Wednesday, June 18, 2008

Developmental Update

Today we had the pleasure of taking the boys to the neonatal follow-up clinic. Since they both had a stay in the NICU, they qualify for a program to be seen at 4 months, 8 months, 18 months, and 36 months (adjusted age) in order to see how they are progressing. This is a more in-depth assessment than their normal doctor's visits and it was SO neat to get some real help and advice regarding their development!

First we met with the occupational therapist, who worked with the boys on the mat, assessing their motor skills. Though they are six months old, she was comparing their abilities to other typical four month olds. Caleb passed with flying colors and in fact she said that he seemed even more advanced than a 4 month old would be. This doesn't surprise us as our little Caleb has always been determined to move even from day one in the womb!

Daniel was more typical of a four month old with his motor skills. She was a little concerned about his range of motion in his neck and debated whether or not to wait to see him until 8 months or to do a re-check at 6 months (adjusted age). In the end, she decided to re-check him, so we will go in again in 2 months just to see how he is doing. She also told us that both of them have slight flat spots on opposite sides of their heads and have a "favorite side" to turn their heads (hence the flat spots). Part of that is my fault because Daniel is always on the right side of the crib and lays on his left side to look at the mirror (left is a little flat) and Caleb lays on his right side and plays with the keyboard (right side a little flat). She told us to encourage them to look the opposite direction of the flat spot more often and also to help them tilt their heads differently to to assist in getting air to the areas around the neck that were really red. This ultimately gives them a fuller range of motion for their head control.

Also, she advised us NOT to put them in the exersaucer or a jumper too soon or for too long (only 10 minutes at a time) as it does not encourage their trunk muscles to work properly. I wasn't aware of this! Apparently, when the trunk muscles aren't developed yet, they will balance themselves by using other muscles and won't get the stabilization of the trunk as well as if you used other methods to help them. For instance, when Caleb is in the exersaucer he locks out his legs from time to time and is stiff as a board (an indication he isn't using his trunk properly) or he lays back in the seat with his back slumped (also not good). She said she wanted their backs to be straight when sitting up in your lap and to aid in that you put them between your knees and really give them a good foundation, so that they are then free to reach for toys in front of them without feeling so unstable. She also gave us ways to hold them to encourage better trunk muscles (different than just the traditional tummy time on the floor). It was very insightful! I wish I had known some of these things the first time around with Josiah!

I forgot to mention that at the VERY first, a gal came in to weigh and measure them. Caleb was 15 pounds, 6 oz and 25 1/2 inches long and Daniel was 15 pounds 14 oz and 25 1/2 inches long also. Compared to other 4 month olds they are in the 50th percentile, but when compared with other 6 month olds they are in the 10th percentile. This is making progress though for sure!

The next gal to come in was an RN who asked us a bunch of health questions about the boys and who also played with them a little bit to see how they responded to her. We had no real health concerns. However, we did find out from the occupational therapist that we should keep Caleb on his reflux medicines until a month or two after he starts walking. Apparently, the symptoms do die down at different stages, but as they start using their trunk in different ways the reflux can crop up again, and so they now advise to just keep them on the meds until they are walking upright more often.

Normally they would also have a social worker present next to ask us if we had any questions about insurance or other such questions, but she was absent today.

Lastly, the nurse practitioner came in and did a final overview of everything and gave us a bunch of handouts and things to take home and peruse. She also told us that one way to really know if your 4 month old is progressing well is if they flirt with people. She said a doctor who sees a lot of babies made that observation that flirting 4 month olds are usually showing signs of normal development. Incidentally, they indicated to us that both our boys are flirts and were quick to smile at them. Our little heartbreakers!!

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