11 September 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
-T & H C
Dear Mr. & Mrs. C: There are several viruses which can cause blisters in the mouth. Coxsackie virus, a summer virus, causes blisters in the back of the throat and sometimes on the tongue. It may cause a rash on the hands and feet and sometimes up onto the buttocks. It is not associated with bumps under the arms. The illness usually runs about 5 to 7 days.
Herpes virus causes blisters inside the mouth and cheeks, and sometimes on the tongue and in the throat. It usually causes swelling, redness, and bleeding of the gums. There may be blisters on the lips and outside the mouth, but there is no rash associated with this illness. The course is usually 7 to 14 days.
For more detailed information about these infections and other causes of sore throat read my article, Sore Throats.
Sincerely,
Dr. Warren
-MM
Dear MM: Multiple Cafe-au-Lait spots could indicate that your child has Von Recklinghausen's Neurofibromatosis. If there is a family history of neurofibromatosis, that would make it more likely that your child has it since it is a genetic disease; however, even without a family history, it is possible for your child to have it as a new mutation. Children with neurofibromatosis have normal intelligence. They develop neurological symptoms related to the neurofibromas. The symptoms will depend on where the neurofibromas are. Patients may grow to old age without significant neurological symptoms. The degree of symptoms is very variable. Certain problems can be avoided by early treatment of neurofibromas which develop in problematic areas. Since your son may have neurofibromatosis, he should be evaluated and followed by a pediatric neurologist.
Sincerely,
Dr. Warren
-MW
Dear MW: Most of the things children find to be fun help eye hand coordination. Gross motor hand eye activities can include ball games, ring toss, or horseshoes. If the child cannot catch at all, start by rolling the ball back and forth to each other. When playing catch start close to each other and use a large soft ball like a beach ball tossed gently. The boy can practice throwing the ball into a bucket starting so close that he can drop it in.
Fine motor control can be practiced by stringing beads or macaroni, drawing, coloring, cutting, etc., activities which are basically arts and crafts. The important thing is to concentrate on providing the boy an opportunity to practice these activities. Too much instruction may be intimidating, and too much emphasis on perfection would be discouraging. Anything he is able to create would be a special accomplishment of which he could be proud.
Sincerely,
Dr. Warren
-AS
Dear AS: If your son wakes up at 5 AM after a full night's sleep, there is little you can do to change his inner clock and may need to simply accept the fact that he is an early riser. He cries because he wants you and stops when you come in because he feels secure. If he sleeps through the night, it is perfectly reasonable for him to cry for you when he is awake for the day. On the other hand, there is no rule that says you must respond to his cries immediately. If you decide you'd like to teach your son to stay in bed until "morning" you should go in to him when he cries. After all, you are awake anyway. Try to calm him, but keep your intervention as little as possible. As time goes by gradually decrease your intervention until he has learned that you will come in for him in the morning when it's time for the day to begin.
Sincerely,
Dr. Warren
-JS
Dear JS: It is possible that your daughter could be wetting herself because she is involved with other things and ignores her urge or waits until the last minute and then has accidents. The best way to deal with that is to schedule bathroom trips for her. Make sure she uses the toilet at least every two hours and before beginning each activity. For most days try to schedule bathroom breaks at regular intervals so that they are not disruptive to your daughter's day. Develop a bathroom routine that she gets used to so that there will be no arguments. If this does not keep her dry, she needs thorough evaluation by a pediatric urologist. There are some conditions which can cause incontinence. Proper diagnosis leads to appropriate treatment.
Sincerely,
Dr. Warren
-RN
Dear RN: The color of stool comes, in part, from bile which is green. When the transit time of the stool through the intestines is more rapid such as when a person has diarrhea, the stool tends to be greener. Even though the stool is often green when someone has diarrhea, the green color does not mean the person is ill. Any color of yellow, brown, or green is perfectly acceptable for stool. The only colors that are worrisome are red blood, clay gray or white which results from the absence of color from bile and implies obstruction of the bile duct, and jet black which is caused by bleeding in the upper GI tract.
Sincerely,
Dr. Warren
Thank you.
-BB
Dear BB: Since I didn't see the little baby and have so little information about what happened, I cannot tell you what the baby's diagnosis is or how to proceed. I once had a patient who could not tolerate grains, and every time he ate cereal he vomited profusely, turned pale, and became unresponsive, just as you describe.
Emergency rooms are great places to go when you have an acute emergency, but even if the ER visit results in a hospitalization, unless the patient is treated by his own doctor, there is no follow up. All diagnostic dilemmas require long term management by one physician or group of physicians who can oversee the evaluation and provide referrals to appropriate specialists. It is possible no answer will ever be found, but the best way to be sure nothing is missed and to have a plan of action in place if the child has the same symptoms again is for the baby to be seen regularly by his pediatrician, and for the pediatrician to be contacted when there is a problem.
Sincerely,
Dr. Warren
-JFP
Dear JFP: Many infant boys have hydrocoeles, which is fluid surrounding the testicle. Many hydrocoeles resolve on their own by one year of age. Hydrocoeles can be associated with hernias. Any hydrocoele that persists beyond a year of age should be repaired since it is less likely to resolve without intervention and has a higher risk of being associated with a hernia. A hernia is an opening in the connective tissue which the intestine may poke through. If the intestine comes out through the opening, it may get stuck and swell resulting in a need for emergency surgery. In order to avoid such an emergency, hernias should be repaired electively. Although all surgery carries some risks, including the risk of anesthesia, hernia repair surgery is minor surgery and very safe. I had a hernia repair 49 years ago when I was 3 years old, and I'm fine today. The surgery and anesthesia is much safer today. You should have your son evaluated by a pediatric surgeon to see if any surgery is necessary.
Sincerely,
Dr. Warren
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