Surviving the NICU with micro-preemies… with a toddler (and partner!) at home: What this pediatric occupational therapist and mother did to support her babies

How to Survive the NICU with 3 under 3, tales from a pediatric occupational therapist and mother of 3

On this episode of the Learn With Less podcast, we’re joined by Jennifer Russell of the Instagram handle @otmomdiaries. Jen is a pediatric occupational therapist by training, and at the time of this recording, on maternity leave with her NICU warrior twin babies and spunky preschooler.

Jen is committed to boosting parent confidence & connection, and her passion lies in supporting young children and families to set the foundation for greater participation in life. She believes supporting children’s emerging skills, as well as bolstering parent understanding during early development, sets the stage for further learning.

On this episode, we discuss:

  • Jen’s own professional background, and how she came to do the work she’s doing today
  • Jen shares with us the story of her journey into three kids under three, and about her NICU experience
  • What resonates with her about the Learn With Less philosophy: how she knew the simple things were the things that mattered, and how she knew that was the “right” thing to do for her little ones
  • Jen’s top tips and resources for all parents – especially applicable to parents of premature babies

Great resources we mentioned in this podcast episode:

Understanding Your Baby and Understanding Your Toddler: the week-by-week development and activity guides to playing with your baby from birth to three years

Learn With Less Curriculum Online Program: get week-by-week developmental info and simple activities based on your child’s developmental age (using what you already have), plus additional group support and virtual workshops

Every Tiny Thing: created by a NICU nurse, products specializing in journaling and celebrating small milestones for parents of babies in the NICU

CanDoKiddo: pediatric occupational therapist, Rachel Coley, shares baby and toddler development resources from an OT perspective

Secret Guide to Tummy Time: Learn With Less podcast episode featuring Rachel Coley of CanDoKiddo

Pathways.org

The Whole Brain Child, by Dan Siegel (amazon affiliate link)

Connect With Us

Ayelet: Facebook / Instagram / Pinterest

Jennifer: Website Facebook / Instagram

TEXT TRANSCRIPT OF THIS EPISODE

Ayelet: Today, I’m speaking with Jennifer Russell, a pediatric occupational therapist by training who is currently on maternity leave with her NICU warrior twin babies and spunky preschooler. Jen is committed to boosting parent confidence and connection, and her passion lies in supporting young children and families to set the foundation for greater participation in life.

She believes that supporting young children’s emerging skills as well as bolstering parent understanding during early development sets the stage for further learning. So Jennifer, I first connected with you on Instagram by following your feed over at @OTmomdiaries, and I just love how you share and talk about your experience both as a mom and a professional. And I want to thank you for being here. So welcome.

Jennifer: Thank you so much. It was, I was honestly so shocked and floored since I’d been listening to you for a couple of years. I have a bit of a commute when I go back to work. So when I went back to work after my first mat leave. You were a regular in our car for those commutes for my daughter in the back. So it’s a, it’s a pleasure to be talking to you.

Ayelet: Oh, awesome. Well, I’ve asked you to come onto the show today to speak to us really about your story and your journey into the world of having three kids under three and a bit about your NICU experience and about your philosophy in supporting all three of your young children. But first, why don’t you just tell us a bit more about you and how you got into the work you’re doing today.

Jennifer: Well, as you said, I’m a pediatric occupational therapist. I graduated from OT school back in 2010 and at that point, within a couple of months I was super lucky to land what I thought at the time or, still is, my dream job right away, at a government funded children’s treatment center here in Ontario, Canada, Canadian here. And since 2010 I’ve primarily worked with the children and their families, zero to five years old.

In case, some listeners are thinking, what is occupational therapy? I came prepared to, to explain that one. Our title is so confusing for people. They always assume we have something to do with helping people work. But as any good pediatric occupational therapist will do, we will then joke that in fact children have very important jobs to do. So.

And then my next joke that usually follows that one up for any new family is that, you know, the speech therapist will look at helping your child to talk. The physiotherapist is going to help them to walk, and then the OT is going to look at all the other stuff in between walking and talking.

Ayelet: Well tell us, just a couple of little tidbits about what that might look like. So people have just like a firm grasp.

Jennifer: Oh, good question. So basically we, we look at daily function. Again, another cheesy joke (I’m full of them) is that we put the fun in function for, for kids since there are so many aspects of their day as they’re learning and growing and playing that they’re really kind of, like I said before, they’re setting those foundations for future skills that they need. And a lot of that really is supporting that early development.

Usually as an OT to help make all the other things in between more manageable, I’ll break it down into three main categories when I’m working with families. So I might ask how things are going in a category called “self care.” So how your child’s doing with dressing, eating, sleeping, their ability to participate or the parents’ ability to care for them. Especially for those younger children where they’re a bit more dependent on you. Seeing kind of how you can support them in feeding or sleeping early on.

The next category we call kind of “productivity.” So to be a productive child, usually that’s play… As they get a bit older into school years, looking at how they’re functioning at school and participating in routine circle time at classroom activities.

