Corn Syrup in My Babies’ Formula?

Posted on
Categories Anger, Formula, Frustration, Infants, Medical, NICU, PrematurityTags , , , , 1 Comment

I gave birth to my twins, J and M, when they reached 33 weeks gestation. They were 7 weeks shy of being a fully cooked 40 weeks along when they were born, and 2 weeks early even for my minimum goal of 35 weeks. We were incredibly fortunate that they didn’t have any serious complications, but both babies still needed special care in the NICU.

I’ve always been a parent who researches, so I was pretty well-versed on the phases of development the girls were going through at various points in my pregnancy. Still, seeing my preemies brought it home in a visceral way that no research could have done.

A very small newborn, with lots of cords and wires all over her.Both M and J were rather furry when they were born, covered with lanugo, or the in-utero hairs that usually fall off well before babies emerge from the womb. I could only distinguish this fur from their eyebrows with the help of the thin line of hairlessness that separated their foreheads from their brows.

The girls’ skin was loose on their bones. After all, they hadn’t yet reached the milestone of 35 weeks, when their baby fat would make them newborn plump. Without the natural insulation of my body or their own body fat, they had to stay in warming isolettes. They couldn’t maintain their body temperature, so the hospital staff did so artificially. On two priceless occasions, we were allowed to provide kangaroo care, placing our tiny little babies inside our shirts, against the warmth of the skin on our chests, letting them bond to us.

Infants who will be born full-term are still getting their nutrition from the umbilical tube at 33 weeks and nearly 2 months afterward. Oxygen and nutrients cross from mommy’s blood to baby’s in the placenta. Getting energy and the building blocks to grow their bodies doesn’t take any work on their part. They can focus on growing, practicing sucking and kicking and, if they’re lucky enough to share the womb with Sissy or Bro, play with their best bud.

My girls were born at 3 lbs 6 oz and 3 lbs 9 oz. They weren’t to have the easy nutrition the placenta granted them. Instead, they were going to have to gain weight with the help of calories they ingested orally. At 33 weeks, babies are usually well practiced at the art of sucking, but they’re not built to use that skill to take in all their nutrition. To help them out the nurses threaded feeding tubes up our teeny babies’ noses, directing food into their stomachs.

That food came in the form of Enfamil Lipil, a high calorie formula for preemies. M and J needed nutrition to provide not only the basics they would have received from my body, but the extra energy they needed to breathe and otherwise experience life outside the womb. Much as I was committed to breastfeeding, breast milk wouldn’t cut it. It just didn’t have enough calories.

Besides, my body was trying to figure out what was going on. Were there live babies to be fed, or was it time to get out of reproductive mode? I’ve known moms with micro-preemies whose milk never came in, their bodies interpreting the early birth as a miscarriage instead of a live birth. Despite my pumping every 3 hours started a couple of hours after the birth, it took days for my milk to come in. A full-term newborn can afford to live on colostrum for a day or two, since they have plenty of energy saved up in all that squishy baby fat. My babies weren’t squishy.

The nurses at the hospital were (with one exception) fantastic. They took every teeny tiny drop of colostrum or milk I could squeeze out. To retrieve it, they filled the doll-sized bottles I pumped into with formula to retrieve every spray of breastmilk. They split that formula in half and fed it to each of my daughters through their feeding tubes.

Lipil Ingredients. The first ingredient is corn syrup solids.I hadn’t done any research into formula before M and J’s birth, being completely committed to exclusive breastfeeding. It never occurred to me to check the ingredients on our hospital-issued formula. I thought of it as medication, something beyond my area of expertise that I should entrust to medical professionals to prescribe. Imagine my surprise, then, when years later I finally read the ingredients and discovered that my babies’ high calorie formula got its high calories from corn syrup. Corn syrup was actually the first ingredients, meaning that there was more of it in the formula than any other ingredient. The composition of the formula has since been changed, but boy, did I feel silly claiming that my daughters’ first refined sugar was the cake at their first birthday party.

Sugar is sugar, I know, but I prefer to eat and feed my family minimally processed foods. I don’t like the idea of ingesting trace amounts of stuff used in processing. Don’t get me wrong. I buy prepared foods like sliced bread, lunch meats, chocolate (lot of chocolate) and crackers. I try to steer clear of non-sugar sweeteners and high fructose corn syrup. I like ingredients to don’t force me to fight the urge to start drawing out organic molecule structures.

We live and learn. If I were to do it again, I would research everything going into my newborns’ bodies. Perhaps I would decide that that brand of high calorie formula was the way to go. Perhaps not.

I always read the ingredients now.

Sadia is raising her 7 year-old identical twin daughters, M and J, in the Austin, TX area. She is divorced and works in higher ed information technology. She is originally from the UK and Bangladesh, but has lived in the US since college.

