Big boy tub

Caedmon is loving taking baths like a big boy these days.  He kicks and splashes and gets a little wild :)

Build a Bear

The boys went to cousin Phoebe's build a bear birthday party on Saturday.  They loved it and both picked out Paw Patrol characters.  I made Caedmon a bear that he fell in love with.

Avocado

We've started Caedmon on a bit of avocado each day to increase his calorie and fat intake.  We don't know yet if it's helping put on the ounces, but he sure loves it :)

Farm

My birthday was last weekend.  Jace was with his mom and Jon was working, so I decided to take Graesen and Caedmon to one of my favorite local farms to pick apples. 

Failure to Thrive

For 2 1/2 weeks Caedmon was gaining weight.  The first half week of pushing feeds and supplementing with pumped milk led to him gaining 5 oz.  This was huge. Then after that it was 5 oz a week for 2 weeks.  This was good gains for Caedmon.  While we were hoping for a little bit more, it was adequate and we were hoping the weight issues were going to be a thing of the past.  This past week, however, he gained nothing.  At the lactation office he took 4 oz, which is a bit jump from the 3 he was taking.  Combined with the added 5 oz of pumped milk per day, he was taking plenty and his weight should have reflected that.  The next day at his GI appointment, the doctor was not happy with his weight.  He wanted him to gain more than he has and says we have no cushion to keep him healthy if he were to get sick.  His BMI and weight to length ratio are well below the normal growth curves.  The doctor says we are not quite at the point of hospitalization or a feeding tube, but we need some cushion to keep that from happening. 
While at the appointment the doctor did an icky exam and found a small stricture or tightening.  He used his finger to release that and Caedmon screamed and cried the rest of the time.  While he doesn't believe that was the cause of the motility issues, it did make Caedmon go, so we collected a sample for the lab.  The lab is testing for malabsorption, so we can see if that's why Caedmon is so small.  The doctor also did a quick stool test and found trace amounts of blood.  He believes that Caedmon may have a milk protein intolerance.  I'm going to avoid all dairy and soy to see if that helps (combine that with my inability to eat wheat and I'm really not left with much).  However, the doctor still doesn't think that's the source of all our problems.  He's asking me to add a small amount of hypoallergenic formula to the 5 oz of pumped milk we give Caedmon daily for some added calories.  Problem is, with the stress and worry about my baby, what I get varies daily.  Before I just used my freezer stash from when Caedmon was a newborn whenever I didn't get enough, but now that's off limits since I was eating dairy then.  I tried to supplement with some straight formula and Caedmon did not like it one bit.  Each time I tried yesterday I only got him to take about 1/2 oz at most.  Getting this little guy to gain is no easy task since he thinks that formula is a form of torture.
The doctor also wants to test for structural abnormalities.  Tomorrow morning we will go in for a barium swallow study.  Graesen had one around 15 months old and it was absolute torture.  I'm hoping that it will be easier with a younger baby.
After the appointment I was looking through the paperwork given to me by the doctor and there it was...the big, dreaded diagnosis.  Failure to thrive and GERD.  I knew we were teetering on the edge of the failure to thrive diagnosis, but it still hurt to see it.  There are days when I watch him scoot (backwards) across a room or sit for long periods while laughing, and I think he's fine.  Look at his development.  Look at how sweet and happy he is.  And then I change his diaper in the morning when all the bloat is gone.  I see ribs and muscle definition and no rolls, and I know that the doctor is right.  This sweet, tiny little guy isn't growing as he should and that's a very scary thing.

4 months

Another month flew by and Caedmon is already 4 months old.  He thinks he's much older and wants to try and keep up with his brothers.  Since he's so tiny, he feels younger to me.  We're still working with lactation on getting him to gain weight.  We've made some progress, but it requires pushing feeds, setting alarms for the middle of the night to wake him up, and lots of extra pumping and bottles after feedings. The lactation nurse said that without forcing supplementation he really would not be taking enough to survive.  He's gotten used to starving because he was in pain and he struggled with swallowing and latch, and now he doesn't know that he needs to eat more.  Since his weight is so much of a concern, we have decided to have me not accept any substitute teaching jobs until we can see that he is showing consistent gains.  Hopefully that will be just a couple weeks.  He doesn't really do any better with a bottle than he does nursing, which is why it is so crucial right now that we give him both.  With the increase in feedings we are noticing that he is more active and alert.  He really is an incredibly sweet baby who loves to be silly.  I feel so blessed to be his mom, and I'm just praying for his health.

