Developmental Wednesday #5

This week's developmental Wednesday is devoted to one of the most important but hardest things for parents to do - allowing your preemie to take the lead. One of the best ways to foster your preemie's development is to OWL - Observe, Wait, and Listen. I know that many people have trouble with this concept - particularly during the time when your preemie can play but isn't really verbalizing much. It's far easier (and quite frankly, faster) to just show them how a toy works rather than wait for them to "figure it out" or play with it in their own way. But waiting and letting them take the lead is a great way for your preemie to explore things, develop new skills and for you to learn even more about your preemie.

Here are some tips and suggestions to get you started on the OWL process:


Observe - Watch and see you what your child is interested in and feeling
Even if your preemie isn't yet vocalizing enough to be understood, you can still figure out what they are interested in by observing their focus of attention, facial expressions, and body language. For example, when our daughter gets excited she wiggles her whole body around, she breathe faster and she starts to open and close her hands quickly. In an instant we know that she likes whatever is going on. If you take the time, you will quickly start to notice and understand your preemie's reactions to various things.

Wait - Before jumping in, wait and see what your child does
This is usually the most difficult part for parents. Parents usually see themselves as the teacher - we feel the need to show our children how to do things or how thing work. While that is basically true, taking the time to wait and let your preemie figure things out opens up a whole new world for both of you. When you wait, you are giving your child the time he/she needs to show his/her interests and how he/she feels about something. If you put a toy in front of your preemie, give him/her a minute or two to touch it, turn it over, move it around, etc. until you start to play with it. My daughter has a drum that sings, lights up and makes fun sounds. Lately all she wants to do is flip it over and exam the sides and the bottom. At first I would put it back the "right way" but then I started to just go with it and we have fun pushing it around and feeling the different textures on the side.

Listen - Take time to listen to your child and hear what he/she is trying to say
Before your child can "talk" and participate in a conversation, it gets really easy to do ALL the talking. Does this sound familiar? "Is that a fun toy? Look how bright the colors are. What is your favorite one? I like that one." Etc. etc. As adults, we are used to (and often most comfortable) filling up any silence in a conversation. Even if your preemie isn't talking, have a conversation with him/her and make pauses that allow him/her to make noise. He/she may still stare at you without doing anything but slowly over time he/she will understand that it is his/her turn to make noise. Pretend that they said something - "Did you have fun today?" Pause. "You did? I did too. What was your favorite part?" Pause. "The slides? You did go on the slide a lot." It doesn't matter what you are talking about - just make it a conversation vs. a monologue. You can also do this with a favorite song. Sing most of a song and then stop near the end. Wait and see if your preemie makes noise and then sing the very last part of the song (as if he/she had sung part of it).

So remember: If you find that you are doing all the talking, helping when it isn't needed yet, directing what happens, interrupting, or assuming that you know what your child is saying - take a moment and OWL. You may be surprised by what you learn.

Taking Pictures

Obviously we all take pictures of our precious preemies - some of us might be accused of taking too many (if you're in that group well, come have a seat next to me). Preemies present some interesting and challenging photo opportunities. I've covered some of those suggestions and issues in previous posts but I thought I would pull them together into one post.

In the NICU:
When your preemie is in the NICU you will obviously want to take a lot of photos. You want to document this very important time in his/her (and your) life and be able to show off your miracle to those who can't visit him/her. Remember to check the flash before taking a picture in the NICU - your preemie's eyes are going to be sensitive to light. Here are tips and ideas for taking photos in the NICU:

• If your baby is in an isolette - try and find the best angle to hold your camera so that the amount of glare is reduced. Whenever possible, take a photo of your babies face through the hand openings so that you can get an unobstructed view of your baby. Step back a few steps and take a picture of the whole isolette too.
• Showing size - pictures always make a baby look bigger than they are. Choose one object and photograph your preemie with that object throughout their time in the NICU. You can use a wedding ring, bracelet, small stuffed animal, ruler, diaper, your hand, a pacifier, etc. It's helpful if you also take a picture of the actual item next to something else so that people know just how big or small the item is in comparison.
• Showing size, part 2 - My mom found one picture of my daughter that had the nurses hand in the picture near her head. She printed out the picture in a 5x7 size and realized that the picture was life-sized. This was a great way for people to really grasp just how small our daughter was.
• Photograph milestones - Obviously you want to photograph the big (and little) events that happen to your preemie in the NICU. Make sure you capture the first time you hold your preemie, give him/her a bath, if he/she is on a vent or oxygen support - photograph when they change oxygen support or come off of it completely, moving from an isolette to an open crib, if grandparents/relatives come to visit - photograph them interacting with your preemie (even if they can't hold him/her), first feeding from a bottle, the day the feeding tube is removed, etc.

