In a message dated 1/18/0 5:05:28 AM, [log in to unmask] writes:

>Subject: sensitive nipple problem
>
>Has baby been to a neurologist?  If babe can't turn head in one
>direction, seems *tight* and facial expressions appear *serious* instead
>of a range of expressions, perhaps something else is really going on
>here.  Not just an average positioning/suck problem.  if it were my
>child, I'd be in the neuro's offices by the end of the day.
>

This would be a tough order in Northern California.  There is a shortage of
pediatric neurologists north of Fresno (including the Bay Area and
Sacramento).  Some of the neuros have appointment wait times from 3-6 months.
 With managed care programs
(both Medicaid and commercial) a neurology appointment needs a referral from
a primary care physician.  This is near and dear to my life as most of my
time these days is spent doing "case coordination" (AKA case management) for
children with special health care needs.  Some of the tertiary care sites in
my area (1 and half hour to Sacramento, Fresno, and Bay Area) have been
refusing patients from my county (we have one very overworked pedi
neurologist) due to their reduced staffs.

Perhaps starting with the child's pediatrician or family practitioner would
be a better first step.  The causes for the facial expressions can be
several: neuromuscular, related to the ear or mouth or even an airway or
reflux problem (just to name a couple).

Mimi Poinsett MD
Modesto CA

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