4 Month Immunizations & 1 Mad Baby

We had a bit of a scare with LB this weekend. He went for his 4 month check-up on Friday and all was well, but AFTER he came home from the doctor, he wasn't quite himself. He was mad and crying (he's usually super happy and he hardly ever cries unless he's hungry or needs a new diaper). We suspected he was a bit fussy from the shots, so we gave him some Tylenol, but that didn't help either. He also started coughing and his nose started running. He was so mad that he would barely eat anything.

We weren't sure if the coughing and stuffiness was from all the crying or if he might have picked up a virus while he was at the peditrician, but the fact that he was barely eating was really concerning. Our instructions from the metabolic clinic are that if he eats 1/3 less than he normally does (they call this "the rule of thirds"), it is cause for concern and we should give them a call. All weekend long, we were practically force feeding the poor kid and he was within an ounce or two of the rule of thirds. I got nervous and called the clinic on Saturday night. They reassured me that he would be ok as long as he didn't drop below 20 ounces for the day (he normally eats 30-32 ounces). They also suspected the shots combined with a possible cold were to blame. We kept him dosed with Tylenol and reverted to our routine of waking him every 3-4 hours during the night instead of every 6, just to make sure he had enough nutrition in his system.

We had a couple of tough nights, but by today, he was right back on schedule. It's amazing how quickly kids bounce back from illnesses.

Four Months

Here is our smiley, happy guy at four months old!  Already one third of a year, so hard to believe.

We went to his four month appointment today and he is still doing great.  Developmentally, he's a little ahead and size-wize, he's making great strides.  He was 14 lbs 15 oz (50th percentile) and 25 inches tall (also 50th percentile), so he is catching up from his days in the 10th percentile.  Unfortunately, he got 4 vaccinations today, three injections and a liquid that he didn't enjoy drinking, so he was a bit unhappy, but we're glad that he continues to be strong and healthy!

Metabolic Appointment

We visited the metabolic clinic again this week.  This was LB's second appointment with them.  We did the usual things -- height and weight, a visit with the genetic counselor and a visit with the metabolic doctor, followed by a trip to the lab for some blood work.  In general, things are going really well.  He's growing and developing right on schedule and his weight of 6 kg means that we can let him sleep for 6 hours at night before waking him to feed him.  We'll have to keep to that schedule until our next appointment in October.

A couple new things that we learned at this appointment...

• Sometimes, kids with MCADD need a supplement of levo-carnitine.  Carnitine is a substance that removes toxins from your body.  Since people with MCADD can't break down medium-chain fats, their body treats those fats like toxins and uses carnitine to get rid them.  The problem is that they also need enough carnitine to get rid of the other, normal toxins in their body (don't know exactly what those are since I'm not medically trained, but anything that a normal person's body would use carnitine to get rid of).  If a person with MCADD can't make enough carnitine to take care of the normal toxins, plus the added fat toxins, an oral supplement of levo-carnitine is prescribed.  The oral carnitine can also be used in conjunction with polycose when a person with MCADD is ill (presumably to take additional stress off their system).  We were sent home with a prescription for carnitine and he has bloodwork done at every appointment that monitors his carnitine levels.  They told us that it's unusual for a child as young as LB to need carnitine supplementation, but that testing him regularly helps them establish a baseline.  They don't expect that we'll need to give him a daily dose of carnitine, but they want us to have it in our cupboard in case he ever needs it when he's ill.  Here's what it looks like...
• They can do DNA sequencing to determine which specific gene in LB's body mutated to cause his MCADD.  A portion of the test is covered by insurance, but there are some out-of-pocket costs associated with the sequencing.  It doesn't change his treatment, but it can give us a thorough picture of which gene is responsible.  Although not necessary, we opted to have the DNA sequencing done.  We figure it might add to the knowledge base about this disorder and that can't hurt.  Plus, they already took the blood sample when he was there for his first appointment, so it doesn't involve another poke.

Three Months

Where did LB's third month go? The days sure seem to fly around here. We’re already almost at 4 months and I still haven’t given his 3 month update! Because I am so tardy, I will include all of the things he did while he was enjoying his third month.

