Bigger and better adventures

Ages ago I read an interesting article about “wonder weeks“. Apparently babies go through predictable stages where they spend a period of time being fussy - unusually clingy and difficult - followed by a period of time when they are much happier after passing through a stage of development.

We’ve definitely had one of those wonder weeks! After several days of extreme crankiness, the last few days have seen Talia

- trying to walk dozens of times a day (whereas beforehand she went for days without trying) and usually managing at least 4 steps per attempt - sometimes up to 8.

- stacking boxes for the first time, including one 4 box tower. Previously she was only interested in destroying any sort of stack.

- standing up in the middle of the room (not pulling herself up on anything) for the first time

- scribbling for the first time (using an etch-a-sketch I bought second hand today)

She has been very pleased with these achievements, with lots of smiles and clapping, and as doting parents we are also very proud of her.

Well another month has gone by and my tiny baby is suddenly 18 months old!

After taking a few tiny steps 10 days ago, she’s decided not to bother any more with that walking business for the time being. But she’s spending more time standing without holding on to anything, and has recently taken up walking like a crab with her bottom high in the air, which is very funny to watch. She can climb up a gently sloping slide and at least 3 stairs, and can come down 3 stairs backwards too. She’s pretty good about turning around and coming down backwards from any sort of step or higher level (such as our bed). She does a lot of reasonably accurate pointing, and will occasionally wave bye bye (but usually not when someone is actually leaving!)

We’ve started baby swimming (synchronised splashing) classes and after 3 classes she’s just starting to relax a little and not cling to me like a limpet for the duration. I hope she’ll start enjoying it soon, as I love being in the water myself. At the moment she uses a little rubber ball as a security toy.

Her favourite activities are going on the swing and reading books. She is particularly fond of books with flaps. She also loves balls, balloons and bubbles, and taking a bath (not to mention her bath toys). I can see a bit of a B theme emerging here! She has also grasped the concept of putting pieces into a simple jigsaw (no interlocking pieces) but doesn’t have the dexterity to complete it by herself. She enjoys posting items into a home-made shape sorter, and playing with pegs. She starts and responds to games of peekaboo - it’s the easiest way to put a smile on her face.

Her spoken language is really minimal - lots and lots of fantastic babble but probably only 3 actual words; “boo” which means both ball and balloon, “woo woo” which means dog (woof woof), and “gat” or “tat” which means cat, cow, bird, elephant, giraffe or any other random passing object which is not a woo woo. Nothing to indicate mum or dad!! She can also indicate milk via sign language. STOP PRESS! Two days after I drafted this post she started using a new word: “dut” for duck.

However her understanding of new words is growing rapidly. I can ask her to find a particular toy (eg ball, balloon, peter rabbit, snugglebunny, etc) and she will go and look around the room and (mostly!) find the thing I ask for. The other day I said “where’s the Maisy book?” and she went to a stack of books and found the Maisy book which hidden underneath another book. (I was so impressed!!!) She has several “that’s not my XXX” books and they all have a mouse on each page. Now all she wants to do is point at the mouse when I read those books. Then today (gotta love this) I was reading a different book which also had a small mouse on one page. I said “Talia, where’s the mouse?” and she looked at the page but she couldn’t see the mouse, so she crawled over to That’s not my Dinosaur” and pointed out the mouse on the cover of that book instead!! She can also point out flowers and other objects she knows the name of when I ask her where they are. Even though I know it’s normal, I find it really quite amazing that she understands so much more than she can say.

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 (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).

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 1-1.5hours long. I wish she’d sleep longer but no luck so far - her room is probably not dark enough.

We’ve just come back from a short trip to visit family in Sydney, and she was marvellous apart from the flights - she threw up on both of them (eeeewwwwww) and also threw the most ENORMOUS tantrum on the way back - easily the worst behaviour in her entire life. I did feel very sorry for the people sitting around us! Then she did a similar thing before we put her to bed. I know she was tired but this was so over the top… I think the “terrible twos” may have arrived early.

