Type of Dr needed??

  1. A friend of mine has no clue what type of Dr. her baby needs to see next, I am going to post what she sent to me...I think that there is a type of disease that this would fall under but for the life of me I can't remember what. I was wondering if yall could tell me what type of Dr. this baby needs to see? Any info. would be greatly appreciated.
    Thanks,
    Wolf


    My baby daughter, is going to be 9 months old on June 18. She was 8lbs. 3oz. at birth. According to the growth charts she was above average in size when she was born. Every check-up since she was born her average has gotten lower and lower. Since she was six months old she has been negative on the chart. She has been about 13 lbs. for two months now. She is still able to wear
    newborn clothes. She has also had a cough since November. I nurse her about 5 times a day, feed her solids two to three times per day, and as of Monday of this week give her 18 oz. of formula per day. We have been to see two lactation consultants and she is nursing fine and taking in milk while nursing. Her immunizations are all up-to-date and her development has been on target for
    her age.
    The pediatrician has done several tests:
    Sweat test to check for cystic fibrosis (this was negative)
    Upper GI (she has mild gastroesophageal reflux everything else is normal, she takes Zantac and Reglan for the reflux)
    Blood Test (some of the readings were abnormal but the pediatrician consulted another doctor who said they were normal)
    Milk Scan - Reflux Study (confirmed she has mild astroesophageal reflux with no aspiration)

    She has been to see a pediatric pulmonary doctor. He performed an infant pulmonary function test (a test to check for asthma or reactive airways disease) that "revealed moderate peripheral airway obstruction." She did not respond the Albuterol they gave her during the test, which means she doesn't have asthma
    or reactive airways disease. They gave her chloral hydrate to put her to sleep during the test and she had a very difficult time waking up. Instead of 20 minutes it took her three hours to wake with an episode of pinpoint pupils and needing oxygen because she was turning blue. He has put her on Pulmicort with a
    nebulizer twice a day to see if that helps her cough. The pulmonary doctor does not believe her pulmonary symptoms or the reflux are enough to explain her being so small, which he calls "failure to thrive."

    I am scheduling an appointment with a pediatric allergist to see if he can find a reason for her "failure to thrive."

    I don't know what else to ask or do. The pediatrician has not seemed as concerned with her lack of weight gain as the pulmonary doctor has. However, when I went to weigh her this week the pediatrician was very concerned about her not
    gaining weight and asked me to give her formula as well as breast feeding.

    So, my question is any suggestions about what to do?
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  2. 9 Comments

  3. by   altomga
    How about a pediatric gastroenterologists? My oldest son had what looked like pyloric stenosis initially when he was a month old (lost @ 2lbs of birth weight with projectile vomiting). Now although they never could find out what was wrong (it happened again at 7mos) the GI doc was very helpful.
    Sorry that she is having a rough time...Keep you in my thoughts.
  4. by   rdhdnrs
    You need to contact a large teaching children's hospital and get your daughter in. Their general peds clinic will be able to figure out where she needs to go next. I wish you the best.
  5. by   Wolfbeareagle
    Thanks for your responses, you guys are great!! Anyone else have any more ideas?
    Wolf
    Last edit by Wolfbeareagle on Jun 5, '03
  6. by   Jolie
    I would also recommend an endocrinologist. I wonder if she may have some obscure metabolic disease. It seems that she is taking in enough calories to gain weight, so I wonder if she has a metabolic disorder that is impairing her ability to process the nutrition she is receiving. Do you live in a state that does expanded newborn screening at birth? If not, it might be worthwhile to request such a test now.

    I agree that a teaching hospital would be the place to go. Perhaps schedule an appointment with an attending pediatrician who could then help arrange all the consults, rather than you trying to guess who to see next.

    Good luck and let us know how she is doing.
  7. by   Zee_RN
    I was going to recommend an endocrinologist also. 13 pounds at 9 months is too small. She definitely needs to be seen by experts. I also second the idea of a large teaching hospital.
  8. by   SmilingBluEyes
    I was with the others on endrocrine. It sounds very much like it could be metabolic.....

    Get to a larger children's center and go from there like suggested above. They can point you in the right direction. I wish you and your friend well. Let us know what they find out, if you can!
  9. by   nowplayingEDRN
    I would suggest the following: Pediatric gastro, ednocrine and maybe cardiology ....but I would definitely start with the first two. Sounds like maybe a malabsorption or metabolic problem. Please keep us posted....and give her our best wishes.
  10. by   fourbirds4me
    If i were you I would suggest a cardiology workup..... heart kids are known for failure to thrive. Also, sometimes a sweat test is not sufficient to diagnose cystic fibrosis. DNA testing could positively rule it out though.
  11. by   angelbear
    I would suggest you contact your local health dept nurse. Ask about haveing her checked through crippled children's for diagnostic testiing. This is a federal program though it is called different things in different area's but bascially it will hook you up with a larger hosp with specialists. Diagnostics is free through the crippled childrens program ( here it is BCMH bureu for children with medical handicapps) I am not saying she is handicapped but they can help you get to the bottom of the problem and then if needed they can also help with medical expenses. Check it out it couldn't hurt.

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