Development

Becoming a Playground Aficionado

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London has discovered playgrounds. The closest one is just up the street. We went IMG_7500there months ago. I have the exact date written down somewhere, but since then, we have had to expand our known playground universe. Throughout the process, London has seemed to enjoy every playground we have been to, but I quickly developed preferences and discovered things about playgrounds that are quite different since I was last climbing around one.

And, of course, some things about playgrounds are still the same. For example, I am still too big for them just like I was too big for them when I was 12.

IMG_7504But the differences are many. Sand is often isolated to a small area of the playground or simply nonexistent. As a parent, I absolutely love this. London would probably prefer more sand, but she has tried to eat it and it has the potential to get places I’d rather not find sand in later in the day. Thus, I love it.

However, the common sand replacement is wood chips. In my opinion, better than sand, but not the best surface. There is a potential for slivers and, apparently, spiders. Spiders like wood chips. London likes the wood chips. Like sand, she has tasted them, but it is loads easier to get wood chips out of a baby’s mouth than sand.

So far, my preferred playground surface almost looks like concrete, but it’s soft and coated in rubber. It’s springy enough to ease a fall, but firm enough to support easy walking and running.

I think it is safe to say that London and I prefer Kompan playgrounds. They build some really sweet playgrounds. They aren’t the playgrounds of my late elementary years, which were starting to be too safe as our society became more litigious. Kompan playgrounds seem to have taken steps back from that fun-sapping trend. So far, our time on Kompan playgrounds has been plenty safe, but I love that they incorporate a lot of ropes and tall playground equipment. I love the potential for injury and risk, even if I still don’t fit well on most of their contraptions. That’s okay! London fits just fine and  every week we are trying out new playgrounds across Denver and finding out that our favorites consistently have Kompan printed all over the playground, a welcome site for this playground duo.

The Complicated Age of Preemies

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Home at last. London’s 4-month and 1-month birthday.

“How old is she?” The simplest of questions for parents of full-term babies to answer, but not so for parents of preemies because there are two answers for this one question.

At some point, a baby arrives so early that their actual age is going to be different from their developmental age. For example, my daughter, London, was born at 26 weeks gestational age, three months early. Her birthday is January 30, 2014. Her developmental birthday is May 4, 2014. This means London’s adjusted age is 11.5 months, even though she’s been with us for 14.5 months.

So how do I answer the question, “How old is she?” Well, sometimes I lie. If the person asking is asking because they are wondering why London is not walking and or talking because she’s the size of some two-year-olds, I lie and give them the adjusted age. By doing so, I direct the conversation toward the obvious and usually hear something like this: “My God, what a big baby.” I would much rather talk about how big my baby girl is than tell the person the truth and then have the conversation inevitably slide toward how London is, developmentally speaking, three months behind.

That said, I think most of the time I tell the truth and answer, “Almost 15 months,” because most people, whether they dwell on my answer or not, just aren’t going to say anything else. But I know, because I’ve seen it in their eyes, that when I say London’s real age some people look a little confused. I don’t know what they are thinking exactly, but it’s something along the lines of:

“Shouldn’t she look older?”

“She should be crawling by now.”

“She should be walking by now.”

“She should be talking more by now.”

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At seven and four-months old.

When I feel this reaction in people I know I could take the time and explain London’s two ages, but somehow just saying, “She was born three months early,” sounds cheap because I’m taking this huge, scary part of our lives and trivializing it in six words. Plus, the majority of people will not be able to comprehend what those six words truly mean. Getting stranger after stranger to comprehend that over and over again can be exhausting. I know, because I would make a casual effort to explain London’s prematurity to nearly everyone that asked. This was right after she came home from the NICU. Still on oxygen. Still rocking cheek patches. NG tube still snaking across her face. Understandably, those people who asked how old she was back then knew they were probably going to get something more than, “3 months.” But after a while, parents of preemies tire of going into the explanation thing. So, like parents of full-term babies we get back to basics with a simple, short answer, “Fourteen and a half months.”

Or am I going to say, “Eleven and a half months,” this time?

Oh hell, maybe I’ll just split the difference.

“Thirteen months.”

To the Internet, Not So Fast

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Back in 2007 I had a troubling sickness. It started with migraines, then it transitioned to the frightening Bell’s Palsy, and whatever I had did not stop there. I developed iritis (inflammation of the iris, which makes the whites of your eyes blood red and the photophobia can be unforgiving). I had partial hearing loss in one ear. Doctors ran me through a battery of tests. In a few months I had a CT, blood draws, many eye exams, an MRI with and without contrast, X-rays, and a flexibility test, where the doctor looked for signs of Ankylosing Spondylitis, a symptom of which can be stiffness and pain in the spine and neck.

