Monday, June 16, 2014

The Newborn Hearing Screen and Upper Lip Tie

Last week I had a midwife friend come out to do the newborn hearing screen for Audrey. At the time of Audrey's birth some midwives were just starting to offer the screening to their homebirth clients and our midwife did not. (For more information on the newborn hearing screening program see here.) And it got swept by the wayside during her 6 week child check up with the pediatrician and so here we are 18 months after her birth doing a hearing screen!

This has only become a concern since she is now officially diagnosed as "speech delayed." The pediatrician wrote a referral to the audiologist, whom we may still have to visit, but I always prefer erring on the less invasive and less traumatic approach first. Kind of our general approach to everything; why go to a specialist if it's unnecessary? Another analogy: most American women see obstetricians for their normal pregnancies and births even though OBs are highly trained in abnormality and surgery whereas midwives are highly trained in normality. It's just overkill and those OBs are trained in and used to finding things wrong when it's usually just a variation of normal and not a high risk situation.

So anyways my friend came over and administered the test, which was very easy and quick and not traumatic - yay! A soft rubber nodule was placed in each ear, one at a time, much like an ear plug, which delivered a sound made by the machine. It then measured the echo that happens when the ear functions normally. Depending on the echo measured the machine either gives the baby a PASS or REFER, which means to refer the baby to an audiologist for further testing. Well Audrey passed, no surprise to us! It's pretty clear she can hear and understand us.

Today we went to see Dr. Darcy of St Croix Kidds Pediatric Dentistry in Hudson, WI about Audrey's suspected upper lip tie. I was pretty sure she had an upper lip tie but wasn't sure if she also had a tongue tie or lower lip tie. Here is what the St Croix Kidds website says about tongue and lip tie, which is better than I can explain it: "The muscles of the cheek and lips are attached to the gums and tissue of the mouth by a piece of soft tissue called a frenum. Sometimes a frenum can be attached too high on the gums causing recession or spaces between teeth. Also, there is another frenum under the tongue. If this frenum is attached too close to the end of the tongue it can adversely affect swallowing and speech. This is referred to as being “tongue-tied”. A frenectomy is a safe and simple procedure where either part or all of the frenum in question is removed in order to maintain a healthy balance to the mouth."

Tongue and lip ties can cause problems with nursing (painful, cracked, sore nipples for mom and insufficient milk intake for baby), speech problems, and dental problems. I did have problems with her latch and severely cracked and sore nipples so I wonder if that would have been alleviated if we had cut her tie at birth. Dr. Darcy recommended that Audrey will need the procedure before she gets her permanent teeth, around 6-8 years old, but since she has no cavities there's no reason to do it now.



Here is an example of an upper lip tie (not Audrey)



Normal upper frenum with no tie



I was still very happy we had a consult with Dr. Darcy for two reasons. 1) She confirmed that night nursing will not cause cavities as long as we brush her teeth before bed, contrary to our pediatrician telling me I need to night wean her. (Yep, great idea! She still frequently nurses at night so let's take away a good number of her calories she's getting based on problems bottlefed babies have! Because it's not like she's had trouble gaining weight or anything!) 2) Dr. Darcy told me how to brush around the delicate frenum tissues, which I've been doing wrong! Normally you would just brush right across the whole area but with all that tissue in the way you need to go in from each side with the top of the toothbrush not going across the tissues but just up to the space between the front teeth AND also do the back of the front teeth.

So two very good appointments! And now we're off on our first camping trip as a family with the Twin Cities Attachment Parenting Group! Four days with a toddler in a tent and cloth diapers, cooking over an open fire! Should be fun!

Tuesday, June 3, 2014

Changes and More Changes!

Audrey has a growth check up today and although she's only gained 1 oz since her last visit a month ago she grew almost an inch in height! The pediatrician was pleased with her progress and said she looks great and is the picture of health! Poor Audrey hates these visits, especially the weighing and measuring. She definitely remembers her unpleasant and painful experiences with medical staff. The pediatrician also said that her kidney issues were the cause of all the subsequent health problems, which we knew but it was so nice to hear a medical professional say so as well!

One area of concern is that Audrey is still not talking. The only word she says is no. She used to say mama and dada, and still makes those sounds, but more in a babbling way. Originally we had planned on waiting until she turned 2 to go to speech therapy but the pediatrician is pushing us to go sooner so the new plan is to go in the fall or late summer. The idea of speech therapy doesn't upset me nearly as much as her physical health problems did and it seems like a fairly painless and minor intervention.

Tonight I was cleaning out the last of the leftover medical supplies to donate or toss. What a happy task! I already love paring down my material possessions but have never been so glad to get rid of something before. It already seems like a very long time ago that we were giving intramuscular injections, using tube feeding pumps, and giving her dozens of medications, but it was only 6 months ago!

Another change I am making is trying to get off my antidepressant for the third time. I have been taking it for over 10 years. I was already at a very low dose (10 mg) while trying to wean off during pregnancy but would absolutely love to not be on any at all. There is some new research that has come out that citalopram is not only linked to postpartum hemorrhage (which I had) but also fetal kidney abnormalities. So I would really like to get off of it.

I have been on half my regular dosage for a week and can already tell a difference in my anxiety levels and mood. I feel very stressed and anxious about nothing in particular much of the time, overreact emotionally to things I cannot control, and often feel very sad. This is what has happened the other times I tried to wean off as well. This time I am trying very hard to notice these feelings, realize that it's ok that I'm feeling this way, and try to ignore it and get on with  my day. In the past I would have dwelled on it, gave into the feelings, and make life miserable for everyone else. I am also trying to get lots of vitamin D every day, exercise, and de-stress with alone time. I will also be trying St John's Wort for the first time after I have weaned completely off the citalopram. I know it's not the worst thing to be on an antidepressant and I will definitely go back on if I need to, but it would be so awesome to not have that drug in my body, Audrey's body via my milk, or future baby's bodies during pregnancy-which is the biggest concern I have.