Growing, Growing, Growing

 

When we last left the heroines of this story, Lea was a tiny little infant who was still in a blob-like phase. Fast forward through the two long weeks of my virtual absence from the blogosphere. She is now a HUGE baby (my best guess is somewhere in the area of 13 lbs., which is shocking to me since that's what Hallie weighed when she was around 6 months corrected and Lea isn't even 4 months old yet) who is beginning to bat at toys and has rolled over from tummy to back a few times. These have all been rolls while-on-somewhat-uneven-surfaces so we're not counting them, but it's pretty clear that our little one is going to begin moving in earnest sometime soon. When she's on her belly, she tends to move her legs in a swimming pattern (I am sure there is a more technically correct way of putting this, but that's all I could come up with on my own) that suggests a desire to scoot. And when she's on her back she rocks around a lot, which means that rolling over onto her belly cannot be long off, either.

 

Lea's a particular little baby. Just a couple of weeks ago, her single mode of eating involved snacking (a half ounce of breast milk there, a half ounce of breast milk here) but now she's taking anywhere between two and three ounces of milk at one time. This is a definite step in the right direction, but you better not run out of milk mid-bottle---it gets her SO mad. And when she's mad, she lets you know it! Also, if you are me, don't ever try to feed her while sitting down. She only likes bottles from me while I'm pacing across the floor, holding her in the crook of my arm. And, never, never try to put her down in the swing these days while she's awake...the swing is only for sleeping. She vastly prefers hanging out on the living room floor or in the changing table part of the pack and play where she can watch what's going on around her (and catch some of her big sister's television shows. We are horrified that Lea already seems so interested in Barney, Sesame Street, and Caillou and we can add 'less television exposure for Lea' to the list of the million reasons we want Hallie in preschool soon).

But the funniest thing that Lea likes to do is to love on her burp cloth. We began to notice this a few days ago. Often, we'll use the burp cloth to prop up the binky while she's in the swing, or we'll end up dropping it on the floor or in the pack and play next to her whenever we put Lea down. After walking away to do something else, we'll invariably come back to find that the burp cloth is over Lea's face. Whoever finds it this way will move it out of the way, only to find it back over her face two minutes later. And if it's next to her, rather than on her in some fashion, Lea will reach out her hands and grab it and throw it over her own face. We've tried to encourage her to use her organic plush bunny lovey instead, but Lea seems to prefer the burp cloths to any other security blanket. Maybe it's because it smells like milk (both fresh and burped?) Who knows. Right now it's very funny (but hopefully we will not have to explain to future college roomates and such why it is that she must carry one at all times!) Lea especially loves the burp cloths made by our excellent friend Sara, who is a nurse in the ICN at Pennsylvania Hospital. On top of being mom to Charlie and Aaron and a nurse, Sara is also hugely creative. She also took some very wonderful black and white pictures of Lea back in mid April that she framed into a collage for us and dropped by yesterday. In a shameless plug for her microbusiness, consider visiting the website where she displays the patterns of her keikicloths; they really do make a lovely baby gift!

Anyway, I digress. The other thing notable about Lea these days is that, if she is entirely asleep on her side (her preferred mode of sleeping since it allows her to sleepily locate Sharon's nipple all night long), she will stay asleep even if others in the bed get up. This worked out very nicely for me on Tuesday morning because it meant that Lea could get the rest that she needed and Hallie and I could have some quality time together.

 

 

So, even though Lea still likes to sleep on people, there's hope that we can someday put her down in her own bed. I'm sure that this will disappoint Grammy, though, who loves to hold her for hours and hours. She got a chance to do so last weekend when Sharon took the girls down to visit (while I was visiting my own mom, who broke her hip and femur a couple of weeks ago, but is doing quite well right now, all things considered):

 

 

Hannah, who just turned six, is hamming it up for the camera in the foreground. It's hard to think of Hannah as one of Hallie and Lea's little cousins anymore. She looks so grown up! Here's a picture of Hallie and Hannah; I wish the light on this were better (Sharon might be able to photoshop it to improve it somehow) because it's otherwise such a great shot:

 

You may have noticed how much neater Hallie's hair looks in these shots.  Sharon took her in to our salon to have Whitney, who, in addition to being a versatile hairstylist also used to work as a childcare provider and nanny, give it a trim.  Whitney did a spectacular job and Hallie really enjoyed the experience.  We were a bit concerned about how she might react to the snipping in the absence of Elmo and company on a DVD player, but Hallie was great.  She enjoyed making faces at herself in the mirror, sat still for the entire experience, and was not at all put off by the comb and scissors.  In our estimation, the results of this haircut are spectacular and Hallie looks like a pretty little French girl.  As it turns out, her hair is not entirely straight but contains some very fetching little curls and waves.  Here's a closeup of Hallie's face during the school bus ride--which she thoroughly enjoyed since she associated it with one of her favorite songs, which she insisted on singing the entire time--to her cousin Sarah's crew meet last weekend:

 

Now if we could only get our Sensory Kid to stop smearing stuff in her hair, we'd be in a really great place where coiffing is concerned!

