Interestingly because they were foster parents with legal custody but not legal guardianship if they are caught they will likely have more legal consequences if it can be proved they took the four year old out of state than because they abandoned the eight year old with us. Our system has some flaws and here it is difficult to actually bring legal charges against foster parents who abandon if they don't have legal guardianship at the time. Of course it will be virtually impossible for them to keep the four year old, ever be foster/adoptive parents, or work with children or disabled adults so there are consequences providing they can be found. I am absolutely not condoning the decision they made. However, from things the caseworker has shared with us, I get the impression now that they never felt they were a good fit for the eight year old (who was four when she went to them) or felt able to parent her. In contrast, I sense that they did bond with her baby sister (who went to them as an infant and never met her biological parents) and in their heart she became their daughter. I can understand how they couldn't let go of her and perhaps they felt this was their only option. Again, I think they made a poor choice which will likely end up hurting both children but I'm trying to understand what they may have been going through.

She is eight so we really aren't sure what she really knows. We certainly have no plans to share with her what the caseworker revealed about the adoption and I would hope that the foster parents wouldn't have but she is old enough that she may have overheard something if they were talking about it at home. When we were talking to the caseworker last week where this information was shared she was at school. Last Monday while we were in limbo unable to reach the foster parents we just told her that there was a little change in plans and she was going to stay for dinner so I was going to make lasagna (which she likes). When the caseworker called us to tell us they believed the foster parents had abandoned her and ask if we could keep her and we agreed we told her that her foster parents needed us to keep her for a little while longer and that we were glad to do that. She hasn't asked for more information and we really don't have it to give so that is hard. She has expressed an interest to see her sister (which in the past we have arranged if we've kept her for more than a few days at a time) so we've told her we are working on that. We really are when she asked this morning I did put in a call to caseworker explaining this and that I needed to know if they had any more information or any guidance on what we should tell her (our full intention is to tell her the truth we just want to do it with the most updated information and in the most appropriate way). We're waiting on a call back from the caseworker now.

Thank you everyone! Yes, this has all been incredibly unfair to this poor child. Actually life hasn't been particularly fair for this child but in the past I held a lot of faith that things would improve for her. We've known her for over a year and our older kids have a sort of "cherished cousin" relationship with her. She wanted to go to our oldest daughter's concert and our oldest wanted her there. She went to some of twelve year olds gymnastic meets last year by choice. Our oldest and my husband also started teaching her how to ride over last summer and before all of this happened we were actually talking about discussing with the foster parents if she was interested in joining 4-H and offering her the use of one of our horses if she wanted to do that. We really wanted to believe the caseworker that the foster parents just needed more support and they could/would become great forever parents for her and her little sister. Even when things semi-imploded at the end of the summer I guess we bought into the caseworker's optimism that the answer was just to support more and allow the family to grow together. I realize now that there were quite a few red flags that we overlooked and looked around but I really hadn't accepted that it wouldn't all workout in the end until after the foster parents abandoned her at our house. We care very much about this child and I think we can come together and transition into at least a pseudo parental relationship (much like if she was a niece who was now coming to live with us). In some ways we think this is probably her best chance. But there are a lot of unknowns including if/when the foster parents will be found, and what would be best for her younger sister (who knows the foster parents only as her parents). So for the moment we're trying to take things one day at a time.

