Baby's blood tests back - update

[Binalina]

This is a follow up from my previous post about "Trying not to Panic"

 

The nurse called me today to say that the bloodwork came back fine except that 2 values were low but within normal. Apparently my Pedi. needed a day to check with an endocrinologist. His Alkaline Phosphotase was low as well as his blood CO2 level. Both of which are apparently not unusual "so she said" But then she went on to say that my pedi wants to do a blood test for thyroid, a urinalysis, X-rays for bone age and referr ds to a GI specialist :001_huh: I was little bit taken aback seeing how she had just said the levels were within normal.

What would be your take on this? I agree about checking his thyroid and checking his urine but I don't know about the x-ray and the GI specialist.

 

Here is a little info on the Alk. Phos. - I haven't found any really clear information about the co2

 

Alkaline Phosphatases are a group of enzymes found primarily the liver (isoenzyme ALP-1) and bone (isoenzyme ALP-2). There are also small amounts produced by cells lining the intestines (isoenzyme ALP-3), the placenta, and the kidney (in the proximal convoluted tubules). What is measured in the blood is the total amount of alkaline phosphatases released from these tissues into the blood. As the name implies, this enzyme works best at an alkaline pH (a pH of 10), and thus the enzyme itself is inactive in the blood. Alkaline phosphatases act by splitting off phosphorus (an acidic mineral) creating an alkaline pH.

The primary importance of measuring alkaline phosphatase is to check the possibility of bone disease or liver disease. Since the mucosal cells that line the bile system of the liver are the source of alkaline phosphatase, the free flow of bile through the liver and down into the biliary tract and gallbladder are responsible for maintaining the proper level of this enzyme in the blood. When the liver, bile ducts or gallbladder system are not functioning properly or are blocked, this enzyme is not excreted through the bile and alkaline phosphatase is released into the blood stream. Thus the serum alkaline phosphatase is a measure of the integrity of the hepatobiliary system and the flow of bile into the small intestine.

 

 

A decreased serum alkaline phosphatase may be due to:

 

• Zinc deficiency.
  
• Hypothyroidism.
  
• Vitamin C deficiency/Scurvy.
  
• Folic acid deficiency.
  
• Excess Vitamin D intake.
  
• Low phosphorus levels (hypophosphatasia)
  
• Celiac disease.
  
• Malnutrition with low protein assimilation (including low stomach acid production/hypochlorhydria).
  
• Insufficient Parathyroid gland function.
  
• Pernicious anemia
  

Vitamin B6 insufficiency

[Annie]

The doctor would need to provide me with a lot more information before I would consent to an x-ray (and the radiation associated with it) on a baby who is happy and developing normally.

[Parrothead]

I'm one of the skeptics in the bunch. My first thought at all those tests you rattled off is that you must have good insurance.

 

Do you see a problem? Does Baby eat, sleep, and poop properly? Is he cutting teeth? Didn't you say he is a busy baby? Has there been anyone else in the family, including past generations, that was just a bit small? What does your gut say? Have you thought of a second opinion?

 

Because of my past experiences with doctors that like to see trouble where there isn't any along with the ones that like my insurance payments I'd wait. I'd be vigilant and watch for any other signs of a problem.

[kalanamak]

 

Here is a little info on the Alk. Phos. - I haven't found any really clear information about the co2

 

 

In light of a patient with no reason not to have a normal pH, I think of a low CO2 as a person who is hyperventilating a bit do to pain, or panic over a blood draw. They "blow off" some CO2. It usually stays in or near the normal range, just a bit low.

 

Beyond this, it gets massively complicated, drawing in numerous illnesses and a buffering system that is the bane of many a medical student. I know this site is in Chinese, but the diagrams aren't, and they are very clear. (Personally, I think them very pretty, but learning them wasn't.)

 

http://www.clinic-clinic.com/clncl-mdcne/Nephrology/acidbasedisorder/acidbasedisorder.htm

 

Hope your little one feels better, soon.

[ktgrok]

I'd get a second opinion.I think that is a LOT of testing for a baby that is developing normally.

[Binalina]

In light of a patient with no reason not to have a normal pH, I think of a low CO2 as a person who is hyperventilating a bit do to pain, or panic over a blood draw. They "blow off" some CO2. It usually stays in or near the normal range, just a bit low.

 

THANK YOU! for saying that! I thought about that myself! As for the diagrams - well, you're right massively complicated - even the "simple" diagram... I don't have enough rudimentary knowledge to decifer even those. But thank you anyways :001_smile:

[joannqn]

It isn't unusual for mainstream pediatricians to want all those tests on a smaller child. I've had friends deal with the whole range of them with each child until the pediatrician finally figured out that smallness was normal in their family. Knowing that, I would base my decision on two things:

 

1) Does being small as a baby run in the family? Were your parents, you, your hubby, or any of the baby's siblings small?

 

2) Are there any indications of failure to thrive other than size? Is baby reaching other milestones okay?

[kalanamak]

The doctor would need to provide me with a lot more information before I would consent to an x-ray (and the radiation associated with it) on a baby who is happy and developing normally.

