Quinlan's Due Date!

      Quinlan was due to be born today. Based on his current size, it looks like mom might have had a longer and harder labor than she did as we think he might be close to 9 lbs now. He will be weighed next at his 2 month follow up with the pediatrician next Wednesday. Yup, our little man is almost 2 months old!
     What a crazy 2 months. We could not have made it without all of the amazing support from hospital staff, colleagues, friends and family. We are truly blessed and appreciate everything that people have done for us. In fact, this blog started as a way for mom to cope and reach out to many regarding the trials of Quinlan's NICU stay, and is now maintained to show everyone how far we have come and the strides we continue to make because of your support.

      We decided to celebrate the Estimated Date of Quinlan's birth with a nice long walk in beautiful New England spring weather. Quinlan wore his favorite duck outfit with great grandma Mary's sweater. We walked over 2 hours and picked up ingredients at the store to make pizza (mom walked around the block while dad popped in quickly as Quinlan is still banned from indoor public places). We thought it only fitting to make pizza, enjoy a glass of read wine, and watch a movie as that was what we did the night we went into labor.
     Dad is also brewing a commemorative California Style Pale Ale "American IPA." Please suggest a name for this beer, and your favorite Quinlan picture for the label!

Working on Quinlan's Development

      Quinlan now weighs enough to carry him in the Moby Wrap or the Baby Bjorn carriers. This allows mom or dad some hands free holding time with our little milk pup, and allows Quinlan to be close to mom and dad while they tiding up the house or make dinner. It also allows Quinlan to work on his head control and eye contact as you can see him doing in this first picture.
     Another way that we work on Quinlan's ability to pick up is head is to have him lay on the floor or on top of us when he is awake, or tummy time. We do this daily although some days he tolerates it more than others. We also drape him over the Boppy pillow to accomplish this as well. Recently Quinlan has started using his strong legs when draped over the Boppy to almost launch himself over it. Since this would result in his head hitting the floor, we have switched to these other positions.
     We should learn some more strategies to help Quinlan develop as he should when Early Intervention starts, hopefully in the next few weeks.   

Mornings with Mom

      Quinlan wakes up with a big yawn in the morning. His routine is that he stays up with dad till his 2 AM feeding, then he comes to bed in his co sleeper where mom is "on duty" through the morning. Dad usually has him either in the living room asleep on dad's chest, the dining room in his favorite swing, or in Quinlan's room in the crib. Dad usually is asleep nearby in case our little man needs anything.
     On some nights Quinlan will be good and sleep until his next feeding at 5 AM at which point mom will bring him out of our bedroom to change and feed him. However, if Quinlan is fussy and making a lot of noise, mom will bring him out of the bedroom sooner and usually assumes the usual position on the couch with Quinlan placed on her chest as this tends to sooth him quickest. In this position, Quinlan can usually return to sleep for another 1-2 hours.
 

     We usually let dad sleep until 10 or until he is rested. Quinlan has watched the sun rise with mommy many times as we listen to the bus out front that used to take mom to work and wait for dad to get up and make us breakfast :) All of those early mornings having to get up to bike in for a 7 AM patient have prepared mom well for being up and alert at this time, just as many late nights downloading techno or playing at WZBC have prepared dad for his shift.
     Quinlan is starting to sleep up to 4 hours at a time, usually from 12-4 or 11-3. From what we have read, babies usually are sleeping through the night by 9 months but some can start earlier. We are hoping for earlier, but will continue on the schedule Quinlan sets until he is able to snooze for longer stretches.

Helping Dad

     Mom and Quinlan helped dad last night to organize the student work he needs to submit for his final teacher performance assessment. Mom's job was to read out the criteria for selection and analysis, to help with thought organization, and to be a sounding board for all of dad's great ideas. Quinlan's job was to quietly look cute.
     Overall this thorough assessment has been a great learning experience helping dad to realize what his strengths are in a classroom setting and how he can continue to improve. It has been a lot of work and self-reflection that we feel will payoff in not only completing his requirements for his national license but also in guiding how he approaches future lesson plans.
     Once this is completed and fully submitted by tomorrow, we will be looking at applying to local area elementary schools to start in the fall.