Here is a picture of our son with a pacifier - we would show people the pacifier along with the picture and it was a great way for them to realize just how small he was.

At Home
Obviously once you get home there are a myriad of photographing opportunities. Just like with any full term baby there will be milestones such as rolling over, sitting up, crawling, walking, birthday parties, etc. For preemies, here are some additional opportunities and ideas for taking pictures that continue to show just how far your little one has come.

• Coming home - clearly you want to document this momentous occasion - hand the camera to someone else so they can photograph your preemie arriving home and checking out his/her new digs.
• First times at home - Although many preemie firsts may have occurred in the NICU, you still get to experience those things at home for the first time. The first bath at home, first time a sibling gets to meet/hold your preemie, first time in the crib, etc. It's a whole new experience doing these things at home than in the NICU.
• Other milestones to think about - first time meeting relatives and friends, first time going out of the house, first time at the park, first time in the stroller, etc.
• Siblings - Make sure you photograph the reaction of your other siblings to the arrival of your preemie. This is especially key if your other children weren't able to see your preemie in the NICU and this is the first time they are meeting their new brother or sister.
• Showing size - still - Your preemie still has a lot of growing to do. You can document this growth by having your preemie hold the same item from the NICU that was used to show size. Take their picture with that item every month, year, or whatever works for you. For our son's first two Christmas's we took a picture of him in a stocking - the first year he fit entirely inside it and by the second year it barely went to his knees. It still serves as the most dramatic proof of how much he grew that first year.

Do you have a tip for a milestone to document or how to best take a picture of your preemie? Please leave a comment if you do. Thanks!

Working therapy into every day

I don't know about you but as the parent of two preemies, I have always felt this enormous pressure to constantly be working with my kids on various developmental skills. Both of my kids have been or were in physical and developmental therapy for several years. The amount of things to work on can seem long and never ending. Trying to fit therapy time/skill building into your day can seem impossible but it can be done. Here are some tips to get therapy time into every day.

1) Play time is therapy time - Preemies spend a lot of time playing. Play time is the absolute perfect time to work on various developmental and physical skills. I normally try and work on one particular skill at a time. My daughter is currently working on trying to crawl so as soon as she is on her tummy I pull her into a crawl position and let her work on that for a few minutes before she starts playing with her toys independently. If you are working on teaching your preemie how to "share" objects than sit in front of him/her and start giving him/her toys and then asking for them back. Trying out one skill at a time throughout the day can go a long way towards helping your preemie develop and help you keep your sanity.

2) It's all in the set-up - If your preemie is working on a specific skill, set-up his/her toys to help facilitate that. For example, if your preemie is learning how to look from one side or the other - place his/her toys so that he/she has to look one way to see them. Put toys farther away if you want your preemie to try and reach for toys or move towards them.

3) Set a timer - We all get busy with the demands of life so it can be hard to remember to actively work with our preemie on something. If you need a small reminder than set a timer. When it goes off that is your cue to work with your preemie on something specific.

4) Short periods of time - You don't need to constantly work with your preemie on various skills. Most preemies do better if they only have short amounts of time where they are actively having to work on something. It also helps them remember a skill if they work on it several times in a day rather than a long period of time once a day. Work with your preemie a little and then let him/her play independently.

5) Sibling help - Older siblings can be a great help for teaching your preemie new skills and working with them on certain things. My son is four and a half and he is my daughter's favorite form of entertainment. I have often asked my son to come over and play a game with my daughter so that she stays interested and continues working on a particular skill. He loves to see her try new things as much as I do so he is also a great cheerleader for her.

Favorite Product Friday #8

This week my favorite product is the Touch and Feel Farm Animals and Touch and Feel Wild Animals books.

These books have been a favorite for both my son and daughter. Each page features a different animal with a spot for your preemie to "touch and feel" what the animal feels like. The books are sturdy so they can stand up to most of the wear and tear that a little person can put it through. Here are some ways to encourage development with these books:

1) Reading the book - children of all ages love to be read too. These books are heavy on pictures with only a few words per page so you can get through it quickly. Babies like to turn the pages themselves and you can easily just describe each page if you have a preemie who is more interested in turning the pages then what is on them.

