Multidisciplinary Evaluation

此次的評估主要是為了語言成長的部份,因為要有完整的個人資料記錄,所以第一次的評估都會包括所有成長的部份.當時是在一個房間裏,裏面有玩具的設施,溜滑梯,樓梯,小房子,玩偶,.......

有2位人員做評估,Occupational Therapist & Speech Therapist(只負責Speech and Language Skills的部份).

以下是她們的報告記錄:
Using My Hands and Moving My Body (Motor Skills)
JD’s motor skills were assessed with the Bayley Scales of Infant and Toddler Development III Screening Test.
JD’s fine motor skills were assessed in the competent range. He is able to stack two blocks and scribble at home. He also demonstrated the ability to pick up tiny objects with his fingertips and point his index finger.
JD’s gross motor skills were assessed as being very well developed at the high end of the competent range. He is stable on his feet for walking and stooping to pick up a toy from the floor. He is also beginning to walk on stairs.
Things I find difficult or need help with:
There are no concerns in this area at this time

Understanding and Communicating (Speech and Language Skills)
JD follows 1 step directions well.
He responds to his name.
He enjoys fingerplays and songs by attempting to.
Understands prepositions of in and on.
He identifies three body parts (nose, ears, and belly button).
He uses an object in more than one way.
Identifies a variety of objects during play.
Things I find difficult or need help with:
There are no concerns in this area at this time

Playing, Thinking, and Exploring (Cognitive Skills)
JD’s play skills were assessed with the Westby Symbolic Play Scale. He demonstrated age appropriate play skills.
· JD is able to put five different shapes into his shape sorter at home.
· He is beginning to scribble and can stack a couple of blocks.
· JD has a play phone that he puts to his ear and pushes buttons. He pretends to take drinks and fed a baby doll in imitation of the examiner.

JD’s cognitive were assessed with the Bayley Scales of Infant and Toddler Development III Screening Test. He demonstrated competent skills.
· JD was able to put a couple of pegs into a pegboard. He could figure out how to obtain a desired object from under a clear box with one open side.
· He was also able to take objects out of and put them back into a container.
Things I find difficult or need help with:
There are no concerns in this area at this time

Relating to Others (Social/Emotional Skills)
· JD is around other children at church and with the children of friends. He usually tries to touch them or he might push them while playing(應該說,他和其他小孩同時都很想玩同一個玩具時,就有可能會去推別人一下下).
· He is a shy boy who needs a little time to warm up to a new situation before getting comfortable.
Things I find difficult or need help with:
There are no concerns in this area at this time

Eating, Dressing, Toileting (Self-Help Skills)
· JD enjoys bath time.
· He sleeps well
· JD can take off his socks.
· He puts his diaper in the trash at home. JD can eat a variety of foods.
Things I find difficult or need help with:
JD has trouble gaining weight. Sometimes he goes in for weight checks.

(藍色的字是從當時詢問媽媽或是媽媽填寫的資料中得知的).


照理說在做Multidisciplinary Evaluation之前,是要先做聽音測試的,因為有人取消appointment,所以JD提前做評估(聽音測試的appointment是在8月初), 但也因為JD不符合需要Speech Therapy的條件,所以就不用做聽音測試了.

此次是以17個月的月齡評估的(JD是在第34/35週出生),語言遲緩大約5個月,但還不需要speech therapy,在家裏多加強多做一些功課就可以了. Speech Therapist 說媽媽還是繼續保持用中文,爸爸用英文和JD溝通.

*Speech Therapist 建議跟JD講話時要縮短字的表達,比如JD還想要多吃什麼,就清楚慢慢地跟他說"more",如果他有任何嘗試表達要說的時候,要讚美鼓勵他,即使發音不是很清楚,正確.
教他說東西的"名稱"時,要將東西拿在嘴邊,讓他同時看到東西及你說話的嘴型.

*可使用簡單的baby sign language(Remember! Sign language is a temporary tool. The goal is to teach your child that communication works. That magic word got him/her the cracker, even if his/her fingers were doing the talking. As children get comfortable with using a sign, they eventually add a sound to the sign, add a word to the sign, and then stop using the sign when it is no longer needed.)
http://www.advantagespeech.com/resources/hpsc45.pdf

*Should be starting some two-word sentences at age 2. If not, bring him back for another evaluation.

