I have an FTT infant on my service. He is literally skin and bones. He reminds me of the babies you see when world vision or some other NGO shows a video to raise funds for "the starving children in Africa." The only difference between my patient and these other children is he is dressed better. His weight and height are less than the 3rd percentile for his age. His head circumference is at the 75th percentile for his age. Babies heads are bigger than their bodies anyway, but this is a significant contrast.
His mom, his sole care provider, is what we call 'a difficult mother' mostly because every time the nurses feed the baby and he throws up she yells and when she feeds the baby and he throws up, she yells. She yells all the time. She is frustrated and upset with us because "we are not doing anything for my son." That in fact is untrue. Speaking of facts, let me mention a few.
Fact 1: The baby lost two pounds over a month at home, under his mother's care, became skin and bones, and it was not until he was referred to the ED by her baby's doctor that she brought him in for an intervention.
Fact 2: Since being with us (a total of 6 days) he has gained 0.34kg or 340g. Babies his age should gain 20g a day which would mean 120g in 6 days. He has actually gained much more than that, almost 3 times that amount which means something we are doing is working!!!!
Fact 3: We did some studies and found that he has significant reflux so we started him on medication and have thickened his feeds. He is still throwing up (mom told us he was doing this after every feed at home) but less so than he was at home (mother's own words).
Fact 4: I have repeatedly (almost daily) explained to mom the symptoms of reflux, and the goal of her son's hospital stay.
The baby's mother decided to have a 'yell at the doctor' session today. Who was the doctor? Your's truly. In fact she was yelling so loudly the nurse called security to ensure I was safe.
Her complaints: She's sick of being in the hospital with nothing being done for her baby. Nothing has changed he is still the same. She wants the specialist to come and take a look at him now because he threw up almost all of what he ate. She's transferring her baby to another hospital because we are not helping. We are blaming her for his weight loss.
Thankfully the baby's dad was there so I was able to speak to him and explain to him, like I had to mom every day for the last week, what we were doing, the improvement in his weight, the daily goal of caloric intake for his son, the symptoms of reflux, and why we were hesitant to jump to something more invasive when his son was indeed gaining weight. The last thing I explained to dad is that there are psychosocial elements to a baby's ability to thrive which my team and I had also spoken to mom about. If mom is depressed, anxious, unable to bond with her son, or has any medical conditions that prevent her from caring from her baby as she should, he will fail to thrive. Even the gastroenterologist had explained this to mom. We were not blaming her for his weight loss we were simply stating the facts and trying to counsel her about the effects on her baby.
Still mother wants to transfer her baby. What can I do? I am learning when to hand responsibility back to the parents/care-givers of each and every patient I have. So I explained to them it is important that the hospital they plan to go to calls us and let us know they would like to initiate the transfer before mom leaves the hospital with the baby. That way we can send over the appropriate documents. Otherwise if she walks out of the hospital she would be leaving the hospital against medical advice (AMA). Leaving the hospital AMA is never a good thing when there is evidence of improved health status of the patient in question. I have many question re: what happens in the home for my patient but my shift is over, I have taken work home with me once again and I need to get some studying done.
Until I return to work tomorrow if God wills it.
images from google images
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