13 March 2000
Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physican who knows you and cares about you.
Dr. Warren
-Adam
Dear Adam: I don't know a number. I see one or two a year. Some years I don't see any. Extra digits are a dominant genetic trait. If a parent had an extra digit, there's a 50% chance that his offspring will too. Since the extra digits are rarely functional, they are removed during early infancy, so you won't get an idea of how common it is in the population by looking at adults.
Sincerely,
Dr. Warren
-(unsigned)
To whom it may concern: If there isn't an urgent reason to travel, I'd avoid traveling with an infant until at least 8 weeks of age because of the concern about exposure to infection. After that, consideration should be given to practical matters such as where you will stay and how easy it will be for you to care for your baby during the trip.
Sincerely,
Dr. Warren
-NB
Dear NB: Pseudomonas is rarely a cause of infection except in patients on respirators or with cystic fibrosis. The only infections pseudomonas causes in healthy people are folliculitis from hot tubs and infections of puncture wounds through sneakers. Pseudomonas found on a throat culture cannot be considered evidence of infection even if it wasn't a contaminant (which it probably was). The purpose of doing a throat culture is to rule in or out Strep throat. If your daughter has been on cefzil and biaxin and her throat culture was negative for Strep, there is no point in repeating the throat culture. Cipro is not approved for growing children.
As to the cause of your daughter's illness, since I have not examined her, I cannot say. But if your daughter has had fever for more than a month (documented temperature over 100 degrees Fahrenheit) then she needs a thorough evaluation for both infectious and non-infectious causes. If she has a sinus infection which has not responded to antibiotic treatment she should be evaluated by an ENT. If she has been on antibiotics all this time and has a severe headache, she may need a spinal tap to rule out a partially treated meningitis. This is a decision that can only be made by a physician who has seen your daughter. Other tests to evaluate possible infection can include repeat chest x-ray, urine culture, and PPD.
Non-infectious causes of prolonged fever include inflammatory diseases and some other more serious diseases. If your doctor feels that there is reason to evaluate your daughter for fever of unknown origin, he will have to start evaluating organ systems based on symptoms and if these tests are negative, order additional tests to rule out other diseases. As this is a complex matter, I will not suggest a particular protocol, but if your doctor is unsure how to proceed, he could consult an infectious disease specialist, a rheumatologist, and if necessary, an oncologist..
Sincerely,
Dr. Warren
Our pediatrician on several visits says everything is normal and it may take him a year to get on a normal schedule. I don't believe a word she says.
Do you have any suggestions.
-Mr. & Dr. B
Dear Mr. & Dr. B: One of the difficulties inherent in evaluating the relationship between infants' crying and gas pains is that screaming infants often tighten their bellies and pass gas as part of their screaming. They also swallow air while crying, aggravating any gassy condition. However, if you think the baby's problem is gas or abdominal pain, there are basically two things to consider: 1. the baby's diet is causing gas pains, or 2. the baby has an intestinal problem, either functional such as constipation, or organic, such as reflux, a malrotation, or colitis.
Dietary considerations include formula intolerance which could include allergy or lactose intolerance. In such a situation, a trial of a hypoallergenic formula such as Nutramigen or Alimentum is in order. In addition, nursing babies may be sensitive to ingredients in their mothers' diets. Spicy foods are notable for causing gas pains in nursing babies, but so may cow's milk. A diary of mother's diet may help isolate the cause.
If dietary causes can be excluded, then a more thorough evaluation of the intestinal tract may be in order, but that depends on the degree of the baby's discomfort and how well he is thriving since one wouldn't want to do a major medical workup on a child who simply has a low threshold of tolerance for normal infant discomforts.
Sincerely,
Dr. Warren
-AE
Dear AE: Pronunciation of words is not as important as using words with regard to child development; however, if your son's pronunciation is so poor that you often don't understand him, he may not get enough positive feedback from you. When a child's use of words gets your attention or gets him what he wants, he learns to use those words appropriately.
