We didn’t know the first thing about prematurity. When the doctor said, “privileges at a hospital with a NICU,” we were so naïve that we just looked at her blankly. She had to spell out that a NICU was a neonatal intensive care unit and we should prepare ourselves for an extended hospital stay. This pregnancy was high risk, all the more so because I was 5’0 and weighed 112 lbs. There wasn’t exactly a lot of room for expansion, at least up and down. The prospect of gaining the ideal 60 lbs over 9 months seemed challenging, and turned out not to be a goal I could accomplish.

Still, the pregnancy was so relatively easy on me – not so my husband; my temper was terrible! – that I was sure I could carry the girls to at least 35 weeks. I had no morning sickness, and I was floating on air during the second trimester. Thirty-five weeks was our goal, because twins tend to gestate about two weeks faster than singletons, and therefore 35 weeks for them was as good as 37 weeks for a singleton.

We went through the motions to prepare for preemies. An aunt got the girls preemie-sized outfits at the baby shower the family threw for us, even though I couldn’t attend. (My doctor highly recommended that I not fly to Oregon.) We took our Lamaze class with a group of couples 2 to 3 months farther along in their pregnancies than I was. Despite these steps, we hadn’t prepared emotionally, and I was still deeply attached to the idea of a natural birth. I had made a list for my hospital bag, but hadn’t actually packed, when my water broke at 33 weeks, 1 day.

The actual birth was a haze. J weighed 3 lbs 6 oz, M 3 lbs 9 oz. J had a patent ductus arteriosus (PDA), or a hole in her heart. It’s a common condition in infants, and resolved itself within a couple of months. Neither M nor J needed any help breathing. They didn’t need oxygen treatments. Unlike some of the other preemies in the NICU, they didn’t have any issues with apnea of prematurity, which is essentially what happens when a preemie forgets to breathe.

They were really small, though. They couldn’t regulate their own body temperatures because their baby fat hadn’t come in yet. They had to stay in their warmed isolettes, although they were strong enough that we were allowed to hold them for several hours each day, and keep them warm with our own body heat. When they finally downed 31 mLs (1 oz) of formula and breastmilk in one shot, I cried for joy, because that was one of the criteria the NICU had set up for release from the hospital. Days earlier, my husband had fought for my right to breastfeed, fighting formula and the feeding tube while I was being moved out of the operating room, until a doctor kindly, but firmly, told him that our babies were really, really sick, and all our plans were going to have to wait.

We had the healthiest preemies in the NICU, but still, they were tiny.

In the picture above, J and M (in the matching white onesies) are a day shy of a month old. D, a dear friend’s son, is two weeks old. That’s half their age. He was born on his due date at 40 weeks gestation, compared to M and J’s 33 weeks. His legs are twice the size of theirs. His arms are twice the size of theirs. Each of his hands could almost contain one of theirs. M or J would disappear inside the newborn-sized onesie D is wearing. What you can’t see is how baggy their preemie-sized onesies are on them.

Remember, M and J are twice as old as he is, if you count from their birth age.

I actually learned not to measure their age from their birthday. When I did use their birth age during their first year, I felt like I had to keep explaining why the girls were so small, or why they weren’t holding up their heads better at their age. Not only that, but my poor friend kept having to defend little D when we were together in public. “He’s not fat! He’s not huge! The twins are just really really tiny!”

Once we reached their due date, the day they would have been born full-term, I began to use their corrected age, that is, how old they would have been if they hadn’t spent the last two months of the gestational period outside the womb. It was so much simpler to tell strangers at the grocery store that the girls were a month old, rather than, “They’re three months old, but they were born two months early, and please don’t look at me like that because I’ve never done a drug in my life and maybe if I’d been on bed rest the pregnancy would have lasted longer, but I did the best I could, and I’m really trying to be a good mother.”

Yes, I was extremely touchy about the fact that the girls were born early. I felt like my first act of motherhood had been to betray them by evicting them from my body half-cooked.

