Happy 4 months, Max!

Wow, another late post. Surprise! Surprise!

Hopefully I can even remember what Max did in his 4th month!

We went to the doctor on March 11th for his 4 month shots.  At that appointment Max weighed 14#14oz (40th percentile) and was 25 inches long (about the 70th percentile).  His head was at 55th percentile.  He did a lot more growing up rather than out I guess!  He went from about the 78th percentile for weight and the 40th percentile for height, and essentially flip-flopped.  His pediatrician wasn't concerned about it though, so I am not going to worry about it too much either!  His trajectory was still decent on the growth curve, at least not trending down anyway.  Of course, he got his 4 month shots combined Tdap, Hib, & Polio, then PCV and Rotavirus.  Gotta vaccinate our kiddos!  We have a measles outbreak in the Twin Cities now since people have been refusing MMR vaccines. . .

Max is still exclusively breastfed and we plan on continuing that (i.e. no rice cereal) until 6 months.  I am just hopeful that we can stay away from formula until at least that time too.  It is really difficult to be a working resident mom and try to breastfeed.  I am learning, though how to stand my ground and just let people know that I need to go and take care of things.  I was timid about it initially, but then realized,   I need to do what is best for my little guy as well.  Besides, any pediatrician should understand the importance of breastfeeding! So we are continuing to work on keeping it up.  Fortunately at the hospital where I have been in February and March there is a fantastic pumping room with 2 Medela Symphony pumps, curtains, chairs and lots of supplies if needed.

I have been making "lactation cookies" and I do think they really work and are yummy too!  I just bought Fenugreek also, just in case.  I start inpatient medicine in April, so I am worried pumping will be even more difficult then.  I haven't had to delve into my plethora of frozen milk yet (at least not to make up for lack of milk) and am only giving him some frozen milk on occasion to rotate through the stock pile.  They say that because their nutritional needs change as they grow, it's good to not wait to use milk from month1 at month 9, which makes total sense, so we are trying that out as well.

Max started to roll over well this past month--mostly from back to font, but he can go from front to back too on occasion, so he is well ahead of the developmental milestones for his age.  Nothing makes this pediatrician mom of a SCAD deficiency baby happier!  (one of the possibilities with SCAD deficiency is developmental delay, so, so far, so good!)  He is also really giggly and has good inflection in his coos.

Once I started back to work, he spaced himself out to every 4 hour feeds rather than every 3.5.  We still have to wake him up in the middle of the night to eat, again because of his metabolic disorder.  We get to space him out to fasting maximums of 8 hours once he turns 6 months, which will be on my birthday--happy birthday to me! :)  All this month he was just taking 5 ounces per bottle feed.  He is not as hungry in the morning, so sometimes we struggle with finishing that bottle, but otherwise he eats really well and we still try to nurse as much as possible.

His nanny, Jordan, is doing such a great job with him.  We started putting him in the Bumbo and he likes it pretty well.  He can sit well with support and is trying really hard to sit up on his own (like from laying down).

Max is still in size 2 diapers, and is wearing a variety of sizes depending on the brand.  Mostly 3-6 month things, but he has a few 9 month pieces that fit him really well.  Max also started sleeping in his sleep sack this month rather than being swaddled.  It was a hard transition at first, but he eventually got used to having his arms free.

It is so fun to watch him grow and change daily.  I am always so, so excited to see him when I walk in the door from work and it is such a comfort to know that he is so well taken care of during the day.  With a house renovation and starting back to work after nearly 5 months off, it is the only thing I don't stress over!  We are so, so lucky to have found such good help.

Here are some other pics of Mr. Max!

Happy Valentine's Day from Max!

Loving his Bumbo!

Max also had his first stay in a hotel this month.  We actually had a couple stays because they were refinishing the floors and we wanted to keep Max out of the smell.  This was taken at Embassy Suites at MOA.

We might have a pianist?  My Aunt Mae would be so proud! :)  He loves his piano, either kicking it or hitting it.  Thanks Mr. and Mrs. Fuller for the great gift!

Happy 3 Months, Max!

Max is now 3 months old, which is hard to believe!

This is what you, Max, have been up to this past month . . .

You weigh NEARLY 15 pounds!  There was no doctor visit for an "official" weight and length, but this is just me weighing myself with you and then just me and doing the math (14.7#)!

You are wearing 3-6 month clothes.  Your 3 month clothes are definitely snug and short!

You started wearing size 2 diapers.

You are eating every 3.5 hours during the day (6:00, 9:30, 1:00, 4:30, 7:30 or 8:00) and then at midnight and 6:00 am.  You ALWAYS have to be woken up at both midnight and 6:00 am, but we have to feed you more frequently because of the mild SCAD deficiency.  You take a bottle of breast milk in the morning because I have more than you need!

