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  1. Opposite Eating Habits

    January 5, 2012 by Michelle

    Our visit in December with the GI & nutritionist was the least painful yet. No blood work was truly a blessing. But, while she did gain weight, it’s still not enough. Then two weeks later we had a well visit and she was down two ounces, and her head shrunk. Ok, her head didn’t shrink, but the nurse at the well visit measured twice, so the last two must have been off.

    Latest stats:

    Age: 19 months
    Height: 2′ 4.75″
    Weight: 17 lb 10.2 oz
    Head Circumference: 17.76″

    Even on the WHO chart that weight puts her below the 3rd percentile line. CDC = 0.03 percentile.

    I was told not to worry about the two ounces, the holidays would have thrown off her eating and with me home from work she was nursing more, a good thing, but maybe less inclined to eat solids (true! She was attached to me more than before I went back to work some days! I think she’d save room to nurse.)

    But all these fluctuations are a reminder that the tools to measure are imperfect, too. And different scales & different people give different results. Still. Bunny’s tiny.

    Eating Schedule Changes

    So big thing from the nutritionist, eat less often. Yep.

    Anytime bunny asks for food, we give it to her. Made sense to us, give her as much food as she can take. But apparently, that may not allow her to get hungry enough to eat enough calories. Eating small amounts all day is how adults loose weight, we have to switch that to help her gain.

    So instead of eating every hour to hour-and-a-half, we’re spacing out more like 2 hours. 3 snacks & 3 meals. Still a lot of eating.

    We’re also trying some new things like yogurt and fruit smoothies (with flaxseed oil whenever I get my act together and remember to buy it.) Plus adding whip cream or cream cheese to her fruit since she’ll eat tons of fruit & the fruit has fiber. (Also still supplementing with fiber.)

    All in all, we’re still just trying to up calories and keep her from filling up on water.

    The Scary Part – Tests

    So the GI’s main thing, more tests. Sweat test to rule out cystic fibrosis (we go tomorrow) and lower colonoscopy/upper endoscopy with biopsy to test for celiac (since blood work couldn’t tell us.)

    I’m a little freaked. The sweat test is the “easy” one. They literally collect her sweat, but they have to stimulate her arms to get it, which involves attaching something to her arms. I don’t quite get all the details, but not looking forward to it.

    Colonoscopy/endoscopy is supposedly quick, but they put her out. The idea of my little girl unconscious like that, scary. That’s why I’m getting the sweat test first.

    Language Explosion

    The cherry on top of all this. Developmentally she’s still ahead of the curve. She’s got crazy amount of words and using 2-3 word sentences sometimes. She can handle directions for 3 consecutive tasks. She’s mastering puzzles. And so much more. But the funniest part is definitely the language.

    So while other kids may outpace her in physical growth, she’s working hard at growing that little brain.

  2. 3 Specialists, But Few Answers

    December 15, 2011 by Michelle

    In the 2-and-a-half months since I’ve written, we’ve had visits with 3 specialists — gastroenterologist, nutritionist, and endocrinologist.

    My delay in writing started after the first two, GI & nutrition, because I felt overwhelmed by the visits. I walked in feeling like I was nearing the end, just a few people to say, “Yep all tests look fine, she’s just small.” But it was the beginning of more stress. We did these visits back to back in what ended up being close to 7 hours between travel, visits, blood drawing, & lunch with no nap. Bunny passed out in the car before I left the parking garage. We both napped about 3 hours once we got home.

    Now, on the eve of follow up appointments with GI and nutritionist, I’m finally getting my thoughts reorganized in a blog post.

    Here’s the quick rundown:

    Early October: GI & Nutrition

    GI actually uses the term “failure to thrive” my heart sinks. Says we have to try to get her caught up by age 3 because it can affect the rest of her life. Good news, head circumference is good, so her brain is growing well. Prescribes a medicine for acid reflux in case that’s keeping her from eating. Orders lots of blood work & refers me to endocrinologist.