*要用吸管(杯)不要用bottle & sippy cup.(S.T.有特別說明,因為用bottle & sippy cup 要用舌頭去吸喝,舌頭就會常常頂向嘴唇上下牙床之間,這樣會影響到語言學習的發音,以後也很容易會走上需要牙齒矯正之路).

*另外Occupational Therapist建議在白天玩的時間,給JD幾個玩偶讓他有模仿與他人溝通,講話的機會.(JD只有睡覺時有機會抱他的動物填充玩偶)

這是從手機轉錄的

第一次說媽媽說得最清楚


說dada

18個月健檢

體重:20lb. 9 oz.(9.327kg) 2%

身高:2' 8"(81.3cm) 42%

頭圍"18.5"(47cm) 28%

成長指數曲線有提高,所以醫生並沒有特別交代要在飲食上做調整,只詢問JD一天大概喝多少牛奶(平均16 oz. 左右).

在 Ages & Stages Questionnaires(18 months)裏的Communication的6個問題中,JD只有pass 2題,其中有3題的問題是:

• Does your child say eight or more words in addition to "Mama" and "Dada"? (可湊到6,7個字)

• Does your child imitate a two-word sentence? For example, when you say a two-word phrase, such as "Mama eat", "Daddy play", "Go home", or"What's this?" does your child say both words back to you?(Check "yes" even if his/her words are difficult to understand. (Not yet)

• Does your child say two or three words that represent different ideas together, such as "See dog", "Mommy come home", or "Kitty gone"? (Don't count word combinations that express one idea, such as "Bye-bye", "All gone", "All right"and "What's that?" (Not yet)

跟醫生提到有點擔心JD說話上的遲緩,她建議可以去做語言成長上的評估,如果真需要Speech Therapy到時我們也不用付費(保險公司和州或聯合政府將會負擔所有的費用),所以醫生就幫JD送出介紹函(要有介紹函才會被通知去特定的地方做語言成長的評估).

Passs Autism(M-CHAT) screening(http://www.firstsigns.org/downloads/Downloads_archive/m-chat.PDF)

最後打了預防針(DIPHTHERID, THTANUS & PERTUSSIS),結束了今天的健檢.

在後院玩的JD

後院的草莓

餵東西給新認識的哥哥吃

重脂不重量(補照片)

今天和營養師見面談JD的飲食方案.

首先營養師詢問我JD飲食時間及都吃些什麼,當時JD飲食的習慣是:

早餐:7點左右

先喝牛奶(2-6 oz.)再吃一些rice cereal,yogurt, 吐司+奶油,cheerios,cheese.

早睡前點心:10點半左右

goldfish,cheerios,yogurt melts,再喝牛奶(3-5 oz.)

午餐:12-1點左右

yogurt+酪梨,cheese,sweet potato+butter,饅頭,麵包,飯,稀飯,麵,魚,雞肉,牛肉,蔬菜,水果,再喝牛奶(3-5 oz.)

午睡前點心:4點左右

牛奶(2-5 oz.)

晚餐:7點左右

飯,稀飯,sweet potato+butter,spaghetti(加肉醬),魚,雞肉,牛肉,蔬菜,水果(有時大人的食物)

睡前點心:8點半-9點

牛奶(4-6 oz.)

牛奶外出時都喝formula泡的,在家時喝whole milk+1匙的formula.正餐會儘量多加奶油或蔬菜油.基本上JD正餐吃的量不定,有時只吃幾口,有時可吃一碗(很小的碗).

JD的飯碗(左),日本泡麵碗(右)

營養師的建議是:

1.在牛奶裏加Carnation Instant Breakfast Drink(其實JD的小兒科醫生已經和我提過,但是我在超市看過它的成份有Artificially flavored,我不大喜歡,所以沒買來加),加了它8 oz.的whole milk可多增加130卡的熱量.(我問說:給了有特別味道的牛奶,以後會不會不喝無味牛奶.營養師:可在早睡及午睡前的點心讓JD先試看看,但不要用他喝奶的奶瓶,用sipping cup,這樣他就不會混淆了)

2.早餐不要先給牛奶喝,因喝了牛奶後容易飽不易馬上消化,其他東西就吃不多,所以先吃其他東西後再給牛奶喝或給果汁(營養師說:給果汁較容易消化,但一天不要超過4 oz.)

