Occupational Therapy

Our girls are transitioning out of their Early Intervention therapies and entering the Intermediate Unit therapies that start at age three. We are very sad to see our therapists leave. They have become a part of our family. Each week they travel to our home and work with the girls. In the process they have gotten to know the girls, Savannah and myself very well. We all seem to light up when they come!

Adeline spends more time with her OT than any other therapist at moment (1.5hr x week). Dot (her OT) does an amazing job addressing Adeline's fine motor and sensory needs. She works on motor planning, visually scanning the environment, messy play and the use of both hands together. All though the above sounds simple, they are all areas in which Adeline needs much help.

The way in which Dot works with Adeline is simply impossible for me to replicate when by myself. Typically, I have to take Lila out of the room because she interferes with Adeline's activities. In the video below, I was shocked that both Savannah and Lila sat quietly and watched. I also don't have the knowledge base that Dot has with regard to sensory integration and motor planning. She is a fantastic OT and has helped Adeline tremendously. It took us a long time to find someone who could address Adeline's unique needs and I am very hesitant to start with a new OT with our transition to the IU. We will deeply miss her.

I rarely take pictures during a therapy session because it is all I can do to keep the other child from interfering. Because Savannah and Lila were "sitting it out" nicely, I was able to grab the video camera. The video below shows Adeline putting pieces of Mr. Potato head together. She had to work on the dexterity in her finger tips to pull her along the floor, use both hands to put the pieces in all while visually scanning her environment in order to form a motor plan. The activity is great for Adeline's weak core. It is just a sample of what Dot does in order to push Adeline in her development.

Infant Carrier

We pulled out Adeline's old car seat for baby Lucy today. Wow, did that thing ever get some wear. I was trying to remember when Adeline actually gave it up. I looked back through all of the pictures but couldn't figure it out. I am pretty sure it was around 18 months though. The last picture I could find was on her first birthday. Keep in mind that Savannah gave up the infant carrier LATE at 8 months old.

5 pounds

8 pounds

10 pounds



about 26 pounds

Our First Philly Friends

We were lucky to visit with our "first Philly friends" today. It had been a couple of months since we last visited. I met Lori when I started teaching in Philadelphia and a couple of years later we both had babies within five months of each other. Katie and Savannah have been friends since day one and it is wonderful to watch them embrace their friendship even when they go months without seeing each other. It is funny that they both became the oldest of three.

For the Big Girl Bed Record. . .

My fear of the girls not staying in their beds appears to be irrational. To my surprise, they seem to get the "not getting out of the bed rule." Savannah never got out of her bed, I mean never. I was sure I wouldn't be that lucky a second and third time. With the exception of the Adeline's third night in her big girl bed, both girls have stayed put. During that night, Adeline didn't really get out of her bed but she did crawl over her foot board into the chair and try to fall asleep there. The novelty seems to be wearing off. I still find Adeline walking all over her bed and Lila throwing her Bunny off the bed which requires me to retrieve it for her but staying IN the bed doesn't seem to be a problem. Please God, don't let me jinx this.

All in all, I am really pleased with the transition. It has been fairly low stress and the girls have enjoyed showing off their big beds to everyone that comes to our house. The best part in all of this is that I can climb into their beds and snuggle them. One morning Lila woke up early and I slipped in bed with her and enjoyed a long snuggle. Is there any better way to start my day?

I was taking pictures of Savannah after I put the twins down when I heard a mumbled, "Picture please Mommy." It took me a minute to figure out what Lila was saying with her "binky speech" but I finally got it. These are the faces that were waiting for me. They don't necessarily look tired, do they?

Three Years Ago

Three years ago this evening, was the worst night of my entire life. I was paralyzed with hurt and fear. My unborn baby was dying inside me. My world stood still. My heart, my faith, and my hopes were broken. Little did I know that it was the first day of 29 very long, yet miraculous days. Today's date, marks the beginning of Miss Adeline Belle's journey.

I encourage you to go back and read last year's post as it gives a sense how miraculous Adeline's life truly is. Click here.

Fast forward three years!

