6 November 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
But now he is having continuous fever for the last 16 days ranging from 98.5 to 100.5. We have done TLC/DLC test, Routine urine test and Chest X-Ray test and found all the reports perfect except (Lymphocytes 80% and Neutrophils 10%). Doctors are expecting Viral Fever with mild Throat infection. Although most of the viral takes 5 to 7 days. They have prescribed Antibiotic (First 5 days cephalexin oral drops 125 mg, next 5 days cefaclor oral drops 125 mg) along with Antipyretic (SOS). On slightly progress from the 3rd day we withdrawn all medicine. After that he use to have normal temperature for 12 Hours in a day , rest of Hours his temperature rises from 99 to 100.5 and some time we have to provide antipyretic drugs to reduce his temperature.
His activities are normal. He is not having any cough. His diet has reduced. These days here mercury raises up to 38 deg cen.
Now my question is does above fever is related to g6pd deficiency? Why and what type of fever he is having? What pathological test should be performed?
I hope you will reply at your earliest to save my Son.
Thank you. Yours sincerely,
-SK
Dear SK: Temperatures under 100 degrees F are considered normal. Temperatures to 100.5 are minimal elevations at best. There is no need to treat with antipyretics for this minimal elevation. If your outdoor temperature is 38 degrees C, your infant may be running mild fevers from being over heated and possibly mildly dehydrated. Make sure your baby is dressed very lightly and drinks adequate fluids. If his appetite is decreased you may need to offer him some electrolyte solution (Pedialyte or Kaolectrolyte) in place of some of his formula feedings to be sure he does not become dehydrated.
The lymphocyte percentage or 80% suggests a viral infection, but since you didn't tell me the total white cell count I cannot comment on the full significance of it.
I see no reason that the fever would be related to G6PD deficiency. There are many causes of prolonged fever, but I am not sure that your son has actually had a prolonged fever. Unless he has had persistent temperatures of 100.5 F or higher, or at least most days with such an elevation, he has not had a prolonged fever. If your son has had prolonged fever and had evidence of a throat infection, your doctor might want to test for mononucleosis or Epstein -Barr virus.
Sincerely,
Dr. Warren
-MA
Dear MA: Without seeing your baby's red mark, it is difficult for me to know what kind of mark it is. The biggest concern would be a port wine stain which can cover the forehead, cheek, and jaw on the affected side. When the port wine stain covers the forehead, there is a greater risk that there may be some involvement of the nervous system, so these children should be evaluated by a pediatric neurologist. Port wine stains do not go away, but they can be treated successfully with laser when the child is older.
Sincerely,
Dr. Warren
-LC
Dear LC: If I had to guess, I'd say fruit is more likely to make stools watery than cereal, but with young infants who have no prior experience with food, only eliminating possible offenders from the diet can tell you. If your baby is gaining weight well and has only one watery bowel movement per day, he may simply have an irritable bowel. As long as he is happy, eating well, and gaining well, I would not look to do a great deal diagnostically or therapeutically about it.
If your baby's sleep pattern has been affected by food intolerance, the only way to tell would be to stop feeding the food you suspect. I cannot be sure why your child slept better when he had a cold. It may be that the cough medicine actually helped him sleep. I think you have to be realistic about what you can expect from a 4 month old. They can learn to go into their cribs awake and to go back to sleep without being fed, but that doesn't guarantee that the child won't wake at all. If you get your son back to sleep in 10 minutes or less with little intervention, I think that you have accomplished all you can reasonably expect with a 4 month old.
Sincerely,
Dr. Warren
Please e-mail me and thank you for your time.
-SD
Dear SD: Hashimoto's thyroiditis is an inflammation of the thyroid gland. Initially it causes enlargement of the thyroid because of the inflammation. If the thyroid gets progressively larger, it may be helpful for the patient to be treated with thyroid hormone. After the inflammation resolves, there is a risk that the patient could become hypothyroid. For this reason, thyroiditis patients should have periodic blood tests to check their thyroid functions. If a patient becomes hypothyroid, that would require lifelong treatment with thyroid replacement hormone. If the thyroid functions remain normal, even though the gland may remain somewhat enlarged, there would be no other consequences to having Hashimoto's thyroiditis.
Sincerely,
Dr. Warren
He seems to do this fairly regularly (once a day at least). It doesn't seem to bother him in the least and he continues about his business of playing without even really noticing it.