3.不用在餵食量上下功夫要在"脂"方面下功夫,多加油脂,可吃炸雞,薯條(我一臉的?@#*?), nuts, 高脂的絞牛肉.....(我問:太多的膽固醇沒關係嗎?營養師:這年紀成長中的小孩不用擔心膽固醇的問題)

4.和大人一起在餐桌前用餐,新的食物需要嘗試給予15-20次(不是在一餐中試15-20次),餵但不開口吃算一次,餵食後吐出算一次,自己拿起食物聞一聞丟在地上算一次....等等,關掉電視專心在用餐上,製造愉快的用餐氣氛,每次餵食時間20-30分鐘,即使只吃一點點也不要再勉強餵.

Remember, the goal is a lifetime of good, enjoyable eating.

我詢問需不需要補充一些維他命及到底一天需要攝取多少熱量?

營養師:(看一看她記錄的筆記)以他目前的飲食並不需要補充維他命,(然後她用計算機計算了一下)現在JD一天大概需要攝取900-1000卡就足夠了.

Nurtition Recommendations for Ages 12-23 Months:

Food Groups-->Recommended Servings per Day-->What Counts as a Serving Size?

Milk & Milk Products-->4-6 servings-->4-6 ounces whole milk and milk products including yogurt or 1-3 ounce cheese.

Meat and other Protein Foods-->2 servings-->1/2-1 ounce meat ,1 ounce meat=1 egg or1/4 cup legumes *Peanut butter not recommended at this age (choking hazard).

Breads, Cereals and Starches(Includes whole grain breads, infant and cooked cereals, rice, pasta, ready to eat cereals)-->6 servings-->1/4-1/2 slice bread, 1/4-1/3 cup rice, pasta or dry cereal.

Fruits and Vegetables(Includes once source of Vitamin C daily[citrus fruits and juices, broccoli] and Vitamin A every other day[dark green and yellow fruits and vegetables such as spinach, broccoli and melons])-->4 servings-->3 ounces juice (limit to one serving), 2-3 tablespoons fruits and/or vegetables.

Fats and Oils-->Do Not Limit.

Miscellaneous(Use sparingly Jams, jellies, soft drinks, candy, sweets)-->Small amount if desired.

(Reference: Texas Children's Hospital Pediatric Nutrition Reference Guide, 7th Edition)

JD的體重檢查

今天去見JD的小兒科醫生談如何幫他增重的方案. 基本上和她上次(12個月checkup)說的差不多. 她就寫了以下三點:
1. 約見營養師(預約到3/31)
2. 增加全脂牛奶量到每天24 oz., 添加 Carnation Instant Breakfast Drink 在牛奶裏
3. 給予高熱量/高脂肪的食物(有calorie boosters 的紙張)
醫生說不要提供水及果汁,就讓他喝牛奶,從牛奶裏就可攝取足夠的水份,又可增加熱量的攝取來源,在正餐之間的零食盡量只給牛奶,牛奶比一般零食有較多的熱量.
今天的體重是19磅5.5盎司(1%),身高30.25吋(23%),頭圍18.25吋.(每次量體重前幫他脫衣服就開始哭,特別是遇到有一位護士ㄚ姨就哭得更厲害,可能他記得這位ㄚ姨幫他打了幾次針)
還好今天的體重比上次(2/25)有增加了1磅多,不然醫生準備要他做驗尿及一些驗血的檢查(好佳在! 不然又要哭得驚天動地了). 原則上下次18個月體檢的體重有增加的話(生長曲線有提高)應該就沒有身體健康上的問題顧慮.

JD的生病記錄-- 第一次Stomach flu & Stye+Pneumonia

第一次到Mall裏的小孩遊樂區(玩得非常高興,有時還會大聲叫!!)