Adeline woke up for the first time in her big girl bed. We hung out as a family in her room for about an hour this morning. Adeline was super affectionate and giving loves and laughs to all. She accompanied us to Dunkin' Donuts and later helped me work in the flower beds. After her afternoon nap, I was laying with her in her bed and she looked at my shirt. "Three bikes Mommy." I looked at Alex and he looked at me. How did she know that? We tested her with cars and sure enough, she knows her quantities up to three. Adeline ate a fantastic dinner (chicken- from fajitas, quesadilla, cantaloupe, grapes and a smoothie). We finished our evening outside where she showed off her skills on her tricycle, she even pedaled up the slope of the driveway. Finally, it was to bed. To our surprise, she went down in her big girl bed without any problems.

The day sounds like that of any other two/three year old. On the outside looking in, no one would guess that Adeline is anything other than your typical toddler. Sure, her walk is a little stiff and her words aren't in 5-7 word sentences but she is going strong!! I think what most people notice about our little Belle is her smile. She can stop a stranger in his tracks. She can light up the darkest of days. All this from a baby who was never supposed to be born alive.

Even in the middle of the terrible twos, I just can't get enough of my Belle. Adeline is full of life yet, at the same time, peace and calm. Somehow this little body can climb up into my lap with a "Hi Mommy," and give me the strength to do just about anything or erase any worry I have. She is physically little but her spirit is larger than life. I love how she still "fits" when I hold her and how her hand on my cheek or head on my shoulder instantly relaxes me and brings a smile to my face. I can't imagine who I would be had I not journeyed beside Adeline, certainly not the mother or woman I am today. I am forever changed and incredibly thankful for it.

I love you Miss Belly Belle.

Good Bye Cribs

I can't believe my girls are in big girl beds. Today was devoted to taking the cribs down and replacing them with their big girl beds that have been sitting in our basement for well over a year. I have been reluctant to transition them for a variety of reasons. I liked the idea of keeping them "caged" as long as possible and I have a VERY hard time saying goodbye to cribs for a final time. I can't believe we are moving on to raising our family instead of creating a family. Where does the time go?

Going into the transition, we were fairly confident that Lila Grace would do just fine with the change. She loves her sleep and is the first to tell you she is tired. We had reservations about putting Adeline in a bed. She is a night owl and is often found partying in her crib well after we have said goodnight. She also doesn't respond to, "lay down." She lays down and pops right up as if it is a game.

Regardless of their readiness, it was a necessary move. Lila has been crawling in and out of her crib for about a year. She knows she is not to crawl out unless I am in the room watching (got lucky on that one!). Adeline has recently joined her sister in "crib gymnastics" and is very unsafe (you can see her moves in the video). In order to keep the Adeline out of harm's way, we felt the bed was called for.

As I type this, both girls are asleep peacefully in their beds. They were so excited as we transformed their room. We were nervous the first night would be rough. Luckily, (it is only 8:40 p.m.) the bedtime routine went well. Actually, Daddy put them to bed without me even noticing. As expected, Lila went right to sleep but Adeline was up and jumping on her bed. I decided to put her in our sitting room which still houses a crib. It was our plan all along. Once she fell asleep, I transferred her to her big girl bed.

We will see how the morning goes. . .

Have you seen messier cribs??
The change. . . not so bad if I do say so myself. The monogrammed pillows from Aunt Natalie add the perfect finishing touch.

To File Away

This post is more for me than anyone. In case I don't remember Savannah's "loves" as she is getting ready to turn six. . .

The birthday wish list is as follows:

Stuffed animal horse - mommy and baby

Hard Plastic horse

Thumbelina and friends (Barbie dolls)

Mommy and Daddy bed for the her dollhouse

Bathroom for her dollhouse

Barbies - clothes, a doll with a pretty pink dress and Barbie's bike

Bean Bag chair

Hello Kitty scrapbook

Camera

Hello Kitty radio

Dinosaur sticker book

Dinosaur figurines


I must not forget that she really wants a Cars (the movie) birthday party. Leave it to my girl to love Barbies, dinos and Cars. I hope she never loses her authentic self. Not many girls play with dinosaurs or cars like she does. She has yet to see that Cars and dinosaurs are "boy toys" in our society. I love this about her. She has never played with baby dolls, gotten into dress up or been over the top girly. I can't deny that it is slowly creeping into our house as she spends more time at school and on playdates. For now, I want to preserve the innocent and "unaltered" Savannah. I know that she will be a very different girl a year from now. Sending her off to school this year is going to kill me.

