Poop.

Day 23. National Blog Posting Month.

Poop.  Oh yeah, I’m going there.

The baby is exclusively breast fed.  He’s gaining weight pretty well (we just had his 2 month well-baby visit and is just shy of 11 lbs), he’s smiling now and watching everything that is going on around him.

The only thing he is not doing regularly …  you guessed it, pooping.

I think the last time he had a good poop was over a week ago.  It might even be 10 days, I’m not sure. In my sleep-deprived state, I’m not even sure what day it is!

You should have seen the horrified look on my mother’s face when I told her.

“Let’s give him an enema,” she said, seriously.

“Um, yeah, mom, no.”

Never have I been so obsessed with bowel movements than when I started having kids.  It starts with that first bowel movement after birth – meconium.  It reveals so much about the infant’s gastrointestinal system.  When it happens, it’s like everyone breathes a sigh of relief.  If it doesn’t – alarm bells sound.

If the infant is breastfed, then over the next 5-7 days the poop changes colour from the tarry black of meconium to the lovely shades of green to yellow.  An exclusively breastfed baby will have liquidy, yellow seedy poop.  (Feel free to Google for an image.)  Most breastfed infants, in the first month of life, will have a bowel movement several times a day.  By two months of age, babies may not poop for a week, sometimes up to 10 days, and this is still considered quite normal, so long as he is nursing well and gaining weight. [http://www.webmd.com/parenting/baby/the-scoop-on-baby-poop]

So, nothing to worry about, right?

Right?

Ugh. I really just want him to have one of these:

The pooplosion.

Is that too much to ask?

Keep It Loud!

Day 10.

An interesting article came across my Twitter feed yesterday.  I follow ScienceNews and yesterday, this article popped up:  “Too little noise is bad for newborns.”

Before I had kids, a friend of mine had twins.  I remember she emailed me from the local Starbucks when the twins were a few weeks old.  I couldn’t believe she was out and about already, nevermind at a coffee shop!  She said something to the effect that her kids were adapting to her lifestyle, not the other way around.  I wondered about the noise and whether they could sleep.  She said the noise actually helped them sleep better!

Growing up, I didn’t have a lot of exposure to infants and children.  My husband, on the other hand, did. At the age of 12 he was changing his nephew’s diapers.  He remembers his mother always saying how it should be quiet when the baby’s sleep.  When we had our firstborn, she spent the first few weeks of her life swaddled in a bassinet while we watched The Lord of the Rings Trilogy and struggled to stay awake during her feeds. [My husband was such a trooper, staying with me at nighttime for those first few weeks.]

I digress.  My point being that in order to stay relatively sane, we made a point to keep up our normal lifestyle, including the noise factor, in our household.  There was no “Shhh–ssshing” when she napped.  Instinctively we believed that our kids should learn to sleep with some normal amount of household noise.  We were lucky in the sense that our kids were pretty adaptable.  We could take them with us anywhere, really.  We slept over at friend’s places and brought the kids with us.  They were portable.  But more importantly, we never needed their environment to be super quiet for them to sleep.

Which is precisely why the article I mentioned above peaked my interest.

NICUs are loud – there are numerous machines beeping, whirring, all working to keep those little people alive, and lets not forget all the talking going on between the nurses, doctors, and parents.  A few years ago, an American Academy of Pediatrics analysis suggested that all this noise actually exceeds acceptable levels (45 dBA).  In response to this, many NICUs started moving away from open wards to private rooms for these little lives. Private rooms led to quieter rooms.  This should be better for them, right?

Researchers at Washington University School of Medicine in St. Louis, studied the effects of noise, and lack thereof, on 136 preterm infants. The preterm infants (< 30 weeks gestational age) were assigned to either a ward room or private room.  The primary outcome was developmental performance at 2 years of age. What they found was surprising.  By the time they left the hospital, babies who stayed in private rooms had less mature brains than those who stayed in an open ward. And two years later, babies who had stayed in private rooms performed worse on language tests. ScienceNews summed it up better than I can:

The researchers believe that the noise abatement effort made things too quiet for these babies. As distressing data from Romanian orphanages highlights, babies need stimulation to thrive. Children who grew up essentially staring at white walls with little contact from caregivers develop serious brain and behavioral problems, heartbreaking results from the Bucharest Early Intervention Project show. Hearing language early in life, even before birth, might be a crucial step in learning to talk later. And babies tucked away in private rooms might be missing out on some good stimulation.

The study took place at the urban St. Louis Children’s Hospital. The parents of these 136 babies visited their babies for an average of 19 hours a week, which means that many of these babies spent a lot of time alone. Babies in private rooms might do just as well as — or better than —babies in open wards if parents were around more to talk, sing and snuggle.

Obviously more studies need to be done to figure out how best to nurture and care for these early arrivals, but it did reinforce for me one simple thing – the noisier the house, the better.

So tell me, parents, how noisy are you around your infants?

