The back story:
Flynn was born at 39 weeks to the day, weighing in at 5 lbs 13 oz. In the hospital he dropped to 5 lbs 6 oz and he was a little bit slow to get back up to his birth weight but he gained it by the goal of 2 weeks after birth.
In the beginning our pediatrician visits were pretty standard, but after a few one of the doctors, Dr. F, the founder of the practice, started expressing concerns that his weight was reading off the bottom of the growth chart and, at one point, the trajectory line of his growth started to drop. She expressed great concern at this, despite us telling her that Flynn ate until and refused more when he was full, was happy and content when he was awake, sleeping great, producing wet and dirty diapers and so forth. She didn't seem to be concerned about any of that, instead focusing on the black and white graph. No one else we had talked to or who had seen Flynn seemed to understand this concern any more than we did.
We had one more appointment with Dr. F where she first introduced "failure to thrive" in her vocabulary to us and stated she felt Flynn needed to have several tests done to determine why he was gaining weight so slowly. Clif, I know attempting to take a stand against what we felt was unnecessary additional procedures, decided to tell Dr. F that we had spoken with other pediatricians who weren't concerned about Flynn's weight. The moment the words came out of his mouth I felt a wave of dread as I watched Dr. F's expression flicker. Clif then added that one of said pediatricians was the one we'd seen at the previous weight re-check appointment. Cat was out of the bag and I can't imagine Dr. F appreciated being questioned or, possibly, feeling undermined by one of her staff.
We decided that we just couldn't understand Dr. F and were frustrated that she was unable to adequately explain her concerns in a way that made any sense to us, despite us asking questions. Her approach seemed more of a "see this plot on a graph? It's bad, regardless of any other factor in play" and Clif and I wanted a pediatrician who listened to us as well as gave us explanations we could understand. We decided we'd go back to Dr. M, the doctor we'd seen the previous time who hadn't been so concerned about Flynn's weight.
At our next appointment we requested Dr. M (at this practice you can't schedule an appointment for a specific doctor, you can only request when you get there - Clif and I have suspicions about this). Suddenly she was concerned about Flynn's weight and instructed Clif to have me pump exclusively so we could count how many ounces I was pumping to get a better idea of what Flynn was eating, despite the fact that pumping is not as efficient as nursing. I agreed to do the exercise even though I thought it was unnecessary and I already knew the information we would gain from it. Dr. M also wanted some lab work done (blood and urine) and we agreed, if for no other reason than we wanted to get the monkey off our back and I'd rather KNOW he is ok than assume so and miss an underlying issue.
I couldn't help but wonder if Dr. F had somehow gotten to Dr. M, maybe realizing we were suddenly requesting to see her specifically after our last appointment with Dr. F. I sincerely hoped I was wrong about that but decided to write a letter for Clif to take in with him at the next recheck appointment (at this point we'd been in the office every 2 weeks practically since he was born) to try to figure out where all this concern was suddenly coming from. After Dr. M read the letter she (according to Clif) said I was right with my points, she was no longer concerned about Flynn's weight, concluded he was as healthy as a "very small" ox and we wouldn't need to come back until his regular 6 month appointment.
Fast forward to yesterday:
Clif finds an afternoon appointment and is seen by a new-to-the-practice-as-of-this-week doctor. Initially, he said, she seemed to have a bit of an attitude about Flynn's small size. Throughout the appointment she seemed to back off from her initial reaction and said Flynn was fine, especially with a history of small children in the family, and the fact that Flynn's weight gain at yesterday's appointment put him at a hair below the 3rd percentile on the chart was a vast improvement over being off the bottom of the chart as he has been every other visit. She did detect a slight heart murmur but they ran blood work on the spot to see if she should recommend a cardiologist, luckily it came back completely normal and she said murmurs in babies are not uncommon (also a history of those in the family). At the end of the appointment Flynn was given a perfectly clean bill of health (minus his weight on the growth chart, as he has been given EVERY other appointment he has had) and we were told our next appointment wouldn't be until 9 months.
20 minutes later Clif received a call from the same doctor who was suddenly concerned about all of these other possible factors that could be going on to impact Flynn's weight, factors she had NOT mentioned during Flynn's appointment, and she would be mailing an order to us for a panel of tests they wanted done, tests that Clif and I have no intention of having done. I am now even more concerned Dr. F has imposed herself with this doctor, too.
Here is some brief research I've done:
Failure to thrive per kisdhealth.org (http://kidshealth.org/parent/medical/endocrine/failure_thrive.html) -
"In the first few years of life most kids gain weight and grow much more quickly than they will later on. Sometimes, however, kids don't meet expected standards of growth. Most still follow growth patterns that are variations of normal, but others are considered to have "failure to thrive."
This is a general diagnosis, with many possible causes. Common to all cases, though, is the failure to gain weight as expected, often accompanied by poor height growth.
Although it's been recognized for more than a century, failure to thrive lacks a precise definition, in part because it describes a condition rather than a specific disease. Kids who fail to thrive don't receive or are unable to take in, retain, or utilize the calories needed to gain weight and grow as expected.
