it. But a few days later, and she's only bothered when we put it on or take it off. (I think taking it off is more bothersome; when the velcro strap releases, it probably echoes around her little skull.)

UPDATE: We go back once a week for adjustments and checkups, and just had one today, accompanied by great news. That measurement that was off by 12mm? It's now down to under 4mm, which is the 'norm'. Further good news: Since Erin's so young and malleable, she'll probably only have to wear it for another week or two. Even better: We were expecting Erin to be in a DOC Band for at least three more weeks. Since she's growing like johnson grass in a Texas lawn, Erin would probably outgrow her band after another two weeks, and we'd have to buy a second one. While we are amazed at how well she responded to her 'helmet', we really don't want a second one, since our insurance isn't terribly keen on paying for the first one yet.

If your child or one you know has a 'flat head' from sleeping on their back, or has plagiocephaly (a misshapen head), don't wait for them to 'grow out of it'. The older the child; the longer they have to wear the band. And after a certain point, there is nothing that can be done.

Family visits

Erin got to meet her Aunt Gretchen and cousins Nicholas, Erica, and Sarah just prior to Nicholas' 10th birthday. A few weeks later, she also got to meet her cousin TJ and Aunt Nancy, when everyone came back down for Aunt Heidi's 40th birthday. She really enjoyed meeting more of the Leibold clan and we know she'll have a great time playing with all of her cousins in the years to come.




Grandma and Grampa Leibold were kind enough to babysit so we could all go enjoy a girl's day out at the spa. Thanks!

Baby Got Back!

On August 8, 2008, Erin made a monumental advancement in her young life. For the first time ever, Erin sought the solace of lying flat on her back. Now, to most people, this milestone would seem rather insignificant. However, as the parent of a child with reflux, I recognized this achievement for the true gift that it is. Until that moment, lying Erin on her back had been associated with blood curdling screams the likes of "it burns, it burns!" along with long episodes of burning reflux, twenty minutes of hiccups, occasional spit up, or vomit. At last, my daughter had found peace lying on her back staring contentedly at anyone willing to make goofy faces. Not only that, but she wanted to be there - for thirty minutes! The next day, she was able to do it again. What an accomplishment. She still can't sleep through the night on her back, but she can enjoy a diaper change. Now we can use the bathroom or fold laundry while she lies in her playpen without worrying that she'll aspirate or scream until she passes out. Plus, lying on her back allows her to be more active and reach developmental milestones. Someday maybe Erin will be able to sleep all night in her own crib in her own bedroom and look at her mobile. For now, I'm just happy watching her find her feet and trying to roll. I'm proud to say that my baby has finally got back!

Two month visits

Erin had her two month visit on August 5th. Erin is in the 50th-75th percentile for everything. She is now 11 pounds 9 ounces and 23.5 inches long. Dr. Grier is concerned with Erin's head shape and that her neck muscles are still tight. So, he has referred her to two different types of physical therapy - one for her cranial asymmetry (plagiocephaly) and the other for her tight neck (torticolis). It's a little overwhelming, but luckily we know how great physical therapy can be.

Erin did so well with her shots, only fussing a few times in the first few hours (which is to be expected). So, we decided to drive to Louisiana so that she could meet some of Kurt's family. We drove a little bit out of the way in order to avoid a potential Hurricane Gustav. Luckily, that turned out to be unnecessary caution, as there was little more than wind and rain. However, it did give us the opportunity to drive through Crockett, TX (where Kurt was born) and visit his grandparents' grave site.

The trip gave us the opportunity to try out my new car, a Volkswagen Passat station wagon, which I refer to as "my sweet ride". It really is a beautiful car, even if Kurt says it now makes me an official "soccer mom". The car handled the drive really well and fit all of us, including Shadow, and our luggage - just barely. I think the in-laws were even more amazed than we were by just how much luggage is required when you travel with a baby. Of course, we are lucky they did not spoil her too much or we wouldn't have had enough room on the way back. (I think we traded out used diapers for toys!)
We had a nice visit with Kurt's family in Louisiana. Kurt's Dad put us up in the newly renovated "guest cabin" out back. It was very lovely, and gave us a quiet place to relax and retreat too. Unfortunately, Shadow didn't enjoy the solitude as much as we did, and wanted to find the other dogs to play with (but Jughead was still recovering from hip surgery).