Share this...Share on FacebookTweet about this on TwitterShare on Google+Pin on PinterestShare on StumbleUponShare on TumblrShare on RedditDigg thisShare on LinkedInEmail this to someone

What Makes Her Special

Posted on
Categories Attitude, Congenital Anomaly, Difference, From the Mouths of Multiples, Identical, Medical, Other people, Parenting Twins, Perspective, School, School-Age, Special NeedsTags , , , , , 16 Comments

When I stopped by my daughters’ school to drop off birthday cupcakes (for J’s class) and doughnuts (for M’s), the principal spotted me and asked me into her office. She must have seen the look on my face–or perhaps she’s merely accustomed to people’s reactions to being called into the principal’s office–and set me at ease, saying, “I need to brag on M.”

“Did M tell you what happened last week?” she asked after we were seated.

“I don’t think so.” M told me a whole bunch of things that happened last week, but none of her stories featured anything principal-worthy.

The principal told me that one of her 4th graders, normally a sweet boy, has been acting up recently. In one incident, he sat next to M at lunch and asked her what happened to her face. M began to cry.

At this point in listening to the story, I began to cry too, which made the principal join in. It was a major tearfest.

Let me give you a little background.

These are my daughters. I don’t think it’s merely maternal pride that makes me think they’re both awfully pretty.

Twin sisters
J is on the left, in green. M is wearing blue.

They are identical twins, but by developmental happenstance, M was born with a facial cleft (think cleft palate, but higher in her face and not affecting her palate), while J was not. M has been seeing a craniofacial specialist since birth. The appointments were every 3 months at first, then slowed to being yearly, and are now every two years. She hasn’t needed surgery, and there’s nothing wrong with the function of her nose. It just doesn’t have a defined tip. The cleft also causes her eyes to be wide set and has given her a widow’s peak hairline. All of it combines, in my mind, to give her an adorable anime/china doll look.

M’s doctor warned us that, even if there was no functional issue with her nose, kids get mean about appearance around age 7, and we could always opt to consider surgery if it was needed for M to have a healthy self-image. Honestly, I haven’t given surgery much thought. M is a well-adjusted kid. It’s not like M’s unusual look has never come up before. When kids have asked why she has a “funny nose,” I’ve responded by saying it’s so that we could tell her apart from her sister. When I overheard a little girl telling M that her nose was “too small,” I responded by focusing on its purpose. “Does it breathe?” Yes. “Does it smell?” Yes. “So is it too small to do its job?” No.

I’ve told M that she has the world’s most kissable nose, and she permits me 5 kisses exactly at bedtime on her “kissy nose.” A while ago, J told someone that a good way to tell her and M apart was her pointy nose, in contrast to M’s flat one. I considered freaking out and then realized that she wasn’t attaching a value judgment to one look over the other. Part of me worried, though, that having an identical twin will eventually add insult to injury. There will always be J there to show M what she would have looked like without the cleft. It’s never come up, though. I hope it never does. It helps that, while my girls value the twin relationship, they also relish being individuals and having some differences from one another.

Let’s return to the principal’s office, shall we? As you may recall, there was crying.

The 4th grader had been mean, and M had cried. It took a while for him to admit that he’d acted wrongly and with intent to hurt, so by the time he was ready to deliver a real apology, M was back in her 2nd grade class. She was called out into the hallway, and he apologized.

“It’s okay,” she told him. “You already said sorry, and I forgave you. People say that stuff to me all the time. It’s fine.”

Just to keep the tearfest going, the little boy began to cry. He was ashamed.

“It’s not fine,” the principal told her. “You’re a beautiful girl, and it’s not okay that people say mean things.”

“But I forgive them,” said my amazing, extraordinary child. “I love this school!” And she skipped back to class.

Tonight, at dinner, J was distracted by her dessert, so I took the opportunity to talk to M about this whole thing. “I heard you were extremely forgiving at school. [Your principal] was pretty proud of you.”

M beamed.

“Wanna tell me about it?”

She told me essentially the same story I’d heard in the office. I reiterated what the principal had said, that she didn’t need to just accept people’s cruel words.

“But Mommy, it’s okay. They can say what they want. It’s my job to forgive. I just don’t get it. I don’t understand why they would want to be mean about what makes me special. My kissy nose makes me special. What’s wrong about that? I don’t know why it’s like this, but it makes me special.”

There was nothing wrong with that, I told her, and by a major act of self control, kept the tears in this time. Would she like to know why her nose was special? She did want to know, so I explained in very simple, objective terms the nature of her cleft. I also pointed out that it was responsible for her widow’s peak, which she calls her “heart hair,” since it helps give her a heart-shaped face.

“I love my heart hair!” she said. “That is part of what makes me special too.”

She went on to tell me that her teacher had told her about being teased as a child for not speaking good English. Her sister’s teacher told her about being teased for having a big nose. I added my own story. I told her my tale of being teased for my eczema. I told her that I’d never realized I was pretty until I was 18.

She gasped. “But Mommy, you’re beautiful.”

“So are you, baby girl. I’m so glad you already know it.”

“Me too. I’ve known ever since Nicole told me I was beautiful when I was very small. That’s why she’s such a good friend,” she said.

