9 October 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
Yours truly,
-Anne
Dear Anne: It's nice to think that every body part has a special purpose, and perhaps, someday, we may discover functions of certain organs about which we didn't know, but some parts of our body are the way they are because of the way the body develops. The appendix, which sometimes causes medical problems, has no special function, but exists as a result of the way the intestines develop. During embryological development, the human being starts with the capability to be male or female. Each cell has the full complement of genetic information capable of producing all the body part for males and females. By a process known as differentiation, cells specialize and become different from each other so that different organs form and the body takes shape. In the process of differentiation the early sex organs have the capability to be male or female, and under the influence of hormones, the organs become either male or female. The genetic information for nipples to form is present in all mammals including human beings regardless of whether the animal or human is male or female. The hormones that influence sex organ development in early fetal life have no effect on breasts. Adult breasts develop under the influence of adult female hormones. The male breast is perfectly capable of developing into a female breast which can produce milk, but the male body doesn't produce enough female hormones to make that happen. So the basic answer to your question is that breasts are genetically programmed into the body development of all mammals including humans, but they only grow and become capable of producing milk under the influence of certain female hormones.
Sincerely,
Dr. Warren
Any ideas?
-MS
Dear MS: They don't teach answers to questions like this in medical school. Why a 2 year old would pull his penis out of his diaper to urinate just anywhere is beyond me, but once he saw your response to his behavior, I'm sure it became a great game to him. You will probably have to experiment with several approaches to see if you can find one that works. Possibilities include putting multiple heavy layers of diapers on with one piece outfits, putting on underwear instead of a diaper and spending lots of time outdoors so he can wet himself and hopefully become uncomfortable without driving you nuts, dragging your son into the bathroom every time he puts his hands in his pants, or just trying to remain calm while you continue toilet training with the hope that he will become more excited about pleasing you by urinating in the toilet rather than by getting your goat.
Sincerely,
Dr. Warren
Any response is greatly appreciated.
Best Regards,
-L
Dear L: There is no standard age to start teaching children to swim. There are some programs that aim at teaching infants to swim, but they are not endorsed by pediatricians because the young infants learn to swim under water without surfacing to breathe and become hypoxic (not enough oxygen in the blood). It is reasonable to let infants become familiar with and comfortable in water, but it is important not to let young children stay in long enough to become hypothermic (low body temperature). Young infants may not be able to let you know they are chilled, so the best thing is to keep them in for short sessions. Once a child has the motor maturity for walking, it should be possible to start real swimming lessons, but expectations must be realistic. Children who are comfortable in water will learn how to swim relatively early, but the most important thing is for them to have fun and be safe.
The chemicals in the pool are drying to anyone's skin, but in proper concentrations they should not pose any risks to children.
Sincerely,
Dr. Warren
P.S., I want to be prepared to watch for it. (I had a baby in March 1995 and she didn't have it.) Thanks.
-AB
Dear AB: According to Nelson's Textbook of Pediatrics the incidence of pyloric stenosis in the general population is 0.02%. If you have a child with pyloric stenosis, the recurrence risk (the risk that another child will be affected) is 3.2% if the affected child was a boy and 6.5% if the affected child was a girl. If a parent had pyloric stenosis, the risk of having an affected child is 24.4% if the mother had it and 4.2% if the father had it. If a child with pyloric stenosis has an identical twin, his twin has a 22% chance of developing pyloric stenosis. So the answer is, there appears to be a hereditary component, but even the twin of a child with pyloric stenosis has a 78% chance of not developing pyloric stenosis. Statistically, the risk is greatest in a first born boy.
If your next infant should have projectile vomiting around 6 weeks of age, an ultrasound study can help establish or rule out the diagnosis. The absence of a palpable olive should not deter a physician from considering the diagnosis of pyloric stenosis in an infant whose symptoms are consistent with that diagnosis.
