Vaccinated

Went in for his 4 year old vaccinations and a copy of his health record for PreKindergarten!  No tears, and not even a flinch for either shot.  Dr. G always makes a big deal about how brave Hans is, and how so many really big kids cry with shots.  Hansie likes hearing this.

Vaccinations:

• DTaP-IPV
• MMRV

Back for flu shots in September.

*And I promise to get back to blogging next week.  Promise.

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.

3 Year Well Visit

Roar!

Hans' Stats:

Height:  38 inches (75th percentile)
Weight:  33 lbs (75th percentile)

Vaccinations:

• None!  

Vision:

• 20/30

My Concerns:

• None

Dr. G's Concerns:

• None

He had his vision checked, and did really well.  I was surprised that he knew the names of the shapes to even complete the test.  Dr. G said he looked good and healthy.  She commented both boys have a good track record of staying healthy.  We'll see her for flu shots in the fall.

Side note:  Dr. G listened to Freddie's breathing to check after his last breathing treatment in the office and he was all clear.  I didn't give him any additional breathing treatments since he sounded better to me the next day, and apparently whatever it was cleared up. Whew.  Hopefully his allergies are just some seasonal irritations that bring some congestion.  

For the medical records

Hans intentionally slid off the arm of the couch last night, and ended up landing face first right next to where I was sitting on the floor picking up toys.  He let out one of those "this is no joke" screams and I scooped him up.  I could tell he wasn't breathing, mouth wide open, face red.  I shook him and blew in his face but without luck.  His eyes rolled back in his head and he went limp in my arms.  He passed out.  It has been just over a year since the last episode.

He quickly got a bump and a bruise on his forehead and after some snuggles settled down.  I asked what hurt and he said "it was scary."  Poor little guy.

I also need to note that Hans has a cough (just like last time) and isn't feeling 100%.  The cough showed up after he had a runny nose for about a week.  He had one day of low-grade fever and the cough seems to be improving.  I did give him a few puffs of the inhaler the previous day, and he keeps asking for more.

I'm not so worried about the fainting even though it is terrifying to see, but I am concerned about his lungs.  We'll give it some time since no fever, allowing him some rest and lots of fluids.  I'd rather that he not be put on inhaled meds or steroids although I don't want the cough to get progressively worse.  My mama ears are listening to the cough and noting the frequency.  I don't want this to turn to pneumonia like a few of his buddies have, nor do I want the cough to get to a point where a lengthy course of meds is necessary.

Vaccinated

Freddie and Hans got flu shots today.  No tears.  They were both so pleased with themselves that they told everyone we passed on the walk home.

All four of us are set.  Fingers crossed that we're healthy all winter long.

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.

Breathing Follow Up

All clear.  Ears look good.  Decrease breathing treatments to once a day for a few days before discontinuing.

Hans will see Dr. G again in June for his 2 year well check.

Breathing follow up

He's to stay on pulmicort for 2 weeks, and can stop the albuterol once his cough subsides.

His oxygen level was 96, the same as Friday.  She said this wasn't bad, but she expected better today.  He has a little wheezing.  His ears are filled with fluid, and his right ear is particularly bad, "bulging with yellow fluid." She discussed with me the latest recommendations to not treat the ears immediately, and even called a colleague for a second opinion, but really felt his ears needed some intervention.

Hans will see Dr. G again in two weeks right before we head out of town.

Heavy Breather

Hans ran some fever last week along with some congestion, and Friday I found his breathing to be a teeny bit labored.  While it was nothing like his last episode, it was a Friday and I didn't want to risk landing in the ER again over the weekend, so I popped into Dr. G's office after closing time.  Thankfully she runs late, and still had patients and was more than happy to tag another one on to the list of those waiting.  His oxygen levels were "not too bad" and he wasn't wheezing but "his right side sounded gunky" and he was tugging somewhat for breaths.  She hooked him up for a breathing treatment of albuterol and pulmicort. 

He improved a little after the treatment, so she sent us off with two scrips and loaned us her nebulizer.  We're to see her early this week to follow up, but instructed us to keep him on albuterol as long as he's coughing and to continue the pulmicort a few days beyond that.  We're in the market for a nebulizer for future occurrences, which seem likely at this point.  He's rebounding, but I can still hear his breathing from several feet away. 

