Our Pediatrician Needs a Crash Course in Statistics and Inference

Chris took Gioia to the doctor today to discuss a little rash on her face. No biggie there, but they took her vitals for her records (as they always do when we come). Turns out she has gained 0.4 kilos since her 15 month visit, which was a month ago. So the doctor says, "She has gained too much weight this month. You need to watch what she eats. No more rice or noodles. Only fruit and veggies and meat."

Um, what? Before we dissect Gioia's diet, let's take a step back and see if the conclusion that Gioia is gaining too much weight holds up to scrutiny.

Data Review #1 - Peer Group Comparison

First, let's look at how she compares other 16 month old females.

• Height 32.5 inches/ 83.6 cm (88th percentile)
  
• Weight 11.5 kilos/ 25.3 pounds (75th percentile)

So the data confirm what we can tell by just looking at her: Gioia is big for her age. But not fat. She is very tall and of an appropriate weight fer her height. Taller than 88 percent of her peers, and heavier than 75 percent of them.

If she were in the 75th percentage in weight, but 40th percentage in height, then we might have an issue.

Data Review #2 - The Historical Record

Second, looking at Gioia's historical weight data, we see that she has been between the 68th and 81st percentile in weight since we brought her back to Taiwan.


Data Review #3 - The Height Perspective

Third and finally, the same pattern holds in her height data: she has been in the 82nd to 94th percentile since February.


So she has been tall (OK, really tall) for a long time. Again, if she were heavy and short, that would be one thing. But she is not.

To top it all off, here is a nice little internet tidbit: "Toddlers aged between six and eighteen months can have widely fluctuating growth curves because the rate of growth is higher in this period. So the doctor will especially be looking for changes in the percentile ratings to see if the relative size of your baby is stable."

Conclusion: Dr. X's* assessment that a one month weight gain of 0.4 kilos (taken in isolation) is cause for a diet was not consistent with the data. I have a sister-in-law who is a pediatric nurse and a brother who is an internal medicine resident, so I am sure that if I am wrong here someone will correct me. Please do. But for now, I stake my claim that my daughter's doctor needs a refresher in statistical inference.

She eats a balanced diet - no junk food - with lots of veggies, fruits, and other healthy things. She is fine.

For those of you who have made it through this boring rant, I leave you with a sneaky night shot. Note the position of her beloved bunny. Today, we fed bunny lunch and tried to put shoes on him, all at Gioia's request.


*Not his (or her?) real name. Ha.

Stuck in Tokyo

As our plane landed at Narita yesterday, the Captain announced that all onward flights to Taipei were cancelled due to the typhoon. Which means that I am still four hours away from home, waiting for the storm to clear so I can go tuck my baby in to sleep.

I met a guy from Vermont while waiting in line for my hotel voucher at the United lounge. This was his first trip abroad, and he did not know what to do with the unexpected layover. He couldn't reach his contact in Taipei and he was not sure where to go next. He had a mask of bewilderness over his eyes. I took him by the hand (figuratively) and led him through the exiting process. I made a joke about not having a visa, and I thought he was going to have a heart attack. Oops. He did not know he needed to fill out immigration and customs forms. Do I have to declare anything, he asked? Well, not unless you have commercial goods or a million yen stuffed in your shirt. You're probably fine. Poor guy.

I hope I get home today. But if I don't, I know that I will just slip off downtown and stay at a nice hotel with a cool glass of wine. This is a positive externality of traveling so much - the confidence that a typhoon delay is no big deal. After all, I'm not stuck in Karachi. I can imagine now, though, how scary the experience can be for some other people. Alone, inexperienced, unsure... not fun.

Lifebook (version 1.0)

One of the things that social workers encourage you to do for your child is to create a lifebook, a book to help tell the story of her early life. Research has shown that is good to encourage open and honest communication about a child's adoption, about her story, even from a very young age. Little ones will spend quite a while just listening to you, but one day they will start to ask questions and have a real discussion about some pretty deep issues. It is our job as parents to help our kids learn about their story and to feel safe in asking all the questions they need to ask.

Adopted children have some pretty big holes in the story of their life. We cannot answer all questions, not even most questions. We only can try to tell her what is known. How much she was and is loved: by us, her parents, by the ayis at the social welfare institute who bathed her and fed her, by the person who placed her near the gate to be found instead of killing her.

I have been meaning to make Gioia's first lifebook for quite a while. This is hopefully the first of many, as she will need a deeper and richer story as she gets older. Perhaps one day she can help assemble her own lifebook.

