22 January 2001
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
Our 2 month old son has had a problem where during the day he is extremely "fussy" from 11am - 8pm every day. During this period he is VERY gassy, and he seems to be in a great deal of pain while passing the gas. Giving him a pacifier at this point seems to help him get through it, although he still is hurting when pushing. Our pediatrician told us to use Mylicon drops (which only seemed to make his gas even worse), Donnatal (which worked somewhat, but we stopped using after 1 week) and now Mylanta in his formula (Alimentum), which seems to work a little. The Doctor has thus, suggested to go to the specialist as he thinks the baby might have reflux. All this time the baby never throws up, so I don't understand how he could have reflux.
I'm thinking that I don't want to subject my child to the nasty tests that might await him in the specialist's office, especially if this whole colicky period will just go away within the next month or so. I think I'll cry if I see what I've heard they do to these children trying to see just what the problem is.
Do you think its worth it to have the testing done, or should we just hold out and deal with his crying spells over the next month? I want what is best for him and it's killing me to make this decision...
Thanks so very much in advance for your timely response and consideration!
-A Worried Dad
Dear Worried Dad: It is possible to have reflux without vomiting. Adults do. As a result they have discomfort (heartburn). Symptoms with reflux can vary from spitting, to coughing and wheezing, to irritability.
If you go to a gastroenterologist, it does not necessarily mean that your baby will have any procedures done. Reputable physicians don't do unnecessary procedures. The gastroenterologist will examine your baby and evaluate the symptoms to determine what the problem is. If he feels any diagnostic tests are warranted, he will explain why. You can inquire about any recommended procedures to find out about the risks, alternatives, risks of not doing the tests, and what sedation or anesthesia will be used. You are not obliged to consent to any procedure and should not consent to any until you are satisfied that you understand all the reasons for doing it and any associated risks.
Sincerely,
Dr. Warren
The good news is we've been about to decrease his mineral oil (at first it was 2 Tablespoons, twice a day) to 1 tablespoon a day. (We tried to reduce the mineral oil but we went for 5 days without a BM.) He's not as fearful as he was. And he has a BM every 2-3 days. We're toilet training... but he won't have BMs on the potty. We never force the issue -- because we're afraid he'll go back to his pattern. If he has to go, we offer to take him to the potty but when he asks for a diaper, we put one on him so he'll go.
How do we get him over the hurdle? He's doing better but I don't see any end in sight for the mineral oil. Are there any medical conditions that would cause him to withhold?
-JFT
Dear JFT: There are medical conditions which can contribute to constipation, but stool withholding is a purely voluntary response of a child who finds the process or sensation of having a bowel movement painful or terrifying. No logic can get past the child's immediate response to his sensation or fear. Children speak the language of their parents, but not the logic.
Unfortunately there is no magic formula to get over the hurdle, but most children eventually get there with encouragement, patience, and soft stools. It is absolutely crucial to keep your child from becoming constipated in order to ever get to the next step; therefore, don't rush to cut down on the mineral oil.
In the meanwhile, since your son is willing to have bowel movements in a diaper, and asks for the diaper to have his BM, encourage him to sit on the potty with his diaper on so he can get used to having a BM in the sitting position while he still has the security of his diaper.
Sincerely,
Dr. Warren
Thanks
-RW
Dear RW: The rib cage of a 3 month old is much more flexible than an older child's rib cage, and so may appear to suck in on normal respirations, especially if the infant has a pectus excavatum (an inward curvature of the ribs at the breast bone). Most infants breathe very rapidly if they have any respiratory problem.
On the other hand, a small infant may experience mild respiratory difficulty from something as minor as a stuffed nose. If your infant appears comfortable, there is probably nothing to be concerned about; however, since I cannot see your infant, I would have to advise that if the baby really appears to be retracting, you should bring it to your pediatrician's attention.
Sincerely,
Dr. Warren
-Concerned Mom,
Kim
Dear Kim: The green color of the stool is of no significance. The clay like consistency results from the fact that the longer stool sits in the rectum, the more water is absorbed from it and the harder it gets. That is the basic mechanism for constipation. If your daughter had always gone long times without bowel movements, there may be a need for medical evaluation to rule out a congenital cause such as Hirschsprung's Disease. If the constipation is recent in onset, you should make note of any change in the baby's diet which may have precipitated the constipation.