You still take great morning naps, which has been so nice for me!  We still swaddle you in the Miracle Blanket or sleep sack for all of your naps and at bedtime.  We still have the same bed time/ nap time routing of singing and sound machine.  You started liking your pacifier for sleep a bit more, although it always falls out!  You haven't dropped a nap yet, and that is okay!

You rolled over the day before you turned 3 months old from front to back and you REALLY started talking (chatting) this month.  You are also, super "drooly" and started loving chewing on your hand.  You are getting QUITE a personality, and I love it!  You are such a happy, smily baby and I love coming to wake you up in the morning and see your bright smile!  You started putting your hand on my forearm when you are on the changing table and you started putting your right arm around my neck when I carry you--it is so sweet!  You also started rubbing your eyes when you get sleepy. You did grow out of your fussy evening stage, which is super exciting for us!  You are really grabbing things, including my hair.

These past 3 months have been so fun and you have changed so much and have really started developing a personality.  Your dad and I love it and we love you!  I am so sad that I can't watch you all day, every day as I start back to work on Monday, but we are so excited about your nanny and know that she will be perfect for you!

0-3 month onsie is a little tight!

Standing man! :)

Happy 2 months, Max!

Okay, so Max is a lot closer to 3 months than he is to two, but I still wanted to blog about his 2nd month!

This is what Max has been up to . . .

Max is wearing 0-3 month clothes, definitely out of newborn clothes!  He can even wear a few 3-6 month items too without them looking too big!

He is solidly in Size 1 diapers and could move to size 2 whenever we run out of the Size 1 diapers.

At his 2 month appointment Max weighed 13 pounds (71st percentile), was 23 inches long (42nd percentile) and head circumference was 42 cm (50th percentile).  Max was in the 78th percentile in weight for length.  When I look at him, I feel like he is really long, so it is funny to me that he is just in the 42nd percentile for length.

Max is still eating every 3 hours during the day and every 4 hours at night, due to his mild SCAD deficiency.  His feeding schedule is as follows:  6 am, 10, 1, 4, 7, 10, 2 am.   He is still on the eat-play-sleep cycle with every feed.  He takes great morning naps (sometimes sleeps for 3 hours) and does really well with minimum of 1.5 hour naps during the day. I still have to wake him up for the 2 am and 6 am feeds, which is frustrating, but he always goes right back to sleep unless he has a big spit up, which fortunately was only a few times.  Often he doesn't want to eat at 2 am, which is frustrating to have to wake him up because I know otherwise he would be sleeping!

We still swaddle Max in the miracle blanket at night with his arms at his side.  We have the same bedtime/naptime routine.  Sound machine on, swaddle and singing.  We always start with "Jesus Loves Me," "Seek Ye First," and "Sanctuary" and this month sang a lot of Christmas songs like "Silent Night," "Away in a Manger," and even "White Christmas."  I love singing Christmas carols to you and may end up singing them throughout the year.  It makes me laugh though that so many of them talk about sleeping!

Max took his first flight during this month--December 16, 2012.  If you know my husband, you will know that Max's first flight is important.  It is just too bad that Marc wasn't with us for the first time Max boarded an airplane.  We flew from Minnesota to Arkansas, Arkansas to Colorado and Colorado back to Minnesota and he did fantastic.  All of our travels though deserve a post themselves!

This month Max really started smiling.  At first I wasn't convinced, but while we were in Arkadelphia, his smile did seem to be purposeful, which was fun.  He also started really bearing weight on his legs and developed great head control for a baby his age.

He still had a fussy period in the evening, which was amplified by the altitude in Colorado, but pretty much once we got home from our trip, it stopped!  He had 2 HORRIBLE evenings in Colorado but we got through them just fine!

We baptized Max on December 23rd (my cousin Jane's birthday) in the church I grew up in.  Again, deserves its own post, but nonetheless a significant event in Max's 2nd month and lifetime!  We were so happy to share the moment with the congregation (and minister) who watched us get married and who supported me in my faith journey.

Naked Baby!!

Maxwell's Nursery

Max's nursery took a long time to finally come together, and honestly, it still isn't complete.  I ordered his crib in early August thinking that was plenty of time, however, it arrived just after he was born.  They said to allow 12-14 weeks for delivery.  The same story holds true for his bedding.  I ordered in probably in September and they said it would take maybe 8 weeks to receive, fortunately it took only about 6 weeks and was here even before the crib itself.

Let's start at the beginning of this room.  Here is the room when we bought the house (picture taken prior to closing).