 

Unless I read this wrong, the OP has a 9 month old boy who below 3rd percentile in wt. after being born at a very healthy weight and normal gestation. Additionally, this seems to be a hungry baby who is consuming enough calories. If a doc did not do a thorough workup over this, s/he would be defenseless in court. Many an angry parent would be venting their grief in rage that this doc did not "do everything" to help their now-stunted child.

 

It takes little radiation to X ray a wrist. I don't know the numbers in a child but a full chest x ray in an adult, which has to get through much more meat and bone, is equivalent to 10 days "back ground" radiation. So, if my dad had lived to 97 years, 1 month, and 17 days, instead of 7 days, it would have been like getting a chest Xray.

 

We are also not there in the exam room. We cannot know if this doc is suspicious that the skin turgor isn't exactly what it should be, or the strength isn't just perfect. Things the doc might not be rattling off to the poor mother who could then panic for nothing. A really good, caring, experienced doc (the kind all should hope to have) often has a Miss Clavel sense: something is not right. And bothering to get a "curbside consult" from the endocrinologist doesn't sound like some quack padding his office visits. IMO, but I am, of course, an "insider".

 

(Said seriously, but not meaning be mean...just blunt.)

[kitten18]

I read your other post yesterday.

 

 

I guess I just don't understand what the Dr is looking for??? Your baby doesn't sound *that* tiny and as you said, is meeting/exceeding milestones. What's the problem?

 

 

My DS was 6lbs at birth and quickly gained to be 50%, then by 4 months he was below 3% and stayed there until he was 2 years. He weighed 16lbs 9oz at 1 year. I was a little concerned with his weight and brought it up at 9 months, his Dr pinched his thigh (he did have a little roll) and said "this doesn't lie, he's fine". Also, I'm barely 5'0" and DH is 5'10" and we were both skinny kids, we were just not destined to have chunky babies. :D

[kitten18]

We are also not there in the exam room. We cannot know if this doc is suspicious that the skin turgor isn't exactly what it should be, or the strength isn't just perfect. Things the doc might not be rattling off to the poor mother who could then panic for nothing. A really good, caring, experienced doc (the kind all should hope to have) often has a Miss Clavel sense: something is not right. And bothering to get a "curbside consult" from the endocrinologist doesn't sound like some quack padding his office visits. IMO, but I am, of course, an "insider".

This is a really good point. If that is the case, I would want to know what the suspicions are before proceeding.

[TheCoffeeChick]

:grouphug: I'm pretty trusting of doctors. If he feels there might be something going on, I'd probably do the tests. But a mother knows her baby best and if you feel he is healthy and nothing is strange, I'd just go with the blood tests and hold off with the others.

[Binalina]

It isn't unusual for mainstream pediatricians to want all those tests on a smaller child. I've had friends deal with the whole range of them with each child until the pediatrician finally figured out that smallness was normal in their family. Knowing that, I would base my decision on two things:

 

1) Does being small as a baby run in the family? Were your parents, you, your hubby, or any of the baby's siblings small?

 

2) Are there any indications of failure to thrive other than size? Is baby reaching other milestones okay?

 

You know - I never really thought about it until now - because I am not close with my father's side but my Dad is short statured and so is his sister - my aunt. Other than that - everyone is fairly average.

 

No other indicators that he is in any way unhealthy. Yes, he wakes frequently to eat still and doesn't eat large quantities. But he does eat and he does sleep - just not as much as I wish. He is super active and strong and hitting every milestone ahead of time (all my other kids were late on most everything) I think he is doing wonderfully. He is a very happy baby.

 

My Dr. is very mainstream - and truthfully - I guess I am more of a mainstream Mom than I like to admit but this may be a crossroad for me and this Pedi.

[mhg]

Sounds like you have a good/thorough pediatrician.

These two values, serum electrolyte and liver enzyme, are important values that need to be normal and should not go unchecked. The doctor's wise to rule out any problem, however minor, at 9 months old. IN any case, mama, this isn't a life or death issue, just one of checking to ensure everything is fine tuned for OPTIMAL health.

 

Having had a husband with spinal compression fractures in his early 20s from severe osteoporosis secondary to undetected malabsorption issues of childhoold, I would have smooched that doctor on the face for catching his malabsorption problem in his childhood! This is what my mother-in-law wanted to do when she heard that this started in childhood::banghead: (BTW, his sister 2 years older, has osteoporosis in her 20s also). Also....BTW, I'm in NO way suggesting that he has a malabsorption issue or that, if he did, it would be of the same ilk as my spouse's! ---- I'm just giving this as a small example of how important it is to look into these little "offs" in childhood as they can later bare some stinky fruit. (and no one would have thought my hubby or his sis were anything but the poster kids for super health...so you can't go by a kid seemingly thriving).

 

An ounce of prevention is worth a pound of cure!

 

:iagree: with the doctor on getting any abnormalities ruled out here in the get-go of his young life.