Chance for Normalcy

I have just come across some rather shocking statistics regarding outcomes of extremely low birth weight babies. "Pediatrics" put out by the NICHD performed a study analyzing "Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants Exposed Prenatally to Dexamethasone Versus Betamethasone." The article really hits home with me because it is one of the first statistics (that I have come across) to recognizes Adeline's unique road of being extremely small for gestational age as well as premature.

The article (from what I gather) followed 5,250 children weighing less than 1000 grams between 1998 and 2001. The children were assessed near the age of 18 months corrected. The over all goal was to determine whether or not the use of two different steroids impacted outcome. Lila Grace and Adeline had their fair share of steroids while in the NICU but missed out on the precious prenatal steroids referred to in this article.

I am most interested in this study because it grouped children both by gestational age and birth weight. There was actually a category for Adeline which was children weighing less than 500 grams. She made the cut off at a whopping 467 grams.

Adeline has always been an anomaly. She was very premature but possibly even more growth restricted. Her size was that of a baby five weeks younger. All the stories, statistics and research I have done does not speak to Adeline's road. I can find data on 27 weekers but not 27 weekers born at the size of a 22 weeker. This article does to some degree.

The study assessed outcome at 18 months and classified children either normal or impaired.
Children were deemed normal/unimpaired if they presented a normal neurological exam, normal vision, hearing, swallowing, and walking. It is important to note that the "normalcy" score is a bit skewed. Many children that fall under the unimpaired category still suffer from their prematurity but are doing well enough to hug the very left of the bell curve or suffer from aliments that were not accounted for. I can safely say that Adeline would fall under impaired due to her very rudimentary walk and problems swallowing at 18 months of age.

Here is what they found:

Less than 1% of children born weighing less than or equal to 500 grams survived to be normal at 18 months of age (I guess the hope is that the statistic drastically changes as they get older??)

Here is the kicker. . .we are working with a 1% chance of being normal at one and half years of age if just born small for gestational age (i.e. some babies can be full term and small). When you put the children together that were born less than 500 grams and less than 28 weeks, the statistics take a dive. Really, how much worse can they get? I guess I need the full article and not the the abridged version to know.

Given these statistics, did Adeline even have a chance at normalcy? These researchers made these categories that fit our little Belle. I have been waiting for someone to do so but now I think I could have waited even longer. I wish I had the full article to see how many of the 5,250 children fit into Adeline's category. Most don't make it out of the NICU.

Lila, on the other hand, falls under the 900-1000 grams category which I am not sure classifies as small for gestational age. Her weight was borderline. Of these babies, 24% are expected to be "unimpared." Not stellar but much better than Adeline's plight. Given their criteria for normal, I believe Lila would have fit into that 24% which is beating some difficult odds. The only factor that I don't have solid information on is her neurological exam at 18 months. We haven't had an MRI since she left the NICU. It was normal then so I am assuming is was normal at 18 months of age. Hmmm. . . Alex did drop her off the changing table right smack on her head when she was very little. . . (had to add some humor to some pretty bleak data).

Now if we just looked at the girls as preemies and assumed they had the proper amount of weight packed on, their expected chance of normalcy (at 18 months of age) jumps - at least for Adeline - to 24%. Not bad when you are looking at less than 1% chance of being unimpaired based on Adeline's birth weight.

Uhg, the whole thing just frustrates me. It is still very hard to see hard core statistics like this. These statistics just remind me of the rotten and grim long shot that Adeline was up against. I thought the 5% chance of being born alive was bad. Clearly, being unimpaired at 18 months was impossible. For once, Adeline fell into the "norm." Unfortunately, the "norm," in her case, is impairment at 18 months of age.

Impaired she is, but normal we hope her to be!!
She is getting closer each and every day.

The Last Day

I finally grabbed the last pictures off of the camera. It makes me miss the beach oh so much! Talk about fun in the sun!! It sure was a perfect vacation. Every time we find some sand seeping out of something brought back from the beach, we all kind of hold our breath and then let out a little sigh of "I wish we were still there." But here we are, back in the real world. Luckily, I have a hard drive full of memories.

I couldn't let these pictures slide without posting them. Miss Grace has had some problems pooping lately. The solution. . . Miralax. This girl can hold it like none other. However, after about three days she is running around with her hand on her bottom telling me she has to go pee pee. She sits and realizes it isn't pee pee that she needs to deposit and pops right back up. Let's just say she isn't going to "drop the kids off at the pool" until the "kids are making a break for the pool." If you are unfamiliar with the saying, you will have to ask around. I just can't blog in detail about POOP.

