The 12-month developmental check

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Each part of the UK undertakes this check at slightly different timings and can range between 9 – 13 months of age. It’s a developmental check that looks at whether the little one’s meeting their developmental milestones (motor skills – gross and fine, speech and social skills), safety in the home, eating habits, etc.

The letter arrived through the post letting us know when the appointment would be, and giving us a form to complete. It asked lots of questions about things that she could or couldn’t do. Some of the things I hadn’t even tried getting her to do – such as scribbling with a crayon! So over the next few days I spent a bit of time testing her. We also had to rearrange the date because they were due to come whilst we were away.

On the day of the appointment I was hoping she would be in good spirits and nap at the right time so she was awake and happy to be checked over, and show off her skills to the nursery nurse (who works alongside the health visitor as part of the child health team). As it was Amelia was in great spirits and trying hard to impress the lady- she was chatty and cruising around the place, and trying to play ball (literally) with her. We went through the form we had completed, and she ticked off her boxes. It was all going well. Amelia happily stripped naked and hopped on the weighing scales like she was sat in a boat, and she lay straight on the measuring tape. The nursery nurse was concerned that she had not gained weight in 2 months. I sheepishly then had to admit that I had been weighing her on the scales at home, and that Amelia was putting weight on just fine and maintaining her centile!

But then I felt the appointment became tense, and like an exam. I found she asked vague questions such as ‘how’s her diet?’ ‘How does she sleep?’ and so on. I wasn’t really sure how much depth she wanted to these answers. I guessed (and tried to use my medical knowledge as a guide) that it was related to whether she was having a healthy and balanced diet. Well I think she is doing well with food – she’s good at trying new foods, she doesn’t eat too much, but is starting to eat more, she loves fruit and vegetables. My only concern was that I wasn’t sure she was getting enough dairy food. She’s not a big yoghurt fan, and for a while she wasn’t so keen on her milk. As a result I was giving her follow-on toddler milk to take to nursery, whilst using a combination of cows milk and breastfeeding at home. I explained all of this to the nursery nurse, and that’s where I felt things got tough. She seemed a little tough with me from then on. I started to feel like I was being judged, for what I felt was trying to do the right thing! She seemed a bit concerned that I was still breastfeeding, concerned I was choosing to give toddler milk over cow’s milk, and concerned that I was giving her too much milk, and that she should be eating more food than drinking milk. She also saw the bottle from just before her morning nap and made sure to point out that I should be getting Amelia to take all her drinks from a cup or beaker now. I felt as though I had been reprimanded!

On we moved to safety in the home – what safety measures did we have in place? Again I wasn’t sure as to the level of detail expected. Our house is not the best for small people – it has a lot of stairs and a step up or down in to pretty much every room! As such I have only one stair gate, where it’s absolutely necessary, because there’s no other way of protecting her. The rest of the time we shut her in the room we are in, and we are allowing her to climb the stairs when its bath time or bedtime. We have also managed to teach her how to get down the stairs feet first rather than her old habit of trying to dive head first off everything. I explained all of this to her and was met by a blank expression, followed up with ‘And where do you keep cleaning products?’ I suspected this was perhaps what she was hoping to hear about right from the outset of that line of questioning! She also asked me how I disciplined Amelia. My first thought was ‘well she doesn’t do much wrong!’ So my response was to say that if, for example, she touches something she shouldn’t then I tell her no in a firm voice. Her advice was that I should always follow up a negative with a positive, e.g. in those circumstances I should direct her to something she can play with. Fair enough, and advice taken.

We then moved on to whether Amelia goes to nursery, and how she gets on. How she sleeps (and advice that I might have to change her feeding routine as she changes her napping schedule), and do we attend baby groups. I felt totally inadequate here. Since returning to work the baby groups we attended have not been on days and times that fit around work and her napping. We take her swimming on the weekend, but just for now we don’t make it to other baby groups. I felt like such a bad mummy by this point. She asked whether Amelia at least has the opportunity to interact with other children. Perhaps she wasn’t listening when I told her that Amelia goes to nursery three times per week…