The timing of our visit wasn't the best, but we wanted to make sure that Erin got to meet her relatives after her shots and before I went back to work. We just wish we that we'd been able to see more of the family and had more time to visit with those we did get to see. Erin was mighty smitten with all of the attention, and we hope she'll have plenty more opportunities to enjoy her Schneider relatives.

Erin had several firsts along the way including her first visit to her Louisiana grandparents, first time out of the state, first time to see the Mississippi River, first time that she wanted to lie on her back, and her first time at a sushi restaurant (yum!). We look forward to many more.

Refluxed Update

It looks like the Prevacid is working. Erin slept at least seven hours each of the last two nights, and a good amount during yesterday. This morning she woke, fed, and went back to sleep for about two hours. The only instance of "painful crying" was last night for less than an hour, just before bedtime. We're getting more smiles, and less of the whining/complaining sounds she's been making.

This may just be a smooth spot in an otherwise rough road, but it looks like things are settling down. I'll keep things updated as we go.

Refluxed Up

Erin's been having a rough time lately. (This is a big part of why I haven't updated the blog recently.) She's not in any danger, just discomfort.

More and more over the past week or so, Erin has spit up a few times, more than just a bit, and she arches her back and cries out a lot. Her sleep schedule has been mixed. Some days she sleeps eight hours at night, and another six or so during the day; at other times she sleeps 3 hours or so at night, and steals a bunch of 20-30 minute catnaps during the day, interrupted by cries of anguish at whatever is hurting her.

On Monday, we saw her doctor and described her symptoms: crying for no apparent reason (but usually briefly), arching her back, hiccups, spitting up, protesting at being laid on her back, and eating slowly. He said they pretty much describe reflux, and prescribed Prevacid for her. We started her on Prevacid on Monday evening, and had a rough night. Last night (Tuesday) was worse; she didn't lie down until 5:00 AM. Tonight, we hope she'll sleep better, because today she didn't sleep much at all.

It's arguable if the medication is causing her sleeplessness. This weekend was pretty bad itself, and the last two nights could just be an extension of that trend. Or the medication could be upsetting her (we were told it wouldn't taste very good). Prevacid takes at least a week to start working, so we may have a rough time in the immediate future.

We have kept some of y'all updated on these things, and we appreciate the support and advice we've received. I'm sorry if I haven't kept everyone up to speed; we're both have quite a sleep deficit, and are running at a pretty high stress level. I'll keep the blog updated with her progress.

Apparently reflux isn't uncommon; most babies will resolve it on their own by four months or so, but some have it up to a year. Since Erin isn't spitting up regularly (a symptom of bad reflux), we're hoping on the former.

Thank you

A special thank you to my parents and to Kurt's mom, Elizabeth, for coming out to help us during the first few weeks of Erin's life. We really appreciate all of your help and are so glad that Erin got to meet you.

Love,

Christine

Breastfeeding

or: My Daughter Doesn't Suck

What could be simpler or more natural than a baby suckling at his or her mother's breast?

Apparently a number of things, because breastfeeding seems to be a rare skill set that is difficult at best, and seemingly impossible to master. I'm amazed that humanity as a whole survived the time period before the first infant formula was created. Perhaps things were simpler back then, and babies just knew how to suckle. And perhaps the crops grew taller, families were happier, and politicians were honest. Who knows?

I do know that our daughter has what is known as a "weak suck". Laugh all you want; I did. I didn't, however, even know that "suck" was a noun. I do know that just about everyone agrees that the best food for a newborn is breastmilk. However, hardly anyone agrees on anything else regarding the production, distribution, or consumption of it.

Oh, sure, there are a few common points: Mom produces as much milk as baby demands. The 'hindmilk' has more fat and protein than the 'foremilk'. But it falls apart after that. Some of the more extreme breastfeeding advocates condemn pacifiers, bottles, or anything that's not connected to a mother's breast; it can lead to 'nipple confusion'.

Some on the other end feel that in many cases, formula can be healthier than an unhealthy or poorly-fed mother's milk, and claim that 'nipple confusion' happens in less than 5% of cases.

And some of us in the middle need to supplement mom's milk because of other considerations (See: Jaundice), and feel guilty about not meeting the strictest standards for breastfeeding.

Others want to give breastfeeding a try, and get frustrated because breastfeeding is not as intuitive, natural, or simple as we would like to think it is.

