No More Preemies: 2 Year Check-up.

For those of you who had preemies, you know that two years old is a developmental milestone. It is when they stop adjusting for prematurity and the child is supposed to be all caught up. We finally got to the doctor for their two year appointment. They are actually 25 months and two weeks old, but the doctor went by 24 months. So, even though he didn't adjust, it kind of happened anyway.

So here are the stats:

Naim:
Age = 24 Months
Length = 34.5 inches
Weight = 26.0 pounds
Head circumference = 50.0 centimeters

Length = 50th percentile
Weight = between 10th and 25th percentile
Head Circumference = between 75th and 90th percentile

Aaron:
Age = 24 Months
Length = 35.0 inches
Weight = 26.25 pounds
Head circumference = 49.5 centimeters

Length = between 50th and 75th percentile
Weight = 25th percentile
Head Circumference = between 50th and 75th percentile

So more or less, they've caught up. The weight thing, if you consider that they started at below the 3rd%ile--not even in the "shaded range"--they've done pretty well. The arc of their weight line is significantly steeper than the average arc, so they did make up a lot during the first two years. After the first year, the doctors/nurses have not worried about the weight thing anymore as long as they are gaining. In fact, the ped said something about how my kids would be more in line with the growth charts from 50 years ago. He says they've changed them because American kids are fatter now. He said slim is a good thing in our society now.

My sister and I were really skinny as kids. We had a neighbor, who was also our school nurse, who always told us we were too skinny and needed to eat a milkshake a day. She got more on my sister than me, because my sister has always been really thin. But it kind of drove us nuts. She was a little plump Italian lady who would come to our class and teach us how to make homemade pasta and sauce, so those were the standards she was coming from. For a while in third grade, after I was hospitalized, she made me eat four of those frosted wafer stick cookies and a big cup of really, really sweet grape soda every afternoon while I was making up work. It was tooth-achy sweet. I can't imagine a school nurse prescribing that now. But point being, maybe the kids' slimness is more based on heredity than on prematurity. They certainly aren't starving.

So the appointment went well except that Aaron has eczema. I'm kind of embarrassed to say this, but he's had it for months and I never thought to take him to the doctor for it. With my health insurance problems, I always have to consider what is worth taking the kid to the doctor for. I often adopt a 24 hour strategy. "Let's see if it gets worse in 24 hours and re-evaluate." The eczema is not severe, mostly it just looks like dry skin which is what I thought it was; he just has a few blotches on his back and he doesn't seem to ever be bothered by them. A few weeks ago, I started putting Burt's Bees stuff on them. The really thick Baby Bee emollient type of moisturizer on top of their regular baby lotion. Aaron calls it putting "goop on my spots". After the Burt's Bees, the spots started improving significantly. They are not as dry and flaky and they are smaller and no longer very reddish in color. I told the doctor this and he kind of snotted at me, "Well, that's not even medicated." So, I'm going to fill his scrip for cortisone and use it to get rid of these spots, and then I'm just going to keep doing what I've been doing and see if that's the end of it.

That pediatrician is hilarious. I'm pretty sure he's on crack. He comes in and talks at ninety miles a minute about stuff I already know and you can hardly get a word in to ask the stuff you don't know and then he leaves and you feel like the wind was knocked out of you and you're not sure what happened. Here is an example of what I was talking about in the previous post. He goes on forever explaining what percentiles mean and what different statistics mean, or tells me some really basic thing about child development. I just want to stop him and say, "I KNOW already. Now can we talk about something I might actually have a concern over?" I feel like telling him, "oh, I have a master's degree in this stuff." Or something. Or is that just totally obnoxious? He has always been a little strange about me and D's disabilities. It's like he is trying to be really cool and open about it, but he really doesn't have a clue so he says some kind of rude stuff without meaning to. Mostly kind of intrusive stuff that has nothing to do with anything. He actually wasn't bad yesterday. Maybe he is getting used to us. But he took us on voluntarily when the kids were on Medicaid and he didn't have to. At this practice they have a quota of Medicaid patients that individual partners can take on a voluntary basis. He took us despite having filled his quota, we heard. So that was very nice of him. But he kind of sometimes acted in the beginning like we were real charity cases. He got into a discussion with D at some point about how D sells software and sometimes does tech support and studied computer engineering, and I could tell he was blown away that we actually do something with our lives. But he's never asked me what I do/did, so there hasn't been a good opportunity to really tell him that he doesn't have to explain the difference between percentiles and percentages to me. In any case, I think he is getting better about us, which is good. And I'm sure they just have these same speeches that they run through for every parent and he's just on autopilot when he comes in. But the man can fit a lot of words into each minute.

