Peds: Day 7, 8

I've been following this 9 month old patient with failure to thrive. She is in the less than 3rd percentile for height:weight for her age, and her head circumference is also below the 3rd percentile. She has a nervous system dysfunction (hypoxic-ischemic brain injury or possibly cerebral palsy), and her development has been far delayed. Currently, she is 4 months old developmentally, as she cannot hold herself while sitting, cannot roll over, and cannot visually track objects. After some investigation, we have decided that the main factor contributing to her failure to thrive is that she simply isn't being fed enough. This is the number one cause of failure to thrive in America. It's not out of neglect or punishment, in this case it is out of the lack of education on how to feed a baby. Mom just lets her baby sleep for 12+ hours without offering a bottle. When she feeds, she feeds one small bottle without offering more. She has not started feeding solid foods yet. So of course the baby will fail to thrive without enough intake. Babies need about 125cal/kg/day in order to gain 10grams of weight per day. This particular baby was receiving about 25oz of formula per day. Since there are 20cal/oz formula, we can find that this baby was consuming 500calories per day (25oz x 20calories/oz). Since she weighed 7.5kg, in order to gain 10grams of weight per day, the baby needs around 935 calories/day (125cal/kg/day x 7.5kg). That puts her at a significant deficit in caloric needs, so it is not surprising that she is failing to thrive. The next thing we did was educated the mom about how to care for her baby so that she may reach the developmental milestones that we expect for her age. THIS is why I don't like pediatrics. Parents have no formal education on how to be a good caregiver, and the child suffers. Even after giving advice, parents often think they know better, and disregard what we have to say, and the child is the one who suffers. It is so unbelievably frustrating. It is so hard to be a patient advocate when the patient's caregivers refuse to be on the patients side by refusing our advice or guidance. For another example, a kiddo with a history of seizures was meant to have an MRI as an outpatient. The mom didn't think it was necessary, and now the kid is in the hospital after having suffered an embarrassing seizure at school, which could have been prevented with proper diagnosis and medication. The list of examples is really endless, and I've only been on inpatient pediatrics for a week. This is definitely not the career for me. Advice and education is at the heart of being a physician, I know I couldn't stand being ignored and disregarded by parents and then watch the kid suffer because of it. Thank god there are people out there that can handle it and do well to education parents on things that would most help their child, but I know that I am not that kind of person. I love kids, I just can't stand bad parenting... ;)

1 week left of inpatient pediatrics, then 2 of outpatient!