Fussy Baby

by Robert Lanz, LCSW

The average adult heart rate is about sixty beats per minute.  A little slower or a little faster would fall into the normal range and is not a problem.  An exercising heart can easily double that rate for a long time if the person is healthy.  After all, the heart is mostly muscle and it can perform hard work over an extended period if it is strong enough.

At six to twelve months of age, a baby’s heart rate is normally about 120-140 beats per minute.  Children who are in pain or scared will get to that 140 or higher quickly but they usually settle down when we can stabilize and comfort them.  Usually a parent, at least a nurturing parent, can do a better job of that than we can.  For a social worker, that’s part of an assessment.  Are we able to comfort the baby better than the parent?  If that’s true, then I know there is some sort of problem.  Maybe a big one, maybe a small one.  Our job is to figure that out.

One night, a baby was brought to us by a hysterical mother, a baby with a heart rate of 220 and inconsolable.  Mom wasn’t doing too well either, crying uncontrollably because the baby wouldn’t stop screaming and squirming in her arms.  Mom couldn’t offer any explanation of what had happened and there were no obvious tender spots or signs of trauma.  Mom said she had picked the baby up at her sister-in-law’s house and the kid was acting fussy.  Soon after, he was screaming like he was on fire.  I, of course, was immediately suspicious, despite knowing there were probably a hundred different medical reasons that could cause these symptoms, ranging from a brain tumor to a torsion testicle.  The docs are paid big bucks to figure those things out.  The social worker gets paid lesser bucks to think about everything else.

It is at times like these when there is an advantage to a social worker being in touch with his own darker nature.  This allows him to consider all of the possibilities, even the ones he’d rather not contemplate.  When I was a field instructor I used to tell my grad students, think kink.  Don’t think the best of people, always consider the worst.  That opens you up to consider all of the possibilities, not just the probabilities.  Maybe it’s in my personality to do that.  Maybe it comes from my background working in correctional facilities.  Maybe part of it is from my Emergency Medical Technician training.  Hope for the best.  Plan for the worst.  If you can’t figure out what the worst might be, then you can’t make a good plan for it when it reveals itself, and it will reveal itself in the most horrific ways.

Parents have been known to kill their children.  Parents will dunk their kids into scalding water, beat them with blunt objects, tie them up and put them in the closet and, well, you can see where this is going.  Think kink.  Being an offspring does not afford automatic protection from a bad parent.  Crimes against children are crimes of opportunity, so when a child has been hurt, don’t automatically start chasing strangers down the street because it is a lot more likely that someone who is supposed to love the kid did the damage.

This kid in our ER was really damaged, but the possible causes were so broad we were going to have to test for everything.  Blood tests, urine tests, X Rays and CT scans, etc.  Getting any baby to sit still for all that is difficult.  With a screaming, squirming, flailing tachycardic baby, it was nearly impossible, and it took two of us to hold him down for a simple blood draw.  Blood draws are first because they take an hour to come back, and in that time we can be doing the other stuff.  I had a bad feeling that night.  It was going to be a long hour.

The doc wasn’t suspicious yet, but I was.  He had so many possibilities to consider and I only had one in mind.  If we didn’t find a medical reason for the baby’s distress pretty quickly, I was going to become even more suspicious.  We ordered a urine toxic screen to test for some type of ingestion like methamphetamine which doesn’t show up in the blood.  Meth was what I suspected to be responsible, and a real possibility given the kids excessive heart rate and irritability.  For most docs, methamphetamine intoxication would be fairly far down the differential diagnosis tree.  For me, it was coming closer to top with each passing minute.

Let me interject something here.  I was one of the staff, along with an ER doc and a pediatric social worker, who started the Suspected Child Abuse and Neglect team, and I had been a member of the team for ten years.  I was well-trained and saw far too many bad things happen to kids, so I was jaded.  Still hoping for the best but…  Anyway, our child abuse team was so highly regarded that the county picked our emergency room, one of only two in the area, to evaluate and collect evidence on endangered children who were swept up by the police when they busted a meth lab.

Here’s a quick primer on why a kid in a meth lab is an endangered kid.  Meth is cooked with caustic chemicals including, at times, battery acid.  Harmful if touched, deadly if swallowed.  Cooking meth requires a burner, that means flames and fumes, both dangerous.  Meth cookers are almost always meth users.  They get too stoned to pay attention to the needs of kids and they are often so jacked up that when they do pay attention, it is usually the impulsive and temperamental kind.  And lastly, meth users are prone to twisted sexual fantasies, and the meth gives them the energy to carry them out.  Now you know what I know and you’d be jaded too, if you had come to know it from personal experience.