The last few days at the beach were racked with taking Lila potty - efforts were in vain of course. We couldn't ignore the request to go because she would throw a raging fit. After running her back to the house four times in 30 minutes, Alex brought the potty to the beach. Notice Lila's less than thrilled reaction when we all burst out laughing.




Before we left, we lined all of the kids up for the annual picture. They have outgrown the couch where they used to sit for this photo op. Wow, are we outnumbered but so very lucky!

The beginning of the long drive back home. Thank goodness we drove at night because the kids slept!

Baby Birds

Early June I discovered a nest in the wreath hanging on my front door. I monitored it for a few days hoping that an egg might appear and, low and behold, it did! The girls were super excited to watch the nest fill with eggs. It was always a mystery as to how many eggs would be waiting for us the next morning. We went from one to two and back to one again. The pattern continued until we were set with four eggs. The girls got to where they could predict where the mother bird would land (while chirping her head off) when we would pull the door open to take a peek at the eggs. "Baby bird, baby bird," was often heard whenever the girls were near the front door. They always wanted to look. At first, Adeline was very nervous about the wreath - wavy branches of flowers threatening to touch her - but she soon was asking for up too.

The above put me right to work on making journals for the girls to use when recording their observations. Call it the teacher in me or the compulsion I have to keep things together and neat! I will admit, it was also an opportunity to work with Adeline on gluing, retelling and focusing on a task. After each journal session I was sweaty and sometimes frustrated but we got through them. The girls LOVED them. Adeline started out by only making one or two marks on the page but later on was asking for me to draw things that she could color. She didn't improve much in gluing. She uses a glue stick and will put the glue on the wrong side of the paper. Lila just gets how to glue but Adeline will need lots of practice. She doesn't use her opposing hand to stabilize the paper either which well below her developmental age. Between Adeline's need of constant help and Lila's lack of patience/need to do everything NOW, I was working over time. Not to mention Savannah's help when spelling words.

In the end the journals came out really nice. The girls can look at them and count the eggs, label the baby birds and mama bird while showing some pride in their work.

Unfortunately, the baby birds were born with a cloud of bad luck looming over their nest. About 48 hours after hatching, the baby bird would disappear. The mama bird chucked the last two babies (at least that is what I think happened) and abandoned the remaining egg which still sits in the nest right before we left for the beach. The birds were interesting while they lasted. Thankfully, Savannah handled their premature nest departure pretty well and, well, the twins are too young to question it.

Here is a video of our birds, journals and fun.

Favorites

We are back and settling in. I am starting to go through pictures and have pulled a few favorites that I am considering for our mantel.

Looking at these pictures reminds me of what a wonderful time we had. The girls were really good and fully enjoyed themselves. In the end, that is really all I wanted -my girls to have fun while surrounded with love. When I sit on the beach looking at the three of them play I can't help but be overcome with all the blessings we have been given. I never imagined us vacationing like a "regular" family two years ago. Regular we are - well sometimes and this vacation was one of those times.

Alex and I had to laugh when we arrived at the beach with NO OXYGEN. We made lists which included cannulas, lines, Tegaderm, nebs and meds but I guess we didn't include O2 tanks. It was more amusing than scary because we were pretty confident we wouldn't run into any trouble. In fact, we escaped conjunctivitis and a stomach bug that were running through the other families in the house. Not bad for a little girl that touched her toes on the sand for the first time at 10lbs, on the O's and nearly one year of age.



Some pictures from this year. . .

Scenes from the Beach

The 4th of July

Beach time
Mermaids

The Jump-Jump

Happy 4th of July

We are still continuing our fun in the sun. The girls are very content and the parents are actually enjoying some "chair time."

Lila Grace is a dream come true on the beach. She follows the big kids around, plays in the sand endlessly and doesn't wade too far into the the surf. She is a delight to watch. Savannah is also having a wonderful time. She ventures out into the waves solo this year and feels pretty confident in the water. Adeline doesn't love the sand or the surf. She would rather spend time in the stroller or in the wading pool that we have on the beach. She requires shoes and every once in a while overcomes her sensory overload and digs in the sand or jumps in the tidal pools. She still manages to have fun out on the beach. It is baby steps for her this year.

This 4th of July we plan to make lots of red, white and blue desserts, spend much of the day in on the beach and finish our holiday on our deck watching the fireworks light up the water. We hope you have a safe and happy holiday as well.