human
Im not going to lie -- between these heart rate numbers, her complaining about "heart pain" when she was younger, and otherwise being healthy and on-target (if slightly smaller than average) for height/weight/BMI...Im concerned. But I'm not a medical doctor. So here are my questions to those of you that are:Should I be concerned? If so, how concerned should I be?If this is concerning, what steps need to be taken? Do we need to take her back to her primary doctor and get a referral to a pediatric cardiologist? Should we insist that she be allowed to (as needed) walk during runs in cheerleading practice / school?Aditional Info and DetailsMy little sister does pee-wee cheerleading, and they start every practice by running 2 laps around a football field, which is ~1/2 mile (i.e., ~0.8 km). She is not quite "sprinting", but is running the whole time at (Id guess) 80-90% of her maximum running speed (with no walking breaks). When she ran it earlier tonight, at the end of the 2nd lap her Fitbit watch said her heart rate was 213 beats per minute. Her heart felt like it was literally beating of her chest, and she said that she felt like she was about ready to pass out.From what I could find online, 213 BPM for a 10-11 year old girl could be dangerously close to her maximum heart rate, though (especially at that age) maximum heart rate is somewhat variable.Ive also measured her resting heart rate a few times (e.g., after sitting down watching tv for 30+ minutes) and it has been in the 100-110 BPM range, which from what I could find online is not unheard of, but is pushing the upper limit of "normal". These measurements were in the evening (close to bedtime, before taking the 50 mg trazodone). I ran the numbers and, at this point, all the vyvanse from her morning dose has been converted into dextroamphetamine, which (on average) has gone through ~1 half-life (~50% has been metabolized, assuming a 1:1 metabolic conversion for Vyvanse --> dextroamphetamine).Note: to check the Fitbit's accuracy, one of these times I also measured her heart rate manually using my (surprisingly effective) homemade double-walled stethoscope. Over a 30-second interval, the fitbit pegged her at between 99-102 BPM, and I counted 50 heartbeats (meaning 100 BPM), so the measurements it takes seem accurate.She isnt the most "active" person -- left to her own she would sit and watch TV and play on a tablet all day -- but between cheer (3x 2-hours practices + 1 game every week), dance (2x 1-hour classes every week) and school (PE, recess) she gets at least an hour or 2 most days whether she likes it or not. And she certainly isn't overweight -- this growth chart suggests she is in the ~30th percentile for weight and ~25th percentile for height. This BMI calculator for girls puts her BMI at the 53.6 percentile (z=+0.09).
gpt
Agree with /u/muchtwojaded. Normal resting heart rate for her age/size, and the >200 HR with exercise isn't concerning to me. Sounds like she gets a good amount of healthy exercise, more than many kids her age.Nothing here sounds dangerous. If she's not complaining of symptoms with exercise, I wouldn't do any kind of workup.
Could her delayed growth be a byproduct of the IUGR? Or is it more likely shes just not taking in enough calories per feed? Additionally, are there any questions that youd recommend I ask the pediatric GI doc? Thanks so much!
Both. IUGR babies are prone to have poor growth. Most continue to have slow growth in the months after birth, often leading to GI interventions such as increasing nutrient density of formula. This is to make up for the nutrient deficit present that an average infant's daily intake typically cannot surpass on its own.While the vast majority (80%) of IUGR and/or SGA (small for gestational age) do catch-up to reach sizes comparable to other children, this typically takes about two years. Many factors affect growth and stature, including any medical problems that led to her being small. For instance, this nutrient deficit and propensity to growth failure tend to be worse in infants who were also preterm (at 37+1 weeks, your daughter was born just two days further along than what we would consider "late preterm").The main things you can control and monitor at this point are her nutritional intake and feeding habits. For now, the baby's goal is to be improving in her percentiles, not worsening. I recommend working with the GI team on this goal. They will likely have you see a pediatric dietitian as well to help figure out how many calories she should be getting.Don't despair - this is more common than you would think. It doesn't mean you're doing anything wrong. You are working very hard and doing everything you can right now. Getting more hands on deck by bringing in a specialist's perspective only means more people in your daughter's corner trying to get her growing better.Most babies born with IUGR do catch up their growth by this age, so I agree with your pediatrician's concern. Increasing the concentration ("fortifying") her formula is a great first step, but it's worth seeing the pediatric GI to make sure there isn't something else going on. I'd suggest keeping track of about how much she eats in a 24-hour period as well, so the doctor can assess whether she's getting enough calories.