Last but not least, her latest statistics: 9.335kg and 74cm in length. Something above the 10th percentile in both cases. She is now in size 0 clothing, size 1 if it’s an all-in-one including toes.

Both parents are very proud!!

Time flies when you’re having fun, and Talia certainly seems to be enjoying herself!

In the past month her crawling has reached warp speed and her cruising is also very good. She pulls herself up on just about everything and anything and will walk while holding on with one hand (although she prefers it with two).

She finally realised it was quicker to go down the step backwards than to sit at the top and call for help, and as a result is now able to move all around the house. She’s also applied the going down backwards knowledge to new steps in other locations, which is good, but isn’t too sure what to do when there is more than one step, which is all we have at home.

A big achievement for the last month has been the development of pointing and waving. Her pointy finger is not the most accurate, but it’s getting better, and the waving is a bit sporadic too - but it’s still pretty exciting for us!

We’ve just started the transition to cow’s milk, and that has gone very well. When I first tried giving it to her several months ago she didn’t seem to like it at all, but now she’s very happy to drink it straight from the fridge, and I’m only making up formula first thing in the morning and last bottle of the day (so probably less than 200ml in total) to give her the benefit of the various vitamins etc that are part of the formula.

As far as eating goes, we haven’t really made any great progress. Talia will occasionally eat a small amount of food from a spoon, and sometimes put the spoon in her mouth by herself, but not often. I’ve given her a small amount of food and a spoon and left her to play with it and she hasn’t wanted to actually eat any of it at all. She still loves to eat beef sausage, peas, corn kernels, and beans, plus a bit of pasta and rice. She’s OK with toast for breakfast and will usually eat bread spread with avocado or pate. I had been buying a range of baby snack foods because I was tired of making things she wouldn’t eat, and for a while she was happy with Heinz muesli bars and cheesey breadsticks, but has now abandoned them too. So I’m back to doing a bit of baking and she is currently happy to eat some biscuits and slices I’ve made. Her weight is still around the 10th percentile or just above it, so I’m not at all worried about it, but I wish she would eat a few more “normal baby foods” like fruit or yogurt, neither of which we’ve had success with.

Talia still doesn’t have any real words, but has a fantastic range of babble sounds (used indiscriminately) and will sometimes copy sounds. I took her into a pet shop and showed her some fish in an aquarium, and when I said “fish”, she said “vish”, which was cute. She still makes a noise which could be interpreted as “cat” when she sees our cat, but she uses the same sound at other times when the cat is absent, so I’m not convinced. She hasn’t picked up any more Auslan signs either, and for a while even stopped using the one sign she had started to use (”milk” which she uses to mean “I want it, give it to me”).

In terms of play, she’s discovered the joy of going up and down the slide. She can almost put in a puzzle piece. Of course she still loves her books, especially the ones with flaps. She gets quite excited by new things, or seeing people she hasn’t seen for a bit, and squeals with excitement. She starts a lot of games of peekaboo and can be kept amused for ages if you have the stamina to keep playing!

We have fully transitioned to one sleep per day. Unfortunately it’s not particularly long - an hour or an hour and a half if I’m lucky. But it seems to be enough to get her through the rest of the day, and if she is too tired then we just put her to bed by 7pm instead of the usual 7:30pm. For a while she was getting very upset about going to bed and crying so much she threw up, but now I put her in sitting down and it seems to be better - she can still get upset sometimes but it’s harder to throw up.

She can also be quite difficult when I’m trying to change her nappy or get her dressed/undressed, but I’ve managed to stop it getting out of hand. I have a change table toy which she doesn’t play with elsewhere, and that is often enough to distract her. I also try to change her clothes while she’s standing up, as that seems to be less distressing to her.

