28 May 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
Thank you so much
-LD
Dear LD: If your son's hair loss was due to a fungus infection of the scalp, Nizoral cream was not an appropriate treatment. Fungus infections of the scalp get into the hair root and cannot be successfully treated by applying a cream. Treatment with a systemic antifungal (a medication taken by mouth) is required.
There are two possibilities:
Sincerely,
Dr. Warren
Thank you for your patience.
-C
Dear C: Sometimes doctors simplify explanations to the point that they become misleading. That is the case with "swallowing amniotic fluid." All babies swallow some amniotic fluid. That doesn't cause a problem. But if, during the delivery, the baby breathes in amniotic fluid, especially fluid containing meconium (the newborn's BM which may be passed before birth if the fetus is distressed), that may cause pneumonia and interfere with oxygen getting to the brain.
Meningitis is an infection of the membranes and fluid surrounding the spinal cord and brain. Newborns who develop any infection are at risk for developing meningitis because their immune systems do not fight and localize infections well. Group B strep, which may be carried in the birth canal, may sometimes cause an infection which is not apparent during the first few days or weeks. When the newborns become sick they may develop sepsis (blood infection) or meningitis. Meningitis is a serious infection at any age if it is caused by bacteria. It requires prompt diagnosis and treatment with intravenous antibiotics. Without prompt treatment it may be fatal. Even with treatment it may result in permanent neurological damage ranging from hearing loss to severe brain injury and cerebral palsy.
Seizures may also be caused by congenital abnormalities of the brain. Metabolic causes such as hypoglycemia (low blood sugar), abnormal concentrations of salts or other blood chemistries, and inborn errors of metabolism must also be considered.
Sincerely,
Dr. Warren
-B & D
Dear B & D: If you've been a faithful reader of Ask Dr. Warren by now you must have read at least one letter where I explained why emergency rooms aren't the best place to get care for illnesses which aren't emergencies. Emergency physicians are experts at dealing with serious traumas, life threatening emergencies, and other potentially emergent medical conditions, but no physician can be an expert at everything. Emergency room physicians don't have as much experience diagnosing and treating routine illnesses as your pediatrician or family doctor, nor can they provide follow-up care.
What does this have to do with your question? Perhaps plenty. Your granddaughter went to the hospital because she wouldn't eat or drink. In the hospital they did what they're supposed to do. They assessed her degree of illness to determine if there was anything which required urgent intervention, and when they found that it didn't, they sent her home. Sure, they recognized her yeast infection, but yeast infections don't make you sick. They don't have any sense of what her overall health is in the hospital, because they don't provide her overall care there. She isn't likely to see the same doctor twice in the emergency room, and even if she does, he won't have a chart to refer to to review such things as her growth and her history of prior illnesses.
So the question remains unanswered regarding the significance of all these illnesses. Are they related? Is there some underlying cause? A physician who has been caring for your granddaughter and watching her progress is in the best position to answer that question, but I don't think they're related. For most infectious illnesses, a key factor is exposure. If your granddaughter was not sick for the first 7 months and now has multiple infectious illnesses, the first question is, "What, if anything, has increased your granddaughter's exposure to infectious disease?" The most common reason is exposure to other children such as in daycare.
A yeast infection in the diaper area is very common, and not considered an illness. It may even be a complication of antibiotic therapy. So might diarrhea be a complication of antibiotics. Ear infections are also common childhood afflictions which are unrelated to the other problems. Ear infections often develop from a cold, and once established, the resultant inflammation in the middle ear may result in recurrent ear infections. The current illness may be entirely unrelated. She may have coxsackie virus. Coxsackie is a summer virus which is often not recognized by doctors without pediatric experience.
So is your granddaughter a sickly child, or has she just had a run of unrelated illnesses which can happen if a child is exposed to infectious illnesses? A pediatrician who provides ongoing care and follow-up is the best person to answer that.
Sincerely,
Dr. Warren
-LL
Dear LL: Sinus infections develop from persistent congestion of the sinuses, usually from a cold. They are more common in adults than children, but children do get them. Most sinus infections respond well to antibiotic treatment and are rarely dangerous, but because of the location of the sinuses, there is a risk that an untreated infection could result in a serious infection around the eye or meningitis.