2) Textures - as you go through the pages, encourage your preemie to feel each page. Show them how the "touch and feel" part is different than the smooth pages. You can tell your preemie "doesn't that feel soft/hard/smooth/etc."

3) Animal sounds - you can use these books to start to teach your preemie about the sounds that animals make. Tell him/her what the animal is and then make the sound that goes with it. Once your preemie starts to verbalize the sounds, let them tell you what each sound the animal makes.

There a lot of options for books that offer a variety of textures to touch and experience. Find one that you like and have fun watching your preemie learn and explore!

Developmental Wednesday #4 (on Thursday)

My apologies about the delayed post - yesterday was just one of those days.

Today's developmental post is about the connection between toys and development. There are so many toys in stores today and sometimes it can be hard to find the right toy for your preemie. When you're looking for new toys (or deciding which toys to bring out of storage), it's important to think about what stage of development your preemie is in. What are his/her interests and abilities? How much movement is your preemie able to do? What kind of toys does he/she like to play with? Our daughter is 15 months (11 months adjusted) and she still likes to play with small rattle like toys. She enjoys being able to control the toy, picking it up and lately - throwing it down as often as possible.

Here are some tips and things to think about when you're choosing toys for your preemie. This post is devoted to 0-6 months of age (adjusted). I'll do another post for preemies that are older.

0-2 Months - It's all about settling in and seeing things
The first couple of months are all about experiencing the basics of life and seeing things for the first time. The best plaything for a small baby is...you! Being able to look at you and listen to you is the absolute best thing for a baby. If your preemie is still in the NICU than the best thing you can do for him/her is to talk and sing as much as you can. Record your voice talking or reading a story and leave it in the NICU for your preemie to enjoy. Check here for tips and suggestions for making a recording.

Toy Suggestions
Toys that your baby can look at are best at this stage. At this age babies can only see about 6-8". Bright colors are most visible as well as geometric shapes and designs. Yellow against dark blue, yellow against purple and yellow against black are very visible, good choices. Remember to put toys low and off to one side for easy viewing by your preemie.

2-4 months - "Look I have hands"
During this time, your preemie will start to make more random movement using his/her arms and legs. Although a lot of the movement is random, babies will start to bring hands together and play with them. You might catch your preemie just staring at his/her hands - this is all good and normal.

Toy Suggestions
Toys that can be batted around are really good for preemies at this stage. A play mat with hanging toys is a great discovery toy. A bouncie chair is also good during this time - especially if the toys attached to it make noise. If you have pull toys - gently pull them across your baby's line of vision. You can also have a fun game of noise making with your little one - take turns imitating the sounds that he/she makes.

4-6 months - Refining movement and controlling their grasp
At this point, your preemie will start to have much more controlled and purposeful movement. When on his/her tummy, he/she may be able to lift his/her head and chest off of the floor. Your preemie will start to reach out and grab for toys which can be a fun game to play. During this time, your preemie will want and need you for entertainment. Handing him/her toys, picking toys up off the ground and helping him/her move around will be important things for you to do during this time.

Toy Suggestion
Toys that are easy to grab and hold onto are great for preemies at this age. Rings, rattles, soft toys that make noise and other items that can easily be held will be great fun for your preemie. Books or toys that have different textures are also good for preemies at this age.

Going Out, Part 3 – Questions

After the anxiety of strangers touching your baby, the second biggest complaint/issue that I have heard from preemie parents is the questions/comments you get. Depending on your preemie, people can ask “How come your baby is so small?” “Shouldn’t he/she be walking/crawling/talking/etc by now?” “What’s wrong with him/her?” Although some people may just be genuinely curious, there are a few that can border on being downright rude. Here are some tips to get through the situation as easily and quickly as possible.

The first thing that you need to decide is how much time you can or are willing to spend explaining your personal situation. If you are in a hurry, just not in the mood, or dealing with someone that doesn’t get it – give a quick answer and move along. If you have more time or want to educate/explain your situation than you can take more time to answer follow-up questions and talk about your personal experience with prematurity. Prematurity has been in the news a lot lately so more people may ask questions.

Here are some basic answers that I have used for people that ask questions:

- My son/daughter was born x weeks/months premature/early
- He/she was born weighing less than x pounds and he/she’s been catching up ever since (this answer is best said with a cheery tone and then you can move along to the next aisle/spot)
- With my son I sometimes just gave his adjusted age since his size more corresponded with that age than his actual age
- My son/daughter was born x weeks/months early so developmentally he/she is just x months old.
- A lot of kids don’t walk at 12 months. Since he/she was born early, he/she has more time to catch up so we aren’t concerned.
- Since he/she was premature his/her lungs/stomach/heart/etc are still developing
- He/she had to get xxx because of xxx. Give the short answer and then go from there.

