4 year well visit

Stats:

• 37.5 pounds (80th percentile)
• 41.5 inches (80th percentile)

Vaccinations:

• None. Since he was a few weeks shy of 4 years old, we have to go back otherwise the department of health would not consider him up to date.  He'll return in August to get a few shots.

Her concerns:

• None

My concerns:

• None

He was SO very shy and would hardly speak.  He did do his vision and hearing test with all answers being in a soft whisper.  Kinda funny.  Vision and hearing are all good.  So thankful to have a healthy, happy child.

2 Year Well Visit

Hans' Stats:

Height:  34 inches (45th percentile)
Weight:  28.5 lbs (55th percentile)
Head circumference:  She didn't do this.  not sure why.  Freddie had his measured at this age.

Vaccinations:

• Hep A (2nd dose)

My concerns:

• Perhaps a lazy eye:  She didn't notice anything but said seeing an eye doctor is never a bad idea.  She said it is fairly common to have one eye that is weak. She gave me a name so I will most likely get him in to see someone in August.
• Inconsolable crying:  He can cry for about 30-45 minutes at times.  It can be triggered by almost anything, which doesn't concern me, but the duration is concerning.  He has a hard time self soothing (or being soothed) or moving on when upset.  She said given the age, it's not a concern but something to watch to make sure frequency and duration decreases.  

Her concerns:

• None.  All healthy.  Chatty, engaging.  Even though he's been stuffy for a few weeks, his ears were clear, thankfully.
• She asked about his breathing and recommended I bring his nebulizer when we travel in a couple weeks.  She said I can call her while we are away if I notice he is struggling rather than taking him to an urgent care clinic.

A med student did the measurements today and I don't think they are entirely accurate.  Dr. G offered to redo them, but I didn't think it was necessary.  He's growing, and that's really all the info needed.

He got one vaccination and no tears!  He said he was going to be brave and Freddie offered his hands.  Big boy.  I was a little concerned as he listened to the patients before us screaming in the examination rooms and then watched them leave with red teary eyes.  Big boy!

Dr. G asked me to tell the med students observing her about potty training a child under the age of two. I don't think they were mamas yet so I don't think they really get the potty training mystique, but imagine they'll hear all about it one day when they start seeing patients.  

Next appt:  Three year well visit to be scheduled at a later date.  I opted to not do the 2.5 year well visit just because there aren't any vaccinations and Dr. G doesn't have any concerns.  We'll see her in the fall for flu shots and I image we'll see her often enough once cold and flu season gets under way.

6 month well visit

6 month well visit at 6 months, 2 weeks, 3 days:


Stats:

• Weight:  16 lbs 2 oz (17th percentile up from 2nd percentile at 4 months)
• Length:  27 inches (53th percentile up from 40th percentile  at 4 months)
• Head circumference: 43.5 cm (45th percentile up from 35th percentile at 4 months)

Vaccinations:

• Rotovirus, 3rd dose
• Hib, 3rd dose
• DTP, 3rd dose
• IPV, 3rd dose
• PCV, 3rd dose 
• Influenza
• Note:  Held off on Hep B today since flu shot was added.  

He looks great.  Dr. G was pleased to see the increase in the percentiles.  No concerns.

I have to admit I have been going back and reading lots of Freddie's posts to compare.  Need to stop the comparing, but wish I had read Freddie's 6 month well visit post prior to Hans' appointment.  Freddie began lead tests at 6 months and while I think we are low risk living in a new building I do want to ask Dr. G about testing (just the finger prick not venous for now).  No reason not to as far as I'm concerned. 

And since I brought up the whole comparison thing Freddie was in the 5th-10th percentile at this point with the exception of his noggin which was in the 50-75th percentile.  Freddie was also far more mobile, holding to stand independently, and was sitting with a great amount of proficiency.  While Hans is not yet there, I'm not worried.  I need to keep in mind that Freddie hit lots of physical milestones early and Hans will do everything on his own schedule. 

Freddie looks/sounds great as well.  