30 g/day

No, I’m not talking about how much fiber one should have in a day – though, 30 g is about right, I think.  I’m referring to the amount of weight a newborn should gain per day during the first few months of life.

For my American readers – 30 grams = 1 oz.

30g/day was drilled into my head in medical school and particularly so in my Family Medicine training program.  A newborn will typically lose about 10% of his/her birth weight in the first few days of life, but usually by a week of age, the majority of infants will have regained the weight.  I was also taught that this should occur within the first 7 days of life.

So, in my first few years of family practice, I was quite diligent about these milestones.  If a baby hadn’t gotten back to birth weight within a week or wasn’t gaining that magical 30g/day, I would refer to the pediatricians across the hall from my office.  After a few of these referrals, the pediatrician walked over to my office to have a little “chat”.  She’s a lovely woman (she actually sees all my children) who sat me down and told me, that while she appreciated all the consults I was sending her way,  all of the infants were healthy and I was jumping the gun on the referrals.  I explained my reasoning, and she basically told me that “in the real world of clinical practice, most infants will regain their birth weight within 2-3 weeks, and so long as they are gaining weight, don’t focus on the 30g/day rule.”  She reminded me it was more important to assess how the mother was nursing, or how much formula was being given; she reminded me that the hydration status of the infant was more important than the number of grams gained.  Clinically, how does the infant look?  Was the infant having adequate numbers of wet diapers during the day? etc.  It was amazing advice and (sadly for her), my referrals drastically declined.

Yet, when it comes to my own child, I am stuck on that 30g/day rule.  Perhaps it’s because, with my first-born, I had a pathetic milk supply and didn’t recognize that my daughter was hungry and losing weight.  By the time she was 2 weeks old, she had lost about 20% of her birth weight, was just getting enough milk to stay hydrated, but not enough to gain weight.  I had to start supplementing with formula and watching her guzzle back that first 4 oz of formula in about 20 seconds made me realize just how hungry she was.  Cue the gut-wrenching mommy guilt.

I didn’t have to supplement with my second child – we had a great nursing relationship and he gained weight well.  Now, with the third. it seems to be following the same pattern, yet today I decided to take the baby to my office for a weight check only to discover that he’s gaining only about 15 oz/ day.

Cue the mommy guilt again. Oh God, do I not have enough milk for him?  Is he hungry and I’m just not clueing in?  Should I be waking him every 2 hours?  When I relayed my concerns to my husband, he just looked at me and said “He’s fine.”  He’s pooping and peeing appropriately.  He seems satisfied at the breast (unlike the firstborn who was clearly frustrated after a few minutes on the breast).  I am being way too hard on myself, yet I just can’t help it. And to top it all off, the baby now has the cold his older siblings have.

Did I mention he’s only 3 weeks old?

FML.

Sometimes I surprise myself.

Back in medical school, I remember trying to listen to the heart of a newborn.  Damn thing was beating so fast, I kept thinking, “How the hell can anyone hear a heart murmur?”  A pediatrician told us it just takes practice.  One has to listen to hundreds of normal hearts in order to be able to recognize one when it’s NOT normal.

Riiight.

Well, that’s actually true for a lot of things in medicine.  Last year, I felt a very abnormal prostate.  It was so obvious to me at the time, that I wasn’t that surprised.  I just realized that it was NOT normal.   Two months ago, I did a routine breast exam on a woman and felt something very, very concerning, completely unbeknownst to the patient, sadly.

Then, yesterday, I saw a two-week old infant for a weight check.  I put the stethoscope on his chest and heard something.  “Whoosh-whoosh-whoosh….”  Hmm … I concentrated really hard, asked mom to stop talking (she was telling me all about his bowel movements) and listened again.  Was this his breath sounds I was hearing?  Definitely not – watching his chest rise and fall, this was clearly a cardiac sound.  Oh. My. G..   This wasn’t there a week ago!

I drilled mom with questions:

“Does he ever sweat with feeds?”

“Does he turn blue in the lips when feeding?”

“Does he breathe faster than you think is normal?”

She answered no to all the questions.  I watched him. He looked happy, content, breathing normally.  The child seemed perfectly fine.  Still, I was concerned enough that I referred him to our local pediatrician who confirmed the presence of the murmur, “It wasn’t really that loud,” she later told me.  Well, it was LOUD to me!!  lol!  In any event, the infant is in good hands and will be diagnosed soon (with, hopefully, nothing more serious than a small VSD that will close on its own).

Despite the pediatrician telling me it wasn’t all that loud, I still had to pat myself on the back.  I heard it.

There are times in my career (and personal life) that I wonder if I am doing the right thing, if I have done all I could have, if I should have done things differently.   I am far from perfect.  I am a flawed individual but I am deeply conscious of it.   I am very good at admitting my mistakes and “bad calls”, yet I rarely give myself due credit for a job well done.

Not anymore.