Unexpected

Yesterday we took Jack in for his four month appointment. We love our pediatricians because they are always so effusive about how happy and healthy our kiddos are, exclaiming over Ryan's giant babyness and Jack's long long legs and torso, so I had little reason to suspect this visit would be any different.

I was quite surprised, then, when Dr. Nancy came in with a rather serious look on her face and immediately commented on Jack's weight (or, really, his lack thereof). He's in the 92nd percentile for length, but only the 10th percentile for weight. At two months he was on track to be in the 40th percentile, so she was really worried that he was not gaining as he should be. I explained that he had been quite gassy and colickly lately, and not sleeping well at night. I also reminded her that I am also chasing around an active two year old and am often nursing Jack cradled in my arm while I wipe Ryan's face or extricate him from some place that seemed (to him) like a good idea at the time...

Dr. Nancy instructed us to extend Jack's nursing time, with a big burp halfway through to remove any bubbles that might make him feel fuller than he really is, and to give him infant gas drops when he seems upset. He also had thrush in his mouth, which was causing him a lot of pain and making him not want to nurse very long, so we got medicine for that. We are also to give him extra bottle feedings of breast milk mixed with formula and cereal (she thinks he may also have reflux, and the cereal will help keep the food from gurgling back up his esophagus). In addition, I cut out dairy from my diet - that help Ryan overcome some major tummy upset, so I'm sure it will work with Jack, too - though I'll miss my ice cream and homemade yogurt (I'll celebrate with a Ben & Jerry's party whenever Jack weans...).

She also diagnosed him with low muscle tone (hypotonia), noting that he is not as strong as most 4 month olds and giving us a referral for a physical therapist who will come to the house and work with him as well as giving us exercises we can do with him daily to help build muscles.

In addition, I had noticed that while snuggling with Jack or burping him on my shoulder, I felt a slight curve in his spine. I mentioned it to Dr. Nancy, who looked at it herself and agreed that it was just outside of normal, with the appearance of congenital scoliosis, and that we needed to see a specialist to take any necessary early action. We asked for a referral for Children's Hospital, since we had such a good experience with them with Ryan, and were able to get an appointment today.

I took lots of photos while waiting for Dr. Glancy, an older doctor who has been practicing pediatric orthopedics in the Denver area for years (Sam's mom is a retired Special Education teacher, and she recognized his name as having worked with many of her physically disabled students).

Here, Dad, I can help hold it!

A full tummy, at last!

And a big burp!

Dr. Glancy was very nice, and yes, he was quite astonished by the length of Jack's torso, exclaiming "Well, this just goes on forever, doesn't it!" He sent us to get an Xray, and diagnosed an 11 degree curve. He said they don't label it scoliosis until it's 20 degrees and they don't do surgery until it's 40 degrees. He also told us that he didn't see anything that would lead him to believe that Jack's spine will curve any more - more likely that his underdeveloped muscles are not supporting his bones enough for them to grow straight, and our campaign to Make Jack Fat should get everything sorted out. We have a follow-up appointment in four months to make sure that is the case.

The curve is hard to see in this scan of the Xray print out they gave us - it's right in middle of his abdomen, where the white mass of organs goes all the way across. In the original Xray, you can even see his little teeth, just hanging out in his lower jaw, just waiting to bust through - hopefully not for a few more months, though!


After the appointment we headed out to the airport to pick up my dad and stepmom, who were coming in for a long weekend. They haven't met Jack yet, and haven't seen Ryan since Christmas 09.

Next time Jack goes to DIA will be for his first trip to Kauai in April!

ED 1/23: Operation Make Jack Fat seems to be working - he has gained a pound in a week; we return to the pediatrician's office on Wednesday to see if he's getting back on course.