low milk supply – Keeping up with the Hoffmans

Baby Emmett, breastfeeding, monthly updates

12 months old

June 8, 2017August 6, 2018 Keeping up with the Hoffmans

I’m three weeks late on posting, but Emmett is officially a year old. The day came and went pretty uneventfully. We’ve decided to celebrate the anniversary of his homecoming in August this year instead of his birthday, so we’ll do a cake, presents, party, etc. at that time. I did put him in the same “Uno” shirt I got for Theo’s first birthday and sent him to daycare in that, and I posted something on Facebook to commemorate the day. Mostly I’m happy to have it behind us. I had mentioned in my previous post that it’s been a little surreal to see photos pop up on my Timehop app of my pregnancy, and I’m happy to not be seeing those anymore, but now I’m seeing NICU pictures, so there’s that. Actually, I’ve started re-reading my daily blog posts from last year each day, and while it does bring up a few feelings of anxiety still, I’m also finding it a little bit healing.

He really has come so far.

Adjusted age: 9 months

Stats: 16.2 lbs and 27 inches

Milestones: Clapping! Walking with a walker!

Sleeping: All night, most nights! Still wakes once a couple times per week. Naps are pretty predictably and hour mid-late morning and another hour early-mid afternoon. I’m thankful we didn’t have to do any sleep training this time around and he kind of figured it out on his own. I hated sleep training Theo but we were desperate, with him waking every two hours!

Eating: He’s doing three solid meals per day now, plus an afternoon snack. Not as interested in nursing these days and is pretty easily distracted, but we’re still trying to get bottles/nursing sessions in him every 3 hours since he needs the calories and breastmilk is more calorie-dense than the solid food he’s getting. Still adding avocado, butter or full-fat yogurt to his purees. Gotta fatten this peanut up!

Personality: The two words I’d use to describe him are happy and busy. So busy. He’s into everything these days. I thought Theo was a busy kid, but Emmett is insatiable when it comes to exploring and getting into stuff. I think he may be my wild child.

Likes: Getting into stuff and exploring, above all else. Also loves his brother so much. He lights up whenever Theo walks into the room.

Dislikes: His inhalers, the Nose Frida and being away from mom. Separation anxiety has officially arrived. I used to be able to drop him off at daycare without much fuss. He’s so intent on exploring and getting into things that he’d crawl over and empty the toy bin as soon as I set him down and hardly even noticed I left. Recently, though, he cries and grabs my legs if I try to leave the room. Breaks my heart.

Mama: Still obsessing over milk supply, though the Domperidone has helped a LOT. I’m still not up to full supply, but I’m usually only 2-3 oz short of what I need to send with him to daycare each day, and there have been a handful of days where I actually pumped enough! I started on the lowest recommended dose of 60 mg per day, though, and have recently increased to 70. I can go as high as 160, I believe, if needed. I’m so close to making enough, that I’m hesitant to increase much more since I’ll need to wean slowly. As of now I still have enough freezer supply to make up the difference and I think E is pretty close to dropping a bottle at daycare now that he’s eating more solids.

In other exciting news, I’ve just begun the process of becoming a volunteer at the NICU where Emmett stayed. There’s a parent advisory board that meets with NICU parents to help them through their journey and I found this resource to be so valuable when we were there. It just really helps to talk to someone who gets it; who’s been there and come out the other side. I know it may be tough to be back there, and I’m sure it’ll bring up a lot of emotions, but I also think it will be healing and a good way to give back. More to come on that — it’s quite the process to get ramped up and approved to volunteer (both by the board and by the hospital) and they don’t like you to officially start until you’ve been out of the NICU for a year, so I wouldn’t start doing any work for them until August, anyway.

Still can’t believe we have a one year-old. I don’t think it’ll really feel like we do until he’s a year adjusted. Right now he just feels like your typical 9 month-old.

Here are some photos from the past month, including some professional shots we had taken.