Edited October 28, 2010 by mhg

[Binalina]

Unless I read this wrong, the OP has a 9 month old boy who below 3rd percentile in wt. after being born at a very healthy weight and normal gestation. Additionally, this seems to be a hungry baby who is consuming enough calories. If a doc did not do a thorough workup over this, s/he would be defenseless in court. Many an angry parent would be venting their grief in rage that this doc did not "do everything" to help their now-stunted child.

 

It takes little radiation to X ray a wrist. I don't know the numbers in a child but a full chest x ray in an adult, which has to get through much more meat and bone, is equivalent to 10 days "back ground" radiation. So, if my dad had lived to 97 years, 1 month, and 17 days, instead of 7 days, it would have been like getting a chest Xray.

 

We are also not there in the exam room. We cannot know if this doc is suspicious that the skin turgor isn't exactly what it should be, or the strength isn't just perfect. Things the doc might not be rattling off to the poor mother who could then panic for nothing. A really good, caring, experienced doc (the kind all should hope to have) often has a Miss Clavel sense: something is not right. And bothering to get a "curbside consult" from the endocrinologist doesn't sound like some quack padding his office visits. IMO, but I am, of course, an "insider".

 

(Said seriously, but not meaning be mean...just blunt.)

 

Agreed - This is why I do like my Pedi. She is thorough and checks everything out. She does not bother with scaring me - she just does her job. Although right now - I could do with a little more information and reasoning. We are going in tomorrow so I will be able ask my questions then. The only thing about being as "good" as she is - is that she really doesn't appreciate the parent questioning her. Seems to me that she takes it as an offense because she knows she is doing what is in the best interest in the child - not the parent. She is fiercely protective of the patients in her care -(which is a good quality to have in my mind) but sometimes it does leave a parent feeling like they've just broken some cardinal law by questioning her. kwim?

[sbgrace]

I very much wish our then pediatrician had been even a quarter of this thorough with my child at nine months. He was FTT and I wish we had identified and addressed the causes at that young age. That said, I would expect my physician to share the reasons for the tests/suspicions/etc. with me and we decide what to do next together. I've got little tolerance for doctors who don't see the parent as a very important piece of the picture and process in serving the child best. I'd make an appointment to discuss...

[Tidbits of Learning]

This is a follow up from my previous post about "Trying not to Panic"

 

The nurse called me today to say that the bloodwork came back fine except that 2 values were low but within normal. Apparently my Pedi. needed a day to check with an endocrinologist. His Alkaline Phosphotase was low as well as his blood CO2 level. Both of which are apparently not unusual "so she said" But then she went on to say that my pedi wants to do a blood test for thyroid, a urinalysis, X-rays for bone age and referr ds to a GI specialist :001_huh: I was little bit taken aback seeing how she had just said the levels were within normal.

What would be your take on this? I agree about checking his thyroid and checking his urine but I don't know about the x-ray and the GI specialist.

y

I have a son who is in the 5th percentile. Recently, the doctor had us go through this with the thyroid and x-rays for bone growth. All it got us was a big bill as most insurance does not cover small for stature as a diagnosis. So if it doesn't turn up a legitimate medical reason other than your child is just small for their age then you most likely will have to pay for all of the tests.

If you aren't worried, then I would calmly tell them that I wanted to give it some time and revisit it at a later date. If the dr. pushes it, then I would go to another pedi and see what they say. The thyroid test I don't regret. I wish that I wouldn't have done the bone age x-ray b/c the doctor keeps wanting to revisit this issue. She automatically referred us to an endo and the endo was making an appt. when I had to let them know that we weren't interested in pursuing it any further.

[Nakia]

You need to call and speak personally to your pediatrician. It is outside a nurse's scope of practice to interpret lab results. I know she was probably just reading off a lab result print out, but it is the physician's responsibility to call you to let you know what the lab results were and to give you his recommendations for follow-up.

 

ETA: I just read that you are going in tomorrow. That's good. I think you should make it clear that you expect her (the doctor) to call you in the future to give you lab results. I don't think that is asking too much. My youngest had to have quite a bit of lab work when she was two, and my pediatrician always called me to give me the results.

[snickelfritz]

But then she went on to say that my pedi wants to do a blood test for thyroid, a urinalysis, X-rays for bone age and referr ds to a GI specialist I was little bit taken aback seeing how she had just said the levels were within normal.

What would be your take on this? I agree about checking his thyroid and checking his urine but I don't know about the x-ray and the GI specialist.

 

I don't know, I have thyroid issues but the rest of what you are talking about is Greek to me. I'm not sure about the urinalysis, (do they cath them?) but the others are non-invasive. I would be inclined to do them to rule out things and at least talk to a GI specialist.

 

My older dd had some eating issues and our doctor sent us, at about 2-3 weeks old, for a suck/swallow test (they give the baby barium and follow the barium through the throat/upper digestive system via ....x-ray?.) By the time we went, I was convinced that the problem was the bottle the psycho Lactation Consultant had us using and not the baby. We had even started being successful with our b-feeding the day or so before the test, which was already scheduled. So, we kept the appointment. I told the technician my theory on the problem and the test showed I was right. Nothing wrong with baby. But, the test was not hard on baby and I didn't regret doing it. We had been through so much difficulty that I wanted any problems settled once and for all.

