Tuesday, April 17, 2012

I worry too . . .

You may have noticed that the blog posts are less frequent than before. That is for a few reasons. As you know, I had Child2, moved, went back to work, had Passover, and a delay in getting our Internet service back. We also had to let go of both of our dogs - one died and one finding a new home. Even more, we are also having health issues with Child1 and Child2.

So you thought pediatricians didn't go through this type of thing? We do. In some ways we have an even harder time because the burden of knowledge is so crushing.

Child1 is behind on his gross motor (not walking) and verbal skills (babbling, not talking). He's also the bottom of the growth curve. We are scheduled for an early intervention evaluation from the local infant services group. They'll come to our house to evaluate him and determine if he needs additional therapy. I sit around and wonder if I've failed him in some way that all three of these things are going wrong.

Did I fail to stimulate him enough? Did exposing him to 2 languages by visiting Israel and speaking Hebrew for the first few months of life mess up his verbal acquisition? Did I feed him too little from birth onward? (All of his food is now spiked with olive oil or carnation instant breakfast.) Should I get him sweat tested for cystic fibrosis? He coughs every once in a while - does he have occult pneumonia from cystic fibrosis or inhaled foreign body? Should I get him retested for lead - even though his level was fine at 12 months? Was our apartment too small?

Child2 has a patent urachus - a connection between his bladder and belly button that oozes fluid and pee out of his bellybutton. If left untreated, it could lead to multiple damaging UTIs and cancer. Correction is surgical. The radiologist told us it wasn't too severe so I should wait for my urology appointment to make any decisions as they are often observed. I stare at his bellybutton obsessively now looking for signs of infection.

Should I have gotten the ultrasound sooner? Should this have been caught on prenatal ultrasound? Did the time I mistakenly ate some chicken that I thought was hot ended up being cold contribute to this? Was thirty feet not far enough away from the portable x-ray machine they use in the hospital - even though radiation doesn't cause this? What will I do if he needs surgery? Should I have insisted on an immediate appointment? He's cried for 10 minutes - am I missing an infection?

Then I ask myself what I would tell a patient. "Child1 is above average in his fine motor skills and has great eye contact. Kids develop at different rates, so see if early intervention as an unbiased observer, thinks anything needs to be done. You have plenty of time to step in and someone is going to be the 3rd percentile. Child2 has a relatively common well known generally uncomplicated abnormality. It was even a regular question on board certification testing. You got your testing done by the head of pediatric radiology and he recommended observation with pediatric urology. You have an appointment with the best pediatric radiologist in 300 miles."

It's comforting to know, but as a parent you'll still worry, no matter what.

Thursday, April 5, 2012

Carseat Roulette - Part 1

Everyone has heard a word problem similar to this one.

Once upon a time a farmer went to market and purchased a fox, a goose, and a bag of beans. On his way home, the farmer came to the bank of a river and hired a boat. But in crossing the river by boat, the farmer could carry only himself and a single one of his purchases - the fox, the goose, or the bag of the beans.

If left alone, the fox would eat the goose, and the goose would eat the beans.

The farmer's challenge was to carry himself and his purchases to the far bank of the river, leaving each purchase intact. How did he do it?

Okay, we all know, take the goose across first, then go back and get the fox, return the goose to the first side, get the beans, and then go back and get the goose.

Here is a new modern version:

Congratulations, JaneMD has had her second child. Child1 is in a convertible carseat. Child2 is in an infant carseat. HubbyJD is 6 foot 2 inches tall. The American Academy of Pediatrics and the US department of transportation has recommended that children remain rear facing till 2 years old, thus increasing the size required by Child1's seat. The safest position is the middle seat. The LATCH system can allow use of the middle seat only or both side seats without the middle. Neither carseat can touch the driver or passenger seat. Both carseats need to hold the children at a 45 degree angle.

What arrangement of carseats will be possible in JaneMD's compact car so HubbyJD can get the children to daycare?

Keep in mind that I am a board certified pediatrician with a bachelors and an MD. I always buy new carseats and check to make sure they have appropriate oversight and are without recalls. I always READ the MANUAL.  The fire department and I are great friends since I have had them install my carseats personally 4 times in 3 months. (Hubby JD often moves them, my pregnancy and recovery did not allow me to do so).  If I'm struggling to get my seats in the safest position, one can only imagine how everyone else is doing it.

The biggest issue is undoubtedly the size of the convertible carseat. While rear facing, it forces any of the front seats to be pulled pretty far forward. When Child1 outgrew his infant seat, pre-Child2, we couldn't fit the convertible seat in the middle because it shoved the driver's seat into the steering wheel. It had to go behind the passenger seat. This was extremely uncomfortable for JaneMD while in her 3rd trimester and worse for HubbyJD at his height.

Adding Child2's carseat was difficult, even with fire department assistance. The massive convertible seat prevented installing the infant carseat in the middle. The convertible carseat used the LATCH anyway, so Child2's infant seat had to go behind the driver. Sadly, this still pulled the driver's seat too forward for a taller guy like HubbyJD.

You should get a minivan!

Funny you should suggest that. We actually just rented a 2012 Dodge Caravan with Stow-and-Go seating for a 1 week trip. (Our compact wasn't going to make it on any drive over 15 minutes with all of us) That should have solved all the problems, right?

Wrong. We installed the infant seat behind the driver and the convertible seat behind the passenger seat. Both front seats had plenty of space. One problem. The two carseats BLOCKED both side doors. I had to climb from the front passenger seat into the center aisle to get to the back seat to breastfeed. Let's not discuss the issues of changing diapers in the back of the rental car. HORRIBLE.

After the first half of the trip, we attempted to readdress the issue as we had made most of the reason for getting a spacious minivan useless. Next we stowed the seat behind the driver, installed the convertible behind the passenger seat, and installed the infant seat in the back.

Wrong again. The back seat isn't perfectly centered so you could not actually sit next to the infant seat. The convertible seat on the passenger side blocked access the the larger seating space on the back side.

So we rearranged again. The barely workable situation ended up like so. Infant seat with base in captain's chair behind drivers seat. Passenger side captain's seat stowed in floor. Convertible seat installed rear-facing in back middle seat. Jane MD able to sit on passenger side in way back and breastfeed while at rest-stops. This barely worked because HubbyJD could barely fit into the drivers seat as the infant seat prevented him from sliding the driver's seat back fully.

Tune in next week for Part 2 of carseat roulette. Next planned article - Poor on 100K?