25 December 2000
Check these Safety Tips for the Holidays from the American Academy of Pediatrics.
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
My question is in two weeks we are going to Myrtle Beach for vacation. My son loves to play in the water, but refuses to wear any type of ear plug or head band, etc. Is there any reason to be concerned if he gets the ocean water in his ears? We are usually very cautious, but I don't want to take any chances.
Please let me know what your suggestions are.
Thank you.
-SF
Dear SF: I am glad that you had such great success with your son's tubes, but I do have some concerns. Tubes are not generally intended to stay in the ears almost 2 years. The longer the tube stays, the greater the risk that the drum won't heal after the tube comes out. There are times ENT surgeons insert permanent tubes which then have to be removed surgically. Whether or not the tubes are permanent, most surgeons will want to see the child for periodic follow up until the tubes come out.
If the tubes are functioning, you child cannot immerse his head in water without ear plugs since he may experience pain and develop an infection if water enters his middle ear through an open tube. A splash of water is much less likely to cause a problem.
Sincerely,
Dr. Warren
-Sandy
Dear Sandy: According to the Denver Developmental Scales, only 25% of 2½ year olds can name one color, therefore, your daughter's lack of mastery over colors is normal for her level of language development. Color blindness is extremely rare in girls, and since it is usually genetic, occurring predominantly in males, you would expect to find color blind men on both sides of the family in order for you daughter to be color blind.
Sincerely,
Dr. Warren
-Linda
Dear Grandma Linda: Most infants will bear weight on their legs briefly even in the newborn period. Many older infants love to bounce on their feet when being held up. But some infants instinctively withdraw their legs when their feet touch a surface rather than extending them and bearing weight. There is no reason to be concerned about an infant who doesn't want to bear weight on her legs at 5 months as long as she has normal movement and muscle tone in her legs. If she CAN'T bear weight because her legs are floppy, then she needs a neurological evaluation.
Sincerely,
Dr. Warren
-Barb
Dear Barb: Bleeding from the breasts is not part of normal adolescence nor is it part of the menstrual cycle. The bleeding may be something as simple as cracked nipples or a rash which may be treatable with cream. Will your daughter let you look at her breasts so that you can see if the skin is inflamed?
Your daughter may be fearful of going to the gynecologist because she anticipates a pelvic exam. Perhaps this is a problem which can be taken care of by her pediatrician. If the pediatrician suspects anything more serious which requires a more complete gynecological examination, he can make it clear to your daughter why it is necessary.
Your daughter should see a doctor, unless you can be sure that there is nothing more than a minor skin irritation which you can treat. Since she is only 15, you must make it clear to her that she can choose which doctor she will see, but she has no choice about going.
Sincerely,
Dr. Warren
-Rick
Dear Rick: Since a significant portion of the sense of taste comes from smell, your friend should have her nose and sinuses checked to make sure she doesn't have an infection causing the foul taste. She should also have her dentist thoroughly check her mouth and teeth to be sure that the source of the metal taste isn't coming from there.
Persistence of a bad taste in the mouth could be related to intestinal or stomach disease and to lung infections. If the metal taste has been bothering your friend for a long time, a complete physical is in order.
Sincerely,
Dr. Warren
He is two months old.
What exactly would I look up to see how often this occurs in infants, how many surgical procedures have been performed and the success rates of them?
Could you please lead me in some direction?
Thanks.
Also she mentioned something like microphaly. What is this?
-Deb
Dear Deb: The term you are interested in looking up is craniosynostosis. The skull is composed of multiple plate like bones. The non-movable joints between them are called sutures. When a baby is born, the sutures are open allowing the bones to overlap for easier passage through the birth canal. The skull does not become one solid bone until complete fusion of the sutures which occurs by 6 years of age. Premature fusion of any of the sutures is called craniosynostosis. If there is premature fusion of all the sutures, the head cannot grow normally, resulting in a small head, which is called microcephaly. Since microcephaly caused by craniosynostosis does not allow adequate room for the brain to grow normally, it must be repaired to prevent neurological damage. If one or more sutures fuses prematurely, but not all the sutures are prematurely fused, the head can only grow along the open sutures resulting in an odd shape to the head. While the head growth allows for brain growth, the odd shape still puts pressure on the brain.
Surgery to repair craniosynostosis is performed by a neurosurgeon. The procedure does not involve any surgery on the brain, but the skull must be opened, therefore it is a major procedure which involves the risks of general anesthesia and the potential for central nervous system infection.
Sincerely,
Dr. Warren
Yours Sincerely,
Suzie
Dear Suzie: I have seen many children after head injuries who concerned me who later turned out to have an infectious illness causing their vomiting or lethargy. I suspect that is the case for your child. Temperature control is handled by the hypothalamus. I can't imagine a head injury reaching the hypothalamus without seriously injuring other brain structures resulting in neurological symptoms and findings on examination. If you believe that your son's initial examination was inadequate, then you should have him checked by another doctor. In addition, after 7 days on antibiotics for a "chest infection" your child should no longer be febrile, so it sounds like some further evaluation is warranted.
Sincerely,
Dr. Warren
-J
Dear J: Bright red blood on the toilet paper with no blood mixed in the stool or in the toilet bowl is generally anal bleeding. Anal bleeding usually comes from hemorrhoids or a fissure. One possible cause of abdominal pain and a fissure would be constipation. Chronic constipation might even result in hemorrhoids by 11 years of age. However, there is no reason for a healthy 11 year old boy to have either a fissure or hemorrhoids, and he does complain of abdominal pain. You are probably right that it is nothing serious, but it should at least be checked.
Sincerely,
Dr. Warren
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