The joy of glop

About a year ago I started trying to give Talia “solids” - which is a crazy name for baby mush which is anything but solid! We called any mixed food that was more or less a puree “glop”. (Glop is the sort of sound it makes as it comes off a spoon and lands on a plate, or the floor. )

A year ago Talia was rejecting farex (and who can blame her?) We bought her a snazzy new high chair at the start of last November which was so big that we couldn’t use the tray because she just disappeared behind it. Here she is in early January 2008.

It took a while before her tongue reflex subsided and she started to enjoy a variety of home-made glop. I cooked up a storm, mixing veges with chicken, beef, fish or lentils. Talia grew steadily and I was so happy to have a baby who ate well.

Then just after her birthday, Talia decided she no longer wanted to be fed - the great spoon strike had begun. At first I worried a lot that she would starve, but thanks to some rapid improvement in her hand-eye co-ordination (one pea or corn kernel at a time), she was able to feed herself finger food and carried on growing.

Occasionally I would try to offer Talia food off a spoon, but my success rate was so low I didn’t do it as often as I probably should.

So today I decided to let her play with a bowl of custard and some spoons and see what happened. (She was driving me crazy anyway, so at least this gave me time to cook dinner!) At first she wouldn’t eat the custard, but enjoyed painting the tray of the high chair. Then she decided the custard wasn’t so bad after all, and fed herself as best she could - using the wrong end of several spoons, and then just trying to pick it up by hand. An entertaining half hour later, with custard spread liberally over just about everything, I decided enough glop had been consumed to call it a successful exercise in self feeding. And modern art.

Necrotising enterocolitis (NEC)

What is it?

Necrotising enterocolitis (NEC) is a condition where the bowels (intestines) become infected and inflamed. “Necrotizing” means the death of tissue, “entero” refers to the small intestine, “colo” to the large intestine, and “itis” means inflammation.

Why does it occur?

Most cases of NEC occur in premature babies, typically within the first 2-3 weeks of life and usually after the baby starts receiving milk feeds. The exact cause is not clear, but it seems to occur when a baby’s immune and digestive systems have not yet properly developed. An immature gut may have difficulty absorbing milk. If a baby’s intestines are weak due to low oxygen (due to the body prioritising oxygen to other parts of the body) or poor blood flow, then the stress of food moving through it may result in bacteria that would normally not cause any problems invading and damaging the walls of the intestine. In addition, a premature baby’s immune system may not be able to deal with the resulting infection.

NEC is less common in babies who are fed expressed breast milk rather than formula, possibly due to the anti-bacterial and anti-inflammatory properties of human breast milk.

Why is it a problem?

If a NEC infection becomes severe, it can cause serious damage to or holes in the intestines, and/or infection of the blood or the membrane lining the abdomen. This can be life-threatening in a tiny baby with an immature immune sytem. Even when a case of NEC is mild, doctors must stop milk feeds until the infection clears up, resulting in a baby failing to gain weight at a critical time in its life.

The lower the birth weight and earlier the gestational age of a premature baby, the more likely they are to develop NEC, and the higher their chances of dying from it.

How is it treated?
For babies who have mild to moderate NEC, treatment usually consists of
- “nil by mouth” - stopping milk feeds and using intravenous feeds (ie through a vein) while the bowel recovers
- a course of antibiotics, and
- removing extra fluids and gas from the intestine via a naso- or orogastric tube.
This treatment usually lasts between 3 and 10 days.

If the baby’s abdomen is so swollen that it interferes with breathing, extra oxygen or a ventilator may be used to help the baby breathe. If the baby does not improve with treatment, or if he or she gets a hole in their intestines, it may be necessary to use surgery to remove damaged parts of the intestines.

Unfortunately NEC is difficult to diagnose quickly, as the earliest symptoms can be quite general (eg apnoea and bradycardia, temperature instability) and vary depending on how severe the condition is. Later symptoms include a swollen belly. A diagnosis of NEC is usually confirmed via x-ray (showing air bubbles in the intestines) and blood tests.

Hospital staff try to minimise the risk of a baby contracting NEC by carefully regulating the amount of milk a baby receives, increasing the volume of milk slowly, encouraging mothers to express milk for their baby, and maintaining strict hygiene standards in the NICU.

Are there ongoing complications?

Most babies who develop NEC recover fully and do not have further feeding problems, but in some cases, scarring of the bowel may occur, particularly if surgery was required. This can lead to future problems such as malabsorption (the inability of the bowel to absorb nutrients normally).

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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.

Talia at 18 months

Doesn’t time fly? It’s hard to imagine that a year ago this gorgeous almost-toddler was borderline failing to thrive, and I was struggling with post-natal depression as a result.

