Category Archives: Illness

Two Updates

Bobbie wrote in to let me know that she talked to her daughter’s teachers. Her daughter is one of the most prepared in the whole class, so it was no problem for her to be out. So they went to visit Bobbie’s husband with no worries. Yay!

Sheila C sent me the link to this article about an enzyme present in the blood of people who died from peanut allergies. It may be a way to tell who will have fatal reactions and who won’t ahead of time. Very cool, and why I love science. Thanks, Sheila.

WWYD?: Temporary lactose intolerance

I decided I should start a special category for questions for which I have no answer. Since I’m turing it over to you, the readers, I’m going to call this category "What Would You Do?". If you have any experience with this, please weigh in in the comments.

Janie writes:

"My 10-month old son has had diarrhea for 18 days now.  (Don’t
worry – he’s not dehydrated and I have had him checked by two
pediatricians!)  Over the weekend I was finally able to conclude (with
the help of my U of Google MD) that he is suffering from temporary
lactose intolerance.  It seems he had a virus or something in the
beginning, and now that is gone, but his intestines were damaged such
that now he can not tolerate milk products.
I nursed him for 9 months, he spent at least one month on the
milk-based formula with no problem, he then suddenly developed diarrhea
and we put him on Isomil DF (soy-based).  Once he improved, at the
doctor’s suggestion, I re-introduced his regular formula (half and half
with the DF).  Within 24 hours he had awful diarrhea again.  Went back
to soy formula only, and the problem is resolving.
Of course, the doctor’s office has not been very helpful – we
actually switched pediatricians over this when the first one just told
me to wait the diarrhea out (on day 11!).  The second doctor is much
more caring and agrees that this sounds like temporary lactose
intolerance.  I plan to keep him on soy formula for 4-8 weeks while his
intestines heal.
So, my question is – do you or any of your readers have any
experience with this?  I am finding it unnerving – I am happy to
finally know what is causing the diarrhea, though, because that was
quite scary for me and very unpleasant for the baby.  He developed a
horrible burn-type diaper rash which has now receded, thankfully.
I guess I’m just looking for advice, support, personal experience
with a lactose-intolerant child.  I am particularly sad because the
baby loves cheese and now his diet must change so much."

Oof. Your poor little guy. It’s good you were able to nurse for as long as you did, or the problem might have been even worse. And how about you for figuring out what was going on! Yay, Tiger Mama.

I’ve got nothing for you here except that of course you know he’ll be fine and perfectly healthy even if he can’t have milk. He may be able to tolerate yogurt, but even if he can’t for awhile (or ever), he’ll still grow up normal and healthy.

Now, readers. Anyone else have any experience with this? Or just with having to put a baby/toddler on a restricted diet? Any advice for weathering this?

Q&A: severe spitting up

Today we have two questions from KatieB. This one is the tough one. The easy one will go up this afternoon.

This question has me mostly stumped, so if anyone has any ideas, please post them. She writes:

"My 9 month old son has had spit up since day one.  At his check-ups he is putting on weight as he should, so no problems there.  He was born before 37 weeks with no problems and no age adjustment.  I was told he will be better at 3 months, then 6 months, and now a year.  We have tried Pepcid and Zantac with only our checking account showing any difference. 

I tried mixing cereal in breastmilk bottles with only more bottles to clean along with pumping supplies, mine and my husband’s shirts, and a pile of burp clothes.  Starting rice cereal and on to more solids and nothing has changed. Sitting him up after a feeding makes no difference.  He spits up with the first burp after eating and again an hour plus later just sitting on the floor playing.  True it is not the projectile, hitting the walls kind of the early days, still enough that I don’t want to hold him and cuddle as I should because I’m tired of bringing spit-up on in every single place, washing carpets, floors, and clothing daily.

I believe it is really effecting my relationship with him. Even the dog has stopped licking up she is so tired of it.  Is it allergies, true reflux that is un-curable, or just his way to drive me batty?"

Oh, Katie, this is so sad, that you can’t snuggle your baby as much as you want to because of the spit-up.

It sounds like you’ve tried every normal cure for the spit-up (Pepsid, Zantac, cereal in the bottle, keeping him upright). If you hadn’t been nursing I might suggest looking into changing his formula, but I’m sure you did a trial of going off dairy while you were nursing to see if that made a difference, so I’m guessing it’s not an allergy.

