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Tuesday, August 25, 2015

The Care and Keeping of Infants

There were two classes that we needed to take post-home-study -- Infant CPR and Infant Care. Well, I should clarify -- we needed proof of Infant CPR via the certificates in our file, but I found that Infant Care was on the "honor system." Which is slightly terrifying to me... shouldn't that be also required? I know I felt like I would feel better being "schooled" in infant care.

The CPR class was relatively easy -- about four hours on a Saturday, learning how to keep blood pumping to adults, children, and infants in crisis. Our agency had offered an infants-only class in the spring for adoptive parents only, but sadly we missed that one due to a business trip Bryce went on, so we had to do the whole deal with the Red Cross. I guess it's not a bad thing to have children and adults too, so we can save each other in the event of an emergency as well as our tiny person.

I dreaded having to do an infant care class, not just for adoptive parents (I didn't see anything on the schedule for the agency), at a hospital with a bunch of pregos. I did not want to do it, but knew I would if that was our only option. Because it has been a long, long time since I have taken care of a baby, and I have very little experience with fresh newborns.

Luckily, we have a friend who is an OB nurse at a local hospital, the one where I wanted to deliver once upon a time, and she is a) a nurse educator, b) postpartum care, and c) newborn care. BOOM! She had access to all the materials and could speak to what the hospital does with those bundles of joy. So, two Saturdays ago we drove out to her house, had a 1:1 infant care class, and a delicious BBQ dinner with her family (her husband is Bryce's best friend, and they have two lovely school-aged children).

It was amazing to have all that time and all the hospital-education-approved materials explained by someone who was a) incredibly smart and engaging, b) knew we were coming to this experience through adoption and with some fear based on loss that we will screw it up somehow, c) completely not judgmental, and d) got our sense of humor. Not having an audience was fabulous as well.

We started with the basics of what a brand-spanking-new baby would look and act like, if we manage to be lucky enough to be there for that stage, and then moved right through all sorts of things to watch out for in the weeks to come.

Some interesting facts and terrific pieces of advice from our personal expert:

- The first two hours is the most wide-eyed and alert
- At six hours, the baby becomes SUPER sleepy
- There's this thing called Transition where the baby is learning how to do circulation on its own, since you know, no more mama ship attached
- Babies can be hairy at birth from the lanugo, a type of fine, furlike hair that grows in utero to help protect it from the fluid-filled environment. Their first poo, that icky sticky meconium, can have that fur in it from swallowing shed lanugo in the amniotic fluid. SO GROSS but also kind of cool, and good to know so that if my baby poops a sticky hairball I shouldn't fear he/she's a werewolf.
- All babies, regardless of race, are pink upon birth because of the high level of red blood cells. Babies with darker skin gradually get darker, and apparently on boys you can get a preview of whatever lovely shade they will stabilize to by looking at the scrotum. I have no idea if there's a similar preview for girls. Interesting stuff.
- Jaundice is actually caused by those red blood cells that make babies pink, when they can't break down properly. LOTS of babies get jaundice to some degree, but severe jaundice is some scary stuff. We were told you can see the yellowed jaundice look in the eyes, nose, and forehead first, but if it dips to the diaper line you need to call a pediatrician STAT. The bilirubin lights help, and are sort of like a tanning booth but healthier. Sunlight apparently helps break down the red blood cells, too.
- If your baby was exposed to cigarette smoking in utero, they will likely be smaller, skinnier, have less vernix (that waxy white stuff on newborns that is like a waterproof coating to protect baby skin from the fluidy environment), and so drier skin. Interestingly, late babies also have drier skin because the vernix starts breaking down at full term and so the skin loses its protective layer.
- Car seats apparently have expiration dates, look on the back and always check before buying/accepting. They need to be replaced if they are in an accident greater than a little fender bender at a stoplight.
- Fontanels are creepy, creepy little things, but can tell you if your baby is sick. There's the big one up front shaped like a diamond (anterior) and then the back one/ones (I think it's more than one). Don't poke it! The fontanel should be flat, not bulging (indicating swelling in the brain) or sunken (indicating dehydration). They should close between 9-12 months. These creep me out.
- NO LOTION for the first two weeks of baby's life! Their sebaceous glands are learning how to work.
- SUPER TIP: Keep your meds (yours too, not just baby's) in a kitchen cabinet-- the bathroom is too moist (argh, was so trying to avoid using that word) and has too much temperature fluctuation. At each baby doctor appointment, ask what updated dosages are applicable for things like Tylenol, as they are weight dependent. Write them on a piece of masking tape inside the cabinet door with the meds they go with. You will never be up in the middle of the night with a fevery baby flipping through your notes from the appointment again! :)
- Correct terms for babies (I found this interesting):
  BABY: generic term
  NEWBORN: 0-30 days old
  INFANT: 1-12 months old
  TODDLER: 1-3 yrs old
  PRESCHOOL: 3-5 yrs old
  SCHOOL-AGE: 5-9 yrs old
  PRETEEN: 10-12 yrs old
  ADOLESCENT: 13-18 yrs old
- While length is subjective (depends on head shape, straightened knees, who's measuring), length and head circumference should be proportional.