Next visit:  February 27th to administer 2nd dose of flu shot and 3rd Hep B dose.

Sick Visits (updated)

Took the boys to see Dr. G this morning since Freddie had fever, again.  He's had fever for at least five days, hovering around 100-101.  He's congested and coughing and complaining his throat hurts.

His gunky nose and bad breathe are signs of a possible sinus infection.  She did say a virus piggybacking on another virus because of his weakened immune system is more probable but went ahead with an antibiotic because of this other symptoms.

This would be only the second time he's ever had an antibiotic.  The first time was for an ear infection and the amoxicillan went down smoothly.  This time he's got a z-pak, and it is not going down.  At all.

The kid doesn't cry for shots, but he's not swalling yucky medicine.  Had I known, I think talking about it ahead of time might of helped, but once he got the stuff to his lips there was no way it was going down.  

My attempt at brute force to quickly get it into his cheek with the syringe resulted in his puking all over the two of us.  Putting it in Coke, the only liquid he's agreed to drink all day, made him gag with each tiny sip.

I'll call the doctor in the morning.  I'm feeling like a bad Mama for now.  I apologized for forcing it down and he says, "It's ok, Mama. I sorry, too."

In other news, Hans is healthy, and weighed in at 14lbs 10oz putting him in the 8th percentile.

Thursday Update:  I spoke with Dr. G  and she advised masking the taste with chocolate, but actually just recommended skipping the antibiotic for another day or two until it was 100% evident it was an infection rather than viral.  And sure enough, Freddie's fever broke on Wednesday and he's been fever free today, so I suppose no meds needed.  I know for next time that zpak ain't happening and to ask for something different.  Dr. G has been very kind and helpful and has called to check in with us three times in the past 48 hours.  Although she doesn't keep the most convenient office hours, which aren't even the same week to week, she is very accessible over the phone.

Hans' Weigh In

At 4 months, 2 weeks:

• 13lbs 2.25 oz (5.97kg) (4.5th percentile)

So, he's gained about 13oz in 12 days.  That's more than the 1/2 oz per day usually recommended for newborns.  He's gaining, but still is "slight."  The kid has a roll on each thigh, but he's still considered slight.  Ah, well...

Last week I spoke with the lactation consultant.  She was kind enough to just chat with me on the phone for a while.  No appointment.  No getting myself or the boys anywhere.  Her recommendations to increase my supply:

• Mother's Milk Tea....haven't gotten any yet, but hope to visit Whole Food this weekend.  I like tea, and there's no harm in it, so I'll give it a whirl. 
• Pump after each nursing, if you have time....HA!  
• Rest...even bigger HA!
• Eat three meals and three snacks a day.  I did increase my caloric intake.

What I have done:

• Mama is now off limits when nursing.  No chatting, no asking her for help, no singing to her and Hans, no requests to watch tricks or jumping jacks.  This has helped Hans focus and I think he is nursing longer.
• We've been inside more.  I'd been staying in more to try to help get Hans' naps later in the morning, so this being in the house more means I've been offering to nurse him every 1.5-2.0 hours rather than every 3 hours.

What won't happen:

• The lactation consultant verified that he is more than capable of getting enough calories during the day.  He does not need to get up at night to eat.  Whew.

What concerns me:

• He is in an extreme state of constipation.  And I do mean extreme.  The pain he is in trying to have a bowel movement is nothing compared to his 9 day poop-less stints.  It is AWFUL to see him strain and cry.
• He acts like he is starving and cannot get enough solids!  Is he that hungry and can I be feeding him too much?

What Dr. G said today:

• Wow!  He sure is active for 4 months!  And he's just going to get more active and burn more calories.
• Keep doing what you're doing. 
• I'm not worried.
• Try oatmeal instead of rice cereal.  Keep up the prunes.
• Feed him as much as he'd like to eat, but always after he's had a full nursing session

Next steps:

• Six month appointment in January, but pop in for a weight check when time allows every few weeks.

