Alt-E
Last night, about two hours after going to bed, Tess threw up in her crib. She's a stealth puker. My wife heard a quiet cough from her room, went in there, turned on the light, and found her lying in about a quart of chunder.
We're no strangers to this; she has gastroesophageal reflux disease (GERD), which means frequent spit-ups after meals, and sometimes as many as four changes of shirts in a day. (It also means a list of dietary restrictions longer than the U.S. tax code, but that's another story.)
Nor is the stealth part anything new. But the combination of these things--stealth, GERD, and sometimes full-on vomiting--is dangerous for Tess, because she doesn't do the usual things that we do when we throw up. She doesn't have that instinct to face downwards while it is happening. She won't call to us from her bed. Even worse, she lacks the ability to clear her airway afterwards.
We found this out a couple years ago, late one night when we checked on her in her crib. "Turn on the light," my wife said, almost immediately. Tess had thrown up. She was unresponsive, cool to the touch, and her lips were purplish-blue. She wasn't breathing right--she'd take a shallow breath and then not take one for a long time. Something was very wrong. We called 911. While waiting fifteen minutes for the EMTs, we knew her airway was blocked, but there was nothing we could do. It was agonizing.
Even after the EMTs arrived, they wouldn't use the ambulance's suction unit to clear her airway, because she was so young. My wife, who's a gastroenterologist, uses suction all the time at work. "Outta my way," she said, carrying the bluish Tess into the ambulance, and she made her way to the suction unit herself. We woke up my in-laws, who came and stayed with our son. We spent the night in the hospital with T. Doctors confirmed that some food had lodged in her airway, and her oxygen levels had gotten dangerously low. They called the incident an ALTE, which stands for Apparent Life Threatening Event. I felt that the A was unnecessary, because the word "apparent" implies that her life wasn't actually threatened. But it was. If we hadn't checked on her, we would never have known she wasn't breathing. She hadn't made a sound.
We feared that it might happen again. I wanted to get an oxygen monitor to clip on her toe, but her doctor said it wouldn't help; she'd wind up pulling it off every few seconds, causing a million false alarms, and we would learn to disregard it in the first few hours if not days. So we got a suction unit to use at home. It's the size and weight of a camera bag. A nurse aide brought it over and trained me on how to use it. It is essentially a vacuum tube with a long, pointy snoot that you can insert into her airway to suck up food and liquid. Months passed. Tess slept great and had no more ALTEs. We relaxed slightly.
This thing sucks. In a good way.
Then, last summer, we went to Acadia National Park for an overnight. Because we are fools, we forgot the suction unit. We were staying in a rented condo with the family of our good friend Julie, who had done her medical training with my wife. All of us slept in one room. As we were going to bed, we checked on Tess, and found her just like that first time: unresponsive and not breathing. This time, we couldn't get her to take even a single breath. We whipped her out of her pack-and-play and into the hallway, calling out to Julie. For several minutes, Julie and my wife did everything they could to snap Tess out of it, alternating between slapping Tess on her back and trying to sweep her airway. We were many miles from any hospital, so calling 911 would not have done much. No matter what the two doctors did, Tess just wouldn't come around.
And then, miraculously, she did. But here's the thing: nothing came out of her mouth. Her airway wasn't blocked by any food. She just started to breathe normally again.
Was the Acadia episode a seizure? Apnea? We have been trying to solve this mystery since then. She has had a battery of tests, including a sleep study and EEG, all of which have come back normal. We suspect GERD was part of it, but if so, why didn't she spit up any food? Worst of all, if we don't know why it happened, how can we prevent it from happening again?
For now, all we can do is watch and listen. Keep checking, checking, checking. We have a Dropcam mounted above her crib. If she's sleeping on her back, we always flip her onto her side to prevent choking. We keep the pack-and-play in our room for her, and frequently put her in it. But we needed her closer after she got sick last night, so she slept in our bed. (True to all kids who do this, she made herself horizontal almost instantly, and remained the nightlong crosspiece of the letter H between my wife and me.) The suction unit was primed and ready, only a few steps away. And basically we slept with one eye open.