For now, we started with the basics: a blank board book, some pictures from her time at the social welfare institute, and a simple narrative of her life from birth to the day she officially joined our family. A book to foster a conversation about who she is, where she came from and how much she was loved and cared for, by God and by man, even in the bleakest of times.

The Genographic Project

Image source: Wikipedia

I am in the US this week for business. Guess what I am carrying around in my backpack, in a small envelope ready to drop in the mail? Gioia's DNA samples. Yep. Kinda weird, huh?

I read about the Genographic Project a few months ago and ordered a kit right away. If you are not familiar with the project, this is an effort by the National Geographic Society and other researchers to track and catalogue the paths of our ancestors by examining our DNA. If you send in a sample, you receive an overview of the migration path of your ancestors - your specific haplogroup - over tens of thousands of years. Women can test only their matrilineal line, while men can test matrilineal or patrilineal lines (those crazy Y chromosomes). Participation in the project not only allows you to obtain personal information about your ancestors' path from Africa to wherever you landed on this green earth, but you also are contributing to the advancement of human knowledge about such things. Pretty cool, if you ask me.

My daughter was adopted from China. She does not know anything about her birthparents, her birthgrandparents. One day, that fact will be a hard one for her to bear. It is hard for me to bear some days, frankly. One of the things that drew me to this project was the opportunity to give her some connection to her ancestral past, to her genetic heritage.

So that is why I am sitting in the Dulles airport this afternoon with two little tubes of DNA. Weird, yes. But also very cool.

Still Knitting

Only two thirds of the way through the red scarf. Must.. get.. cracking... I hope to finish it up on my trip to the United States next week. If I do, then I can mail it in country instead of trusting it to the Taiwan postal system. Which is not so good at delivering things, especially my magazines.

I am using the Irish Hiking Scarf pattern, and I am liking it a LOT. It looks much more complicated than it is. Just slow going, but that is more my fault (and hot Taipei's fault) than the pattern's. I am using yarn that has been in my stash for years - Berroco's Uxbridge tweed - with size 8 circular needles.

Nice little project for an even nicer cause. I am ready to finish the scarf though, so I can move on to fall sewing for kiddo. Or maybe a new dolly.

Tai Feng

The Mandarin phrase for typhoon is Tai Feng, or great wind. Yesterday at around 6:15 the government said - Everyone go home. And so they did. People take typhoons very seriously around here. They don't say, "Well, I think I'll just wait it out in my trailer park on the beach." No.

We hunkered down at home today for the storm. But it was Saturday, and we had come to the end of our weekly food supplies for the adults in the house. Frankie had a large bag of dog food on the porch, and Gioia had a freezer full of baby food. Chris and I, on the other hand, were facing a weekend of Kraft macaroni and cheese.

So today, we watched the storm and tried to gage the best time to venture out for some vittles. The wind kept getting worse and worse, so finally we just ran for it. Luckily the grocery store next door was open (and curiously full of people, perhaps in the same boat as us).

When we got to the dairy section, we found that the container of whole milk that we buy for Gioia was nowhere to be found. What to do? I know that whole milk is labeled in blue, while low fat milk labels are green. So I bought a container similar to the one we usually buy, one with a blue label.

After we trudged home though the rain, we gave the milk to Gioia. She kept making a face while drinking her sippy cup, so we investigated. Ah, not milk. It was a drinkable yogurt-like substance. Probably made with whole milk, but definitely not milk itself. So I trudged back out into the storm to 7-Eleven (which was also open, interestingly) and bought another jug.

For the record, it was an easy mistake to make. Behold the evidence - the container on the left is milk, while the container on the right is the yogurt drink. Most of time, I get by on my little handicaps and tricks, but not this time.


But all is well. The storm has abated. Gioia got her milk. And now we know how to distinguish the jug of drinkable yogurt from the jug of milk.

Reading

Gioia loves, loves, loves to read. In the morning, after she finishes her milk, she immediately signs "down" and "book." If you ask her to go get a book from her room, she will bring one of her favorites:

What Do You Say?
Where is Baby's Belly Button?
And the whole Baby Be of Use series*

She doesn't have the patience for longer books yet. We keep trying to foist them on her, with a false cheerfulness. Hey! Let's try this one! What do you think? Because frankly, reading the same books OVER and OVER is ... ummm ... tedious. But she is not fooled. Oh no. Get away from me with your Guji Guji and your Mister Seahorse, she says. Now let's do the belly button book again, Mom.

OK baby. Let's do.

