5 days before the twins turned 5 months old, they had a developmental evaluation. It was prescribed when we checked out of the NICU as a standard procedure for premature babies. Also, an occupational therapist a few weeks ago, who was giving us the results of Colin's last cranial exam (tons of improvement, no helmet prescribed!), suggested that he get evaluated because of weakness in his neck and shoulders and trunk.
I was anxious to hear the opinions of the therapist at the developmental evaluation, because Colin, for lack of a better word, is still pretty low tone and "floppy." Claire, on the other hand, is so high muscle tone that she can barely relax. She could win awards for her inability to sit still or her extreme ability to fight off sleep.
Colin's attitude toward learning is very observant. He watches everything and then practices on his own. He won't just grab, he'll think and do it slowly. He's also a perfectionist. So his gross motor skills like reaching and grabbing for things are not behind, but they are carefully calculated so he does it less often. He'll only take matters into his own hands if he feels you aren't doing something fast enough... like feed him. But he'll use his bottle and will occasionally accept a pacifier so he can practice putting things in and taking them out of his mouth (and a successful attempt earns a little giggle). Colin is VERY strong, but because he's low tone it sometimes feels like you're carrying a sack of potatoes. This makes him a very good cuddler, but you really have to encourage him to exercise.
Claire, on the other hand, is a learn-as-she-goes type of girl. She will reach and grab and touch and pull the spoon of your hand as you're feeding her. Adam wanted to be independent and do things on his own, but he at least let me try to feed him with the spoon every once in a while. Claire doesn't care if she does it perfectly, she just wants to do it, which results in more practice. Also, since Claire is high tone, she's pretty much sitting up on her own and loves to socialize, but will kick and squirm and grunt if you "just" want to cuddle.
So you can imagine how curious I was about the results of the evaluation when I took in these very different babies, born on the same day.
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| Claire's concerned face |
For one thing, they shocked us with their height and weight measurments. It's hard enough to be close in weight as it is, but despite being almost completely opposite in almost every way, they came in exactly the same, down to the decimal point:
24 1/4 inches long.
15 lbs 6.8 ounces.
For Colin, (plotting the percentiles at his chronological age) this means that he is still in the 25-50th percentile for weight and in the 5th percentile for height. His head circumference is in the 25th percentile (41.75 cm).
She estimated his developmental levels at:
Gross Motor: 3 1/2 months
Fine Motor: 3 months
Cognitive: 3 months
Receptive Language: 4 months
Expressive Language: 4 months
Colin immediately rolled over from his stomach to his back and she asked me if he ever did it more "intentionally" because that looked like "it was almost an accident." I didn't know what to say, but after leaving wish I had thought to say: "If Colin does anything it is not an accident. He just made it look easy."
She did a little hmmmm-ing at hearing about his gag reflex and about how long it takes him to sometimes finish a bottle (he can be a little slow at times but I put it to casualness usually). But overall she said he was great and right where he is expected to be, and just needed more work with his head and neck strength. She said she has a twin boy and girl, and her little boy was also "floppy" as an infant -- he is still good at sports and is so flexible that he can put his leg behind his head.
Her notes:
"Colin is a sweet little boy of twins born preterm at 34 weeks gestation. He has minimal plagiocephaly and mild GERD. He is making nice progress with all skills between adjusted and chronological age."
She estimated her developmental levels at:
Gross Motor: 4 months
Fine Motor: 4 months
Cognitive: 4 months
Receptive Language: 4 months
Expressive Language: 4 months
Claire also rolled over immediately at the evaluation, and even pushed up on her arms and tried to sit up on her own. Claire likes being on her stomach less than Colin does, but was doing a little showing off.
The therapist paused a little at Claire's eye symmetry (her left eye is a tiny, tiny bit cross-eyed), but didn't say anything about it. I guess there's still time for it to correct itself. She also point out some mild plagiocephaly on Claire's right side as well, which I had noticed but it's incredibly minimal so we're just doing the same things we do with Colin, minus the sleeping on the stomach.
Her notes:
"Claire is a sweet little girl born the second of twins at 34 weeks gestation. She is making lovely progression with all skills between adjusted and chronological age."
So even though they are so different, they are so much alike and are developing quite nicely. We are supposed to continue tummy time, lots of sitting and pull to sit exercises, no TV until 2 years old, and she said to avoid exersaucers or walkers (who knew?). They are supposed to be bad for their backs, especially for premature babies, but we don't use them that much anyway and not really for exercise, just for interacting -- they make it much easier for Adam to interact with them.
She also gave me a dirty look about letting Colin sleep on his stomach, and I told her I understood her concerns. She seemed stunned and wanted to continue to scold me, and contemplated doing so. I almost told her that if she was that opposed to it that she could come to our house and try to put the kid to sleep when he has reflux that is worse on his back or elevated, he won't keep off the right side (flatter side) of his head, and he flat out prefers it on his stomach. I kept my mouth shut though, mostly. And after making her dirty faces, she let it go too -- but not without first judging me and thinking I'm an idiot.
I do know the concerns about SIDS and letting babies sleep on their stomach, and quite frankly I am just as concerned about it and am constantly checking on Colin to make sure he's okay... that there's nothing on or even close to his face and that he's turned his head far enough to the side and that he's still breathing. But I'm constantly checking on Claire too. I have encountered some medical professionals who look like they are contemplating turning me over to CPS for allowing my baby to sleep on his stomach. I get it, I do. I have gotten the lectures and tried everything I can think of. Him being on his stomach means that he gets the comfort and deep sleep that he needs to grow.
Because Colin and Claire have a wonderful new nanny now, in just the last week I can already see improvement with Colin's head and neck control. He is socializing like crazy and talking just as much as Claire. As you can tell from the evaluation of the babies' "expressive language", I have very verbal children. Shannon and I are a little on the quiet side so they must have been sent to pick up the slack around here. Now they can talk with each other and get the one-on-one attention they deserve.
On Wednesday because they all had a little cold, Adam stayed home and spent some quality time with his brother and sister and Papa and Shane, who came into town. That wouldn't have been possible in our previous situation. And yesterday, Colin and Claire got to take naps in their own cribs and chatted with each other from their beds until they fell asleep. And that just makes me very happy.
We go back for another evaluation in 5 months, including vision and auditory. So much changes in 5 months! I will most likely need back up to contain two very mobile babies.
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