Pyloric Stenosis

Baby Elijah had been spewing, spilling and vomiting his milk lately. At first, we thought it was just the result of burping or gas. But then on Tues Dec 13th, after one of his feeds, Elijah did an Exorcist's Linda Blair on us. They call it projectile vomiting. We've never seen so much come out so forcefully from Elijah. We took him to the paediatrician that night.

The doctor advised that there could be a problem with Elijah's stomach - either Gastroesophageal Refllux or Pyloric Stenosis. The latter being more serious, which requires surgery to correct. The doctor also asked us to try breastfeeding and burping Eliha upright for 24 hours and come back with the results.

We went back to the doctor's the next day. The results were mixed and inconclusive. There was still some vomiting. The doctor advised us to send Elijah for a barium test to rule out pyloric stenosis. As parents, we also need to know once and for all what's been ailing Elijah. And we do need to know so that we can decide on the right course of action going forward. Until the problem is fixed, Elijah risks being dehydrated and will suffer from its consequences.

So, this morning (Thu, Dec 15th), we wil be going down to Thomson Medical Centre to have the barium test done. We update this blog more often - we've been so tied up with caring for Elijah that we've not been update this blog more often. So many draft articles sit uncompleted. We'll try and blog again soon.

Photo album

This blog is not updated daily. Even then, not all postings will carry photos. And even when there are photos, only a few are selected for posting. Some relatives and friends said they would like to see more photos and not just when there are blog postings. In response, Daddy has signed up for a Flickr Pro account to create online photo albums of Elijah. Check out the albums here or click the link on this blog site's list of links.

Cord blood: To store or not to store

Prior to pregnancy, we had not heard much of umbilical cord blood (UCB) storage. Our first introduction was through a commercial pamphlet at our O&G. It sounded like a wonder cure if ever our child needed it.

Briefly, the UCB stored may just save a child in the future in re certain critical illnesses. Science has found medical use for UCB. What is required is for the UCB to be drained and stored at birth. This is a "once-in-a-lifetime" opportunity for parents to extract the UCB and have it stored long-term. In cases where the UCB is not drained for storage, the umbilical cord (together with the UCB inside) is cut from the baby and disposed.

We were initially keen. Before deciding, we had:

1. Discussed with our gynae. She encouraged storage if we could afford it.
   
2. Spoken with a doctor friend who'd recently given birth to her firstborn. She didn't store.
   
3. Spoken with friends who had stored.
4. Attended a talk of one of the companies providing private UCB extraction and storage services.
   
5. Read articles on The New England Journal of Medicine, WebMD, Cord-Blood.org and the internet generally.
6. Discussed (and argued) with each other.
   

In the end, we decided against it. Of course, if it turns out to be the only thing that can save our child's life, we would be kicking ourselves. On the other hand, we may never have to use the stored UCB.

I believe there's no right/wrong answer here. A parent is prima facie presumed to have acted in the best interest of his/her child, and dare I say, no one has the right to question the parent's bona fides in such a case.

I guess only time will tell whether we made the right decision. This was just one of the early decisions we had to grapple with as parents. Not easy.

[Note: Although we didn't opt for commercial storage, we considered public banking at the Singapore Cord Blood Bank but this was not yet available for babies delivered at private hospitals. If we ever have more children, we may just consider public banking if it becomes available to us.]

Feeding Update

Breastfeeding is getting better. Elijah is latching on well. Latching (or failure to do so) can really put mothers off breastfeeding. So, we're glad that Sister Lim helped made it less terrifying for Mommy to breastfeed.

We've learnt not to force the issue with Elijah. After a few attempts (we normally spend no more than 3-5 minutes), if Elijah does not latch on, we would take a break by burping him. It's important not to condition Elijah with the wrong experience. Trying too hard is likely to put Elijah off. After burping, we try latching again. It's worked for us. So far.

Breastfeeding usually takes 60-75 mins. Increasingly, we are seeing shorter (but more frequent) feeds of 15mins. Elijah is also taking in more each feed.

We've also started using the bottle (with expressed breast milk) for night feeds. Ideally, we shouldn't because we risk "teat-confusion." We're bottle-feeding it for practical reasons. Elijah feeds up to 3 times between 12am-6am - most times he feeds twice, and in a good night, just once. At that frequency, and Mommy's physical and mental state at that hour, bottle-feeding is more convenient.

So far, the night bottle-feeds have not confused Elijah. Thankfully.