The one suggestion I have is to see a pediatric chiropractor to see if having some adjustments will make a difference. The theory is that the GI nerves can get subluxated a little during the birth process and that that causes reflux or spitting up, so that when the subluxations are relieved the spitting up stops. I know my cousin (who is a chiropractor) has had success with kids with mild reflux and also constipation problems. It may help your son, if the spitting up is caused by nerve compression.

I also wonder if maybe doing a specific routine of massaging him while he’s on his stomach might both help the spitting up and also give you a way to cuddle and touch him without worrying about cleaning yourself up. You could put him on a towel and just give him a little massage at the same time every day. If he spits up, he’ll do it on the towel, but you still get that skin-to-skin time with him.

And that’s all I’ve got. Anyone else have anything for Katie? It’s tough to be the case that doesn’t respond to the normal treatments.

Follow-up to the peanut allergy post below

(Sorry for boring anyone who isn’t interested in this discussion. I’ll answer another question in the afternoon.)

The peanut allergy post seems to have sparked a lot of discussion, and it made me think about the whole allergy issue. I think that many people not only "don’t get it" about food allergies, but think that people (or parents of kids) with food allergies are making them up, or exaggerating them, or will somehow lose the allergy if they don’t "give in" to it. It’s almost as if they resent the person for having the allergy and cramping their lifestyle.

I don’t get this (I mean, I get that people think that way, but I think it doesn’t make sense). In trying to work through it in my head, I compare it to making accommodations for other kinds of chronic conditions or illnesses. The best comparison I could come up with was accommodating a child with diabetes. If there was a kid in your child’s class with diabetes, you wouldn’t bring sugary snacks because you know that child couldn’t have one, and it wouldn’t be fair to make one kid have to sit out when all the other kids were eating the sweet. I think most people would agree to bring in something else pretty happily and without comment.

So why the push-back about allergies, which are much more serious because even inhaling the food can cause the allergic reaction?

Is it because we see this as a weakness that can be overcome with grim determination and positive thinking? Or because we see it as a luxurious problem to have? Or something else?

What do you internets think?

Q&A: dealing with other’s lack of concern for your child’s allergies

Megan writes:

"I have a four year old and an (almost) one year old.
The older one has tested positive for a peanut allergy, and we believe the
younger one may have it as well.  This took us by surprise as neither my
husband or myself, or anyone in our families have this allergy.  Before we
found out when he was 18 months old, I knew virtually nothing about allergies.

At preschool, playgroups, park and rec classes, playdates…any
time my son is around anyone else and especially if I leave him in the care of
others, I am constantly explaining and reminding other parents and teachers
about this. I must always leave an epi-pen with him in case of a potentially
lethal reaction.  Many moms (and dads) are sympathetic and helpful and
honestly do their best to help.  The teachers at the school my son attends
have been fantastic.

However, there are some parents who don’t seem to get
it, no matter how much I try.  They bring trail-mix to playgroups when
they know we will be there.  They allow their children to wander at a
playdate after having eaten a peanut butter and jelly sandwich without washing
their hands.   They send things to school for snack that have peanuts
listed as an ingredient. These are people who know he has an allergy! 

Now Moxie, I know that this is primarily my job, and I am willing to police his eating as much as possible.  But, it would make it a lot easier if I could somehow get these parents to understand that, for my son, the peanut butter that is on their child’s hands as they swing could mean death for my son if he has a turn on the swing next.

Also, I have had to approach strangers at the park to ask them to please make sure that all the peanut butter is cleaned off their child before they send them out to play. I feel strange doing this, but luckily so far people have been very nice about it.

So, my question is:  How do I communicate to people how  important this is?  What can I say to them to make it sink in?  To  your readers out there whose kids do not have an allergy, if you were approached by a woman at the park with this sort of thing, what would you want her to say?"

I think this is a tough situation, and a tough question, but I think it’s an issue that’s going to affect all parents at some point. Every one of us is going to have to deal with allergies (especially nut allergies), whether it’s our own kid or one of our kid’s friends or classmates.

So, before I get to my answer, I’d like everyone to click over and look at the instructions for how to use an epi-pen. If a child is going into anaphylactic shock from ingesting nuts or some other allergen, you may be the only adult present, so you need to know how to use one. It could mean the difference between life and death for someone’s child.

