02 February 2016

Zoe at 4 Months

Beautiful girl Zoe
We have entered into the phase of significant developmental changes with Miss Zoe. During the month of December, she turned into quite the chatterbox. She loves talking to her family and her toys. When Rose is in the room, Zoe's eyes follow her wherever she goes, and she loves watching Darwin. She has become increasingly more attentive and reacts to our animated faces with great joy. I'm grateful that she has proven herself to be very tolerant of her sister's less-than-gentle ways, and that she continues to be very healthy and strong.

During her fourth month, we continued dealing with Zoe's skin rash and sensitivity on and off. We were in the northeast during early December and had to apply lotion and vaseline to her face daily, and sometimes several times per day because the air was so cold and dry. I stopped eating dairy after reading about the various causes of eczema in infants, which can include the mother's diet in breastfed babies. We did notice some improvement, but it was really difficult to maintain that diet while traveling, and especially hard over the holidays. The dairy seemed be be a major trigger, but there also seemed to be something else that caused the rash that I couldn't figure out. In addition to the dairy, I eliminated breads (because of yeast) and eggs. When I was off all three ingredients she did seem to do a lot better, but it is so hard to stay away from all of these when eating out. So many restaurants cook with butter!

We noticed the greatest improvement in Zoe's skin during the few days that we went to Hilton Head over Christmas. I think Zoe is trying to tell us we need to live at the beach! Her daddy is in complete agreement. During those few days at the beach, we cooked most of our meals at home since restaurants were closed. I was able to keep to a strict yeast, dairy, and egg-free diet.  Unfortunately, when we arrived back home, she had a few more flare ups, making me question whether it was diet or environmental. It was so frustrating to not be able to control the rash, and to not be able to completely be in control of my food intake because of eating out on the last day of our trip. I also hated lathering her face with over the counter hydrocortisone cream, which seemed to be the only thing that would help clear her face when it was rashy. The worst though, was seeing her uncomfortable and itchy. We had to cover her hands with mittens because I just couldn't keep her nails trimmed enough or prevent her from scratching her head and face. Leading up to her 4 month doctor's appointment, her face was not only rashy, but raw from her rubbing, scratched up from her nails, and a little dry from the cold weather and forced hot central air.
Zoe at 4 months
At that 4-month doctor's appointment we arrived without treating her face with any hydrocortisone so the doctor could see how bad it was. Thankfully, Zoe was given a clean bill of health otherwise, giving the doctor her full attention and showing off all her skills during the visit. We spent most of the time discussing what to do about the rash. The doctor swabbed the areas that were raw to test for bacteria, and gave us two cream-based prescriptions, a 2% hydrocortisone and an antibiotic, after we voiced our objections to an oral antibiotic. He said the skin was likely infected (needing an antibiotic and confirmed to be a staph, not MRSA, infection), and that we really needed to treat it with the hydrocortisone to keep Zoe from being so uncomfortable. In his opinion, it would be too difficult to figure out the cause of the rash. I had hoped we could identify the cause, but really didn't expect the doctor to have an answer. One of the most helpful suggestions we received at the doctor's office came from the front desk staff who suggested filing nails instead of using the scissors.

Within 24 hours of treating the rash with the antibiotic, it was significantly better. Instead of using the 2% hydrocortisone cream, I found a 0.5% over the counter (marketed "for sensitive skin") that seemed to work really well in combination with the antibiotic cream. I decided not to use the 2% after reading the medication information inside of the package that said no research had been done on children under 2. While I don't like that the 0.5% hydrocortisone also says not for children under 2, I feel a little better that it is not as potent. The doctor told us there would be no problems using the over-the-counter (1%) hydrocortisone long-term, but I will continue to use the minimum amount necessary to keep the rash at bay. We only needed the antibiotic a few days to clear up the rash, and used the hydrocortisone daily for a few weeks. Now, at 3 weeks since starting the medication regularly (and me continuing to avoid dairy and eggs, and sometimes bread), we only spot treat with hydrocortisone as needed.

Sweet Zoe enjoying a rest in the co-sleeper
As Zoe approached 4 months, and I started working in the office again, we transitioned Zoe from the co-sleeper in our bedroom to her crib in her own room. The transition was fairly easy, starting with a few naps in her crib to putting her down in her crib at night. We still swaddle her at night only and try to put her down sleepy, but awake. Sometimes she falls asleep while nursing and I am unable to arouse her before putting her to bed. We've also continued using the incline wedge since she seems to sleep better on the incline than flat on her back.

Her overnight schedule continues to be a challenge, and was especially difficult at the notorious "4 month sleep regression." I had read about it and thankfully only experienced one night where she woke to nurse every two hours on the dot (11:30p, 1:30a, 3:30a and 5:30a). At least it was over the weekend, when I could sleep in the next day! For the most part, Zoe goes to sleep around 7:30-8pm when Rose does, and sleeps until 6:30-8am with only a few wake ups. I always check in on her before I go to bed (10:30-11:30p), and will feed her if she stirs when I walk in. If she is sleeping deeply, I don't wake her, and sometimes get woken up shortly after going to bed. She has been waking up around 2am and/or 5am to nurse. The 5am is the tough one for me, and it is really hard when she wakes at both times.

Zoe gets serious in front of the camera
Zoe's eyes remain very blue and she continues to have a fair amount of hair in the back (with serious male-pattern baldness). She smiles so much, but gets very serious while I pull out the camera! She is a very sweet child, and still gets a little tired/cranky in the evenings around dinner time.

We continue to cloth diaper both Rose and Zoe, with both only using disposables at night. The disposables are great at keeping all the pee in the diaper all night (8p-8a) so I don't have to change Zoe when I wake up to feed her. Unfortunately, they are not as good as the cloth diapers at keeping poop explosions in. There have been a few nights where Zoe has pooped during one of her nighttime feeds and I've had to change her whole outfit when I just wanted to finish nursing and get back to bed.

At 4 months, Zoe is outgrowing her 6 month clothes. The doctor weighed her at the 65th percentile (14.2 lbs) and measured her at 23.5 inches, or 33rd percentile. I don't think her height is accurate, but I will confirm that her 6 month clothes are more tight than too short. :)  She is such a cute chunky baby!

Having gone back to work in early January, Zoe now stays with my mom at home while Colin and I are at work and Rose is at school. I try to pump a bottle (or two) before I leave for work and about 3 bottles (all about 4oz each) during the work day. I have a freezer full of stored milk, but much of it was pumped before I went dairy, yeast, or egg-free. I think the first day I went back to the office, when Zoe took a full day's worth of previously pumped milk, was what triggered her really bad rash that became infected. I'm nervous about being able to meet her demand by pumping, and try to pump 3-4 times in the office. So far, no one has commented on my door being closed so often, and I've been able to pump a little extra on a few occasions. I continue to be grateful for a job where I have a private office where I can work as I pump.

Sisterly love for the camera
A couple of friends of mine on Facebook posted a beautiful piece about appreciating each moment in time as it comes. I knew the first three months would be difficult and will admit I looked forward to their passing. But now that Zoe is sleeping a little longer, engaging with us, and sitting up more independently, I want time to slow down. I know life doesn't work like that. Days, weeks, months, and years pass quickly. I want these milestones and these memories to be recorded, which is why I write the blog. But I need to remember to balance documenting the milestones with enjoying them as they happen.