    Nutritionist brings to light the fact that bunny being constipated some days could be a huge issue. That tiny tummy only holds so much. If she’s constipated, no room for food & she won’t eat. (this makes much more sense then the “maybe it’s GERD” from the GI, at least to me.) We get tips to add about 30-40 more calories a day, meal time tips, & told to give her a fiber supplement. She also reinforces something I read online, that breast milk will help with weight gain more than whole cows milk. (Though cows milk is ok, too, breast milk is better.) So glad I’m still nursing 2-3 times a day.

    We decided not to fill the acid reflux prescription, but focus instead on the fiber. With no other symptoms but low weight to go on, we can’t bring ourselves to give her medicine.

    Blood Test Results #1

    I was told to call for results, that they wouldn’t call me. 2-3 weeks later when I still had neglected to call, the nurse called and left me a message. Another 2-3 weeks later I finally call back. Mom fail.

    Results were mostly ok. They still can’t read the celiac panel, but nutrition looks good–except Vitamin D is in a gray area. It’s in the normal range, but the low end of the normal range.

    We increase Vitamin D supplement. I feel guilty about the 4-5 weeks she could have been getting Vitamin D if I had gotten my act together & called a few days after the test. Nurse says if it had been a major worry, they would have called me back more. I still feel guilty.

    Late November: Endocrinologist

    I was feeling okay going into this one. I figure she must have grown since her clothes are looking short in the arms & legs.

    We measure. More than an inch taller! Yippee! She’s lost weight. Only a few ounces, but still, how could she be taller and even skinnier than before? She should have gained, so in my mind it’s almost like more of a loss. The weight for height curve is looking even worse. I haven’t even met with the doctor yet, and I’m stressed again.

    Once he does come in, he says the weight looks like more of an issue than the height. (Height would more likely indicate endocrine related issue, weight, GI.) Also, he notices her soft spot hasn’t really closed in as much as expected at this age, could be delayed related to rest of her growth delay. (My brain flips back to Vitamin D guilt.) He orders blood tests but warns me that growth hormone is hard to test with blood work. There are 2 factors they can test with blood. If both are low, most likely growth hormone deficiency. If one is low and one normal, could be growth hormone could be caloric/nutrition deficiency. Essentially, inconclusive. He tells me it’s obvious she has a good appetite (she nursed almost the entire visit.)

    Guess how the blood work comes back. Yep. Inconclusive option, could be growth hormone, could be nutrition. There’s another more involved test, but it doesn’t sound fun, and he doesn’t think it’s worth it yet. We’ll keep tracking height and seeing other docs, and unless something major happens, we don’t go back for another 6 months.

    Tomorrow: GI & Nutrition Follow Up

    Please have gained weight in the last 3 weeks. Please. Please.

    At one point in the last three weeks I coated blueberries in olive oil and added a touch of whip cream just to increase calories on a food I know she likes. We don’t generally do dessert, but we give her ice cream one night just to sneak in a few more calories. I’m sure this is the wrong way to do it but I’m feeling desperate.

    I’ll know more tomorrow. I doubt I’ll know much, but at least I’ll know her weight.

  3. 15 Months – Still Small & Growing

    September 27, 2011 by Michelle

    Aside from the shots, the 15 month checkup last Friday was easy compared to our last few. Our pediatrician said she’s done all the testing she can and thinks it’s probably genetics (though we still have the specialist appointments next week) so there isn’t a lot left to say.

    Latest Stats

    Height: 28 inches
    1.49 percentile CDC
    1 percentile WHO

    Weight: 17 lbs. 2.4 oz.
    0.14 percentile CDC
    3 percentile WHO

    The printouts from the doctor give me exact percentiles to 100th of a percent on CDC and a plotted chart for WHO. I have to look up numbers on WHO charts so they aren’t as exact.

    The height is a huge jump! She’d pretty much fallen off the chart before. I knew she must have grown since she recently stopped walking under the dining room table after hitting her head constantly.

    Weight is right on track. At least on the WHO charts, she’s stayed right along that 3rd percentile line most of her life.