There was nothing more to say.

Share this...Share on FacebookTweet about this on TwitterShare on Google+Pin on PinterestShare on StumbleUponShare on TumblrShare on RedditDigg thisShare on LinkedInEmail this to someone

Talking to Kids About Depression

Posted on
Categories Education, Medical, Mental Health, Mommy Issues, Perspective, School-AgeTags , , 16 Comments

My 6-year-olds love going through the drive through pharmacy. They’re fascinated by the hardware that allows me and the pharmacist to send clipboards, debit cards and medications back and forth without my having to leave the driver’s seat of my car. They never tire of the box magically closing just before it disappears into the cavern above our heads.

While we were waiting for my refills and debit card yesterday, M wanted to know what the medicine was for. I told her I’d explain on the way home. I needed a few minutes to gather my thoughts.

I have clinical depression.

I didn’t say I was depressed. I’m not depressed. My emotional and mood responses to the challenges in my life are proportional and appropriate. I see the little joys in my day. My temper is completely under control. I don’t find myself needing to examine my every thought to determine whether it’s a real one or the product of a brain that isn’t working right. It doesn’t take an all-consuming act of will to get out of bed, eat, or breathe. Not any more.

I explained to my daughter that, many years ago, I started having horrible feelings of sadness. There wasn’t a reason to be sad, at least not as sad as I felt. Some mornings, my brain would tell my body to sit up, but my body wouldn’t listen. The sadness was controlling my body. I went to a doctor and a counselor—my daughter knows about counselors because her school has two amazing ones—and tried to fix things by thinking about my feelings, talking about my feelings, understanding my feelings. It wasn’t enough. I tried all the things we practice at home to manage our feelings: deep breaths, time out, reading a book, writing about our feelings, asking for help. It just wasn’t enough.

Finally, my doctor told me that I have an illness called “depression.” Everyone’s brain has chemicals in it, just like all other parts of the body, to make sure it works right. For some reason we don’t understand, some of my brain’s chemicals were missing. (I figured that 6 was a little young to go into serotonin reuptake. “Missing chemicals” would have to do.) The doctor recommended that I take medicine to help. I didn’t want to take medicine to put new chemicals in my brain. That sounded scary to me.

“This is a scary story!” my daughter interjected.

I asked if she wanted me to stop. She wanted to hear the ending, so I continued.

I started taking the medicine. After a few months, I felt better. My body started listening to my brain, and I felt happy. When I did feel sad, there was a reason, and fixing the reason fixed the sadness. My brain was all better.

When I decided to have babies, I didn’t want those medicines in their bodies. Their brains probably would never need them, and it’s not a good idea to have medicine in your body that you don’t need. With a doctor’s help, I stopped taking my medicines, and I still felt fine.

I had my beautiful little girls. (M smiled at that.) For four years, I felt just fine. Then, one day, the bad sadness came back. I recognized it right away this time. I went back to the doctor, and told them that I had depression and that it was making me feel sick again. He asked me to try the medicines that had worked before, and they worked again.

“So if you don’t take your medicine, you’ll be sick?” M asked.

“I don’t know,” I told her. “I’ll probably just be the same that I always am, but this sickness, depression, might come back and make my brain sick again. Since the medicine helps make sure that I stay healthy in my brain, I keep taking it. There may be a good reason to stop taking it some day and be careful about watching my brain health, but for now, I think I should keep taking it.”

“Okay,” she said. And that was that.

J looked up from the book she was reading. “Did you say something about being sick?”

I told her we’d talk about it another time.

Twinkly TuesdayWhen the Dust Settles

Sadia is a divorced mother of precocious 6-year-old identical twin girls. She works in higher education information technology and has her depression well managed. She hopes that some day, the stigma of mental illness will go that way of cancer stigma. She believes that knowledge is power. So is compassion.
Share this...Share on FacebookTweet about this on TwitterShare on Google+Pin on PinterestShare on StumbleUponShare on TumblrShare on RedditDigg thisShare on LinkedInEmail this to someone

Am I Being Responsible?

Posted on
Categories Ask the Readers, Birth Stories, Medical, Pregnancy25 Comments

I keep assuming that my experiences this pregnancy will be similar to the ones I had in my singleton pregnancies. I have been wrong over and over again. My first Ob appointment was no exception… totally different.

My Dr. started my first visit by saying ” I know since you’ve done this three times you feel like you’re an expert, but you’ve never been pregnant with twins”. He then went through a whole list of ways this pregnancy would be different: 2 gestational diabetes tests, more weight gain, more caloric demands, no more running, more appointments, more ultrasounds. None of those phased me. Then he hit me with “Now you know you’ll have to labor and deliver in the OR and you’ll have to have an epidural.”

What?

He then went on to explain that he understood how I felt about having natural births, but I needed to get comfortable with a very different experience “For the safety of the babies”. When I asked if I could try laboring without an epidural he said that it was my choice but “he’d just put me under when it was time for my C-section”

I literally didn’t know how to respond. So I didn’t.