I think it may help if you understand that stopping bleeding is a two phase process: 1.) Primary Hemostasis is dependent on platelets forming a temporary clot or plug. The platelets attach to the surface (and each other thanks to the action of VonWillebrand Factor on glycoprotein Ib/IX), are activated and release arachadonic acid which stimulates platelet release and aggregation. Arachadonic acid is converted (via Cyclooxygenase) into Thromboxane A2 which further recruits platelets, induces vasoconstriction (clamping down vessels stops the bleeding), and exposes platelet surface glycoprotein IIb/IIIa. Fibrinogen/Factor VIII then cross connects the surface glycoproteins to form the temporary platelet plug. Unfortunately this platelet plug only lasts for 12-24 hours which basically gives the clotting factors time to work through the coagulation cascade. 2.)Secondary Hemostasis is due to the clotting cascade. The intrinsic and extrinsic pathways ultimately converge to convert prothrombin to thrombin which leads to clot formation by converting Fibrinogen to Fibrin. *Because our bodies love homeostasis we also have natural anticoagulants in our bodies which help limit clot size and start breaking down the clot as well. Patients who have deficiencies of Protein C and Protein S or patients who have significant protein deficiencies in general can have unchecked thrombosis which can lead to DVT, PE, and even death. Aspirin (by irreversibly modifying Cyclooxygenase) and Ibuprofen and other NSAIDs (which reversibly binds to Cyclooxygenase) decrease platelet function and interfere with primary hemostasis. This is why we like to hold them prior to surgery or other procedures where bleeding is likely. Heparin (and it's newer formulative derivatives) and Warfarin (and other newer clotting factor inhibitors) interfere with secondary hemostasis. The reason Ibuprofen can be helpful with dysmenorrhea is because it inhibits prostaglandin production. It is the prostaglandin which causes the menstrual cramping. Theoretically the Ibuprofen may also reduce bleeding because blocking the prostaglandin also reduces vasodilation and increases vasoconstriction reducing bleeding. (Prostaglandin causes vasodilation.) To my knowledge, there really isn't great evidence to support this bleeding reduction it is just one of those physiologic theoretical things but I am not an OB-Gyn so there may be some more recent literature that actually corroborates the theory I'm unaware of.

As some of you know, the child we have been doing medical respite for had wanted to attend our oldest daughters orchestra concert two weekends ago so we had planned to take her for a long weekend that weekend. Originally my husband would have picked her up from her school on Friday (11/9) afternoon and her foster parents would have picked her up from our home on Monday (11/12) afternoon. Things haven’t exactly worked that way. On Wednesday (11/7) I was almost done with working another “fun filled†twelve hour ED shift. I picked up my phone after putting in a central line and saw a text from my husband to call him before I left work. I called him while waiting for radiology to come over and shoot a portable film to confirm line placement. He explained that our respite child was in a different ED with another asthma flare and the foster parents were uncomfortable taking her home so the caseworker was wondering if we would just take her early for respite. He had wanted to talk to me before we made a decision about this and had told the caseworker he would have to get back to her after we talked. We both felt that we didn’t want to take her home if she really should be admitted somewhere (which she has been multiple prior times). We also didn’t want to bring her into our home if she had some viral URI causing her asthma to flare (which is a very common cause in kids) because we didn’t want to risk our infant daughter being exposed. So we decided that I would drive to the hospital where she was after leaving work and if neither of our concerns were applicable we would just take her for an extra two days of respite. To make a long story a bit shorter we did take her home Wednesday night. I wasn’t working Thursday and we had a very low key day at home. Our older two had on campus school days, my husband took our soon to be three year old to her swimming class in the morning, and then came home for lunch and to get ready for a board meeting he needed to attend for one of his corporate accounts. She played candy land after lunch with our little daughter while I was feeding our youngest and she was fine. Honestly she probably could have gone to school on Thursday. My husband did drive her to her school on Friday morning and that went fine. We had a good family weekend. Our oldest daughter’s concert went really well and everyone except our youngest two attended. Her foster parents were supposed to pick her up after lunch on Monday afternoon. When they hadn’t appeared by three and we were unable to reach them by phone we attempted to call the caseworker (which required going through the emergency system because CP/FS was observing Veteran’s Day). Apparently CP/FS couldn’t reach them either and when they finally managed to send a caseworker out to the home no one was home. We kept her that night because it seemed a better option for her than sending her to an emergency placement. Now a week later she is still with us for the same reason. We don’t know exactly where this will end up. We do know it will be complicated. She has a younger full sister who it appears the foster parents took with them when they fled. The caseworker also revealed that a little over a year ago the foster parents tried to separate the adoptions so they could adopt the younger sister and return this child to foster care. The judge wouldn’t grant the separation and so the foster parents grudgingly kept both children. This was when the caseworker upped the medical respite hours and when we met this child. The whole situation is a mess and we really pray that God will us to make the right choices for our family and for this child. If you pray we would love your prayers for guidance as well.