Baby Emmett, breastfeeding, monthly updates

11 months old

April 27, 2017August 6, 2018 Keeping up with the Hoffmans

It’s been an interesting month, health-wise. As I mentioned before, we’ve been seeing a pulmonologist at Children’s Hospital, due to E’s chronic breathing issues. After chest x-ray and echocardiogram results came back normal, the pulmonologist decided to refer us to a feeding therapist to check for silent aspiration as a potential cause for his wheezing and coughing. She didn’t think it would be the culprit, but wanted to “rule it out.” Unfortunately, we weren’t able to rule it out because it turns out that is the culprit. Or at least part of it. Emmett is aspirating as he’s eating. So now we have to add thickener to his bottles. As of now I’m still allowed to continue breastfeeding morning, night and weekends as I have been, as long as I keep him upright and give him breaks, but we have a swallow study coming up May 2 to assess the severity. Depending on how badly he’s aspirating, we could end up having to go to all bottles. After working so hard to breastfeed this kid, now this.

I suppose I shouldn’t be surprised by anything at this point. Eveyone had warned me that prematurity doesn’t end when you leave the NICU, and that the consequences of being born early can follow kids for quite a while — sometimes a lifetime. But I’ll admit that a part of me had hoped he would be the exception. He is such a strong little boy, though, and I know we will get through this. And as frustrating as it is to keep encountering hurdle after hurdle, I am also acutely aware of just how much worse things could be. Perspective is so important.

With that said, here’s what’s going on with our 11 month-old:

Adjusted age: 8 months.

Stats: 15.6 lbs and 27 inches. We have growth finally! He is still a peanut, just barely clinging to the charts around third percentile for his adjusted age and nowhere near the charts for his actual age, but it’s nice to see progress. Thank you, butter.

Milestones: Finally reliable at sitting (without feeling like I need to spot him), pulls up to standing, and even lets go briefly.

Sleeping: Getting much better! He sleeps through the night about half the time, and the times he doesn’t he’s only up once. But a good friend told me to never trust a baby. So there’s that.

Eating: This kid loves to eat, and he’s getting much more efficient about it. In other words, more is finally ending up in his belly than on his belly. He also doesn’t appear to be picky at all, and will even eat any green veggie (could have something to do with the fact we’ve been instructed to add butter to everything, though!). We’re experimenting with some dissolvable finger foods like puffs, yogurt melts and mum mums, but haven’t made the leap to real table food yet. I’m still terrified of choking and he also still doesn’t have any teeth yet! I know I need to get over that fear and start giving him stuff soon, though.

Personality: So happy and very curious and determined! He gets into everything, but is also very good about responding to me correcting and redirecting him when he gets into something he shouldn’t. He seems very socially aware, if that’s even possible for an eight month-old. It will be interesting to see if this trait of his continues as he develops.

Likes: Bathtime, big brother, getting into stuff.

Dislikes: Still hates his inhalers.

Mama: Still stressing about my milk supply. Interestingly, when we took E in for his feeding evaluation, the OT, who is also an IBCLC (lactation specialist), confirmed what I’ve known deep down for quite a while — I’m not making enough milk. I knew I was only pumping about half of what he needed, though everyone kept telling me babies are more efficient than the pump and if he was really hungry he would let us know — so I had just continued to dip into my freezer stash to get him though the day at daycare and continued to exclusively nurse on the weekends. But the OT reiterated that while yes, babies are more efficient than the pump, nursing is still supply and demand, and by the time I got to the weekend my body was already adjusted to what I was pumping all week — about half of what he needed. On the weekends he was probably nursing just enough to take the edge off, but there’s no way he was getting enough from me alone.

I cried on the way home from the appointment, feeling like a shitty mom for basically starving my baby on the weekends. Thankfully, the OT/IBCLC and I worked out a plan, and I’m feeling good about what we have to do to move forward and get him enough food without losing any more of my supply. So now after nursing, I’m supposed to offer him an extra ounce or two via bottle, and ideally pump too, though she acknowledged that wasn’t very practical with busy schedules. She also said I was a good candidate for Domperidone, which is supposed to be very effective at increasing milk production. In fact, it’s so effective that adoptive mothers sometimes take it so they can actually induce lactation. I just started it and am hoping to start seeing results soon. If it doesn’t work, I think I’m probably ready to throw in the towel on nursing once we reach the end of our freezer stash, knowing I’ve tried everything I could. And depending on the results of the swallow study, that may be the direction we’re headed anyway. I had hoped to nurse to a year adjusted, but I may have to settle for a year actual.

A year. How is that possible it’s been almost a year?