But the smearing has an upside, I suppose:  Hallie has been trying lots of new foods lately and a lot of them end up in her mouth and not just her hair.  She is very fond of watermelon, appears to have a passion for Rita's mango water ice, has been very into eating raisins, and has tried cantaloupe (jury is still out on whether she likes it, but she's definitely interested in gnawing on it).  She's been willing to put chunks of raw zucchini in her mouth.  And, drum roll please, she ate a third of a piece of regular (cow milk cheese) pizza last Monday after gym class without any prompting or bribery.  She just picked it up and ate it.  She did insist on eating it upside down (cheese and sauce on the bottom, crusty bread on the top) and this made things a bit messier than average, but we're not going to be sticklers for detail.  What we did notice, almost immediately (and it was Nadia who pointed this out to me, so it's not even my paranoia peeking through) is that Hallie began to sound very snarfly and stuffy and she clearly had some reflux after eating the pizza but the important thing is that she kept it down.  This suggests to me that she is still sensitive to cow's milk and that we need to proceed with caution, but that a little bit isn't going to set off the major episodes of vomiting and reflux that we used to see around here.  I'm beginning to wonder, too, whether something like Lactaid wouldn't help her.  Perhaps it's an issue of a missing digestive enzyme (which seems to be the case for beef with Hallie).  I know that Lactaid makes milk, cheese, and also pills that adults can take, but I am not sure whether they, or anyone else, makes lactase in a form appropriate for a small child who cannot swallow pills.  If anyone has any leads, please let me know.

So the eating is going pretty well around here.  Hallie is trying new stuff all the time and is eating a wider variety of food (she had a few bites of bialy the other day and really liked it; is willing to tolerate chunks of chicken nuggets dipped in catsup, of which she is quite fond; and adores creamy goat cheese spread on toast--which has to be brown and which she'd prefer to use only as a vehicle for transporting goat cheese to her mouth but not necessarily as a food worth ingesting in its own right; likewise, she loves the tomato sauce on pasta but is fairly indifferent to the noodles in their own right).  Just as importantly, she has not been vomiting.  At all.  I am sure that I will be jinxing myself at this stage, but it's been fourteen straight days now and she has not upchucked.  I do believe this is our record.  And we stand at 89 days of no vomiting this year, so things are looking really good.

Because of this, we decided to pull the Reglan altogether from her list of medicines.  Reglan has some scary immediate and cumulative neurological side effects and, while we believe it was a very important drug that helped her at some critical points, what we're seeing now indicates that she's no longer in need of it.  She does not appear to have delayed gastric emptying at this point and, to the extent that she does, prunes and water (she loves water, which of course makes sense since it has no calories) are doing the trick.  On top of this, we've cut her dose of Axid down to once a day.  We're keeping the prilosec for now, but down the road may consider weaning her off of this too.

Hallie still has good and bad eating days, but we do notice that, over time, she does fine.  Some days she might drink as little as six ounces of her super-charged goat milk and other days as much as 18 ounces.  She stays hydrated, though, because she drinks a fair bit of water and juice (not to mentioned swigs of diet coke that she steals from me and once or twice a gulp of coffee--not that these are particularly hydrating and heaven knows that the last thing she needs is caffeine).  

Our biggest concern now is getting her to eat like other kids.  We don't mean that she needs a broader variety of food--honestly, the fact that she eats about 20 things and is willing to try stuff at her own rate is fine by us.  What we mean is that we would like to get rid of the high chair, the TV/DVD player, and the prompting/reward system while still managing to get enough calories into our kid to keep her growing.  We are not sure how to proceed with this, so if anyone has any clues, PLEASE let us know.  Every time we try to feed her at the table with us and have a family meal (even if there are other kids here to keep her company), it never goes particularly well.  She might take a bite or two but that's it, and usually a meltdown ensues.