With each of my births I have used less and less intervention. W’s  had the works: pitocin, epidural, the Dr. broke my water, and constant monitoring. G’s had a little less. O’s was intervention free: My water broke at home, no pain meds, no IV, and intermittent monitoring. I am proud of and happy with all of my births. They each resulted in a healthy baby. One of my friends asked me recently why I prefer natural birth. I explained to her that she competed in triathlons and I had babies. I love the challenge of getting through the pain and watching what my body can do. I am seriously weird in that I look forward to labor.

When I found out I was pregnant this time my husband and I decided that we’d like to use a midwife and deliver at a free standing birth center. He’s an ob/gyn so this decision didn’t come easily for us. We talked and talked and read and read. We felt confident in our decision. Then we found out it was twins and our plans changed.  We agreed that we both felt safer having the babies at a hospital. We felt better knowing that if something did happen we’d have experts on hand to help and  we wouldn’t have to waste time getting to a hospital.

So here’s my dilemma: How much intervention is needed in order to be responsible?  I had already happily come to terms with delivering in a hospital.  I’d also decided that I could deal with having  to labor and deliver in the O.R., but is having an epidural really necessary? Also, why is my Dr assuming I’ll have to have a C section?  And telling me he’ll “just put me under”? is he being flippant?

All I want is the CHANCE to have these babies vaginally without an epidural.  Is that being irresponsible?

I’ve had one more visit with Dr. Doom (my new name for him) since the awful first one.  I didn’t have the nerve to bring up our discussion.  I didn’t ask any questions and realized I was smiling and shaking my head a lot.  If you asked him I’m sure he’d say the visit went fine.  I left the appointment feeling like I either need to find a new Dr. or  have a very open conversation with him. Neither of those options sound particularly fun.

Per my usual I have launched into research mode. I’ve questioned other twin moms about their experiences, I’ve read all I can find on birthing multiples, and I have talked with my husband and a midwife friend about their approaches to delivering twins.  I’ve learned a lot and in the end I think I’ve realized that I still need to know more. So much of this decision to birth vaginally or by C section and with what interventions is dependent on my babies.

Right now my plan is to become comfortable with not knowing how I will give birth to these babies. This is very hard for my type A uber organized self.  I still want the chance to deliver naturally, but I won’t dig my heels in and refuse other options. I think being open is the only responsible choice.

Talk to me about your birth experiences. Anyone deliver their babies naturally? How much intervention did you find was truly necessary? Would you change anything about your birth?

 

Elizabeth lives in Central Texas with her husband and 3 sons.  She is 13 weeks pregnant with twins. 

 

Share this...Share on FacebookTweet about this on TwitterShare on Google+Pin on PinterestShare on StumbleUponShare on TumblrShare on RedditDigg thisShare on LinkedInEmail this to someone

Breaking Lockstep

Posted on
Categories Development, Difference, Medical, School-Age4 Comments

Today, I took J to the dentist to get her newly erupted adult molars sealed. While she was in the capable hands of the dental assistant, M and I sat in the room and read silently.

J is helping out at the dentist.

This sort of this is the norm for many families; while one sibling is involved in a procedure or activity, the others have to wait it out. For us, though, this is new. All our twin daughters’ preventive care and major milestones have come on nearly identical schedules. They crawled within a week of each other and both walked within a month of their first birthday. They both needed speech therapy, progressed through it together, and graduated on the same day. They have matching cavities.

J, however, now has her first molars, and M doesn’t. They have intensely different personalities, but I can’t help thinking that this divergence in their dental schedule marks a shift from the lockstep development timeline they’ve shared thus far.

Do your multiples reach milestones around the same time? Which ones?

Sadia’s identical daughters, M and J, are 6-year-old rising second graders in El Paso, TX.

Share this...Share on FacebookTweet about this on TwitterShare on Google+Pin on PinterestShare on StumbleUponShare on TumblrShare on RedditDigg thisShare on LinkedInEmail this to someone

RSV

Posted on
Categories Infants, Medical, PrematurityTags , , , , , , , 4 Comments

To parents in the know, there are few acronyms that make one’s heart sink faster than “RSV.”

Respiratory syncytial virus is an everyday virus that gives adults and most children no more than the sniffles. When it comes to young infants, especially preemies, the disease can ravage their lungs, and even prove fatal. I’ve heard that many parents of triplets and more put their infants on complete lock-down to protect them during their first flu season. In order to keep their home RSV-free, they keep family and friends alike away until the weather warms up.

We were fortunate to have health insurance that covered Synagis, the RSV shot, our daughters’ first year. Decision-makers in the military health care system deemed that RSV was a high enough risk for our daughters, 7 weeks premature, to cover the monthly thousand-dollar shot. Every month for 7 months, I took our tiny daughters to the one clinic in Central Texas that carried the antibody shot. They learned to start screaming at the sight of Candy, the lovely nurse who innoculated what seemed to be all the multiples in town.

