The brief conclusion to my previous post

Took Younger Brother to his post-surgery check-up yesterday.  Told the plastic surgeon about the whole dietitian appointment weirdness; he agreed that it was weird and said he’d look into it.  I heard him talking to someone about it on the way out.  Highly anticlimactic, but anticlimactic is a good thing when you’re talking about your baby’s health.  YB’s awesome zig-zag scar is healing nicely and his head’s doing great overall.  And we don’t have to go back to the disorganized clinic for another four months.

The more emotional experience of the day happened on the way home.  I stopped by a local thrift store and dropped off a big box of outgrown baby clothes.  I’m pretty nostalgic about stuff, so it hurt my heart a bit to drive away and leave that box behind.

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A rant that’s too long for Twitter

Younger Brother’s next post-op follow-up appointment is next week.  Plastic surgeon, Tuesday, 11:30 a.m.  He’s doing extremely well as far as I can tell, but the doctor will be able to make sure that his skull is healing and growing correctly.

I got the usual automated reminder call late in the afternoon yesterday.  I checked the robotic voice against my planner and the confirmation letter we’d received in the mail.  Appointment—got it, Tuesday—got it, 10 a.m. and 11:30—wait, what?  TWO appointments?  The plastic surgeon has his own private practice, but he sees infant patients at a kids’ clinic near the hospital.  This clinic has already proven itself to be a disaster when it comes to scheduling and communication; it took two weeks and five phone calls for them to send our original referral to the neurosurgeon, apparently because they’d lost their own electronic referral.

I called the clinic this morning.  “The reminder call said my son had two appointments scheduled for the same day?”  Turns out it wasn’t a basic clerical error: they had scheduled Younger Brother for a meeting with a dietitian.  What the heck?!

Two calls and a voicemail later, I got the nurse on the line who explained: YB’s BMI was in the fifth percentile, she said, and they watch for low weight gain in patients after surgery.  Hence the dietitian.

Dear readers, YB is eight months old.  At his initial post-op checkup, his weight was in the 60th percentile, roughly what it has been at for his entire life.  If his BMI seems low, it is because he is in the 90+th percentile for length.  He is not the chubbiest baby you have ever seen, but he is a big boy and very solid.  I appreciate the general concept of what they were trying to do here, but the most minimal of basic sanity checks would tell you that a baby holding strong at the 60th weight percentile is absolutely fine.

Not to mention—what on earth did they think a dietitian was going to do for an eight-month-old baby?!?  He gets most of his calories from breast milk.  He has a lunch and dinner of oatmeal and/or baby-food purées, as much as he’ll eat.  He hasn’t figured out finger foods yet.  What were they going to do, recommend more yogurt and avocados?

And on top of all that, when were they going to tell me about this appointment?!???  You can’t just schedule my baby for extra things and leave it up to the auto-reminder to inform me.

I have cancelled the dietitian appointment, and I will be raising some questions about this system when we see the plastic surgeon.

P.S.  After my initial WTF?!! reaction calmed down a bit, I did some Googling and discovered that BMIs are only supposed to be used for children above the age of two anyway.  Not infants.

T minus 6 days and counting

We’ve less than a week to go before Younger Brother’s head surgery, and people keep asking how I’m doing.  I never know how to answer questions like that.  I’m confident that my baby is going to be OK in the long run, but I’m increasingly stressed about the hows and whats of it all.

In any big event, my worry gets focused on logistics.  Getting everyone to the right place at the right time, with the right paperwork signed and the right preliminaries completed: these are the things that cause me stress.  I also like to know as much as possible in advance about what’s expected of me, lest I fail to live up to those expectations.

Right now, I’m worried about the pre-op testing.  We might have to take Younger Brother in for a blood test or something, to make sure he’s healthy enough for anesthesia.  Or maybe it’ll just be a phone screen.  I don’t know, because folks from the hospital are supposed to call about it and they haven’t yet.  I can’t just trust that what needs to get done will get done, because we’ve had multiple referrals get lost in the ether at earlier steps in this process.  I’m worried that something important will be forgotten and we’ll show up on the day of surgery and be told to reschedule.

