G361Parental photographic monitoring of ascites

AimsPrimary Chylous Ascites is a rare cause of abdominal distension in infants. Our patient had six weeks of intravenous octreotide and total parenteral nutrition followed by medium chain triglyceride formula feeding. We describe his monitoring by girth measurement and parental photography.MethodsA four week old boy who presented with worsening abdominal distension and discomfort had ultrasound confirmed ascites. At paracentesis, 100 ml of chylous fluid was aspirated. His clinical course was monitored by serial girth measurement and parental photography using a modern mobile telephone.ResultsVariability in abdominal circumference measurements (Figure 1) made detection of clinical improvement more difficult than it was with serial photography (Figure 2). His mother found the photographs helpful in monitoring her son's progress.[Figure][Figure]ConclusionThis superiority of parental photography over formalised girth measurement monitoring in our patient mandates critical review of these techniques. Informal parental photography has been used in assessment of dermatological conditions1 and inguinal hernias.2 Inter-observer variability in measurements of abdominal circumference is recognised.3 Parental photography may increase parents' perceived involvement in their child's care in such chronic treatment and promote a family centred approach. We speculate that measurements from technical photographs4 as employed in sports biomechanical studies5 will be the most sensitive tool for clinical assessment of ascites.ReferencesNayler JR. Clinical photography: a guide for the clinician. J Postgrad Med. 2003; 49:256-262Kawaguchi AL. Inguinal hernias can be accurately diagnosed using the parent's digital photographs when the physical examination is nondiagnostic. J Pediatr Surg. 2009; 44:2327-2329Johnson TS, Engstrom JL, Gelhar DK. Intra and interexaminer reliability of anthropometric measurements of term infants. J Pediatr Gastroenterol Nutr. 1997; 24:497-505Jensen RK. Estimation of the biomechanical properties of three body types using a photogrammetric method. J Biomech. 1978; 11:349-358Wicke J, Lopers B. Validation of the volume function with Jensen's (1978) elliptical cylinder model. J Appl Biomech. 2003; 19:3-12