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The Art of Medicine

A mother in mourning

Maurer, Brian T. PA-C

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Journal of the American Academy of Physician Assistants: August 2020 - Volume 33 - Issue 8 - p 58
doi: 10.1097/01.JAA.0000684148.38849.4c
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“I'll either buy you a house or dress you in mourning,” he told his sister Angetita.

—El Cordobes

Immediately, the father rises from his chair when I enter the examination room. His wife remains seated with their baby resting in her lap.

I greet them with a smile. “Four months old already!” I say. “How is she doing?”

“She's been fine,” the mother says. “She's much more alert now, reaching for things, making sounds.”

“We had some concerns,” the father says. He produces a smartphone from his pocket and taps the screen. “How is she doing with her weight?”

I glance at the growth chart. “She's gained well,” I say, demonstrating the growth curve. “Still a peanut, but her overall rate of growth is good. How are the feedings going?”

“We are giving her formula now,” the father says. “Three and a half ounces every 3 hours. Is that enough?”

“How many bottles a day?” I ask.

“About eight,” the mother says.

“Twenty-eight ounces a day,” I say. “That's fine for her age.”

“Another thing,” the father says. “She tosses her head back and forth as she falls asleep.” Again he swipes the digital screen, clicks on a video clip, and holds the phone up for me to see. I watch the child move her head from side to side, then drift off.

“Any symmetrical jerking movements of the arms or legs?” I ask. “Any rolling back or darting of the eyes?”

The father shakes his head no.

“I don't think this is anything to worry about,” I say.

“Another question,” he says. “Can we start feeding solids?”

“You can start with some infant cereal,” I say. “Rice is best. Mix it with a bit of formula in a small bowl—”

The father swipes the screen of his phone again. “This is what we have bought.” He shows me the photograph of a box of baby rice cereal.

“Yes, that's fine,” I say. “Well, let's have a look at her.”

The father lifts the child from the mother's lap and places her on the examination table. The mother rises to her feet and takes a step toward the infant. As I lean in to listen to the child's chest, the mother smiles.

“We were also concerned about the shape of her head.” The father's muffled words mix with his daughter's heart sounds through the stethoscope. I pop the earpieces out and study the slight flattening on the back of the infant's head.

“Just a little bit of positional flattening,” I explain. “Have you been giving her some tummy time?”

“Every day,” the father says.

“How long?”

“Five minutes.”

“How often?”

“Once or twice.”

“Oh, you can increase that to 8 to 10 times a day,” I say, smiling at the mother.

The mother looks as though she has gained weight since I saw her last at the infant's 2-week well-child visit. I study her face. A trace of lipstick crosses the vermillion border of her upper lip, marring the subtle line between beauty and disarray.

“And you?” I ask her, “How are you doing?”

“Much better,” she beams. “The weather is so much better. I get out for walks now. It's warm; I like the sun.”

“I'm glad to hear it. You look well.”

The husband lifts the infant off the examination table and cradles her in his arms. “When do you wish to see her again?” he asks.

“Two months,” I say, “when she's 6 months old. She'll be due for her next set of shots then.”

“Perhaps we can bring her back in 1 month,” he says, “for a weight check.”

The mother's eyes dart at him; the smile fades from her face. She opens her mouth momentarily, then quietly closes it, sealing her lips. Her gaze drops to the floor. Somehow I sense a trust has been broken.

“If you'd prefer to,” I say, in the softest voice I can muster. “But really, she looks good. I'm sure she'll do just fine.”

Momentarily, if only for an instant, the mother's smile returns.

Copyright © 2020 American Academy of Physician Assistants