(I’ve called the pre-op testing people.  The receptionist said I should hear back today.  We shall see.)

I’m worried about Younger Brother getting sick.  His brother has caught yet another preschool cold and we’re trying hard to keep the germs contained.  The surgeons tell me that a bit of sniffles is fine, but a phlegmy cough is a no-go with anesthesia.  We’d have to postpone the surgery.  I’m worried that my mother will drive 1000 miles to be with us, only to have the surgery rescheduled for illness.

I’m not worried about the surgery itself.  In a way, it will be a relief to know that at that point, all we have to do is wait.  I trust the doctors and the nurses and the anesthesiologist to do their best for my baby.  He’ll be asleep; he won’t know what’s going on.

I’m worried about after.  When will we get to see him?  When will he be able to eat?  Will I be able to hold him and nurse him?  Will we be able to stay with him?  Will we be expected to be with him 24/7?  That last one seems horribly selfish to ask, but… I’m worried about my own sleep.  I’m worried that the nurses will judge me if I need to leave him for a while and take a nap.  My only experience with babies and hospitals has been giving birth, where they expect the parents to provide basically all of the infant care.

I’m worried about when he comes home.  Will it be like the newborn days again?  Will we be waking every hour to tend to a poor sad baby who doesn’t understand why he hurts?  Do we have the right clothes for him, things that can go on over his healing head?  Do we need more baby hats?  I’ve been reading every craniosynostosis blog I can find, trying to get a feel what this part is like and how long it takes to return to “normal.”

I gave up practicing Christianity a long time ago, but I have been thinking about Matthew 6:34 lately.  This is the “sufficient unto the day is the evil thereof” verse, but I prefer the New International Version:

Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.

If ever I needed to stick a Bible verse in big bold letters on my wall, it would be this one.

Long scary medical words about my baby’s head

Metopic craniosynostosis.

The infant skull is made up of multiple pieces, allowing the head to be squashed a bit during birth and then accommodating rapid brain growth over the first few years.  As a child grows, the fontanelles (soft spots) close, and the suture joints between the skull pieces begin to harden.  The first suture to close is the metopic suture, running down the forehead between the frontal bones.

Sometimes one or more of the skull sutures fuse too early, before birth.  This is called craniosynostosis, and this is what happened to Younger Brother.

Looking back at his newborn pictures, we can see the bony ridge running down the center of his forehead, the sign of a prematurely fused metopic suture.  Nobody thought anything of it at the time; after all, newborn heads are often somewhat misshapen.  He also had a big—and completely normal—purple bruise at his hairline from a long time spent crowning in the posterior position.  The bruise faded within about a week.  The forehead ridge didn’t go away.

For a while, I figured it was just a funny quirk of his appearance.  With fine, patchy hair and a lingering birthmark on his eyelid, Younger Brother is adorably goofy-looking in the way that only babies can be.  His behavior and motor skills have progressed normally, and his head circumference at his two-month checkup was right on target.

Eventually, though, we started to get a bit concerned.  The ridge remained prominent, and his forehead took on a distinctly pointed appearance when viewed from above.  (Metopic craniosynostosis is also known as trigonocephaly, or “triangle head.”)  We decided to ask about it at his four-month appointment.

“Wow,” announced our pediatrician.  “I’ve never seen this before in 30 years of practice!”  Gee, thanks.

Fortunately, though, the doctor knew what it was.  He’d seen craniosynostosis of other sutures, just not the metopic, and he knew the plastic surgeon in town who could treat it.

Left untreated, Younger Brother’s condition could constrain future brain growth and lead to developmental problems.  In 10–15% of cases, the surgeon told me, untreated craniosynostosis produces measurably increased pressure on the brain, which is very bad.  So this isn’t a watch-and-wait kind of situation.  It won’t resolve on its own.

My baby needs surgery.  And not just any surgery—they literally have to remove his forehead, reshape the bones, and reattach them so as to allow his skull to grow properly in the future.  The rate of complications is very low, especially in children that are otherwise healthy, but it sure does sound scary.