The tests turned up nothing of concern, but the symptoms continued to give me plenty of reasons to worry. In between visits to the doctor I would sometimes have a lapse of judgment during which I logged onto the internet and did some self-diagnosing. What I found was terrifying. There was an encyclopedia of diseases and unheard of (to me) maladies that could, in theory, give me some of the symptoms I had. Brain tumors. Cancers. Crohn’s disease. Thinking about it all scared me. The doctors, I knew, were doing their best to give me an answer. For a time, I thought that their lack of explanation was a bad sign. When I was firmly convinced of this I went to the internet. Ultimately, what I found led to prolonged worry and who knows, maybe some of the symptoms would have gone away sooner if I was not giving them their unwarranted attention.

By 2008, all of my aches, pains, and inflammation were gone. Most likely a virus had attacked me and, my body, with some hiccups along the way, crushed it. However, if any of the symptoms had returned in the seven years since I would not have consulted the internet. I would have gone to a doctor.

To have this lesson in my back pocket heading into London’s bumpy start to life was an unexpected blessing. London’s actual and possible complications from prematurity were a tsunami of information compared to my sickness years ago. The first wave of preemie particulars and statistics hit even before London was born. While I was waiting outside the operating room a doctor came by and ran down a random list of possible complications. She told me 26-weekers have an 85% survival rate. This brief conversation introducing me to the challenges preemies face was similar to seeing the tip of an iceberg above water. The other 90% was below the surface, or in our case, through the OR’s double doors and on into the NICU. To borrow from The Lord of the Rings, it was “the deep breath before the plunge.”

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Upon your family’s arrival in the NICU, you might feel like you’re drowning. There are more people taking care of your baby than you can keep track of. There is a new procedure every day. Thus, there are results every day, results that must be explained to you, sometimes three or four times. In addition to that, there are a lot of unknowns and, regardless of how talented the NICU staff may be, no one can accurately foresee the obstacles ahead for your baby. The internet is not going to be any different. There, you will find many question marks and new and more dangerous preemie complications to worry about, even if your baby is not suffering from them.

As parents with a baby in the NICU, Kate and I felt like there needed to be a sacred part of the day, during which we would try to not worry about the next results from London’s latest blood draw or echocardiogram. Of course, to not worry is impossible. It is more accurate to say we carved out time in each day during which we would purposefully not heighten our worry. This time became essential to getting us through every month our daughter was in the NICU.

Seeking information or support online seemed to only disrupt any sense of peace and hope we had regarding London’s course of treatment. If it was information we sought, then it was to go down the rabbit hole again, entering a world where one complication, like a brain hemorrhage, could lead to hydrocephalus and, almost certainly, cognitive disabilities. At least, that is what the internet would like you to believe at times. And if it was support we queried, we discovered far more troubling accounts than our own, which led to more worry.

Very early on in our NICU adventure we discovered the very poor predictive quality of the internet. Thus, the net never became a source of information for us. We much preferred getting answers straight from the trained professionals who were taking care of our daughter.

I have used the internet for queries about preemies many more times since starting this blog than I did while my daughter was in the NICU. When I am using the internet to find a definition of a certain malady, it can be helpful and I am grateful for that, but the internet will remain a horrible diagnostician and a font of worry for parents with a baby in the NICU.

Born in the USA, Raised in the NICU

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London is a remarkably happy baby. She tolerates so much and cries very little. We hear this from nearly everyone London meets. I tell them I have a theory. For the first 3.5 months of London’s life she had medical professionals treating her around the clock. In addition to the diaper change, temperature check, and respiratory check every four hours, she was also interrupted with head ultrasounds, echocardiograms, at times shots, the placing of a new IV line, and physical therapy. This is the NICU norm. For the baby, they assume this is what life is like, this is how all babies live out their early days. So, what is crying going to do?

That is the attitude London embraced. To make London cry now, you almost have to give her an ROP exam. Her frightening start and all the procedures that it necessitated made her one tough babe. I like to think that most long-term NICU babies also graduate as super tough and tolerant little things, but I have a few reasons to believe that that is not the case because all too often nurses would tell us how amazing London is with a shot, for example, when she would barely cry for one second in response to the needle, but the boy next-door would wail for a couple minutes.

