You Got Questions...I Don't Got the Answers

Paxton had a therapy session late in the morning. This was Paxton's first appointment since having his cleft palate repaired. Susanne requested that they work on motor skills today to give Paxton another 24 hours before working on anything dealing with his mouth. She wanted to give him as much time as possible to increase their chances for success. Paxton did well throughout the session. There wasn't much change regarding his skill level, but that was to be expected at this point. Susanne was given goals to work on over the next week before the therapist left.

After a quick nap, Paxton had to be woken up for his next appointment. He had a follow up visit with the pediatrician as well as his next scheduled Synagis vaccine. The appointment went very well. Dr. Lynn was more than impressed with Paxton's weight gain over the last few weeks. He was finally back on track with his own personal bell curve.

Susanne came prepared today with a list of questions for the doctor. First, she had the pediatrician calculate out his current daily caloric intake. For once, it was exactly where she wanted it to be and it didn't need adjusting. The continuous feeding overnight had allowed for this to occur. Susanne was able to add in what would equal an additional feeding without causing fluid overload to his system. It seemed like his body had a sufficient amount of time to digest the additional calories since it was given over such a slow rate. Since he was on strictly formula overnight, there wasn't the same concern about it being out of the refrigerator for the full eight hours like there was with the breastmilk. Overall, this was a better set up for everyone involved. Paxton was gaining weight, the pediatrician was meeting his nutritional requirements, and Susanne was getting a little extra sleep.

Next, Susanne asked about the two new upper pre-molars (or possibly molars) that had erupted right after Paxton's cleft palate repair. Susanne had pictures of the roof of his mouth prior to the surgery and they were not present at that point. She was curious if any of the instruments used during the operation could have forced the teeth to poke through the gums sooner than they would have otherwise. It appeared that the teeth were coming in at an abnormal location. They were visible right on the inside of the upper gumline. The pediatrician confirmed that they were in an odd place, but she couldn't definitively give the reason why. She thought that it may have to do with him having Pierre Robin, but she couldn't be certain. It was just something that Susanne would have to watch for now. There was nothing that anyone could do at this point. It was a known fact that Paxton would eventually be seen by an orthodontist as part of the craniofacial team he was required to be followed by once he turned 18 months. They would just have to wait it out to see if this would cause any long term problems.

Also, Susanne inquired about the shape of Paxton's head. Instead of his forehead being nicely rounded, it had more of a scalloped appearance. There was a slight indention in the middle of his forehead that seemed odd to Susanne. The pediatrician thought that it could just be a result of the bony plates that make up his skull not yet coming together completely. He still had an abnormally large "soft spot" that supported this theory. She wasn't sure if the shape of his forehead would change once the fontanelle closed, but it was something she also wanted to watch for sure.

Susanne's most important question was about Paxton's never-ending diaper rash. She wanted to know what else it could be since it wasn't clearing up. Susanne was worried about food intolerance or a food allergy. The pediatrician wasn't convinced. Since it improved somewhat in the hospital while Paxton was on antibiotics, the pediatrician thought that it was more likely to be bacterial in nature. They knew it was less likely to be yeast because Susanne had already treated him with a long course of antifungal cream. Before the pediatrician started switching a lot of things in Paxton's world like using different diapers, changing his food, or putting him on antibiotics, she wanted Susanne to let Paxton sit without a diaper on as often as possible for a week or so to dry him out. If this resolved the issue, then they would not have to go to any further extreme. If not, then they would start changing things up. Susanne knew that this would result in long days of endless laundry, but Paxton was well worth it.

All in all, Paxton looked great. Dr. Lynn couldn't be any happier with his progress. She couldn't wait to see him in a month once he was completely healed from surgery. She had high hopes for this kid. She didn't expect any less.