3 September 2001

1. Enlarged Lymph Nodes
2. Simian Crease
3. It Ain't Easy Being Short
4. HSV-1 (Herpes Simplex)
5. Contagion of Warts
6. Decreasing Growth Percentile
7. Predicting Adult Height
8. Flight, Altitude, and Prematurity
9. Disclaimer

• Read Questions & Answers in Another Column

Enlarged Lymph Nodes

Now, 2 month passed and everything does not change. All the lymph nodes still there but no obvious enlargement. I don't know what's the reason. Can normal healthy baby have slightly enlarged lymph nodes? Will that be related to some food allergy? or just the post period of virus infection? Should I do more to get him examined or just keep an eye on him to see if those lymph nodes change or not?

Thank you for the help.

Sincerely,
-HD

Dear HD: Small lymph nodes may persist a long time in the head and neck area of healthy children because they become reactivated every time the child has a cold or other minor virus. If the child is otherwise well they are not a cause for alarm. Since I have not seen your child, it is not possible for me to give you complete reassurance. At 15 months, your baby should be having healthy checkups and immunizations at regular intervals. At his next checkup, your doctor should recheck the lymph nodes and perhaps repeat the blood work to ascertain that it has normalized.

Sincerely,
Dr. Warren

-JH

Dear JH: Simian creases occur with much greater frequency in people with Down's syndrome and with certain other syndromes than in the general population, but simian creases do occur in a small percentage of perfectly normal, healthy people. A simian crease as an isolated finding is not diagnostic of anything, i.e., it doesn't mean anything. If your child is healthy and your pediatrician doesn't find anything to suggest that the baby has a problem, don't worry about the simian crease.

Sincerely,
Dr. Warren

Thank you and hope you write back soon.

-(unsigned)

Dear Friend: Growth ceases when the body is fully mature, which for boys si usually somewhere between 16 and 21 years of age. The earlier a boy enters puberty, the younger he will probably be when he stops growing. If your friend is still growing, he may benefit from a consultation with an endocrinologist to determine if he has a treatable condition responsible for his short stature. If your friend has already stopped growing, there is nothing which can make him get taller.

Sincerely,
Dr. Warren

-Sue

Dear Sue: Fever blisters (also known as cold sores) are caused by HSV-1 (herpes simplex virus). Any person who gets recurrent fever blisters has had a primary herpes infection at some time in his life. The fever blisters represent recurrent outbreaks. Unfortunately, herpes viruses set up permanent housekeeping in any body they infect, and under periods of physical or emotional stress, they may cause fever blisters . During an outbreak of blisters, fever blisters are contagious; however, they do not spread just by being in the same room with an infected person. Any person who has never had a primary herpes infection is susceptible to infection on exposure. Exposure means a membrane such as the mouth, eyes, or genitals must come in contact with the virus. Therefore, kissing a person who has active fever blisters or drinking from his glass, sharing an ice-cream cone, etc., can result in an infection. Herpes viruses are hardy enough to live on surfaces for a while, therefore the infected person must not touch his blisters and then go about his business without washing his hands. If he does, his hands can spread infection directly to others; however, it is more likely that germs from the infected persons hands will go from his hands to an object to another persons hands, or from hand to hand, and ultimately into the other person's mouth or eyes.

Children who develop a primary herpes infection usually develop gingivostomatitis, an illness which causes swollen, bleeding gums, sores in the mouth, and fever. The acute illness can last one to two weeks and may result in dehydration because the children find eating and drinking very painful. Once a child has herpes gingivostomatitis, he will be prone to fever blisters for the rest of his life.

In summary, HSV-1 is not dangerous to healthy young children but can cause a miserable illness. Immunocompromised children and newborns may become seriously ill with herpes. People who have fever blisters can work around children, but if they must have direct contact with the children, appropriate caution and hygiene (hand washing) must be exercised to avoid spreading the infection to the children.

Sincerely,
Dr. Warren

I've already received some advice from our son's pediatrician, and would like a second opinion. Do you think it would be harmful to bring my son into this environment?

Please advise. Thanks in advance!