Talia at 18 months

Now she’s a little above the 10th percentile at 9.33kg and 74cm long, and has made the move into size 0 and size 1 clothing. I pulled out her summer clothing from last year and marvelled how 000 could look so small, when at first we could hardly imagine she would ever be big enough to wear it. We’ve come through winter with only two minor colds, which is fantastic given that she left hospital with chronic lung disease.

Developmentally speaking, Talia still exhibits global delays, but they do not stop her enjoying life immensely. She is nearly walking, having taken her first few steps, but is happier crawling at the moment - including some new crab walking with her bottom in the air. She recently started baby swimming classes (known here as “synchronised splashing”) and hopefully that will help her core body strength as well as giving her confidence around water.

Her favourite activities at the moment are going on the swing in the park, reading books, playing with balls, pegs and balloons, popping bubbles, starting games of peek-a-boo and hanging out with her bath toys. She has recently grasped the concept of putting pieces into a simple jigsaw (no interlocking pieces) but doesn’t have the dexterity to complete it by herself just yet.

Talia at 6 months (3 corrected) - one year ago.

Eating is still patchy, with the same problems of “loved it yesterday, hate it today, don’t even bother tomorrow”, but she’s continuing to gain weight (and grow out of things) despite the fact that she’s almost 100% self fed on finger food and I’m no closer to getting her to eat off a spoon, regardless of whether I’m holding it or she is. On the positive side, we can feed her a little bit of whatever we are having and no longer have to rely on food organised specifically for her (although we still do to some extent), and we’ve moved from formula to cow’s milk in the last month without any problems - in fact she clearly prefers it.

She will sometimes allow us to brush her teeth but it does take quite a bit of persistence. She sleeps well overnight and has one nap in the middle of the day, usually 1-1.5 hours long. I wish she’d sleep longer during the day but no luck so far - her room is probably not dark enough.

All in all, a wonderful, easy-care baby, even if she came without a manual! We feel very fortunate, and very proud.

PREM milk bank is 2 years old

I’m not sure if they had an offical celebration, but the PREM human milk bank at King Edward Memorial Hospital in Perth recently turned 2 years old. finisterre.minti.com

Last year they held a first birthday party and invited all the babies who had benefitted from donated milk, including my daughter Talia. It was only a small gathering, but a big event for us as Talia was only 6 weeks corrected and I vary rarely took her further than a few blocks from our house at that point.

The Perth PREM Milk bank celebrates its first year

I was aware of the milk bank’s existence before Talia was born. I must have read about it when I visited KEMH for an antenatal appointment, and I remember thinking it would be nice to be able to donate milk to help other mothers. I had no idea that I would end up on the receiving end!

My milk came in very slowly, and without the assistance of medication would never have been enough to sustain a baby. However, before the medication kicked in, Talia’s requirements, minimal though they were, outstripped my feeble supply. One afternoon I received a call from the NICU asking if we would be prefer to use formula or donor milk. We had no hesitation in accepting donor milk, knowing it is much better for babies in almost any circumstance, and particularly when the baby has an immature gut. Talia received donor milk for about a week before my own supply caught up and I was able to take over myself.

I have read articles in magazines and online where women react to the idea of giving their milk to another baby (or having their baby drink another mother’s milk) with revulsion. However I can’t imagine they would respond that way if their own baby really needed that help.

The irony is that in the not-so-distant past, it was quite common for women to share their milk, without any worries about disease (which is carefully screened out in the donor milk bank). A lady I know, now in her 60s, told me that when one of her own children was just born she had abundant supply and would go to the hospital nursery and pump - and they would use her milk to feed all the babies in the nursery!  How times have changed.

Return of the spoon!

Talia has been doing very well eating only finger food, but at some point she will need to graduate to cutlery.  I decided it’s time I relaxed enough to let her practice using a spoon and not stress if it goes everywhere. She’s been putting a toothbrush into her mouth for the last week or two, and I figured a spoon shouldn’t be any more difficult.

So on Friday I let her loose with 2 spoons and a limited amount of yogurt in one of those suction-cup bowls. And it went really well! I was helping her load up the spoons, but she was putting them in her mouth herself (she really doesn’t like me trying to do it) and a surprising amount of yogurt actually went in and stayed in.

The next morning I tried the same thing and she threw the spoons on the floor - yogurt-o-rama!  Fortunately our sealed cork floors are very forgiving and easy to clean. Then in the evening we visited my parents, and I shared some dessert with Talia by passing small spoonfuls of icecream and lemon pudding, and she did a much better job.  (If you’re reading this Mum, please email me the recipe, it was delicious!)  

So I think we’ll be doing spoon training every day or two until she gets the hang of it, although I think the challenge will be more the food than the spoon!