14 January 2002
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
-N
Dear N: The absence of demonstrable reflux on an upper GI series may not be sufficient to rule out reflux. Any child who vomits in his sleep most nights needs further evaluation. The child should see a pediatric gastroenterologist who may want to do a pH probe or gastroscopy.
Sincerely,
Dr. Warren
The other question is: Is it OK that my children are 'far from' using a sipper cup. They always drink from it, but I'm the one who's holding it for them. I've tried to encourage them to use it on their own, but they just won't and end up making a mess. What do I do???
Sincerely in need,
-Mother of Twin Boys and Also One On the Way
Dear Mother of Twin Boys and Also One On the Way: At 12 months some children are simply not ready for any particulate matter in their mouths. I personally recommend finger food instead of stage 3 because a spoonful of mush and chunks is really more difficult to handle than a small piece of food. But there's no rush. Your kids will get to it.
I can understand how helpful it would be with twins for them to become more self sufficient, especially before the new baby comes. But they are only babies themselves, so don't rush them. If they are able to drink from a cup that's great, but at 12 months, many children make a mess with a cup. Many 1 year olds are still drinking from bottles.
Sincerely,
Dr. Warren
-RS
Dear RS: Since I don't know how old your granddaughter is or how long she has had a GT tube, I don't know how severe her eating disorder is, but I have to assume that if it were severe enough to require a GT tube, you really need the ongoing treatment of a specialist. Therefore, my main suggestion would be to ask Dr. R's office who he is recommending to see his patients while he is unavailable.
To establish a pattern of regular eating in a child who is not driven by hunger or instinct to eat, you would need to establish a program of trying highly flavored and textured foods in an effort to find those things which would motivate the child to eat coupled with a program of positive reinforcement for good eating behaviors. The specifics would depend on the age of the child and should really be set up by a trained therapist. Those involved would have to have realistic expectations and understand that it may be a long time before eating will provide the bulk of the child's nutrition. Putting pressure on the child to eat would likely backfire and result in resistance from the child or anxiety which is not good for the appetite.
Sincerely,
Dr. Warren
Thanks for your time and advice.
-AA
Dear AA: A TSH of 20 in a 3 week old is elevated and could indicate that the baby is hypothyroid in spite of a normal T4. If the TSH was measured shortly after birth, it could have been elevated because of the normal TSH surge that occurs shortly after birth. Before any action is taken, the TSH should be repeated. If it remains elevated, the baby should see a pediatric endocrinologist for treatment of primary hypothyroidism.
Sincerely,
Dr. Warren
-AA
Dear AA: According to the Harriet Lane Handbook (a copy of which should be owned by any physician who treats children) TSH from 1-4 weeks of age should range from 0.6-10.0 mIU/ml. Since the level has come down considerably, it may be reasonable to wait a little longer and repeat it, but considering the confusing information you have been receiving, I would advise consulting a pediatric endocrinologist. You have nothing to lose by visiting the specialist.
The elevated TSH does not cause any symptoms. It suggests that your baby is hypothyroid. Left untreated, hypothyroidism can lead to growth failure and mental retardation. There is still time to evaluate and treat the condition without any ill effects on the baby.
Sincerely,
Dr. Warren
I am concerned that he will continue to grow abnormally quickly and possibly have some internal physical problems because of this. He is not socially active with his peers, since the other 3 and 4 year olds think he is 6 or 7 years old. My sister also finds this amusing, she thinks it is "awesome" that he does not like other children and encourages his antisocial behavior. He is very aggressive to both children and adults, both verbally and physically and has been expelled from preschool. She does not believe in "making him do anything he doesn't want to." Please give me some advise I can pass along to her on both the physical and emotional problems her son is exhibiting. He has asthma and is constantly sick with colds throughout the year. He has lost hearing due to repeated ear infections.
I am a paramedic and mother of 7, so I am not an inexperienced person in regard to pediatric medicine. I am concerned for this child.