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  2/9: 白天拉了2次肚子,晚餐前把之前吃的點心全部吐出來,睡前又拉,需要洗澡換衣.
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  2/10: 右下眼瞼有點紅腫(早上起來時只有一點紅點)只吐一次(午餐後1點半左右),胃口不是很好.
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  2/11: 早上打電話留言給醫生, 護士回電詢問我一些問題..... 判定下眼瞼可能是針眼,叫我用乾淨溫的毛巾或紗布敷紅腫的部位(一天3-6次,一次約10分鐘),吐及拉肚子的事再觀察看看.因11點有約所以10點多出門,3點半回到家(這中間吐了2次)所以回家後馬上幫他洗澡,洗完澡才發現有電話留言(上午10點40幾分的留言,是另一個護士打來的,說JD的醫生一定要JD今天去看診,叫我盡快和她們聯絡) 本來要在去看醫生前餵他喝奶,但想想他去到診察室一定又會哭,到時又會吐那就麻煩了,果然在脫衣服中就哭得唏哩嘩啦(在這裡小小孩量體重都要脫光光的),體重是:18磅12.5盎司(1%)減輕了. 醫生診斷是Stomach flu還有Stye(針眼).所以等看診完才讓他喝奶,結果之後在家也全部吐出來,照著醫生給的一些指示只給Pedialyte,若不吐了再餵牛奶....
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  2/12:12:00AM Pedialyte (2.5 oz.)
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  4:25AM 開始餵牛奶(臉色有點蒼白虛弱),之後也讓他喝一些Pedialyte 及吃一些東西(cheerios,bagel,其他東西不吃),拉肚子2次.
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  2/13:3:30AM 餵牛奶(4oz.).
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  8:20AM 餵牛奶(5oz.).
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  9:45AM 拉肚子.
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  11:AM 只喝了0.5oz.的Pedialyte就睡著了.
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  1:00PM 吃了yogurt melts(2個),香蕉幾口,一點點麵包,給牛奶但不喝,又拉肚子.
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  2:40PM 再拉肚子.
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  6:30PM 吃了cheerios+yogurt melts 和3.5T的rice cereal.
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  8:20PM 喝了2 oz.的Pediolyte就睡著了.
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  2/14:7:25AM 2.5T的 rice cereal, soy milk(5oz.), 3.5 oz. 的Pediolyte.
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  午餐吃了bagel, cheerios ,喝了4.5 oz.的formula.
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  6:xxPM 拉稀.
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  6:45PM 吃yogurt melts,一點麵包和cheese.
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  8:00PM soy milk (5.5oz.)
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  2/15:早餐吃吐司+奶油, cheese, soy milk(7 oz.).
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  午餐吃cheerios, soy milk(5.5 oz.), [大便軟硬+一點點稀稀地].
  晚餐吃rice cereal,炒蛋, 幾口薯條(爸爸給的), soy milk(5 oz.).
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  2/16:12點清晨醒來喝了1 oz. 的W. milk.
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  7:20AM 半片吐司+奶油, soy milk(6 oz.).
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  午餐bagel,幾口cheerios,葡萄.
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  5:00PM yogurt melts了(10), W. milk(5 oz.).
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  6:10PM 蒸蛋+奶油,飯,葡萄. 7:35PM soy milk(5 oz.) **今天開始有一點咳嗽.
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  2/17:早餐 半碗的Oatmeal+butter+1 T rice cereal, W. milk(3 oz.).
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  9點多拉稀.
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  11:50AM 通心麵+義大利麵醬+蒜頭+洋蔥+奶油, 葡萄.
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  2:00PM W. milk(3 oz.).
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  3:00PM Goldfish(點心).
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  5:35PM yogurt melts(10).
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  7:10PM 通心麵(和午餐一樣)+一些花椰菜,胡蘿蔔,芹菜, 吃完一碗還要吃,就給bagel, cheerios, 然後吃葡萄.
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  8:25PM W. milk (6 oz.) **今天很有胃口.
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  2/18:早餐 Oatmeal+butter+1 T rice cereal, cheerios, W. milk(5.5 oz.), 吃了一些蘋果,結果吐了一些些之前吃的東西(大部份是牛奶).
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  11:45AM 通心麵...(和昨晚一樣), 葡萄[大便硬硬地].
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  2:00PM W milk(5.5 oz.).
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  4:00PM yogurt melts, 一些水.
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  5:08PM 體溫 100.6F. (註)
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  5:35PM W. milk(5.5 oz.).
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  6:25PM 體溫 100.2F.
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  6:30PM 葡萄, cheerios, 一點點水.
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  9:20PM 體溫 101.1F, 泡澡後97.7 F(但量的時候他有點掙扎).
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  9:55PM W. milk(7.5 oz.).
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  10:50PM 體溫100.6F. **今天咳嗽咳得較頻繁
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  2/19:3:20AM體溫98.5 F, W. milk(7 oz.).
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  6:35AM 體溫100.6 F.
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  7:00AM W. milk(2.5 oz.)
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  7:40AM 體溫99.9 F
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  8:40AM 嘗試餵奶不喝, 再餵蘋果汁也不喝.
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  8:50AM 吃了差不多半碗葡萄.[大便硬硬地]
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  9:20AM 體溫99.8 F
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  10:00AM yogurt melts,cheerios
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  1點多Pedialyte (1 oz.) [硬給的]
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  1:35PM 體溫99.3 F
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  2:00PM yogurt melts+yogurt, 一些些通心麵.
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  2:35PM 體溫100.2 F [尿片蠻濕的]
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  4:20PM 體溫100.5 F
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  4:30PM 嘗試給Pedialyte 他不要, W. milk(6 oz.)
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  5:05PM 體溫100.2 F
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  5:xxPM cheerios+一點點Pedialyte.
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  6:45PM 給通心麵他不吃, 吃完葡萄後吐.
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  7:20PM 體溫100.6 F, W. milk(5 oz.)
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  11:50PM W. milk(1.5 oz.), 體溫 99.6 F. **今天開始流鼻水
  