Most diagnoses of failure to thrive are made in infants and toddlers in the first few years of life — a crucial period of physical and mental development. After birth, a child's brain grows as much in the first year as it will grow during the rest of life. Poor nutrition during this period can have permanent negative effects on mental development.
Most babies double their birth weight by 4 months and triple it by age 1, but kids with failure to thrive often don't meet those milestones. Sometimes, a child who starts out "plump" and who shows signs of growing well can begin to fall off in weight gain. After a while, linear (height) growth may slow as well.
If the condition progresses, undernourished kids may:
- become disinterested in their surroundings
- avoid eye contact
- become irritable
- not reach developmental milestones like sitting up, walking, and talking at the usual age"
"Your baby is fully engaged with the world now: She smiles, laughs, and has babbling "conversations" with you. And she's on the move – by 7 months she can probably roll to her tummy and back again, sit without your help, and support her weight with her legs well enough to bounce when you hold her. She uses a raking grasp to pull objects closer and can hold toys and move them from one hand to another.
Your baby is more sensitive to your tone of voice and may heed your warning when you tell her "no." She also knows her name now and turns to look at you when you call her.
Peekaboo is a favorite game and she enjoys finding partially hidden objects. She views the world in full color now and can see farther. If you move a toy in front of her, she'll follow it closely with her eyes. Watching herself in a mirror is sure to delight her.
Red flags
Each child develops at her own pace, but talk to your child's doctor if your baby:
- Seems very stiff or floppy
- Can't hold her head steady
- Can't sit on her own
- Doesn't respond to noises or smiles
- Isn't affectionate with those closest to her
- Doesn't reach for objects"
Here are some facts about Flynn:
- His head circumference is in the 5th percentile, his height is in the 10th percentile and now his weight is right below the 3rd, all of which seems to be fairly proportioned
-He has gained weight and continues to do so, though slowly, is back ON the growth chart and doubled his weight by 6 months, which is the projected goal for weight gain
-He eats until he is full and will refuse more by crying or pushing a bottle or spoon away. In some cases we have offered food until he spits up, uncommon for him, which makes me feel terrible for letting the doctor's concerns override his needs
-He goes to bed between 7:30 and 9 pm, sleeps until 5:30 or 6 am, wakes up long enough to nurse then goes back to sleep for another couple of hours. That's 10-12 hours of sleep every night with a pause for a snack in early morning
-When he is awake he smiles, laughs, engages, reaches for toys, coos, chatters, watches his surroundings, etc.
-He shows signs of learning and reasoning: turning on and off the night light in his co-sleeper and interactive play such as understanding when he holds my hand with both of his I shake it like a motor and when he lets go I stop until he holds on again
-Starting to play peekabo and gets excited when I hold his hands with my thumbs and asks if he's ready, he knows it means we are going to practice his sit ups and he pulls himself up
-Not quite rolling front to back or back to front on his own yet but he's about 95% of the way there, just needs a little bit of help starting (front to back) and finishing (back to front)
-Scooting himself in circles on his back or front and starting to put his knees under him to lift his butt in the air on occasion
-Isn't sitting up independently but is doing well when assisted (Bumbo seat, play saucer, etc)
-Happily and eagerly eating cereal from a spoon
-Pats and holds my hand, snuggles in for hugs and kisses, interacts with affection and joy
-He has very small cousins who are not standard in their size but are perfectly healthy and normal children (one is 4 and, though stretched, can wear an 18 month bathing suit)
Here is where we are looking for advice:
Clif and I do not agree with the level of concern exhibited by our pediatricians and I am worried Dr. F, the practice founder, is infiltrating our appointments via other doctors, though that is admittedly an unproven concern. However, we like the rest of the staff and the proximity of the office to our house can't be beat. The next closest pediatrician is literally across the parking lot but an online search did not turn up very much by way of reviews of their practice so we would be exploring a big unknown if we go there. At this point I am unsure which action to take next (past trusting my gut in regards to how Flynn is doing) and wonder what your suggestions might be.
1) Ignore the request for additional testing and schedule 9 month appointment as usual. Since he is so close to the 3rd percentile on the growth chart and we are discontinuing nursing (a very likely factor in his initial slow weight gain) in favor of bottles and solids my assumption is at 9 months he will have a much more solid showing on the chart and there won't be any reason for any more weight-related concern and we can just continue on having gotten past that hurdle.
2) Call or write another letter to the doctor that Clif saw yesterday with the same points listed above that I already presented to Dr. M and that should be IN Flynn's file to rehash what we already discussed last time, namely why NONE of the other factors going on with Flynn are being taken into consideration and, if there is a legitimate reason to focus EXCLUSIVELY on the black and white of the chart why that reason isn't being adequately explained to us.
3) Go straight to the source and send a letter to Dr. F explaining our concern and that if we are unable to come to an understanding and open line of communication where we aren't left confused and questioning what is being told to us we may need to seek a new practice and see what the response is.
4) Get a second opinion from the other practice in the lot and/or another practice all together before making a decision regarding continuing with our current one.
5) Abandon ship (get files from current practice without making any further effort to seek resolution and understanding) and find another pediatrician. At this point we have spent a lot of time and money with our current practice, they know my history and Flynn's, I would hate to just give up without making an effort to make the relationship work.
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