     Anyone know of a district looking for an amazing elementary school teacher this fall?

Looks Like Mom?

     Dad was going through the pictures on his phone and came across this one of Quinlan with a semi-scowl on his face. Unfortunately this is the only picture where mom thinks he resembles her, as she is pretty sure that dad receives this face on occasion (there is likely photos to prove that as well).
     Mom and dad have spend little time outside the house over the past few days due to not wanted to expose Quinlan to foul weather and extensive time spent finishing up dad's teacher performance assessment that is due Friday. Both parents are a little stir crazy today and have taken turns running errands by foot or bike today to soak up some much needed sun.
    Quinlan received "days of the week" socks as a gift, and mom now realizes it is so she can keep track of what day it is... never thought such a lack of time orientation could happen, or that one could spend more than 3 days in their 700+ sq ft apartment without setting foot outside (and not realize it).

Quinlan's Early Intervention Evaluation

     Three women came today from Criterion Early Intervention to evaluate Quinlan's development compared to other infants his age (1 month old, as they round down) without correcting for his gestational age (-4 days old). They assessed him in 5 domains: Adaptive, Personal-Social, Communication, Motor and Cognitive by asking question regarding his feeding and interactions with mom and dad as well as performing physical tests and observing his reactions. Each domain was scored resulting in a "developmental quotient" with average scores being between 85 and 115 and scores below 77 qualifying Quinlan for early intervention services. This was his score card:

Adaptive - 90 (this was related mainly to feeding, which Quinlan is excellent at)
Personal-Social - 70 (this had to do with making sustained eye contact with the observer)
Communication - 84 (this related to how well Quinlan responded to touch and mom's voice)
Motor - 69 (this appeared to be a general assessment of his movement including head control during the session)
Cognitive - 61 (here they looked at his ability to track light, which he showed little interest in. They told us this was common with NICU babies who were exposed to constant lights during their hospital stay making them less attentive to them)

     The end result of this testing is that Quinlan demonstrates developmental delay in 3 of the 5 areas and qualifies for home services for up to one year working towards improving his development and supporting mom and dad through the process. Most of the cost is picked up by the state and likely only a $250 fee for the year will be needed from us. Of course, if adjusting for his gestation, Quinlan is a rock star for being 4 days from his due date!
     We look forward to working with these women weekly to help Quinlan progress towards his developmental milestones. He will be assessed at 6 months.

A Rainy Sunday

     Mom and dad have been good about getting Quinlan outside for some fresh air daily, but today it is pouring. It looks like mom and Quinlan will not be getting out today. Dad will be out all day working on his final teacher performance assessment that is due at the end of this week. We have found that it is hard for dad to get work done in the apartment with an adorable Quinlan around. Here he is accepting kisses from mom after a long day yesterday.
    One of the most challenging things to accomplish when dad is gone is the inability to do laundry. Quinlan is now going through 8-10 cloth diapers a day, and we just started using cloth wipes as well. We were even able to find a good wipe solution recipe online, and now Quinlan smells faintly of lavender. We are really liking the cloth diapers and wipes, and Quinlan is also seeming to enjoy them. He is definitely fitting into them better as he has continued to grow.

     Quinlan usually gobbles up his bottles and we now find that we need to slow him down when he eats to decrease his spit up and reflux. However, he still sometimes goes into a snacking mode and refuses to take more than 1/2 the bottle. This is a challenge as it wastes precious breast milk that mom works hard to produce, pumping up to 8 times daily to keep up with Quinlan's growing needs. This can sometimes be quite challenging to juggle: feeding Quinlan, soothing him, changing him, and finding time to pump around everything else.
     So, here dad is trying to encourage Quinlan to wake up and finish his bottle. Dad has been using the Boppy pillow that you see in this picture to prop Quinlan up into a good feeding position.