- NYS Law says that a newborn WILL have:
  - vitamin K injection
  - eye prophylaxis (for gonorrhea, usually arithromiacin)
  - Hepatitis B (but up to birth mother, can get at week one if declined)
  - Newborn screening after 24 hours of good feeding but by 5 days/before discharge, screening via heel stick for 50+ metabolic disorders including PKU, results go to your pediatrician.
  - hearing loss test
  - congenital heart disease screening.
- I don't know what other states require, but these are all recommended by the American Academy of Pediatrics, NYS makes it law to have the heel-stick screenings done.

- Bulb syringe -- awesome for clearing out stuff from nose and mouth for choking, the cheaper the better because it's more flexible, you need to replace it because that thing can't be totally cleaned out and gets NASTY. "Little Noses" saline drops are helpful to clear blocked noses.
- Sneezing is normal for a newborn, babies going through withdrawal sneeze more
- under armpit is the best for taking baby's temperature, rectal is no longer recommended as people were perforating baby's bowel (AAAAACK). 100.5 is considered a fever for infants, but NO fever is acceptable for under 8 weeks, something is wrong and off to the doctor/ER you go. (Interesting fact... under armpit isn't best for adults because of hair and deodorant which can interfere with accuracy. Those fancy temporal ones are expensive and not accurate on babies, so waste of money. Get the regular $6 digital drug store one, it's fine for oral and armpit.)
- This sounds so funny to me, but makes sense: Keep a chart of when you change diapers for your baby for the first weeks, because the doctor will ask you about it and it helps to know how many pee diapers, how many poo.
- When you swaddle your baby, put them Foot to Foot -- baby's feet to the foot of the crib. This way, if they kick off their swaddle and have scary loose blanket, when they scooch (because they do apparently scooch all the time), they tend to scooch UP. This way they scooch their little faces and breathing apparatus AWAY from the scary loose blanket.
- Co Sleeping is different from bedsharing. Co Sleeping is now recommended, that you have the baby in your room with you (but in a separate bassinet or cosleeper contraption that you can't crush them in) for the first few months. This is because there are better response times to distress (whether because of changing, hunger, or respiratory distress) and EVERYONE sleeps better, which makes everyone happier and more sane.
- Bottle feeding: switch side to side to mimic breast feeding; don't lay the baby flat to bottle feed, feed them at an incline as you would with the boob, you can do skin to skin while bottle feeding to get that same effect, and keep the bottle upright so the baby works to intake liquid and doesn't get too much. Breastfeeding they have to work for it, it's good for gastrointestinal stuff and if you are breastfeeding AND bottle feeding it won't be easier for the baby to get flow with the bottle. (This all made me feel better about being 90% decided that I won't induce lactation, which is heartbreaking to me but necessary for my sanity.)
- Once baby can turn over, you don't have to worry about belly sleeping anymore.
- This one was AWESOME: Wear your baby in public places like the grocery store. Strangers feel somehow free to touch your baby in a stroller or the carrier in your cart, but rarely will they touch a baby kangaroo'd to your body. Genius.
- The reason why they say breastfed babies are at a lower risk for SIDS is because breastfed babies wake up more, sleep less deeply than formula fed babies. More checks on a breastfed baby. (Pretty sure I'll be checking my baby a zillion times).
- Unless prescribed/recommended explicitly by the doctor/hospital, DO NOT use those wedges for sleeping in an inclined position. Inclined sleep can cause breathing problems. Breathing problems scare the shit out of me. Also, breathing mat monitors like An.gel Car.e are not at all necessary unless your child has apnea and it was recommended explicitly. You can do it, but it's not necessary. It will likely go off all the time and prevent everyone from sleeping, but not necessarily prevent SIDS. Apnea is different from SIDS. Everything baby-not-breathing makes me not breathe and freak out, so I'm going to stop talking about this one RIGHT NOW.