Does this need to be evaluated or could it be no cause for alarm?
Thank you.
-JM
Dear JM: Your son's full body shiver probably occurs in response to urinating. If not, it's just something he does.
Sincerely,
Dr. Warren
Now that I have got him home from the hospital, I want to put him back in. My problem now is that he's very fussy. He is up every hour and a half to feed but only takes an ounce or so. He also rarely sleeps through the day. In a twenty four hour period I would be surprised if he got more than five or six hours sleep. My question was, could his problems at birth have any thing to do with the problems he's having now. If so what can we do to soothe him, and make him sleep better and longer. I'd really appreiciate any information you can offer.
-Donna
Dear Donna: It is possible that either low blood sugar or extremely high jaundice could have had an adverse effect on your infant, but if the bilirubin level was not high enough to require exchange transfusion and the low blood sugar was not prolonged, it may not have any bearing on your infant's poor sleep patterns. Same comment regarding the baby's pallor and low blood pressure at birth. When we look at children who have subtle neurological problems or developmental delays years after their births, many of them have had perinatal experiences such as low APGAR scores, low blood sugar, or severe jaundice, which may damage an immature and developing nervous system. But we also see children who have similar birth histories who have no evidence of problems. With regard to irritability and poor sleep patterns, children with neurological problems may be more likely to be irritable and have disorganized sleep patterns, but some normal children may also take a long time to settle into a comfortable pattern.
Since your son was premature and had several perinatal problems, he may be at risk for developmental problems. This does not mean you should be alarmed or worry constantly about the future. I was 4 weeks early and weighed 4 lbs. 14 oz. at birth. However, it would be wise to have your child evaluated periodically in a developmental clinic in order to avail yourself of any early intervention services should they be needed.
Whether or not factors surrounding your son's birth could contribute to his poor sleeping, your question about dealing with him is the same question I get from many mothers of high needs infants. Some people get lucky and have an infant who sleeps 22 hours a day, wakes only for feedings, and as he gets older seems to enjoy every waking moment. Unfortunately, many young parents enter parenthood with the idea that that's what dealing with a baby is like, and it's a rude awakening when they discover that they have sleepless nights, feeding difficulties, and sometimes their best efforts at soothing the baby don't work. All of us who have had children have spent some time walking the floors with a screaming baby. But with high needs, overly stimulated infants, the screaming can be constant and dealing with them becomes overwhelming. When parents have passed the point of exhaustion and their nerves are frayed, they cannot effectively soothe their infants. Often their efforts at soothing are acts of desperation rather than calm and purposeful. It's hard to have a gentle voice and a soothing touch when every muscle in your body is tense as you pray that this will finally be the moment when you get a few minutes peace. There's really only one answer when it reaches that point. Get help. Take shifts caring for the baby. Get aunts, uncles, grandparents, neighbors, and friends to help out. Hire help if you can. Get some time for yourself. Get rest. Take care of your own needs and your other responsibilities so that the time you spend with your baby can be devoted wholeheartedly to him. Then, if you need to spend 3 or 4 hours at a stretch just comforting him, you can do it and have the gratifying feeling that comes form meeting his needs. He may always be a high needs baby, but eventually the constant demands of this early part of his life will pass. If you take care of yourself, in the end you will do a better job of taking care of him. Do not let any mistaken notion that your success as a mother depends on doing this alone. Get the help you need. Your son will thank you for it.
Sincerely,
Dr. Warren
-MC
Dear MC: Local reactions to insect bites are not usually related to allergy. If there is itching and swelling cool compresses and hydrocortisone cream may help. If there is painful swelling and pus, those are signs of infection which require medical attention. If she does have an allergy to insect bites, an antihistamine like Benadryl may help to decrease her reaction. If she has any medical conditions or is on other medications, you should check with her doctor before giving her an antihistamine.
Sincerely,
Dr. Warren
-Sheri
Dear Sheri: If your son goes back to sleep easily and quickly there is probably nothing else you can do. A white noise machine may help prevent outside stimuli from waking your son, but if he is waking in response to internal cues, you really can't prevent him from waking. When he gets older, he will be able to deal with the waking without crying or needing your intervention. My son cried out at least once a night to be covered until he was 6 years old. If we didn't cover him he wasn't awake enough to deal with it himself, but he wasn't asleep enough to fall back to sleep. Since we were awakened by him, it was just simpler to cover him and go back to bed.
Sincerely,
Dr. Warren
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