For successful breastfeeding, there are a number of elements that need to be properly lined up. The baby has to latch on correctly; if you haven't breastfed, it's not quite how you're thinking. The baby has to know how to suckle (note that I didn't say 'how to suck'; this isn't a sports bottle or straw we're dealing with). The baby has to have enough endurance to get through the 'let down' phase, and to keep suckling long enough to get more out of the feeding than he or she is putting into it. Mom's milk has to have 'come in' properly. And mom has to produce enough milk to support the baby, and express it fast enough for baby to feed properly.

None of these elements will necessarily occur intuitively or instinctively, much as we might like to think they will. When things don't work right, it's easy to blame oneself or to consider it a failure of the first test of motherhood. Don't. There are resources out there that can help.

It's also easy to doubt yourself, especially when there are so many opinions out there regarding 'proper' breastfeeding. Did that bottle of formula screw up Baby's breastfeeding? Did the pacifier the nurses used in the hospital cause nipple confusion? Are you enough of a milk producer to feed your child? What do you do when your milk isn't quite in, but Baby's screaming for food? What if you do 'ban the bottle', but Baby loses too much weight before your milk comes in? Will your (perceived) failings cause your child to fail later on in life?

What we've found:

• Don't be a perfectionist. Don't make the best the enemy of the good. While regular breastfeeding may be the best possible outcome, there are many elements that have to be lined up to make it happen. Don't be afraid to supplement, to use a pump and bottle, or to do whatever it takes to get your child fed.
• Stop the cycle of questioning and doubt. Define what's important, and do what it takes to make it happen. We decided that breastmilk is more important than formula, but formula is better than a hungry or under-fed baby. We also decided that we don't care how the breastmilk gets to Erin.
• Get help. Ask your friends who've breastfed and your doctors to recommend lactation consultants. Ask them why they recommend them. Use your judgment when picking one, and when listening to them. Don't be afraid to get a second opinion.
• Talk to your friends and family. Our neighbor happens to be a mother-baby nurse who is pursuing her lactation consultant certification. I ran into her while Christine was having a tough time with Erin, and the ten minutes of advice and assistance she gave was invaluable. Other friends surprised Christine when they told her that they had also had a tough time breastfeeding, but were afraid to mention it at the time because they felt inadequate as mothers.
  
• Don't stress yourself. Get enough food and sleep, and remember that all of the opinions out there on breastfeeding are just that, someone's opinion. Read up on breastfeeding and get a good overview of it before your baby shows up. Life with a newborn is difficult enough without having to sort out all the strongly-worded opinions on breastfeeding on little sleep and even less free time.
  
• It will get better. Both mother and baby are learning a very new skill set, and it takes time. As baby develops, he or she will get stronger and have more
  

Jaundice

An Eyewitness Account
of the Battle Between
the Courageous Erin Anneliese
and that Yellow Coward, Billy Rubin

Like all babies, Erin was checked at the hospital for jaundice, a condition in which the baby turns yellow. Jaundice is caused by the buildup of bilirubin, a by-product of the breakdown of red blood cells. Bilirubin is normally cleared from the blood by feeding; a compound in milk binds to it, where it is filtered out and excreted through the bowels. Elevated levels are treated through phototherapy (light breaks down the compound); extreme cases can be treated with transfusions. Because Erin was breastfed, and didn't get much milk for the first few days, her bilirubin levels went up after we left the hospital.

As far as we know, Erin's bilirubin levels peaked at 17.4 ml/dl on Tuesday after she was born. This isn't in the danger zone, but it's close to it. Her pediatrician called us with the report, and started the clinic on a search for a suitcase light or fiber-optic blanket for her. They weren't able to find one, and he suggested that we keep Erin near a window with her shirt off as much as possible. Some limited direct sunlight was okay, but because newborns are particularly sensitive to sun, indirect sunlight would work fine. Dr. Grier also prescribed supplementing Erin with formula so that she could get enough volume of food to process the bilirubin from her system.

At that point, the fight was on. Bilirubin was represented by Billy Rubin, a yellow coward who had wronged Erin and (in Texas terms) "done earned himself a beat-down". No offense intended to anyone, but he wore a number of personae over time, from Yankee carpetbagger to the classic Western 'citified' and cowardly villain to the spoiled brat of a Bronx diamond merchant. (Sue me, but the last name fits.)

Erin scored points by the unconventional method of bowel movements. Every soiled diaper was met with cheers of "Go, Erin! You show that mean old Billy Rubin!" or "Erin's kicking the crap out of Billy Rubin!" etc. We were a bit troubled by supplementing with formula, mainly because some of the more militant breastfeeders say that anything but a living nipple will sabotage your child's development, but we figured that a known condition trumps an unknown possibility any day.