Sincerely,
Dr. Warren
If you could answer this as soon as possible that would be great!
-PF
Dear PF: The pains you describe could be ulcer disease or esophagitis. So now what? I do understand that people hate to go to the doctor. But terrible pain was not meant to be ignored. It is a signal that something could be terribly wrong. What better reason could you have to go to the doctor?!? Even if my e-mail diagnosis is correct, it doesn't help you avoid a doctor visit.
What do your parents say? Have you told them about your pain. You're only 16. I realize that's quite grown up, but not enough to take full responsibility for decisions about your health. Your first step is to tell your parents what's going on. Your next step is to have them take you to your doctor. There are worse things than seeing a doctor, like getting so sick you end up in the hospital.
Sincerely,
Dr. Warren
I ask because: my sister's firstborn (she) flew at one month old. Afterwards she had serious chronic ear and sinus problems immediately after the trip, which resulted in "tubes" being placed in the upper ear canals. She is now three, and has not completely healed to this day, and still experiences pain when her ears are subjected to water and changes in pressure.
My sister just had another baby (2 weeks old) and wants to fly her, the newborn, and the firstborn on a pressurized aircraft when her infant will be almost a month old.
The only reference I could find which pertains to infants and flying, is the info posted on websites for commercial airlines that give advice for making the infants trip easier, with zero consideration for the risks.
What do you think?
-AG
Dear AG: Most infants tolerate airplane trips quite well. Unfortunately, because of the anatomy and the size of an infant's middle ear, infants are more prone to ear infections that older children and adults. If a child has middle ear congestion, the pressure changes associated with air flight may cause pain. If the conditions are ripe for an ear infection to develop, the flight may tip the scales. But it would be a stretch to say that flights cause ear infections. The child you describe obviously has middle ear problems which were aggravated by her first flight, but her chronic ear problems were not caused by the flight and would not have been avoided by not flying.
Sincerely,
Dr. Warren
-MS
Dear MS: Children can demand a lot of attention when they are ill, and of course, since they need the attention, their parents give it to them. But some children can also develop a habit very quickly of wanting that kind of attention. At 10 months of age, many babies have separation anxiety. That coupled with her experience during her recent illness could account for an apparent personality change.
The question of pain in your baby's mouth causing her to close it when she cries is easily answered. Does she move her mouth normally when eating or babbling? If not, you would have to have her doctor check her mouth. Since measles can be a serious illness, I would even have to suggest a neurological exam if her mouth movements are not normal. But if the only thing you see unusual is related to crying, I'm not sure that it means anything. Since a baby of 10 months should be having fairly regular checkups, what does your pediatrician find when he examines her?
Sincerely,
Dr. Warren
As we look back now and put all of this together it seems as thought our little man has something going on in his little body that it can't fight off. Traditional medicine helps to soothe the symptons, but what is the cause? Any suggestions on were to go from here would be much appreciated!!!!!!
-MS
Dear MS: Although I can't say that I have any patient who has specifically had your little grandson's combination of ailments, not one of them is strange. Colic and thrush are extraordinarily common. Warts are certainly seen in children under two.
Herpes of a finger is fairly uncommon and usually results from putting the finger in the mouth when there is a herpes infection in the mouth. Herpes infections tend to recur, so the recurrences don't suggest a problem. Herpes is a contagious illness and was probably spread to your grandson by somebody with a fever blister.
Fungus infections of the nail bed can look pretty gross, and the nail can fall off, but any skin or nail infection implies nothing more than exposure to the offending organism. An immune deficit is suggested only by a deep infection, systemic infection (inside the body) or an infection with a fungus which doesn't normally cause infections in healthy people.
Tooth rot in infants is far too common and results from infants sleeping with bottles of juice or milk in their mouths or from nursing a bottle all day long. Constantly bathing the teeth in juice or milk sugar promotes decay.
If your grandson is generally healthy and thriving, this frequency of annoying but not serious problems is probably just a coincidence, but since I haven't examined your grandson, I can't say for sure. If you asked what evaluation he should have done to be sure nothing unusual is going on, I would have to suggest consulting an immunologist to evaluate his immune system.
Sincerely,
Dr. Warren
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