    So the numbers are in and still low. Until next week, there’s nothing more to do.

    Big Smart Head

    Despite her small stature, this little kid has got a good head on her shoulders. Head circumference is 40th percentile; a healthy size head, without being huge. All the better for that big little brain that has her developmentally hitting milestones they don’t look for until 18-24 months. Dancing, pointing out her nose, ears, and other body parts, and her vocabulary and beginning to string words together occasionally, to name just a few.

    In fact, she’s always been ahead of the curve developmentally. The only real challenges have been skills affected by height. Stairs took a bit long to master, for example. When her peers started climbing down, she still had to jump down each step.

    As long as I have to deal with the extra doctors appointments for her size, I’ll take the pleasure of hearing them tell me my child is quite smart.

  4. Test for One Thing, Find Another

    September 8, 2011 by Michelle

    After a little bit of procrastination & getting through a summer cold, I finally bit the bullet and did the urine test with Grace last week.

    This was not a fun test. To do it, we had to literally attach a bag with adhesive to her and wait. She took it much better than I was expecting, and once we managed to collect & get it to the doctors office, I relaxed.

    Test Results Call – “Good News and Not-so-good News”

    As baby bunny was racing around downstairs and I was gathering the energy to put her to bed last night, the pediatrician called. “I have good news and not-so-good news.”

    Good News – She does not have what we were testing for, Renal Tubular Acidosis (RTA).

    Not-so-good News – She was positive for a Urinary Tract Infection (UTI).

    Ugh. As if having a UTI isn’t bad enough on it’s own, if she’s had it for a while undiagnosed, it could contribute to low weight gain. However, it’s a very unlikely cause she tells me. Could be totally unrelated and caught by chance!

    She also tells me, it could be a false positive. The only way to know for sure is to catheterize her and test again. She asks us to come in as soon as possible. Double ugh.

    Rush to the Doctor, to be Sent Home

    Tonight, after work (and two awful commutes with the flooding everywhere) I rushed right back out with baby bunny to have the follow up test done. Unfortunately, one of the docs never made it in today and when we showed up, no one could take us. So now, this semi-urgent test is delayed at least one more day, possibly two.

    Until then, I wait, wondering if she’s in pain and uncomfortable or perfectly fine. Though I don’t know anything yet, I can’t help but feel guilty that she may have been in pain for a long time. I can only hope the next test shows the first one was a false positive, then I only have to think about her being small.

    Update 9/9/11
    Second test showed no UTI. Phew.

  5. 9 Month PJs at 14.5 Months

    August 22, 2011 by Michelle

    In the spring, I started buying 6-9/9/9-12 month size clothes for the summer, because I didn’t want to go through two sizes over the summer. Though a bit big, t-shirts worked. But, shorts, leggings, & pjs unfortunately I had to buy from 3-12 month in sizes depending on the brand. But her growth slowed down and really, she’s been a 3-6 month size in most brands, even though I dressed her in some larger clothing. I even have a 0-3 month skirt from last summer that still fits her.

    But this weekend, we hit a milestone: 9 month Carter’s PJs.

    For better or worse, Carter’s sizing is my yardstick. I suppose because they are consistent across clothing type & because everyone seems to have at least some Carter’s clothes. In addition, PJs are my marker of a true clothing size change because they have less wiggle room on sizing. Shorts might have stretchier waists & t-shirts will work snug or baggy. Footie pajamas can only work for a limited time.

    So about 8.5 months later than the average child, we’ve moved to the next size PJ. Unfortunately, Carter’s doesn’t start adding anti-slip grips to the feet of PJs until 12 month size. Good thing we’ve got mostly carpeted floors! Our little walker has been walking in 6 month non-grippy PJs for a few months, and has done okay, but most days this means stripping her to a diaper to run around when she first wakes up in the morning. This has been fine for the summer, but could be a problem when it gets colder.

