iPhone or Isomil

24 09 2011

As a non-parent, I cannot fully understand the impact of the multitude of challenges that come with raising a child, much less raising a healthy, well-behaved one who will grow up to be a productive member of society who makes good life decisions.  Because I don’t have kids, I have to make a conscious effort when I encounter certain types of parents not to judge them for how they are raising their kids.   Turns out, there is a very very very very very very VERY fine line between a good doctor and interfering with a parent’s right to, well, parent.

When their decisions negatively impact their child’s health, though, that gets more difficult.

Now I’m not talking about things like feeding the kiddo fast food once a week, or letting them eat hot dogs or sugared cereals or drink soda or feed them things from containers that have BPA.  These things are completely fine in moderation, and although the vast majority of my friends who have recently given birth make a special effort to feed their children (and wash and dress them in) organic everything, and actively voice their opinions that anything less is nothing short of abuse.  But there is a significant number of people for whom that method is not feasible. Most of the patients I see struggle to afford any fruits or veggies for their kids at all, let alone fresh and organic and varied ones.  Because we’re getting into flu season, I’ve also seen a lot of parents say “No, I don’t want my kid to get the flu shot, it gave little Johnny the flu last year.”  Ugh.  I was so sick of hearing this that I started to have the “This shot is a killed virus and can’t give you the flu, you feel a little ill because your immune system mounting a response” talk.  Vaccines are clearly a topic for another day.

So this young married couple came into the office yesterday with their 8-month-old child.  It was just a well-child visit, but it came up that the little one was eating more cans of formula in a month (10) than WIC would pay for (7).  While he was eating more than normal, he was growing proportionately and was at the 75th percentile for length and weight.  He was not an obese baby or anything, he just ate more.  And no matter what his parents mixed with regular cheerios, the baby would only eat the pre-made infant cereal.  In short, his parents described him as an “expensive child.”

You could go ahead and say that it’s ridiculous that someone in that situation would choose formula over breastfeeding, but this mother began to formula feed under the impression that WIC would be paying for all of the formula that her child needed.  In a population that lives paycheck to paycheck, they had written most of the baby’s food expenses out of their budget.  I personally think this was a poor decision, but I can see why they would think that way.

As I was sitting there and interviewing them and doing a quick exam on the baby, dad pulled an iPhone out of his pocket to answer a phone call.  An iPhone.  To be fair, the dad may have committed to the iPhone prior to his child developing accelerated eating habits, but it still made me sad.

Shortly after that, I saw a 3-year-old little girl with one side of her jaw swollen.  She was in pain, and had been losing a lot of weight because it hurt so much to eat.  Her lymph nodes were enlarged, her cheek was warm, and she could barely open her mouth.  When I looked in her mouth, even though I couldn’t see much, it was appalling.  The poor kiddo had a ton of seriously huge cavities that had clearly been there for at least a year.  When her mother had finally taken her to the dentist last month, it was so bad that the dental office referred her to the children’s hospital for sedation to get them filled.  The kicker:  “They wanted $150 up front, and I couldn’t afford it,” she said as she dug her buzzing phone out of her Coach purse.  Yep, Coach.

So of course this poor 3-year-old wound up with an abscess (a deep infection in her jaw from the bacteria in her cavity) and was at risk of blood infection.  I can’t pretend to fully get the circumstances.  Maybe the purse was a gift. Maybe she bought it at a discount, who knows.  She then went on to look at her child and say “See now, Breanna, I told you eating all that candy was bad.”

Seriously? She’s three years old.  You. Are. The. Parent!  I actually almost said something, but the resident held her tongue and I followed her lead.  Once we were out of the room, though, she went off on a strongly opinionated rant.  I listened, and then did the only helpful thing I could think of: offered helpful information.

This story has a good ending.  I knew that the dental resident was there that day and so I told my resident this.  She was pumped and had me find her, pull her away from the resident she was shadowing, and introduce her to the patient.  Just one phone call from the dental resident and the kiddo had an appointment that afternoon at a dental clinic that allowed deferred payment.

Certainly there are going to be parents who frustrate me more than these (I’m not even in pediatrics yet).  It is kind of nice to encounter these people only sparingly, so that I can gain patience and watch the doctors that I work with to see how I should respond, if at all, in order to do what I’ll be obligated to do when I earn my MD: treat my patients.





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