11 June 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
-NS
Dear NS: Try adding more fiber to your daughter's diet in the form of whole grains like bran, fruits, and vegetables. Fiber helps to regulate the stool by making hard stool softer and more bulky and liquid stool more formed. Use a heavy layer of Desitin or Triple Paste ointment with each diaper change to protect the skin. When the skin is inflamed, clean it first with a soft, dry tissue and then with baby oil and a soft tissue rather than water or any soapy solutions.
Sincerely,
Dr. Warren
-TE
Dear TE: You'll find your question already answered in the archives of Ask Dr. Warren in a letter titled Ugh! My Son Ate Stool. Will He Get Sick? which I answered as follows:
You don't have to worry even a little about your son ingesting some stool. The reason that stool contamination of food or water is considered a health hazard is that it can spread disease like salmonella and parasites. But your son couldn't possibly catch anything from his own stool. In order for his stool to have any pathogenic organisms in it, he would already have to have the disease.
Sincerely,
Dr. Warren
Sincerely,
-WB
Dear WB: Without seeing the bumps or blisters in your baby's mouth, it's hard to be sure what he has, but if I had to guess, given the time of year [summer when this e-mail was originally answered], I'd say possibly coxsackie virus. Blisters in the mouth could also be herpes virus. For more information about coxsackie virus and herpes virus read my article about Sore Throats.
Sincerely,
Dr. Warren
My question was, her grandchildren are visiting and she has concerns. The 7 year old is on Ritalin as has been for a short period of time. He has trouble focusing-too much stimuli in classroom. His grandmother notices that he tends to pick a fight with brother or rather irritate him-she is unsure if he's frustrated. And to her he seems kind of sad. The boys mother has been on Prozac for many years with good results and she had problems as a child. Would antidepressants be the way to go? rather than Ritalin or a combination? Do children this young get antidepressants? The doctor her daughter took him to in Las Vegas told her to experiment with the dose of Ritalin. I don't know what dose he takes but he seems sleepy. Any advice or referral would be appreciated-she does not have e-mail and would like some direction. thank you!
-SL
Dear SL: Yes, children do take antidepressants, but if your friend's grandchild has ADHD, an antidepressant is not necessarily the appropriate medication. If he is having a reaction to the Ritalin, his dose may need to be adjusted or the medication may need to be changed. Finding the correct dose does involve a little trial and error or experimentation, but it should be done under the guidance of a physician with feed back from the school as a guide.
Any child who requires antidepressants should be getting full time counseling as well as medication. Children who require psychoactive drugs require close monitoring by the treating physician. Treating depression or behavior problems is not like treating a cold. The only person who can recommend medication for the child is a physician who has done a thorough psychological evaluation and who is following the child's response to treatment.
Sincerely,
Dr. Warren
I talked to the therapist and they seemed to think we were "jumping the gun" a bit. They sent me some workbooks with exercises to help him along. He is now 2 1/2 and he is "talking" a LOT more (I can't count the number of words he uses), but he is still sticking with 2-4 word sentences. He is starting to "repeat" us a lot more now (sort of like a game). He knows his colors, body parts, favorite movies, and is pretty good with toddler software, etc. He understands EVERYTHING we ask him including multiple commands. And yes, we do read to him. Niether my husband nor his brother talked till after they were 3, I was an early talker (under 2).
He is a VERY happy, playful, and "cuddle-monster" little boy. He sat up at 6 months and walked at 14 months. He is the only grandchild on my side (and stays with Grandma during the day) and is the youngest of 3 on his Dad's side. We are working on potty training but I don't think he's 100% ready yet (the scowl with a "No Potty Mom!" kinda gave me a clue), but we are readily offering him the chance (he will get the "urge" to try from time to time - so we've been trying to make that time fun). We visit friends quite a bit and I plan to start swimming lessons with him soon (my goal is to give him time with other kids since he stays with Grandma during the day and I don't like the price or quality of daycares in my area).
I worry that my intuition may be blinded by my love for him and that I'm setting him up for disaster by not enrolling him in some sort of speech development class at the doctor's recommendation (the visit only lasted maybe 15 minutes) and he declared him speech delayed based on the little chart he was looking at. (He had some sort of chart with him that stated the "average" child's development).
Aren't we expecting a little much out of kids? One's childhood is soooo short.
I know you get a TON of email, but I'm curious about your opinion.
Yours Truly,
-KE
Dear KE: By your description, your son's language development sounds perfectly normal. Perhaps the doctor drew his line in the wrong place on the developmental assessment chart he referred to. If you spoke to a speech therapist who felt there was no cause for concern, you should accept her judgment on the matter. Speech pathologists have more experience in assessing language development than pediatricians. If I think a patient of mine has a language problem, the first thing I recommend is evaluation by a speech pathologist.
Now that you're probably feeling better about the situation, can I comment on your last remark? The developmental norms for children were established doing a statistical analysis of the developmental achievements of large populations of children at various ages. They were not established to put pressure on children to achieve as this is not a competition. The purpose of developmental norms is to help identify children who need evaluation in order to find, diagnose, and treat those children who may have medical conditions interfering with development or who might benefit from early intervention programs.
It is true that childhood is short and should be enjoyed by both the parent and child. But to those children who have various handicaps, both obvious or undetectable to the average person, early intervention has helped to increase the quality of their lives, by helping them to accomplish all that they are capable of. Most children who require special programs enjoy the programs. I don't think we're expecting too much from our kids when we look to boost their chances of succeeding in today's world as long as we balance these efforts with all the love, support, and fun we can muster.
Sincerely,
Dr. Warren
-N
Dear N: Although you never asked me a question in your e-mail, I understand that you are asking for a recommendation. Unfortunately, in spite of my presence on the Web, I am not famous like Ann Landers and do not have access to all the top people in their fields. I am not in a position to give you a referral. When I did my training at Montefiore Hospital in the Bronx over 20 years ago, I know they had a top notch cranio-facial center. If you are in a position to travel and spare no expense to get the best for your daughter, you might seek an opinion from the cranio-facial center at one of the best known teaching institutions such as Harvard Medical School or Johns Hopkins. If that is not possible, I'm sure there are many fine institutions in your area. It might not be unreasonable to thank your plastic surgeon for all he has done and ask him for his recommendations and a referral for the next step. However, before your daughter undergoes additional reconstructive surgery, it is important for your to be sure that you have realistic expectations about what can be accomplished.
Sincerely,
Dr. Warren
About 1 month ago, we found his body is softer than other babies. We think he is short of vitamin D or Ca elements or sunshine. So we feed him some vitamin D and Ca pills and take sunshine.
In recent days, we see some pediatricians. When they lift up my baby, they found my baby's two feet meet and touch together, and his listening not very sensitive. They think it's some problem in his brain, but they test my baby's IQ is good enough. They say it's one kind of illness of baby. They suggest us to take CT test. In CT picture, some of doctor say no problem. But some of them think it's suspicious problem. They say this kind of illness has no influence on his IQ, but action. But there are some one think it's not enough growth.
Dear Doctor, I don't know how to do. My baby looks very cute and lovely, and looks no any illness. I just think it's not enough growth or short of Ca element.
Could you give some advices and do me a favor?
Best regards,
-JBG
Dear JBG: From your description, it sounds like you are telling me that your baby is hypotonic (floppy). Low muscle tone is not a result of inadequate calcium and vitamin D. In addition, if your baby is nursing adequately or eating formula, it would be almost impossible for your baby to have inadequate calcium intake. You should have your baby evaluated by a pediatric neurologist. If the baby is hypotonic, even if he has no other neurological deficits, he would benefit from physical therapy or early intervention aimed at improving his muscle strength and motor skills.
Sincerely,
Dr. Warren
-ML
Dear ML: Even in a household where two languages are spoken a child should have good language development by 3 years of age. Even before a child learns to speak, he should be able to understand and follow instructions in both languages. If your child's development has been normal in every other way (walking, toilet training, feeding) there is no reason to suspect serious brain damage. Your daughter could have language delay without other neurological problems. If she is difficult to deal with, she could have a pervasive developmental disorder or autism. Proper treatment requires a diagnosis. Your daughter needs her speech and hearing evaluated by a speech pathologist. She may also need evaluation by a pediatric neurologist. If your daughter does have significant language delays, it may be best to speak only one language to her, but being in a bilingual home does not cause major language delays.
Sincerely,
Dr. Warren
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