In a way, the NICU schedule of around the clock treatments or feedings continues when some preemies come home. Usually with full-term babies it’s the baby waking the parents up, but with preemies, it is quite often the parents waking the baby up. Whether it is a feeding time, a cannula check, a breathing check, or just a general are-you-alive-over-there check, London’s day and night were interrupted by her parents for quite some time.

Below are some pictures and a video that only give you a sliver of the stuff London and other preemies endure at the NICU.

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One of the less intrusive procedures, an echocardiogram when London was not even a week old. This one revealed a PDA, which was resolved over the two weeks following this echo.

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As London’s lungs strengthened, she was placed on CPAP. Of course, I loved the progress, but I had a strong dislike of CPAP because it covered up most of her face. It was nearly impossible to see both of her eyes from the same angle when she was wearing her snorkel-like attachment. It drove me crazy, but London, always so chill, tolerated it like a champ.

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An every four-hour checkup on London, one of her “cares.” This particular picture was taken during London’s three-chin phase of life.

It was May by the time of this echo. As you can see, it’s no big deal to her. She’s about ready to fall asleep mid-echo while nurse Eileen chats away in the background about how busy the NICU is that morning. We thought London was done with echocardiograms by this stage, but the doctor ordered another battery of tests to see why she was so tired and not eating. On this particular day, day 95 in the NICU, it was London’s peaceful state of mind that helped calm us down.

28 Weeks, Not Too Early to Start Reading

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Reading In the Night Kitchen, one of my favorites.

Posted near the hand-washing station at the NICU entrance is a sign promoting the NICU library. By the looks of it, they have all the classics: Goodnight Moon, The Very Hungry Caterpillar, and Guess How Much I Love You. However, even though I looked forward to reading to my kids, I was a bit skeptical about reading to a baby who weighs four pounds and is on bubble CPAP. How could I even concentrate enough on a kid’s book? How could she hear me over the noises of the NICU?

The skepticism did not last long. After so many hours next to the isolette I had to do something to keep my sanity. Kate and I started reading to London while she was still vented, pre-30 weeks gestational age. Too early? Yeah, but we sensed a theme with London, she wants to do everything early. Why not oblige her? Plus, reading is a love of mine and I want it to be for my daughter too.

We started with a book of Disney short stories. I introduced In the Night Kitchen, An Awesome Book (by Dallas Clayton, one of my favorites), and On the Night You Were Born. London not only was calm while I read to her, she satted high too. Her eyes would wander around, trying to find my voice. I was hooked.

But what do you do when you’ve read every kids book you own several times already? Easy, you start over if your kid is old enough to make requests. But London couldn’t so I moved on to magazines and novels. The New Yorker…why not? I started reading from The New Yorker app on my phone, but then began bringing the magazines into the NICU. The subject of the piece did not matter to London. As long as she heard my voice and could watch my mouth move and see my face we were making progress. I read about the origins of house music in Berlin clubs, Amazon’s effect on the publishing industry, and the start of Under Armour. Sometimes I had to whisper the words to her because they weren’t exactly NICU-appropriate.

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Introducing London to Middle Earth in the NICU. The Hobbit. Read April 21-May 7.

Done with the magazines, a novel was next. Having seen the second of The Hobbit movies just a week before London arrived, and not having read the book since my freshman year of college, I had a strong desire to read the book again. I read this one from my iPad. I would shut the curtain to London’s pod for a little privacy, pick her up from the isolette, sit down in the recliner, rest her on one half of the pillow and the iPad on the other, and start reading. We finished The Hobbit in two weeks, every word of it read out loud to London as she drifted in and out of sleep on the pillow in front of me. We finished on May 7. By May 12, I had selected the next book, Harry Potter and the Sorcerer’s Stone, which meant I was committing London to a lot of listening and, for me, a lot of reading, because you can’t just read one book in a series. Well, you can, when the series sucks, but I didn’t expect that to be the case with Harry Potter. I had never read more than ten pages of a Harry Potter book. Now we are 250 pages into the third book.

I guess all the previous paragraphs represent my attempt at telling you it is never too early to read to your kid. It is hugely beneficial. Even before London was “full-term” she knew my reading voice from my regular voice. Realizing this could not have encouraged me more. She even smiled in response to the sound and rhythm of the words when she knew I was reading to her. She still does. Sometimes she flails around on the floor in pure excitement at the sound of the words and the sight of the book. And at other times she rests in the mamaRoo, so intensely focused on the movement of my mouth that I can see the learning in her eyes. And when she falls asleep I stop at the end of the page so, together, we won’t miss a word.