Swimming in his grandparents’ pool in Arizona

Meeting his great great grandma for the first time

Baby Emmett, breastfeeding, monthly updates

10 months old

April 5, 2017August 6, 2018 Keeping up with the Hoffmans

What a fun little guy we have. I remember thinking at one point there was no way I could love another child as much as I love Theo. But everyone told me your heart makes room and grows for more children and they were totally right. Emmett is the perfect addition to our family and our lives are so much better because of him. He is so similar to T in many ways, but has his own quirks and personality, and well, we just love him to pieces. This is such a fun age.

Adjusted age: 7 months

Stats: 14.8 lbs and 26.25 inches. Still not a lot of growth with this little peanut, unfortunately.

Milestones: Crawling everywhere, getting better at sitting unassisted (but still topples frequently), standing pretty well while holding onto something, and almost pulling himself up to standing. He’s also eating more foods with texture, like Mum Mums and puffs.

Sleeping: For the last month he’s been sleeping horribly! Up 3-4 times per night and not settling as easily as he had been. But then just this last week we seem to have turned a corner (knock on wood). He now takes a while to settle initially, and might wake up a few times the first couple hours he’s down, but after that initial settling he’s been sleeping through until morning! I don’t know that I’d count it as sleeping through the night since he’s still up a couple times, but those wakeups are usually before I go to bed, so he’s sleeping through my night. I’ll take it. Naps are still hit or miss. Sometimes he’ll give us 2-3, one- to two-hour naps. Other days he crap naps for 30 minutes at a time. But he’s happy, so I’ll assume he’s getting enough sleep.

Eating: As mentioned earlier, we’re experimenting with different textures and he’s doing really well. He loves food. We haven’t really found anything he doesn’t like yet, and we’ve even begun venturing into some green vegetables like peas and green beans. We are seeing a nutritionist to help him pack on the pounds, and she is having us add butter (yes, butter!) to his purees to give him some extra calories. Maybe that’s why he eats his veggies with no protest. Everything is better with butter, right? For fruits, she’s having us mix with avocado for extra fat. Funny, I was talking to a coworker recently who has 16 year-old twins who were born premature. He said they were also instructed to add butter to their food to help them gain weight and to this day they still add butter to everything (and are still very petite). Nursing has gotten better again. He isn’t quite as distracted as he was, though I still find I have to take him somewhere quiet sometimes to get him to focus. He probably never will be the easy nurser T was, but I’m thankful we’ve made it as far as we have, considering preemies are notorious for having difficulty breastfeeding.

Personality: Always happy, and always moving. He is one busy guy, just like T was, and he’s very determined in all that he does. I like to think this “go getter” attitude will serve him well later in life.

Likes: Exploring, laughing, bathtime, big brother, eating! I’m especially glad he’s enjoying eating since he still needs to pack on the pounds.

Dislikes: Still hates his inhalers. I feel like I’m torturing him when I give them to him and really hope I’m not harming him psychologically.

Mama: I’m still stressing over my milk supply, though I have noticed with his increased stretches of sleep at night, I’m able to nurse him in the morning and then still pump more than my usual amount afterward. Interestingly, my subsequent pumps throughout the day have been higher volume as well. I’m sure I’m making the same amount but just pumping what I would have been nursing overnight when he was waking multiple times. But if nothing else, it’s a nice morale booster to see the higher volume. Though I have heard sleep is good for your supply, so it could be that these longer stretches of sleep have allowed my body to recuperate some and produce more.

The closer we get to his birthday, the more emotional and reflective I’m getting. I’m sad that the first year has almost come and gone and I haven’t been able to fully enjoy it because I’ve spent so much time worrying; willing him to grow; feeling like we were always trying to catch up. At the same time, I’m fiercely proud of him and how far he’s come this past year. He had such a rough start and he’s doing amazing, all things considered. I know we aren’t out of the woods on complications, and some things could possibly crop up in adolescence and early adulthood. I made the mistake of googling long term affects of prematurity and saw some scary stuff. But he’s just so amazing and bright and happy, that sometimes I can’t shake the feeling that he must be destined for greatness. I have these visions of him on some stage somewhere, someday, telling his story of how he overcame the odds. No matter what happens, he’s got a pretty amazing group of family and friends that love him and will cheer him on.

Drinking from a sippy cup like a big boy.

