23 July 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 for your time.
-RM
Dear RM: Herpetic gingivostomatitis can cause recurrent fever blisters or cold sores. The original illness which made your son so sick will not recur.
Sincerely,
Dr. Warren
-anonymous
Dear Anon: There are medications which can help bedwetting. These include Tofranil (imipramine), Ditropan, and DDAVP which has been available as a nasal spray and recently became available as a tablet to treat bedwetting. None of these medications can be guaranteed to cure bedwetting forever. Even when the medications work well, the wetting may recur when the medication is stopped; however, many patients who are treated with these medications remain dry after discontinuing the medication. Alarm systems are really the only thing that can train a person to wake up in response to a bladder spasm. They work well but are not universally successful. For more information on these treatments and on bedwetting, please read my article about Bedwetting.
Sincerely,
Dr. Warren
-TR
Dear TR: The problem I have in answering your question is that I don't know of any controlled studies which demonstrate the safety an effectiveness of chiropractic treatment in infants. This does not mean that these treatment have been shown to be ineffective or unsafe, but since I have no chiropractic training, in the absence of proof of safety and effectiveness, I would not be in a position to advocate or critically evaluate chiropractic treatment.
Even if I could tell you that chiropractic treatment were safe for infants, before I would recommend it, I would like to know what evidence there is that subluxations of this sort can cause low muscle tone and developmental delay. If there is no evidence of cause and effect, there is no clear basis for treatment. Based on my knowledge of the nervous system, compression of nerve roots sufficient to cause low muscle tone over most of the body should cause severe dysfunction of other systems and cause pain. But you must understand that my training does not include any chiropractic or accupressure theory.
Whatever you decide, you should have your child evaluated by a pediatric neurologist or a developmental specialist.
Sincerely,
Dr. Warren
Thank you.
-Worried in Arkansas
Dear Worried in Arkansas: If you are referring to stains from bowel movements on your stepdaughter's underwear, or the color of her stool, an orange color may not be a cause for concern unless there is enough red to suggest blood. If you are not talking about stool, there is no kind of discharge from the rectum which would ever be considered normal. I see no reason to consider this a gynecological problem and would suggest an appointment with your regular family doctor.
Sincerely,
Dr. Warren
He is eating well...acting normal, sleeping fine. I am single and have five children. I have no health insurance and very little money. Should I wait to have him checked?
If you could answer this, I would appreciate it.
Thank you very much.
-BE
Dear BE: The main concern about diarrhea is the risk for dehydration. If a child has severe diarrhea, poor fluid intake, or is vomiting and unable to retain fluids, he may become dehydrated. If there is not a lot of water loss from the diarrhea and the child is drinking well, the child should be okay. Two weeks is a long time for diarrhea, but if your child is not having severe diarrhea and is drinking well, it may not require you to see a doctor. If your child is running fever or seems ill, then he should see a doctor. I cannot say what the rash is without seeing it. It may not be related to the diarrhea.
Sincerely,
Dr. Warren
I know that this disease primarily effects smaller children but is it possible that it could also carry over into the teenage years? Any help or advise would be greatly appreciated. I apologize for rambling but I didn't know how to concisely explain our problem.
Thank you for any answers that you can provide.
-JR
Dear JR: Fecal soiling as a result of stool withholding can occur in older children. Most teens who are still soiling and have been doing it since childhood are difficult to treat and require the intervention of a gastroenterologist to regulate the bowel and a psychologist to deal with the emotional/behavioral aspects of soiling. On occasion an older child who had not previously had a problem with soiling may develop a problem because his intestines become severely full of stool. This may happen in a child who is too busy to spend the time to sit, or who is uncomfortable with the available bathroom facilities (inadequate privacy, not at home or in familiar surroundings), or who has developed severe constipation and pain on defecation due to a fissure.
Older children who don't have chronic constipation and who have remained clean for years who then start or resume soiling should be evaluated not only for intestinal problems and neurological problems which may interfere with bowel control, but also, for psychological factors which may contribute to the soiling. Regression to infantile behavior including soiling and wetting can be seen as a response to abuse, especially sexual abuse. A teenage girl who soils and refuses to wear sanitary napkins for her periods may have serious conflicts about her emerging sexuality.
Children of divorce who change living arrangements may lack stability in their lives and be extraordinarily insecure. Under the circumstances, I suggest your stepdaughter see a psychologist. She should also see a gastroenterologist for help regulating her bowel. A consultation with a specialist does not obligate you to agree to any procedures. The specialist should present you with your options in terms of diagnostic and therapeutic interventions, explaining the risks and benefits, including the risks, benefits, and alternatives if you do not agree to all his recommendations.
Sincerely,
Dr. Warren
Gratefully,
-Charles
Dear Charles: Normal stool gets its color from bile as well as waste products of the food eaten. Stool may be green from the bile or from vegetable matter. A person who has no complaints, good appetite, and normal consistency stools need not be concerned about the stool being any color of brown, yellow, or green. White or gray stools may need attention because that could signify obstruction of bile flow. Jet black stools occur with upper intestinal bleeding. And, of course, red blood in stool requires attention.
Sincerely,
Dr. Warren
You can get back to me at xxxxx@xxxx.com
Thank-you very much for your help.
-DB
Dear DB: You have a difficult choice to make. From a strictly medical point of view, I have to recommend that you put the baby in on his back. Once he is old enough to turn over (which should be soon), he will choose how he will sleep, and you will have to leave it at that. If your baby is so much easier to deal with sleeping on his stomach, then, in order to make a choice, you have to understand the risks. SIDS is a relatively rare event, but it is devastating. Sleeping on the stomach does not by any means guarantee that a child will die of SIDS, but it increases the risk. I and all of my children slept on our stomachs when we were infants because this relationship between SIDS and sleeping on the stomach was unknown. Now that I know what I know about SIDS and sleeping on the stomach, I recommend that all my infant patients be put into their cribs on their backs.
Sincerely,
Dr. Warren
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