J and M contracted RSV their second winter. They were relatively sturdy at 18 months of age, and didn’t require hospitalization. Still, I was out of work caring for them for nearly a month. I have documented the rest of the girls’ lives in excruciating detail, but I have no photos or blog posts from that time. Even my memories are minimal, just hazy impressions of fear even deeper than I usually felt during the months my husband was at war. The one clear memory I had was of calling my neighbour Heidi over. She was our only neighbour who was neither elderly nor a parent. I asked her to monitor the girls’ breathing so I could take my first shower in a week; J had thrown up on me. I will never be able to repay her for not only giving me peace of mind during those moments alone under the hot water, but also cleaning J’s vomit off the floor. Her husband was also in Iraq at the time.

M and J continued to suffer aftereffects of RSV for another 3 years. Only recently were we able to permanently (we hope) retire their nebulizer and put breathing treatments behind us.

This week, I learned that a coworker’s 3-month-old was on a ventilator because of complications from RSV. The last update I received was that she had been extubated and is tolerating a nasal cannula. She has been weaned off the meds that were keeping her sedated and is now moving and crying. If all goes well, she should be home from the hospital in a couple of weeks.

What can one say to a parent whose child is in the pediatric intensive care unit? The only words of comfort I had were of sympathy. It seemed out of place to tell her that M and J, after 3 long years, had finally overcome the setback of RSV.

Update, 9:36 am CST

My friend emailed to say, “Good news today!  She’s off of both oxygen and pain meds.  They want to watch her today to ensure that she continues to do all right without them.  If so, we get to go home tomorrow!”

Have you dealt with RSV? Do you have words of comfort for my coworker and her husband?

Share this...Share on FacebookTweet about this on TwitterShare on Google+Pin on PinterestShare on StumbleUponShare on TumblrShare on RedditDigg thisShare on LinkedInEmail this to someone

Inoculation Time Made Easier

Posted on
Categories Medical, Parenting Twins, School-AgeTags , , , , , 6 Comments

I have discovered the parenting equivalent of the New World. Our daughters got flu shots recently, and neither kids nor mom walked away from the experience in abject terror. We didn’t need to resort to blankie time or heavy doses of chocolate.

Sorry, folks. My discovery isn’t one that I could have taken advantage of before now. You’ll need to wait it out too. My repertoire of vaccination-related pain minimization strategies is the usual, the list your doctor and other parents told you about in preparation for your kids’ first well baby visit:

  • Don’t schedule your appointments anywhere near nap time.
  • Give your child Tylenol, or whatever the safest kid-approved pain reliever and fever reducer is where you live, 30 minutes before your appointment. This minimizes pain and the chance of a fever over the next day or so.
  • If your child is old enough, promise a treat after the visit, and follow through on your promise. Give yourself a nice big reward too.
  • If your child has a lovey, a toy or blanket–my sister had a washcloth–bring it with you.
  • Use  all your limbs and available personnel to hold your children down during the act of vaccination.
  • Ask your medical service provider what formulations they have available to minimize the number of pricks your children must endure. A lot of vaccines now come packaged in a single vial.
  • Seriously consider investing in earplugs for yourself.

The new information I have to offer is the observation that inoculation is crazy easy at age 5. This year, we walked into the clinic, and I filled out the requisite paperwork while the girls read Alice in Wonderland. When they started to express some concern, I told them that the flu shot would hurt, but only for a second. It would feel like a brief bug bite. I illustrated by quickly tapping their skin with my nail. When we saw the nurse, the girls clambered onto the examination table in turn, selected a band-aid, got her shot, said “That didn’t hurt so much,” picked a sticker, and jumped down. No tears. No flailing. No new bruises for me from trying to hold them still.

I’m usually the very first in line to get my girls their shots. Having grown up in a developing country and being allergic to the eggs in which many vaccines are grown, I am all too painfully aware of the risks of foregoing vaccination. This year, however, navigating the medical system in our new town has been fraught with challenges. It has taken me until just recently to figure out when and where to take J and M for their flu shots.

My husband has been deployed during all but two flu seasons since our daughters were born. In addition to the regular vaccines pediatricians recommend for all children, the girls got monthly RSV shots for 7 months in a row as infants. I consider myself well-versed in the ways of solo parent/double child vaccination.

I’d hold both children in my lap, one on each knee, and thank my lucky stars that my children did not outnumber my knees. The nurse would make small talk, but as soon as she reached for the syringe and vials, the thrashing, kicking and screaming would start. M suffers from more anxiety than J, but it never mattered who went first.  M would scream in anticipation as soon as we reached the exam room, and J would sob in sympathy. I would set the phrase “This too shall pass” on repeat in my head. The tragic response would last until the girls cried themselves asleep or, once they were old enough to appreciate them, they could select stickers at the front desk of the office.

Sound familiar? It did eventually pass, after all.

Sadia, her husband and their 5-year-old daughters moved to El Paso by order of Uncle Sam last year, after having done all their child-rearing in the Austin area before that.

