Constant Progress

Matthew pulled himself up to a standing position this morning (grabbing on to Mike's shirt). I'm not sure that I'm too happy about this new development -- standing up is something that big kids do, and he's still supposed to be my little baby!

Though I must admit that the crawling over to us and climbing up on our laps is quite endearing. :) Mattie sometimes wants us to lift him up and down so he can bounce (he loves to bounce!), but since he's 19 and a half pounds now, our arms get tired a lot faster than he does! (Good thing he still fits in the Jumperoo!)

Mattie is also saying a lot of "dada" and "mama", but he hasn't connected those words with us yet.

Jamesie's developmental therapist was pleased and impressed with his progress. Besides the crawling, she had also been working with him last week on taking objects out of containers, and now he's doing that like a pro. He catches on to things quickly!

James also has been doing very well with his milk; yesterday he set a new record at 870 mls (out of a goal of 900 ml, which is 30 oz), and probably wouldn't have needed to have any overnight feeding through the pump if his daddy had just given him a bigger bedtime bottle! (Today he was over 800 ml, too. We're very pleased! If he weren't going in for surgery next week, we could probably start trying to go without the pump, but at this point we want him to have all the calories he can, since he won't be able to eat regular food right before and right after the surgery. Presumably they'll have him on IV nutrition, but still. He's getting some baby food and rice cereal most days, too, but it's still more for practice than counting toward his nutrition.)

James is Crawling

At least for a few steps! He's still doing a lot of rolling, but I saw some actual all-fours crawling this morning!

Rescheduled

James was supposed to get his hearing aids fitted today, but they didn't arrive in time, so the appointment has been rescheduled for Monday.

The boys are more and more mobile every day. James is getting up on all fours a lot more, and even made a little forward progress that way yesterday morning (his hands were on the rug, but his legs were on the wood, so he couldn't get much traction!) Matthew can pull himself up to stand on his knees on his toy or on our legs when we're sitting down with him, and is lifting his bottom in the air with his feet and hands on the ground (downward dog, for you yoga fans). They are both very fast and apparently have no sense of self-preservation whatsoever, so we can't leave them unattended for more than a moment or two at a time.

Matthew has been sleeping in the cosleeper (set up bassinet-style) recently, and the edges are about 18 inches above the mattress. Clearly it was time to lower the mattress before he flipped himself out of it, so we put the mattress on the bottom (making it into basically a pack and play). That was completely miserable! It was murder on my back to put him down and pick him up, and it felt like we were putting him in a pit (the kind where you dig a big hole to catch some wild animal). So, we finally gave in and bought a second crib. I think they're just too big and active (and Matthew is too much of a light sleeper) to go back to sharing one.

We are quite enjoying James's clapping skills. Every so often he just pauses and claps a little bit, and it's very nice to have some random applause throughout the day.

We put on the Signing Time baby sign language video this evening. The babies don't really watch any TV yet; we don't have it on all that often when they're awake, and when we do, they glance at it every now and then but don't usually seem too interested in it (except for football). But they were mesmerized by this video! I don't know if it was the singing and music, or the fact that there were a lot of babies in it, or what, but Matthew especially was glued to the screen. (It was a bit disconcerting, actually.) It'll be interesting to see if it actually helps them pick up any sign language. (It'll help me, anyhow!) When they were doing the sign for "dog" (patting your leg like you're calling a dog), I did the sign and said to Matthew, "That means dog." He looked at my gesture and then looked right at Stanley.

Friends

We enjoyed a wonderful visit with Feesh and Bonnie this weekend. (The babies, in fact, were so excited by the company that they decided they didn't need their naps!)

The boys were very well-behaved for a trip to Carrboro for lunch and ice cream, and then went to bed in time for the adults to indulge in crawfish pie and Avatar.

Proper Motivation

Matthew is doing a few steps at a time of regular crawling (hands and knees) and James is getting himself forward by army crawling (especially on the hardwood floors). It turns out they just needed the proper motivation: Stanley's ball!

Duck

Mattie was playing with Rubber Ducky today, and saying something that sounded a lot like "duck." :) We're not quite willing to count it as a word yet, but I think he's on the way!

On Monday, James also had a blood pressure check, and because everything looked good, his nephrologist said we could discontinue one of his medicines (Enalapril). Hooray!!

Happy Birthday to Uncle Jim and Charlotte (and Blizzy!)