By the time the appointment was over I was relieved and happy to see her out! I felt that I hadn’t learnt anything that I didn’t already know – We knew that Amelia was developing just fine. She does what other toddlers her age do, and she’s growing nicely. I was left feeling a little deflated and deficient in the parenting skills department. I was confused as to why she seemed so unimpressed by the fact that I was still breastfeeding to some degree. The WHO advice is to continue complementary breastfeeding until age 2 or beyond. I spoke to other mummies, who agreed that you are encouraged to breastfeed, and judged if you don’t. But once a baby turns 1, all of a sudden it becomes something you shouldn’t really be doing, and are judged for continuing to do so. Also, it felt that, as a working mummy, I was being reprimanded because we weren’t going to baby groups! Amelia attends nursery where she interacts with other babies and toddlers. We are in a fortunate enough position that she doesn’t need to go to nursery – she has plenty of loving grandparents who would happily help to look after her. But we made a conscious decision to pay for her to attend nursery, for the very purpose to encourage her development and have the benefit of being able to play with other children. When she’s not at nursery she is getting plenty of attention and nurturing from everyone around her. She’s a very social girl! As for safety in the home, I could make Amelia wear elbow and kneepads, and a crash helmet, and possibly wrap her in bubble wrap. But it doesn’t help her in the long term. We have chosen, instead, to try and teach her safety skills as she grows up. Of course she’s not going to fully understand, hence why we don’t let her roam the house freely! But she’s learning, and you can see she takes it all in.

I wanted to share this experience, and let you know how I felt, because I think a lot of mummies feel this way after these checks. But it’s just so important to remember that all babies and children are a different, and all family set ups are different. So try not to be disheartened about how you’re doing as a mummy, or daddy! As long as you are acting with the best intentions and in the best interests of your little one then you’re probably doing just fine! Yes, it’s important to put all of the bad stuff out of reach, feed them a healthy balanced diet, keep them safe from harm, and nurture their developing skills and behaviour. But you don’t have to be a super mum, or raise a super baby (well I think all babies are pretty super), you just have to love and care for them and do your best. Ask for help if you need it, and just remember that these checks are general, and most of the advice they are giving is general too, and not suggesting that you’re a terrible parent!

 

Anyway, I have just about gotten over this check. We’ve got quite a while before I need to brace myself for another, and plenty of time to perfect my mummy skills!!!

Breastfeeding – the bits no-one tells you about!

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This is a post I wrote last October. I am still breastfeeding to some degree and Amelia is now just turned 1 year. It amazes me that Looking back to how I felt this time last year I am still breastfeeding! It’s been a long and difficult journey…

Firstly I should say that I don’t regret breastfeeding in the slightest. I have been doing it for almost eight months, which is far longer that I would have imagined I would. But I felt that, even after read the leaflets given out by the midwife or health visitor, I was definitely not expecting it to be as challenging as it has been at times. So here is my fully honest account of Amelia and mine’s breastfeeding journey to date.

1 – The first feed – seemed easier than I thought it might be. The midwife was really helpful at assisting Amelia to latch on and advised me of how I should know if she is properly latched on. I had already been aware of the advice ‘nose to nipple’, which also helped. Amelia didn’t spend all that long on the breast for that first feed. It’s daunting as unlike a bottle where you can see how much your baby has fed, you have no real idea with breastfeeding. What I knew was, initially whilst you are producing the yellowy coloured colostrum, they only need about a teaspoon at a time as the colostrum is so rich and nutrients are concentrated.

2 – Feed number two – We went home the same evening she was born. I wanted to attempt feeding once more prior to discharge as I was not keen to go without being happy and certain that she was feeding ok, and that I was doing the right thing. The midwife watched as Amelia latched on, and advised that I would be able to see if she was feeding as I could watch for her swallowing or listen for it. At this point I asked the midwife how often I should feed her. She advised that Amelia would let me know when she was hungry and not to worry. In hindsight I wish I had read more than just the leaflets offered, as I now know that I should have been expecting to feed every couple of hours.

3 – The first days – seemed easy. I wondered at this stage what all the fuss was about! Amelia was feeding when she wanted to be fed, filling her nappy regularly and sleeping well, especially at night. The midwife visited the day after discharge and rechecked my breastfeeding technique. She was happy.

