8 May 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 physician who knows you and cares about you.
Dr. Warren
-Jen
Dear Jen: Some babies start sucking their thumbs or their wrists before they are born. If your baby has found her thumb and prefers it to a pacifier, I would just let her enjoy it. Getting rid of a pacifier can be just as frustrating as trying to get a child to stop sucking his thumb.
Eye turns (lazy eye) can sometimes be hereditary. If your daughter's eyes don't look straight to you when she is looking straight at an object, you should ask her pediatrician to check them. You can get a pretty good idea yourself if you can get her to look at a flashlight. If she is looking straight at a flashlight, the reflection of light should be in the center of both pupils.
Sincerely,
Dr. Warren
This has to do with the recent Schneider Lunch Mate Outbreak, and no one seems to know what serotype D is/means.
Anxiously awaiting your reply
-Joanne
Dear Joanne: E. coli is a completely different organism than Salmonella. Salmonella is a bacterium commonly found in poultry, eggs, turtles, and reptiles. The most common source of infection is undercooked chicken, or contamination of other food when the food preparer doesn't wash after handling raw chicken, or the food comes in contact with a surface contaminated by raw chicken. The Salmonella species in Group D are Salmonella typhosa, Salmonella enteritidis, and Salmonella gallinarum-pullorum. Salmonella enteritidis is the most common cause of food poisoning in the USA. Salmonella typhosa is the most serious, causing typhoid fever.
Salmonella infections can make people quite ill; however, the treatment is generally supportive and symptomatic only, unless the bacterium is causing invasive disease extending beyond the gastrointestinal tract since antibiotic use can cause the patient to become a chronic carrier.
Sincerely,
Dr. Warren
-DM
Dear DM: The main risk of placing ventilation tubes in children's ears is the anesthesia. Since the procedure is microsurgery, it requires the patient to be completely still, and for young children, that means anesthetized. Anesthesia these days is fairly safe, but nothing is 100%. The risk of anesthesia in competent hands is no greater for an 8 month old than for an older child.
The placement of tubes is not an age related issue. Young infants often have the most serious ear problems if they have their first ear infection early and have recurrent ear infections. Many of these children do significantly better after tubes. Considering that this is the time when your child should start developing speech, if he has had many infections or has persistent fluid, then it may be the right time for tubes.
Sincerely,
Dr. Warren
When she stands still, her feet appear straight and flat on the ground. But when she walks or sits in a reclined position, her feet are turned inward. None of her classmates have this condition. They have either outgrown it or never had it.
With that added bit of information, is your advice still the same?
-KM
Dear KM: It's difficult to make a decision about treatment when doctors give you conflicting advice. Unfortunately, I can only talk in generalities since I haven't seen your daughter, although, since you say her feet are straight when she stands, I suspect that there is no structural abnormality of the legs or feet. If the specialist is honest and has a good professional reputation, then his advice should be the most authoritative. If you have any doubts, you should seek a second opinion from another qualified specialist.
Keep in mind that when you consult a specialist, he assumes that you are coming for a problem that concerns you. He is therefore likely to present you with treatment options if there are any. You will need to make it clear that you want to know what the natural progression of the condition would be without treatment and what the risks of treatment and the risks of delaying treatment would be.
Sincerely,
Dr. Warren
My 8.5 month old baby boy has had sweaty palms and feet since birth, but condition seems to worsen now that he is moving around more. Now, not only his palms and feet, but the back of his hands and the top of his feet, perspires continously, and literally drips. They feel very icy cold. At the same time his head and neck will be perspiring too but feel hot, and you can feel the heat from his head a few inches away. There will even be large drops of sweat above his upper lip and below his lower lip, on his nose, and down the sides of his head.
I have consulted a few pediatricians and all of them just say it is okay without asking more. Baby now always slips when he crawls, and slides when he stands, and had a few bad knocks because of the water - the floor tiles gets very very wet! So does everything he touches!
The only time his tiny feet feel warm and dry, is when he is asleep.
If we give him socks with anti-slip, his feet will perspire less, but after a while he gets smelly feet.
On his head and neck area, when he sleeps in air-conditioned room at 25 Celsius, he still perspires and will invariably wet the pillow. He does not have a blanket over his sleepsuit because of this.
We are concerned his sweaty palm/feet will affect his physical development, and that it will be a permanent condition. Does he have weak heart? We also do not understand why his head area is always perspiring so excessively.
What is possibly wrong and what can we do? He is 9.3kg and otherwise healthy and active.
-JS
Dear JS: It is most unusual for a child to sweat as much as you describe, but without more information, I can't be sure if it is medically significant. If your child perspires from minimal activity and fatigues easily and is feeding and growing poorly, he could have a heart condition which requires evaluation. If your child seems to be very nervous and active, and eats a lot but still can't gain weight, he could be hyperthyroid. Since your son's weight, 9.3 kg is at the 50th percentile for his age, it seems that he is growing normally, so it is unlikely that he has either problem, but only a doctor who has examined him can know for sure.
Perhaps you are keeping him too hot. 25 degrees C is pretty warm. 20-21 degrees C is a more reasonable room temperature.
In the meanwhile, you might try powdering his hands and feet lightly to see if you can help with the sweating and slipping.
Sincerely,
Dr. Warren
In Singapore our temperature averages 32 C in the day, and seldom below 25 C at night. Recently day temperatures went to 36 C. Problem here is with humidity - above 95%. One 10 year old just collapsed and died after a physical education session under the heat while in school.
I am also perspiring alot since I delivered (it is a very unpleasant change in my own body system - I get very hot and wet when others are feeling okay, and it is definitely after childbirth), but not my palms and feet! The other two adults in the family hardly perspires even in this heat as we are accustomed to it.
What I am still puzzled is why the palms and feet and why are they always icy cold? You can see the sweat collecting at the back of his hand and on top of his feet too. And why his head is so hot with heat at the same time?
He is active, but he frightens quite easily - is that nervousness? Recently he is getting very active and fighting to keep awake at the point he is dozing off. How else can we tell hyperthyroid?
It is painful to see him keep slipping. I will try powder. But can't imagine chasing after him with powder. He is getting frustrated with slipping, and just yesterday he sat back, moved his feet on the floor, watched them slide and slide, and scolded the floor.
On a seperate note, we never gave him a pacifier altho he likes one. He does not have any security objects. Does that make a child more nervous and easily frightened? Should we introduce a security object and if we do not, will he become less secure as an adult? How can we introduce one?
-JS
Dear JS: Sweating is the body's way of controlling body temperature in the heat. Your son's hands and feet feel cool because when the sweat evaporates it removes heat from the skin. A dog's nose feels cool because it is moist for the same reason. A baby's head has a large surface area and a rich blood supply to the skin. In order to allow the heat to escape from the body, the blood flow to the skin is increased. In spite of the sweating, the large amount of blood flow to the scalp will make the baby's head feel hot.
Fighting to stay awake and frightening easily is normal for babies. Hyperthyroidism will cause poor weight gain, jitteriness, and a high heart rate. It shouldn't be necessary for you to decide if your baby has a medical condition. That should be done by his doctor. I provided the information only to answer your question regarding possible causes of excessive sweating. It sounds like the main problem is that the baby is overheated.
Isn't it possible for the baby to do his crawling and walking on a different surface rather than a tile floor where he slips and gets frustrated?
Some babies do have objects they use to soothe themselves, but they are the ones who choose these objects. You can't make something a security object for your child. The most important security for any child is the availability of loving parents who meet his needs in a stable household. The absence of a security object in childhood does not make a child more frightened or affect his security as an adult.
Sincerely,
Dr. Warren
-DV
Dear DV: Antibiotics do increase the risk of developing a yeast infection, but little girls don't develop vaginal yeast infections be cause the immature vaginal lining does not support the growth of yeasts. The skin can become infected with yeast. If so, it will be bumpy and red. If you think your daughter has a yeast rash, you can try treating it with Lotrimin. If you're not sure, she should see her doctor.
If your daughter's urinary symptoms are not improved, she should have a repeat urinalysis and culture. After she finishes the medications she should also have a culture to be sure the infection is fully clear.
Sincerely,
Dr. Warren
-MS
Dear MS: Comparing two illnesses may sometimes be like comparing apples and oranges. Intestinal viruses (which cause vomiting and diarrhea) may sometimes cause abdominal pain. If the other illnesses you are comparing to did not cause any pain, you really can't compare them.
Persisting high fever with bloody or mucousy stools may be a sign of a bacterial food poisoning like Salmonella or Campylobacter. Severe abdominal pain may also be a sign of appendicitis, but appendicitis generally causes only low grade fever and rarely causes diarrhea. The pain with appendicitis starts in the middle and goes to the right lower part of the belly. If your daughter's pain is severe or she keeps vomiting, she needs to see the doctor.
Sincerely,
Dr. Warren
-(unsigned)
Dear Parent: Most infants meet their fluid needs by eating formula or nursing. Water is a major constituent of breast milk and formula so it isn't necessary to offer additional water. If a baby wants to feed frequently it may help to offer water between feedings, but many infants gag on water or refuse to take it. Water may be offered starting in the newborn period. It should be boiled to sterilize it until the baby is 6 months old. Of course, it should be cooled before feeding.
Sincerely,
Dr. Warren
Dear Parent: In my previous response I told you that infants can start drinking water in the newborn period, but that it isn't necessary because their fluid needs are met by nursing or formula. I'd like to add an additional caution. Water has no salts in it, and sodium and potassium are both essential salts for normal bodily function. For this reason, infants should not be fed water in place of their feedings or have their feedings diluted with a lot of water, nor should they drink large quantities of water. If an infant isn't feeding well because of illness, rather than being offered water, the baby should be offered an electrolyte solution like Pedialyte or Kaolectrolyte.
Sincerely,
Dr. Warren
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