Erin's bilirubin was checked the next few days, early in the morning, and trended downwards, slowly at first. After a few rough nights and early mornings, I realized that a 10:00 or 11:00 AM appointment would retain more parental sanity than an 8:00 AM one, so we switched to a later time for our lab visits.

At Erin's latest Well Baby checkup, her bilirubin levels show at 12 ml/dl. It's still a bit high, but is in the safe range and trending downwards. Our daughter showed Billy Rubin that his type ain't welcome here.

Birth Day

Christine's water broke on the night of Wednesday June 4th, just after 8:00 PM. We were talking on the phone to my mother, and Christine took off for the bathroom in a hurry. She came back, and said "I think my water just broke." I asked her to repeat it for my mom, but she had already heard it, and replied, "Isn't this exciting!". We said quick goodbyes and called our doctor's office. The doctor had us come right in to the hospital; luckily we had packed our bags a couple of days before, just in case.

Erin's due date was June 21st, two and a half weeks away. It would be a severe understatement to say that we were not quite ready. Christine had just finished the "What to Expect" chapter on childbirth, and was planning on reading the chapters on baby care next, and I had about four unfinished projects strewn about the house.

We made the hospital by 9:00 PM, and Christine was hooked up to various monitors, IVs, and such. Since it was after hours, our chosen doctor (Dr. Sally Grogono) was not available, and one of her partners (Dr. Patrick Nunnelly) was on call. We were told that delivery may well take until late in the morning, and looked forward to Dr. Grogono delivering our child. But we had nothing to worry about, as Dr. Nunnelly was excellent.

Christine's sister Heidi, her husband Larry, and their 3-year-old Lauren showed up to support us, and probably expected a long wait (as did we), but Christine's contractions started getting more intense, and they left us after a couple of hours. We appreciated their support, but we didn't feel comfortable with Lauren seeing how much pain Christine was in.

We went in to the delivery with open minds regarding pain management, open to either an epidural or a drug-free approach. From our 'baby classes' , we understood that Christine needed to be at a certain dilation, and be in an "active labor pattern" in order to receive an epidural. But because the baby was already so low, the nurses and doctor were unable to check Christine's dilation. In addition, we had expected dilation to take about an hour per centimeter.

So we assumed that Christine wasn't quite ready for an epidural, although she definitely wanted one. But when Christine's contractions started to hurt so bad that she curled up into a ball and cursed her way through them, we decided to ask what exactly the threshold was for an epidural, and if we were yet in an "active labor pattern". We were floored when the nurse said that Christine had been in an active labor pattern since her water broke, and she could have had an epidural at any time; all she had to do was ask.

There was the briefest of pauses, and then (very politely, but very firmly) Christine asked, "May I please have my epidural now?"

The anesthetist was called in, and was very professional and confident with his procedure, but he zinged Christine's leg nerve, and her leg kicked HARD against my knee, then back against the bed. I honestly expected bruising on her leg after the delivery. He adjusted the insertion, finished his procedure, and told Christine that it should start to take the edge off after the next few contractions.

Apparently the epidural worked fine, because a couple of contractions later, Christine was giggling and outright laughing her way through them. She'd press on her backside and giggle that it felt like it was about to fall off... The nurses said they'd seen all kinds of reactions to the drugs, but this was new to them. The giggling continued until the pushing began.

As I mentioned, we were unsure of Christine's dilation. Once the epidural was in effect, around 12:45 AM or so, the nurse checked her again, and we were all surprised to hear her announce that Christine was already dilated to 8 cm. I'm incredibly proud of Christine for making it that far into labor without any pain medication. Even the nurse said that she was surprised because she didn't feel that Christine was showing enough pain to be that far along.

And then the hard part started: the pushing. At one point during labor, one of the nurses mentioned that it may take a while to push, as this was a new experience for Christine. But she did beautifully, taking only two hours.

I'll skip over the details, but at one point a mirror was brought in so Christine could see what she was doing, and a pair of grips was added to the bed so she could have something to push against. I was holding Christine's right leg; the epidural had left her unable to move it at all (although her left leg was merely numb). Once Erin made it past the pubic bone, she started to move right out. In fact, she moved so far and so fast that she started crowning and coming out before the doctor answered his page! One of the nurses closed Christine's legs, and Erin slipped back in. We were a bit crestfallen, and dreaded another hour of pushing, but the nurse assured us that the baby would have no problem slipping right back to where she was.

