17 September 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.
-OGC
Dear OGC: The presence of an odor from products like paints or sealers does not necessarily mean that there is anything toxic in the air; however, I cannot give you any specific reassurances regarding any particular products. If the company states that their product is not toxic, you should contact their consumer affairs division and ask them to provide you with details about studies regarding the timing and duration of exposure which were proven to be safe after their product has been used. In addition, ask them to provide details about the age of subjects in the studies and what they can tell you regarding newborns. If they can only provide animal studies, ask for the evidence that their data is applicable to humans, especially newborns. If you are not satisfied that the information they provide can be trusted, contact your local poison control center to see if they can help.
Sincerely,
Dr. Warren
-RB
Dear RB: Sometimes children start wetting themselves because they become too involved in their activities and don't want to be interrupted. This is not really laziness, because it isn't that the child is unwilling to make the effort to get to a bathroom. What happens is that the child who is engrossed in his activities ignores the initial urge because he doesn't want to miss a moment of what he is doing, and erroneously believes that he can hold his urine a little longer. Eventually the bladder gets so full that the child can no longer ignore the urge and he makes a mad dash for the toilet but wets himself before he gets there. Sometimes only a little urine comes out before he gets to the bathroom, and other times he may lose complete control even before he gets to the bathroom and so just decide to continue his activities in his wet pants. The only way to deal with it is to schedule bathroom breaks every two hours or more if necessary. Until he starts to stay dry he will have to urinate before the start of any activity and he will have to come in every two hours regardless of what he is doing. You cannot make him urinate. He knows that, but he will probably cooperate because he also knows that you can prevent him from returning to play until he does. So as not to make him miserable, since the real purpose is to keep him dry and get him in the habit of using the toilet regularly, try to schedule the bathroom breaks at natural breaks in his activities. Don't pull him off third base as he's about to score a homerun or take him away from his favorite show when a break between shows will do. But don't depend on him to decide when he needs to go either.
Since the problem is relatively new and hasn't existed since the time your son was trained, it may just be a result of his having more freedom to become involved in activities without your supervision, but it could also be the result of a medical problem such as a urinary tract infection or diabetes. If your son has not had a urinalysis since the problem began he should see his doctor and have and evaluation.
Sincerely,
Dr. Warren
-Concerned Mom
Dear Concerned Mom: Your son is 13, and whether he likes it or not he is still a child and NOT capable of making medical decisions. While you may be overprotective, it is just as likely that your son is in full blown adolescent denial. I know of no better reason for a child to see a doctor than a mother's concern. If he is acutely ill, he doesn't have to have cancer to get medical attention. Call your son's doctor and don't let your son give you any guilt trips. If it turns out your son is perfectly okay, you can all be happy and it will not mean your decision was wrong.
Sincerely,
Dr. Warren
Thanks
-Catherine
Dear Catherine: You should probably contact your local health department for specific instructions to protect both your self and your charges. Most children are immunized against HIB disease today. Any child who has had a full primary series of HIB vaccine and a 15 month booster is probably safe. Infants who have started but not yet completed the series have some protection. If the child's sister's immunizations are up to date, she is probably safe. Unfortunately, being immune does not prevent a person from carrying it in his nose and throat. Even though most adults are not susceptible to HIB disease, when one of their children has HIB disease, the parents are generally treated with Rifampin to eradicate the carrier state in order to protect the other children. The source of HIB disease may have been an adult asymptomatic carrier.
HIB disease spreads through close contact. Chances are, unless the children are kept relatively separated in your home, if they spent several hours with the child shortly before the baby got sick, they have all been exposed. So have you. If the baby had not been in daycare for a day or two before becoming sick, the likelihood of exposure decreases significantly. If, because of the sick baby's young age he had not really been in direct contact with any of the other children, the only people exposed would be his sibling, and the people who cared for him. Of course, if the daycare workers picked up the organism, since as adults they would not likely get sick, they could unknowingly spread it. Those who have been exposed should be treated with Rifampin.
Sincerely,
Dr. Warren
-KB
Dear KB: If you have good success with metamucil, then use it; however, I suspect that if you were really having good success, you would not have been getting advice from your doctor about treating the constipation.