And then the third category we call “leisure.” So kind of just what that child wants to do on a daily basis. We kind of just think of occupation as the meaningful activities that people want to do and people need to do on a daily basis. And we look at any of those barriers that are in the way to having those children participate in what they want to do every day.

Ayelet: Perfect. Ah, so well-stated I’ve had several OTs come on and everyone does their little bit, but that was, that was great. Thank you. So tell us, you became a mom the first time around. Tell us a bit about life back then. You went from professional working with families to being an actual parent. So tell me a bit about… What were some of the biggest challenges that you found yourself experiencing the first time around?

Jennifer: The first time round, I guess it was just kind of an eye-opener I think to kind of transition from telling people what to do or should do to then realizing maybe how realistic or not realistic some of the recommendations or things that I may have been giving to families, pre-kids. And just the aspect of time, and what you kind of have the bandwidth available to do.

So I guess not necessarily, well I guess it was a challenge and trying to, just being… Reflecting back on previous assumptions or clinical skills and kind of reflecting on how going forward I’m going to change how I work with a family or what I might recommend going forward, and just breaking things down and just being more manageable, being more digestible and kind of saying if I can give you one thing to work on this week, it’s this versus maybe the 10 things I might’ve given them before having my own child.

Ayelet: Right! Yeah, so the overwhelm, the need to really things down into one piece. I think that’s exactly what I found as well. All right, so now your little girl is a toddler, and you get pregnant again. Talk us through a little bit about your journey with the twins.

Jennifer: I’ll just say so if I take everyone back to, I guess, our 12 week ultrasound with the twins. My first daughter was I think one and a half at the time and we had that first ultrasound at 12 weeks and kind of had our worlds rocked to find out that there were two babies instead of one at that point along. And then we were still recovering from that news, when my obstetrician called us to schedule another ultrasound at 16 weeks.

I’m not sure how it is in other places, but here in Ontario, Canada, it’s routine, you kind of have a 12 week ultrasound and then you don’t have another one usually until 20 weeks unless there’s other complications and things. So I was a bit surprised to get a call that there was a new ultrasound I wasn’t, I never needed the first time around. And it was because we had twins, and later we found out it especially because we had what they call monochorionic twins, which are identical twins that share one placenta.

So we had to be followed much more closely and scanned more frequently for complications. The very complications that did happen. So I guess that’ll be my one awareness plug that if you know somebody who is expecting twins and they haven’t been told to have this extra scan at 16 weeks, make sure that you’re getting monitored by somebody who knows what they’re looking for.

Because at 16 weeks, it revealed the beginnings of something called twin to twin transfusion syndrome. Or I’ll just call it TTTS from now on to keep it short. And this only happens to those identical twins who are sharing a placenta.

So my girls had shared blood vessels in this shared placenta and essentially to sum it up, shortly, it’s just that the blood flow issues occur and one baby who’s known as the “donor” ends up kind of giving away, sending away all their blood and nutrition to what they call the “recipient” twin through these shared blood vessels, and things get kind of pretty scary pretty fast.

We were immediately referred to a hospital in Toronto where we luckily only live a short distance from, as we later found out that maybe only one or two other hospitals in all of Canada can deal with this and are ready to treat.

So we felt really fortunate that we could either drive when there’s no traffic or take a commuter train downtown. So we had that scan around 17 weeks and then by 18 weeks on the dot, I had an in utero surgery that I was wide awake for. They made a small incision beside my belly button and they just placed in a camera and a laser to essentially zap all of those blood vessels that were causing the blood flow issue. And I was just there watching, they asked if I wanted to watch on a TV screen and I said, sure.

I guess having a healthcare background, I was more just fascinated and I was like, it’s not very often you’ll have that type of opportunity to see your fetuses at 18 weeks I saw them saw little hands, feet float by and it was truly surreal. I was pretty, we were, we were very successful. The surgery was very successful. They were able to stop that blood flow issue.

But, there’s a but, the doctors had told us that on top of this blood flow issue, the girls were not sharing the placenta evenly. So they kind of explained that with the surgery, they could prevent Olivia or donor baby from giving away what she was getting, but they couldn’t give her any more of the placenta than what she had.

So she had what they also call selective intrauterine growth restriction or IUGR, on top of the twin to twin transfusion. So they didn’t know at that point if she had a big enough share to grow big enough and strong enough to make it to a gestation where she could be viable. So it was kind of just a wait and see after that surgery.

Ayelet: It’s a lot. It’s a time to take in. That’s really when you’re managing the big needs of a toddler at the same time.

Jennifer: Oh yes. Yes. It gets, it gets even more dramatic.

Ayelet: Keep going.

Jennifer: So our specialist at the time of the surgery gave her about a 30% chance of surviving the pregnancy, not to mention on top of that, one of the main risks in having the surgery itself is your water breaking, because they put a hole in it to do the surgery. So then from weeks 18 to 31, we had ultrasounds every two weeks, just to kind of keep monitoring to make sure that the surgery was successful and that…

It was, it was actually really quite incredible, the degree of precision that they could monitor certain blood flows to different parts of each baby’s brain and heart. And it was, we tried our best to keep up with what they are telling us and I was so grateful to have the OT background that I can’t imagine what it’s like for those parents who don’t have that kind of previous knowledge to allow them to be, it would just be so overwhelming.