And just a few stats: 9.03 kg; 72.0cm long; head circumference of 47cm … and 11 teeth

Just a quick post with Talia’s latest achievements…

Since her 12 month corrected paed check up, Talia has started:

- walking behind a cart

- climbing up and down steps (only one a time as our house doesn’t have a staircase)

- responding to a simple command to give me her cup, which was previously always dropped over the edge of the high chair

- recognising some words - she will, if asked, go and find some of her toys which she knows by name

- making a few new sounds - like ta ta ta, and something that sounded suspiciously like her name - Ta-ee-ah

- hugging some of her toys

 DEVELOPMENTAL REVIEW OF:
NAME: Talia
DATE OF BIRTH: 20/03/2007 EDC: 20/6/07

SEEN IN.-THE KEMH DEVELOPMENTAL ASSESSMENT CLINIC ON 25/06/2008
Talia was seen for developmental assessment today as part of the neonatal follow up programme. Talia was born at 26 weeks gestation weighing 855gm and is now 15 months of age equivalent to 12 months corrected age. Neonatal details are shown on the discharge summary. Features of note included: Chronic lung disease requiring supplemental oxygen and CPAP for a long time. Normal cranial ultrasounds, no IVH, no retinopathy of prematurity.

RECENT MEDICAL HISTORY
Talia has been healthy with no hospital readmissions since she was initially discharged. She is seen regularly by ophthalmology and they have no concerns. She has also been seen in audiology for hearing testing - there has been some middle ear Eustachian tube dysfunction and she is due to be reviewed again for hearing testing. Immunisations are up to date. Health is otherwise satisfactory.

DEVELOPMENTAL PROGRESS
Talia has demonstrated developmental delay across all skill items at each of her developmental reviews, however she is beginning to make some considerable gains and her parents are pleased with her progress. She has now been crawling on all fours for about a month and did not ever commando crawl. She pulls herself up to standing and is cruising around the furniture and will walk when she is led with fingers. She does not yet walk behind a trolley toy and is very reluctant to climb up any steps or pull herself up over a ledge or onto a sofa. Hand preference is not yet clearly established. She claps hands in imitation but is not yet waving ta ta or pointing at objects of interest with her index finger. She can pick up small objects with a bilateral pincer grip. She does not yet use any words specifically apart from possibly cat and does not say mama or dada. She, however, responds to her own name, enjoys music and singing but does not vocalise to herself with this. She does not consistently shake her head for no. She is normally a very placid and happy little girl. She is not particularly affectionate, however plays interactive games and helps with dressing. She fingerfeeds herself and can drink from her own sipper cup, is not yet using a spoon. She sleeps right through the night and has two short daytime sleeps.

ON EXAMINATION
Talia’s height was 70.1cm (3rd-10th percentile), weight 8.56kg (10th-25th percentile) and head circumference 46cm (50th percentile).Talia is now well established on the percentile chart and tracking along the percentile lines.

A Griffith’s Test (Revised) was carried out, with the following results:
A Locomotor 31 - 10.25 months
B Personal / Social 35 - 11 months
C Hearing / Speech 26 - 9.5 months
D Eye / Hand Coordination 31 - 10.75 months
E Performance 31 - 11.25 months

Age Equivalent 10.5 months

During testing Talia was beginning to demonstrate concept of object permanence and roll a ball in reciprocal play. She currently drops a cube for a third, clicks bricks together and is starting to put blocks in and out of containers in play. She made attempts to play with the formboard puzzles but was not able to complete these. She was trying to replace the bricks back in the box and demonstrated normal fine motor dexterity.
Neurological examination shows no evidence of focal neurological signs or asymmetry. She has normal muscle tone and power but reflexes were difficult to elicit. Parachute response was symmetrical.
General examination of cardiovascular, respiratory and abdominal systems showed no abnormality.
Normal female genitalia. No birthmarks or scars of note.
Vision was assessed using Stycar mounted balls and she followed diameters down to 2mm suggesting normal visual acuity.
Hearing screening was carried out using visual reinforcement audiometry and this produced prompt responses on either side at 25dB level suggesting normal auditory acuity. Tympanic membranes and Tympanography were not done. Dentition was normal.