Did you click over? Seriously, do it now, please. I can’t be the only one who thought you were supposed to plunge it into the heart like they did in the movie "Pulp Fiction." (Update: Be sure to read these helpful tips about the EpiPen. Yikes.)

Now, to me this is an issue of public health. If anyone in the school or playgroup has a life-threatening allergy to a substance, the group as a whole needs to make rules limiting the use of that substance. And everyone needs to help police.

I’d like to think that some of these parents don’t realize how serious a nut allergy is. They may think it means that if your child eats nuts he’ll get hives or a rash. They may not realize it closes off his airway and can kill him by suffocating him. I really hope they don’t know how serious it is. Because if they do know and they still send snack with nuts or bring trail mix to playgroup, it’s the equivalent of bringing a big bag full of candies made out of rat poison.

Yes, you have to be the main advocate for your son, but the other members of your community should take responsibility, too. Ask the director of your son’s school and his teachers to make sure all parents know they can’t bring snacks with nuts in them. (It may also be a liability issue for them, so I’m sure they’ll take it seriously.) Any snack with nuts need to be sent back home immediately. They could even institute a policy of having the kids all wash their hands as soon as they get to school to make sure there are no traces of peanut butter left. (This will also make sure the kids themselves get in the habit of checking to be sure they’re not nut carriers.)

At playgroup, do you have a friend who gets how serious the nut issue is? Maybe she will be the watchdog on your behalf. (If you were in my playgroup I’d rip anyone who brought trail mix a new one.) If more than one person is saying it (and especially someone who has no personal stake in it), then people start to listen and pay attention. Or, you could just start a new playgroup with the parents who get it.

My only problem is with the playground issue. It’s just not going to be logistically possible to make sure it’s an allergen-free zone. That doesn’t mean you don’t have to try, but I don’t think you can lock down a playground the same way you can lock down a school or private property. I think your best bet is going to be to make sure you wipe down any equipment your son is going to play on. You can also approach the parents of any kids your so is playing with to ask if they’ve eaten any nuts and to ask if they’d mind washing hands and faces if they have. Yes, some parents will be offended, but I’m betting most of them will be sympathetic and possibly even sheepish that they didn’t think of it themselves. Readers? How would you react?

The public space issue is one that will continue to plague you, although my guess is that it will get slightly easier when your son gets older and can be more of an advocate for himself.

I really think most people just simply don’t know how life-threatening nut allergies can be. That means it’s incumbent on all of us to keep educating so people don’t think peanut butter crackers are good snacks for preschool. We love peanut butter in my house. I’d guess we probably go through a jar or two a week. I’ve been absolutely anal about not having any at school, but the playground issue honestly never occurred to me. We’re going to have to insititute an "only on the house and then wash your hands and face with soap" policy about peanut butter. Maybe everyone reading this will do that, too.

If you have a peanut (or any other serious) allergy, please let everyone around you know. It could be the difference between life and death.

Q&A: waking in the middle of the night and screaming

Kate writes:

"Here’s my question: My son, Brody, started sleeping through thenight at 4 months. He went 7 months without waking during the night.
Suddenly, at 11 months, he started waking at midnight- we’ll feed him
and he’d go back to sleep. He’ll wake again around 3-4 a.m., we
feed him, and then he screams (and I mean SCREAMS) for 60-90 minutes
before finally collapsing from exhaustion. We’ve tried everything-
rocking him, gas drops, singing to him, CIO (which I hated),
etc. Nothing has worked, aside from letting him sleep with either my
husband or myself on the couch. Up until this point, he’s never slept
with us. It’s been 3 1/2 months. Do you have any suggestions?
 
We do follow a very strict bedtime routine- dinner, then 30 minutes of playing,
followed by a 15 minute bath, and a final bottle before bed at 8 p.m.
 
Is he too old to be sleep trained? If not, what method would you recommend?
 

Thanks for your help!"

            

I’m going to cut to the chase: I think your son has some kind of digestive problem of the reflux/heartburn/ulcer type.

Here’s how I got there:

You’ve got the bedtime routine, so rule that out.

When he wakes up, it’s not just to play, so I eliminated having the wrong nap schedule (some kids start waking in the middle of the night for playtime when they’re on the verge of going from two naps to one because the sleep times are disturbing their body cycles).

It’s been going on for 3 1/2 months, so rule out a developmental spurt, which would last a month or two, tops.

