Sally Walsh, MSN, RN, CPNP


J Pediatr Health Care. 2008;22(5):315-317. 

In This Article


When the day first began, you thought parental questions about eye color referred to the usual iris color of brown, blue, or green that is passed down from parents and grandparents. By the end of the day, you had other reasons to discuss eye color. The newborn who came in with "yellow eyes" involved the usual discussion and management of an infant with an elevated bilirubin level. Multiple patients were seen as a result of having "red eyes," because both viral and bacterial conjunctivitis cases were marching through the community. In the midst of these focused eye examinations, you are now seeing a 4-month-old whose blue eyes are more of a concern than any of the previous patients. The family is new to the practice and has transferred from an inner-city clinic. This infant is the youngest of seven children. No medical records are available, but the mother has filled out a family history form that you review with increasing dismay.

In the family history, she has briefly stated that several children were born prematurely and have developmental delays and/or learning disabilities that have required early intervention and school special needs services. The father is obese and has diabetes. One of the children had a tibia/fibula fracture at age 3 years from a fall. Nothing else of significance is documented. A comprehensive discussion of the family history is not possible because of the mother's need to get home for the other children and your own patient schedule.

On examination, the infant was in the 30th percentile for weight and the 25th percentile for length. The outstanding physical finding in this infant was her china blue sclera. As you talked with this mother, you note that she also has a light blue tint to her own sclera. On questioning, she says that most of her children have a similar color to their eyes and seems irritated that you asked. She pressures you to quickly finish the appointment, so the examination of the infant is completed. The rest of the physical is within normal limits, although the infant seems slightly placid and the mother doesn't show much attachment to her. The baby has not had her 2-month immunizations, which increases the concern about the competency of the parents to care for this family. The mother has appointments in a couple of weeks for two of her older children, so you hope for a better opportunity to evaluate this mother and family at that time. You discuss diet, development, and safety as best you can, fill out the Women, Infant, & Children program forms (which is currently supplying the baby's formula), give the baby her immunizations, and schedule an appointment for a weight check for the baby at the same time as the sibling appointments. The mother has given a written release for the children's medical records, and it is hoped they will be available prior to the next visit.

The next week the mother cancels the appointments for the two older siblings but reschedules them with a colleague. After their appointments your colleague comes to you shaking his head. The two siblings are very developmentally delayed, have blue sclera and severe caries, and both are iron deficient. The mother did not bring the infant to this appointment and again has refused to stay for further evaluation. She has scheduled appointments for two other children the next month.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: