9 Month Well Check

The trio had their 9 month well check. The entire family went since Jesse is on spring break. Jackson was especially grumpy and ended up falling asleep in the van. We knew waking him up would cause more difficulties, so Jesse stayed with him in the van while I took the babies inside. 

Their "6 month check" was a few days shy of 7 months. We're back on track now since the babies just turned 9 months old yesterday. In just over two months, each baby has gained over two pounds. James and Amelia weighed less than they did at their sick visit the other week, but that is because they were weighed wearing clothes and full diapers. They are always weighed completely naked for well checks.

James-17 lb, 6 oz and 2'5" 

The only concern I had with James is that he frequently coughs while eating. He mostly seems to shovel down food and eat so quickly, but there have been a few times where we've had to do a finger sweep and smack his back because he seems to be choking. She said she wasn't concerned yet since he wasn't aspirating on liquids. If it is a regular occurrence at 12 months, she will refer to a SLP.

Amelia-16 lb, 11 oz and 2'3"

My concern with Amelia is that when she is sitting up unassisted she does great for a few minutes, then suddenly falls over with no warning. She never seems to correct herself or try to catch herself. The pediatrician had Amelia sit up on her own until she began to fall over. She assured us that was normal for a beginning sitter and not to worry.

Madeline-13 lb, 5 oz and 2'2"

My questions regarding Maddie now extend to the neurologist and physical therapist. Nothing new was addressed. We were happy with her weight gain. Her reflux is manageable, though she continues to take Prevacid twice a day. The pediatrician did try to get Maddie to pull up to a standing position, which was ridiculous. We're aware that Maddie is on a different time frame, but the gap is smaller than it was two months ago. 

The trio had two vaccines (Prevnar 13 and Pediarix). They are now up-to-date on all vaccinations. 

Downtime and Flu Shots

It's no secret that I love being out and about.  When you're running errands, the house stays clean, the kids get a change of scenery, and I can interact with other adults.  Unfortunately, I like to stay busier than Jackson does.  It's taken me nearly three years to realize my introverted boy needs downtime to recover from an overly stimulating day.  After preschool, he sweetly asks, "You want to snuggle, Mommy?" He's perfectly content sitting on my lap while watching TV or being read to all afternoon.  Unfortunately, his three siblings demand my attention more. 

I had to take the babies for their second flu shot today by myself.  It really wasn't a big deal and if I had felt uncomfortable going alone I would have asked Jesse to take off work early.  The only thing I was slightly worried about was Jackson's unpredictable mood. Since their appointment was in the afternoon I knew I had to be careful not to exhaust Jackson so he would be my happy little helper. 

In attempts to preserve his energy, we had a very low key morning at home. Our day consisted of watching a lot of Umizoomi,

Even Amelia can't turn away

 tummy time,

 laundry,

Stuffing diapers is one of my least favorite chores.

and "car washes" (aka smearing shaving cream on a cookie sheet and running Jackson's cars through it).

When it came time for the babies' appointment, Jackson was eager to get out of the house.  It was pouring rain and so cold outside.  Jacks was very intent on dressing appropriately.

The receptionist had assured me when I scheduled the appointment that we would be in and out of the office in under thirty minutes. The pediatrician's office is one of those places that has multiple doors and winding hallways.  I didn't even consider using the quad stroller!   I opted to carry James and Amelia in their carseats and wear Maddie in the ergo. 

The nurse was amazing! She let me leave James and Amelia in their car seats and simply unbutton their pajamas.  All three fussed and screamed when the needle pierced their flesh, but no tears were shed.  I took these pictures AFTER their shots. 

Our fantastic nurse even carried James out to the van for me.  Jackson was a great helper opening doors for us. 

Jesse brought home pizza for dinner and we spent most of the evening on the couch.  Our brief outing did not expend enough energy as Jackson was obnoxiously loud and hyper.  He finally crashed after 8 p.m. 

6 Month Well Check and Cardiologist

The trio had their 6 month well check last Thursday (though they're really closer to 7 months old).  Here are the highlights for each child:

James-He weighed in at 15 lbs, 7 oz.  Neither the doctor or Jesse and I had any concerns.  James prefers putting weight on his legs and jumping than he does sitting or rolling over.  While looking in his mouth she said, "Those teeth are right there." James was especially silly and talkative throughout the appointment.

Amelia-Her weight was 14 lbs, 9 oz. At her last check we had expressed concern over a mildly flat head.  It has corrected itself now that she spends more time on her tummy or in a exersaucer or bumbo.

Maddie-She weighed 11 pounds even.  While she is clearly still the runt, she's holding her own.  All three babies gained around two pounds in the last two months.  The doctor was pleased that Maddie was putting on weight and has made excellent progress with trunk control.  She was concerned that Maddie is continuing to keep her fists closed and doesn't cross the midline.  For example, if Maddie has a toy in her left hand, she never puts it in her right hand.  People always comment on how sweet and dainty Maddie is because she always keeps her hands clasped together in front of her.  However, this is not developmentally appropriate for a six month old.  Our pediatrician referred us to get her evaluated and receive OT at home through early intervention services.

The babies had four vaccines each: DTaP, Hib, PCV, flu.  They go back in one month for the second dose of the flu vaccine.  At 9 months they will be caught up with all their vaccines.  (There aren't typically shots at the 9 month check, but we had a delayed scheduled.)  It took longer to sign permission the forms than it did to administer the shots, thanks to two very efficient nurses.

