Monday, October 6, 2008


Brynna's 2-month well-child checkup was today. And she is very well indeed! In fact, the first thing the doctor asked me was whether she was breast or bottle-fed. When I said that I was breastfeeding, he asked how that was going for me. I said "great," and he glanced at Brynna and then her growth chart and said, "and it's certainly going great for her!"

Brynna is now just shy of 13 pounds (5.85 kg, to be exact). She is in the 80th percentile for weight and 60th percentile for height for a girl of her age. (This does not have any bearing on her eventual weight and height as a grown-up...I expect her to gradually come down on the growth curve over the years, until she hits her genetically determined "midparental height" and what will probably be quite an average weight.)

Little B is also meeting all of the developmental milestones for 2 months, and some for 3 months (what a brilliant child!). Of course, right after we described her to the nurse as a happy, smiley child, she had a total screaming meltdown in the office. This was an excellent reminder that the very limited time I spend with my patients, especially the kids, often will not give me a very good sense of what they are like in their normal home environment!

B was awake and chipper in the waiting room, smiling over my shoulder at the other patients and then cooing happily at the nurse as we entered the examining room. She started getting a bit skeptical when we stripped her down to her gDiaper (perhaps she needs to be a bit older to gain an appreciation of naked time?) and the fussing started when we laid her down on the hard, chilly scale and then in the little measuring box. She really lost it while waiting, still undressed, for the doctor to come in. I walked her and jiggled her, Alex walked her and jiggled her, I offered the breast, she screamed louder, we tried covering her with a blanket, and Alex finally reached a tentative peace by carrying her around on her belly, a calming technique that M (B's grandfather) uses with great success. This truce lasted most of the way through the doctor's brief questioning but was broken the moment we laid her down on the examining table.

The doctor was able to listen to her heart and lungs before she really got going with the yelling, but then she rapidly descended into red-faced lobster territory. I had to pick her up and soothe her a bit before the doctor could get a good look in her eyes. This is actually a super-important part of the baby exam because the presence of a red reflex—the same thing that ruins flash photos—is a check against retinoblastoma, one of the few cancers that can present in little ones. He also checked her hips for dysplasia. He has no concerns for B at all.

Then it was time for vaccines. As I have written about earlier, I am a huge believer in vaccines as a cornerstone of preventive care. So is Alex. We intend to do the full complement of vaccines on the regular CDC schedule (Brynna will be exposed to way more antigens just by touching a surface and sticking her hand in her mouth than even the days when she gets eight vaccines, as she did today). So poor little B had one oral vaccine and five shots. She was so upset by the time this process got started that I'm not even sure she noticed the shots...her screaming certainly did not get any louder or more distressed when the poking started! I think the nurse was appreciative that neither Alex nor I got upset, and in fact were fairly useful in holding Brynna still for this unfortunate event.

The vaccines today were for:
Rotavirus (oral drops), which causes severe diarrhea. This very rarely is fatal, but causes a lot of hospitalizations for dehydration. Almost all kids get rota by age 5 if not vaccinated, so we're hoping to spare B some misery with this one.

Streptococcus pneumoniae (shot), which is the #1 cause of bacterial meningitis, which can be fatal. Strep pneumo can also cause pneumonia and ear infections.

Polio (shot). This is an inactivated polio vaccine, not the live oral polio vaccine that is really useful in higher-risk parts of the world but can, in rare cases, cause polio.

Haemophilius influenzae Type b (Hib) (shot). This bug also causes meningitis and other nasty infections like pneumonia and epiglottitis, which can be fatal. Epiglottitis, a throat swelling that can cut off breathing, has almost disappeared since the advent of this vaccine.

Hepatitis B (shot). This is a virus, usually passed through body fluids, that can cause chronic liver damage and liver cancer.

Diphtheria, Tetanus, and Pertussis (shot). These are all bacteria that can make kids very, very sick. This shot—specifically the pertussis (whooping cough) part—is one of the big culprits in the general fussiness in the couple of days following vaccination, and can in super-rare cases cause seizures or very high fevers. But the risk of getting pertussis—there are outbreaks yearly—is much higher. And the disease itself can cause seizures and brain damage in bad cases, and a lot of misery even in straightforward ones.

By the time we left the office, Brynna had settled a bit and then zonked out. She's never cried herself to exhaustion before, which was very sad. But she's perked up now and seems to be doing just fine. In fact, here she is enjoying some tummy time with her Papa:


Kate said...

I think that's one of my favorite pics yet! Too bad Alex's noggin is in the way ;)

Clara said...

Yay for the Pertussis shot! Whooping cough is just ass. :(