If there was no puke in my life...

...I'd be a much happier lady.

Dylan has had reflux forever and that may be a factor in the puke, but I don't think it's necessarily the answer.

There are two main pukes:

1) Immediately After Bedtime Bottle Puke

2) Middle of the Night Puke

The Immediately After Bedtime Bottle Puke consists of mostly "milk" (Pediasure or formula at the moment) but also has nice little chunky bits of dinner.  It's really convenient that it happens immediately before bed...right when Dylan is super sleepy.  Usually when I'm transferring from the rocker to the crib.  When I'm lucky, I get all of the puke on me so I can just strip off my clothes, get another bottle (he always eats after and has never thrown up a second time) and we move on.  The lights stay off...not too bad.

But on other nights Dylan pukes all over the rug.  Or on one night, all the way from the rug in his room to the kitchen sink.  On those nights, lights come on, I have to find a spot for Dylan to chill in while I clean puke off the rug or strip his bed, etc.  Then we repeat the bottle and bedtime is just pushed back a half an hour or so.  (Or the carseat pukes....those are probably even worse.)

The MOTN Puke is the more worrisome and baffling.  Google says it could be low blood sugar, or a brain tumor....or reflux.  Don't worry; I'm not going off the deep end, I'm sticking with reflux as the most plausible answer for now.  Dr. S (The Ped) thinks that his ear infection caused most of the MOTN puking.  (This puke is orangey-yellow, full of bile, with some partially digested food sometimes.) D has only woken up crying during one of the MOTN pukes and so in the morning we find him, with his hair plastered to his head and a pukey bed.  (So sad and upsetting as a parent!)

But then last weekend he puked in the middle of the day!  It was after a bottle as I was putting him down for a nap, but come on!  That wasn't part of the routine.

I'm finding that my mood is set by whether or not Dylan has puked that day or not.  It's horrible to spend so much time making sure he's getting enough calories and then see them all come right back up.  (And even more horrible to know that your baby is sick in the MOTN : (.)

So I took him back in yesterday and this is the new plan:
1) Up his Prevacid dose.  Most babies outgrow reflux by 6 months, then the rest by 1 year.  I guess we are part of the lucky few where it persists.  But we're hoping he grows out of it by 18 months.

2) We are switching from Pediasure to Whole Milk with added whole milk powder.  The puking really started with the Pediasure.  It may just be an ingredient in it.  Or it may be that he can't process the 30 calories an ounce. I don't know.  But it's artificial and expensive so we are going to see if whole milk works.

3) We are adding a probiotic.  Maybe the Amoxicillin wiped out too much bacteria in his gut (but the puking started before the Amox.)  Can't hurt to try.

*     *     *     *     *

The hardest thing for me is working through all of the different variables to figure out how to fix the problem!  Is it what he's eating? When he's eating? How he's eating?  And how am I supposed to switch to a sippy from a bottle when we are so concerned about his overall calories (I'm working on it!)?  It drives me bonkers and brings me back to the days when we were trying to get out of the NICU.

But Dylan is slowly gaining weight (he's at 17 1/2 pounds now - 12 months adjusted, 15 1/2 actual).  That's still not on the growth chart but we're getting closer and closer.  He eats lots of different foods, just not huge volumes.  Recent favorites are casseroles and cottage cheese.  And the best, best thing is that he has no lung issues.  If we can just get through this flu season (which just exploded in CA), we will be in a really good place.  The doc would just like to get him to 20 pounds and then maintain that weight.  Then we can relax a little.

It's amazing in the wide world of the internet how it can sometimes feel like you're the only person dealing with a particular issue.  Anyone else have a problem of the puking variety?

When he's not pukey, he's really happy!

Enjoying his Adjusted Birthday Celebration cake.  He knows what to do with it now!

Officially a Toddler!

Remember way back 3 1/2 months ago when Dylan turned 1?  Well today is finally the day that he is supposed to be 1...so he's now a toddler no matter how I decide to count.

And he's doing big things!

Milestones

Speech:
Dylan has his first word.  It's not "mama," not "dada"...it's "da" for dog.  He very clearly looks for and talks about the dog.  I guess it's a good first word - prevents competition between mom and dad. : )  Although I'm sure "dada" will be next because Dylan LOVES his dad, prefers the "d" sound over "m" and has a father who says "dada" to him over and over and over all day long.  Hah.

Dylan is definitely not ahead of the curve on language, but he's in a fine place.  Before the last couple of weeks he had three syllables, "ma," "da," "ba," but in a very short time he's added his first word as well as a variety of new consonants and vowels. It's kind of fascinating to watch how language develops!

Gross Motor:
Last night Dylan stood on his own for a good 10 seconds.  He doesn't think about doing it himself, I have to get him away from things and then let go, but he has excellent balance.  He stands up on his with no hands, he just doesn't realize walking is a possibility.  I have a feeling once he does, it'll all happen very quickly.

