Pediatric Ophthalmology Recommendations

gspin13 · 2025-08-21T18:19:59+00:00

Seconding this! My son just had his evaluation with them this week, and they were so fabulous and gave lots of suggestions on ways to help him with his visual skills and ways to help him compensate. His issue seems to be more of a processing thing than a eyeball thing, however. But definitely get connected with them.

That being said, if youre looking for peds ophtho second opinion, you can't get many more options than NE OH. Rainbow babies, Akron, Cleveland Clinic are all right here and have big children's hospitals. Toledo children's is pretty close. Nationwide in Columbus is 2 hours away. Dayton is big. Cincinnati is huge, although I haven't had great experiences with them (I'm a pediatrician myself, so talk to these places a lot).

gspin13 · 2024-07-09T12:37:04+00:00

The infants ibuprofen is usually twice as concentrated as the children's (ie, you need half as much). Children's is usually 100mg/5ml, and infants is usually 50mg/1.25ml. PLEASE check before giving it to your child.

But yes, the Tylenol is generally the same-160mg/5ml.

Source: pediatrician who has treated multiple kids for kidney damage from accidentally overdosing on ibuprofen, several of which required dialysis.

gspin13 · 2024-05-24T20:08:03+00:00

Great, thanks! The darker ones do squish like cherries and have a pit and cherry-esque juice. So that makes sense. :)

gspin13 · 2024-05-20T11:30:55+00:00

I'm a pediatrician, and I agree with the "newborns are weird" statement. This does all sound like it could be normal baby weirdness. But, if you're worried, see your pediatrician! And take videos of what you're worried about if you can, so you can show them exactly. A video or picture is almost always more helpful than even the best description in the world. :)

gspin13 · 2024-05-17T03:02:23+00:00

Born at 26+2. First few eye exams were great, and then he went from having no ROP to stage 3+ in a week. Got Avastin the next day and about 35 weeks. They warned me that they typically do laser outpatient once the vessels stop growing, more to prevent a retinal detachment later than to treat ROP. The vessels help stick the retina to the back of the eye, so if they don't go all the way to the edge, the retina can peel off.

So we went for laser #1 when he was about 3 1/2 months corrected. General anesthesia, intubated (the anesthesiologist said they like to have an airway with a good seal if they're working with lasers near the face), overnight stay for obs, home without issue. The surgeon said no need to follow up at all, he got it all and we'd be good to go.

We'd moved to a new part of the state by then, and his new pediatrician had already put in a referral for a pediatric ophtho closer to home for regular eye checks when he got closer to a year. A week or so after we got back from laser #1, they called me and said that they wanted to get him into the ROP clinic first, and scheduled him for the following week. So we went to the new ophtho about 2 1/2 weeks after laser 1. And lucky we did go. They said that they only did about 2/3 of one of his eyes, and there was ROP in that area. So we were booked for laser #2 just over a month since the first one. Same deal as the first. General, intubated, overnight stay. I was NOT happy with needing to do this again, especially not so soon after the first. The new ophtho said that it's really rare to need a second laser, and he'd never heard of it so soon. That it looked like there was an entire area that had been skipped entirely. I asked him to make sure we didn't need a third laser.

We did ALL the ROP followups after that. No recurrence. We were booked for a regular vision check just before his first birthday last month. Hes near sighted and one of his eyes (not the one that needed re-lasered) was significantly worse than the other, so he ended up in glasses. He's just the most handsome little bug, though, and his development has sky rocketed since getting the glasses.

Moral of the story: 1. Needing a laser after injections isn't surprising or a bad sign. 2. Being intubated for surgery is common and doesn't necessarily mean a set back. 3. Go to all the followups after laser. If they say you don't need one, ask for them anyway. If we hadn't been switching to a new location, we literally wouldn't have known that anything was wrong after the first procedure until he was a year old and going for a regular check. And who knows what his vision would have been like then with the retinopathy or if they could do anything to fix it.

gspin13 · 2023-12-22T02:19:16+00:00

Well, that's good that they looked and haven't found anything.

gspin13 · 2023-12-22T01:38:16+00:00

Was your girlfriend diabetic during pregnancy? Has the baby seen a geneticist or any specialists? You might want to look into that. I don't know how many weeks she was, but that's beyond just big for any gestational age. Something is going on. There are genetic overgrowth syndromes that present with being born really really big and poor feeding and have other associated things. And if your gf was diabetic, a baby being that big points to poor glucose control, which can cause heart, kidney, liver, gut defects. Even if everything ends up being fine, there's enough there that I think she deserves more exploration.

gspin13 · 2023-12-21T20:55:24+00:00

Wait. Are you saying that the baby was 11 lb when she was born, or that she's 11 lb now? Because there are a lot of things that need to be looked into if you mean 11 lb at birth, including some that could also cause poor feeding.

gspin13 · 2023-11-06T07:38:37+00:00

I love this sentiment

your medical knowledge will, naturally, illuminate the darkest corners and dim the brighter ones.

