During my second pregnancy, all seems well for the first several weeks. Then one morning, it’s as if someone has flipped a switch that was buried deep in my immune system. I wake up with pains in my abdomen and an uneasy feeling I cannot shake. Specialist appointments follow. “You’re measuring normally,” the OB-GYN verifies at an 18-week ultrasound – the last time I hear the word "normal" during this pregnancy. Lab tests quickly confirm what we’re dealing with: my body has elected to wage war on itself, focusing its wrath on my digestive system.
Despite an aggressive course of medication, my health deteriorates. The high-risk OB-GYN delicately broaches the topic of ending the pregnancy, which I refuse. Instead, I focus on what I need to do: take in enough nutrition so the baby can grow. My husband painstakingly prepares three-egg omelets for breakfast and brings protein-packed smoothies to my bedside, but eating remains an agonizing ordeal. The little girl growing inside me has to subsist on the most meager of rations. When Lily is born at 31 weeks, she measures small for gestational age. “A little bit IUGR,” notes the doctor gently, referring to Intrauterine Growth Restriction, in which a baby does not grow to a normal weight during pregnancy.
After 41 days in the neonatal intensive care unit, she’s discharged weighing four pounds – almost two pounds heavier than when she entered the world. Lily is healthy. But her subsequent growth remains a concern that’s always on our minds. We follow the neonatologist’s advice and supplement breastfeeding with special, high-calorie formula. When Lily starts solid foods, she seems hesitant at first, turning her face away. This makes us nervous, so we start applauding and cheering manically whenever she takes a tiny bite, something we never did with our oldest child. As Lily enters the toddler years, we continue to watch her like a hawk at meals. “One more bite, just one more bite,” I plead. In my head, the drumbeat continues: You must eat. You must eat. If you don’t eat, you will not grow, and we can’t have that. I can’t fail you again. When Lily turns four and remains at the lowest percentiles on the growth chart, our pediatrician cheerily ships us off to the endocrinologist. I sit at the appointment with my child, a happy, bright preschooler who is blissfully unaware that everyone in the room is analyzing her from all angles, as if she’s a puzzle they want to solve. The lead doctor briefly discusses human growth hormone, and how it can be prescribed if lab work reveals any abnormalities.
I feel my blood pressure rising. I watch as my sweet girl endures the sharp poke of a needle, her eyes widening in hurt surprise. Next, a technician grasps my daughter’s wrist for an X-ray – a test that assesses growth by calculating bone age. This procedure is painless, but my daughter has had enough. She wails, squirming away from the cold examination bench, her happy mood finally shattered.
A few weeks later, we learn that the results are all normal. We start to relax just a little bit about food and nutrition, realizing that our daughter will grow and gain weight as she needs to, whether we choreograph every meal or not. We remember that nourishing her development means more than simply filling her belly, and that small size does not equate failure, nor does it affect her potential to live a meaningful life. The type of growth that doctors measure is the kind that’s easy to see and track in a logical fashion. It makes sense, and it can be helpful. But it’s not the only information that matters.
Lately, I’ve been thinking that if I had my own chart, I’d plot an entirely different set of milestones, markers that have nothing to do with my daughter’s physical growth. Like the first time she was able to swim underwater to her dad, or the first time she read through an entire book on her own. Or her dance recital last year, when we dropped her off at the theater entrance and she skipped away to play with her friends, carefree and completely oblivious to her parents. Just like any other five-year-old. These are milestones worth celebrating, reminders that growth cannot be measured only by pounds or inches.
I think of all of these experiences like points holding my daughter in space on her own curve. Her path may not be linear. It won’t be the same as everyone else’s. She’ll probably always be small for her age. But I know that she is growing – exactly as she was meant to – each and every day.