I guess this was the previous owner's office.  The floors were not in good shape at all (just stained in areas) and we knew we would need to redo them eventually, just didn't know when we'd do it.  

We moved our desk, bookshelf and a chair in here and it became my office/study.  I didn't use it a whole lot except when I was studying for Step 3, as intern year didn't offer a lot of time for reading!  I don't have any pictures of the study when we had it, but we did repaint the walls a nice green color, which ended up being great later on for a nursery (not in the plans originally!)

So finally, just before Max was born, we gave up on our attempt to redo the hardwoods in another bedroom and had professionals come in to complete the work.  At the same time we had them refinish all the bedrooms upstairs, including the office, but minus the bedroom that was soon to be demolished.  

So back to Max's nursery. . . I chose Romina furniture for Max's room.  While we were initially drawn to just the look of the furniture, we learned that it had a lot of other great features too.  The crib is made of solid birch without any chemical treatment.  The wood is treated only with water based products that are all organic and the finish is bee's wax and the glue is made of a tree sap base.  The drawers are all self-closing (trying to avoid those loud noises and resulting startle responses).  We just felt that overall it would result in a very safe, healthy sleeping environment for our little guy.  The furniture is made in Europe, which is why the order time took so long. Here is a picture of the crib from their website:

This is the Imperio Collection

I got advice from my sister on where to shop for baby bedding.  I wanted something a little unique and definitely wanted to stick with a real "baby" theme for some reason.  Although we nearly got the same bedding as my older sis has for her boys, we found something else that we also loved.  We used a company called Posh Tots to find the bedding and chose Taylor's Toile in green for our little guy!

Now we had the bedding, the crib and the dresser.  The room was just too small for a "changing station" so we headed to Ikea and bought a white changing table for Max, which has worked out great. My mom put it together for us while I was on bed rest and for a while it was the only thing in the nursery at all!  Next we needed a rocker and my sister-in-law, Misti, helped us with that.  We ended up getting a Pottery Barn upholstered rocking chair and ottoman that is just tall enough so that both Marc (my 6'4" husband) can rest his head comfortably while rocking Max.  We ordered the wingback rocker in Belgian linen with matching ottoman.  All the pieces were finally coming together, now they just all needed to be delivered.  

On Max's first night at home, we didn't make it in time to get the furniture delivered, so Marc had to rush to Target to by a pack and play (along with a few other essentials) and Max spent the first night in the nursery without a crib!  Fortunately, the next day, they came out to deliver and assemble the crib and the dresser, and this is what his room looks like now.

 A better look at Max's crib bedding (taken when he was 11 days old)

And just because I love this picture of his sweet feet!

Looking into his room from the hall.

We still need to find somethings for the walls, so it isn't complete, but I certainly love it.  Right now with all of the construction, it is my favorite room in the house!

Thanks for reading,

Margaret

Construction Update

Marc and I were gone for about 2.5 weeks over Christmas and a lot had changed while we were gone.  To get you up to speed on the project, here is what has happened so far.

After the temporary walls were put up, the crew continued with demolition. The back end of our house was totally destroyed!

And the whole back end is down...

And this is the view of what is left:

Foundation addition for the mudroom

backyard with a big hole!

Above is what it looked like when I left and now, this is what it looks like:

This is the back of the house

View of side of house.  Straight ahead is the mudroom

Inside the family room (ceiling view)

Back of the family room.  This is where the new gas fireplace will go with built-ins on either side

more of the back of the family room.

View into the family room

View from the mudroom

2nd floor still has to be added (obviously!)

This is what the view from the garage will look like after completion:

And above is the interior addition, however the cooktop will be in the island and not the peninsula.  They were just showing us options!

The second floor should be added next week and then the roof should go on soon.  Once they have insulated everything, they will "break into" the temporary walls and began work on the existing part of the house.  Then we will be without a kitchen!  Marc and I have been appliance shopping this weekend without much luck.  The process sure is frustrating, as is living in cramped quarters, but we will love it once it is done!

Max's first month

Time has certainly flown by and I can't believe that Max is now 8 weeks old (yes, this post is a little late, but better late than never!  I still need to write about his birth day too)!  I wanted to write a bit about our first month with Max.