If someone asks if you are worried about the long term effects of prematurity (based on recent articles), autism, or other related issues, here are some things you can say:

- Right now we are just taking it one day at a time.
- We are just thankful that our son/daughter survived – he/she truly is a miracle and we are blessed that he/she is with us today.
- We are really excited/happy about how far our son/daughter has already come or how much he/she has already accomplished.
- No one really knows how each individual baby will do long term. So far everything looks good. Or depending on your situation – right now we are just working though XYZ issues.
- Every baby is different

I think the most important thing to remember is that you can control the situation. If someone is rude or just not understanding, move along and don’t worry about them. You don’t have to answer their questions or explain everything. Be simple, direct, to the point and then say goodbye. As I’m sure you already know, many people simply don’t understand prematurity and the effects it can/does have on babies, parents and families.

Going Out, Part 2 - Signs

Over the years I've talked to a lot of preemie parents about the issues they have faced taking their preemie to places such as the store, the park, or a party. Pretty much everyone has expressed the same frustration - how to get people to stop reaching in and touching their preemie. Last week I wrote up some tips for ways to avoid people and germs while you're taking your preemie out places. I know that sometimes you have to get a bit aggressive with strangers who just don't get it. Some people have hung a sign from their preemies car seat or stroller. You can get signs from My Tiny Hands and Synagis or make your own.

I thought I would get you started with some ideas for making your own. Some of these are a bit over the top and just for fun. If you have a sign that has worked for you - please share it in the comments section.

Are you Purell'in?
She looks even cuter from 5 steps back
I was born weighing less than ____ pounds, please ask before touching me
I have Purell and I'm not afraid to squirt it.
Yes I do look healthy and I want to stay that way
The word germs with a line through it
I wouldn't touch you without asking first

Favorite Product Friday #7

This week my favorite product is baby activity gyms/mats - specifically the Tiny Love Gymini Super Deluxe.Baby activity gyms or mats are one of my most used and favorite baby play products. Most preemies love them and they can be used to foster several different developmental milestones. They also help give moms and dads a break too! I was always a bit disappointed when each of my kids outgrew their baby mat.

Pretty much any baby gym or mat will do for your little preemie. I personally like the Tiny Love Gymini - it has a nice sized mirror, bright colors, and flowers that light up and play music when touched.

Here are some tips for how to use your baby gym/mat to maximize development and play time.

Back and Tummy Time - in the beginning most preemies are just happy and mesmerized by watching all of the hanging toys. You can help keep their attention by slowly batting the toys around so that your baby can track the movement and stay entertained. The baby mats are also good for tummy time. You can keep the arches on or take them off. Your preemie will still like to feel the mat and check out what's going on around him/her. When your preemie is on his/her tummy, hang the toys on either side so he/she is encouraged to look in both directions.

Reaching and Batting toys - once your preemie is old enough, he/she will start to reach up towards the toys. The first few times, the motion will be accidental but once your preemie realizes that he/she can control what toys he/she touches - he/she will start to do it a lot more. You can help facilitate this by hanging the toys in strategic locations. Make sure that several toys are within reach of your preemie's hands and feet. Hang them low enough that your preemie can easily touch them. Once he/she gets the hang of it, you can raise the toys up and make it more challenging. Hang toys that make noise near your preemie's feet to encourage him/her to kick.

Side lying - Encourage your preemie to stay on his/her side by hanging all of the toys on one side. Put the toys at various lengths and positions so that your baby stays interested.

Going Places, Part 1

With the weather getting warmer (in most places), RSV season coming to a close and the urge to get out of the house growing stronger, preemie parents are going to start taking their precious miracles out into the world. While most parents can't wait to show off their baby's to the world - preemie parents are often nervous, apprehensive and downright scared about the potential risk to their babies. It's a germ filled world and I don't know about you, but I can't help thinking I'm living in a Lysol commercial where you can literally "see" the germs everywhere.

Here are some tips to try and stay as germ free as possible during your outings.

1. Timing. If you are going to the store, try and go early in the morning when there are less people. If you aren't sure when the store's downtime is - call and ask. Any employee should be able to tell you when they are most busy or slow.

