Feeding Schedule - Take #54

*big, big, big sigh*

Today was check up day at the Special Infant Care Clinic (SICC) at Duke. I was so excited going in. I finally had good news to report. The girls have been eating so well and have made great progress in the 10 days since the 2-hour schedule started. They've already added 10mls and were up to 40mls per feed. I was anxious to see how much weight they'd gained and put the g-tube on hold.

The only good news of the day was that they had gained weight. This is only good because gaining weight is better than losing weight. However, the change was minuscule. In the 18 days since they were last seen there, Natalie gained about 250grams. Abby only gained 125grams. They should have each gained over 500grams. Despite their oral progress, they just aren't getting as many calories as they need.

I actually knew this, but had decided that as long as they were gaining weight, I was okay with them being a little small. What I didn't know is that the whole calorie/growing thing is less about gaining weight and more about the brain. It seems the most crucial period of growth of the brain is the first 6 months and first year. This is determined by the head circumference. As the brain grows, it pushes the plates of the head apart and the skull gets bigger. I did know, of course, that the brain grows and the skull grows; I didn't realize it was directly related to the caloric intake. So, basically, their little brains have been starving. The doctor didn't say this, of course. That's my mommy-guilt talking. But, essentially, that's the danger. We'll let our imaginations run wild with all the horrible things associated with poor starving brains. I'm not sure how I missed this rather crucial piece of baby development. I don't know if it was just never mentioned, or I just didn't hear it. In any case - let a new feeding schedule commence...

So, they need about 600mls of souped-up breast milk a day. On our previous schedule of 10 feeds, they'd have to eat 60mls each time. Not likely to happen. On a 3 hour schedule of 8 feeds, they'd have to eat 75 mls each time. Definitely not going to happen - at least not in the next week. Keep in mind that the bigger they get, the more they need. That's why it feels like we are fighting a losing battle. Just when/if we reach one goal, the goal changes.

The doctor wants us to feed every 3 hours, 4 times a day with the hopes of getting 200+mls of milk. Then, we are to gavage 4 times during the night with 100mls over 1 hour each time to equal 400mls. If they can handle it, we'll go to 120mls gavaged. It's with a heavy heart I announce we are back on the ng (nose tube). Now, both girls need it. The doctor wants us to just stay on a straight 9, 12, 3, 6...schedule, but that means I have to stay up until 3am to start their feed and then wait until 4 to stop it before I can go to bed. Then I would have to get up at 9 to feed the girls. That's never going to work. So, we are trying a modified plan as follows:

6am - 100ml gav
9am - 100ml gav
12pm - 8pm - bottle as much as possible
10pm - 100ml gav
1am - 100ml gav

At least this is the plan for tonight and tomorrow. We are going to try to work out something that allows Ben to actually bottle feed the girls at 6am. It's his special time with them and he likes it. I have to say it makes me very proud, because he could be very lazy and just do the gavage. It's much easier. You just pour in the milk, hook up the tube, set the pump and press go. I'm not quite sure how it will work trying to bottle feed at 6am. You can be sure Schedule #55 is around the corner.

BTW, we haven't actually tried 55 different feeding schedules. I was just trying to make a point by picking an arbitrary large number. We have probably changed the schedule about a dozen times so I guess it just feels like 50.

Oh, one more thing to top off the day. Abby has her first ear infection. If nothing else, this proves she really is my daughter. My ears are so scarred that when doctors check them, they make funny faces and say "your ears just don't look quite right." The doctor said that they probably didn't drain properly after her cold. So it's a round of antibiotics for Abby and one more med for mom and dad to keep track of. Thank goodness for Microsoft Word and the "Insert Table" function. Where, of where, we would be without charts!