The one other little thing that bugs me about him is that he tells me to pull the kids' foreskin on their penis back once a day. I've never heard anywhere else that this is necessary. When I made the decision not to circumcise them, I did a bunch of research on what kind of care they needed and how to prevent infections and whatnot. In everything I read, including the American Academy of Pediatrics official statement, it says not to do this. If you didn't know (and I didn't), I guess the foreskin is sort of attached on babies, and then slowly over time it unattaches. Like this will take maybe four or five years in some kids. So, they say that just in life doing the things boys do, they will loosen it themselves and there is no reason to force it. You can actually cause an infection by forcing it before its ready. So you are just supposed to wash in soap and water and then when the kid gets older and it is all unattached, you teach him to pull it back and wash it. I'm probably not using the right terminology here, but you get what I mean, right? Okay. So last time I was there, he forced Naim's back, and I could tell it was very painful, and it was red for a couple of days. Since then, I've noticed that it was getting unattached, but I never did pull it back even once. So, this time, he does it and it pulls back and he goes, "Oh, I'm glad to see you've been pulling it back." Well, I haven't. Then we get to Aaron, whose all attached still, and he told me I needed to pull it back once a day. And I said that from what I've read this isn't necessary. He looked kind of surprised at went off on varying theories about that. I said I was going by the AAP and the American Pediatric Society. And then he kind of cocked his head, like "whatever you say, silly mom."  So, I guess we agreed to disagree there. I mean, do you think mothers have been pulling back their son's foreskins everyday throughout the dawn of time because it is so necessary to do this? If so, wouldn't I have heard about it? Have you? There is no medical reason for it so I'm not going to do it. Maybe I should send him this. (.pdf pamphlet against forced retraction of the forskin from UN sponsored National Org. for Circumcision Information and Research Centers)

I should probably delete that paragraph before the kids reach adolescence, huh?

Basically, I think that D and I have enough medical experiences to know that you can usually let nature take its course and then try a few naturalpathic things first (a la Burt's Bees) before medical intervention is necessary in many cases. I also am a slow vaccinator, mainly due to Aaron's seizures. We vaccinate, but we do just one or two at a time, instead of like, six. I think he is a bit annoyed by this, mainly because it means they have to think a bit before giving them the shots instead of just using what they use for everyone else. As a medical doctor, I think he wants to jump to intervention and write scrips a little too quickly for us. But I'd actually rather take that than the alternative, when you have to beg doctors for medical intervention after you already have tried everything else.  In general, he gets points for taking us on in my book and I think he is very knowledgeable about most things and means well. So, he'll do.

The only other thing I wanted to add here for this two year kind of status update is some info for my own memory about their developmental evaluation by healthy start. (Healthy Start's assessment tool is kind of meh. They will get a better one next week when their nurse comes.) Aaron is above average in language, way above average in fine motor skills and problem solving, average in social emotional, and slightly below average in gross motor. Naim is average in language, way above in fine motor and problem solving, average in social emotional and just a hair on the average side of the bump in gross motor. I think the problem solving advantage comes from being a twin. They just don't have me there all the time to help them when they get stuck, so they have to figure out a lot on their own. The healthy start teacher gave me a nice compliment about this and the fine motor. She said I have the best developmental toys of any house she's seen, and that they all compliment each other and teach them something instead of being junk. (See? Being a toy snob has its advantages.) I think also because I don't have a lot of money, I am really, really selective about what toys the kids get. Also I use  mostly educational supply companies (or eBay knockoffs of such) instead of toys 'r' us, so that helps as well. I think the gross motor might be a little bit of a combination of prematurity, twinness, and single momhood. The prematurity factors in because, in Aaron especially, his head is just too big for his legs. He hasn't grown into the type of body that can run, jump, and balance yet. He will, but right now he just doesn't have the body for it. Twinness and single momhood kind of go together because I think that I avoid taking them out for walks or trike rides more than I should. We go to the park and stuff, but I stroller them there. Walking out in the world alone with two toddlers going in different directions at different speeds is just dauntingly impossible right now. This is why I signed them up for the gym thing where they can run around in the safety of the gym.

