Thursday, July 26, 2012

Our Six-Month, Not-So-Well-Visit

Michael had a six-month well-visit this morning, and I made sure that Tom and I were both there.  To add to the frustration I've regularly felt after each appointment, having gotten no answers or hope for relief, I always seem to think of one or two things that I forgot to mention when I get home.  It was my hope that if both Tom and I were present, sleep-deprived as we each are, we could fill in the blanks on what the other forgot.

The result was a lot of desperation and frustration pouring from both of our mouths simultaneously, as Michael's increasingly-overwhelmed-looking doctor looked on.

Mostly all he could do for us was offer his sympathy, and offer to try a stronger medication.  It has been my hope (and his, I believe) that we could avoid having to use anything stronger, but Michael is clearly still uncomfortable for a great deal of the time, and, even more concerning, is simply not getting the amount of sleep that he needs.

Most concerning, however, were the final numbers on his weight.  The scale settled at 17 lbs, 1.2 oz, bringing him down to the 38th percentile.  And that was with a fairly heavy diaper, which, in retrospect, I should have pushed the nurse to let us take off first.  When I felt the weight of it, removed from his body, it occurred to me that without it on, he may not even have registered above 17 lbs.

I should clarify now that I realize that these numbers do not sound bad, in-and-of-themselves.  And they are not!  Just below average, which accounts for a fairly large population of babies.  But this particular baby started out in the 80th percentile for weight at birth.  He had dropped to the sixty-somethingth by four months, and 43rd by five-and-a-half months.  His weight curve is trending towards a plateau.

In the meantime, his head circumference (16 inches), and height (27.2 inches- 67th percentile) look pretty good.  Because he is otherwise growing as he should, Michael's doctor does not think that the problem is a blockage.  But he does feel that we should, at this point, get a GI specialist involved.  So we've finally gotten a referral.

I don't know whether to be relieved or overwhelmed.  Michael will have to be seen by someone at either INOVA Fairfax or Children's Hospitals, and I've been lead to believe that there may be some wait-time involved in getting seen, since this will not be considered an urgent case.  Michael is, after all, still gaining, just not as quickly as any of us would like to see.

I called the number I was given as soon as I arrived home, but after waiting on hold for awhile, ended up leaving a message.  It is my hope that I will hear from someone by early tomorrow, within the promised time-frame of "one business day."  If not, I guess I'll be camping out on the phone for as long as it takes, to get something scheduled before the weekend comes and pushes back my opportunity to talk to someone.

In the meantime, I've had to make some hard decisions regarding whether or not to attempt supplementation.  After a long talk with a lactation consultant over-the-phone in an attempt to determine whether Michael's battles at feeding time might be indicating a dwindling supply on my part, she and I reached the conclusion that at least trying to offer some formula might be best.  Not only will I not know if it will help until I try it, it will be one more step that Tom and I will have taken to remedy the current situation by the time Michael is seen, which will give the GI specialist a clearer picture of where we stand if there is no improvement by then.

Breast-fed babies are notorious for refusing formula initially, and the smell of the Enfamil Gentlease that we settled on trying did not make me feel any more confident about my chances at getting Michael to take it, so I tried to pump some breast milk to mix it with while Tom took the kids for a walk.  All I could get was an ounce, and I had wanted to start with a 2/3 breast milk to 1/3 formula ratio, while having at least two ounces to offer.  I ended up doing one ounce each, and then adding an additional ounce of water, since Michael's been having some trouble pooing now that we've really gotten going with solids (he's up to 2 ounces of peas at dinnertime now).

To my great relief, Michael gulped it down.  And so far, has kept it down.  He's been sleeping for an hour now, and I pray that there will be no issues when he wakes.  Only time will tell.

I can't say that I'm going to enjoy the formula-breath that he's now sporting, though.  Never was a fan of that.

Despite his continuing tummy troubles, I have observed a growing streak of independence in Michael, which has been a wonderful relief as well.  More and more, he has been willing to spend little bits of time in the various activity centers we make available to him: the swing, the bouncy chair, the jumperoo, the playmat.

Tom played photographer the other day while Michael was in the jumperoo.  The focal points are off in a few of the pictures, unfortunately (he was snapping off a bunch in quick succession), but Tom still captured a few pretty great expressions.

He's also starting to really pay attention when we read to him, which, God willing, when things settle down some more, we can do more often.  I tried to take some pictures of him with Tom and Abby, but struggled with the lighting a bit.  I had to brighten these up some, and they're still a bit dark and uneven.

This led me to playing around with white balance/metering for the first time yesterday, with some- er- interesting results.

"Fluorescent" setting (0)- much too cool
"Incandescent" (0)- even worse

So, I put it back to where it was before for that last one- "flash" (also at 0).  That setting has been working well for me for awhile now, but I know that metering is something that is supposed to be adjusted for different conditions, and I'd really like to understand just how it works.  Clearly, I have some research ahead of me to do on that front, if I can ever find the time.

Which maybe might happen soon, if we can find some relief for poor, little Michael.  Let's hope he has a nice, looooong sleep tonight.

With the help of some new medicine, and (maybe) some formula.

In his new little bed.

Nah, pink isn't his favorite color- that's just the only sheet we have right now that fits.


  1. Hi, Sharon! It sounds like you are totally on top of things, but I wanted to share one thing that came to mind. My fourth breast-fed baby boy is now three months old and I did not know until my third baby that there is a different chart that can be used for breast-fed babies, but most pediatricians don't use it. Every one of my babies "fell off" their growth curve drastically around four or six months, like dropping from the 95th percentile down to the 40th. My pediatrician always told me not to worry since that just happens a lot with breast-fed babies. And then they all found their groove there and stayed around the 40th to 50th percentiles for weight while above the 90th for height. It sounds like Michael may have some other issues since you mention him being uncomfortable and not sleeping, so I don't know if this applies at all. But I'd rather say it and risk being way off than not say something that could potentially ease your concern. My boys are all also notoriously AWFUL sleepers, so I can empathize with you there, too! Again, good luck!

  2. To be clear, I should have said that when compared only with other breast-fed babies using the other chart, they wouldn't have appeared to fall off their curve at all.

    1. Beth, thank you so much for your insight. I'll admit that part of why this scares me so much is that my daughter was totally the opposite (though, she was supplemented from the beginning due to initial problems with latch). And though I know that every child is different, I can't help feeling (and it seems that Michael's doctor feels, too) that I should see a similar trend when comparing my two children. I do recognize that even two siblings may be drastically different, though.

      However, Michael's doctor did make a point of telling me that it was the Breastfed Baby WHO chart that he was using, and Michael is still falling below the curve on it. This is why he's finally sufficiently concerned to write us a referral.

      In the meantime, I'm still struggling with whether to continue supplementation. I think that breast milk, particularly in his situation, is really the best thing to be offering. I've just reached a point that I'm scared that one of the problems may be that somehow (despite going no longer than 3 hours without a nursing session, pretty much EVER), I may simply not be producing enough for him. And I just don't know how to confirm that I am...