Now that we’ve had his diagnosis confirmed, I’m of many different minds about it.  Part of me is optimistically stoic.  It’ll all be OK, just stay strong, get us through this, he’ll be fine.  Part of me is pretty freaked out, especially after learning how swollen he’ll be in the hospital after the surgery.  He won’t even be able to open his eyes for a few days.  Poor kid, he will be so sad and scared!  He won’t know what’s going on.  What if he’s never the same?  And part of me—especially in the middle of the night—is worried that we’re all just overreacting.  What if it turns out he doesn’t need surgery and you’ve told everyone for no reason?

All the parts of me want to give my baby extra love and hugs and songs and snuggles.  I stroke his funny head and imagine what we’ll tell him about it when he’s old enough to understand.  We haven’t told his brother about it yet; we’ll wait until the surgery is scheduled and then give an overview appropriate for a three-year-old.  Little Boy had his adenoids removed last week, so he has some personal experience with the concept of hospitals and operations, and won’t, I think, be overly upset.

A weird little part of me is glad that I didn’t put more effort into job-searching in the fall.  If I had, we might’ve already moved and be dealing with new doctors, new health insurance, and complicated schedules with limited time off.  As it is, we’re here in a place that we know, with reasonably good insurance, and I have all the time I need to take my baby to his appointments.  Sometimes, things work out the way they need to.

Postpartum dispatch #3

With my first baby, I learned that the first three months are the hardest.  I also learned that it gets worse before it gets better: newborn fussiness peaks around six weeks and slowly drops off from there.  This time around, the roughest parts for me were the seventh and eighth weeks, because we’d hit that peak and it seemed like things should have been improving but they weren’t.

We made it through.  Things did start to improve, slowly and erratically but noticeably.  Younger Brother dropped to two night feedings, then one.  His naps are still all over the place, but that’s less awful now that I’m not as desperate for naps myself.  He’s a sociable happy bean when he’s awake, cooing continuously in his delightful baby voice.  He “talks” to me, to the mirror, to the ceiling fan, to the toys on his chair.

I enjoy spending time with him—and with his brother, although three-year-olds require an entirely different sort of energy—and I enjoy having time to think by myself again, too.  There’s still a sort of underlying panic in my mind about all the things I need to do, but I can ignore that feeling much of the time.  At this point, I figure my priority is to get us all through Christmas, and then I can step up the job searching and other activities in the new year.

Postpartum dispatch #2

Ninety minutes is the magic number, the length of one adult sleep cycle.  One 90-minute nap resets my brain enough to carry on a little longer.  Three 90-minute stretches over the course of a night and I am semi-human the next day.  Zero such stretches—the nights when Younger Brother wakes at the end of each of his 45-minute sleep cycles—and life is gray and heavy.  I fantasize about checking into a hotel, taking a sleeping pill, and crashing for 12 hours beneath a puffy white duvet.

(Update: He slept for five-and-a-half hours straight last night, then went down for another two.  It was glorious.)

 

Postpartum dispatch #1

For the first two weeks after giving birth, feeling like a mental wreck isn’t pathological.  Something like 80% of new moms experience the “baby blues.”  To nobody’s surprise, it turns out that dramatic hormone fluctuations and acute sleep deprivation can really mess with your head.

I have cried over the strangest things since Younger Brother was born.  For example: I thought of happy memories from when Little Boy was a baby, like going on walks in the evening light, and that made me sad.  They were not tears of joy, but tears of deep melancholy.

The wacky mood swings have mostly faded now, a month out, but chronic sleep deprivation is taking its toll.  I distinctly recall feeding Younger Brother shortly before midnight last night, and I know I was roused again by a hungry baby around 4 a.m.  I think there might have been another feeding in the middle, about 2 or 2:30 . . . but I honestly cannot say for sure.  Perhaps I dreamed it, or perhaps I merely stirred briefly and glanced at the clock.

 

Introducing Younger Brother

Kid #2, who shall henceforth go by the pseudonym of Younger Brother, has arrived!  Eleven days early and nearly nine pounds.  He is healthy and adorable and relatively calm for a newborn.