    Growth Spurt Signs

    There were other signs of this little growth spurt:

    • Hitting her head when she walked under the table.
    • Her big belly shrinking (she tends to fatten up slightly then stretch, which means she goes up & down in pant sizes.)
    • Finding things in her little hands that were previously safe in the middle of bed stands & end tables.
    • An easier time & greater willingness to climb down the stairs (each step used to be like a little jump.)

    Oddly not on this list: eating everything in sight. I thought at one point she seemed to be eating more, but as I look back, no more so than her normal feast to famine eating habits. I’ve thought she was going through a growth spurt a few times before based on food intake. One of those times it actually turned out her growth had slowed down. (Which was right around the time I was starting to buy 9 month clothing.) I’ve come to find eating an unreliable way to predict growth spurts.

    So my next dilemma? What size to buy for fall/winter? Layering helps, but I still need to draw a line. I’ll hold off awhile, but with consignment sale season starting soon, i’ll have to decide in the next several weeks. I’m leaning toward 9 month sizes, but perhaps 12 month is a wise move to take me throughout the whole season?

    Any other moms with slow growers out there (or regular or fast growers) have some clothing buying tips? Leave a comment below.

  6. Blood Tests Inconclusive – More Tests to Come

    August 11, 2011 by Michelle

    After 3 phone calls in 5 days from my pediatrician (love that she’s giving us this much attention) I know very little. I’ve been up and down as she’s told us the results are mostly good but after consulting with others given us more things we need to test.

    Thyroid, blood count, and liver function were all good. However, her Celiac panel and Metobolic panel each had something that we’ll have to look into further.

    Disclaimer: The following is a summary as I understood it when it was explained to me and is unique to our situation. If you are in a similar situation, please speak with your own doctor.

    Celiac Panel – Low IGA

    The baseline IGA level (a type of antibody) was on the low side which apparently makes it hard to interpret the rest of the panel. According to the pediatrician, children with low IGA usually also have other symptoms such as chronic ear infections, which Baby Bunny doesn’t have. So it could be a fluke, but we’ll have to run this blood test again in a few months. Celiac faqs.

    Metabolic Panel – Low CO2

    Her CO2 levels were a little below the normal range. Apparently low CO2 could indicate Renal Tubular Acidosis (RTA), a disease of the kidneys. We’re doing a urine test to rule out this uncommon cause of slow growth.

    GI & Nutrition Consult in a Month

    With an inconclusive Metabolic panel, the pediatrician went ahead and ordered a Gastrointestinal and Nutrition consult. Those were difficult to schedule, but after half-an-hour on the phone I managed to get them back-to-back on a Friday morning in September. I’m grateful to have them scheduled finally so I don’t have to think about them for a while.

    I’ve included links for more information on both of the possible diseases, but I have not looked into either extensively because it is not worth it! I’m doing pretty well not freaking out, so why worry myself with details of diseases she might not have? The tests can rule things out, eventually leaving what I believe in my heart to be true, she’s perfectly fine.

  7. Success! Stride Rite Sesame Street Shoes Fit

    August 7, 2011 by Michelle

    After a long hunt for shoes for my little walker, we had success last weekend! The winner, Stride Rite Sesame Street – Abby Cadabby, purchased at Nordstrom. We also picked up a pair of Nike Sandals at Footlocker, which I’ll review in a future post once Baby Bunny tests them out more.

    Sesame Street Stride Rite Shoes - Abby Cadabby

    Why They Are Great for a Small Baby

    The key feature that made these a good pick for petite feet is the cross Velcro straps. The cross over design allows a snug fit for a petite, narrower foot, but is of course adjustable as she grows.

    A bonus, 2-direction straps make them more challenging for a bored toddler to rip them off. Though because they are comfortable and fit better, she doesn’t try to take them off as often.

    They came in a half size, so the 3.5 fit perfectly, which means no more tripping over her own shoes! (Please note, different shoes fit differently, she was not a 3.5 in all brands we tried.)

