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Premature child has asthma, lazy eye and developmental delay. Cancer, epilepsy or autoimmune disorder?

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General & Family Physician
Practicing since : 2009
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This question concerns a child who attends the preschool where I work. He's not presently in my classroom, however, I've worked with him quite a bit in the past. I have a lot of history with this child. I've been through a lot with him, and I've come to love him like my own.
This child had a rough start in life. He was born extremely premature, at just 24 weeks gestation. As a result of this, he's quite small for his age, and he has a lazy eye. Additionally, he has asthma, and he takes albuterol to control the symptoms. He has some delays in his development, but with the help of various therapies, he has been making good progress.
For a long time, he seemed very healthy, in spite of all these strikes against him. During the last school year, he never showed any signs of his asthma in the classroom. He was always very active, to the point of being hyperactive. He never seemed to get sick, and he was famous for never missing a day of school. He seemed to be very lucky, having escaped the worst of his extreme prematurity.
This year has been different. This past fall, his asthma symptoms flared up, and he had an on again/ off again asthmatic cough for a few months. He actually missed a few school days here and there because his asthma was acting up. something that had never been an issue before. Then, as we moved into winter, the cough went away, and he seemed to be doing fine.
Then, in the middle of January, a new set of problems cropped up. It started innocently enough. On a Monday morning in the middle of January, he came off the school bus looking droopy and miserable, complaining, "I'm sick XXXXXXX He was told that if he continued feeling sick, his mother would be called. This did not end up being necessary, as he perked up shortly after this, and when I came by his class to check on him later, he was happily playing with his friends, seeming perfectly fine. We wrote off the morning's episode as a fluke, a false alarm, signifying nothing. The next day, Tuesday, he came to school, and seemed fine. Then, on Wednesday, he did not come to school, and he was absent on Thursday as well. He came back Friday. I asked where he's been, if he'd been sick. He told me, "Yes XXXXXXX and I could see in his face that he had been sick. Later, I stopped by to check on him. He was eating snack and laughing with his friends. I did notice that he sounded congested when he spoke to me. After this, we had a three day weekend for XXXXXXX XXXXXXX King Day, so there was no school on Monday. On Tuesday, he was in school, a bit sniffly and still congested, but alert and participating in classroom activities. Wednesday, again, he was in school. alert and participating in classroom activities.
On Thursday, the staff person taking the children off the bus immediately informed us that this child was not feeling well, that he said he felt like throwing up. The child trudge/ staggered off the bus with tears on his face. The school principal took one look at him, instructed me to bring him right inside. His mother needed to be called, he needed to go home. As I walked him to the classroom, I asked him questions, which he barely answered. This is a child who's normally quite loud, and his voive was coming out so faint and whimpery, I could just barely hear him. About 20 minutes latey, the assistant in that classroom came looking for lysol spray because the boy had just had a bout of diarrhea.
His mother had presumably already taken off for work by this time, so it was a couple of hours before she was able to arrive at the school to pick him up. By that time, he still didn't feel well, but he'd perked up enough to participate in some more low-key classroom activities, such as painting a picture at the easel. When his mother arrived he headed straight for her with an exclamation of, "Mommy!" His mother was bringing him directly to the doctor from school, because she was obviously concerned. The next day, Friday, he did not come to school.
On Monday, he returned to school, still looking a bit pale, but he said he was feeling better in response to inquiries. He was alter and participating in classroom activities. On Tuesday and Wednesday, he was in school, and seemed fine, his regular active self. Thursday, he was absent again. I asked around, and discovered he was out because he had an appointment with the doctor for a follow up due to his illness the previous week. The next day, Friday, was a staff development day, so there were no students and attendance. The following week, he came to school all five days. Early in the week, he seemed a bit congested, and possibly less active than usual, but still alter and participating. Later in tthe week, he seemed completely fine, his regular active self.
Monday of the following week he came in acting like his regular active self, but he had developed a cold sore above his upper lip (not his first, he's had a cold sore last Spring). Tuesday, again, he was his regular active self, but the cold sore had gotten worse and had formed something of a cluster. Wednesday, he did not come to school. He returned to school on Thursday. Mindful that he has some difficulties with expressive language I asked him, "Where were you yesterday? Were you sick?" He paused for a moment to consider my question, then replied, "Yes XXXXXXX After another brief pause, he added, "I go (went) to the doctor XXXXXXX By Friday, his cold sores looked much better, and the main one had scabbed over.
We then had a three day weekend for President's Day, and the students returned to school on Tuesday. He did not come to school that Tuesday. I hoped that maybe his family had just gone away for the long weekend and gotten back late. When he returned to school on Wednesday, I said to him, "I didn't see you yesterday. You took a day off?" His response was, "I sick XXXXXXX Later I stopped by , and he was in the block area playing with blocks, and he engaged with me in conversation. Thursday, he came to school, and he was alter and participating. Then, on Friday, he was absent again. I asked around and discovered he was out because his mother had brought him for a meeting with the district about Kindergarten placement next year (standard procedure for children on IEPs). That brings us to this past week. He attended school Monday through Thursday. It was a busy week, so I couldn't spend as much time visiting and observing him as I would have liked, but in those moments I did get to see him it seemed that he was regressing a bit with his Speech, using shorter sentences, and omitting words he wouldn't have omitted before. I wasn't with him enough to confirm that.
Friday, he was out again. I asked around, and discovered that he was absent due to an appointment with a neurologist. Apparently, there had been a recent incident, and when the mother described it to his doctor, the doctor said that may have been a seizure, and referred them to a neurologist. That brings us to this weekend, and I have no further updates.
Like I said, I love this little boy, definitely more than is healthy, and he's been really worrying me lately. He was so healthy, and I don't understand what's going on, why all these problems are cropping up all of a sudden. What could be wrong? What does it sound like? Cancer? Epilepsy? An autoimmune disorder? What are his chances of survival? Any chance he could return to being that active boy full of life and energy who never misses a day of school? What are his future prospects? These past weeks have been a nightmare for me, and I'm beside myself waiting for answers. Any insight would be appreciated.
Posted Mon, 25 Mar 2013 in Child Health
Answered by Dr. Luchuo Engelbert Bain 59 minutes later
Hi and thanks for the question.
I suggest this child needs a more keen evaluation bu a neurologist , as it already started and a pulmonologist. His past medical history characterized by growth retardation is an important risk factor for epilepsy under certain condition.
The behavioural aspect described, with bouts of getting missing is actually what is called absence seizures. This can be evidenced by a neurologist or neurophysiologist with electroencephalogramme, which shall actually detect electrical activity in his brain. A CT scan of the brain at some time might be important.
This is critical at this age for if he continues having these seizures, and if not controlled, he might develop epilepsy associated encephalopathy and a permanent decrease in his intellectual quotient.
I suggest a pulmonologist and neurological consultation shall put things into perspective, and certainly better the child s quality of life.
I XXXXXXX t think its time yet to think of a cancer at this stage. The child can live a normal life as others if well taken care of, I believe.
Thanks and best regards,
Luchuo, MD.

Above answer was peer-reviewed by
Follow-up: Premature child has asthma, lazy eye and developmental delay. Cancer, epilepsy or autoimmune disorder? 25 hours later
Today, I asked around for more information. It doesn't seem that it was an absence seizure. Apparently,during this episode, he presented with "vomiting and stuff." That was according to his present teacher. She didn't have any information regarding what the neurologist found, as she had not yet checked for information. I also don't know if it was just the one episode, or if there were others. If possible, I will ask more questions tomorrow, as I'd like to get to the bottom of this. Any further insight would be appreciated.
Answered by Dr. Luchuo Engelbert Bain 15 minutes later
Hi and thanks for your question,
I would be very useful to know exactly what the neurologist found. Those results are fundamental in confirming or negating diagnostic possibilities. Depending on the information requested, it would easier to proceed and give for concrete and scientifically valid ideas with respect to the child s health.
I shall very glad coorperating with you so we get to know what s going on with this lovely child as soon as you get hold of these pieces of information. Please, they are really very necessary for us to to proceed.
Impatiently waiting on this information so we can proceed,
Thanks and best regards,
Luchuo, MD.
Above answer was peer-reviewed by
Follow-up: Premature child has asthma, lazy eye and developmental delay. Cancer, epilepsy or autoimmune disorder? 23 hours later
Unfortunately, I was not able to get a hold of much information, other than it seems that the possible seizure presenting with "vomiting and stuff," was a single episode, at least as of this morning, when I spoke to his teacher. The trouble is, he's not presently my student, and he takes a bus to school. For that reason, his mother does not generally come to the school, and communication is done through a notebook. The mother has not written an update, though I believe his present teacher requested one. That could mean she's still waiting on results, she doesn't want to share the results for some reason, nothing was found that she finds worth sharing, or she simply forgot to check his notebook. He has attended school the past two days, and he's been alert and active. I don't know whether that will continue to be the case, or if more information will be forthcoming. I'm impatiently waiting on more information as well.
Answered by Dr. Luchuo Engelbert Bain 30 minutes later
hi and thanks for communicating,
will be glad getting an update on his health condition too.
Thanks and best regards,
Luchuo, MD.
Above answer was peer-reviewed by
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