The baby I posted on a couple weeks ago is still undiagnosed, and
unimproved.  

The mother has been in contact with the hospital on 5 occasions since my
first post, and has gotten nowhere.  I should add that the only place a
child would be seen by a paediatrician is in the hospital as there are no
community pediatricians here.  The hospital docs provide an ambulant service
to the well-child care network; all major care is done through referral to
hospital or the outpatient clinic there.

Baby gains a little and they want to believe the problem is resolved so they
wait and see.  But he is now not gaining normally, and still refusing to
feed.  She has managed by almost superhuman effort to get about 16 ounces of
her own milk into him by bottle in the past 24 hours, but no gain, and he
spits up if he takes more than 3.5 ounces.  Her two year old is not going to
tolerate this much longer either. Not a situation we can really live with in
the long term.

She phoned me after they were readmitted to the peds unit today, to report
that the docs are investigating two potential causes for his failure to
thrive.

One theory is that he has had numerous infections, most of which have been
subclinical so unnoticed, that have tapped his energy and made him feed
poorly.  They are doing blood tests for the common viral infections to see
whether he has antibodies, which would indicate prior infection.  What they
plan to do to fix his feeding difficulty if they find anything, remains to
be seen.  My knowledge about infant feeding does not extend to the effects
of subclinical viral infections on appetite or growth.

The other potential cause, according to them, is that he can't tolerate
'something' in her milk.  To check that, they are planning to take him off
her milk for 24 hours and feed him soy formula to see if he improves.  

The mother is aware, after we spoke on the phone, that she has the right to
decline the soy formula in favour of ruling out other causes for his
distress and refusal to feed first.  She feels it is unrealistic to expect
to see any change one way or the other in as little as 24 hours, and she
would far prefer to give him her own milk.

I will be at work tomorrow and can find out more about why they are
seemingly ignoring gastro-esophageal reflux as a possibility.  She has asked
them, and they have not answered even her direct questions about why they
are not looking at it.

From the responses I had to my last post, I think GER is the most important
thing to rule out, before looking for more exotic things.  Those of you who
responded mentioned overactive MER and GER, with a slight majority for GER,
while noting that overactive MER can co-exist with reflux and will only
cloud the picture.

That's about it for now.  I'll write more when I have more to tell.

Rachel Myr

Kristiansand, Norway

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