Behavioral Testing

As I've already mentioned, we went in for James's behavioral hearing test today. They do the test in a sound booth, a small soundproof room (pictured here).

The first thing they did was a quick test that puffed some air into his ears to test his eardrum responsiveness. The results showed a bit less than normal flexibility, which could mean that he has a little fluid behind his ears, or it could just be an individual difference. Either way, they didn't seem particularly concerned about it.

Then, they had Mike sit with James on his lap. The assistant (a graduate student) was in the room with us, and the audiologist was in the control room. (In the photo, the control room is behind the slightly shaded glass behind the table.)

The idea behind the test is to get the baby to turn and look at some boxes with dancing puppets when they hear a noise, and so you can use the response or lack of response to indicate what they're hearing. The boxes are the black things at the edge of the photo. They're dark glass, but when the baby turns to a noise, they light up and a stuffed animal inside moves around -- they have a lion who roars and shakes his head, an elephant that raises his trunk, and so on. The first part of the test is training to get the baby to realize that when they hear a sound and turn that direction, they'll be rewarded by dancing puppets. The assistant's job at first is to direct the baby's attention to the boxes, and then for the rest of the test, her job was to be "interesting but not too interesting" -- that is, keep James's attention focused elsewhere so that they could make the sounds when he wasn't already looking at the boxes.

The training part went very quickly for James; he got the idea in just a couple of tries. And he loved the puppets! Every time they appeared he would get a big smile and talk to them. It was so cute!

The assistant had a whole range of toys, from a ball with glitter water inside to trucks and small animals. (Her task was more difficult because we all had to remain silent, so she couldn't distract him with talking!) Every time James started to lose interest in one toy she'd pull out the next one. The sounds came from speakers that are in the corner behind where I'm standing in the picture. They ranged from static-like noises to Star Trek/space age type noises. When he heard them he would perk up and turn to the boxes. The tricky part was that he sometimes turned around to check out the boxes just to see if anything was happening there, so occasionally it was hard to determine if he actually heard a particular sound -- when that happened, they just tried it again later.

After the first round of testing, they put James in a high chair for the second round, and I got to go into the control booth and see it from the other side. For the second round the audiologist started at 10 decibels lower than where he'd responded the previous time at each pitch, to see if he could hear quieter sounds. It seemed like he was fairly consistent, though, which was nice because it gave us reasonable confidence in the results. For part of the session, they also put a device that looked like a headband on his head to do a bone conduction test, which sends sounds directly to the inner ear.

James really did a wonderful job; he was so happy and attentive. Sometimes they have to try multiple sessions to get a good test, so it was great that he managed it the first time around. In fact, the testers complimented him on his cuteness and his developmental skills. :)

The results indicated that he had reasonably good (although not completely normal) hearing at lower pitches, and it got progressively worse as they moved toward the higher pitches (so, it took a sound of about 70 decibels for him to react at the highest pitch). They chart the results on a grid called an audiogram with decibel level (loudness) on one axis and pitch on the other, and so his line looked like a diagonal. Apparently this is a fairly typical pattern for kids with sensorineural hearing loss.

They told us that the loss was in the mild to moderate range, which actually seemed pretty encouraging to us. And this is a range that is generally very correctable with hearing aids. And because James did so well with the testing, they felt comfortable recommending that we go ahead and start the process of getting his hearing aids. (Their perspective is that the sooner kids get the amplification they need, the better -- which makes sense because once they can hear at normal levels, they'll pick up a lot more language.) They'll do a couple more tests to get a more fine-tuned measure of his hearing (for example, testing each ear separately), but they were confident enough in the information that they had from today's test that they should be able to get the settings fairly close to what he needs. (If he does have some fluid in his ears, that might affect the results a tiny bit, but probably not much.) The audiologist also said that if she had a six year-old, for example, with the same pattern of hearing loss, she'd be able to carry on a conversation with him even if he didn't have his hearing aids, but she might have to raise her voice a little and wouldn't lower her voice. So that's also kind of nice that he wouldn't completely miss out on things if for some reason he didn't have his hearing aids in.

The first step (besides knowing the hearing levels) to get hearing aids is to make an ear mold, so they did that today as well. They put a little cotton with a string on it in the ear first, and then they squeeze this pink stuff that looks like Silly Putty into the outside of the ear. It dries in a few minutes, and they use the string to pull it out, so they have a model of the ear shape. The hearing aids for babies have one part that goes inside their ear, and then another part that fits around the back of the ear. They have a bunch of different colors and a few patterns you can choose from, and apparently older kids enjoy picking out fun patterns.