We got all of the blood tests back: nothing.  X Rays: negative.  CT scan: normal.  The kid was still screaming and spaced out.  Because he was so small and so hyperactive, he had used up all his fluids and needed to have an IV started so we could get him tanked up enough to pee in the plastic bag we had taped over his penis.

Once all of the initial tests came back normal, I began to feel that my suspicions were justified.  We went with diagnosis of elimination.  Everything looked okay except for the patient, and now we were focusing on the probabilities and not just the possibilities.  We had a pretty good idea that when we finally got the urine back, it would be positive for meth.

It was getting busy that night, and I had other patients to see, so I didn’t have the luxury of waiting for the urine tests to come back.  I went in to share my suspicions with mom.

“Here’s the good news.  Everything looks okay, except we think he got a hold of some drugs.  Any chance of that?”

There was a moment of hesitation, and I could see that mom’s mental calculator was considering the range of possibilities of what came next.  Cops, social workers, foster care.  Nothing good.  The direction of the rest of her life could be decided in those few seconds in which she could either tell the truth or lie.

“That fucking bitch. She always leaves ecstasy around the house.  I’m calling her right now.”

Everybody had a cell phone, so it took less than a minute to hook up.  I could only hear mom’s side of the conversation.

“You’re missing a hit of ecstasy and you think my kid may have eaten it?  Why didn’t you tell me?  Now they’re going take my kid away.”

Then she turned to me as if I hadn’t heard.

“Ecstasy.  He took some ecstasy.  He only weighs fifteen pound and he took a whole hit of ecstasy.”

I went to tell the doc.  We still didn’t have the urine test back but it was pretty obvious what had happened.  I called the cops, hoping that by the time they arrived, I’d have the evidence in hand.

Soon, the baby’s father showed up, and he looked like he might be a meth user himself: skeletal, antsy and angry, demanding to see his son.  I have my own policies in situations like this, and Number One is: This Is My House.  In My House, I make the decisions about when my patients can have visitors, especially when there are concerns for the safety of the patients or the staff.  Number Two: If it came down to being physical, I was up for it.  I’ll admit, I was okay with being attacked and with fighting back, if necessary.

When I tried to explain his son’s situation, the man wasn’t hearing it.  Not giving in to my inclination to let this escalate to a physical encounter, I took him into the lounge where his wife was waiting, still in tears.  The confrontation was immediate.

“Your fucking sister let your son take ecstasy,” the wife screamed. “He’s been crying for two hours straight.”

Totally missing that part of the deal, dad demanded to know where the kid was and I explained that he was in a treatment room getting some medication to calm him down.  I explained that the county Children’s Services Worker would be there soon, along with the police and that I needed to get some information about his sister.

“I’m not saying shit,” was his answer.

“I just want her name and address.  I’ve got a lot of paperwork to do.  The police will be here soon and they’ll ask the same questions.”

“Fuck the cops.  I’m not telling them shit either.”

No more Mister Nice Guy.  “Let me explain my position here.  I’m the guy who gets to decide if your son goes home with your wife or goes to foster care.  And right now I’m leaning heavily towards foster care.”

Mom started crying harder.  At least she had the rudiments of her reality testing intact.

“I’m not saying shit and fuck you, too” the dad said.

It was hard not to jump across the table, and I’d be really suspicious of anyone who didn’t have that exact same feeling under the circumstances. Luckily for everyone, my cell phone rang.  It was the charge nurse telling me the cops had arrived.

When I went to meet them, they told me they already knew the dad from previous drug-related busts.  “Real asshole” is the term they used.

“Yeah. That sound like him,” I said.

The drug test came back positive for ecstasy.  The little boy was admitted for observation.  The cops went to arrest the kid’s aunt and told me they would contact the dad’s probation officer.  I knew that I’d probably be going to court to testify about the night’s events.

I saw it clearly. I’m on the stand having taken the oath to tell the truth, the whole truth and nothing but the truth.  The district attorney asks me a couple of simple questions and then gets around to the meat of the case.

“Can you describe the father’s reaction when he found out his son had taken ecstasy?”

“He was an asshole.”

“An asshole, you say?” the DA repeats, turning to face the judge.

“That’s right.  A total asshole.”

But of course, that was just a dream.  Like the dream I had about jumping over the table and punching the asshole’s lights out.

The kid eventually went to foster care.  The aunt went to jail.  The dad went back to jail.  The mom filed for divorce.  When I was contacted by the dad’s probation officer he told me he didn’t think any of this would alter the dad’s behavior.

That’s how assholes are, I guess.  Nothing seems to change them.

Dividing line

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About robertjlanz

Author and health care professional.
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