4 – The first weeks – It was at this point that it started to become tougher. After the first couple of days I noticed that Amelia was becoming jaundiced (a yellowish tinge to the skin with a number of causes). With my ‘doctor’ hat on I was fairly laid back about this. I reason that it had developed later than the first day or two after birth; also Amelia was very well with it and her poo and wee were normal colours. I knew I needed to keep a watch on her, and that at this stage the most likely cause was breastfeeding jaundice. Our midwife was due the next day so I felt comfortable to wait until her visit to discuss it with her. I would however say that if you notice this happening to your baby it is always important to discuss with the midwife/health visitor/GP at the earliest opportunity. As I say there are a number of causes, including a few serious causes, of jaundice in a newborn baby. Babies needs to be checked over, and though it may just involve some monitoring by the midwife on a more frequent basis it is best for them to be seen sooner rather than later. Our midwife agreed that it was likely related to breastfeeding. At this stage she was also due to weight Amelia. She had lost just over 10% of her initial bodyweight. The midwife felt there was unlikely a serious cause for this, and that to some degree the jaundice was probably making her a little drowsier, contributing to her not feeding quite as much. It was also important to feed her lots as the more she would feed the more it would help the jaundice resolve sooner. It was at this point where it became clear that I was not feeding her often enough. I should be feeding her two hourly, with the two-hour mark kicking off from the start of a feed and not from the end of the last feed. The maximum I should go without feeding was six hourly, in order to keep my milk production on track. The more I fed, the more milk would be produced. It was from this point on that I became pretty much house and sofa/bed-bound. I became rigid about timings and feeds. A feed often took 45 minutes to and hour to complete. The time spent between feeds involved toilet breaks, washing and thinking about food for my husband and myself. It was important to drink and eat plenty to further encourage milk production and keep my energy up. This went on for a number of weeks. Leaving the house required some degree of military preparation. I would need to feed just prior to leaving the house and know where I would be ready for the next feed, right on schedule! I did feel at this point like I was losing control of things a little and becoming crazed!

5 – Expressing – I was keen to express milk so that my husband could have some involvement in feeding Amelia, and allow me to have a little longer at night between feeds. Again, I really didn’t imagine this was a tough process. Surely you attach the pump and away you go. I started pumping fairly soon after Amelia’s birth. There is a lot to read out there on expressing. A lot advises to hold off pumping for a few weeks, whereas some information suggests it can also help with improving milk supply. I was really disheartened by pumping. Initially I was managing just 30mls at a time. Some websites were suggesting the best thing to do was to pump after each feed. If I included this in to the length of time it took to feed, plus the amount of time it took to take it apart, wash it, sterilise it and put it back together I was in the world of feeding and little else. The lowest point came when I spilt a small amount of the milk I had just expressed. I had been careful until this point to save every drop as ‘every drop counted’. My husband burst into laughter – a risky strategy in my books – and I burst into tears. He helpfully explained that I was literally crying over spilt milk. What had become of my normal, rational self? I was using a Tommee Tippee electric pump. It was not the most comfortable pump. I had been given it by a friend, so had felt I had not needed to do much research on pumps. It was during the times I was frantically trying to pump myself dry that I would Google things such as ‘why am I not producing enough milk’, ‘improving expressing, ‘best breast pumps’ and ‘how much breast milk does my baby need’. It was here I came across the Medela swing breast pump and lots of reviews said it was great, much better that the Tommy Tippee one, etc. It was also where I came across www.kellymom.com This website was a great resource and source of comfort for me regarding breastfeeding. It had really straightforward advice. I invested in a Medela swing pump. From this point on expressing improved – I was expressing more milk in a more comfortable way and quicker than previously. It was also much quicker and easier to clean and take apart/reconstruct. It was quieter, and sounded less like I was a cow being milked by an industrial sized pump, which helped my self-esteem!

6 – Breastfeeding doesn’t equal good sleep – Breast milk and formula have different proteins in them. Generally, formula tends to be ‘heavier’ and fills a baby for longer than breast milk. Hence breastfed babies need to be fed more regularly than formula fed babies. It also means they don’t tend to sleep through the night as quickly as formula fed babies. A potential benefit to this is that there seems to be a protective effect of breastfeeding against cot death. They think it’s partly related to the frequency with which breastfed babies and mothers wake during the night. However, when you’re awake several times at night it makes you really tired and frustrated at times. This is where I found the expressing became helpful – it allowed my husband, or one of my (very kind!) sisters, to give some of the night feeds to allow a great stretch of uninterrupted sleep. I always made sure to pump within six hours of the last feed. Even if I didn’t want to my breasts would let me know by becoming engorged and uncomfortable if I didn’t express sooner than this. It took six months to get Amelia to sleep through. Don’t get me wrong – I know other breastfeeding mums who have managed to achieve this a lot sooner but it’s better to be prepared for less sleep!

7 – Breastfeeding in public. This was not the part I was most looking forward to. I am not a prude but I am also not in any way and extrovert or someone that likes to draw attention to myself when out and about. So I was nervous about feeding her in public. Especially when you read lots of stories about people asking you to feed elsewhere, or making a big deal of it. However, I would rather her not scream the place down than worry about exposing myself in public. After some internet searches I found some really good breastfeeding tops and a dress that allowed me to feed discreetly, which made me feel more comfortable.