Dr. Nunnelly arrived shortly, and another nurse arrived and started warming up what looked like a McDonald's fry bin, but turned out to be an incubator. Christine pushed a few more times, and Erin slowly began moving out. The mirror was still in place, and Christine got to see the tip of her head before the doctor mentioned 'episiotomy', and I asked a nurse to please move the mirror now.

At 4:54 in the morning of Thursday June 5th, Erin was born, only taking a little coaxing from Dr. Nunnelly. He artfully flipped her over and said, "Congratulations, it's a girl." We were both pretty surprised. Christine had expected a boy, although she wanted a girl. I had wanted a boy, but prepared myself for a girl. And about 90% of the people who guessed, told us that it was a boy.

But regardless of our expectations, Erin was beautiful. Dr. Nunnelly cleared her mouth and nose, clamped her umbilicus, and handed me a pair of medical scissors to cut her free of Christine. I did the honors, and have to say that the umbilicus is tough; it feels like cutting a garden hose with a sharp pair of shears.

Erin was then checked for her Apgar scores (8 and 9), cleaned up, and checked out. There was a lot of talk about 'immediate mother-child skin to skin contact' in our classes, but it was quite a few minutes before Erin was laid atop a cloth over Christine's gown, and covered with warm towels. During that time, Erin was weighed and checked out, and Christine was stitched and cleaned up. While I was watching our little miracle through tear-filled eyes, Christine asked me who she looked like, and I will forever regret my immediate thought of "Gollum". Sorry, Erin.

Erin lay on Christine's chest, and we hugged our daughter and cried tears of joy and relief, and said, "Look at what we did!" Dr. Nunnelly came over, congratulated us, and took our first family picture. Despite doing all the work, Christine managed to look far better in the pictures than I did.

Christine was wheeled to a recovery room, and I followed Erin to the nursery, where I learned to bathe her, put on a diaper, and do a proper swaddling. Apparently shift change happened right in the middle of everything, and it was about two hours later than Erin and I were escorted to Christine's recovery room a bit later.

Prologue

We're absolutely positive that Erin was conceived on the night we celebrated our first wedding anniversary, in a castle in Dublin, Ireland. We even discussed the possibility of an "Irish Baby", and what names we would choose. Erin will be relieved to hear that her name won out over Brigid, Reagan, and Caitlin. (Although I secretly was pulling for Reagan.)

When we returned from Ireland, both of us walked in the Breast Cancer 3-Day. Not knowing that she was pregnant at the time, Christine was frustrated with how much more difficult it seemed this year than last. But when we did a home pregnancy test, and then a doctor's visit, we knew why.

At the doctor's office, right before Thanksgiving, I saw my daughter for the first time. I'm not ashamed to say that I got choked up, and nearly cried when I saw her on the sonogram monitor, even though she looked like a gummi bear. Of course we announced it to everyone at Thanksgiving.

Christine's pregnancy wasn't effortless, nor was it notably difficult. The worst issue by far was gestational diabetes, a temporary condition that develops when a placental hormone interferes with her insulin. Christine's normal diet is heavy on fruits, vegetables, and juices; the transition to a low-carb diet was difficult for her.

Another issue was anemia, and its effect on Christine's mood. At the beginning of the second trimester, Christine went through some abrupt mood swings, occasionally sliding into depression. We both knew that something was not right, but we didn't know what it was. A regular checkup showed that Christine had developed anemia, and once her iron prescription started to work, her mood changed back to her normal self. We even noticed that if she took her iron late enough in the day, she'd have a few hours of grumpiness before it kicked in. This is a bit personal, but Christine wanted me to include it because she doesn't want anyone else to suffer through this without some advice and support.

Considering that some of our friends had to be hospitalized for malnutrition or dehydration due to morning (and every other time of day) sickness, we feel pretty blessed.

Our OB was Dr. Sally Grogono, a graduate of Tulane, and a mother herself. She's got a great manner, and went through a difficult pregnancy of her own, so we knew she could handle just about anything we could throw at her.

And finally, some advice for those expecting:

• Ride it out. Pregnancy is a temporary condition; focus on each other and what's important: the child.
• Take your vitamins and eat healthy.
• Get some sleep; building a baby is hard work. And you'll need that sleep when baby gets here.
• Keep a sense of humor. You'll definitely need that when baby gets here.
• Don't start any new projects unless you are absolutely, positively sure that you can finish them well before the baby shows up. Trust me on this.
  

-Kurt