Saturday, January 12, 2008

Silly Mommy

Yesterday in clinic was "Silly Mommy" day.

Case #1: First time young mother has a two week old baby, coming to clinic for newborn checkup and state screen #2. Looking through the chart, we notice that the baby has an ER visit in the chart. What could send a 1 week old baby to the ER? Chief complaint: constipation. When questioned further, mom reported that the baby was constipated after being fed rice cereal. Her ER chart stated very politely that "mom was educated that newborn infants should only be fed breastmilk or formula."

Case #2: Similar to case #1, we had a young first time mother bring her newborn to clinic for a 2-week checkup. Mom said that the baby hadn't pooped in 2 full days, so she'd been giving her water to get her going (see case #1). When I went to examine her, I pulled off her diaper to reveal very thick yellow stool (in other words, normal baby poop). As I was pointing this out to mom, the baby started pooping more, scrunching her face and straining. Then, while her mom was trying to clean her bottom, the baby farted right in her face. She totally freaked out: "Oh my GOD, that is so disGUSTing! Baby, that is TERrible! Oh no you didn't!" I was laughing too hard to be of much help to her.

Case #3: 15-month-old male for well-child checkup. Baby was noted to be so far above the weight scale that he charted onto the height scale, located above the weight chart on the page. When the attending pediatrician came into the room to examine him, his older sister (>2 years) was also in the room. Both children were drinking from bottles when we walked in. The attending flipped her lid. "No es bueno para los ninos usan estos! No no no!" Fortunately a drug rep had left us some sippy cups for kiddos, so both kids left with free cups. We also gave mom some nutrition guidelines for the chunky kid: "El jugo tiene mucho azucar" (Juice has a lot of sugar). Her eyes widened. "El jugo de WIC tambien?" Uh, yes, mom, just because the government paid for it doesn't make it low-calorie, low-fat, low-sugar, and perfect for your child to drink in very large quantities.

From a pediatrician's point of view, these cases have a few things in common. A) Pediatricians aren't doing a very effective job (at this clinic at [county hospital]) of teaching parents about proper nutrition. B) There is a lot of misinformation out there about what to feed your kid. C) No wonder there's an obesity epidemic when we get 14-kilogram 15-month-olds in clinic.

From a (distant-future) parent's point of view, I feel frustrated for those parents. What will I do to my kids that my pediatrician laughs at? And how much of these teachings are hocus-pocus? Is there solid evidence that babies fed bottles have extra problems with their teeth? How strong a risk is it, really? (I don't know). Is this yet another thing that today we abhor bottles in toddlers, but tomorrow we learn that it causes higher IQ's and less foot fungus so we recommend it? I don't know. I do know that I felt for those moms. Sure, now I know not to give a newborn water (it can actually be quite dangerous, as they can get hyponatremic or have failure to thrive, depending on the amount) but I didn't before I took pediatrics.

Silly mommies or not, I'm sure these kids will grow up to be fine.


Enrico said...

"El jugo de WIC tambien?"

Priceless! You should have said, "El jugo de WIC es lo mas peor!" (The WIC juice is the worst!) LOL!

Tiny Shrink said...


Gauderio said...

Having lived abroad in a culture somewhat similar to [county hospital], I have a few things to add.

Culturally, that particular collective group of people tend to believe that their babies need to take about 4 ounces of formula beginning at newborn. Nevermind the fact that's about twice as much as the newborn stomach can hold. The trend just continues throught their childhood. And that is one reason, I think, why that population "tiene mucho diabetes".

As far as the teeth thing, yeah it really can rot out all the teeth. But that is also very dependent what's in the bottle and when the kid has it. Anything with lots of sugars (like milk or juice) in a bottle at bedtime is a recipe for disaster. I can't say I saw it on my two months of peds, but once again, while living abroad in a country with poor health care and dentistry, I saw lots of kids with teeth rotted out to black little nubbins. From sugar coated pacifers and nighttime bottles with non-water beverages.

And on a side note, don't you find peds rather like being a vet. You have medical mysteries on your hands with patients who just make weird noises at you.

Tiny Shrink said...

"As far as the teeth thing, yeah it really can rot out all the teeth. But that is also very dependent what's in the bottle and when the kid has it." Exactly. Taking a bottle of juice to bed and leaving it in your mouth all night is a good way to get muchos cavities. I, too, have seen kids with godawful teeth b/c of such behavior. I was more referring to a toddler drinking from a bottle in the middle of the day. Is it just that you suspect that the kid drinking from a bottle during the day is using it at night? I saw some stuff about jaw growth and tooth formation, but I've also heard that sucking your thumb is supposed to give you bad teeth. I sucked mine till I was in kindergarten and never had buckteeth or any dental problem that could be attributed to thumbsucking.

And yes, I had a mom whose baby was vomiting after feeds. Turned out baby was eating about twice as much in a feed as a baby that age can handle. Yeah, I'd probably vomit too.

Midwife with a Knife said...

It is amazing. I think I'd probably mess up any child left in my care for long enough!

Megan said...

you're not supposed to give newborns water? Shit, I didn't know that. Maybe THAT is why no one will have sex with me. Yes, that must be it.

The MSILF said...

Wait, why aren't you supposed to let a kid at a certain age have a bottle? I know about the not falling asleep with them for tooth decay, but walking around?

Tiny Shrink said...

Why is it important to wean my child off the bottle?

* Children using bottles are more likely to develop tooth decay.
* Children who drink from a bottle may have improper dental development.
* Children who depend on bottle feedings may not consume enough solid foods to meet their nutrient needs.
* Children who are not weaned from the bottle may not develop appropriate feeding skills.