|Case 997: August and Rachel|
|Mr and Mrs. Verde have just moved to Biddeford from a small town in western Massachusetts. Their former pediatrician has recommended you to the Verdes and they have transferred their medical records to your office. They are in today with their children for an initial check up.
Mr. Verde is a computer programmer. He has been hired by the city of Biddeford to computerize the city offices. Mrs. Verde was an elementary school teacher, but she has not worked since her children were born. The Verdes are renting a house in Biddeford until they can find a house they would like to buy. The house has city water which is fluoridated. The Verdes have two children, August, who is three years old and, Rachel, who is three months old. Rachel had a normal birth following a normal pregnancy. At birth, she weighed 8 pounds 8 ounces and was 21 inches long. She is being breast fed and Mrs. Verde reports that both she and Rachel are quite content and happy. At three months, Rachel now weighs 14 pounds 8 ounces and is 25 inches long. Mrs. Verde indicates that she intends to continue to breast feed Rachel as long as both she and Rachel are content with it. Mrs. Verde is planning to start Rachel on cereal when she is about six months old.
Mr and Mrs Verde both indicate that their experience with Rachel is quite different from their experience with August. When August was born, he weighed 7 pounds 8 ounces and was 20 inches long. August did not adapt to breast feeding very easily. He sucked only for very short periods of time and was not very enthusiastic. He slept a lot and had to be wakened for feedings. Mrs. Verde was determined to breast feed so she persisted, but August lost quite a bit of weight during the first month. Finally he seemed to get the hang of it so that by 3 months he weighed 11 pounds and was 24 inches long. August was started on solid foods when he was four months old. Mr and Mrs. Verde were quite concerned about his weight so they fed him frequently and encouraged him to eat everything. You review the record from August's pediatrician and find the following.
Mrs. Verde says August usually eats about six times a day. She says sometimes he doesn't seem to want to eat much at lunch and dinner so she really has to coax him. He's usually hungry for snacks and seems to prefer the snack foods to the "healthy" foods she tries to feed him at meal times. Both children are on fluoride supplements. The well water at their old house did not contain fluoride.
August spends much of his day watching TV or playing video games. Mrs. Verde says she is very busy with the baby and trying to get settled in the new house, so she is delighted that August can keep himself amused. As a hobby, Mr Verde reconditions old computers for donation to schools. Sometimes August helps him with this work in the evenings.
Mr Verde tells you that he thinks August is getting too fat but Mrs. Verde disagrees. She keeps reminding Mr. Verde how thin August used to be and how he needs a little extra weight to keep him healthy.