I did actually freak out about the not breathing and all the things that can totally kill your baby. The anxiety was a little high. At one point, our friend's husband said, "You're not going to kill your baby, don't worry," and although we didn't say it then out loud, it turned out BOTH Bryce and I were like, "yeah, well, we don't have a great track record of that so far." Not real live fully formed babies, but potential babies, HAVE NOT DONE WELL IN OUR CARE. This is different though...but this is an area where our past trauma and tragic experiences inform our anxiety level in this new adventure.

Lastly, some hilarious pictures of diapering and swaddling. We got some great advice here, such as if you have a boy and you are changing him and the penis becomes erect, GET THAT DIAPER BACK OVER THAT THING BECAUSE IT'S GOING TO PEE AT YOU! So, I guess you have to be very aware and like a ninja when you change boys. Apparently girls can pee at you too, but there's no warning. Excellent.

Picture Storytime!
DIAPERING: 

Baby doll baby's butt in the air, after we've used the diaper to wipe off giant (imaginary) chunks of poo and folded that nasty shit over so it doesn't make us gag, in theory
Wiping baby doll's butt, front to back, then putting that wipe in the folded dirty diaper so everything contaminated is contained, supposedly all neat and tidy
Pointing out that poop can hide way up the crack, and if it's a blowout you need to wipe down baby's back. So have a boatload of wipes at the ready, apparently. Also not pictured: Have a new diaper new and ready to grab.

Bryce giving it a solid go

Me wiping down fake baby butt crack

SWADDLING: 

We got step-by-step directions AND got to take baby home with us along with some diapers and swaddle blankets, for practice.

Step one, put baby on two blankets with the top corner folded down on each, short side to your left, long side to your right.
Fold the top blanket, right corner little fold around baby's neckline.
Fold the next corner and first big swath of blanket up to the opposite shoulder, tuck it in under baby good and tight.
First tuck the top left little corner around the neckline on the other side, then pull up the big corner that's left at the bottom
And tuck that corner around tightly to the other side so that baby is a tightly wound burrito...
Then do it all over with the blanket underneath for a snug, secure double wrap!
I concentrate real hard on my tight wrapping  skills, and discover to my displeasure that cellulite is sprouting on my upper arms... 
My beautiful handiwork! Trying to focus on  baby burrito and not the awful state of my upper arms. A struggle many moms  have, so I understand...
Proud mama of a fake baby burrito
Bryce captures my "bitch face" perfectly. Forgot what was said to elicit my facial wrath, but it must have been bad... :) I'm sure this face won't arise at 3 in the morning ever. 

There you have it--our infant care class! We actually do feel super prepared and have done our homework, with the swaddling at least. On a nonsquirming infant without flailing limbs. Although Bryce did try to swaddle one of our cats. Many many thanks to our wonderful RN friend, who made this a fun and hands-on experience where we felt cared for. We definitely wouldn't have gotten this individualized attention (or cheeseburgers) from the hospital class.

Next steps... swaddling and diapering a real, live, squirmy, shrieking baby at 3 am, sometime not too far in the future!

PS: Any errors in factual stuff are mine from frantically jotting down notes, not our friend's. 

6 comments:

  1. Use humid instead of moist.
    The problem with co-sleeping is that months turn into years and soon the kids is sleeping between the parents ALL THE TIME. My best friend did that and her daughter is terrified of being alone.....and she is in college. If her roommate isn't there at night, she can't sleep and is anxious. Why don't parents see how much they harm their kids by keeping them glued next to them 24/7? Yes, I have children, two daughters who are happily independent, content with themselves and not scared of the dark!

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    1. Ah, I knew I was missing a synonym for moist! Thank you.