The next step is an appointment to do the fitting, and they're going to try to do that before his surgery; we'll see if the scheduling works out.

Apparently the big challenge at his age is that the kids grab them and take them out of the ears and try to put them in their mouth. :) (Surprise!) They have little hats they can wear for a while until they get used to having the aids on or until they grow out of that particular phase.

Short Version

James did a great job with the behavioral hearing test today. They were able to get a lot of good information, and it looks like he has what they would classify as a mild to moderate hearing loss. He hears reasonably well (although not perfectly) at lower pitches and his hearing gets progressively worse at higher pitches (so, at the highest level they tested he's hearing at around the 70 db level). So, he'll be getting hearing aids to help bring his hearing up to normal levels.

This is about what we expected or maybe even a bit better than we expected -- we were confident that he was hearing some things, but we also knew that he wasn't always hearing softer sounds, and didn't react to sound as much as Matthew does.

More details later.

Brilliant

Matthew demonstrated his genius the other day when we were holding him by the refrigerator. We have a lot of pictures up, and we asked him, "Where's Stanley?" and he pointed to a picture of Stanley! (We then asked him, "Where's Matthew?" but he didn't point to anything for that one -- I suppose it's too much to ask for him to recognize a picture of himself as a younger baby! He was probably thinking to himself, "I'm right here. Adults are so silly sometimes.")

And Jamesie did indeed demonstrate his clapping when his therapist was here. When we all cheered for him in response, he looked surprised but pleased. :)

We had beautiful weather this weekend. The local Garden Show was in our neighborhood this year, so we enjoyed the specatacle of crowds of people coming to look at the yards we walk by every day (although the gardens on display were mostly in the backyards, which we don't get to see). We strolled around with our friends, but didn't actually go see the displays, since you needed a ticket for that (and I'm guessing the garden owners wouldn't be especially thrilled with us dragging our stroller and dog through their prize plants.)

Today we did our part to encourage childhood obesity by taking the boys on an outing to Sugarland, a local bakery and gelato shop. But since they aren't big enough for cupcakes yet, we had to eat ones for them. Ah, the sacrifices we make for our children.

And speaking of eating, James had what I think was another record day with 805 ml, out of his intended total of 900 ml, so we're very pleased! Of course, we would have been more pleased if one of his meals hadn't been at 6 AM, but we'll take what we can get. I don't expect a repeat record-breaker performance tomorrow, because we have a long day at the hospital (the behavioral hearing test and a checkup), and that always messes up the eating and napping schedule.

Round of Applause

Guess who was clapping today? That's right -- James! (It's kind of in slow motion, but that's okay!) He clapped for me this morning when I was doing Patty Cake for him, which was cool because he hasn't done much if any imitation of gestures before this. But even better was after his bath this evening, when Mike said "patty cake, patty cake" without doing the gestures and James clapped! We'll have to see if he does it again, but if he was actually hearing and understanding the words (instead of it just being a coincidence), that would be really exciting. Hooray for James!

We're hoping he decides to show off his new skills for his developmental therapist tomorrow morning. :)

Happy Birthday, Grandpa!

James and Matthew say Happy Birthday, Grandpa B!

Eleven Months

James went to the eye doctor today. The appointment was originally scheduled because he was still crossing his eyes sometimes when he last saw the eye doctor, and they wanted to follow up. We couldn't remember the last time we noticed him crossing his eyes, so we figured he'd grown out of it like they expected. We were tempted to cancel the appointment (and save our $60 copay!), but we decided to be on the safe side and go. So, everything looked great and he doesn't need to go back for another 18 months (same time as Matthew). Yay!

Mattie was playing a new game today. He had one of his teething toys, and he would bat it away on the hard wood floor, then crawl over to get it, then bat it away again, then crawl over to it. I'm pretty sure he was doing it on purpose (that is, he wasn't just having a hard time picking it up). He's definitely enjoying getting around! He also crawled across the room to try to get a toy from James, but Mommy wouldn't let him. :)

A+ (...and Incomplete)

James's developmental therapist (accompanied by his Early Intervention coordinator) came for a session on Friday, and she was very pleased with his progress -- she had been working with him on holding a toy in each hand and banging them together. During the first session, he would mostly just drop the first toy to grab the second toy, but now, he's holding two toys and banging them with ease. She was impressed with how quickly he got the hang of it! Now the next step is clapping. (There's always a next step!)