But what we do maintain is to continue feeding Elijah with breast milk - whether directly or via bottle. Not sure how long we can go on, but we'll try for as long as we can. The Similac Excellence formula milk powder we bought last week upon discharge remains unused. For now.

12th day Chinese custom

Today, Ah Mah and Ah Kong celebrated the "12th day" of Elijah's birth. According to Chinese custom, on this day, two special dishes are prepared and distributed to relatives to announce the arrival of a newborn. The two dishes are: (1) pig's trotters in black vinegar; and (2) chicken in glutinous rice wine. Such a custom took root in a time when communication systems were less developed. So, whenever a family came bearing these dishes, relatives would know of a new addition to the clan. Ah Mah prepared the two dishes and distributed to our KL relatives.

Traditional dishes
Pig's trotters (L) and chicken wine (R).

Milestone: A week at home with baby [PHOTOS]

We're coming to a week since we brought Baby Elijah home. In that time, we've survived a week without a confinement nanny. Struggle we did. Frustrated we were. But Mommy and Daddy has gained confidence.

Mommy's breastfeeding regularly now. To be sure, we do use the bottle (with expressed breast milk) - but only during the night. We've found that it was not practical to breastfeed at say 3am when Mommy was dead tired and not alert.

These past few days, Daddy has learnt how to:

1. Change diapers
2. Bathe baby
3. Swaddle
4. Burp baby
   
5. Cradle
6. Wash/sterilise bottles
7. Help with the nursing
   

Daddy's first
Daddy bathing baby the first time - Sat 12-Nov-05
Daddy is pictured using the "football hold."

Sharing a family moment together
Ah Mah, Ah Kong and Ashley playing with Elijah.


Firm and gentle hold
Babies like to be held firmly. It gives them confidence in the handler.

Burping calms babies
What would we do without burping?

Elijah frowning
Baby Elijah tends to frown whenever he looks up.

Meeting the paternal grandparents [PHOTOS]

Finally, the paternal grandparents met their grandson. They've been itching to get down to Singapore since Elijah was born but could not make the trip earlier.

We had a number of guests today. Cousin Ashley and great-grand-aunt June also made the trip down from KL. Grand-uncle Clem and grand-aunt Sharon also popped by. Aunts June and Sharon had not met since 1969. It's always fun whenever family ties are renewed - be it after 36 years or 36 days.

And on the 8th day ...
Baby's cord fell off. It normally takes 1-2 weeks.

The paternal grandparents
Ah Kong and Ah Mah couldn't remember how small babies can be.


Cousins meeting
Ashley

Newly minted grand-uncle and grand-aunty
Grand-uncle Clem and grand-aunt Sharon beaming re their new status.

It was also a reunion of sorts
Great-grand-aunt June and grand-aunt Sharon - meeting again after 36 years.

Getting the hang of things [PHOTOS]

Soon after we were pregnant, we decided we would not hire a confinement nanny. Y'see, when Mommy and Daddy were babies, they did not have a confinement nanny (well, Daddy actually had one for two weeks before the nanny left after a quarrel with Daddy's aunty).

But I am not sure if our decision is right. The first night we had Elijah back, it was so tough that I regretted not hiring a confinement nanny. Elijah was not feeding well and was at his fretful worst. Karen's blood pressure was not coming down and my cough became worse whenever I was stressed out. A nanny would have been nice.

So, the next day, I called up Thomson Medical Centre's ParentCraft Centre to enquire about their nanny sourcing service and if I could hire one at short notice. They told me I needed to make a 3-month advance booking. Well, at least the decision's made for us. For better of worse, we were stuck and had to go at it alone.

Fortunately, while we were still at the hospital before discharge, Daddy thought it would be good if we signed on for Thomson's HomeCare Service. A trained nurse/specialist would visit the newborn parents to teach them things like breastfeeding, bathing, etc, etc - stuff that new parents need to know right away.

So, today, Sister Lim visited us. Sister Lim recently retired from Thomson after 26 years with them. She had headed Thomson's 3rd Ward. We took to her immediately. She looked matronly and had a kind and gentle disposition. Sister Lim taught Mommy the finer points of breastfeeding, burping, bathing and answered all our questions. Our fears were allayed and we felt much better after the session. Maybe, just maybe, Mommy and Daddy can hack it as parents.

Coming away from the session, we feel it would make a fantastic gift to future new parents - family and friends alike.