At just 12 months corrected age, Talia is making satisfactory developmental progress following her extremely preterm birth and low birthweight. I think she would benefit from involvement of Play and Learning and understand that she has also been referred onto CDC Physiotherapy for monitoring of gross motor skills in recent months.
As part of the neonatal follow up programme Talia will be seen on a regular basis until school age and the next anticipated review is at 2 years corrected age at the State Child Development Centre. I would be happy to review Talia again in 6 months to monitor her developmental progress should there be any concerns in the meantime.
DR XXXX Developmental Paediatrician

Happy one year corrected Talia!

This evening I am pleased to report independently verified (ie Daddyfeatures saw her do it too) cruising along the footstools.

The cat is looking increasingly worried at these new developments in mobility!

As I said in an earlier post, the longer you leave between blogs, the more things you have to talk about. Talia has been making fantastic progress in the past few weeks.

• Since crawling (her technique is beautiful), she has worked out how to pull herself up on the footstool we use as a table for one of her favourite toys, and is also trying to pull herself up on a few other things (like her mother, for example!)
• In just the past few days she has also started to be able to sit herself down from a standing position in a slightly more controlled fashion than in the past, when she just put her bum backwards and let gravity take its course.
• She has started to put blocks and balls IN to a box, not just take them out.
• She will put blocks and balls through posting holes in a home-made shape sorter (with a bit of encouragement)
• She can post balls and push buttons to make the music start on her favourite toy.
• Much to my delight, she has started giving the hand sign for milk. She uses it to mean “I want” or “give me” and it doesn’t always refer to milk, but it’s a major step forward and one I am very pleased about.
• She will give me an object if I ask for it and point to my open hand. (I have to stop myself signing for milk at the same time!!)
• She’s banging two objects together more frequently, which is (hopefully) a precurser to clapping.
• Her babbling is coming along nicely, with lots of nan-nan, although sadly (for me) no mum-mum since the first week she did it.
• Tooth number 6 is now through, so she has four along the top jaw and the 2 middle ones in the bottom jaw.

We are now trying to encourage her to cruise along 2 adjacent footstools. At present her hands move along but her feet stay planted. We also encourage her to walk while we hold her hands, which leads to some fabulous “ministry of silly walks” exercises.

The doting parents just got even dottier…

Talia has been having some extra physiotherapy to help with her gross motor skills and in the past week it seems to have really come together for her.

At 6 months corrected she was able to sit, lean forward, and roll from front to back, but then she failed to make any significant progress for several months.  She couldn’t move out of the sitting position, or off her back.  At 9 months corrected we started the physiotherapy, and within weeks she had started turning to the side, an important first step in being able to shift her weight from her bottom (while sitting) onto all fours (ready for crawling).

Now, at nearly 11 months corrected she has finally started to pull herself up (not successful yet but definitely trying), she is rolling from back on to her front, she pulls herself onto all fours from both a sitting and a lying position, she is starting to rock on her knees and looks like she will crawl very soon.

Today I held her hands and she was able to take a few wobbly steps with very little assistance.  We have her 12 month review coming up in another 5-6 weeks and suddenly I feel confident that we won’t be a complete disaster in the gross motor skills department after all!

I have lots of warm fuzzy mummy feelings today.

Physiotherapy is one of those emotionally fraught issues for a parent. You know you are doing the right thing by giving your child extra help to reach their physical milestones, but at the same time you still feel fragile and vulnerable because your baby isn’t making progress like everyone else.

When it was first suggested Talia have physio I was ready to burst into tears, even though I knew she was lagging behind her peers. When she made early progress and sat by herself, I was very proud, and assumed we were over that hurdle and wouldn’t need to go back. Unfortunately a few months later the original prognosis came back to haunt us - her development was very patchy and would only lead to frustration as she matured mentally but was trapped physically. She could sit all day like a buddha, surrounded by toys, but nothing on earth would persuade her move from where she sat. If a toy was out of reach, so be it. Shortly after her birthday four weeks ago we resumed one-to-one physio sessions at the hospital to help Talia develop the skills she needs to be able to reach, turn, crawl, stand and eventually walk.