James's auditory-verbal therapist also came on Friday, and she too was happy with all the progress he'd made since she started working with him. Of course, a lot of that progress was simply growing into different developmental stages, but still, he's doing a lot of things now that he wasn't doing in December when we first saw her. So, A+ for James!

This morning we went for a hearing test that was intended to assess cortical activity in response to sound (essentially, looking for brainwave activity in a different part of the brain than the previous hearing test, which measured activity in the brainstem). This test required that the baby be awake but quiet. So...that didn't work out so well. James can do awake and quiet, but he was not at all amused with people putting things in his ears (little microphones to transmit the sounds) and sticking electrodes on his head. They were able to get some measurements from the right ear (which indicated a response at 75 db), but he was moving too much for them to get measurements from the left ear. So, the fact that there was some cortical response is a good thing, but other than that it didn't give us too much new information. He's scheduled for the behavioral test next Monday, and the audiologist thinks that he's ready for the test and that it should give us some good information. However, she warned us that sometimes with babies it takes multiple sessions to actually get a complete picture of their hearing.

The audiologist mentioned again that there are two issues with auditory neuropathy -- the level of hearing (detecting sounds, which they can assess with the behavioral test and help address with hearing aids) and whether the sounds are too garbled to permit speech perception (which is hard to diagnose until the age when kids start developing more language skills). For the second case, cochlear implants usually seem to help. And although she was saying that James has a lot of good things going for him (excellent attention skills, educated parents, expert medical facilities, etc.), it was still depressing to have all that scary uncertainty out there. (I think I surprised her a bit by starting to cry when she was actually telling us all the encouraging things about James's case! "What did I say?" she asked. "It's nothing you said, it's just the situation.") So, we'll see; at this point all we can do is to keep on with making sure he's exposed to lots of language, and keep hoping for the best.

Interspecies Bonding

Abby is very patient with Matthew. :)

Junior Axemen

Rocking with Daddy and Uncle Adrian.



* Axeman = slang for "guitar player"

Great Babies Think Alike

Now James has discovered that he can roll and scoot his way over to the books. Of course, then he also maneuvered himself backwards and got stuck under the recliner.

James and Matthew have been talking to each other the past couple days -- one of them will babble and the other one will repeat it. I've seen Matthew doing it, and our babysitter was excited to tell Mike that she heard James doing it.

This evening, they were both on the floor and Matthew was lying on his back with a paci. James reached up and grabbed his sleeve and then grabbed the paci. I saw this coming, so I had put another paci nearby. Matthew just picked up that one. So James dropped the first paci, grabbed Mattie's sleeve again, and snagged the second paci. He then had one in his mouth and one in his hand, so he was happy. Fortunately, Matthew didn't really care; he just picked up some other toy. It was very funny!! (And it goes both ways -- we've seen Matthew take toys or books out of James's hands, too. It hasn't caused major meltdowns yet, but I'm sure we'll have plenty in our future!)

Mobility

Matthew has the army crawl down; he can make pretty good time across the floor! He's also getting up on all fours and rocking back and forth.

James is now rolling all over the room, and "crawling" backwards. He got his legs wedged under the couch yesterday, but before I could go rescue him, he cleverly turned and got himself out.

They both love to make their way over to the exersaucer and play with the bottom of it. I'm not sure what the appeal is there, but as long as neither one of them is in the exersaucer (that is, no risk of getting fingers pinched under it!), then I suppose it's okay. (It was so cute -- the other day James rolled and scooted over to it, grabbed on, and then turned to look at me, as if he was checking to see if it was okay. I smiled at him, and he gave a big smile back and then continued what he was doing.)

Matthew does tend to gravitate towards things he's not supposed to have. In the midst of a gazillion baby toys, he managed to find Stanley's ball and wanted to put it in his mouth. (We took it away from him -- Mike was about to give it back after washing it, but since Stanley was hovering nearby wanting to play, I figured that wouldn't end well!) And of course, his affection for the telephone continues unabated. And recently, he's developed a fascination with the electrical outlet in the bathroom, the one just above his reach when we change his diaper on the counter changing station. (Yes, we have a safety plug in it.) So, I'm sure he will test all our babyproofing (which we'd better get working on!)

What's in that basket?!

James is completely surprised by....by what? We don't know.

Happy Easter!

Happy Easter, everyone!