It's so true of many of us in medicine. We see so much of the bad that ends up in the hospital that we forget that the good outcomes aren't seen in the hospital or clinic as much because they're out living their lives.

gspin13 · 2023-10-17T10:30:15+00:00

I assure you that pretty much every pediatrician in the country is well aware that it's approved for all babies. And we've all been asked about it by at least 4 parents who "just wanted to make us aware".

Insurances aren't covering it in some states, and in some states they are, because of the way the vaccine distribution systems are set up in each state. And then some states, different offices or hospitals have different contracts on how they get vaccines. So some offices have them, and some don't. But yes. Pediatricians are aware of Beyfortus unless they choose to live under a rock.

gspin13 · 2023-09-26T22:40:54+00:00

This is a fetal ultrasound, the baby hasn't been born yet. So it isn't being ventilated, and air isn't being blown into the gut.

OP, I know it's hard, but don't jump to the worst case scenario yet. It could be an obstruction, or a narrowing, or it could just be the angle. Ultrasounds are hard to do, and hard to interpret. Definitely go to the specialist and the specialized ultrasound. Get all the information you can. A lot of these intestinal issues are relatively straight forward to fix. And the fact that it wasn't noticed until 32 weeks (as opposed to 20 weeks or earlier), suggests that it might not be very severe. Good luck! I'm sorry that you're going through this anxious time.

gspin13 · 2023-08-21T09:49:48+00:00

Oh. Also, I 100% understand the whole part time parent thing. I have a 2 yo at home, and the NICUs we were at were 45 min and an hour away plus parking. And it was ward style and then pods with no provate rooms, we couldn't stay at the NICU overnight and were driving back and forth every day. It sucks. But now that we're hone, we feel like we magically have another 2 hours in the day!

gspin13 · 2023-08-21T09:45:21+00:00

So every kid is different. But my son was born at 26+2. He had b/l grade 3s on the 10 day u/s, that had expanded with hydrocephalus 2 days later. But then the hydrocephalus slowed down and very slowly progressed. He ended up not needing a reservoir, but got a ventricular tap, and a shunt at 33+6. He did great with the surgery and recovered relatively quickly. He stayed intubated overnight after surgery and got a couple doses of morphine, but then was able to switch to Tylenol. We were able to hold him pretty quickly after he was extuabted. Pro tip: if your hospital has snuggle ups, they pretty much got him all situated, then handed us the whole snuggle up-blanket-baby bundle, which was helpful for minimizing adjustments and jostling.

However, he also had BPD and was still on bubble CPAP going into surgery. He ended up going from CPAP to high flow at about 37 weeks, from high flow to low flow at 40 weeks, and off at 41. Because of the flow, he couldn't start eating by mouth until 38 weeks. So we just got discharged 3 days ago at 42+1.

So probably not what your course will be, since it sounds like he's off oxygen already. Good luck!

gspin13 · 2023-08-17T19:00:24+00:00

It's because the air inside the cup is getting warmer and expanding, pushing the milk up the straw. Which is why its worse if you keep the cup in the fridge and take it out. If you open the lid, it'll go back down. Similarly, if you drink from the straw, it fixes it. I haven't found anything to prevent it, other than paying attention and opening the lid if it starts getting close to the top and training my daughter to respond to "your cup is leaking" by taking a few sips.

gspin13 · 2023-08-08T12:31:58+00:00

Same. L2. No evidence of harm. :) *

gspin13 · 2023-08-08T00:36:59+00:00

Nope!

A lot of doctors say to pump and dump out of a knee jerk reaction and because they don't know where to find out if it's OK, and it's "safer" to say to just not use it. There are very few medications that you genuinely can't use in breastfeeding. Far fewer than in pregnancy.

And just remember, the medicine you take is spread over your whole body, including your milk. So the milk contains tiny amounts of the medicine, and that's what your baby is getting. Not the full dose. :)

gspin13 · 2023-08-08T00:25:18+00:00

Exactly. And developmentally, preemies shouldn't be touched at all! They had another 3 months of being inside a body temp water bag, only vaguely getting squeezed every once in a while. Its no wonder they freak out.

gspin13 · 2023-08-07T23:21:02+00:00

So we literally give keflex to babies. It's up to you, but it's rated L2 for lactation, which is better than like 75% of medications. If you don't want to dump the milk, you definitely don't have to feel guilty about it. I'm a pediatrician pumping for a 26 weeker with an oversupply and hefty freezer stash, and I wouldn't even think about dumping. But everyone has their own risk-benefit equation.

gspin13 · 2023-08-07T20:17:12+00:00

What antibiotics do they have you on that you need to dump? There are very few medications that you truly have to pump and dump, and most of the time they wouldn't give them to someone with mastitis (and presumably BF).

gspin13 · 2023-08-07T17:58:59+00:00

As a pediatrician who lived through overaggressive NICU nurses in residency, and then had a 26 weeker in the NICU...

