Sunday, July 25, 2010

A Spoon

I am sitting in with the paediatrician when a couple comes in with their 6-month-old baby girl. She has been referred on because of “failure to thrive”, meaning that she just isn’t growing as much as expected. The registrar does the physical examination including weight and measurements while the paediatrician takes a history. The girl is not chubby like you’d expect – we can see all of her ribs and even her hip bones. Her weight has fallen below the 3rd centile for her age, and length has dropped a centile, although head measurements have been increasing as expected. The poor baby is malnourished, although she is happy and bubbly and her parents obviously love her very much.

The mother tears up a little as she gives the girl’s history – lately she’s been breastfeeding for almost 24 hours a day and she’s exhausted. The paediatrician knows that there isn’t enough breastmilk for the baby anymore, and asks if she’s getting anything else to eat. Apparently they have tried giving her porridge, which she likes. The paediatrician enquires how much, and Mum replies, “a spoonful”. “What size spoon?” the paediatrician asks, because it is important. “You know, a spoon – a spoon like you get in cutlery sets.” “Yes, but a teaspoon, or a dishing up spoon, or a dessert spoon ...?”

In the end they decide that it is a dessert spoon, and the paediatrician gives very specific instructions about what the baby should eat every day. She gives the instructions twice and then writes them down. And then she goes through the written instructions again. It might be enough ... good luck, baby. Good luck.

No comments: