posted
I am so frustrated right now with my daughters pediatrician. My daughter has always been a healthy kid. Not much to complain about at all. When she was an infant, she was at the top of the height weight scale. Since then, she has been in a steady decline. Because she had fallen from the 95th percentile to the 25th percentile in the last year, her doctor wanted to run a bunch of tests. I wasn't sure it was necessary and resisted. My husband and I are both on the smaller side and were both really small kids. However, after much persuasion from my husband and the doctor, I agreed to run the tests.
Ellie had a bunch of blood work done looking for a possible cause. Today we go the results. The doctor found nothing wrong with her to indicate why she is small and now thinks thats just the way she is. Great, right? Unfortunately, the dr. also said Ellie has lipidemia which is essentially fat cells in her blood. The dr. said this has nothing to do with the previous problem and came out of left field. Now she wants to run a whole other set of tests including a fasting blood test and a urine test which involves me trying to get my 18 month old to use the potty. When asked what we were looking for the dr gave me no clear answers at all. I was so frazzled by the conversation I feel like I really didn't handle it well and just don't get what the problem is. I looked online, and usually lipidemia is associated with obesity. Clearly not our problem. I am just so frustrated with more testing looking for I don't know what on a kid that is having no problems. She doesn't get sick, she has lots of energy, eats well, and is hitting all of her developmental milestones. I don't know what I am looking for here but it feels good to just let out some of my frustration.
Posts: 416 | Registered: May 2005
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posted
Respectfully, I want to say that a change from the 95th percentile to the 25th percentile on pediatric growth charts is rather interesting and certainly would be a good reason to decide to run some tests, just to be on the safe side. Really, running some simple exclusion diagnosis on your kid is probably worth doing — even if they find out nothing is wrong, it is good to pay attention to these things.
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Possibly. Although a similar drop is not uncommon in a child as they become more active. Which is about right for that age. Most pediatricians I know would want to keep an eye on it, but if the child is otherwise healthy, would not necessarily push for tests.
I am more concerned buy the fact that Theresa feels that the doctor is not clearly communicating what her concerns are, and expecting an 18 month old to pee in a cup.
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I'm sure they'd be happy to use a catheter instead. That sucks that you're not getting transparency (even if the doctor is trying, it's not enough if you don't understand).
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Yeah, I'd say the lack of communication is the big problem. Extra tests don't necessarily hurt (though having a 1_1/2 year old myself, I can sympathize with the idea of trying to get a child that age to use the potty).
I can't imagine my pediatrician getting riled up over that drop in weight, to be honest. My son dropped in percentiles as a baby and he just kind of said, "we'll keep an eye on it."
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Samprimary, I did get the tests done that the dr wanted because of the weight drop. I agreed eventually the drop was enough to check even if I didn't think there was a problem. The part that is frustrating me is now there is a completely different problem to investigate. It is so disheartening to take in what you think is a healthy kid and hear she still needs more tests. The part that is super frustrating is that the pediatrician just kind of drops these bombshells on me without much explanation and by the time I get my thoughts sorted out I am already out of the office. When we talked again on the phone, I still felt like she was just fishing for problems. She doesn't have a good idea of what is wrong. I guess it makes sense then to do more tests but I am worried that more tests won't solve the puzzle and we'll be right back where we started.
I never imagined it would be so hard to get a simple blood test. I would gladly do it 100 times over to stop from having to do it on my baby. It is so hard to hold her down and extra hard this time because she is going to be super hungry and cranky waiting for her appointment. that doesn't even take into account the joys of collecting a urine sample. I know its better than a catheter but its a bit daunting to face all this pressure to have success when we are only just starting the process.
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I think you should ask questions regarding time limits. Is there really a reason to investigate this now, or can you put it off for 6 months to a year, assuming you monitor things? What potential diseases are there and what treatments do they have (like if there is a preferred diet for the potential problem, you could maybe just try that for a year and then do the extra tests)?
ETA- my daughter dropped in percentiles similar to what you are reporting. Being part Chinese, the doctor figured it wasn't that weird for her to be smaller. Also, high activity level at the time of drop, and I breastfed, which can affect expectations.
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quote:Originally posted by theresa51282: Samprimary, I did get the tests done that the dr wanted because of the weight drop. I agreed eventually the drop was enough to check even if I didn't think there was a problem. The part that is frustrating me is now there is a completely different problem to investigate. It is so disheartening to take in what you think is a healthy kid and hear she still needs more tests. The part that is super frustrating is that the pediatrician just kind of drops these bombshells on me without much explanation and by the time I get my thoughts sorted out I am already out of the office. When we talked again on the phone, I still felt like she was just fishing for problems. She doesn't have a good idea of what is wrong. I guess it makes sense then to do more tests but I am worried that more tests won't solve the puzzle and we'll be right back where we started.
I am sure this is a bit trying and it's bad that your pediatrician has not managed to work with you on understanding sufficiently, but remember that in many circumstances, not having an idea of what is wrong is par for the course, thus a diagnosis of exclusion. It is a response to abnormal readings, not an attempt to create them.