Our pediatrician was fantastic. The entire practice has a lot of experience with preemies. In fact, all the twins I knew in our old town went to one of two pediatricians. (Not all twins are premature. My husband’s now 16-year-old triplet cousins were born full term. However, the rate of prematurity is high for twins, over 50 percent.) The doctor focused always on how M and J were doing compared to where they started, rather than looking at averages. When he tracked their growth on the growth chart, he used their corrected age. When it came to timing immunizations and the introduction of solid foods, we followed the guidelines of the American Academy of Pediatrics, again using their corrected age.

M and J are healthy. They only long-term effect of prematurity appears to be the state of their teeth, although we faced some challenges in the early years with their lung development. We’re the lucky ones, though. Others aren’t as fortunate.

Here’s what I would tell my pregnant self if I could:

Don’t be irritated with he doctor when she tells you that you need to quit working. Listen to her when she says that you’re having too many Braxton Hicks contractions, too early. Working part time and telecommuting was a great alternative to working full-time, but you could have afforded to stare at the ceiling for a few weeks to give those precious girls a better start. It might have made a difference. It might not have. You’ll never know.

I will never know what I could have done differently to give J and M another day or two in utero, but I will always wonder.

Sadia’s daughters, J and M, are now thriving in first grade. They’re a head and half shorter than their classmates, thanks to inheriting Sadia’s (lack of) height. A previous version of this post was published on Sadia’ personal blog, Double the Fun, on honour of the Bloggers Unite Prematurity Awareness event 2009 .

• There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.
• Follow your gut.
• It never hurts to get a second opinion.
• Some lessons are more likely to stick if they come from someone other than a child’s parent.
• Things are often more complicated than they appear.
• There is such a thing as knowing too much about something.

The first time we visited a speech therapist was at the recommendation of the family pediatrician. When M was nearly 3 years old, I became concerned about how slowly she ate. I once timed her spending 17 minutes chewing a single piece of meat, and finally had her spit it out. The pediatrician suggested that she had dysphagia, or trouble swallowing. I had imagined that a couple of degrees in linguistics gave me a basic understanding of what speech therapists do, but I was wrong. Speech therapists deal with all sorts of oral motor issues, including problems with chewing or swallowing.

It turned out that M had never quite figured out how to use her tongue to effectively move food around in her mouth as she chewed. Because of that, foods that required chewing would cause her to choke. After six sessions of feeding therapy with an amazing speech therapist and a lot of reinforcement at home and daycare, she could eat successfully. Meals became enjoyable again. It’s been over 2 years, and we haven’t seen any backsliding. In fact, M enjoys food so much now that she plans to open a restaurant when she grows up. Bonus: military medical insurance covered 100% of speech therapy session costs.

It was during feeding therapy that the therapist raised a concern that M might have articulation delays. It had never occurred to me that there was anything off in her speech, since the child talked incessantly and no one who knew her—I, her teachers, or our neighbours—had any trouble understanding her. I thought her pronunciation of yellow as “lellow” was darling, rather than worrisome. The linguist in me had always ignored the nagging doubts, knowing full well that there was variation in the timing of pronunciation mastery, but there should be no cause for alarm as long as the order of acquisition were being followed.

When my husband returned from Iraq and need me or J to translate for him so that he could understand M, it was clearly time to revisit the speech therapist. My MA in theoretical linguistics hadn’t taught me as much about the practicalities of language development as I’d thought. The practice we’d been to for feeding therapy no longer took our insurance, so we had to find a new therapist. We had both girls, now 3 months shy of turning 4, evaluated at the new practice. They ended up being evaluated by different therapists, and we learned how incredibly subjective these evaluations can be.

J was determined to be 2 standard deviations above the norm for her age when it came to grammar, vocabulary and comprehension, but 2 standard deviations below the norm for articulation, the production of mature speech sounds. She sounded more like a child just turned 3 than one soon to be 4. M, on the other hand, was evaluated only for articulation, and declared to be just dandy. These results didn’t ring true for us. M was, to our ears, far less clear in her speech than J. My husband insisted that M be reevaluated, this time by the therapist who had seen J. When the office staff let us know that they were concerned that insurance might not pay for a second evaluation, we offered to pay out of pocket. Insurance did end up covering it, though. The second set of results was more in line with our expectations. Although J’s need for speech therapy was a judgment call, M definitely needed it. Where the first evaluation had her placed her in the 43rd percentile, the reevaluation placed her in the 2nd percentile for articulation.