-LY
Dear LY: Your nephew's size is well above the 95th percentile, but that in itself does not mean that he has or will have a medical problem. His height/weight ratio is in the 90th percentile, which suggests that his large size is caused to a significant degree by overnutrition. Regardless of whether or not his mother thinks that everything is okay with him or thinks there may be a problem, a child his age should have regular checkups to assess growth, development, general health, and update immunizations. This child should be seeing a pediatrician at least once or twice a year. If he's getting routine care, his pediatrician should be able to tell from the child's growth curve (not just the current measurements) whether or not there is a cause for concern regarding the boy's growth.
Your nephew doesn't fit in with the other children. As a result, he protects his ego by lashing out at them and being antisocial. In the end, he will be happier and learn some valuable skills if he can get along with other children. His mother can encourage that by having him participate in activities that interest him. There, he will find children he can relate to based on these interests rather than social or physical skills he does not yet possess. This will be easier when he is older since the interests of most 4 year olds are somewhat limited. In the meanwhile, his mother can try to arrange play dates with children in the neighborhood on a one to one basis so that some of the children can get to know your nephew.
Sincerely,
Dr. Warren
Sincerely,
-Michele
Dear Michele: There's no sense kicking yourself about what you did or didn't do that got you into your current situation. There was nothing wrong with taking your baby into bed with you to nurse when she was an infant. The problem is, that you missed the point at which you should have been working on separation. Some kids separate from their mothers more easily than others. It's the tough ones that usually end up in this situation because they make it so difficult that Mom usually finds it easier to just give the child his way. If you want to change things, you have to expect that your daughter will give you a very hard time, and you can't give in just because it's easier.
If you need, or want, to work, it would be worth the expense to have your child in a private daycare setting in somebody's house where there are only a few children and make it clear to them that for the price you are paying, you expect them to keep her there so that she can learn to separate from you.
Your daughter is also significantly overweight. I suspect that she is very demanding and turns to food and nursing for comfort. If the bulk of her weight is from nursing, you must cut down on the nursing. Most especially, she should no longer be nursing in the middle of the night. You will have to make that break if you want to get her out of your bed. I suggest you read my article, Helping Your Child to Sleep Through the Night.
You've got a rough road ahead of you. I suggest you start the journey you've been dreading, and do NOT turn back once you begin. It's one thing to realize that you have an obligation to your child to provide for her physical and emotional needs, or even to devote your life to her, but it's an entirely different matter to let a demanding child take control of your life. It isn't good for you or her, but she doesn't know or care. She just knows what she wants and thinks is her right. Be gentle, distract her, comfort her, but take charge and do what has to be done for both of you.
Sincerely,
Dr. Warren
Thank you.
-Michelle
Dear Michelle: The American Academy of Pediatrics recommends keeping infants on formula or human milk until one year of age. At that time, the child can be switched to whole milk. If your child is resistant to the taste of whole milk, you can try mixing the formula with milk, starting with a small volume of milk and gradually increasing the concentration of milk in the mixture. There is no reason, medical or otherwise, that the formula shouldn't be mixed with milk once the baby is old enough to start to switch.
Sincerely,
Dr. Warren
He has been asked to take ZOVIRAX - 1 teaspoon for 5-7 daysThe information booklet accompanying the tablets mentions some adverse reactions. He is also supposed to apply an ointment called HERPERAX externally.
Do let us know if this is the right medication...
We are waiting anxiously for your reply.
Thank you very much.
-SR
Dear SR: Zovirax is not an experimental drug. It is used for the treatment of chicken pox and herpes, but because most children don't become severely ill from chicken pox, the medication only decreases the duration and severity of the chicken pox, and the medication does have side effects, it is not routinely recommended for healthy young children. It should be given to children with severe chicken pox, immunocompromised children, and any adolescent or adult with chicken pox. To be effective the medication must be started at the first sign of chicken pox.
I am not familiar with, nor can I find any reference to a medication called Herperax.
Sincerely,
Dr. Warren
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