Piper has been diagnosed with a heart murmur. It was at her 2 year check up (which actually occurred when she was about 2 years, 3 months old). I was supposed to get it followed up after Chloe was born, just bring her along to an appointment. Well, I didn't. I took advantage of the opportunities to go with just Chloe alone.

As a nurse, I've listened to my own kids hearts, and since the initial diagnoses of Piper's murmur, I've noted that it's not only gotten louder, it's arrhythmic... and I"ve noted over the last 9 months or so that she squats when she's "tired". I know what this can be indicative of, and I found the following to make me all the more concerned:

Tetralogy of Fallot constitutes 4%-9% of congenital heart disease and is the most common cyanotic congenital heart disease when considering all age groups together. Tetralogy of Fallot and pulmonary atresia with ventricular septal defect consist of: a) ventricular septal defect, b) pulmonary stenosis, c) overriding of the aorta, and d) right ventricular hypertrophy. Approximately 25% have a right-sided aortic arch, and about 4% have a coronary artery anomaly. The degree of cyanosis depends on the degree of pulmonic outflow obstruction. This is quite variable, from a slight obstruction, to severe obstruction with pulmonary atresia. Pulmonary atresia constitutes about 18% of the children with tetralogy of Fallot (3). The major right ventricular outflow obstruction in tetralogy of Fallot is infundibular stenosis. With mild stenosis, there may be congestive heart failure in infancy, also known as "pink tetralogy of Fallot." As infundibular stenosis increases, progressive cyanosis develops (due to less pulmonary blood flow), and infants and children may develop cyanotic or hypoxic spells, which consist of sudden onset of increased cyanosis, excessive crying, hypoxemia, acidosis, dyspnea, fainting, rarely seizures, and occasionally death if untreated. During these episodes (called "Tet" spells), there is increased right-to-left shunting (with less pulmonary flow), and decreased systemic vascular resistance. Older infants and children may assume a squatting position during playtime or long walks which increases systemic vascular resistance and decreases right to left shunting, increasing their oxygenation.

From: http://www.hawaii.edu/medicine/pediatrics/pedtext/s07c03.html

Needless to say I'm anxious for the check up that Piper has next week with the pediatrician.

One of a mom's worst nightmares, realizing they may have overdosed their child.

Tylenol can be an absolute blessing - for the teething, or feverish baby. Motrin isn't recommended for a baby my daughter's age, so when she's ill, Tylenol - or it's generic, acetaminophen - is really the only choice.

So when Chloe developed a temperature of 100.8, I ran downstairs to check the internet for her dose, and this is what I find:

11-16 lbs, 80mg 1 dropper (0.8ml) ½ tsp (2.5ml)
17-21 lbs, 120mg 1 ½ dropper (1.2ml) ¾ tsp (3.75ml)

That's one dropper of the infant concentrated formula, or 1/2 tsp of the children's liquid - versus 1 1/2 dropper of the infant concentrated formula, or 3/4 tsp of the children's liquid.

The most common error in giving this medication is not checking your formula and giving the liquid dose of the infant formula - which is a HUGE overdose (as you can see in the ml's). In my case, I just misread the line info, and gave Chloe (weight unknown, estimating 14-15 pounds, but she could be more) the dose for the 17-21 pounder.

I realized it when I thought more about it, AFTER dosing her... not the most brilliant time to turn on my brain. I ran downstairs, double checked it, and sure enough, half again as much as she probably should have received.

I called the poison control hotline for California (1-800-222-1222), which I highly recommend all parents have on speed dial just in case, and they reassured me that such a small amount, one time shouldn't be a problem, especially with her weight unknown, and my estimate being on the conservative side.

Overdose of acetaminophen can be toxic to the liver, and shouldn't be taken lightly. This is one time I'm actually breathing a sigh of relief at her being less than sleepy in the middle of the night - in fact she's playing happily in her exersaucer and is super giggly and smiley. I'm happy to watch her over the next hour or so - or however long it takes to make me a little more comfy that she isn't exhibiting any signs or symptoms of toxicity (despite the reassurance that she should not - should is the keyword there).