I need to do a better job of keeping Hans rested when he's a bit under the weather.  His lungs cannot handle being pushed when they're stressed, but Mama tends to ignore low grade fevers because laying low can be painful when both boys are involved and one is totally healthy. 

Dr. G feels this will be something he'll most likely outgrow, perhaps very soon if we can go a long stretch without catching some bug.  Hopefully spring weather is on the horizon and we won't be needing that nebulizer after all.

{Any inexpensive, compact nebulizer recommendations?}

Follow Up to the Follow Up

Hans returned to Dr. A this morning for another check. 

Breathing sounded good.  He still has a bit of congestion, but his ears were clear. 

She recommended holding on to the inhaler, and if he should begin wheezing in the future administer 2 puffs every four hours until I can get him in to see someone.  She stressed the importance of staying ahead of the wheezing and getting his lungs some support ASAP if his breathing becomes labored again.

Let's hope everyone manages to stay healthy from here on out.

Breath Holder

The neurologist is fairly certain Hans is just a breath holder.  She said breath holding tends to begin between 12-15 months but she has seen it begin between 18-24 months.  She was surprised there were no other breath holders in our family, as it occurs in families and siblings.  We should expect high frequency at onset, a period of latency, and it will then reappear, and hopefully he will grow out of it by age 5.

His development is on par with a 24 month old and she had no concerns.  She warned of the potential for the breath holding to become manipulative.

She asked that I refrain from Dr. Google, and to call if the fainting is ever accompanied by convulsions as that would warrant and EEG.

Whew.

18 Month Well Visit

At 18 months 11 days..

Stats:

Weight:  24 lbs 10 oz (30th percentile)
Height:  32.75 inches (60th percentile)
Head Circumference:  47.5 (50th percentile)

Vaccinations:

• None.  Hep A has to be given 6 months apart.  His last dose was in July, so she said we'd just wait until his two year visit.

She said he looked "outstanding."  He had lots to say after he finally decided it was ok for her to examine him.  He wasn't happy about being undressed in the cold room, and screamed for a bit when trying to weight him.  She noted his stuffy nose and said even though he has some congestion his chest sounded clear. 

She was a bit concerned about his weight gain being so slight, down from the 75th to 30th percentile, but thought it was just something to check again when she sees in him June.

Her main concern was his two fainting spells.  I went in expecting her to tell me it was fine and not to worry.  Her general approach is very laid back.  She has a ton of experience so I know she's seen it all.  I explained what happened and her immediate recommendation was to see a neurologist ASAP.  She thought he was a little old to just now be showing behaviors of a "breath holder."

Her recommendation for a neurologist doesn't accept insurance, so I am waiting to hear back from a few people for recommendations and will see who can see him soonest.

Update:  Pediatric neurologist appointment on January 23rd. January 8th. After messaging the neurologist, the appointment was moved up.

Repeat, minus the ER visit

He did it again.

He wasn't watching where he was going, ran into the table, and knocked his cheek and forehead.  He fell to the floor crying.  I scooped him up and his eyes were rolling back into his head. His body went limp.  I shook and jostled him until he looked at me.  He was no longer crying.  With a few tears on his cheek he curled up on my shoulder and acted as though he was ready to go to sleep.

Eventually I put him down after I was confident he was going to continue to breathe, and he walked normally, began jabbering, and pulled down a candy cane from the Christmas tree.

I know the ER doctor said some kids do this, but I am having a hard time with it happening twice in less than 24 hours.  I'm worried.  And scared.

His 18 month well visit is tomorrow morning. 

For the medical records

H-man hit his head on the table.  And then he passed out. 

Absolute scariest moment of my life. 

He wiggled from my arms as I sat at the kitchen table and conked his head on the table in doing so.  It wasn't a particularly hard bump.  He screamed and motioned for me to pick him up.  He threw his head back to let out a big scream, and when I pulled him to me, he went limp.  I shook him and within a minute he was alert, but lethargic. 

Off to the emergency room.  The doctor said his balance was good, and his eyes and ears looked clear.  His head showed no evidence of fracture or trauma.  He was given a popsicle to see if he would keep food down.

She sent us home with the conclusion he must have held his breath in that moment prior to letting out a scream and fainted.  She also said to be on the look out for repeat behaviors, because some kids just tend to hold their breath when they are upset.  Interestingly, she said not to wake him because of fear of concussion as that recommendation is outdated. 

