11December 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
Thank you and regards.
-JJ
Dear JJ: Please try to be very patient with your 1 year old. Having a new baby in the house is a big adjustment for him. He is still a baby himself and a bit young to be truly disciplined. You must have realistic expectations about what you can expect from him. Try to ignore his noise when his demands are inappropriate, but try to get to his needs as soon as reasonably possible. If possible, talk to him while you care for your new baby. If you must, put him in his room or a playpen to keep him out of harm's way or your way. Try to have him participate with you when you care for the baby so that he doesn't have to compete for attention. Have him help you when he can. Have him get you things you need when you care for the baby. Praise him for helping and he will feel special. After having a baby, and having to take care of the baby, I know you are tired, but make an extra effort to find some time just for your older baby. His need for your attention did not diminish just because you need time for the newborn.
Sincerely,
Dr. Warren
-PK
Dear PK: Most drug reactions are not confined to just one location of the body. While drug reactions may not be totally symmetrical, they almost always cross the midline. Sulfonamides like Septra can often cause rashes, but under the circumstances, I doubt that the rash is a medication reaction. Unfortunately, I cannot be sure since I haven't seen the rash. As to making a diagnosis by e-mail, most rashes need to be seen in person to be diagnosed. It's even often difficult to make a diagnosis from a photograph, but if you can send me a digital picture by e-mail, I would give it a try. If there are no pediatricians where you live, how about seeing a dermatologist?
Sincerely,
Dr. Warren
Any advice on what to do? Thanks.
-LF
Dear LF: While most boys have started puberty by 15 years of age, the normal range for starting puberty is up to 16 years. The first sign of puberty is enlargement of the testicles, which may not be obvious to you unless you are looking at your son's genitals. Once the early stages of puberty start, you can be certain that the later stages will follow. Rapid growth does not occur until mid puberty, at which time the young man has adult sized genitals (penis and testicles) and a significant amount of pubic hair, although not necessarily any body hair.
Prior to puberty, the testosterone level is low. The testosterone level rises as puberty progresses.
I am not sure from your statement that your son "has shown little signs of puberty" whether you mean that there is some evidence that puberty has started, or there are no signs of puberty. If your son has started puberty, you need only be patient and it will progress. If your son hasn't started puberty, he is not yet delayed. If he is not distressed by being a late bloomer, you don't need to do anything at this point. If it is having an adverse affect on him, you should consult a pediatric endocrinologist.
Sincerely,
Dr. Warren
She appears to be fine. There is no discharge of any type from this hole even though it appears quite deep and blood tests have shown no infection. In all other ways she appears to be a fine healthy female infant. Her development and motor function distal to the area in question appear normal for her age. If you can shed any more light on this it would be much appreciated as our concerns are not being answered locally.
Yours truly,
-GE
Dear GE: If the hole you are describing is about the caliber of a pinhole and is located just below the tailbone at the top of the crease between the two buttocks, it is a pilonidal sinus. Pilonidal sinuses do not cause any problem unless they become obstructed and form a pilonidal cyst. If a pilonidal cyst becomes infected it requires surgery.
If that is not what you are describing, I would need more details to figure out what you see.
Sincerely,
Dr. Warren
Thanks,
-Jenny
Dear Jenny: Cellulitis is an infection which spreads out in the skin. There may be some degree of cellulitis associated with an abscess, but a lump with pus is a boil or abscess, rather than cellulitis. The distinction is important because the treatment of an abscess is drainage. A small abscess may resolve without drainage by treating with antibiotics and hot soaks, but once an abscess has come to a head, it should be drained.
Some children may be more susceptible to skin infections than others, but if she has many skin infections there may be reasons to consider evaluating your daughter's immune system. The fact that she developed cellulitis from chicken pox does not really suggest an unusual problem since secondary infection is one of the risks of chicken pox.
Sincerely,
Dr. Warren
-TL
Dear TL: Because the American Academy of Pediatrics recommends keeping babies on formula for a year rather than giving cow's milk, many parents who follow their pediatrician's advice on the subject have the mistaken impression that their children are not being exposed to cow's milk when they eat formula. Milk based formulas like Enfamil and Similac are made from cow's milk, but they are made to be more like human milk by adding carbohydrate and other vital nutrients. It is not that cow's milk is dangerous to infants, but cow's milk has a higher protein and salt content than human milk. Nursing is the best food for infants to grow on. By making formula as close to human milk as possible, formula provides the best mixture of nutrients for infant growth for infants who don't nurse. However, infants who are fed milk based formulas are getting cow's milk protein. Only soy formulas and special hypoallergenic formulas are devoid of cow's milk protein.
In the old days, before formulas were available, mothers who didn't nurse made formula for their babies by mixing Carnation evaporated milk with water and sugar or corn syrup. Today's Carnation formula is much more sophisticated and provides complete infant nutrition just like other brand name infant formulas. Carnation formula is perfectly good to start infant feedings with even in the newborn period if a mother chooses not to nurse.
Sincerely,
Dr. Warren
-Suzie
Dear Suzie: If your son didn't lose consciousness and is acting fine, and the doctor found nothing on examination (I assumed you saw a doctor since you had a skull x-ray), then there is no need for additional testing. You should watch for vomiting, irritability, sleepiness, seizures, or a significant change in behavior to suggest a need for further evaluation.
Sincerely,
Dr. Warren
I got the chicken pox on 6/12, it IS A MILD CASE, although I HAVE to go to a Washington D.C. trip that cost $1930, scheduled for 6/17. I really do have to go on that trip because I'd feel horrible if I wasted their money. (it's too late to get their money back, so I need to go). But anyways, I wanted to know:
-Keeping in mind that it's a mild case:
Sincerely,
Nathan
AGE 14
Dear Nathan: Four days of fever before any spots develop would be an unusual course for chicken pox, but if you have a very mild case, you might not have noticed the first few pox. I guess you weren't too sick if you were in school. The course of chicken pox is usually about one week. If a person has a lot of pox, he is usually sicker and stays sick longer. Someone with a small number of pox usually recovers faster and isn't as sick. Once all the pox have blistered, opened, and scabbed, it is no longer contagious, and even though there may be marks remaining, the illness is over and the person can go about his business. Based on what you have told me, I would anticipate that you would be over the chicken pox by Wednesday, but I cannot promise that. The only treatment that shortens the course of chicken pox is a prescription medication called Zovirax. In order to make a difference, it has to be started at the beginning of the illness. I usually recommend it for teens who develop chicken pox, but not for healthy children who don't tend to get as sick. If you have a mild case, you were lucky. At this point, I wouldn't consider it beneficial to take Zovirax. The illness just has to run its course.
Sincerely,
Dr. Warren
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