• 12 lbs 12 oz- 6%(taken 4 days early)
• 26 inches-86.3%
• Size 1 diapers (I have cloth, but we've been so stressed and focused on feedings and appointments, that I just haven't been up to the extra laundry)
• Newborn shorts still fit. For everything else it's anywhere from size 3 to size 6 months.  One piece items, he can wear size 6 months, since he is so long.  However, everything is big around, even the newborn shorts.
• He was sleeping up to 9 1/2 hours at night, but I'm now waking him after 5 hours to get another feeding in.  After that I only let him sleep 3 hours at a time to make sure he's eating enough.
• He just had his tongue and upper lip clipped and is healing well.
• Doing tripod sit
• Rolls front to back occasionally
• Scoots around the room on his belly. Mostly backwards, and he can turn in circles to get to see what he wants
• Plays with his toes a lot
• Loves his Sofie giraffes
• "Talks" all the time
• Loves the cat
• Drools A LOT all the time
• Taking 2.5 mL of omprezole twice a day for reflux
• Taking .7 mL of erythromyacin 3 times a day to strengthen his gut and speed up motility (the hope is that faster motility will mean he gets hungry more frequently)

First Day of School

Graesen and Jace started second grade on Tuesday.  Graesen is thrilled to be in the same class as his best friend.  We ran into his first grade teacher and she told me that she made sure those two stayed together.  She said they are just too sweet together and care about each other too much to separate.
I only have one picture of Jace, because it was his week with his mom.  I just sneaked into his classroom for a quick picture at the beginning of the day.

Weight, tongue tie, lip tie, and other such fun

Since finding out that Caedmon was losing weight, we have been busy.  On Thursday we visited the lactation specialist.  She noted that Caedmon's tongue and lip tie were creating major issues with this ability latch, transfer milk, and swallow.  She said he has dysphagia and we needed to do some serious work to get him gaining.  We are now squeezing in an extra feeding...no more letting him sleep 8+ hours at night :(.  We started with an extra ounce of pumped milk after each feeding.  I am also pumping 4 times a day. Yuck! It's necessary, though, as having a baby who doesn't latch well create supply issues. 
On Tuesday we went back to the lactation specialist.  Caedmon gained 4.6 oz in 5 days! This is huge for him and means he gained all that he lost over 2 weeks, plus an extra ounce. The lactation specialist calls Caedmon a "happy to starve" baby.  He doesn't show hunger cues as often and isn't as concerned with eating as most babies.  He's been like that since birth when I struggled to get him to eat at all.  To this day I often have to make him eat because I know it's time for him to eat, even though he's napping or playing or otherwise preoccupied.  He has to be put on a feeding schedule and we can't do feeding on demand, because he just doesn't demand it often enough.  The good news is that my supply is already increasing from pumping.  And now we are down to feeding an extra ounce after 5 feedings a day versus every feeding.
We also visited a pediatric gi doctor on Tuesday.  He doubled Caedmon's reflux med doses.  He will now get it morning and night.  In addition, he prescribed an antibiotic.  The antibiotic is not for an infection, but we will use it as it tends to speed up motility and strengthen gut muscles.  The hope is if Caedmon "empties" more frequently, his motility will increase, causing him to feel hungry more frequently and eat more.  We also did a blood draw.  Not fun, but the phlebotomist was quick to get the blood needed.  The tests have come back ok.  A few things are slightly off, but not enough to be concerned. 
Wednesday we visited an ent and had Caedmon's tongue and lip tie fixed.  He screamed a ton and bled more than I remember Graesen bleeding.  The upper lip tie fix will be much more painful to recover from than the tongue tie, so we're giving tylenol to make him more comfortable.  Since he's older it will take a lot more work to teach him better habits.  He frequently struggles to latch and transfer milk even with a bottle, so we have some work to do.  Caedmon also has a recessed lower jaw.  It was very prominent at birth, but has gotten better.  Unfortunately, because of the position of his jaw, Caedmon is still likely to struggle somewhat with feeds after he heals.  Both the ENT and the lactation nurse have said that if he doesn't improve the way we want, he may benefit from craniosacral therapy to help relax and release that lower jaw.
So that's where we are at this point.  We will continue weekly visits with the lactation nurse until we see the progress we like, and we will go back to the gi in a few weeks for a check up.  Caedmon is already starting to look healthier with the addition of 4 oz.  When I look at some of the old pictures I see how thin he was starting to look.  I feel like his eyes are looking brighter and he's having more energy than before.