At one point there was one follow-up and I remember clearly it was, it was black Friday and so about three weeks after our surgery. And for some reason we had um, a new specialist filling in that day to interpret our results from our ultrasound. And he actually told us that, well my husband didn’t come because things have been going so well.

So I was by myself and that doctor actually told me to prepare for her to pass away. And that based on what he was seeing that day, she wouldn’t make it and to be fully prepared at the next ultrasound to not hear her heartbeat.

So we kind of spent two weeks grieving really hard in the middle of everything and trying to make sense of what that all meant. But then at the next followup she was there, she was fighting hard. We never saw that doctor again. So I never got to fully tell him how I felt about his prediction.

Ayelet: Right. I’m sure you rehearsed that one in your head many times though.

Jennifer: Oh yeah! But then it was all at the same time glad not to have to see him again. So then, yeah, every, every two weeks she was there, she was always tracking underneath the first percentile, if you can imagine a baby growing that slowly and that small. So we just kinda kept showing up, just waiting to find out how things were going to happen.

It was always just looking for signs that we needed to deliver, that things would be better out than in as they say. So we reached 31 weeks and I was admitted to the hospital on my birthday, with new symptoms that were kind of happening that we weren’t sure what they meant. So I had the steroid shots at that point. They do two shots, I think 24 hours apart, I believe to help with the lung development, to prepare for premature labor.

I was there for a week every single morning, at that point they had an ultrasound again, it all those precise measurements and then every three hours they hooked up my tummy to what they call non-stress tests or NSTs, kind of like those monitors they put on when you have contractions when you’re out to go into labor. Just to be, tracking heart rates and things like that to make sure if they see any big decelerations then it just means they need closer monitoring or maybe they need to come out.

So because Olivia was always so tiny, our doctor had kind of, when we asked for, kind of his blunt opinion of when is it that she has a chance to make it, he told us that he felt we needed to make it to 32 weeks for her to be big enough and strong enough.

So, low and behold, 32 weeks and one day, that morning the daily ultrasound showed some fluid in her tummy that wasn’t there the day before and up until that point all week, the steroids shots actually give the babies what they call a “honeymoon period” where the steroids might temporarily increase blood flow and give the babies more positive readings than they might have without them.

So she’d been doing really well all week and then we saw the fluid on her tummy and the doctor said, we don’t know what this means, but we know leaving her in there means she’s going to get sicker. So you’re having your babies today. And we had them that afternoon and they were able to kind of show me Evelyn, Baby A, or the receipient, quickly.

They pulled her out first and showed me her on the other side of the curtain. So I got to hear her, and then Olivia though needed to be taken right away to the resuscitation room and my husband was able to go with them as the doctors kind of did their thing to make sure everybody was breathing and seeing what kind of support they need. While I had to wait to be stitched back up, I think it was a good, I don’t know, half an hour, 40 minutes till I got to get in the room and see how everyone was, was doing.

So Evelyn, just to give you an idea of like how small everybody was, Evelyn at 32 weeks and one day was three pounds, 10 ounces and Olivia was only one pound, 10 ounces, still. Even though she was 32 weeks gestation, she was about the size of a 25 week old baby. Evelyn was able to breathe right away on room air and then Olivia just needed some light kind of pressure to help those lungs fill or otherwise known as C-PAP for anyone that knows what that is.

But actually she didn’t require any supplemental oxygen, which was pretty incredible for such a small baby, she, she was, they actually say that sometimes those IEGR babies because they’re under so much stress in utero that they come out just fighting because they’re, they’re just used to fighting for their life. And then the next part, sorry, it keeps going!

Ayelet: No! It’s the story! No apologies!

Jennifer: So everything was kind of under control for a day. We were like, wow, okay. We didn’t know until that day if we were going to be a family of four or five. So we kind of started settling into we’re going to be a family of five, we need to buy a van.

Ayelet: All the practical issues.

Jennifer: Emma needs to be moved into a smaller room so the twins can share her big bedroom. You kind of start nesting now. But then on the second warning, the nurses that had been with her the day before, had said to me that they thought, they asked me if they thought her stomach looks more swollen and more red. And when I looked, I definitely thought it did.

So the doctors did some x-rays and saw air in her abdomen, now. So the doctor sat me down and said that this meant there must be a hole somewhere in her bowel and that kind of her breathing support was pushing air out into her tummy through that hole.

At this point at this hospital, they couldn’t tell me if this was just kind of like a fluke, a hole just from her bowel being fragile, from being so restricted in her growth or if it was something called necrotizing enterocolitis, or they call it NEC for short, which is a pretty common and and very aggressive and very scary infection that preemies can get in the NICU.