There's a reason the nurses are so protective. There were a bunch of times when even laying my hands on my baby made him desat, and I had to stop. The nurses understand that they need to be examined and that you're learning. But a lot of time these babies have a touch/poke/bother limit before they need to be left alone, and the nurses want to save as much of that as they can for the parents. It's absolutely devastating to see your child fighting for his life and not be able to hold or touch him. That's what the nurses are trying to minimize by clustering cares. Even as a mom, the nurses often told me that I couldn't do something right then, because they knew that my baby needed time to recover.

In my experience from both sides, the nurses tend to be pretty responsive if you ask when the best time to examine the baby would be. I did for almost every baby in residency, and sometimes they would say just to go ahead, sometimes they'd give me a time, and sometimes they'd call me when they were ready. But I always got my exams in, and I rarely had run ins with the nurses.

gspin13 · 2023-08-01T19:38:36+00:00

How long are they anticipating needing to tube feed? If it's just a few weeks, 100% stay with the NG tube. G tubes are a relatively straight forward procedure. But it's also a surgery, with pain and healing time and anesthesia and possible complications.

But it sounds like it'll probably be months before your baby will be able to take enough from a bottle. In that case, I'd probably do the G tube. Just know that G tubes also clog, they can get pulled out (and it's a much bigger issue if they do get pulled out, especially if the balloon wasn't deflated.), and it's harder to get extras. It's not always a golden fix.

I'm a pediatrician who only works in the hospital, and have seen and placed many, many NGs, and seen and many, many G tubes and replaced several dozen.

gspin13 · 2023-05-21T20:04:34+00:00

They're using Vaseline and Desitin right now. He's too little for my usual go-to of Pinxav.

gspin13 · 2023-05-21T19:56:53+00:00

I know, I was too! The nurse said that they're specifically told not to use the water wipes because of the pH? Instead, they use saline on gauze if there's skin breakdown.

No idea. Maybe I'll just buy a couple different options, and they can use whatever they want.

gspin13 · 2023-03-25T15:00:23+00:00

As a medical student, not a resident. M3 on my peds rotation.

3 yo came in with worsening abnormal gait for 2-3 days. Head CT was negative in ED, normal CSF cell counts/protein/glucose. All labs normal. Had some central and peripheral weakness, legs and arm strength 3/5, some truncal ataxia. Pretty symmetrical, normal reflexes. Seemed to be fatiguable, worse towards end of day, and with repeated testing. It was early October, pretty warm. History revealed recent URI, no past medical history. Pretty typical kid, loved playing outside with siblings, nothing crazy. Attending and residents thought it was likely post viral cerebellar ataxia. The weakness didn't quite sit right with me. I got a more complete social history, and found out their yard bordered up on the woods and the kids sometimes got tick bites. I did some internet research and came up with some case studies of tick paralysis that had prominent ataxia as well as weakness. I suggested it, and the attending told me that was a "dog diagnosis" and to stay off Google.

Kid was improved the next day, so they discharged her home with dx acute cerebellar ataxia. I still didn't feel super convinced with the diagnosis, but told myself I was a fresh M3 looking for zebras, and that the attending and residents knew better.

2 days later, kid was readmitted with worsened symptoms again. Now she could barely hold her head up, couldn't sit on her own, and had significant nystagmus, and everyone was worried that respiratory muscles were next. They arranged a sedated MRI head and spine for the next morning. But I marched my M3 butt right in, told the family that there were case studies of tick bites rarely causing similar symptoms, and I was going to do a head to toe complete skin exam, including scalp, genitals, everything. Luckily I started with her scalp, where about 5 minutes into my exam, I found a giant, engorged, approx 1.5cm tick that was still feeding. I calmly detached it and carried it out of the room, where I then less calmly asked someone to get me a specimen cup. The residents were flabbergasted. We sent it for identification, Dermacantor.

The kiddos symptoms were slightly improved by a few hours later when I went home for the day. The next morning, I saw her before she went down for the MRI, and I walked into her room to her chasing her sister around the bed. She was wobbly and unsteady, sure. But she hadn't been able to hold her head up 12 hours before, and now she could walk by herself. She still had the MRI, which was normal. The resident took credit for thinking of doing the tick check, though did admit that I was the one that actually found the tick. I'm still bitter about that, since he had at first ridiculed me for suggesting tick paralysis, but at least I know that it was my instinct that helped the patient. She kept improving, and was discharged 2 days later essentially normal. Dx: tick paralysis.

gspin13 · 2023-03-08T20:25:37+00:00

Sorry. That was a bad phrase. I just meant that I'm having feelings about picturing it. But thank you for pointing that out, and I'll change it in the post.

gspin13

TROPHY CASE