Fine Motor:
Dylan can use a pincer grasp and do fine activities, but he's still not great at it and still results to scooping at times.

Other:
He's had 8 teeth for ages now and nothing else has popped through.  I think they'll come soon though (based on ridiculous amounts of drool.)

Health

I think our only major health issue is reflux and it's definitely still interfering.  I have a separate post planned, loosely titled "vomit."  He throws up his nightly bottle A LOT, but he's also starting throwing up in the middle of the night, often without really waking or crying.  (He sleeps on his tummy so not a huge choking risk, but still scary!)  Google says it could be a brain tumor...or low blood sugar, but reflux is also a culprit and that seems most likely in our situation.  Otherwise, general health is good.

D is gaining weight like a champ too!  We switched from formula to Pediasure a month or two ago (30 calories an ounce versus 24).  He's also doing pretty well with solids.  He'll try most things, it's just hard to get him to eat much volume.  He averages between 6 and 9 ounces of solids a day and about 18 ounces of Pediasure.

Sleep

D is still an excellent sleeper, thank goodness.  he sleeps through the night, about 12 hours (6:30 pm - 6:30 am) and takes around a 2 hour nap.

Fun!

Dylan LOVES to read which makes this English major and English teacher very happy.  I'll write a favorite books post soon, but he pretty much likes ALL OF THE BOOKS and can happily sit on my lap and read books for a half an hour or more.

D still loves to be outside.  He got a wagon for his birthday and it's so cute to watch him ride in it!  Have I mentioned his car on here?  I better post a video of that too.

All in all, it's been a fantastic year plus...even though at this time last year, Dylan was still in the NICU.  It feels much, much longer than that though.

I love this little boy : ).

When to go to the doctor.

I see so many posts on parenting forums asking whether or not they should take their little one to the doctor.  (And also many asking if contractions are normal at a certain point - just go get it checked, pleeeeeeeease!)  I am not a doctor, so please always consult your pediatrician, but I would like to share our doctor experiences.

Dylan has had lots and lots of doctor's appointments since he is a 25-weeker.  When he first got out of the NICU, we went weekly, then bi-weekly, then monthly and now we go every couple of months, mostly to check his weight.

Over the course of the last 10 1/2 months (Dylan was still in the NICU this time last year), I have taken him in twice for non-scheduled visits.  Both times, I debated with myself about when to go and both times he required a prescription.

Visit 1: Diaper Rash

Dylan developed his very first diaper rash on a Saturday morning.  His entire bum was bright red and spotted.  My internet research gave me all kinds of home remedies and I tried many of them including baking soda baths, diaper free time, and liberal amounts of maximum strength Desitin (don't even bother with the regular stuff...get the purple box).  Dylan also had diarrhea and was going through about 1 diaper every two hours almost round the clock.

Life was beyond horrible for all three of us.  Dylan screamed and cried for diaper changes and it was nearly impossible to accomplish without two of us.  He seemed a little comforted by the baths, so we did them a couple of times a day and then let him air-dry.  Diaper free time resulted in poop on two separate rugs, one pile of which was eaten by my dog as I chased down Dylan as he tracked poop across the room.  Absolutely disgusting.

We didn't take him in until either Tuesday or Wednesday night before Thanksgiving.  He had one spot that was turning into more of an open wound and it very suddenly seemed to get worse.  After-hours care was a complete debacle, but it ended with a confirmation that it had become a yeast rash and needed a Nystatin cream.  I am so glad that I decided to go in when I did!

Visit 2: Ear Infection

Dylan got a little bit of a cold after Christmas.  It mainly consisted of a runny nose, but I was still slightly terrified that it would turn into RSV or something else in his lungs (and had emailed the Ped about when to come in for a cold without fever or change in eating/sleeping habits).  But then on Saturday and Sunday night, Dylan threw up in the middle of the night.  He throws up his night-time bottle all the time, but has only ever thrown up in the middle of the night once before.  My little angel is a fantastic sleeper.  But on Sunday night, he woke up at 2am and we could barely settle him.  He finally fell asleep close to 4am (in our bed which means I was barely sleeping).  I had to go back to work Monday morning, but I called the nurse line and told the nanny what the night was like.  Eventually I got an appointment for yesterday evening, but he was happy all day so I wasn't too sure I needed it...I just kind of wanted the Ped to confirm that everything was okay.

Lo and behold, Dylan has his first ear infection!  I guess it can cause kids to throw up although that's not the most common symptom.  Poor baby!  His lungs are perfectly clear and he's on Amoxicillin to clear up the ear infection.  Again...so glad I went in.

So the moral of my story is to trust your gut.  If you are not sure what your gut is saying, go in!  The worst that will happen is that your lo's schedule will be thrown off for a day, but you'll get the piece of mind that everything is fine.

Here's my new favorite picture:

And this one's pretty cute too : )