Sam was born 6 weeks premature to Jane and Roberto by Cesarean section. His Apgar scores improved from 5 to 8 after 5 minutes. Jane drank heavily during her last trimester of pregnancy around the time Roberto lost his job, and there is suspicion Sam may have Fetal Alcohol Spectrum Disorder. Sam is a fussy eater requiring frequent short feedings and does not sleep through the night. Jane and Roberto live rurally without nearby family support, though Jane's mother has offered temporary help.