16 April 2001

1. Long QT Syndrome
2. Regression in Response to Change
3. No Head Control in 6 Month Old
4. Skin Color
5. Breast Lump in Boy
6. Blood in Stool from Cow's Milk Allergy
7. Growth Parameters
8. Yeast Infection, Early Puberty
9. Disclaimer

• Read Questions & Answers in Another Column

Long QT Syndrome

On both of these episodes, she had the following symptoms:

• High fever
• Cyanosis
• Blacked out
• No involuntary movements
• No spasms

Because cardiac arrhythmias donīt leave any traces on autopsies, and based on a study recently published at the new england journal of medicine, correlating SIDS with LQTS, I have doubts about the diagosis of this episodes. I would appreciate if you could clarify the subject.

Any related bibliography would be more than appreciated.

Thanks.

-Marcelo

Dear Marcelo: The diagnosis of SIDS is made when a "healthy" infant dies and no cause of death can be found. Each time researchers find another possible cause for SIDS, we come a little bit closer to eradicating SIDS, but while a number of deaths previously classified as SIDS may have been caused by prolonged QT syndrome, as long as there are unexplained deaths, the diagnosis of SIDS will be made. Since QT segment prolongation can only be discovered by EKG on a living patient, the diagnosis cannot be confirmed after death, but can only be suspected if family members are found to have LQTS.

The situation you describe is suspicious because benign febrile convulsions are brief generalized convulsive seizures provoked by fever. The absence of tonic or clonic rhythmic movements can occur with some seizure types, but is not consistent with the diagnosis of benign seizure with fever.

As far as I know there is no way anyone can further clarify your situation. You will never know for sure what happened with your daughter. But for your own information and for the benefit of yourself and other family members, you and your spouse should have an EKG done to look for Long QT Syndrome.

Sincerely,
Dr. Warren

My 22-month old child is in what we consider a very forward-thinking, nurturing daycare. Overall we are pleased. When my daughter was 9 months old she was moved into the 1-year-old room because she was doing the things that 1-year-olds do (saying a few words, drinking from a cup, walking, self-feeding with fingers and trying with a spoon). She was estatic and although we were nervous, we now know it was the best thing for her. She is extremely bright. She speaks in complete sentences, (Yes!), counts to 10 (by 1 and by 2), says her ABCs, knows some colors, can identify common shapes, can dress herself and brush her teeth, etc. While we'd like to take all of the credit, my husband and I know that much of this comes from being around children who are between 3 months and 1 year older than her).

Now here's the problem: two months ago her friends (who are now between 2 and 2.5) moved to the two-year-old room. At first my child was fine, but after about two weeks I noticed things that made me quite sad. She misses her friends and would often run to hug them when she'd see them in the hall. They'd usually reciprocate, but it was obvious they didn't miss her nearly as much as she missed them. Lately she had begun acting like a baby (babbling, crawling, whining, thumb-sucking, clinging). The worst part is that she now cries and clings to me uncontrollably in the mornings when I drop her off (unless someone picks her up and holds her until I leave). I know she does these things for extra attention and usually if I ignore her she will stop (except in the mornings - NOTHING HELPS). For example, when she's babbling and pointing, I simply tell her that "I don't understand baby talk. Please speak like a big girl." She gives me a sly grin and begins speaking in complete sentences.

Her current caregivers are helpful in that if a child from the two-year-old room is out on a given day or for a few hours, they take my daughter over there so she can play and learn with her friends. But, I still can't help worrying that being around these babies instead of kids her developmental age is going to hurt her and cause developmental delays. In two months, she will be two but there may not be room for her in the two-year old room (unless the Director adds a caregiver - which she says she's working on). Should I be looking for a new daycare? PLEEEESE HELP! Thanks!

-Kathy

Dear Kathy: Your child's regression is a result of her missing her friends. A bright child does not acquire developmental delays by being with younger children. Of course your child needs some stimulation, but since there is an age range in each of the groups, surely there must be some children close to your daughter's age and/or her intellectual ability. In addition, the caregivers who have had her in their group all this time should have some idea as to what your daughter's intellectual needs are.

Whether or not to consider changing daycare situations depends on what you find in other daycare facilities and what commitments you can get from her current caregivers. Keep in mind that while her current situation may not be perfect, her caregivers are making an effort to put her with her friends when they can and she does have an opportunity to see them from time to time. In a new school her old friends will be completely unavailable, and she will be in unfamiliar surroundings with new caregivers. Of course, if the situation is good, her adjustment to a new place may be easy. I cannot predict.

Sincerely,
Dr. Warren

Thank you.

-Nora

Dear Nora: A 6 month old who has complete lack of head control as you describe has either muscular or neurological problems. Have your baby evaluated by a pediatric neurologist.

Sincerely,
Dr. Warren

-LT, Ed. D.

Dear Dr. T: My comments about non-genetic factors affecting skin color were aimed at helping the grandparent who wrote to me understand that skin color may be related to other factors besides race. Some babies may have increased pigmentation because of exposure to maternal hormones in the womb. This increased pigmentation does not persist. The high red blood cell count in newborns makes them appear much redder than older babies. This may also make the baby appear darker. All of these are moot points when it comes to the race of the child.

Some black babies are quite light skinned when they are born but become darker during infancy. Some Caucasians have darker skin than some blacks. In this country where white is the majority, people tend to forget that the factors which define race include more than skin color and that Hispanics, Indians (from India), and some other dark skinned people are Caucasians. There is a broad range of skin color among blacks just as there is among Caucasians (whites).

All of this misses the point that an interracial child is neither more black nor more white based on his appearance. This is all an issue that depends more on societal attitudes and the parents' attitudes than it does on genetics or skin color.

Sincerely,
Dr. Warren

-F

Dear F: It is fairly common for boys in early adolescence to have breast engorgement as a result of the hormonal changes of puberty. This is not a hormonal problem, but simply the normal course of events for some boys. It does not have to be symmetrical. Some boys may only have swelling of one breast. It is perhaps a bit unusual for the swelling to be as large as you describe without any enlargement of the other breast. Of course, you should get it checked by a doctor to be sure that the swelling is just breast tissue. After 7 months, it is not suddenly an emergency, so you should find a doctor and make an appointment rather than running to an emergency room.

Sincerely,
Dr. Warren

-CT

Dear CT: If the blood in your infant's stool has decreased as expected from following your doctor's advice about eliminating cow's milk protein from your diet, it would be reasonable to wait a little longer as long as your daughter is thriving. If your daughter appears to be in pain, feeding poorly, or gaining poorly, or if the blood persists, you should consult a pediatric gastroenterologist. If your peace of mind depends on it or something doesn't seem right to you, then you should consult the specialist now.

Sincerely,
Dr. Warren

Thank you

-MP

Dear MP: At 33 pounds, your daughter's weight is in the 25th percentile which is the lower end of average. As long as she is eating a reasonable variety of foods that would go against any problem with her nutrition. Even if your daughter's diet is not perfectly balanced, since she is eating enough calories for her weight to be in the normal range, she should have enough calories for normal growth.

At 36 inches your daughter's height is below the third percentile. How concerned you should be about this depends on what her height percentile has been in the past, and what the family growth pattern has been. If your daughter's height has always been below the third percentile but her height gains are steady, there is much less cause for concern than if your daughter is short because at some point she stopped growing or her growth slowed excessively.

Since your daughter's height is below the third percentile, your pediatrician can order a bone age x-ray to determine if there is an abnormal delay. If there is, he may want to check thyroid function or refer her to a pediatric endocrinologist.

Sincerely,
Dr. Warren

Sincerely,
-Frantic Mother

Dear Frantic Mother: Heat does not cause yeast infections, although it may cause increased sweating which may irritate the skin. The moist irritated skin is a good place for yeast to grow. Powder may help with the moisture, but if your daughter is prone to yeast infections, don't use cornstarch. The yeast is a living organism and cornstarch is food. If you feed the yeast it will grow better.

Puberty does not cause yeast infections either. Breast development and pubic hair development before eight years of age is early. Your daughter should be evaluated by a pediatric endocrinologist to determine if there is any medical cause for precocious puberty.

Your daughter's yeast infection should be evaluated and treated by a doctor since she has had a recurrent problem with it. If the doctor cannot clear the infections, your daughter should be evaluated to make sure she doesn't have diabetes or any problems with her immune system.

Sincerely,
Dr. Warren

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