Letter from the health clinic

Just after B's first birthday I get a letter following up the appointment at the health clinic. They list the "problems" as concerns regarding motor delay, faltering growth and puffy feet.

The specialist registrar reports that B is hungry and ratty but settles after a breastfeed. He seemed active in the clinic but he's not that active at home. She says he appeared pale but his conjectiva were pink. He had a small anterior fontanelle but was well perfused centrally. She noted B had purple swollen feet that were cold to touch. I told her they are always like this and it doesn't matter how many pairs of socks that you put on him, he continues to have cold puffy feet. He has some excema on his feet and I told her that he has previously been treated for a fungal infection of his feet. His peripheral pulses were normal and his femorals were of good character and volume.

His heart sounds were normal and chest was clear. His abdomen was soft and non tender with no organomegly. His neurological system as grossly intact with normal power tone and reflexes. There is no evidence of wasting. His buttock muscles looked normal and there seem to be normal hip creases. Still pointing out his weight growth and without having anything to compare it too (I didn't have him weighed at all since birth) she can't assess whether or not this is genetically where he is meant to be. She has no explanation for his cold purple puffy feet at present.

She mentions again that she is confused regarding his cold puffy feet and has included autoimmune profile in the blood works. She is referring B to the Physiotherapists so they can see  him regarding his gross motor delay. I  don't want to see a dietician and she agrees that this is acceptable given his dietary history appears appropriate for his age. I promise to use follow on milk instead of cow's milk from now on at home.