Courtney Larson takes a picture of her quadruplets just before their first day of kindergarten on Sept. 5, 2017, in Lima, N.Y. (Jackie Molloy) )

The Larson quadruplets started kindergarten this month in Lima, N.Y. For any 5-year-old, this would be a normal event. But for Cooper, Brody, Ashlyn and Kylie, it was a hard-fought achievement.

The quadruplets were born at 25 weeks and four days, said their mother, Courtney Larson, 31. (A normal pregnancy usually lasts 40 weeks.)

Babies born before 26 weeks are termed "micro-preemies." The survival rate for these tiny babies , while improving, is still low — 72 percent — and survival without "moderate to severe neurodevelopmental impairment" is 43 percent, according to the National Institutes of Health . The survival rate for all four babies in a set of quads, especially those born prematurely, is even lower.

At birth, the Larson quadruplets ranged in weight from 1 pound 15 ounces for Brody to 1 pound 5 ounces for Kylie. They spent between 121 and 137 days at the neonatal intensive care unit at the Strong Memorial Hospital in Rochester, N.Y., before coming home in July 2012.

Cameron and Courtney Larson hold their babies in June 2012, before the infants were released from neonatal intensive care. (Nancy Langenbahn) )

At the NICU, Larson and her husband, Cameron Larson, 32, could hold Brody and Cooper a week after they were born and Ashlyn when she was a couple of weeks old. But they couldn’t hold Kylie till she was 6 weeks old.

All four children were born with patent ductus arteriosus (PDA), or a hole in the heart. Brody and Ashlyn underwent surgery to close the hole at 2 weeks old, and Kylie when she was about 10 weeks old. They each have a scar on their back from the surgery, Courtney Larson said. Cooper had the hole in his heart closed nonsurgically, via a catheter through his leg, at age 4.

All of them also had feeding tubes inserted while at the NICU, and came home with them. Cooper, Ashlyn and Kylie had theirs inserted into their noses, and had a tough time learning to eat, breathe and swallow at the same time, their mother said. The tubes were removed when the children were 9 to 10 months old. Brody had his inserted through his stomach; it was taken out just before he turned 3.

Of the four children, Brody has suffered the most complications. His PDA surgery left a vocal cord paralyzed. That made it hard to hear him cry, Courtney Larson said. Although better now, he sounds hoarse after he talks a lot.

As a baby, Brody couldn’t control the milk that he swallowed: It would end up in his lungs, his mother said. To correct that, he had a surgical procedure that left him with a five-inch scar and complications. Brody cannot burp, and he gets aches from gas accumulation. If he gets sick, he can’t throw up.

Brody also had major bleeding in his brain. If it continued, physicians at the NICU said, cerebral palsy and other developmental problems might occur. But a month later, the bleed completely resolved itself without any interventions. It was “nothing short of miraculous,” Courtney Larson said. Kylie had a minor brain bleed that physicians said wasn’t as much of a concern.

The last of the surgeries the children have gone through was a laser procedure for retinopathy of prematurity in Ashlyn’s left eye. Surgery is required in some cases lest the disease leads to blindness or other vision problems.

The quads at breakfast on Nov. 10, 2014. (Jackie Molloy) )

After the babies came home, they saw specialists a couple of times a week for two months, then scaled back to once a week. At an early intervention preschool and now at kindergarten, Cooper, Brody, Ashlyn and Kylie get occupational therapy to develop fine-motor skills such as writing and using scissors; physical therapy to help with balance and coordination; and speech therapy.

All four also have preemie-induced asthma. When they were in preschool, they often picked up colds, Courtney Larson said. But now, as their immunity increases, they are sick less frequently.

Three of the quadruplets also have individual struggles: Brody’s asthma requires him to use an inhaler every day, Kylie has less energy than the others, and Ashlyn experiences anxiety when she is around new people and in large groups. But Cooper never gets sick; he “is our easygoing one,” his mother said.

Physicians have told the family that the children are going to be pretty normal, though there isn't much data on such quads. Just 10 to 15 years ago, micro-preemies rarely survived, and it was extremely unusual for all four to live, studies show.

The quadruplets are doing very well, their mother said. They love going to school and therapy. Brody enjoys spending time with his friends. Ashlyn likes going to the library. Kylie is excited about artwork. And Cooper is happy at the gym. They also swim, ski and do gymnastics.

Ashlyn tells her brother Cooper, "That's not how the rainbow is supposed to look" after he finishes a chalk drawing in the days leading up to their start of kindergarten. (Jackie Molloy) )

Although each has scars, they have no memories of the surgeries and pain they went through as babies, their mother said. Cooper, Brody, Ashlyn and Kylie are happy and mostly healthy children, and the family has faith that they will continue to be so.

Jackie Molloy began taking pictures of the Larson family in 2014, when the quadruplets were 2 years old. Molloy had a college assignment on family, and a friend introduced her to the Larsons.

“Family is the root of my passion for storytelling,” Molloy said. “I am interested in topics ranging from transgender rights, fertility issues, foster care and disability. My photographs explore how these differences can mold and shape the dynamic of each family.”

Documenting the lives of the quadruplets was her first project as a photojournalist, and she hopes to continue till they are at least 18. “The piece has a lot of themes throughout it, from fertility to raising multiples and what that looks like, as well as religion,” she said.

Cameron and Courtney Larson watch a movie after a long day of caring for their childen in 2014. (Jackie Molloy) )

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