Spawn off thought from another thread...
I have a colleague who had twins 6 weeks early. They were in the hospital for a while, and the first few months, if they were in foster care, I'd assume that they would have been listed as "medically fragile." Their biggest issues were GI related, reflux and such. It took many months to get the right medicine and such for them. So, I know through her that they were not allowed to go to daycare their first year because of being premature. She was fortunate that her DH and her scheduled could be monkeyed with that with some help from family, they didn't need a stranger caregiver either.
Now, of course her kids were not drug exposed, just natural.
My question that I have pondered for quite a long time. Is every drug addicted preemie automatically considered medically fragile just because they were preemie?
Or, is it only the micro preemie's that get considered medically fragile?
Or, is it the combination of being addicted AND a preemie, micro or not, that get that MF standing.
And, once the children are at an adjusted 6 week mark in their development, why do they still have to wait a year for daycare, assuming that they have no other major issues?
Please add whatever else meets these questions. I have been very curious about this for a long time. My friend at work, I don't see any reason why her kids couldn't have gone to daycare after say month 5.
So, what are all of these different tubes about? I know Pink's girl has I think it is called a G-tube? And then there is a J-tube? So, what I am getting at is it possible that the baby needs those for feeding, but otherwise the baby could be perfectly "normal" and whatever issue is causing the feeding issues resolves, they get the tube removed and are just like any other child?
I know that about the brain bleeds and of course shaken baby syndrome, but in my mind's eyes, a MF baby would be one that is connected in some way to some tubes. But then, baby could be epileptic, would that be MF, or what about CP?
Again I am not so much concerned with money because here, there are different levels not just on medical needs but development/psychological. I should have been bumped up the last year with my girls because I had to take them TWICE a week, one day for one, the other for the other girl to therapy for most of the last year they were here, I didn't even know I could have submitted mileage for that! So, they weren't MF but on per-diem basis.
I am thinking that MF is reserved then for the most severe of babies.
Temp: I have had several babies "with tubes"... When on oxygen they are connected 24/7 including a pulse oximeter monitor...these 2 pieces of equipment go together.
All of my tube fed babies over the years have been G-J tube feeders...this is a continuous feed 24/7 - they are "connected" to a tube feeding bag that needs tending to several times a day....a tube that bypasses the stomach and goes to the jejunum...that can only handle small about of drips per hour (hence, connected 24/7).
Some may outgrow the tube and learn coordinator/control to eat down the road but not without some set backs of aspiration pneumonias (inhaling food/liquid bits into lungs while trying to learn to eat) intensive speech therapy and other don't get off tubes because of brain damage, ect..
And you are right:
Med. Fragile labels are for the "severe" babies.
Med. Needy label is for NON-life threatening conditions.
My first placement was a 30 weeker and drug exposed. He was not considered medically fragile. He was traditional even with my home being therapeutic...so it would have been easy to have been done. He was born at 3 1/2 lbs and came to us 5 weeks old and exactly 5lbs. He didn't have any other medical issues other than small.
Thanks Kydz. So, follow-up question, would the need for the tube feeding be due to some physical limitations or defects? or is there a higher need in micro preemies.
I don't know how they fed Chubbs in the hospital, my friend said probably through a tube in his nose to his stomach? The first 2-2.5 weeks he was not sucking and thus not bottle feeding.
I see a lot of babies on the AdoptUsKids.org with those I think it is called Trach tube and just wonder if those are permanent and then I think Pink's baby girl has a feeding tube.
I am amazed at all of your therapeutic homes. I imagine you must do an extensive amount of education on your own to understand all of these different issues.
I thought to be deemed MF you had have a certain amount of appointments a month. Feeding tubes are so easy. I have never done trach care before but I'd be open to it. Its a little scarier since I have never done it before but I would love to learn. I have a friend who's son had a trach and feeding tube but now at 8 he has neither and is a typical kid.
Sometimes "slightly" premature babies require an NG tube (nose to tummy) briefly until they get the hang of suck/swallow...this is usually only done in the NICU with the intention of baby moving to full bottle feedings within a short period of time.
In general, micro preemies may need long/er term more complex, tube feeding due to severe reflux where if they eat by bottle they can reflux into lungs...so the tube feeds protect liquids from getting into lungs or they have brain bleeds that impair the suck/swallow ability or they may have lost part of the intestine due to NEC (a complication of extreme prematurity).
I am actually not listed as a "therapeutic home" my county just knows I will take medically fragile or needy babies. I purposely, don't want that label because then I would not get normal newborn calls, as well as, medical. Most therapeutic homes in my county take the "behavioral" kids not medical.
And yes, I worked in the medical field for several years before fostering.
Oh and trachs...yes, could be removed if no longer a need but I feel most severe kids have them for good reason and are in for the long term.
My 23 weeker was not drug exposed, she was and still is considered MF due (mostly) to her chronic lung disease.
A few DCF employees would give us the old, "oh, she's fiiiine, Mom can handle this" but they always took princess's health pretty seriously.
When she was small, we were attending 3-4 medical appointments a week for her eyes, kidneys, lungs, neonatology, pediatrics and then also feeding and nutrition and physical therapy would visit our home. To be honest, I do not know how in the world I would have worked outside the home and cared for her. I remember one week where we visited her high-level specialist 2 hours away and they asked us to consult with another doctor, an hour in the opposite direction in a major city- immediately. Also known as 'the week we spent 8 hours in the car and 5 hours in waiting rooms". Also, MF preemies are often overwhelmed by a lot of activity and have sensory processing issues. I wonder how well even a "healthy" preemie would handle daycare.
Healthy kids get a virus or cold and develop immunities that will perhaps protect them later in the season. Children with reactive airways are often more affected by subsequent infections/illnesses. Aspiration is a major risk for CLD/poor muscle tone babies also.
I dont want to deter you but you deserve an accurate picture of what it can be like. Not all preemies are MF and its probably fair to say that you'll know what you're likely to be up against by the time they're discharged.
I have 2 kids with mild CP, both were evaluated for g-tubes but I pushed to try thickened feeds. This means all their liquids are thickened to a honey state. One has seizures and both have SPD. And one has a genetic issue. They are not medically fragile. They are level 3 therapeutic.
The tube through the nose is an NG tube or nasal gastric. It. Is a short term option.
A G-tube feed go directly to the stomach and each bolus is pushed through the tube typically by hand, occasionally by pump.
A trach is many times permanent, but it depends on the reason it was placed. I know many who have come off a trach as they progressed. For instance my friend was on a trach following a stroke and once she could breath well on her own and had the strength to cough and stay clear it was removed.
Just a note (as I am a maternity nurse) that a full term delivery is actually 37 weeks and later. A baby isn't a "preemie" unless they we born at 36 weeks and 6 days or earlier.
NSB
Just a note (as I am a maternity nurse) that a full term delivery is actually 37 weeks and later. A baby isn't a "preemie" unless they we born at 36 weeks and 6 days or earlier.
As a NICU nurse, any baby born before 39 weeks is considered "late preterm". They don't automatically come to the nicu like a kid less than 35 weeks does, but they still have more issues than a baby born at or after 39 weeks. Lung development/respiratory distress is the most common reason for late preterm babies to come to the NICU.
Re recertifying. My state has a program where you can read a book, which they mail you from a library. Then I don't even think you have to answer a questionnaire, just tell them you read it. You probably know all the prigrams in your state, just thought I'd toss this out. If you checked with your agency, they might give credits for reading a book, or various online classes.
Wow, this has been such fascinating information! Thanks. Chubbs was born at 41 weeks and 5 days and I never understood how they knew that. I seriously doubt his bio mom knew exact date of conception, but maybe she did.
Re: taking MF kids, I am thinking more later on, I definitely don't think I could do it based on what you all are reporting until I was no longer working.
So, how do you all who have several MF handle all of the appointments. I do think maybe when I retire I could help in this area. Assuming I can afford to retire before I am 70, LOL.
The doctors & hospitals have a list of what conditions fall under the medically fragile label. Being a preemie, drug exposed, etc is not an indicator or an automatic negation of the MF label. There are full term babies with no risk factors who end up with the MF label. My nephew was full term, no exposure, but had complications right after birth that led him to be classified as MF for a while. He is fine now, at age 6.
BD was born at 35 weeks. The hospital had a policy that every baby less than 36 weeks automatically went to the NICU for evaluation. They took her from me the minute she was born - I didn't even get to see her. She was in the regular nursery the next day - no medical problems. She had to eat every hour due to some digestion problems we discovered. During that feeding of 1 oz, she had to be burped 2 or 3 times. No daycare would take her because theydidn't have the time to feed her the way she needed to be fed. The docs recommended no daycare, and anyone who touched her had to wash hands & use antibacterial gel for 6 months. I ended up becoming a SAHM. Six years later, she is healthy as a horse but did have RSV around 18 months of age. No hospitalization needed, though.
I have done in-home respite for MF children. They generally required nursing care/visits. The medically needy kids were able to be cared for by their parents after a little extra training. None of the kids (MF or MN) that I did respite for were exposed to drugs.
There are ways to know gestational age in a newborn [url=http://www.slideshare.net/themedicalpost/gestational-age-assessment-and-neonatal-reflexes]Gestational age assessment and Neonatal reflexes[/url]
HB was born very small (5lbs) and bio mom claimed he was early but the doctors say he was full term. I believe the doctors because even though he is still small for his age, he is on target if not advance in developmental milestones.
I don't have any trouble with AD's dr and therapy appts because I'm very lucky to be a stay at home mom.
I know many empty nester foster homes (aged 65+) that make terrific foster parents;)
buckeyemama
I know many empty nester foster homes (aged 65+) that make terrific foster parents;)
Yeah, so do you think I could do a MN, maybe not MF, AND a teen mom at the same time? I'd still like to help a teen mom, but the idea of helping a baby is appealing too.
I am hoping to have enough stocked away to semi-retire around age 65 and not have to wait until 70 1/2. My goal is to get my teaching degree and be a substitute teacher for a while. By then the mortgage and student loans should be gone so I could live off 1/4 my current salary. :-)
Oh. Wait. The boys will be in college then. I may need to rethink that plan...