It happens every night, so it’s not night terrors or nightmares.

He’s waking up screaming from a dead sleep, which says to me that there’s some kind of pain involved. Probably from lying flat, since he can only fall asleep on top of one of you.

My guess is that he’s having some kind of stomach trouble while lying flat that makes him wake up and think he’s hungry (so he eats again at midnight, and then again at 3) but then it just gets too painful and he wakes up and screams. You hold him upright for an hour, the pain goes away, and he can sleep again. That’s the exact cycle I had when I had an ulcer 7 years ago. It hurts, but it feels like eating will make the pain go away, but then it actually just makes it worse.

I’m assuming he’s getting a bottle of formula or milk at bedtime, then the same thing when he wakes up? During the day, does he get this same meal right before going down for a nap? If so, how are his naps? Or does he get bottles and then stay upright for an hour or so afterward? If he’s staying upright, he won’t have pain symptoms because all the acid will stay down in his stomach until digestion is in full swing.

You could try propping the head of his crib to see if he sleeps a little bit longer at an incline. If the pain is severe, though, that won’t solve the problem.

The other thing I’m wondering is what changed at 11 months to make this start happening then. Did you change formula? Or switch to cow’s milk then? If you didn’t make any change in what you’re feeding him at night, then I’d talk to your doctor to see if s/he can run some tests to see what’s causing this. Since my experience is with ulcers, not reflux or heartburn, I’m thinking he maybe somehow got the bacteria that causes ulcers (helicobacter pylori), which they can find by analyzing a poop sample. But there’s got to be a straightforward diagnostic path for reflux and heartburn, too.

I do not think this is a sleep problem. If it was, something would have changed in the last few months just because baby sleep changes all the time. It seems clearly pain-related to me. Try to watch and see what happens during the day when he has a bottle. Try propping the crib. Think back to anything that might have changed right before this started. Talk to your doctor (and emphasize the pain and screaming, so you don’t just get the "let him cry it out" crap they sometimes try to hand you because they think you’re just a "nervous first-time parent"). See what happens if you give him a banana or another food that is unlikely to cause reflux instead of a bottle in the middle of the night.

Then write back and definitely let me know what happens, because I’m going to be preoccupied with Brody’s problem until I find out what the real story is.

Q&A: “spoiling” a sick baby

MFAMama asks:

"I’m a WAHM with three boys aged four, seventeen months, and ten weeks.The little one has been very ill all his life (soy and dairy protein
allergies, reflux, esophagitis, weight loss, dehydration, and then a
bout with RSV that didn’t help matters AT ALL).  He has had two
prolonged hospital stays (during which I abandoned the older two to
their father and a succession of friends and family members and stayed
by his side 24/7) and is currently dependent on an NG tube (which I had
to learn to reinsert if it comes out) for all of his feedings and
medications.  His feedings are every two and a half to three hours, and
he gets two medications a total of five times per day at timed
intervals (one twice a day half an hour before a feeding, the other
three times a day one hour before a feeding).  Using the NG tube to
feed and medicate him is complicated and, if done incorrectly,
potentially fatal (you have to learn to use a stethoscope and check the
tube’s "placement" before putting anything down it for fear of dumping
it into his lungs), and as a result I can’t leave him with anybody,
ever (my husband works outside the home and is squeamish of infants in
general, nevermind infants with NG tubes, and we can’t afford to hire a
nurse to babysit). 

The baby’s prognosis overall at this point is good,
but he is expected to need the NG tube for at least another month and
possibly several.  All issues of my personal sleep and sanity aside,
I’m worried about the effect his illness has/will have on my other two
children, and on my relationship with the people around me.  My husband
and I are on the same page (thank goodness), but already I have caught
some heat from "well-meaning" family and friends about leaving the
other two to stay with the little guy in the hospital, and have started
to hear a lot of remarks about "spoiling" and "how IS Mr.
Center-of-the-Universe today, anyway?"  While some friends and family
have amazed me with their empathy and willingness to help, it has been
implied by others that I am neglecting or sleighting my other children
by caring for the littlest one’s special needs or else creating a
monster by keeping the baby in my line of sight around the clock, but
a) if he pulls the tube partway out and I don’t see him do it and help
him he could die from that, and b) crying excessively aggravates his
condition and even if I did not tend to "spoil" babies anyway there
wouldn’t be any other option but to soothe him by any means that will
work even if it means carrying him around for six hours, give or take.