Today was pretty nice out and my dad and I took the kids for a walk with their ride-on toys. With just one kid to watch, it is a total breeze. If I had a 1:1 ratio, I could do that every day and we could probably walk a pretty good distance. We had fun today and I probably need to work on that more. Eventually, I will have to deal with them without the security of the stroller. [Cue Jaws music here]

Comments

[luolin]

Sometimes I think that the health professions I have dealt with have their spiel about something, and it is easier for them to give the whole thing, rather than have me disrupt it by saying "oh, I already know that part". (I loved reading Thalya's blog about how her husband gently told an RE, "she has a PhD in genetics" when he started his spiel.) The thing is that with a primary care doctor (as opposed to a long consult), there's often no time to waste on stuff you already know.

I had heard about the foreskin thing, but only because I read a comment on a blog somewhere that said "and DON'T let the doctor pull it back!".

[B]

I enjoyed your eye-opening post about being talked down to regardless of your professional background. While I don't have any experiences as a disabled person, I too find myself being talked down to by our pediatrician (as well as OB-GYNs) and occasionally wonder whether to tell the doc that s/he isn't the only one with an education. I assume health care providers go into autopilot and just switch on their internal tape when dealing with patients and their caregivers. On those occasions when I ask questions, I often get a less than satisfactory response. Two possible explanations suggest themselves: 1) The doc is still talking down to me even after I ask a focused question. 2) The doc isn't actually much of a reader/thinker him/herself, hence doesn't KNOW much beyond the standard, canned response. In the example with pulling back the foreskin, sounds like your doctor hasn't been reading the literature lately.

[Ron Low]

You really do have actionable mal-practice by this doctor. Nobody but the owner should EVER try to retract a foreskin.

If he gets past the initial discomfort ok, the worst outcome is likely that he may wind up with a shorter than average foreskin. I've helped intact guys use foreskin restoration methods and they report early retraction as the suspected cause of their problems.

Don't be a sucker. DROP this asshole doctor like yesterday.

[Gretchen]

I don't have advise about foreskins - although if we had a boy I was lobbying for no cutting.

But eczema I did have as a kid, (well into elementary school I was itching my butt because of it). My Mom has told me that it cleared up after she started using the "free and clear" type laundry detergent. No promises that it'll work, and I don't know what you use now, but something to think about.

[Keri]

Hi there! Deaf mom here! ;) I do get that "talking down" from various people even though I have an effing M.Ed. So annoying! Luckily, my 18-month-old son's ped is a really nice woman. We made it clear that we did NOT want to vaccinate our son and wanted NO pressure from her. She respected that.

Our son is also uncircumcised and we have left it alone. His ped leaves it alone as well. One other thing I like about the ped is that she is not in a hurry to fill out prescriptions for every little ailment. We wait it out first and then try homeopathic remedies. My son NEVER had OTC or prescibed meds until yesterday. After three days of low-grade fever, we visited the ped who could find nothing wrong, we decided to go ahead with Tylenol before trying antibiotics. The Tylenol seems to be masking my son's symptoms but at least he's feeling a little better. Will wait a bit longer before trying antibiotics (tmw will use if he's not better).

Also, Burt's Bees PASTE rocks! My son had mild eczema last year and the paste made it go away. Be sure NOT to use lotion because it dries out the skin. Just use the paste alone.

Your boys are adorable! =)

[That Girl]

I used to be a "slacker" mom who didnt take my kids to the doc for every little thing. With the baby now of course he is medicated for everything instantly out of necessity rather than my wish or general attitude.
There are also a lot of school rules that cause problems tho - most schools require a doctors note after 3 days absent so if your kids gets the flu or a virus you have to take him anyway. It's annoying.
Im glad the children are as healthy as they are cute!