22 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
-SA
Dear SA: Small head size may indeed be related to developmental delay. If a child's brain is not developing normally, the head may not grow normally. On the other hand, if the bones of the head fuse prematurely interfering with growth of the head, this can affect the brain adversely. Premature closure of the head bones is generally not symmetrical and so results in the head being misshapen as well.
How concerned you or the doctor should be depends on what the baby's head growth looks like on a head circumference chart. Since I have no numbers, I can't tell you how concerned to be. The doctor should review the chart with the baby's parents and explain how much of a concern there is.
Does your son need the family doctor's permission to see a pediatrician? If your son wants a second opinion, he should seek one, but first he should get a complete explanation from the baby's doctor, after which he may be satisfied. If the head growth is abnormally small, then a pediatric neurologist should be consulted.
Sincerely,
Dr. Warren
-SM
Dear SM: Diabetes does not directly cause cramping. It is possible that the small artery disease associated with poorly controlled diabetes could lead to pain, but since the cramps are only in your son's hands, it is most likely due to specific activity. Golf is not likely to lead to carpal tunnel syndrome, but it could certainly lead to tendonitis and muscle strains in the overused hands. Sports related symptoms are generally treated by an orthopedist. Your son should not wait until his symptoms become debilitating. He should see a doctor now.
Sincerely,
Dr. Warren
-BM
Dear BM: Stress related headaches don't require that a child be unhappy or doing poorly in school. Children can feel stress in response to things they look forward to such as a trip or a party. The bright child who does well in school and likes school may be under stress because of demands he places on himself. Muscle tension headaches, which often feel like a squeezing of the head may be caused by emotional stress, but may also result from physical stress such as strenuous activity, hunger, or fatigue.
Pain in the frontal area could be related to sinus congestion which could be allergy related. Pain at the temples is unlikely to be caused by sinus congestion, unless it is a secondary headache caused by the sinus pain.
Children get migraines. These are usually described as pounding headaches, are on one side of the head, often cause nausea and vomiting, and photophobia (light bothers the eyes). Migraines may be relieved by sleep. Migraines may be provoked in children with certain food sensitivities by chocolate and hard cheeses. Caffeine addiction can result in withdrawal headaches which are similar to migraines. Children who drink caffeinated soda or tea regularly may experience caffeine withdrawal symptoms if they go without caffeine for a while.
Even though not all headaches are related to the nervous system, most neurologists are experts at dealing with headaches. Aside from the issue of whether or not your son needs further evaluation to find the cause of his headaches, if your son is debilitated by the headaches, he needs effective treatment. Therefore, if your son is having a significant problem with headaches, you should ask your doctor for a referral to a pediatric neurologist.
Sincerely,
Dr. Warren
Thank you for your help.
-LL
Dear LL: I don't know of any proven benefit to using garlic oil in the ear. As long as the ear is not draining and the child doesn't have tubes, and the oil is not irritating or caustic, it probably won't do any harm.
Sincerely,
Dr. Warren
Thank you.
-Tina
Dear Tina: Propulsid should decrease the amount of reflux while Zantac and Maalox decrease the acidity of the stomach. Even still, if the baby's esophagus is inflamed from reflux, it may take time for the symptoms to improve. You should stay in touch with your gastroenterologist. He may want to see you back sooner or adjust the medication if the baby remains uncomfortable.
Sincerely,
Dr. Warren
I don't want to push too hard so I never make it a big deal but I am concerned. What do you think all this means? Thanks!
-Kathy
Dear Kathy: Your daughter may have become frightened by a painful bowel movement or some discomfort on urination. Or she may have become bored with the process and feel under pressure to perform (even if YOU don't pressure her. After all... She's not stupid. She knows what you want). Your daughter may simply be at the point where she has decided to be in control of that which she can control. In any event, the thing to do is to go back to square one and encourage and praise any activity related to the potty with no pressure to perform. Reread my article on Potty Training for more details.
Sincerely,
Dr. Warren
-CS
Dear CS: Petechiae (little blood spots in the skin), easy bruising, cuts that bleed a long time, and nosebleeds that are frequent and hard to stop, are all signs of a low platelet count. The nature of things which are idiopathic (cause unknown) is that it may be difficult to predict the course. Your son may grow out of it, but he may not. It is not an indication of anything more serious, but some people who have ITP also develop other immune mediated blood disorders such as hemolytic anemia. Your son should be under the care of a pediatric hematologist.
Sincerely,
Dr. Warren
-LC
Dear LC: What does your son do when you are holding him? You certainly can't always have him on his belly. If he is content to be held in the same positions he refuses to sit, then there should be no reason he couldn't sit in those positions. If he cries any time he's not on his tummy, then your doctor needs to evaluate the cause of his apparent discomfort.
Since you say the problem occurs primarily when your son needs to sleep, I'd suggest you work on a flexible schedule that allows you to go out right after he wakes up, and make a point of putting him in the sitting position when he is not tired so he can get used to it. At 3 months your son should be able to go longer than 2 hours without a nap and as he gets older, these awake periods should increase in length allowing you more time to get things done.
Sincerely,
Dr. Warren
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