Two sessions of physio (plus plenty of practice at home) later, Talia has steadily improved her abilities, and now does things other babies (and their parents) take for granted, but which were entirely new for her: playing with a toy using both hands on the same side of her body; turning to the side over her knees and raising her bottom off the ground; moving her body so she is on “all fours” (although she usually slips down onto her tummy); turning and reaching and then bringing herself back to a sitting position; pulling herself up to standing while holding my hands. With help she can put weight on her knees and will occasionally start rocking in a way which some babies do before starting to crawl.

Today I went proudly to the monthly group physio session, knowing that Talia would be surrounded by ex-24 weekers who are crawling like Olympic champions but glad at least that she no longer spends these sessions just lying on a mat crying, and hopeful that she might have crept up a little on the development chart. (Yes they have percentile charts for development too, not just height, weight and head circumference!)

The physiotherapist who saw us was very pleased with her progress - but regretfully showed me that Talia has in fact slipped lower on her development chart due to the very erratic nature of her progress. I am making up an example here, but apparently most babies develop skill A (like rolling) before skill B (like sitting) before skill C (like pulling themselves up on furniture) before skill D (like standing confidently with support). Talia has decided to do B before A, and D without C. So from the physiotherapist’s perspective, she still has a long way to go. In contrast, my mother has been overseas since we started the extra sessions and will no doubt be amazed to see how far Talia has come in 5 weeks.

The hospital provides physiotherapy only until their NICU graduates are 12 months corrected, which in our case is only 2 months away. So it will be interesting to see how much more progress we can make in the next 8 weeks, before we are out on our own.

Today was my birthday (old, even older than when I was pregnant and didn’t people go on about “advanced maternal age” even then!) and also the date of Talia’s 8 month check up.

As before our four month check up, we were sent a questionnaire to complete in advance of the appointment. In contrast to the previous time, we were delighted to be able to tick “yes” to many of the questions, including almost all of those relating to fine motor skills. She can pick up items as small as a sultana. There were still a few “not yet”s, including two of the gross motor skills - rolling and crawling. However we are much less worried about Talia’s development overall than we were 4 months ago, when she was clearly showing delays in many areas.

The actual meeting with the paediatrician was relatively short, and he told us that he considered all her development to be within normal ranges, with the possible exception of her speech development. Talia babbles happily, but doesn’t use many consonants. It might be that she is not hearing everything clearly, so he arranged for us to see an audiologist to double check Talia’s hearing. Of course it might just be that she is taking her own time - the same way she has been setting her own timeline for other milestones.

In the waiting room we met up with Talia’s boyfriend Reuben who was born the same day, at a similar gestation. He has always been bigger, and now at 8 months corrected he is around 10kg, has been crawling for weeks and is already cruising the furniture. In fact he is doing better than the full term babies in my mothers group who are the same age!

Talia herself is almost 7kg - 6960g to be exact, and nudging the 10th percentile. Four months ago she was only about 4.5kg and so far below the 3rd percentile that I was stressing myself into a state of depression. Thank goodness times have changed and all for the better. Her length is a little below the 10th percentile, although with the amount of wriggling going on I’d be amazed if they actually took a correct measurement. Most amazing though, was the head circumference. This has always been bigger than anything else, but when I put it on the chart after we returned home I couldn’t believe it - 90th percentile, up from less than the 75th. I guess those brains will come in handy, especially if she turns out to be as bad at sport as her parents.

As I’m writing this post it’s the end of the day and I’ve blown out a candle and made a birthday wish - to see my daughter continue to grow happily and healthily, and tick off all those boxes as “yes” eventually.

Hip hip, hooray!

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This post was originally written for the main LAP blog and can be seen at http://www.lilaussieprems.com.au/blogs/02/our-8-month-corrected-check-up/