2. What to Bring - make sure you pack plenty of Purell (or any variant of it) and put the bottles in easy to find places. If you or your kids touch something "questionable," don't hesitant to put some Purell on. Put a pack of Clean Wipes in your purse or diaper bag. They are perfect for wiping down shopping cart handles or playground equipment.

3. Stroller/Carrier - Depending on where you are going, try and have your preemie stay in the stroller, car seat or baby carrier. When we take our daughter out in her stroller, I pull the sun shade down most of the way and then throw a blanket on top so she is totally covered. She's not a huge fan of this but it helps keep little (or big) hands from reaching in when we are in a crowd of people (like the doctor's office). A baby carrier or sling is perfect for shopping trips. Make sure to face your baby towards you - strangers are less likely to reach towards your personal space to touch the baby. Or if they do - they will only be touching the back of his/her head.

4. Keeping people away - if your baby is in a stroller or other covered carrier, the best way to keep people from trying to touch, cough or breath on your preemie is to tell them he/she is sleeping. This is especially useful for small children who are naturally curious about babies. Just gently tell them your baby is sleeping and slowly start backing up/moving forward so you and your baby are out of reach. If they can plainly see that your baby is awake - just tell them he/she is tired and then move along. A lot of people also use signs to gently remind strangers they need to be careful.

5. Outside vs. Inside - If your friends and/or family want to get together for lunch/play date, ask to meet a park. Or in a backyard. It's much easier to have kids play outside - they have more space to move around without swapping germs on every toy available.

6. Older siblings - While your protecting your preemie - don't forget about protecting your other children. Before we go into any store I have my son use Vick's Early Defense on his hands. We then Purell afterward - just in case. I also remind him that he shouldn't touch his face for the entire time we are in the store. Siblings can also be a helpful diversion from your preemie. If a friend or stranger wants to touch the baby - try and divert their attention towards your other kids. "Bobby is so excited about his little sister," "Alison is really excited about playing soccer," etc. Anything to move the focus away from your littlest one.

7. Take it slow - We've been stuck inside since July of last year so I know about the urge for freedom and well, spur of the moment shopping. You still want to take it slow. Try one trip and see how it goes. How do you feel? How did your baby do? If you take it one day at a time, you'll learn the best ways to handle things for you and your baby.

This weekend I'll post part 2 of Going Places - how to handle stares, questions and downright rudeness.

Developmental Wednesday #3

This weeks developmental Wednesday is focused on transitions. Specifically, helping your preemie transition from various positions smoothly and easily.

We often think of a baby's movement and development in separate phases or positions. For example, we want our baby to roll over, to sit, to crawl, to stand, etc. Often times what we forget is that babies need to learn how to change from sitting to a crawl position. Or how to roll over when they don't want to be on their tummy and/or back anymore. When your baby is fussing, it gets really easy to just pick him/her up and change his/her position. Before you do that - think about what they would need to do in order to get from one position to another and help them through that movement.

How do they get there?
It doesn't take a PT to know how a baby needs to move in order to get from one position to the other. We all have to make movement transitions in order to go from sitting to standing, etc. Watch what your baby is doing. Then try it yourself. Think about what you need to do in order to move from one position to the other. Go through the motions as slowly as possible and really think about what you are doing. Once you've tried it a few times, help your baby move from one position to the next. It may take some time but you'll figure it out - with your baby's help.

Good positions to transition

• Rolling over
• Tummy to all fours - crawling position
• Sitting to tummy/all fours
• All fours/tummy to sitting
• Sitting to kneeling
• Sitting to standing

How do I do it?
Before you start helping your baby move from one position to the next, watch and see how much he/she can and can not do on his/her own. For example, my daughter has trouble rolling from her back to her tummy. She can get to her side but she seems to forget what to do next. If I gently push her hips towards the direction she is facing, she will bring her head and shoulders around and tada! she's on her tummy. For some positions your baby may need more help and for others, he/she may just need a gentle push to get them over or up. Over time, the amount of help your baby needs will lesson as they get stronger and more able to do each movement. Once you try it a few times, you'll start to notice how and where your baby needs help.

Oxgyen

If your preemie has to come home on oxygen, it can cause a lot of worry, anxiety, questions and confusion. Here is what I have learned about questions to ask and information that can be helpful to make the process as easy as possible.

Equipment
- What size tanks do I have? Tanks all have different letters and numbers that correspond to its size. Ask your equipment provider what size or sizes you have and make a note of it. A customer service provider may not look at your records before placing an order so to make sure you are getting the correct tanks delivered – know what you’re ordering.