We're no strangers to this; she has gastroesophageal reflux disease (GERD), which means frequent spit-ups after meals, and sometimes as many as four changes of shirts in a day. (It also means a list of dietary restrictions longer than the U.S. tax code, but that's another story.)
Nor is the stealth part anything new. But the combination of these things--stealth, GERD, and sometimes full-on vomiting--is dangerous for Tess, because she doesn't do the usual things that we do when we throw up. She doesn't have that instinct to face downwards while it is happening. She won't call to us from her bed. Even worse, she lacks the ability to clear her airway afterwards.
We found this out a couple years ago, late one night when we checked on her in her crib. "Turn on the light," my wife said, almost immediately. Tess had thrown up. She was unresponsive, cool to the touch, and her lips were purplish-blue. She wasn't breathing right--she'd take a shallow breath and then not take one for a long time. Something was very wrong. We called 911. While waiting fifteen minutes for the EMTs, we knew her airway was blocked, but there was nothing we could do. It was agonizing.
Even after the EMTs arrived, they wouldn't use the ambulance's suction unit to clear her airway, because she was so young. My wife, who's a gastroenterologist, uses suction all the time at work. "Outta my way," she said, carrying the bluish Tess into the ambulance, and she made her way to the suction unit herself. We woke up my in-laws, who came and stayed with our son. We spent the night in the hospital with T. Doctors confirmed that some food had lodged in her airway, and her oxygen levels had gotten dangerously low. They called the incident an ALTE, which stands for Apparent Life Threatening Event. I felt that the A was unnecessary, because the word "apparent" implies that her life wasn't actually threatened. But it was. If we hadn't checked on her, we would never have known she wasn't breathing. She hadn't made a sound.
We feared that it might happen again. I wanted to get an oxygen monitor to clip on her toe, but her doctor said it wouldn't help; she'd wind up pulling it off every few seconds, causing a million false alarms, and we would learn to disregard it in the first few hours if not days. So we got a suction unit to use at home. It's the size and weight of a camera bag. A nurse aide brought it over and trained me on how to use it. It is essentially a vacuum tube with a long, pointy snoot that you can insert into her airway to suck up food and liquid. Months passed. Tess slept great and had no more ALTEs. We relaxed slightly.
This thing sucks. In a good way.Then, last summer, we went to Acadia National Park for an overnight. Because we are fools, we forgot the suction unit. We were staying in a rented condo with the family of our good friend Julie, who had done her medical training with my wife. All of us slept in one room. As we were going to bed, we checked on Tess, and found her just like that first time: unresponsive and not breathing. This time, we couldn't get her to take even a single breath. We whipped her out of her pack-and-play and into the hallway, calling out to Julie. For several minutes, Julie and my wife did everything they could to snap Tess out of it, alternating between slapping Tess on her back and trying to sweep her airway. We were many miles from any hospital, so calling 911 would not have done much. No matter what the two doctors did, Tess just wouldn't come around.
And then, miraculously, she did. But here's the thing: nothing came out of her mouth. Her airway wasn't blocked by any food. She just started to breathe normally again.
Was the Acadia episode a seizure? Apnea? We have been trying to solve this mystery since then. She has had a battery of tests, including a sleep study and EEG, all of which have come back normal. We suspect GERD was part of it, but if so, why didn't she spit up any food? Worst of all, if we don't know why it happened, how can we prevent it from happening again?
For now, all we can do is watch and listen. Keep checking, checking, checking. We have a Dropcam mounted above her crib. If she's sleeping on her back, we always flip her onto her side to prevent choking. We keep the pack-and-play in our room for her, and frequently put her in it. But we needed her closer after she got sick last night, so she slept in our bed. (True to all kids who do this, she made herself horizontal almost instantly, and remained the nightlong crosspiece of the letter H between my wife and me.) The suction unit was primed and ready, only a few steps away. And basically we slept with one eye open.
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