Later in the afternoon, we were up for another baptism of fire - our first trip out with Elijah. We were due to meet with our O&G and paediatrician. We were franctic. What milk should we bring? How do we transport the milk? What should we pack in our travel bag? What if he poops? How do we change him? What if he cried non-stop in the car in the middle of the PIE/CTE (bumper-to-bumper traffic)?

Thank goodness, we got away easy. Elijah cried once - at the paediatrician's clinic - even then, only because he was due for a feed. We whipped out the bottle of breast-milk and he calmed down.

At the paediatrician's, Elijah weighed in at 2,490 g. A week old, he put on a mere 15 g. Babies tend to lose weight in their first week. At the O&G, Mommy was given a clean bill of health. So far, so good.

At the end of another exhausting day, Mommy and Daddy collapsed together and reflected. Sure, at times we're stressed, exhausted and frustrated, but we also sense it will be worth it, this labour of love. We still can't get over how we managed to create Elijah. God willing, Elijah will live up to his name. :-)

Sister Lim shows how it's done
Burping is a versatile solution.
Burp the baby when he/she cries, wakes up, in between feeds, etc.

Professional bath
The Professionals. They make it look easy.

Professional swaddle
Swaddling the infant - another important skill.
Infants feel secure being swaddled - it replicates Mommy's womb.

We were terrified of our first trip out with baby

What if he poops? What if he bawls non-stop?
How do we transport the milk? How do we feed him?

Meeting the O&G ladies
Dr Yvonne Soong's staff - Alice (a registered nurse) and Margaret.

Waiting to see the doc
Mommy went to see the gynae while Daddy brought Elijah to see the paediatrician.

Full battle pack
Daddy models the latest Universal Soldier action figure suit
(wearing the Daddy Battle Gear).

Putting into practice
Mommy is getting better at burping baby.

Big burp
KK earning his "Burping Badge (Bronze Medallion)."

War zone [PHOTOS]

Our first night was tough. Elijah required three feeds. Koong-Koong helped Mommy with it. Daddy was knocked out from all that running around in the day and stress from trying to cup-feed Elijah.

Parenting. It's a frightening experience. We want to do what's right for our baby. The scary part is we often don't know if we are doing it the right way. When Daddy was trying to cup-feed Elijah, Elijah was motionless. Daddy didn't know if Elijah was asleep or had been choked.

At times, we were disorganised and disheveled. Too many of us trying to do the same thing. We were not playing to our strengths. We got up this morning and realised we should focus on our respective "competitive advantages." So, Mommy and KK will focus on feeding, bathing and caring. Por-Por will focus on cooking and washing. Daddy will take care of the administration and running around.

After a tough night, today was a good day. Elijah consistently latched on well. Mommy managed to breastfeed Elijah for long stretches - we had sessions lasting 30 mins, 40 mins and even an hour.

First bath at home
It took three of us. KK bathed Elijah.
Daddy read out the instructions from the ParentCraft book.
Mommy assisted by watching and commenting.

Looking pleased after a bath
KK applying anti-rash cream.

Earning his spurs
A proud KK, after earning his "Bathing Baby" badge.

Loving it
Babies love being burped. The look on Elijah says it all.

Baby's first tan
Because of jaundice, we were advised to
place Elijah near the window for a while each day.
[Parents-to-be, please note: Do not expose baby to direct sunlight.]

A fairy came by
Godma Jacqueline sneaking up on her godson.

Recovering well
Mommy indulging in a favourite past time.
With help from KK and PP,
Mommy's coping well with motherhood and cesarian wound.

Contentment
After a marathon of breastfeeding,
Elijah's alert and likes to check out his surroundings.

Homecoming [PHOTOS]

Late last evening, we were told that Elijah's jaundice level had come down to about "7," and that Elijah was likely to be discharged soon. This morning, Dr Keoy confirmed that Elijah and Mommy were ready to be discharged.

KK and PP had been anticipating this so much that they couldn't sleep last night. PP said, "boy-boy is coming home." Their grandson was indeed coming home. KK and PP came to the hospital to help us pack and check out. This was the first time KK and PP saw Elijah in person.

We successfully breastfed Elijah this morning. He was at it for 30 mins. That gave us some confidence and encouragement.

We left the hospital at about 1330hrs and was home within 15 mins. Elijah, we're so happy to bring you home.

Back home we had another succesful breastfeed with Elijah at about 3pm. We tried to breastfeed Elijah again at about 7pm but this time it was terrible. We then tried to cup-feed him. We were advised that Daddy (and not Mommy) should do the cup feeding so that Elijah associates Mommy with breastfeeding and Daddy with cup feeding. It was terrible. Daddy didn't know if he was doing it right.