At Play

     Quinlan is spending more time awake these days discovering the world around him. So, in addition to tummy time, we are spending time in the bouncy seat or propped up in the Boppy pillow. While he is taking little interest in any of the 0+ toys that he was given, he is starting to discover movement and recently started kicking his legs about in addition to waving his arms.

    Here he is wearing his Friday socks. He has a pair for each day of the week. It helps his mom remember what day it is!

Resting on Mom

     Quinlan and mom spent the morning yesterday resting up for their big afternoon walk. We walked for 3 hours with our friends Rachel and baby Nora. Quinlan did really well only fussing a couple of times, and we were both ready for food and napping afterwards. Today we actually ran 20 minutes together on the bike path around the Mystic River with our friend Matt.
      Quinlan and mom both like the outdoor exercise and it helps them sleep better. Hopefully the run today carries over into the evening as our little man was quite restless last night ensuring both him and mom did not get more than 2 hours of straight sleep at a time. We are hoping for more tonight!

Little Boy Blue

      Our little man weighed in at 7 lbs, 7.5 oz at his visiting nurse appointment yesterday. This puts him in the newborn size range, gaining 2 oz/day and potentially decreasing his need for home nursing services. Apparently once they are "newborn size" and are continuing to gain weight, they are no longer in need of such constant monitoring. The nurse plans to call the pediatrician's office to determine if yesterday was actually her last visit. We would then just follow up with his doctor at his next scheduled visit on 5/2/12.

     Both mom and dad had medical appointments as well on Wednesday. Mom has been cleared for all activities by her midwife and has been scheduled to see a maternal fetal medicine specialist in early June. This is a meeting for both parents to discuss why Quinlan may have come early and what this means for any future pregnancies. Any future pregnancies may be considered "High Risk" as having a preterm baby puts you at higher risk for a second preterm baby.
     Dad went to the dentist to figure out the source of some recent tooth ache. Turns out dad will need to have his bottom wisdom teeth removed as soon as possible. Dad has decided to wait until after all of his school work is completed and the appointment with the oral surgeon has not been made yet.
     Quinlan is excited that most of the planned medical visits moving forward are not for him. His photo was proudly displayed at both mom and dad's appointments, and everyone is excited to hear how well he is doing.

     Quinlan is lying on a blanket made for him by our friends Fiona and Steve. We use it on the floor in our living room for tummy time. It just happened to match his shirt beautifully. Our boy does look good in blue!

Superstar Quinlan!

      Our friend Toshi is producing a film to celebrate the 50th anniversary of the World's Fair in Seattle that will be shown this Thursday. He had a vision of using a newborn opening his eyes for the final frames and sent our friend Eric over to try and capture Quinlan doing just that. Quinlan was surprisingly awake the entire 2 hours that Eric was filming, however, he kept his eyes open for most of it and we are unsure if any of the footage has the shot Toshi was hoping for.
     Here Eric is filming our little man against a black background in our living room. He made all sorts of faces during this and was definitely quite cute, even if he did not comply with the directors directions. Eric also took some still frame shots during this session and plans to send them along to us when he gets the chance.
     We are unsure if Toshi will use any of the shots taken, but Quinlan enjoyed his time in front of the camera. This also tired him out and set the stage for a good afternoon nap.

Bath Time

     Quinlan had his second bath at home yesterday. He has done a good job of distracting mom and tiring her out so that she forgets that she had planned to wash him up. Last night however, mom remembered and Quinlan did not hate it as much as he had the last time. Likely there are 2 reasons for this: (a) he is bigger and fits better in the tub that we have and (b) he is regulating his temperature better and did not mind the water as much. Either way, we finally cleaned out all the milk he had been keeping in his little neck folds!
     This must have been some work for Quinlan as it tuckered him out enough that he slept for 4 hours straight allowing mom to rest up while dad was away at the radio show prior to him taking on the 2-5 AM shift. We are hoping for good sleep again tonight, although the baths will likely be more like 1-2 x week than daily right now as he isn't getting himself too dirty in the apartment or stroller (the 2 places he has been.)
 