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We are meeting wtih Eliza's dr. today to discuss some options before we agree to do the tests. We will be asking for sure how necessary it is to run all of these tests now and if a wait and see approach might be more prudent. I really don't want to put her through a lot of unnecessary procedures and visits. As for simply preemptively changing her diet, that is really tricky. It looks like most of the recommendations involve increasing exercise and decreasing fat intake. I can't imagine giving Ellie more exercise. She is constantly on the go all the time and we go to the park daily. Decreasing fat is especially problematic because we were just given recommendations at her last visit to actually increase her fat intake because of her low weight. The dr. was wanting me to add butter and olive oil and heavy cream to her foods. We'll see what she says this afternoon about continuing to add more fats.
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quote:The dr. was wanting me to add butter and olive oil and heavy cream to her foods.
That seems like a really, really bad idea! That sounds like the easy way to gain weight--not the healthy way. I'd definitely get a new doctor.
Posts: 2880 | Registered: Jun 2004
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quote:The dr. was wanting me to add butter and olive oil and heavy cream to her foods.
That seems like a really, really bad idea! That sounds like the easy way to gain weight--not the healthy way. I'd definitely get a new doctor.
I've gotten similar advice from our pediatrician. I'm not sure that this is as unhealthy as you seem to think it is, when it comes to kids who could stand to gain some weight. (Actually I'm pretty sure you're wrong.)
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Considering that things like giving kids whole milk are standard practice (like if you are on WIC, you cannot get 2% until the kid is over 2), I don't think that it is unhealthy advice.
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I am a bit weirded out by expecting an 18-month-old to pee in a cup as well. In order to get a urine sample for my one-year-old (or maybe he was younger at the time), the doctor just put a little plastic bag over his genitals inside his diaper. It had adhesive to stick to his body. Obviously, boys and girls are different, but I can't imagine that they don't have similar things for little girls. After they put it on, we just waited at the doctor's office for him to pee.
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Brinestone, the ped did mention that if I couldn't get her to pee in her potty that taping a bag was an option to try but that the risk of it being contaminated would be high and that would result in having to retest yet again.
We met with her this afternoon and I do feel a bit better. Essentially we are going to do a retest of the first blood test with fasting to ensure that the first results were accurate. If they were, with a child of her weight, it would indicate that she might have a problem with her kidneys or thyroid because it is not obesity or nutrition related. She would need to then see a specialist. The retest is meant to save us from having to go to a specialist who would want a second test anyways to see if it was just a bad lab sample. Apparently wait and see isn't really an option. There is unlikely to be clear additional symptoms even if she did have long term kidney and thyroid problems. We would just need to repeat the test at some point to find out.
I did get a copy of her lab results and records and am going to send them to a pediatrician friend for a second opinion but right now I am leaning towards getting the retest.
As for the extra fat in her diet, we are going to continue to try and increase it as the dr. doesn't believe her problem is at all related to too much fat in the diet like it normally is. At this age, they need the fat for brain development. I was skeptical at first but talking to others, adding fats seems a pretty commmon prescription for underweight toddlers.
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You mentioned holding her down for the blood test. Do you lay her down or just hold her in your lap while they do it? I don't remember which child it was, but he would scream when held down for anything, especially blood draws. The next time it was necessary I held him in my lap and gave him his pacifier. He sat and watched them put the needle in. He was fascinated and didn't cry at all. Maybe bring her favorite stuffed toy to hold in the arm they aren't using.
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Good. It sounds like sitting down and talking with the pediatrician has alleviated some concerns. Hopefully, it was a bad test and nothing is wrong with her kidneys. It actually like the doctor is being thorough, and following up to ensure your little one is healthy - and re-testing before referring to a specialist is a prudent move.
All that said, I'm a big believer in trusting your instincts about medical personnel...if you feel a need to change pediatricians, chances are you probably should. Someone can be a wonderful doctor and just not be the right fit for you. There is nothing wrong with getting second opinions or changing caregivers if you want to find someone who is more in line with your expectations.
Posts: 14428 | Registered: Aug 2001
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The big problem I see here is that your pediatrician isn't communicating with you very well. All the medical advice given seems pretty decent/standard, but I would feel very uncomfortable with a Pedi I couldn't get a strait answer from!
I know how hard it is to get medical tests for a toddler. I still have a scar from one toddler medical procedure! My former step-daughter was amazingly strong (owing to a tumor in her adrenal gland), but my son was never much better. It's such a pain to get kids to fast, and I've never met one that liked a needle!
I wouldn't stress too much over "peeing in a cup". My son, his sister, and my little cousin have all had urine tests as toddlers, and they ALWAYS used the urine collection bag. I'm sure there's a chance of contamination, but we never had a problem with it.
Good luck. Please keep us posted. I hope the lab tests were just wrong the first time!
Posts: 1321 | Registered: Jun 2006
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quote: Good. It sounds like sitting down and talking with the pediatrician has alleviated some concerns. Hopefully, it was a bad test and nothing is wrong with her kidneys. It actually like the doctor is being thorough, and following up to ensure your little one is healthy - and re-testing before referring to a specialist is a prudent move.
All that said, I'm a big believer in trusting your instincts about medical personnel...if you feel a need to change pediatricians, chances are you probably should. Someone can be a wonderful doctor and just not be the right fit for you. There is nothing wrong with getting second opinions or changing caregivers if you want to find someone who is more in line with your expectations.
posted
Thank you all for your support. It really has made me feel better. I'll update when we get the results back.
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That sucks that you're not getting transparency (even if the doctor is trying, it's not enough if you don't understand).
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That seems like a really, really bad idea! That sounds like the easy way to gain weight--not the healthy way. I'd definitely get a new doctor.
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