Since their delays were along the same continuum, the therapist offered to work both twins together in weekly sessions. The sessions were great fun for the girls. The therapist pulled out board games, and let them each take a turn after they completed a pronunciation exercise. She focused on making them aware of how the sounds coming out of their mouths were different than hers. Soon enough, they could say ‘sh’ and ‘v’ easily. It was extraordinary to see how those two sounds alone helped with others’ comprehension of their endless chatter.

After 3 months, both the girls graduated from speech therapy. All J had left to master were ‘l’ and ‘r’, and the speech therapist didn’t think those needed to be rushed. M had a lisp to work on too, but we were comfortable with the exercises she needed to do at home to help with that. We should keep an eye on the girls, she told us, and consider revisiting a speech therapist if they didn’t appear to be making any headway after a while.

My husband and I think that we’ve given it long enough, and both girls’ ‘r’s are still very baby-like. At this point, speech evaluations are often conducted through the school district, so we need to ask both their classroom teachers what they think of their speech before we go hunting for yet another speech therapist.

If you’re curious about what precisely goes on in a speech therapist’s office, feel free to peruse the detailed tales of feeding therapy and speech therapy sessions on my personal blog.

Sadia and her 5-year-old girls, M and J, do their talking, lisps and all, in El Paso, TX, much to the exhaustion of her soldier husband. They try not to talk while eating, but it’s tough when there’s so much to say. They are happy to report that chewing challenges are no longer to blame for the length of conversations around the dinner table.

Our family’s experience with prematurity was a lot less scary than it could have been, although it felt devastating at the time. Neither of our girls needed help breathing, but they weighed under 7lb (3.2 kg) put together. Their Apgar scores were excellent, but they didn’t have the body fat they needed to maintain their own body temperatures ex-utero. They were released from the hospital over a month before their due date.

Looking at our vibrant, sassy, smart and downright hilarious five-year-olds, no one who isn’t in the know about twin birth statistics would guess that their birth held any unusual struggle. They’re short for their age, but so am I. My 5 ft 0 in (1.5 m) genes appear to have beaten out those of the girls’ 6 ft 7 in (2.0 m) great uncle. M and J have had only two lasting effects from being born before they were quite ready: a susceptibility to lung infections, and teeth missing enamel.

The lung infection issue came as no surprise. Our pediatrician and the NICU staff had warned us that lung complications were common in babies who began to breath when their lungs were still forming. Our insurance covered Synagis, the vaccine against RSV, a virus that gives you and me the sniffles, but can be fatal to a premature infant. I made the monthly trek to the one local clinic that dispensed the vaccines for the entire seven months of our girls’ first cold season. Their second winter, our insurance company deemed them out of danger. Sure enough, first J and then M came down with RSV. It was another three years before we were able to celebrate the retirement of the nebulizer that J used to ease the laboured breathing that kicked up without warning year-round.

The tooth issue, on the other hand, came as a huge surprise.

I thought we were doing everything right in the dental care department. We started using infant finger toothbrushes to massage the babies’ gums well before they had teeth. We added toothpaste when their first teeth broke through, and brushed morning and night, without fail. We brushed their teeth for them until they turned five, and gave them toothbrushes that they could practice with. Before M and J turned two, we introduced flossing, the the form of one-time-use kids’ flossers. To this day they consider going to bed without flossing unthinkable. Our pediatrician praised the girls for their dental hygiene. Even though I knew full-well that dentists recommended a first visit be scheduled at the sight of the first tooth, I put it off until the girls were three.

At their first visit, the dentist discovered cavities in both girls’ mouths. It turned out that both J and M suffered from enamel hypoplasia, or a lack of enamel on a number of their teeth. As luck, or more likely genes, would have it, our monozygotic daughters had hyplasia on the same teeth. Their cavities were were also coordinated. Identical twins, with identical tooth issues, I suppose.

We left the dentists’ office with fillings, prescription fluoride toothpaste, and another reminder that however far away their premature birth feels, it keeps popping back up. At our next visit to the pediatrician, I told him the sad tale of the girls’ teeth, and he promised to pass along to the next preemie parents he saw the recommendation to get to a dentist soon. And now, I pass that recommendation to you.

