D: What can I do for you today?

P: Hi, yes, I just brought my son to the ER. We've noticed in the last two days he's been just making these grunting noises and just seems a little bit like just not himself, just more quiet. Not really crying.

D: OK, and when did you, you said last few days, when when exactly did you first notice the grunting? How long?

P: It was two days ago.

D: OK, two days ago. Was it when, did you hear this sound when your baby is trying to breathe?

P: Yeah, today I was trying to pay more attention. It seems like that like this really trying to breathe more. And also I like he's like the chest I see moving a lot more.

D: OK. And so you've been hearing this grunting sound, and he's been trying to breathe. And you see that his chest is moving more than usual and he's crying. Has he been sleeping well or no?

P: Uh yeah, so last night it was really hard to get him to sleep. He did sleep, I would say like around like 4 hours last night, but it was really difficult.

D: And what about feeding? Does he take a formula or is he breastfed?

P: So he's, uh, he takes formula and today it like yesterday he was feeding. Today it's been really hard to get him to feed. Maybe he fed for like one or two times, but not much.

D: It happens when you try to feed him?

P: Uhm, Kind of just uh after awhile, just pushes it away, not really, uhm, yeah, uhm not really too excited about feeding.

D: OK, and what about diapers? How many wet diapers has he had over the past, or yesterday and today? 

P: Probably around the same like usually has like five to six weight diapers and it's around the same.

D: OK. OK. Uhm and did you try anything? I know that he's six months old. Did you try feeding him anything new or anything different?

P: Uh, no, it's just been the bottle feeds.

D: Nothing new right? No solid foods yet?

P: No.

D: OK. And uh in terms of his activities, you mentioned that he's not as he's not moving and, as active as he usually is?

P: Yeah, today I also thought I felt that it was a bit warm, warmer than usual, but I didn't have a thermometer at home.

D: OK. Uhm have you noticed, has he been drooling at all?

P: Drooling?

D: Mhmm.

P: No, I haven't noticed that.

D: OK. What about coughing? 

P: Uhm, I haven't heard any, any coughing, no.

D: OK, Sorry, is he is able to sit up on his own?

P: Uhm, up against like a sofa or chair, but not really on his own.

D: Have you ever been has been left alone over the past two days at some point? Do you feel like you might have taken something in his mouth accidentally?

P: Uhm no I I tried checking his mouth like I was there with him like all all the time.

D: No, OK nothing like that? OK, how has his immunizations been so far? Has he as he received them?

P: Yeah, he's received all his immunizations, up to date.

D: Uhm, did he have, it has he was vaccinated anytime recently? Because sometimes you said he's warm and sometimes, sometimes just getting vaccinated can cause a reaction.

P: Yeah, no. He was vaccinated like I think more than two or three weeks ago.

D: OK, alright. And you said no diarrhea or anything like that, right?

P: No.

D: OK, any, is he does he have any nausea or not nausea but is he vomiting? Is he bringing anything up?

P: No, not really. Like he was just pushing away the bottle. But like he didn't bring anything up.

D: OK. Has he been limp and lethargic?

P: Uhm no, I don't think so.

D: OK, has you said that he hasn't had his formula much? But what about drinking? Like has he had anything to drink? Any milk or anything like that, or no?

P: No, I don't think so. 

D: No, she hasn't had much to eat and or drink over the past or today?

P: Yeah mostly.

D: So he might be a little bit dehydrated. 

P: Yeah. 

D: OK. Uhm, OK, well uhm, I, I, OK, so that's all I wanted to do know in terms of his current status, I would obviously want to examine him very carefully and see what's going on. Uhm, how has uh, how is he like just going back, how was your pregnancy?

P: Pregnancy was uh, OK, no complications, but he was premature by two weeks, so I think he was born at 35 and four days.

D: OK, and were there any complications at that time, including complications related to the lung, something like respiratory distress syndrome? 

P: Yeah, so when he was born there was they needed to do, I forgot what it was, but they told me that initially he wasn't breathing, but then right afterwards after like within 5 minutes, he was fine.

D: Hmm, uhm, OK, uhm, was he kept in the hospital in the NICU after being born?

P: Yeah, just because of that scare, they kept him for three more days, but like he was growing while there were no more episodes of the breathing issue, so they let him go after. 

D: OK. Uhm, has, how has he been since then over the past six months?

P: Since then, he's been fine. No, we didn't have to go to the hospital or anything, and during our routine visits he's been growing well, no normal issues.

D: Any issues because development?

P: No, he's been pretty, like he's been meeting his milestones according to like the family doctor.

D: Has he had any surgeries or any, or no hospitalizations you said, and no, uhm no diagnosis, right? He hasn't been diagnosed with any condition?

P: No.

D: Alright. Can you tell me about allergies? Is he allergic to anything that you're aware of?

P: No, not that I know.

D: OK, is there uh, can you tell me about his family history? Anything that you might have or uhm his dad or anyone else in the family?

P: Uh, no, him, his dad and I are pretty healthy, yeah. No medical conditions.

D: Anything like cystic fibrosis in the family?

P: No, not that I know of.

D: OK. Alright, well we'll examine the child and look at his vitals, listen to his lungs, look, look inside his mouth and that's this sounds serious, so we'll keep you, we'll keep you updated and we'll let you know what needs to be done. He might need, potentially need antibiotics. He might need potentially, to be intubated, but we will have all these discussions after the baby's been seen and we'll draw some labs and go from there.

P: OK, sounds good.

D: Alright.

P: Thank you.