Thursday, September 25, 2008

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.

Wednesday, September 24, 2008

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?

Wednesday, September 17, 2008

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.

Tuesday, September 9, 2008

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.