Well Visits

Freddie at 2 years, 8 months:
Stats:

• Weight: 27 lbs (15th percentile)
• Height: 34 inches (5th percentile)

Vaccinations:

• Hep A, 2nd dose
• Influenza

Right on track with growth, with the 1 inch growth in about six months!  Dr. G said to expect about 2 inches per year.


Also, the child DID NOT CRY for either shot.  And he watched the needle go in both times!  I was amazed.  We have been talking about going to see Dr. G for the past week and told him he was going to get a shot.  We also told him that shots hurt.  He went with Charlie to get his allergy shot and he's seen Hans get his shots.  He knew what he was in for and this morning he was actually *excited* to go to the doctor to get a shot.  It was if he was getting initiated into the club.  I told him it'd be ok if he cried because it does hurt.  Not a tear. 


No concerns.  Development looks great.  She was impressed with his toileting, vocabulary, and imagination. 

Mama at 37 years 4 months:
Stats:

• 3 lbs from prepregnancy weight and nowhere near fitting into my prepregnancy pants.  Sigh.

Vaccinations:

• Influenza

I asked if she thought my OB had the vaccinations and would administer one to me, and she offered to take care of it.  She said I had too much other stuff to worry about and didn't need to schlep into the city with two babies for a vaccination.  I agree!  I didn't cry but man my arm is aching!

Hans, 4 month well visit at 4 months, 5 days:

• Weight:  12 lbs 5 oz (2nd percentile)
• Length:  25 inches (40th percentile)
• Head circumference: 41.5 cm (35th percentile)

Vaccinations:

• Rotovirus, 2nd dose
• Hib, 2nd dose
• DTP, 2nd dose
• IPV, 2nd dose
• PCV, 2nd dose

Well, can you spot the problem?  Hans is only in the 2nd percentile for weight.  A drop from the 22nd percentile at his last visit.  And even thinner than Freddie at the same age.  All of his percentiles dropped, actually, but the weight is the most significant.

We began the visit with my concerns, where I brought up the issue of his bowel movements being infrequent, once every 7-9 days.  Although there have been a few days of daily bowel movements here an there, he continues to go long stretches.  And she said this was normal, even if he is showing some signs of "discomfort."  I've been doing some weight checks on the scale at home and knew he was not gaining a significant amount of weight and had a feeling she might change her opinion of the "normalcy" of his infrequent bowel movements once she saw his weight.

Sure enough, she's concerned about his weight.  The fact that he's not pooping as often in addition to the weight supports her concern.  "As much as I hate to say it, I think you should supplement with formula," she said.

And I said, "I really don't want to do that."  So we talked about why: 

• Supplementing often results in the baby refusing the breast and at the very least means I will produce less with the baby getting (some) nourishment elsewhere.  
• I breastfeed to pass on antibodies.  Charlie suffers with allergies, and I want to take whatever steps necessary to prevent Hans from having allergies.  The recommendation is a year, and I want to nurse for a year.  She, as a pediatric allergist, wholeheartedly agrees with nursing for this reason. 
• Freddie was (is) small, and he's fine.  I think it is completely in the realm of normal for both boys to be similarly sized.

So she gave me the name of a lactation consultant who may have some suggestions.  She said she wouldn't dare recommend waking him during his 9 hour slumber to nurse, and hoped the lactation consultant might have some other ideas.  I sure hope those other ideas don't include the pump.  Sigh.

She checked his urine, for what I don't know, and it was "normal."

She talked about the expected drop in weight for babies around the 6 month mark because of their increased activity, but still thought this drop at 4 months was a little premature and quite severe.

She thought starting solids might help and gave me the go ahead, although she said her typical recommendation is to wait until 6 months.  At the very least, she wants me to come back in a few weeks to check his weight.

His development was normal, cooing and babbling, smiling, wiggling, and lifting his chest and head off the table nice and steady. 

My general feeling is that he's doing just fine, but I do feel it necessary to follow through with the next few precautionary steps just to be certain.

Next appointment:  November 9th with Dr. G.  Appointment pending with lactation consultant