Motor Monday-Primitive Reflexes Part Two

Here's the promised part two of primitive reflexes and why they matter. This is a short one because we haven't been getting much sleep around here lately and I'm not functioning at the top of my game cognitively!  Like I said last week, we still don't fully understand the role of primitive reflexes and their relationship to motor development though I talked a bit about how primitive reflexes are hypothesized to help with motor development.  Primitive reflexes are controlled by the brainstem and as the higher level parts of a baby's brain develop they learn movement patterns that are more complex that take over for the reflex patterns.

The important thing to know about primitive reflexes is that they aren't normally "obligatory" in that they don't happen to the extreme every time the stimulus happens. Sure, most of the time if you touch a baby's cheek they will turn toward the touch because of the rooting reflex, but it doesn't happen every time.  Obligatory reflexes where the baby or older child can't NOT do the movement is a red flag that there is something atypical going on with the nervous system.  Cerebral palsy is a good example of a diagnosis that might involve primitive reflexes that are obligatory.  Another red flag is when reflexes don't fade away as much as they should or when they should, known as persistent reflex patterns.  One study of very low birthweight infants (i.e. tiny preemies) found a clear association between the strength of primitive reflexes and motor delays (i.e. infants with very strong reflexes at 4 months were more likely to have motor delays), while another found no association between primitive reflexes and motor skills in term babies.  Persistent reflexes may also be associated with delays in other areas like reading skills.

Last week I included a picture of Isaiah in ATNR or fencer's pose. Can you picture how ATNR could seriously get in the way of rolling back to belly?  Baby looks to the left and tries to roll that way to get to mom but that darn left arm is sticking out to the side like a kickstand?!  ATNR typically fades by 4-6 months, which happens to be just when babies are learning to roll from back to belly.  A persistent ATNR could also interfere with crawling.  Picture the infant below who turns his head to the left to see his dad.  If he has persistent ATNR (which you'll remember should be integrated by 6 months), his right elbow would bend or buckle, which would be pretty inconvenient and might mean a good head bonk for baby. 

When crawling we need to be able to look side to side without
our support arm collapsing

One other interesting thing to note about primitive reflexes before I sign off on this post is that they sometimes show up again in older adults, particularly those with severe dementia or Alzheimers.  I think this is fascinating! Okay, time to try to get some sleep before the babies wake up again!

Tearing our hair out!!!

Seriously!! Michelle and I are going to be bald like the babies before long! Michelle's experiencing record setting hair loss thanks to the drop in hormones. She can't shower without pulling out a handful of hair and got out of the shower last week and asked "will you still love me if I'm bald?"  Of course, the answer to that question is yes, but I'm trying to convince her that this happens to everyone and she is not going bald. =)

And I think we both might be bald from tearing our hair out after dealing with insurance for the past couple of weeks to get the last Synagis vaccine paid for!  If there's one thing triplet moms don't have in abundance, it's time and it is maddening to spend an hour on the phone, half of it on hold, only to hang up without having made any progress whatsoever!  The whole reason we applied for Medicaid was because our pediatrician warned us that the copay for Synagis was ridiculously high.  But now that we have it, the two insurance systems seem to have no idea how to play nice.  And what I can't understand is why no one seems to be able to provide any guidance on how we navigate these two systems.  Surely we are not the only family dealing with this situation!!

To make a long and maddening story short, the primary insurance Aetna, only pays 50% of the cost which leaves us with over a $1000 copay PER KIDDO for ONE SHOT!  The kiddos are enrolled in one of the PA Medicaid HMO plans called Geisinger Health Plan, but the Aetna Specialty Pharmacy says they can't bill the GHP plan so they referred us to another copay assistance program instead. (Getting this info took four phone calls for a total of over two hours!)  Only problem, that copay assistance program can't help you if you are enrolled in any Medicaid plan! (whoops! there goes another 30 minutes!) The GHP folks said that Aetna Specialty legally has to bill them and can't "balance bill" us because the kiddos are in a Medicaid plan. But that regardless, the pediatrician needs to submit to GHP for authorization before they will pay anything and they don't know until that auth is approved how much of the $1000 they will pay. (The rep was very nice, but had to talk to his supervisor so there went another hour!)  Next step...call the pediatrician's office to make sure they submitted to GHP for authorization. "Oh yes, of course we did, but let me check the system to make sure.  Oh, no, I guess we don't have auth from GHP yet.  Let me just resubmit everything on Monday."  (20 minutes gone!)

OMG!!! So, clearly, the kiddos will not be getting their third Synagis shot on Tuesday at their 4 month well check up.  And who knows if they'll ever get it.  The nurse at the doctor's office said "Well, at least they've gotten two doses!"  As if that is supposed to make me feel better?!  Their primary insurance, who doesn't want to pay for any of this, approved them for three doses so I feel like they should be getting all three doses.  If one of our kiddos gets RSV because of this whole insurance shenanigan I'm going to lose it.  And really, if one gets it, they'll probably all get it, in which case, you might have to check me into a sanitarium for a week! (do those even still exist anywhere?!  I guess a spa retreat would probably work too!)  ;)  

Shots are no fun for anyone!!

But they are a necessary evil!!  I already posted this picture on Facebook, but thought I should probably get it up on the blog too so that one day our kiddos would see it. Here's what our house looked like the day after this last round of shots. (Synagis & HIB). 

It's just plain awful

So sad

Shots are no fun! They are heartbreaking in the moment and, at least so far, have left us with crankier than normal babies for a couple days afterwards. The first 24 hours after shots hasn't been too bad for us because they're on Tylenol, which tends to make them sleepier, but once they're off the Tylenol they tend to be pretty fragile. They'll be fine one minute and so sad or mad the next.

 Our friend Carrie joined me for the doctor visit on Thursday so that Michelle could get some school work done. I warned her on the drive there that their cries would be heartbreaking and they were.  I was going to try nursing them while they have the shots this time to help with pain relief, but they said that instead we could have two nurses come in and deliver the two shots simultaneously & that seemed like a good plan so we did that instead.  Immediately after their shots I nursed them to help them calm them down.  Avery was screaming so much that she couldn't even latch right away, poor thing. Carrie was surprised at how quickly they calmed with just a minute or so of nursing.  

My doctor visit helper

While we were at the office for shots I asked the doctor to take a peek at Avery's back to confirm my suspicion that the red area on her low back was indeed a hemangioma as I suspected.  It is and is no big deal. Here's a picture of it. 

Avery's hemangioma

We first noticed it when she was about three weeks old. Then it was just a small red spot and it lined up so well with the diaper covers that I thought maybe it was a blood blister from the skin getting pinched during changing. But it never went away and instead got a little bigger. It is now raised and when I checked in with "Dr. Google," it seemed to fit the description of a hemangioma. Here's a wiki link if you want to read more about it http://en.m.wikipedia.org/wiki/Hemangioma.  It will likely continue to grow over the next few months and then start to shrink on it's own, likely disappearing over the course of the first couple of years. 

I also asked the doctor about the dosage for Zantac for Isaiah because he's been fussier over the past week or two and often seems uncomfortable after eating (though not every time).  She did say we could up his dose to .6ml from .4 now that he weighs more to see if that helps.  

We can't wait til he (& the girls) outgrow this reflux business!  Sometimes spitting up doesn't seem to bother them (see this video of Ellie for example: http://youtu.be/NEztIrEsZRk), but other times they seem to be on pain or just be so sad about it. The worst though, is when it happens when they're sleeping or just falling asleep and it wakes then up!  Grrrr....  I'm actually nursing Isaiah right now because he spit up and woke himself up!  Like I said, we're ready for them to outgrow this!