Baby Emmett, breastfeeding, monthly updates

9 months old

March 6, 2017August 6, 2018 Keeping up with the Hoffmans

Can we really be getting that close to a year old? Time is so non-linear when your baby has two ages and you vacillate between viewing him as a nine month-old (because that’s what he is, and he’s been in your life for nine months) and a six month-old (because he looks and acts like a six month-old and you’ve only had him home for six months). I will say, I’ve started just telling people his actual age when they ask, as I’m learning most people have no clue what a six or a nine month-old look like. Sometimes I’ll get a comment about how little he is (usually from other parents of young children), at which point I’ll say he’s a preemie and has some catching up to do. Sometimes this leads to a lot of questions I may or may not feel like answering, but a few times I’ve ended up connecting with other parents of preemies. In fact, just last week I met a woman whose baby was in the same NICU at the same time as Emmett! Small world.

Here’s what’s happening at nine months:

Adjusted age: 6 months.

Stats: 14.6 lbs and 25.75 inches. Not much growth since last month. It may just be his continued illnesses and increased activity, but we’ve started seeing a pulmonologist for his wheezing and she referred us to a nutritionist because she wants him to start packing on the pounds. His lungs will grow and get stronger as he does.

Milestones: Eating solid foods! So far we’ve tried sweet potatoes, avocados, apples, bananas and peas. He still pushes his tongue out more than he swallows, and so more ends up on his shirt and tray than in his stomach most nights, but his OT feels good about how he’s doing, and the important thing is that he enjoys it. Right now solid foods are less about nutrition (he still gets everything he needs from breastmilk), and more about introducing flavors and textures. He is also so close to crawling, but hasn’t quite made any forward progress. He gets up on his hands and knees and rocks back and forth, and sometimes goes backwards, so I’m sure it’ll happen any day now. Update: I had drafted this post last night, and he officially made his first forward crawl tonight.

Sleeping: We’re dealing with a little bit of a regression. After getting used to just one wakeup per night, he’s now usually up two to three times per night. But he’s been nursing less during the day (more on that below) and I feel like his middle of the night feedings are his most productive, so I’ll take any opportunity to get some extra calories in him. As tired as I am, I know it’s temporary. Theo was the world’s worst sleeper as a baby and he’s great now. I’ll sleep again someday. For now, coffee.

Eating: Solid foods once per day (at dinnertime so we can all eat as a family), four to five 4-ounce bottles at daycare (fortified with NeoSure), and nursing whenever we’re home together. As I mentioned earlier, he’s been nursing less, though. He’ll often latch for 3-4 minutes and then pop off and fight me if I try to relatch him. I think it’s mostly an issue of him being easily distracted, as he does this on the bottle too, but will focus and eat better if we go into a quiet room. He also eats really well when he’s sleepy and relaxed. The rest of the time, he’s got a major case of FOMO (fear of missing out). I’m hoping this is a quick phase, because it’s incredibly frustrating, and my supply is already struggling and it worries me when he goes several feeds in a row without eating much.

Personality: I sound like a broken record, but he’s just so HAPPY. Smiles at everyone and is incredibly social. So far no stranger danger, though I know that often kicks in around this time. He also loves other babies, which is funny because I didn’t think they typically noticed other babies at this stage. Maybe it’s because he’s used to being in daycare with other babies, but when we get together with friends and we put the babies on the floor together he stares and smiles at the other babies — and then usually tries to grab their face.

Likes: Being tossed in the air. I get the biggest belly laughs out of him when I toss him up. Also laughs and laughs at big brother, sometimes when he isn’t even trying to be funny. Which causes Theo to whine and tell us to make baby Emmett stop laughing at him.

Dislikes: His inhalers. As I mentioned earlier, we’re seeing a pulmonologist to get his wheezing and coughing under control. He is now on a twice daily steroid inhaler, and an albuterol rescue inhaler as needed. They come with a special mask that goes over his mouth and nose so you can puff it in and he is not a fan. Especially since you have to hold it over his face until he takes 5-6 breaths… and then repeat. Sometimes if I catch him in a good mood and talk to him in a high squeaky voice while I give it to him I can avoid a freakout, but most of the time he screams and cries and tries to fight us.