 

You need to call and speak personally to your pediatrician. It is outside a nurse's scope of practice to interpret lab results. I know she was probably just reading off a lab result print out, but it is the physician's responsibility to call you to let you know what the lab results were and to give you his recommendations for follow-up.

 

Yes, to this. Outside of very basic things (normal test results or minor medication changes/antibiotics/etc...)---My doctor calls with test results.

Edited October 28, 2010 by snickelfritz

[Binalina]

You need to call and speak personally to your pediatrician. It is outside a nurse's scope of practice to interpret lab results. I know she was probably just reading off a lab result print out, but it is the physician's responsibility to call you to let you know what the lab results were and to give you his recommendations for follow-up.

 

ETA: I just read that you are going in tomorrow. That's good. I think you should make it clear that you expect her (the doctor) to call you in the future to give you lab results. I don't think that is asking too much. My youngest had to have quite a bit of lab work when she was two, and my pediatrician always called me to give me the results.

 

I was thinking that as I was on the phone. If I were a bolder person I would have asked to speak to the Dr. I was also just trying to absorb the info at the moment. After I hung up I chided myself for not being more assertive - there's always tomorrow for that dream to come true ;)

[Nakia]

I was thinking that as I was on the phone. If I were a bolder person I would have asked to speak to the Dr. I was also just trying to absorb the info at the moment. After I hung up I chided myself for not being more assertive - there's always tomorrow for that dream to come true ;)

 

:grouphug:

[sbgrace]

Agreed - This is why I do like my Pedi. She is thorough and checks everything out. She does not bother with scaring me - she just does her job. Although right now - I could do with a little more information and reasoning. We are going in tomorrow so I will be able ask my questions then. The only thing about being as "good" as she is - is that she really doesn't appreciate the parent questioning her. Seems to me that she takes it as an offense because she knows she is doing what is in the best interest in the child - not the parent. She is fiercely protective of the patients in her care -(which is a good quality to have in my mind) but sometimes it does leave a parent feeling like they've just broken some cardinal law by questioning her. kwim?

In my extensive experience with medical professions this is not good. Parents are very important sources of information on their children. And she well could be wrong. It's unnecessary and at times downright dangerous in my opinion and experience to be closed to being questioned. Our first pediatrician (and some other specialists we've sense dealt with) was very much like this. She made grievous errors in my son's care and she had an excellent reputation as the best. Anyway, good doctors imo do not work that way. I've since met many excellent specialists and pediatricians. They see the value in parent input and feedback. You're important in giving her a full picture of her patient among other things. It's not in her patient's best interest to have that attitude.

Edited October 28, 2010 by sbgrace

[Elizabeth in WA]

We are also not there in the exam room. We cannot know if this doc is suspicious that the skin turgor isn't exactly what it should be, or the strength isn't just perfect. Things the doc might not be rattling off to the poor mother who could then panic for nothing. A really good, caring, experienced doc (the kind all should hope to have) often has a Miss Clavel sense: something is not right. And bothering to get a "curbside consult" from the endocrinologist doesn't sound like some quack padding his office visits. IMO, but I am, of course, an "insider".

 

(Said seriously, but not meaning be mean...just blunt.)

 

This is an important point. On the flip side, I have stopped cold questions about my daughter's size by pointing out that I, her mother, am not quite five feet tall. She was off the bottom of the chart at her last well visit, but as she is strong, active, has good color. etc. and I am not terribly tall myself, no follow-up testing at all has been done on her size. Since she has always been off the bottom of the chart, I don't think she was any bigger than the OP's child at that age. I do know that her limb length was directly checked versus body size, and I thought checking those ratios reasonable as she does have a second cousin with a kind of dwarfism; but other than that, no special testing has been done or particularly urged by her doctors. Since then, I do think she has gotten taller, because she isn't much shorter than Jean in Newcastle's daughter, but maybe she is short too. On the other, she is 8 and still wear's some size 5 clothes.

 

So... whether to do the follow-up depends imho. Is there some reason other than size to be concerned? Can size be easily explained as a genetic issue?

[Ellie]

I'd get a second opinion.I think that is a LOT of testing for a baby that is developing normally.

:iagree::iagree::iagree:

[kalanamak]

A Seems to me that she takes it as an offense because she knows she is doing what is in the best interest in the child - not the parent. She is fiercely protective of the patients in her care -(which is a good quality to have in my mind) but sometimes it does leave a parent feeling like they've just broken some cardinal law by questioning her. kwim?

 

I KWYM. She might be suffering a condition common in docs: if you give too much info, a certain percentage of the patients will have problems with it. Freak out, freak out and never come back (bury head in sand), hate you for making them vomit and lose sleep when in the end it was a minor problem, etc.

 

Peds is especially tricky, because studies have shown that once a mother labels her small child as "sickly" or "vulnerable" it can adversely affect their relationship for YEARS. Even if the child wasn't all that ill. "I'm just checking a few things out" is much less alarming than "I'm worried about chronic reflux or a hiatal hernia or inflammatory bowel disease". And, as kookie as this sounds, there is a certain percentage of people who pick up on anything you say and tell the next doc they "have" that condition. Some do it in panic, and some do it for attention. It drives me rather batty, and has turned me into a Class A "old records sleuth". My favorite was a patient who told me she had "renal cancer" and wanted to see if it recurred. Most patients use the term "kidney cancer". She told me she had cancer in part of her renal system. Plus, she'd had no blood in her urine.

 

I insisted on old records. Well, she'd had ADRENAL cancer. She'd never heard the AD. Her jaw dropped, and I made her a copy to take home and put under her pillow. She'd spent 5 years thinking she was a kidney cancer survivor, reading up on, etc. She also, I must add, never came back. The blow was too much. I'd popped her notion of herself.

 

Having "two patients" (the child and the parent) was one of the big reasons I didn't go into family practice, but only wanted to do adult med. I felt that when I shadowed a vet: animal AND owner.

 

Another thought, for you to consider, is if her demeanor in a MAN would not be a person "taking offense". I found that some patients simply expected me to be more girly than I am, and medical training does not encourage girly!

 

Just some thoughts to try and make the mind of those crazy doctors a little less opaque. :)

 

You might try telling her you'd like to understand the situation a little better.

[mhg]

the growth issue is a tertiary concern of the doc's, it's not a primary concern. The doc is concerned that it (growth) is SECONDARY to an underlying problem -- thus ordering the blood work in the first place. The blood work came back with two low values and these values aren't like IRON that can be slightly low and we can tweak diet/supplements, these are of values that are of more import. The doc is piecing together a clinical picture and she has three areas of concern: growth, low CO2, and low ALP. The doc is doing her job to make sure there's no important common denominator. Sounds like she's first class.

[mhg]

One more tidbit....

 

Regardless if this doc is good at what she does, it's not right AT ALL for you to feel intimidated/shamed/wrong for asking any and all questions you have and for wanting to thoroughly understand what's going on. You need to go in there confident (not-mousey) and with your head held high ask everything you want. If she reacts as if you're questioning her and makes you feel ANY sense of dread of doing so, then RIGHT there I'd say, "I'm getting the impression from you that you are annoyed by my asking _______ and it makes me feel pressured not to ask my list of questions; am I reading your reaction correctly?" I'd make NO apologies for asking every jot and tiddle I wanted to ask. If she makes you feel rushed and like she doesn't have time for your list, then I'd say, "I understand we're one of many clients you have to see today, and I can't proceed on this until I have some more questions answers, so would you like us to make another appointment for next week to talk this over...?" And, if the intimidation crops up, then maybe say something like, "I choose to do business with you and to trust my child's health to you and I feel like I've shown you a great deal of respect in doing so and I'd like to feel respected as well in our relationship." or maybe, "I want to feel completely confident in the decisions I make regarding my son's health and the only way I can do so is if I feel like I've made an informed decision based on having ALL the information I need....." But, whatever you do, don't cower or waver or act intimidated. Our culture deifies physicians and we inherently can feel intimidated by them and, in fact, they are RARELY questioned or asked to even explain things sometimes. Besides what we do with Jesus, decisions about our kids are the most important we ever make, so ----- don't accept intimidation.

Edited October 28, 2010 by mhg

[Paige]

I have a good friend who's DD has a growth hormone deficiency. She was 18lbs at about age 2.5 and still 18-20lbs at age 6, and her pediatrician was saying she was fine and just petite. :001_huh: She saw some specialists for unrelated issues who had been encouraging the parents to pursue some more testing regarding her growth and they put if off because the pediatrician insisted she was fine. She wasn't diagnosed until she was 7 and about 22lbs. I know her parents would love to have those years that she could have been getting treated back and maybe their DD would be stronger today. There is something to be said for catching things early and not just blowing it off as genetics. She and her DH had histories of being extremely small children so they explained it away as just that they were small people so DD was small.

 

Still, at 9mos....and the tests results are within the normal range...can the doctor explain why watching him a little more closely than average, but waiting and seeing how he grows over the next year or so would not be adequate? My friend's DD did get a bone age scan done at 3, which showed she was about 6mos behind, and again at age 5ish which showed she was about 2yrs behind but she was told that it didn't mean much at her age and it was the pattern over several years that was more important than the actual number. And the quick thyroid test came back normal for her too- she only came back positive for GHD with a very long stimulation type test and I would consider her pretty severe at 7yrs and the size of a petite 2yr old. My point being- even these tests may not show a problem if there is one, and without a reason to feel he would be harmed by waiting and watching, I would be reluctant to do any further testing. Maybe your pediatrician could tell you better exactly what he is worried about so you'll feel better about the testing or maybe he thinks you want the test to feel better and thinks he is doing what you want?

 

Also, FWIW, my youngest didn't hit 20lbs until she was 3. She was 14.5lbs at age 1, and perfectly normal with no testing needed. Her pediatrician explained that there was no reason to worry with her because she was hitting all her milestones on time or ahead of time, she had good coloring to her skin, plenty of good skin folds and rolls in the right places, and normal, healthy eating, sleeping habits, and activity levels. If any of those were off, she would have wanted some tests just to be safe. My other DDs were 15 and 15.5lbs at 1yr and did get sent to the GI because they were showing a lot of problems with food and had extremely low iron. They were also delayed in other areas. So, same doctor, similar weights, but very different responses based on the specifics of the children.

Edited October 28, 2010 by Paige

[DianeW88]

Unless I read this wrong, the OP has a 9 month old boy who below 3rd percentile in wt. after being born at a very healthy weight and normal gestation. Additionally, this seems to be a hungry baby who is consuming enough calories. If a doc did not do a thorough workup over this, s/he would be defenseless in court. Many an angry parent would be venting their grief in rage that this doc did not "do everything" to help their now-stunted child.

 

It takes little radiation to X ray a wrist. I don't know the numbers in a child but a full chest x ray in an adult, which has to get through much more meat and bone, is equivalent to 10 days "back ground" radiation. So, if my dad had lived to 97 years, 1 month, and 17 days, instead of 7 days, it would have been like getting a chest Xray.

 

We are also not there in the exam room. We cannot know if this doc is suspicious that the skin turgor isn't exactly what it should be, or the strength isn't just perfect. Things the doc might not be rattling off to the poor mother who could then panic for nothing. A really good, caring, experienced doc (the kind all should hope to have) often has a Miss Clavel sense: something is not right. And bothering to get a "curbside consult" from the endocrinologist doesn't sound like some quack padding his office visits. IMO, but I am, of course, an "insider".

 

(Said seriously, but not meaning be mean...just blunt.)

 

I agree. There are some very serious conditions that can be associated with these values and just because you (or anyone else) thinks your baby "acts normal" does not mean there isn't something going on that needs attention to make sure your baby continues to develop normally. The tests your ped is suggesting are safe and non-invasive. The radiation from one x-ray is nothing to worry about. I would follow his/her recommendations and proceed with the testing.

[Tidbits of Learning]

I would also caution against googling what the nurse said was low but still not unusual. It can open a big can of worms and fear as the worst case scenarios can pop up and then you just worry about them until you talk to the doctor.

[Tidbits of Learning]

I agree. There are some very serious conditions that can be associated with these values and just because you (or anyone else) thinks your baby "acts normal" does not mean there isn't something going on that needs attention to make sure your baby continues to develop normally. The tests your ped is suggesting are safe and non-invasive. The radiation from one x-ray is nothing to worry about. I would follow his/her recommendations and proceed with the testing.

 

They are not cheap though. I would definitely call my insurance company and make sure that if it turns out the diagnosis is small for age or such that they will cover the costs incurred.

[akmommy]

In my extensive experience with medical professions this is not good. Parents are very important sources of information on their children. And she well could be wrong. It's unnecessary and at times downright dangerous in my opinion and experience to be closed to being questioned. Our first pediatrician (and some other specialists we've sense dealt with) was very much like this. She made grievous errors in my son's care and she had an excellent reputation as the best. Anyway, good doctors imo do not work that way. I've since met many excellent specialists and pediatricians. They see the value in parent input and feedback. You're important in giving her a full picture of her patient among other things. It's not in her patient's best interest to have that attitude.

 

:iagree: I would be looking for anew ped. If I felt like I couldn't ask questions and wasn't being heard. The ped. May be right in ordering the tests, but you as this baby's momma have a right to ask questions and know exactly what her reasons are for ordering them.

 

Try to to worry to much though, some babies/kids are just small. My nephew was born at an average weight and length but just grew slower then other kids. He started K two weeks before his 6th birthday wearing 3 and 4Ts. my older brother followed a similar pattern of growth. When he hit puberty he finally hit a growth spurt and grew several inches rather quickly, but he will always be on the short side just like his dad, aunt, grandfather, and great

grandfather. You just can't fight genetics.:tongue_smilie:

[Alice]

There is a difference between small stature/petite and failure to thrive. Most pediatricians won't be worried if a child is small if the rest of the family is small and the child is growing well. However, if a child is much smaller than the rest of his family that is a concern or if a child id not growing along the curve it can be a concern.

 

As a pediatrician, this is one of the issues I hate the most since most of the time the baby is totally fine and all I am doing is worrying the parents for nothing. However, I also don't want to miss something. It's a fine line between doing too much and doing not enough sometimes.

 

You should of course feel like you can ask questions. I would say to consider how your relationship with the pediatrician has been over many visits, not just one or two. We all have bad days. I know there have been times when I've been short with someone because of reasons not at all related to that person. I was tired from being up all night with my own kids or I had just had a really difficult encounter with another patient or I'm running really behind and am hurrying when I shouldn't be. My point is that we're all human. But if you feel like it's a pattern of your doc not listening to you then that's something else.

[Pamela H in Texas]

Well, I tend to agree it sounds like overkill because though I'd be concerned that he's so small at 9months (and wasn't born early or small), his bloodwork so far was normal. Otherwise, the child seems healthy too so why go there. However, I'd do the testing. Better safe than sorry. I'd want every opportunity if he were my child. It's not like they are talking about a kidney biopsy or testing bone marrow or something. These are simple tests.

 

Note: I have never heard of insurance deciding not to pay because nothing serious was found. That is just silly as MOST testing, thankfully, comes out that nothing is found. Insurance could get away with not paying for most tests which would certainly get around and people would quit having tests so easily (and *I* have had 20 times my fair share of testing!).

 

And you have to be very careful about what you decide based on the message board. Seriously, say your doctor didn't suggest the testing. Down the road, another doctor doesn't see why this wasn't followed through on, talks you into testing, and finds something. We'd all feel for you that your first doctor was inept. Really, doctors can't win with the board collectively. They are being too aggressive in checking if nothing seems or is wrong. But if they don't do more, we fuss about that too. The second kind of post is found on the board quite regularly. The board, collectively, can't decide whether we want doctors to be aggressive or laid back.

[ktgrok]

No other indicators that he is in any way unhealthy. Yes, he wakes frequently to eat still and doesn't eat large quantities. But he does eat and he does sleep - just not as much as I wish. .

 

Nightwaking at 9 months old is totally normal. Both my skinny boy and my super chunky girl were night wakers at that age. The boy woke every couple of hours, the girl does it less.

 

As for being at the bottom of the chart....someone has to be!!! I'd get a second opinion from another pediatrician. And check the WHO charts. I think you can find them on the KellyMom site.

[Renee in NC]

When we started down the path of FTT with my ds, he didn't seem like he was "sick." At that point, he was developing normally, but just wasn't growing like the doctor thought he should. The dr ran the blood work and then did some more when the values on that bloodwork were a little off, but at that time it was nothing major.

 

Even when he was in the hospital a couple of months later, the doctors and nurses kept commenting on how "normal" he seemed. Even though he was dropping weight like crazy (by that time), being fed through a tube, and being poked and prodded all the time, he was still happy and playing. Development wise?

 

It was deceiving, because he was thriving at ALL. By this time the damage had been done, even though no one could "see" it.

 

When the doctor first became concerned, I asked on another message board I frequented at the time about it. I got the SAME answers that you are getting here - he is fine as long as he looks fine, the doctor just wants to pad his bills, he doesn't need all that testing, maybe he is just small, he's breastfed so his growth curve will be different, etc.

 

If I had listened to them, left that doctor and/or ignored his reccommendations, my ds could have died! Even though I did everything the doctor wanted, my ds is still affected by this today. If I could go back and change this for him, I would!

 

A few tests will not hurt your baby, but long-term malnutrition might. Insurance will cover this - she isn't calling your baby "small stature" she is saying "Failure to Thrive." Big difference.

 

I am only passionate about this because I am a parent of a child with learning disabilities and other issues caused by failure to thrive. Listen to your doctor - she has had significant education and experience in pediatric health. She isn't asking to do surgery - just run a few tests.

[Carrie12345]

I would stay calm (none of it sounds panic-worthy to *me*), talk to the ped about her specific concerns, then ask about taking each test/recommendation one at a time, in a prioritized order that considers invasiveness:usefulness. But that could just be me! ;)

[jplain]

The additional bloodwork, urinalysis, and x-ray wouldn't bother me at all. The bone age determination may put the issue to rest, and the level of exposure is low, so that one is worth doing.

 

However, I wouldn't see a GI specialist unless I had specific reasons to suspect we were dealing with severe reflux or other GI problems, because the testing s/he'll do will be more invasive. But if you do decide to go ahead with seeing a gastroenterologist, try to research him/her first. Some pediatric GI docs are ridiculously unfriendly to breastfeeding. It is just crazy. :glare:

Edited October 28, 2010 by jplain

[Margaret in GA]

When we started down the path of FTT with my ds, he didn't seem like he was "sick." At that point, he was developing normally, but just wasn't growing like the doctor thought he should. The dr ran the blood work and then did some more when the values on that bloodwork were a little off, but at that time it was nothing major.

 

Even when he was in the hospital a couple of months later, the doctors and nurses kept commenting on how "normal" he seemed. Even though he was dropping weight like crazy (by that time), being fed through a tube, and being poked and prodded all the time, he was still happy and playing. Development wise?

 

It was deceiving, because he was thriving at ALL. By this time the damage had been done, even though no one could "see" it.

 

When the doctor first became concerned, I asked on another message board I frequented at the time about it. I got the SAME answers that you are getting here - he is fine as long as he looks fine, the doctor just wants to pad his bills, he doesn't need all that testing, maybe he is just small, he's breastfed so his growth curve will be different, etc.

 

If I had listened to them, left that doctor and/or ignored his reccommendations, my ds could have died! Even though I did everything the doctor wanted, my ds is still affected by this today. If I could go back and change this for him, I would!

 

A few tests will not hurt your baby, but long-term malnutrition might. Insurance will cover this - she isn't calling your baby "small stature" she is saying "Failure to Thrive." Big difference.

 

I am only passionate about this because I am a parent of a child with learning disabilities and other issues caused by failure to thrive. Listen to your doctor - she has had significant education and experience in pediatric health. She isn't asking to do surgery - just run a few tests.

 

Brilliant post.

 

My ds had FTT and we did the whole thing-- tests, specialists, etc. What we had in the end was a really vague diagnosis: immature bowel. Which even the GI admitted was kind of like "we don't know what's wrong with him" Still---I am so glad that I did all that. I couldn't have slept otherwise not knowing if he was seriously sick. I will say that in our case, cutting dairy out of his diet made a huge difference in his bowel problems, but not his growth. He's still (at age 11) very small for his age (well about 10% percentile for height) and we are going through some of that stuff again. Just had his wrist xrayed just to make sure he's growing OK. Don't have the results back and have that old, familiar feeling I had 10 years ago when we went through this the first time.

 

Anyway, another vote for you to do the tests, see the doctors, and sleep well.

[Renee in NC]

Brilliant post.

 

My ds had FTT and we did the whole thing-- tests, specialists, etc. What we had in the end was a really vague diagnosis: immature bowel. Which even the GI admitted was kind of like "we don't know what's wrong with him" Still---I am so glad that I did all that. I couldn't have slept otherwise not knowing if he was seriously sick. I will say that in our case, cutting dairy out of his diet made a huge difference in his bowel problems, but not his growth. He's still (at age 11) very small for his age (well about 10% percentile for height) and we are going through some of that stuff again. Just had his wrist xrayed just to make sure he's growing OK. Don't have the results back and have that old, familiar feeling I had 10 years ago when we went through this the first time.

 

Anyway, another vote for you to do the tests, see the doctors, and sleep well.

 

We had the same sort of thing - they didn't know *exactly* what it was, but removing gluten from his diet made a difference at the time. The other help was the liquid diet (pediasure) until he was almost 2 - he ate very little solid food at all. At that time, gluten was added into his diet, but he tolerated it better then. Now, at 9 and 5 feet tall, there are no growth issues - just the cognitive ones from malnutrition.

 

For honesty's sake, the learning disabilities are genetic, but his are far worse than anyone else's in the family. The developmental delays are not. Malnutrition (for whatever the reason) in the first year can lead to serious problems because the brain is growing so fast at that time.

[ColoradoMom]

Well, if it were my child I'd do all the tests. I'd rather have everything ruled out than to sit and wonder about something I decided to omit and possibly hurt my child in the process.

[lionfamily1999]

The doctor would need to provide me with a lot more information before I would consent to an x-ray (and the radiation associated with it) on a baby who is happy and developing normally.

:iagree:

[Binalina]

Thank you all for your input - I appreciate all of your honesty and advice :001_smile: I went to the Pedi today to do the urinalysis and pick up the orders for the thyroid test and x-ray - and also to speak with the Dr. Well, DS decided not to pee in the alotted time I had to wait there but I did talk to the Dr. She was very open to explaining what her reasoning was for further testing. The nurse really misrepresented the Dr.'s thoughts during our phone call. It was not because the 2 levels came back low (but within normal) that she wanted further testing. She said this was just the next step if the blood work came back fine and since she confirmed that his numbers were ok with endo - she is fine with his blood work. If the blood work had come back any differently then we would be doing different things. She said to me very specifically today - as of now we have no indication that anything is wrong - we are just making sure we cover all the bases so that we don't miss anything. :001_smile: I knew I liked her. I think that I will go through with the 3 tests she asked us to do and meet with the GI but can't really imagine doing anything more invasive than that unless something changes with him.

[Jean in Newcastle]

Binalina -

 

I'm so glad that you had that talk with your Dr.:)

[lionfamily1999]

She sounds like a wonderful doctor. I'm glad you're so comfortable with her and can trust her :D

[Nakia]

Thank you all for your input - I appreciate all of your honesty and advice :001_smile: I went to the Pedi today to do the urinalysis and pick up the orders for the thyroid test and x-ray - and also to speak with the Dr. Well, DS decided not to pee in the alotted time I had to wait there but I did talk to the Dr. She was very open to explaining what her reasoning was for further testing. The nurse really misrepresented the Dr.'s thoughts during our phone call. It was not because the 2 levels came back low (but within normal) that she wanted further testing. She said this was just the next step if the blood work came back fine and since she confirmed that his numbers were ok with endo - she is fine with his blood work. If the blood work had come back any differently then we would be doing different things. She said to me very specifically today - as of now we have no indication that anything is wrong - we are just making sure we cover all the bases so that we don't miss anything. :001_smile: I knew I liked her. I think that I will go through with the 3 tests she asked us to do and meet with the GI but can't really imagine doing anything more invasive than that unless something changes with him.

 

Thanks for the update! I'm glad you are doing the tests. And I hope she has a word with her nurse. :glare:

[Margaret in GA]

Binalina -

 

I'm so glad that you had that talk with your Dr.:)

:iagree: