19 February 2001

1. Sleep Position and GER
2. Don't Go to ER for a Rash
3. Extra Vaccine Doses, Forged Documents
4. Excess Gas
5. Decreased Growth
6. Tongue Tie
7. Thumb Sucking - Is it Worth Battling?
8. Zoning Out vs. Seizure
9. Disclaimer

• Read Questions & Answers in Another Column

Sleep Position and GER

Thank you,
-Megan

Dear Megan: If you suspect that your infant has reflux, you should have him evaluated by a pediatric gastroenterologist. With appropriate treatment, you may not need to keep your infant upright to sleep. Of course, since he sleeps well at night lying down, it may not be due to reflux.

Sleeping in a seat should not cause a problem for the baby, however, try to find the angle that is as close to flat as possible and still tolerable to your infant so that his head won't hang all the way to the side. If your baby does have reflux and cannot sleep comfortably lying down, you might also look into a sling type cradle for the crib which holds the baby semi-upright and supports the head such as Nature's Cradle by Infant Advantage.

Sincerely,
Dr. Warren

-SA

Dear SA: Hospitals and Emergency Rooms are for emergencies. Finding out what a child's rash is isn't an emergency. You don't want to sit in an emergency room for a rash. See a pediatrician to find out what her rash is if it persists.

The rash of chicken pox can develop about two weeks after exposure. It consists of red ovals with water blisters on the ovals. The blisters open, crust, and scab. Within a day or two, all the stages of the rash can be seen on the body. There is no special treatment for childhood chicken pox and so diagnosis is not urgent. It is highly contagious. The hospital would not appreciate it if your daughter came there with chicken pox.

Sincerely,
Dr. Warren

Here is the deal. It's a long story but I will try to make it short. I am 17yrs old and I was abused terribly as a child, and I did really bad in school, got bad grades, and dropped out in 10 grade. I was never really part of mainstream society. I was always isolated and maladjusted due to my parents poor parenting skills. I dont want to be an outcast. I want to go to a good college. So I am going to go into another high school district and pretend to be 14yrs old. So I am going to lie about who I am. I'm going to tell them that I never went to school and I'm starting from 9 grade. That's why I gotta get new immunizations under a different name. I'm probably going to retake the immunizations.

So, basically my main 2 questions are:

1) Are there any risks to retaking immunizations?

2) What shots are required for public high school?

-Zack

Dear Zack: All vaccines have risks. The risks are small, and they are justified by the benefit provided by giving immunity to serious diseases. You can't overdose on vaccines, so there is no particular risk associated with having an extra dose of vaccine except that each dose of a vaccine carries certain risks, and taking an unnecessary vaccine is taking an unnecessary risk.

To enter school you will need proof of immunization against diphtheria, tetanus, measles, mumps, rubella (German measles), and polio. For more information about the kinds of reactions each of these vaccines can cause, check the CDC's immunization information site at http://www.cdc.gov/nip/.

Since you've thought your plan out far enough to realize that you'll need proof of immunizations to enter school, have you also thought about the fact that you'll need a birth certificate and proof of residence in the school district in order to register? Since you won't have any school records, how will you explain your entry into school in ninth grade? A fourteen year old is a minor. You can't just go to school and register. Your parents have to go.

Okay, lets assume that you've thought of all that and have figured out how to get around all this with tricks, lies, and forged documents. You say you don't want to be an outcast and you want to go to a good college. Are you prepared to live the lie you're creating for the rest of your life to accomplish that. Let's suppose you graduate from high school and apply to college. Your diploma will be under your assumed name. Now to apply for financial aid you need a social security number, and unless you can prove that you've been supporting yourself, your parents' tax returns. You can't just apply to college and say, "I know my high school diploma says I'm Joe Blow, but I'm really Zack!" Every application you fill out for school or employment will ask you to sign attesting that the information you provide is true to the best of your knowledge. Every application will require official documents like your social security number and proof of identity. The bigger this lie gets, the closer it comes to catching up with you. If you get caught, you lose your job, your financial aid if you're still in school, and your degree may be voided. If you get financial aid with forged documents and false applications, you may even be convicted of a crime and go to jail. Is this how you want to improve your life?

You can't build a good life on a lie. At 17, your school district is still responsible for you. Make an appointment with the guidance counselor in your high school and explore your options.

Sincerely,
Dr. Warren

What should I do?

Thanks

-Shirley

Dear Shirley: If your grandson is not having abdominal pain or diarrhea, I'm not sure that there is any intervention which can make a difference. Your grandson should make sure he has a bowel movement prior to going to school. If he is constipated he is likely to have more of a problem with the urge to pass gas. Make sure he eats adequate fiber and doesn't consume excess sugar. At 10 years of age, he should exercise some control and go to the rest room if he has a lot of gas. He should eat slowly so that he doesn't gulp and swallow air. A medication like Mylicon may help.