Month 3 was eventful…

• He now smiles, a LOT, and very socially which is tons of fun for everyone.
• He flew on an airplane for the first time, attended his first wedding, visited his first new state and his first foreign country (he has a leg-up on his big bro on this one since it was his big brother's first venture off US soil, too).
• He was finally convinced that his bouncy chair is entertaining. He can now kick and bounce with fervor instead of just looking forlornly for someone to come rescue him from the ergonomic, vibrating comfort of his seat (I kept telling him that adults would LOVE to have a bouncy seat like his).
• He experimented with new types of vocalization beyond simple cooing. He can now screech, squeal, giggle and seems to be performing some early babbling – I could have sworn he said “thank you” when I retrieved his lost pacifier a few days ago.
• He figured out how to hold onto things, his favorite objects to hold include – burp cloths (by far his favorite, he stares at any burp cloth you are holding until you actually give it to him and then he squeals as he puts it into his mouth), his ring of baby keys (I tell him they are the keys to Mommy’s heart and he smiles), his telephone rattle and his toy ball. He also really likes the grasping rings on his toy zebra and toy firefly.
• He loves to watch his big brother and he loves to fly with his Daddy. He always keeps an eye out for Mommy, though. I’m still his favorite person to snuggle with. I’m holding onto that one for as long as I can since I know how much more fun Daddies can be for little boys who like to rough-house.
• He has gained a lot of torso and leg strength as he can now bear weight on his legs (while we support him, of course) for quite a while. He often prefers to stand instead of sitting or being held.
• He became mobile. He can now roll from his back to his front…and he looks pretty darn proud of himself when he does it. The pride lasts for a few minutes before he realizes that he can’t roll back onto his back and he’s not very crazy about being on his tummy – MOMMY!! HELP ME!!
• He successfully weathered his first illness (coxsackie virus that causes hand, foot and mouth disease) without missing a beat on his feeding schedule and without needing any medical interventions -- woo-hoo! It was a mild case with only blisters on his hands and feet. The mildness of the illness was especially nice since it materialized two days before we were supposed to fly to Detroit for my brother’s wedding and we were concerned about 1) taking a sick baby on such a big trip and 2) potentially having to deal with hospitalizations in a different state. He did just fine and I feel like this gives us a little more confidence that he IS going to be a relatively normal kid.
• His food intake grew pretty steadily. He’s now up around 32 oz per day and some of those feedings are in 6 oz increments. We’ve switched to the larger bottles and to the higher flow rate nipples in response to his growing appetite.
• He continues to be a great sleeper and can fall asleep in practically any situation – noisy birthday parties, while hanging out on the bathmat as his big bro gets ready for bed, in the middle of a blanket while Mommy makes dinner (or dashes to prepare a bottle) and his big brother crashes around him with toys and books and other toddler antics. He can sleep for about a 6 hour stretch at night before we have to wake him, and most nights only involve one middle-of-the-night feeding.
• He continues to gain weight and is now sporting the 3-6 month wardrobe. The idea of hand-me-downs between the boys hasn’t been so successful thus far. Despite the fact that I packed away all of our older son's clothes as he outgrew them, the fact that he was so always so big for his age and LB is more on the small-to-average size for his age combined with the November and March birthday span has made us almost exactly one season off with clothing. I opened the 3-6 month clothing bin to find it is mostly long sleeves and cozy fleece sleepers when I really need shorts and rompers for summer. Oh well, at least he got to use the 0-3 month sizes for a while.  His brother only wore them for a few weeks before he busted into the 3-6 month sizes (as a 1 month old!).

Two Months

LB had a big day today. It was his two-month check-up! He was 11 lbs 11.5 oz (30th percentile) and 22 inches tall (10th percentile) with a 60th percentile head measurement. I was stunned. After the our older son (who was never less than 85th percentile on any measurement at any point in his life), I didn't think it was possible for us to have a 10th percentile kid. I know I shouldn't compare them because LB is completely entitled to do his own thing, but to put this in context, our older son was 21 1/4 inches tall WHEN HE WAS BORN, so this whole 10th percentile thing is a bit shocking for me. Oh well, at least he's getting use out of those 0-3 month sizes. He's also a healthy and happy little guy who is completely on track developmentally, so that's really all that we can ask for. Very thankful for that!

He is starting to do a lot more smiling and he almost has a laugh, but it's still not time for belly laughing yet (that's one of my favorite milestones). We can tell his cries apart and the cry for "feed me Mommy!" is the most emphatic, followed closely by the cry for "you have no idea how messy my diaper is right now Mommy!" He loves looking at the toys hanging from the shelf over his changing pad and the animal mobile hanging over his crib and he sometimes cries when you take him away from those spots when he isn't ready to leave. Sleeping is one of his favorite things to do, especially when he's in Mommy's arms for a nap. He's also a champion eater and usually packs away somewhere just shy of 30 oz of formula in a day (in 3-4 oz increments about every 2 hours during the day and about every 4 hours at night). We can now set the alarm for 4.5 hours at night based on his weight of a little over 5 kg (we could probably go for 5 hours, but we are trying to remain conservative just to be on the safe side).

Here are some pics of our big (in heart) little guy...

Failure and Acceptance

LB turned six weeks old yesterday. As I write this, I am thawing the final serving of breastmilk that he will receive. It has already been more than two weeks since he last nursed. Despite what I believe were my best efforts, breastfeeding lasted a mere four weeks and my freezer supply only another two. Writing these words pains me. I REALLY wanted breastfeeding to work. I tried VERY hard and I failed. I'm still working on being OK with it.

We seemed to do just fine in the first few days of LB's life, but things deterioriated very quickly. The MCADD diagnosis on Day 3 with instructions to feed, feed, feed him every 2-3 hours sent us into a panic. I erred on the side of caution and had the boy at my breast every 2 hours for the next 4 days not caring the slightest bit about the quality of his latch or the condition of my body so long as he was eating. That lasted until Day 7 when my nipples were so raw and painful that I could barely hold him close to me, let alone provide one more feeding. This is when the first case of mastitis set in, likely because of some combination of 1) the ugly condition of my nipples, 2) the stress of his diagnosis, 3) the sleep deprivation and/or 4) the stress of his delivery, in general.

We resorted to pumping and botttle feeding him with breastmilk exclusively until my nipples healed and that took about a week. At the point that I was gradually reintroducing him to the breast, I was still in quite a bit of pain as he nursed. It felt like I was dispensing shards of glass through my nipples instead of milk. After a consultation with a lactation specialist at the hospital, we discovered that I had a secondary yeast infection called thrush (likely caused by the antibiotics I was on for the mastitis). Subsequently, both LB and I went on medication to clear that up. It had only been two days since we finished the mastitis antibiotic and here we were -- already back at the pharmacy for more drugs...and yes, I was still doing a lot more feedings by pumping and bottling than I was by straight nursing which seemed such an institutional way to feed a newborn baby to someone who was used to nursing (I nursed my older son until he was 7 months old).

The first weekend of April was glorious. Not only did we have beautiful weather outside, I felt like the metaphorical clouds that were hanging over the nursing situation were also lifting.  LB and I were both a week into the thrush recovery and I was able to breastfeed him without biting my lip or curling my toes in pain. Finally! We achieved a healthy nursing relationship. Finally! I was able to conduct a night feeding in less than an hour and a half (how long it takes when you have to add the steps of pumping, sanitizing the pump stuff, bottling the milk, and sanitizing the finished bottle to the usual steps of changing a couple diapers, feeding, burping and rocking the baby back to sleep). I was SO happy. I thought we had made it out of the woods. After another week of finishing the thrush medication, we would be home free.

I was wrong. The mastitis came back the very next day.

As I was pacing through the house, holding LB akwardly away from me to prevent him from touching my very sore breasts, the reality of my situation hit me like a ton of bricks. I was spending so much effort trying to make breastfeeding work that I was missing everything else. My typical day consisted of pumping every 3 hours and feeding LB the pumped milk every 2-3 hours. This meant 20 minutes to prep, pump, store milk and clean my pump parts every three hours around the clock, followed by at least 20 minutes to prep a bottle, feed, burp and give LB his thrush medicine every two to three hours around the clock. In addition to that, there was a daily load of laundry to gather, wash, fold and put away and a twice daily regimen of sanitizing bottles -- both aimed at eliminating the yeast that was causing the thrush from our clothing and his eating vessels. In a single 24-hour period, I was devoting at least 8 hours just to trying (in vain, it seemed) to make this breastfeeding thing work.

The rest of my days were spent attempting to spend at least a little bit of time paying attention to my older son and my husband while also putting breakfast, lunch and dinner on the table for the family, keeping up with other necessary household chores (laundry, grocery shopping, dishes, etc) -- the other stuff like vacuuming and general tidying up were already out the window -- and getting a couple hours of sleep. In short, I was exhausted and that made me grumpy. That led to me feeling even more crummy and also quite guilty for not having the time or energy to spend any "quality" time with my boys or to really step back and enjoy the early days of LB's life. I was either missing it entirely or I was walking through the day as too much of a zombie to appreciate it.