 
Can you think of any way to mitigate the damage to my older children?
The middle guy is, IMO, less oblivious than you might think; he has a
twenty-plus word vocabulary that does not include "Mommy" and asks for
Daddy when he is upset.  And the four-year-old has been misbehaving in
ways that are not like him (being mean to his brother, disobeying me
and my husband, talking back).

   Also, do you have any ideas on how to respond to the
people (ranging from strangers to dear friends and family) who make
these ignorant remarks in a way that will hopefully alienate them as
little as possible but also let them know in no uncertain terms that
the things they say are inappropriate and hurtful?"


What is wrong with people?

What the fucking hell is wrong with people?!

It sounds to me like you guys are in a truly shitty situation, and everyone (in your house) is responding in the most appropriate way possible. You are caring for your teeny tiny baby, who needs his mother more than anything else at this point. Your husband is caring for your other children. Your oldest is acting out because of the stress and fear, which is all he can do and is completely reasonable in this situation. Your middle child is turning more to daddy. Everyone is doing what they need to do to get through this crisis.

You all know I’m not a psychologist, but I firmly believe that your older two will have no lasting effects from this short period of time. In another year, they won’t remember that the baby was sick and they didn’t have full-time access to you while you were tending to the baby. If anything, they’ll remember that they hung out with dad and other people a lot then. But unless this turns into an ongoing, lifelong health problem that means the baby is always the biggest priority, this isn’t going to be any more significant or stressful than it would be if you guys were moving cross-country or doing something else that disrupts things for a matter of a few months. Thank goodness humans are so flexible and adaptive.

I cannot believe that anyone is giving you crap about caring for your baby. He needs you. He’s only 10 weeks old. Who thinks you can spoil a baby that young anyway, let alone a sick baby? You’re supposed to just toss him to the wolves? Anyone who makes an even remotely negative comments about the way you are nursing your child to health (when half of us couldn’t even hold things together for 10 minutes under your circumstances!) is being unreasonable. Inappropriate, unreasonable, and cruel.

But I can understand that you don’t want to and can’t tell people to screw off because a) you love some of them, and b) you need their help. So I’m going to suggest going on lockdown and only making contact with the bare minimum of people you need to. First, figure out who you can trust to care for the older two kids while your husband’s at work. Sit down and be completely honest with them about how you are at the breaking point, the baby needs you, and without their help for the next two months you won’t be able to make it through. If they give you any pushback about leaving the baby, ask them in all seriousness if they have any better ideas about how the baby can get the constant care he needs. Either they’ll come up with something, or they’ll shut up about it.

Second, see if you can find a nursing student or hypochondriac medical hobbyist who can learn to do the tube stuff for the little guy, and who can come spell you for 1-2 hours every day. (You may have to pay for this, but you can probably get the person for the same rate as a babysitter, not a RN.) Then make sure you spend that time with your older two so they still get a little bit of cup-filling from you, even though things will be better in a month or two.

Third, don’t talk to anyone else. Let your machine pick up the phone. Or see if your husband will field all phone calls. You’ve got enough stress and don’t need anyone else adding to it, so blow any non-essential personnel off for the time being.

Now, if it were me I’d just play the manipulation card with my close friends and family. If anyone made any negative comments about my caring for the baby I’d burst into tears and talk to them in that jerky, hiccupping voice and "confess" that I was at the breaking point because if I didn’t care for the baby he’d die and an infant needs his mother, but I was beginning to wonder if I was a bad mother and horrible person because people were always criticizing me and all I wanted to do was take care of my baby so he didn’t die. The recipient would probably be too freaked out to mention anything stupid again. Or maybe they’d feel so sorry for me that they’d volunteer to help some way. In either case, they’d stop saying stupid stuff.

But I don’t know if that’s your personality. So maybe you want to practice saying, "I’m sure you can understand that I have to be with my sick child during this serious medical crisis" and nothing else. If you don’t engage any further they should get bored and drop it. And you shouldn’t be talking to anyone but the people you really need to talk to now anyway.

I know there are parents out there who have gone through similar crises with sick children (or multiples with one in the NICU and one or more at home) and can give some support. I am furious on your behalf at the unreasonable (unreasonable!) comments and lack of support you are getting from the people who should be helping you through this. You are a great mother and your children are lucky to have you.