Wednesday, March 24, 2010

Dysphagia 1 feeding

Well, not really, but a dysphagia 1 diet consists of pureed foods and that's exactly what early baby foods are: puree.

So, after he took the Praxis, Jon came back for some hang time with the nephews. I got to take Luke for the non-existent whoopie pies and he got to feed Zac.

The last time Jon fed a baby, he was in the NICU at St. Bernardine's, feeding preemies from a bottle. This is not as easy as it sounds. You would think, "Hey, feeding a baby; no big deal. And, hey, feeding a really small baby; even less of a big deal. Because the baby is, you know, smaller. And probably less feisty." But no.

Bottle feeding a preemie involves teaching the baby how to swallow. Early preemies are born before the swallow reflex has developed, which is why they are tube-fed until they are old enough to learn to swallow. Plus, preemies are already medically-fragile and have compromised respiratory systems. One of the easiest ways to really mess with a respiratory system is to allow someone with any kind of swallowing disorder (including not yet knowing how to swallow) to eat. If you don't swallow correctly (and this involves timing and laryngeal elevation and coordination with the respiratory system and the ability to cough to clear if all else fails), then you can aspirate and end up with food in the lungs. Let me assure you, this is not good.

Preemies who don't know how to swallow have to be taught. You have to stroke the palate to get the tongue moving. You have to stroke the cheek to encourage them to root. You have to position them correctly (generally, in front of you, head in your hand, body on your forearm, at a steep upward angle). You have to check the monitors to make sure the O2 sats don't fall to low. Preemies will often find feeding so new and challenging that they, well, for lack of a better term, forget to breathe!

After you feed them, you must burp them. They must burp! Upright! This is crucial because, again, they don't really know how to swallow and if they burp in a supine position, they are likely to aspirate. After all that, you'll probably have to change their diaper. Jon changed his first diapers in the NICU (talk about a pressure situation but the nurses and his supervisor all found it very amusing).

Feeding preemies is definitely not for the faint of heart. But feeding Zac? Piece of cake. The kid loves to eat. And he knows how to swallow. The worst thing that can happen with this little guy is that he will start to get fussy if the spoon arrives at his lips too slowly. He should be working his way up to a dysphagia 2 diet (minced) before we know it.

Friday, March 19, 2010

No whoopie pies?!?

Ann and the nephews came up on Saturday while Jon and Kurt were both taking tests (Jon--Praxis, Kurt--single subject tests for math and physics). One of Luke's favorite treats is only twenty minutes away at West Coast Whoopies! Seriously, the kid talks about the whoopie pies and knows his favorite is mint and he's probably only had them about three times in his life. Well, he's four and he's been on solid foods for only three-quarters of his life so maybe that's not unreasonable.

Anyway, I decided to take him to West Coast Whoopies all by himself. That's right, just me and the four-year-old. He's toilet-trained now, so I figure what's the worst that can happen?

I must have had some sort of premonition, though, because I didn't tell him we were going to West Coast Whoopies. I just told him we were going to go get a treat. We got in the car (Luke looked at the booster seat and said, "Hey, we have one just like that;" ummmm, yeah--that one is yours Luke-o) and headed down the freeway to WCW! We talked the whole way. Luke is a talker. He's got opinions on everything. For example, he prefers Kutless to Chris Tomlin. My kind of kid.

We got off the freeway and pulled into the parking lot of WCW and I just about had a heart attack! It was closed! Permanently closed! The storefront was empty and it was just ... gone. No more whoopie pies. I hate this stupid economy.

See? Lucky I hadn't told the child we were getting whoopie pies. It would have been a huge let-down. As it was, he's four. He was busy talking and listening to Kutless and looking at the liner notes from the rejected Chris Tomlin cd. So I was able to quickly pull out of the WCW parking lot and take us straight to Frugo's for frozen yoghurt. He was a happy camper (and put together a totally disgusting concoction of chocolate and vanilla yoghurt with gummy worms, white chocolate chips, Captain Crunch, and Fruity Pebbles) and I quite like Frugo's, too.