We are hoping that preschool helps teach her a thing or two about how kids eat (and enhances her general social skills), but how that all plays out remains to be seen.  The IEP is next week and that, and Hallie's assessment, warrant a separate post (yeah, I know I say that a lot, but this time I really mean it).  Meanwhile, I leave you with some cute shots of Hallie taken at Sesame Place three or so weeks back:

 

Just Chillin' in her Stroller

 

Sliding was lots of fun but Hallie had the best time cavorting on the gym mats (and pulling her mama into the fray)

 

 

 

And here she is hugging Zoe:

 

As it turns out, she's in a Zoe phase (I am guessing that many little girls go through one). She especially likes imitating Zoe performing ballet. She'll place both hands over her head, pirouette-style, and lift one leg. This is cool, because I had no idea that she was able to stand on one leg even for a brief few seconds (this is one of the things that you are supposed to do by age 3; there are many many things that you are supposed to do by age 3 that Hallie cannot do, so it's nice to see that she can do one). So, between dancing like Zoe, galloping around the house with a cowboy hat on, saying "I ride horsie! NAY!" and marching like Barney the purple dinosaur (one of Hallie's longest sentences is "Barney purple dinosaur is MARCHING!"), I do think we have a bunch of emerging pretend play skills (one of those milestones-not-quite-met), which makes us very happy. So if she needs to be Zoe and Barney, that's fine by us! Now if we could only break her of some of her TV watching, we'd be even happier!

Hallie at the Drive In

Wow. It's really spring. What better time for a quick zip over to the Drive-In (Home) Theater and a few hundred episodes of Sesame Street? At least that's what Hallie thinks!

Anyway, today was gorgeous--around 70 degrees--and even if I had to work, and got home on the typical late side (around 7pm), Sharon got home early enough (kind of has to, in order to relieve Ami) to take Hallie to the park to hang out with the neighborhood kids. It had rained this morning and early afternoon, so the slide was wet and Hallie stuck to it (making it harder for her to use her blossoming pushing-off skills) but apparently she had a great time and tuckered herself out (despite her three hour nap this afternoon). It seemed like Hallie had a great day, and we'll know better in the future when Hallie can actually tell us something about it.

But we're not complaining. Hallie has been imitating like crazy this past two weeks, and especially over the past few days, and we're (ok--at least I am crediting this (in part) to adding one capsule of Nordic Naturals EPA to her two capsules of Nordic Naturals 3-6-9, and constant speech drilling. Hallie has been saying the following words, on command, this past week:

"kitty" (her favorite, never has lost this one), 'teddy', 'diaper' (sounds a bit like 'pah' sometimes), 'good' or 'good girl', 'cookie' (another favorite), 'buh' (big bird), 'seh-see seet' (sesame street), 'buht' (bert), 'eh-die' (ernie), 'day-dee' (baby), 'am-ma' (mama), 'igg-ee' (piggy), and of course, 'wah-dah' (water). There are probably others, but those are the ones that come immediately to mind. And the thing is: the repetition and imitation is fluid and on command. This has never been the case before, and we certainly hope that it lasts. (And none of this has replaced signing; in fact, tonight, Hallie signed an entire book -- Goodnight, Baby! -- to me as I read it. It was way cute. And very smart, since she has consistently chosen this book as the book she'd like me to read to her when she wants to go upstairs to take her bath and go to sleep and we moms are dilly--dallying).

In this photo, Hallie is saying 'buh'.


Doesn't she have a great pout? I am certain that she will use it against me!

Anyway, we are heartened by the speech gains and are hoping that the SLP with whom we are trying to work privately does manage to get us approved by our session on Sunday. If not, we'll call out the big guns (our fab pediatrician will write all sorts of letters and make every effort to use his diagnostic tool bag to get us services). But we are hoping that Independence Blue Cross doesn't make us get ornery (or cross) with them. It ain't pretty when the mamas get their feathers all ruffled.

In other related news: the eating is getting a bit better. Hallie has thrived on her diet of Veggie Stix (those meltable snack food items and NOT carrot and celery sticks in the raw) and has mastered the art of making it through about 20 of these at a dinner time seating, meaning that we get to sort of eat as a family these days. And even more impressively, she ate 5 whole Scooby Snacks graham cracker sticks tonight at dinner. This is a whole 60 calories, folks, and replaced an entire jar of baby food puree. And even her purees are getting a bit more sophisticated (she ate two jars of Stage 3 this week). So maybe we're seeing some oral progress across the board. Who knows, perhaps we will free up that big shelf filled with tiny jars some day? I'm not going to run away with my fantasy of having more space in our cupboard just yet, but I am pleased that Hallie does seem to be making a bit of progress in terms of texture and that this progress has gone on long enough for it to seem real as opposed to totally fleeting.

And, finally, sort of in terms of progress, I do have two more vomit free days to log in to our tally, one in the month of March and one in the month of April. Hallie did well on Saturday AND Sunday (making it another one of those two-in-a-row sort of victories), but Monday ended up being a wash out (huge post dinner vomit) for reasons utterly unknown. Today was a good one, however, and so we got to start off the month of April on the right foot (or mouth...). The kiddo is still not pooping up to our standards (or her GI tract's standards, at least) and so this continues to be of concern. We have her on Reglan, Miralax, Pear nectar, and taking a pretty large dose of flax seed oil. We are also giving her Calcium/Magnesium and the fish oils. All of that should promote easy pooping. Yet not in our girl (who will be embarrassed to read this some day. Sorry, baby!)

We're hoping that our eagerly-awaited upcoming visit to the Allergist (what the hell kind of parent can't wait until an Allergist pricks their kid's skin?) will shed some light on what's going on here. And it might provide some insight into the small patch of dry skin/eczema that Hallie has on her thighs and, more intermittently, on her eyelid. It's hard to know what's setting this off, but we'd like to get some insight into this so that we can nip this problem in the bud. There's a strong family history of allergies, asthma, and eczema (and all three seem to go hand in hand and are to some extent related to diet), so I am not sure we can place the blame here on microprematurity. But whatever is going on, we mamas really want to get at the root of things so that we can fine tune our very fine toddler.

Synagis Shot No. 3: Poor Baby!

Hallie had her third Synagis shot of the season yesterday. She hardly shared our opinion of these injections (which are not quite vaccinations, but rather infusions of live antibodies subcutaneously that are designed to protect---though not vaccinate you against---respiratory syncytial virus, which is what causes a common cold in most of us but can land preemies and others who have lung damage on ventilators). While we might conceive of yesterday's infusion as an early Christmas present for Hallie, it is pretty clear that she saw it as a huge lump of coal (in each thigh).

She kind of knew what was happening, too. At first, she was very eager to be at the ped's office---we let her run around instead of confining her to the stroller. Now that she can walk and isn't on all fours on the carpet and isn't quite so prone to putting things in her mouth. We purelled the heck out of her and the table top toys and are hoping for the best. There were literally no other kids in the waiting room and it was totally quiet, so that made us feel better. Lee Ann, Hallie's favorite nurse, was thrilled to see her walking and waving and even got to hear "diaper" and a few other words from Hallie. So that part, and the usual marauding that Hallie does in the examining room were fun: she shreds the exam table paper, reaches for the scopes to use them as phones, opens and closes the drawers under the exam table, and other fun things. It's IMPOSSIBLE to take her in to the doctor on one's own and still retain sanity/have the capacity to discuss what's going on with Hallie with nurses, doctors, etc. While this is annoying, it is also part of Hallie's singular charm and frankly I love it that our little girl enjoys exploring her universe so thoroughly, even if she does leave a bit of a destructive debris field in her wake).

Then, however, Hallie realized that other kids were screaming from rooms close by. Hallie has inherited Sharon's empathy streak; this is a good thing, but can be a problem in situations like these. So she was virtually on the verge of tears when the two nurses came in to double team the Synagis shots, which are now (like Hallie) pretty hefty in terms of dosage. She screamed, bawled, squirmed, and tried to get away from me and Auntie Neystice (my co-conspirator in RSV shot administration). Then, after the injections were done, she continued to cry and shake. It was pathetic: she soaked my sweater with gallons of genuine tears, held onto Bailey (her new baby that was a present from my mom that Hallie absolutely loves) and Grover (the other big light of her life right now), and was inconsolable. We dragged her pants on (which probably made things worse, but it was 35 degrees and raining out and we were not going to transport her to the car in her diaper) and fled the office. She calmed down the minute we left the doctors' office because she knew that the pain of the RSV shots was all that she was to endure and that she was now safe. But it took quite a bit to calm her down even once we got her into the car and I was thankful for her bottle and for her binky. Then Hallie fell asleep, hard and long, and we sat in the car parked in front of the house for two and a half hours while she slept it off.

