Check bloods and hormone profile

The parents are not happy with blood tests being done on their daughter. Although they appreciate that she is not growing as she should, they point out that she was born very small and has done well since. She is now beginning to put on weight.

You explain that it is important to check that she has not become anaemic, and that her liver and kidneys are functioning well.

With some difficulty and no little crying, the blood for the tests is taken. The parents leave the room as soon as Davina is dressed.

The next day the results are back (adult normal range in brackets):

When you bring Davina and her parents into the clinic room, she looks visibly bigger, with more fat on her cheeks and a healthier skin colour.

You explain that the blood tests are all normal for her age. You expected Davina’s parents to be relieved, but instead they look angry – they thought that the tests would be a waste of time and just unpleasant for their baby daughter.

On a more positive note they tell you that they had a visit from the community midwife. She asked about the feeding and watched a feed happening. It was immediately evident that Davina was in the wrong position and not latching on properly to the nipple. Once this was sorted, she began to feed for longer, was more satisfied by the feed and had longer breaks between feeds.

On the downside, she now brings up a little milk after each feed, and you explain to the parents that this is called ‘posseting’ and quite normal.

You re-examine her and there are no new findings. She has more subcutaneous tissue, especially on her abdomen.

Her weight is now 1.68 Kg and length 47.5 cm, head circumference 32.0 cm.

You plan to see her again in three months and then potentially discharge her from the neonatal follow up clinic. Davina’s parents ask you again if it was worth doing the blood tests at all – it was clearly a feeding problem that could have been identified at the initial visit.

In three months time you again welcome Davina and her parents back into the clinic room. Davina is now wearing a baby dress and looks very interested in the new surroundings.

Her parents are very happy with her progress. She is smiling, recognizes her parents and beginning to try to use her hands.

As far as feeding goes, she is still fully breast fed. Her mother continues to enjoy the process and now feeding has become very natural and easy. Her posseting has stopped.

She is again measured - Weight 5.25 Kg, length 57 cm, head circumference 39.5 cm.

You are very pleased with her growth and her progress. You discharge her from the clinic, but leave the neonatal secretary’s contact details so that they can make another appointment if new problems develop.