    Other Pros

    • Easy on & off – Of all the ones we tried, these were the easiest to slip on and off my squirmy child.
    • Lightweight & comfortable – She keeps these shoes on and will even bring them over to us to put them on, so it’s safe to assume comfortable.
    • Versatile Color – They are pink AND purple (and white) so they match more outfits.
    • Good Treads – Enough to grip the ground, not so much to trip her.
    • Rubber Toe Guard – When climbing stairs, hitting a bump in the sidewalk, or just the occasional crawl, she’ll often scrap her shoes against cement and other rough surfaces. The extended rubber toe is protecting the shoe from damage and keeps them looking nicer around the toe than her last pair.

    Minor Drawbacks

    The shoes are really best with a pair of socks, which I’ve been skipping during the summer. They can be worn without socks, but leave some red marks on the tops of her feet.

    I’m also not a fan of TV character branding, even if it is Sesame Street. The AAP recommends avoiding television for children under the age of 2, so we don’t watch Sesame Street (yet)! Still, this is a very minor issue, and she isn’t making the connection, so I’m ok with it.

    Quick Note about Nordstrom and Stride Rite for Kid’s Shoes

    Baby Bunny in her new Sesame Street Shoes

    After my last post, people comment on the blog, Twitter, and Facebook recommending Stride Rite for shoes, citing great customer service and that they measure their feet. We did go there, but they had just one shoe in her size Β in stock for early walkers, and we didn’t like the style as much.

    Nordstrom was just as excellent on service, measured her feet, and had a nice selection of shoes we didn’t find elsewhere. It wasn’t much of a surprise to me. Nordstrom is my go to place for quality shoes for me, they do kids shoes right, too. If you live near a Nordstrom and have never been in the kid’s shoes section, check them out! Nordstrom Rack carries kids shoes, too, but no helpful shoe salesmen, just good prices.

    Overall, Baby Bunny, hubby, and I are all thrilled with the Stride Rite Sesame Street shoes and shopping experience at Nordstrom.

  8. Tiny Feet Need Tiny Shoes

    July 28, 2011 by Michelle

    My hubby and I both agree that our Baby Bunny will always have new, well-made shoes. It’s one thing we won’t get used.

    At the end of March, we bought Baby Bunny her first pair of good shoes for cruising around at the park, a size 0-6 month PediPeds. There was a discount if we bought 2 pairs, so we bought the next size up, 6-12 month, at the same time.

    So when she finally outgrew the 0-6 size shoes this past weekend, at nearly 14 months old, I pulled out the next pair. They are HUGE! They look like clown shoes on her, and have tripped her more than once. There is way to much of a jump between these sizes, pictured below.

    The jump in size from 0-6 month to 6-12 month PediPed shoes is huge.

    The jump in size from 0-6 month to 6-12 month PediPed shoes is huge!

    We headed out to several stores searching for an in-between shoe in another brand, but with little luck. Most shoes her size are crib shoes with flimsy soles meant to just look cute (and they do). After our failed shopping trip, I figured we’d just live with the shoes and she’ll grow into them.

    I came home last night to a dime-sized red bump on her forehead, and 2 slightly skinned knees. She’d had a slight fall on her daily walk with daddy & doggy around the block. I’m pretty good about not freaking out about these things, but still, it’s hard to see that perfect tiny body I would do anything to protect, get hurt.

    The Search For Shoes

    Seeing those bumps and scrapes, made me revisit the idea of new shoes. But it’s going to take some effort. Sizing is different in every brand it seems. Here are our in store attempts so far:

    • Robeez – don’t fit correctly, leaving red marks on her heels and the tops of her feet
    • See Kai Run – have a good in-between size for length, but are too wide for her feet
    • Other Brands at Olly – Start at size 4, too darn big
    • Payless – little selection in the size 2s (which fit her best here) and didn’t like flip flops that spread the toes for young walker. In general, not that great of soles
    • The Children’s Place & Macy’s – not very good soles, more of a crib shoe
    • Kids Foot Locker – Nike Free fit pretty well, but were not in stock in a girls color, in her size. Also, I worry a full sneaker is too much for her developing little foot.

    I’ve always preferred to try shoes on before buying, but I’ve done some online research also, since the really tiny sizes are harder to find. I’m impressed at the number of companies that make baby & toddler shoes. The baby Merrill’s & Teva’s are adorable! If we can’t get something in store, I may try ordering one of these.

    This weekend we’ll venture out to the bigger mall in search of shoes for those adorable tiny feet.

    If you have any suggestions for good, very tiny shoes, leave them in the comments. I’ll report more on the pros and cons of what we find.

  9. Doctor Orders Tests – Daddy Gets the Dishes

    July 23, 2011 by Michelle

    16 lbs. 6.4oz – I win the bet and am dishes free for the weekend.

    Of course, as predicted, our pediatrician went ahead and ordered a round of blood tests to test for Celiac, thyroid conditions, kidney function, and some other things I don’t remember. (Which is good so I don’t obsess over it.) Her reasoning, rule out the medical causes before we can say she’s just a petite baby and will catch up.

    But the reason for these tests is not so much weight, she told me, but the height, which has dropped off the curve a bit more, and isn’t in line statistically with my and my husbands adult heights.

    Personally, I have to say I’m not as concerned about the height either, just watching my Baby Bunny over the last year, she tends to get pudgy, stretch, pudgy, stretch, so depending on when the doctors visits land, the curve could be way off.

    WHO Growth Charts Drastically Change The Picture

    One HUGE revelation at this visit, is that her weight is not quite as dire as we thought. The lactation consultant at the last breastfeeding support group I attended tipped me off that the CHOP Care Network had recently added the World Health Organization (WHO) growth charts to their computer system, however, the default is still the US Centers for Disease Control (CDC) growth charts. (Read more about pediatric growth charts.)

    So, when we plotted her Friday, she was 0.21 percentile, a drop from the 0.35 percentile on the CDC charts. Then, at the end of the visit, I remembered and asked about the WHO chart – which is much more accurate for breastfeed babies, with a click of a button, we went from a view of dropping off the chart, to a perfect 3rd percentile curve on weight. Phew. Where were these charts 6 months ago?

    Though as I mentioned above, even on the WHO charts, there is a length drop, hence the testing. If I can find the time, I plan to download the software from WHO to do some of my own plotting.

    Other Notes from this Visit

    At the last visit, Tom (hubby) accidentally left every weight check slip from support groups I had saved for her baby book. Turns out, the pediatrician had saved them! She’s a mom, too, and figured I’d want them. Hooray!

    The pediatrician is NOT concerned about breastfeeding as a problem. She told me her 2-year-old still breastfeeds and is a beast. So grateful for a pro-breastfeeding doc.

    If the blood tests come back normal, next steps are GI and nutrition consult. I’d actually love a nutrition consult anyway, but apparently they are tough to get without the blood work and a GI consult first.

    Docs and nurses agree, watching my tiny tot walk around the office is just plain adorable. πŸ™‚

    Dishes, Dishes, Dishes

    So far Tom’s honoring the bet and doing the dishes. Of course last night he got off easy. We ordered pizza because it was too darn hot to turn on the oven. Tonight & tomorrow, I need to come up with some complex, multi-dish meals.

  10. Placing Bets – How Much Will She Weigh?

    July 22, 2011 by Michelle

    Tomorrow, I take my Baby Bunny back to the doctor for another weight check.

    Seven weeks ago she was 15lbs. 15oz., at 1 year and 1 week old. We were told to give her a high fat diet and come back to see if we could push her up to at least the 1st percentile. So what do we responsible parents do? Place bets. The stakes? Dishes for the weekend.

    My bet 16lbs. 7oz.
    His bet 16lbs. 9oz.

    He was trying to get her to eat extra guacamole & cheese tonight in the hopes of packing on an extra ounce before tomorrow. But, I’m hoping my track record of weight prediction will stand. I was weighing her every 1-2 weeks at one point, so I got good at it.

    Of course, both of our guesses probably mean the same thing – the doctor will be ordering tests to see why she’s so darn small.

    We won’t know until tomorrow, so no more speculating tonight.