Close-up image of a newborn baby's foot.

I like a good birth story, so I’ll write up the details of my labor for a later post.  I never went into labor with my older son (who was breech and born via C-section), so this birth was an entirely new and different experience.  Recovery has been much easier.

(Side note: You might have noticed that I’ve changed some blog things recently—like the name—to reflect my graduation and changing life.  Those updates aren’t completely finished, so please pardon the mess!)

There’s new advice for new parents

It’s been a busy week when it comes to telling new parents what they should and shouldn’t do.  The American Academy of Pediatrics (AAP) released several new policies, and the US Preventive Services Task Force (USPSTF) reviewed and updated their recommendations on breastfeeding support.  Even though Little Boy is well past infancy, I’m still very interested in the science of infant care (and we might decide to have another kid), so I’ve been paying attention.  Let’s take a look at each of the new policies.

Kids & screen time

The general message of the AAP’s new policy statement on media use by young children is familiar: choose age-appropriate media, talk to your kids about what they’re watching, and turn off the TV (and other devices) before bed.  But there are a few key updates worth pointing out:

  • They’ve lowered the age of “no digital media” from 2 years to 18 months: you are now allowed to introduce “high-quality programming” to your 18-month-old if you so choose.  I’m pleased with this recommendation, because it agrees with my observations of child development.  Little Boy was 17 or 18 months old when he started really caring about Sesame Street.  By age 2, he knew all the characters and could identify the letter C (is for Cookie) in other contexts.  The old ‘kids don’t get anything out of TV before age 2’ policy seemed frankly incorrect.
  • For children under 18 months, the “avoid digital media” recommendation now explicitly says video-chatting is OK.  It’s a little thing—I mean, we all kind of figured that Skyping with Grandma didn’t really count as “screen time”—but it shows that the AAP put some thought into the various uses of media in modern society.
  • I also appreciate that this statement is included: “…there are intermittent times (eg, medical procedures, airplane flights) when media is useful as a soothing strategy…”

Safe infant sleep

Again, most of the recommendations in the AAP’s new policy statement on infant sleep safety are things we’ve heard before.  Babies should sleep on their backs.  Avoid blankets and soft bedding.  Don’t smoke.  Offer a pacifier (nobody quite knows why, but pacifier use is associated with lower rates of SIDS).  In a few cases, though, the details have changed:

  • Room-sharing (baby sleeps in parents’ room but in his/her own crib or bassinet) is now explicitly encouraged for the first 6–12 months.  Popular media articles seem to be treating this as a shocking new development, but the old safe sleep policy already recommended room-sharing, just without a specific length of time.  The science around this is up for debate, though; it’s not clear if the references cited by the AAP really show strong support for room-sharing.  (Some thoughts from educated folk here and here.)
  • The AAP remains very strongly against bed-sharing; however, they now admit that parents get really fricking tired caring for new babies and sometimes falling asleep with your baby in bed is the least bad option.  While bed-sharing is most definitely not for me, I appreciate their concession to reality:

    However, the AAP acknowledges that parents frequently fall asleep while feeding the infant. Evidence suggests that it is less hazardous to fall asleep with the infant in the adult bed than on a sofa or armchair, should the parent fall asleep.

Supporting breastfeeding

The recommendation statement by the USPSTF, accompanied by an in-depth statistical analysis, addresses whether anything hospitals and medical professionals do actually increases breastfeeding rates, and if so, what interventions are most helpful.  They conclude, “with moderate certainty,” that breastfeeding support has a “moderate net benefit.”

