Twice a month I am the teaching attending for the medical team which goes to the local orphanage weekly.
Today I went for the first time since before the serial blast of holidays that started with Christmas.
First I went with our staff nurse and pediatric assistant to the “newcomer’s wing” and sick clinic.
We had a 7 month preemie with positional plagiocephaly, with a misshapen skull from always preferring the same position.
The easiest suggestions was to move his dangly toy to the right side of his bed.
The nanny was not so keen on taking down the bumper pad to let him see what was going on around him, so we had to leave that up.
Really, the best suggestion for him is to go to the regular kids section in the other building where he will spend much more time out of his crib, and we tried to make a case for that with the house doctor later.
Another 2 month old had pretty significant seborrheic dermatitis of the scalp and eczema of the face and chest. We discussed vaseline, which is my personal preference for the eczema, and oil to soften the scalp plaques.
A baby who had repair of omphalocele shortly after birth was finally beginning to gain weight, a little bit.
A newcomer, 3 weeks old, had been diagnosed with pneumonia and treated in the hospital. I heard a small heart murmur, and we mentioned that to the house doc as well.
We looked at some kids who have had some skin rashes for about 3 months, and I suspect it was scabies. Discussed different treatments and their availability here. And the lovely treatment of bedding, etc.
In the regular wing we saw a 3 year old boy with congenital clubfoot, who is actually walking pretty well on his own uncorrected curved feet. He also had a pretty significant speech delay, and we recommended a hearing test.
Then there were two more kids with growth well below the 3rd percentile, including an 18 month preemie who is actually progressing in milestones.
Two kids were gone by the time I went with the resident, and I was happy to hear they had gone to their foster home for the evening and night.
All in all, a palette of teaching opportunities, and thoughts to ponder.
Will the thin crib bumper truly keep a baby in if they are trying to crawl out of a crib that’s too small for them?
What is the scabies resistance incidence here?
Is there anyone in town who can do the Ponsetti clubfoot braces, or is the only local option surgery? I have seen plenty of kids with surgical scars from the repairs.
Need to think about how we could organize a hearing screening day for a bunch of kids. It’s one of those tests that very rarely gets done, yet could make a huge difference for many.
We discussed the fact that there are many fewer kids in the orphanage this year under 3, and especially under age 1. Even compared to two or three years ago.
When I asked the residents and nurse why, they shrugged and mentioned these thoughts.
Perhaps the one child policy? (That was enacted almost 30 years ago).
Perhaps more people these days keep their children instead of abandoning them.
How do the abortion trends compare?
And are the numbers of children with disabilities who stay with their families, climbing?
Are some of the babies getting adopted domestically and we just don’t know about it?
Hmm. Will sleep on it.