     So, what is everyone guessing he weighs in at tomorrow with the visiting nurse? Grammy has her money on 7 lbs 10 oz, which would be an entire pound gain in a week!

Father and Son Napping

      Dad is super tired this morning after taking the early morning shift: 2 AM to 7 AM. Quinlan was a little less than cooperative with sleeping peacefully in his crib during this time so neither of them got the restful sleep they had hoped for.
     After mom got up and started her morning, her boys decided to retire to the bedroom to nap together. Look at how peaceful they both look. Hopefully they are resting up for our big outing planned later, a lovely walk to Davis Sq to run all sorts of errands. Since Quinlan cannot be inside stores or other indoor areas filled with people as it can increase his risk of acquiring a cold or infection, we have worked out a system where one of us stays outside while the other runs the errand inside.
     Today is supposed to be 86 degrees out: not great for running the Boston marathon but excellent for taking our little man out on the town!

Morning Feeding with Dad

 
  So, Grammy left us this morning to head back to PA after staying 10 days to help settle Master Quinlan into his new home. She was an unbelievable help and mom and dad are now realizing all of the things they will have to start doing that she had just taken care of: dishes, laundry, and the 9PM - 2AM Quinlan shift. We will all miss Grammy and look forward to her return visit at the end of May.
   Thankfully dad has successfully finished his student teaching and will be more available during the week. He does plan to return to substitute teaching a few days a week while looking for a full time placement for the fall. Mom is hoping to remain out of work till July, but will need to make sure we can afford the out of pocket expense of our benefits.
     Here dad is taking the early morning feeding shift 430-6 AM. Quinlan again is raising his hand up to the bottle to help. Quinlan has been feeding on a odd schedule recently taking more frequent feedings at sometimes lower amounts. We knew he would at some point veer from the nice NICU schedule of every 3 hours like clockwork. Also, the shortened intervals between could indicate cluster feeding and a potential growth spurt in our future.

Here dad is wearing the appropriate shirt for the occasion: "Keep Calm and Carry On."



   And later he is burping Quinlan, something our Little Man does not really enjoy.

Feeding Himself Now?

    Quinlan is now assisting with his feedings (or attempting to), although we have to keep slowing him down! He is gobbling down his bottle feedings and has increased his intake from 50 mL to 90 mL per feeding in the last 10 days. We are guessing he is likely over 7 lbs at this point!
     Even though most of his time is spent feeding and sleeping, he is having more periods of alert playful time, is starting to use his hands more, and lifting his head up. Early Intervention is coming April 24th to assess Quinlan's development thus far. There will be a physical therapist, an occupational therapist, and a speech therapist. Apparently they do not adjust developmental milestones to Quinlan's gestational age, so he will be compared to full term children. If it is determined that he has developmental needs in any one area, he qualifies for early intervention therapy for one year prior to a reevaluation, the cost of which is covered by insurance and the state.
    Of course we feel he is perfect already :) However, it is always good to learn what we can do as parents to help him develop and grow as he should.

Getting into a Rhythm

    Now that we have been home for 10 days, we are starting to develop a routine. Quinlan stays up with Grammy till 2-3 AM, and usually falls asleep on her for 30 min to an hour after his last bottle feed. He then moves to the co-sleeper in mom and dad's room until waking up around 4-5 AM to feed again. Mom then brings him into the living room, changes him and gives him another bottle. Mom then usually stays up with him until 615-630 AM when dad gets up to chant. Quinlan sits beside him in the baby boucher seat until dad needs to get ready for school an hour later at which point mom takes him back. He is usually pretty awake for about an hour at this point so mom will sometimes place him over the bobby to work on his ability to lift his head.
      Grammy then sleeps until 9-10 AM and watches him when she gets up so mom can shower and get ready, and as of yesterday even go for a small jog. Quinlan then spends the morning & afternoon eating and sleeping usually getting up every 3 hours to feed and be changed. By mid afternoon, Quinlan will get suited up and placed in his car seat which snaps into his stroller and we will go for a walk or an errand.
       We then return home and unpack any items we picked up, prepare dinner and wait for dad to get home from school. Quinlan then falls asleep on dad after dinner and peacefully rests until his evening feed around 8-9 PM. He has been recently waking up for another alert hour around 7 PM.

