Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-06-30 Encounter: Spruce text message followed by in-person office visit (2026-07-06), with subsequent imaging ordered CC: Escalating projectile vomiting after feeds, occurring after both breast and bottle feeds, with concern for pathological cause. HPI: Macklin (approximately 12 weeks old) had ongoing and worsening spitting up, with the parent reporting projectile vomiting 5–10 times between every feed over several days, with acute worsening over the prior 5 days including a particularly severe day on July 4th during cabin travel. Vomiting was previously more associated with breastfeeding but had progressed to occurring after bottle feeds as well. Parent described volumes approximated at ~1 oz per episode with approximately 10 episodes since 4pm on July 5th. Stool changes were noted — green, smellier than usual, but no blood or mucus. Infant was described as a "happy spitter" with maintained energy overall but increased fussiness near feed times. Parents were well. Weight on home scale was 12.5 lbs, possibly slightly down from prior week. Overnight feeds (breastfeeding at 3am) were tolerated without vomiting. Imaging was ordered and performed on 2026-07-08 with results returned 2026-07-09. Assessment: Dr. Hobbs was concerned about the acute escalation in vomiting frequency and volume and wanted to rule out a structural or pathological cause. He assessed that the vomiting volumes, while notable, did not represent complete feed loss. Improvement was noted when feeds were reduced to single 4 oz bottles every 3 hours, raising the possibility of volume-related overfeeding as a contributing factor. Imaging results returned as normal. Plan: In-person office visit on 2026-07-06. Imaging orders sent (radiology study performed 2026-07-08 at Children's). Results returned 2026-07-09 and reported as "all looking good and normal." Feeding adjustment trialed: single 4 oz feeds every 3 hours with significant improvement in vomiting. Parent advised to experiment with small supplemental volumes (0.5–1 oz) if infant showed hunger cues. Tongue tie consult also being pursued (scheduled with Dr. Lervick). Key clinical quotes: "This sounds like a pretty dramatic change in a short period. Are you noticing anything else? Change in stool? Rash? How's is overall energy level and disposition?" "I may want to see him tomorrow if this isn't settling down" "I'm so curious what sparked the sudden change" "I'd think of it more as over eating, you described him showing you hunger cues and you fed him." Source: Spruce conversation t_2NMHFV8FSP800