That’s not terribly surprising, but there are some really, really interesting specifics in the report, highlighted in a Journal of the American Medical Association editorial:

  • There is no evidence that the Baby-Friendly Hospital Initiative (BFHI) does any good.  If you’re unfamiliar with the BFHI, the idea is that hospitals can be certified if they implement a set of ten “baby-friendly” (read: breastfeeding-friendly) steps.  Some of these steps are controversial; for instance, if a new mother wants to formula-feed, the BFHI requires that hospital staff “educate her about the possible consequences to the health of her infant.”  Anyway, the USPSTF report determined that “individual-level interventions” (seeing a lactation consultant, attending a breastfeeding support group, etc.) were useful, while “system-level interventions” (the BFHI and other hospital policies) were not.
  • There is no benefit (in terms of breastfeeding duration) to completely avoiding formula during the newborn period.  Moms who supplement with formula before their milk comes in are just as successful at breastfeeding!  This is a big deal, because current breastfeeding advice tends to take an “any formula ever will ruin your breastfeeding relationship” approach.
  • Pacifiers are also OK!  Pacifier use is not associated with breastfeeding problems.  In fact, because pacifier use is associated with lower SIDS risk, the JAMA editorial goes so far as to say that

    routine counseling to avoid pacifiers may very well be ethically problematic.

Interestingly, when the USPSTF posted a draft of their recommendations back in April, there was apparently some concern about their choice to talk about the “support” of breastfeeding instead of the “promotion” of breastfeeding.  Because people are weird about this.

A letter to my baby on our second Mother’s Day

This is my response to


My dearest child,

This is our second Mother’s Day.  You haven’t the foggiest idea what that means yet, except that Daddy will give you a pen and ask you to draw all over my card, which you will do with great care and enthusiasm.  Because that’s what Mother’s Day means: it means I’m part of a family.

Before you were born, for all those months that I carried you in my womb, we were a family.  Your Daddy and I laid our hands together on my stomach to feel your hiccups.  We worked together to prepare you a room, and we went to classes to learn about your arrival.  My body did the hardest work of growing, but your Daddy was always there to keep me (and you) close.

The day you came into this world, the moment we met, I smiled and told your Daddy to follow you to the nursery.  His bare chest comforted you; his heartbeat soothed you.  You came to me an hour later, tiny and pink, and I was astonished—how could something this amazing have come from me?  Your Daddy helped me carefully hold you, carefully bring your tiny head to my breast.

Your first few weeks, we learned together how this family would work.  My milk fed you, but your father and I shared the journey of staying up with you late at night when you didn’t understand the difference between night and day.  I learned to pump milk so that others could nourish you in my absence.

Soon, you started to take a bottle with ease, and I rejoiced to watch you snuggle with your father and your grandparents.  I read you books and played with your toys—and so did they.  We all watched together as you learned to focus, learned to smile, learned to reach, learned to roll.  It was always you, and me, and our family.

After six weeks, I went back to work part-time, trading shifts with your father.  We woke at night together when you stirred, he to change your diaper, I to offer food to soothe your rumbly tummy.  I remember snuggling in the quiet night with you, alone in the darkness.  I also remember the nights when you would not sleep, when I cried and your Daddy came out to take over.

And then, you began to sleep through the night.  You no longer needed me in the darkest hours and I rejoiced.

I rejoiced because it was never about you and me, and how you needed me.  It was about you.  About you growing, gaining independence.  Watched and loved by two parents.

You need me now much less than you did in that first year.  You run on your own, and you wiggle away when I try to hold you tight.  Someday your father and I won’t need to change your diapers, or pick out your clothes, or slice your food up into bite-size pieces.  Someday you’ll be reading on your own, truly reading and not just the nonsense syllables you make now as you turn the pages for yourself.  You have grown so much, and I am so proud.

It was never just you and me, and we are all the more blessed for it.  You have learned that many people provide safety and comfort, and you have learned that Mommy and Daddy always, always come back.  You are making friends at daycare, and I delight in the joy that shows in your face as you run around together.

So this Mother’s Day, our second Mother’s Day, I am going to sleep in.  I am going to take Daddy up on his offer to watch you all day.  I don’t know what I’ll do yet with that time—maybe I’ll have lunch with a friend, or go shopping, or just curl up at home with a book.  Because I know that I need that break, and that I’ll be a better wife and mother for it.  Because I know your face will light up when I come back, just as it lights up when Daddy comes home from work.

Because I know you will always be my baby, even when I’m not around.

Love,

Mommy