[In the bottom picture, the boys are wearing hats with bunny ears -- you can see one of Matthew's.]

Summer Clothes

It was in the 80's today, so the boys got to wear their summer clothes for the first time this season! They enjoyed both a walk around the neighborhood with friends, and a trip down to Franklin Street for ice cream (though they didn't actually get to eat any of the ice cream).

Summer Cut

Matthew and James were asleep last night by the time Stanley got home from the groomer. I was wondering how Matthew would react to his big fluffy dog suddenly becoming a sleek short-haired dog (and was hoping the change wouldn't upset him, since Stanley is about his favorite thing in the world!) The boys didn't seem to notice the difference, or if they did, it didn't bother them -- they were just as excited to see Stanley as always. (I did explain to them that he got a haircut, but, you know, they don't know that word yet.)

We are pretty sure Matthew is saying "dog" or trying to when he sees Stanley, but since he also makes a lot of d and g sounds at other times, it probably doesn't officially count as his first word yet. :)

No Foolin'

The boys had an appointment with Nephrology today, and both of them had good blood pressures! So we get to cut Matthew's medicine (Labatalol) dose in half, and we get to give one of James's medicines (Enalapril) only once a day rather than twice a day. So, that's a step in the right direction! (The Nephrology docs are awesome, but we're looking forward to "graduating" from them one of these days.)

We also heard the report on James's kidney ultrasound. The good news is that there was no evidence of kidney stones or calcium deposits. Excellent! The not-so-good news is that his kidneys hadn't grown since the previous ultrasound (in September). But the doctor said that they usually measure growth over the course of a year, so it's hard to know what to make of measurements earlier than that. So, they'll look again in the fall, and hopefully things will be on track then.

We also had an appointment with the Peds Surgery nurse practitioner. I had requested this one, because I wanted to have James's g-tube checked, and we also had some surgery questions. It turned out the tube (Mickey button) was about due for replacement (they seem to get gunky about every three months or so), so the NP supervised while Mike changed it -- a pretty quick and easy process, actually, but one we hope we don't have to do on our own (that is, if James pulls it out).

The nurse practitioner was wonderful. She was so reassuring about everything. She said that usually by the time the kids go home from the hospital, they're close to back to normal, maybe with some minor soreness remaining. The worst part is apparently the diaper rash (and poor Jamesie already has sensitive skin, so I sure hope the diaper cream works well!) We're allowed to bring his own clothes and toys to the hospital, and we'll have a private room with a fold-out bed for parents to stay.

I also asked about the antibiotics, because some of the ones he's been on in the past can cause hearing loss -- and he doesn't need any more challenges in that department! But apparently now that he's older, the ones they use don't have that risk. So that was a relief.

The regular surgery appointments always feel a little rushed, so it was really nice to have a chance to go over everything and get a better idea of what to expect.

In other news, James has been babbling away today (dididi, dadada, mmmmm, ayaya, and so on). Baby babble is about the most adorable sound there is, and it's extra-nice to hear it from James (since it's potentially a good sign for his hearing/language acquisition).

And I'm impressed with Matthew's listening skills. When I was talking to Mike, in a normal adult tone, I mentioned Matthew's name (not talking to Mattie, but talking about him), and Matthew turned and looked at me. When the automated message called to remind him about his appointment, I had the phone on speaker, and once again he alerted when they said Matthew. (Our babysitter reports that when she asks him where Stanley is, he looks around for the dog.) So, he's definitely getting some receptive language skills!

Camo Baby 2

James's camo outfit allowed him to capture the elusive Giant Crib Octopus.

Weigh-in

We were back at the doctor's office yesterday for the last of the Synagis shots. (Yes, we thought last month was the last one, but when they called us up to say there was one more, we weren't going to argue with them!)

James is 25 inches tall and weighs 15 lbs, 6 oz. We're delighted to finally be out of the fourteens! And Mattie is 26 and 1/4 inches tall and weighs 18 lbs, 10 oz. Big boy!

After the babies got the shots but while we were waiting around (they always keep us about fifteen minutes to make sure the babies don't have a reaction to the shots), the nurse was looking at the computer and said, "It looks like they've had a pretty healthy year." We were stunned into silence. She continued, "With the Synagis, I mean." Well, yes, if your definition of health is "didn't get RSV", they did indeed have a healthy year. By any other definition, well, let's just say that people having a healthy year don't usually get to deduct medical expenses from their income tax!