8 – The older they get, the harder it becomes again. Though it takes them much less time to actually take a feed, the process seems to lengthen out again as they become so nosy! It’s better now but there was a period where trying to feed Amelia out of the house was tough work, as she would become distracted trying to stare at people and what was going on around us. Try doing that on a busy train! It leads to her trying to reveal my breast to anyone nearby, and both of us becoming covered in squirting milk that she should be drinking!

9 – Your breast becomes a comforter. There have been many times when I have ‘fed’ Amelia. It has been clear that she is not bothered about the milk but the comfort she gest from suckling. With experience you can tell quite clearly when they are actually feeding versus just having a comfort suckle. This does not always make it easy on you. The other point here is that the little one becomes reliant on you and no one else for his or her feeds. Amelia began refusing milk from a bottle around 3.5 – 4 months old. Just like that she was not interested in anything but mummy’s breast. It was a tough period adjusting to this. It kind of also means that my breast has become other peoples concern. Now I regularly get ‘do you think she could be hungry’ ‘do you want to try feeding her’, etc. This can be come exceptionally frustrating when you know that she has fed well and she just wants some comfort. It is also frustrating when all you’d like is to have some time to yourself that doesn’t involve being someone else’s food source.

10 – Leading me on to when do you stop feeding? Amelia is now well underway with weaning, though she is still getting most of her nutrition from milk until she is 1 year old. When it was really tough at the beginning I was happy to just get to her first set of injections and then quit. By the time they came around breastfeeding had just become ‘easy’. So my timeline changed that I would be happy to continue until she was weaning. Now we are at 8 months and I really don’t know how it’ll end. I kind of have an exit strategy, which is slowly transitioning. She is starting nursery soon. My aim is that she will transition to bottles for her two daytime feeds and then slowly I will wean her off her morning breastfeed on to the bottle, and finally the bedtime feed. I am now looking forward to a time where she is not reliant on me for her milk.

Breastfeeding has been a wonderful bonding experience for the two of us. It has saved money, been much easier to go out not worrying about whether we have bottles and milk at the ready. It has not been easy for something that is such a natural process. I am glad of the experience. I just wasn’t prepared for it! So I hope that you find this account honest and helpful, and it allows you to persist with breastfeeding if you are struggling!

 

Please share your tips and advice or personal experiences of your struggles with breast-feeding

Breast is best…Apparently!

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In preparation for Amelia’s arrival my aim was always to try breastfeeding, but without putting too much pressure on myself. I had seen many women feeling really frustrated or like they had failed by not being able to breastfeed for one reason or another. I really didn’t want to be in this position having reassured so many women that it was ok and that they shouldn’t beat themselves up about turning to formula.

There has been a big drive to encourage breastfeeding in recent years and you cannot avoid the propaganda. Breastfeeding does have proven benefits – protection from illness, cheaper, possibly reduces allergies and for the mother – reduced risk of breast cancer and possible help with losing baby weight (if that’s at the forefront of your mind!). New research comes out all the time with possible new benefits – increased IQ as one such possibility. I am wary over this potential benefit due to the high number of confounding factors.

I looked at breastfeeding from the following view, though I may be wrong – I was formula fed. I am well with no health concerns, I don’t suffer allergies and I have made it through medical school. So in the grand scheme of things there are other ways of keeping baby healthy and on the right track if you struggle to breastfeed, cannot breastfeed or just feel it’s not for you. I cannot fully appreciate why anyone can take such strong views either way.

In advance of her birth, I had not made any financial investment towards breast or bottle-feeding since I didn’t want to waste money on an endeavor that might not work out. I had been given a breast pump and a steriliser by a friend, and my sister had purchased some bottles for me. So when the midwife asked me if I wanted to try breastfeeding her shortly after her birth I gave it a go. With a little help she was latched on and doing what she should do. We opted to go home later that evening and at the changeover of midwives they rechecked I was happy to go. I sensibly thought I better have another go at feeding before we left in case there were any issues. Nope – everything was fine! So my parting question to the midwife was “How often should I feed her?” The response was “Don’t worry she will let you know when she’s hungry!” So off we went.