- How do I put the regulator on and off the tank? This is an important skill to know. Make sure that the RT who trains you on the equipment shows you how to put the regulator on and then take it off. After the RT has show you, do it yourself to make sure you can do it from start to finish. If you don’t know how to do it and you’re in a hurry than it makes the situation much more stressful and difficult.

- How do I open/close the tank once the regulator is on? This is also essential to know – you tank won’t put out oxygen unless it’s open. You also need to close the tank before taking the regular off. There is a specific tool that you need to open and close the tank – make sure you always have it with you. We attached ours to the oxygen tank travel bag so we never have to look for it or worry about where it is.

- How long does each tank last? Surprisingly enough I found this to be a tricky question. Many employees and/or companies aren’t used to dealing with babies on oxygen so they haven’t calculated out flow/timing for small amounts. My daughter is on ½ liter and most employees were used to patients who are on 1-2 liters. Obviously you need to know how long your tank will last so make sure you get the correct information. Sometimes it might just take some simple math – if a tank lasts 4 hours on 1 liter and if your baby is on ½ liter the tank will last for 8 hours (and so on). If the company can’t tell you for sure, put your baby on a travel tank at home and time out how long it takes for it to empty so you know for sure.

Equipment Provider
- Who do I call if there are problems on a weekend or after hours? This is important to know. Make sure that the company has an after hour number and the capability to respond if you suddenly have an issue with your equipment.

- When will my tanks be delivered? If possible, try and get an established date for when your new tanks will be delivered. It may take a couple of weeks while you (and the company) figure out how quickly you go through the tanks but when possible, ask for a scheduled delivery date. You may still have to call ahead to confirm the number of tanks needed. When you are ordering smaller tanks (for traveling), make sure you check your upcoming schedule so you know if you will need extra tanks for doctor visits, trips to the store, outings, etc.

Nasal Cannula
Getting the nasal cannula working and staying in my daughter’s nose was one of the most challenging things for me because my daughter is a regular Houdini when it comes to pulling that thing out of her nose.

- How often can I get new nasal cannulas? The equipment provider should provide you with new cannulas so find out how often you can get replacements. Some of the timing depends on your insurance. If your insurance or the equipment provider doesn’t cover nasal cannulas (or doesn’t provide enough), you can purchase them online.

- How do I replace the nasal cannula? – While your baby is still in the NICU, ask an RT to show you show to replace the nasal cannula. Find out if the prongs should go up or down, if you need to trim the prongs, etc. If possible, have them help you change your baby’s cannula so you know how to do it.

- Keeping the cannula on your baby’s face is a challenging part about having your baby on oxygen. There are different techniques to keeping the cannula on. Some of it depends on your child. Does he/she try and take the cannula out? Is his/her head big enough that the cannula doesn’t slip off easily once you tighten it?
- Duoderm and tape – this is a popular way to keep the cannula on. It’s pretty sturdy however it is hard to adjust the tube once you have taped it on. Some people cut the duoderm and tape into hearts which is quite cute and works just as well as standard rectangles.
- TenderGrips – these are often used in the hospital. They are easy to put on and you can adjust the tubing if need be. You do have to replace them every couple of days so make sure you have a good supply on hand.

Tubing
The oxygen tube can be one of the most frustrating parts of having your baby on oxygen. It can be tripped on, stepped on, pinched, etc.

- Long vs. short cord – depending on the liter flow that your baby is on, you may get to choose between a long or short cord. Find out what your options are as well as what length cord you need. We originally had a 50 ft. cord for our daughter however we quickly realized that we could make do with a 25 ft. cord. It took up less space and made it easier to move around because we weren’t dragging a huge amount of cord behind us.

- If you have other children, make sure they understand that they can’t step on or block the cord. It can take some getting used to but with continued reminders, your other kids will soon move past the cord without even thinking about it

- Visitors – the cord can easily trip people up so make sure you remind visitors to watch their step. Try and move it out of the walking path if possible.

Traveling
Taking your baby places while he/she is on oxygen can make things a bit challenging but with a bit of planning, it can be pretty easy.

- Before you go somewhere, determine how long you will be out and how many tanks you will need.

- If you are going somewhere where you can take a stroller, take one! It makes it much easier to get around. Use a stroller with a big basket so that your tank and any other necessities can fit underneath.