We are traveling tomorrow and have a well visit on Thursday already scheduled so Dr. G can give him another once over. 

*Not exactly interesting blog material, but this is my place to archive everything.  I already visit this space so keeping up with things here is easy.  It is also relatively easy for me to search and locate information quickly if needed in the future. 

Lab results

Hans' lab results:

• Hemoglobin:  12 gm/dL (normal is 11 to 13 gm/dL)
• Lead: 3 micgrograms/dL (According to CDC, above 5 is reason for concern.)

He'll need another lead test before entering school in NY State, but we'll do another in a few months.  

The results were emailed to me after being inputted by the lab.  I *really* like this feature of Dr. G's set up. 

Vaccination Visit

Hans saw Dr. G this morning.

Vaccinations:

• Varicella
• Influenza

He also had a lead test.  Just a finger prick and lots of tear (although there weren't any tears for the shots.)  NY requires two lead tests for school admission.  Although I think our risk, living in a new building, is relatively low, I still have concerns since we live in an urban area.  We'll ask about the results on Monday when we're in there for Freddie's flu shot.

Next visit (for Hans) is his 18 month well visit and he'll get his last dose of Hep A.

Vaccination Visit

Vaccinations:

• Hep A, 1st dose
• PCV, 4th dose

At this appointment I mentioned Hans also seems to have a constant runny nose.  It seems as the cold he had so many months ago never totally resolved itself although generally mild, the severity does tend to fluctuate.  He also tends to snore.  (The plot thickens, Dr. A commented.)  She checked his tonsils and said they were a bit enlarged and should be monitored.  Both ears are also filled with fluid.  It could very well be allergies, as Charlie suffers with allergies and asthma.  It could be mucus associated with teething, as he's definitely on the cusp of cutting two teeth.  Not much to do at this time but monitor it.

I asked about potential issue with language development because of the (constant?) fluid in the ears. Perhaps.  I'm finding Hans' language development to be completely typical currently and she agreed that his vocabulary seemed appropriate.  Something else on the radar but not worrisome at this time. 

We'll return on August 13th for varicella.  Want to make sure no one contracts the chicken pox.  We'll also do the lead test at that time.  Today we had a long wait and Hans was ready to go so I wasn't in the mood for attempting a blood draw.

1 Year Well Visit

At 12 months, 1 week:

Stats:
Weight:  22.8 lbs (75th percentile)
Length:  77 cm (60th percentile)
Head circumference: 47 cm (75th percentile)

Vaccinations:

• MMR
• DTaP

Today we saw Dr. A who has joined Dr. G.  She is also a developmental pediatrician which is nice to have someone who specializes in child development checking in on milestones.  She thought Hans looked great and commented that he looked like the Gerber baby.  

Next appointment:  July 30th, 10 am.  More vaccinations and a lead test.

Sick Visit

for my records...

Hans has been "off" the last few days.  He has been cranky and not eating much.  I chalked it up to teething, and he's been getting regular doses of ibuprofen.  This morning he refused to nurse and was lethargic.  Hands have been in his mouth, he's tugging on his ears, his diapers are pretty gross, and he seems irritated and in pain, as opposed to just uncomfortable.  After nap he had a temperature of 101.6. 

I ran him over to Dr. G so she could give him a look after her last appointment this evening just to make sure he didn't have an ear infection  His congestion which began in late February is finally just now clearing so I wondered about a secondary infection.

She checked his ears and throat.  No signs of infection although his throat does look red and swollen so it's probably the source of his pain.  Mama isn't feeling well this evening either. 

Vaccination Visit

Hans went to see Gr G today to get two vaccinations:

• Hep B (3rd dose)
• Flu shot (2nd dose)

She said he's all clear for starting on cow's milk at 9 months.  She's pretty much old school in many of her practices, which I have grown to appreciate.  She acknowledged the young(er) age at which many in my generation started on cow's milk (6 months) and thought by the 9 month mark cow's milk rather than formula (or breast milk) was fine.  I don't plan to wean him earlier than a year, but won't fret about his losing interest over nursing because the boy definitely prefers real food. 

We did a quick weigh in, with clothes, just to get a ball park idea of where he was:  18 lbs 14 oz, about 40th percentile.

And in keeping with her old school ways, she said the 9 month well visit is not really necessary unless there are concerns.  She thought his weight was solid and his milestones are right on target so we're going to hold off on visiting again until he's a year.