      Co sleeping in this example is definitely not "between parents," as that would be bed sharing which is very dangerous as am infant. There are people who subscribe to attachment parenting where children sleep in the family bed for what seems like forever (how are the subsequent babies conceived for these fertile people then, is my question...). That isn't the recommendation here, though. This is just for newborns to young infants, so that you can respond faster to respiratory distress or feeding needs for better sleep for everyone. Like any advice, you can take it or leave it--many families also have infants sleep in the crib day one. The point isn't to rear dependent kiddos, because you do want the baby in the nursery eventually, but to take care of immediate need in that highly vulnerable period after birth.

      Safe sleep are always evolving and infant death rates are going down because of it, but each parent makes their own decisions based on information and what's right for their family (barring known unsafe practices). I'm glad your daughters are so well adjusted and good sleepers! That's the goal for everyone, I would think. :-)

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  2. I bed shared for 13 months with my son, and loved it. Then, I was done. Two nights of fussing and he was fine on his own. So don't listen when people try to make blanket statements about it. Especially since I wasn't breastfeeding, I needed that closeness. It worked for my family and I did it in a safe way.
    Also, as to swaddling, we did the same thing in my newborn class... and I have yet to have any friends who have ever swaddled once the baby came along. We all used the pre-made type, like this: http://www.amazon.com/Summer-Infant-SwaddleMe-Adjustable-Sports/dp/B003JHYDIQ
    Very excited for you!

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    1. Thanks so much for your excitement! I actually registered for a bunch of swaddle helper blankets/sacks, so if hand swaddling doesn't work out at wee morning hours, we have an easier option. I love how old fashioned the swaddling is! Also, the no bed sharing was a hospital recommendation, bit per our home study agreement we can't do that even if we could do it safely...We aren't even supposed tho co sleep in anything other than a pack n play. Adds another layer of complexity and anxiety when you have post-placement social worker visits tho be sure everything is kosher (4-7 depending on the state). I'm glad it worked out for you and gave you that closeness. I am so sad about the breastfeeding thing, but I have no clue Howe to prep pumping in advance for a baby with no arrival date, or one who falls through after I've pumped for weeks. Plus there's the whole working thing. :-) thanks so much for weighing in--so much to navigate here!

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  3. I really think it's great that you had a one on one infant safety class, B and I intended to take one, but never did (btw, they should require new parents of all stripes to take these classes--not just adoptive parents--there's a lot of good information here). So I appreciate your thorough write up here. When I was living in Africa and I saw black newborns for the first time, I was absolutely shocked at how light they were and they also had super silky curly hair. There was a clinic (so little more than a cement building with screens on the windows) about half a mile outside my village and the women would walk back with their newborns strapped to their backs. It was the cutest thing, those little newborn bums wrapped in the brightest cloth imaginable (I could go on and on about the difficulties about giving birth in non-developed countries, but I won't).

    Breathing issues are scary, and babies breathe funny and make funny noises in their sleep. When A was a mere 3 weeks old we got freaked out about his nighttime breathing (fast breathing that seemed to last forever, but in reality only lasted a few minutes and is in fact normal) and called our doctors. Everything was fine, but it was helpful to know that babies' breathing changes frequently, from fast to slow to even stopping for a few seconds. But super scary.

    We're talking about transitioning A from his bassinet by our bed to his nursery, but I really like having him there. It's not like this now, but at first (like many new moms), I woke up all the time terrified that he'd stopped breathing. Now he gets fussy in his sleep (either his pacifier has fallen out or he's unswaddled himself--we use both the prefab swaddles and the blankets, the blankets are way cuter) and I can just reach over and pat his stomach or rock the bassinet just enough so he doesn't wake himself up. And you're so right about boys peeing; for us it didn't seem to happen until just a week ago, then the pee started flying as soon as he was exposed to air!

    I can't wait for you to get a squirming, snuggly, baby. I really, really can't.

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    1. Oh, I'm glad this was helpful! I love your description of the adorable brightly clothed baby bums in Africa. I can only imagine what birth is like in so many places elsewhere without all the medical equipment and conveniences we have here. That would be a whole other level of fear I think...

      The bassinet thing is driving me batty because everyone raves about that, and I found one that is mostly mesh, so hopefully that will be okay with the agency. It sounds amazing to have your baby within arm's reach for middle of the night soothing and response in the beginning. Especially with all that fast and slow and stopped breathing business! Ack! Sounds very stressful.

      Thank you so much for your warm thoughts... We can't wait, either! Time is just counting down, we just don't know what the endpoint is. :)

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