- If you’re child is older and walking, make sure they know to stay close enough to you that the cord doesn’t get stretched or pulled out off of the tank.
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If you are going on a longer trip (overnight or more), make sure you bring an extra nasal cannula and adhesive for attaching it to your baby’s face. You don’t want to be stuck in case you need to make a change.

Favorite Product Friday #6

This week my favorite product is the Sassy Stacking Cups.

These cups were a favorite of my son and now my daughter is a fan too. We are using the same set of cups and they have survived nicely over the past 4 years. The cups can be played with and used in a number of ways - all to encourage exploration and development. Since they are stackable, you can fit them inside each other and easily throw them into a diaper bag for entertainment at a doctor's office, restaurant, friend's house, etc.

Teething - the top of each cup has a textured rubber area that is ideal for kids who are teething. Each one is different so it provides a nice change for baby's who like to put things into their mouth.

Stacking and Knocking them down - these cups make for easy stacking and knocking over which can entertain a baby for quite a long time. They stack up to a perfect height for baby's who are sitting. The bottom of each cup has a rim so it's easy for babies to pick up the cups once they are stacked. You can start with a knocking down game and then as your baby gets older - let them try putting the cups on top of each other.

Tap together - My daughter loves to hold onto two of the cups and then tap them together. Since they are cups, she can hold onto the top and easily keep a tight grip as she taps them together.

Take out and put in - Baby's first learn how to take things out so put the smallest cup into the largest cup and let your baby practice taking it out. As he/she gets older, try having your baby put the cup back into the largest cup. Once he/she has mastered that skill, try having them put the cups inside of the next largest size. You can also use the cups for teaching kids about putting small objects (like Cheerios or puffs) into the cup and taking it out.

Developmental Wednesday #2

This week's developmental information is focused on baby's who are 0-2 months old. Many babies who are born premature end up coming home around their due date which is when their actual age and developmental milestones start. Although preemies at this age spend a lot of time sleeping or eating, there is also a lot of development that happens during this time.

Some of the developmental milestones to look for are:

Large/Gross Motor
- can roll partly to side
- can lift his/her head when on their tummy
- can start to support him/herself on forearms
- kicks feet alternatively
- lifts head

Small Motor
- can turn head to follow a moving object up/down and side to side
- repeatedly moves arms and legs about - no direction
- fingers own hand in play

Social/Play Skills
- Quiets when picked up
- Vocalizes/smiles when talked to or touched
- Explores toys with mouth or tongue

Communication
- Makes small throaty noises
- Says ah, uh, eh
- Alerts or quiets to sounds or voices

Ways to optimize your preemie's development
- Go slow. Preemies often get startled when things happen too quickly or all once. Bring your face close to your baby's face slowly and quietly. Once your baby is okay with that, smile and talk softly.
- Talk to you baby. Tell them what you are doing or what you did at work today. Just hearing your voice can relax them and help them later learn to verbalize.
- Place your face (and later a bright shiny object) about 8-12 inches in front of your baby's face.
- Give your baby toys that make noise (like a bell or rattle) - your baby will start to realize that they can control the noise of the toy which helps them fine tune their fine motor skills.
- Hang a mobile above your baby's bed or changing area
- Put your baby on his/her tummy to play. It's best to do this several times a day. This will help them strengthen their muscles and begin learning how to move around.
- Sing songs. Babies don't care if you can't hold a note or follow a melody. They love to hear songs no matter how good or bad they sound.
- Smile and make happy sounds - baby's respond to the feelings of their caregivers so help them feel happy and relaxed through you and your moods.
- Let your baby feel and play with different textures - stuffed animals, blankets, plastic toys, terry cloth.

Most importantly - have fun playing with your beautiful baby.

Fun Project #2

I thought Monday would be a great day to present a new Fun Project suggestion. This one is called Then and Now. All babies are great subjects for documenting changes over time however preemies often present a unique opportunity because they are born so small and their changes can be very significant. The Then and Now project is really an opportunity to show (and celebrate) how far your preemie has come.

Here are some ideas for things to compare:

• Footprints - Make a copy of your preemie's footprints now and put them next to the ones that they took in the hospital.
• Pictures - Take several pictures that showcase how much your preemie has grown. If you put something in your baby's isolette or crib to show how small he/she was - take a new picture with him/her holding the same object. If your preemie is still in the NICU - find one item and take pictures of your baby with the same item over time. Great ideas include: your wedding ring, a special bracelet or necklace, a small stuffed animal, etc.
• First outfit - Take a new picture of your preemie now holding the first outfit he/she wore or the one that he/she wore home. If you don't want to have your baby hold the original outfit, just take a current picture and use it to compare what your baby is wearing today. Put it next to the picture of your baby in the original outfit.
• Changes - if your preemie has a new favorite toy, pacifier, blanket, etc. then take a picture of him/her with the new item and then put it next to a picture with his/her old favorite item

If you don't have pictures - then words work just as well for capturing these great changes in your preemie. You can use journal entries or simply notes to show how much your baby has changed.