*I bought these books as a joke, especially the Baby Mix Me a Drink book, but she adores them. Perhaps they are the right size, the right, length, the right amount of pictures. So now she knows how to balance my checkbook and to make me a margarita.

Xie Xie

One of Gioia's favorite phrases lately is Xie Xie, or thank you in Mandarin. Each morning, she repeats:

Xie Xie. Xie Xie. Xie Xie. Ma Ma. Ma Ma. Xie Xie. Ma Ma.

Well, you are welcome baby. Certainly.

It is interesting because I don't think many English speaking babies are saying Thank You at this age. Thank you is hard for a fifteen month old. They have to put the "Thanks" with the "you," which is hard to do. But Xie Xie is easier, at least for Gioia. It is one word, really, just repeated. She tends to turn words into repeated phrases anyway - like saying "fu fu" for Dou Fu (tofu). Xie xie is much easier for her than thank you. The pleasant result of all of this is that I have a fifteen month old who thanks me all the time.

On an unrelated note, we just found out that babies should not be given bubble baths. They can cause yeast infections. Umm, ooops. Because she has had a bubble bath every other night since...well... we got her. Yeah, oops.

So bubble baths are now a thing of the past. But, as a remnant from our previous, ignorant days, we have this massive tub o' bubbles sitting in the bathroom. Tonight as I gave her a (bubble free) bath, she repeatedly pointed at the container. I finally brought it over and asked, "Is this what you wanted?" She looked straight at me and said: "bubble."

Oh dear. No more bubbles, kiddo. How do you explain "Mommy screwed up" to a toddler?

Yang Ming Shan Lunch

In July, we met up with some of our friends for a lunch at the top of Yang Ming Shan mountain, which is in the North part of Taipei. It was a very cute outdoor-type place, with excellent mountain and city views. We met up with the same friends for lunch today (Mexican this time), and they gave us a DVD with some great pictures from the previous outing.


Gioia was not walking yet on her own when we went to this lunch, but she still looks like such a big girl. The shoes she is wearing are now too small, though - further evidence that she keeps growing and growing.

Mmm... Cool mist, margaritas and friends. The only way to pass a hot summer in Taipei. More pictures here (mostly of Baby G).

Kids and Cameras

We went to a small party this evening at my friend's apartment. We brought our SLR, and I was haphazardly taking some photos. One of the guests at the party, the nine year-old son of another friend, picked up the camera and took some photos. He was very careful with it, and throughout the evening took some outstanding shots. We set the camera on auto, so he didn't really have to worry about aperture and f-stops and all that jazz (but we did talk about those things as he began to ask questions about settings). But still, he did a great job, especially with framing his shots. I was quite impressed. He took the two photos here, and many more good ones.

Philosophically, I support the idea of giving kids access to real art tools and real supplies. How can they get interested in art if all they have to work with is a couple of pots of cheap tempera paint and rolls of butcher paper? Now, I am not saying that every kids needs to have an SLR. That would be silly. But kids surprise you with what they can do. Really.

Catching Up

I have been a little discombobulated lately, primarily because I took a quick little business trip to Macao this week, from Sunday to Tuesday night. I forgot my camera, which was frustrating. It was probably just as well because I never left the Venetian during my entire stay. The rooms there were quite fancy, as was the spa pedicure I sneakily arranged after my official day was done on Monday evening.

If you have been to the Vegas version, then you would recognize the Macao one for sure. But the interesting thing is that in Vegas, everyone drinks while gambling but no one smokes indoors. In Macao, everyone is sober, but the cigarette smoke is so thick it could kill a horse.

It was a good time, though. Not a bad place for a conference, really.

While I was gone, Chris took Frankie to the vet to see if a spot on his tummy was cancer. It wasn't. Thank God.

Speaking of medicine, Gioia went to the doctor today for her 15 month check-up and Japanese Encephalitis shot. Because ... WOW.* Yes, we let the nurse stick Baby G in the leg with a big ol' needle. Last time, with the MMR shot, she cried out in surprise and anger, one of those silent screams which break your heart to watch. You know the one: the scream where she squeezes her eyes super tight, opens her mouth in a noiseless yowl, and turns bright red, shaking with rage. Ya. Scary.

But this time, it was more of an indignant scream. A "what in the world" and "ow, my leg" kind of scream. Baby G is growing up. She is fierce and independent. On the way out of the hospital, she walked all by herself. We kept offering her our own hands as support, but she kept shaking her head - no. No.

* Full disclosure - I was worried about safety and efficacy, so I did a *little* research. Reassuring.