They needed to send her across the street to a specialized children’s hospital. So that part was, I still feel like when I think of that memory, play it back in my mind. It feels like I was kind of watching from above. Like one of those moments in your life. They had to intubate her, so kind of put a breathing tube in and stabilize her to be moved and prepped for the surgery.

And I still remember we’d had the same nurse for a couple of days and she was crying as she was getting her ready. So it was just kind of like, wow, okay. If the nurse is this upset, like this is serious, I just, I just remember sitting beside the bed being helpless. I couldn’t touch her, just waiting for the team to move her and singing her, “you are my sunshine” because that’s what I saying to them in my tummy the whole whole time.

So yeah. So we, my husband had to wheel me and that wheelchair across the street since I was still recovering from the C-section, it was the middle of like the middle of February. It was freezing. And so for whatever reason, I, we weren’t allowed to go with the actual transport team through the specialized tunnels and things that they bring her. So we… yeah, I’m not sure what the policy and procedure is there.

We met with the surgeon in the NICU at the other hospital, and he was kind of going through all, we had to sign off on the paperwork saying that we understood all the risks. And then, yeah, before we knew it, he was back and he was able to say that even though he had thought it was NEC, that infection, it wasn’t.

And we didn’t know at the time it happened, later kind of confirmed that it was just when a fetus has really severe IEGR, it’s really smart and it takes the blood and nutrition that it is getting and it sends it to all the really critical organs like the brain and the heart and the bowel was after the first place that it kind of starts neglecting.

So it can become very fragile. And then if there’s that meconium sticky poop in there, that’s the babies have, that those breathing reports can end up blowing that through the sides of the intestine. So, the surgeon removed an inch and a half of her bowel. But because she was so tiny, she was less than a pound and a half when he operated because of that weight that they lose. And she didn’t want to, I guess for lack of a better explanation, sew both backs ends together, because that would just potentially cause more scar tissue, more blockage and potentially another rupture.

So he left the two ends outside of her tummy and gave her what they call an ostomy. So there was a bag that got secured around what we called her two little nubs just to catch her stool, and she came home with this ostomy 10 weeks later and I was left to be the nurse at home to change it and clean it.

Ayelet: How often does you have to do that? I mean every time a newborn poos or pees…

Jennifer: Luckily, it had like a little cap on the end that as it filled up, you could empty it into a diaper or a syringe, but a lot of times depending on how good you were at putting it on or how well you cleaned the surface, like to stick the bag on, usually the more of the concern was that it started leaking.

So some days if I did a really good one it would last maybe three or four days. But then there were some days I think if I was extra sleep deprived or, or what have you, that it felt like upwards of like three times a day where it, when it was like the process too. She wasn’t a huge fan because we cleaned the area and then drag it off and yeah…

Ayelet: Of course. So, okay. So let’s just back up for just a second, because you said 10 weeks later they came, did both twins stay for 10 weeks or did she stay longer, Olivia?

Jennifer: Yes sorry. I can, I can go back. So Evelyn was kind of like a NICU rock star. She just was what they call like a “feeder and grower.” There were no complications. So when a baby’s that little, they just need to wait till they’ve matured enough to be able to coordinate, kind of that suck, swallow, breathe to be able to feed successfully at home and not without the support of the feeding tube down her nose. So she was home in five weeks.

Ayelet: With the feeding tube removed?

Jennifer: Yep!

Ayelet: Amazing.

Jennifer: Yeah. So she, she did great. She was bottle fed at that time. And yeah, so that was five weeks. Cause usually when you have a baby premature, they, they tell you to prepare for them to at least be there until their due date. So we were pretty lucky that she came home at what would have been like 37 weeks I guess then. And then so those early days were really hard because the girls were in two different hospitals.

Olivia couldn’t be transferred back to where Evelyn was, and Evelyn, they wouldn’t send her to a hospital that had more care than she needed. And we were actually quite fortunate, the hospital that Evelyn was at, she would have otherwise been transferred to kind of what they call the step down care somewhere else then because they weren’t twofold.

They had said to us that if it’s easier for you to have your babies across the street from each other versus in different cities, then we’ll do that here for you. Yeah. So, um, so I would kind of split my day. You know, I, I’d wake up, I would pump.

Well, that was the other piece too is that I remember the morning after Olivia’s surgery, the nurses said to me, your breast milk is critical to your daughter’s bowel recovery and her surgery, like she needs it. So I was pumping about nine times a day to get that going so that way my milk could help her heal.

So there was pumping nine times a day. There was getting up, taking the train downtown and then from the train a subway up to one hospital for around three, four hours. Then I’d literally walk across the street, while eating the sandwich that I packed in my backpack, I’d walk and eat over to the next hospital to spend another three or four hours with my other daughter.

And then, I mean my toddler was not even two yet when they were born. So she still needed me too and we would, if she went a day without seeing me, we could see it in her behavior. And knowing what I know about childhood and development and attachment, I was like, it’s equally as important that like she feels all this stress, she knows what’s going on.