      Mom and dad will sometimes take turns making lying with him on the floor, allowing him to stretch and look around. Then mom and dad go to sleep and Quinlan again stays up with Grammy.
       The routine will have to change when Grammy leaves on Sunday. The plan is for dad to take the night shift, but it'll be an adjustment for all and Grammy will be missed!

A Good 2nd Visit

    Quinlan had his second pediatrician visit and it went really well. He weighed in at 6 lbs 14 oz (still the 1th percentile) and the doctor said he is developing perfectly and doesn't need to see him back until his 2 month visit. We are still staying on the current 24 kCal diet of fortified breast milk for most feedings, and then working on breast feeding for 2-3 feedings a day. The doctor wants us to stay on this plan until Quinlan is in at least the 5th percentile for his weight.
    We also discussed Quinlan's dislike for sleeping in his co-sleeper. He sleeps unbelievably well on top of mom, dad or granny and in his swing, however, he does not care for long stretches in his crib or co-sleeper. This causes some difficulty for mom and dad who are kept awake by his squawks and squirms in the middle of the night. We discussed why that might be including the nice body heat, stomach sleeping position and elevation. The doctor said it would be OK to elevate the head of the crib to 15-30 degrees and see if that makes Quinlan more comfortable as it will decrease some of his reflux. We will be trying this tonight and hope that we all get more ZZZs between the hours of 2 and 5.

     Here are some pictures of Quinlan makes faces at us after our day at the doctors.

Quinlan Continues to Gain Weight

     We have been busy eating and growing since leaving the NICU and Quinlan weighed in at 6 lb, 10 oz today with the visiting nurse. She said he was doing so well that she anticipates next Tuesday to be our last visit. We go to the pediatrician tomorrow so we will see how he comments on the weight gain. According to the visiting nurse, Quinlan is gaining at the full term newborn rate: 1-2 oz a day verses the preemie rate of 0.5-1 oz a day. So, our little man is acting like a full term newborn, excellent!
     The pediatrician might change his milk regimen and decrease some of the fortified calories or increase the number of breast feed sessions. The only problem with that is that Quinlan has gotten used to the decreased effort involved in bottle feeding and has not been feeding as well from the breast... this might require some significant amount of work in the future if we hope to transition him off the bottle. Of course the bottle feeding has really helped us develop a schedule where dad and Grammy have been able to cover the last 2 night feedings and mom has been able to sleep for 5 hours prior to waking up to pump and bring Quinlan back to the co-sleeper in our room.
     Quinlan is now up for longer periods during the day: about 1 hour, 3 x day, so mom will try and be better about taking pictures. So, more Quinlan pictures to come!

First Visit with Pediatrician

    Quinlan had his first doctor's appointment yesterday, and we traveled all the way in to Mass General in the car seat. We were sure to bundle up as the temperature had dropped since that bizarre week in the 80's. Plus Quinlan gets cold easily as he is still a little man.
     We made it to our appointment on time despite significant traffic driving there. Mommy explained to Quinlan that this is why she commutes on her bike. However, that is not a good way for Quinlan to travel yet, although dad is already thinking about attaching a child's seat to his bike.
      His appointment went well: while explaining that he has been having trouble with his bowel movements during his patient history, Quinlan took a large dump. He also peed on the weigh scale while weighing in at 6 lb, 2 ounces! The pediatrician said Quinlan was doing excellent and we should keep up all that we are doing at home as he was showing great progress. Of course, he still is in the zero percentile for height, and the 1 percentile for weight. This is because he is compared to other 1 month olds, but no one here is hung up on the numbers. We see Quinlan as perfect.

 Quinlan loves being home!!!