Sincerely,
Dr. Warren
Thank you
-LV
Dear LV: If your child is going to sleep at night easily but fights sleep during the day, there is no special approach that will take care of the daytime problem. I'd say you should count your blessings for the night time success. A 3½ month old is too young to leave screaming for an hour unless you have to. Since your child goes to sleep well at night, perhaps you should try to approximate his night time routine as much as you can at nap time. This includes making your house as dark and as quiet as it usually is when your baby goes to sleep at night. If your son does wake after going into the crib, try to comfort him without taking him out of the crib so that you won't have to repeatedly cycle between getting him to sleep, putting him in, and then having him wake again.
Sincerely,
Dr. Warren
I realise our son is still quite young, and we should not be concerned at this point. However, this is something that we eventually will want to discourage; do you have any suggestions as to how we should begin? Also, at what point should we begin to view this as a problem?
Thank-you.
Best regards
-AJB
Dear AJB: Thumb sucking is one of those problems that just isn't worth making an issue of at any age. The child has his thumb with him at all times which makes it impossible for a parent to prevent a child from sucking it. Given the number of important things we must teach children, putting a lot of energy into keeping a child's thumb out of his mouth isn't worthwhile. Many children stop sucking their thumbs on their own. The child who reaches school age and still sucks his thumb is usually aware that it is an immature habit and generally learns to be circumspect about letting others see him suck his thumb.
The only approach I can recommend is that when a parent feels it's time for his child to stop sucking his thumb he should tell the child and explain his reasons; however, most children who are young enough to be told it's time to stop sucking their thumbs are too young to be impressed by logic. After that, gentle reminders should be given if the child is seen with a thumb in his mouth. If the child resists stopping or becomes upset, I reiterate that thumb sucking is not an issue worth creating tension about or making a disciplinary issue.
Sincerely,
Dr. Warren
Can I take legal action against this creep?
-CS
Dear CS: Your description of the events does not sound like you would have grounds to sue for malpractice. If the incident occurred in a hospital, you should speak to the director of the department and/or file a complaint with the hospital administrator. The events you described can sometimes occur in acute care facilities or emergency rooms because the physicians are involved with more urgent cases; however, in these facilities, proper triage should make it unnecessary for multiple people to ask why you are there, and if there is a long delay after you are in a room, someone should at least take a minute to tell you why.
I cannot come up with any explanation why you could have had the experience you did in a private office. Given the large number of nurses and doctors you refer to, you should find out who was in charge to seek an explanation and file a complaint.
Regardless of whether you were so poorly treated in a private facility or a clinic, you can contact your state's licensing board to find out how to lodge a complaint of professional misconduct.
Sincerely,
Dr. Warren
Thanks alot.
-Amy
Dear Amy: For some reason I have never understood, some of my colleagues think it is easier for patients to understand explanations which are so over simplified that they become inaccurate, rather than to give accurate explanations of the medical facts in simple English without any medical jargon. I have never heard of sloppy vocal cords and can only guess that it is the doctors sloppy way of explaining gastroesophageal reflux (GER).
All babies spit, some more than others. Because of the rotation of the stomach, the valve between the stomach and the esophagus is not fully competent. The rotation of the stomach changes as the baby grows and spends more time upright. As a result, the valve becomes competent, that is, it does a better job of preventing regurgitation of stomach contents into the esophagus. As a result, toddlers don't walk around spitting up.
As I stated, some degree of reflux is normal in all infants, but severe reflux resulting in significant vomiting and poor weight gain is not normal. GER may not be the only reason for severe spitting. Babies may spit excessively because of formula intolerance. If the baby is actually vomiting, especially if the vomiting is projectile, pyloric stenosis must also be considered. Because of the baby's poor weight gain, some evaluation to determine the cause of the spitting and poor weight gain is necessary.
By adding vegetable oil to the formula, the doctor is trying to increase the fat content to increase the calories of the formula. This is probably being done in an attempt to get the baby to gain more weight. It may be difficult to get the vegetable oil to mix into the formula well. If the baby needs more calories, it may be easier to use a commercially prepared 24 or 27 calorie per ounce formula.
Some babies have a somewhat sunken soft spot, but given the baby's spitting and poor weight gain, since I can't examine the baby to tell you if there is anything to worry about, my main concern about a sunken fontanel would be that it could be a sign of dehydration.
Sincerely,
Dr. Warren
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