Mama: I’m … surviving, I guess. As I mentioned last month, I’m feeling pretty overwhelmed, like I’m failing in all areas of my life. It hasn’t really gotten any better, but it hasn’t gotten any worse, either. I’m madly in love with this little man but also feel like I have a hard time just enjoying him because I’m always worried and stressed. I’m sure the stress is one factor in my diminishing milk supply, which in turn also makes me stress out (it’s a vicious cycle). Thankfully we still have a huge freezer stash. He’s getting about half fresh and half frozen at daycare because I can’t pump enough in a day to send with him the next day. At one point I had an oversupply and managed to completely fill two freezers with milk. We’re blowing through that at an alarming rate, though. At some point he’ll be eating more solids and drinking less milk, but at the rate we’re going, we’ll probably have to supplement with formula at some point, unless I can increase my supply. I’m pumping as much as I possibly can during the workday, nursing as much as possible at home, taking fenugreek, eating oatmeal and trying to up my water intake, but it’s not making much of a difference. Not that formula is the end of the world (and we’re already fortifying anyway), but it makes me sad sometimes that we don’t have the (relatively) easy breastfeeding relationship that Theo and I had. The fact that this is our last baby and so much of it hasn’t gone how I’d planned makes me mourn that aspect so much more.

Whew. Okay. As consolation for making it through my therapy session, here are some cute baby pictures.

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Baby Emmett, breastfeeding, health & body, monthly updates, musings

7 months old

January 14, 2017August 6, 2018 Keeping up with the Hoffmans

True to form, this seven-month update is closer to his eight-month birthday. But at least the photo was taken at exactly seven months. Time is flying and this little man has become such an important part of our lives. I’m so proud of him and how far he’s come.

Adjusted age: 4 months

Stats: 13.4 lbs. and 25.5 inches

Milestones: rolling like crazy. Babbling with consonants. Really wants to crawl! Theo was an early crawler at six months, and I won’t be surprised if Emmett crawls by six months adjusted (which would be nine months actual).

Sleeping: Still waking up 1-2 times most nights. Naps are getting more substantial and consistent – usually around 3 per day: one long one mid-day with a shorter one in the morning and late afternoon.

Eating: Nursing is going well, despite some supply issues (more on that later). He’s taking about 3.5 oz per bottle at daycare, still fortified with NeoSure, and then we’re pretty much exclusively nursing at home. I don’t even bring backup bottles with me anymore, which is so nice.

Personality: Still the happiest baby I’ve ever met. He’s been sick a lot since he started daycare, but even that doesn’t get him down. Pretty much the only time he cries is when he’s hungry. He gets a little fussy and needy in the evenings before bed, but that’s easily remedied by just holding him. I think after a long day at daycare he’s just a little tired and probably misses us.

Likes: Being tickled. His neck is especially ticklish and sometimes when I’m getting him dressed, just pulling his shirt over his head sends him into a fit of giggles. I need to capture this on video one of these days. He also adores his big brother. Anything T does is basically the most hilarious thing he’s ever seen. The bond these two already have is honestly my favorite part of being a mom.

Dislikes: Saline and suction. Because he’s been sick so much we’ve had to give him saline drops and suction out his nose. He really fights it, and he’s freakishly strong. But after I’m done he’s back to his happy self.

Mama: As I briefly mentioned earlier, I’ve been battling some milk supply issues, and it’s been stressing me out (which I have heard can also affect your supply, but I have yet to figure out how to break THAT cycle!). It all started when I got mastitis a couple months ago. Then it dipped again when I got my period, but seemed to recover. But then it plummeted again. There are times when I get ONE ounce total (from both sides) in a pumping session. And even on a normal day, I’m not making enough to send with him to daycare the next day. I’m thankful I have such a huge freezer stash, and truthfully it’s good to have an excuse to use that before it all goes bad. But the low pump output made me worry that I might not be producing enough to exclusively nurse while we’re home together. I mean, if I’m only pumping an ounce in a session sometimes, that’s obviously not enough for a full meal for him. But I had also heard that babies are more efficient than a pump, and that pump output isn’t necessarily indicative of what you’re producing. So I rented a baby scale from the breastfeeding center at the hospital for a couple weeks and weighed him before and after feeding just like when we were back in the NICU. And while there were definitely times he didn’t eat much, I noticed he would usually make up for it at the next feeding. I’m assuming this is all normal (after all, my appetite varies throughout the day too), and it was reassuring to see he’s probably nursing enough. I still find it depressing when I have a sucky pumping session, but I’m not as worried about his intake anymore. The real test will be at his next appointment, whether he’s still following his growth curve.

Here are some photos since our last update: