6 months corrected and sitting!

Following a recommendation from the hospital physiotherapists, we have been putting more time into helping Talia sit. I started by sitting her up in a sturdy cardboard box, and more recently bought her a second-hand Bumbo seat, from where she can watch me hanging out laundry or pottering in the kitchen. I wedge her between cushions, toys and my legs, so that she can sit up and play without any fear of hurting herself when her balance fails and she pitches sideways or backwards. Or occasionally forewards, her head curving in a slow and graceful arc which ends as she kisses the carpet.

Up until last night, Talia always needed the support of an adult finger in her hand, or a leg behind the small of her back. Then, we noticed that she seemed to be leaning forward almost confidently, and we moved back, leaving space behind her. And she stayed sitting! She played with her toys, waved her arms around and generally behaved like someone who has been sitting for months, not minutes.

My husband and I were as excited as if Christmas had come already. I grabbed my camera and took a dozen or so photos - most of which were blurred due to Talia waving her arms or moving her head. Maybe she was doing a happy dance too!

Today, December 20, Talia is exactly nine months old, six months corrected. Halfway through one of the most amazing developmental years of her life, and we are as proud as parents can be.

This post (6 month update) was also placed on the main LAP blog, following on from Talia’s 5 month update, 4.5 month update and 3 month update.

First time on public transport

Slowly we are making use of what the real world has to offer, in a way that I would not have contemplated in the first few months after Talia came home from hospital.

Last Thursday we went shopping, catching the train half a dozen stops to a big retail complex. Talia was very well behaved, in what was probably the longest time she has spent in a pram. She was tired and cranky by the end of it, but I was really pleased to have finally gone clothes shopping, with the baby, for the first time since she came home. I didn’t buy anything for Talia - she is the lucky recipient of many excellent hand-me-downs from one of my best friends, who has a little girl a few months older. So I bought my friend a voucher for Pumpkin Patch - so that she can choose some nice new outfit which I anticipate will later become another fabulous hand-me-down.
Now I’m looking forward to doing it again!

Apnoea, bradycardia and desaturations

What is it?

Apnoea (pronounced Ap-knee-ah) is when a baby stops breathing for 15-20 seconds or more. Apnoea can occur in full-term babies, but is more common in premature babies, especially those born at less than 31 weeks gestation. It may occur while the baby is awake, but is more common during periods of sleep. The baby’s skin colour may become pale, purplish, or blue, and the apnoea may be followed by bradycardia. This is a slowing of the heart rate, usually to less than 100 beats per minute for a premature baby) because as breathing slows the heart rate also slows. You may find nurses often use the shorter “braddy” when talking about bradycardia. Some babies have “braddies” without any apnoea, but because the same things can cause both problems, the two conditions are often lumped together and referred to equally. A common term for apnoea with bradycardia is “As and Bs.”

Desaturation is a decrease in the percentage of oxygen found in the circulating blood supply. In premature babies a saturation below 85 is considered below normal. In most babies, oxygen is adjusted to keep the oxygen saturation at 92-96%. Desaturation is often the result of bradycardia.

Why does it occur?

The most common reason for apnoea and bradycardia in a premature baby is that the part of their brain which controls breathing (the respiratory centre) is immature and “forgets” to tell the baby to breathe. The baby may have a burst of big breaths followed by a period of shallow breathing or pauses. As the baby gets older, their breathing becomes more regular, and by the time they reach their due date this type of apnoea usually goes away.

Bradycardia will often follow apnoea, a period of rapid shallow breathing, insertion of a feeding tube, or an attempted bowel movement.

Less commonly, apnoea and bradycardia can also be caused (or increased in frequency) by other issues, such as infection, low blood sugar, patent ductus arteriosus (PDA), high or low body temperature, insufficient oxygen, etc. Bradycardia may also be caused by acid reflux. Medical staff will examine each baby to determine whether any of these issues are relevant to him/her.