And she needs to see me at least for an hour or two before she goes to bed. So every day was being torn three different ways and then waking up in the middle of the night for pump for babies that aren’t even at home.

Ayelet: How long were you in the hospital and at what point did you go home at least, I mean obviously you were in the hospital all the time, but at what point were you discharged?

Jennifer: That’s a story in itself. I’ll condense that one. So, we had the babies Friday afternoon and they were trying to, like, I would have been discharged the Sunday afternoon, but that’s when we started seeing the difficulties.

So I remember, I don’t know, I think I was technically discharged, but she had the surgery Sunday night around like 11:00 PM or midnight and we just kind of didn’t leave the hospital because we didn’t know where else to go by midnight or ever so. But like by Monday morning we had to be out and yeah, she was. Yeah, it was pretty quick. Yeah.

Ayelet: What was the biggest, I mean in terms of both practical and emotional challenge that you would say for you that happened then when you were home and they were still there?

Jennifer: I feel like it’s, it is a big blur. It’s kind of like, I don’t know, like an, I do kind of compare it to the difference between when you have your first baby, the only… and it’s only one, you just get so used to doing and being everything for that, that child, but then kind of when you don’t have a choice, I don’t know, it just, it felt like this is what we have to do and I trusted the teams, I trusted the doctors.

The hospitals are so renowned that I just knew that I needed to take care of myself. I needed to pump and I needed to not get sick because if you get sick, you can’t go to the NICU. So it was just kind of like, I think you just are purely functioning on adrenaline. Yeah. And you just, you’re just moving kind of like a robot through what you need to do. And if you stop, you don’t know if you’ll start again. So you don’t entertain that.

Ayelet: Okay. Okay. So now everyone’s home 10 weeks later. What then, how did you manage everyone’s needs? What were your biggest challenges in all three of them at once?

Jennifer: We had a set of grandparents, or at least a grandma, 24-7, and we were so fortunate for at least a few good months. And even now, my mother-in-law still does help a few times a week because three at this age is just insane. Like I can manage everybody during the day, but then I have no energy left at the end of the day to do the laundry or go grocery shopping or anything like that. So…

Ayelet: And the twins now are how old?

Jennifer: They’re almost 17, almost 17 months. 17 months and almost 15 months corrected. Right. It’s hard to keep track of their actual age and the, that corrected age for preemies.

Ayelet: Okay. So in the beginning.

Jennifer: I got really good, I had this amazing, um, pillow. It’s like a twin size boppy pillow. So the only way I could really, the girls never ended up being able to actually breastfeed. So I actually exclusively pumped for 14 months. Evelyn, I don’t know, the lactation consultant couldn’t come up with anything other than she was a little bit lazy and just preferred the bottle.

And then Olivia, because she was so tiny, she came home with strict kind of rules around being fed exactly on like a three hour schedule, a certain amount. And they had me adding formula to all of the breast milk for extra calories, so there wasn’t a lot of wiggle room to practice breastfeeding. And then when you have twins and a toddler and you’re still pumping cause you need to be making milk, there’s not a lot of time to practice.

So I just kind of threw in the towel after about a month of being home and a few visits to the lactation consultant to just survive, survive. So then kinda back to my big pillow, I found a way that I could lie each twin on their side, prop the bottle up and then be pumping at the same time.

So that at least I could have some sanity and not kind of feed and then pump and then clean the bottles. It was more just if I can feed and pump at the same time, then… then I can at least have a little bit of free time to try and see the toddler or snuggle a baby or… shower.

Ayelet: And actually enjoy or take care of something to keep you alive. Yeah. All right. So you mentioned a little bit about your own background as an occupational therapist and you know, having some knowledge at least a little bit of just the medical knowledge, the, the terminology, all of those things. What about your husband? How was he fairing?

Jennifer: I think… He’s an engineer by profession, so it was just interesting I think too to see a therapist brain versus like an analytic and linear brain, kind of what information stood out to him versus me where you can get very stuck on like statistics and numbers and where I like, I’d always be more concerned like long-term function and like that type of thing.

I do think he was really good at asking questions when he didn’t understand so he’d get his information that way. But there was definitely a lot of times where I could be like, Oh they mean this or like that means that where it was, I guess he would get that second hand through me and being able to kind of interpret what some of the doctors and nurses meant sometimes. Especially around like things like feeding.

Ayelet: Right. That’s great. Because there is so, I mean in general there’s so much of that physical care is sort of overwhelming when you have a new baby and then when you have three babies essentially, especially the youngest of which have extreme physical care needs. That’s a lot. That’s a lot of the time.

Jennifer: Yes.

Ayelet: So tell me more about as things went along, when do you feel like the physical care sort of started to subside and the actual care and love and play and all of that started to replace it?

Jennifer: That’s, that’s a really good question. So I guess by the time Olivia came home, she was two weeks past her due date. I’m trying to think. It was a couple of months l,ike especially as I got used to just that care for the ostomy and we’d have different professionals coming and going from our homes. There were a lot of follow-up appointments right away too where that kind of just takes all of your time and you’re just trying to function and get from doctor to doctor and wait for results.