Once you have your pictures or notes, now it's time to create and showcase these then and now moments. Here are some ideas to get you started.

• Scrapbook - create a small mini book that is dedicated to showing the changes that your baby has gone through. It can be as simple as putting the then and now photos beside each other or creating special pages for each comparison. Totally up to you.
• Frame - if you are going to showcase just one big comparison, then use a matted, two picture frame so that you can put the two photos next to each other and hang it on the wall.
• Collage - create a large (or small) photo collage that shows all the comparisons.
• Slide show - create a picture video slide show with the photos and notes you want to highlight. This makes a great item to email to friends and family.

Don't forget to put a date on each photo and/or note. Label each item as "then" and "now" with the date underneath or on the back.

Have fun reminiscing over your amazing preemie.

I'm still working on my own then and now project. As soon as I finish I will update this post with photos.

Favorite Product Friday #5

This week my favorite product is the Fisher Price Ocean Wonders Musical Fishbowl.

Beyond the total cuteness factor, I like this toy because it can keep kids entertained and learning in a variety of ways. The fish bowl has lights and music that play when you move it or drop the fish into the bowl. The three fish are easy to grab which makes it nice for kids who are learning how to pull and put things into a container.

Here are a few fun ways to use this toy for optimal fun and learning:

Tummy Time - this is a great toy to use for babies who are learning to reach for things while on their tummy. The lights and music are activated by touching the bowl so your baby will get immediate "feedback" and reaction when he/she is able to reach out and touch it. Great fun for them!

Exploring Toys - once kids have mastered sitting, they like to start exploring their toys. This is a fairly light toy so kids can easily turn it over, grab it, and push it around. My daughter loves to flip toys over and this is one of her favorites.

Grab and Drop - Obviously one of the best uses for this toy is to get kids to learn how to pull toys out of a container and then drop them back in. When your playing with your baby, drop a toy in and say "in" and then pull it back out and say "out." Overtime your baby will start to learn what the words mean and will copy your actions. Make sure there is a lot of cheering involved for your little superstar. When they are just starting out, fill the fishbowl with other small toys so it is easy for him/her to pull something out.

Can I have it? - Once kids have learned how to pull a toy out of the fishbowl, start asking them to give it to you. Hold your hand out and help them release the toy into your hand. Once you have cheered them on, give the toy back and start over. Sometimes it helps to have another adult or older child there to show your baby how to do it (make you cheer for your helper as well).

Enjoy this great toy and watching your baby learn all sorts of new skills!

Developmental Wednesdays

I'm introducing a new feature today - Developmental Wednesdays. Every Wednesday the post will be focused on some aspect of baby/preemie development. Everything from what to expect, positions to encourage specific movement, ways to interact and more. Development can be a huge area of focus and concern for parents of preemies so I hope you will find the information useful. As with all developmental expectations, remember to look at your baby's adjusted age not his/her actual age.

The following is a list from the Active Learning Series called the "Baby Can List." I found this to be a helpful chart that shows how your baby's skills change and develop as they going from being a newborn to a 5 month-old.

Newborn
- feel, taste, smell, and hear
- move arms and legs to play
- cry when in need of something
- enjoy being held and spoken to
- see things 8" to 12" away
- begin to turn head
- make eye contact
- look at clear simple pictures or designs
- grasp a small thing briefly
- make cooing sounds
- lift head to look around
- smile
- follow with eyes from side to side
- reach toward a toy
- show happy and sad feelings by making sounds
- sit supported, head steady
- turn head toward your voice or other sounds
- watch your mouth when you talk
- hold and shake a small toy
- see things farther than 12 inches away
- look at hands and feet
- bat or hit at things
- support head and chest with arms when on stomach
- try to roll over
- reach out when on stomach
- watch moving things
- answer a sound you make with another sound
- try to pull up to a sitting position
- bounce when held in a standing position
- enjoy looking in a mirror
- hold something in either hand
- play peek-a-boo
- recognize familiar people
Five months