I'm sorry this happened. I'll definitely include you and your family in my prayers.

:grouphug: Pam!

:iagree: I haven't been an EM physician for thirty years, yet. I will get there eventually even if a few of my uptight colleagues get really offended when people refer to our ED as an ER which I think is a bit much:tongue_smilie:. Although my experience is a bit more time limited than your MIL I have to agree with her. We've never had a home trampoline and won't. Our gymnastic child is allowed to use a trampoline in a supervised and structured fashion at the gym only. She knows that doing gymnastics on a someone's backyard trampoline will be a good way to end her gymnastics experience early. In the interests of full disclosure, I will admit that we do have an inground pool. We take the precautions necessary with our pool so I don't think it is more risky that we have one at home than taking our kids elsewhere to swim.

Pamela, Hugs! I get this I really do. Our foster daughter has been in our home almost three years and we still do not have a TPR. This is in violation of all permanency laws but since the parent who didn't relinquish is also facing criminal charges that has complicated things further. I will pray that everything works out for both of our daughters.

-Dresses, tailored shirts, skirts, and dress pants go in their closet. -Shoes go on the shoe shelves (in their closet) -Undergarmets, socks, tights, jeans, shorts, casual tops, sleepwear etc go in the appropriate drawers of their dresser. -Outerwear goes in the closet in the foyer or the closet in the mudroom depending on what it is. There really isn't a closet in our nursery so our youngest is the exception. The few items she has that must be hung I put on one side of my closet.

I'm glad your family is safe, sound, and now in a warm and well-lit home. Best wishes for clean up after the storm.

A pediatric cardiology attending I liked as a student used to say that you could think of murmurs as noisy blood. Some people (like kids with Venous hums) just have noisy blood. But sometimes people have noisy blood because there is turbulent flow. Sometimes they have a valve that is abnormally formed, infected, or just doesn't open or shut properly. Or sometimes there are communications that were meant to close but didn't (like patent ductus arteriosus or foramen ovale) and sometimes there are communications between the heart chambers that aren't really meant to be there at all (like Ventricular and Atrial Septal defects etc). So yes, murmurs can be perfectly benign and even murmurs that are due to an abnormality may not be disabling. If this was my child I would want to know which/what we were dealing with. So I'd want this worked up further. Our kids pediatrician is amazing and our pediatric cardiologists are really busy so I'd probably be ok with her ordering the EKG, Echo, and Chest X-ray and going from there. Other places pediatricians aren't comfortable doing the initial workup and that's ok too. I also realize that at some hospitals you can't order pediatric echos without permission from cardiology so pediatricians may be limited more by hospital politics than their own training. You are mostly correct. AHA did revise their guidelines for SBE prophylaxis in 2008 and with this revision they did relax them a lot and stop prophylaxing groups that were previously prophylaxed. They also stopped advocating prophylaxis prior to GI/GU procedures. For dental work (and in a few other situations more complicated than relevant here) we do still prophylax those with: -Prior endocarditis -Prosthetic valves -Unrepaired Complex Congenital Heart Disease -Repaired Congenital Heart Disease with residual defects at the site -Heart Transplant patients with valve disease -Completely repaired Congenital Heart Disease less than six months out from their repair surgery

I agree with others, your oven may be too hot. It is also possible that your oven rack position is the problem. You might experiment with both. Good Luck! We love baking stones here for pretty much everything except quick bread type recipes (ie banana, pumpkin, cranberry etc).

