Meeting with the Physical Therapist

Yesterday, we met with the physical therapist who assessed the boys development. They are right on target for what you would expect for babies that are 37 weeks gestational age. She sat and discussed many things to keep in mind when we went home with the boys about how to help them as well as what to expect in their development. Some of the things we talked about were things we learned the hard way when Lucy was born and some were things that I wish I had known when we brought Lucy home at 35 weeks gestational age!

She reminded us that while the boys are 3 weeks old chronologically, they are still developmentally not at full term. For about the first two years, they will be about 6 weeks behind what "term" babies are accomplishing. They will eventually close that learning gap, but for the first little while, our expectations should relate to them according to their gestational age. (Example: When they are two months old, they will act like 2 week old boys. . . when they are six months old, they will act like about 4 1/2 month olds, etc.) We went through this with Lucy as well. For the first year, she picked things up about a month later than other babies. She quickly closed that gap though and since then, she has even been slightly ahead of others her age. (Sorry - just had to brag for a minute! :)  )

One of the most interesting things I learned from the physical therapist was about they boys sensory development. Hearing develops in utero starting around 32 weeks. The stimulus for vision to finish developing is when light hits the baby's eyes. So for the boys, having been born at 34 weeks and then having the light hit their eyes 6 weeks early, both vision and hearing are trying to develop simultaneously. This can cause hearing and vision to have to compete for development. In order to help with this, it is important that we keep the visual stimuli the boys see limited to faces as well as things in their natural environment. The PT said to hold off on introducing any toys that had flashing lights or movement until they are about one month developmental age (For Alex and Charlie, that will be when they are 10 weeks old). It's also important to provide them with plenty of sounds - singing, talking, reading books, etc. Sounds need to be kept at a lower volume however because they are used to hearing things muffled in the womb. They already recognize Mommy, Daddy, and Lucy's voices and respond to those. In fact, while Alex was being assessed and I was getting ready to feed Charlie the other day, Alex quit paying attention to the PT and turned his head looking for me because he heard me talking to his brother! ;)

She also talked about the importance of helping the boys to avoid overstimulation. At this stage, their abilities to interact with others is limited and can quickly tire them out. She discussed how feeding is a lot of work for them so they will often close their eyes while eating so as to shut out their other senses - they aren't necessarily falling asleep. I had noticed this with them a lot so it was nice to have  a reason behind it. It also reinforces the importance of having a nice, calm, quiet environment for meal times. The boys also are only capable of looking at other for brief amounts of time. When they are tired, they will avert their gaze or close their eyes to let you know they need a break. Again, we have seen both of these behaviors from them - when they get to this behavior, it's important to make sure to let them take a break so they won't be overstimulated. Another very important aspect is to not let them be held and passed around too much. Too much movement along with so many new faces and voices can really wear them out. For this reason, once they come home, we will probably wait a while before bringing them to church. We so want everyone to be able to see them and love on them but we don't want it to be an unpleasant experience for the boys.

A baby's brain is developing and growing in utero up to 39 weeks and when babies are born early, they don't have the same amount of development as those babies that go to term. The only chance premature babies have to let their brains grow is during their deep cycles of REM sleep. If their brains are not able to have that time to develop properly, it can lead to things like an added risk for ADD/ADHD. When they come home, they will still need the opportunity to have this deep sleep that they have been able to have while being in the NICU. So when they are sleeping, we'll try our best to keep noise (AKA Lucy!) to a minimum as well as any other distractions. When they are sleeping, they need to be in their crib, allowing them to get into that deep sleep cycle. There will be plenty of time to play and interact but these first few weeks at home, they will still need a chance to let their brains rest and grow.

She also reiterated the importance of back to sleep as well as moving their head placement when we lay them down each night. She encouraged us to let them co bed at this stage since it is comforting for them to be together, but to make sure to alternate their positions so they won't develop a flat spot . . . we are prepared for that one! After Lucy, I really would love to avoid having to purchase two lovely DOC bands!

We talked about tummy time as well, which we already knew the importance of. Hopefully they will tolerate time on their tummy better than their sister did at that age! As they grow, we will continue to meet with her outside of the hospital just to have them assessed in their developmental skills. This way, if there appears to be some sort of delay in their development, we can catch it early and be able to give them the appropriate therapy (physical therapy, occuapational therapy, speech/language therapy. . . you know!) needed to allow them to progress forward with their development.

It was so great to sit and talk with her about all of these things. I wish someone had this conversation with me before we left the hospital with Lucy -  I could have used all of this information. 34 week babies though most often can develop without too many delays and most of them have no developmental issues as they grow. While our beginning will consist of a lot of eating and sleeping (for them, not so much for us!), they will grow up all too quickly - we'll try not to blink so we don't miss a thing.