Sunday, December 21, 2008

Afternoon update (Sunday 12/21)

The Christmas slowdown at the NICU continues: the team rearranged beds to take advantage of the lull in business, and now Max is in Ada's old spot. We're not sure how we feel about this. It's certainly a little disorienting. When Ada was in the spot, though, she had so much extra support equipment that her isolette was pushed out into the main space. Max's crib is tucked back into the bay, affording us more privacy, as well as giving the space a very different feel.

Carolyn went in this morning to make the 8:30 AM cares, and I spelled her at 11:00 AM. Max is still on a nasal cannula and seems to be thriving on it. He seems to be getting the hang of stooling, producing dirty diapers all on his own, without the assistance of Carolyn's knees-to-chest exercise program.

I spoke with the speech therapist. She said that they are not going to try Max with a bottle again for a while, certainly not until he develops a strong and consistent suck reflex. (To feed himself, Max has to get the hang of the complicated suck-swallow-breathe pattern.) The idea of teaching a reflex seems strange, especially one as basic as the suck. To me, it seems that nature would have hard-wired the suck reflex into the deepest parts of a baby's brain: what else could be more important? According to speech therapist S., breathing is more important. If a baby is in respiratory distress, he won't suck or root or do much of anything besides turn his attention inward and try to draw breath. It's certainly true that Max has very little respiratory cushion to fall back on. Although he does well enough when cradled gently, jostling him about just slightly can cause his sats to fall. As Max gets stronger, therefore, the speech therapists expect him to become more interested in sucking. Speech therapist S. encouraged us to stimulate Max's lips and tongue with a pacifier, and to introduce to his mouth whenever possible.

(Last night's head circ reading was 36.0 cm; the graph will be updated tomorrow night.)