But I’d say a good two months at home to get in that groove of feeling like I’ve got this pumping and feeding thing down. I’ve got this ostomy bag thing down and then like, okay, now it’s just time to snuggle a bit. And yeah, like probably a couple, a couple months, but I was always so thankful that it wasn’t my first parenting experience and I always, when I would see brand new parents in the NICU, I would just feel for them cause I couldn’t imagine.

I mean you’re so overwhelmed as a new parent of a typically fully grown full-term baby that I was always so thankful that I already had some tools in my toolbox to kind of talk. And you have that experience that like if a baby’s crying, you remember that like it was tough but you got through it and like without that added stress like it was, yeah. So my heart goes out to all you, all you preemie mamas, that that was your first experience. That must’ve been so tough.

Ayelet: Right? It’s tough all around. And then knowing what you know about early development, tell me a bit about what resonates with you about sort of the Learn With Less philosophy. Did you read both books or did you just read the toddler book?

Jennifer: I’ve just got to the toddler book. When, when did you have them come out? I don’t know if it was while the pregnancy, but anyways, but yeah, like I part of me like I mentioned that I wish I had found the baby book, but I’ve been all over the, the toddler book.

So what resonates with me is that, you know, when all of a sudden you have three children under three and you just realize that you’re living life with less anyway, less time, less sleep, less patience. So you want to make the biggest impact in the limited time that you have so that you feel like you are doing something good for and with your baby or toddler, as you always say.

But in reality they really just need you and maybe some random stuff around the house. So when you can get that concise, impactful and practical information about their development and how to foster it without any crazy equipment or toys, it’s so, so empowering.

And then the philosophy is just such a great reminder of how it is those simple things and simple moments that matter the most. It’s quality over quantity. Which is what you got to work with when you’re, especially in some survival mode, whether that be because of premature birth or just life.

And you don’t need, you don’t need to break the bank to support their development. I wish I had found the books while the girls were babies, but I’ve been so appreciating the toddler book, especially as everybody gets older and busier. So currently I’ve been following along for their corrected age, and love how simple your suggestion was even just at 15 months old that adding in music doesn’t mean a full song. I think some people get really intimidated by music especially, I’m not that musically inclined. So just the reminder that you can just use one word and just change the intonation.

So the girls are loving if we’re making a tower just up, up, up, and then it’s just so funny to see that they look at me differently, they notice the activity’s different when I’m adding that in and just keeps them interested that much longer and adds a bit more excitement and they, they love it. And even though I’m a therapist that’s supposed to kind of know this stuff, you forget at the end of a long day or I haven’t been practicing for almost two years…

Ayelet: Right! When you’re the mom, it’s harder.

Jennifer: It’s so much harder. So to, like, have three or four pages a month to kind of turn to when I remember it, whenever I remember it, is really invaluable and so manageable and the suggestions are so incredibly easy to implement and it’s often just a tweak to what you’re doing to your daily routine anyway.

Ayelet: Yeah. Yeah. I couldn’t have said it better myself. Great. So what, what was it that made you feel that you even needed to find something like this? Like what do you feel like instigated that, that problem, I guess you could call it?

Jennifer: I think it was just like, yeah, that realization of just having no time and feeling… I think no matter what your background as a parent, you always have that nagging feeling in the back of your mind that, am I like, am I doing what I’m supposed to be doing? Am I doing enough? So I was just super intrigued that it was so simple.

And having had listened to you for a couple of years, I knew exactly where kind of all your approaches and your games and everything was coming from. And I, I especially loved that, just, you know, keep it simple. So I knew that I was completely in line with, with your philosophy and was just curious about what it looked like.

And to be honest too, I’m always looking for resources to give other parents and I like to have it fully know what that resource is and read it myself. So that I’m not just saying I think this is good, try it.

So it was partly just as a clinician knowing, okay, I like everything that she does on her podcasts. Let’s see what the books look like. They might be helpful for me, but then I’ll have a resource to recommend to other people.

Ayelet: Ah, excellent. That’s awesome. Well, let’s take just a brief break to hear a word from our sponsors and then we’re going to get a few tips from Jen about supporting early development with multiple young children who have different developmental needs, and we’re to hear her favorite resources for parents and caregivers who are interested in learning more about that.

Ayelet: Okay. Jennifer, let’s get into it. We would love to hear after all this crazy experience, what are your top tips for parents and caregivers who are hoping to better support their infants and toddlers? Whether their babies are developing along a typical progression or whether they’re at risk for delays or experiencing delays. So what are some of your best tips for families who need a boost of encouragement and confidence?

Jennifer: I think, well my number one tip I’ve got here in my notes in bold is just letting go of, you struggles sometimes as a new mom to let anyone do anything else for your baby. And it was so much easier the second time around when it was twins and they were premature and it was like literally I had no choice but to let it go and just take the help. Take all the help you can get, then ask for more.

I think sometimes it’s just getting over… I think it’s something that’s become cultural, especially in North America, that it feels like we’re supposed to do this… We’ve lost that village, we’re village-less. And when I really did embrace that village, this, this second time around, it was, it was so like it sounds cheesy but beautiful and refreshing to see how well grandma or auntie or uncle could care and love on my child. And it was a blessing to see those relationships flourish in a way that maybe I kind of blocked the first time.

Ayelet: Yeah. I so get that. I totally did the same thing the first time around and was totally less in control the second time around. But it is… I mean it’s really hard. In my perspective, it was really hard to accept that even though as I was trying to figure out how to do the things and feeling like I was doing them “right or wrong”, I was not able to just let go and accept that other people might do them and do them differently and it would be equally as okay and it would, you know, it would result in a deep connection with someone else in addition to me and that’s… it’s hard, though. It’s so hard.

Jennifer: Yeah, I think, you know, I think that first time like you get so protective that it feels like if you let someone kind of in and do the things that it’s like an “instead” kind of situation instead of an “and” so that they can have more beautiful connections instead of it taking from the one that you have. If that makes sense.

Ayelet: I think that’s perfect sense. Yeah.

Jennifer: So yes. So that’s the main tip is whether their preemies are new or you have to, or you have one. Just take the help, take all the freezer meals, take it all! And I guess just as an aside, I few people, other people have asked me when they have friends or family going through this situation where there’s a premature birth or just a mom going through a hard time and they always ask like what’s the best way to support someone going through that?

My number one tip is, you know, everyone, I know everyone always means so well and there was always so many people saying like “anything you need, just let me know.” But when you’re going through that, you don’t have kind of any, you don’t even know what you need. You don’t have any bandwidth or time to kind of reach out to set it up. So it’s more just like if you know someone’s going through something and you think you could do something helpful, just just do it. Even if it doesn’t end up being that helpful, I’m sure it is.

But they’ll, they’ll get the gesture or reach out to their partner or the grandma or the aunt that’s helping coordinate some things. Drop off a meal. Food is always good. Pay for a hospital parking pass a few people did where they gave us gift cards for say the coffee place that happens to be in the hospitals where mom’s at. So if she forgot a lunch or just kind of those simple little things that say, I’m thinking of you, because I remember sometimes my mom would ask me, what do you want me to make you for dinner? And I honestly couldn’t even, I couldn’t even tell her. I was like, just…

Ayelet: Whatever’s here. Put it in my mouth.

Jennifer: Yeah, exactly. Look, I couldn’t even come up with how to tell the person that’s living with me, helping me, to tell her what to make for dinner. It was, it was kind of that overwhelming. It was just like, I just know one, I’m going to pump, when I’m going to go to each hospital, what train I’m going to catch home, and I’ve got nothing else left.

Ayelet: … And that I need to put some sustenance in my body.

Jennifer: Yeah, yeah, exactly. Yeah. So don’t ask. Just do. So another piece, again, preemie parents or any parents, I think you might be waiting for me to give you all those great nuggets for the child, necessarily. But the more I learned in my OT practice, the more I keep finding that sometimes it’s so important to take care of you as the parent.

If you can’t be a calm, regulated, well taken care of parents, you can’t, you can’t give that to your child. So what I found huge for me while we were going through the NICU was was writing. Journaling. There’s so much research to support how your brain, it helps your brain kind of connect those dots, putting the story together, processing what’s happening to you when you retell your story.

Whether that’s you just read it down and no one ever reads it again. Or now that I’m further out in my journey, I’m sharing more of it on Instagram, hoping to reach other people that may have the same situation as me.

And I do find, and I honestly do think that I’m doing as well as I am with this process because of how much I’ve been able to kind of rehash it all and let my brain makes sense of what is happening. Write. Even if you don’t know what to write, just write what happened that day, write how you’re feeling in that moment.

And then gratitude is huge. Write down one thing you’re thankful for even if that day sucked. So that’s kind of a number. Another one that’s I found really huge in helping your child is helping you first.

Ayelet: So whatever that outlet is for you, whether it’s writing or taking pictures or meditating or whatever, or exercising, just taking a walk around the hospital or around the block. That’s, yeah, that’s important. Totally.

What about, yes, it is so hard to remember and when you’re in it, it can be hard to remember that it’s important. What about, because with your situation specifically, you were, you were managing two very different developmental stages and still are, as I am. What, what kind of tips do you have for parents and caregivers dealing with that?

Jennifer: I think the two biggest things is just really keeping things super simple. I did really want to talk about, you know, kind of how there is so much equipment out there that’s kind of pushed in your face, shoved in your face as something that’s “good” for your baby’s development or something that, you know, it’s so cute and it’s so pretty that you can’t help but register for it. I did, the first time around

Ayelet: They got you too, huh?

Jennifer: Yeah, they got me too. But then it was funny in a way because with twins and having preemies, a lot of the teams and doctors and therapists would actually say full out that that,, say an exer-saucer is not allowed for your preemie and a Jolly Jumper’s not allowed for your preemie.