What kind of oven do you have? Have you tried using a baking stone?

We have a home near there and (thankfully) that part of New York really wasn't impacted by Sandy.

Thanks everyone for all of the positive baby thoughts (whether you agree with the decisions we're making I believe you want the best for our family)! So far things are going pretty well. Our baby daughter is settling in and starting to develop the earliest glimmers of a personality. On the work front, I survived a pretty hectic day shift in the ED on Halloween and was glad I did it at the end (even if just as glad to be going home at the end). I like this perspective. I think the caseworker is still hoping if she can just give the current foster family enough respite that it will all come together. For this child's sake, I hope she is right. She should be joining us again the weekend after this because our oldest daughter invited her to attend her youth orchestra concert which is happening next weekend. We'll probably do a four day weekend because I don't think she has school (as they will be observing Veteran's Day).

You can also do GC/MS confirmatory and quantitative testing of urine samples that is much more reliable.

-We take advantage of the little moments. We're kind of at the ideal ages for this at the moment. My husband's son is married with his own young family. Our older two girls are just turned 17, and 12 and our younger girls are almost 3 and 2 weeks so we have sports practices (and they are old enough to be left alone there), music lessons, overnights with friends, and of course NAPS! -We spend quality time together with the kids. -We share cooking and often cook together (and, yes, with the kids help sometimes too) which is something we both enjoy. -We communicate well what we need from each other. There is a lot of love there and both of these aspects have carried us through a lot.

Many (most?) state medical boards consider drug testing part of responsible prescribing of controlled substances. This helps reduce prescription diversion. It also helps identify patients who may be mixing their prescribed medications with other controlled substances (legal or not). Although not a psychiatrist, it is my understanding that if you have hyperactive ADHD the recommendation now is one of moving away from drug holidays because medication is geared just as much at reducing the impulse issues that may lead to risky behavior (including substance abuse) as to improving school performance. Those with inattentive forms will often do well with a non stimulant medication which is not a controlled substance.

We're pretty early risers in general so our kids really don't get up earlier than usual even on Christmas morning. We usually eat breakfast together as a family and Christmas is not an exception and then we do stockings together after breakfast. We have a fireplace in the great room extension from our kitchen so the kids have hung stockings on that fireplace the past few years. Under the tree presents are usually done in stages before and after Christmas Dinner (which isn't always at our home). We do let the kids open one present on Christmas Eve (which is usually new sleepwear---kind of a family tradition, I guess it makes for nice Christmas Morning pictures). If we're celebrating on Christmas Eve (or later in the Christmas Season) with family we will not see on Christmas then we will exchange gifts with them at the time.

You're right…life isn't always fair but I'm sorry you're going through this and I hope things improve. :grouphug:

Hugs and prayers for an ultrasound that shows an IUP!

To update: -We have a beautiful new daughter. She is very loved and we are all very blessed. -We did end up doing a little respite before our daughter was born. The caseworker thought that would give her time to make the already established foster situation work. From what we understand it really didn't so we're doing some more praying on where we go from here. We will probably be taking her again this weekend for respite and I think that may help us have a better understanding of how this could all work (or perhaps that it really won't work). -I should be trying to start back to work next week so we'll see how that goes. Halloween is always a crazy time in the ED :glare: :huh:

I think they had a Santa out there for a day or two also but he was like one tenth the size of his reindeer so I guess they must have decided he looked silly and took him down.

Our youngest is almost two weeks old now so she won't be old enough until we're out of our flu season here. That made getting the rest of the family immunized even more of a priority. The main contraindications for flu shots (the inactivated virus) are egg allergies and Guillain Barre Syndrome (especially if after a prior vaccine). We don't have any history of GBS in either side of the family but I think if we did I might be a little more wary. Of course Influenza infection (and various other infections) can certainly trigger GBS as well so I would probably still proceed the same with a family history.