Our first month started out a little rough, not because Max was a bad baby or poor sleeper, but because we got a call from the on call resident at Mayo with a positive newborn screen result.  I will say that being on the other end of that phone was a lot more difficult than I ever imagined.  I was able to keep myself together while on the phone, but then fell apart once I hung up.  I kept telling myself, "Margaret this isn't all that bad."  I kept thinking to myself about all the kids I'd taken care of who had much worse inherited conditions and needed things like liver transplants, but nonetheless the mom hat overpowered the doctor hat and I was emotional about it for days.  I didn't even want to talk to my parents about it just because it made me so upset.   During that phone call it didn't help that the resident said to take him to the ED immediately if he didn't eat or started throwing up and told me that they'd already arranged for me to see the geneticist at Mayo the next morning at 8:00.  All of that just added to my anxiety.   Our pediatrician was so nice and called us at 8:00 that night to be sure we knew about the results and knew we had options on where to take Max.

 Turns out, the diagnosis remains unclear as Max doesn't have a full blown genetic mutation, but regardless they want us to treat him like he does.  Basically he doesn't metabolize short chain fats at 100% so he has to eat more frequently to ensure that everything gets all of the energy it needs (in simple terms, for my medically inclined friends, it is SCAD deficiency [short chain acyl Co-A dehydrogenase deficiency]).  The frustrating thing is that only 31 states test for it and they still don't know the clinical significance and even stated that he would likely never develop any symptoms.  Right now, it means that he can't "fast" so for at least one more month I have to wake him up every 4 hours to eat and take him to the ED if he ever gets a GI bug and can't hold anything down.  The feeding schedules spreads out as he gets a bit older, thank goodness, but I just know that Max would have been sleeping through the night within his first 6 weeks if it weren't for us needing to feed him on this schedule!

All this newborn screen experience has really taught me a lot as a physician, as has just being a mom.  I will be sure to be as informed as possible when trying to explain things to parents over the phone and reassure them that it is in fact only a screening, not a diagnosis, and needs further work-up.  Many of these diseases tested for on newborn screen are complex and go all the way back to biochemistry, but I will try to do my best! We are just grateful that Max's mutation isn't as serious as it could be and for right now I will continue to sacrifice sleep even though we don't know if he really needs to eat as scheduled.  I get to spread out his feeding schedule to 6 hours maximum fasting at 3 months, so hopefully I will be able to get at least 5 hours of continuous sleep at night before starting back to work.

Other great things about Max's first month were all the visitors and just getting to know his personality and watch him grow.  He did have a follow-up with the geneticist at almost 1 month (26 days) and he weighed 4.4 kg or 9.7 pounds up from about 3.5 kg at birth.  He was 20.7 inches long up from 20 inches at birth, so our little guy did a lot of growing his first month (probably due to having to eat every 3 hours, which is what the feeding schedule was before the follow-up appointment).

We are exclusively breastfeeding, which is going well and for which I am grateful. At his weight check at about 9 days of life he had already exceeded his birth weight and weighed in at 7#13oz.  For the first 2 weeks, we just let Max sleep when he wanted and were sure to feed him every 2 hours during the day (once we got the results of the screen) and every 3 hours at night.  We were able to spread this out to every 3 hours during day and night once we saw the geneticist for the initial visit.  When my older sister came to town, she got Max on a schedule, which was so nice!  He had been taking all of his naps in his newborn sleeper (thanks Hannah) and sleeping in his crib at night, but Mary E. had us put him in his crib for all of his naps.  This was hard to do, but I was really grateful because it allowed me to be productive during the day.  We started eat-play-sleep cycles at 1,4,7,10 am and pm.  All of this continued until Max was 26 days old and we had a follow-up visit with the geneticist who said Max could "fast" for a Max of 4 hours, so then we switched to a 2am and 6 am feeding schedule.

Other notable things in Max's first month:  We switched from newborn diapers to Size 1 at about 2.5 weeks.  He was able to wear newborn clothes, but quickly grew out of those around the end of month one (although I still squeezed him into a few afterward, but you could tell that he was stretching them out).  He has always been a strong fella and has good head control for a baby his age.  Two of my favorite things he did during the first month were 1) nuzzle into my neck when he was working so hard to hold his head up and 2) how he ALWAYS straightened his legs out with each diaper change--it made it a little easier.  I loved holding him up with just one hand supporting his bottom and loved how tiny he seemed, although he really wasn't ever THAT small!

I need to come up with a better "template" to mark these month milestones--maybe I will get the hang of it soon.  Here are some pics of Max's first month.  Month 2 post coming soon!

First bath at home.

He loved his newborn sleeper!

This was one of my favorite newborn outfits.  Max made a lot of his doctor visits in this outfit. haha!  thanks Mary E. for letting us borrow it!

Max's first bottle.  We waited probably until he was just over 3 weeks old to introduce a bottle.  Marc gave him his first bottle and he took it really well, however we now somewhat struggle with bottles.  We are working on it though! It just went downhill after the first 3, but now is getting better!