The countdown has begun! As of right now there are 13 days left until preschool starts this year, I can vividly remember one of the back to school commercials with the parents singing “it’s the most wonderful time of the year”. We had a taste of it last year from January-June and everyone benefited, but it didn’t come without some work. They attended two 1/2 day sessions a week. This year they are going 4 full days.  We are blessed enough to have a wonderful public school system in a very small community. When my son Reese was aging out of early intervention and still needed services the next place was the public preschool. Initially I was told that only he was going to be admitted mid-year but I put my foot down, insisted that I was not sending one without the other, and suddenly they had spots for both boys. I got that news in September. The boy’s turned 3 years old in December and Reese’s services at that point would be the school’s responsibility. There was a lot of meetings and planning.

In September, I met with the principal, speech therapist, occupational therapist, school nurse, preschool teacher and his current therapist’s, to decide what his “needs” were and if further testing would be required prior to writing his IEP (Individual  Educational Plan).  It was decided that no further testing was needed but that a plan was needed to address his severe peanut allergy in the classroom and seizure disorder. I did my research and came back with a plan in October when we sat down to write the plan.

Thankfully, his peanut allergy is by ingestion only so he can be near peanut products. I was so afraid he was going to be ostracized because of the school’s fears. But a plan was developed that they felt safe with and that I could live with. Of course we need to revisit the plan this year since he will be eating lunch there. As for the seizures, again it was the education of the staff but in this case it was my feeling safe with the plan.

The IEP was like a foreign language to me, luckily a good friend of mine is a special education teacher and reviewed it prior to me signing it. He receives 30 minutes of Speech and OT a week right now, which will be re-evaluated in October.  I have noticed a difference in his speech intelligibility and his confidence. My concerns have now shifted to his emotional regulation, inattentiveness and impulsiveness, all of these will be discussed.

Clay had some trouble adjusting to Reese being pulled for his services, but they were great in the beginning and just let him go also. I have found the structure, activities and time away from home to be very positive for both boys’. With that said it had been a lot of work, letting go and trusting other’s to keep my children safe and just watching them grow up.

Friday night: I was getting the bath ready, undressing the girls etc., when Riley decided to pee on the floor , then: while in the tub, she gagged herself and threw up.  Luckily her sister was already out when her dinner joined her in the tub.  But Reese was unclothed, freezing, and not happy about it.

Saturday: We had 24 people coming over that evening- 15 kids and 9 kids as we were having our March of Dimes team over.  Riley decided that it would be a good day to have fever… just hours before the arrival of the crowd.  Ugh!  It was too late to cancel, but we put her to bed early and it was fine.

Sunday: I bought the girls these adorable (dollar!) sunglasses because they love to wear ours around.

They LOVED them. Until… Riley was crawling around a corner when Reese FELL on her head!  The sunglasses cut her forehead- deep!  Riley Grace had her first ER trip.  :(  But instead of stitches, they glued her cut closed.  STRESS a mama out!  Ahhh!

Monday: Yesterday when things were looking up, Reese began throwing up.  Is there any sickness our kids catch that’s worse?!  I sure despise the stomach bug.

Today: things are much better.  Life sure can be crazy, but at least we have some great stories to tell.

Anyone else have such a crazy weekend??!!

What do you do when one multiple gets sick, especially when they are too young to understand about washing hands and coughing in their sleeves? How do you manage with two sick, demanding little ones?  And, for those with older children, how do you teach them to avoid spreading germs when they are contagious?