Share this...Share on FacebookTweet about this on TwitterShare on Google+Pin on PinterestShare on StumbleUponShare on TumblrShare on RedditDigg thisShare on LinkedInEmail this to someone

Prematurity Is Never Easy

Posted on
Categories Guilt, Medical, Mommy Issues, NICU, PrematurityTags , , 6 Comments

M and J were born 7 weeks premature. When we found out we were having twins, my ob/gyn told us, right off the bat, that we could expect them to arrive early. She offered to help us find a new doctor who had privileges at a hospital with a neonatal intensive care unit. My husband and I agreed that we wanted her to care for us during the pregnancy, even if she wouldn’t be the one to perform the delivery if it was early.

We didn’t know the first thing about prematurity. When the doctor said, “privileges at a hospital with a NICU,” we were so naïve that we just looked at her blankly. She had to spell out that a NICU was a neonatal intensive care unit and we should prepare ourselves for an extended hospital stay. This pregnancy was high risk, all the more so because I was 5’0 and weighed 112 lbs. There wasn’t exactly a lot of room for expansion, at least up and down. The prospect of gaining the ideal 60 lbs over 9 months seemed challenging, and turned out not to be a goal I could accomplish.

Still, the pregnancy was so relatively easy on me – not so my husband; my temper was terrible! – that I was sure I could carry the girls to at least 35 weeks. I had no morning sickness, and I was floating on air during the second trimester. Thirty-five weeks was our goal, because twins tend to gestate about two weeks faster than singletons, and therefore 35 weeks for them was as good as 37 weeks for a singleton.

We went through the motions to prepare for preemies. An aunt got the girls preemie-sized outfits at the baby shower the family threw for us, even though I couldn’t attend. (My doctor highly recommended that I not fly to Oregon.) We took our Lamaze class with a group of couples 2 to 3 months farther along in their pregnancies than I was. Despite these steps, we hadn’t prepared emotionally, and I was still deeply attached to the idea of a natural birth. I had made a list for my hospital bag, but hadn’t actually packed, when my water broke at 33 weeks, 1 day.

The actual birth was a haze. J weighed 3 lbs 6 oz, M 3 lbs 9 oz. J had a patent ductus arteriosus (PDA), or a hole in her heart. It’s a common condition in infants, and resolved itself within a couple of months. Neither M nor J needed any help breathing. They didn’t need oxygen treatments. Unlike some of the other preemies in the NICU, they didn’t have any issues with apnea of prematurity, which is essentially what happens when a preemie forgets to breathe.

They were really small, though. They couldn’t regulate their own body temperatures because their baby fat hadn’t come in yet. They had to stay in their warmed isolettes, although they were strong enough that we were allowed to hold them for several hours each day, and keep them warm with our own body heat. When they finally downed 31 mLs (1 oz) of formula and breastmilk in one shot, I cried for joy, because that was one of the criteria the NICU had set up for release from the hospital. Days earlier, my husband had fought for my right to breastfeed, fighting formula and the feeding tube while I was being moved out of the operating room, until a doctor kindly, but firmly, told him that our babies were really, really sick, and all our plans were going to have to wait.

We had the healthiest preemies in the NICU, but still, they were tiny.

In the picture above, J and M (in the matching white onesies) are a day shy of a month old. D, a dear friend’s son, is two weeks old. That’s half their age. He was born on his due date at 40 weeks gestation, compared to M and J’s 33 weeks. His legs are twice the size of theirs. His arms are twice the size of theirs. Each of his hands could almost contain one of theirs. M or J would disappear inside the newborn-sized onesie D is wearing. D wasn’t a particularly large baby. What you can’t see is how baggy their preemie-sized onesies are on them.

Remember, M and J are twice as old as he is, if you count from their birth age.

I actually learned not to measure their age from their birthday. When I did use their birth age during their first year, I felt like I had to keep explaining why the girls were so small, or why they weren’t holding up their heads better at their age. Not only that, but my poor friend kept having to defend little D when we were together in public. “He’s not fat! He’s not huge! The twins are just really really tiny!”

Once we reached their due date, the day they would have been born full-term, I began to use their corrected age, that is, how old they would have been if they hadn’t spent the last two months of the gestational period outside the womb. It was so much simpler to tell strangers at the grocery store that the girls were a month old, rather than, “They’re three months old, but they were born two months early, and please don’t look at me like that because I’ve never done a drug in my life and maybe if I’d been on bed rest the pregnancy would have lasted longer, but I did the best I could, and I’m really trying to be a good mother.”

Yes, I was extremely touchy about the fact that the girls were born early. I felt like my first act of motherhood had been to betray them by evicting them from my body half-cooked.

Our pediatrician was fantastic. The entire practice has a lot of experience with preemies. In fact, all the twins I knew in our old town went to one of two pediatricians. (Not all twins are premature. My husband’s now 16-year-old triplet cousins were born full term. However, the rate of prematurity is high for twins, over 50 percent.) The doctor focused always on how M and J were doing compared to where they started, rather than looking at averages. When he tracked their growth on the growth chart, he used their corrected age. When it came to timing immunizations and the introduction of solid foods, we followed the guidelines of the American Academy of Pediatrics, again using their corrected age.

M and J are healthy. They only long-term effect of prematurity appears to be the state of their teeth, although we faced some challenges in the early years with their lung development. We’re the lucky ones, though. Others aren’t as fortunate.

Here’s what I would tell my pregnant self if I could:

Don’t be irritated with he doctor when she tells you that you need to quit working. Listen to her when she says that you’re having too many Braxton Hicks contractions, too early. Working part time and telecommuting was a great alternative to working full-time, but you could have afforded to stare at the ceiling for a few weeks to give those precious girls a better start. It might have made a difference. It might not have. You’ll never know.

I will never know what I could have done differently to give J and M another day or two in utero, but I will always wonder.

Sadia’s daughters, J and M, are now thriving in first grade. They’re a head and half shorter than their classmates, thanks to inheriting Sadia’s (lack of) height. A previous version of this post was published on Sadia’ personal blog, Double the Fun, on honour of the Bloggers Unite Prematurity Awareness event 2009 .

Share this...Share on FacebookTweet about this on TwitterShare on Google+Pin on PinterestShare on StumbleUponShare on TumblrShare on RedditDigg thisShare on LinkedInEmail this to someone

Our Speech Therapy Journey(s)

Posted on
Categories Development, Feeding, Medical, Preschoolers, Solid Foods, Speech Therapy, ToddlersTags , , , , , 4 Comments

M has successfully completed two programs with a speech therapist, and we’re considering having her evaluated again. Twin sister J joined her for the second of those programs, and also benefitted greatly. Watching both my daughters work their way through speech therapy has taught me a few new things, and convinced me all the more of others.

  • There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.
  • Follow your gut.
  • It never hurts to get a second opinion.
  • Some lessons are more likely to stick if they come from someone other than a child’s parent.
  • Things are often more complicated than they appear.
  • There is such a thing as knowing too much about something.

The first time we visited a speech therapist was at the recommendation of the family pediatrician. When M was nearly 3 years old, I became concerned about how slowly she ate. I once timed her spending 17 minutes chewing a single piece of meat, and finally had her spit it out. The pediatrician suggested that she had dysphagia, or trouble swallowing. I had imagined that a couple of degrees in linguistics gave me a basic understanding of what speech therapists do, but I was wrong. Speech therapists deal with all sorts of oral motor issues, including problems with chewing or swallowing.

It turned out that M had never quite figured out how to use her tongue to effectively move food around in her mouth as she chewed. Because of that, foods that required chewing would cause her to choke. After six sessions of feeding therapy with an amazing speech therapist and a lot of reinforcement at home and daycare, she could eat successfully. Meals became enjoyable again. It’s been over 2 years, and we haven’t seen any backsliding. In fact, M enjoys food so much now that she plans to open a restaurant when she grows up. Bonus: military medical insurance covered 100% of speech therapy session costs.

It was during feeding therapy that the therapist raised a concern that M might have articulation delays. It had never occurred to me that there was anything off in her speech, since the child talked incessantly and no one who knew her—I, her teachers, or our neighbours—had any trouble understanding her. I thought her pronunciation of yellow as “lellow” was darling, rather than worrisome. The linguist in me had always ignored the nagging doubts, knowing full well that there was variation in the timing of pronunciation mastery, but there should be no cause for alarm as long as the order of acquisition were being followed.

When my husband returned from Iraq and needed me or J to translate for him so that he could understand M, it was clearly time to revisit the speech therapist. My MA in theoretical linguistics hadn’t taught me as much about the practicalities of language development as I’d thought. The practice we’d been to for feeding therapy no longer took our insurance, so we had to find a new therapist. We had both girls, now 3 months shy of turning 4, evaluated at the new practice. They ended up being evaluated by different therapists, and we learned how incredibly subjective these evaluations can be.

J was determined to be 2 standard deviations above the norm for her age when it came to grammar, vocabulary and comprehension, but 2 standard deviations below the norm for articulation, the production of mature speech sounds. She sounded more like a child just turned 3 than one soon to be 4. M, on the other hand, was evaluated only for articulation, and declared to be just dandy. These results didn’t ring true for us. M was, to our ears, far less clear in her speech than J. My husband insisted that M be reevaluated, this time by the therapist who had seen J. When the office staff let us know that they were concerned that insurance might not pay for a second evaluation, we offered to pay out of pocket. Insurance did end up covering it, though. The second set of results was more in line with our expectations. Although J’s need for speech therapy was a judgment call, M definitely needed it. Where the first evaluation had her placed her in the 43rd percentile, the reevaluation placed her in the 2nd percentile for articulation.