Feeding is the one of the most frustrating aspects of infant care. There is the pressure of making sure the baby is adequately fed, while trying to do it right, when the baby is wailing away. Right now, it is a demoralising experience. I don't know ... we'll try to take it feed at a time. We'll see how it goes.

Snoozing together
Koong-Koong catching a nap with "boy-boy"
while waiting for Daddy to settle the hospital bill.

Back home
Getting used to new surroundings.

Breastfeeding frustrations

Today, Dr Keoy informed us that Elijah's jaundice is improving - the level was at 10.9. This was considered "mild to moderate."

Meanwhile, we're having a a tough time trying to breastfeed Elijah. Some of our problems are:

1. Being a premature baby, Elijah hadn't developed the suckling reflex. So, he doesn't suckle so well. and needs to learn.
2. Elijah's a fretful baby. Some character, he's developed a reputation with the nurses. The nurses know him as one tough cookie. That said, it cuts both ways - he's also become a "favourite" with at least one nurse. :-)
3. Because Elijah frets easily, he loses patience quickly when he can't suckle properly. I hope he doesn't develop a short attention span. :-0
4. Like dogs, you may need to be firm with babies. Conditioning is important. It's imperative that we continue trying to breastfeed Elijah and not give up. So, breastfeeding requires the patience of Job.
5. At the same time, conditioning cuts both ways. We have to be careful not to push too hard lest Elijah develops an entrenched dislike for breastfeeding.
6. Breastfeeding is tough. Having seen how it's done, I know it's a frustrating experience. You want to tear out your hair.
   
7. Breastfeeding requires "inconvenient" workarounds ie using a breast-pump to extract milk; we have to be careful of "teat confusion" - hence no bottle-feeding, only cup-feeding; etc.

On the lactation specialist's recommendation, we bought a breastfeeding pillow to help support Mommy's arm during feeding. It costs about S$80 and is called "My Brest Friend." It's pricey and at first I didn' think twice about paying for it. But later, I wondered if this was a case of parents not sparing any expense for the ostensible good of their child. I've seen parents throwing money at things because they want the best for their kids, only to realise they had bought doodads. But after Mommy tried the pillow, I am happy to report that it was money well spent. Because of the cesarian wound, it helped Mommy to support Elijah's head during breastfeeding and avoid unnecessary exertion.

Jaundice [PHOTOS]

Monday, Nov 7th, 2005, Dr Keoy informed us that Elijah was beginning to develop jaundice and will be placed under the photo-lamp for UV treatment. First, ICU, now, UV treatment.

Lactation specialist Uma Thambidurai informed us that jaundice was nothing to worry about - about 85% of babies developed jaundice. She also said Singapore treats baby jaundice more aggressively. In other countries, they tend to treat the baby only if the jaundice level reached "14." In Singapore, they treat earlier. Also, we learnt that the doctors prefer not to discharge the baby lest the baby develops a worse case of jaundice at home, which would then be more difficult to bring down back at the hospital.

Mommy got to bottle-feed Elijah for the first time. We later learnt from Uma that we should avoid this, and instead cup-feed him. This is to avoid "teat confusion." Uma also showed us how to burp the baby. Sit the baby upright on your lap. Hold the baby's chin firmly - apparently babies like being held firmly here. Cupping your other palm, proceed to pat the baby gently. Sounds easy (yeah, right).

I also signed consent forms to innoculate Elijah with "BCG" and "Hepatitis B" jabs. Elijah will have his "BCG" today and "Hep B" tomorrow.

Later in the evening, we ordered our baby car seat, a gift courtesy of Aunty Ree, Uncle Hen, Jac, Nick and Aunty Bats.

Time to wake up, baby

In their swaddle, babies can really sleep so snugly.

Mommy's first bottle-feed
We later learnt that we should avoid bottle-feeding him.
Instead, we should cup-feed him.


Formula milk
We're using Similac formula milk here.

Having a go
Daddy trying to calm a fretful Elijah.

Our O&G
Dr Yvonne Soong. No gym session required this week.

Cup feeding
We're trying to avoid using the milk bottle, to avoid confusing Elijah.
Here, Uma Thambidurai (Lactation Specialist) demonstrates how to cup-feed.

Burping
Uma shows us how to burp a baby.
Uma burped Elijah in two pats. They make it look so easy.
Elijah's burps were loud. Uma says he was trying to show off.