Sincerely,
Dr. Warren

Regards,
-BW

Dear BW: Standard growth curves usually have percentile guides at the 3rd or 5th percentile, the 10th percentile, 25th percentile, 50th percentile, 75th percentile, 90th percentile, and the 95th or 97th percentile. It would be unusual for a physician to report growth as being on the 15th or 1st percentile, which leads me to question whether the information was fully understood. While I'm happy to try to answer your question, since the doctor pointed out the decrease in growth, what did he say it meant? Since he has the baby's entire growth history in front of him, he is much better able to judge the significance of this change. In addition, growth parameters include both height and weight. The significance of the change depends on whether the problem relates to height, weight, or both.

If the baby's growth has been normal up to this point, the only action that should be taken is to get several more measurements, perhaps at closer intervals than the routine for healthy infants, in order to determine if there is a problem. If the height or weight is at the 1st percentile, that is below the normal range, but doesn't necessarily imply a problem if the growth continue along that curve. Family growth patterns must also be taken into account to determine the significance of the decreased growth. So must changes in the baby's diet and activity level.

There are many causes for poor growth. While several of them relate to endocrine glands (the glands which produce hormones), there isn't one hormone which treats all problems. Before any treatment can be instituted, a diagnosis must be made. Before a diagnostic workup is started, a decision has to be made whether or not testing is necessary. This is done by getting a few more measurements to determine if there is a growth problem. If there is a growth problem, prior to complex testing for gland disorders the doctor might order a bone age x-ray, urinalysis, urine culture, routine blood chemistries and thyroid levels. If these are all normal or the bone age is profoundly delayed, then the baby should be evaluated by an endocrinologist. If any tests or findings on examination are abnormal, treatment or evaluation by the appropriate specialist will be determined by what the abnormal findings are.

Sincerely,
Dr. Warren

-Cara

Dear Cara: The role that tongue-tie plays in infant feeding problems and speech problems is controversial. There was a time when tongue-ties were routinely cut in the nursery. I would say that it would have to be a fairly severe tongue-tie in order to prevent a baby from nursing, but it may have contributed to the problem you had with nursing.

At this point treatment would require the services of an oral surgeon and may require general anesthesia; therefore, I wouldn't do anything about it unless the tongue-tie were presenting some problem for your son. Unless the dentist feels it is adversely affecting the development of his teeth, the only significant problem I can foresee would be related to speech. If his speech is clear, I wouldn't be concerned, but if it is not, have your son evaluated by a speech pathologist to determine if restricted movement of his tongue is affecting his speech.

Sincerely,
Dr. Warren

-S

Dear S: Given the number of battles parents will fight with their kids in the process of civilizing them, I always advise parents to choose their battles wisely. That means deciding how important something is to you and/or your child, being realistic about what you can hope to accomplish and what price you will pay to accomplish it (constant battling makes for an unpleasant and often unsuccessful parent-child relationship), and deciding what strategies might accomplish your goal besides disciplining your child or imposing your will on her.

With regard to thumb sucking, since the child always has his thumb with him and has complete control over whether or not to suck it, if it becomes a battle to stop your child from sucking his thumb, it becomes a difficult battle to win. At 2½ years of age, your child may derive considerable comfort from sucking her thumb and may be quite miserable if she were forced to stop. Keeping in mind that most children stop on their own, you have to decide if this is a worthwhile battle. Included in the equation is just how much your daughter's mouth is being affected by her thumb sucking since at this age her permanent teeth are not yet in. You have to take into account your child's personality in making the decision. If every time you say "Take your thumb out of your mouth" she complies and it's no big deal, it's worth keeping after her at this point to extinguish the habit. Maybe gently taking her hand out of her mouth and distracting her will help. Making a game out of it could put some humor into an otherwise stressful situation. The awful tasting stuff may discourage your child from sucking, but if her need to suck is strong enough, she will do it anyway and develop a tolerance to the taste. If that happens, you will need to know if there are any potential risks to ingesting a lot of the bad taste material.

Sincerely,
Dr. Warren

Thank you so much for your help.

-Mr. & Mrs. M

Dear Mr. & Mrs. M: There are many kinds of seizures. They don't all involve falling over or twitching. By virtue of the fact that your daughter appears slightly disoriented when she snaps out of her episodes, her zoning out could be a form of seizure. It may not be, but if it is, it is treatable, and treatment will lead to a better school and social experience. You should have your daughter evaluated by a pediatric neurologist.

Sincerely,
Dr. Warren

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