Many children who speak 2 or more languages may have a slight delay in starting to use language while they sort things out, but most do very well with 2 languages. The benefits of speaking more than one language far outweigh any potential early delays. By 2½ years of age, even a child who speaks 2 languages should be using words to communicate and put words together into phrases.
The cadence of oriental languages is significantly different from Arabic, English, and the romance languages. This may add to your son's confusion because he is not understood when he does use words. Under the circumstances, it may be wise to make a concerted effort to communicate with him in one language and stimulate his use of that language by reading to him and playing word games with him in that language. That does not mean that he should only hear one language, but a decision should be made regarding which language should be his dominant language now so that you can concentrate on stimulating that language. It is essential that the person he spends the most time with and who cares for him speak that language to him.
Sincerely,
Dr. Warren
At 6-month-old, he started to roll over. He learned to creep on his tummy when he is about 7.5-month-old. But he shows no sign of crawling yet. The concern I have is he still cannot sit well without support. I have tried using pillows to support him but he will force himself down or slide down on his bed and then roll on his tummy. I have also tried putting him in high-chair (with pillow support) but he will only do it for a while. I notice that he love to stand and bounce on his feet. His legs can support his weight pretty well with my support under his armpits. It looks to me that he is learning to walk.
He eats well and is active and alert. Is my baby developing normally? What should I do to help him? My pediatrician advise me to exercise my baby more and he prescribe vitamin to him to strength his done.
Thanks a million for your reply.
Regards..........
-Serene
Dear Serene: Many babies don't sit without support before 8 months. The usual range for sitting is 6 to 8 months. By 9 months most babies can sit without support. If your son has good muscle tone and holds his head steady, this minor delay is not a cause for major concern. If your son is relatively limp and does not hold his head up well, then he needs further evaluation.
Motor development usually proceeds without any special help as long as children have the opportunity to move around, roll around, and play on their tummies. Good nutrition is important for growth and development, but it is misleading to suggest that vitamins can make children stronger. Stimulation by playing with and talking to your child is essential to normal development.
Sincerely,
Dr. Warren
-TD
Dear TD: Ear infections can come on suddenly and can make a child quite ill. They can also cause vertigo, but rarely make it so that a child will refuse to stand or walk. Since your child is only 14 month's old and probably hasn't been walking for a long time, a combination of feeling awful and poor balance may account for her refusal to walk or stand, but if your child doesn't respond to treatment quickly with disappearance of the fever and improved activity level and balance, she should be reevaluated to be sure there is nothing more serious going on.
Chronic ear infections can cause hearing loss, but a single bad ear infection should not cause any permanent hearing loss even though hearing will be decreased during the infection.
Sincerely,
Dr. Warren
It seems as though he is sick all the time, but he is growing. Our pediatrician indicated that this was a good thing. Lately, I began to wonder if maybe we should see an Ear, Nose, & Throat doctor on this.
Our son is very active, just as you would expect a four year old to be. He requires very little sleep. He is up at 6:30 a.m. and has a 2 hour nap in the afternoon at pre-school. He is in bed at 8:30, but rarely is asleep before 11:00 p.m. Could this be connected to the sinus problem, or is this just normal for some children.
Thank You.
-NS
Dear NS: If your son has chronic or recurrent sinus infections, he should be evaluated by an ENT doctor. Some children are more prone to sinus infections than others, but often the problem is simply multiple colds, some of which result in sinus infections. Unfortunately, colds are difficult to avoid. You want to be sure that your son really has a sinus problem before embarking on any major procedures. A thorough ENT evaluation with follow up can help you determine what is actually going on with your son's sinuses and what, if anything should be done.
As regards your son's sleep habits, if he is being kept awake because he is not feeling well, the sinus problem may play a role, but otherwise, there would be no relationship.
Sincerely,
Dr. Warren
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