-JS

Dear JS: Warts are not generally highly contagious nor are they serious. Unless there is a likelihood that the warts can be gone soon and the trip conveniently rescheduled, the trip should go as planned. The children and their great grandparents should not be deprived of seeing each other for warts. If you are concerned about the great grandparents handling your children with the warts on their hands, purchase a box of latex or vinyl exam gloves for the great grandparents and ask them to wear them before handling the children.

Sincerely,
Dr. Warren

One more thing I would like to ask about my son is that he has had the poor weight gaining since he was 6 month old:

1) At the 6 month regular check up, his weight percentile dropped from 45% to 15% while his height dropped a little.

2) After following his weight gaining about another 3 month, his doctor sent him to see the GI specialist as his weight still dropping. The GI doctor considered him to be allergic to milk protein and put him on Nutramigen, although his blood tests showed negative and he never had the vomiting or diarrhea.

3) Now his weight and his height are still at the bottom of the growth chart (5%). His head has always been at 50%. My questions are:

1. ) Based upon your experience, is it common that some baby do drop their weight and height that much (from 45% to 5%) at some age?
2. ) He is still on Nutramigen and is taking regular food. Do you have any suggestions can help me to feed him better?
3. ) He is a very active baby. Do you think that might also contribute to his poor weight gaining?

Thanks again for the attention.

-HD

Dear HD: When children are born their weight and size may be more related to their placenta than their genetic potential. Some children whose parents are small may drop percentile during the first 6 months to year in order to grow along the curve for which they are genetically programmed. This may also happen if the parents are not small but were small as children. If your child's growth settles along a certain percentile curve and he maintains that growth rate, as long as he is healthy, there is no cause for concern. If his percentile continues to drop, further evaluation is needed.

High activity level may contribute to decreased weight gain.

Without more details about his diet I cannot make any recommendations. The combination of Nutramigen and food should be fine. If your son is maintaining his current percentile, there is no need to change his diet. If he is not maintaining his percentile, you must review his diet in detail with his pediatrician, and his pediatrician must decide if dietary changes or further evaluation is warranted.

Sincerely,
Dr. Warren

Thank you

-(unsigned)

Dear Parent: Nobody can predict your children's heights based on their current height and age since factors affecting growth are complex and growth rates can change. Neither you nor your husband is tall, so it is unlikely that your boys will be tall, but since your parents are tall, they may be taller than expected. My wife is 1,52 and I am 1,67. My son is 1,62. My identical twin brother is 1,70. Going back to my wife who is only 1,52 - her mother is 1,72 and her father was 1,79. Her brothers are 1,83 and 1,93! Based on your height and your husband's height, and the fact that they are boys, I would anticipate an adult height between 1,60 and 1,70. My advice.... Don't compare your children to others, and don't worry about things you cannot change, as long as your children are healthy and growing normally. If their pediatrician should find that their growth is not normal, then they should be evaluated to determine the cause and treatment.

Sincerely,
Dr. Warren

-JN

Dear JN: Young infants do not suffer any ill effects from flying any more than older babies. Babies are more prone to ear infections than older children because of the anatomy and size of their middle ear structures; however some children never have ear problems. If an infant is nasally congested, flying may be more uncomfortable. If an infant or child has an ear infection, it is unwise to fly. The only thing that I would consider unique to newborns with regard to flying is that infants are more susceptible to infectious illnesses for at least the first 8 to 12 weeks of life. Since airports and airplanes mean exposure to large crowds of people, that means increased exposure to infectious diseases; therefore one should weigh the need to travel against the potential risk of infection.

Babies live in a low oxygen environment just before birth and therefore have a high red blood cell count to increase their oxygen carrying capacity. Therefore, a newborn who has a normal heart and lungs should have no greater difficulty handling high altitudes than adults. Babies are born at high altitudes without any major difficulty. But reason demands that we not put unreasonable stresses on young infants. If you are climbing to heights at which people don't normally live, you should not bring your infant along.

Prematurity would only be an issue if the infant had suffered some compromise from the prematurity such as bronchopulmonary dysplasia or had not fully recovered from the complications of prematurity. A 5 pound infant who had been on a respirator and was recently sent home from a neonatal ICU is not ready for any nonessential travel. Keep in mind that if either baby is anemic that will significantly increase his difficulty handling high altitude. One twin may be anemic if there is a twin-twin transfusion. Both may be anemic if their postnatal course is complicated.

Sincerely,
Dr. Warren

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