Discharged from ICU

Sunday, Nov 6th, 2005, greeted us with good news.

Paediatrician Dr Keoy Soo Shin, said Elijah would be discharged from the ICU. Elijah's laboured breathing on birth was merely a case of fluid in the lungs and nothing serious.

Our gynaecologist Dr Yvonne Soong came by later in the morning. We asked her why Elijah wasn't placed in an incubator. Dr Soong explained the wonders of mother nature. Because Karen was suffering from hypertension, the foetus had stepped up on maturation. So, although Elijah was born a month too early, he had developed a lot for a premature baby.

Later that morning, Elijah was moved to the nursery.

As new but older parents - being in the wrong half of our thirties - we were concerned for the well-being of our baby. As each day passed, we were beginning to see more and more progress. We were just grateful for the simple blessings in life.

The day after - family together [PHOTOS]

The day after - Saturday, Nov 5th, 2005 - for the first time both Mommy and Daddy got to see Baby Elijah together. It was the first time since the delivery we were together as a family. Elijah was still in the ICU. But we were happy to see that he was not required to be in an incubator. Elijah slept in the bassinet-trolley like any full-term baby.

In the afternoon, Daddy brought Koong-Koong and Por-Por to the ICU to see Elijah. Only parents were allowed entry. So KK and PP could only catch a glimpse of Elijah through the glass door.

Later in the evening, we saw Elijah again and this time he was awake. We were thrilled to see him awake for the first time since delivery. Ah Kong says Elijah has Daddy's eyes.

Mommy is recovering well. She could walk a few steps at a time, although she needed to be wheeled to the ICU to see Elijah.

Elijah in ICU
A favourite photo with the grandparents.

So relaxed
Although you came into this world without due notice,

you look so calm and rested. No incubator was required.

Seeing you for the first time

Mommy had been so worried about your condition.

Mommy felt better after seeing you for the first time in ICU,
since you were born.

A photo op for Daddy
Daddy had escorted you to ICU soon after delivery.

This is just an excuse for Daddy to take a picuture.

Recovering well
Mommy feeling much better after seeing you in ICU.

Eyes wide open
Later that night, Mommy and Daddy visited you in ICU again.

For the first time, we saw your eyes opened.

A playful moment
Only a day old and you're already so playful.

And baby makes three - the start of a family (and a blog) [PHOTOS]

Baby Elijah was born - prematurely by a month - on Friday, Nov 4th, 2005 at 1850 hours, at Thomson Medical Centre. He weighed in at 2.475 kg (5.47 lbs). His height was 46 cm and his head circumference was 32 cm. (Lottery punters, take note). :-)

Mommy Karen had a cesarean delivery. Daddy Chonz was with Mommy in the OT.

Dr Yvonne Soong chalked up a week's worth of gym work, trying to yank Elijah out of Mommy's womb. It was a scary time for both Mommy and Daddy as the OT table shook back and forth. Finally, with the anaesthetist's help and the use of forceps, Elijah came into this world.

We endured another hairy moment waiting for Elijah to let out his wail. It felt like the longest time as the attending paediatrician massaged Elijah to stimulate the baby's wail. We felt so relieved and happy when Elijah eventually wailed announcing our family's arrival.

The anaesthetist said Elijah was a "good sized baby" and his "facial features looked normal." We were amazed at Elijah's full head of hair.

As Elijah's breathing was laboured, he was admitted into the Neonatal ICU for further observation. It seemed he may have fluid in his lungs which is not uncommon for premature babies.

Daddy joined Mummy in the suite at around 8pm. Pops, Moms, Aunty Rita, Uncle Hen, Aunty Bats and JacGui then joined us as a flood of SMSes and calls came in. Mommy was alert and chatted for 3 hours before crashing out.

Fresh from the oven
Mommy beaming with pride and relief.
Daddy looking ridiculous in OT garb.


Head full of hair
Elijah may look like Daddy,
but he sure got his head full of hair from Mommy.


There's no love like a parent's love

You don't have to listen to Mozart in mommy's womb.

You don't have to be a scholar.

You don't need to drive a big car.

All we ask is for you to be a good boy and
to love God with all your heart, soul and mind.

Elijah's first weigh-in
It's an amazing feeling, creating life.


You're so light but we will feed you, baby

Because Baby Elijah was born prematurely (by a month),
he hadn't developed the suckling reflex.
We need to start him on formula milk, fed by tube.