A GI specialist (in this case a pediatric GI specialist) is a gastroenterologist, and you should be seeing one who works just with children and adolescents.
Gastroenterologists deal with all aspects of the digestive system. This includes the mouth, swallowing, the esophagus (the tube going from the mouth to the stomach), the stomach, the small intestines, the large intestines, and the rectum.
GI doctors also deal with the organs that work with digestion such as the liver, gallbladder, and sometimes the pancreas (although the pancreas is more complex and problems with the pancreas are often dealt with by an endocrinologist.)
The GI doctor is going to start by taking a very thorough history. He will want to know all about the conception and pregnancy, the delivery, development, and everything that has happened in the past (almost) 2 years.
Then the doctor will do a physical examination, much like the pediatrician. He will check the baby's weight, length, listen to the heart, lung, and stomach, feel the belly, etc.
There are procedures that the doctor can do, but this depends on what the symptoms are that is causing you to bring your 21-month old to see him.
At this point, can you tell me more about the problems that are causing you see to bring your baby to the GI doctor?
Some of the tests that the GI doctor may do, which may have already been done, include blood tests to establish the nutritional status of your son.
The doctor will want to make sure his electrolytes, blood glucose, liver enzymes, pancreatic enzymes, and blood counts are all fine. This will help determine how much of the nutrition he needs, he is actually getting.
The doctor may want to do an upper endoscopy which is a procedure where a small, thin tube is put down the throat and into the stomach to make sure the lining of the esophagus and stomach are fine. The doctor can also check on the valve that goes from the stomach to the small intestine to make sure it does not appear abnormal. Your son would be sedated for this procedure so he would sleep through it and feel no pain or discomfort at all.
He may want to do a swallowing study. There are a number of ways to do this, but basically some sort of x-ray or tube will be used to watch him chew (or not chew) and see exactly how formula and soft foods go down the esophagus.
These are the major procedures the doctor may choose to do. On the other hand, based on the initial history, physical examination, blood work, and results of any tests done so far he may have suggestions for you to try before doing any procedures.
At this point I would still use the bottle if this is what he prefers. You should do this at least until the GI doctor sees him and advises you.
Yes, that is correct.
Any other procedure that would cause discomfort is done with sedation (not general anesthesia like in an operating room) but much simpler sedation with an IV that is safe and just has him go to sleep.
While it can be difficult to obtain blood from a 21-month old, a competent phlebotomist, nurse, or doctor will be able to do it. I would not allow 10 attempts over 2 hours. Some people are just better at this than others. So unless it is an emergency, I would not let the GI doctor or the pediatrician do this again.
If the doctor is unable to draw blood after a few attempts, ask about using a small amount of a sedative - not to put him to sleep - but to help make him more relaxed.
Also, a pediatric surgeon, anesthesiologist, neonatologist, or emergency room physician may have more experience. So ask your doctor if he knows of a colleague in one of these areas who can do him a favor. If so, you can take your son to one of these specialists just to have the blood drawn.
I definitely think you are doing the right thing by consulting a GI specialist. Remember, your pediatrician is expected to know a little bit about everything involving a newborn through an older teenager. But the GI doctor will know a lot more about everything related to the digestive system.
The fact that he "is not growing in height or weight and he refuses to eat" is all that is required for me to say you are definitely doing the right thing.
He is at a critical stage in his development. Allowing a problem like this to go unaddressed can effect him for the rest of his life. Your demand for answers is not just to make you feel better - it is the necessary thing to do to help your son.
You are not hurting your child. I think if you ignored this problem you would be taking serious risks with his health - now and for the rest of his life.
So trust your instincts because they are 100% correct. The fact that "some of the tests [you] might not like" is hardly a reason to allow this problem to go unaddressed. Seeing a specialist is the right thing to do.
Stop questioning yourself - you know what you are doing and why, and your concerns and thinking are absolutely correct.
You are welcome. I am glad I could help.
Have a good night,