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  2/20: 810:AM 體溫 98.1 F. yogurt melts, cheerios, W. milk(6.5oz.)
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  12:00PM 嘗試餵食(Tender chicken stars), 不吃還哭, 想大便大不出來(換尿片).
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  12:35PM 大便很硬,有一點點血(很用力下push出來的), 吃了半個小蘋果,一片cheese, 幾個goldfish(M.G)
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  1:35PM 又大便(硬硬的很大一坨)
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  3:00PM W. milk(3.5 oz.)
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  晚餐吃1/3條的cheese, 1/4的小蘋果, cheerios, W. milk(6.5 oz.). **咳嗽有痰的聲音
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  2/21~27: 這幾天都只吃yogurt, cheerios, cheese, 水果和牛奶(W. milk會再加半匙的formula).[大便都軟軟的]
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  2/25: 看醫生,照X-光, 體重18磅3.5盎司(0%),診斷是輕微Pneumonia,要吃抗生素(Amoxicillin 每次4.5c.c. 一天2次, 吃10天[到3/6] ). 我詢問關於體重及吃的問題,醫生說:目前他喜歡吃什麼就盡量讓他吃,即使每天每餐吃一樣也沒關係,體重的問題再約他的小兒科醫生詳談,所以預約3/6 和再他的醫生討論如何幫他增重.
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  2/28:今天除了吃yogurt, cheerios, cheese, 水果和牛奶, 又多吃了sweet potato+butter, 差不多恢復平常的胃口了:-)

註:用平常的電子體溫計,當時是量腋下,所以真正的體溫應該高於所顯示的.

後記:以後要記得, 帶JD去公共場所玩,上車回家前一定要先洗手或擦手!!

P.S.
Calorie Boosters:Offer whole(not reduced) fat products such as whole milk, cottage cheese, cheese, creamed soups, pudding and yogurt.
Add 1-2 tablespoons powdered milk to foods whenever you can. Put powdered milk in puddings, hot cereal, pancake mix, gravy, potatoes, and whole milk to increase calories and protein.
Add non-hydrogenated margarine or butter to mashed potatoes, bread, crackers, hot cereal, grains, noodles and soups.

---Kaiser Permanente---

農曆一歲生日

和爸爸,媽媽慶祝農曆一歲生日,還和曾外祖母去探訪曾外祖父&Grandma的Grave.