My son was born 9 weeks premature(ly?), and spent 2 months in the hospital. He is now 2 1/2 and, despite some ongoing health concerns, is very healthy otherwise. Except that he’s still kinda small. Well, really small. He’s getting taller, but he’s not really gaining much weight. He’s about 34 inches tall and 22 1/2 lbs.
We just got back from a follow-up with the neonatologist office that cared for him in the hospital. We go back every 6 months. This visit was the same as in February. “Your son is healthy, but he needs to gain weight. Start giving him Pediasure.” This is all well and good, except that the pediatrician we go to has never said boo about his size. For various reasons, we (his mom and I) are loathe to give him Pediasure (it’s expensive, we’d rather he ate food instead).
The added detail is that he just had surgery last week (tubes in his ears and adenoids removed). He’s still not himself and he’s lost a bit of weight because of it. Before our last appointment in February, surgery! He had just had a hernia repaired. I honestly don’t think they see him at his best.
Anyway, my question is, do I just keep going back to the neonatal people who want me to fatten the kid up (there are health consequences with him being too small, the doctor didn’t go into great detail), or fire them and stay with the pediatricians (who, I might add, see my kid much more frequently)? Is there that great a risk that he needs to see another doctor? I was under the impression that there was also a research aspect to the follow-up visits. They compile statistics, “9 week premie with these conditions at age two and a half is blah blah blah”. Am I being stupid? Am I not looking at the best interests of my kid?
I’m still kind of mad at the whole situation, so maybe I’ll calm down some more and not worry about it. Thanks for the input.
You’re not required to follow their advice just because they’re doctors. And, as you say, he has recently lost weight. OTOH, it couldn’t hurt to try to fatten him up a bit. And instead of just dropping them, I’d mention at the next checkup “How long do we need to keep coming here as wwell as the pediatrician?” Some parents are more worry-worts than others and may want to stay with the specialist, who doesn’t mind billing your insurance company for a 10-minute visit. It may be totally unneccesary to continue going. make them justify themselves and their usefulness to you.
StG
IANAD
According to the CDC’s growth chart for boys here , your son is in the 5th percentile for height and below the chart for weight. I’m not sure how that relates to preemies.
Some thoughts:
Have you asked the pediatrician about his weight? You said that he hasn’t mentioned it but it might be good to force him to talk about it. AND, does the pediatrician have a lot of experience dealing with preemies (other than yours)? Maybe you need another opinion?
Having a neonatologist when your kid is 2.5 seems odd. I realize that the guy is a pediatrician too, but it just seems weird that a infant specialist would still see a toddler. Unless it truly IS for research and then I hope you aren’t paying for these visits. Still, he probably knows what he’s talking about, he IS a frigging neonatologist.
Advice:
Sit the neonatologist down to give you the real concerns and problems associated with low weight. Do some research. Talk to the pediatrician, ask him for his thoughts. Maybe get a nutritionist that specializes in kids. Has your son seen a pediatric endocrinologist? Take this seriously, he’s your KID for god’s sake!
Look here:
http://www.dietitian.com/infants.html
http://www.merck.com/pubs/mmanual/section19/chapter262/262a.htm
Thanks for the advice.
I think I am taking this seriously, **Sue **, I don’t know why you would think I’m not.
One of the problems we have with giving him Pediasure is that the he eventually will only want Pediasure (at least, this happened last year) and won’t want to eat real food. The last time they (neonatologists, that is) wanted him on Pediasure, we eventually called in a nutritionist because he wasn’t eating much else. He started eating better and we quit the Pediasure.
It’s quite obivous that my son is small, and his regular pediatrician has said just that. “He’s small, but doing well, all things considered”. I was a small child, my wife was a small child. Wow, we have small children! I don’t know how much experience his pediatrician has with premies, that’s a good question. I would imagine, though, that they see a good number of them, it’s a large practice.
I don’t think clearly when I’m angry and I rarely think in an orderly, organized manner at any time. I only think of important questions after I leave (like thinking of that great comback the next day?). So I was not ready to ask clear concise questions of the neonatologist at the office. So now, we get to make phone calls, wait for callbacks, waste another day on the phone.
It’s the aggravation of waiting for callbacks, the pain of someone telling us our wonderful kid isn’t perfect 
, and the irritation from fact that the two doctors don’t agree. And other factors I won’t go into.
Since you say you don’t think clearly, the best thing to do would be to before your next doctor’s visit, make a list of things to ask your doctor about. That way you won’t forget anything important when you’re talking with him. And I think, more mportant than the actual weight is whether he is proportional to his height. I mean, if he’s in the 50th percentile in height and only the 5th in weight, then you might have a problem. But if he’s in the 5-10th percentile in height and roughly the same in weight, then he’s probably just a small healthy child. there’s nothing wrong with that.
StG
We try to write down our questions when we go to the doctor. This was a bad week in a lot of other ways too.
Thanks for the tip.
According to the chart in Sue’s post, his weight is a lower percentile than his height. But he just had surgery and his appetite will come back.
Isn’t there sort of a happy medium here? I would certainly second that you force the topic with the pediatrician-- quote the neonatologist and specifically ask about the Pediasure, etc.
In the meantime, though, would it be possible to feed your child regular meals, as usual, but add Pediasure as dessert after dinner? Make it a treat item rather than a habit-item, so that he won’t expect Pediasure and only Pediasure at every meal and more than he would expect ice cream. Way I see it, he’s getting food and getting most of his nutrition from it, with Pediasure as an added resource.