Another CMH day

We spent the day at CMH for some follow-up appointments. First, they were giving away books in the waiting room, so that was fun. I got the impression they do it regularly, but that was the first time we happened to be there on give-away day. It was just like RIF from my elementary school days! Yeah for free books!

Our first appointment was with the psychologist as part of the developmental screen. The appointment consisted of the doctor giving Adele different toys and items to see how she'd play with them or react to them (nothing scary, of course!). There were blocks, rubber ducks, bells, a hoop on a string, etc. Then they moved to the floor to check out Adele's sitting and rolling skills (she's got mad skillz, yo!). Long story short, she is "lovely" and is absolutely appropriate for her adjusted age. No worries whatsoever. The only thing she said is that she would have liked Adele to be a little more vocal, but we assured her that usually wasn't a problem. I invited her to come to the house around 5:30 am when she's happily jabbering and screaming in her crib. ;) She also would have liked a little quicker response on some of the hearing tests on the left side (not formal tests like before, just ringing a bell and making other noises on that side to see how Adele would react). Adele DID react, just not quickly and not consistently. We mentioned the hearing tests we had earlier in the month and the doc said we could answer the question definitively and have a hearing test at CMH, but she didn't think it was immediately necessary. So, we'll play that by ear (yuk yuk) and think about it for later. We're at CMH often enough it's not like we'd have to make a special trip just for that should we decide we want to go that route.

We saw her pediatrician, Dr. Harvingson, after and that was a good appointment too. I think the main reason for this visit was to see how Adele was doing after going back on Prevacid. Thankfully, Adele gained weight well over the past month and is a full pound heavier than she was last visit. The doc wanted to see a 15-gram-a-day gain and Adele averaged 18 grams.

Some other highlights/points of interest:

• Our insurance reauthorized Adele's Neocate until her first birthday, 5/7/08 (which is rapidly approaching--eek!). Both doctors (Dr. H at CMH and Dr. Murphy at LFP) want her on formula/breastmilk until she's 15 months actual/12 adjusted. However, the insurance said they rarely authorize payment of formula past 1-year actual, AND they want her to try another form of food (breastmilk or other formula) before 5/7. If she tolerates it they won't renew her authorization. If she doesn't tolerate it then...??? The insurance company's recommendation was to put her on cow's milk at 1 year, but no way in heck that is happening. Introducing cow's milk will happen slowly and not for a long, long time.
• Because of the point above, we asked Dr. H. what she'd recommend we transition Adele to or try in the meantime. We decided that we'd start with breastmilk and fortify it with Neocate (since breastmilk is only 20 cals and we want her to still be on 24-cal liquid) and see how that goes. She also said we could try a standard Enfamil-type formula if we were feeling particularly frisky. Buying formula at the store like regular people?? I never thought that could happen. Of course there's no telling if our experiments will work, but I have faith!
• Because of the point above, we have to explore other thickening options. We can't take her off thickener entirely until she has another swallow study, and we still haven't made that appointment. (Dr. H. promised she would have them call us right away.) Unfortunately, the thickener we currently use for her formula doesn't work on breastmilk. The only kind that does is available only by mail-order or through home-health companies by prescription. (And of course it's twice as expensive as the stuff we currently use, that's available at our local Walgreen's.) So, Dr. H. is starting the process to see if we can get insurance to cover the thickener we need. They should be happy to do so since it would mean NOT having to pay for formula anymore, right? So, we'll see. If they don't cover it we'll just buy it ourselves--no biggie--but it would be nice to have that covered too. (I know, I know--I'm so greedy!)
• We're starting the first steps of "sleep training" for Adele. The psychologist mentioned that developmentally Adele should not still be waking up during the night. However since weight gain/formula volume intake is still a concern for her, we're not sure that we should encourage her to drop that overnight feeding. The hope, though, is that if we do drop the night feeding she'll make up for it during the day. Since she doesn't ever eat more than 4 ounces at night (or ever, for that matter), IN THEORY it shouldn't be too difficult to make up that 4 ounces elsewhere. Of course, we're talking about Adele and food and we know how she likes to defy all logic and common sense. ;) So, we may try to drop that feeding and see if she does okay without it. Of course, that means somehow getting her back to sleep in the night, which will be a struggle. Everyone is telling us that we should start putting her to bed drowsy and to let her soothe herself to sleep, even if that means a bit of crying. Unfortunately that "bit" of crying has been as much as 30 minutes the few times we've tried it. I'm still not sold on the idea, but the thought of a full, uninterrupted night's sleep is so very, very tempting. They assure me that letting her "cry it out" won't be psychologically damaging, but it's still hard to hear her be so sad when I KNOW picking her up would soothe her instantly. But that's the problem--she needs to soothe HERSELF, not rely on me or Steve to do it for her. So, the more I think about this, maybe the training is for the parents, and not so much for the kid? Anyway, I know the Goddess in Progress family is attempting this very thing in the near future, so maybe I'll let them do their experiment first and before I decide whether to jump in or not.
• We're slowly going to try to increase her feeds by a bit at a time to see if she'll take more than 4 ounces if it's there. The times when I'm CERTAIN she'll eat 5 ounces, she ends up leaving 2 ounces behind. The times when I don't think she's very hungry and only pour 4, she drains the bottle in no time flat and probably would have taken 5. I just can't win!

So yeah...lots of changes in store, some not so fun. I know if we can get over those first few days and weeks of resistance things should be better.

And for the fun stuff... We finally got a real highchair for Adele! Well, it's a space-saving highchair so it straps to one of our kitchen chairs, but it's better than the Bumbo. And so far, the difference in feedings in the two chairs is like night and day. In the Bumbo, Adele would twist and buck and practically rotate Linda Blair-style to get away from whatever we were feeding her. Now, in the proper highchair, she's comfortable and secure and so much more receptive to whatever is on the spoon. And she looks like such a BIG GIRL in her new chair. I think she ate twice as much fruit today than any of her other feedings prior. Woo! The doc said we could add in a third solid-food feeding now, but with all the other feeding changes in store for her, I think we're good with two for now. Don't want to rock her world TOO much.

Just a few highchair photos for your enjoyment:

It's a good thing I'm finally getting over my "babies with food on their faces" phobia, huh? Now I just need to work on my "babies spitting wet food into my hand" phobia. Ewwww....