How do I know if my baby has apnoea and/or bradycardia, or desaturations?
What happens if they do?

As apnoea and bradycardia are common conditions, premature babies (under 35 weeks gestation, or older if they are still on caffeine medication) are constantly monitored by machines that will sound an alarm if breathing stops or the heart rate drops below 100 beats per minute. Most babies will also have a device called an oximeter attached to a hand or foot to monitor oxygen saturation levels. If your baby has an instance of apnoea or bradycardia, this will be written in your baby’s notes, and the nurses will usually mention it to you if you were not near your baby at the time.

If the monitor sets off an alarm, a nurse will observe your baby to see if he/she is breathing, if there is a change in colour, or if the heart rate is falling. False alarms can occur in some babies. The nurse may stimulate your baby if they need a reminder to breathe, by patting or rubbing their arms, feet, back etc. If there is a change in colour, the nurse may give your baby extra oxygen.

How is it treated?

Apart from the continuous monitoring and patting/tickling as required, premature babies who experience apnoea and bradycardia may be given medication such as caffeine to stimulate breathing. In some cases a baby may require continuous positive airway pressure (CPAP) - a continuous flow of air and/or oxygen via small tubes in the baby’s nose to help keep tiny air passages in the lungs open. In very severe cases, the baby may need a breathing machine (ventilator or respirator) to help with breathing.

As babies mature, they are less likely to suffer from apnoea, bradycardia and desaturations. Cardiac (heart) and respiration (breathing) monitoring in the hospital will continue until medical staff are confident that your baby is no longer having any As and Bs. Some babies may require apnoea monitoring after coming home, and the hospital will advise you if your child falls into this category.

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This is one of a series of articles I’ve written for the L’il Aussie Prems newsletter under the heading of Premmie Health. Read my disclaimer here.

Café Finisterre

Corrected age: 5 months, 3 weeks
Weight: 5.555kg (yes, today has been brought to you by the number 5!)
Diet: breastmilk, formula, a smidge of vegetable mixed with farex and milk

We’re back with the solids, but not very convincingly. I’m starting to wonder if the tongue is a problem, so I asked the child health nurse this morning if it was abnormal for her to be sticking it out so much. She said it might just be a habit, or it might be the sign of an underlying problem - but she is not qualified to comment. So I’ll just have to wait and see.

I have a freezer full of orange icecubes - sweet potato, pumpkin and carrot. I’ve also discovered that orange coloured mush is really hard to wash out of bibs.

I wasn’t expecting to hear from the hospital until shortly before Talia’s 8 month check up in February, but today I received an “infant temperament questionnaire - 6 months” in the post. It is LONG - 95 questions! I intend to ignore it until later in the month. Don’t ask me what that says about parent temperament.

Physiotherapy

We went to our monthly group physio appointment at the hospital this afternoon.

I don’t know why it is, but Talia hates it. She transforms from a placid, happy baby into a wailing, uncooperative mess every time we go. I’m starting to wonder if she doesn’t like the smell or the lights - because there is nothing else I can see that is particularly different about the place, and she starts fussing even before we ask her to do anything.

I also find these visits stressful, partly because Talia is unhappy, and partly because it becomes ever clearer how far behind she is falling compared to babies of similar corrected age. She is 5.5 months corrected (8.5 months actual) and shows no signs of wanting to roll yet. She doesn’t automatically reach and play with toys, or bring her hands together often, and she doesn’t play with her feet at all.

Finally today they told me they feel she would benefit from one-on-one sessions in addition to the group sessions, so we will be starting in January. We are hoping to avoid the situation where she becomes frustrated because mentally she wants to progress but physically she is not capable.

Talia’s “boyfriend” Reuben also comes to these group sessions. Reuben and Talia were born on the same day, with only 2 days difference in gestation, but Reuben has always been larger. In the beginning Talia was 855g where Reuben was something over 1kg. Now Talia is 5.4kg and Reuben is a whopping 8.7kg.

It’s so cute to see them together!