Since their delays were along the same continuum, the therapist offered to work both twins together in weekly sessions. The sessions were great fun for the girls. The therapist pulled out board games, and let them each take a turn after they completed a pronunciation exercise. She focused on making them aware of how the sounds coming out of their mouths were different than hers. Soon enough, they could say ‘sh’ and ‘v’ easily. It was extraordinary to see how those two sounds alone helped with others’ comprehension of their endless chatter.

After 3 months, both the girls graduated from speech therapy. All J had left to master were ‘l’ and ‘r’, and the speech therapist didn’t think those needed to be rushed. M had a lisp to work on too, but we were comfortable with the exercises she needed to do at home to help with that. We should keep an eye on the girls, she told us, and consider revisiting a speech therapist if they didn’t appear to be making any headway after a while.

My husband and I think that we’ve given it long enough, and both girls’ ‘r’s are still very baby-like. At this point, speech evaluations are often conducted through the school district, so we need to ask both their classroom teachers what they think of their speech before we go hunting for yet another speech therapist.

If you’re curious about what precisely goes on in a speech therapist’s office, feel free to peruse the detailed tales of feeding therapy and speech therapy sessions on my personal blog.

Sadia and her 5-year-old girls, M and J, do their talking, lisps and all, in El Paso, TX, much to the exhaustion of her soldier husband. They try not to talk while eating, but it’s tough when there’s so much to say. They are happy to report that chewing challenges are no longer to blame for the length of conversations around the dinner table.

Share this...Share on FacebookTweet about this on TwitterShare on Google+Pin on PinterestShare on StumbleUponShare on TumblrShare on RedditDigg thisShare on LinkedInEmail this to someone

Preemie Medical Issues: Lung Function, and also Bad Teeth

Posted on
Categories Identical, Infants, Medical, PrematurityTags , , , , , 5 Comments

Our daughters, J and M, were born prematurely at 33 weeks gestation. Preemies make up 54% of twin births, compared to 9.6% of singleton births, according to statistics gathered in the 1980s. In my experience, conversations with parents or grandparents of multiples eventually turn towards the issue of prematurity, either its reality and the shared bond of the NICU experience, or how lucky some families are to bypass that rite of passage.

Our family’s experience with prematurity was a lot less scary than it could have been, although it felt devastating at the time. Neither of our girls needed help breathing, but they weighed under 7lb (3.2 kg) put together. Their Apgar scores were excellent, but they didn’t have the body fat they needed to maintain their own body temperatures ex-utero. They were released from the hospital over a month before their due date.

Looking at our vibrant, sassy, smart and downright hilarious five-year-olds, no one who isn’t in the know about twin birth statistics would guess that their birth held any unusual struggle. They’re short for their age, but so am I. My 5 ft 0 in (1.5 m) genes appear to have beaten out those of the girls’ 6 ft 7 in (2.0 m) great uncle. M and J have had only two lasting effects from being born before they were quite ready: a susceptibility to lung infections, and teeth missing enamel.

The lung infection issue came as no surprise. Our pediatrician and the NICU staff had warned us that lung complications were common in babies who began to breath when their lungs were still forming. Our insurance covered Synagis, the vaccine against RSV, a virus that gives you and me the sniffles, but can be fatal to a premature infant. I made the monthly trek to the one local clinic that dispensed the vaccines for the entire seven months of our girls’ first cold season. Their second winter, our insurance company deemed them out of danger. Sure enough, first J and then M came down with RSV. It was another three years before we were able to celebrate the retirement of the nebulizer that J used to ease the laboured breathing that kicked up without warning year-round.

The tooth issue, on the other hand, came as a huge surprise.

I thought we were doing everything right in the dental care department. We started using infant finger toothbrushes to massage the babies’ gums well before they had teeth. We added toothpaste when their first teeth broke through, and brushed morning and night, without fail. We brushed their teeth for them until they turned five, and gave them toothbrushes that they could practice with. Before M and J turned two, we introduced flossing, the the form of one-time-use kids’ flossers. To this day they consider going to bed without flossing unthinkable. Our pediatrician praised the girls for their dental hygiene. Even though I knew full-well that dentists recommended a first visit be scheduled at the sight of the first tooth, I put it off until the girls were three.

At their first visit, the dentist discovered cavities in both girls’ mouths. It turned out that both J and M suffered from enamel hypoplasia, or a lack of enamel on a number of their teeth. As luck, or more likely genes, would have it, our monozygotic daughters had hypoplasia on the same teeth. Their cavities were were also coordinated. Identical twins, with identical tooth issues, I suppose.

We left the dentists’ office with fillings, prescription fluoride toothpaste, and another reminder that however far away their premature birth feels, it keeps popping back up. At our next visit to the pediatrician, I told him the sad tale of the girls’ teeth, and he promised to pass along to the next preemie parents he saw the recommendation to get to a dentist soon. And now, I pass that recommendation to you.

Share this...Share on FacebookTweet about this on TwitterShare on Google+Pin on PinterestShare on StumbleUponShare on TumblrShare on RedditDigg thisShare on LinkedInEmail this to someone