So these were things that with my first, I used, still sparingly having my OT background, but they were kind of fun things that I would add to break up my day. And so I thought, how would I, how am I going to do this? Not using those things when I’m been told I’m not allowed. And I honestly didn’t even end up noticing it.

So just you know, all a baby needs to do when they get home is they need somewhere to sleep. They need to be fed, they need lots of snuggles, and they need a flat surface to play and they need your face.

And that’s pretty much it. Whether you have a premature baby or you have a full term baby, that’s it. So I really, really embraced that. Just flat… Give that baby’s body the ability to move and roll and respond to their own. And it was huge. And both my girls, even Olivia was walking by 12 months, corrected. And I did not do any extra mummy therapy.

I just made sure that I met that free play time, having a toddler run around, my number one did for anyone as baby number two is use a pack and play with the bassinet insert. So that way they’re kind of off the floor, and still cannot be reached by said toddler. So I had the twins in a twin sized pack and play for a good chunk of their first year up on that higher insert where they could play.

Maybe a mobile, maybe a book stuck on the side. They can look around and yeah, that was kind of that piece. And just using your daily routines to the most of your ability. Sometimes you know, just thinking of tummy time differently than when your baby’s just flat on their face, not liking it.

That tummy time is whether they’re lying on your face to cuddle or maybe tell me time is you have to take the baby from this room to that room, so you’re going to hold them, tummy down in a football hold or maybe it’s just every time you change their diaper, you think, okay, I’m going to flip you on your tummy right now for a few seconds. It’s kind of just building those things into your day that you’re already doing and not feeling like development needs to be something extra that you’re…Yes.

Ayelet: Oh yeah. Yes. So then just to clarify completely for everyone listening, like the tip literally was just work in the development into your day and the play into your day. You’re already doing it. It’s already happening. You just need to figure out how to maximize those moments.

And it’s with these little things like that tummy time stuff that you know you’re supposed to be doing, do it during caregiving routines or do it while you’re holding your baby in a football hold and your toddler is brushing their teeth and you’re singing a song about teeth. Right. Or counting or whatever. That’s how you address all of the development with the stuff that you’re already doing.

Jennifer: Exactly. Exactly.

Ayelet: Yeah. That’s awesome. What about a few favorite resources that you enjoy sharing with families? You mentioned that you like to collect good resources.

Jennifer: Um, well your books! And… there was something that I found after we left the NICU that I really wished, I had found when we were in, the website is called every tiny thing, and it’s a NICU nurse who has created specialized NICU journals for parents, and special milestone cards.

So I think sometimes in the NICU parents are kind of overly aware of all the “normal” things that other babies get to do and have like those cute milestone cards that say “I rolled over today” or like “I did this” or she’s made a set that you can kind of pop into your child’s isolette that’s maybe said, you know, like “I came off my breathing support today” and kind of make that a normal, beautiful thing.

I wish that I had known about that earlier. But if you know somebody who maybe is going through the same journey or you are going to be about to go through this journey, it would be a really cool resource.

I really love, I know you’ve interviewed her, Rachel Coley and CanDoKiddo, I’m always telling parents to go check out her Instagram or her website. She does that simple childhood development so well, as well. And if you do have any concerns about your child’s development, we use this one at work a lot. Pathways is a great organization.

Yeah, where they’ve got things right down to those videos of saying normal motor development versus atypical so that you can actually see some of those differences. And just really helped inform yourself if you do have some of those concerns. I’m trying to think of what other books I’m really into right now. I’m a big audio book junkie.

Ayelet: Hmmmm, good.

Jennifer: Cause I find with three kids, the only time I can quote unquote read is when I’m listening while doing dishes and things like that. Yeah. The whole Brain Child by Dan Siegel is a really great, that’s a great one. That’s a really great resource. I think that’s it off the top of my head.

Ayelet: Excellent. Did I tell you that I’m now just starting to release the books in weekly email slash audio book form based on where you are and where your child is you get that week or that corrected age, week, whatever you put in. And then you get it as an email wherever your child is and you get a downloadable audio as well. And that’s, that’s…

Jennifer: That’s amazing.

Ayelet: Sound good? Excellent. And then you get, you also receive a link to a video and then a place where like a members area where you can also engage with other videos and post your own and see other examples of other families engaging with the curriculum.

Jennifer: Oh, that’s amazing. That community piece is so huge to kind of just be able to see what other people are doing and just chat about, Hey, this is where I’m at. This is how I’m doing it and share. It’s, that’s huge. That’s amazing that you’re doing that.

Ayelet: All right. Well Jan, thank you so much for being here and thanks to all of our participants of the Learn With Less Curriculum Online Program who are listening live. We are going to continue the discussion and open up for a Q and a session for you guys in just a minute, but for everyone listening from home or on the go, thank you so much for joining us and we will see you next time.

From Pediatric Occupational Therapist to Surviving The NICU with Three Under Three, with Jennifer Russell

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