30 April 2001

1. Paternity Question
2. Soda for Young Children
3. Peeling Fingers and Toes
4. Recurrent Canker Sores
5. Lots of Bruises
6. Jaundice During Pregnancy
7. Head Banging
8. Feeding Questions
9. Disclaimer

• Read Questions & Answers in Another Column

Paternity Question

Thanks

-(unsigned)

Dear Pregnant: I don't think knowing the results of all possible blood type combinations is useful to answer your question. It also creates a lot of unnecessary work for me. If you tell me your blood type, then I can provide you the information you need.

Sincerely,
Dr. Warren

-Wondered

Dear Wondered: There are no specific dangers of giving soda to children, but it seems unwise to have young children develop a preference for sweets and empty calories since these things will enter their lives soon enough. Young children are often hard to feed and if they have a preference for filling up on empty calories, they will refuse good food. Soda may give children gas. The same is true for adults, but a young child may be quite distressed by it.

Coca-Cola and many other soft drinks are caffeinated. Caffeine may cause palpitations and irritability. It may do the same to an adult, but adults can deal with it better and understand the choices they are making. Giving caffeine to children regularly is unwise even if they appear to tolerate it well. Caffeine is an addictive drug. When a caffeine addict doesn't get his caffeine it can lead to fatigue and headaches. Why would anybody want that for their children?

Sincerely,
Dr. Warren

-BB

Dear BB: Peeling fingers and toes may be seen after a Strep infection, so if your son was at all sick before his peeling began, you might want to have his pediatrician do a throat culture. Toes often peel because the skin becomes mildly inflamed from sweating when the kids wear sneakers on hot days. Since the hands are out in the open, sweating doesn't usually make the hands peel. Peeling can be seen after any inflammation of the skin so atopic dermatitis (allergy) and eczema may also cause peeling. Sometimes the rash may be mild so it isn't noticed until the dead layer of skin begins to peel away. Being in the ocean may have helped the peeling begin.

If your son is acting well and his hands and feet don't bother him, you should not worry.

Sincerely,
Dr. Warren

-BR

Dear BR: Canker sores have nothing to do with lactose intolerance or sour stomach. Stress and illness may contribute to canker sores. Fluoride toothpaste does not cause canker sores, but injuries from the toothbrush might.

If your daughter has canker sores on a regular cycle, they may be related to having a low white blood cell count at regular intervals as is seen with cyclic neutropenia. The next time your daughter has canker sores, she should have a complete blood count done.

Sincerely,
Dr. Warren

He is in fine health, doesn't complain of any discomfort, and is quite happy.

Should we be concerned about his bruising? Is it a symptom of some type of vitamin or diet-related deficiency? Is it a possible symptom of some type of disease?

-Mr. & Mrs. H

Dear Mr. & Mrs. H: If all of your child's bruises can be explained by injuries from activity, there is no reason to worry. Active children usually have tons of black and blues on their shins. If your son is having bloody noses and cuts that take a long time to clot or deep purple bruises in locations like the chest or abdomen with no clear injury to explain them, then your son would need evaluation for a bleeding or clotting disorder.

Vitamin deficiencies could certainly contribute to poor healing and increased capillary fragility, but there would probably be other signs besides bruising. In any event, if your son's diet is varied and balanced (which does not mean large quantities), he should not have any deficiencies. If your son's diet consists of only a few foods, then you should put him on a vitamin supplement to ensure that his vitamin needs are met.

Sincerely,
Dr. Warren

The question firsts needs some background. My wife had severe abdominal pains throughout her entire pregnancy. All the doctors commented that it was only gas. She continued to take Mylanta, Zantac, Tums everyday. My daughter was born 4 weeks early and the delivery process was only 1 hour long. My wife continued to have pains after labor and was admitted to the hospital. She had an obstructed duct and her gallbladder needed to be removed. This was the reason for her pains throughout her pregnancy.

I know the having a blocked duct in the gallbladder will increase her level of bilirubin within her body, resulting in some form of jaundice. Could that jaundice, even if in low quantities, have traveled to the fetus? Could the pains and or higher than normal levels of bilirubin have been a potential cause for our daughters CP?

I know that these questions are very vague and a million questions may arise that you would probably need to ask, but I am searching for any information that someone may have relating to my wife's gallbladder incident and my daughter's diagnosis.

Thank you and I look forward to your response.

-ED

Dear ED: I did multiple literature searches and could not find any articles about maternal jaundice during pregnancy and its effect on the fetus. This could mean that the matter hasn't been studied. There may have been too few cases to make a statistical association to suggest a need for study. It does not mean that jaundice during pregnancy is known to have no effect. Since I have no studies to back me up, I will have to answer your hypothetical question with hypothetical answers based on what I do know.

1. Jaundice can cause brain damage, but kernicterus (the neurological syndrome caused by severe jaundice) only occurs with very high levels of bilirubin (> 20-25) when the bilirubin is rising rapidly in the neonatal period.
2. Premature infants develop kernicterus at lower levels of jaundice than full term infants.
3. The placenta does not allow everything in the mother's blood to pass to the fetus. I do not know if bilirubin crosses the placenta, and if it does, what level of bilirubin the fetus' blood will reach as a percentage of the mother's bilirubin level.
4. Even though bile duct obstruction may cause jaundice, if your wife never appeared jaundiced, she may not have had any significant elevation of her bilirubin level.
5. As stated above, I know of know evidence that prolonged exposure to low levels of bilirubin starting early in fetal life can cause brain damage. Neither do I know of any evidence that it is not harmful.
6. Brain damage associated with high bilirubin levels usually causes sensorineural hearing loss. If your baby has sensorineural hearing loss, that would raise your index of suspicion that bilirubin may have contributed to her problem.
7. While we know that perinatal risk factors are associated with cerebral palsy, we do not know how much host factors (preexisting conditions in the fetus) contribute to these risk factors. The cause of cerebral palsy remains unknown since the exact condition has not been reproduced in animal models. Many children who suffer perinatal asphyxia and other adverse perinatal events do not develop cerebral palsy.

Sincerely,
Dr. Warren

-ME

Dear ME: Some children find the rhythmic banging of their heads soothing. I can't give you a good reason. It is considered normal, because some normal, healthy infants do it. Normal does not mean desirable, and I can understand that you would like to find a way to stop your son from banging his head. Unfortunately, if this is how he puts himself to sleep, I know of no way to stop him. Even if he gets some superficial bruises on his forehead, it is unlikely that he will hit his head hard enough to cause significant injury. The only thing I could suggest, if you are concerned, is to put padding around the entire crib.

Sincerely,
Dr. Warren

Thank you for you help.

-TW

Dear TW: By 6 months, after you have introduced rice, oat, and barley, you may introduce wheat. After introducing cereal, fruits, and vegetables, you may introduce meat. I generally avoid eggs or fish until one year of age for all babies, but especially recommend delaying their introduction for allergic children. For more information on infant feeding, look at my article, Feeding Your Infant.

Sincerely,
Dr. Warren

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