After a long road with infertility and IVF, we were elated to be pregnant and with TWINS- we had no idea what was in store for us!  :)  I had a normal pregnancy and never would have guessed I would have had them so early.  On September 4, 2008, I went to my scheduled perinatologist appointment.  The doctor told me/showed me that Twin B (Riley)’s blood flow was not sufficient through the umbilical cord for some reason.  She was suddenly significantly smaller than Twin A (Reese) which had never been the case before, so the dr wanted the girls and me hooked to heart monitors… to be monitored.  The nurse brought me to another room, hooked me up and just left me there.  Everything was kind of in slow motion, but I just kept thinking it would all be okay.  All I could really think about was that I hadn’t eaten and was STARVING.  While watching the print out of my babies’ heartbeats and dreaming about Chick-Fil-A, I noticed the bottom line (Riley) dropping really low.  Not good.   I suddenly realized the extent on this little “problem” when my OB walked in.  When your perinatologist calls your OB from a different office building completely, you KNOW something’s up.  Dr. H was so sweet, cool, and calm as she explained to me that it would be better for the girls if they came into the world for care due to Riley’s dipping heart rate.  And since I was only 30 weeks, we needed to deliver at a hospital with a Level 3 NICU, which meant she could not do the Emergency C-Section and I could not deliver at my hospital.  WHAT?!  Not a moment you want to experience and especially not alone! My hubby came to pick me up and bring me to the hospital.  We were so scared.

We got checked in (after asking directions to this unknown hospital) and I was given a steroid shot for my twins’ lung development.  We learned that with every contraction I was having (I think they were just Braxton Hicks??), Riley would get MAD and her heart rate would drop.  They gave me a shot to stop the contractions, but no such luck.  Within two hours and only 1 steroid shot in my system , Dr. Owens, whom I met minutes before, said it was time to get the girls out… at 30 weeks and 1 day.  Due to my Harrington Rods (surgery to correct scoliosis in 1995), the anesthesiologist attempted an epidural SIX places, but had no luck (QUITE painful the next day), so I was knocked out while my hubby waited outside.  Reese Abigail was born at 5:29 PM weighing 3 lbs and Riley Grace was born at 5:30 PM weighing 2 lbs 3 oz.  

Reese when she was 3 days old

Riley when she was 3 days old

The NICU was amazing- the nurses were so kind, reassuring, and knowledgeable.  The doctors were amazing as well.  By the grace of God, my babies were not born with any health issues.  They had to learn to breathe outside the womb and stayed awhile in order to learn and master the “suck, swallow, breathe” reflex- eating and breathing are quite important!  So after many tears from mommy and daddy (it’s scary to see your babies so small and sad to leave them each night), bacterial infections, staph infections, blood transfusions, Riley (who was named the “feisty one”) pulling out her feeding tube at least twice a day, jaundice, weight gains and losses, and finally mastering feeding after 38 days for Reese and 55 for Riley, we were finally home with our angels: Reese 4 lbs 9 oz, Riley 3 lbs 11 oz.  I couldn’t believe that we were allowed to take them home!  I have to admit we were terrified.  

They’ve come a long way this year (and so have we… we kinda know what we’re doing now) and it was a joy to see those nurses and dr at the NICU Reunion, so they could see with their own eyes- the fruits of their labor!   I will never forget September 4, 2008, Reese and Riley’s birth day, as “blurry” as it feels.  It was the day my life changed forever- for the better.  As a year is approaching, I’m so thankful, have fallen more and more in love with my husband watching him with his girls, and my heart melts daily when Reese and Riley’s eyes light up when they see ME, their mama.  Their first birthday will be a CELEBRATION of how far they have come and what little miracles they are!  I guess that’s why I have been so emotional… it’s thanksgiving.  Overwhelming thanksgiving.  

Reese when she was 309 days old (She now weighs 18 lbs)

Riley when she was 309 days old (She now weighs 16 1/2 lbs)

Disclaimer: I apologize up front if you or anyone you hold dear is a member of this, um, nobel profession.  But, ARE THESE PEOPLE CRAZY??!!

I think it was at the girls’ one year check-up when my pediatrician first asked me how the tooth brushing was going.  Come again?  You were serious about that?  Loud sigh.  So, off I went to Wal-mart to purchase the necessary supplies.  Incidentally, who knew baby toothpaste was so expensive?!   

I drove home with a lighter wallet, but with high hopes for our first tooth brushing session that night.  I was optimistic, and dare I say, excited, to add this to our bedtime routine.  They seem interested when I brush my teeth, I thought to myself.  I’ll just instruct them to open wide and say aah.  Then, I’ll brush their little white stubs for the recommended two minutes, all the while explaining what I’m doing and why healthy teeth practices are so important.  Piece of cake.  Note to self: immediately refill whatever prescription I was on that day.