By evening she was fine and back to her usual self. She's still pretty irritable, but this is largely attributable to her teething (those molars really are coming in---her gums are all shredded feeling but no teeth have cut through yet; their arrival could not come soon enough for me because she's LIVING on tylenol these days. Whenever she sees the tylenol bottle, she smiles, reaches for it, opens her mouth and calms right down. Yes, we have a junkie in our house and yes we keep the bottle far away from her because she is clever enough to figure out how to open it and ingest its contents. We do not want an unscheduled ER visit any time in the near or distant future.

On the eating front: she's kind of on strike right now and we are not sure whether this is related to the teething, her increased willfulness and the appearance of some obviously behavioral eating issues now that she is older, or her delayed gastric emptying/constipation. It could be all three, really. She's been pretty good with her bottle and her bear (milk) and decent with her juices (though she likes the miralax free version better than the stuff laced with laxative). But she's been horrible in terms of purees and baby food. She did accidentally get fed some mac and cheese gerber stage 2 food earlier this week and this might have set her back; in any event, we are going to start the goat trial over again, and I think I will back down on the calories some more and see what happens. Miralax does not seem to be working. This could be because she isn't getting enough of it in her system or it could be because its benefits tells us are limited when constipation is a result of an allergic reaction (why the GIs failed to mention this is beyond me; sometimes I wonder why we see them at all). Milk of Magnesia works great but may lead to malabsorption of nutrients and the GI doesn't want her on it (I might seek a second opinion, given our opinion overall of the GI), But maybe fewer calories plus more liquids will help. Her diet is already replete with all sorts of anti-constipating foods: mangos, prunes, very ripe bananas (turns out these are great for constipation whereas the green ones are great for diarrhea. Who knew?), berries, karo syrup and the like. She eats mostly fruit these days, and she drinks juices, and is off of yogurt (but takes probiotics in her formula) so she should not have a big problem with pooping, but alas, that is not the case. We'll see how it goes and if I need to try her on soy milk, we'll do that next.

But meanwhile, she continues to grow. She's now a whopping 23 lbs. 12 ounces, which puts her at close to the 50th percentile for her actual age. She is doing phenomenally where that is concerned. We're not sure how this happened, but we're thrilled at her size and sturdiness and we promise not to ask too many questions. All I can say is that there is no evidence of her crawling down the stairs (thankfully, since in our house with its boxed in windy staircase this is too frightening to imagine) and raiding the fridge in the middle of the night (I should know: I am up in the middle of the night. Sigh).

So, if we could only get her GI tract working right motility and elimination wise and then figure out how to handle the texture issue, we'd have it made. So, if anyone can figure out how to give me that scenario for Christmas (yes, Virginia, I am Jewish, but it's okay to believe that there is a Santa Claus, isn't it?), please do... I am tired of boring everyone with tales of vomit (I did not even bother to tell the story where she vomited this week on herself and Ami and I ended up washing Ami's cellphone) and poop and want instead to talk about Hallie's laughter, mischievous streak, antics, words, and the like.

Baaaaaah, Humbug, or Hallie's Got our Goat

Things have been getting better and better in terms of Hallie's intake and Hallie's general lack of refund since Saturday. Her mood has even gotten better (and this is a kid who seemed happy even while she was retching and gagging and vomiting multiple times a day. This is saying something).

What changed? We're not sure, but this is what we are doing and it seems (for now) to be working and hopefully it's not some sort of fluke.

1. Food change. Instead of either Nutren, Jr with Fiber or Pediasure with Fiber, we now have her on a super charged goat milk formula. Sharon felt that part of the constipation issue might have been related to the Simply Thick, and without the Simply Thick, we'd be sunk in terms of her eating orally because we strongly believe (we have a bit of data, and we'll leave it at that) that she is still aspirating on thin liquids. We needed a lot of Simply Thick to thicken the pediasure or nutren, jr. and we felt that even unthickened, she had begun to slow down on stooling on the super rich 30 calorie formulas. Given that she did well on the mix of breast milk with Enfamil AR powder and Karo Syrup that we used to have her on, I did a bit of research on other milks and found a lot of data that suggested that the proteins in Goat Milk are the ones most similar to human breast milk and that they tend to be easier for people in general to process. Given our desperate situation, it seemed worth a try. We started mixing Goat Milk and the Enfamil AR powder (we are also adding in vitamins to compensate for the lower B-s and especially Folic Acid in Goat Milk, relative to the complete nutrition formulas) with a bit of Karo syrup and less in the way of Simply Thick. Hallie loves the taste of it and, in contrast to the other formulas, is also taking more of this during meals (from a straw cup) than she ever did the Pediasure or the Nutren Jr. We estimate it at 27 kcal/ounce and that she is now taking (for the first time in a long time) more than 20 ounces of this a day, on top of her purees (appx 4 ounces per meal, with a goal of an average of at least 100 calories per meal, three times a day).