Well the first couple of nights when she did sleep she slept for a few hours. We couldn’t believe our lucky stars – what a good baby (apart from the need to mostly sleep in our arms!) The midwife checked her latching on at the visit on day 1. All was fine! Then at day 5 she was weighed – she’d lost 10.2% of her birthweight. In addition to this she had become a little jaundiced. The midwife advised that she would have to re-weigh her the next day and if she had lost any more weight she would have to refer her to the hospital. I re-clarified how often I should be feeding her since she didn’t seem all that hungry. The midwife advised that in the day I should be feeding two hourly and at night definitely not leaving it more than six hours. The night feeding was more related to milk supply and keeping this going. She suggested I download an app to monitor feeds and nappies (especially when there was a massive discrepancy between the number of nappies Daddy and I thought we had changed each day). From this point on I spiralled into insanity and crazy behaviour. My life revolved around the app and remembering to start it when I started feeding. This period lasted a good couple of weeks until the health visitor reassured me that Amelia was gaining weight and doing ok. Until this time was over I was debating whether to give in. At night Amelia would cluster feed for two hours from 10pm on and then still be hungry. The midwife had suggested topping her up at night with some formula. I saw this as a potential sign of weakness and it took a couple of days of people reassuring me that it’d be ok before I gave in and bought a few cartons of formula. It took another day or two to try it. She would gulp the full 200ml carton down, even after two hours of suckling.

Feeding itself was a long process. I would start feeding and it would take about an hour before she would have finished. I would then have only an hour to feed myself, wash, sleep, have a break before starting again. I felt like a feeding machine and it did get me down. I stopped going out because we didn’t have time between feeds. It reached breaking point when the midwife discharged me from her care and I broke down in tears at the thought of not seeing her again. Luckily I had enough insight to know this was not rational behaviour.

There is much so more to say about the breastfeeding. Though I end here looking like a crazed woman, rest assured it does get better and I will tell you about it another day!

Weaning!

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About 3 or 4 weeks ago Amelia started waking more at night. When I say more I mean it got to the point where for several nights she was waking every 2-3 hours. This followed a period where she was starting to sleep longer and a few nights even treated us to 5-6 hours straight from midnight onwards. Frustratingly this was also accompanied by a refusal to take a bottle (having done so really well previously). This was becoming really tiring. Especially since I recalled asking someone what the best baby age was for mum and dad. Their answer had been “4-5 months because they are more interactive, still not mobile and sleeping more”. After extensive googling and chatting to fellow parents I was even more confused! Was this the start of the wonder months, change in sleeping habits, or ready to begin weaning. The only one I felt I had any control over was weaning.

I had always been set on waiting until 6 months to wean Amelia. To those who questioned why, or blamed the health visitors for changing their minds so frequently I didn’t have a clear answer. However, what I did know from reading leaflets, websites, etc. was that the feeling was a baby’s gut was not well developed until 6 months, and early weaning increases the risk of food intolerance and gut problems in later life.

Pretty much everything I read seemed to suggest that baby was definitely not ready before 17 weeks – the gut is certainly not ready and there may be too much pressure on the kidneys too.  At this point I thought about myself – I am certain my own mother did not wait until 6 months to wean me, and I know that she was a big fan of rusks to help her kids sleep through the night (she had 6 in total – I don’t blame her for wanting a good nights sleep!).

So I procrastinated, thought about it, chatted about it to anyone that would listen, rambled on whatsapp at 3am to my fellow nocturnal mothers! I made a plan that I would wait a couple of weeks, see if things improved and if not would start the weaning process. I downloaded some ebooks (see recommendations page) and read about how to wean. My decision was made when one of the big supermarkets had a baby event on. The baby rice and baby porridge was discounted and this spurred me on to take the plunge. So last week I started. Day 1 was baby rice for dinner – she gobbled it up! However, she woke every 2 hours that night and didn’t poo for 24 hours. I then tried porridge – she seems to enjoy this even more, it doesn’t constipate her and she seems to sleep well after having this at dinner. Well most of the time she sleeps better.

This week we have started with a portion of puréed vegetables each lunch, in addition to the porridge. I opted for vegetables after having read that trying vegetables with a slightly more bitter taste first may be helpful in ensuring they like a wider range of food in the long run. I have also been adding some breast milk to the purée to provide some familiarity to the taste. So far we’ve tried potato (didn’t seem to enjoy much), carrot, parsnip and courgette (which she surprisingly loved!). I have also given some small tastes of banana and papaya.

Last night she slept from 7.15pm until 3.20am – best run she’s had yet, so I’d say weaning is going well. Though it’s funny how I still feel slightly ashamed to tell people that I’ve started weaning and she’s not quite 5 months yet. I overhear other mothers saying “I’m waiting until 6 months”, and I think fair play but Amelia is loving food, getting some more sleep, and now I don’t feel quite so guilty as she stares at everyone longingly whilst they’re eating!