Gastroenterologist
Community medical question
Patient question
*Need pediatricians Advice Please*
Baby _ Hamnah
Age - 2 years 9 months
*Parent’s concerns*
1.Chronic constipation
2.Don’t take food literally the whole day,
3.Only 1 chicken boti / seikh kebab in day
4.maximum 7 oz milk – during night sleep
5.Burps loud and scary – often throw up
6.Drools excessively
*Interventions*
1. Dompiridone 5cc twice/day
2. Famotidine 5 cc twice / day
3. Lactulose syp 5-7 cc / day
*Is this acid reflux / Gastrointestinal Reflux Disease (GERD),
How can we address this effectively?*
*History*
Birth weight - 2.3 kg
Day 7 after birth for diarrhoea
Day 9 after birth for admitted in hospital, Turned out to be Sepsis - remained in hospital under injections antibiotics for 6 days,
Day 21 or so, for readmitted for sepsis, as her conditions werent improving. Remained there till her vitals got normal.
*Here weight was dropped to mere 1.7kg.*
During this spell she was put on oxygen too for 5-6 hours. Had tests for lactose sensitivity, and amino acid residuals in urine. All were negative. No significant findings.
She had problem feeding since Day 1.
Sever reflux issues in first year, and still gets it often.
*Delayed milestones:*
1. Sitting 7-8 month
2. Crawling 11th month on belly using arms
3. Proper crawling in 13-13 month
4. Standing in 18 months - no stepping
5. Walking {3-4 steps} or taking support from things started in 24th month
6. Now walking without supports but some balance issues. Had physiotherapy sessions.
*Activity status*
1. Can speak sentences of 5-6 words, total 500+ vocabulary
2. Follows direction,
3. Can show love, empathy and affection, gratitude
4. Can count objects,
5. Memorised numbers by heart and can read from 1 to 10
6. Can name colours -12+ colours
7. Singing rhymes, memorised many rhymes in fragments
8. Excellent expressions, with appropriate tones
9. Knows shapes
10. Story telling, pretending characters,
11. Fast learner
12. Can identify about 10 or so alphabets
13. Physically very active and interactive
MRI Result
^^^^^^^^^^^^
Abnormal T2 and FLAIR hyperintense signal seen in peri trigonal white matter and
periventricular/sucortical white matter in right fronto-parietal and left posterior frontal
lobes. Subtle irregularity of left lateral ventricular margins. Overall imaging findings are
suggestive of changes of periventricular leukomalacia, possibly due to prior hypoxic
ischemic insult. Low possibility of neurodegenerative disease.
Baby _ Hamnah
Age - 2 years 9 months
*Parent’s concerns*
1.Chronic constipation
2.Don’t take food literally the whole day,
3.Only 1 chicken boti / seikh kebab in day
4.maximum 7 oz milk – during night sleep
5.Burps loud and scary – often throw up
6.Drools excessively
*Interventions*
1. Dompiridone 5cc twice/day
2. Famotidine 5 cc twice / day
3. Lactulose syp 5-7 cc / day
*Is this acid reflux / Gastrointestinal Reflux Disease (GERD),
How can we address this effectively?*
*History*
Birth weight - 2.3 kg
Day 7 after birth for diarrhoea
Day 9 after birth for admitted in hospital, Turned out to be Sepsis - remained in hospital under injections antibiotics for 6 days,
Day 21 or so, for readmitted for sepsis, as her conditions werent improving. Remained there till her vitals got normal.
*Here weight was dropped to mere 1.7kg.*
During this spell she was put on oxygen too for 5-6 hours. Had tests for lactose sensitivity, and amino acid residuals in urine. All were negative. No significant findings.
She had problem feeding since Day 1.
Sever reflux issues in first year, and still gets it often.
*Delayed milestones:*
1. Sitting 7-8 month
2. Crawling 11th month on belly using arms
3. Proper crawling in 13-13 month
4. Standing in 18 months - no stepping
5. Walking {3-4 steps} or taking support from things started in 24th month
6. Now walking without supports but some balance issues. Had physiotherapy sessions.
*Activity status*
1. Can speak sentences of 5-6 words, total 500+ vocabulary
2. Follows direction,
3. Can show love, empathy and affection, gratitude
4. Can count objects,
5. Memorised numbers by heart and can read from 1 to 10
6. Can name colours -12+ colours
7. Singing rhymes, memorised many rhymes in fragments
8. Excellent expressions, with appropriate tones
9. Knows shapes
10. Story telling, pretending characters,
11. Fast learner
12. Can identify about 10 or so alphabets
13. Physically very active and interactive
MRI Result
^^^^^^^^^^^^
Abnormal T2 and FLAIR hyperintense signal seen in peri trigonal white matter and
periventricular/sucortical white matter in right fronto-parietal and left posterior frontal
lobes. Subtle irregularity of left lateral ventricular margins. Overall imaging findings are
suggestive of changes of periventricular leukomalacia, possibly due to prior hypoxic
ischemic insult. Low possibility of neurodegenerative disease.