A Smile To Treasure

Emily Garcia and her husband were surprised and excited about adding a fourth child to their growing family. They wanted to pick a unique name for this child and decided to name him River upon learning they would be having a boy.

No stranger to high-risk pregnancies due to her high blood pressure and gestational diabetes, Emily made an appointment with her obstetrician, Dr. Tracy Lyon at CHRISTUS Women’s Health associated with The Children’s Hospital of San Antonio. When Emily was 12 weeks along, Dr. Lyon detected on the ultrasound that River’s chin was tiny and pushed back. At the 20-week mark, they discovered River had a clubfoot, a birth defect that affects muscles and bones in a baby’s feet, making their foot (or both feet) point down and in.

“I was super emotional because I had never dealt with anything like that with my previous pregnancies,” said Emily. “But my husband and I decided to take it one day at a time and deal with whatever came our way.”

The remainder of Emily’s pregnancy was uneventful until she hit 35 weeks and started feeling a little “off” and suspected that her blood pressure was high. When her blood pressure medication didn’t make a difference, she called her doctor.

Emily’s blood pressure remained high after doctor tried a different medication and gave her an IV. Doctors decided to prepare her for a C-section.  

Once River was born, doctors discovered that in addition to the small chin and clubfoot, he also had a cleft palate, a condition where the roof of the mouth does not fuse completely during pregnancy. River was immediately taken to the neonatal intensive care unit (NICU).

When Emily was reunited with River, he was doing well and breathing on his own. Dr. Maria Pierce, River’s primary physician in the NICU, told Emily that as he grew, River’s need for supplemental oxygen may increase, and it did.

“I had a lot of communication with Dr. Pierce and some of the other physicians. They were always so helpful and understanding. It was a constant ‘two steps forward, one step backward’ scenario,” said Emily.

River was having some issues eating and, as a result, had trouble gaining weight. After the speech pathologist conducted a swallow test, together with River’s doctors, they pinpointed precisely what he needed to help him eat.

When he was about six weeks old and after he had gained some weight, River reached the point where he could have his jaw distraction surgery. His plastic surgeon, Dr. Alejandra Garcia de Mitchell, and her team carefully positioned plates in his jaw and little pins behind his ears. Every day, the doctors turned the pins to help push his jaw forward.

As for his clubfoot, Dr. Elizabeth Magnabosco, pediatric orthopedic surgeon at The Children’s Hospital of San Antonio, is treating it with ‘casting’ and his foot has slowly started to turn in the correct position.  Dr. Magnabosco is also using the “boots and bars” mechanism, where boots and bars are used to stabilize the muscles and ligaments and prevent them from tightening up.

Emily and her husband were excited when River was finally able to go home, but also a bit overwhelmed. Before they left the hospital, they were given everything they needed to know about caring for their little one at home.

Emily and her family are immensely grateful to the team at The Children’s Hospital for taking such great care of River, especially the plastic surgery team.

“The plastic surgery team made our lives better. River is able to do so much more than I ever thought he’d be able to do because of them,” said Emily. “They brightened our outlook for my son and increased his quality of life.”

When River is a little older, Dr. Garcia de Mitchell will perform the surgery to repair his cleft palate in two stages. The first stage will be to correct his soft palate when he is about one year old, and the second phase to correct his hard palate will occur when he’s between 15 and 18 months old.

In the meantime, River is reaching some key milestones. He loves to be held, enjoys his swing, and has started to smile and even talk a little.

“There were times when I wasn’t sure we would ever see him smile,” said Emily. “Now, when he does, it means the world to me.”

To learn about how you can make a difference for more children like River, visit childrenshospitalsafoundation.org.