I saw myslef holding LB at that moment (in my forearms, as far away from my breast as I could) and realized just how broken this situation was. The best part of breastfeeding for me last time (with my older son) was the physical closeness we had. We snuggled, we bonded and it was so rewarding. I knew that I wasn't establishing that same bond with LB because the breastfeeding itself was so physically painful that not only did I not want to nurse him, here I was holding him as far away from my chest and the beating heart that he undoubtedly found so comforting, as I could. The psychological guilt that I felt at that moment -- wanting to hold my beautiful, warm, snuggly baby and at the same time not wanting him or anyone else to touch me was THE WORST -- a dagger straight through my heart. I realized that I wasn't hugging my older son or husband tightly to me anymore either. This was all wrong!

Walking through the house that night, I was crying because I wanted breastfeeding to work so badly, but I was also crying because I knew that it wasn't working and that I needed to move on before it consumed me, threw me into depression and/or damaged the establishment/maintenance of a bond between me and my boys. In some respects, it was the hardest decision to make, but at the same time, I knew it was the only decision I could make. So much more was on the line here than just the uncomfortable stares I would start receiving from other moms as I mixed up a bottle of formula instead of donning a nursing wrap. This was my family and I needed to start feeling like a Mom again, not just like a walking advertisement for La Leche League. I needed to let go of breastfeeding and start hugging my kids and my husband again.

I visited the doctor the next morning for yet another course of antibiotics to clear up yet another bout of mastitis and I called the lactation nurses for instructions on how to taper off my milk supply. I was finished with breastfeeding.

It's still hard for me sometimes to admit that I failed at breastfeeding. It seems like such a natural thing, like something that automatically works unless you do something to break it and I must have somehow broken it for it to have been such an epic failure, but I know that I did everything I could. Every single doctor and nurse and lactation consultant that I worked with over the course of those 4 weeks told me that I was doing everything right and that they couldn't explain why I kept getting infections. They also all told me that no one would fault me for quitting if that's what I chose to do. They assured me that millions of babies eat formula and turn out just fine.

I wanted to believe them and I did believe them, but I also knew that I had to give myself permission to quit before I could move past the failure of it all and into acceptance. That's where I am now. I haven't pumped in nearly a week and my last trip to the grocery store included a sizable purchase of powdered infant formula. I have removed the nursing wrap from the diaper bag and packed away the breastpump.

LB takes the bottle happily and is thriving in every way. For the last two nights, he has woken up at around 4 a.m., not because he's hungry, just because he wants to be snuggled in my arms. I hold him close and he squeaks his little infant squeaks before closing his eyes and drifting off to dreamland snuggled against my chest and the comforting sounds of my heartbeat. We are bonding and I know that he loves me. I am happy.

My older son has returned to running headlong into me when I pick him up from the sitter and whenever the mood strikes him to come hug his Mommy. I can snuggle in bed next to him to read him his bedtime story without worrying about whether he is going to bump me in the wrong place during the unpredictable and exuberant wiggling as we get to his favorite parts of the book. We are back in a comfortable and affectionate place and I can return his love for me with great big hugs of my own. I am happy.

Of course, Husband has been uber-supportive of me on this from day one. He supported me in my efforts to make it work and he supported me in my decision to call it quits. He is getting his happy wife back because I am happy. Deep down I know that this is the right decision

Breastfeeding this time around may not have turned out the way I was expecting/anticipating, but it is what it is. As long as LB gets fed and snuggled, everything will be just fine.

One Month

It has been one month since LB joined our family...and what an eventful month it has been! We've had our share of hurdles -- both hurdles typical to those anyone would encounter as a newborn enters your life and a few unique ones on top of that because of his MCADD -- but, all in all, it has been a great first month.

We are so fortunate that LB is such a happy and cooperative baby. He likes to sleep, which is great. He must be doing lots of growing to always be so sleepy. He is starting to show some interest in toys and especially in the mobile over his crib. He gets very excited when the music plays and the animals dance around as he gazes up at them. He also likes to watch his big brother, which is fun for us to watch. He was laying on his quilt today and our older son was playing near him, sort of near his head.  LB practically rolled over since he was looking over the top of his head trying to keep an eye on his big brother.

LB has also been very tolerant of all of the affection bestowed upon him by his brother. He is the lucky recipient of many exuberant kisses and an endless supply of toys to play with. His big brother absolutely loves him and is the proudest big brother in town.

Husband and I are also adjusting pretty well to being the parents of two little boys. We go to bed tired at night, that's for sure, and we also go to bed feeling incredibly blessed. The fun is just beginning!