Doctors Lounge - Pediatrics Answers
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Forum Name: Pediatric Topics
|xrats - Sat Jan 05, 2008 1:53 am||
My son is 2 1/2 years old. He now weights 24lbs and is 33.5 inches tall. He is below the zero percentile. He was full term and an average weight when he was born. When he was less than a month old he was diagnoised with GERD and put on Zantac and Reglan. For the first year he gained weight very slowly and had moderate problems with GERD symptoms. A year ago he was diagnoised malnursihed and failure to thrive. Shocked me he eats all the time. He was then put on Neocate to supplement his diet. Allergy testing was done, doctors took eggs, milk, soy, and wheat out of his diet. Less stomach achs and sleeps better at night. He has had a scope w/biopsys done and a flex sig. Everything was normal. He was put on Previcad at 18 months. Now my son is off the Reglan. He still has bouts of vomiting lasting about 2 weeks at a time (4-7 times a day) the bouts come every couple of months. He has developed a limp that comes and goes with his right leg. He gets rashed around his thighs and face. In the last two months he has lost a little over a pound. THe doctors have done blood work and nothing comes back. We have tried appitite stimulants and they have not worked. The doctors said they are going to have to put a feeding tube in if he does not gain weight. Do you have any insight as to what could be causing this? All of this cannot being going on with no reason at all. I would love to treat the cause instead of the symptoms. Please Help.
|Dr. Chan Lowe - Sat Jan 05, 2008 10:57 pm||
Failure to thrive is a difficult thing to figure out sometimes. It sounds like your son is getting a proper evaluation. If they have not been performed I would recommend he have testing of his urine organic acids and plasma amino acids. These are good screening tests for many of the metabolic disorders.
I would also recommend he be tested for celiac disease if he has not been. Generally this would be seen on the endoscopy if they did biopsies of the duodenum but in rare cases it may not be seen. Eosinophilic esophagitis and eosinophilic gastroenteropathy could cause this but should have been evaluated for by the endoscopy and biopsies as well.
I would recommend he be tested for cystic fibrosis as well. This is done with a sweat chloride test.
Follow up with a GI doctor is important. In some cases a gastric feeding tube (G-tube) is necessary, if even for a short period of time, to reestablish good weight gain and growth. G-tubes are a relatively simple device to insert. They can be removed and heal well after removal. If it becomes necessary to have this done, be sure to talk with your doctor and the GI specialist or surgeon that will be putting the tube in to be sure you know all the risks/benefits to be able to make an informed decision.
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