Adjusted vs. Actual

[triciaism]

Hi,
For those of you who have older premies than mine (mine are 17wks but 5wks adjusted) - just wondering . . .

My pedi gives me the 2month check sheet, 3month etc. when I go. They were "3" months early so obvioiusly NOT doing anything on the sheet. Where does the adjusted come in then?

I realize that at my premie follow up clinic they will look at adjusted and I asked the pedi if "anything that comes before the adjusted age is considered a bonus" and he said yes . . . but it makes me start to wonder about when they start to eat other foods (besides EBM & formula), etc. Is it at their actual or adjusted or just a wait and see thing?

The check sheets are kind of annoying although I guess it's good for when they "catch up"?

TIA,
Tricia

[CrystalAZ]

They will slowly start catching up to the "actual" age. At Wyatt's 18 month visit, he was at 25% weight, 50% height, and still 3% head on the "regular" chart, so he is off the preemie charts now with physical development.

As far as skills development, we have a free state program where a social worker comes out every few months to do developmental checklists with him through age 3. It is interesting to see, because at first, he couldn't do anything on the lists (which are based on "actual" age) and now he can do everything on there, other than he is still a little behind in speech. It is really cool to watch him "catch up".

As far as when to try solids, your babies will let you know. They will start really watching when YOU eat and you will just know. Anyway, if you try before they are ready, they'll just spit the food back out instead of swallow it, and you can put it away and try again a couple weeks later until they are ready. No biggie.

Crystal

[m(or)]

Ignore the sheets, or save them until they hit the adjusted age. I waited until 5 1/2 months adjusted to feed solids to my 34 weekers. Why invite allergy and GI trouble? Do let them play with the baby safe spoons and let them handle teethers on their own. Preemies sometimes have trouble with eating. This is usually sensory. Your follow up clinic can give you more info on that too.
Something I wish I had done was spread out their vaccines. Between those and the synagis, they were always getting stuck.
If they are not breast feeding, now is a good time to try again. Ask a lactation consultant with preemie experience to help. It is so much easier than pumping and bottle feeding.
Try to enjoy the milestones without worry. The best is yet to come.

[Suzan33]

I have 24 weekers here and we ignored anything that dealt with adjusted or actual age. We lived in Arizona at the time and we had a WONDERFUL Early Intervention team who was on top of everything. If they even hinted at a delay it was immediately worked on. Our pediatrician did most things based on adjusted age and was never too concerned with any of their stats as long as they were following their own curve.

As for solids and things like that, I waited until or pediatrician told us to start. Why rock they boat if they are not ready.

The trio is almost 4 years old now and they are completely caught up to their peers. They were caught up by 2 years old. They are a little small for their but I am not worried about it and neither is their pediatrician.

[hedgehog]

DD was born 27w6d. Early on our ped did both with us. She'd show us the stats on both adjusted and actual curves. The hand outs that she gave are "standard" and are computer generated based on actual, so she never ever put emphasis on them. Sort of "here you go if you want them". But she looked for the typical development on adjusted age. She deferred to the NICU follow up team for most of the big stuff, when to quit fortifying EBM, when to start solids, is her head too big (LOL) She has a nice working relationship with them and it makes it easier that they are on the same page. Anymore, there is no need for such close collaboration since DD has been progressing nicely, and she dropped using adjusted age for the curves once DD solidly on the actual charts.

The NICU follow up (we have appt every 6 months that includes developmental ped, speech, PT and OT) exclusively goes by adjusted.

As far as what we did... DD is 19 months now. We did solids on adjusted age (honestly, she was not ready before then anyways, there are specific things that they need to do to show that they are ready). But them she breezed really fast to table foods. Switch form formula to milk we did on adjusted as well. I think we did all the big changes according to adjusted age. Only two thing were based on actual : we had permission to turn the car seat forward by actual age (though we did it only today :P ) and vaccines were done on actual age except MMR, but that was personal preference.

[triciaism]

Hi,
Thanks for all your input! It's nice to see so many with baby(ies) born around or earlier than mine doing well.
I choose my pedi because he has a specialization in neonatology (one of the pedi's that relieve the neonatologists in the NICU) and he has been good in not expecting them to be at actual age other than giving me the check lists. The premie clinic (follow up NICU) will go only on adjusted - supposed to begin at 4months (adjusted) but they made me an appointment for 3m adjusted (July). I was just thinking ahead - I go back to work in August (urghhh) which is 7m but 4m adjusted so was trying to "picture" where they might be at in regards to feeding, etc. for sitter training. We will just wait and see when it's closer. Good to know that waiting (if need be) is fine in the feeding department. I actually have a degree in child development and "should" know that - but I guess it "is" different with your own They told me that they generally catch up by age 2 and the clinic will follow them till 2yrs. adjusted. The home nurse and OT both came a few times in the beginning (one dd has head shape issues from NICU stay and neck tightening (also contributing to the head shape issue)) but they said wait till the clinic now and do exercises/positioning in the mean time.

m(or) - Re: the breastfeeding, it has been an up and down thing. I had tons of milk at first then lost alot of supply. One dd was not a good latcher and it made nursing one and bottling the other a challenge and I found myself giving more bottles and "trying" to pump in between (not helping the supply issue). Well dd "just" began nursing pretty well - so I'm trying to catch up. Although - they are both still hungry within the hour (sometimes/often 30minutes). My friend said she nursed her singleton approx. every 2hrs. for the first 6m. With two I have trouble imagining that scenario as I would have someone latched on constantly. Although yours were gestationally older, did yours do that? I have met with a LC but don't think she was experienced with premies/twins. She gave me all the supplimental supply's (breast shield for the one, suppliment tube where the milk just leaks out of their mouth, ect. but . . .still plugging along at it and feel a little hopeful now that dd can latch properly. Of course they are used to finishing and being full from a bottle in 15minutes so are stopping nursing about that amount of time and are NOT full.

Thanks!!
Tricia

[m(or)]

By 6 weeks adjusted they should have more energy and awake time. So they can nurse for longer stretches. Try tandem nursing. They are a bit bigger now and will be easier to hold/adjust. Also try a nipple with a smaller hole. That makes bottle feeding more work. A nurse in will really build supply. Expect to spend about 48 hours just breast feeding. Have your dh do all the cooking/cleaning. Feed on demand. Drink lots of water. Eat whenever you are hungry. Don't give any bottles or pump. Your little girls will build your supply. and gain more stamina.
You are doing a great job sticking with this. The pay off is healthy babies and a much less labor intensive feeding job. M