But no more whoopie pies?!? What is wrong with this country?

Monday, March 15, 2010

Jury duty

I didn't get picked for the jury. Is it weird that I kinda felt bummed? It was like a flashback to all those softball and kickball games when I was the last to be picked. And, even as I was picked, you could tell the team captain was wishing it was like jury selection and he could tell me the team was full and I was excused for another year.

Friday, March 12, 2010

It's ok to cry

It's ok to cry, buddy.

I know this has been a traumatic week for you. On Monday, you said good-bye to your teacher and your friends and your RSP teacher and me. You said good-bye to your school. Then you moved with your mom to a new house in a new city. We had talked about the move and you were excited. And then, yesterday, I got the notification that you were back, three days later, and now you were living with your dad.

I don't know what happened, K. I don't know what changed. All I know is that I found you, sobbing your heart out all by yourself outside the cafeteria. You're a tough guy and you can be a bit of a challenge but today you were just broken. Just really, really sad. You were back at your old school but now you had a new teacher and different classmates and everything was all wrong.

I'm glad I was the one who found you. I'm glad I could hug you while you cried into my shirt. I'm glad you let me hold your hand and walk you up to the office so I could find out who your new teacher was. I'm glad you let me walk you to your new room and then talk you inside. I'm glad you were brave enough to sit back down and just cry quietly.

You're gonna make new friends in your new room, K. And you'll find your old friends waiting for you on the playground. I think it's all gonna be ok.

But for today, on such a scary, confusing day, it's ok to cry. Truth be told, I wanted to cry, too.

First Look

I found this truly old photo the other day and had to laugh because it brought back so many memories! Not necessarily of falling in love with Jon, although I have lots of other photos that bring back that, mmmmm, yummy time. Nope, this photo makes me remember the way he looked when we first met!

This was back in the early 90's. Yes, we are that old. He was sporting jeans rolled and tapered at the ankle, surf-brand tees and sweatshirts, graphic-print sweaters, and ... an earring! The earring didn't last long but I still can't believe I fell in love with a guy with an earring! Ah, yes, the fashion joys of the 90's. Not that I'm one to judge. I was rolling and tapering my jeans, too, wearing truly enormous, oversized sweatshirts, and had my hair pulled back in the ubiquitous scrunchy.

Back to the photo. It was taken while he was on a college floor retreat in Joshua Tree. He's holding a purple ski jacket; we still joke about that. I don't think he'd be caught dead in anything purple today. And he's wearing a bandana! We've been together for 18 years and I have never seen the guy in a bandana.

Today his ski jacket is army green and he's more likely to pull on a cashmere sweater than a sweatshirt. And that old earring is rolling around in my jewelry box. Can't say I was sorry to see it go.

Thursday, March 4, 2010

Consonant blends

I was picking up one of my kindergarten groups on Tuesday, when the following conversation took place between H and me.

Me: Hi, H, ready for speech?

H: Yeah. Mrs. Pilgrim, you got sex?

Me: What?!?

H: You got sex?

Ok, I admit it. I had absolutely no idea what she was trying to say but I knew it wasn't "sex." So much for a master's degree in speech-language pathology.

Me: Um, no (thinking that was the safest response).

H: Well, you got lunch?

Ahhhhhhhhh, the light finally dawns.

Me: Yes, H, I had lunch. And I have snacks. After speech we'll have a snack, ok?

Consonant blends are a big deal. And, for that matter, so are short vowels. H and I will be working on that in the upcoming months. Could be worse, however. I have no idea why, but "f" is a very common substitution for the "tr" blend. And there are a lot of little boys out there who like to use the word "truck." And the parents of these little boys are usually asking me to fix that word before I fix anything else. Yep, consonant blends are a very big deal.
Here's Jon, administering the Goldman-Fristoe Test of Articulation with Luke as his practice client and establishing that, lucky for his parents, Luke wasn't producing the f/tr substitution.