2. Meds might have kicked in. We are splitting 30 mg prilosec into two doses, mixed with applesauce (morning and night). We are keeping up with the Reglan (1 ml 4 times a day).

3. Hallie is on a firm schedule that spaces her meals, bottles, and naps more effectively. She is napping upwards of 3 hours per day (two naps) and sleeping from 10pm to 7am (roughly). She seems to thrive on this schedule and we are aiming for complete consistency to enhance her happiness and our own. Her last bottle is around 12am and it is still a sleep-feed but we are hoping that we might, over time, increase her consumption during the day and be able to discontinue this. In any event, it sure as heck beats the 3am bottle of yore.

Stooling is now regular, more of the consistency that one has while on breast milk (instead of pebbles, which is what we had been getting some of last week, and sometimes hard formed cakes). She is no longer retching and her gassiness has subsided. She seems happier.

So we are pretty happy. The only vomiting we have seen has been mechanically (mommy) induced: we had one bottle that was too thin (hence our data about aspiration), and one meal that came too quickly on the heels of a bottle (hence our very precise scheduling). Otherwise, no retching, two small wet burps and a whole lot less laundry. And she sounds clear as a bell and has no congestion whatsoever.

Did I mention that we are happy?

Very belated Hallowe'en pics to follow later on tonight...

If a Picture Could Tell A Thousand Words...

This would be the one that summed it all up.

This amazing shot (yes...it is a picture of Hallie in mid-projectile vomit) was captured by our good friend Vanessa a few months ago. Sadly, it just about sums up our life on a daily (who are we kidding...multiple times a day) basis.

This week has been a pretty bad one. Hallie did have her ear tubes placed, is probably teething (she's always teething), and ran a bit of a fever after getting three vaccines during her belated 15 month well-baby (???) check up, during which we discovered that she has not gained much weight at all in the past three weeks (like 2 ounces total, for a grand total of 9640 grams, or 21 lbs. 5 ounces. We know that, after two 300 to 400 calorie days, she has lost at least some of this weight). Anyway, our ped. put Hallie on reglan, which used to scare us but which looks far better than the alternative (a surgical procedure called the Nissen Fundoplication that essentially places a knot in the baby's esophagous that will a. shorten her already too short GI tract and make reflux worse and b. prevent her from vomiting, even when she really needs to do this to clear a bug or something poisonous from her system). Alas, the reglan is not helping Hallie empty her stomach (maybe because she's not eating?) yet and is not having any of its magical anti-emetic effects yet, either. At least it is not having any negative neurological side effects (which is why we were reluctant to place Hallie on it in the first place).

Anyway, after a bunch of projectile vomiting and virtually no food intake, we decided to bring Hallie into the ER yet again. I was hopeful that Hallie had a hairball---yes, you heard it right, a hairball: after all, the kid loves carpet fuzz more than any other food group---but alas, no obstruction (we had to subject the kid to an NG tube to do an upper GI series. Hallie was in serious emotional and physical pain over this particular aspect of our ER visit). At least we've ruled this out.

In the end, what we're left with is a diagnosis of reflux and delayed gastric emptying. We're not sure what caused the flare up and why Hallie isn't able to process food and poop as well as she had been able to in the past. Perhaps it's the antibiotics she had been on in August and September; maybe it's teething (she is veritable drool factory right now); maybe it's the change in formula from pediasure to nutren, jr. to nutren jr. with fiber (and now to pediasure with fiber). Maybe, like in the NICU, she finds it hard to process 30 calorie/ounce food. Perhaps the simply thick is simply constipating.

We've decided to focus once more on diet in the hopes of managing this beast: We're adding probiotics and we're trying Hallie on a mixture of goat's milk (supposedly easier to digest and closer to breast milk than other forms of milk) and Enfamil AR powder (to add some calories and more nutrients), and less in the way of Simply Thick. We're trying to remain optimistic, but that is getting pretty hard to do.

Meanwhile, I bought a lot more laundry detergent, because if there is one constant in our life, that's it.