Help with what to push for with doctors appointment

[11NigelTufnel]

I have booked ds a gp appointment as something seems wrong, but very unsure as to what needs investigating. Can anyone give suggestions as to what we should be pushing for them to check? It is so difficult to get medical access these days that I don't want to risk being fobbed off.

He is 5 and tall and thin. He doesn't seem to have put on weight in a very long time, so just gets even thinner in proportion. He gets ill regularly, most commonly respiratory issues. We have discussed asthma already, but he would be too young to test yet.

He has always been reluctant to walk much and very often complains his legs hurt. I always need to carry him downstairs in the morning, when he is ill and generally overwhelmed. School have him on a motor skills intervention for writing and he tends to hold a pencil in his fist still. He is probably hypermobile, like his brother, but wouldn't let me check and he hates other people touching him.

His eating is very restricted, but he is good with fruit, veg and bread. Protein wise, he eats eggs, cheese on pizza and white fish, baked beans and sometimes peanut butter. We believe he is autistic and are awaiting his assessment, but would explain his food issues.

Any thoughts on what we should be asking for them to investigate? It feels to me like there could be a muscular issue or food intolerance going on perhaps?

Sorry you’re going through this op. If he’s tall could his muscles be struggling to keep up… getting tight and then making it painful to him to walk when they have tightened over night?
is he super tall? Like upper 10% quartile? Paeds physio may be able to help him strengthen and stretch if very tight?

@naranjajuice that is interesting, never thought of that. He is on the line for 91st centile in height and in age 7 clothes despite being between 25-50th centile for weight. I had always just assumed that he didn't like walking, but it doesn't seem much of an issue when still in the push chair phase. Now we have been out of that for a couple of years, he still is having issues. I can piggyback him for a while, so often resort to that.

What about getting his iron levels checked?
I suspected my DD had asthma, persistent night cough and breathless on exercise. GP asked us to keep a peak flow chart for a month and when we went back because there has been a 10% swing in peak flow that was enough to start her on an inhaler. She was 7 and GP said they didn't test at that age but looked at symptoms and if they improved using an inhaler.

I'd want his bloods checked and perhaps a referral to a paediatrician.

With hypermobility may come other issues - Marfan being one, though it is unusual to be diagnosed early in childhood. Perhaps ask the GP to refer to physio for assessment of the problems with movement as a starting point. They are usually pretty good at spotting other related issues!

Yes I was wondering about Marfans also.. but it could be he is just tall also.. does being tall run in either family op?

@BonnieBairn iron levels could be an issue. He has never eaten much in the way of meat and stopped completely last summer he does eat eggs a lot, so I think they are high iron. He only drinks milk, flavoured milk and water, so I think milk isn't good for iron absorption.

@naranjajuice my family are tall. My nephew is a year older than him and has always been taller, so his height seems about right for our side of the gene pool.

I would ask for a referral to community or developmental paediatrician. They are very good at looking at the whole picture.

I would push for a referral if you think asthma. My daughter's asthma nurse said that they can do the peak flow test at that age, my daughter was referred at 6 to the hospital as had constant chest infections and they did the peak flow tests and also allergy tested her.

On the hypermobility, would he allow a doctor to check for that? I think that alone can cause joint pain

We’re having similar problems with my older DD. She’s 11 and we took her in recently because she gets chilblains every year despite us trying everything to prevent them. When GP checked her feet they were cold to touch but she didn’t realise so he ordered full bloods.
They’ve come back as borderline VitD and high folate levels. GP suggested a vitD supplement and asked if she takes folic acid - she doesn’t.
She is vegetarian and now putting together some other niggles she’s had over the years - heart palpitations, skin infection, joint aches etc, I wonder whether she has low B12 as well.
Could this be an issue for your DS?

@annlee3817 he hates his inhaler with spacer, I normally have to try and use it when he is asleep. He only gets wheezy when he gets a virus, but it is every time and he gets them frequently. I just don't see him agreeing to breathe into a flow test. He doesn't have signs of allergies like hayfever, but I do wonder about food intolerance.

@Ohhelppp definitely worth checking out vitamin d. He does seem to get tired a lot. His leg bones are straight, so if it is, it hasn't got that far. I do put on high factor sun cream in summer, as he is so pale.

I agree with asking for a referral to the community paediatrician. Where I live they look at everything and also screen for neurodiversity.

@11NigelTufnel what type of inhaler spacer does he have? The mask? Kids often hate the mask type spacers, we swapped to a mouthpiece one like this amzn.eu/d/bZnctQ7 which was much better. My kids also have viral induced asthma. The peak flow meter is a tube you breathe into - hard and fast, like blowing a pea shooter so shouldn't be such an issue!

@handmademitlove thank you, will try that. Yes we have the mask one, which I can imagine is scary when you are little and feeling like crap. I still don't think he would agree to blow into a flow meter for enough times to get readings. It's hard enough getting him to agree to teeth brushing.

I have friends who's kids have asthma or assumed to have asthma who are under 5. One has been having treatment since about 1 when he got breathless crawling.

Keep a food diary, it could be a nonige food allergy (delayed, similar to intolerance) or intolerance. I would also ask for a blood test for coeliacs too. Also ask for stool samples to be tested too.

We have to do YouTube teeth brushing videos with my 3.5 yo. It was a gain changer as teeth cleaning is completely non negotiable as she has acid damage due to severe gerd. We also use an electric toothbrush and the novelty of this gave us a few weeks of good teeth cleaning!