As a general rule, it is best to let the baby develop her own natural rhythm for bowel movements. It is not a good idea to constantly stimulate the rectum to induce bowel movements. If the baby becomes uncomfortable and is struggling to have a bowel movement, then stimulation with a lubricated thermometer or swab may help. If the baby can't have a bowel movement in spite of stimulation, you can try Babylax, a liquid glycerin which comes in a little squeeze bottle and is inserted into the rectum just like an enema (but is not an enema).
You should also continue to try to keep your baby's stool soft by giving the prune juice regularly. If that does not help, you may need to discuss other stool softeners or perhaps a diet change with your pediatrician.
Sincerely,
Dr. Warren
Silje had urine infection many times in spring '97. In Sept. it showed a meatalstenosis. She was admitted to children's surgery ward for a cystoscopy and blockage. The surgery was performed in Oct. '97 and it did not work out. She is still suffering a great deal with pains and high fever just about every week or two. She is now on Furadantin and/or Penn. for almost a year. Is there anything else other than antibiotic she can take? What kind of procedure she could have in the U.S. without being put to sleep or surgery? Please give us some advice, quick. Thank you.
-AM
Dear AM: No physician can advise you on further management of your granddaughter's urinary tract problem without further evaluation of her urinary tract. She should be fully evaluated by a pediatric urologist including urodynamic studies to determine if there are any abnormalities of bladder or sphincter function which might respond to medication or if any additional surgical procedures are warranted.
Sincerely,
Dr. Warren
Thank you
-LG
Dear LG: I hope this e-mail finds you well. I apologize for the delay in response, but my e-mail link did state that I was away on vacation and not available to answer questions. Unless your web browser displayed an old page, you had to bypass that information to send your e-mail.
Viruses can cause sore throats and make you feel quite ill. Since viruses do not respond to antibiotics, your doctor correctly advised you to discontinue medication when your throat culture turned out to be negative for strep. Your impression that the medication was helping you may be the result of the fact that your virus infection was following its natural course and improving in spite of the antibiotic rather than because of it.
While most viral sore throats get better in a few days without intervention, mononucleosis can last much longer. Rarely, a peritonsillar abscess can develop from a viral sore throat. Peritonsillar abscesses do require antibiotic treatment. If you're not getting better, you should see your doctor again.
Sincerely,
Dr. Warren
-LW
Dear LW: You may be having difficulty finding information about Hirschsprung's disease if you are using a search engine that is picky about spelling. In fact, I have a book that spells it one way in the index and another way in the text, but I believe the above spelling is correct.
The diagnosis is generally made in early infancy because of severe constipation resulting in a megacolon (enlarged intestine filled with stool). Hirschsprung's disease causes symptoms because a small segment of lower intestine lacks innnervation and therefore does not move. In the absence of normal intestinal movement, stool is not propelled forward down into the rectum. This acts as a functional obstruction, i.e., the intestine is not actually obstructed, but since the stool is not moving, it seems like it is. Hirschsprung's disease does not develop later in life. One must be born with it. It is generally diagnosed in early infancy. Treatment is surgical, involving removal of the abnormal intestinal segment and pulling the normal intestine down into the anus through the rectum. Successful surgery leads to normal bowel function; however, some patients may become incontinent for stool after the surgery.
Sincerely,
Dr. Warren
She doesn't have a fever, and seems to be eating well (we nurse her -- we have introduced some food once/twice a day), and she seems generally happy, alert and happy.
Our pediatrician said we should just keep an eye on it. I was wondering if you could provide some better info on what this might be.
Thanks in advance.
-EH
Dear EH: From your description, it is hard for me to tell whether there is a cyst or swelling in your infant's breast, or if the infant has some swelling of breast tissue. Since your doctor has examined the baby, you should get some clarification from him as to what he thinks the swelling is.
It is fairly common for newborns to have swelling of breast tissue when they are first born because of exposure to mom's hormones in the womb. This breast swelling may sometimes persist well into the first year an beyond and may change in response to estrogen (the female hormone); however, it is not generally red and does not change size significantly in a short period of time (as is implied in your statement that the lump alternately swells and contracts).
If the baby has a cyst in the breast which is not very large and is not infected, it is okay to leave it alone. If the baby has a progressively enlarging lump, it requires attention. If the swelling is breast tissue, it will probably shrink over a period of time, but your pediatrician, who has seen it, is in the best position to tell you if further evaluation is needed.
Sincerely,
Dr. Warren
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