Thursday, August 15, 2013

Lack of Organizational Skills

Premature babies are often referred to as "disorganized" by nurses, doctors, occupational and physical therapists, lactation consultants, and their own parents when they're eight years old and up (I can just see the excuse from Tootsie now:  "But Mom, I've been disorganized since birth!  I was born this way!").

What the professionals are referring to is the babies' tendency to flail arms and legs around, crane neck from side to side, and generally exhibit entropy from their core.  Unlike full-term babies, they don't have the motor skills and neuro pathways developed enough to keep things centered and calm.  If you watch Tootsie, she's still trying to figure out her hands as they're related to her mouth (and her arms!).

It all makes sense if you consider that at almost 35 weeks gestation, our baby girl should still be in the womb for a month more, curled in a ball, organized.  Almost everything they do here in the NICU is meant to replicate that experience (lots of sleep, quiet, swaddling) so that her brain and body can continue to develop, as was her only job inside of me.  Now, though, she is charged with learning to eat from the breast and bottle, too, and fatten herself up so she can regulate her own temperature outside the consistently warm environment in utero.  It's quite a transition, and she has a lot of work to do that would normally be accomplished by amniotic fluid and the umbilical cord.

Since she can't only focus on the skills that will bring her home--feeding and fattening--and since brain development is so crucial too, her Care Team restricts the number of time she breastfeeds (and bottle feeds) for now, ensuring that she not only gets enough extra calories through her tube feeds, but that she also has plenty of opportunities to sleep.  The process of getting her home is slow and steady, and the discharge date on her board still reads "TBD" as I suspect it will for some time.

Yesterday's leap was, after recording weight gain to 4lbs. 12 oz., lifting the pop top of her isolette and having her sleep in room-temperature air.  Last night's nurse bundled her up and watched her temp closely, and so far so good.  She may even graduate to a big-girl crib soon!

In the meantime, we're keeping her organized:  Legs tucked, arms and elbows oriented to her midline.

It will be interesting to see what her backpack looks like in middle school...

Organized baby:  swaddled, tucked in, binky deployed, and doll from the USVI providing support

1 comment:

vertigomama said...

Reminds me of our own premie girl who's about to start Kindergarten. So happy to hear all of the progress Tootsie is making.