Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-06-09 Encounter: Spruce text message followed by in-person office visit (2-month well visit) CC: Parent concerned about possible tongue tie and ongoing feeding difficulties with spitting up and fussiness. HPI: Parent raised concern that Macklin may be tongue-tied, noting that some of his symptoms align with tongue tie presentation. This was initially flagged via message on 6/9, with a planned in-person 2-month well visit scheduled for 6/12. After the visit (6/12), parent reported Macklin was overall happier on a new feeding schedule but continued to have episodes of fussiness and significant spitting up after some feeds. He was taking full 2 oz at every feed. Parent was considering switching from Nara Organics to Kendamil formula. Assessment: Dr. Hobbs agreed to assess for tongue tie at the in-person visit, noting referral to dentist or ENT if intervention is warranted. Post-visit, Dr. Hobbs advised against frequent formula switching and recommended continuing at 2 oz per feed for at least another day before considering volume increase, with ongoing monitoring of the spitting up pattern. Plan: Tongue tie assessed at in-person 2-month well visit on 6/11 or 6/12. Post-visit: parent advised to continue current 2 oz feeding volume, avoid switching formulas too quickly, and monitor/document feeding pattern (happy vs. fussy/spitting up feeds) through the weekend with follow-up as needed. Key clinical quotes: "Happy to assess. I refer to dentist of ENT if I think it needs to be dealt with" "I'd not switch too often or too fast." "I'd stick to the two oz for another day before thinking about increasing it" Source: Spruce conversation t_2NMHFV8FSP800