Tuesday, March 31, 2009

9 month check up (at 10 months.)

It was mostly good.

He weighed in at exactly 11 pounds. 22 3/4 inches long. Of course, I never know what to think about length stuff because depending on the day and how cooperative Robbie is, he gains and loses and inch at will.

As soon as Dr. P walked in the room and said hello to him, he started screaming. As he's really quite friendly with most people, I was mildly horrified, but Dr. P was THRILLED. She said stranger anxiety is an "upper brain function" and should start between 6 and 8 months. (Keep in mind that he's not quite 7 months adjusted.)

He continued to scream with tears rolling down his face the entire time she examined him.

Being the world class mother that I am, I managed to walk out of the house without a pacifier so short of waiting for her to finish, I couldn't do anything to soothe him.

His physical exam was great. He's had a lump on his neck for a while and she confirmed that it's just a gland. (I'd asked about it in the hospital as well. But I wanted a 2nd opinion.) His head shape and size are excellent. (He's ALMOST on the chart for head circumferance, which also pleased her.)

She passed him back to me and watched to see if he calmed down right away. He did and that confirmed to her that he just didn't like her. And she loved it.

She asked what "things" he was doing and I was suddenly struck dumb and couldn't come up with his whole list of stuff, but managed to think of a few things and she was pleased.

We talked about the lack of rolling and she was pretty unconcerned. I explained that OT thinks he has the skills to do it, just no desire because it hurts and she thought that was reasonable. She managed to get him to sit up unassisted for a couple of seconds (he's REALLY wobbly.) and commented on how good his hand-eye coordination is.

I wish I'd have thought to mention how he's learning to turn his pacifier to put it in his mouth. That's a big one in my book.

She was also very happy to hear how well he's sleeping at night. We talked about his cat-napping during the day. (He rarely sleeps more than 20 minutes at a time during the day.) She said it's very common in babies that sleep as well as he is at night. That he may catnap even 4 or 5 times a day and it's fine. Eventually I can push him to stay awake through a morning nap to adjust his sleep/activity cycle, but for now it's fine the way it is.

Basically, she thinks he's right on track for his adjusted age. His gross motor delays are all attributable to his stomach problems and since we're already working with OT and likely starting PT soon as well, she's not concerned.

The only "bad" points were that he's too skinny. That obviously wasn't much of a surprise. She plotted his growth on the chart and it was pretty pathetic. So we discussed various ways of fixing it.

As I expected, she was more amenable to my way of thinking that GI has been. She thinks it's entirely possible that he just doesn't tolerate powdered formula well. She thought my proposals of trying liquid concentrate, increased volumes and added fats were all valid. She actually said she'd like to see him taking 28oz of breast milk every day. (He's currently getting 20.) I'm really not sure I can push him that far, but I'm certainly willing to try to increase it a bit.

And the "bad" thing that surprised me: Four more weeks of quarantine.

I had really expected to be released. Both of our NICU friends who see the same doctor were released. When I asked about it, she said that they are both larger and have more reserves. While RSV isn't a big concern right now, because Robbie is still so little, if he were to get sick at all (even a cold) he just doesn't have the stores to handle it and he's very likely to end up hopitalized.

So she wants us to work on bulking him up and giving it another month.

I won't lie- I'm bummed. I'd already mentally planned our first trip to the zoo. But he's worth it, so we'll stay home a while longer.

All in all, the good outweighs the bad by leaps and bounds. I'm calling it success.


P.S. All the pictures are clickable to be seen bigger.