Quinlan is home, grammy is visiting and we have a new computer!

Indeed! Life is good!
I had the most active, exciting, busy, and memorably intense week of my life balancing my student teaching and Quinlan returning with Mom. My take over time at school has been great, but I'm also relieved to be focusing on taking care of things to graduate and supporting all the amazing activity at home!
YAY! I can feel that I am growing as much as our lil' Q man!

Enjoy these pics:

Quinlan at Home

   Quinlan has been home since Monday evening, and it has been an adventure for all. Dad now has mom and son home and is doing a great job helping out when not at school. Mom is working on reading Quinlan's feeding cues as she no longer has a world class nursing staff or constant monitoring to help her. Quinlan is adjusting to life on the outside! He has all new sounds and smells to learn, and is exploring his new home constantly.
   Quinlan is still sleeping for 3-4 hours between feedings as he is only 36 weeks gestational age and still needs a lot of down time. He is being bottle fed 40-70 mL at a given time with 2-3 breast feeding sessions a day. Quinlan and mom are working out the best timing and positioning for this. He only rests 1-2 hour after breast feeding as he is liking getting more milk with the bottle at this time.
    Quinlan is still getting his breast milk fortified with calories from formula when fed from the bottle, and is getting iron and vitamin D drops 1 x day. He is also getting 5 mL of prune juice 2 x day to help with the constipation he has from the added calories and iron.

    Quinlan has also had to adjust to the temperature in the apartment. Thankfully great grandma Mary sent over this mint green sweater from the UK. He basically lives in it. That and footie pajamas.

Day 30: Discharge!

   Quinlan past his car seat test last night, his antibiotics have finished and his PICC line removed. Mom has packed up the room and we are just waiting for dad to get finished with school to come help us home!
   It has been a month in the NICU and we are all ready for Quinlan to come home, although it'll be strange to not be at MGH tomorrow. This is the only place Quinlan knows and mom has been here over 12 hours/day, so being home is going to be a major adjustment for all.
  People have been asking how they can help with this transition. This is all new to us, so we don't even know where to ask for help yet. Our friend Phil signed us up for Meal Train to help organize visits and keep us well fed. We really appreciate this and are looking forward to the visits. Other than that, it has been suggested that we may need help with grocery shopping, laundry, etc. We will keep you posted on what assistance is needed, as I am sure we will be calling on Team Quinlan for support!
   Thank you all for the support you have given us already. This was a long hard month that you have all helped us through.

The blog will continue, as we anticipate that our little man will just get cuter and dad plans to take many pictures. If the posts are not as frequent as first, be patient as mom is used to having amazing NICU nurses 24/7 helping out and she may need time to adjust :)

Day 29: Difficulty Digesting

 So, Quinlan continues to do well with his feedings and is still growing with the change to "cue based feeding." Quinlan is no longer being feed at 3 hour intervals, but instead is being feed when he indicates hunger with feeding cues. This could be 2 hours after his last feeding or longer, however, we wake him if he goes longer than 4. He has been resting longer in between the bottle feeds and waking up sooner after breast feeding, but he is still gaining weight so we are doing well.



Here Quinlan is showing you one of his feeding cues: sucking on his thumb or hand.

And here he is gnawing on his outfit.


     Currently while he is feeding well, Quinlan is a little constipated on the fortified milk. The teams tells us that this is common as babies are designed to digest the pure breast milk and their immature systems struggle with the added calories. Where this becomes an issue is the discomfort and extra effort to digest. Sometimes this sends Quinlan's heart rate above 200 bpm and his oxygen saturation below 80%. It only happens for brief intervals and self-resolves, but it may cause Q to fail his car seat test. He is not allow to drop his O2 sats below 80 for 1 hour while in the car seat. The team has prolonged doing this test as they do not want him to fail, and they have lowered his total calories and started him on prune juice to help with the issue.

    They will likely need to do the car seat test tonight if he is to go home tomorrow, or he may be delayed on discharge till this is more resolved. We will keep you posted.