Mineral oil does not cause any cramping. Therefore, if your daughter is experiencing pain and is screaming with the increased dose of mineral oil, it means that she is fighting harder to hold her stool in and screaming because she cannot fight the urge to have a bowel movement. This is exactly why your doctor is telling you to increase the dose of mineral oil. It's beginning to do its job. If she is having pain when you clean her, clean her first with a dry tissue and then with a tissue and baby oil rather than water.
A person cannot have diarrhea and constipation at the same time. If your daughter's intestines were empty and she were having diarrhea from the mineral oil, you should be able to cut down the mineral oil to a smaller dose and your daughter should have normal bowel function, making every one happy. Unfortunately, I suspect that is not the case. It is more likely that your daughter is impacted with stool and is leaking around the impaction. The only way to deal with that is to empty her rectum of stool. Of course, I cannot tell for sure since I have not examined your daughter, but if your pediatrician finds that she is impacted, he can advise you on the use of suppositories or enemas to clear the impaction.
As far as your daughter is concerned, the only thing that will make her happy is to never have another bowel movement. She is not capable of understanding that it hurts because she holds it in, and that it will hurt more later if she doesn't go. She only knows that she doesn't like the way it feels when the stool comes out, so she has decided not to do it anymore. I am sympathetic to her discomfort, but if you want to help your daughter, you cannot let her battle to control her bowels decide her treatment. This is a difficult problem to treat and it takes a long time. If you do not trust your pediatrician's guidance on this matter, you should consult a pediatric gastroenterologist. Your daughter's screams are tantrums being thrown because she refuses to have a bowel movement. Before her bowels are regulated, I suspect you will see a lot more tears. You will need your doctor's support and close management in order to get you through this. You cannot make your daughter happy in the short run regarding this matter and still help her in the long run.
Sincerely,
Dr. Warren
My question is... he always has his tongue sticking out. I have heard there was a disease associated with this. Is there?
Thank you for your time.
-Jean
Dear Jean: Children with Down's Syndrome, Beckwith-Wiedemann Syndrome, and hypothyroidism often have large or protruding tongues. Normal children sometimes stick out their tongues.
Sincerely,
Dr. Warren
-BC
Dear BC: If your granddaughter is taking allergy shots, I presume her allergy testing showed her to have allergies. Allergy shots can sometimes take up to a year before they begin to make a difference. Allergies and asthma can both cause chronic cough. Children with allergies or asthma have a higher risk of developing sinusitis which can cause or aggravate a cough. These children are also more prone to bronchitis and pneumonia, but generally patients with either bronchitis or pneumonia are ill. Exposure to irritants such as cigarette smoke can cause children to cough as well as increasing their susceptibility to upper respiratory infections and aggravating asthma.
Sincerely,
Dr. Warren
I thank you for any answer you can give us. We are very concerned about our son learning and his future.
-DW
Dear DW: I wonder if you think your son has dyslexia rather than dyspraxia. Dyslexia is a reading disability. Dyspraxia is a general term referring to impairment or painful functioning of an organ. I haven't heard it used to describe developmental problems. The term apraxia has been used to describe specific deficits of purposeful function such as motor apraxia - the inability to make movements or use an object for the purpose intended. In any event, it sounds like your son has significant learning difficulties for which he needs a thorough evaluation by a pediatric neurologist or developmental specialist. An evaluation will help to determine if your son has global intellectual deficits (mental retardation), dyslexia, specific learning disabilities, language deficits, etc. This information can be used to set up an appropriate individual education program with realistic goals, and which uses his specific strengths to help him learn.
The causes of mental retardation and learning disabilities are varied and can include brain injuries from birth events as well as genetic factors. There are some syndromes which include mental retardation and small genitals as features, but these are not specific findings which can be used to predict mental capacity. Genital size is not related to IQ or body size. Before puberty boys have small genitals which do not grow significantly from infancy until puberty. A large child will therefore appear to have relatively small genitals. If he is obese, the genitals may even be buried in the pubic fat pad. If your son has abnormally small genitals or any retardation syndrome, his pediatrician should be able to tell you from a routine examination.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