Unfortunately, the shots had an ill effect and all three babies were crying and ran fevers the following day.  At least one baby was up fussing every half hour throughout the night.  Amelia wouldn't keep any food down until mid-afternoon. It took until Saturday evening for the trio to return to their predictable moods and schedule.

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Maddie had her cardiologist appointment scheduled for Monday afternoon.  Scheduling the follow up was a headache in and of itself because the cardiologist was adamant that Amelia was the one with the heart murmur.  I assured the office that it was Madeline who had the echocardiogram in the hospital when she was three days old.  We finally tracked it back to original paperwork for"Baby C", which was indeed Madeline, not Amelia.

The cardiologist's office is located one floor above my MFM's office.  I felt all kinds of nostalgic navigating the parking deck, elevators, and corridors.  I was excited to listen to Maddie's heartbeat and watch the blood flow on the machine, just like when she was in utero.

The nurse, pediatric cardiologist, and ultrasound technician were completely smitten with Maddie's smiles and coos.  I don't think any of them ever made eye contact with me because they were so enamored by our sweet girl.  Before the appointment, my main concern was how Maddie's hands and feet turn purple.  Just like the pediatrician, the cardiologist also assured me that it was still typical for infants and was not a result of anything related to her heart.

The cardiologist could no longer hear the murmur and the ultrasound confirmed that the larger of the two holes has closed.  She does, however, have a PFO, which is a pinhole size heart defect.  Apparently, 1 in 5 adults has a PFO and most people with PFOs don't know they have one because they are harmless and have no symptoms.  He told me the only time it would be an issue is if she wants to go deep sea diving.  He also let me know that there are current studies about the correlation between PFOs and strokes, but there is nothing preventative or treatment for it. I'd rather not dwell on that possibility.

Maddie was very cooperative during the ultrasound.  I held her hand, not because she needed comfort, but because she kept trying to grab the cords.  The tech printed a picture for me and said, "Here's your first Valentine from her."

Four (Almost Five) Month Well-Check

We FINALLY had an appointment with a pediatrician!  I can't tell you what a weight off my chest this is!  After exhausting all our resources with pediatricians in our county, Jesse found a children's clinic in the neighboring county that accepts new Medicaid patients.  We filled out the paperwork on Tuesday, made the appointment on Wednesday, and went to the doctor this morning.  When calling to make the appointment, I kept repeating, "Now our insurance cards do not have you listed as the Primary Care Physician.  Are you sure that's okay?"  The receptionist asked for the phone number listed on our cards, put me on hold, and called them directly while I was on the phone.  She clicked back over two minutes later and said, "They gave us authorization to treat.  You're good to go."  Seriously???  Why the hell couldn't our former pediatrician have done that three months ago?  This whole thing has been a disaster, but praise God that we have proper medical care for our children once again.  Here are the stats:

	Weight	Height	Head Circumference
James	13 lbs 5 oz	25.75 in	16.3 in
Amelia	12 lbs	24.75 in	15.4 in
Madeline	9 lbs	23.75 in	15.2 in

I really appreciated the fact that the doctor made it feel like three separate appointments.  She treated each baby individually and reminded me not to compare the three.  She had read their files beforehand and was familiar with their brief history.  Here's a quick recap: 

James-no concerns, all is well.  We were given Vitamin D drops to give all three babies since they are breastfed. 

Amelia-I mentioned I was worried about her diaper rash and possible flat head.  The doctor told us that Amelia did have a mild flat head, but there was no asymmetry and it was not pronounced enough to require a helmet.  As far as the diaper rash, she just told us to use the lowest dose steroid cream when needed, but that her skin was likely just sensitive.

Maddie-Our obvious concerns were weight gain and reflux.  It has been nearly three weeks since Maddie has taken her Prevacid because the previous doctor would not refill her prescription without an appointment.  Our new doctor called in a prescription and we've already been able to give Maddie a dose this evening.  We were given samples of Similac Alimentum to supplement with that should be easy for Maddie to digest.  She is supposed to drink breastmilk as usual, but then we are to offer 1-2 oz of Alimentum after each feeding.  We go back in two weeks for a weight check.  If Maddie has not gained "adequate weight" despite medication and supplementing, she will be referred to a GI doctor. 

I also expressed concern that Maddie wasn't lifting her upper body during tummy time.  The doctor said she was delayed but exhibited great tone and neck control so she wasn't concerned at this point.

She also wrote a prescription for creams for Maddie's eczema, gave us prescription shampoo samples for stubborn cradle cap, and checked her heart murmur. 

The appointment was long and thorough.  Thank God Jesse accompanied me.  He kept Jackson occupied by walking around with him and playing in the lobby.  After 90 minutes, James was over it.  Mind you, this was before shots!

I had been concerned about delayed vaccination schedule.  The babies aged out of the Rotovirus, which I'm indifferent to anyway.  They had DTaP, Hib, and PCV vaccines.  They will have vaccines at 6 months and again at 9 months, and then be caught up.  Thanks to an efficient nurse, we had quite the assembly line going.

I think that's everything.  Now we just need prayers that Maddie gains weight and James and Amelia continue to thrive.  Hooray for healthy children.