Holy freaking moly, people!  The screaming, the crying, the flailing about!  It was like wrestling two alligators to the ground, and I strongly suspect, just as dangerous.  Wrestling aside, I didn’t get too upset over their initial reaction, and chalked it up to the unfamiliarity of the experience.  Best not to push too hard, too fast.  We’ll just try again tomorrow. 

Tomorrow came and went.  Lots of tomorrows have come and gone.  My girls will be two in September, and they still hate having their teeth brushed.  I’ve tried everything — battery operated brushes, funky toothpaste flavors, singing silly tooth-related songs — ad nauseum.  They are so not convinced.  Neither am I.   It doesn’t help matters that the dental hygiene portion of our day occurs at bedtime; the girls’ antics are typically at a record high, while Mama’s patience is dangerously circling the drain.  Consequently, I regulary declare  Ladies’ Choice Nights and hand over the tooth brushes.   Brush your teeth or don’t: your choice, ladies!

Several months ago, I even consulted a pediatric dentist for advice on tooth brushing when my concern over Amelia’s swollen gums prompted me to schedule an appointment (Note: see my prior post on hypochondria!).  His advice: keep it up.  Hold them down by force if necessary, and brush for two minutes, or as long as tolerated.  When I told him their duration of tolerance was typically somewhere in the 2-3 SECOND range, he offered me this gem of a metaphor: Kids don’t always like to ride in carseats, but you strap them down nonetheless.  Why?  Because carseats are in their best interests — just like teeth brushing.  Um, so not the same, buddy.  I told you these people were crazy!!

So, I’m dying to know… what are your toddler tooth brushing secrets?  What works for you?

He ended up there late last Tuesday upon the recommendation of the pediatrician, after efforts to calm his coughing proved ineffective. A long evening, short-term admission, and heavy duty breathing treatments later, my brother, sister-in-law, and nephew headed home. Tired, but on the mend.

As I was discussing the blasphemy of such delayed information dissemination with my partner, the conversation moved quickly from vilifying grandma to asking one another: “What would we do if something like that happened with us?” And I’m talking single event situations, as opposed to longer-term illnesses, because that’s a whole different ball o wax.

As with most readers of this blog, unlike my brother, we have two or more child(ren) to address and waking/taking the doing-just-fine kiddle is not going to pay off. And if you do go as a family, you better have banked the mental cost of jacking with more than one child’s routine. And what we decided – as well as you can go on deciding without going through it -was the following:

For semi-planned urgent care, one stays and one goes. Such as with X and croup, one of us would stay with the better kid, while the other of us (probably me, since i used to work in the healthcare industry) would take the not-better kid to the hospital. We’d keep in touch via calls and text messages. But to us, it would be important to keep one parent and the other child(ren) with as much rest and as little routine disruption as possible.

For unplanned urgent care/emergencies, same thing. This would be something like big falls or a need for stitches or something of the sort. While it would be poopy for one of us not to be there, keeping things moving with the well kid is equally important.

For rapid-onset illness, one stays and one goes, but the one staying is making plans to go. That means the stayed-homer would shore up plans, clothing, materials, childcare, and phone calls to family, then joining the other and sick child as soon as possible.

For critical illness or injury, we’d probably both go immediately after calling upon godparents (we should probably inform them of this, no?) or friends to stay with the well child until the situation was stable.

We also have a good circle of neighborhood friends who could likely step up in a time of crisis, as well as godparents and a set of grandparents that live within 30 miles. Of course, under any of the above scenarios, it’s possible that we’d have no choice but to take the well kid, too. And we’d figure things out from there.

We are immeasurably blessed and grateful to have emerged this side of infancy without major incident [warning: we're entering toddlerhood], but I also know these things can be inevitable at some point in time. Certainly, there isn’t a wrong way or a right way to handle a childcare situation when one of the children falls ill/injured. But to the extent that we can somewhat prepare, the smoother the chaos can be.

For those who have had an urgent/emergent care incident, how did you handle the other child(ren)? Did you have a loosely organized plan as to how to handle a situation like that? What would you differently?

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Rachel is a mom who managed to survive the first year with twins, but hold the applause because the second year has only just begun. You can read more about their adventures on her blog.